Bedlam: London and Its Mad

As expected from an Oxbridge graduate, author Catharine Arnold’sBedlam: London and Its Mad is a well-written and very readable book. However, as will be discussed later, the agenda of the author in writing yet another book on the world’s infamous London psychiatric hospitals should be made evident to us at the outset. We learn from the jacket copy that Ms Arnold is a psychology graduate and from the introduction that she suffers from depression. That “this book is for all whose lives are touched by madness” is a laudable objective.

In the final page of the book, we discover that “over the years, [the author has] learned to embrace melancholy,” and “some of us prefer to endure ‘melancholy’ in its various manifestations and accept that this variety of madness is part of our identity.” A “Government Health Warning” should accompany this frank, therapeutic nihilism and negativity toward psychiatric treatment (particularly medications).

Is Bedlam accurate, historically reliable, and of academic and therapeutic value? I think not. The author relies almost entirely on select secondary historical sources. Thus, considerable reference is made to the suspect book by Richard Hunter and Ida Macalpine, Three Hundred Years of Psychiatry, whereas no reference is made to the excellent book 150 Years of British Psychiatry, edited by distinguished academic psychiatrists, German Berrios and Hugh Freeman.

The slavish and frequent references to 3 books by Macalpine and Hunter-mother and son psychiatrists and amateur historians-raise cause for concern. In the chapter on the illnesses of King George III, America’s last King, the author quotes from the 1969 Macalpine and Hunter book, George III and the Mad-Business, which dismisses earlier detailed analyses of the King’s illness by American psychiatrists and claims that the King suffered from acute porphyria.

In addition, there is no mention by Arnold of the criticisms by international experts of porphyria or the detailed analysis in 1993 by the medical historian Roy Porter of Macalpine and Hunter’s medico-political agenda in putting forward the porphyria claim. Recent reevaluation of the King’s records, contemporary diaries, and the publications of Hunter and Macalpine (including their personal correspondence) has revealed their highly selective reporting of the King’s symptoms.

Catharine Arnold is highly critical of the UK’s current “Care in the Community” approach to mental illness. In fact, adequate funding was not made available and society’s expectations of unlimited health care were not achievable-but the alternative of yet more and larger asylums was clearly unacceptable. The advances in medications for such patients available in the 1960s are not discussed and surely deserve at least a mention, again perhaps reflecting the author’s agenda?

It is, however, easy to be critical of Bedlam. The emphasis on individual patients, referred to as clients, enhances its interest to the lay readership. Bedlam is suitable for bedside or holiday reading, but it is not an authoritative account of the history of British psychiatry.