Bedlam (12 page)

That night late I was back again in the Dead House carpentry shop at work on my mouth-key—to have it ready to show Pinel, so he could know that in England what we do for our patients is more than symbolical—when Bryan Crowther wandered through on his way to the basement dissecting room to start his day. He liked to have his post-mortem examinations out of the way earlier than the two or three hours before breakfast when he saw to
the living,
as he resignedly called them, as if the root of their afflictions was their reluctance to be dead. Once Crowther told me weepily of a brave eulogy for a lunatic spoke by the lunatic’s daughter, a girl only eight or nine, mentioning her beautiful long
grey
hair when he meant
blonde,
and that macabre little slip summed him up pretty well.

Sarah used to tell me I only despised Crowther so much because he was what I lived in fear of becoming, were I ever to let down my guard. This was why I never gave him the chance he needed to do enough around the place to maintain his self-respect. I would say there was something in what she said. In light of how things turned out, there’s not a day I don’t regret how hard I was on him. Yet, at the time, I didn’t know what to do about it, when I could hardly bring myself to look at him.

In appearance he resembled a slug that had staggered to its footpads after ten hours under a rock. Not so much fat as soft. Hair close-cropt, short almost as our inmates’, short enough to show the scar that wound from behind his left ear to the top of his head where I sewed him up the year before when he tumbled down a flight of stairs after he was kicked in the head drunk by a patient. He was in every sense a creature of the place. Sunlight excruciated his eyes. In them you saw the same swollen, muzzy look as entered any keeper’s after a few years of working and living in the galleries. It was the miserable, complacent gaze of a man the terms of whose employment allowed no life beyond the workplace except what could be guzzled from the beer tap. But Crowther lacked the stolid menace of a keeper, having more in common with the patients. His physiognomy betrayed the same twitching, beleaguered irresolution as theirs, his body the same absence of definition. He wasn’t mad though, Crowther, at least not yet, and not a fool either. And totally incompetent only when he swilled like a tinker, which was not every day.

Sober, our surgeon showed a pathetic eagerness to be part of things, and that night he took an immediate interest in my mouth-key, though when he first detoured from his usual path to the dissecting-room stairs to stand and watch as I pondered a better shape for the handle, he had no idea what he was looking at. But soon as I explained the purpose of the key, which is simply to open the patient’s mouth, he understood, assuring me how painful he found it to consider the number of teeth he’d seen smashed and mouths lacerated because patients refused to eat or take their medicine. On this point we were in perfect agreement. Too many of our patients, especially the female, and among them the more interesting, left us to be restored to their friends without a front
tooth in either jaw. I don’t suppose there had been a Bethlem keeper on the job more than four years who hadn’t lost a patient under his hand in the act of what is called
spouting,
or force-feeding by knocking out the teeth. When Mrs. Hodges, wife of the vestry clerk of St. Andrews, Holborn, had died that way two years before, I made a personal vow to him I’d discover a way to avoid this dreadful practice.

“What’s your procedure with the key, then?” Crowther was curious to know.

I explained to him how, if a patient insisted on keeping her teeth shut, we restricted her movements and blindfolded her, then squeezed her jaw, or used snuff to make her sneeze, or tickled her nose with a feather. Anything to get the teeth apart long enough to slip in the key. Then, the instrument consisting of an ovoid of flattened metal with a wood handle, all you did was depress the patient’s tongue, or with a turn of the wrist force her mouth open, for the insertion of food or physic as required.

It so happened (Crowther now told me) he’d himself for some time been considering what material might be sufficiently flexible to make a hollow tube that could be fed in through the nose and thereby a nourishing wine posset, say, passed direct down the throat of patients who refused to unclench. Leather, he’d been thinking, lubricated with olive oil. But to his credit he immediately appreciated the genius of my key and right away was making suggestions for improving the handle, on the model of a simple corkscrew, the principles being similar: firmness of grip and ease of rotation.

As we worked together on a drawing, the two of us looking at the paper and not at each other, we went on to talk, by way of the subject of forcing, about the general lot of the keepers, and he readily
agreed when I said they didn’t have an easy life, always needing to compel and coerce individuals who were not only disposed to recalcitrance but capable within seconds of overwhelming violence. Combine this with daily exposure to madness on all sides, no life outside these walls, a steady diet of beer, the creeping infirmities of age, low pay, and no pension, and it was no surprise an observant patient like Matthews was kept busy recording daily abuses. What we ask of warders of lunatics is more than is expected of the most brutalized foot soldier, galley slave, or workgang convict, and nobody would think of putting tormented unfortunates at the mercy of them. You don’t call in hardened killers to keep the peace.

But I went too far, frankly confessing I agreed with William Battie when he argued keepers ought to be properly trained, at least in order to acquaint them with certain elementary principles in the humane treatment of those in a condition of mental suffering. The instant these words were out of my mouth, I regretted them. Praising Battie with qualification to Monro’s face in order to let him think he’d caught a true glimpse of the limits of my position was one thing. Concurring with Battie in the presence of an uncertain quantity like Crowther was quite another, and very likely to mean my view would reach Monro by a route that made it appear subversion. First a book, now this.

Right away, as if eager to confirm my worst fears, Crowther replied, with a knowing look, “Battie got more than that right.”

And thinking,
There’s candour, and then there’s the naked intemperance of a Bryan Crowther,
I said, “What do you mean,” in a flat tone intended to warn against any real answer.

At first he made no reply, and I thought he’d taken the hint. Then he said, “There’s more to madness than was ever dreamt of in the Monro philosophy.”

“I daresay,” I muttered, and thought,
For God’s sake, man, shut it now.

But no, he pressed on. “What Reverend Willis did to cure the King of his insanity, whether you agree with his methods or not—The thing is, it looked to everybody like they worked.”

“Not to me,” I said flatly. “The King came round by himself and could relapse at any time. The nine-out-of-ten success rate Willis boasts of has made him the laughing-stock of the profession. Everybody knows the man is a mountebank.”

“But so does everybody imagine the King has been cured. I’m saying Battie’s optimism has not gone away. It’s in the air we breathe.”

“Somewhere out there somebody’s curing madness? Is that what you think?”

“I don’t know if they are or aren’t,” he replied. “I just know the time’s ripe for different approaches. People now have it in their minds that if the King can go mad, anybody can, at any time, and they’re asking themselves, How would I like to be treated if it happened to me?”

I knew what lay behind this. Though a decade older than me, and like Monro the son of his predecessor, Crowther was of the new breed of mad-doctor: a believer in mental illness as a disease of the mind. As our surgeon, he performed such incisions, extractions, and amputations as the bodies of our patients required. Also, like me, he was engaged in a study of the physical state of their brains at death. But the purpose of his research was explicitly to contradict mine: to establish that, except in cases of head injury, insanity need have nothing whatsoever to do with the physical brain.

“Have you a new treatment in particular to recommend?” I asked him now. “That we could try out here, perhaps?” Though I
hated the facetious tone I took with him, relax with such a one and you quickly found yourself in a quagmire of dubious sentiment, and I don’t think this was just my fear that at heart I was him. He had a mind, Crowther, but in his misguided humanity you constantly glimpsed symptoms of his laxity. I wouldn’t have been surprised if in moments of alcoholic stupor he didn’t also experience visions of universal brotherhood.

Of course he couldn’t, to me, come right out and say
Mental illness is nothing but a confusion of ideas,
so instead he said, “Well, to start with, perhaps treating a lunatic as a rational being would show better results than treating him as a brute.”

“Is that what you see us doing here? Because Monro would be surprised to hear it.”

“Are you surprised?”

“To hear this coming from you, yes I am. I don’t treat them like brutes—”

“I’m not saying you do. I’ve often heard you speak to Matthews, for one, when he’s calm, as a rational being.”

“Which don’t mean I don’t think he’s an inveterate lunatic until he stops being one for reasons I won’t understand. I treat none of them like brutes. I’m sure you don’t. Monro’s certainly kind enough with them, when he’s here—”

“Exactly. Mostly it’s the keepers with them.”

“So we’re back to the keepers. The red-nosed keepers, who must bear the brunt of the filth and violence of the insane. And what’s to be done there, I wonder?”

“Proper training, as we’ve been saying. As Battie said nearly half a century ago. Define their work hours. Pay them a living wage, with a pension. Let them reside outside the walls, if they want to. And no more of this practice of hiring former inmates.”

I sighed. “And the money?”

“The Government must come up with the money. What’s government for if not to help those in need?”

“The Government help those in need?” I cried. “My God, man! What country are you living in? The Government, don’t you know, would prefer the private interests took over. Private madhouses make money out of madness, the Government only loses it. The less money the Government pours into madness, the more quacks pop up to turn madness into money. What in this does the Government not approve? Not only are public funds not being spent but at the end of the day much more of it than was never spent is going into the economy of the Commonwealth, and what’s good for the economy of the Commonwealth is good for everybody. As everybody knows. It’s only a matter of time before we have some enterprising practitioner scrambling around on our ramparts, hollowing wild accusations up at us. Seeking to found a lunatic-Elysium on the rubble he intends to make of our good name. And when he does, the only losers will be medicine and the mad. And you stand there and tell me it’s time we behaved more like quacks.”

This time he didn’t venture a reply, for he could see he’d annoyed me. He made an excuse and shifted back to work.

But my anger didn’t slip away so easy. I was as angry at myself for risking candour with such a one as for the pitiless, crazy note I struck with him. But I was no less angry at him, a man incapable of the most elementary management of himself, that he should dare to tell me we treat our insane like brutes when he knows perfectly well I do all I can six days a week, just as he does when he’s sober and Monro when he’s here.

By now I was turning a longer piece of hickory on the lathe, for
a handle with a better grip, but I was working mentally blind. My every cell and faculty registered the infection of Crowther, who seemed to me then the living shambles of Bethlem as it was and always had been, a type of what was coming in the larger world, when confidence of progress plus ignorance of human nature would force Truth deep down where Matthews said it already was: into the basement of things, for each man his own basement, a solitary fantasy.

And then—I don’t know why, unless it was thinking of Matthews on the subject of Truth buried deep down and, who knows, a guilty sense our patients do live like brutes—my thoughts came round once more to our lunatic and his situation, and gazing at the mouth-key I now saw myself so servilely
making for Pinel,
I thought, But what
of
Pinel? What if he could get Matthews out? His interest in our lunatic could well have to do with why he was being held, which might mean a simple word in his ear could set off republican alarm bells. Perhaps if Matthews’ detention was owing merely to some former embarrassment or annoyance he’d caused the Ministry in its relations with France, then Pinel could speak to the French authorities. He’d have the access; it was a scruffy crowd in charge over there, and the fact he could propose a trip to England in war time bespoke influence. He could sway the authorities, who would second my reassurances, and Matthews’ release effected that way.

And then I thought,
My, how luxuriant have grown my ambitions since I graduated to words.
By talent and hard work a man throws off the shackles of his station, and the next thing you know he’s dreaming republican collusion. Perhaps instead of assuring Margaret Matthews she could count on me to do the best for her husband, I should have taken from one who loved him a lesson in
alarm. Because however reasonable a plan can seem in candlelight, there’s always the grey dawn as type and figure of old habits and old doubts returning and new doubts cropping up all the way to the moment of action—or paralysis.

Meanwhile, my thoughts continued to proliferate so feverish, conflicting, and unaccountable I feared next I’d be joining the ranks of the insane, so I quit the lathe and went to bed. There I lay saucer-eyed next to Sarah, whose every breath was an effort, and as I imagined a hundred versions of what I’d say to Pinel and what he’d say back to me, with my mind I caressed Sarah’s suffering lungs, from the apical to the posterior basal lobe, until the starlings under the eaves started up their dirty racket and it was time to rise dizzy and bilious and head out into another day in the place Matthews in his witting way called simply Old Corruption.