Bedlam has long been synonymous with chaos. But it was also a place: Bethlem Royal Hospital, London's great asylum. In fact, Bethlem still stands – although its current incarnation, in the leafy suburbs of Beckenham, shares little but a name with the asylum that was first founded in 1247 and which would eventually inspire the moniker by which it became better known.
But viewed as a whole, this institution – perhaps the oldest of its kind in the world – offers a unique window into the world of madness and mental illness. It is within this narrative that the Wellcome Collection has set its latest exhibition, "Bedlam: the asylum and beyond". Using historic and contemporary patient art, archival materials and objects, as well as new artist commissions, Bedlam explores how notions of madness have been shaped over the centuries and how treatments and attitudes towards mental illness have changed.
The exhibition also asks: what next? While the mental hospitals and psychiatric units of today might not be the inhumane "loony bins" – as they were known – that gave the asylum a bad name, they're far from perfect. A critical lack of resources means that many people with mental health problems don't get the treatment they need. And although the shackles have long been unscrewed from the walls, the public perception of mental hospitals has struggled to move beyond the image of Nurse Ratched in One Flew Over the Cuckoo's Nest.
"The notion of asylum – that it is a safe place – is something we've lost completely and need to take back," says James Leadbitter, an artist who uses the pseudonym "Vacuum Cleaner", and, alongside fellow artist Hannah Hull, is trying to reclaim the true ethos of the asylum. Their project Madlove, which was started in 2014, re-imagines the asylum by asking those with lived experience of mental illness – as well as those without – what their dream asylum would look like.
In his essay, The Lost Virtues of the Asylum, Oliver Sacks wrote how the 19th century asylums allowed, through the protection they offered, "the freedom to be as mad as one liked and, for some patients at least, to live through their psychoses and emerge from their depths as saner and stabler people".
And it is this vision of the asylum – as a safe place to go mad – that is at the core of the Madlove project. Although, it's also important not to view the Victorian asylums – often places of cruel, institutional abuse – through rose-tinted glasses. Crucial, too, is the idea of madness as a journey – that it's something to be lived through, and how that experience need not necessarily be a negative one.
"I don't see madness as an inherently bad thing," says James. "There are many different ways for the human brain to be, and we should be celebrating that diversity. However, it can be a very painful thing, so we need to support people in a whole host of ways: earlier interventions, providing better environments to be in and removing this idea that the only way you can be productive in society is if you work and have a job. For many people like me, that model just doesn't work. We're not consistent people. We need flexible approaches and flexible support."
So what did people who took part in the project want from their ideal asylum? "We had the full spectrum," says James. "From the really obvious things like access to nature, being able to swim in a pool, being with others in the same situation, to more left-field ideas, like the young guy who said he wanted a room full of Faberge eggs and a hammer. I thought that was genius."
Although James and Hannah are clear that everyone should be involved in the development of Madlove, key to the project is asking those with mental illness how they would like to be treated.
"James and I both have mental health disabilities, and it's such a rare question to be asked, 'What do you think will help you?'" says Hannah. "You would have thought it would be the first question you would ask somebody."
For psychiatrist Alex Langford, in a cash-strapped NHS, the future lies outside hospitals. "Inpatient care is ever more pressured by NHS and social care cuts. It would be a huge challenge to make it into the picture of an asylum that we would like. We need to think of social care in the longer term. Those who have nowhere to go when they leave hospital just come back in the end, but if we made an asylum for them post-hospital, where they can spend months and years, I think that would be a much more worthwhile venture."
James and Hannah aren't the only ones thinking about what a new model of the asylum could look like. Mental Fight Club (MFC), a charity founded by people with experience of mental illness, runs the Dragon Cafe – the UK's first mental health cafe. Located in Borough in London and open every Monday, the Cafe offers arts-led activities to encourage conversation about mental health. "It's a space which allows all people be together in a supportive community," says Lamis Bayar, the chair of MFC.
"The MFC project from the very start was about proposing an alternative model to that of the contemporary asylum," Lamis continues. "Mental health is a lifelong experience… Health and social care is focused on a crisis dialectic where help comes only when it is arguably too late. That's what we're trying to respond to as a model and service."
In looking to the future of mental health care, what's clear is that the asylum needs to stretch beyond the idea of just being a physical place. "It's not a space, it's not a procedure, it's not a policy – it's the way we're existing together," says Lamis. "Currently, there is very strong binary between the mentally ill and the capable well, and that's something that needs to change."
James and Hannah have very real plans for the Madlove project – they hope that one day a dream asylum will be built. "That's very much a long term goal," says James. "It's going to take a fuck-ton of money and a lot of resources, but we will be working towards opening a temporary space that strives to transform both the institutional model of care and the way people view hospitals."
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