The Popes and Science / The History of the Papal Relations to Science During the Middle Ages and Down to Our Own Time

by James J. Walsh

Personally, I was very much surprised some years ago, while collecting material for a paper to be read before the International Guild for the Care of the Insane, to find how many things that are most modern in our methods of treating the insane, and that are among the desiderata which are universally conceded to be most necessary for the improvement of present conditions in our management of mental diseases, were anticipated by the generations of the thirteenth to the fifteenth centuries. It is not hard, for instance, to show that such eminently desirable conditions as the [{367}] open door for mild cases, the combination of the ordinary hospital with a ward for psychic cases, the colony system for the treatment of those of lower mentality, were all in existence in the Middle Ages and did good work. The colony system particularly, as it comes to us from the Middle Ages, has recently been studied very carefully, and this has given us many valuable hints as to the methods that will have to be adopted in other countries in modern times.

The conditions which developed at Gheel in Belgium have deservedly attracted much attention in recent times, and have been the subject of articles in the medical journals of nearly every country in the world, because of the poignant realization by our generation that large institutions, meaning by this large single buildings or closely associated groups of buildings, are very unfavorable for the care of the insane. In America, one of these articles was published in the Journal of Nervous and Mental Diseases, and a second, written by my friend, Dr. Jelliffe, who is the Professor of Mental Diseases in Fordham University School of Medicine, was written after a special visit paid to Gheel by him, in order to investigate conditions there. Though the situation at Gheel now is practically identical with that which originated there at least five centuries ago, there are many who consider that similar conditions would be ideal for the treatment of certain classes of the insane even in our own day. It is this sort of interpretation of the work of these old-time philanthropists and physicians that we need, and not the cheap condemnation which makes it necessary for us to begin all over again in each generation.

In the light of this unexpected revelation and the [{368}] consequent revolution of thought it suggests, a short review of the treatment of the insane will not be out of place. It is usual for our self-complacent generation to consider that it was not until our own time that rational measures for the care of the insane were taken. Most of the text-books on mental diseases that touch at all on the historical aspects of the treatment question, are apt to say that the evolution of methods for the treatment and cure of the insane might be divided into four historical periods: First, the era of exorcism, on the theory that insane patients were possessed of devils. Second, the chain and dungeon era, during which persons exhibiting signs of insanity were imprisoned and shackled in such a manner as to prevent the infliction of injury upon others. Third, the era of asylums. Fourth, the present era of psychopathic wards in general hospitals for the acutely insane in cities, and colonies for the chronic insane in the country, which is only just beginning to develop.

From this classification, the ordinary reader would suppose that nothing at all was done for the insane during the first two periods, except exorcism in one and confinement in the other. As a matter of fact, the number of the harmlessly insane has always been much larger than the violent, and the latter, indeed, constitute only a very small portion of the mentally ailing at any period. Exorcism, as a rule, was applied only to the violent and to the hysterical. In the asylums at all times there were a number of patients who were not chained or confined to any great degree, and unless one had shown some special violent manifestation, severe measures were not taken. It is the treatment of the great mass of the insane rather than of the few [{369}] exceptional cases, that must be considered as representing the attitude of mind of the generations of the Middle Age toward the mentally afflicted, and not what they found themselves compelled to do because of their fear and dread of violence.

For those who were mentally afflicted in a mild degree, abundant suitable provision was made by the generations of the fourteenth and fifteenth centuries. When historical writers suggest the contrary, they are only making one of the usual assumptions from ignorance of the details. Because in some cases insanity was supposed to be due to possession by the devil, to say that, therefore, in all cases no provision was made for the insane is nonsense. It is comparatively easy to find, from records of the hospitals of the fourteenth and fifteenth centuries, that there were what we now call psychopathic wards for the acutely insane in the cities, and some colonies for the chronic insane in country places.

Knowing nothing of this, Prof. White, for instance, says: "The stream of Christian endeavor, so far as the insane were concerned, was almost entirely cut off. In all the beautiful provision during the Middle Ages for the alleviation of human suffering, there was for the insane almost no care. Some monasteries indeed gave them refuge. We hear of a charitable work done for them at the London Bethlehem Hospital in the thirteenth century, at Geneva in the fifteenth, at Marseilles in the sixteenth, by the Black Penitents in the South of France, by certain Franciscans in Northern France, by the Alexian Brothers on the Rhine, and by various agencies in other parts of Europe; but, curiously enough, the only really important effort in the Christian Church [{370}] was stimulated by the Mohammedans." This last clause is a slur on Christianity absolutely without justification. As is true for all broad generalizations, to ignore thus the work of caring for the insane and the methods employed in earlier times, amounts to deplorable injustice to generations whose provision for the sick of every class was not only much more abundant, but more rational and complete, than it has been our custom to recognize and acknowledge. The earliest city hospitals that we know of were due to the fatherly care and providence of that great Pope, Innocent III., whose pontificate (1198-1213) has been more misunderstood than perhaps any corresponding period of time in history. It was Virchow, the great German pathologist, whose sympathies with the Papacy were very slight, and whose attitude in the Kulturkampf in Germany showed him to be a strenuous opponent of the Papal policy, who paid the high tribute to Pope Innocent III. which we quote in the chapter on the Foundation of City Hospitals. It was in connection with these hospitals founded by Pope Innocent III., or the result of the movement initiated by him, that the insane were cared for at first. This may seem to have been an undesirable method, but at the present time there is an almost universal demand on the part of experts in mental diseases for wards for the mentally diseased in connection with city hospitals, because admission is thus facilitated, treatment is begun earlier, the patient is not left in unsuitable conditions so long, friends are readier to take measures to bring the patient under proper treatment and surveillance, and, as a consequence, more of the acutely insane have the course of their disease modified at once, and more cures take place than would otherwise be possible. Of course, this was [{371}] not the idea of the original founder of the medieval hospitals, or even the conscious plan of those who were in charge. They had to take the mentally infirm because there was nowhere else for them to go at that time. As a matter of fact, however, their simple method of procedure was better in the end for the patient than is our more complex method of admission to insane asylums, with its disturbing necessity for formal examination of the patient under circumstances that are likely to increase any excitement that he may be laboring under. And the transfer to an institution bearing the dreaded name of asylum, or even sanitarium (for that term has taken quite as ominous a meaning in recent years) is sure to aggravate the patient's irritated state, and to exaggerate symptoms which might otherwise be relieved by prompt, soothing care, and by the consciousness that his ailment is being treated rather than that he himself is being placed in durance.

An examination of the methods for the care of the insane in the Middle Ages brings out clearly the fact, that the modern generation may learn from those old Catholic humanitarians, whose hearts and whose charity served so well to make up for any deficiencies of intellect or of science the moderns would presume them to have labored under. There are said to be three great desiderata for the intelligent care for the insane:

First: The open door system, permitting patients who are not violent, and who can be trusted even though they have many queer notions, to come and go at will.

Second: The after care treatment of those who have been insane, to the end that they may not be compelled to go back to strenuous lives of toil; and above all, that they [{372}] may not be forced into the too harrassing conditions of which their mental breakdown originally was born.

Third: A colony system by which patients of lowered intelligence may be cared for in the country, far away from the stress of city life, and where, without the cares of existence pressing upon them, they may be surrounded by gentle, patient, kindly friends who will make every allowance for their peculiarities and strive to help them in their up-hill struggles.