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A 45-year-old, right-handed man was electively admitted to a London hospital following an illness of at least 7 years' duration. On admission, he was described as exhibiting ‘unusual’ behaviour, but was not thought to be a risk to himself or others. He was prone to walking round ‘screaming’ and complained of auditory hallucinations. His admission was prompted by social concerns, as he was unable to manage his activities of daily living. The clinicians performed no tests, recorded no treatments in his case notes, and he died within 2 years of admission. It was 1912 and Abraham Raphael had general paralysis of the insane (GPI).
Abraham Raphael's case notes are recorded in the male casebook held in the Bethlem Royal Hospital archive. He had been admitted with ‘dementia of the general paralytic’ (GPI) and ‘ideas of a widely exaggerated nature’ to Bethlem (figure 1) while it was in St George's Fields, Lambeth, having been transferred in February 1910 from Camberwell House, a private asylum in Peckham. Although Bethlem's alter ego Bedlam is notorious, at the time of Raphael's admission the hospital was compared to the best London hotels, an image in sharp contrast to the common representations of Edwardian asylums as dark, forbidding Gothic institutions. Since the mid-19th century, Bethlem had gone through a period of reform: the wards had been improved and a convalescent home had been opened in Surrey. Now largely removed from the public eye after the scandals of the early 19th century, Bethlem in 1910 was a semi-private institution to which middle-class patients like Raphael, a headmaster at a Jewish orphanage, could be admitted for a modest charge to one of its 200 beds. Neither dangerous nor suicidal, like many patients Raphael found his way into an asylum because he had become too difficult to manage within …
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