Mansions in the Orchard

Project historian Jennifer Walke recently attended several conferences to present some preliminary findings from the Mansions in the Orchard project. This included the ‘History of Medicine in Practice’ at Uppsala University and ‘Alternative Psychiatric Narratives’ at Bi, University of London. The research charts the history of Bethlem at its current site, through the experiences of current and former staff, service users and local residents. Below, Jennifer reflects on some emerging themes, the implications of this work, and describes future plans.

1. Place and Purpose

One of the things that I think is really important about the Bethlem site is that it is a place of asylum in the real positive sense of the word. (Current social worker).

The research examines the historic relationship between the site and architecture of the Bethlem Royal Hospital and its therapeutic function, and changing ideas of ‘asylum’ and ‘community care’. Many respondents felt that the relative tranquillity of the Bethlem environment provided sanctuary and promoted recovery. Conversely, staff also described the personal and practical effects of hospital expansion and sale of properties; one forlornly remarking that [they] ‘couldn’t have expected us to remain in our own little bubble’.

2. Institution and Identity

We used to say ‘Oh, you are a Maudsley chap’. We would know the ones that had come from Maudsley; I think they were more forward-thinking than Bethlem... I don’t know if they were really. (Ex-nurse).

We were interested to learn whether the institution offered an identity for staff and patients, and if this had changed over recent decades. Also, what are the differences and similarities between Bethlem and contemporaneous institutions? The stereotype of Bethlem as more relaxed than the Maudsley Hospital was entrenched in different generations of staff testimony, and discussed with humour and irony. One service user, first treated in the late 1960s, compared inpatient experiences at the ‘Bethlem hotel’ to those elsewhere and in the community. Particular contrasts were observed in environment, ward regime, and diligence of staff: at Bethlem, she recalled, ‘nobody ever gave up’.

3. Community and Communication

Since time immemorial really Bethlem was 'Bedlam' and local people here have tremendous misconceptions. (Ex-nurse)

Some current and former staff members were also local residents. The varying personal accounts of ‘community relations’ ranged from acceptance or complacency, to fear and uncertainty, to outright hostility (the latter concerning admission of forensic patients). Recent years have seen ongoing efforts to engage the public in the life of the hospital, and thereby demystify and destigmatise mental illness. However, service user testimony indicated that these efforts should be directed equally at the (general) medical profession and supported the idea that community care, rather than being a progressive measure, could exacerbate isolation and stigma.

What Next?

The remainder of this project will focus on service users and local residents. The assumptions made by staff about local residents’ views (as above), may reflect extreme or minority opinions. Alternatively, some people may believe that we are only interested in amassing positive accounts of the hospital (understandable amid a tradition of rose-tinted institutional histories) yet this warrants further examination. Furthermore, service user input has been somewhat sporadic, e.g. responses to photographs or the chance revelations of those interviewed in other capacities. We hope that a collaboration with the Dragon Cafe in September will enable us to increase these perspectives, and explore present-day interpretations of ‘asylum’.