Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis Read Online Free Page A

another five-day effort at stabilization.
    In contrast, by early Bethlem standards a “short stay” was one in which the patient was discharged after twelve months or less. Even one year of treatment proved to be inadequate for many patients at Bethlem, as the hospital archives reveal. The hospital developed a means of classifying patients as either “curable” or “incurable.”
    “When a patient, after sufficient trial, is judged incurable,” an eighteenth-century hospital document explains, “he is dismissed from the hospital, and if he is pronounced dangerous either to himself or others, his name is entered into a book, that he may be received . . . [into] the house whenever a vacancy shall happen.” Despite the dangerous conditions that these patients were deemed to have, the number of patients in need of longer-term care far exceeded what Bethlem Hospital could offer. “There are generally more than two hundred upon . . . the incurable list,” the document continues, “and as instances of longevity are frequent in insane persons, it commonly happens that the expectants are obliged to wait six or seven years, after their dismission from the hospital, before they can be again received.”
    In response to this great need, Bethlem expanded yet again in 1730, adding two wings for the “incurables,” who were now permitted to stay until the moment when—or if—they recovered. One such patient was Richard Dadd, an artist who began suffering from paranoid delusions at the age of twenty-five. Dadd said he received messages from the Egyptian god Osiris and stabbed his father to death in a park, believing him to be the devil in disguise. The hospital documentation mentions that Dadd remained in Bethlem until his death, forty-two years after he was first admitted to the incurable ward.
    The expansion of Bethlem Hospital to treat—or at least contain—patients whose struggle with mental illness would be chronic and severe was not one entirely characterized by altruism. The sheer number and concentration of (often visibly) ill patients at Bethlem became a major eighteenth-century London tourist attraction. Visitors bought tickets from the hospital to gawk at the spectacles of both frenzied psychosis and the brutal forms of physical restraint that Bethlem employed. The tour began on the Bethlem grounds beneath two reclining sculpted figures called
Melancholy
and
Raving Madness
and then processed past the patients, some caged or shackled or with iron bits protruding from their mouths. Using Bethlem’s name, the witnessing public soon coined a new word for the conditions they observed: “bedlam.”
    In retrospect, “bedlam” seems an apt description both for the scenes of madness in Bethlem’s early halls and for the torturous range of “therapeutic” treatments whose efficacy was tested on the captive patients. Every spring, under the orders of one particular physician, there was a prescribed bloodletting for every patient in the hospital. At other times, depending on the psychiatric treatment currently in vogue, patients were restrained in submersible cages and then held underwater in the hopes that the near-drowning experience would shock the ill mind into a new outlook on life; they were strapped to seats that spun for hours at great speed, and treating practitioners marveled at how well the induced nausea would calm the most agitated patients into more placid behavior.
    Even in that earlier era, a patient’s finances could determine the treatment he received. Bethlem’s eighteenth-century hospital physician, Thomas Monro, was called before a House of Commons committee to discuss the use of Gothic fetters—iron restraints to which hospitalized patients were frequently riveted. Monro reassured the committee that the fetters were “fit only for the pauper lunatics,” explaining that “if a gentleman was put in irons, he would not like it.”
    Though the treatments I can offer to my patients today