Influences of The Greeks and Romans

Chapter 1
Influences of the Greeks and Romans

Janet R. Matthews and Lee H. Matthews
Interest in abnormal behavior, or psychopathology, appears to have existed

from the time of early written records. Our understanding of both the causes
and treatment of behavior that differs from the typical has not been a steady
movement of learning but rather has had periods of intense interest and writ-
ings followed by periods when prior knowledge seems to have been lost. The
following chapter presents some of the highlights of this process from the
perspective of the early Greek and Roman cultures. Brief information about
some of the early people, myths, etiology, and treatments related to abnormal
behavior is presented to illustrate the breadth of information they provided
as a foundation that influenced thoughts about psychopathology for many
centuries.
THE GREEKS
Personalities
For many scholars, the most influential Greek physician was Hippocrates
of Cos (460–377 B.C.). Because he believed that the brain was the central
control of human activity, he felt that disrupted behavior was the result of brain
pathology. Scientists of this era believed that the four basic elements of the world
were earth, air, fire, and water. These elements had the attributes of heat, cold,
moistness, and dryness. A combination of these attributes led to the develop-
ment of bodily fluids known as humors. These bodily fluids were influenced by
2 History and Conceptualizations
many factors, including the weather and the foods one has eaten. According to
Hippocrates, abnormal behavior was the result of an imbalance of the humors.
The four basic humors in this system were black bile (cold + dry), yellow bile
(hot + dry), phlegm (cold + moist), and blood (hot + moist). For example,
a person who had an excessive amount of yellow bile would be expected to
exhibit symptoms of mania. Such a person would engage in a range of exces-
sive and frenzied activities. However, a person who had an excessive amount of
black bile in contrast to the other humors would be expected to exhibit symp-
toms of melancholia, or extreme sadness.1 Hippocrates also believed that such
environmental factors as air and water quality, altitude, and time of the year
contributed to the development of these imbalances. He noted that abnormal
behavior sometimes seems to impact more than one member of a family and
thus suggested that heredity also plays a role in the development of psycho-
pathology. Finally, Hippocrates hypothesized the presence of a life force that
was psychological in nature. Although this force typically operated through
the senses and motor system in a traditional biological fashion, when sleeping
it could produce dreams that were important to understanding the person’s
problems. In order to have an adequate understanding of a person’s psychopa-
thology, Hippocrates noted the necessity of close behavioral observation of the
patient.
Based on this theory and his detailed patient observations, Hippocrates de-
veloped one of the earliest systems for classifying mental illness: mania, mel-
ancholia, and phrenitis (brain fever). This theory provided an early foundation
for viewing abnormal behavior (mental illness) as an illness. This mental illness
was comparable to the physical illnesses and therefore should be treated in a
similar manner. This approach was different from the more general belief of
viewing people who exhibited abnormal behavior as moral degenerates. His bio-
psychosocial theory has some basic similarities to current thoughts. This theory
of abnormal behavior was in marked contrast to that of many of his colleagues,
who believed that such behavior was the result of the work of gods and demons.
Hippocrates made treatment recommendations based on his theory of men-
tal illness. He suggested that learning about the person’s dreams would help the
physician have a better understanding of the individual’s personality. He also
believed that the person’s environment was potentially relevant to the treatment
process. In many cases he recommended that patients be treated away from
the influence of their families. Depending upon the specific form of abnormal
behavior being treated, he recommended having a regular schedule and calm life
situation, vigorous exercise, abstinence from all forms of excessive behavior, and
a mild diet (often vegetarian). In the case of hysteria, a disease limited to women
and attributed to a strong desire to have a child, he recommended marriage as
the best treatment. On the other hand, he also believed in medicinal days. These
Influences of the Greeks and Romans 3
were the days when it was safe for the physician to administer medications.
Medical historians have suggested that this concept may have been the result
of his careful observation of patients and noting that behavior changes from
day to day.
When the Macedonian king Alexander III (356–323 B.C.), known pop-
ularly as Alexander the Great, founded the city of Alexandria in 332 B.C.,
Hippocrates’ theories were transported to Egypt. Alexandria became a center
of Greek culture where medical practices developed to a high level. Many of
the temples dedicated to the god Saturn became similar to sanatoria, thus
acknowledging the importance of the environment to the healing process.
Mental patients in these sanatoria were given many activities that would be
considered part of 21st-century activity therapy. They included dancing, gym-
nastics, walks in the garden, concerts, and rowing on the Nile. Although they
did use such treatments as bleeding and restraints, they also provided massage,
hydrotherapy, and dieting. Alexander the Great also lends his name to a disorder
that would be described in the 19th century—alexanderism. Alexanderism is a
form of psychopathology in which the individual has uncontrollable desires to
destroy or exterminate entire societies or cultures.
Among the early Greeks, philosophers also wrote about abnormal behavior.
For example, Plato (429–347 B.C.) seemed to have had a strong interest in
mentally ill people who had committed criminal acts. He suggested that such
individuals should be made to pay for any damages they had caused but that
no other punishment should be given. He believed that these people should be
treated in hospitals within their own community. His ideas about treatment
centered on a form of conversation analogous to modern psychotherapy,
although he also recommended the use of both incantations and drugs.2 As
Freud and others would suggest much later, Plato stressed the importance of
dream interpretation. He noted that dreams were the result of frustrated de-
sires and thus an important part of understanding the person. Unlike Hip-
pocrates, who felt the center of human behavior was the brain, Plato said the
spirit or soul was the core. Plato suggested that problems originating in the
soul led to physical illness, and in his system abnormal behavior was one form
of physical illness. Abnormal behavior was caused by problems in the part of
the soul that controls reason. This part of the soul, for Plato, was located in the
person’s head. When describing the causes of abnormal behavior, Plato felt that
some forms of abnormal behavior were naturally caused while others were the
result of action by the gods. In some of his writings, therefore, Plato suggested
that there were two different types of mental illness. One type was inspired by
the gods. This mental illness gave the person the ability to see into the future.
Since prophetic ability was viewed positively, this type of mental illness should
not be altered. The other type of mental illness was caused by physical disease
and therefore needed to be treated.3 Thus, he held to both traditional ideas

about madness and a more biological approach. Another topic about which
Plato disagreed with Hippocrates was the role of the gods in mental illness.
Hippocrates took the position that no illnesses were caused by the gods; how-
ever, Plato supported the ancient belief of holy disease. Plato wrote that a form
of insanity was due to the divine breath of the gods. This breath was actually a
gift to the person who might experience such characteristics as holy delirium
and clairvoyance.
Plato’s student, Aristotle (384–322 B.C.), also wrote about mental illness but
seemed to agree with some of Hippocrates’ ideas about causation. He wrote espe-
cially careful descriptions of affective states and the relationship between epilepsy
and mental illness. Like his mentor Plato, Aristotle also wrote about the role of
the soul in the development of abnormal behavior. Since difficulty with reason
was a major component of abnormal behavior, it is not surprising that Aristotle
suggested the importance of logic and reason in conversations with these individ-
uals. In modern psychotherapy these factors are core to the cognitive therapies.
Another of Aristotle’s concepts, catharsis, is an important part of psychodynamic
therapies. He was not, however, referring to a part of psychotherapy but rather
the reaction of the audience during the performance of one of the Greek trag-
edies. Aristotle suggested that emotional cleansing occurred as a result of the
person experiencing feelings of strong terror and pity, which were elicited by the
actors in the play. As tutor to Alexander the Great, Aristotle also conveyed Hip-
pocrates’ ideas to his student, who would later carry them to Egypt, as noted
previously. Another of Aristotle’s concepts, earlier also emphasized by Socrates,
was physiognomy. According to this concept, there is a correlation between a per-
son’s personality and his or her outward appearance. Twentieth-century person-
ality theorists, like William Sheldon, would use this concept as the foundation
for their work. Aristotle was especially interested in people’s facial features and
how they related to the personality. In a book attributed to Aristotle, the con-
cept of physiognomy was carried even further by suggesting that people have the
temperament of the animals they resemble. He even suggested that this principle
could be applied more broadly to an entire race of people since there are broad
commonalities in facial features that are found within such groups.
Myths
The role of myths and the numerous gods they described was an impor-
tant part of Greek life. Many of these myths described both the behavior and
treatments that in modern times are included in the diagnostic classification
systems of abnormal behavior. In Greek mythology there was even a goddess
of madness, Lyssa. According to mythology, if you offended Lyssa, she would
possess you and cause you to lose your mind. These myths also provide fur-
ther insight about how such behavior was viewed within the Greek culture.
For example, the maenads were a group of women in myth who had superhu-
man strength. They did not follow the social customs of their times but rather
roamed the countryside hunting wild animals. Their rites led to frenzies, which
became identified in the culture as a form of madness.
Medea was a sorceress in Greek mythology. In one of the stories about
Medea, she falls in love with a man named Jason. Jason is, however, engaged
to be married. Her jealousy leads her to kill his fiancée. Because of the conflict
she feels about having committed this murder, she later kills her own children.
This myth forms the basis of the Medea complex, a term first used in the 1940s
to describe mothers who have feelings that they want to kill their children.
This death wish is often associated with a desire to seek revenge against the
children’s father.4
Narcissus was described in Greek mythology as the beautiful son of a river
god and a nymph. According to myth, he never experienced love until the first
time he saw his own reflection in a pool of water. What happens next varies,
depending on which version of the myth you read. One version of the myth
says that he thought this reflection was a nymph and he dove into the water to
reach her. The result was that he drowned. In a different version of the myth
about Narcissus, however, he spent the remainder of his life pining for the love
he could not reach. This myth forms the basis of the narcissistic personality
disorder found in modern classification systems. The person who is given this
diagnosis today is considered to have an exaggerated sense of his or her self-
worth and importance.
The story of Oedipus in Greek mythology not only describes abnormal
behavior but has had a major impact on psychological theory over time. Ac-
cording to this myth, an oracle predicted that the king of Thebes, Laius, would
be killed by his son. When his wife Jocasta gave birth to a boy, Laius had the
child taken to the mountains to be left to die. The shepherd who was given this
task gave the child to the childless king of Corinth, Polybus. This child was
named Oedipus. When Oedipus became an adolescent, an oracle told him that
his destiny was to kill his father and marry his mother. Oedipus was horrified
by this prediction. In order to avoid this outcome, he decided to leave home.
As he traveled toward Thebes, he met Laius on the road, had an argument
with him, and killed him. He then married Jocasta. When he realized that the
oracle’s prediction had actually come true, he blinded himself and Jocasta com-
mitted suicide. This myth forms part of the basis for Freud’s theory of infantile
sexuality.5 Sexual attraction between parent and child was also the theme of
the myth about Phaedra, who fell in love with her stepson. The term Phaedra
complex was later used to refer to a mother’s sexual attraction to her son.6
Treatment
Historically, there has been a strong tradition of using herbal medication.

Many of these remedies can be traced to the early Greeks and Romans. Colonial
Americans used many home remedies based on herbs. In recent years people in
the United States have begun to show an interest in herbal medicine. Prior to
that time, herbal medicine was popular in many Eastern countries and in central
Europe. The early Greeks made use of many natural products in the treatment
of abnormal behavior. Consideration of a few of these items illustrates the range
of plants and herbs that were used in ancient times. The peony is a plant that has
been used in several different ways as a treatment for mental disorders. It was
recommended that if you wore the root of a peony around your neck, you would
prevent the onset of epilepsy. You could also take it in powder form by mouth
as a cure for various forms of abnormal behavior. An infusion of peppermint
leaves was considered a stimulant and thus could be used to treat depression.
Practitioners who subscribed to the evil spirit theory of causation of abnormal
behavior might use the wild herb, St. John’s wort, as a treatment because it was
believed that evil spirits did not like this herb. Vervain was another plant often
used in the treatment of mental disorders. Hippocrates often used it with his
patients. In the 21st century, with the popularity of tales of vampires, werewolves,
and witchcraft, other uses of this plant may be more familiar to the reader. Black
hellebore, also known as the Christmas rose, was used to treat severe mental
illness in ancient Greece and continued to be popular well into the 19th century.
The best black hellebore was considered to come from Anticyra, a peninsula on
the Gulf of Corinth. People who were seen as seriously mentally ill were told to
“sail to Anticyra.” This was a gentle way of telling the person or family that the
individual was really mentally ill and needed to have hellebore. The use of hel-
lebore was also popularized in Greek mythology when the character Melampus
was granted part of the kingdom of Argos because he used hellebore to treat an
epidemic of mental illness there. The women of this kingdom had a group delu-
sion that they were all cows and roamed the countryside accordingly.
GREEKS TO ROME
Personalities
Greek and Roman cultures have a degree of overlap. As the cultural center of
the times moved from Greece to Rome, a number of prominent Greeks moved
as well. Some of them brought the Greek ideas about abnormal behavior with
them. Aretaeus of Cappadocia was a Greek physician born in the first century
A.D. He studied in Alexandria prior to moving to Rome to practice medicine.
Aretaeus was among the first to note the importance of the person’s premorbid
personality. He devoted time to investigating and describing the personality of
mental patients prior to the onset of their overt symptoms. Aretaeus also ex-
panded on the classification system developed by Hippocrates. His system had
seven categories of mental disorder: epilepsy (both ordinary and the hysterical
variety, which was found only in women), melancholia, mania, phrenitis, drug
delirium (a temporary disorder), senile dementia, and secondary dementia. He
believed that melancholia was the basis of all psychotic disorders.
Another first-century Greek physician with an interest in mental illness was
Dioscorides Pedanius. He served as a physician to the Roman emperor Nero.
He brought the herbal tradition to Rome. His writings covered over 600 dif-
ferent plants and have been preserved in an illustrated manuscript that is now
in the Bibliotheque in Paris. Nero had multiple emotional problems, which are
described later in this chapter. One of the remedies Dioscorides prescribed for
Nero was mandragora, or mandrake. This plant has been used in many cultures,
including China, Palestine, Spain, and Italy, for the treatment of symptoms of
mental illness. Although he gave it to Nero for insomnia, Hippocrates also
found it useful for the treatment of depression. According to modern analysis
of this plant, it actually has depressant, hallucinogenic, and hypnotic proper-
ties, usually producing both delirium and hallucinations. Later cultures would
describe mandrake as having magical properties which not only cured various
forms of mental illness but also served as an aid to fertility and an aphrodisiac.
These latter uses were based on the specific shape of the plant.
Galenus Claudius (A.D. 129–199), better known as Galen, was also a Greek
physician who trained in Alexandria and later moved to Rome. He integrated
the concepts of Hippocrates, Plato, and Aristotle with his own ideas to form
a holistic system of medicine. Rather than just talk about a single soul, Galen
wrote that humans have two distinct subsouls. The brain was the site of the
rational soul, but not the subsouls. The female subsoul was located in the liver
while the male subsoul was located in the heart. Galen did such an impressive
job of synthesizing and organizing the medical knowledge of his time that
his works became the medical standard for about 1,500 years. His theories
were based, to a great degree, on his dissection of animals. Human autopsies
were not yet permitted, so he had to work with lower animals and then apply
these findings to humans. He agreed with Hippocrates’ theory about the impor-
tance of the humors but developed a somewhat different classification system
for them. His eight-part system included anoia (reasoning problems), moria
(retardation), phrenitis, melancholia, mania, lethargus, hysteria (found in both
males & females), and epilepsy. Because he saw these problems as the same
as physical disorders, his treatments were those used at the time for physical
disorders—bleeding, drugs and herbs, and diet.
Alexander of Tralles (A.D. 525–605) was another of the well-known phy-

sicians who trained in Alexandria but later practiced in Rome. Some authors
have described him as second only to Hippocrates among Greek physicians.7
His writings were translated into numerous languages, including Latin, Greek,
and Hebrew. Like Hippocrates, he strongly favored humane forms of treat-
ment for his patients. Among his common treatments were baths, special diets,
drinking wine, and taking sedatives. He also prescribed amulets to be worn
by his patients. These amulets were custom-designed for the patient and fre-
quently included religious sentiments. He discussed the importance of devel-
oping individualized treatments for unique patient problems. For example, one
of his deluded patients believed that she had swallowed a snake. Not surpris-
ingly, she became quite distressed by this belief. Alexander, in a fashion some-
what similar to the move of a modern magician, produced a snake for her to
see. She thus believed he had removed that snake from her and was cured. He
developed a classification system similar to that of Hippocrates but seemed
to have a particular interest in melancholia. Alexander’s classification system
included six types of this disorder. When he became elderly and found the
practice of medicine too tiring, he wrote about medicine, his major work titled
Twelve Books on Medicine.
ROMANS
Personalities
Although most people think of Cicero (Marcus Tullius Cicero, 106 B.C.–
43 B.C.) as an orator and philosopher, he also wrote about medicine. He was
not a physician but expressed strong feelings about the incorrect nature of parts
of Hippocrates’ humoric theory. Specifically, he objected to the idea that an ex-
cess of black bile was the cause of melancholia. Cicero wrote that melancholia
was due to psychological factors such as fear or anger. He also wrote that strong
emotions can lead to physical symptoms. He did support Hippocrates’ theory,
however, that such disorders should be treated by skilled healers rather than
one’s depending on the gods to heal people.
Publius Ovidius Naso (43 B.C.–A.D. 17), better known as Ovid, was an
early Roman poet who wrote about ways to deal with problems of sexuality.
Although he was born into a rich family and educated as an attorney prior to
dedicating himself to writing poetry, Ovid seems to have been an early special-
ist in an area of psychopathology that was often hidden until modern times.
Because his lifestyle was found offensive by Roman authorities of his time,
he was exiled. His writings after that period indicate that he found isolation
to be a problem for people who have some form of psychopathology. Perhaps
because of his own rather harsh treatment by the culture of the times, he also
noted that harsh forms of treatment do not help those with mental problems.
Aulus Cornelius Celsus (25 B.C.–A.D. 50) wrote on a range of medical
topics including mental illness. He was a nobleman but not a physician because
that profession was considered below his social status. He is credited with be-
ing the first person to use the term insanity in relation to abnormal behavior.
Today that term is used in legal rather than medical settings. He said that the
presence of a mental disorder influences the entire personality. His classifica-
tion system was similar to the one developed by Hippocrates. He was one of
the early writers who also emphasized the importance of the doctor-patient re-
lationship, or what in modern times is called the establishment of rapport. His
treatment suggestions were quite broad. They included the common medical
procedure of bleeding, various potions such as emetics and herbal treatments,
as well as activities ranging from sports to listening to music or travel. He also
suggested the use of gestation, or a process of gentle rocking, of the mental pa-
tient in a suspended bed. One of his more unique concepts was the idea that
epilepsy was cured differentially in males and females. He noted that epilepsy
in boys may be cured by their first coitus while for girls the cure may be the
onset of menstruation.
Scribonius Largus (A.D. 14–54) was an early Roman physician who had
an interest in the use of a range of medications for the treatment of abnormal
behavior. He was the first of the Roman physicians to describe the use of the
sting of the torpedo or electric fish to treat the pain of intractable headaches.
This treatment can be viewed as a somewhat crude precursor of ECT (electro-
convulsive therapy), which remains a treatment in the 21st century. Although
most industrialized countries now use electronic equipment for this procedure,
some African tribes in the 21st century continue to use the Nile electric catfish
(malopterurus electricus) as a form of shock treatment, which their ancestors
learned from early Greek and Roman healers. He also described the use of an
opium extraction, as well as the drinking of one’s own blood, for the treatment
of various problems. He wrote one of the early books on the use of various
drugs, Compositiones Medicamentorum. He took some of his ideas about the
treatment of psychopathology to Britain when he visited there in A.D. 43.
Gaius Plinius Secundus, also known as Pliny the Elder (A.D. 23–79) ap-
peared to have more interest in the treatment of abnormal behavior than in
the development of a classification system. As a naturalist, he emphasized
the use of natural products as remedies. For example, he suggested that calf ’s
dung which had been boiled in wine was a remedy for melancholia. He said
a safe remedy for epilepsy was the hollyhock (althea officinalis), a small plant
found most often near the sea. In more modern times, British healers suggested
harvesting the leaves in the summer to treat lung and kidney problems and
harvesting the root in the late autumn to treat digestive problems. He realized
that even natural products, when used excessively, could have a negative effect.
One example of this problem was the use of henbane. Henbane, an annual
plant, may be the oldest anesthetic known to humanity. It was used as a pain-
killer. When it was used to deal with earaches, people of the time often poured
its juice into their ears. According to Pliny this application of henbane could
cause mental disorders, including hallucinations. Its hallucinogenic properties
would be used in the Middle Ages as part of the practice of witchcraft. An-
other useful product was the juice of the poppy. Pliny noted that it was helpful
for inducing sleep but was easily abused. The Greeks first used the modern
term opium for this product. For depression, a problem found throughout the
ages, Pliny recommended the use of the herb borage, also known as starflower,
to elevate a person’s mood. Although this annual herb originated in Syria, it
is found commonly throughout the Mediterranean area. Today, homeopathic
practitioners still use borage as a mood elevator, most often for the treatment
of PMS in women. Like Scribonius Largus, Pliny described the use of electric
eels in the treatment of severe headaches.
Nero Claudius Caesar (A.D. 37–68), a Roman emperor, lived during the
time that Pliny was writing about the treatment of abnormal behavior. Perhaps
if he had received treatment from Pliny, his life might not have ended the way it
did. Nero’s behavior has been described as depressed at some times and manic
at others, or what 21st-century mental health professionals would call bipolar
disorder. He was also reported to have suffered from epilepsy. Historians have
noted that both his father and mother came from families that were consid-
ered to have exhibited mental illness. From the time of Nero’s birth, he seems
to have been viewed in a negative way. Historians say he was born feet first,
and this was considered a bad omen at the time. When he was only two years
old, his father died and he was adopted by Emperor Claudius. As an adult, he
was described as having difficulty controlling his anger. This behavior may well
have been a symptom of his mania. During these periods he murdered his first
two wives, the second of whom some sources say he kicked to death while she
was pregnant. He also ordered the execution of his mother. Nero is said to have
set the city of Rome on fire and then recited poetry about the burning of the city
of Troy while he watched Rome burn. He committed suicide on the anniver-
sary of the death of his first wife, Claudia Octavia, who was also his stepsister,
during a period when he was in hiding and learned that factions within the
country were rising against him. Descriptions of his behavior illustrate the fact
that although there were some who wrote about psychopathology at that time,
leaders of the country were not willing to seek such treatment.
The modern definition of sociopathy can be traced to the life experiences of
Lucius Aelius Aurelius Commodus, better known as Emperor Marcus Antonius
(A.D. 161–192). Historians have described his behavior as both extravagant

and cruel. Among his characteristic behaviors were his sexual demands of his
300 concubines and young boys, offering human sacrifices to the gods, fighting
with wild animals in the arena, and torturing men by making multiple cuts
on them with surgical implements. He exhibited no shame or regret for his
behavior but rather ordered that his most infamous actions should be included
in public records.
Myths
The belief that the moon has a major impact on human behavior dates
from ancient times. Although the role of the moon is part of many cultures,
the modern term lunacy comes from the Latin word luna, which means moon.
Pliny noted that the moon could cause both nightmares and complete insanity.
Many Roman physicians believed that the moon caused epilepsy. The influence
of the moon on mental state persisted through many subsequent cultures.8
Even in the 21st century, it is not uncommon to hear someone note, during
times of upheaval, that there “must be a full moon.” Modern science, however,
does not support the idea that the presence of a full moon correlates with in-
creased psychopathology.9
Another important part of Roman folk lore was the role of spirits of the
woods, known as fauni. Many people of this era believed that mental illness
was caused by the fauni. Pliny the Elder, the naturalist previously described,
referred to several forms of mental illness as “mockeries of the fauni.”
Treatment
Somatic and psychic illnesses were initially seen as part of the same whole,
therefore were treated using the same substances as well. Psychic and somatic
symptoms were considered as separate phenomena only in later times, before
finally being progressively considered once more as different manifestations af-
fecting the same body in the course of the same disease.
Instead of looking just at natural sources for remedies from pain, illness, and
death, the ancients looked to magic and the supernatural for cures. In fact, the
word remedy comes from the Latin mederi and is related to the Latin origin of
the word medicine. Thus, the original goal of medicine, regardless of the source
of the cure (environmental, herbal, magic or supernatural), was to provide re-
lief from suffering.10
One example of the interaction between herbal and supernatural treatment
is mistletoe. The word mistletoe is related to the Latin name of the god of medi-
cine, Asclepius. The Greeks thought of mistletoe as a life-giving plant, a symbol
of sexuality. For the Romans, it was tied to Saturn, an agricultural god, and
used as part of fertility rites. Harvesting mistletoe, especially that growing on
oak trees, was seen as symbolically castrating the tree because the juice from
mistletoe berries, seen as the oak sperm, was considered to be charged with
therapeutic powers. Due in part to mistletoe’s role in fertility rites, the Greeks
used it for menstrual complaints. Both the Greeks and Romans also used it
to treat epilepsy and other neurological disorders and for external tumors and
cancers. Mistletoe is just one among many different herbs and trees used in
ancient medical practice; the bark of willow trees surrounding the temple of
Athena contained salicylate, an antipyretic and anti-inflammatory drug still
widely prescribed.11
In many ways, Roman medicine can be viewed as illustrating the overall
view of humanity of the culture at the time. There was a focus on pleasure and
comfort, especially for the leaders of the society. Thus, treatment of abnormal
behavior was often designed to make the patient comfortable. Physicians made
extensive use of such physical treatments as massage and warm baths. One
principle that was quite popular at the time was the use of contraries, which
refers to the importance of opposites. Thus, a physician might recommend sit-
ting in a warm tub while drinking a chilled wine. Another unusual treatment
from this era was first described for Rome’s empress Faustina Augusta (A.D.
124–175). She developed such strong sexual desires for one of the gladiators
that she became seriously ill from her desires. When she confessed her problem
to her emperor husband, he had the gladiator killed. He then had his wife’s
body anointed with the warm blood of the gladiator, which cured her passion.
This case led to the use of the warm blood of killed gladiators to treat certain
forms of mental illness.
Although modern society has specific laws that relate to the mentally ill,
the Roman culture seems to have been somewhat more organized in codifying
this material. The main body of Roman law, Corpus Juris Civilis, was developed
during the reign of Justinian (A.D. 483–565). This document recognized the
importance of soundness of mind, rather than the health of the body, when mak-
ing a will. This legal code not only defined the criminal responsibility of the
mentally ill but also addressed their ability to testify in court, to make such
legal documents as wills, their ability to marry and divorce, and to sell their
possessions. This system even covered the influence of drunkenness and strong
emotions on criminal behavior.
CONCLUSIONS
This chapter has provided an overview of the way abnormal behavior was
explained and treated by the early Greek and Roman civilizations. There are
many other people who could have been cited. We have attempted to discuss
a representative sample with the hope that interested readers will continue to
explore this topic in both other secondary sources and primary sources. The
work of these early cultures forms the foundation for viewing psychopathol-
ogy as an illness. Despite the counterargument that psychopathology is really
a cultural phenomenon,12 the overriding position today seems to have moved
only slightly to a biopsychosocial position rather than a purely biological one.
Although the views of modern professionals are probably not as diverse as
those of ancient times, the field continues to be divided in terms of both causal-
ity and treatment. Demon possession is no longer viewed as a cause of psycho-
pathology by mental health professionals. On the other hand, the role of nature
in contrast to nurture, relative to many forms of psychopathology, remains a
point of debate. Whereas early cultures had myths depicting various forms
of abnormal behavior, modern society has films.13 The lay public continues to
have sufficient fascination with the behavior of those who differ from them-
selves that these films are often large-budget items, winning major awards.
The early Greeks and Romans used a wide variety of natural products in
their treatment of abnormal behavior. Today in the United States, we see such
terms as homeopathy or naturopathy as alternatives to traditional medical
interventions for a range of problems including psychopathology. Although
these approaches have been used in this country since the early 19th century,14
there seems to be a rising interest in them in the 21st century. Today some
states even license professionals in the specialty “homeopathic physician” (e.g.,
Arizona, Connecticut, and Nevada), but these individuals are typically gradu-
ates of either traditional or osteopathic medical schools. The natural products
recommended by these practitioners are regulated by the federal government in
the same manner as over-the-counter drugs.
REFERENCES
1. Arikha, N. (2007). Passions and tempers: A history of the humors. New York: Ecco/
HarperCollins.
2. Milns, R. D. (1986). Squibb academic lecture: Attitudes towards mental illness in
antiquity. Australian and New Zealand Journal of Psychiatry, 20, 454–462.
3. Ackerknecht, E. H. (1959). A short history of psychiatry. New York: Hafner.
4. Stern, E. S. (1948). The Medea complex: Mother’s homicidal wishes to her child.
Journal of Mental Sciences, 94, 321.
5. Freud, S. (1954). The origins of psychoanalysis: Letters to Wilhelm Fliess, drafts and
notes: 1887–1902. M. Bonaparte, A. Freud, & E. Kriss (Eds.). New York: Basic
Books.
6. Graves, R. (1993). The Greek myths: Combined edition. New York: Penguin.
7. Howells, J. G., & Osborn, M. L. (1984). A reference companion to the history of

abnormal psychology: A-L. Westport, CT: Greenwood Press.
8. Oliven, J. F. (1943). Moonlight and nervous disorders: A historical study. Ameri-
can Journal of Psychiatry, 99, 579–584.
9. Wilkinson, G., Piccinelli, M., Roberts, S., & Fry, J. (1997). Lunar cycle and con-
sultation for anxiety and depression in general practice. International Journal of
Social Psychiatry, 43(1), 29–34.
10. Hoffman, D. (2003). Medical herbalism: The science and practice of herbal medicine.
Rochester, VT: Healing Arts Press.
11. Evans, J. (2005). Mistletoe: Good for more than free kisses. Herbal Gram, 68,
50–59.
12. Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15,
113–118.
13. Wedding, D., Boyd, M. A., & Niemiec, R. M. (2010). Movies and mental illness:
Using films to understand psychopathology (3rd ed.). Cambridge, MA: Hogrefe &
Huber.
14. Ballard, R. (2000). Homeopathy: An overview. Australian Family Physician, 29,
1145–1148.
Chapter 2
Perceptions, Thoughts, and Attitudes

in the Middle Ages
Eva D. Papiasvili and Linda A. Mayers
From the fall of the Western Roman Empire in 476 CE to Columbus’s

discovery of the New World in 1492, massive geo-political reconfigurations
coincided with profound transformations in a wide range of human activities,
norms, and abnormalities. This millennium embraces the Early Middle Ages
(476 CE–11th century CE), High Middle Ages (12th century–1347 CE), and
Late Middle Ages (1347 CE–1492 CE).
A once dominant view saw the Middle Ages as a detour between the Classical
period and its Renaissance. Twentieth-century historians, however, came to
characterize the years of the Middle Ages as leaving legacies in their own right,
including the inception of the parliamentary system, the nation state, trial by
jury, and the legal definition of mental incapacity; the birth of banking, the uni-
versity, and experimental science; achievements in philosophy, architecture and
the fine arts; and the invention of eye glasses, the clock, and the printing press.
The creative output of the period is all the more remarkable for having
transpired amid multiple epic traumas. Pestilence, famine, and plague matched
territorial reconfiguration and war throughout the Middle Ages, marking the
people who lived and thrived through them for their adaptability and uncom-
mon resilience.
The Middle Ages were born out of the trauma of cultures clashing over the
ruins of Rome. When the Greco-Roman ideals of rationality and self-reliance
were no longer viable, they were replaced by the adaptation model of early
Christian theology. This new model emphasized faith over reason, and reli-
ance on supernatural forces to transcend everyday threats to physical survival.
Rooted in Neo-Platonic subjectivism, early Christian theology paired with a

post-traumatically fragile connection with physical reality to effect thinking
rich in symbols, metaphors, imagery, and mysticism, and perceptual phenomena
such as visions and hallucinations. With the High Middle Ages came Neo-
Aristotelian Christian theology and the renewed legitimacy of reason, part of
a multifaceted recovery halted only by the Black Plague. The posttraumatic,
regressive adaptation which followed characterized the Late Middle Ages and was
manifest in behaviors such as group rituals, self-flagellation, pogroms, and cults.
In the Middle East, where the Eastern Roman Empire survived as Byzan-
tium until 1453, mental conditions were identified and treated as illnesses, as
they were in parts of North Africa and non-Christian Spain. Early Christian
Europe, in contrast, conceptualized “madness” in theological terms, as a mix-
ture of the divine, diabolical, magical, and transcendental. In the High and Late
Middle Ages, new developments in philosophy and law, together with new
empirical findings and the rediscovery of ancient knowledge, contributed to
more diverse practices in every field, including mental health assessment and
treatments.
This chapter will begin with the consideration of norms and abnormalities
with regard to the Middle Ages. It will proceed with a historical-cultural review
focusing on the two major traumas of the Middle Ages, the aftermath of the
Fall of Rome and the Black Plague. In examining their respective posttraumatic
adaptations, special emphasis will be placed on attitudes, perceptions, lifestyles,
behaviors, and thought. The chapter will conclude by contrasting Christian
Europe’s approaches to mental conditions with those of the Middle East and
the non-Christian Mediterranean.
NORMS AND ABNORMALITIES

“Contemporary research now supports the idea that the social environment
has important consequences for mental health. Within a social context there-
fore, behaviors that are considered abnormal are those that deviate significantly
from those standards of behavior generally regarded as normal by the majority
of people in a society”1 (p. 2).
Where behaviors of any era belong to the norm, and where they cross the ab-
normality border, can be assessed according to several criteria: historical/cultural,
objective/universal/legal, subjective, and statistical. The Historical-Cultural
view holds that certain lifestyles, behaviors, attitudes, perceptions, and thoughts
might be deemed pathological in one historical-cultural context and not in an-
other. The Objective/Universal/Legal view holds that there are certain states
of extreme withdrawal, states of disorientation, incoherent thoughts, and un-
conventional, disorganized behaviors, which will be universally considered
Perceptions, Thoughts, and Attitudes in the Middle Ages 17
the product of mental affliction, regardless of the attributed etiology. In the

Middle Ages, this view was articulated in early medical models of mental dis-
order deriving from the Four Humor classification and the legal definition of
insanity originating in Thomas Aquinas’s Canon Law. Aquinas’s High Middle
Ages text postulated the “Sick of Mind” category, identifying degrees of in-
sanity rather than varieties in kind. The objective was the evaluation of an
individual’s legal competence to participate in valid contracts. The Subjective
Report concerns the individual’s experience. The first Subjective Report writ-
ten in English was the Late Middle Ages autobiographical account of Margery
Kempe. The Statistical Assessment (prevalence, incidence) addresses the
frequency with which a given condition occurs in a general population. In the
absence of statistics, inferences may be drawn from available sources, such as
chronicles, public records, and literature.
HISTORICAL-CULTURAL CONTEXT: EVOLUTION

OF ATTITUDES, BEHAVIORS, THOUGHTS,
AND PERCEPTIONS
Initial Traumas and Posttraumatic Adaptations
Rome was sacked by “Barbarians” in 410, 453, and 476 CE. While the result-
ing physical devastation was great, the psychological effect was greater still. As the
institutions and the identity of the Western Empire crumbled, the Greco-Roman
ideal of the independent, rational, self-reliant man was decapitated. Amidst
death, destruction, and chaos, terrorized survivors fled the city en masse: at the
end of the fifth century, Rome retained only 30,000 inhabitants, one tenth of the
imperial city’s population at its height. Attempting to grasp the incomprehen-
sible, Christian Neo-Platonists of the Academy invoked faith as reason’s guiding
light in the pursuit of truth. In 410 CE, this new adaptation model was articu-
lated by Augustine in The City of God. Augustine drew on his own transformative
experience, his consuming lust having become love for God, his soul’s catastro-
phe becoming salvation, all through his conversion to the Christian faith2 (p. 27).
Augustine formulated the Early Medieval Christian conceptualization of man
as God’s beloved instrument, a helpless child-creature occupying a pre-ordained
position in the divinely designed order, wholly dependent on supernatural forces,
rewarded for his suffering by the eternal salvation of his soul. Compared to this
transcendental super-reality, the traumas and miseries of physical reality were
temporary and insignificant. Based on Augustine and later Boethius’s (480–525
CE) philosophical synthesis, stressing the mystical and subjective elements of
Plato’s philosophy, Early Christian theology offered the comfort of continuity
with the Classical world within the context of monotheism, transcendence, and
community. It wrote a meaningful narrative around society’s trauma, defining the

mentality of Christian Europe until the 13th century.3
Early posttraumatic attempts at adaptation touched and linked every con-
stituent of the clash of cultures and every emerging segment of Early Medi-
eval Society. As with ideologies, old identities had to be transformed and new
identities forged. Disorientation, withdrawal, and depression were countered
by attempts at mobilization and integration, as were disassociation, vigilance,
paranoia, and aggressive enactment against others and self.
The posttraumatic adaptation process of Rome’s senatorial aristocracy was
tracked by Sidonius Apollinaris (unknown–489 CE), Senator-turned-bishop:
from disorientation, literary escapism and disillusionment with Rome to wide-
spread clericalization and, finally, identification with the adopted “Barbarian”
culture (p. 4).4 Even while monks around the Mediterranean suffered wide-
spread depression and holy anorexia5 and prepared for the end of the world,
another Roman aristocrat, St. Benedict (480–547 CE), established the first
Western monastic order rigorously organized around daily work, prayer, and
study. A third Roman noble, Pope Gregory the Great (540–604 CE), effected
an “integration of Lombard and Anglo-Saxon invaders into the Christian world
by a deliberate missionary program”4 (p. 41).
Just as some Romans came to identify with the culture of their conquerors,
the Barbarians strove to become those whom they had decapitated, keeping
totems of Rome everywhere. The heads of emperors adorned the Roman cur-
rency they circulated. They used Roman titles and wrote Roman inscriptions
on their state buildings. Between the 5th and 9th centuries, they teamed with the
Roman clergy to establish stratified feudal monarchies with written legal codes,
integrating Latin law, ecclesiastic law, and tribal customs.6 The Ascendency
celebrated its new identity in 800 CE, when the Pope crowned the Frankish
Charlemagne Roman Emperor. The new emperor treated his own “Barbarians,”
the Saxons, with violence comparable to Caesar’s. The ensuing “Carolingian
Renaissance” rivaled antiquity in intellectual achievement, only to collapse
shortly after Charlemagne’s death.
Having become Roman, the Franks now suffered their own Fall of Rome,7
and years of chaos ensued.4 Reports of barbaric behavior, of young men engag-
ing in raids, rape, and slaughter, and terrorizing neighborhoods8 coincided with
early records of lycanthropy.9 Communities apparently lived in terror of werewolf
attacks, just as Romans once lived in terror of Barbarian raids. The werewolf
was a projection or a direct manifestation of the Devil.9 Local violence and the
lycanthropic response may be illustrative of posttraumatic regression, with loss
of identity spawning a vigilant paranoid adaptation in insulated manorial com-
munities. Echoing the fifth-century Mediterranean monks, some communities
were reported to fear the imminent end of the world.4
In this mad world hid an unlikely voice of reason. By assuming the role of
Fool, men of keen insight and caustic wit enjoyed a special “freedom of speech” in
the courts of Medieval princes.10 Under the cover of asses’ ears and mismatched
colors, the Greco-Roman institution of independent thought survived.
Some Holy and Normative Lifestyles

Peculiar to the Middle Ages
Once the mystical and the transcendental were elevated to the status of
“super-reality,” what distinguished between “holiness” and aberration was the
ideological content of the behavior. Content-fitting theological aspirations
were pronounced “holy,” therefore indisputable by reason.
Typically for the Middle Ages, several social groups engaging in the study,
defense, and service of God, renouncing some or most of their physical and
social needs, were deemed to be close to God. Hermits, monks, clerics, ancho-
rites, and some knights all held recognized holiness in varying degrees, and it
was generally among them that specific perceptual, attitudinal, or behavioral
phenomena termed “holy” occurred. Some monks and clerics, most knights,
and all anchorites began rigorous schooling at the age of eight, boarding away
from their families.11 Consequently, some measure of emotional and physical
deprivation may have started early in life.
Some hermits reportedly castrated themselves to prevent temptation.
Some monks perpetually fasted, experiencing “holy anorexia.” Although
organized monastic orders did not institutionalize extreme deprivation mea-
sures, their spiritual training and religious involvement included various
restrictions of social and sexual behaviors. Apart from speaking with ani-
mals, St. Francis, founder of the Franciscan monastic order, reported scores
of visions and painful physical sensations, including stigmata (bleeding from
“Christ’s wounds”). Monks regularly engaged in self-flagellation to expiate
their desires of the flesh.2
The lifestyle of Anchorite women included seclusion in the proximity of a
church or a cathedral, serious study, and prayer. As a viable alternative to mar-
riage, it provided some with a unique opportunity for self-realization. One of
the most famous anchorites of the twelfth century was Hildegard von Bingen,11
who went on to become an abbess, writer, and illustrator, as well as a com-
poser of liturgical music and poetry. She traveled through Europe on “preach-
ing tours” and corresponded with monarchs and popes. Hildegard’s description
and illustrations of her visions in Scivias11 show them to be symbolic expres-
sions of emotional conflicts, highly condensed “picture-insights” into the es-
sence of events inside and around her. From childhood on, she was consistently
able to differentiate them from the real physical world around her.
A Knight’s code of honor included a religious aspect, a martial aspect, and,

from the High Middle Ages on, an aspect of chivalry as well. The early pro-
totype of St. George slaying the Dragon is a symbolic expression of a knight
fighting the evil forces. In the High Middle Ages, knights evolved into a complex
cultural group. Twelfth-century Romances portrayed knights as Men in Robes,
decorated with emblems of arithmetic, geometry, astronomy, and music.12 Of
particular psychological interest is chivalry, whose provision for platonic courtly
love served as a potent motivation for a knight’s heroic military service. A knight’s
worshipping the “pure lady” and devaluing the “whore” (all other women) was
a cultural norm, while his aggression on a Holy Crusade was sanctioned and
blessed by church authorities.13
Some Specific Patterns of Perceptions and Thought

in the Early and High Middle Ages
Regarding perception, the posttraumatic fluidity of the boundary between
the real and the transcendental was evidenced by abundant reports of visions
and hallucinations. These fall on a continuum of distinction from physical
reality. However, the divisions between them were often blurred, as people
tended to call “visions” all they heard and saw that was not perceived by others.
Many personalities besides Hildegard and St. Francis reported visions and/or
hallucinations, including Abelard, Joan of Arc, and St. Augustine. Visions were
often described as two-dimensional translucent images, like stained glass win-
dows in Gothic cathedrals.11 Visions of saints and scenes of piety, subjectively
beneficent, were believed to be divinely inspired. Visions of menacing charac-
ters, subjectively disturbing, were believed to be devil-inspired, and therefore
pathological.8,14
Written and spoken speech was rich with metaphors, allegories, and con-
densed symbolism11–abstract principles and generalizations were illustrated
allegorically, metaphorically, and symbolically. The dominant pattern was of
symbolic relational associations rather than causal logical abstract connections.
For some, amidst traumatic chaos, suggestibility and superficial associations of
co-occurrences substituted for causality and bred popular superstitions, which
guided the regressive magical thinking.9 For others, heavily symbolized associa-
tive-relational thought, even under stress, lacked neither depth nor complexity,
nor organization and structure. A fifth-century example of in-depth analysis
of internal psychological processes is Augustine’s Confessions, which describe
“the poignant inner experience of the soul catastrophe in a catastrophic world”2
(p. 27). Dante’s Divine Comedy offers a 14th-century example, describing as it
does a soul-healing journey through a hierarchical, internal world. The Inferno
translates as the seat of the Id’s Sexual and Aggressive drives, while Purgatory
serves as the seat of the Ego’s insight and working through of one’s problems,
and Paradise forms the Superego’s moral and ideal superstructure. The Divine
Comedy thus parallels Freudian psychoanalysis of the 20th century.15
Hildegard’s twelfth-century Scivia comprises volumes on philosophy, music
and poetry, society, economics, and the natural sciences, including the biology
of sexual organs. Even when she wrote on economics and the natural sciences,
allegories, metaphors, and condensed relational symbols were invoked to con-
vey information.11
Thinking was heavily influenced by primary process (characterized by con-
densation and displacement, as in dreams and poetry). Thought was predomi-
nantly relational, everything being defined by its relation to something else, as
nothing exists alone.3,11 An example of this is Augustine’s “first relational defi-
nition” of time which foreshadowed the Big Bang Theory. It posited that God
created the world with time, not in time, as time and matter could not exist
separately. Neo-Aristotelian thought broke this pattern, whether in the 13th-
century deductive reasoning of Aquinas and Abelard, or in Grosseteste’s and
Bacon’s 11th- and 12th-century inductive, empirical reports on optics.4,11
The High Middle Ages, a stage for cultural recovery, the birth of cities, the
Magna Carta, universities, commerce, and Gothic cathedrals, re-engaged the prob-
lem of Faith and Reason. Aquinas’ Neo-Aristotelian thesis defended the legiti-
macy of reason by arguing that both Reason and Faith present different ways to
discovering the truth. Aquinas’s revolutionary thesis became central to scholas-
tic philosophy, reflecting the need for a conceptual framework for diversification
in all fields, including approaches to mental conditions.
Later Trauma and Posttraumatic Developments
The Black Plague of 1347–1348, following the Famine of 1315, killed one-
third of the population of Europe and the Mediterranean.12,16 Death and decay
were everyday occurrences. As once with the approaching armies of Barbar-
ians, so now with the advent of the Black Death, terror was general. Citizens
fled town amidst a sense of impending doom, disorientation, helplessness, and
disillusionment. The multigenerational, traumatic psychological effects were
immense.16 Specific to this period were repentance, self-flagellation, peniten-
tial exercises, and the “macabre culture.” This complex phenomenon involved
Dances of Death, a “devil-may-care” attitude of excess, and the fascination with
magic, rumored to spread in the form of witchcraft and satanic cults. Ultimately
the macabre culture provoked a backlash of religious excitement and ensuing
pogroms against “The Others,” who became the targets of projected guilt.9,16
The art of this time reflected its mood: torture, death, and decay were all por-
trayed naturalistically, particularly in Bosch’s “Temptations of Saint Anthony,”
depicting the Witches’ Sabbath, Brueghel’s “Last Judgment” and “Apocalypse”, and
the Block books “La Danse Macabre” and “Ars Moriendi” by Antonio Verard.17
Among examples of regressive group behavior surrounding famine and
plague were epidemics of wild dancing, jumping, and drinking, which spread
all over Europe as “St. Vitus’ Dance.” First noted in Italy in the tenth century
as “Tarantism,” it began spreading during the Plague and continued after the
Plague subsided.9,16 Tarantism was triggered by the real or imagined bite of
a spider, which was to be cured by music. Reports of major outbreaks of the
St. Vitus’ dance in Aachen, Germany, in 1374 describe men, women, and chil-
dren breaking into dance, for no discernable reason, and continuing until they
collapsed. Musicians often accompanied dancers to ward off the mania, but
often this backfired because the music encouraged more people to join in.9
From the 11th century on, the mysticism of the Cult of the Free Spirit ap-
peared, a strand of mysticism separate from that which was sanctioned by the
Church. Although both “sprang from a craving for immediate communion with
God; both stressed the value of ecstatic experiences; and both took their con-
ceptual apparatus from Neo-Platonist philosophy” 18 (p. 51), there were crucial
differences. While the Church recognized the experience of the mystical union
with God as a momentary illumination, the adept of the Free Spirit felt him-
self to be utterly transformed, identical with and surpassing God. After such
a transformative experience, the adepts of the Free Spirit adopted an amoral
stance, claiming that “practicing free love re-created the state of innocence
enjoyed by Adam and Eve in earthly paradise”18 (p. 65).
Sin-expiating, self-flagellation processions flared up in the wake of the Black
Death, famine, and typhus in the High and Late Middle Ages. Flagellants at-
tributed sin to themselves. Those perpetuating pogroms, on the other hand,
attributed sin to another group of people. Flagellants usually formed a public
procession, inflicting wounds on themselves until blood squirted from their
bodies, expiating sins that caused deadly epidemics.9 The predominance of
magical thinking under conditions of extreme trauma is illustrated in accounts
of Pope Clement VI’s attempt to stop French Farmers’ Pogroms of Jews during
famine and plague. No logical arguments got through. Only when the Pope
threatened the farmers with God’s wrath did the killing cease.9 The attribution
of evil by one group to another or to an individual who became the target of a
crowd’s aggression continued during the Later Middle Ages in various forms.
Creative adaptations of a different kind to the horrors of plague and fam-
ine were depicted in literature, for example, Chaucer’s Canterbury Tales and
Boccaccio’s Decameron, describing groups of survivors comforting each other
with humorous, lascivious stories. This was an era of pilgrimages, lay piety,
and growing interest in the Cult of Virgin Mary and her mother St. Anne, the
saviors of Plague survivors.16
While some historians see the post-Plague depression extending into all
spheres of human functioning,16 others4,12 argue that, economically, post-Plague
Europe may have yielded improved conditions for the survivors. With fewer
people to share available resources, wages grew, land was cheaper, and while some
cultural centers were afflicted, new ones rose to replace them. New universities
were founded in Prague in 1348, Warsaw in 1358, and Heidelberg in 1360.
Viewed synthetically, both trends—the normative, posttraumatic depression
of older cultural centers (France) and the posttraumatic mobilization of ascen-
dant ones (Germany, Bohemia, Poland, Flanders, England, and the Low Coun-
tries)—co-existed. The Late Middle Ages are known for such monumental
advances as the inventions of the astronomical clock and the printing press and
new precision and dynamism in paintings, ushering in the Renaissance.17 The
access to information, art, and culture was promoted in the Late Middle Ages
by written and printed vernacular languages. While in the High Middle Ages,
new texts were written primarily in Latin and French, the Late Middle Ages
saw the dominance of English, Italian, Flemish, Catalonian, and Czech. The
development of vernacular production was promoted by religious reformers,
knights, merchants, bankers, and poets alike. In the Late Middle Ages, Europe
became a complex civilization of new diversities, reflecting resilience in the face
of unfathomable traumas.4
MENTAL ILLNESS AND TREATMENT

IN THE MIDDLE AGES
The Middle East and the Non-Christian Mediterranean
In the Middle East, where classical knowledge survived, abnormalities in

perception, thought, mood, and behavior were identified and treated as ill-
nesses in psychiatric hospitals as early as 707 CE. Patients were treated with
hydrotherapy, music, and activities that could be viewed as forerunners of
projective doll play, therapeutic puppetry, and psychodrama. Middle Eastern
scholars and physicians combined the Greco-Roman tradition with Muslim
religious influences and their own empirical findings. Some of the most impor-
tant personalities and their contributions are listed below.
Expanding on Hippocrates’ (460–370 BC) Four Humor Theory and
Galen’s (129–200 CE) extension, which identified the brain as the seat of men-
tal functioning and illness, Al Balkhi (787–886 CE) classified fears, sadness,
and obsession; Al Tabari (839–923 CE) identified the need for counseling;
Rhazes (865–925 CE), the head of the “psychiatric unit” at the general hos-
pital in Baghdad, advocated the importance of hope in addressing psychologi-
cal, moral, and spiritual problems. His Liber Continens included the successful
employment of “shock psychotherapy.” His shocking of an unsuspecting, long-

term paralyzed patient by attacking him in a steam room with a knife, scream-
ing “run or be killed!” demonstrated an awareness of psychogenic factors in
hysterical paralysis (p. 52).2 Avicenna (980–1037 CE) combined physiologi-
cal and psychological approaches, addressing insomnia, hallucinations, vertigo,
mania, and melancholia in his Canon of Medicine. He “exerted deep and last-
ing influence on all the great scholastic thinkers of the Middle Ages (p. 53).”2
Avicenna’s Canon of Medicine proved to be a daring attempt to synthesize the
Greek and Arabic healing arts and served as the standard for European medi-
cine for five centuries to come. His belief in the influence of the mind over
the body was apparent in his version of the free-associative method. Averroes
(1126–1198 CE) identified Parkinson’s disease. A personal physician to the
Caliphs and a critic of charlatanry and superstition, he authored the important
concept of “double truth”—what is true in theology may be false in philosophy,
and vice versa, which opened the scientific inquiry at a time of religious fer-
vor.2 Unhamad (870–925 CE) identified nine classes of psychopathology with
treatment recommendations: Febrile Delirium; Dementia; Obsessive Com-
pulsive Syndrome; Involutional Psychotic Reaction; Paranoid and Melancholic
Disorders; Paranoid Mania; Antisocial Personality; and Depressive-Loss Re-
action. Humoral pathology and interaction with other somatic symptoms, as
well as the importance of interpersonal relations and self-concept, were seen as
etiologically prominent. Dietary and other treatments varied according to how
acute or chronic the symptomatology was. If inflammation was present, treat-
ment included a mild form of bloodletting and a milk diet. In most other cases,
a high caloric diet was recommended with occupational therapy, games, and
hydrotherapy. Patients were never permitted to sit in the dark. Patients with
agitation or aggressive behavior were restrained to prevent injury to themselves
and others. Attempts were made to help patients to develop attitudes and be-
haviors to reengage with the world after a loss.2
Psychiatric Hospitals
The first psychiatric hospitals were founded in Baghdad and Fes in the early
eighth century, in Cairo in 800, and in Damascus and Aleppo in 1270. Patients
were benevolently treated with hydrotherapy, music, and activities. Restraint
was used only sporadically to prevent injury to self and others. In the thir-
teenth century, Rabbi Benjamin of Toledo wrote: “. . . demented people who
have become insane in the towns through the great heat of the summer . . . are
provided with the food from the house of the Caliph. Every month the officers
of the Caliph inquire and investigate whether they have regained their reason,
in which case they are discharged”19 (p. 88).
One of the best-known institutions in the Arab world was the Mansuri
Hospital of Cairo, whose designated sections for various diseases included a
wing for the treatment of mental disorders with the practice of “bibliotherapy.”
In a collegial atmosphere, male and female patients were encouraged to select
books on a wide range of subjects from the hospital library, attend lectures
and seminars, and communicate their feelings and suffering in “therapy” groups
(p. 57).2 By the 12th century the Arabs introduced the puppet shows to enter-
tain the sick. In the 13th century, a Jewish physician of Arab origin, Al-Mawsili,
wrote about a highly developed form of shadow play under the title Phantoms
of the Imagination and the Knowledge of Shadow Play, which anticipated pro-
jective doll play, psychodrama, and puppetry. Other developments included
modern methods for research, diagnosis, and psychotherapy.2
Overall, the Greco-Roman traditions of empirical inquiry, including
research, diagnosis, and treatments, remarkably unobstructed by ideologies,
with an admixture of non-conflicting cultural values of the region, continued
until the sacking of Baghdad in 1258 and the end of Byzantium in 1453.2
LATIN WEST—CHRISTIAN EUROPE
Theological Approach
Medieval attitudes and perceptions of mental illness as possession stem from

the Bible: According to St. Mark, Jesus cured a madman by casting out the devils
within him into a herd of swine. The swine stampeded and fell to their deaths,
thus destroying the evil spirit.14
In Early Medieval Europe, the conception of “madness” was largely under
the jurisdiction of theologians as a mixture of the divine, diabolical, magical,
and transcendental. For a society that perceived all events as a cosmic struggle
between good and evil (schism), madness was evidence of a battle lost. If mad-
ness was possession and a moral malady, then the remedies were spiritual. An
example from Early Medieval England was Prince Guthlac.8 After nine years
of rape and slaughter, at twenty-four, Guthlac experienced an existential crisis.
Subsequently, he entered a monastery and began rigorous spiritual training.
He did not fit in, so he left to live alone (with servants) on a nearby island.
There he was assailed by hallucinations and visions of screaming demons. Re-
portedly, Guthlac overcame all of his infernal opponents through the power of
self-flagellation and prayer and became known for his ability to cure insanity
through exorcism and prayer.
Within Medieval Christianity’s concept of divine harmony, the purpose of
treatment was to repair the “illness” of schism and to re-institute the previous
order. Because Christian theology saw mental illness as a moral issue, a test
of faith or punishment for sins, it endorsed various therapies such as fasting,

music, and prayer for those estranged from God and various forms of exor-
cism, including self-flagellation, torture, and occasional death by fire for those
possessed by the devil. The “possessed” were termed witches. The first recorded
witch’s trial in Toulouse in 1275 was not yet part of a systematized effort.20 In
the Early and High Middle Ages, the inconsistencies in the application of theo-
logical concepts left a window open for creative strivings in the face of chaos,
culminating in the High Middle Ages Renaissance. It took two hundred more
years of traumas of plague, famine, and wars for a vigilant systemic counter-
attack to mobilize effectively.
Towards the end of the Late Middle Ages, the theological trend became
systematized in the Hammer of Witches, Malleus Maleficiarum, by the two
monks Henry Kramer and James Sprenger, endorsed by Pope Innocent and
Emperor Maxmilian. This approach was seconded by Letters of Approbation
in 1487, written by the Faculty of Theology of the University of Cologne.
Both documents accused countless people of witchcraft, among them many
on the spectrum of mental afflictions, who stood out with their observable
behavioral abnormalities. The chief Texts of Anti-Satanism in Europe, de-
fining “The Devil” and “The Witch,” described how Lucifer could induce Evil
Love in both sexes, bewitch them to procure abortion, induce disease in any
organ, deprive individuals of reason, and make them impotent. According to
Kramer and Sprenger, the witches were primarily women because “all witch-
craft derived from carnal lust, insatiable in women”1 (p. 11). The Hammer of
Witches, together with the Letters of Approbation, provided an early taxonomy
of perceived deviant behavior and proposed guidelines for prosecution and
“treatment.” It was designed to reassert control over the maddening chaos and
the staggering loss of population in the aftermath of the 100 Year War, famine,
and plague. It set up the Witch Trial System of the Inquisition for centuries
to come.
Medical Approach
From the 11th century, Latin translations of Islamic medical texts began to
appear in Europe and were incorporated into the teaching of medicine at the
universities of Naples and Montpellier, spreading into all European medical
schools. By the beginning of the high Middle Ages, Canon of Medicine, by Avi-
cenna, extending Galen’s tradition, became the medieval physicians’ curriculum.
Towards the fall of Byzantium in 1453, there was an influx of Greek scholars
and manuscripts into the West, which established two traditions: the Conser-
vative Arabian and the Greek Liberal, offering a direct comparison between the
original Greek texts and Arabic translations and commentaries.
In England, by the 13th century classical notions of humoral imbalance had

become the standard explanation of psychiatric conditions in medical treatises
and encyclopedias, thanks to the brothers Anglicus and others who summa-
rized ancient learning on the subject. Bartholemew Anglicus (1203–1272) dis-
tinguished mental retardation from mental illness and described depression
and treated it with music therapy, dietary, herbal, and surgical regimes of classi-
cal medicine.19,21 The regulation of diet was mostly effected through the use of
spices in cooking. Pepper, cumin, cinnamon, cloves, etc., were perceived as the
essential regulators of the different humors. For the peasant class there were
poultices made by healers from local herbs. Surgical techniques were limited
to bleeding. In practice, the most widely used method to contain disorganized,
aggressive, disruptive behaviors was confinement in chains.20
Synthetic Approaches
Arnaldus de Villanova (1235–1313) combined Galenic principles with be-
liefs in the devil and astrology. Specifically, he recommended trepanning as a
treatment to let both demons and excess humors escape. His poem Flos Medi-
cinae became a mainstay of applied psychotherapy through the Renaissance.21
Trepanning or trepanation related to an old idea, that mental illness was
caused by foreign bodies lodged in the head. Starting in the Late Middle Ages,
a series of paintings by Peter Breughel the Elder, Hieronymus Bosch, and oth-
ers portrayed the removal of stones from the head and other parts of the body,
addressed themselves to the conflicts of the culture, and incorporated reli-
gious, intellectual and social trends. Depicting the interrelationship between
mental illness and sin, madness, and sexuality, the paintings illustrated the
salient issue of the religious and secular Middle Ages—the loss of control
and sinfulness related to the kind of passions which make people “lose their
minds.” The stones operation was a means of controlling madness and its cor-
relative sexual passions.22
Legal Definition and Evaluation of Insanity

Thomas Aquinas (1224–1274) provided the first legal definition of men-
tal incompetence, designating the “Sick of Mind” category in his Canon Law.
Aquinas’s Canon Law differentiated between the “insane from infancy without
periods of lucidity” and those “with periods of lucidity,” those who “were at one
time sane but have suffered loss of reason,” and the “mentally deficient [who]
can take thought for their salvation”2 (p. 72).
In High and Late Medieval England, the application of the legal definition of
mental illness rested on somatic understanding. During the reign of Henry III
(1216–1272), the crown assumed the right to the guardianship of “congenital

idiots.” A government-appointed commissioner investigated the matter in front
of twelve local jurors, selected for their knowledge of the subject. A verdict was
suggested, the commissioner proceeded to interview the subject, and a ruling
was reported to Chancery, where guardianship provisions were determined.14
The implementation of such procedures is illustrated by the case of Emma de
Beeston. An inquest in 1382 determined that she had not been an idiot from
birth but had been insane for only four years. Consequently, the king ordered
her person, lands, and goods to be entrusted to her kinsman during her infir-
mity. Emma, supported by the mayor and several other townsmen, challenged
the decision. She charged that the inquisition had been suborned by her kins-
man and unnamed accomplices, who hoped to benefit from her idiocy. Emma
petitioned for her guardianship to be granted to burgesses unconnected with
either party. In 1383 a second inquest was held in Lincoln to determine her
state of mind. The abbreviated record stated that Emma was asked where she
was born, and she answered that she did not know. Being asked in what town
she was, Emma said that she was at Ely. Being asked what day that Friday
was, she said that she did not know. Being asked how many days there were
in the week, she said seven but could not name them. Being asked how many
husbands she had had in her time, she said three, giving the name of one only
and not knowing the names of the others. Being asked whether she had ever
had issue by them, she said that she had had a husband with a son but did
not know his name. After such commonsense questions, the justices found her
not to be of sound mind, having no sufficient intelligence to manage herself
or her property. The questions considered her experience and circumstances.
Assessment of her general awareness was related to memory, life skills, and
general knowledge. In the end, Emma herself was placed in the guardianship of
her kinsman, but her property was managed by four burgesses on her behalf.23
The same pragmatism and empiricism inform the vast majority of cases from
1349, for which records survive. Many returned a verdict of congenital idiocy,
while some cases found post-natal insanity and detailed the circumstances, for
example, being struck on the head by a lance during jousting, after fever,19,21,23
etc. Even in cases with no known cause, there were no appeals to supernatural
influences.14,23
Subjective Report
The first subjective account of mental disorder in the English language is
the autobiography of Margery Kempe from the 1430s. At the time she wrote
her autobiography, she was in her 60s24 (pp. 39–44). The daughter of the
mayor of a town, she married well, but after her first confinement she suffered
what would contemporarily be called postpartum psychosis. After giving birth

to 14 children, she tried to sever marital relations with her husband and was
subject to sexual fantasies and temptations. She suffered bouts of incessant
weeping and later in life reported constant visions and conversations with God
the Father and various female saints. She restlessly traveled to authorities and
shrines throughout England and Europe to justify her experiences. Margery
described herself as “like a mad woman,” “a drunk woman,” “without reason.”
She recognized her illness as insanity, but this recognition was useless to her.
Her life became a constant struggle with the devil to realize her spiritual es-
sence. What for most were symptoms of disease were for Margery a cosmic
drama. And through that drama, Margery attained the peace that she longed
for. By the time she wrote her autobiography, she “realized her essence,” living
a pious life, surrounded by her family and friends. By investing her illness with
meaning, she gained control over it. In some cases metaphysical representations
of mental illness were more effective. The perception of mental illness as con-
taining a metaphysical meaning took into account the person and the mind.14
Treatment Institutions
During the Early and High Middle Ages, the mentally ill were cared for
by their communities and families. As we saw in the case of Prince Guthlac,
already at that time monasteries functioned officially or unofficially as asylums
and spiritual “training” centers for mentally afflicted, who may have “checked
themselves in” voluntarily. In some countries of Eastern Europe, where
Orthodox Christianity became a state religion, as in Russia, the monasteries’
role was legitimized as early as the 10th century by Prince Vladimir’s statute. It
was now “mandatory for the church to provide shelters for widows, orphans,
and the mentally ill”26 (p. 34).
In the Late Middle Ages, the more formal segregation between the mentally
afflicted and physically ill was under way. The London hospital of St. Mary
of Bethlehem, founded in 1247, later known as “Bedlam,” sheltered (and ex-
hibited) exclusively mentally ill individuals from 1402.26 By then, the Flem-
ish village of Gheel, which housed the shrine of St. Dymphna, had gained a
reputation as a healing center for the mentally disturbed. Asylums were also
founded at an early date under religious auspices in 15th-century Spain. In
1410 CE, the first mental asylum opened in Valencia, Spain, when Friar Jofre
witnessed a mob abusing several insane people. Local tradesmen financed the
construction and functioning of their city’s asylum. Similar situations arose in
Zaragoza, Seville, Valladolid, Toledo, and Barcelona.14,24,25,26
To summarize, Middle Ages Christian Europe’s approach to mental abnor-
malities has shown great variability. While originally firmly in the grip of Early
Christian ideology, with monks and monasteries taking on the role of mental
health arbiters, gradually the empirically driven medical models and pragmati-
cally driven legal models emerged more and were applied with varying success
and varying degrees of humanity. The 21st-century observer must exercise cau-
tion in ascribing an unquestioningly positive value to the “progressive” medical
model and a negative value to the “regressive” theologically derived approaches,
for in some instances engagement with a theological “cosmic struggle” between
good and evil actually proved curative while medical assessment and treatment
did not. We could conjecture that especially with the legacy of intergenera-
tional traumas, the access to the irrational, magical, and transcendental proved
to be a needed resource in adapting and healing.
CONCLUSION
An era of massive generational traumas and posttraumatic developments,
the Middle Ages ended with a “diversity of the hundred centers of political and
cultural aspirations competing for success”4 (p. 329). The fracturing and frag-
mentation of the large empires, causing the devastating trauma at the earliest
point of the Middle Ages, became a resource of creative resilience and recovery
amidst the pandemic trauma of the Late Middle Ages, as competing percep-
tions, opinions, attitudes, and remedies became accessible to more people. This
diversity posed the opportunity for various avenues of adaptation, which ush-
ered in the Renaissance and the Ages of Discovery, Humanism, and Reason.
In the area of approaches to mental conditions, this diversity guarded against
an exclusive application of any one empirical/scientific or philosophical sys-
tem over another without regard for the suitability to an individual. In general,
those with mental abnormalities constitute a minority in any society, and they
are therefore, by definition, at risk. Throughout history, when diversity was
suppressed, abuses followed.26
REFERENCES
1. Cockerham, W. C. (2010). Sociology of mental disorder, 8/E. Upper Saddle River,
NJ: Pearson, Prentice Hall.
2. Graham, T. F. (1967). Medieval minds: Mental health in the Middle Ages. London:
George Allen & Unwin LTD.
3. Russell, B. (1972). History of western philosophy. New York, NY: Simon &
Schuster.
4. Holmes, G. (1988). The Oxford history of medieval Europe. New York, NY: Oxford
University Press.
5. Bruno, W. (1993). Holy and profane mental anorexia. Rivista Psicoanal, 39, 81–99.
6. Drew, K. F. (1991). The laws of the Salian Franks (Pactus legis Salicae). Philadelphia:
University of Pennsylvania Press.
7. Pirenne, H. (1980). Medieval cities: Their origin and the revival of trade in Europe.
Princeton, NJ: Princeton University Press. (Reprinted from 1925 and 1952
editions)
8. Colgrave, B. (Ed.) (1956). Felix’s life of Guthlac. Cambridge, UK: Cambridge
University Press.
9. Ginsburg, C. (2003). Nocni Pribeh. Prague: Argo. (Translated from the Italian
Original Storia Nocturna, 1995 by J. Hajny)
10. Swain, B. (1934). Fools and folly during the Middle Ages and the Renaissance.
Psychoanalytic Review, 21, 119–120.
11. Cahill, T. (2006). The mysteries of the Middle Ages. New York, NY: Random
House.
12. Keen, M. (1984). Chivalry. New Haven, CT: Yale University Press.
13. Blanchard, W. H. (1956). Medieval morality and juvenile delinquency. American
Imago, 13, 383–398.
14. Roffe, D., & Roffe, C. (1995). Madness and care in the community: A medieval
perspective. British Medical Journal, 311, 1708–12.
15. Chessick, R. D. (2001). Dante’s Divine Comedy revisited: What can modern psy-
choanalysis learn from a medieval “psychoanalysis”? Journal of American Academy
of Psychoanalysis, 29, 281–304.
16. Langer, W. L. (1958). The next assignment: Epidemics and underlying psycho-
logical states at the time of the Black Death 1348–1349. American Imago, 15,
235–266.
17. Myers, B., & Copplestone, T. (Eds.) (1990). The history of art. New York, NY:
Dorset.
18. Cohn, N. (1961). The Cult of the Free Spirit: A Medieval Heresy Reconstructed.
Psychoanalytic Review, 48A, 51–68.
19. Adler, M. N. (1907). Itinerary of Rabbi Benjamin of Tuleda (Translator Henry
Frowde). London: Oxford University Press.
20. Kroll, J. (1973). A reappraisal of psychiatry in the Middle Ages, Archives of Gen-
eral Psychiatry, 29, 276–283.
21. Neubegauer, R. (1979). Medieval and early modern theories of mental illness.
Archives of General Psychiatry, 36, 477–483.
22. Hartman, J. J., White, S. H., Ravin, J. G., & Hodge, G. P. (1976). The stones of
madness. American Imago, 33, 266–295.
23. CIM (1957). Calendar of inquisitions miscellaneous preserved in the public record
office, iv, 1377–1388; 1348–1350. Public Record Office (London).
24. Porter, R. (1988, April). Margery Kempe and the meaning of madness. History
Today, 38, 39–44.
25. Bloch, S., & Reddaway, P. (1977). Russia’s political hospitals. London: Victor
Gollanzc, Ltd.
26. Millon, T. (2004). Masters of the mind: Exploring the story of mental illness from
ancient times to the new millennium. Hoboken, NJ: John Wiley and Sons.
Chapter 3
Abnormal Psychology
in the Renaissance
Diane E. Dreher
The Renaissance was a time of dramatic change and rising individualism,

leading men and women to examine their lives with greater introspection, a
passionate interest in their own consciousness, and a new awareness of abnor-
mal states of mind. This dynamic era inspired countless journals and spiritual
autobiographies as well as John Donne’s Devotions, Robert Burton’s Anatomy
of Melancholy, and Shakespeare’s greatest tragedies. Renaissance healers and
medical practitioners attributed mental illnesses to divine retribution, demonic
possession, witchcraft, astrological influences, excessive passions, and imbal-
anced humors. They treated mental disorders with a combination of magic,
medicine, science, and religion and saw balance—in humors, passions, diet, and
activities—as the key to health.
Balance was essential to the Renaissance, a time when people saw life as
a complex set of correspondences in which each person was a microcosm, a
small reflection of the larger world around them. Human consciousness was
comprised of 1) the vegetal soul, the ability to take in nourishment, grow, and
reproduce, shared with plants; 2) the sensible soul, the senses, movement, and
passions, shared with animals; and 3) the rational soul, the powers of reason,
understanding, and will, shared with angels. The four elements of air, fire, wa-
ter, and earth in the physical world were paralleled on the personal level by the
four humors: blood, choler, phlegm, and melancholy. Blood was hot and moist,
choler hot and dry, phlegm cold and moist, and melancholy cold and dry. There
were four personality types, determined by one’s dominant humor: “sanguine”—
lively, energetic, good-natured, and amiable; “choleric”—hot-tempered,
impulsive, with great strength and courage; “phlegmatic”—lethargic, sluggish,

inactive; or “melancholy”—sober, serious, intellectual, sad, and often wryly
witty.1,2,3 In Renaissance art, philosophy, and literature, the plan of all creation
was portrayed as a “Great Chain of Being,” in which human life was a precari-
ous balancing act. People were positioned midway on the chain between angels
and animals, the powerful polarities of reason and passion, and predisposed to
inherent tension and inner conflict between these two polarities of our nature.
MENTAL DISORDERS IN THE RENAISSANCE
The Renaissance has been called “the most psychically disturbed era in
European history.”4 Rapid changes in science, religion, culture, politics, and the
arts produced widespread anxiety and a vast panorama of mental disorders,
some bizarre and extreme, while others are still familiar to us today.
The term “lunacy,” a term for insanity dating back in England to the 13th
century, was originally associated with the influence of the moon. From the
15th century onward, “lunatic” and non compos mentis were legal terms for the
mentally ill, who could experience lucid intervals or even a complete recovery.
These cases contrasted with the mentally retarded, who were known as “natural
fools” or “idiots.” By an act of Parliament in 1540, lunatics and fools were made
wards of the court, and their properties and personal care overseen by the state.
Early papers from the English Court of Wards and Liveries recorded Renais-
sance cases of lunacy caused by physical illness, a blow to the head, sudden
emotional shock, extreme and prolonged grief, the stress of economic ruin, and
excessive drinking.5,6
Renaissance descriptions of lunatics emphasized their wild, animalistic
qualities. Imbalanced and deprived of reason, the quality distinguishing us
from beasts on the Great Chain of Being, the mentally ill often ran around
disheveled and nearly naked, like Tom O’Bedlam in King Lear. English astro-
logical physician Richard Napier described how one of his patients, Elizabeth
Knot, tore her dress and ran around naked on the cold, wet ground.7 Lunatics
were known to stick weeds in their hair, run wildly about, or lie motionless
and passive for hours at a time. They refused to eat or gobbled down garbage
and often attempted suicide. Beset by jerks, gyrations, and convulsions, they
babbled, shrieked, ran or wandered aimlessly, fell into fits of weird laughter, and
howled at the moon.7,8
Richard Napier diagnosed his mentally ill patients with three levels of
insanity: “madness,” “distraction,” or “lightheadedness.” Mad patients were wild
and violent, distracted patients babbled and raved incoherently and could also
be violent, while light-headed patients were nonviolent, engaging in nonsensi-
cal babbling.7 Renaissance sources described a panorama of mental illnesses.
Abnormal Psychology in the Renaissance 35
In cases of mania (which Napier called madness), people behaved like wild
animals, unable to control their passions.5,9 They were frightening and danger-
ous, lashing out with phenomenal physical strength and prone to fits of rage,
raving, and violent acts.7 A 1663 treatise by English physician Robert Bayfield
described cases of lycanthropy or “wolf-madness” in which people ran around
the fields at night, barking and howling like dogs.5
One form of madness, known as melancholy, became especially prevalent
during this period. According to Robert Burton, melancholy was “a kind of
dotage without a fever, having for his ordinary companions fear and sadness,
without any apparent occasion.”2 In this condition, known today as Major De-
pressive Disorder, symptoms included sadness, exhaustion, heaviness of mind,
anxiety, delusions, the inability to experience pleasure, withdrawal from social
activities, fearfulness, and thoughts of suicide.2,10 Richard Napier diagnosed
some of his patients as melancholy and others as “mopish,” suffering from a
chronic and less acute form of melancholy involving idleness, gloom, and exces-
sive solitude, which we might diagnose today as Dysthymic Disorder.7,10
In what was known as religious melancholy, the afflicted were plagued by
religious doubts, fears, guilt, visions of their sins, the fires of hell, and the
belief that they were incorrigibly damned. One form of religious melancholy
was scruples, a condition described by English Bishop Jeremy Taylor in which
sufferers were riddled with anxiety, focusing obsessively on the details of their
daily lives, afraid to eat for fear of gluttony, afraid to sleep for fear of the sin
of sloth, or afraid of offending God through some mistaken action, no matter
how small.5 Today we might see this behavior as a form of phobia or Obsessive-
Compulsive Disorder.10
Specifically female mental disorders included the “green sickness,” a species
of melancholy affecting young women, with episodes of sorrow, headaches,
difficulty breathing, indigestion, faintness, pallor, absence of menses, anxiety,
and abdominal pain for which, Burton says, the best cure was marriage. Many
women supposedly suffered from “suffocation of the mother,” a form of melan-
choly blamed on a wandering uterus that migrated upward toward the heart
and lungs, causing anxiety, choking, convulsions, difficulty breathing, and in
some cases a fainting fit, in which the victim fell down unconscious, appearing
dead to the world for up to three days.2,3,7,11
Renaissance physicians recognized what we now know as Dementia, the
cognitive deficits and loss of memory that can afflict the aged.10 English physi-
cian William Salmon described one such case in The Practice of Curing Diseases
(1694), in which Sir John Roberts, a man he had known for years, became “de-
cayed in his intellectuals,” laughing and crying for no apparent reason. Unable
to remember what his doctor had just said to him, he asked the same question,
then forgot and asked again five or six times in a row.5
Because the Renaissance was still a patriarchal, authoritarian society, people

who refused to blindly submit to authority were frequently regarded as men-
tally ill, including wives who refused to obey their husbands and children who
rebelled against their parents. Napier records the case of Ellen Hixon, a young
woman brought to him as a mental patient simply because she refused to obey
her parents.7
RENAISSANCE EXPLANATIONS
FOR MENTAL DISORDERS
A variety of causes were proposed for mental illnesses: the influence of the
moon, the stars, the weather, earwigs in the head, and an imbalanced life involv-
ing excessive or insufficient drink, diet, sleep, exercise, passions, and humors,
along with witchcraft and the devil himself. Excess in any form was considered
unhealthy. Timothy Bright saw an overly rich diet as a major cause of melan-
choly, advising people to avoid cabbage, beets, dates, olives, chestnuts, acorns,
pancakes, rye bread, beans, pork, beef, mutton, goat, boar, venison, mutton, wa-
ter fowl, quail, eels, porpoises, milk, cheese, eggs, red wine, and dried and salted
meats.12 Excessive passions could cause a dramatic case of “melancholy adjust.”
According to Bright, melancholy adjust burned the humors with excessive heat,
which would bring about symptoms associated today with a Major Depres-
sive or Manic Episode:10 “the greatest tempest of perturbations and most of all
destroys the brain with all his faculties, and dispositions of action, and makes
both it, and the heart more uncomfortable: and if it rise of the natural melan-
choly, beyond all likelihood of truth, frame monstrous terrors of fear and heavi-
ness without cause. If it rise of choler, then rage plays her part, and fury joined
with madness, puts all out of frame. If blood minister matter to this fire, every
serious thing for a time, is turned into a jest and tragedies into comedies, and
lamentation into jigs and dances: thus the passion whereof the humor minis-
ters occasion, by this unkindly heat advances itself into greater extremities.”12
As in the Middle Ages, mental illness was often associated with demonic
possession. Religion, popular culture, and medical practice attributed many
cases of melancholy, madness, and anxiety, as well as sadism and sexual addic-
tions to witchcraft and the devil’s powers. Martin Luther associated madness
with the wages of sin and the work of the devil, describing hardened sinners
as mentally deranged, raging, possessed, and lunatic.13 People often attributed
their unconscious urges to the devil’s work and referred to supernatural causes
to explain mysterious illnesses and accidents. Belief in witchcraft was wide-
spread throughout the Renaissance. More than 500 of Richard Napier’s pa-
tients believed that they or their family members were bewitched. Many of his
bewitched patients exhibited symptoms of schizophrenia and other psychotic
disorders. Hearing bizarre voices, they believed themselves possessed by devils,

were tempted to extreme acts, and often screamed out in terror.7,10
Suicide was considered a civil and religious crime in Tudor England,
believed to be the devil’s work because it involved the loss of one’s immortal
soul. Religious leaders taught that melancholy made people vulnerable to the
devil’s temptations, as dramatically portrayed in Marlowe’s Doctor Faustus.
Chief among these temptations was “the sin of despair,” leading to suicide.14
Yet with the increased focus on melancholy and the influence of new scientific
attitudes during the late 16th and 17th centuries, suicide came to be seen more
as a symptom of mental illness.7
New scientific attitudes and direct observation gradually led to less magical
thinking and more objective conclusions about mental illness. German physi-
cian Johann Weyer maintained, in De Praestigiis Daemonum (1563), that many
old women persecuted as witches were actually suffering from melancholy
delusions.15,16 In 1584, Reginald Scot, an English justice of the peace, noted
that people accused of witchcraft, as well as the accusers, were often mentally ill,
recording his views in his book, The Discoverie of Witchcraft.5 Concerned that
science was not giving the devil his due, in 1597 James I, then king of Scotland,
wrote Daemonologie, condemning Weyer and Scot, while warning of the devil’s
powers.17 When he became king of England in 1603, he ordered Scot’s book
burned. His Witchcraft Act of 1604 condemned witches to death, leading, for
a time, to increased witch hunts and persecutions.3,5,14 In this heightened at-
mosphere, Shakespeare wrote Macbeth in 1606. However, science ultimately
prevailed. The last witch was hanged in England in 1684, and in 1691 English
minister Timothy Rogers warned people not to confuse the disease of mel-
ancholy with the work of the devil, advocating kindness and compassion for
people with this disorder.5
Physician Richard Napier kept detailed records of his patients’ symptoms
and causes of their mental disorders, many of which are still relevant today.
Although more than 264 of his patients believed they were bewitched, 99
suffered from financial distress, experiencing severe anxiety over losses and
debts. Grief at the loss of a loved one was a common cause of mental illness.
One patient, Agnes Stiff, suffered from extreme melancholy months after her
mother’s death, unable to work, and given to fits of weeping and aimless wan-
dering. Nearly one-third of Napier’s patients suffered from illness or insan-
ity after the death of a spouse. Relationship problems were another common
cause of mental illness. Nearly 40 percent of his patients complained of mental
disturbances caused by courtship and married life. Forty-one patients attrib-
uted their insanity to the fact that their families would not let them marry
the person they loved, and 135 complained about marital problems, including
alcoholic spouses and spousal abuse.7
RENAISSANCE TREATMENTS FOR MENTAL DISORDERS
Treatment for mental illness depended upon the diagnosis and cultural
contexts. In the early Renaissance, religious rituals and aggressive treatments
were used to expel evil spirits or excessive humors. Catholic priests performed
exorcisms, and Puritan ministers employed ritual, prayer, and fasting, while
astrologers and folk healers used charms and talismans. Richard Napier
purged and exorcised patients and also gave them sigils, metal disks inscribed
with astrological signs, to wear on ribbons around their necks.7,13,18,19 Medical
treatments were often extreme, painful, and brutal. Patients were whipped,
chained, given a diet of bread and water, and left in darkness and solitary
confinement, like Malvolio in Shakespeare’s Twelfth Night. The mentally ill
were subjected to a debilitating course of emetics, laxatives, and bleeding to
purge the offending humors.20,21 Yet the German doctor Paracelsus rejected
the humors theory. Believing that health and sickness were part of our spiri-
tual journey, he used prayer, herbs, minerals, opium grains, and spiritual
alchemy to treat his patients. Diagnosis and treatment of mental illness often
differed with social class. In Germany upper-class patients were treated medi-
cally to expel the excess of melancholy humors while lower-class patients with
the same disorder would be exorcised as sinful or demonically possessed.19,22
In addition to prayer, exorcism, and astrological cures, common medical
treatments included removing the cause of the disturbance, as well as begin-
ning a regimen of diet, healthy activities, and herbal remedies to restore the
patient to a state of balance. Since body and mind were intrinsically related
in Renaissance beliefs, physical remedies were commonly used to treat men-
tal illness. Special diets were prescribed to balance the humors. A person
suffering from a hot and dry disease was to avoid spicy foods and eat lettuce
and other cold and moist foods. Activities, too, were prescribed to promote
balance. Sleep was believed to warm the body while activity cooled and dried
it.3 Healers used kitchen remedies, rubbing the patients’ heads with vinegar
and potions of herbs and ground ivy leaves. They gave patients oxtail soup
for breakfast and cooled their humors with drinks of lettuce water or lem-
onade.8,13 Timothy Bright recommended a diet of broth; tender young meat,
preferably fowl; bread made from oats and wheat; carrots, parsnips, and let-
tuce; cherries, figs, grapes, apricots, and either orange or lemon juice; and
eggs, oysters, sole, haddock, and trout. Some healers shaved their patients’
heads and applied split chickens, capons, or other animal parts to reduce
fever.12,13
The traditional purge, advocated by Bright, involved emptying the exces-
sive humors by applying a “clister” or laxative, then bleeding the patient and
often making the poor soul vomit as well.12 The clinical records of Daniel
Oxenbridge, an early-seventeenth-century English physician, provide an in-

sight into the medical treatment suffered by one patient:
Mrs. Miller, aged 24, a cloth-worker’s wife, was mad for two years, though she
took many remedies. I was called in 1628, in the spring. After a common clister,
I bled her plentifully in the cephalic vein, on both arms, at the saphena in both
feet, at both the salvatellas, in the forehead, under the tongue, and by leaches to
the hemorrhoid vein. I made her drink much cider made fresh in the house, with
apples and water. I tempered the atribilarious humors, with syrup of borage,
buglos, endive, . . . apples . . . and . . . after the general evacuations, once in three of
four days, I either bled her or vomited her strongly, or purged her . . . she would
vomit 12 times, and purge two of three times downward. . . . After she was gener-
ally thus evacuated, I shaved off all the hair of her head, and used a stillicidium
daily to her head of warm water, wherein the herbs rosemary, sage, lavender,
betony were boiled, and . . . cloths wet in the same about her head, and anointed
her head with mandrake oil. At bed-time she bathed her feet in warm water
to dispose her to sleep; other opiates she used inwardly, as laudanum, paracelsi
sometimes or lettuce boiled and sweetened with sugar or an emulsion of barley,
with . . . lettuce seed or white poppy seed, . . . Oil of violets, of nympheae, roses,
and to her head shaved, I applied the warm lungs of lambs, sheep, young whelps,
pigeons alive.5
Like Oxenbridge, Richard Napier also prescribed laudanum, an opium tincture

developed by Paracelsus, to calm the raging madness of some patients and help
others sleep.7
Other treatments for mental disorders were also recorded, some unusual and
extreme. Drowning or dunking was advocated by Dutch physician Franciscus
Mercurius Van Helmont in 1694.5 In 17th-century England, Oxford physician
Thomas Willis treated a young woman for madness by throwing her naked
into a river for a quarter of an hour, then had her taken out, whereupon she
experienced profound sweats, fell asleep, and then recovered her wits.20 Willis
also practiced trephination or trepanning, making a hole in the patient’s skull
to release the foul vapors and excessive humors.23 In 1667, the French Doctor
Denis performed a transfusion on a 34-year-old man suffering melancholy after
an unhappy love affair, first bleeding the patient of ten ounces of blood, then
replacing some of it with cow’s blood. Remarkably, the patient recovered from
the operation as well as the melancholy.15 Among less vehement herbal cures,
English doctors treated victims of melancholy with St. John’s Wort.23 Robert
Hooke, M.D., Fellow of the Royal Society, even proposed using marijuana to
relieve symptoms.5
England’s first mental institution, the priory of St. Mary of Bethlehem in
London, founded in 1247, had been used to house and treat lunatics since 1377.
In 1547 it became a public insane asylum, managed by a court of governors and

by Bridewell, a house of correction. In the asylum, known as “Bedlam,” patients
were whipped, chained, bled, and subjected to a meager diet, a bed of straw, and
exhibited like circus animals for curious visitors, who regarded Bedlam as one
of the “must-see” sights of London. By the end of the 17th century, as many as
96,000 a year visited the asylum.7,8,20
Yet some raised their voices against inhumane treatment of the mentally ill.
As early as 1538, Juan Luis Vives wrote that mental patients were first and fore-
most human beings, to be treated with compassion and kindness. He believed
that our primary motivation was to love and be loved, recognizing that when this
desire is thwarted, it produces anger, shame, and a mixture of mental illnesses.15
While acknowledging that the treatment should correspond to the condition,
he encouraged healers to create an atmosphere of tranquility to quiet patients’
minds and settle their spirits. In 1542, Andrew Boorde wrote that the men-
tally ill were to be comforted, withdrawn from noise and bothersome thoughts,
and cheered with pleasant music before sterner measures were tried.21 In 1586
Timothy Bright also advocated a clean, pleasant atmosphere, with clean clothes,
pleasant surroundings, and the solace of a garden.12
Gradually, people recognized that the mentally ill needed greater compas-
sion. In the 17th century, the Quakers, inspired by their founder, George Fox,
cared for the mentally ill with kindness.7,24 English medical writer Thomas
Tryon criticized the use of blood-letting and sedatives, as well as the expo-
sure of Bedlam inmates to public viewings. In A Treatise of Dreams & Visions
(1689), he wrote that observation had disproved and invalidated medical treat-
ments based on the humors theory. Madness, he argued, came from extreme
passions which unsettled the balance of the soul and could best be treated by
a simple, balanced diet, peaceful atmosphere, and caring friends, who could
listen with compassion.5 In 1691 English minister Timothy Rogers wrote that
the mentally ill needed the kindness, gentleness, and companionship of a friend
who would listen to their feelings, no matter how extreme, with acceptance and
empathy. Above all, he felt, the compassionate friend must convey hope, telling
the patient of others who have suffered and recovered, as he himself had recov-
ered from a prolonged bout of melancholy.5
MELANCHOLY: DEPRESSIVE DISORDER

IN THE RENAISSANCE
Melancholy was the most popular and prevalent mental disorder of the
Renaissance. From the 1580s onward, references to this disorder abounded in
English medical, legal, and literary texts, including Bright’s Treatise of Melan-
choly (1586); Shakespeare’s Hamlet (1602); John Donne’s treatise on suicide,
Biathanatos (1644); and Burton’s Anatomy of Melancholy (1621), which became

a best-seller, with eight editions in the 17th century. In this cultural context,
educated men and women who found themselves sad, anxious, or troubled,
often concluded that they had come down with the melancholy and sought out
treatment.7
As mentioned earlier, symptoms of melancholy included overwhelming
anxiety, fearfulness, sadness, and gloom, restlessness, dissatisfaction, emo-
tional instability, suspicion, weeping, complaining, ill-tempered and aggressive
behavior, withdrawal from social life, disturbed sexual relations, torpor, the in-
ability to feel pleasure, lethargy, oppression with a sense of guilt and unwor-
thiness, inability to sleep, delusions, hallucinations, profound weariness with
life, and suicidal tendencies.2,3,12,14 These symptoms anticipate Sigmund Freud’s
description of melancholia three centuries later: “The distinguishing mental
features of melancholia are a profoundly painful dejection, cessation of inter-
est in the outside world, loss of the capacity to love, inhibition of all activity,
and a lowering of the self-regarding feelings to a degree that finds utterance in
self-reproaches and self-revilings, and culminates in a delusional expectation of
punishment.”25,26
Reflecting a profound inner imbalance, the melancholic’s emotional state
was extreme, out of all proportion to any external conditions. As Timothy
Bright explained: “We do see by experience certain persons which enjoy all the
comforts of this life whatsoever wealth can procure, and whatsoever friend-
ship offers of kindness, and whatsoever security may assure them: yet to be
overwhelmed with heaviness, and dismayed with such fear, as they can neither
receive consolation nor hope of assurance, notwithstanding there be neither
matter of fear, or discontentment, nor yet cause of danger, but contrarily of
great comfort. This passion being not moved by any adversity present or immi-
nent, is attributed to melancholy the grossest part of all the blood, either while
it is yet contained in the veins: or abounds in the spleen, (ordained to purge the
blood of that dross and settling of the humors) surcharged therewith for want
of free vent, by reason of obstruction.”12
As today Depressive Episodes are often recognized to be preceded by
anxiety,10 so in the Renaissance melancholy persons were seen as driven by
an underlying fear. According to Bright, “fear is the very ground and root of
that sorrow, which melancholy men are thrown into. For a continuance of fear,
which is of danger to come, so overlays the heart that it makes it as now present,
which is only in expectation, and although the danger feared be absent, yet
the assuredness thereof in the opinion of a melancholy brain is always present,
which engenders a sorrow always accompanying their fears.”12 With their cog-
nition disordered by “melancholy fumes,” patients often misperceived reality,
suffering from delusions, believing themselves kings or emperors, or, in the case
of religious melancholy, tormented by ghosts and visions of devils and hellfire.

Although today the term melancholy is synonymous with sadness or depres-
sion, the Renaissance disorder also included symptoms of what we would now
call Schizophrenia, as well as Anxiety and Obsessive-Compulsive Disorders.10
Six of Napier’s patients were tormented by devils’ voices that told them to kill
their relatives, and one patient, Alice Davy, diagnosed with “extreme melan-
choly,” was phobic about dirt, obsessively washing her clothes, and afraid to
touch anything or go out to church for fear of the dust soiling her clothes.7
Causes and Types of Melancholy
Burton’s Anatomy, at over 1,200 pages, provides the most compendious

Renaissance description of melancholy, its causes, types, and treatment.
According to Burton, melancholy could have natural or supernatural, internal
or external causes. Supernatural causes involved God (causing a dark night
of the soul in a call to conversion), the devil, or the devil’s agents, namely
magicians and witches, luring a sinner to damnation. Natural causes involved
the stars (astrological influences); and congenitally, our temperament and
heredity (for Burton observed that melancholy is “an hereditary disease”), as we
derive our temperament in large part from our parents;2 as well as old age,
which makes people’s humors cold and dry, predisposing them to melancholy.
Outward causes included imbalanced relationships, adverse experiences with
parents, nurses, and schoolmasters (for Burton recognized the powerful influ-
ence early childhood experience has on our emotional development); as well
as imbalanced external conditions such as accidents, misfortune, loss, poverty,
and death of friends. Inward causes involved physical diseases and imbalanced
humors. Burton described three categories of melancholy:
1. head melancholy—brought about inwardly by excessive passions and im-

balanced humors, an adjust humor, disease, or excessive or deficient sexual
activity; and outwardly by a heat stroke, a blow on the head, hot wines, exces-
sive spices, lack of sleep, idleness, loneliness, and excessive study or work.
2. hypochondriacal or windy melancholy—involving imbalance in the digestive
system, affecting the spleen, belly, stomach, and bowels.
3. whole body melancholy—brought about by an imbalanced diet, distempered
liver, or excessive worry.2
Yet even as he drew these distinctions, Burton recognized the interrelation

of the body and mind—“For as the body works upon the mind by his bad
humors, troubling the spirits, sending gross fumes into the brain, and so per
consequens disturbing the soul, and all the faculties of it, . . . with fear, sorrow,
etc., which are ordinary symptoms of this disease: so, on the other side, the
mind most effectually works upon the body, producing by his passions and per-
turbations miraculous alterations, as melancholy, despair, cruel diseases, and
sometimes death itself.”2
A major cause of melancholy was “perturbations of the mind” or excessive
passions: intense grief, anger, jealousy, sexual desire or love melancholy (to
which Burton devotes 300 pages), or religious melancholy. Melancholy was
also caused by imbalanced activity and external conditions, such as idleness,
excessive work, and insufficient fresh air and exercise. As an Oxford scholar,
Burton was well aware of the hazards of a sedentary life, describing “the
scholar’s melancholy,” in which the brain grew dry from overexertion, while the
body languished from lack of exercise, proper circulation, and severe indiges-
tion. Excess study, he said, “dries the brain and extinguisheth natural heat; for
whilst the spirits are intent to meditation above in the head, the stomach and
liver are left destitute, and thence come black blood and crudities by defect of
concoction, and for want of exercise the superfluous vapors cannot exhale. . . .
hard students are commonly troubled with gout, catarrhs, rheums, . . . bad eyes,
stone, and colic, crudities, oppilations, vertigo, winds, consumptions, and all
such diseases as come by overmuch sitting.”2 Renaissance physician Richard
Napier treated 27 men and women who claimed they were mentally ill from
excessive study, while research today has shown how excessive sitting and lack
of exercise can adversely impact our physical and emotional health.7,27
Burton and his contemporaries believed melancholy was caused by an
imbalanced or excessive diet. Thus scholars and physicians gave extensive—
often contradictory—dietary advice. According to Burton, beef, “a strong and
hearty meat” should be avoided as it could “breed gross melancholy blood.” He
also counseled people to avoid venison, pork, and goats; all shellfish and hard
and slimy fish; milk, butter, and most cheeses; cucumber, melons, cabbage,
onions, garlic, root vegetables such as turnips, carrots, and radishes; peas and
beans; and raw fruits such as pears, apples, plums, cherries, and strawberries, as
well as nuts. He also advised people to avoid spices such as salt, pepper, ginger,
cinnamon, cloves, and mace, as well as sugar, oil, vinegar, and mustard. Food, he
believed, should not be fried or broiled and should be eaten in moderation, and
beer, cider, and all dark wines should be avoided since they were conducive to
melancholy.2 Denied most meats, vegetables, fruits, and spices, what remained,
for his health-conscious Renaissance readers, was a decidedly bland diet.
Treatment of Melancholy
Unlike many of his countrymen, Burton advocated moderate means to treat
melancholy patients, beginning with modifications in diet and living conditions
to restore them to balance, resorting to more aggressive purging and bleeding
only when needed. He offered a lengthy discussion of foods believed to bal-

ance the humors and cure the melancholy, including “such meats . . . which are
moist, easy of digestion, and not apt to engender wind, not fried nor roasted,”
and predominantly fowl, such as hen, capon, and quail. He praised the restor-
ative powers of broths, “especially of a cock boiled”—a 17th-century reference to
chicken soup. Eggs, mild fish such as trout or perch, pure wheat bread, raisins,
apples, oranges, parsnips, and potatoes were recommended by Burton while
Bright also allowed oysters and a wider variety of fruits, including cherries, figs,
grapes, and apricots as well as orange and lemon juice.2,12
Both Bright and Burton recommended fresh air, clean clothes, and a clean,
light, pleasant atmosphere to restore a person’s health, doing everything possible
to reassure the patient and dispel any feelings of dejection—the antithesis of the
sordid conditions of Bedlam.2,12,14 They recommended prayer, as well as reading
in Scripture and moral philosophy, and moderate exercise of body and mind
to divert patients and raise their mood. Burton lists all manner of diversions:
engaging in sports, hunting, fishing, going to plays, taking journeys with friends,
going out socially, listening to music, or playing with dogs and cats. Especially
effective, Burton believed, was to walk with friends “amongst orchards, gardens,
bowers, mounts, and arbours . . . between wood and water, in a fair meadow, by
a river-side,” taking in the beauty and healing influence of nature.2 Burton also
advocated pleasant experiences and pleasant company, believing in the healing
power of positive emotions, and felt that friendship was a powerful cure, that
“the best way to ease is to impart our misery to some friend.”2
If, after attempts to restore a patient’s balance with diet and living condi-
tions, the unfortunate person was still suffering from melancholy, then physic
or medicinal means should be tried, beginning with moderate herbal reme-
dies, which Burton called “alternative medicines,” to balance the system. For he
believed that “Many an old wife or country woman doth often more good with
a few known and common garden herbs than our bombast physicians with
all their prodigious, sumptuous, far-fetched, rare, conjectural medicines.”2
Herbal remedies included teas, infusions, ointments, and sachets made of
borage, melissa, marigold, dandelion, roses, violets, rosemary, and chamomile.
Ointments of fragrant herbs were to be rubbed on the skin after bathing the
patient in warm water with rose petals and violets; little bags of herbs were
applied to the head, heart, and stomach, and water lilies, lettuce, violets, and
chamomile were to be applied to cool the head. Precious stones such as gar-
nets, coral, emeralds, and sapphires were thought to dispel melancholy as well.
Burton also recommended a newly-discovered caffeinated beverage said to
increase energy and raise the spirits: “The Turks have a drink called coffa . . . so
named of a berry as black as soot, and as bitter . . . which they sip still of, and
sup as warm as they can suffer: they spend much time in those coffa-houses,
which are somewhat like our alehouses or taverns, and there they sit chatting
and drinking to drive away the time, and to be merry together, because they
find by experience that kind of drink, so used, helpeth digestion and procu-
reth alacrity.”2
If herbal remedies were insufficient, then Burton felt, the next level of treat-
ment should be tried, with purgatives “upward and downward,” for which he
offers herbal recipes; then bleeding or phlebotomy of the arm, head, or knee,
using leeches to draw out the blood. He also mentions the use of trepanning—
”Tis not amiss to bore the skull with an instrument to let out the fuliginous
vapours”2—and sedatives made of laudanum to help with difficulty sleeping.
Hamlet and Melancholy
Although many Renaissance theories about the causes of melancholy and other
mental illness were erroneous, their observations about symptoms were often
quite accurate. Shakespeare’s dramatization of melancholy in Hamlet is one
notable example. Early in the play we learn that Hamlet, naturally of a healthy
sanguine temperament, is suffering from melancholy, imbalanced by deep grief
at the death of his father.1,26 As he says to his friends, “I have of late—but
wherefore I know not—lost all my mirth, forgone all custom of exercise; and
indeed it goes so heavily with my disposition that this goodly frame, the earth,
seems to me a sterile promontory” (II.2. 287–290).28 The sadness, gloom, dis-
satisfaction, anhedonia, lethargy, withdrawal from exercise and social life, and
profound weariness with life are apparent. His first soliloquy reveals more
symptoms: thoughts of suicide and weariness and disgust with life, all associ-
ated with a Major Depressive Episode:10
O that this too too solid flesh would melt,

Thaw, and resolve itself into a dew.
Or that the Everlasting had not fixed
His canon ’gainst self-slaughter! O God, O God,
How weary, stale, flat, and unprofitable
Seem to me all the uses of this world!
Fie on’t, ah fie, fie! ’Tis an unweeded garden
That grows to seed; things rank and gross in nature
Possess it merely. (I.2. 129–137)28
The soliloquy ends with a profound sense of foreboding—“It is not, nor it

cannot, come to good”—and a deep sense of isolation. According to Shakespeare
scholar Paul Jorgensen, Hamlet represses his anger and sense of betrayal at his
father’s death, mother’s remarriage, and his bitter suspicions about his uncle:26
“But break, my heart, for I must hold my tongue” (I.2.158–159).28
Hamlet’s gradual recovery begins when his close friend Horatio comes from
college at Wittenberg to console him. Horatio provides Hamlet with that pow-
erful remedy for melancholy—a trusted friend in whom he can confide his
grief, to whom he can unburden his conflicted soul. As Renaissance healers
recognized, the emotional support of a caring friend was profoundly therapeu-
tic,2,5,12 and as Jorgensen has noted, Horatio was “also an extraordinarily good
listener.”26 Throughout the play, Horatio is there to listen, to witness, and to
support his friend, offering him steadiness and support in his journey through
the darkness of melancholy to the light of deeper understanding.
Contrast Horatio’s healing presence for Hamlet with the lack of support
experienced by another young person suffering from the melancholy of deep
grief. Ophelia, too, has lost a father. After Hamlet’s violent rejection of her in
Act III, he kills her father, Polonius, who is hiding beneath a curtain in the
Queen’s chamber. Emotionally devastated, Ophelia is bereaved, betrayed by
love, and abandoned. Alone in her grief—for even her brother is out of the
country—she collapses into madness. Singing songs of lost love and dirges
for dead fathers, she drowns, clutching wildflowers that Shakespeare’s con-
temporaries would have recognized as emblems of regret and phallic symbols,
revealing her repressed sexuality, pain, and confusion.29
Hamlet’s healing process continues, without the brutal Renaissance medical
regimen—there are no purges or bleedings in Hamlet. Leading to his gradual
recovery are support from Horatio and the cathartic episode with his mother
when he finally expresses his repressed anger and outrage at her hasty marriage
and his father’s murder. Shakespeare’s contemporaries believed that unexpressed
rage (or choler) could cause melancholy.26 Burton notes that unless expressed,
“Anger, a perturbation, . . . carries the spirits outwards, preparing the body to
melancholy, and madness itself.”2 Thus in Macbeth, Malcolm tells the bereaved
Macduff not to let his anger fester inside but to express it: “Give sorrow words.
The grief that does not speak/ Whispers the o’erfraught heart and bids it break”
(IV.3.210–211).28 Finally, in the last act of the play, with his inner balance re-
stored by catharsis, time, and supportive friendship, Hamlet sees his life with
new patience and perspective, telling Horatio: “There’s a special providence in the
fall of a sparrow. If it be now, ’tis not to come. If it be not to come, it will be now.
If it be not now, yet it will come. The readiness is all” (V.2. 157–160).28
RENAISSANCE PERSPECTIVES ON MENTAL

ILLNESS AND CURRENT PARALLELS
As we have seen in this chapter, the Renaissance offered a range of
approaches to the cause and treatment of mental illness, from superstition and
folklore to medical purges to expel offending humors, to prayer and spiritual
practice, observations inspired by the new science, and therapeutic healings

based on compassionate personal support. Some approaches are absurd,
abhorrent, outdated and extreme, but others are still relevant today, including
the holistic view of mental health. As Renaissance scholar Lily Bess Campbell
has noted, “No modern psychologist has more strenuously insisted upon the
fundamental relationship between body and mind or body and soul than did
these writers of the 16th and 17th centuries in England.”1
Centuries before research on love and attachment, in 1538 Juan Luis Vives
wrote that our primary motivation was to love and be loved, and that frustrated
love can cause all manner of mental illness.15 In 1621, Burton attributed many
cases of melancholy to lack of love and affection in childhood, criticizing the
“offences, indiscretion, and intemperance” of parents who either neglect their
children or “are too stern, always threatening, chiding, brawling, whipping, or
striking; by means of which their poor children are so disheartened and cowed,
that they never after have any courage, a merry hour in their lives, or take plea-
sure in anything. There is a great moderation to be had in such things, as mat-
ters of so great moment to the making or marring of a child.”2
During the 17th century the perception of mental disorders gradually moved
from humors theory, folklore, and superstition to more scientific approaches
involving case studies and observations, inspired by Sir Francis Bacon, who
advocated direct observation and detailed study of individual cases5 (p. 78).
In The New Organon (1620), Bacon proposed the investigation of the history,
symptoms, and treatment of diseases, and the study of the emotions, sleep,
dreams, the intellectual faculties, and memory—all now studied in contempo-
rary psychology.30
Although one would hardly expect bleeding, purges, and trepanning from
contemporary therapists, many Renaissance treatments for mental disorders
are recognized today. Among them are:
t The use of exercise to relieve depression, advocated by Bright and Burton

and validated by current research.27 Closely related is the debilitating
effect of what Burton called “overmuch sitting” on mental and physical
health.2 A contemporary parallel to the “scholar’s melancholy” may well
result from the sedentary solitary lifestyle of information workers, who
spend hours sitting at the computer, sitting in their cars, or in front of
television screens.
t The effect of pets on mental health, recognized by Burton and validated by cur-
rent research.2,31
t The therapeutic benefit of music, noted by Burton and also recognized today.2,32
t The therapeutic influence of nature. Burton recommended that melancholy pa-
tients spend time walking in gardens and meadows, and research has demon-
strated the healing effects of nature.2,33
t The effect of caffeine on mood and mental acuity. Burton listed coffee as a pos-
sible treatment for melancholy. Studies have shown that caffeine improves
psychomotor performance, energy, and the sense of well-being, and in 2011 a
longitudinal study revealed a possible protective effect of coffee consumption
on the risk of depression.2,34
t The importance of positive emotions. Burton, citing Vives, said that “Mirth . . .
‘purgeth the blood, confirms health, causeth a fresh, pleasing, and fine colour,’
prorogues life, whets the wit, makes the body young, lively, and fit for any
manner of employment. The merrier the heart, the longer the life.”2 Many of
these insights have been validated by research in positive psychology.35
Above all, our Renaissance counterparts recognized the healing effect of what
is now called the “therapeutic relationship,” the presence of a caring friend
who will listen, offering moral support, and what Carl Rogers called “uncondi-
tional positive regard.”36 In 1621, when many unfortunate mentally ill persons
were relegated to solitary confinement, Burton recognized that “the best way
to ease is to impart our misery to some friend, not to smother it up in our
own breast . . . for grief concealed strangles the soul; but whenas we shall but
import it to some discreet, trusty, loving friend, it is instantly removed.”2 In
1691, centuries before Carl Rogers, Timothy Rogers advocated kindness and
compassion, saying, “You must be so kind to your Friends under this Disease,
as to believe what they say. Or however, that their apprehensions are such as
they tell you they are,” advocating kindness, acceptance, and compassionate lis-
tening.5 In the Renaissance, Rogers recognized that a soul in distress needs
emotional acceptance, respect, and understanding, the qualities of an affective
therapist today, for an atmosphere of trust can bring the light of hope to people
working through the darkness of a mental disorder, helping them gain greater
understanding, health, and personal balance.
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Vintage Books. Originally published 1621. Quotes (in order by book) are from
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107, 213, 246–247, 242, 119, 107.
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Influences of The Greeks and Romans

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Chapter 1

Influences of the Greeks and Romans

Interest in abnormal behavior, or psychopathology, appears to have existed

and therefore needed to be treated.3 Thus, he held to both traditional ideas

Historically, there has been a strong tradition of using herbal medication.

Alexander of Tralles (A.D. 525–605) was another of the well-known phy-

(A.D. 161–192). Historians have described his behavior as both extravagant

7. Howells, J. G., & Osborn, M. L. (1984). A reference companion to the history of

Perceptions, Thoughts, and Attitudes

From the fall of the Western Roman Empire in 476 CE to Columbus’s

Rooted in Neo-Platonic subjectivism, early Christian theology paired with a

NORMS AND ABNORMALITIES

the product of mental affliction, regardless of the attributed etiology. In the

HISTORICAL-CULTURAL CONTEXT: EVOLUTION

Initial Traumas and Posttraumatic Adaptations

community. It wrote a meaningful narrative around society’s trauma, defining the

Some Holy and Normative Lifestyles

A Knight’s code of honor included a religious aspect, a martial aspect, and,

Some Specific Patterns of Perceptions and Thought

Later Trauma and Posttraumatic Developments

MENTAL ILLNESS AND TREATMENT

The Middle East and the Non-Christian Mediterranean

In the Middle East, where classical knowledge survived, abnormalities in

employment of “shock psychotherapy.” His shocking of an unsuspecting, long-

LATIN WEST—CHRISTIAN EUROPE

Medieval attitudes and perceptions of mental illness as possession stem from

of faith or punishment for sins, it endorsed various therapies such as fasting,

In England, by the 13th century classical notions of humoral imbalance had

Legal Definition and Evaluation of Insanity

(1216–1272), the crown assumed the right to the guardianship of “congenital

what would contemporarily be called postpartum psychosis. After giving birth

The Renaissance was a time of dramatic change and rising individualism,

impulsive, with great strength and courage; “phlegmatic”—lethargic, sluggish,

MENTAL DISORDERS IN THE RENAISSANCE

Because the Renaissance was still a patriarchal, authoritarian society, people

disorders. Hearing bizarre voices, they believed themselves possessed by devils,

RENAISSANCE TREATMENTS FOR MENTAL DISORDERS

Oxenbridge, an early-seventeenth-century English physician, provide an in-

Like Oxenbridge, Richard Napier also prescribed laudanum, an opium tincture

In 1547 it became a public insane asylum, managed by a court of governors and

MELANCHOLY: DEPRESSIVE DISORDER

Biathanatos (1644); and Burton’s Anatomy of Melancholy (1621), which became

of religious melancholy, tormented by ghosts and visions of devils and hellfire.

Causes and Types of Melancholy

Burton’s Anatomy, at over 1,200 pages, provides the most compendious

1. head melancholy—brought about inwardly by excessive passions and im-

Yet even as he drew these distinctions, Burton recognized the interrelation

only when needed. He offered a lengthy discussion of foods believed to bal-

Hamlet and Melancholy

O that this too too solid flesh would melt,

The soliloquy ends with a profound sense of foreboding—“It is not, nor it

RENAISSANCE PERSPECTIVES ON MENTAL

practice, observations inspired by the new science, and therapeutic healings

t The use of exercise to relieve depression, advocated by Bright and Burton

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