Bethlem is one of the more substantial privately-run asylums I have investigated, providing a contrast with the large County pauper asylums. Like the York Retreat, Bethlem was a charitable institution. It had been founded as part of the work of a Priory in Bishopsgate, which took in and cared for the insane from the fourteenth century. In 1815 the Hospital found new, purpose-built accommodation in St George’s Fields in Southwark. While at the beginning of the nineteenth century, Bethlem was a similar size to other private asylums and the first of the new state-run asylums, the growth of pauper asylums meant Bethlem did not expand to the same extent during the nineteenth century, and it moved towards catering for the poor educated class, who were not counted as paupers, but could not afford private care.

Bethlem’s arrangements and size meant music did not develop along the same lines as in larger institutions. The institution lacked the funds to build a large recreation hall until the 1890s, and staff numbers were insufficient to support a band or large-scale entertainments. However, the Hospital boasted numerous supporters who provided amateur music making and theatricals, tickets to the theatre or funds for visiting performers. Bethlem’s situation in London also meant a wide variety of entertainment opportunities were available. Middle-class patients meant many were trained in music, and the women’s galleries hosted small parties on a regular basis. In the 1880s an influx of musically-talented Medical Officers, particularly successive Medical Superintendents R. Percy Smith and Theo B. Hyslop, brought with them friends and colleagues which made frequent concerts and musical gatherings possible.

A Report in the Hospital Magazine Under the Dome from 1898 gives a flavour of the kinds of entertainment on offer by the end of the century:

On December 2nd we all had a great treat at the Musical Evening. The Recreation Hall was turned into a huge drawing room, and looked in every way worthy of our great institution. Dr. Hyslop must be congratulated upon having obtained the services of a number of really good artistes, and all the professional performers kindly gave their services free. Miss M. Chatterton again gave us two charming solos upon the harp. The bell-ringing by Mr. Hopkins was also a great success. The songs by Miss A. Kinnison, Mr Hofler, Dr. Rice, and Mr. Lane were all well received.’


Talk at Bethlem Museum of the Mind

Unfortunately I had to cancel my talk at Bethlem Museum of the Mind on 25 March. This has now been rescheduled for 1 July. I hope that anyone who had hoped to attend the original talk will be able to make the new date.

Talk at the Bethlem Museum of the Mind

I’m currently preparing a talk which I will be giving at the Museum of the Mind in Beckenham, south London, on Saturday 25 March. Entitled ‘Music as Therapy in the Nineteenth-Century Asylum’, the talk will cover all aspects of my project, drawing on archives from across the country. Entry is free but places are limited: see for details.

Bethlem logo

Bedlam at the Wellcome Collection

Back in January I caught the last few days of the Wellcome Collection’s exhibition on the mental asylum, seen through various prisms including a contemporary art installation, historical documents, videos and sculpture and a modern re-imagining of asylum space. The exhibition highlighted a number of key points where music was considered in relation to madness. Robert Burton’s 1629 Anatomy of Melancholy, for example, recommended music along with drugs, bloodletting, prayer, exercise, diet, friendships and occupation as potential treatments for particular forms of mental illness. The following century, Benjamin Franklin’s glass armonica was invented with the intention of soothing distress, but was considered by many to be overstimulating and a possible cause of madness.

FRANKLIN: ARMONICA, 1761. – Musical instrument invented by Benjamin Franklin, 1761. Fine Art. Encyclopædia Britannica ImageQuest.

The final part of the exhibition focussed on a series of workshops and interviews in which the idea of a modern asylum had been investigated. The resulting artworks, models and displays considered the five senses alongside more practical elements of an ‘ideal’ asylum space in which mental health could be nurtured and healed. Rather than assimilating patients to the social norms of the nineteenth century, where participating in large-group activity was valued, here it was the individual needs that were being attended to. Yet I wondered how nineteenth-century practices might fit into the modern asylum being mooted. Would patients be invited to attend an asylum night club, where social anxieties and inhibitions could be faced (with or without the assistance of mood-altering substances)? Perhaps an upbeat asylum radio station offering performance and DJ-ing opportunities, or a resident samba band with visiting Strictly Come Dancing stars to accompany picnics and excursions? And what might modern health professionals think to being expected to join the band or the theatre group, or coach the football team? Music and dance are common practice in therapeutic treatment today, but transplanting nineteenth-century ideas into the modern conception of asylum certainly gives some food for thought.

Case books and the patient experience

It’s been a little tricky fitting in archive visits around part-time work and a toddler, so I’ve been delighted to find the Wellcome Collection have digitised some of the patient case books from Holloway Sanatorium, an asylum for middle-class men and women which opened in 1885. The asylum was housed in opulent buildings near Virginia Water in Surrey, and from the outset was equipped with the opportunities for recreation and entertainment that one might expect from its clientele. As most of the patients were unused to employment, recreational activities were all the more important in keeping them occupied and providing structure and discipline on a day-to-day basis. Concerts, choirs and bands were part of this, and the sanatorium employed ‘companions’ especially to help patients become engaged with a wide variety of activities.

Patient case books provide a rare opportunity for insight into the lives of individuals, their particular mental states and their responses to treatments and therapies. Each entry in the Holloway case books contains details of the patient’s background, age, marital state and occupation, together with a brief history of previous illnesses. There follows the two letters explaining the current complaint and reasons for certification. Finally, the asylum’s medical staff added a paragraph giving observations on arrival at the sanatorium. Following this, the pages were updated with relevant changes or, every couple of months, to note a lack of change. Case book A gives information on females certified between 1885 and 1887; reasons for illness include domestic trouble, inherited mental disorder and disappointment in love. One patient was convinced she was a steam engine. Women of all ages were represented, married women generally without occupation, but among the unmarried women were governesses and teachers.

The very first woman listed in the case book happened to be musical. Stella James was admitted in a state of Dementia, and took little part in activities. However, after a few months she began to sing and play the piano. Music was a sign of normality, engagement with others and mental functioning, but also became a subversive act for Stella: later on she is recorded as dancing and singing all night, her liveliness becoming ‘objectionable’. I find it interesting that music straddles the two sides in this way, reflecting both normality (for most women of this class would have learnt the piano) and disturbance. But this reflects in some ways the dual place of music throughout society. As an art form it could be refined, reflected in fashionable soirees or intellectual orchestral concerts; music was encouraged by philanthropists as a means of ‘rational recreation’ for the working classes. At the same time, music’s image suffered because of the link to the morally degrading activities of the music hall and tavern. Returning to health, music could both cause and cure madness. This dichotomy is one of the reasons music’s place in asylums is particularly interesting.

Link to Wellcome Collection digitised case books:


Music making at Worcester asylum is the only example widely known today, due to the involvement of Edward Elgar in the 1870s and 1880s. Elgar was appointed Band Master in 1878, succeeding his violin teacher. He rehearsed the band, led performances, and composed a small amount of dance music which survives.

As at other asylums, a band was formed in the 1860s, and the annual reports also attest to a choir in the chapel, both staffed largely by attendants. However, records for musical activity, with the exception of payments to band masters and the material associated with Elgar, are sparse.

View from Worcester Asylum site
View from Worcester Asylum site

The asylum site at Powick is beautifully situated, overlooking the Malvern Hills. Only the very central portion of the main building, and the house built for the medical superintendent, remain.

Main Asylum building, Worcester
Main Asylum building, Worcester
Superintendent’s House, Worcester

Worcester boasts two medical museums, and both of these contain exhibits dedicated to mental health and the work of the asylum. The George Marshall Medical Museum, contained within the Worcestershire Royal Hospital, includes medical instruments used within the Asylum, together with a death mask of one of the patients. See

The Infirmary Museum features a special corner devoted to the history of the asylum, including details on its use of music:

Singing and Health today

This week’s World Mental Health Day reminded me that singing is often linked with physical and mental health. We often see studies purporting to show the benefits of singing, particularly in a choir, and these opportunities are often part of life at hospitals and care homes. In 2012 Stephen Clift reviewed the literature on singing and health, concluding that there was little evidence for the positive effect on physical health, but that singing was clearly beneficial to overall health and wellbeing in many studies (see ‘Singing, Wellbeing, and Health’ in Macdonald et al. Music, Health, & Wellbeing (Oxford, 2012) pp. 113-121). A cross-national survey reported by Clift identified six key ‘mechanisms’ which resonate with some of the reports of patients and attendants  experiencing music in the asylum:

  • positive affect
  • focused concentration
  • controlled breathing
  • social support
  • cognitive stimulation
  • regular commitment