Mental Illness During the Middle Ages

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Mental Illness During the Middle Ages


Mental illness remains a mystery wrapped inside a puzzle. Although much research has been done, mental disorders remain elusive, and their treatment is still disputed. No single paradigm for explaining mental illness exists.

It is no wonder that throughout history people of different cultures have explained deviant or abnormal behavior as the work of demons, external spirit forces, and poisons. As a result, magical approaches to therapy and rituals evolved. With the development of the Christian church during the Middle Ages, exorcism, shrines, and saints became of great importance for the treatment of mental illness.

During the early years of the Middle Ages the community took care of the mentally ill. Later, hospices, then asylums developed to house them. London's Bethlem asylum—better known as Bedlam—was founded in 1247, making it one of the oldest institutions of its kind. The term "bedlam" became associated with chaos, confusion, and poor treatment, which reflected the general attitude toward mental illness at the time.


People with mental disorders have always been recognized as different and treated in various ways. The divergent responses have paved the way for lasting controversy that exists even today. Early medicine men, considering such individuals to be possessed by demons, introduced a technique called trephination. This procedure involved drilling a hole in the head of the individual to let evil spirits out of the body. Many other civilizations independently developed such a procedure. For example, among the remains of the Incas in Peru are skulls with holes and trephination devices.

Madness has been know and feared by society throughout history. Herodotus (484?-420? b.c.), the famous Greek historian, described the madness of King Cambyses of Persia who mocked the gods. Indeed, the idea of mental disorders as religious conflicts evolved early. In Greek mythology Ajax, in a deranged state, slaughtered sheep thinking they were enemy soldiers.

Hippocrates (460-377 b.c.) viewed the body as stable until illness perverted it. He developed the theory of the four humors: blood, yellow bile, black bile, and phlegm. These humors were connected to the four ages of man, the four elements, and the four temperaments. Hippocrates classified madness as either mania or melancholy. Mania was characterized by choler or yellow bile, and melancholy, or depression, by black bile. Hippocrates proposed that the treatment of mental disorders should involve restoring the balance of fluids or humors in the body. In addition to bleeding and purging, this could be done by rest, exercise, abstinence from alcohol, and sex.

Both the Greeks and Romans recognized that the mentally ill were capable of causing major social problems, as well as harm to themselves. They made provisions for guardians to take care of the insane. Realizing that these people would hurt themselves or others and could destroy life and property, laws were passed that set specific guidelines. Since there were no lunatic asylums, people with mental illness were a family responsibility. The seriously impaired were restrained at home, but others were permitted to wander in the hope that evil spirits might fly out of them.

In general, those considered crazed were feared and shunned. In the New Testament in is related how Jesus cured the Gadarene demoniac, who spent his years wandering among the tombs. The evil spirits were cast out into a herd of swine, the most despicable of animals for Jews.

Galen (130-200) later discussed hysteria marked by pain and breathing difficulties, which were caused by a wandering uterus in women. In fact, the Greek word for womb is "hyster." The term hysteria developed from the idea of the wandering womb. The cure was marriage.

Greek and Roman medicine served as the foundation of medical knowledge for the next thousand years. Practitioners of the Middle Ages would add their own unique twist to the subject of mental illness.


During the fifth century, Rome was overcome by waves of barbarian invaders from the north and the empire lapsed into decline. The Roman capital was moved to Constantinople, or Byzantium (now modern Istanbul in Turkey). Constantine, the Roman emperor for which the city was originally name, became a Christian in 313 and, by the early fifth century, Christianity became the official religion of the Eastern Roman empire. The Church then became the controlling force over medicine, with the spiritual taking precedence (at least where the Church was concerned) over the body. The Church blended folk superstitions and religious tradition, so that many old healing practices became incorporated into Christian beliefs. For example, Paul of Aegina (c. 625-c. 690), who studied and practiced medicine in Alexandria, recommended gentle treatment for mental illness, including music. He also alluded to satanic possession.

During the Middle Ages their were some many health problems that treatment and distinctions became overwhelming. Outbreaks of bubonic plague, smallpox, and leprosy would come in waves and decimate populations. However, mental illness was another major public concern. Madness, insanity, and lunacy were terms used to describe a variety of mental illness and mental handicaps. What caused these conditions and what to do about them was especially disputed.

Devotion to Galen's medical teachings led the people of the day to adopt four major categories of mental illness: frenzy, mania, melancholy, and fatuity. Each of these was purportedly caused by an imbalance in the humors. To restore balance was a goal of the physicians.

Folk beliefs and traditions, however, largely guided the perception of mental illness among the common people. The belief that the moon caused lunacy (the Latin word for moon is "luna") persisted well into the nineteenth century. The mentally ill person was thought to have slept where the moon beams hit his head, causing the erratic behavior.

The Church had a different interpretation of people with mental illness, viewing such disorders as evidence of sorcery or possession by a demon. Later, people who had degrees of insanity, especially women, were considered to be dabbling in witchcraft. However, some viewed the mentally ill as having a divine gift, perhaps like the gift of tongues. Many villages would take mentally handicapped people under their wings and treat them like children. Some of the troubadours or traveling musicians sang of tragic love madness.

Views concerning the treatment of mental illness were even more diverse. Bleeding was one of the primary treatments thought to balance the humors, but some physicians recommended drugs to sedate and calm the mentally unstable. A unique form of "shock" treatment was also tried—the mentally ill individual was hurled into the river to try to help him or her come to the senses.

Certain saints were thought to be more active in the domain of madness. In northern France the shines of Saint Mathurin at Larchant and Saint Acairus at Haspres were known for healing. In Flanders, now Belgium, citizens of Geel developed at shrine to Saint Dymphna that became a hospice to house the mentally ill. When there were too many people for the building, villagers took them in, forming a special family colony that still exists at Geel.

Attitudes toward the mentally ill varied from place to place. Some German communities cast out the mentally ill and mentally retarded by whipping them out of town or pointing them in the direction of other villages. Monasteries were often a welcome haven for such individuals.

Some towns had madmen towers, in which the mentally ill were incarcerated in chambers called "narrenturme." Some hospitals, like the Hôtel Dieu in Paris, had special rooms set aside for the mentally ill. The Teutonic Knights at Elbing had a madhouse called the Tollhaus, serving as a special place for the mentally ill. Under the influence of Islam in Spain, specialized hospitals developed at Granada (1365), Valencia (1407), Zaragoza (1425), Seville (1436), Barcelona (1481), and Toledo (1483).

In London, in 1247, Saint Mary of Bethlehem was established to house people "deprived of reason." By 1403, six people were housed there. The institution gained more and more patients and eventually developed into the infamous Bedlam, a perversion of the name Bethlehem. The asylum became notorious for its terrible conditions, under which people were chained and lived in squalor. Bedlam was like a living hell, and the name has come to signify conditions that are chaotic and hopelessly confused.

In some areas the "fool" was romanticized. A ritualized "feast of fools" developed during the Middle Ages, serving as a vehicle by which society came to grips with the idea of madness by becoming mad themselves for a short period of time. This festivity was accompanied by much drinking and debauchery.

As the medieval years progressed, insanity became linked to witchcraft and demon possession. Those considered to be possessed with demons were exorcised. This ritual, performed by a priest, would call upon the demon to come out of the individual and to transfer itself into an animal or inanimate object.

The Church, trying to find a scapegoat for the cause of plague and heresy, were convinced that these possessed people were the causes of their difficulties. The witchcraft delusion spread rapidly. In 1484 Pope Innocent VIII declared Germany full of witches that needed to be hunted out. The next 300 years were characterized by terrible witch-hunts designed to seize those thought to be possessed by the devil. Upward to 50,000 people, mostly women, were tortured and killed in these searches. People actually believed that witches existed and that they befriended the devil, brewed strange mixtures of toads, serpents, and poisons in cauldrons, rode broomsticks, and brought curses and plagues upon the earth. Witches were thought to be identifiable by the stigmata diaboli, or mark of the devil, on their body, providing the origin of the word "stigma." Worse still, a simple accusation of witchcraft was often enough for an individual to be found guilty and condemned.

The treatment of mental illness deteriorated in the late Middle Ages and remained poor through the eighteenth century. It was only in the nineteenth century that scientists and society began to reconsider deviant behavior from the perspective of mental illness rather than as a manifestation of evil spirits.


Further Reading

Alexander, Franz G., and Sheldon Selesnick. The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. London: George Allen and Unwin, 1967.

Andrews, Jonathan, et al. The History of Bethlem. London: Routledge, 1997.

Porter, Roy, The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton, 1997.

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Mental Illness During the Middle Ages

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