ABSTRACT
Matters of names and realities, institutions and images, of course raise the eternal question Heraclitus posed - one that applies particularly acutely to the historian of institutions: the problem of continuity and change, the question of identity. One cannot step into the same river twice, observed that ancient Greek philosopher. Should we, in other words, be talking about Bethlem as if it had some fundamental essence or at least a continuing unfolding? In one sense the answer must be 'yes', since, like a single living human being, its activities have been unbroken. Whatever else has happened, since 1247 Bethlem has never been shut, pulled down, bolted and barred, abolished and refounded. In another sense, the answer must be 'no', since, unlike a growing human who is programmed in a certain way by the laws of genetics, biochemistry and physiology, the actual course of Bethlem's development was utterly unpredictable and the outcome of contingency. Its entire history is a saga of mighthave-beens: it might never have taken in lunatics in the first place; it might have been finally closed by the Henrician Reformation. Today, undergoing what Eric Byers has called a 'greater period of uncertainty than ever before', who can say what its future might be? Certainly not its historians.
