Early Modern Europe to the Seventeenth Century

In this period, no single approach to the problem of insanity dominated. Although categories of insanity in the Renaissance derived mainly from the classical system of mania, melancholy, and dementia, which were based on the broad medical doctrine of bodily humors, the implications were diverse in practice. Physicians and lay people alike typically depicted mad persons as wild beasts, devoid of reason. Brutal handling of the insane was commonplace. Yet a pattern of hospital care for the insane had been emerging since the late Middle Ages. The famous English hospital of St. Mary of Bethlehem, later known as "Bedlam," was founded in 1450 as an institution to care for those who had "fallen out of their wit and their health." Moreover, in that age a belief prevailed that melancholies and some mad persons held powers similar to those of saints, such as talking in tongues and prophesying. Erasmus himself wrote that Christianity is a form of madness. This tradition stemmed from the rediscovery of Plato's teachings, that human beings are compound beings, part heaven and part earth. When the organic part is disturbed, as in madness, the soul becomes partially liberated. Poets, seers, and lovers might all exhibit true mania. And because this was a time when religion infused everyday life, visions were not rejected as deformed thoughts of diseased minds. Rather, they were embraced as tangible manifestations of a divine imiverse that was otherwise liminal.

More to the point, religion, magic, and medicine in this eclectic age were viewed as overlapping - not incommensurate - domains. Loss of reason was attributed to any combination of natural illnesses, grievous misfortunes, evil spirits, and deeds so sinful as to incur God's direct wrath. Insanity thus became the proper business of astrologers as well as physicians, and of clergymen as well as lay adepts. Moreover, these roles often merged. A healer of sick souls might offer counseling to assuage a spiritual affliction in combination with a therapeutic regimen to restore a humoral balance. A course of physic might be accompanied by a magic spell and implemented according to the patient's horoscope. For the Renaissance doctor, an individual instance of madness was a thorny interpretative challenge, for its meaning might be located in bodily corruption, in devilry, or even in the signs of sainthood.

These entangled threads, however, pull apart in the seventeenth century as a consequence of intellectual and social revolutions. A foundation was being constructed for a naturalistic interpretation of insanity that would eventually overshadow supernatural and religious frameworks. First, the scientific revolution that culminated in the work of Francis Bacon and Isaac Newton placed science and the experimental method at the forefront of human achievement. The universe was beheld as a clockwork whose structure and mechanism could be understood - and eventually manipulated — by rational human investigation. As the macrocosm could be found in the microcosm, such investigations explored the physiology of the human body; the most notable was William Harvey's demonstration of the function of the heart and circulatory system.

Attention was also drawn to the mechanisms by which the soul commanded the body-the search was on for the sensorium commune, the organ that might mediate between passions, sensations, and body humors. The pineal gland, the organ suggested by René Descartes during the first half of the seventeenth century, was one of many candidates proposed at the time. Descartes's philosophical tour de force of dualism, although known for its splitting the analysis of mind from the analysis of body, nonetheless spurred research into the somatic mechanisms that commute a volition into an action. The seventeenth-century work of Thomas Willis, who is often considered the father of neuroanatomy, stands out for its pioneering efforts to place the brain at the center of human action - and disease. For example, Willis's studies on women with hysteria led him to conclude that the disease originated in the brain, not in the uterus, as maintained in classical doctrine. His teachings, later expanded by such students as John Locke, directed investigators to uncover the role of the nervous system as the basis of human experience and knowledge. Paralleling the interest in the somatic mechanisms of self was a focus on the range and force of the passions. Of special interest were the late-sixteenth- and early-seventeenth-century physicians Thomas Wright, who discussed how patients' mental states could be critical to their recovery from illnesses, and Robert Burton, whose Anatomy of Melancholy (1621) stressed the psychological causes and cures of insanity.

Major social upheavals were also underway. Following the midcentury English Revolution, in which religious enthusiasts temporarily gained power, respectable people repudiated religious fanaticism in all its forms. Embracing the rationalist worldview of scientists and natural philosophers, the educated classes ridiculed astrologers and empirics, in the process abandoning therapies based on religious and magical means. The way was clear for the nascent scientific communities to construct new interpretations of health and illness. In turn, the consolidation of the naturalist model had important consequences for the cultural boundaries of insanity. During the Reformation, Puritan ministers often demonstrated the powers of their practical divinity by healing sick souls. Considering themselves "physicians of the soul," they led afflicted individuals through intense rituals of community prayer and healing fasts. Such potentially helpful ties between learned religion and popular culture were lost, however, in the rush to remove demons from psychopathology.

In addition, the naturalist model allowed for a novel form of ideological warfare. Where Anglican pamphleteers might be labeled heretics by their religious enemies, the favor was returned when they denounced these foes as sufferers of a mental disease. Madness thus emerged as a form of "counterreality," an appellation that marginalized the religious fanatics who so recently had destabilized the nation. Before the Restoration, a time when talking directly to God was still thought possible, hallucinations and delusions were not especially important signs of insanity. Afterward, however, such experiences were considered the very essence of madness. In the hierarchical world order before the Revolution, it was one's willingness to obey that determined one's insanity. In the new political order, which was constructed around innovative theories of social contract and willful association, it was the inner choices behind assent that were open to dispute and control. Not yet sorted out, however, was the exact role that physicians would play in constructing, and responding to, this new "counterreality."

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