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‘Can we distinguish the “mad” ambitions for an asylum from the “sane” ones?’

Bedlamindex copy

The troubled history of the asylum tests the limits of architectural design

Bedlam: the Asylum and Beyond at the Wellcome Collection undertakes a momentous task, aiming not only to provide visitors with a comprehensive overview of the history of psychiatry through the story of Bethlem Royal Hospital, but also to question the perception of the asylum in contemporary society. In addition to being a well-intentioned venture to bring forward major issues surrounding mental health, this attempt to reclaim the asylum as ‘a place of refuge, sanctuary and care’ also opens up an interesting conversation for architecture. Assuming that mental health facilities for long-stay patients were once more deemed necessary on a larger scale, the need for purpose-built structures would soon pose difficult questions about designing for mental health and for architectural practice in general.

The idea that there may be something to learn from the asylum and the safety it represents calls for abandoning the idea of medical progress that tends to plague histories of mental health. After all, if the asylum is an obsolete method for engaging with these issues that has since been surpassed by others, there cannot be much to gain from studying it. Yet this is where the exhibition seems to struggle the most. Distancing from such an approach becomes increasingly difficult when aiming to inform the general public on the history of psychiatry. A relatively linear structure telling the story of Bedlam from its inception to contemporary times almost inevitably leads to a general progression from early asylums, to non-restraint, the villa system, medication, electroconvulsive therapy, to care within the community and beyond.

High royds hospital, menston, ilkley, yorkshire. credit wellcome library, londoncomp

High royds hospital, menston, ilkley, yorkshire. credit wellcome library, londoncomp

Source: Wellcome Library

High Royds Hospital, Menston, Yorkshire

Only in the final space of the exhibition that deals with society today, does the narrative so clear in the accompanying text become apparent. This is where pieces acknowledging the possibility of positive experiences of the asylum are located alongside references to the problematics surrounding the varied nature of mental health care policies today. These and other issues could perhaps have been iterated more clearly, but it is safe to say that they are implied. Is this simply too little too late? The message emphasising a variety of experiences would be far more powerful, if it were to be made visible in the entirety of the material that is represented. That said, it is commendable that the exhibition does take care to include the different voices that are part of Bedlam’s story and does not simply present it from the perspective of the medical professionals or external reformers. The patient’s voice is heard loud and clear through letters, portraits and various commissioned artworks.

‘If James Tilly Matthews’ experiences in Bedlam influenced his work, it is not immediately apparent in the design’

Having been ignored or often mediated via the interpretations of those who have been deemed responsible for their care, the patient’s perspective has consistently been difficult to access. Thus, having this particular interpretation of Bedlam focus on the contribution that patients could have in the design of their environments should undoubtedly provide an interesting perspective on asylum design. It can quite simply be argued that no one is better placed to understand the asylum experience and bring out its benefits and mistakes than those who have been housed in one. Looking at the plans James Tilly Matthews, a patient at Bedlam from 1797 to 1814, conceived for the new hospital (lead image), we can see a building with a central plan and a classical portico, much like the other asylums built by architects at the time. If Matthews’ experience influenced his work, it is not immediately apparent in the design. In the accompanying notes, his arguments for non-restraint and work therapy echo the alienist discourse that was beginning to take hold at the time.

Richard dadd, sir alexander morison, 1779 1866. alienist, courtesy of the scottish national portrait gallerycomp

Richard dadd, sir alexander morison, 1779 1866. alienist, courtesy of the scottish national portrait gallerycomp

Source: Scottish National Portrait Gallery

Sir Alexander Morison, 1779-1866, Alienist by Richard Dadd, a patient at Bethlem hospital

The ‘moral treatment’ that had begun at the York Retreat in 1796 was becoming increasingly well known and their policies of allowing patients to partake in the daily activities of the asylum – make themselves useful by growing vegetables and helping with the general chores – were part of the public disputes surrounding the care of the mentally ill at the time. Work was increasingly becoming an important aspect of the treatment received at asylums. In a Foucauldian interpretation, this can be seen as a way to reintegrate individuals whose behaviour differed from the norm back into bourgeois society. It presents a way of learning to function in a way that complements the general discourse.

This is where the idea of patients contributing to the design of their environments seems to reach an impasse. Is it possible that patients whose mental health has at one time suffered remain unaffected by the general societal preconceptions regarding what constitutes an environment conducive to good mental health? Can we distinguish between ‘mad’ ambitions for an asylum and ‘sane’ ones? Ignoring the architectural form of Matthews’ proposal, the ideals it represents become eerily familiar. It represents a refuge where people can rest, do moderate physical activity, work on daily tasks according to their abilities etc. A narrative that is reproduced ad infinitum on the websites of companies offering private mental health care today.‘Set back within landscaped gardens, the tranquil environment of the Priory Hospital North London offers calming and recovery-focused residential treatment […] alongside the use of a range of therapies, as well as an art room and communal lounges.’

Henry hering, richard dadd at his easel, 1857, courtesy of bethlem museum of the mind

Henry hering, richard dadd at his easel, 1857, courtesy of bethlem museum of the mind

Source: Bethlem Museum of the MInd

Richard Dadd at his easel in 1857, by Henry Hering

In theory, there is not much difference between Matthews’ proposal and the above description of a private facility run by the Priory Group, the largest independent provider of mental health care in the UK. The continuing emphasis on the picturesque placement of the building and the varied activities offered to patients almost seems to imply that at least in theory, the reformers had it right in the beginning of the 19th century.

‘It seems that not much has changed in what is needed to provide the calm necessary for a troubled mind’

This similarity becomes even more apparent when looking at another contemporary commission in the exhibition. Madlove – A Designer Asylum is a project led by artists the vacuum cleaner (James Leadbitter) and Hannah Hull that aims to use people’s experiences of mental health to create a positive space to experience mental distress. The result is once more a utopian space of tranquillity and freedom allowing the pursuit of those activities to which an individual is most drawn. Located within an idyllic landscape with treehouses to sleep in and spaces for gardening and baking, all socially acceptable activities intended to socialise and entertain, it seems that not much has changed in what is needed to provide the calm necessary for a troubled mind. Clearly, the social preconceptions of what constitutes an environment that is good for mental health remain mostly unaltered, nor are they heavily influenced by people’s experiences of mental health problems. If it lacks the innovative input it so often claims, does this give cause to question the importance of the experience-based design that Madlove represents? Perhaps, but more importantly this also indicates a broader problem within architecture and community engagement.

Javier tellez, caligari and the sleepwalker, 2008 (c) the artist and galerie peter kilchmann

Javier tellez, caligari and the sleepwalker, 2008 (c) the artist and galerie peter kilchmann

Source: the artist and Galerie Peter Kilchmann

Javier Tellez, Caligari and the Sleepwalker, 2008

While a commendable action, basing your design practice on ‘real’ experience ironically tends to provide it with a false sense of objectivity, which in turn disguises the ideological processes behind it. Basing architecture on experience with the excuse of providing people with ‘what they want’ means that the discourse within which these desires exist is rarely questioned. Thus, perhaps quite provocatively, Madlove leaves the viewer with a series of unanswered questions. Why do asylums need to be situated in picturesque landscapes? Are cities inherently bad for mental health? Is there a point at which this could change?

However, the real message that Madlove seems to convey is more implied in the intention of the project, rather than the actual design product. From the numerous workshops and interviews that the artists conducted, one thing rings clear. People who struggle with their mental health want to be in control of their environments, to determine their lives according to their specific requirements, much like everyone else. Thus, instead of speaking of designing for ‘madness’, perhaps it would be more appropriate to simply discuss designing for people.

Bedlam: The Asylum and Beyond

Where: The Wellcome Collection, London

When: until 15 January 2017