A History of London County Lunatic Asylums & Mental Hospitals

By Ed Brandon

From the Middle-Ages onwards, London’s notorious Bedlam lunatic hospital saw the city’s ‘mad’ locked away in dank cells, neglected and abused and without any real cure and little comfort. The unprecedented growth of the metropolis after the Industrial Revolution saw a perceived ‘epidemic’ of madness take hold, with ‘county asylums’ seen by those in power as the most humane or cost-effective way to offer the mass confinement and treatment believed necessary. The county of Middlesex – to which London once belonged – would build and open three huge county asylums from 1831, and when London became its own county in 1889 it would adopt all three and go on to build or run another eight such immense institutions. Each operated much like a self-contained town; home to thousands and often incorporating its own railway, laundries, farms, gardens, kitchens, ballroom, sports pitches, surgeries, wards, cells, chapel, mortuary, and more, in order to ensure the patients never needed to leave the asylum’s grounds. Between them, at their peak London’s eleven county asylums were home to around 25,000 patients and thousands more staff, and dominated the physical landscape as well as the public imagination from the 1830s right up to the 1990s. Several gained a legacy which lasted even beyond their closure, as their hulking, abandoned forms sat in overgrown sites around London, refusing to be forgotten and continuing to attract the attention of those with both curious and nefarious motives. Hanwell (St Bernard’s), Colney Hatch (Friern), Banstead, Cane Hill, Claybury, Bexley, Manor, Horton, St Ebba’s, Long Grove, and West Park went from being known as ‘county lunatic asylums’ to ‘mental hospitals’ and beyond. Reflecting on both the positive and negative aspects of their long and storied histories from their planning and construction to the treatments and regimes adopted at each, the lives of patients and staff through to their use during wartime, and the modernisation and changes of the 20th century, this book documents their stories from their opening up to their eventual closure, abandonment, redevelopment, or destruction.

• Language: English
• Publisher: Open Road Integrated Media
• Release date: Sep 21, 2022
• ISBN: 9781399008747

Book preview

Introduction

The history of organised mental health care in London has no definitive point of origin; certain charitable and religious hospitals, monasteries, and almshouses tended to adopt the role informally on a small scale, while the remainder of those suffering from mental health problems – if not accommodated and cared for by their families or immediate community – might find themselves begging on the streets if unable to work, sent to gaol or prison, or otherwise punished and persecuted if their symptoms transgressed social norms.

It is not necessary to evoke specific images of the kind of persecution that would have been suffered by the ‘mad’ in medieval times, but for most it would have been brutal and unforgiving, and was usually felt to be justified on a religious basis: before the business of ‘mad-doctoring’ became a distinct profession in the eighteenth century, mental illness was almost invariably believed to be the result of failed morals, evil deeds, or possession by demonic forces, and so whatever punishment was meted out was felt to be perfectly justified.

Since the county asylums discussed in this book were intended to operate in keeping with a common set of rules, regulations, and practices which changed and developed at all of them at roughly the same time – in tandem with the changes in the world around them – the author has attempted to avoid excessive repetition by covering some of the many topics in greater depth only within certain chapters. So, while each chapter acts as a separate ‘biography’ of each particular asylum, a greater understanding of the workings and history of any one of them (as well as the various differences between them) can be gained by reading all of the chapters.

In regard to the historical terminology used around mental health care, the author has tried to simplify the presentation of these complicated and frequently changing terms as far as possible. Although the buildings in this book were variously referred to as ‘lunatic asylums’, ‘mental hospitals’, ‘colonies’, or simply ‘hospitals’ at various times in their service (not to mention the many informal, usually pejorative names also used), all were originally classed as county asylums. In order to avoid confusion, the author has noted when subsequent changes of name occurred but continues to refer to the buildings as either ‘asylums’ or ‘former asylums’ throughout, even when discussing an era in which that term would no longer have been formally used. Since their names changed so often, the author has also settled on the name given at the start of the chapter – ‘Colney Hatch’, for example – and continued to use the same one throughout, to provide consistency.

Many of the medical terms used throughout the text are now not only outdated in a historical sense but have also gained negative or even offensive connotations over time; the history of mental health terminology is sadly littered with formal words which later entered the everyday language as terms of abuse. The author wishes to clarify strongly that no offence is intended, nor any casual attitude held toward the repetition of such terms, but has attempted to use the correct words in their once-appropriate contexts to maintain historical accuracy, rather than introducing any system of revision or sanitisation; explanations for what or whom these various terms were originally intended to describe are included within the glossary.

Bethlehem Priory was founded in 1247 at London’s Bishopsgate as a resting and visiting stop for pilgrims and other Catholic figures and invariably acts as the starting point for any timeline of mental health care in Britain; over the following 150 years, it would evolve into ‘Bedlam’, and its reputation became so entrenched in the popular imagination during the following centuries that it not only became notorious itself, but also spawned its own noun in the English language.

In 1377, King Richard II (1367–1400), then only 10 years old, had the ‘lunatic’ inmates of a small hospital in Charing Cross marched off to Bethlehem Priory in shackles because the noise they made was apparently disturbing the poor boy’s pet ravens, housed nearby. By 1403, ‘Bethlem’ or ‘Bedlam’ (as it came to be interchangeably known by popular truncation) was recorded to have ‘sex viri menti capti’ – six men who had lost their minds; this confirmed its adopted role had begun by then, and so either 1377 or 1403 tends to be referenced as the formal starting point of Bethlem’s evolution from a priory into a ‘lunatic hospital’.

Bethlem was funded by charity, so its inmates were exempt from vagrancy laws and permitted to seek alms (to beg) in the streets under the watchful eye of their ‘keepers’ in order to help pay for their own and the institution’s upkeep. By 1509, King Henry VIII (1491–1547) sat on England’s throne and Bethlem – as a former Catholic establishment – was soon to be dissolved as part of the Reformation. The Lord Mayor of London, Sir Richard Gresham (1485–1589), convinced Henry to spare it from sale or demolition on the basis that it was no longer used for any purposes relating to the Catholic Church, giving a good indication that its role had developed and become somewhat formalised by that time. Henry bequeathed it to the Anglican Church on his deathbed, only on condition that it could never be sold, and it was henceforth run by the same committee who oversaw Bridewell Prison. Bethlem received the most meagre share of all available funds and would have been a truly miserable place of detention, with inmates shackled in stinking, fetid conditions (an open sewer ran down its centre), freezing cold in winter, and with no curative regime in place besides perhaps some occasional kindness from the keepers working there. However, the keepers appear to have been under little if any outside scrutiny, and over the decades, many came and went, with most being dismissed due to some scandal or other, including mistreatment of the inmates, stripping the hospital of whatever assets it had for a quick sale, or even selling the food and drink donated to the patients for personal profit.

By 1610, the regime was somewhat more organised, and patients were brought to Bethlem by their families for ‘care’ or confinement, which was provided for a small weekly fee. It is unclear whether the majority of those committing their relatives were doing so in the genuine belief that some cure might be administered or simply to pass a ‘problem’ on to somebody else (and both scenarios likely occurred), but a thriving black market of quack tonics, potions, blessings, and tinctures developed around the building purporting to cure anything from baldness to scabies, so it must at least have gained some sort of reputation for dispensing effective cures and medical knowledge. By this time, visits for educational or ‘entertainment’ purposes were being organised too, as Bethlem lay within walking distance of London’s theatre district and other ‘attractions’: here begins its descent into the squalid circus it became during the sixteenth and seventeenth centuries before the concept of offering genuine ‘asylum’ for lunatics gained traction in the medical sphere. Group tours were even organised, and paying visitors allowed to enter in order to ogle, irritate, and mock the inmates, or to study them for purposes of scientific, artistic, philosophical, or more general curiosity – all under the premise that this would at least cover the building’s running costs and feed those confined within.

In 1666, the Great Fire of London destroyed Bridewell Prison (along with half the city) and so its committee had to use Bethlem’s shabby, stinking, squalid frame to conduct their meetings, which led to their overdue realisation that the old buildings were no longer fit for purpose; thus ‘New Bethlem’ was built at Moorfields in 1676. The old Bethlem was eventually demolished, and the only remaining sign of its existence now is the small blue plaque that can be seen on the side of the Great Eastern Hotel on Liverpool Street (formerly ‘Bethlem Street’), Bethlem having occupied the site where the railway station now stands.

New Bethlem was the first purpose-built and permanent ‘lunatic hospital’ in the world and would form the general template for all such buildings for more than a century to come. It was considered one of the finest buildings in London by many and was then the third largest civic building in Britain, appearing in guidebooks and travelogues of the time as a ‘must see’. With its grotesque statues atop the entrance gates depicting the tortured figures of ‘raving madness’ and ‘melancholy madness’ functioning as an advert of sorts in much the same way as, say, a carving of a lion might outside a zoo, it is in this second form that Bethlem truly came to be thought of as a place of entertainment and one of London’s premier ‘attractions’.

New Bethlem Asylum (Bedlam) at Moorfields, London. Engraving by unknown artist, c.1770. Collection of the author. (Public Domain)

Needless to say, the hordes of visitors leering, mocking and provoking the inmates seems unthinkably callous and damaging to those poor souls who instead required care and respite at the very least, but it did allow a few to become minor celebrities and earn decent coin by performing or acting as raconteurs for their ‘spectators’. To reflect on this in a positive way purely because certain inmates were forced to learn to make the best of it would be folly, but it is also true that, in most cases, New Bethlem would still have represented a considerably better fate than that to which they would be subjected on the brutal, unforgiving streets outside. While some patients pleaded to be released, others are recorded as having begged to stay in Bethlem even after formal discharge; however, this likely speaks more to the toughness of survival in London in general at that time than it does to any positive aspects of life in Bethlem.

‘Melancholy madness’ which sat atop the gates of New Bethlem from 1676 to 1810. Sculpture in Portland stone by Caius Gabriel Cibber (1630–1700). Housed at Bethlem Museum of the Mind. (Copyright Ed Brandon)

After almost a century of fulfilling its awful role as little more than a human zoo, attitudes began to change. The superintendent of St Luke’s Hospital,1 Dr William Batty (1703–1776), introduced a regime at his institution as different to Bethlem as possible, and key to his agenda was ensuring that visitors with no ties to the patients or other legitimate business to conduct there would not be allowed inside. He also sat on the committee for New Bethlem and his efforts, along with those of other powerful men and women, particularly within the growing Quaker and Methodist movements, eventually pressured and embarrassed Bethlem into changing its ways so that it would, like St Luke’s, also come to rely only on donations and ‘subscriptions’ rather than continuing to function as little more than a sordid freak show.

Toward the end of the eighteenth century, the madness of King George III (1738–1820) generated increased sympathy toward mental illness among the public as well as in some quarters of the press. Along with the ‘humane treatment’ regime adopted by Quakers at The Retreat in York (another charitable lunatic hospital), more progressive ideas began to ingrain themselves in the minds of a new generation of medical practitioners as well as among powerful reformist and philanthropist circles within society and government. While it would be incorrect to assume that the mood which led to the creation of the county asylums discussed in this book was one of pure altruism, free from any elements of class or social control, the 1808 County Asylums Act for England and Wales gave an indication of the change in thinking from its title alone; ‘asylum’ represented a new and progressive but also more curative and care-led attitude toward addressing lunacy.

While Bethlem had been notoriously secretive about its regimes and practices, the County Asylums Act was the first significant attempt to amalgamate all the knowledge, thinking, and expertise developed at the handful of existing institutions across Britain and aimed to empower and guide counties to build their own. The Act attempted to comprehensively address all potential issues and perceived obstacles, advising on all manner of topics including where an asylum should ideally be located, how it should be constructed, who should be employed within it and in what capacity, how the finances might be run, the separation of the genders, treatment regimens, the classification of different types of patients, and so on. The act empowered Justices of the Peace (JPs) across Britain to use taxes to pay for the building of public county lunatic asylums for paupers and it urged them to do so at haste. However, until the overhaul of the Act in 1845, this was merely a ‘recommendation’ and not mandatory by law, so with JPs elected by the very people whose rates would pay for any such building, the vast majority – perhaps unsurprisingly – found more reasons not to build one. After all, why should lunatics benefit from such exclusive additional expenditure when money had already been spent on gaols and workhouses into which they could be sent?

This reluctance was anticipated, and the documentation suggested various measures to reduce the financial burden, including allowing smaller adjacent counties or those which had lower numbers of registered lunatics to go into partnership if appropriate, thereby sharing the cost. But despite such attempts to smooth and facilitate the process, highlight the potential benefits to law and order, and suggest where costs may be saved and the health and productivity of the population improved in the longer term, uptake was slow; Bedfordshire, for example, claimed to have surveyed all of its parishes and found that they had not one single lunatic anywhere in the county.2 Even twenty years later, only nine county asylums had been built: Nottinghamshire was the first to open its county asylum in 1812, and Bedfordshire followed it later that year. Norfolk’s opened in 1814, followed by Lancashire in 1816. The West Riding of Yorkshire and Staffordshire each opened their first county asylum in 1818, and others followed for Cornwall in 1820, Haverfordwest Borough in 1822, and Gloucestershire in 1823.

Meetings between William Hone MP (1780–1842), the architect and reformist James Bevans (dates unknown), and the Quaker reformist Edward Wakefield (1774–1854) led the trio to investigate conditions at various public and private lunatic hospitals. At Bethlem in 1814, they discovered the tortured figure of James Norris, chained to a metal pipe, constricted in a straitjacket, and left in a cold, dingy cell in solitary confinement for almost a decade; and he only represented one of the worst of the myriad horrors they encountered. They presented their shocking findings to a Select Parliamentary Committee in 1815 which coincided with Norris’ excruciating death from the explosion of an impacted intestine caused by his constriction, leading to a public scandal and subsequent parliamentary inquiry which generated additional popular and political sympathy toward the idea of regulated, state-funded lunacy provision.

James Norris at New Bethlem. Coloured etching by G. Arnald, 1815. Courtesy of the Wellcome Collection. (Public Domain)

Earlier in 1814, the trio had also proposed a plan to Parliament for a ‘London Asylum’, which would have involved the purchase of forty acres of land on the outskirts of the city upon which a 400-bed asylum, built to designs by Hone and Bevans, would be constructed. Their design was a ‘radial’ plan (see Hanwell chapter) and envisioned to be run according to the ‘humane treatment’ principles practised at The Retreat – deliberately different to New Bethlem – with Hone to serve as its first superintendent. Despite the submission of their architectural plans and some funding and general interest being raised, Royal Bethlem – its third incarnation – opened at Southwark in August 1815 and was perceived as a convenient panacea to London’s need for provision and the reputation of the Bedlam of old, as well as removing any need for a county asylum proper. This drained the funding from the London Asylum project and, as Hone developed a severe illness which meant he was no longer able to contribute, the idea was abandoned.

The revised County Asylums Act of 1845 made the construction of such buildings mandatory for each county and county borough, with each expected to build one large enough to house all of its registered pauper lunatics. Workhouses could also legally accommodate lunatics but would eventually have to include dedicated wings or wards to house that particular category of inmate; they were also only supposed to accommodate ‘harmless’ and chronic cases, and not acute cases or those deemed to be potentially curable, suicidal, violent, or dangerous in any other way. Although this arrangement rarely worked quite as smoothly as hoped, it was generally adhered to in most counties.

The London Asylum, plans by Hone and Bevans, 1814. Collection of the author. (Public domain)

The first three county asylums built to serve the London area were all built by the Middlesex authorities, while the fourth was actually built by Surrey but inherited just a few years later by the new London County Council (LCC) which was formed in 1889 when London became its own county. All four were inherited by the LCC, who went on to complete Middlesex’s planned Claybury Asylum and build a further six themselves. This book covers those eleven buildings formally referred to as ‘London County Asylums’ between 1889 and 1930, and not the Metropolitan Asylums Board institutions, converted workhouses, or any of the other buildings in the London area which also performed roles in mental health provision.

From the 1970s onward, areas of jurisdiction and the names of the various health authorities which oversaw the former asylums tended to change quite frequently. The author acknowledges that his coverage of this particular aspect of their late history is not exhaustive in relation to any given building, believing that such minor yet frequently occurring details – relating as they do more to opaque bureaucratic systems than the buildings themselves or what occurred within them – would likely be neither essential nor particularly interesting for the majority of readers.

While many modern psychiatric units exist today on what was once a county asylum’s grounds or estate, among the 120-odd3 county asylums that once stood, there are now only a tiny handful at which a part of the original structures (if any remain at all) are still used for psychiatric in-patient services; there are two or three others that retain some small outpatient facilities, and a few others that retain some part of the old buildings for non-psychiatric medical use. Discussion regarding the closure of the former county asylums – and whether or not they should have been run down at all and how that process might have been better or differently handled if so – tends to be extremely divisive and represents a hugely complex topic that could not be addressed here in its due depth.

It is a matter of fact that numerous medical procedures as well as many social or medical ideas and concepts now quite rightly considered abhorrent were made manifest within the walls of the county asylums. From the everyday abuses and neglect which occurred unseen or simply ignored, to the tortures, indignities, and even mutilations once so confidently dispensed as convenient solutions (if not cures), including but not limited to leucotomies, focal infection therapy, aversion therapy, etc., hubristic and all-powerful doctors subjected thousands of patients to damaging and dehumanising practices which often appear to have placed the patients’ physical health – and indeed their very lives – secondary to those same men’s overwhelming desire to ‘win’ the battle with madness at any cost to the individual. Whether or not they truly believed they were doing the right things for the right reasons becomes immaterial given the price others ultimately paid for their misplaced confidence or curiosity.

But the simple question of whether the county asylums were a good or bad thing overall is not quite so straightforward to answer without bias, because any answer would necessarily depend on who was being asked. By the standards of differing eras, any given asylum might, for example, have been relatively comfortable and well managed in 1890, then overcrowded and insanitary by 1930, and perhaps have offered a productive and therapeutic regime to willing, voluntary patients by 1980. In many real-life examples, the geriatric wards were dirty, neglected, and staffed by miserable, demoralised workers in, say, 1970, while acute patients at the same institution at the same time benefited from cheerful decor and the latest therapies administered by positive, optimistic, and inclusive staff in another ward-block only fifty yards away. Any review or summary of the value of the county asylums would therefore also be biased by what any given patient experienced, and how that related to what they believed they would have experienced had they not been there – how and why they felt their time in a county asylum had either benefited or blighted their lives as an individual.

Unfortunately, for the first 150 years or so, such questions were rarely asked of the patients themselves (and usually not often enough even after that), at least not in any way which really allowed their voices to be heard, but examples do crop up throughout history. The narrative regarding the role of asylums in general has become an almost completely negative one over the years, largely because the horror stories tend to be the more marketable ones, and because the image of the Gothic Victorian lunatic asylum undeniably lends itself to exaggerated or purely fictional