Mental Health 2: Bedlam

Bethlem Royal Hospital, aka Bedlam

Purpose

To orient students to the kinds of treatment and care the mentally ill received prior to the 19th century—using the example of England’s legendary Bedlam, the world’s oldest mental health asylum.

Context

This lesson is the second of three lessons on mental health and human behavior.

Mental Health 1: Human Behavior provides students with a sound introduction and historical overview of the important figures and discoveries that have greatly advanced the study of human behavior since the early 1900s.

Mental Health 2: Bedlam gives students an up-close, personal look at Bedlam, the world’s first mental health asylum, and the kind of life and treatment that mentally ill people received before the 20th century.

Mental Health 3: Mental Health Through Literature examines how mental illness has been portrayed in the arts while highlighting for students a more insightful way to further develop their ideas about human behavior.

In elementary school, students should learn that all people experience a variety of emotions, yet they often deal with their feelings or personal problems differently. Students also learn that talking to someone about their feelings and problems can help them, but that human beings often remain confused about why others act the way they do (and even about their own feelings and behavior). As a result, students at this level should understand that people differ in how they cope with stressful situations—whether internal or external—and that they often cope by denying there is a problem in the first place. (Benchmarks for Science Literacy, pp. 147–149.)

By the time students enter high school, they probably would like to have a clearer understanding of why people behave as they do. While the world itself can be extremely confusing and stressful, dealing with unexplainable feelings and behavior can often be even more puzzling. That is why it is important at this stage of their development to expose them to the "general truths about social and psychological processes." Regarding health, it is worth pointing out that students of all ages tend to focus on the physical aspects of health and pay less attention to the mental and social aspects. The lessons in this series are intended to help students develop their ideas about the importance of understanding mental health.

In general, students at this level should come to realize that good mental health involves the interaction of psychological, biological, physiological, social, and cultural systems. Good mental health generally is regarded as the ability to cope with the ordinary circumstances people encounter in their personal, professional, and social lives. Ideas about what constitutes good mental health vary from one culture to another and from one time period to another. (This fact is probably the most important insight students can gain about mental health.) Moreover, students should be able to grasp the concept that what they may consider to be insane behavior could very well be viewed as simple eccentricity or divine inspiration by other people, for example, in Middle Eastern cultures. Similarly, differences in the ways cultures treat abnormal mental states can also differ widely; whereas one culture may prescribe therapy or drug remedies, other, more traditional cultures may promote prayer or social involvement to alleviate the ills of the person. (Science for All Americans, pp. 82–84.)

Ideas in this lesson are also related to concepts found in these Common Core State Standards:

CCSS.ELA-Literacy.RST.9-10.6 Analyze the author’s purpose in providing an explanation, describing a procedure, or discussing an experiment in a text, defining the question the author seeks to address.
CCSS.ELA-Literacy.RST.9-10.8 Assess the extent to which the reasoning and evidence in a text support the author’s claim or a recommendation for solving a scientific or technical problem.
CCSS.ELA-Literacy.RST.11-12.1 Cite specific textual evidence to support analysis of science and technical texts, attending to important distinctions the author makes and to any gaps or inconsistencies in the account.
CCSS.ELA-Literacy.RST.11-12.2 Determine the central ideas or conclusions of a text; summarize complex concepts, processes, or information presented in a text by paraphrasing them in simpler but still accurate terms.
CCSS.ELA-Literacy.RL.9-10.10

By the end of grade 9, read and comprehend literature, including stories, dramas, and poems, in the grades 9-10 text complexity band proficiently, with scaffolding as needed at the high end of the range.
By the end of grade 10, read and comprehend literature, including stories, dramas, and poems, at the high end of the grades 9-10 text complexity band independently and proficiently.

CCSS.ELA-Literacy.RH.11-12.7 Integrate and evaluate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, as well as in words) in order to address a question or solve a problem.
CCSS.ELA-Literacy.RH.11-12.8 Evaluate an author’s premises, claims, and evidence by corroborating or challenging them with other information.
CCSS.ELA-Literacy.RH.11-12.9 Integrate information from diverse sources, both primary and secondary, into a coherent understanding of an idea or event, noting discrepancies among sources.

Motivation

Begin the lesson by piquing your students' attention about the subject matter of this lesson. Elicit responses with the following questions and do not provide explanations.

Ask students:

Have you ever visited a mental health facility? If so, what was it like? If you haven't, what do you think they are like?
What kinds of people are there?
Why do you think these people are there?
What kinds of behavior would make you think someone is mentally ill?
How do you think Americans in general perceive or regard people with mental illness?
What is your impression of people who are mentally ill?

(Accept all responses and encourage students to support their feelings and views.)

Next, using the Bedlam esheet, have students explore the Museum of London: Bedlam exhibit, which provides general information on the world's oldest mental health institution. As students look around the site, encourage them to click on the assorted images, drawings, maps, and patient cases that allow visitors to "click on for more detail."

Briefly review what students saw and read by asking questions like the following:

How would you describe Bedlam?
What story do the photographs tell you about the lives of the people kept there?
Given Bedlam's long history, what do you think it was like to be a patient there, say, during the 1400s? Why?
Compared to Bedlam, what do you think life is like for patients in mental institutions today? Why?
How do you think people with "acute mania" behaved?
Why do you think some of the Bedlam patients, like WG, were "calmed by the process of being photographed"?
What does the depiction of Richard Dadd tell you about people with mental illness?

(Accept all responses and encourage students to support their feelings and views.)

Development

Have students explore the following online resources. These resources provide a more in-depth look and analysis of the Bedlam experience as well as how issues and problems related to mental health were handled and regarded in England before the 19th century.

Next, using the Bedlam esheet, have students explore Bedlam: Madness. This resource provides students with a general overview of the famed, historic mental institution. Among other things, students will learn that Bedlam used to attract visitors not for humanitarian interests but for its insane human spectacle.

By clicking on the link, students will learn about and see a visual representation of the "four humours," the rough, classically-influenced theory by which Europeans explained human physical, mental, and personality characteristics before the 20th century. (Note: In short, an imbalance in one of the humours could lead to madness and possibly a long stay at Bedlam.) This resource also briefly examines "madness" from a literary standpoint.

Encourage students to click on the active links for a more in-depth understanding of Bedlam and its influence on English culture. When they are finished, ask general comprehension review questions like the ones below. (Use the Bedlam teacher sheet as an answer guide for this and the other discussion activities in this lesson.)

Ask students:

What is "melancholia"?
How was "madness" portrayed in the arts in this era? What kinds of behaviors were viewed as madness by people of this time?
What kinds of theories or causes of madness are cited?
What are the "four humours"?
What differences are there between how Americans today view "melancholy," or "madness," and how the British viewed it at this time?

"Four Humors" Activity
Divide students into groups of three and have them do a more in-depth review of the "four humours" chart (either online or from provided copies). Using the chart, have students quickly determine with each other where their personalities fall in terms of the four humours. Encourage them to be as specific as possible—finding labels for themselves, like "choleric-sanguine" or "phlegmatic-melancholic," as noted. When finished, have the group members: (1) announce their personality types and discuss—among other things—the general insights or problems they found with this near-ancient personality classification system; (2) support their own "mental classifications" by describing the kinds of thoughts or behaviors they have that led them to this conclusion; and (3) touch on the plight of the mentally ill and the extent to which the four humours either hurt or helped both "normal" and "imbalanced" people back then.

Teaching Note: The two remaining resources below are personal accounts made by visitors to Bedlam (presumably) in the 18th century. It is suggested that students read each account first, then discuss their reactions to the readings in the format provided below. After the general discussion for the last reading, it is recommended that you lead into the Assessment, which has students draw direct comparisons between the ideas of the benchmarks and the life and ways of Bedlam, as depicted in this era.

The London Spy
Using the Bedlam esheet, students will explore The London Spy. This resource will provide students with an up-close look at what life was like inside Bedlam—from the point of view of an English outsider who visited this "tourist destination" in the 18th century. Students will also catch a glimpse of the general perspective of how "normal" and "sane" people of this period perceived and treated the mentally ill. The writer describes many of the residents he encountered, offering students a view of what the "patients" at Bedlam were like (and the types of people who would go there to watch them for amusement and excitement).

After students have read the article, ask them questions like the ones below discussing their reactions to the account. Answers are provided on the Bedlam teacher sheet.

Ask students:

How would you describe the attitude of the visitors?
What do you think is the reason for their critical perspectives?
What was the scene at Bedlam like?
How did you feel about the patients and what was happening?
Do you imagine that a scene like this could happen today? Why or why not?
How do you think the symptoms and behaviors of the patients would be viewed by people today?
How do you think the patients felt about being on display?
What other aspects of this account of Bedlam either surprised or bothered you?

Assessment

Refer students to the "Understanding What You’ve Learned" section of the esheet. They will be directed to read Henry Mackenzie, The Man of Feeling, Chapter XX next, another account of one man's visit to the notorious Bedlam. Direct them to pay particular attention to the young woman who captures the attention of Henry Mackenzie.

The esheet will direct students to answer the questions:

How does this account of a Bedlam visit differ from the visit made in "The London Spy"?
Judging from the conductor, what conclusions can you make about the quality of care the residents at Bedlam receive?
What is significant about the truth behind the notion that "the passions of men are temporary madhouses"?
What is your impression of the story of the young lady (and her tearful connection with Harley)?
To what extent do you think society is to blame for the decline of the residents and for the chaos of Bedlam?
What else did you find surprising, insightful, or tragic about Mackenzie's account of Bedlam?
If this were the 18th century and you had the chance to visit Bedlam, would you? Why or why not?

Students can use their Bedlam student sheet as reference for the questions. You can use these to conduct a culminating discussion of the ideas in this lesson or you can collect and grade them. Suggested answers to these questions are found in the Bedlam teacher sheet. As noted, lead this activity into a broader discussion of mental health and human behavior—past and present—as shown below.

Depending on your time availability, the following assignment can be done in class and/or as a homework assignment in the form of an essay.

Ask students to discuss the ideas in the benchmarks, especially specific contrasts between views of mental illness and institutions like Bedlam in the 18th century and their parallels today.

Extensions

Richard Dadd, from Tate Online, offers students a broader and more personal look at the life and artistic genius of one of Bedlam's most renowned residents.

History of the South Carolina Department of Health provides students with an insightful, illustrated history of the central figures and conditions of the S. C. Lunatic Asylum, which first opened its doors in 1828.

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