Madness: A Brief History (4 page)

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

The witch-hunts resulted from a marriage of traditional popular belief in the supernatural with the learned demonology advanced by Protestant and CounterReformation theology, Renaissance magic, and renewed anti-heresy crusades. From the mid-seventeenth century the ruling orders were giving such teachings up: not only did they seem irrational and pre-scientific, but they had failed to provide guarantees for social order. Witches ceased to be prosecuted and began to be patronized— though it was a case of ‘new witches for old’, with the new scapegoats including beggars, criminals, and vagrants. John Locke wrote to insist upon
The Reasonableness of Christianity
(1694): even religion now had to be rational.

This pathologization of religious madness led Enlightenment free-thinkers to pathologize religiosity at large. In effect, this was also, much later, Freud’s position. God was an illusion, faith ‘wish-fulfilment’, and belief, though all too real, was a mental projection satisfying neurotic needs, to be explained in terms of the sublimation of suppressed sexuality or of the death wish. In reducing religion to psychopathology, Freud was echoing the more biting of the
philosophes
, like Voltaire and Diderot, who adjudged Christian beliefs the morbid secretion of sick brains.

These days, while the Churches continue to accept, in principle, the reality of visions, spirit possession, and exorcism, they are profoundly suspicious of credulity and deception. The Roman Catholic or Anglican who claims to be assailed by the Devil has become an embarrassment. His priest may try to persuade him that such doctrines are merely metaphorical; and, if he persists, he may be urged to see a psychotherapist.

As just shown, opposition to religious models of madness was largely expressed through the concepts and language of medicine. In time doctors replaced clergy in handling the insane. It is to medical theories of abnormal thought and behaviour that we now turn.

‘The
original
or
primary
cause of Madness is a mystery’

(William Pargeter, 1792)

Reasoning about madness

Early civilizations, as we have seen, saw madness as supernaturally inflicted. The Assyrians and Egyptians regarded many diseases as hurled from the heavens; healing was therefore entrusted to priest-doctors, and for diagnostic and therapeutic purposes they had recourse to auguries, sacrifice, and divination. Archaic Greek myths and epics similarly viewed madness as a visitation from the gods, while popular lore ascribed illnesses to spirits, and hoped to restore health through divine intercession at Aesculapian shrines.

The philosophers who emerged in the Greekspeaking city-states from the sixth century bc onwards, however, viewed the cosmos and the human condition naturalistically. Socrates notoriously slighted the gods and, with his pupil Plato, analysed the psyche’s constituents: reason, spirit, the passions, and the soul. In due course Aristotle, Plato’s pupil, defined man as a rational animal, within the system of Nature. Man, for Protagoras, was the measure of all things.

The Greek philosophies of the fifth and fourth centuries bc systematically reasoned about nature, society, and consciousness, in attempts to fathom the order of things. Thinkers cast the rational individual—or, more precisely, educated, eminent males like themselves—as the paradigm for ethical and political ideals. In thus championing reason, they did not deny the reality of the irrational. On the contrary, the great store they set by rational thought and action attests what dangers they saw in the passions and in the blind destructive force of fate: only the calm pursuit of reason could rescue humans from catastrophe.

Plato (c.428-c.348 bc) in particular condemned appetite as the arch-enemy of human freedom and dignity; and the Platonic polarization of the rational and the irrational, enshrining as it did the superiority of mind over matter, became definitive of Classical values in such later philosophies as Stoicism, expounded by Seneca, Cicero, and Marcus Aurelius.

Through self-knowledge—the Delphic oracle’s ‘know thyself—reason could analyse and explain human nature and thereby master enslaving appetites. Terrified by the titanic and primordial forces disrupting the mind, Platonism, Pythagoreanism, Stoicism, and similar schools of philosophy exposed the irrational as a danger and disgrace which reason or the soul must combat.

By exalting
mind
and valuing order and logic, Greek thinkers defined for future ages—even if they did not solve!—the problem of the irrational. In making man the measure of all things, they plucked madness from the heavens and humanized it. They also adduced various schemes for explaining disorders of the mind. So how did the Greeks account for that shipwreck of the soul—and hope to prevent or cure it?

Medicalizing madness

Complementing the theatrical and philosophical traditions already noted was medicine. Above all, in those texts known as the Hippocratic corpus, purportedly the teachings of Hippocrates of Cos, though in fact rather later, dating largely from the fourth century bc, Greek medicine developed a comprehensive holistic explanatory scheme for health and sickness within which madness was included. Hippocratic medicine aimed to aid Nature in creating and preserving a healthy mind in a healthy body.

Human life, in sickness and in health, was to be understood in naturalistic terms. As one of those Hippocratic texts tells us,

Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant. ... It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absentmindedness, and acts that are contrary to habit.

Medicine thus excluded the supernatural by definition.

Hippocratic medicine explained health and illness in terms of ‘humours’ (basic juices or fluids). The body was subject to rhythms of development and change, determined by the key humours constrained within the skin-envelope; health or illness resulted from their shifting balance. These crucial vitality-sustaining juices were blood, choler (or yellow bile), phlegm, and melancholy. They served distinct life-sustaining ends. Blood
was the source of vitality. Choler or bile was the gastric juice, indispensable for digestion. Phlegm, a broad category comprehending all colourless secretions, was a lubricant and coolant. Visible in substances like sweat and tears, it was most evident when in excess—at times of cold and fever, when it appeared through the mouth and nose. The fourth fluid, black bile, or melancholy, seems more problematic. A dark liquid almost never found pure, it was reckoned responsible for darkening other fluids, as when blood, skin, or stools turned blackish. It was also the cause of dark hair, eyes, or skin pigmentation. Among them, the four major fluids accounted for the visible and tangible phenomena of physical existence: temperature, colour, and texture. Blood made the flesh hot and wet, choler hot and dry, phlegm cold and wet, and black bile produced cold and dry sensations.

Parallels were drawn with what Aristotle’s philosophy called the ‘elements’ of the universe at large: air, fire, water, earth. Being warm, moist, and animated, blood was like air, while choler was like fire, being warm and dry; phlegm suggested water (cold and wet), and black bile (melancholy) resembled earth (cold and dry). Such analogies further pointed to and meshed with other facets of the natural world, central to Greek science, such as astrological influences and the cycles of 
the seasons. Being cold and wet, winter thus had affinities with phlegm; it was the time people caught chills. Each fluid also had its distinctive colour—blood being red, choler yellow, phlegm pale, and melancholy dark. These hues were responsible for body coloration, explaining why particular races were white, black, red, or yellow, and why certain individuals were paler, swarthier, or ruddier than others.

5
This bath-house containing six men and an onlooker is an allegory of the four humours and five senses; after Dürer,
c.
1496.

Humoral balance also explained the temperaments, or what would, in later centuries, be called personality and psychological dispositions. Thus someone generously endowed with blood would present a florid complexion and have a ‘sanguine’ temperament, being lively, energetic, and robust, though perhaps given to hot-bloodedness and a short temper. Someone cursed with surplus choler or bile might be choleric or acrimonious, marked by an acid tongue. Likewise with phlegm (pale phlegmatic in character) and black bile (a person with swarthy appearance and a saturnine disposition, giving off ‘black looks’). There was, in short, boundless explanatory potential in such rich holistic interlinkages of physiology, psychology, and bearing, not least because correspondences were suggested between inner constitutional states (‘temper’) and outer physical manifestations (‘complexion’). Analogy-based explanatory systems of this kind were not just plausible but indispensable so long as science had little direct access to what went on beneath the skin or in the head. The values of Periclean Athens regarded the human body as noble, even sacred, and hence ruled out dissection.

Holistic in its disposition, humoral thinking had ready explanations for the plunge from health into illness, both physical and psychological (though in a holistic system, these were never polarized). All was well when the vital fluids cooperated in their proper balance. Illness resulted when one of them gathered (became ‘plethoric’) or dwindled. If, perhaps through faulty diet, the body made too much blood, ‘sanguineous disorders’ followed—in modern idiom, we might say that blood pressure rose—and one got overheated and feverish. One might, by consequence, have a seizure or apoplectic fit, or grow maniacal. Deficiency of blood or poor blood quality, by contrast, meant loss of vitality, while blood loss due to wounds would lead to fainting or death. Specifically in terms of mental disorder, excesses both of blood and of yellow bile could lead to mania, whereas a surplus of black bile—being too cold and dry—resulted in lowness, melancholy, or depression.

Fortunately such imbalances were capable of prevention or correction, through sensible lifestyle, or by medical or surgical means. The person whose liver ‘concocted’ a surfeit of blood or whose blood was polluted with toxins—both could cause mania—should undergo blood-letting (also known as phlebotomy or venesection), which was to enjoy a long future as the prophylactic and therapeutic sheet-anchor in Europe’s lunatic asylums. A change of diet could help. Raving madmen would be put on a ‘diluting’ and ‘cooling’ diet, with salad greens, barley water, and milk, and a ban on wine and red meat. Enormously detailed recommendations were spelt out for the regulation of diet, exercise, and lifestyle.

Humoralism provided a comprehensive explanatory scheme, staking out bold archetypal parameters (hot/ cold, wet/dry, etc.) and embracing the natural and the human, the physical and the psychological, the healthy and the pathological. Plain and commonsensical to the layman, it was also capable of technical elaboration by the physician.

Within humoralism’s easy-to-visualize grid of opposites, it was simple to picture mental conditions as extensions of physical ones. In a scheme in which healthiness lay in equilibrium and sickness in extremes, mania implied—almost required—the presence of an equal but opposite pathological state: melancholy. The categories of mania and melancholy—representing hot and cold, wet and dry, ‘red’ and ‘black’ conditions respectively—became ingrained, intellectually, emotionally, and perhaps even aesthetically and subliminally, in the educated European mind, rather, perhaps, as key psychoanalytical concepts (repression, defence, projection, denial) did in the twentieth century.

The clinical gaze

Greek medicine did not develop this plausible and satisfying explanatory framework in the abstract: it was clinically grounded and full of practical applicability to the sick. Case histories from the Hippocratic writings onwards record mental abnormalities. In one, a woman is noted as being rambling in her speech and mouthing obscenities, exhibiting fears and depression and undergoing ‘grief’; another woman, suffering anguish, ‘without speaking a word ... would fumble, pluck, scratch, pick hairs, weep and then laugh, but ... not speak’. A case which reads like delusional melancholia, said to arise from black bile collecting in the liver and rising to the head, involved a condition which ‘usually attacks abroad, if a person is travelling a lonely road somewhere, and fear seizes him’.