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

These desiderata are so absolutely modern that they have only been formulated definitely with the beginning of the twentieth century. Notwithstanding this apparent newness, I think that it will not be difficult to show that the old-time methods of caring for the insane partook, to a greater degree than would be suspected at the present time, of these desirable qualities that modern science has come to recognize as so indispensable for the rational care of the mentally unbalanced. In saying this I do not wish to claim for the Middle Ages accomplishments beyond their deserts. My idea is rather to write an interpretation; to make clear from what we know of the details of the care of the insane in the fourteenth and fifteenth centuries, that unconsciously those generations, in their large-hearted charity, anticipated what is best in our present system.

The first record in English medical literature of a home for the insane is that of Bethlehem Royal Hospital, London, which has become famous under the familiar shortened name of Bedlam, meaning a house or place of confusion. Bethlehem was a general hospital into which during the fourteenth century insane patients were admitted. There is a historical record to the effect that at the beginning of the fifteenth century a royal commission [{373}] investigated the methods of treating the insane in vogue there, because there had been complaint of abuses in the institution. Practically every century since there have been written corresponding records of similar investigations. The trouble seems always to have been that there were too few attendants properly to take care of insane patients, and thus they had to be placed in confinement in various ways, which inevitably led to abuses.

For a generation or longer after each exposure by a committee of inspection, the evils of this system would be more or less tolerable; then they would become unbearable once more and another investigation would be demanded. I would like to feel that we have progressed in all respects beyond these hit and miss methods, but any one familiar with the present situation in the matter is quite well aware that there are still many abuses that need correction, and inspection committees find many suggestions to make and sometimes gross evils to stigmatize.

Bedlam seems, however, to have always been as well and as humanely conducted as the spirit of the times demanded. It must not be forgotten that according to well authenticated tradition, a very large part of the hospital's income was obtained by the collection of fees for the admittance of visitors who came to be amused by the vagaries of the insane. The number visiting the asylum for this purpose must have been enormous, for, though only a penny was charged for admission, the resulting revenue is said to have amounted to four hundred pounds sterling a year, showing that nearly one hundred thousand persons had visited the institution.

From generations that were pleased to derive morbid amusement out of the misfortunes of others, humanitarian [{374}] care of the insane could not be reasonably expected; but in view of this custom it is difficult to understand how there could have been at this period any great abuse of patients, in the matter of severe punishments or inhuman restraint.

Some of the customs of the old-time hospitals were interesting. It was believed that the one chance for an insane patient to recover lay in trusting him somewhat, allowing him even to go unattended outside the walls at times. Patients in Bedlam were permitted to go out alone after they improved in health, and if they were poor they were allowed to obtain their living by means of begging. In order that they might more easily work upon public sympathy, they were permitted to wear tin plates fastened to their arms. The wearers of these were called "Bedlams," or "Bedlamites" or "Bedlam beggars," and tradition says that they received much more consideration than ordinary beggars.

It may appear that this was dangerous liberty, but the ordinary person is apt to consider as dangerous the open door treatment of the insane which most alienists now hold to be the most commendable feature of present day treatment. It seems reasonable that to permit patients to go into the open air and sunshine was better than confining them in the hospital, and doubtless the insignia which they wore especially commended them to the care and alms and sympathy of the people.

Much has been said with regard to the alleged neglect and abuse of the insane during the period of exorcism, because of the misunderstanding of the cause of the disease. There are persons who consider neurasthenia and major-hysteria as more or less modern forms of nervous diseases, but it is more than probable that they [{375}] existed with considerable frequency in the olden time. Many of these cases would be cured by strong suggestions, that is, by the treatment usually given to supposed possessed persons, and as we know that the best possible treatment for certain forms of major-hysteria is to frighten the patient (the earthquake at San Francisco cured a dozen persons who had not been regarded as able to walk, some of them for years), it is probable that a goodly number of the patients of the past were cured by the rather heroic measures sometimes devised. Sir Thomas More mentions such cases, and though himself eminently humane, commends this method of treatment "in which such patients were severely scourged and thoroughly aroused from their willfulness."

When psychiatrists talk slightingly of the old-time methods of caring for the insane, it is well to recall that, considering the conditions and limitations of scientific knowledge, they seem to have done very well in those times. It has been the custom of critics to hold up to ridicule that insane patients were sometimes taken to special shrines in order that their ills might be cured by the direct interposition of Heaven; or that the devil supposed to possess them, might be driven out. It must not be forgotten, however, that such procedures were of supreme utility in mild cases viewed merely from the human standpoint, and without any appeal to the supernatural. The journey to a favorite shrine, undertaken under conditions that gave variety to life and new interests, together with the hope aroused while there, were sufficient to help the patient physically and, not infrequently, mentally.

Some of the most distinguished specialists in mental diseases in Germany, France and England are on record [{376}] as believing that one of the most helpful agencies in the relief of certain symptoms of mental disturbance, and even the cure of milder forms of insanity, is confidence in the Almighty as expressed by prayer. At a meeting of the British Medical Association two years ago, this idea was expressed very forcibly by a distinguished specialist, and was concurred in by a number of those at the meeting of the Section on Mental Diseases. He said: