Shining a light on mental illness and its treatment

The Wellcome is hosting a major exhibition on mental health, using the famous Bethlem Royal Hospital as its inspiration and starting point. Bedlam: the Asylum and Beyond examines how historic perceptions of madness, distress and mental illness, and the treatment of these, have shaped our contemporary notions of mental health.

I visited the exhibition with Dr Helen Fisher, Senior Lecturer and MQ Fellow at King's College London. It challenges from the moment you enter into the first room, where there is a large-scale installation, Asylum, by artist Eva Kot'átková. Restraint, protection, and the tension between these, loom large. Actors' heads and limbs poke up through a large central table to stare unblinkingly at miniature walls, or loll listlessly, amongst a gagged monkey, billowing white heavy cloth, a tiny bed with restraints, decoupage, string. For me there was something intangible in this room which provoked in me a sense of not being finished, or complete, and I found the room eerie, even anxiety provoking, but quite, quite brilliant. 

Moving through into the main body of the exhibition, more artists' works mingle with artefacts to shine a light on the two themes of mental illness and its treatment. Madness is defined by law not medicine in the Vagrancy Acts of 1714 and 1744, and the transition to a more therapeutic approach is documented through references to art, and to buildings used to house those deemed to need it. Dr Fisher pointed out to me an iconic image of Pinel freeing inmates from their chains at La Pitié-Salpêtrière, with the wry legend '….in reality the process of reform was more gradual'. I bet it was. There was however an early encouraging sign of what we now refer to as Patient and Public Involvement, in the shape of architectural plans drawn up by the patient James Tilly Matthews in 1810-1811, for a therapeutic building and community for the treatment of mental health.

Passing through the decades, Dr Fisher and I were struck by how little some things change. Consider the observation from a parliamentary investigation led by the Quaker philanthropist Edward Wakefield in the late 18th century against today's context of funding for mental health treatment: 'a hospital regime that was underfunded and understaffed'. Thankfully there has been huge improvement on his further conclusion, that things 'had sunk into cruelty and neglect'.

Into the 1900s, and the architecture of the exhibition changes to reflect the way architecture changed to reflect notions of treatment in the 20th century. Everything has cleaner lines, is sharper, is whiter, although if you look up above you will see angled metal spikes reminiscent of those on top of prison walls. Here were two of the most paradoxically beautiful of all the exhibits in my mind, Jane Fradgeley's Within and Cocoon. These are photographs of clothing worn by inmates: heavy, restraining, prison-like, but also somehow comforting and implying protection, with an overall ghostliness and sense of lives gone by.

In 1930 the Mental Treatment Act replaced asylums with 'mental hospitals', and Bethlem Royal Hospital itself moved to Monks Orchard, where it was housed not in a giant building, but in a villa system. This seems progressive, until we're shown an alternative model of the family care system in Geel in the 1930s, where families welcomed those with mental illness into their homes and provided care and sanctuary. We see how art begins to be used as therapy. However, we are also reminded of electric shock treatment, and the starkness of the wards. Those restraints which were so affecting in Kot'átková's installation might have a slightly different shape, or be made from different materials, but they are still there. The anti-psychiatry movement also makes an appearance too, reminding us that controversy has always surrounded ideas of mental health and its treatment.

The exhibition ends with two artworks. Erica Scourti's Empathy Deck contains a card tower, where each card depicts an empathetic message. The project is more than what you see though, and visitors are encouraged to follow @empathydeck on Twitter, and receive a daily personalised message. I signed up and receive my daily message. It hasn't changed my life, but it has made me smile occasionally. Finally there is Madlove: A Designer Asylum, a utopian design for a mental health hospital, created by a consortium of artists and designers, alongside hundreds of patients and service users. It evokes those early drawings by James Tilly Matthews, and reinforces the message that those best placed to design treatment environments might just be the people who use them. Madlove represents a truly creative partnership, and echoes the spirit of this exhibition, for which a group of organisations came together. It feels like a collaboration shaped the essence of Bedlam, and if at times the exhibition can be somewhat bitty, that's a small price to pay. The Maudsley Charity provided support, working in partnership with the curators at Wellcome (Mike Jay and Bárbara Rodríguez Muñoz); the Adamson Collection; and Bethlem Museum of the Mind (short-listed for Museum of the Year 2016 and reviewed previously in The Psychologist). This partnership has given rise to a programme of accompanying events over the next three months, all on the themes of mental health and its treatment.

- Bedlam: the Asylum and Beyond, is at the Wellcome Collection until 15 January 2017.

Reviewed by Dr Sally Marlow, Public Engagement Fellow, Institute of Psychiatry, Psychology and Neuroscience, King's College London.

Image: Eva Kot'átková, Asylum, 2013, mixed media, dimensions variable. Installation view at Kunsthalle Baden-Baden, 2014, courtesy Meyer Riegger, Berlin/Karlsruhe and Hunt Kastner, Prague © the artist