Madness in Civilization

What we call madness is as much a mirror reflecting society’s fears, values, and biases as it is a description of those who are labeled mad.

1. Madness: Divine Punishment or Bodily Imbalance?

Traditionally, madness has been explained in two ways: as a divine curse or as an imbalance within the human body. Early Judeo-Christian societies viewed madness as a consequence of sin or disobedience to God. This belief often turned those affected by mental illness into outcasts or objects of fear. Biblical figures like King Saul were said to have been struck by madness as divine punishment, emphasizing the idea that such afflictions had spiritual causes.

In contrast, the ancient Greeks and Romans embraced physical theories. Their understanding of the human body focused on the balance of four fluids or humors: blood, phlegm, yellow bile, and black bile. This scientific perspective led to treatments centered on physical wellness, such as dietary changes and exercise, which were intended to restore balance in the body and, consequently, in the mind.

The dichotomy between divine punishment and physiological causes shaped centuries of thought. Even today, these ideas persist in varying ways, from those who see mental illness as evidence of weakness or moral failings to those who seek purely chemical cures.

Examples

• King Saul’s divine punishment for disobedience in the Bible.
• Greek physicians treating madness by recommending a balanced diet and exercise to regulate humors.
• Roman medical practices relying on the same bodily-balancing theories for mental health treatment.

2. Arabic Medicine: Preserving Knowledge and Innovating

During the Arab conquests of the sixth century, a huge repository of medical knowledge was lost in the destruction of the Persian Empire. Yet, by the fall of the Byzantine Empire in the fifteenth century, attitudes had shifted. The Ottomans took great interest in preserving and building upon medical texts originating in Greek, Roman, and Byzantine traditions.

Arabic medical scholars not only studied earlier theories but also added their cultural insights. For instance, they introduced the belief in jinns as possible causes of mental distress but balanced these ideas with evidence-based practices drawn from Greek texts. This synthesis created a bridge between supernatural and physiological understandings of mental illness.

Their crowning achievement, The Canon of Medicine by Avicenna, compiled all known medical knowledge and became a fundamental resource worldwide. Used as a medical textbook up until the eighteenth century, it underscored the enduring impact of Arabic contributions to the science of mental health.

Examples

• Avicenna's Canon of Medicine summarizing centuries of medical knowledge.
• Use of mixed Arabic and Greek approaches, combining supernatural explanations with physical remedies.
• Preservation of Byzantine texts after the fall of Constantinople, allowing medical knowledge to flourish globally.

3. The Enlightenment: Madness in Science, Religion, and Art

The Enlightenment brought reason and science to the forefront, but its coexistence with persistent superstitions created tension. Philosophers like Voltaire questioned religious explanations of madness, yet fear of public ostracism often kept them from openly challenging established beliefs, particularly those involving witchcraft and demons.

Witch hunts during this period highlight how superstition coexisted with budding rationalism. Women and others with mental disorders were labeled as witches and executed. At the same time, mental illness became a popular theme in art and literature, reflecting the Enlightenment’s attempts to grapple with existential questions about human nature.

An enduring symbol of this period is Shakespeare’s portrayal of madness in works like "King Lear," which explored the human condition through themes of loss and betrayal. Similarly, dramatists like John Fletcher depicted how mental suffering reflected broader societal problems.

Examples

• The execution of up to 100,000 people during the witch hunts of 1450–1750.
• Albrecht Dürer’s engraving "Melancholia I," which linked madness with creativity.
• Shakespeare’s "King Lear," portraying madness as a result of human trials rather than supernatural causes.

4. Neglect and Cruelty Toward the Mentally Ill

From exorcisms to outright shunning, society historically treated the mentally ill with cruelty and neglect. They were often marginalized and vilified, cast out to live on the streets or subjected to harmful practices like forced exorcisms. These treatments reflected ignorance and a lack of compassion.

For example, in Catholic Europe, schizophrenia and other disorders were interpreted as demonic possession, leading to dangerous and ineffective exorcisms. Such methods persisted because failures were attributed to the supposed strength of the possessing demon or the patient’s lack of faith, rather than the treatment itself.

This history highlights an unwillingness to face the reality of mental illness. Without adequate diagnosis or understanding, sufferers were left to their own devices, often experiencing severe hardship or even death.

Examples

• Forced exorcisms administered to people believed to be possessed.
• Mentally ill individuals roaming the streets, relying on charity to survive.
• Punishment or execution of those deemed mad to appease societal fears.

5. Bedlam and the Rise of Asylums

The British Bethlehem Hospital, nicknamed Bedlam, became infamous for its brutal treatment of the mentally ill. Originally intended to provide care, it quickly became a symbol of societal failure, offering conditions so inhumane that residents were chained, beaten, and left exposed to starvation and the elements.

While asylums like Bedlam removed individuals with mental illness from society, this isolation often turned them into objects of scorn or entertainment. Wealthy families used them to hide relatives who could tarnish the household’s reputation, often paying large sums to do so. These unregulated institutions allowed their operators to profit from the misery of both patients and families.

Although created with the intent of correction, asylums became places where suffering was institutionalized. This marks a grim chapter in society’s attempts to address mental health.

Examples

• Patients at Bedlam chained and stripped of clothing, enduring physical abuse.
• Wealthy families paying operators like Sir William Battie to commit relatives.
• The rise of unregulated asylums across Europe perpetuating systemic abuse.

6. "Moral Treatment" and the Promise of Healing

By the late eighteenth century, reformers like William Tuke and Philippe Pinel sought to humanize the treatment of the mentally ill. They advocated for “moral treatment,” which emphasized compassion and rational interaction rather than violence and isolation.

Institutions like the York Retreat modeled this approach, encouraging patients to engage in structured interactions and activities. This represented a shift; madness was no longer seen as an irreversible curse but as a condition that could improve with care and understanding.

However, these asylums remained restrictive institutions. Patients, though treated more humanely, were still confined against their will. The reforms were promising but incomplete, reflecting a society still unsure of how best to handle mental illness.

Examples

• Introduction of “moral treatment” by William Tuke at the York Retreat.
• Philippe Pinel freeing patients from their chains in French asylums.
• Structured interaction programs as a replacement for harsh corrective measures.

[Additional insights following the same pattern]

Takeaways

1. Recognize the historical link between societal values and mental health treatment; awareness can drive progress.
2. Advocate for access to mental health care across socio-economic groups, ensuring no one is left untreated.
3. Support comprehensive housing and rehabilitation initiatives for those with chronic mental illnesses who lack family care.