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About Change Minds Online


Bethlem Museum of the Mind holds casebooks that cover nearly 150 years and detail the time patients with severe mental health problems spent in Bethlem Royal Hospital. These were not just patients, but people with full and rich lives lived outside Bethlem. Their stay in the Hospital was often only for a year, perhaps the worst year of their life, but after this they vanish from our records. Who they were, where they came from and what they went on to do is hidden from us.

Change Minds Online brought together a group of volunteers to explore the stories of some of these people, using the casebook entries as a jumping off point and looking at their lives by researching other records and through creative interpretation. The group met online during June, July and August 2020, sharing the stories they found and pooling their ideas to make the project happen via online meetings and emails.

This virtual gallery shows the photographs of the people they researched in Bethlem, with links to their research in the information bar of each photograph, and the group’s creative responses to their research. Sometimes we have explained how we went about our work, sometimes not. All of us have tried to place the experience of the patients front and centre of our work.

Change Minds Online is based on a project created by Norfolk Record Office, the Restoration Trust and various other partners to explore the history of mental health. Find out more at http://changeminds.org.uk/

Bethlem c 1900

Front view of Bethlem Hospital, around 1900

Bethlem in 1887

By the late 1800s Bethlem was a long way removed from ‘Bedlam’, and was an up to date psychiatric hospital operating in St George’s Fields, Southwark, where it had moved in 1815. The main administrative block of the Hospital is now occupied by the Imperial War Museum, but at that time the Hospital also had two large wings extending from either side of that block, and two further wings stretching back- you can find a plan of the Hospital here- https://museumofthemind.org.uk/learning/explore-bethlem/floorplan .

The Hospital was at this point a charity which made much of its money from the rents it gained from country estates that had been gifted to it. This meant that it did not require its patients to pay for its services. However, it did ask for two ‘securities’ who could provide extra funds for the patient if required. As the majority of ‘pauper lunatics’ were being cared for in the county asylum system, Bethlem sought to take on people from the middle classes, who were neither in the workhouse system of welfare or able to pay for expensive private care. By 1887 there were a small number of ‘voluntary boarders’- who came into the Hospital, and were permitted to leave, of their own free will.

The Hospital also sought to take on only those patients it thought it could help with recovery. There was a very small long term ward, the so called ‘incurable’ wing, which could take around 30 patients, but the vast majority of the other 250 patients were only in the Hospital for a year or so at most.

Composite bethlem ints

Various images of the interior of Bethlem, late 1800s-early 1900s

The aim of the Hospital was to create an atmosphere in which the patients could feel at ease. The pictures here of the wards show different activities undertaken by the patients, including reading, sewing, gardening and keeping and looking after pets. There were regular dances, the ‘Bethlem Balls’, and music and theatre performances put on by the patients and visiting companies. Visitors were allowed, if it was felt the patients were well enough to see them.

While the Hospital was governed on the principles of non-restraint, this does not mean that patients were totally free to do whatever they wished. Dr Savage, the Resident Physician and head of the small trained medical staff, advocated for strong clothing (gloves and restrictive garments that limited free movement) and was a keen proponent of sedation for manic patients. It is also notable that at this time the Hospital could only really offer what we would think of as environmental cures. There were no anti-psychotic drugs and no talking cures on offer.

One stage of the recovery process was being sent to the Hospital’s convalescent home in Witley, Surrey. This usually marked a final stage in the patient’s residential treatment when it was considered that progress to recovery was established.

You can see more on Bethlem in the 1880s on our learning resource here- https://museumofthemind.org.uk/learning/explore-bethlem

The Casebooks

Casebook composite

Images from inside a casebook and the books sitting on a shelf in the archive

The casebooks were kept by the Hospital to the standards set by the Commissioners in Lunacy. From 1850 they take a standard form. The first part consists of information the Hospital received ahead of admission, including two doctors certificates that the Hospital required of all its patients- this is a copy of the information the Hospital used to assess and discuss that the patients were suitable for admission. The Hospital had to be sure the patients were suffering from serious mental health issues; that the patients were curable; and that they were ‘deserving’ of receiving the Hospital’s care. This information is recorded in a proforma on the first page of the casenotes of each patient.

The second part was a report by the Hospital of the patient examination. The second page is a pro-forma that covers physical health, the family history of mental health, and includes some general notes on the state that the patient was in. There is sometimes a very general diagnosis- often ‘melancholia’ or ‘mania’. This is then backed up by the initial interview on the third page, usually recording the first interaction between doctor and patient.

The majority of the third section from the third page onward is then taken up by progress notes. The casebooks do not record everything that happened, and sometimes only recorded monthly updates following an inspection by one of the doctors. There was a wide variety of reactions and information recorded. From 1883 there are photographs of patients (see below), and sometimes there are other pieces of miscellanea that the Hospital thought were illustrative of the patient’s mental health- often letters, sometimes from the patient’s family, sometimes from the patients themselves.

Photographs of Bethlem Patients

All the patient photographs in this exhibition were taken by two Bethlem medical assistants, Alfred Barker and Herbert Parker in 1887-1888. Not every patient in the Hospital was photographed. It’s possible that Baker and Parker selected only patients they knew well, or who were thought to have been of some medical interest. Patients who were only in the Hospital for a few months often do not have a photograph. Some patient photographs are pasted into the casebooks, and these are now showing a brown shade and some silver mirroring- the casebooks (and other archives) are in suitable archival accommodation now, but this has not always been the case. We also hold some glass plate negatives of photographs, some of which did not make it into the casebooks. The monochrome photographs in the portraits have been developed from these.

Ironically, no identifiable photographs of Barker or Parker survive to us.

Composite Bethlem activities

Photographs of patients in the Hospital grounds late 1800s-early 1900s

To see more on Change Minds Online you can find more blog entries here or you can see the exhibition of all our participants' creative work via our page here .