Custodial madhouses with chains and cages (Bethlem)

Domain XVI · Historical, discredited & harmful · 1247 · London

What it is

This is a historical institution and a custodial regime, not a therapy. Bethlem was founded in 1247 as the Priory of St Mary of Bethlem. It admitted the sick by 1403 and by the mid-15th century was known as a place for the care of the mad. For much of its history its main job was to confine people,…

Format

• Session number and length follow the client's needs and the setting.

Who practises it, and how they are trained or regulated

• The madhouse trade (1774 onward). The 1774 Act for Regulating Madhouses brought in licensing and inspection. It went unamended for 54 years and made no provision for paupers. The 1808 County Asylum Act allowed counties to build asylums but did not require it. The 1845 Lunatics Act made county pauper asylums compulsory. The 1890 Lunacy Act limited the further growth of madhouses.
• This is a historical institution and a custodial regime, not a therapy. Bethlem was founded in 1247 as the Priory of St Mary of Bethlem. It admitted the sick by 1403 and by the mid-15th century was known as a place for the care of the mad. For much of its history its main job was to confine people, with treatment secondary. Patients were kept in bed for much of the week and chained, sometimes for years. Until 1770…

Evidence status, as the guide reports it

• Exposure (1814–16). In 1814 the philanthropist Edward Wakefield found a patient who had been kept under restraint for about ten years. A former American seaman, he had been admitted in 1800. Wakefield, William Hone and James Bevans campaigned for change, and the Select Committee on Madhouses was…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• defensiveness, and coercion coming to seem normal. It is working when specific practices change.
• pressure to stay quiet, and retaliation. It is working when the concern is logged, acknowledged and investigated.
• the ending stirring up memories of abandonment by institutions. It is working when the client leaves with a plan.
• advocacy being used to avoid personal grief, and burnout. It is working when the advocacy feels chosen and sustainable.
• setting faith against medicine in a way that drives the family away. It is working when faith becomes a source of support for safe care.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.