THE CULTURAL CONSTRUCTION OF MADNESS I
written by: Stanley Wilkin
This paper considers the changes in perception of mental illness from a phenomenon created by external supernatural forces to one produced by internal psychic and physical forces, gradually becoming from the 16th century the province of intellectuals and physicians. It will also consider the effects of humanism on ideas of insanity, indicating a growing negativity amongst physicians towards the mentally ill, considered in relation to writers who perceived insanity as a way of highlighting the inadequacy of human society, as containing immense wisdom within its apparent confusion, and of dramatizing philosophical views. In this work, mental illness will be considered an urban construct with links to ideological and personality formation in earlier periods of human development, and in addition will be concerned with the essentiality of shared social reality. Accordingly, Michel Foucault’s ideas will be referenced. From the 16th century began the process of secularising the soul, along with a growing interest in human motivation and behaviour. This involved concerns on the nature and effects of folly, melancholy and madness, as belief in the extremes of religious devotion, superstition and magic declined. Margaret Pelling (1998: 29) has noted the Elizabethan obsession with mood and states of mind; of consideration only it seems if the sufferer was wealthy or useful for society, as elsewhere she notes that the distracted and mad were bodily ejected from Norwich and probably other cities too (page 96). This work will in addition look at how urbanisation, the expanding money economy and gentrification altered both the perception of madness and the way the mad were treated, changed the space they occupied, and during a later period how definitions of madness were arrived at through professional competition and dramatic presentations of grief and guilt.
Introduction: ‘In the early modern period, madness assumed an important role in European thought and to a certain extent replaced the obsession with death that had characterised the preceding centuries. If by the late middle ages, human vices were being satirized in the danse macbre, with the allegorical figure of Death heading a morbid parade of characters from across the social spectrum, then by the early modern period, it was Madness who was leading the procession, suggesting that nothing was what it seemed.’ Maria Tauset, CSIC Madrid. Taming Madness: Moral Discourse and Allegory in Counter-Reformation Spain.
This paper begins by analysing how perceptions of mental health changed from evidence of god and the devil, of evil and the existence of other beings and planes of existence, to conduits of wisdom and philosophy, the nature of morality and human corruption, worldly corruption of human spirituality, to the wholly negative one dimensional characterisation provided by the medical model in which force and control play such an essential part of treatment and cure. The approaches embedded within historical periods will be analysed, from Classical Greece to the 17th century, when Michel Foucault believes that attitudes towards the mentally ill changed. In this and other papers, the continuance of such beliefs will be examined within modern psychiatric and therapeutic jargon. The Logos of the Greeks is considered, perceiving it as an urban phenomenon. This paper will also consider how human experience changed from early medieval times until early modern times, and with it human behaviour.
Different historical periods will be reviewed, analysis of different approaches to madness, from ancient societies to the 17th century England and France. It will also attempt to consider the nature of mental illness, and whether anecdotal evidence is sufficient to decide levels of and sufferers from mental illness. Although Foucault holds that the development of a concept of reason caused mentally ill individuals to be marginalised, this essay will consider also social change, urban special manipulation and 16th and 17th century gentrification (see above), with its values of orderliness and clarity, as crucial to concepts of mad people as occupying wildness and representing the dangerous Other. This work will review Michel Foucault’s idea of incarceration of the mentally ill, prisoners and beggars, named The Great Incarceration, during the Early Modern period, and the employment of constraint and control of the mad, doing so in part through social changes that altered concepts of the world. Foucault at certain points in his career determined that madness is a social construct, developed through the power of elite groups. This paper will also consider at length the views of those who reject Foucault’s position. To widen our perceptions of the cultural construction of madness, this paper includes Shakespeare’s plays, particularly Hamlet, and Jacobean Revenge Dramas and how they presented insanity, followed by images of madness and the connection between witches and mental illness.
Foucault holds that at the beginning of the Early Modern period those who did not conform to the requirements of urban life, work, accommodation, and continuity, were subject to incarceration. While this did not immediately impact on the development of professional healers, it needs to be focused upon due to physician’s later involvement with the state and the processes of incarceration. The chaining of maniacs is nevertheless evident in Early Medieval narratives and has more to do with the excessive, extreme behaviour of some sufferers, including inappropriate emotional expression, and their perceived danger to others. The response of a Somalian student of mine to the chaining up of those considered mad at a time of social collapse and civil war in Somalia was that it was necessary in case they killed others, although in his locality neighbour was killing neighbour. Were the mad in this context guilty only of the individual-nature of their behaviour, while other murderers functioned within groups? The latter also exhibited a congruent or socially accepted response, even if there was madness in their behaviour. Although psychiatry strongly advances a physiological construct of mental illness, many historians of medicine adhere to the idea that mental illness is a cultural construct dependent on historical period and social power.
The second part of this paper will consider a number of ideas on the nature of mental illness, further consider its part in urban development and the gentrification of cities during the 17th century.
SECTION 1: IDEAS OF MADDNESS
Ideas of madness, where they existed at all, were varied in the past but seem to stem from urban life. Like many of our long-held beliefs, madness emanates from city-life and urban conflict and conceptual negotiation with the countryside, domesticated or wild. This review of perceptions of madness holds that it is an urban construct, the end result of human domestication that began prior to, but accelerated swiftly during, the onset of farming. This section will consider ancient and modern views.
Even though it appears commonplace in ancient societies to ascribe odd, destructive and repetitive behaviour as due to the gods or even to possession by spirits and demons, Hippocrates at times located it in the brain (The Sacred Disease) and at other times in the heart. For the Greeks of his period madness occurred in relation to Logos, meaning language, reason, harmony, proportion, which required a direct engagement with the social world and social life. Although Hippocrates testimony suggests a separation of body and psyche, this may only be in so far as engagement with social life is concerned. Where causation of insanity is concerned, and on this Hippocrates considers mainly melancholy and delirium, the body is perceived as a container that becomes unbalanced according to the location of humours. While the absence of gods in human behaviour is essential for the development of the self, coupled with the identification of cause and effect, but as elsewhere I have disputed the apparent originality of this axiom, this paper will only be concerned with the creation of a relationship between interactive community values and human behaviour that threatens such values.
This may have been, with variations based on other more contingent values, likely within all or most ancient cultures. Although in ancient Mesopotamia, illness was conceived of as the god’s displeasure at human misbehaviour, subject to cultural perceptions, through the agency of demons, it was the consequence of not living a ‘well-ordered life in a well-ordered society’. There is a consistent urban aspect to the responses to and nature of mental health, fear of social alterity emanating from alternative individual behaviour. Although Thiher (1999) perceives Greek concepts of madness as a rupture between self and the world, this concerns the social being not the inner being of modern times. The earliest ancient Greek personality to suffer from madness, as seen by Thiher (page 13), was Bellerophon, who shunned the world therefore proving his instability. For ancient Greeks the community or city-state was the ideal. Habitation of such a community was equated with balance and thereby health.
Relationships to the social world figure equally large in diagnostic exercises in the present day. Inhibited or loss of communication skills (Logos) also figures in today’s diagnosis of mental health. To be mad in Greek theatre often meant to be driven from human society, while there is no clear complement in Mesopotamian culture where responses to grief (Epic of Gilgamesh) can lead to self-neglect and unhappiness, but where the self is viewed in a more complex, many layered fashion. Although Gilgamesh is devastated by the death of his companion, Enkidu, his grief also concerns loss of part of his self, the reality of his own mortality, and the development of human nature as humankind breaks away from divine control.
Hippocrates provided two explanations of madness, one to do with wind, heat and other natural forces, the other humours. For example, madness occurs when fire is dominated by water in the psyche. They become melancholic and fearful for no apparent reason. Madness is a consequence, one of several (Hippocratic Writings: 1978: 231), of an individual not maintaining equilibrium of heat and moisture that diet and exercise provide. Causation is from external factors, working with humours on different parts of a hierarchically determined body. While this can be seen as an early biological explanation it also presents a connection between body and psyche in which other properties of self, such as perception, play no part. The identification of the brain as the source of madness made in The Sacred Disease, is consequent on the presence of excessive moistness within it, creating movement and agitation, or excessive bile. These properties accordingly create, as a consequence of the former, passive behaviour in the sufferer, or, in the latter, aggressive behaviour. An overheated brain causes sudden anxiety, with, it appears, volatility, caused by a rush of bile into the brain through the veins. The brain, as examined in The Sacred Disease, is equally subject to seasonal change. The above descriptions do not provide evidence of bipolar symptoms for example, one of the most favoured modern psychiatric diagnosis, but indicate separate illnesses, behaviour or states of mind. Rather than providing clear evidence for modern classifications of mental illness, Hippocrates conflates all kinds of disturbed states, from sudden violent behaviour to nightmares. He appears concerned with imbalance of temperaments, no matter what form it takes.
Opposition or possible conflict between natural phenomena on and within the body, produces psychic responses. The notion of imbalance occurs also in today’s biological ideas on the causes of mental illness. The humours, which Hippocrates described as numerous in some texts but in The Nature of Man limited to four: phlegm, yellow and black bile, and blood, appear to have been influenced by the idea that human beings are influenced by the four seasons. Certainly, all the above appear to have their roots in pre-Socratic thinkers who held that the elements were instrumental in creating and composing the substance of the world.
I have described ancient Greek ideas on madness as being part of a social construct, the Logos, being that which forms and regulates human society. This may have been common to many early urban societies, including Mesopotamia. It is also one definition of madness commonly used today by laypersons and physicians. Here, Logos, integral to concepts of modern rationality and thereby sanity, will be considered as based upon discourse, the ability to employ language to construct reality, correct decision making, both domestic and political, providing balance/proportion/equilibrium/reciprocity (Johnstone, 2009). It is a specifically literate construct occasioning synthesis of different and differing viewpoints over time. When Robert Burton considers the opposing conditions of reason and Melancholy:
‘We, as long as we are ruled by reason, correct our inordinate appetite, and conform ourselves to God’s word, are as so many living saints: but if we give reins to lust, anger, ambition, pride, and follow our own ways, we degenerate into beasts, transform ourselves, overthrow our constitutions, provoke God to anger, and heap upon us this of Melancholy…..’
He equates reason with balance and order, community virtues, not with empirical judgement. Madness involves a failure to be involved in the community, reason a healthy capacity to engage with others through God.
Christopher Lyle Johnstone demonstrates the appearance of Logos in Western culture but perhaps erroneously perceives only its Western antecedents not those of middle-eastern and North African wisdom literature based upon the literary presentation of alternative viewpoints. Discussions on the nature of God, often preceding ancient Greek intellectuality, perhaps form the roots of ancient Greek thinking. Surely, the envelopment of Greek Asia Minor, the exposure of the Greeks to other ideas from distant lands, caused the formation of Greek wisdom, the supposed miracle of Greek natural philosophy?
The achieving of Logos is done through at least two groups imbued with abstract language establishing common procedure and perception prior to or on completion of an act or series of acts. It is society in which happiness is best produced in, and for which a state of conflict is the alternative. In such a worldview, excessive acts or series of actions, are held as destructive and destabilising, in other words ‘mad’. It affects civic life and the common good (Johnstone, 2009, chapter 5, Civic Wisdom, Divine Wisdom). In ancient Western writing on insanity, causation comes from a physical, external source. Through the ideas of Late 18th century Enlightenment thinkers, such as Voltaire and Rousseau, reason and rationality began to be formulated as: secularism, whereby society is no longer ruled by elites interpreting sacred texts: personal autonomy, with emphasis upon individual good judgement: humanism, whereby human beings and the environment they create are at the centre of society’s endeavours and curiosity. Jon Elster suggests also in understanding reason: impartiality with regard to persons, temporal impartiality, and rational and well-founded beliefs. Rationality feeds from other roots, according to Elster, although the two are normally twinned, providing opposition to passion and self-interest, within a subjective belief system not within a financial system. Elster includes appropriate action and aims directed towards the common good. All these notions, while not essential to 17th century views of madness, are essential to modern views. The rationality and reason of the ancient world appears to have been based on community, while recent European developments have generally based them on the individual.
Plato: As Plato has had such influence on Western and Islamic thinking his ideas on madness-or rather reason and passion- must be specifically scrutinised.
Plato, commenting on the story of Medea, perceived that reason and passion were strictly divided within the individual mind, the alcoholics desire to drink separate from the knowledge that drink is destroying him/her for example, or anger, and the thinking associated with anger, separate from calmer or less involved states of mind.
Medea, in Euripides play, has been betrayed by Jason with whom she had two sons. She in turn, as daughter of the King of Colchis, betrayed her country and first family for the love of Jason. In order to re-establish his fortune, Jason has agreed to marry the daughter of the King of Corinth. Medea’s wrath is extreme, and she considers, in order to revenge herself on Jason, murdering their two sons. Medea has sufficient insight into her state of mind, but cannot fully control the anger-or thumos. She is in effect in two minds, whether to follow her anger or act like a sensible person and mother. The anger nevertheless has her in its control. Eventually, she gives way to her anger.
While Plato believes she is in two minds, one human and rational, the other beastlike and irrational, the Stoics consider that there is no division but simply aspects of the same mind or entity. When angry, she thinks through anger, and when that emotion subsides she thinks differently. What has been noted is that both states have their own observable logic-cause and effect operate comfortably in each. While the Stoics express unity in their understanding of internal psychological conflict, Plato sees merely separation.
From here it is possible to see our prevailing view on madness, although there is at present evidence of change, as separate, irrational and un-human. In Medea, anger wins because it is stronger than reason, although when she kills her children she does it in a cold, methodical manner not in the throes of passion.
Plato’s understanding of the mind is the one that underlies a belief in madness, whether imagined as disordered feelings or chemical imbalance. Plato, like other Greeks, was caught up in a belief in natural separation between those inhabiting the polis, who were civilised and therefore were intimately associated with rationality (ordered thoughts and emotions), and those driven by emotion; peasants, slaves and foreigners. Medea as a citizen of Colchis fitted the latter description. In Plato’s world, as understood here, reason is a powerful tool occasionally overthrown.
While ancient Greece believed in community and its theories evolved from the idea of the supremacy of the community, Rome from early in its history conceived of the city state as occupying a community/power nexus, with later emphasis on the individual, therefore, although Galen structured his ideas on Hippocrates, there would be differences in his approach. At this point I will reference the sociological concepts expressed by Klaniczay (1990) in an effort to accentuate differences between Galen and Hippocrates. While on the surface Classical Greeks pursued ideologies of communitas, stressing equality through citizenship values based upon ethnicity and gender, Rome concentrated on structure, based upon rank and wealth. Although born a Greek, Galen practised in Rome in the second century AD. He appears to have competed vigorously with other doctors, subject to boasts and power-play. He attacked the skills of other doctors and may have gained notice through his diagnostic ability and the extent to which he provided titles for conditions. This is a process visible today, in that conditions are provided, named and after being described at length, separated from other conditions and provided with treatments. His competitiveness, need to be in control and belief in his superiority to other physicians might have had to do with the environment in which he practised. A scholar as well as a physician he integrated Aristotle’s and Plato’s ideas into the medical concepts of Hippocrates.
In Shock and Awe, Maud W. Gleason describes Galen’s anatomical demonstrations, done on those lowest in the social order and animals, and rightly she connects these to the public shows of the coliseum. They served also to confirm the order of things. In essence, Galen was concerned with his authority, Hippocrates with his healing of others.
Medieval madness: definitions.
Peter Breughel the Elder’s ‘Dulle Grete’ c 1562 (Mad Meg). The ship of fools is situated at the picture’s centre, but is too small to contain all the world’s madness, demonstrated through images of war and anarchy. Mad Meg runs across the painting, an icon of madness through her dishevelled appearance and tattered clothing, towards the mouth of hell. Sinful behaviour, profligacy and gluttony, mix with symbols of lunacy and demons. From the time of the Enlightenment onwards, such paintings as this would be immediately considered products of lunacy.
The medieval world, according to Thiher (1999), by contrast did not clearly differentiate the mad and the non-mad, sanity and insanity, but in fact evidence of this separation, see above with reference to Plato whereby a clear division is made, can be found in matters of law and through developments in concepts of possession. Possession as the chief understanding of ‘madness’ belongs to the early medieval period. Extreme expressions of Christian piety were the norm, with self-torture, self-abasement not only tolerated, but venerated. Madness was attributed to the committing of sin, as much a metaphor as a condition. Golem in Lord of the Rings is a modern version of this type.
Many behaviours of the Early and Late Medieval world would now be classified as mental illness. Saint Cecilia, venerated from the 4th century, upon marriage clothed her body in haircloth, fasted, preyed and wept out of fear of intercourse. In a secular society, standing on top of a styloi for decades would be judged insane and likely to result in incarceration and forced infusions of drugs as recommended by a bevy of drug companies and psychiatrists Simeon’s rationalisation for his odd behaviour is legitimised by its historical context, concepts of Self and of life. Self-flagellation, common amongst the very powerful, if carried to extremes, would also be a candidate for psychiatric treatment and not evidence of saintliness or of a strong conscience. Other attitudes would solicit a worrying response, such as on occasion, while a female virgin was often employed as a symbol of holiness, a sexually active woman was used to symbolise sin and depravity. Although the latter can be found in societies around the world, it remains irrational in that it conforms to an internal logic and not to an external one, attached to untraceable religious commands. We usually consider all such notions irrational. In fact, behaviour has been constrained and fulfils, in the present day, notions of domestication. Sedgwick, in his repost to Foucault and Szasz, declares that there is a normative framework to mental illness that exists within all contexts, and therefore St. Simeon, one imagines, would be judged sane now no matter how extraordinary his behaviour, or that his behaviour anyway would be modified. As with the others illustrated here. But immediately, with Sedgwick’s reasoning, we have still the problem of who decides who is mad, which will be considered later.
Excess in behaviour or mood was often the deciding factor. Wild men often represented bestiality, and can be connected to the raving lunatic. Removed from the public world largely inhabited by men, women who were sexually highly active, through too often occupying the public domain, were also considered beastly. Were the voices of St. Joan examples of spiritual exclusivity or of schizophrenia? Perhaps, they were the only way a young woman of humble origins could communicate her perceptions and be listened to in a hierarchal world, with God as its supreme authority. In a world as different from our own as the medieval world, perhaps we should not and cannot employ the same classifications.
The law early became involved in definitions of insanity. Wendy J. Turner has edited an insightful volume on medieval madness and the law, referenced here, but the book fails to distinguish between different kinds of mental illness and demonstrates complete acceptance of the supposed generic condition of mental illness as fact. Her occasional case studies involve anecdotal evidence, and might simply reference temperamental unsuitability for business or other worldly transactions of the time. She also concentrates on the Late Medieval period when group perceptions were probably undergoing change from a reliance upon religious conviction and communal understanding to one on book learning based upon the authority of ancient sources and caste-bound commentators. Nevertheless, she demonstrates an early involvement of the law with madness, consequent to matters of inheritance and property possession. Many of the examples provided appear to refer to the cognitively limited. In her piece Silent Testimony she describes exaggerated emotional incongruence (upon the enacting of a criminal offence) and memory tests (possible idiocy) as providing evidence of mental instability. Evidence of inappropriate emotion often appears linked to dementia. As Turner points out, incarceration or constraint only occurred when the sufferer was in a position of responsibility. Johann Weyer (1998), in the 16th century denied the reality of witchcraft and asserted that witches were mentally ill, employing legal judgements in his arguments. By the late 16th century in parts of Europe, physicians were consulted when witches were tried. Weyer’s work is seen as a forerunner of insanity defence, whereby he declared old women merely imagined those matters they confessed to, driven into incompetence by excesses of melancholia.
Turner also includes consideration of changes to understanding of emotion and how it defined personality and intentionality. By the end of the medieval period, passion, if it results in inappropriate action, has become a form of temporary madness. Thiher too makes note of how emotional expression was viewed, from humoral determination, supernatural possession and Stoic concepts of emotional excess as a form of madness. Two of these perceptions we have retained, although descriptions of both have suffered alterity to fit in with modern ideologies.
In Heresy in Transition Sabina Flanagan, Heresy, Madness, and Possession, demonstrates that papal attitudes to possession were changing as a consequence of wording on heresy from the Fourth Lateran Council of 1215 that conflates heresy and madness. Although, other commentators describe the conflation of heresy and madness as a medieval topos of no great importance. Nevertheless, the writer points to the diminishment of references to the Devil as the cause of, to-the-prevailing powers, inappropriate thinking and behaviour.
Through the development of humanism and changes in society, madness was becoming increasingly subject to professional and intellectual gaze. Behaviour has changed from medieval times to the Early Modern period. Religious excess has become unusual, and when evidenced, frowned upon. The scatological communication of the educated, such as in the works of Thomas More, is disapproved of or becomes increasingly unfashionable. By the end of the 16th century responses to madness had undergone immense change, viewed below, encapsulating the negativity of the physician, and the exploration of writers. In France, Du Laurens (Thiher, 1999: p 74) presents the view that the insane cannot be regarded as human, but are bestial in nature. Worse, because they fail to live up to the perfection expected of a creature made in god’s image they are symbolic of deicide. Peter Sedgewick, an apparent believer in medical history as an evolutionary journey from ignorance to truth, pinpoints Johann Weyer (page 125) in 1563 producing clinical descriptions of auditory hallucinations and persecutory ideas, advising medical treatment for those accused of witchcraft and consequently being placed on the Papal index. Although in recent years, Weyer has become lauded as an exponent of early psychiatry in fact he was concerned primarily with the nature of witchcraft and the methods employed to counteract witchcraft.
MICHEL FOUCAULT: MEDICAL POWER IN FRANCE.
Foucault’s theories have mainly been concerned with power, knowledge and discourse, ‘The boundary of politics has changed, and subjects like psychiatry, confinement and the medicalization of a population have become political problems.’ (Foucault, cited in Macey 1994: 217). As an historian he emphasised a great incarceration, when people considered idle were imprisoned and made to work. Foucault perceives early psychiatry as an attempt to capture minds, patients placed under a psychiatric discourse, the result a psychological trial (Merquior, 1985: 24) that they are never released from, even when the patient accepts the psychiatric viewpoint. The moral torture that ensues becomes reason’s tyranny over madness. The constitution of madness as an illness, broke the dialogue between reason and insanity. According to Foucault, psychiatry has enforced: ‘a monologue of reason about insanity’ that has pushed ‘madness’ in its many forms into the margins of both society and intellectual curiosity.
Modern critics have largely attacked his research methods and research expertise, but nevertheless seem also to be attacking the threats his ideas have for prevalent and current status quo. If knowledge concerns power, historical and social positioning, than all experts must be viewed with scepticism. These critics focus upon his limited research, pointing out that he based his ideas on the literature and images of the Late Medieval, Renaissance and Early Modern Society. He did not give sufficient focus to the documents of these periods and therefore his conclusions are not justified. J. G. Merquior (1985: 44), certainly one of his sternest critics, berates Foucault for referencing Paracelsus and not more eminent figures such as Erasmus and Montaigne, forgetting, one hopes, the influence Paracelsus had on fellow physicians and that he was after all a working physician and writers and thinkers like Montaigne were not. In the end, it is what doctor’s think, not philosophers. This is more the case in the present day, when physicians have separated their ideas from the philosophical, sociological and psychological viewpoints found in universities, for example. The above viewpoints suppose that images are not evidence without documentation, and that documentation provides more credible examples of reality. Unfortunately, this allows for history, especially ancient history, to become fossilised within academia, not permitting thereby the infusion of insights from elsewhere. Foucault has been as much criticised for his temerity in critiquing psychiatric mores as in his methods and for not appreciating that incarceration occurred in medieval times.
Hieronymous Bosch: late fifteenth century Ship of Fools. Icons of immorality, such as eating of cherries, mix with icons of madness, the melancholic fool with his fool’s stick. The gathering of clergy and apparently ordinary individuals indicate that this is a satire on prevailing social conditions. Although the ship is an early image of containment and isolation of the mad it is also a microcosm of Late Medieval/Renaissance society. The mad here still play a reflecting role to the rest of society.
In Madness and Civilisation (1967), Foucault describes how in France mad people were placed on a ship, which floated between rural authorities. Called the Ship of Fools it became later symbolic of managers of states and other institutions. Neely (2004) points out that there is no evidence of such events. Nevertheless, this may be an early urban myth that symbolises how city administrators constructed order and dealt thereby with its apparent antithesis. Paintings of the period show a variety of fools journeying together in ships, indicating perhaps their social and mental rootlessness. Madness is now a thing apart, contained and enclosed. Merquior refers to how, in Foucault’s thinking, the ship of fools alludes to realms of thought beyond reason, while also showing mad people searching for their reason, the capacity to be involved in production and meaningful employment.
Foucault places madness or Folly central to the Western experience, the primacy of madness a consequence of the breakdown of medieval religious symbolism, which had pervaded everything. To the modern mind the religious world that preceded and continued during the renaissance, one of devils, fear, and Satan, is irrational: it is mad. The panoply of strange, disturbing symbolism became in a socially ordered world based upon civic commitment the irrationality of the mentally ill. According to Foucault, madness had found a place in the medieval hierarchy of vices, linked it seems to me not just to folly, ranked among ‘the wicked soldiers of the psychomachy.’
The strange creatures of the medieval supernatural had a place in the knowledge of the time, which was different to that which developed from the renaissance onwards. While modern psychology might say it concerns the outward projection of inner individual and group anxieties in fact such a view represents an unwillingness to accept alternative kinds of knowledge. Folly perhaps refers to those who cannot access the knowledge. Medieval thinking relied on image, analogy and symbolism. The horned beast, gargoyle, troll and whatever else. Such creatures are now the subject of horror films, not companions of space and time.
For Foucault the incarceration that followed the renaissance concerns the containment of this experience/imagery in a different age. The imprisonment of the mad symbolises the development of social order. He perceived madness as part of an historical process, not as universal or objective categories. He illustrated how madness, poverty and unemployment began to be seen as social problems. Meaning and ethical values attached to them determined how these phenomena were experienced. In order to fully understand this phenomena, Foucault undertook a structural study of the institutions, places of confinement, ideas, juridical and scientific constructs that framed and supported the phenomena. Merquior (1985) criticises Foucault for asserting that the mentally ill were confined within converted leprosaria, as leprosy died away, when many institutions also accepted the mad. He gives little space nevertheless to the attitudes towards lepers, that of sinners punished by god, or/and the walking dead and the possible wholesale transference of such attitudes to the mentally ill and the disadvantaged. Like Sedgwick (1982) he sees mental illness as inhabiting an ideal form, unchanging and unchangeable, not liable to poor diagnosis, dissembling, and context. Foucault perceived madness as an objectification that changed human beings into subjects (Tover-Restrepo, 2012), specimens for study. Since, madness has become far more widespread it seems as society has become transmogrified by medical perception and interference. As a society, our minds have become the objects of study of an autonomous body, empowered by laws and in a capitalist, consumerist alliance with pharmaceutical companies. Or at least that is one interpretation. Another is: ‘analysis shows that psychiatry is a new type of hybrid discipline, exhibiting a complex epistemological structure and philosophical language, located in the terra ignota that stretches between the old social and natural sciences.’ Foucault was concerned with the very nature of knowledge. In this new world of the 17th-18th centuries, humankind (man) became increasingly the focus of attention, rather than god.
Foucault perceived society as constructed upon contingent discourses that reflected group power and social stratification. He saw knowledge as bound to power, a point Plato had made several thousand years before. Madness therefore became the subject of those engaged in rational, often understood as scientific, purposes. The mad became objects of study, objects of gaze of those in power, involving containment in some form or another, as others, for example the poor and criminals became subjects of punishment as a consequence of ideas of possession and labour. In terms of mental illness, some have questioned his apparent rejection of mental illness as a genuine, rather than cultural, phenomenon and suggested that such an approach could result in social difficulties and that it is wrong to deny other’s expressed suffering. While clearly people suffer immensely from a number of verifiable conditions, understanding of and remedies for these conditions need to be removed from power-relations. There, he was not wrong.
Foucault focuses on the establishment of the Hopital General in Paris, existing within its royal remit with absolute authority outside of ‘courts, decides, judges, and executes,’ the intention being to control the city’s poor, ill and mad. Foucault points out that the original Hopital, as many were later set up in every French city, for the prevention of ‘mendicancy and idleness.’ I have previously considered a number of these issues. Foucault (page 47) asserts that many of these developments were a consequence of poor government economic policies and legislation against begging. Unemployment had risen in the early 17th century and riots had occurred in Paris, Lyons and Rouen. As we have already seen, the king took responsibility for administrating social control and citizen health in France, thereby centralising the development of medical care. In 1676 the king ordered the setting up of a general hospital in every city.
According to Foucault, the great confinement occurred as a government policy to deal with unemployment and begging, the result of conflict and social change, forcing inmates to work. Shortly after the Royal Edict that established the Hopital General, militia connected to the Hopital hunted down beggars and forced them into the different buildings of the Hopital (Foucault, 1971: 49). Once confined, all inmates were made to work, a social construct that may have emerged from puritanism involving a precise use of time and energy. The confinement revolved upon a belief in an ill-considered economic response to idleness framed within moral paradigms, involving exclusivity and punishment. From these evolved perceptions of the mad, idle and useless, and methods of treatment. But for Foucault, of far more import it seems, is the construction of a power ethos behind treatment of those excluded from industrious, wage-bound society. In Foucault’s view, Royal power devolved down to minor administrators engaged in the processes of confinement, and with it methods of control, constraint and punishment. These continued into the 19th century when the majority of those confined in the Hopital General were regarded as insane. During the 18th century a tenth of those arrested and confined in the Hopital Generals were regarded as insane.
Famously, Merquior (1985) and others challenge Foucault’s idea that the Enlightenment was unusual in its response to madness, and his belief that in previous ages people responded more positively to the mad. He points out that Peter Sedgwick has shown that many insane people had been in custody and made in undergo treatment, always cruel, long before the Enlightenment. Midelfort too has provided clear evidence of incarceration of the mad in late Middle Ages accompanied by extraordinary cruelty. But does this genuinely undermine Foucault’s idea of madness as the end-result of a power discourse? For Merquior’s dismissive arguments to be correct we need evidence on what the mad were suffering from, and whether the madness of medieval patients was the same as that of modern sufferers of mental illness. While Merquior (1985) rightly points to the hospitals for the insane across the Rhine valley ‘prior to Foucault’s classical age’, and charitable asylums in fifteenth century Spain, with various treatments, stemming from Muslim societies, based upon physiological concepts of mental illness, he does not define the nature of that illness, whether they meet the same definitions as modern psychiatric viewpoints. Clearly, containment and incarceration of the mad was a developing paradigm, epitomised by Edward Schon’s woodcut of the cage of fools (1530), found in Gillman’s ‘Seeing the Insane’1982:48), but usually it was in relation to anxiety on morality. Incarcerating the mad, or those judged so, in the medieval world might also have concerned the containment of the larger world’s immoral behaviour. In other words, for wholly different reasons then in the Early Modern period.
While Foucault’s detractors focus on his research, they have rarely challenged the importance of central power on the evolution of French medical care nor the creation of places of confinement for the poor. Nor it is reasonable to deny the connection made between beggarly poor and idleness and moral corruption directed by powerful elites who feared the depopulation of workers from the country and social instability. Merquior (1985) appears again not to appreciate the evolution of one power-based view of a separate group, such as beggars, to that of another, such as the mad, and how such views can be connected allowing the officially sanctioned attributes of one group to be imposed upon another. One crucial aspect of later incarceration of the mad, up until the present, is the way in which the mentally ill symbolised poverty and material and social deprivation. It is generally accepted that the poor of the time were seen as an untapped source of wealth that required management and control (McHugh, 2007: 46).
Brockliss and Jones (page 443) concur with Foucault that in 16th century France the mad were seen as moral symbols, not as subjects for care and understanding referencing depravity or divine wisdom. In the 17th century they were associated with irrationality and improper use of the will, socially dangerous animals who had to be excluded from human society. Consequently, they were locked away with beggars, prostitutes and blasphemers. Today, all such groups are liable to be placed under the category of mental illness. Whatever occurred, the mad were disenfranchised and excluded, locked away in hopital general. In support of Foucault, Johann Weyer (1515-1588), as noted, attacked the concept of witchcraft, and suggested, for example, that old women accused of witchcraft were hallucinating and crazy, and therefore should not be punished. This fitted in with the Roman legal maxim employed during that period: ‘the mad man is not punished because he is punished enough by his own madness.’ Erasmus asserts an inclusive philosophy, that all creatures are touched by god, therefore the mad are also expressions of god.
17th CENTURY CONCEPTS OF MADNESS, AND THE IMPACT OF SOCIAL CHANGE
The 17th century witnessed changes in the approach to insanity with more engagement with problems of aberrant social behaviour. Many scholarly treatises were produced commenting on the causes and prevalence of problems of the mind, but, as yet there were few unchallenged self-appointed experts in mental health matters.
Erik Midelfort identifies three specific notions or images of madness: folly, demonic possession and melancholia. At this period, these forms of madness also incorporated a co-existing form of irrationality that was beneficial, offering deeper sources of wisdom and insight. In ancient times, disordered senses were valued as a form of religious experience in which social controls and customs were overridden. In Dionystic rites, women, the group most subject to control in ancient Athens, were allowed complete freedom of expression, emotional and physical. Midelfort identifies Christian wisdom as a kind of madness or folly, according to St. Paul and Erasmus, which brought the believer closer to god. The leaving of the senses allows for another form of knowledge. Demonic or spirit possession also indicated alternative, or in medieval times customary, forms of knowledge, allowing access to another world beyond the material one we inhabit. The writer then demonstrates that melancholy had a positive side, being linked, as sometimes now, to creativity.
From this evidence Midelfort construes that madness was central to experience during the Renaissance, although clearly it constituted then a completely different experience from the present. These expressions of madness were closely tied to present day notions of inspiration and genius, of a god, or devil, provided view of problems unavailable to the conventional and staid. Great individuals were more likely to be possessed than their steadfast counterparts.
Theories of madness remained attached to cultural perspective. Although, as Midelfort makes clear, Paracelsus’s ideas on madness were subject to contradiction, he developed a theory based upon the triadic scheme of human nature: body, spirit, soul. He understood madness as an ignoring of the essential integrity of the individual, the sidereal body or mortal spirit, what made them human, and therefore becoming merely a beast, and the conflict over this part of individual nature caused madness.
Paracelsus divided madness into five types. The first was epilepsy, the falling sickness: 2) mania, a corruption of reason rather than the senses, produced by intrusive elements such as worms. This was treated by bloodletting, or oil of camphor, silver, mercury or lead to cool the individual: St. Vitus’ dance connected to abandon and associated with sexual thoughts and activities: a suffocation of the intellect, decision making, which again he believed had physical causes such as worms, poor diet or uterine problems: privatio sensuum, loss of the senses, including lunatics, the congenitally insane, the mad, those afflicted by witchcraft, and those by melancholy. He attributed causes to each. For example lunatics had fallen under the influence of the moon, instituting chemical disorders, while those insane from birth had their parent’s insane passion during intercourse for blame. Like a true physician, Paracelsus expanded on examples of madness to include those who disagreed with him (Midelfort, 1999, page 119) based upon a notion of astral drunkenness. All in all, he connected madness to the behaviour and cognitive capacity of beasts that many individuals intentionally acquire. Madness here is either achieved or the result of outside effects, and is dependent on Christian concepts of soul.
Apart from the above, in-depth evaluation of madness was limited to melancholia, seen as, according to Midelfort (1999), a disease of both genders. It was often attributed to education, the excessive reading of intelligent people. This is the accusation against Hamlet, accounting for his procrastination. While today many assume that it represents an early identification of depression, I hopefully will later demonstrate how diagnosis can be the result of interaction between involved members of the healing process, and also of rarely considered processes of interaction especially between healer, healee and those involved with both parties. Also at this time, demonic possession was seen as one determinate of madness, affecting men and women equally. Whatever the nature of mental illness, it remains, then as now, subject to cultural interpretation and design. In the modern age, it is particularly subject to the vagaries of the observer. Retarded and mentally ill people were often retained in European courts to provide both entertainment and to tell their aristocratic master’s the truth, not willingly supplied by the sane.
In essence, madness was perceived of as to do with those who behaved differently, often acting outside of social convention in physically shameful ways, or in an uncertain relationship to position and possessions. In medieval and Renaissance times it was seen as an imbalance of the humours, often viewed within a religious context, as the world’s evils, especially evils of the flesh, intruding into the purity of the soul. One popular cure for madness was music and dance that were said to work against dominance of black bile.
Lawrence Babb shows that Renaissance saw mind and body as acting as one, animated by the soul, divided into three sub-sections: the vegetative, sensitive, or sensible, and the rational, or reasonable. The vegetative soul, common to plants and animals as well as human beings, was seen as located in the liver; the sensitive soul, concerned with imagination, the senses and intentionality, was perceived of as seated in the brain and heart; the rational soul, separating man from all other creatures, was seen as seated in the brain.
Renaissance people recognised, according to Babb, five external senses and three internal ones; common sense, imagination and memory, all located in the brain. Common sense gives sensory experience form. The imagination then evaluates whether experiences are pleasant or unpleasant, and delivers these evaluations to the memory. The internal senses create emotions, divided into motions, affections, passions and perturbations. The rational soul has two divisions, intellectual and volitional, that is, reason and will. Reasons perceives the essence and appearance of matter, seeking truth through a logical train of thought, determining if something is good or bad. Will, implanted by god, desires good, not bad, promoting physical action.
As the soul, in its various forms, resides in the body, the body is seen as the principal conduit of understanding of the world and the capacity to deal with it. This was a physiological position rooted in the humours, aided by digestion, or concoction, and those elements, chyle, in the body dealing with the product of digestion. This process illuminates Hamlet’s psychological journey, from the activity of the senses to the delaying or re-consideration of the will (Babb, 108). Locating all the above manifestations within the body, although subject to external manipulation (food and weather), suggests individualism, certainly compared to the external agencies of madness, demons for example, of the medieval world. Nevertheless, in an unjust and violent world there seems no room yet for the psychological effects of that world on individuals.
According to an interesting volume edited by Yasmin Haskell, the Early Modern concept of madness was based upon the notion of diseased imaginations, connected to the above dynamic between sense and rationality. This survived until recently into modern thinking when more mechanistic understandings of the mind gained popularity. Instead of saying, whenever someone becomes anxious, that: ‘It is in your imagination’ we now might declare ‘you are suffering a chemical imbalance.’ In the 17th century and beyond, imagination was held to be a powerful force capable of overcoming the reasonable (reasoning) mind. This force connects madness due to disease, birth defects for example, to melancholy and fevered disruptive behaviour of, what we now call, psychosis, to St. Vitus dance and demon possession. The imagination was a force wielded by the individual that allowed, if the individual were weak-willed or infirm, misuse by other forces both material and supernatural.
In fact, there were a number of theories on the reasons for mental disturbance, from astrology, rebellion, to passion, particularly sexual passion, fear, and principally imagination. While Hunter (1982) records evidence of Early Modern acquaintance with hypochondria, other forms of diagnosed mental illness included Lycanthropy, Catalepsy, which Robert Bayford, writing in 1663, considered common. John Graunt constructed statistics on lunacy from the Bills of Mortality, noting how few there were, unlike the numbers today, but how many more could be found if the effort to find them was made.
In the 1664 Thomas Willis, who invented the term neurology, wrote Cerebri Anatome. In doing so he set aside, at last, Galen’s view that the anima, which dwelt within the body, explained the mind. He had, according to William Feindel, re-connected with Hippocrates’s original notion that the brain was the seat of all desires, emotions and thoughts. An associate of Wren and a member of the Royal Society of London, he experimented with ink injected into carotid arteries and noted how blood circulated through the brain. He described how different parts of the brain had different functions. He appears to have been influenced by Descartes, referring to animal spirits in the same explanatory fashion. Roy Porter (page 55) describes Willis as occupying the ‘cutting edge of respectable scientific thinking’, determining that he perceived the body as a corporate soul subject only to the capacity to receive and react to stimuli. He distinguished sensory from motor functions, and separated human nature into two, the animal soul and super-rational soul. While convinced of Willis’s supreme importance, he admits that he may have had little effect on common perceptions. As with many celebrated thinkers during this period, Willis’s influence may have been limited to a small elite group, his importance mainly in hindsight.
Although Willis’s work appears to evoke present day neurological and psychiatric concerns with brain construction and chemical imbalance, most theories were concerned with moral or religious perspectives. For example, a landowner not attending to his estates would be considered mentally ill, the association made that sanity was expressive of an individual’s better self and insanity, or distemper, evidence of the baser side obtaining dominance. Efficiency indicated sanity. Those judged insane often behave without inhibition, verbally and physically assaulting those they dislike, unclean in person and habits, and significantly attend to housework, unless carried to excess (Hunter, 1982: 103). While cleanliness was considered next to godliness, so sanity was associated with order in habits and general behaviour. Bad behaviour towards others encourages a rogue to go insane, while behaving calmly and ethically towards others encourages internal calm and balance, or sanity. In this view, the individual plays a part in whether or not they become insane.
This view that insanity was a consequence of individual responsibility and of baseness of thought or deed, gave authority to the intrusive treatments employed. Shackling in irons, beatings, induced vomiting, purges, bleeding and numerous shock treatments, apart from those already described, such as ducking. Many of these treatments would be continued into the 20th century.
Foucault’s position on the perception and treatment of madness appears predicated upon his view of the Great Confinement, the creation of institutions to deal with largely social problems, the poor, landless and unemployed. While some grew out of the medieval hospitals and lazar houses, by the early 17th century such places resembled the institutions of the present day. The organisation of space closely resembled and resembled monasteries, with discrete activities sectioned off. By the 17th century, according to Casella (2007), these were organised around principles of segregation with restricted and controlled access. Practices of surveillance and ordered symmetry emerged during the latter part of the 17th century. In 1647 the London Workhouse was erected, which was principally designed for the purpose of institutional confinement. Here, a central chapel connected separate wings, one for destitute children and the other for petty criminals. In the Netherlands the first male house of correction occurred in 1589 where destitute men pulverised wood for use as a textile dye, and in France the L’Hopital General was built in Paris in 1656. Here were incarcerated those members of French society deemed unproductive and ‘unreasonable’, beggars, debtors, prisoners, invalids, prostitutes, orphans, elderly and the insane. Rehabilitation consisted of enforced labour, which also had the added incentive of wealth production. Those who did not comply were severely punished. Casella, along with many other commentators, taking the line initiated by Foucault, describes these institutions as evoking a change from Christian, exploitative care of those outside of society into morally charged state repression.
Of interest is who is considered mad, especially in a mad world? Is diagnosis of madness in the supreme control of the observer, especially if the observer is extremely powerful? Mentally-ill people tended to be classified as vagabonds, beggars and disorderly persons and dealt with in the same way. Hunter (1982) provides examples, page 6 from Thomas More’s dialogue of comfort against tribulation, in which the individual described may simply be rascally and free-thinking. As with the notion of witchcraft and madness, possession and madness, heresy-‘after that he had fallen in to ye frantike heresyres, fell soone after in to playne open fransye bysyde- is an important descriptor of the condition. There is an element here of an individual thinking and acting outside of proscribed ways, which More was always deeply concerned with, reflected in his treatment of Tyndall.