The subject of charity inevitably provokes exhortation. Appropriately, then, I should like to begin this chapter by urging that the history of psychiatry has been coloured by a vituperative view which needs to be confronted more fully, if not abandoned altogether. This view, I would suggest, is largely the product of an overly retrospective and Whiggish historiography, which has failed to appreciate the pragmatics of psychiatric care in their proper context. The usual depiction of Bethlem Hospital, as an almshouse, or detention centre, rather than a centre of cure, belongs to this tradition, and although recently challenged, has remained particularly pervasive.2 While this account may be accurate in many respects, its tone is misplaced and misleading, tending to denigrate the authenticity of the relief such institutions offered, and forging a somewhat anachronistic distinction between material and medical relief. Early modern charity embraced both these provisions. Even the modern concept of the hospital is not exclusionist, but is defined both as an ‘institution providing medical and surgical treatment for persons ill or injured’, and as a ‘charitable institution’ (OED). In fact, the way in which Bethlem functioned, even in its limited capacity as a charity dispensing material relief, has been little understood. Moreover, however ineffective we may judge the array of medicaments at Bethlem, it is simply erroneous to assert that the hospital was not concerned with therapeutics, and the cure of its patients; or, in other words, was not a hospital at all. In this chapter
I have space to present only a selective outline of these issues, but one which I hope will posit some alternative ways of interpreting the type of care Bethlem dispensed.