Stars of Bedlam

History, according to Thomas Carlyle, is the essence of innumerable biographies. The great achievement of the authors of The History of Bethlem is to have created a biography of place. The book does not merely gather together the known facts of the long history of Bethlem Hospital in London from its founding in 1247, but interprets them to create a characterisation of the institution as it moves into the last quarter of its first millennium. The result is a lucid appraisal of Bethlem's emblematic role in the development of British psychiatry.

We have such a set of cultural interpretations of Bethlem as a place of mistreatment, suffering and medical ignorance, that it might come as a surprise - or even as a disappointment - to discover that the hospital still flourishes today. The Foucauldian assertion that the mad are denied by treatment the freedom to express the truth (which Michel Foucault does not define) remains influential, and it seems that the still powerful anti-psychiatry movement does not want to acknowledge the open, accessible services provided today by the Bethlem and Maudsley Trust.

The History of Bethlem records in great detail the contributions of doctors, carers and patients to the progress of the understanding and treatment of psychiatric illness. The book performs the invaluable service of identifying Bedlam as a cultural myth, describing it and discarding it, setting in its place an objective historical discussion of the role of Bethlem Hospital in the history of psychiatric medicine. Our image of Bedlam, we are made to realise, is based primarily upon fictive sources, which have obscured the physical reality of the hospital.

In the early 17th century several plays, such as John Webster's The Duchess of Malfi, Thomas Middleton and William Rowley's The Changeling and Thomas Dekker and Middleton's The Honest Whore (to be staged at the Globe theatre this season) included scenes set in a madhouse. This dramatic evocation of Bethlem arose at the same time as the development of the metaphorical use of the word "Bedlam" to mean madness and, consequently, to signify the irrationality of the world.

To a degree, the story of Bethlem Hospital is a dismal catalogue of human failings and misery. There were, no doubt, widespread and major problems. The disciplinary records of the governors in the 17th and 18th centuries repeatedly refer to the drunkenness of staff, the abuse of patients, the embezzlement of hospital resources. Despite the steps taken by the governors to protect and care for patients, The History of Bethlem contextualises the shortages of food, fuel and medicines in a society that was not organised to maintain those unable to support themselves.

We are appalled by treatments that now seem barbaric. We are made uncomfortable by the idea that the insane were regarded as spectacular, and perhaps even entertaining. Jonathan Andrews et al go a long way towards rehabilitating the past, arguing that the motivation behind the visiting of the great and the good (Samuel Pepys and John Evelyn both record visits in their diaries) lay in pity rather than jollity. Public perception of Bethlem has been shaped over centuries by awareness of the story of individual inmates and, in some instances, by the artistic output of individuals while inmates. The History of Bethlem integrates their work into its discussion of conditions in the hospital and examines the powerful image of Bedlam in The Rake's Progress by William Hogarth, who became a governor of Bethlem in 1752, differentiating between its journalistic and imaginative influences.

However, the hospital's story is told largely through the narrative history of its inmates, especially the most famous, or notorious. This inevitably invites the reader metaphorically to regard the inmates as spectacular, which in turn must question our motives for reading about Bethlem, even as its 18th-century governors questioned the motives of its visitors. They drew a sharp distinction between those who came in compassionate understanding and those who came for "idle and mischievous purposes".

In short, The History of Bethlem brings the reader an understanding of the development through time, not only of the hospital, but of English society's understanding, awareness and treatment of mental illness. There are, of course, niggles. Chief among them is the editorial decision not to identify the authors of individual chapters, which irritates in a book otherwise so clearly designed to be helpful to students of the particular subjects included within its scope.

As the authors make clear, The History of Bethlem is not the last word: the place is still adding to the history of psychiatry. Let us hope that the new chapters attract such dedicated and scholarly biographers.

Charlotte McBride is a postgraduate research student, University of Wales, Cardiff.