Madness and Melancholy

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MADNESS AND MELANCHOLY. When we think of madness and melancholy in the Middle Ages and early modern period, a number of prejudices often obscure our vision. It has been common, for example, to assume that in the age before the European Enlightenment, Christian faith so completely dominated that all mentally ill people were regarded as demonically possessed or that the mentally ill were frequently persecuted as witches. It has also been easy to conclude that the mad were basically neglected until they were confined in a massive roundup starting in the seventeenth century. Other scholars, looking for the origins of modern problems, have emphasized major gender differences, arguing that women were regarded as mentally more unstable than men or that women's cold nature was thought to preclude exalted states and genius. These and other images are either wrong or misleading, but quite common. They survive in part because we moderns often prefer to regard earlier periods as simpler and less sophisticated than ours.


A better approach to the history of mental troubles begins with the recognition that during the early modern centuries (as in our own time), men and women had complex ideas that did not always harmonize easily with each other or foreshadow our concerns. Professional men, for example, usually tried to bring together the medical theories of the ancient world with the teachings of the Bible and the Christian tradition. Ordinary villagers, too, often tried to combine traditional folk wisdom with whatever their priest or pastor might tell them. When these sets of ideas clashed, as they necessarily did, professionals and villagers alike often tried to specify where and when one should think of madness as a medical problem and when as a religious disorder. Or else, they might try to smooth over the discordant features of both pagan and Christian notions so that they might mesh more seamlessly.


The legacy of Galen, the greatest late-ancient physician (c. 129199 C.E.), survived in this way into early modern times. Revived first by Arab physicians (from the ninth to the twelfth centuries) and then in the West (from the twelfth to the fourteenth centuries), Galen became the core of the medieval medical curriculum. Renaissance physicians edited, published, and studied his numerous works along with the major Arab and Latin commentaries on him, making Galen even better known in the sixteenth century than he had been earlier. His medical theories were philosophical efforts to reconcile the competing claims of Plato, Aristotle, Hippocrates, and a host of lesser thinkers, but he was also an avid empirical investigator with a great interest in psychological and neurological disorders. For Galen, mental disturbances were sometimes due to accidents (such as a blow to the head), sometimes to brain fevers ("phrenitis"), and sometimes to hereditary flaws (which might produce retardation). In other instances, madness was the product of disturbances of the four basic bodily juices or humors: phlegm, bile, blood, and black bile (which was called melancholy, using the term in Greek). Renaissance physicians revived Galen's thought about melancholy ailments because they presented the opportunity for attractive theorizing about the place of temperament (natural or morbid) in the context of the four elements (water, fire, air, and earth), the four seasons, the four ages of human life, and four of the planets (the moon, Mars, Venus or Jupiter, and Saturn). Good health meant keeping one's humors in balance through diet and daily regimen (sleep, play, exercise, human company, sexual activity, and intellection). Too much heat or cold, too much smoke or moisture, too much study or worry, the wrong foods, too much drink, or the wrong music could all untune one's temperament and disorder one's juices, making one "unbalanced," overly fearful or sad, foolishly confident or belligerent, apathetic, raging, sanguine, phlegmatic, choleric, or melancholy, the last terms revealing even today their historic ties to the humoral system. Early modern philosophers also drew on a pseudo-Aristotelian work called Problems to conclude that the melancholy humor often prompted poetic or philosophical genius and religious prophecy. Writers as diverse as Desiderius Erasmus, Miguel de Cervantes, and William Shakespeare deployed melancholy disorders to evoke wisdom and folly. Albrecht Dürer used the image of melancholy as a figure for genius.

More commonly, however, bad habits and a bad diet were thought to produce an artificial black bile (melancholia adusta) that in turn caused deep depressions, optical and aural hallucinations, visions, sudden outbursts of wrath, weeping, and general madness. So melancholy meant much more than just sadness or depression; it was a physical condition that could include digestive disorders and flatulence, but it regularly led to illusions, delusions, the inability to test reality, and to insanity. The longer these conditions lasted, the harder they were to cure by means of changing the diet, the air, the regimen of sleep, sex, friendship, and music. One might need to add the therapy of vomits, sweats, and bleedingindeed, many Galenists advocated bleeding with each change of the seasons so that one's physical and psychic system would be reset for each season's conditions.


It is worth emphasizing that the strictly medical literature of medieval and early modern universities regularly excluded demonic and magical interpretations of madness. This exclusion of demons was part of what it meant to have a separate faculty of medicine, and straight through the Renaissance, physicians usually cultivated a "know-nothing" or even a skeptical approach to spirits. Medieval and early modern university life depended upon tacit (or sometimes explicit) rules of engagement so that medical thinking could be insulated against ideas and even words whose religious or folk origins might contaminate what was conceived of as a thoroughly natural pursuit. After all, physicians were those who studied and understood physis, or nature. Physicians were naturalists.

An example of this sort of thought is provided by André du Laurens (1560?1609), who wrote a much-cited work on "Melancholike Diseases" (1599). As the chief court physician to King Henry IV of France, he was eager to affirm his royal master's charismatic power to heal the scrofulous, using the traditional English and French practice of "touching for the king's evil," a power that might look magical or miraculous. In the hands of Du Laurens, however, melancholy was a great naturalizer. All sorts of strange, wondrous, or even miraculous conditions might be unmasked as the workings of black bile:

The melancholike man, properly so called (I meane him which hath the disease in the braine) is ordinarilie out of heart, alwaies fearefull and trembling, in such sort as that he is afraid of every thing, yea and maketh himselfe a terrour unto himselfe, as the beast which looketh himselfe in a glasse. . . . To conclude, hee is become a savadge creature, haunting the shadowed places, suspicious, solitarie, enemie to the Sunne, and one whom nothing can please, but onely discontentment, which forgeth unto it selfe a thousand false and vaine imaginations.

Drawing on the Arabs and the ancients, Du Laurens described several well-known melancholy delusions, such as the man who feared he had become a rooster or the man who feared that if he urinated, he might flood the world. Another famous melancholy madman thought himself made of glass, and yet others thought they had swallowed a serpent or a frog. Interestingly, the standard cure for such ailments often required the physician to play along with the fantasy rather than trying to argue with the patient. In this therapeutic drama, a sick fantastic might come to recognize the absurd contradictions in his or her mind.

In rare instances, Du Laurens claimed that the cold and dry humor (black bile) might grow hot, causing "a kinde of divine ravishment, commonly called Enthousiasma, which stirreth men up to plaie the Philosphers, Poets, and also to prophesie: in such manner, as that it may seeme to containe in it some divine parts." With a suggestion like this, Du Laurens showed how dangerous it was to mix medical and religious ideas, for if the humor of melancholy could explain the pretense of having direct access to God, more radical interpreters might move on to argue that all revelation, all prophecy, was the product of a sick mind. During the seventeenth century, this line of argument became a polemical weapon to debunk "fanatics" and "enthusiasts"religious writers or leaders who based their essentially personal, mystical, or charismatic authority upon some supposed special access to God. During the eighteenth-century Enlightenment, this strategy was sometimes employed even against the supposed irrationalities of revealed religion.

Usually, medical thinkers avoided speculating about religious matters, but by 1600, a few medical writers were developing theories of magic, spirits, demons, or preternatural forces as a way of updating their understanding of illness, and especially of madness. Physicians began to write treatises on demonic pathologies; students now defended theses such as the 1650 Leipzig dissertation entitled "Diseases Arising in Spells and Witchcraft." Even when they accepted the role of demons and their power to cause all manner of illness, however, physicians strove to understand demons as part of nature, applying Aristotelian categories to their theories of what spirits could actually do. Most often in these discussions, the devil was thought to act through nature, disordering the humors, stirring up the natural passions, disturbing the sense of vision or of hearing so that while the illness or madness might originate in witchcraft or in demonic possession, these disorders remained natural in the important sense that they were caused immediately by the familiar disorders of humors and vital spirits that were entirely physical and natural.


Perhaps the only physician to coordinate demonic theories with a whole system of thought was Theophrastus of Hohenheim, better known as Paracelsus (14931541). He developed an astrological and religiously infused medical theory that paid close attention to the parallels and connections between sin and madness. He was such a medical heretic, however, that he lost his teaching position at the University of Basel and spent the rest of his life as an itinerant preacher and healer. In his view, demons were as real as humors, and one's physical and mental health mirrored one's spiritual condition. Orthodox university medicine could not easily integrate Paracelsus's strangely religious and experiential doctrines, but most sixteenth-century academic physicians were usually ready to admit that demons could indeed infest a person.


Michael MacDonald has explored these overlapping areas of theory and expertise by studying the life and work of a seventeenth-century Anglican priest and medical practitioner, Richard Napier. Napier deployed a full range of Neoplatonist therapiesjudicial astrology, alchemy, amulets, and even angelic consultationsto help him treat his far-flung clientele. Even among the orthodox, remedies for madness usually included purges, sweats, vomits, and bleeding as well as herbal concoctions, changes in diet, hot or cold baths, travel to different climates, music, alcohol in moderation, and sometimes prescribed doses of sex. University-trained physicians did not usually prescribe verbal therapies, talk sessions, amulets, magic, pilgrimages, or prayer.

On the other hand, when their methods failed, patients tried a host of nonmedical and unorthodox therapies. In the case of the last duke of Jülich-Cleves, Johann Wilhelm (15621609), for example, orthodox Galenic physicians first tried to heal him of his madness, but after several years of fruitless efforts, his councillors authorized a series of highly irregular cures: a regimen of astrology, magic, holy water, consecrated salt, Latin prayers, and exorcisms, herbs soaked in beer, and amulets sewn into his waistcoat and the soles of his shoes. Two women provided folk remedies and homemade potions, to no effect. An English "wonder doctor" managed to establish rapport with the prince, but the underlying melancholy remained, and so the university-trained doctors turned to concoctions of alkermes (ground insects), bezoar stone (a calculus from the stomachs of goats or other ruminants), and theriac (a mixture of seventy drugs used to combat poison). Finally, they concluded that their duke was either bewitched or possessed; therefore, priests began to deploy elaborate exorcisms, including some that Rome might well have condemned. For example, they engraved a devil on a lead plate and beat it with rods; they fitted out Johann Wilhelm's mattress with blessings and crosses and fumigated his chambers with incense. By late 1605, however, the exorcists were also giving up.

This example shows how difficult it can be to speak of early modern medical imperialism, the process in which overconfident physicians claim competence over disorders that are moral or legal. Around 1600, orthodox physicians agreed that they could hope to heal only natural illnesses and that if natural remedies weren't working, it might be worth trying spiritual cures. But when exorcisms failed, Catholic confessors and priests concluded that their failure was due not to the weakness of spiritual remedies in general but to the fact that the mad duke was really insane, and thus beyond their ministrations.


It is also difficult to generalize about the care provided for the poor. Most families, however impoverished, were expected to take care of afflicted or disabled family members, but increasingly from the sixteenth century onwards, they could send suffering or incompetent relatives to newly founded hospitals. There they might receive room and board or even certain modest kinds of therapy. Forty years ago, Michel Foucault argued that a "Great Confinement," beginning in the seventeenth century, incarcerated the mad along with other "unproductive" or "immoral" segments of society, but it has become clear that in many countries, hospitals, private asylums, and small urban work-houses remained the favored receptacle for those of troubled mind. A large-scale confinement of the insane really began in the nineteenth century under circumstances rather different from those sketched by Foucault. Rab Houston and Roy Porter have also shown that in Scotland and England religious motives and explanations remained important well into the eighteenth century, that "madness" was hardly a mere label attached to the undesirable, and that healing the mad remained the goal of physicians throughout the early modern period. The so-called Age of Reason did not produce a novel intolerance of "unreason," and did not treat the mad as brute animals. Foucault's work has stimulated a great deal of fresh research, but many of his conclusions have been sharply revised.


Despite the fact that early modern society enforced a wide range of gender distinctions and often placed women under the control of men, there is little evidence that madness was seriously "gendered." Most mental disturbances were suffered as commonly by men as by women; men were as likely to be incarcerated or mistreated as a result of their madness; and even hysteria (which because of its supposed origins in the womb pertained only to women) was balanced by other madnesses that were thought to afflict men more often. A close analysis of these comparisons reveals, however, that they rely too often upon a hopelessly inadequate statistical base. We rarely have good evidence of the numbers of persons of either gender diagnosed as mentally disordered; and so, at this time, many ingenious comparisons are little better than guesses.


Probably the best introduction to early modern attitudes toward madness is Robert Burton's The Anatomy of Melancholy (1621). This Oxford Anglican was a solitary, often depressed, academic, whose great book is a treasure of the English language but also a massive monument to the richness of melancholy as a diagnosis and as a metaphor for life. Despite his familiarity with the vast medical literature, Burton was also steeped in the Platonic tradition, in which melancholy could be the source of genius, prophecy, and poetry. Thus, Burton was careful to maintain a difficult balance between the biomedical Galenic model of madness as a physical illness and the mental or spiritual model of madness as sin but also the source of exalted mental states. From this balanced perspective, Burton was well equipped to criticize what he thought were the two scourges of his day: infatuated love and religious enthusiasm. His lengthy sections on love madness were perhaps a response to the growing value placed by some on love as the one true good required for happiness. Burton's critique of religious enthusiasm stemmed from his conservative sense that Scripture and church would not long survive if mystics, prophets, and other inspired spokesmen made good their claim to have direct links with the divine. Burton's critique of love and religious enthusiasm surely did not curb infatuated lovers or God-besotted fanatics, but his treatise robbed these figures of some of their self-proclaimed license, their claim to special authority and unique insight. As Michael Heyd has shown, this style of analysis became a common means during the Enlightenment of debunking the special claims to religious insight of Pietists, mystics, and even the advocates of traditional religion.

Madness has always been entwined with the social and philosophical problems of its age. As the most malleable early modern source of madness, melancholy, the black humor, found itself deployed to explain genius as well as folly and was used to justify a wide range of medical and social responses. Even though anatomists and physicians from the mid-seventeenth century onwards had increasing trouble locating black bile in the human body, melancholy remained a powerful concept down to the nineteenth century.

See also Anatomy and Physiology ; Cervantes, Miguel de ; Enthusiasm ; Erasmus, Desiderius ; Hospitals ; Medicine ; Paracelsus ; Passions ; Shakespeare, William .


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H. C. Erik Midelfort

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Madness and Melancholy

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