'Those whom the gods destroy, they first make mad'. (Euripides)
In the Beginning
Madness may be as old as mankind. Archaeologists have unearthed skulls datable back to at least 5000 bc which have been trephined or trepanned—small round holes have been bored in them with flint tools. The subject was probably thought to be possessed by devils which the holes would allow to escape. Madness figures, usually as a fate or punishment, in early religious myths and in heroic fables. In Deuteronomy (6: 5) it is written, ‘The Lord will smite thee with madness’; the Old Testament tells of many possessed of devils, and relates how the Lord punished Nebuchadnezzar by reducing him to bestial madness. Homer has mad Ajax slaughtering sheep in the deranged belief that they were enemy soldiers, a scene presaging Cervantes’ Don Quixote tilting at windmills. Violence, grief, blood-lust, and cannibalism have commonly been associated with insanity. Herodotus described the crazy King Cambyses of Persia mocking religion—who but a madman would dishonour the gods? Wild disturbances of mood, speech, and behaviour were generally imputed to supernatural powers. Hinduism has a special demon, Grahi (‘she who seizes’), who is held responsible for epileptic convulsions, while in India a dog-demon is also accused of seizing the sufferer. (Canine traits and madness have often been linked, as in the widespread belief in werewolves— lycanthropy, or ‘wolf-madness’—in which the madman prowls about graves and bays at the moon, or, in the use of the term ‘the black dog’ for depression.) The Babylonians and Mesopotamians held that certain disorders were caused by spirit invasion, sorcery, demonic malice, the evil eye, or the breaking of taboos; possession was both judgement and punishment. An Assyrian text of around 650 bc puts what were evidently epileptic symptoms down to devils: If at the time of his possession, while he is sitting down, his left eye moves to the side, a lip puckers, saliva flows from his mouth, and his hand, leg and trunk on the left side jerk like a slaughtered sheep, it is migtu. If at the time of possession his mind is awake, the demon can be driven out; if at the time of his possession his mind is not so aware, the demon cannot be driven out. Early Greek attitudes can be gathered from myths and epics. These do not present faculties like reason and will in the manner familiar from later medicine and philosophy, neither do their heroes possess psyches comparable to that, say, of Sophocles’ Oedipus, still less to those found in Shakespeare or Freud. Homeric man was not the introspective self-conscious being who populates Socrates’ dialogues a few hundred years later—indeed, The Iliad has no word for ‘person’ or ‘oneself. Living and conduct, normal and abnormal alike, were rather seen as being at the mercy of Wild disturbances of mood, speech, and behaviour were generally imputed to supernatural powers. Hinduism has a special demon, Grahi (‘she who seizes’), who is held responsible for epileptic convulsions, while in India a dog-demon is also accused of seizing the sufferer. (Canine traits and madness have often been linked, as in the widespread belief in werewolves— lycanthropy, or ‘wolf-madness’—in which the madman prowls about graves and bays at the moon, or, in the use of the term ‘the black dog’ for depression.) The Babylonians and Mesopotamians held that certain disorders were caused by spirit invasion, sorcery, demonic malice, the evil eye, or the breaking of taboos; possession was both judgement and punishment. An Assyrian text of around 650 bc puts what were evidently epileptic symptoms down to devils: If at the time of his possession, while he is sitting down, his left eye moves to the side, a lip puckers, saliva flows from his mouth, and his hand, leg and trunk on the left side jerk like a slaughtered sheep, it is migtu.
If at the time of possession his mind is awake, the demon can be driven out; if at the time of his possession his mind is not so aware, the demon cannot be driven out.
Early Greek attitudes can be gathered from myths and epics. These do not present faculties like reason and will in the manner familiar from later medicine and philosophy, neither do their heroes possess psyches comparable to that, say, of Sophocles’ Oedipus, still less to those found in Shakespeare or Freud. Homeric man was not the introspective self-conscious being who populates Socrates’ dialogues a few hundred years later—indeed, The Iliad has no word for ‘person’ or ‘oneself. Living and conduct, normal and abnormal alike, were rather seen as being at the mercy of external, supernatural forces, and humans are portrayed as literally driven to distraction with wrath, anguish, or vengefulness. The Iliad’s protagonists are puppets, in the grip of terrible forces beyond their control—gods, demons, and the Furies—which punish, avenge, and destroy: and their fates are decided largely by decree from above, as is sometimes revealed through dreams, oracles, and divination. The inner life, with its agonizing dilemmas of conscience and choice, has not yet become decisive, and we hear far more about heroes’ deeds than their deliberations. A more modern mental landscape was emerging, however, by the time of Athens’s golden age. The thinking on the psyche developed in the fifth and fourth centuries bc set the mould for mainstream reasoning about minds and madness in the West, as was tacitly acknowledged by Freud when he named infantile psycho-sexual conflicts the ‘Oedipus Complex’, paying tribute to Sophocles’ play. Greek drama combines elements of both traditional and of newer casts of mind. The plays of Aeschylus, Sophocles, and Euripides dramatize terrible elemental conflicts—a hero or heroine tormented as a plaything of the gods or crushed under ineluctable destiny, the rival demands of love and honour, of duty and desire, of individual, kin, and state. Sometimes the inescapable result is madness: they go out of their minds, raging and rampaging utterly out of control, as when Medea slays her children. Unlike Homer’s heroes, however, the tragedians’ protagonists are the conscious subjects of reflection, responsibility, and guilt; they betray inner conflict as agonized minds divided against themselves, as is often echoed in the contradictory thinking-out-loud of the Chorus. The powers of destruction in the tragedies are no longer solely those of external fate, proud gods, and malevolent furies. Ruin is also self-inflicted—heroes are consumed with hubris, with ambition or pride, followed by shame, grief, and guilt; they tear themselves apart, and help to bring their own madness upon themselves (nemesis): psychic civil war becomes endemic to the human condition. Drama also suggested paths to resolution—or, as we might say, theatre served as ‘therapy’. Transgression might, of course, simply be punished in death. But, as with Oedipus, agony was shown as the path to a higher wisdom; blindness could lead to insight, and the public enactment of drama itself could provide a collective catharsis (purging). Shakespeare would show the same happening with King Lear, whose self-alienation led at last, via madness, to self-knowledge. The supernatural beliefs about possession typical of the archaic age were also confronted and challenged by Greek medicine. As already noted, the gods had traditionally been held responsible for epileptic fits, the victim of the ‘sacred disease’ being overcome by a demon or spirit which wrestled with his body and soul. The disorder was in turn countered by prayers, incantations, and sacrifices offered at temples dedicated to Asklepios, the god of healing. A treatise ‘On the Sacred Disease’ demurred. Its author, a follower of the so-called ‘father of Greek medicine’, Hippocrates (c.460—357 bc), could not find anything supernatural in the condition. Epilepsy was simply a disease of the brain:
the sacred disease appears to me to be no more divine nor more sacred than other diseases, but has a natural cause from which it originates like other afflictions. Men regard its nature and cause as divine from ignorance and wonder, because it is not like other diseases.
The Hippocratic author catalogued with sneering delight the different gods supposed to bring about the distinctive forms of seizure. If the sufferer behaved in a goat-like way, or ground his teeth, or if the right side were convulsed, Hera, the mother of the gods, was blamed. If the patient kicked and foamed at the mouth, Ares was responsible. And so forth. Call it sacred merely because of its bizarre symptoms, and you would have to do the same with no end of illnesses. With the example of epilepsy in mind, Hippocratic medicine naturalized madness, and so brought it down from the gods. The explanatory theories it developed will be explored in the following chapter.
Christian Madness
The Emperor Constantine recognized Christianity in the Roman Empire in ad 313, and the subsequent triumph of the Church and conversion of the barbarian invaders gave official sanction in the centuries to come for supernatural thinking about insanity. Unlike Greek philosophy, Christianity denied that reason was the essence of man: what counted were sin, divine will, and love, and a believer’s faith (credo quia absurdum: I believe because it is absurd). It preached, moreover, an apocalyptic narrative of sin and redemption in which the human race was vastly outnumbered by otherworldly spiritual beings—God and His angels and saints, the souls of the departed, Satan and all his squadrons—to say nothing of the ghosts, wood-demons, and hobgoblins omnipresent in peasant lore and semisanctioned by the Church’s supernaturalism. (Folk beliefs in traditional societies typically view some diseases as supernatural, and hence in need of magical remedies. Pulverized human skull was widely recommended, for instance, for the treatment of epilepsy.) In Christian divinity, the Holy Ghost and the Devil battled for possession of the individual soul. The marks of such ‘psychomachy’ might include despair, anguish, and other symptoms of disturbance of mind. The Church also entertained a madness which was holy, patterned upon the ‘madness of the Cross’ (the scandal of Christ crucified) and exhibited in the ecstatic revelations of saints and mystics. Holy innocents, prophets, ascetics, and visionaries too might be possessed by a ‘good madness’. But derangement was more commonly viewed as diabolic, schemed by Satan and spread by witches and heretics. In his Anatomy of Melancholy (1621), the Oxford don Robert Burton thus identified the Tempter as the true author of despair and suicide, if often working through such victims as the sick whose weaknesses made them particularly susceptible. His contemporary, the Anglican clergyman Richard Napier, who doubled as a doctor and specialized in healing those ‘unquiet of mind’, found that many who consulted him were suffering from religious despair, the dread of damnation aroused by Calvinist Puritanism, the seductions of Satan, or fear of bewitchment. Unclean spirits were to be treated by spiritual means: amongst Catholics, the performance of masses, exorcism, or pilgrimage to a shrine, like that at Gheel in the Netherlands, where Saint Dymphna exercised singular healing powers. The insane were also cared for in religious houses. Protestants like Napier preferred prayer, Bible-reading, and counsel. The witch craze which gathered momentum across Europe from the late fifteenth century, peaking around 1650, likewise viewed uncontrolled speech and behaviour as symptoms of satanic maleficium (malice) directed by witches who had compacted with the Devil. In the conflagration of heresy-accusations and burnings stoked by the Reformation and Counter-Reformation, false doctrine and delusion formed two sides of the same coin: the mad were judged to be possessed, and religious adversaries were deemed out of their mind.
‘I was seiz’d with great Fear and Trembling’
Believers themselves personally experienced madness and despair as indications of sin, diabolical possession, or a lost soul. A high proportion of the autobiographical writings of mad people (see for example Margery Kempe and John Perceval, discussed below in Chapter 7) have been religious. Born in Exeter in 1631 into a wealthy family of Anglican lawyers, George Trosse later looked back at his youth as a Sodom of sin—turning into a ‘very Atheist’, he had followed every ‘cursed, carnal principle’ which had fired his lusts. Pricked by a ‘roving Fancy, a Desire to get Riches, and to live luxuriously in the World’, as he recorded in his autobiography, Trosse travelled abroad to enjoy the ‘unregenerate World; the Lusts of the Flesh, the Lusts of the Eyes, and the Pride of Life’, being led into ‘great Sins and dangerous Snares’, and indulging in ‘the most abominable Uncleannesses’ short of ‘compleat Acts of Fornication’. Even grave illness did not lead him to think on death and damnation, or on the merciful Providence which had spared him. Eventually he returned home, a notorious sinner against all the Commandments, enslaved to a licentiousness which had hardened his heart. Crisis ensued. After one particularly gross drinking bout, he awoke hearing ‘some rushing kind of noise’ and seeing a ‘shadow’ at the foot of his bed. ‘I was seiz’d with great Fear and Trembling’, Trosse recalled. A voice demanded: ‘Who art thou?’ Convinced it must be God, he contritely replied, ‘I am a very great Sinner, Lord!’, and fell to his knees and prayed. The voice proceeded: ‘Yet more humble; yet more humble.’ He removed his stockings, to pray upon his bare knees. The voice continued. He pulled off his hose and doublet. Warned he still was not low enough, he found a hole in the floor and crept within, praying while covering himself in dirt. The voice then commanded him to cut off his hair, and at this point he anticipated it would next tell him to slit his throat. Spiritual illumination now dawned: the voice was not God’s but the Devil’s! Knowing he had ‘greatly offended’, he finally heard a call: ‘Thou Wretch! Thou has committed the Sin against the Holy Ghost.’ Falling into despair—the sin against the Holy Ghost which was reputed to be unpardonable—he wanted to curse God and die, and his head exploded with a babel of clamouring voices, making a ‘Torment of my Conscience’. Buffeted by further voices and visions, Trosse fell into a ‘distracted condition’. His friends, fortunately, knew of a physician of Glastonbury in Somerset who was ‘esteem’d very skilful and successful in such cases’. There they carried him by main force, strapped to a horse; he resisted with all his might, believing he was being dragged down into the ‘regions of hell’. Voices taunted: ‘What, must he go yet farther into hell? O fearful, O dreadful!’ The Devil, Trosse later recalled, had taken complete possession. He identified the Glastonbury madhouse with hell, seeing its fetters as satanic torments and his fellow patients as ‘executioners’. Eventually, however, though long seeking ‘revenge and rebellion’ against God, he grew more tranquil, largely thanks to the doctor’s wife, ‘a very religious woman’, who would pray with him, until his ‘blasphemies’ began to subside. Finally ‘I bewail’d my sins’, and he was thought to have recovered enough to return to Exeter. Alas! Like the proverbial dog to his vomit, he returned to his old ways. This time, however, the fight with the Tempter was in the open. He now applied to godly ministers for guidance in removing his ‘great load of guilt’. Carried once again to Glastonbury, he ‘rag’d against God’, believing that he had sinned once more against the Holy Ghost, but the doctor ‘reduc’d [me] again to a Composedness and Calmness of Mind’. Even then, his regeneration was not complete, for his faith was but ‘Pharisaical’. Backsliding, he was induced to return for a third time to Glastonbury. Finally, and this time permanently, ‘God was pleas’d, after all my repeated Provocations, to restore me to Peace and Serenity, and the regular Use of my Reason’. A man reborn, Trosse went off to study at Oxford. With divine assistance, he was called to the ministry, and he became a pious Non conformist preacher. The Trosse who then penned his autobiography—a conversion narrative comparable to Bunyan’s Grace Abounding—had a well-defined religious concept of madness. Reason was walking in harmony with God, derangement that state of mind when the soul, diabolically assailed, blasphemed against the Almighty. Madness was thus a desperate, acute phase in the trial and redemption of souls, because it brought a sinner into a state of crisis, and provided the prelude to recovery.
Against the grain
The bloody excesses of witch- and heresy-hunting— over 200,000 people, mainly women, were executed during the witch craze—eventually bred official and public scepticism about demoniacal possession. An early medical expression of this doubt is contained in the De Praestigiis Daemonum [On the Conjuring Tricks of Demons: 1563] of Johannes Weyer, a medical officer from Arnhem in the Netherlands. Weyer warned how readily illness in the old, the solitary, the ignorant, could be mistaken for witchcraft. The Fiend could indeed influence human behaviour, Weyer conceded, but since his power was ultimately limited by God, those he was capable of afflicting were melancholics and others prone to disturbances of the imagination. Witches fantasized the enormities which they confessed, and their imaginings were the products of hallucinatory drugs or dreams. Likewise, the crimes of which they were accused—inflicting sudden death, impotence, crop failure, and other misfortunes—were purely natural disasters. Supposed witches were to be pitied and treated, not feared and punished. Reginald Scot from Kent, author of the Discovery of Witchcraft (1584), trod in Weyer’s footsteps and similarly questioned the reality of witchcraft—it was chiefly to refute his scepticism that King James, an orthodox Scottish Presbyterian, wrote his Daemonologie (1597). From around that time Anglican leaders questioned supposed instances of demonic possession, fearing that such sensations played into the hands of Papists and Puritans: their manifestations were put down instead to fraud or the self-deluding fancies of zealots and the vulgar. For the same reasons the Anglican Church ceased to make use of exorcism. Physicians too expressed their doubts—not generally about the possibility of supernaturally induced madness as such but about its proof in the particular instance. With three other London doctors, Edward Jorden was summoned in 1603 to testify in the case of Elizabeth Jackson, arraigned on a charge of bewitching the 14-year-old Mary Glover. The latter had begun to suffer from ‘fittes ... so fearfull, that all that were about her, supposed that she would dye’; she had become speechless and temporarily blind, and her left side was anaesthetized and paralysed. Classic symptoms: but was it maleficium or sickness? Glover had first been treated by physicians from the Royal College, but when she failed to respond, they deemed, perhaps all too predictably, that there was something ‘beyond naturall’ in it. Jorden demurred, however, arguing for disease, and he defended his medical explanation in a book whose title staked his claims: A Briefe Discourse of a Disease Called the Suffocation of the Mother. Written uppon occasion which hath beene of late taken thereby, to suspect possession of an evill spirit, or some such like supernaturall power. Wherein is declared that divers strange actions and passions of the body of man, which in the common opinion are imputed to the Divill, have their true naturall causes, a,nd do accompany this disease (1603). Jorden named Glover’s condition the ‘suffocation of the mother’ (i.e., matrix or womb), or simply the ‘mother’: that is, ‘hysteria’. Such symptoms as digestive blockages and feelings of suffocation pointed to a uterine pathology.
Relying on Galen’s teachings, he argued that irregularities of the womb bred ‘vapours’ which wafted through the body, inducing physical disorders in the extremities, the abdomen, and even the brain, thereby producing the paroxysms, convulsive dancing, etc., so often misattributed to possession, yet properly explained by ‘the suffocation of the mother’. Jorden’s prime concern was to establish a natural explanation. Medical interventions like Jorden’s could exonerate a woman from being judged the Devil’s disciple, and her life might thus be spared. Its downside might then be to draw down on her the charge of being guilty of ‘imposture’—being a fake witch. In later centuries, ‘hysterical’ women were stigmatized much as ‘witches’ had been, though they escaped legal penalties: misogyny remained, only the diagnosis changed. In a revealing letter to his friend Wilhelm Fliess, Freud noted how he could understand the witch-hunters of bygone times.
Enlightened opinions
Opinions like Scot’s and Jorden’s were to find increasingly receptive ears among educated elites. The Thirty Years War (1618-48) on the Continent and the Civil Wars in Britain (1642-51) stirred strong reactions against religio-political extremism, condemned as ruinous to public order and personal safety alike. A barrage of invective was unleashed against Anabaptists, Ranters, Antinomians (those who believed that the Holy Spirit resided within them and that ‘to the pure all things are pure’), and other self-styled saints who assailed public order in church and state alike. Their anarchic teachings were denounced not just on grounds scriptural, theological, and demonological, but medical too: these puffed-up prophets were literally brain-sick, ‘inspired’ not with the Holy Spirit but with wind. Doctors and their allies pointed to the affinities between the religious fringe and outright lunatics: did not both display glossolalia (speaking in tongues), convulsions, weepings and wailings, and similar symptoms? ‘Enthusiasm’ was read as a sign of psychopathology. Some likened ‘zeal’ to epilepsy; a surfeit of black bile was blamed by humoralist doctors; while the new mechanical philosophy suggested that religious swoonings and spasms could be inflicted by inflamed fibres, vascular obstructions, or smoky vapours ascending into the head from obstructed guts and clouding the judgement. On such grounds Thomas Willis—seventeenth-century Anglican, royalist, and coiner of the term ‘neurologie’—thus excluded the Devil: so-called possession was all a matter of defects of the nerves and brain. Especially after 1650, elites thus washed their hands of witchcraft: it was not a Satanic plot but individual sickness or collective hysteria; eighteenth-century magistrates similarly deemed converts who shrieked and swooned at Methodist meetings fit for Bedlam—John Wesley himself, by contrast, upheld belief both in witchcraft and in demonic possession. In England, as late as the 1630s, a physician as distinguished as Sir Thomas Browne might give evidence in court backing the reality of witchcraft. In other parts of Europe, the demonological debates rumbled on longer. Around 1700, Friedrich Hoffmann, the great medical professor at Halle in Prussia, was at the thick of attempts to resolve that issue in the German-speaking lands. In Jena in 1693 a Dr Ernst Heinrich Wedel advanced the claim that ‘spectres are fictitious representations, against the law of nature’. Hoffmann for his part stated that the Devil acted upon witches through the animal spirits, and one of his students reaffirmed the Devil’s influence over both the mind and the body. In the Dutch Republic, France, and Britain, all prominent physicians by Hoffmann’s time explained religious melancholy wholly naturalistically. Referring to the visions of Quakers and other sectaries, Dr Nicholas Robinson, an avid Newtonian, claimed they were mere madness, and arose from the ‘stronger impulses of a warm brain’. Dr Richard Mead’s Medica Sacra (1749) provided rational explanations for possession and other diseases traditionally credited to the Devil: such beliefs were ‘vulgar errors ... the bugbears of children and women’. A generation later the Midlands practitioner and champion of enlightened thought Erasmus Darwin was aghast at the survival of popular belief in the workings of Satan. In his Zoonomia (1794) and elsewhere, he blamed the Wesleyans for preaching hellfire and damnation: ‘Many theatric preachers among the Methodists successfully inspire this terror, and live comfortably upon the folly of their hearers. In this kind of madness the poor patients frequently commit suicide.’ Himself an unbeliever, Darwin cited case histories of wretched sufferers whose ‘scruples’ had plunged them into religious madness, and thence to despair and death:
Mr —, a clergyman, formerly of this neighbourhood, began to bruise and wound himself for the sake of religious mortification ... As he had a wife and family of small children, I believed the case to be incurable; as otherwise the affection and employment in his family connections would have opposed the beginning of this insanity. He was taken to a madhouse without effect, and after he returned home, continued to beat and bruise himself, and by this kind of mortification, and by sometimes long fasting, he at length became emaciated and died ... what cruelties, murders, massacres, has not this insanity introduced into the world.
Thus religious madness—indeed all belief in the existence of supernatural intervention in human affairs— was turned into a matter of psychopathology.
Secularizing madness
By Roy Porter in the book 'Madness, A Brief History', Oxford University Press, New York, 2002, p.10-24. Edited and adapted to be posted by Leopoldo Costa.
See also:
MEDICINE IN ANCIENT GREECE
http://stravaganzastravaganza.blogspot.com/2012/02/medicine-in-ancient-greece.html
MIDWIVES AND MATERNITY CARE IN THE ROMAN WORLD
DISTURBANCES IN EATING BEHAVIOR
COME PREVENIRE CELLULITE CON L'ALIMENTAZIONE
TEN FOODS FOR A BETTER SEX LIFE
CHILD MALNUTRITION AND POVERTY
HIPPOCRATES - ILLNESS OF MAIDENS
A PARTEIRA NO BRASIL IMPERIAL
HISTORY OF HOMEOPATHY
SPANISH INFLUENZA PANDEMIC OF 1917-19
MEDICINE IN ANCIENT MESOPOTAMIA
MEDICINE IN ANCIENT EGYPT
MEDICINA NO BRASIL COLONIAL
HISTÓRIA DA ODONTOLOGIA NO BRASIL
USE OF PLANTS IN THE EUROPEAN PALAEOLITHIC
Actually Browne attended as a member of the public, not giving evidence but merely an opinion in 1664 but most of the Royal Society, the vanguard of the scientific revolution, believed in witches and unicorns.
ReplyDeleteMadness of the individual and of judicial laws are not really comparable.