Medieval Medicine

by James J. Walsh

The effect of alcohol in producing insanity was well recognized during the Middle Ages, and many writers have alluded to it. Pagel, in the chapters on Medieval Medicine in Puschmann’s “Handbook,” says that Arculanus, of whom there is mention in the chapter on Oral Surgery and the Minor Surgical Specialities, has an excellent description of alcoholic insanity. The ordinary assumption that medieval physicians did not recognize the physical factors which lead up to insanity, and practically always attributed mental derangement to spiritual conditions, especially to diabolic possession, is quite unfounded so far as authoritative physicians were concerned. Their suggestions as to treatment, above all in their care for the general health of the patient and the supplying of diversion of mind, was in principle quite as good as anything that we have been able to accomplish in mental diseases down to the present time. Their insanity rate, and above all their suicide rate, was much lower than ours, for life was less strenuous and conscious, and though men and women often had to suffer from severe physical strains and stresses, their free outdoor life made them more capable of standing them.

The history of human care for the insane, it is often said by those who are reviewing the whole subject briefly, may be represented by the steps in progress from the presumption of diabolical possession, and exorcism for its relief, to intelligent understanding, sympathetic treatment, and gentle surveillance, with the implication that this has all been a gradual evolution. There is no doubt that during the Middle Ages even physicians often thought of possession by the devil as the cause of irrational states of mind. Not only some of the genuinely insane—though not all, be it noted—but also sufferers from dreads and inhibitions of various kinds, the victims of tics and uncontrollable habits, especially the childish repetition of blasphemous words, and sufferers from other psychoses and neuroses, were considered to be the victims of diabolic action. Exorcism then became a favourite form of treatment of all these conditions, but its general acceptance came about because it was so often successful. The mental influence of the ceremonies of exorcism was often quite as efficient in the cure of these mental states as mesmerism, hypnotism, psycho-analysis, and other mental influences in the modern time.

It may particularly be compared in this regard to psycho-analysis in our own day, for this cures patients by making them feel that they have been the victims of some very early evil impression, usually sexual in character, which has continued unconsciously to them to colour all their subsequent mental life. Some of the curious theories of secondary personality, the subliminal self and what has recently been called “our hidden guest,” represent in other terms what the medieval observers and thinkers expressed in their way by an appeal to diabolic influence. They felt that there was a spirit influencing these patients quite independent of themselves in some way, and their thoroughgoing belief in a personal devil led them to think that there must be some such explanation of the phenomena. Even great scientists in the modern time who have studied psychic research have not been able to get away entirely from the feeling that there is something in such possession, and have admitted that there may be even alien influence by an evil spirit. The more one studies the question from all sides, and not merely from a narrow materialistic standpoint, the less one is ready to condemn the medievalists for their various theories of diabolic possession. The Christian Church still teaches not only its possibility but its actual occurrence.

Such conservative thinkers as Sir Thomas More, one of England’s greatest Lord Chancellors, the only one who ever cleared the docket of the Court of Chancery, continued to believe in it nearly a century after the Middle Ages had closed, but above all is quite frank in the expression of his opinion that some of the mutism, the tics, and bad habits, and repeated blasphemies, attributed to it, may be cured by soundly thrashing the young folks who are subject to them. Neurological experts will recall similar experiences in the modern time. Charcot’s well-known story of the little boy whose tic was the use of the word uttered by the corporal at Waterloo, and was cured by being soundly licked by some playmates at the Salpêtrière gate, is a classic. Some of the medieval cruelty represented unfortunate developments from the observations that had been made that a number of the impulsive neuroses and psychoneuroses could be favourably modified, or even entirely corrected, by attaching to the continuance of the habit a frequently repeated memory of distinctly unpleasant consequences that had come upon the patient because of it. Our experience in the recent war called to attention a great many cases of mutism, functional blindness, tremors, and incapacities of all kinds, some of which were cured by painful applications of electricity. The medieval use of the lash for such cases can be better understood now as the result of this very modern set of clinical observations.

In the meantime it must not be forgotten that the people of the Middle Ages, even when they thought of insane and psychoneurotic persons as the subjects of diabolic possession, felt themselves under the necessity of providing proper physical care for these victims of disease or evil spirits, and as we know actually made excellent provision for them. Not only were the insane given shelter and kept from injuring themselves and others, but in many ways much better care was provided for them than has been the custom down almost to our own time. They had many fewer insane to care for; life was not so strenuous, or rather fussy, as it is in our time; large city life had not developed, and simple existence in the country was the best possible prophylactic against many of the mental afflictions that develop so frequently in the storm and stress of competitive industrial city existence. This prophylaxis was accidental, but it was part of the life of the time that needs to be appreciated, since it represents one of the helpful hints that the Middle Ages can give us for the reduction of our own alarmingly increasing insanity rate.

They had no large asylums such as we have now, but neither did they have any poor-houses; yet we have come to recognize how readily they solved the social evils of poverty. The almshouses at Stratford, with their accommodations for an old man and his wife living together, are a typical, still extant example of this. Each small community cared for its own sufferers. They did not solve their social problems in the mass fashion which we have learned is so liable to abuse, but each little town cared to a great extent for its own mentally ailing. They were able to do this mainly because hospitals were rather frequent; and psychic cases were, at the beginning, cared for in hospitals, and when in milder state their near relatives were willing to take more bother in caring for them than in our time. Delirious states due to fever had not yet been definitely differentiated from the acute insanities, and all these cases then were taken in by the hospitals. This was an excellent thing for patients, because they came under hospital care early; and one of the developments that must come in our modern hospitals is a psychopathic ward in every one of them, for patients will be saved the worst developments of their affection.

The better-to-do classes found refuges for their non-violent insane in certain monasteries and convents, or in parts of monastic establishments particularly set aside for this purpose. When the patient was of the higher nobility, he was often put in charge of a monk or of several religious, and confined in a portion of his own or a kinsman’s castle and cared for for years. There are traditions of similar care for the peasantry who were connected with monastic establishments, and sometimes small houses were set apart for their use on the monastery grounds. As cities grew in extent, certain hospitals received mental patients as well as the physically ailing, keeping them segregated. After a time some of these hospitals were entirely set aside for this purpose. Bedlam in England, which had been the old Royal Bethlehem Hospital for the care of all forms of illness, came to be just before the end of the thirteenth century exclusively for the care of the insane. In Spain particularly the asylums for the insane were well managed, and came to be models for other countries. This development in Spain is sometimes attributed to the Moors, but there is absolutely no reason for this attribution, except the desire to minimize Christianity’s influence, even though this effort should attempt the impossible feat of demonstrating Mohammedanism as an organizer of charity and social service.

Some of the developments of their care for the insane in the Middle Ages are very interesting. Before this period closed, there was a custom established at Bedlam by which those who had been insane but had become much better were allowed to leave the institution. This was true, even though apparently there might be no friends to care for them particularly, or to guarantee their conduct or their return, in case of redevelopment of their symptoms. This amounted practically to the open-door system. The authorities of the hospital, however, made one requirement. Those who had been insane and were allowed to leave Bedlam were required to wear a badge or plate on the arm, indicating that they had been for some time in this hospital for the insane. These people came to be known as Bedlamites, or Bedlams, or Bedlamers, and attracted so much sympathy from the community generally that some of the ne’er-do-wells, the tramps and sturdy vagrants who have always been with the world as a problem quite as well as the insane, obtained possession of these insignia by fraud or stealth, and imposed on the charity of the people of the time.

It is easy to understand that wherever these patients were recognized by their badges as having been for a time in an asylum for the insane, they were treated quite differently from ordinary people. Though allowed to leave the asylum, and left, as it were, without surveillance, they were really committed to the care of the community generally. No one who knows the history is likely to irritate a person who has been insane, nor are such people treated in the same spirit as those who are supposed to have been always normal, but out of pity and sympathy they are particularly cared for. They are not expected to live the same workaday existence as mentally healthy individuals, but their pathway in life is smoothed as much as possible. Many an unfortunate incident in modern times is due to the fact that a previous inmate of an asylum is irritated beyond his power to control himself in the ordinary affairs of life by those who know nothing of his previous mental weakness. It is not unlikely that our open-door system will have to be supplemented by some such arrangement as this medieval requirement of a badge, and that we can actually get suggestions from the medieval people with regard to the care of the insane that will be valuable for us.

Another very interesting development of care for the mentally afflicted was the organization of institutions like the village of Gheel in Belgium, in which particularly children who were of low-grade mentality were cared for. This was practically the origin of what has come in our time to be called the colony system of caring for defectives. We now have colonies for imbeciles of various grades, and village systems of caring for them. At Gheel the system developed, it might be said, more or less accidentally, but really quite naturally. St. Dympna was an Irish girl-martyr whose shrine, said to be on the site of her martyrdom, existed in the village of Gheel. Her intercession was said to be very valuable in helping children of low-grade mentality. These were brought to the shrine, sometimes from a long distance, and when the prayers of relatives were not answered immediately the children were often left near the shrine in the care of some of the villagers, to have the benefit of the martyr’s intercession for a prolonged period. As a consequence of this custom, many of the houses of the village came to harbour one or more of these mentally defectives, who were cared for by the family as members of it.