THANKS TO MICHEL FOUCAULT, no self-respecting academic believes that early
Paris asylums were purely in the business of sympathy and cure. In the nearly
forty years since the publication of Madness and Civilization, Foucault's
sweeping thesisthat the mental hospitals of the Enlightenment were instruments
of social control designed to silence, rather than treat, the madhas attained
the status of gospel.
Now, with the appearance of The History of Bethlem (Routledge)a massive
work representing the combined efforts of five British historiansthe French
philosopher's hold on history may finally be coming undone. In theory, Bethlemthe
infamous London mental asylum, which celebrated its 750th anniversary last
fallmight seem just the kind of place Foucault had in mind when he conjured
up regimes of terror and barbarism in Madness and Civilization. After all,
Bethlem gave us "bedlam," our colorful catchall for uproar, chaos,
and insanity. Yet according to the book's co-authorsJonathan Andrews, Asa
Briggs, Roy Porter, Penny Tucker, and Keir WaddingtonBethlem Hospital was
a place of considerable humanity.
The Routledge volume is by no means a whitewash: There is no denying that
Bethlem inmates often had a very hard time of it indeed. Because the hospital
was the object of a long and arduous tug-of-war between city and Crown authorities
who sought to control its financing, Bethlem regularly experienced shifts
in administration and policy. Patients were frequently neglected, malnourished,
and filthy. But by the time the asylum was acquired by the city of London
in 1547 and began to keep detailed records, evidence that "soule sicke"
individuals were sent to the institution "to be cured" turns up
in abundance. Simply gaining admittance was no easy matter: Only those deemed
insane and curable after a preliminary examination could stay. ("Congenital
idiots" who were retarded but healthy were automatically turned away.)
Once inside, patients were to be accorded basic courtesy and respect. In
1620, for instance, when one father complained that his daughter's "foote
was rotten...for want of good looking to" after three weeks in Bethlem,
the governors immediately ordered an investigation. And in 1681, when two
of the hospital's staff, Edward Langdale and William Jones, managed to impregnate
two female patients, the perpetrators were dismissed.
Thus, The History of Bethlem provides ample evidence that directives issuing
from hospital administrators were from an early date couched in humanitarian
terms. Less clear, however, is the degree to which these official statements
corresponded to any treatment worthy of the name "humane" inside
the hospital walls. Certainly, many of the therapies administered by the
hospital seem bestial by modern standards. Well into the eighteenth century,
both darkness and cold were considered sedative to the mad. (As one sixteenth-century
authority opined, "The medycyne isthat in the begynnynge...he be well
kepte or bounde in a darke place.") Many patients were restrained in
chains or subjected to purges and bloodletting. According to The History
of Bethlem's authors, however, these methods were in keeping with medical
theory of the day, which regarded mental abnormalities such as manias and
depressions as imbalances of the humors.
Perhaps the most persuasive evidence for Bethlem's enlightened institutional
practice stems from its relationship with the larger society. In contrast
to the lock-'em-up-and-throw-away-the-key policies chronicled by Foucault,
Bethlem remained open to the public through most of the eighteenth century
and was a popular destination for middle-class London. "Unlike the
silent mad in the Foucault model, the mad in Bethlem were talking politics
and they were talking religion," says Roy Porter, a professor of the
social history of medicine at London's Wellcome Institute. "You went
along to Bethlem to hear the mad jabber." Stories abound of visitors
to Bethlem being guided around by a "decent-looking chap," only
to learn that he is in fact an inmate.
Such anecdotes are potentially as revealing as they are delightful. But
UC-San Diego sociologist Andrew Scull, co-author of Masters of Bedlam
(Princeton, 1996), a broadly Foucauldian account of nineteenth-century psychiatry,
urges caution. Although he welcomes the new Routledge volume as "the
first serious, sustained look at the whole sweep of the hospital's history,"
he believes the book "draws slightly too rosy a picture of things."
Nevertheless, Scull concedes a point that Lawrence Stone and other historians
have been making for years: Foucault may have been too quick to generalize
about the punitive agenda of Enlightenment-era asylums.
As for Bethlem itself, the hospital has outlasted the anti-psychiatry polemics
of the 1950s and 1960s: It currently has 228 inpatient beds. As Porter explains,
Foucault's searing critique of psychiatry and its institutions came at the
end of an era characterized by overreliance on extreme and sometimes destructive
physical treatments, such as lobotomies and electroshock therapy. "The
horror of psychiatry as it seemed to people living in the 1950s and 1960s"
says Porter, "was not necessarily its old, outmoded quality but the
sheer recklessness of its new technologies." This climate of opinion
ensured a swing toward deinstitutionalized community care. But today, professionals
are increasingly wary of throwing open the asylum doors: Too often
has been used as an excuse for governments to cut funding, disgorging onto
the streets a stream of helpless individuals, too confused even to beg.
As Porter observes acidly, "there's no community and no care."
In one important respect, then, it seems Foucault was right. Social policyeven
the most seemingly progressive or benignis all too frequently entangled
with political self-interest. Though in its conclusions The History of
Bethlem stands opposed to Madness and Civilization, it is not
hard to detect the oscillations of Foucault's pendulum beneath its surface.