Asylums and mental health

Bethlehem HospitalThe priory of St Mary of Bethlehem was founded in 1247 on Bishopsgate, London – now home to Liverpool Street Station. Eventually becoming known as Bethlem Hospital, by the mid-fourteenth century it was being used as a refuge for the sick. Since 1403 Bethlem Hospital, also known as ‘Bedlam’, has treated those with mental health problems. In the sixteenth century any patients deemed dangerous were restrained with chains. Stories include claims that up until the late nineteenth century thousands of people paid to see patients being 'exhibited' on Sundays.

Bethlem Hospital has occupied various sites over the centuries in order to accommodate fluctuating patient numbers, legislative changes and the state of buildings. It first moved in 1676 to a baroque building in Moorfields. By 1815, it had moved again, this time to St George's Fields, Southwark – now the Imperial War Museum. The final move in 1930 to a former country estate in Beckenham, Bromley gave Bethlem its current location. In 1999, Bethlem Royal Hospital became part of the South London and Maudsley NHS Foundation Trust.

Daniel Hack Tuke (1827–1895) was born in York. He was a physician and writer on psychological medicine although poor health affected both his education and his career. He was raised near to the York Retreat, an asylum which had been established by his great-grandfather William Tuke. In 1847 Daniel was appointed York Retreat secretary and house steward, and after qualifying in 1853 he worked there as assistant medical officer. He spent long periods studying patients and their illnesses, read widely about insanity and made meticulous case notes. He also created a course on psychological medicine at York medical school and took his students to the Retreat to observe patients.

Tuke was an author of some repute. He wrote regularly about the moral management of the insane and about how the Retreat used compassionate methods rather than mechanical restraint to treat their patients. His book A Manual of Psychological Medicine, written with J. C. Bucknill, was published in 1858 and became the standard text on insanity.

He moved to Falmouth and lived there for fifteen years where his health improved. Then in the mid-1870s, Tuke moved to London where he began lecturing at Charing Cross Hospital medical school and became a governor of Bethlem Hospital. He visited asylums in Europe and North America and wrote on the comparative, historical, geographical and medical aspects of psychological medicine. In 1882 he published the historical work Chapters in the History of the Insane in the British Isles. His understanding and knowledge allowed him to promote psychological medicine to the general public as well as appealing to medical practitioners.

York Retreat

Original building of The Retreat, York. An engraving by Cooper after Henry Cave (1779?-1836?) Frontispiece from 'Chapters in the history of the insane in the British Isles' by Daniel Hack Tuke. London : Kegan Paul, Trench & Co., 1882.

Psychiatrist Lyttelton Stewart Forbes Winslow (1844-1913) was born in Marylebone, London and grew up in the private asylums owned by his father Forbes Benignus Winslow. He was educated at Rugby and Cambridge and qualified to practice in 1869. After his father’s death in 1874 Winslow managed the asylums, although he left them following a family feud. He lectured on insanity at Charing Cross Hospital and founded the British Hospital for Mental Disorders in London.

Winslow also worked as an expert witness in criminal trials. He believed that alcohol was a cause of insanity and crime commenting that 'so long as the "uncontrollable drunkard" is allowed to go free and unmolested, so surely must lunacy continue to increase.'
Mad humanity : its forms, apparent and obscure (1898) p25.

He was involved with many infamous cases such as the ‘Balham mystery’ Bravo case and the Florence Maybrick case. Even if he did not actually appear as a witness in court, he involved himself in the sensational cases of the time by stirring up the press, writing letters and speaking at public meetings. He was a controversial figure and the medical establishment did not appear to approve of his involvement in such notorious cases.

In 1888, Winslow received notes signed ‘Jack the Ripper’ and he believed he knew the identity of the murderer. The police investigated but did not agree or co-operate with Winslow, and even briefly suspected him of involvement in the killings. He seemed obsessed with solving the case and believed that his actions forced the Ripper to flee the country.

Forbes WinslowPortrait of Lyttelton Stewart Forbes Winslow, frontispiece from 'Recollections of forty years : being an account at first hand of some famous criminal lunacy cases, English and American ; together with facsimile letters, notes, and other data concerning them' by L. Forbes Winslow. London : John Ouseley, Ltd., [1910?].

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