Culture, Madness and Medicalisation: A history of madness before psychiatry

In our third year Culture, ‘Madness’ and Medicalisation module, students receive a critical introduction to today’s dominant psychological/clinical practices such as psychoanalysis, bio-psychiatry, psychotherapy, counselling and clinical psychology and the importance of anthropology in illuminating how psychological/clinical practices are dramatically shaping contemporary subjectivities and wider socio/cultural life. This year, our featured essay from the module is by Calum Mathison – what follows is an abridged version of the piece.
Calum Mathison
Calum’s bio: I have recently completed my final year at Roehampton, and I am about to embark on a Master’s in Social Anthropology at Manchester University. My main interests lie, in one way or another, in the cultural differences between our so-called modern world and those concepts seen by those within to be at the edge of it. This has led me from topics such as magic and witchcraft, to mental health and madness. My focus going forward is to introduce and translate anthropological ideas to a wider audience both within and outside of an academic setting.

This essay began with the aim of answering the question of where the contemporary idea of ‘madness’ has come from, and what paths and routes it has taken to get here. Upon beginning to write, however, I quickly realised the depth of the subject and the huge span of time I would be summarising. And so, to prevent the essay from becoming more of a shallow whistle-stop tour, I decided to focus the idea to a more defined point in time. Thus, this history of madness will be focused entirely on ideas of madness before the rise of psychiatry in the 19th century.

Calling someone ‘mad’ in the classical era was usually not a medical act. To call someone ‘a fool’ or ‘mad’ was mostly casual, without implying any sort of illness or disease (Eghigian, 2010). One place where ideas of madness could often be seen in a more serious light, however, is in the stories and literature of this period. In ancient Greek stories, especially those in Homeric texts, characters are often little more than puppets without much agency of their own, pulled in various direction by the will of the gods.(Porter, 2006). Therefore the madness Homer’s characters suffer are punishments or judgements inflicted by the gods (Porter, 2006). Later works by playwrights like Euripides depart from this tradition, however. According to Porter, plays like Oedipus Rex show protagonists and other characters far more in control of their own destinies, and although they are still very much influenced by the machinations of the gods and are still controlled mostly by them, they are aware of it, with complex inner lives. They are often brought down, and, yes, driven mad by their inner conflict and particularly by their hubris (Porter, 2006). According to Porter, these plays often ended one of two ways. Either the transgressions of the characters catch up with them, and they die, or they survive their bout of madness, and their suffering leads to some great insight (Porter, 2006).

This, I think shows a view of madness which will return to throughout this essay. For one, it appears to have been a state that either in the case of it being inflicted or in the case of its being brought about by circumstance, it was a temporary affliction defined by an action or single event in which someone would be struck with madness. A good example of this can be found in the story of Hercules, where he is temporarily struck with madness by Hera (Blanshard, 2005). It can also be seen that in some cases it was believed that madness could lead to healing or to greater wisdom through suffering. Even the famous philosophers of the period can be seen in this category, with stories of Socrates taking advice and counsel from the voices of daemons: voices only he could hear (Nicholls, 2013). Of course, based on the ideas of the time, this was not madness, but was certainly framed as such by later authors.

However, these more spiritual and mystical ideas of madness do not fully escapsulate how madness was seen in this period. Medical writers also commented on madness, and in ways that would influence medical discussion for centuries to come. According to Eghigian (2010), ‘Hippocrates’s followers held that disease was the result of an imbalance within the body of fundamental fluids, referred to as humours… Hippocratic physicians largely rejected spiritual explanations and treatments, looking instead to environmental factors, diet and lifestyle’. This also applied to what Hippocrates considered diseases of the mind, as he argued for a natural cause apart from prevailing view that such illnesses were due to supernatural causes – like possession, divine influence or divine punishment (Porter, 2006). This debate around madness as caused by supernatural or external influences or by internal ‘natural’ influences would be one of the many debates that would come to surround the topic.

As for how the people of this time would describe ‘madness’, it was often associated with a certain wildness or beast -ike nature, with many stories having madmen going to live in the wild with animals (like Nebuchadnezzar in the Old Testament) or performing acts of cannibalism, bloodlust, or violence (Porter, 2006). However, according to Eghigian (2010), medical writers had more subdued ideas of madness, with three categories identified: 1) phrenitis or frenzy (associated with delirium), 2) melancholy (associated with fear, anxiety and sadness) and 3) mania (also a chronic disturbance, characterised by excitement, delusions and anxiety). Hysteria was a common category also, thought to chiefly effect women, and characterised by disassociation, paralyses, and loss of motor skills; it was, however, usually categorized as a form of mania (Eghigian, 2010).

Moving into the Medieval period, between the 5th and 15th centuries, ideas about madness largely followed themes that can be clearly seen in antiquity. The debate between madness as external and supernatural or as natural and internal continued, and although the supernatural argument and view were far more common, that did not mean that the more naturalistic and physically-focused view disappeared. Humour theory and its implications for mental health continued, changing in complexity and becoming seen as part of personality too, with imbalances of these humours causing personality changes that could be cured by the removal of the excess, often by bloodletting or similar shock treatments, or sometimes just by making lifestyle changes (Porter, 2006).

This is also the period in which some writers began to root these forms of madness in the brain, which Rufus of Ephesus identified as the source of melancholia (one of three categories of madness created in antiquity) (Eghigian, 2010). However, as previously stated, religion dominated ideas about what could be called madness, with what had previously been called madness by Greek and Roman definitions often being instead labelled possession, the explanations being mostly spiritual in nature. (Eghigian, 2010; Porter, 2006). Concepts of madness continued, however, but they were usually seen through this lens.

There were two main concepts of madness that dominated throughout this period of history, which can be widely defined as ‘good’ madness and ‘diabolic’ madness (Eghigian, 2010; Bynum, Porter and Shepherd, 2003). Diabolic madness involved the individual’s possession by, or influence from, demons, devils or other evil spirits (Porter, 2006). This usually presented itself as uncontrolled speech or actions and was often also a sign of some sort of Maleficarum or witchcraft either on the part of the person affected by the symptoms, or on the part of someone else who cursed them with these symptoms. Stories of madness were also commonly told and written, almost always represented as stories of demonic influence, judgements from God, or a result of the actions of witches (Porter, 2006). Divine madness was far rarer, only told about in stories of saints and martyrs (Porter, 2006).

Similar to the great change felt in a wide variety of areas, the Renaissance was also a period of great change in the way madness was seen. As classical texts began to bubble back up to the surface once again and become influential on many of the writers of the time, some of their ideas began to have a fresh impact on culture. Influenced by classical scholarship, writers like Erasmus begun to write differently about ‘divine’ or ‘good’ madness. In 1511, he argued that the ‘proper goal’ of any Christian was achieving divine madness – a certain detachment from the material world (Bynum, Porter and Shepherd, 2003). He argued that divine madness was seen often in the Bible, from the ecstatic visions Paul witnessed on the road to Damascus, to Jesus being accused of being mad and being restrained by his family (Bynum, Porter and Shepherd, 2003). In Anatomy of Madness, M.A Screech provides another example of this when he says, ‘Some of the fathers of the Church certainly believed that they meant when they bluntly said: God, having despaired of saving the world by his wisdom, decided to save it with an act of divine madness. God’s mad action was the crucifixion of his only son’ (Bynum, Porter and Shepherd, 2003). This, I think, also illustrates that this idea was in no way just limited to a few isolated individuals and is a rare case where a line of descent of a kind can be directly drawn between one idea and another. At least in the case of Erasmus, these concepts of madness were heavily inspired by Socratic ideas, which argued that madness (in this case, mania) was not a bad thing in all cases, that although sanity should be cherished: ‘The greatest of blessings come to men through charismatic manias sent by the gods’ (Bynum, Porter and Shepherd, 2003).

The more widespread idea of daemonic madness had also begun to change in this period. As scepticism about the witch panics and their brutality began to spread, doubt about Maleficarum, witchcraft and possession soon followed (Porter, 2006). Writers like Johannes Weyer argued that those convicted of witchcraft were too often just people who were ill, old, solitary or ignorant; in his view, the devil could influence people but because his power was limited by God he could only afflict people who were afflicted with melancholy or delusions (Weyer cited in Porter, 2006). These ideas began to reduce the importance of ideas of demonic witchcraft and possession as explanations for, or equivalent concepts to, madness (Porter, 2006).

Of course, it is very difficult to gauge how, or even if, these ideas were limited to just a certain number of theologians and academics. However, as with the classical period, it can be argued that a lot of interesting ideas about how people saw madness are evident in the literature of the time. One particularly influential trope in the contemporaneous literature was a character archetype that I would argue can even be seen in places today: the mad fool (Porter, 2006). The mad fool was a character who would seem to speak nonsense and act in ‘mad’ or ‘foolish’ ways, but through his actions would portray wisdom through veiled references and pointed satire. Examples of this range from Feste in Twelfth Night and The Fool in King Lear who ‘outwitted logic in nonsense ditties which gave voice to darker truths denied to sober speech’ (Porter, 2006).

This idea of wisdom associated with madness was not just limited to fictional characters. Their authors too were also often seen as mad. In this period, the concept of the author inspired by a particular kind of insightful madness became popular, and therefore to be considered mad was a great compliment.(Porter, 2006). Even Shakespeare was considered in such terms by his contemporaries, and made mention of the idea in his work, as in Twelfth Night when he wrote ‘The Lunatick, the lover and the poet of imagination, all compact’ (cited by Porter, 2006). This idea can be seen almost as a reflection of earlier views on madness as a kind of inspiration that had existed since antiquity, and similar ideas about a kind of wisdom and greater insight that came from madness, and meditating on it.

These ideas, however, would begin to fall out of favour around the 17th century, with the beginning of the time period sometimes known as the Age of Reason. This idea of ‘reason’ would, in fact, prove central to the way madness was understood in this period. During this period, a defining feature of ‘man’ would come to be understood as reason, with madness defined by its lack (Porter, 2006). Thus, those seen as mad became more and more dehumanized. And earlier ideas of the ‘mad author’ and the ‘wise fool’ began to fall very much out of favour as more medical ideas of madness began to rise (Porter, 2006).

Theories based on Cartesian dualism began to emerge at this time, and these strongly informed ideas about madness. According to this idea, the mind was a pure and perfectly rational thing that could not be in any way misled (Porter, 2006). Following this logic, madness could not be a part of the mind, as madness was the opposite of reason and therefore was anathema to the rational mind. By this line of reasoning, it had to be rooted in the body (Porter, 2006). It was in this period that the idea of a ‘nervous disorder’ emerged. The importance of the nervous system had been rising in scientific understanding over this period, and humour theory began to be displaced – fluids and gases of humours being replaced by nerves and the beginnings of neurology (Weyer cited in Porter, 2006).

Another shift that happened at the tail end of the 18thcentury was the idea of chronic madness – something that continues to be important today (Eghigian, 2010). Prior to this period, one common thread in accounts of madness was that it was a condition people were ‘struck’ with and was therefore a temporary state: from demonic possession in the medieval period, to the exstasis of the ancient Greeks.

In conclusion, there seems, to me at least, to have been a continual debate over madness, a questioning of whether it came from within or without. To Socrates, the voices he heard were daemons, who informed and gave counsel (Eghigian, 2010). But to those that followed a more Hippocratean model, there were no supernatural elements to these illnesses of the mind, which had a source rooted in the natural world. Later, the argument shifted, turning to the debate over whether ‘unreason’ was rooted within the mind itself, or in the body, causing failures of perception and experience rather than failures of cognition. Perhaps this debate can even be seen in the modern day, reflected now in the debate between whether issues of mental health come from within the psyche itself, or from outside, from social circumstance or changes in life stage.

 

References

Blanshard, A. (2005). Hercules. London: Granta.

Bynum, W., Porter, R. and Shepherd, M. (2003). The anatomy of madness. London: Routledge.

Eghigian, G. (2010). From madness to mental health. New Brunswick, N.J.: Rutgers University Press.

Nicholls, A. (2013). Goethe’s Concept of the Daemonic. Cambridge: Cambridge University Press.

Porter, R. (2006). Madness: A brief history. Oxford: Oxford university press.

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