On Finding Out I Was Being Committed to Bedlam Hospital
My Eight Weeks in London’s ‘Notorious Asylum for Lunatics’
By Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal
When I was growing up in Brooklyn in the 1950’s, we had a time-honored ritual for rainy Saturday afternoons. A bunch of us went to the movies for the Saturday matinee. Typically, they either had a marathon of cowboy movies or horror movies. It was the original model of “binging.” Unlike today, back then, it was an all-afternoon affair. First, the cartoons, and then back-to-back flicks. There were no “starting times.” You got to the theatre and just started to watch for as long as you wanted. Typically, you stayed until you realized that the movie you were watching was the movie that was playing when you came in. You turned to your buddy and whispered, “This is where we came in.” This was the signal that it was time to leave.
We loved the Westerns (Roy Rogers, Gene Autry, John Wayne, Tex Ritter) since we all wanted to eventually be cowboys. But it was the horror films that tested our courage. The biomarker for heroics was refraining from closing your eyes when Dracula appeared.
We white-knuckled through The Mummy, Frankenstein, The Werewolf, Voodoo Island, The Black Cat, and others. One of the scariest of all was the 1946 horror movie, “BEDLAM.”
The plot thickens: It is 1761 in London at St. Mary Bethlehem asylum for the mentally ill and an acquaintance of Lord Mortimer dies in an attempt to escape from the asylum. Master George Sims appeases Mortimer by having his "loonies" put on a show for him. Mortified by the treatment of the patients, Mortimer's protégée Nell Bowen seeks his aid, then seeks the help of Whig politician John Wilkes to reform the asylum, threatening Sim's corrupt practices.
The movie was based on the Bethlem Royal Hospital, founded in 1247, also known as St. Mary Bethlehem, Bethlehem Hospital and Bedlam. It was the first psychiatric hospital in London. Its famous history has inspired several horror books, films, and television series, most notably Bedlam, a 1946 film with Boris Karloff—the very startling movie that caused me to drop my box of Goobers on the floor (luckily I was able to evoke the ten-second rule).
One of the many events at the hospital which demonstrated curiosity about mental health by the public was the visits by friends and relatives that were allowed and encouraged. It was expected that the family and friends of poor inmates would bring food and other essentials for their survival. Bethlem was and is best known for the fact that it also allowed public and casual visitors with no connection to the inmates. This display of madness as a public show has often been considered the most scandalous feature of the historical Bedlam. The word “bedlam” which means a place, scene, or state of uproar and confusion, was derived from the hospital’s official name, Bethlem, which became Bedlam Hospital.
I performed my clinical training in medical school in London; and for my eight-week psychiatric rotation I was assigned to St. Mary’s Hospital, the hospital that was the former Bethlem Lunatic Asylum.
Visions of the movie Bedlam quickly vanished with my contact with dedicated, skilled and empathetic clinicians and support staff. Over the course of my rotation, which included both inpatient and outpatient cases, I worked with patients with resistant depression, schizophrenia, trichotillomania, bipolar disorders, anorexia, and PTSD. I participated in single and group counseling, medication withdrawal, electroconvulsive therapy, transcranial magnetic stimulation and other therapies which in many cases had very promising outcomes.
“May is Mental Health Awareness Month and, once again, we are confronted with the realization that mental health clinicians receive little formal training in treating people with IDD and co-occurring psychiatric conditions.”
Looking back at my attachment at Bedlam, I don’t recall any of the patients having an intellectual and developmental disabilities (although the British referred to those conditions as “learning disabilities,” a term that stuck until recently).
May is Mental Health Awareness Month and, once again, we are confronted with the realization that mental health clinicians receive little formal training in treating people with IDD and co-occurring psychiatric conditions.
An article in the Journal of Psychiatric Services (August 2021) by Debra Pinals et al, “Persons with Intellectual and Developmental Disabilities in the Mental Health System” provides a clear understanding of the results of an inadequately trained workforce and how it impacts on our vulnerable population.
“Individuals with intellectual and developmental disabilities (IDD) are at high risk of co-occurring mental health conditions, including major depressive disorder, bipolar disorder, anxiety disorders, psychotic illnesses, impulse control disorders, and others. Because of symptoms associated with these illnesses and with the disabilities themselves, these individuals are often served in a mental health service system framework. However, treatment for them in these settings has typically not been sufficiently nimble, knowledgeable, or adept. Most mental health professionals receive little training about the needs of this population, and system structures typically bifurcate care, when, in reality, conditions can be complex and overlapping. In this first of two articles on care for persons with IDD in the mental health system, the authors provide a clinical overview of these neurodevelopmental disorders and of mental health and other conditions that co-occur with IDD. Considerations and challenges for treating this population in the mental health system include early recognition of mental health conditions, which often requires caregiver and family input, as well as information from a variety of additional collateral sources. The importance of trauma-informed and person-centered care; the promotion of self-determination through use of decision supports; use of approaches such as applied behavior analysis to develop a frame to address challenging behaviors; and the need to properly assess and provide thoughtful pharmacologic intervention when appropriate. The ability of individuals with IDD to thrive in a wide range of community integration opportunities depends on many factors, and clinicians must understand and use the available approaches for treating them.”
I cherished my time in Bedlam.
Bedlam Hospital was England’s first hospital for patients with mental illness, and thankfully its history, like most institutions for mental health, demonstrated the adoption of humane, compassionate, and progressive treatment. The system is at a crossroads, and it is time to appreciate that for inadequately treated individuals with intellectual and developmental disabilities with co-occurring psychiatric conditions, everyday can be considered bedlam.
About the Author
Rick Rader, MD, FAAIDD, FAADM, Editor-in-chief, Helen Journal