The facade of an imposing red brick building, the Bethem Royal Hostpital.

Bethem Royal Hospital, from which the term “bedlam” was originally derived.

As the central setting of Holmes and Watson and for its prominence in media and entertainment, the asylum is an important thing to consider. The treatment of mental illness in the Victorian era was very substandard and the “spooky” idea of mental health hospitals can be attributed to poor conditions in asylums, such as the Bethlem Royal Hospital, from which the word “bedlam” – meaning uproar and confusion – is derived.

Prior to the Victorian Era, mental illness was considered the family’s problem, but for-profit institutions become popular in the 17th and 18th centuries. During the Enlightenment, people began to care more for the mentally ill and thus more humane treatment began to appear as sufferers were seen as patients rather than monsters. However, rapid institutionalization of the nineteenth century – as evidenced by the increase of facilities in England from a few thousand to 100,000 – overwhelmed doctors and thus care returned to pre-Enlightenment conditions and many sufferers were often sent to workhouses instead.

In addition, psychiatry has the unusual honor of being more prone to abuse due to false diagnosis to remove problem citizens – such as dissident women and criminals – from society. For example, early asylums often physically restrained victims with straitjackets or shackles, they would sedate victims in a variety of ways, engage in bloodlettings, use certain “shocks” – water, for example, and later electroshock – among other methods such as certain psychosurgeries, which would damage the brain and often turn victims into vegetables whether or not they were actually mentally unwell. The treatment of patients was really quite terrible and people rarely got the care or attention they needed as many of their issues or symptoms were waved away as a ‘delusion’. Thus, the appearance of three Sherlock Holmes in an asylum would not have ended well in the historical reality.

(courtesy of Arizona Theatre Company’s Play Guide to Holmes and Watson)


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