Now 750 years old, Bethlem Hospital has been continuously involved in the care of the mentally ill since at least 1400 - as such it has a strong claim to be the oldest foundation in Europe with an unbroken history of sheltering and treating the mentally disturbed. This text examines Bethlem’s role within the caring institutions of London and Britain and its place in the history of psychiatry. Bethlem is not simply Europe’s oldest psychiatric establishment; it is the most famous and the most notorious. It has assumed many guises over its 750 year history, it began as a religious foundation in the context of the Crusades. It became a hospital for the insane by accident, survived complex battles between Crown and Papacy, Parliament and the Corporation of the City of London, and gained great prominence for many years as Britain’s only lunatic asylum. The name of Bethlem has actually turned into everyday speech and become part of a national culture. From Shakespeare’s time, Bedlam was becoming detached from the institution and assuming a life and a persona.