This Way Madness Lies

We used to call them lunatics and lock them up 24/7, and a clearly defined line separated the insane from those of sound mind, or so we thought. Now, though, the term “lunacy” has been replaced in law by “mental illness” with “care in the community” taking the place of asylums.

Just as sufferers are no longer segregated from society, the distinction between the sane and insane is rapidly dissolving. Increased awareness brings with it the realisation that most people will experience mental health problems during their lifetime while for some, dementia lurks on the horizon.

With such extreme changes afoot, now seems an appropriate time to chart the ways mental illness has been treated in the past and to learn something from it. In This Way Madness Lies, cultural historian Mike Jay traces changing attitudes towards mental illness through the history of Bethlem Royal Hospital – better known as Bedlam, a name associated with extreme forms of madness and the worst kinds of abuse. The book was published to accompany Bedlam: the asylum and beyond, an exhibition co-curated by the author for the Wellcome Collection.

“Things are changing fast, “says Jay, “yet we still have inherited ideas about mental illness as something that happens to others. And there’s the notion of linear progress constructed by doctors, the assumption that everything is getting better; but in each era there has been a mixture of care and concern, neglect and abuse. The patient experience is similar, so I wanted to stress the continuity.”

The patient experience is at the heart of Jay’s project and he highlights examples of art by patients which provide glimpses into their inner worlds. James Tilly Matthews, a Bedlam patient in the 18th century, for instance, produced a detailed drawing of the Air Loom, a huge machine that he believed controlled his mind.

“I first got involved in the subject 15 years ago when I wrote a book about Matthews”, Jay explains. “He insisted he was sane and accused the Home Office of wanting him locked up because he had been a double agent during the French Revolution.”

If the Air Loom suggests that Matthews was delusional, the plans he submitted to a competition to design an asylum were eminently sensible. He envisaged a sympathetic regime in which patients were involved in their own care, growing food in gardens surrounding a light, airy and pleasant building – the antithesis of the squalid conditions he had to endure himself.

Meanwhile near York, the Quakers opened a hospital run along similar lines to Matthews’s ideal institution. Patients and staff lived and worked together in a therapeutic community intended to benefit the whole person by fostering good relationships in a friendly and stable environment.

“Places like the York Retreat depended on friends and family – passionate volunteers. Staff and patients lived together, but it still needed resources”, explains Jay. “Health care needs to be properly funded; you can have good or cheap treatment; but not both. I want to encourage thought about where we are today, since the end of the asylums 50 years ago, and I hope my cultural take on mental health gets the level of interest up.”

Recently, cases of autism among children have risen dramatically, but so have claims that autism and even schizophrenia can be cured by diet. So instead of swallowing pills, sipping a kefir may soon become the norm. What does Jay think about these claims?

“There are many examples of cultures where the role of food and nutrition are intertwined with wellbeing and familial and cultural relationships,” he replies. “It’s a complex and interesting subject. I’d like to do research in Japan and China, for example.

“The millennial generation has very high levels of mental illness, which is a challenge we have to face. Pills offer a very atomised model; they avoid blame and the thought that it could be a social problem. We should welcome pills as far as they work, but we can’t continue with the assumption that they solve all problems. Nutrition therapy is a medicalised idea, but care and support are just as important as clinical intervention.”

Sarah Kent