The hostility to cruelty in the late eighteenth century covered so wide a front, ranging from the treatment of soldiers to that of criminals, chimneysweep boys, boxers, women mine workers, and baited bears, that denial of its reality flies in the face of the evidence. It also undercuts the basis of the whole liberal enterprise of the last two hundred years, which has done so much to diminish man’s personal and legal inhumanity to man. One has only to read how the medical profession treated King George III when he went mad—encasing his body in machinery, chaining him to a stake, beating him, starving him, threatening him, blistering and bleeding him, giving him digitalis, tartar emetic, and other noxious medicines—to recognize that the shift to “moral” treatment of the insane was a major amelioration of the human lot, regardless of its practical efficacy in making long-term cures, which admittedly was not great. It is not enough to advance the valid argument that more humane treatment of the insane depended on the revolutionary notion that the loss of reason was neither irreparable nor a cause to treat a human being like an animal, and that the cure depended on treating the mind rather than the body. It is perfectly true that theory determines treatment, but the wide extent of the humanitarian trend is still undeniable.
Foucault and his followers argue that it was the doctors who were behind the great confinement of the insane, where as in fact a better case can be made that they were merely responding to social demand. Society was willing and anxious to pay for incarceration. The private madhouses that sprang up all over England in the eighteenth century were run by entrepreneurs who supplied an expensive need of society. Large numbers of well-to-do families were now willing to pay to have their mentally defective children, or hysterical or merely redundant wives, or senile parents taken care of by someone else, out of sight and out of mind. There was push more than pull at work in the creation of the English private madhouses of the early eighteenth century, and even more in the building of the huge public asylums of the early nineteenth century. Moreover, all the children in school, as well as the insane in mad-houses, were paid for by their relatives or by the parish under the conviction, often fulfilled, that the experience would do them good. As for the helpless poor, some of whom were confined in workhouses, it is hard for anyone who has read about their conditions in eighteenth-century London or in France to believe that their lot has not improved since the age of confinement. This leaves only the poor criminals, and even they, if asked, would probably choose prison rather than the alternative penalties of severe flogging, mutilation, or execution.
Foucault thus provides us with a dark vision of modern society which accords with only some of the historical facts.6 Abstract and metaphoric in expression, unconcerned with historical detail of time and place or with rigorous documentation, Professor Foucault’s work has had an enormous and disturbing influence upon traditional views of recent Western history. By challenging the conventional wisdom of the Whig interpretation, he has forced the historians to turn to a careful investigation of the facts. He deserves full credit for drawing attention to the growth of confinement of a variety of deviants over the past two hundred years, for casting doubt on the motives of professionals, and for focusing attention upon the history of the treatment of insanity. It is he who has set the agenda for the last fifteen years of research.
There are several possible ways of tackling the history of madness. One is by institutional histories of the places of confinement, the private madhouses and their successors the public asylums. Another is by a study of ideas about madness, particular types of madness, and how to treat them, in order to display changes in the underlying conceptualization of the mind/body problem, and changing roles of revealed religion, magic, and scientific medicine. A third is by seeking out the rare records of the host of unqualified practitioners, to see how they regarded patients, how their patients regarded them, who those patients were, and what treatments they were prescribed.
One type of madness, so-called “possession” in the sixteenth and early seventeenth centuries, has been made the subject of a brilliant little book by D.P. Walker, the implications of which are very far-reaching. Possession was a species of madness which could only be dealt with by magical means, since it was thought to be the involuntary occupation of an individual by a devil. The marks of possession were speech in an unknown language, knowledge of hidden secrets, supernatural strength, and horror at the use of sacred objects or words. Many of the possessed denounced their neighbors as witches, which led to the death of many innocent people. If fraud was not involved, the only possible explanation for such symptoms were possession by the devil, or some physical disease, such as epilepsy or hysteria. The Catholics chose the devil theory, and threw him out by the use of exorcism, a magical process using the Eucharist and other sacred objects and words to put the devil to flight; and the treatment often worked. Protestants, who believed that miracles had ceased with the apostles, had no such remedies to offer to the possessed.
Medical practitioners hastened to fill the void, for example in 1589 when the Throckmorton children were diagnosed by Dr. Barrow of Cambridge University as bewitched, on the basis merely of a urine specimen. The children caused the executions of three members of a family as witches, before “these abominable little girls,” as Dr. Walker rightly calls them, decided that the game had gone on long enough. Belief in possession was closely linked to belief in witch-craft. In 1600 a number of English writers were casting serious doubts upon possession as anything more than a mixture of melancholy and ambition for notoriety by young girls, working upon a popular belief in the stereotype of the witch as “an old weather-beaten crone, having her chin and her knees meeting for age…going mumbling about streets, one that hath forgotten her pater noster and hath yet a shrewd tongue in her head.”
But denial of the reality of possession led to denial of the reality of the devil, and denial of the reality of the devil was an encouragement to atheism, for “if no devils no God.” Dr. Walker suggests that women were particularly liable to possession since it was the only way they could draw attention to themselves, and get the chance to preach to a large audience. But in the long run the rejection of miracles by Protestants led to skepticism about possession; skepticism about possession led to skepticism about devils; skepticism about devils led to skepticism about witches; skepticism about witches led to a more rational religion; and a more rational religion opened the way to the development of early modern science. As John Aubrey remarked at the time, “Printing and gunpowder have frightened away the fairies.”
This is therefore a little book with brilliant insights and far-reaching conclusions, which do not differ in any major way from those of Keith Thomas in his Religion and the Decline of Magic. Dr. Walker has provided a superb case study of the transformation of the way early modern man looked at the world around him and how the medical profession established its hegemony over the treatment of madness. The only criticism one can make is that he is unreasonably rationalistic in his charges that most of the possessed were guilty of fraud rather than suffering from genuine psychosomatic disturbances.
Another way to approach the history of madness is to investigate the vast underworld of unlicensed practitioners—wise men or women, magicians, astrologers, amateur clergy, and downright quacks. Taken all together, it is clear that in the towns the total number of these practitioners per capita was very large indeed, even by modern standards, perhaps as high as one per 250 to 400 inhabitants. The quantity was therefore ample, whatever may be said about the quality of the treatments prescribed. In sixteenth- and seventeenth-century England, even country people had someone to turn to—more often than not an unlicensed practitioner—within five miles.7 The problem for the historian, however, is to find out about these practitioners and their patients, since the former did not normally keep records, and if they did they tended to be destroyed.
Every now and then, however, an inquiring scholar stumbles across some unknown and revealing cache of documents, and if he has the imagination to see the possibilities (and the stamina to carry out the enterprise) he stakes out his claim and starts digging. About ten years ago, Professor Michael Mac-Donald found one such gold mine—a series of detailed casebooks of 60,000 consultations over a period of thirty-seven years from 1597 to 1634, kept by the most popular practitioner of both physical and psychiatric healing we know of in early seventeenth-century England. What makes this study so important is not only the scale and detail of the documentation but also the intellectually ambiguous position of the practitioner himself, the Reverend Richard Napier.
Napier was teetering unsteadily on the edges between magic, astrology, alchemy, religion, and the contemporary medical pharmacopeia, and was uncertain in his own mind where truth and efficacy lay. He was a learned Anglican theologian—a Master of Arts of the University of Oxford, and the parson of a rural parish in Buckinghamshire. He was an astrologer who told horoscopes. He was an alchemist, a mathematician, and a conjurer of spirits, using an archangel as a medium. He was, as Professor MacDonald claims, one of the last Renaissance magi, an expert in a whole series of now wholly discredited but at the time highly sophisticated and respected intellectual systems, Galenic, Rosicrucian, alchemical, Hermetic, cabalistic, Neoplatonist, and also Christian. To some contemporaries he was suspect as a “necromancer,” a “conjurer,” whose activities were challenged by the “piss-prophets,” the professional doctors with their urine specimens.
His eclectic notion of causation was soon to be dissolved in the light of the new Baconian scientific method, the new Newtonian scientific theory, and the new Latitudinarian and rationalist religious atmosphere of the post-Restoration period. The Reverend Richard Napier would not have fitted easily into the world of Samuel Pepys and King Charles II. He was a product of a specific period of history: one of home care rather than confinement, of amateurs rather than professionals, and of therapeutic eclecticism rather than pseudo-scientific medicine. He is important both as an exemplar of the intellectual climate of the early seventeenth century and also as a careful note-taker who opens a window for us on a hither-to unknown world, that of the humble, or not so humble, patients themselves, of whom this book deals only with those who were psychologically disturbed rather than physically ill. Napier’s clients were drawn from those classes able to afford to pay his modest fees of six to eighteen pence per consultation—that is, the top three quarters of the population, excluding the very poor. Half of them came from within ten miles, and almost all from Buckinghamshire or neighboring counties. They are thus a good sample of a rural population not too far from London.
Many of these objections have been raised by H.C.E. Middelfort, "Madness and Civilization in Early Modern Europe," in After the Reformation: Essays in Honor of J.H. Hexter, edited by Barbara Malament (University of Pennsylvania Press, 1981).↩
M. Pelling and C. Webster, "Medical Practitioners," in Health, Medicine and Mortality in the Sixteenth Century.↩
Many of these objections have been raised by H.C.E. Middelfort, “Madness and Civilization in Early Modern Europe,” in After the Reformation: Essays in Honor of J.H. Hexter, edited by Barbara Malament (University of Pennsylvania Press, 1981).↩
M. Pelling and C. Webster, “Medical Practitioners,” in Health, Medicine and Mortality in the Sixteenth Century.↩