It was not until 1890 that the status of lunatics was changed, in Britain by Parliamentary legislation, from prisoners to patients.
Asylums were prisons disguised as hospitals, where the poor and incurable could be swept out of sight,
It was a far cry from the charitable intentions of Simon FitzMary, who founded Bethlem in Bishopsgate in 1370 as a priory offering asylum to London’s mad paupers.
During the Crusades, he had been led to safety by the star over Bethlehem: the motif appears on the hospital’s crest to this day.
Traditionally, the medieval Church equated health and madness with good and evil.
The mad were possessed by evil spirits, which could be driven out by beating, immersion in freezing water and periods in isolation.
Sir Thomas More was as much in favour of thrashing the insane to bring them to their senses as he was of flogging heretics.
Bedlam was racked by scandals. One inmate died after his intestines burst, having been chained in a confined space for years.
Others slept naked on straw in the cold, tormented by sadistic keepers.
There was money to be made out of the misery, hence the rise of the private madhouse.
As the materialistic Victorian era gathered pace, Bedlam pushed its pauper inmates into new county asylums, making room for a burgeoning market of shabby, genteel inmates, driven to insanity by the pressures of middle-class life.
Private madhouses were convenient dumping grounds for unwanted wives. Defoe noted that if they were not mad when they arrived, they certainly ended up so.
By ancient tradition, the possession of a womb predisposed a person to insanity. Virgins and menopausal women were particularly vulnerable.
One Victorian doctor advocated applying leeches to the labia, while another maintained that removing the clitoris saved a woman from insanity.
It was no wonder, then, that the medics were perplexed when 80,000 ostensibly fit and active men suffered mental breakdown during World War I. They were not women, so why the hysteria?
It was a further blow to conventional belief that most of the victims were officers, the elite drawn from the public schools.
Accused of malingering, they were subjected to a new, barbarous electric shock treatment, before a more enlightened approach emerged.