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From Bethlem to Bedlam

18th-century Bethlem – chains, belts, purges, bleeding and thousands of visitors gawping at the inmates. Nell Leyshon on the asylum that inspired her latest play

My new play, Bedlam, about to open at the Globe, is set in a fictionalised Bethlem, in the mid-18th century, a time when psychiatry had yet to be born, and London was still enthralled with gin.

Bethlem's name gave rise to the word bedlam, and comes from a shortened version of St Mary Bethlehem, the name of one of the oldest asylums in the western world. It has been the subject of many plays and texts, from Shakespeare through the restoration comedies, up to the crazes in the 17th and 18th centuries for popular songs. Although there were many private, unregulated madhouses, where terrible cruelties and injustices took place – where it was possible to get rid of an inconvenient wife, or an illegitimate child – it was Bethlem that came to represent the notion of the asylum, and indeed madness.

The hospital was feared for good reason. The treatment was barbaric – bleeding, purges to make patients vomit, cold baths – and until 1770 the public were allowed into the asylum to view (and provoke) the patients. The scale of these visits were breathtaking: every week more than 2,000 visitors were free to wander through the wards, and mix with the patients, whose nurses and keepers would parade them and get them to "perform".

In theory, the visits were to have two impacts: the public would learn a moral lesson and henceforth curb their own behavioural excesses, and they would learn the act of charitable giving. In reality they attracted all of society, from London's fashionable to London's lowlife, most of whom drank and made sport for the day.

I started my research by reading Roy Porter's works on the social history of asylums and mad doctors, as well as histories of gin, books on the staffing structure of Bethlem and a dictionary of vulgar language. There's a great comfort in immersion in another world before beginning to write, but its seductive quality eventually becomes a delaying tactic. So I closed my books and faced the fact that Bedlam, now Bethlem Royal Hospital in Kent, still exists. My first visit was to the archives, looking at the original records, including colourful accounts of staff meetings and admissions and discharges. The pages are peopled with untold stories and summaries of difficult lives, written in a few copperplate lines. I also visited the museum, which displays the old restraints: chains, early straitjackets, leather mouthpieces, belts with cuffs. It also has a world-class collection of psychiatric art containing some disturbing attempts to illuminate the reality of the mad inner world, with work by Richard Dadd and Louis Wain, as well as some moving paintings by women in the 20th century.

On my second visit I met the forensic psychiatrist, Dr Tim McInerny, and his patients. I went to River House, a medium-secure unit for patients who had committed crimes while mentally ill. The men talked with great lucidity and intelligence about the humiliation and loneliness of madness. They described the reality of what it is to suffer an illness so severe that it may cause you, in a state of psychosis, to murder the people you love the most. They explained that they remembered everything they had done while ill, and much of the hospital's work is an attempt to help them come to terms with the crimes they committed.

After talking for a while, we discussed the infamous open days. The patients told me they still felt observed, and that their madness meant they led public lives. The staff observed them, visiting experts observed them – Bethlem is now at the forefront of humanitarian treatment – and indeed, as one patient pointed out, I too was a voyeur. Another patient described how their behaviour was constantly monitored and if they wanted to be allowed out, they had to learn what was "acceptable". He described himself as a highly trained circus animal.

The patients offered to read the play, and they will be coming to the Globe to see it. They also met the director, Jessica Swale, and the actors who will represent the 18th-century patients. But there was one uncomfortable question I had yet to raise. Representations of Bethlem have always invoked not only pity but humour. I asked the patients if I was free to make the play funny. They all said yes, they would prefer it if I did. The wards were full of misery, but there was much humour, too, shared with the staff.

Madness has a particular attraction for a writer. Dialogue involves what is unsaid as much as what is said. The actor fills in body language, and the audience's role is to work out from the words spoken, what thought patterns lie behind. Drama becomes exciting when the words spoken and the words unsaid are at odds, and we become aware of deep undercurrents. When madness is portrayed, each line of dialogue can be rational and reasonable; it is the thought behind the lines which is not.

We no longer believe madness is a matter of possession by another spirit, and we know it is not a moral "choice" or an imbalance of the humours. We know some things, that a family propensity or an extreme experience can take us into new territories of depression or mania. We know that everyone is open to it. It is the great leveller, and reduces to meaningless all human endeavour and gain. Money and standing become irrelevant.

The word madness means everything: it can take your power away from you, can lead you to being locked up against your will. But it also means nothing. It is only a word used to describe a vast amount of human experience, from the heights of joy and creative thinking that mania can enable, to the depths of catatonic misery. The dark state of madness is still one place left to be fully discovered.

Bedlam by Nell Leyshon is at Shakespeare's Globe from tomorrow to 1 October 2010. Bethlem Hospital Archives and Museum, www.bethlemheritage.org.uk

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From Bethlem to Bedlam