A Visual Record of Four Centuries of Asylum Care

“The story of psychiatry has had its medical breakthroughs, but it is also defined by repeated pendulum swings and unresolved questions,” writes Mike Jay in This Way Madness Lies. The book was released last month by Thames & Hudson as a complement to the exhibition Bedlam: The Asylum and Beyond, co-curated by Jay with Bárbara Rodriguez Muñoz at the Wellcome Collection in London.

The book stands on its own as a visual narrative on four centuries of society’s approach to mental illness. Over 650 illustrations from the archives of Wellcome Collection and Bethlem Royal Hospital punctuate Jay’s accessible text. He emphasizes how, whether the 18th-century madhouse or the 20th-century institution, each era has been characterized by a cyclical nature of care, swinging from sanctuaries to prison-like confines. This Way Madness Lies concentrates on London’s Bethlem Royal Hospital, better known as Bedlam, as a locus for psychiatric trends.

“Psychiatry was accepted as a proper branch of medicine only after a long struggle, both with the rest of the medical establishment and with society at large,” Jay notes. “The profession that defined mental illness originally was not medicine but the law, in which for centuries questions of guilt and mitigation have turned on concepts such as compos mentis (of sound mind), mens rea (guilty mind), and diminished responsibility. The legal term coined for it — ‘insanity’— remains in common use today.” And how this “insanity” was defined has always been in flux. For instance, in the 18th century, French physician Philippe Pinel gave medical support to eradicating monasteries, as their religious devotions could be classified as hysteria.

As a counter to Bedlam, which begin as a 13th-century priory and morphed into a hospital whose name was shorthand for horror, Jay introduces Geel, Belgium. There, since the 13th century, mentally afflicted strangers have been cared for by the community. (Hyperallergic previously shared Hugo Minnen’s 1980s photographs from Geel, which are included in the Bedlam exhibition.) Currently, this kind of treatment is in wider vogue, such as retirement villages that host both patients and the elderly who may have worked in care and want to remain in a communal retirement.

The book also visualizes cruel conditions from mental institution history, like iron collars for restraint and blood-letting in the 18th century. Jay describes how these tactics warped from humane intentions, which often meant to address the problems of the past. Quaker philanthropist Edward Wakefield arrived at Bedlam in 1814, on a reform campaign partly informed by the confinement of his mother, and was shocked to find patients like James Norris who had been kept in a restrictive harness for a decade.

His work set off a new era that prioritized moral management over physical control. Yet there were limits to that success, and 20th-century medication attempted to curb the number of lifetimes that were being spent in hospitals, even while they relied on new tranquilizers, and insulin injections and barbiturates that restricted quality of life. “The younger generation of psychiatrists, who had begun their careers among the warehoused ranks of incurables in the old asylums, advocated these new therapies with a powerful sense of moral mission,” Jay writes.

Some took innovations to the extreme. In the mid-20th century, James Watts got so good at performing lobotomies that he could do it alone, with an ice pick banged under the eyelid, in just a few minutes. He crossed the United States visiting mental hospitals in his “lobotomobile,” charging $25 a pop.

The centuries of patients remain themselves mostly voiceless. This Way Madness Lies humanizes them by including “galleries” of their artwork at the end of each chapter. Whether the colorful cats of Louis William Wain, committed to Bedlam in 1924, or the elaborate pen and pencil representations of the mystical epiphanies of watchmaker Heinrich Hermann Mebes, who died at a German asylum in the 19th century, they’re transfixing reminders of the diverse people who found themselves in these fluctuating systems.

This Way Madness Lies by Mike Jay is out from Thames & Hudson.