Bethlehem Royal Hospital in London was the first institution for the mentally ill. Originally a priory for the Order of St. Mary of Bethlehem, it became a hospital in 1329 and began admitting ‘distracted’ patients in 1377. For much of its history, the conditions were grim and treatment meted out brutal. In the 17th century it became a popular diversion for the leisured classes who turned up in droves to watch the antics of the inmates. Reforms introduced from the late 18th century onwards improved conditions and treatment of patients but it endures in the popular imagination as the archetypal ‘madhouse’; a gothic dungeon of gibbering lunatics.