Historically Speaking: The Long, Dark Shadow of the Real ‘Bedlam’

Today’s debate over compulsory treatment for the mentally ill has roots in a history of good intentions gone awry

The Wall Street Journal

January 12, 2023

This year, California and New York City will roll out plans to force the homeless mentally ill to receive hospital treatment. The initiatives face fierce legal challenges despite their backers’ good intentions and promised extra funds.

Opposition to compulsory hospitalization has its roots in the historic maltreatment of mental patients. For centuries, the biggest problem regarding the care of the mentally ill was the lack of it. Until the 18th century, Britain was typical in having only one public insane asylum, Bethlehem Royal Hospital. The conditions were so notorious, even by contemporary standards, that the hospital’s nickname, Bedlam, became synonymous with violent anarchy.

Plate 8 of WIlliam Hogarth’s ‘A Rake’s Progress,’ titled ‘In The Madhouse,’ was painted around 1735 and depicted the hospital known as ‘Bedlam.’
PHOTO: HERITAGE IMAGES VIA GETTY IMAGES

The cost of treatment at Bedlam, which consisted of pacifying the patients through pain and terror, was offset by viewing fees. Anyone could pay to stare or laugh at the inmates, and thousands did. But social attitudes toward mental illness were changing. By the end of the 18th century, psychiatric reformers such as Benjamin Rush in America and Philippe Pinel in France had demonstrated the efficacy of more humane treatment.

In a burst of optimism, New York Hospital created a ward for the “curable” insane in 1792. The Quaker-run “Asylum for the Relief of Persons Deprived of the Use of Their Reason” in Pennsylvania became the first dedicated mental hospital in the U.S. in 1813. By the 1830s there were at least a dozen private mental hospitals in America.

The public authorities, however, were still shutting the mentally ill in prisons, as the social reformer Dorothea Dix was appalled to discover in 1841. Dix’s energetic campaigning bore fruit in New Jersey, which soon built its first public asylum. Designed by Thomas Kirkbride to provide state-of-the-art care amid pleasant surroundings, Trenton State Hospital served as a model for more than 70 purpose-built asylums that sprang up across the nation after Congress approved government funding for them in 1860.

Unfortunately, the philanthropic impetus driving the public mental hospital movement created as many problems as it solved. Abuse became rampant. It was so easy to have a person committed that in the 1870s, President Grover Cleveland, while still an aspiring politician, successfully silenced the mother of his illegitimate son by having her spirited away to an asylum.

In 1887, the journalist Nellie Bly went undercover as a patient in the Women’s Lunatic Asylum on Blackwell’s Island (now Roosevelt Island), New York. She exposed both the brutal practices of that institution and the general lack of legal safeguards against unwarranted incarceration.

The social reformer Dorothea Dix advocated for public mental health care.

During the first half of the 20th century, the best-run public mental hospitals lived up to the ideals that had inspired them. But the worst seemed to confirm fears that patients on the receiving end of state benevolence lost all basic rights. At Trenton State Hospital between 1907 and 1930, the director Henry Cotton performed thousands of invasive surgeries in the mistaken belief that removing patients’ teeth or organs would cure their mental illnesses. He ended up killing almost a third of those he treated and leaving the rest damaged and disfigured. The public uproar was immense. And yet, just a decade later, some mental hospitals were performing lobotomies on patients with or without consent.

In 1975 the ACLU persuaded the Supreme Court that the mentally ill had the right to refuse hospitalization, making public mental-health care mostly voluntary. But while legal principles are black and white, mental illness comes in shades of gray: A half century later, up to a third of people living on the streets are estimated to be mentally ill. As victories go, the Supreme Court decision was also a tragedy.

Historically Speaking: Fashion Shows: From Royal to Retail

The catwalk has always been a place for dazzling audiences as well as selling clothes

The Wall Street Journal, Sept. 12, 2019

The 2007 Fendi Fall Collection show at the Great Wall of China. PHOTO: GETTY IMAGES

As devotees know, the fashion calendar is divided between the September fashion shows, which display the designers’ upcoming spring collections, and the February shows, which preview the fall. New York Fashion Week, which wraps up this weekend, is the world’s oldest; it started in 1943, when it was called “press week,” and always goes first, followed by London, Milan, and Paris.

Although fashion week is an American invention, the twice-yearly fashion show can be traced back to the court of Louis XIV of France in the 17th century. The king insisted on a seasonal dress code at court as a way to boost the French textile industry: velvet and satin in the winter, silks in the summer. The French were also responsible for the rise of the dress designer: Charles Frederick Worth opened the first fashion house in Paris in 1858. Worth designed unique dresses for individual clients, but he made his fortune with seasonal dress collections, which he licensed to the new department stores that were springing up in the world’s big cities.

Worth’s other innovation was the use of live models instead of mannequins. By the late 1800s this had evolved into the “fashion parade,” a precursor to today’s catwalk, which took place at invitation-only luncheons and tea parties. In 1903, the Ehrich brothers transported the fashion parade idea to their department store in New York. The big difference was that the dresses on show could be bought and worn the same day. The idea caught on, and all the major department stores began holding fashion shows.

The French couture houses studiously ignored the consumer-friendly approach pioneered by American retailers. After World War II, however, they had to tout for business like anyone else. The first Paris fashion week took place in 1947. But unlike New York’s, which catered to journalists and wholesale buyers only, the emphasis of the Paris fashion shows was still on haute couture.

The two different types of fashion show—the selling kind, organized by department stores for the public, and the preview kind, held by designers for fashion insiders—coexisted until the 1960s. Suddenly, haute couture was out and buying off the rack was in. The retail fashion show became obsolete as the design houses turned to ready-to-wear collections and accessories such as handbags and perfume.

Untethered from its couture roots, the designer fashion show morphed into performance art—the more shocking the better. The late designer Alexander McQueen provocatively titled his 1995 Fall show “Highland Rape” and sent out models in bloodied and torn clothes. The laurels for the most insanely extravagant runway show still belong to Karl Lagerfeld, who staged his 2007 Fendi Fall Collection on the Great Wall of China at a cost of $10 million.

But today there’s trouble on the catwalk. Poor attendance has led to New York’s September Fashion Week shrinking to a mere five days. Critics have started to argue that the idea of seasonal collections makes little sense in today’s global economy, while the convenience of e-commerce has made customers unwilling to wait a week for a dress, let alone six months. Designers are putting on expensive fashion shows only to have their work copied and sold to the public at knockdown prices a few weeks later. The Ehrich brothers may have been right after all: don’t just tell, sell.

Historically Speaking: Beloved Buildings That Rose from the Ashes

From ancient Rome to modern London, great structures like Notre Dame have fallen and been built again

The Wall Street Journal, May 2, 2019

A disaster like the Notre Dame cathedral fire is as much a tragedy of the heart as it is a loss to architecture. But fortunately, unlike most love affairs, a building can be resurrected. In fact, throughout history communities have gone to remarkable lengths to rebuild monuments of sacred or national importance.

There is no shortage of inspirational examples of beloved buildings that have risen from the ashes. The Second Temple was built in Jerusalem in 515 B.C. following the destruction of the First by King Nebuchadnezzar II of Babylonia in 586 B.C.; Dresden’s Baroque Frauenkirche was faithfully rebuilt in 2005, after being destroyed by bombs in 1945.

Often the new structures are exact replicas, as with Venice and Barcelona’s opera houses, La Fenice and Gran Teatre del Liceu, both of which were rebuilt after suffering devastating fires in the 1990s. If France decides to rebuild Notre Dame according to the principle “as it was, where it was,” the skill and technology aren’t lacking.

In other cases, however, disasters have allowed for beloved landmarks to be reimagined. The Great Fire of Rome in 64 A.D. led to a revolution in architectural styles and techniques. After Hagia Sophia cathedral was torched during riots in Constantinople in 532, the Byzantine Emperor Justinian asked his architects Anthemius and Isidore to build something bold and impressive. It was risky to change such a renowned symbol of the Eastern Roman Empire; moreover, for security and financial reasons, the work had to be completed in just six years. Still, the result dazzled Justinian, who exclaimed when he saw it, ‘‘Solomon, I have outdone thee.” Almost a thousand years later, following Constantinople’s fall to the Turks in 1453, Sultan Mehmet II had a similar reaction and ordered Hagia Sophia to be turned into a mosque rather than destroyed.

Sir Christopher Wren, who rebuilt St. Paul’s Cathedral in London, was not so lucky in the reactions to his creation. The Great Fire of 1666 had left the medieval church in ruins, but there was little appetite for an innovative reconstruction and no money in the Treasury to pay for it. Wren endured setbacks at every turn, including a chronic shortage of stone. At one point, Parliament suspended half his salary in protest at the slowness of the work, which took almost three decades and spanned the reigns of five monarchs.

The reason for the delay became clear after the finished building was revealed to the public. Inspired by drawings of Hagia Sophia, Wren had ignored the approved design for a traditional reconstruction and quietly opted for a more experimental approach. Ironically, many of his contemporaries were appalled by the now iconic great dome, especially the Protestant clergy, who deemed it too foreign and Catholic-looking. Yet Wren’s vision has endured. During the German bombing of London in World War II, St. Paul’s was the one building that Winston Churchill declared must be saved at all costs.

It is never easy deciding how to draw the line between history and modernity, particularly when dealing with the loss of an architectural masterpiece. There isn’t always a right answer, but it may help to remember Churchill’s words: “We shape our buildings and afterwards our buildings shape us.”