Madness: A Brief History (2 page)

It is to the birth of medical science that Chapter 3 turns, examining the rational and naturalistic thinking about madness developed by Graeco-Roman philosophers and doctors and incorporated in the subsequent Western medical tradition. Lunacy and folly meanwhile became symbolically charged in art and literature: these cultural motifs and meanings of madness are explored in Chapter 4. Taking madness in society, Chapter 5 proceeds to examine the drive to institutionalize the insane which peaked in the midtwentieth century, when half a million people were psychiatrically detained in the USA and some 150,000 in the UK.

The ‘new science’ of the seventeenth century replaced Greek thinking with new models of body, brain, and disease: the early psychiatric theories and practices which derived from them form the core of Chapter 6. And the following chapter turns to psychiatry’s subjects: what did the insane themselves think and feel? How did they regard the treatment they received, so often against their will?

The twentieth century has been widely called the ‘psychiatric century’, and so a whole chapter (Chapter 8) is given over to its developments. Particular attention is given to one of its great innovations, the rise (and fall?) of psychoanalysis, and also to major innovations in treatments via surgery and drugs. Psychiatry’s standing as science and therapy at the dawn of the twenty-first century is then briefly assessed in the Conclusion: has its chequered history anything to tell us about the psychiatric enterprise at large?

As will be evident, much is omitted. There is nothing on non-Western ideas of insanity or psychiatry. I have not engaged with questions of social psychopathology (what makes people go mad in the first place?), nor have I tried to explore the representations of madness in high culture or the popular media. In such a short book, I have focused on a few core questions: who has been identified as mad? What has been thought to cause their condition? And, what action has been taken to cure or secure them?

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?

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In the Old Testament Nebuchadnezzar, king of Babylon, has a dream, which Daniel interprets as a harbinger of madness. When he later spoke with pride of how he had built his wonderful palace, God’s voice announces that ‘the Kingdom is departed from thee’, and Nebuchadnezzar is driven mad, as in the dream.

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.)

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A seventeenth-century epileptic being restrained by another man is brought before a priest to be blessed. Epilepsy was long associated with the supernatural and hence the Church was involved in its treatment.

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.