• Email
  • Single Page
  • Print

Madness

Unclean Spirits: Possession and Exorcism in France and England in the Late Sixteenth and Early Seventeenth Centuries

by D.P. Walker
University of Pennsylvania Press, 116 pp., $16.00

Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England

by Michael MacDonald
Cambridge University Press, 323 pp., $39.95

Health, Medicine and Mortality in the Sixteenth Century

edited by Charles Webster
Cambridge University Press, 394 pp., $45.00

Madhouses, Mad-Doctors, and Madmen: The Social History of Psychiatry in the Victorian Era

edited by Andrew Scull
University of Pennsylvania Press, 384 pp., $9.95 (paper)

1.

During the last fifteen years, a series of semi-independent intellectual trends have come together to transform the history of what society has thought about madness and how it has treated those it considers mad. Once upon a time, the history of medicine was regarded, like that of pure science, as largely “internalist,” a story of how a progressive endeavor by a handful of gifted intellectuals slowly replaced superstition and error by empirical proven truth. More recently, however, historians of both science and medicine have begun to fit the protagonists in these ancient intellectual battles more deeply into their social settings. In the process, they have revealed a welter of unproven pseudo-scientific theories, professional or national rivalries, institutional jealousies, personal and professional ambitions, cultural conditioning, sexist and racist prejudices, political exigencies, economic incentives to save money, and religious biases, out of which new and powerful scientific and medical paradigms have emerged.

Some now argue that medical progress has been a power grab by the medical profession, and institutional treatment for the purpose of better care has been relabeled the “great confinement.” It is now credibly believed that hospitals were lethal death traps before Pasteur demonstrated the importance of a sterile environment. It is now also generally recognized that doctors may—presumably unwittingly—have killed more patients than they cured, certainly before the early nineteenth century, and maybe before the invention of anti-biotics in the mid-twentieth, and that their most valuable contribution to public welfare was psychological reassurance that help was on its way.

The most ambitious attempt ever made to examine the demography of early modern England concludes that the prolonged growth of population which began in the 1740s and only petered out during the last few years owed little, at any rate in its early stages, to a decline in the mortality rate. Medicine, therefore, can have had no part in the beginnings of the great demographic transition.1

The beneficial effects of the medical profession are now thrown into doubt, and scientists generally are no longer regarded simply as wise men battling the mysterious forces of nature with supremely elegant conceptual thinking, and incredibly patient and exacting testing and retesting of data. Newton is now known to have been as concerned to establish the measurements of the temple of Solomon or to unravel the meaning of the Book of Revelations as he was to elucidate the laws of gravity or optics. James Watson’s frank disclosures in The Double Helix of the strength of personal ambition as a compelling motive behind scientific research has forever destroyed the image of the detached scholar selflessly dedicated to the pursuit of truth. The self-evident fact that exploitation by politicians of the recent discoveries of nuclear physicists is quite likely to result some time in the next few decades in the destruction of civilization, and possibly of most life on earth, merely reinforces this atmosphere of cynicism and suspicion.

The second trend has been a turning away from the history of elites, whether intellectual or political, to the history of the poor and downtrodden, a trend in which the nature of surviving documentation has inevitably also led to a focusing on social “deviants,” such as homosexuals, criminals, and the insane. One effect of this more catholic approach has been, in the case of the history of medicine, no longer to limit it to the study of orthodox medicine (as practiced, in England, by the members of the Society of Apothecaries and the Colleges of Physicians and of Surgeons) but to include also popular medicine, which antedates Galen and continues to this day to be far more widely used than orthodoxy likes to admit. Some of its practitioners were wise women, white witches, whose full significance has only emerged as a byproduct of yet another contemporary trend, a sudden revival of interest in the irrational in general and witchcraft in particular. Today the distinction between magic and science is no longer as clear-cut as it used to be, now that seventeenth-century science is seen as emerging from a strange brew compounded of Hermeticism, alchemy, and astrology.

Finally, interest in problems associated with madness and its treatment have been stimulated by the writings of Michel Foucault.2 According to him, the whole post-Enlightenment attempt to treat the mad more humanely, and to devise positive ways to cure them, was largely an aspect of a drive to confine and isolate all deviants in society, to lock them up and throw away the key. It was part of what he calls “the great confinement,” other parts being the extensive growth of workhouses, schools, and prisons. In the eighteenth century, he says, the mad replaced the medieval lepers in isolation hospitals on the out-skirts of cities. There is, he claims, an identical attitude of mind behind the treatment of the two, and the places of isolation were the same.

Foucault is certainly correct that Enlightenment hopes of devising ways to reform criminals or cure madmen through incarceration have proved a gigantic failure. Today no one really knows what to do with either, except to lock up the former and drug the latter. Yet the residual belief remains that a test of the moral worth of a society is the way it treats its more impotent members, the indigent, the sick, and the mad. The battle has thus been joined between post-Enlightenment optimism about the power of society to provide remedies for human pain and suffering, and a cynical suspicion that any change is liable to be for the worse. The former effort reached its apogee in the mid-twentieth-century welfare state, and in America with President Johnson’s “Great Society.” Today, in 1982, there has re-emerged the older, more pessimistic view that nothing much can or should be done, and that whatever is done is morally corrupting to the recipients and financially crippling to the donors. So far as the mad are concerned, we are just about where we were five hundred years ago, when, in about 1450, a lord mayor of London concluded that “some be restored unto their wit and health again. And some be abiding therein for ever. for they be fallen so much out of themselves that it is incurable unto man.”3

What is not by any means so certain, however, is whether there is any firm basis in reality to Foucault’s vision of the “age of confinement.” Was there a major disjunction in Western treatment of deviants in about 1650, based on a new principle that madness is shameful, and that the best treatment is forcible isolation from society under management by professionally trained doctors? If this is so, was it merely the result of a conspiracy of professionals to seize power for themselves to lock people up and determine their treatment? That there was a trend toward confinement is undeniable, but the motivation is questionable. The mad were put into institutions at least partly in order to save them from exposure to greater cruelties at the hands of the public or their families. In any case, the few dangerously mad had been locked up in cages like animals from at least the late Middle Ages. So far from being isolated were the twenty-odd manacled madmen gibbering and rattling their chains in their filthy cages in Bedlam, one of the great tourist attractions of London from the early sixteenth century to the early nineteenth. It was one of the standard sights of the city, on a par with the royal tombs at Westminster Abbey, the lions prowling in the moat in the Tower of London, the flogging of half-naked whores at Bridewell, and the bull- and bear-baiting over the river at South-wark.

It has also been pointed out that there were enormous differences in the degree and organization of incarceration from country to country, England leading the way in private madhouses in the eighteenth century, and France in huge state-supported institutions. Moreover, the chronology is complicated, since the poor were the first to be incarcerated in large numbers in the seventeenth and eighteenth centuries, but the mad only in the nineteenth. In England in 1810, the total number of mad persons in confinement was only 2,500 out of a population of 9 million, or about 30 per 100,000, and the numbers did not begin to rise rapidly until the 1830s.

Foucault’s comparison of treatment of the mad during the early modern period and that of lepers during the Middle Ages does not stand up to close examination. Early modern madhouses were not disused leprosaria but evolved out of medieval hospitals, based on Arab models. Bethlem Hospital, or Bedlam, is one example. Lepers were condemned to lifelong isolation from the community, whereas very large numbers of the mad have always quickly come and gone. During the year 1788, for example, Bedlam held 282 different inmates, but it admitted 219 and discharged 205.4 This transit camp of the mind, with its constant turnover, was entirely unlike the lifelong prison of the medieval leprosarium.

Finally, Foucault’s attempt to link the treatment of schoolchildren, the poor, criminals, and the insane under a single conceptual umbrella, since all were subject to confinement, is both unhistorical and misleading. No serious scholar would doubt that the poor, in or out of workhouses, have been substantially relieved of the crushing burden of indigence in the last two hundred years, or that children, at least up to the 1960s, were increasingly better educated, and thus better prepared to take their place in society and better able to improve their chances in life. Moreover, poor parents willingly paid money to send their children to school, since they knew it gave them moral precepts, behavior discipline, and learning skills that would come in very useful in later life. Whether criminals and the insane have either benefited or suffered much from incarceration is an open question.

The central challenge of the Foucault model is to the humanitarian values and achievements of the eighteenth-century Enlightenment. The acute sensitivity to cruelty, and the vaulting ambition to cure social ills by the use of planning and science, were first made possible by the decline of religious faith in the late seventeenth and eighteenth centuries, which opened the way to a more secular view of human ills and their possible amelioration. Sins against the Holy Ghost and violations of God’s law such as heresy now took a lower priority than acts that were harmful to sentient creatures. It has to be admitted, however, that this desacralizing of traditional morality also opened the way to the use of cruelty as a value-free means to secular ends—political for Machiavelli, sexual for Sade, racial for Hitler. 5

Despite these possibilities, the Enlightenment was a force that in Western Europe resulted in the substitution of imprisonment for torture, mutilation, or death as the main punishment of poor criminals; the abolition of the slave trade; the reform of conditions in the prisons, which reduced opportunities for hideous cruelty (as well as those for easygoing tolerance of irregularities); the reduction and final abolition of the appalling floggings (up to 1,000 lashes) which were common in the armed forces; and the introduction of moral therapeutic methods of treatment of the insane.

  1. 1

    E.A. Wrigley and R. Schofield, The Population History of England 1541-1871 (Harvard University Press, 1982), p. 484, note 60. I confess I find this argument dubious.

  2. 2

    M. Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (Pantheon, 1965).

  3. 3

    P. Allderidge, “Management and Mis-management at Bedlam, 1547-1633,” in Health, Medicine and Mortality in the Sixteenth Century, p. 144.

  4. 4

    London Chronicle, 1788, p. 294.

  5. 5

    J. Shklar, “Putting Cruelty First,” Daedalus, Summer 1982.

  • Email
  • Single Page
  • Print