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This Way Madness Lies
This Way Madness Lies is a thought-provoking exploration of the history of madness and its treatment as seen through the lens of its proverbial home: Bethlem Royal Hospital, London, popularly known as Bedlam. The book charts the evolution of the asylum through four incarnations: the eighteenth-century madhouse, the nineteenth century asylum, the twentieth-century mental hospital, and the post-asylum modern day, when mental health has become the concern of the wider community. The book reveals the role that the history of madness and its treatment has played in creating the landscape of the asylum, in all its iterations.
Moving and sometimes provocative illustrations sourced from the Wellcome Collection's extensive archives and the Bethlem Royal Hospital's archive highlight the trajectory of each successive era of institution: founded in the optimistic spirit of humanitarian reform but eventually dismantled amid accusations of cruelty and neglect. Each chapter concludes with a selection of revealing and captivating artwork created by some of the inmates of the institutions of that era.
This Way Madness Lies highlights fundamental questions that remain relevant and unresolved: What lies at the root of mental illness? Should sufferers be segregated from society or integrated more fully? And in today’s post-asylum society, what does the future hold for a world beyond Bedlam?
Moving and sometimes provocative illustrations sourced from the Wellcome Collection's extensive archives and the Bethlem Royal Hospital's archive highlight the trajectory of each successive era of institution: founded in the optimistic spirit of humanitarian reform but eventually dismantled amid accusations of cruelty and neglect. Each chapter concludes with a selection of revealing and captivating artwork created by some of the inmates of the institutions of that era.
This Way Madness Lies highlights fundamental questions that remain relevant and unresolved: What lies at the root of mental illness? Should sufferers be segregated from society or integrated more fully? And in today’s post-asylum society, what does the future hold for a world beyond Bedlam?
256 pages, Hardcover
Published September 15, 2016
14 people are currently reading
724 people want to read
About the author
Mike Jay
17 books37 followersLibrarian note:
There is more than one author in the GoodReads database with this name
There is more than one author in the GoodReads database with this name
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Displaying 1 - 19 of 19 reviews
April 11, 2023
A really beautiful collection of images spanning mostly between 1700-the 2000s. This is one of the nicest, well-curated art books I've seen on psychiatry. The writing is solid, but basic. At a few points, especially for the 20th century, Jay puts forth a bit of history as if it's settled when it's really contested without mentioning that fact, and at least once, this veers into telling a story that has now been proven false or at least much different than originally told (the Rosenhan episode). But all in all, it's good and appropriately contextualizes the images.
September 6, 2023
This was an interesting book, and I enjoyed the pictures. However, it felt very brief and didn’t do much detailing into the history of Bedlam as I had hoped. Additionally, it bothered me that almost every page ended in an unfinished sentence, with the next page being photos. The text would then be continued several pages later. This caused me to have to reread passages several times due to the breakup of information.
August 25, 2022
This is the second time this year I’ve read a book that was the gift shop book for a museum exhibit about mental institutions. The first was “The Lives They Left Behind” which accompanied an exhibition of the suitcases left behind at the Willard Asylum for the Chronic Insane in New York. This was for the exhibit Bedlam: The Asylum and Beyond at the Wellcome center in London in 2016. In contrast to the Lives They Left Behind, the makers of this book were given a huge budget. The book is just gorgeous, there are so many photos and drawings, there are glossy inserts of patient art, there are floor plans, it would be worth buying for how the book looks as a coffee table book without even reading it.
The book (and I’m assuming the exhibit as well) traces the history of institutions for the mentally ill using the Bedlam hospital in London as its case study. It divides the institution’s history into three stages. Each section of the book uses a different font that matches the time period. It’s so thoughtful. The first stage is the Madhouse in the 1700s, which consists of locking the mentally ill away from the public in absolutely abhorrent conditions. The prevailing theory about mental illness at the time was an imbalance of the humors. This was the beginning of mental illness coming under the purview of medicine, when previously it had been under the jurisdiction of the church (demon possession, witches, etc). "Mad" really encompassed anyone who was undesirable or deviant in society, which included sex workers, epileptics, or even anyone deemed "lazy", and it amounted to a prison you could be thrown in without a trial or any recourse to get out.
The second stage is the Lunatic Asylum in the 19th century, which had slightly more of a focus on treatment rather than just locking people away. However, in reality, the conditions weren’t much better and patients were still restrained, abused, and forgotten. This century saw many changes in the way mental illness was thought of. It saw the birth of psychoanalysis. The medicalization increased. Up to 20% of male mental patients turned out to have late stage syphilis, and this could be cured by administering malaria (as long as the patient didn’t die of malaria lol). Doctors and psychiatrists hoped that more physical causes for mental distress could be found. This is also when there began to be a divide between the healthcare the wealthy could receive, which was like a retreat or hotel, and the conditions of the poor in state hospitals. After WW1 happened and many previously normal soldiers returned with “shell shock”, the cause of mental illness was reevaluated. Previously it was thought you were either insane or you weren’t, but after WW1 they figured out that madness existed on a spectrum and nearly anyone could lose it if they were traumatized enough.
The third stage is the mental hospital. Medicine advanced, bringing us lobotomies and ECT and pharmaceuticals. Lobotomies and heavy sedatives are just a high tech way of restraining patients like they did in the madhouses. The pharmaceutical industry exploded, and the divide between “insane people locked away in hospitals” and “sane people free in the regular world” blurred. Now you have housewives popping their valium etc. Truthfully, even though things were supposed to be modern and scientific, conditions still sucked. I’m currently reading “the Man Who Closed The Asylums” about the Basaglian revolution in mental healthcare, so it was interesting to see photos and more about this time. Even though medicalization increased and the biochemical theory of mental illness was gaining traction, during the 60s there was lots of radical thinking about society’s role in who and what is deemed deviant. Foucault, R.D. Laing, Thomas Szaz, etc. People began questioning whether mental illness even existed or if it was an understandable response to social conditions.
The last chapter is about the current state of affairs and the future. Most public state institutions have been closed, so in the United States our main healthcare system is the prison system (This book is focused on England which has the NHS, but it’s still true that prisons are a de facto mental healthcare system). Only those with wealthy families can afford residential treatment, and even then there are huge waiting lists for beds. If you aren’t in jail and aren’t wealthy you’re left to languish on the streets, which is reminiscent of the 17th century Tom o’ Bedlams (26). The book ends on a hopeful note citing the town of Geel, just as the suitcase book did, and the Gould farm in Massachusetts as models of mental health care we should use going forward.
The content is mostly a broad overview and by necessity doesn’t go into detail. For example, the Basaglia book I’m reading right now is 400 pages and this gets 2 pages in this book. So I am not really mad at it because what it does is show the ways in which the institution has remained the same even as it has evolved over the centuries, and it was really interesting to see this done through the lens of one particular hospital. The images are really helpful. There are many images of the institution and floor plans etc, so I wish that there had been a discussion of the spatial politics of Bedlam or even just asylums/madhouses/hospitals in general. The whole thing made me wonder what the next chapter will be like. The madhouses of the 1600s look barbarous to us but it’s a daily occurrence in 2022 to see someone having a mental crisis out on the street. And all we ever do about it is police sweeps that help absolutely no one and just make it so that the problem isn’t as visible (for like 5 minutes). We look at lobotomies or restraints as so backwards but how will our descendants view the fact that we leave people out on the street or lock them in jails? This is of course making a possibly erroneous assumption that society will progress forward, but as the book shows sometimes things just laterally evolve. Mental illness is on the rise and there’s just as much confusion as to whether it's biochemical or societal or both. Someday CBT and SSRIs will fall out of favor and seem ridiculous and we’ll have a new thing. Or maybe we will go back to the spirits and demon possession framework.
The book (and I’m assuming the exhibit as well) traces the history of institutions for the mentally ill using the Bedlam hospital in London as its case study. It divides the institution’s history into three stages. Each section of the book uses a different font that matches the time period. It’s so thoughtful. The first stage is the Madhouse in the 1700s, which consists of locking the mentally ill away from the public in absolutely abhorrent conditions. The prevailing theory about mental illness at the time was an imbalance of the humors. This was the beginning of mental illness coming under the purview of medicine, when previously it had been under the jurisdiction of the church (demon possession, witches, etc). "Mad" really encompassed anyone who was undesirable or deviant in society, which included sex workers, epileptics, or even anyone deemed "lazy", and it amounted to a prison you could be thrown in without a trial or any recourse to get out.
The second stage is the Lunatic Asylum in the 19th century, which had slightly more of a focus on treatment rather than just locking people away. However, in reality, the conditions weren’t much better and patients were still restrained, abused, and forgotten. This century saw many changes in the way mental illness was thought of. It saw the birth of psychoanalysis. The medicalization increased. Up to 20% of male mental patients turned out to have late stage syphilis, and this could be cured by administering malaria (as long as the patient didn’t die of malaria lol). Doctors and psychiatrists hoped that more physical causes for mental distress could be found. This is also when there began to be a divide between the healthcare the wealthy could receive, which was like a retreat or hotel, and the conditions of the poor in state hospitals. After WW1 happened and many previously normal soldiers returned with “shell shock”, the cause of mental illness was reevaluated. Previously it was thought you were either insane or you weren’t, but after WW1 they figured out that madness existed on a spectrum and nearly anyone could lose it if they were traumatized enough.
The third stage is the mental hospital. Medicine advanced, bringing us lobotomies and ECT and pharmaceuticals. Lobotomies and heavy sedatives are just a high tech way of restraining patients like they did in the madhouses. The pharmaceutical industry exploded, and the divide between “insane people locked away in hospitals” and “sane people free in the regular world” blurred. Now you have housewives popping their valium etc. Truthfully, even though things were supposed to be modern and scientific, conditions still sucked. I’m currently reading “the Man Who Closed The Asylums” about the Basaglian revolution in mental healthcare, so it was interesting to see photos and more about this time. Even though medicalization increased and the biochemical theory of mental illness was gaining traction, during the 60s there was lots of radical thinking about society’s role in who and what is deemed deviant. Foucault, R.D. Laing, Thomas Szaz, etc. People began questioning whether mental illness even existed or if it was an understandable response to social conditions.
The last chapter is about the current state of affairs and the future. Most public state institutions have been closed, so in the United States our main healthcare system is the prison system (This book is focused on England which has the NHS, but it’s still true that prisons are a de facto mental healthcare system). Only those with wealthy families can afford residential treatment, and even then there are huge waiting lists for beds. If you aren’t in jail and aren’t wealthy you’re left to languish on the streets, which is reminiscent of the 17th century Tom o’ Bedlams (26). The book ends on a hopeful note citing the town of Geel, just as the suitcase book did, and the Gould farm in Massachusetts as models of mental health care we should use going forward.
The content is mostly a broad overview and by necessity doesn’t go into detail. For example, the Basaglia book I’m reading right now is 400 pages and this gets 2 pages in this book. So I am not really mad at it because what it does is show the ways in which the institution has remained the same even as it has evolved over the centuries, and it was really interesting to see this done through the lens of one particular hospital. The images are really helpful. There are many images of the institution and floor plans etc, so I wish that there had been a discussion of the spatial politics of Bedlam or even just asylums/madhouses/hospitals in general. The whole thing made me wonder what the next chapter will be like. The madhouses of the 1600s look barbarous to us but it’s a daily occurrence in 2022 to see someone having a mental crisis out on the street. And all we ever do about it is police sweeps that help absolutely no one and just make it so that the problem isn’t as visible (for like 5 minutes). We look at lobotomies or restraints as so backwards but how will our descendants view the fact that we leave people out on the street or lock them in jails? This is of course making a possibly erroneous assumption that society will progress forward, but as the book shows sometimes things just laterally evolve. Mental illness is on the rise and there’s just as much confusion as to whether it's biochemical or societal or both. Someday CBT and SSRIs will fall out of favor and seem ridiculous and we’ll have a new thing. Or maybe we will go back to the spirits and demon possession framework.
March 23, 2018
Covering the history of the asylum. Difficult to read, not because of the subject matter but because the font was quite small. The book was full of pictures and graphics, some at a reasonable size but very many so small it was difficult to see the details. As there are many books covering this topic I recommend you find another one, or a magnifying glass.
August 21, 2019
This collection of art and artifacts was made to accompany a gallery of similar images and installations. The focus of the book and presentation is "Bedlam,"the sanatorium and asylum properly named Bethlem Royal Hospital, based in London. The book also contains a history and explanation of mental asylums and mentions the major changes in care for the patients that have occurred over the centuries. Portions of the collections in the book contain spreads that focus on artists associated with various hospitals and their work.
The content in the book is informative, compiled by an author and historian. Usually, I dislike reading books that are compilations of artworks, due to the focus on images over written information. The layout of this book, at least in the edition that I own, leaves something to be desired, with important statements being broken apart mid-sentence by a two-page spread of images.
I unfortunately do not have access to the gallery the book references, so I am unsure about how well the two connect. I read this book because of a book club assignment, and I feel that it is somewhat successful as a stand-alone anthology of artwork and historical anecdote.
The content in the book is informative, compiled by an author and historian. Usually, I dislike reading books that are compilations of artworks, due to the focus on images over written information. The layout of this book, at least in the edition that I own, leaves something to be desired, with important statements being broken apart mid-sentence by a two-page spread of images.
I unfortunately do not have access to the gallery the book references, so I am unsure about how well the two connect. I read this book because of a book club assignment, and I feel that it is somewhat successful as a stand-alone anthology of artwork and historical anecdote.
February 27, 2021
Amazing. Congrats on this feat. I've read a lot about the history of asylums, and I think following one place (Bedlam) over its history did the perfect job. In following one place, you can see the shifts within the madhouse over time, but also within the society outside its walls (that would influence that went on within its walls too). The way Jay interweaves what was going on in public perception of madness at the time - especially paying attention to literature, art, activism, etc - and what was going on in the madhouse itself was brilliant. Great book that answers many questions but also leaves spaces open to ask some more because, as we know, the story of mental illness is far from over.
May 23, 2017
This is a spectacular book, very well designed and loaded with illustrations. It's subtitled "The Asylum and Beyond," and is a history of the asylums and madhouses where people designated as being insane were sent often for long periods of time. It include pictures of these facilities and the "procedures" used in them. It also includes art work of the inmates or patients. Even if you're not interested in the topic I think you will find the book impressive as I did.
October 29, 2023
surveys the “evolution” of the madhouse/asylum/mental hospital and how society handles its “mentally ill” (forgive excessive use of scare quotes; there is so much fraught and socially constructed when exploring these issues), through the lens of a particular london institution, Bethlem. lots of good contextualizing writing for all the photos and art that comprised a 2016 exhibition.
March 6, 2017
Fascinating, thorough, and aesthetically gorgeous.
February 13, 2020
Unfortunately, this was a book that was designed to go along with an artistic exhibit and not a standard historical work. This made some of its analysis superficial but it had some interesting parts.
Read
October 30, 2021Bedlam/Bethlem. Mental health treatment. Geel Belgium. Art therapy. Wellcome Collection.
May 10, 2023
a must-read
October 14, 2024
Beautifully documented and explained, but deeply disturbing history
February 6, 2017
This is extremely well put together. The artwork and architecture designs will spark everyone's interest. I think if you were to strip back the pictures (because they are huge and really do make up over half of the book) and resized the font then you would be looking at maybe 50 pages of text? Perhaps not even that so it does leave holes and skips quickly which I found difficult because I had to stop and google it and then search through resources to really understand what was happening at the time. I am reading mad in America now and devoured half of it last night and it is answering every single question this book left me with.
It does what it does well, but to understand the topic you do need to complement it with something more thorough. I would say it makes an excellent coffee table book but the pictures are a little bit off putting so maybe should only be offered to macabre friends.
It does what it does well, but to understand the topic you do need to complement it with something more thorough. I would say it makes an excellent coffee table book but the pictures are a little bit off putting so maybe should only be offered to macabre friends.
February 7, 2017
A beautiful edition combining artworks and facts.
Because the book has the amazing illustration the text gets sometimes sidelined and leaves you wanting more. (Same time I will complain that some illustrations were printed so small that you cannot read the text in those works.) Few patient histories are too short mentions and I felt the earthy 20th century history could have had even more discussion.
Otherwise a great read, recommend to those interested in the early forms of intitutions and mental health care.
Because the book has the amazing illustration the text gets sometimes sidelined and leaves you wanting more. (Same time I will complain that some illustrations were printed so small that you cannot read the text in those works.) Few patient histories are too short mentions and I felt the earthy 20th century history could have had even more discussion.
Otherwise a great read, recommend to those interested in the early forms of intitutions and mental health care.
October 30, 2016
A gorgeously published book that gives a good overview of the history of ideas surrounding the mentally ill and how to care for them ("care" is a rather blurry term here), from the Middle Ages until today. The images in the book are plenty and well picked; depicting things like mentally ill persons, treatments, the asylums, and art made by patients.
This book also has a rich list of further reading for those who want to dip deeper into the subject.
This book also has a rich list of further reading for those who want to dip deeper into the subject.
August 20, 2017
Detailed history of mental illness, theories behind it and treatments in Europe and US. Pictures and works of art by patients showing the treatments and later medication uses and the de-institutionalization movement.
February 1, 2017
Fascinating reading and images, including 'galleries' of the art of the insane, in one of the most beautifully designed books I've encountered in ages.
April 3, 2017
a super fascinating look at the history of how institutions have evolved to care for the mentally ill, from madhouses to psychiatric hospitals. i skimmed through it mostly, for the photos and works of art created by some of these patients. would def pick it up again for a more thorough read.
Displaying 1 - 19 of 19 reviews