By David Phillippi

In the same 16th century England which brought the world ambition and love (see Madness: A Modern Phenomenon), a new form of mental disease—madness—appeared. While previously known forms of mental illness were temporary, related perhaps to an infection, an accident damaging the brain, a pregnancy, a bodily illness like “pox” (syphilis), or old age, madness was chronic—usually appearing at a fairly young age (without evidence of an organic cause) and lasting till death. Another of its names, lunacy, reflected the suspicion of a physical cause—specifically implicating the waxing and waning of the moon in the periodic alterations in the character and symptoms of the sufferers. The word insanity entered English at that time too, apparently referring to the same phenomenon as madness and lunacy.

The chronic nature of madness made it a legal issue from the very beginning; the first provision in English law for mentally disturbed individuals—referred to, specifically, as “madmen and lunatics”— dates back only to 1541. Also in the middle of the 16th century, Bethlehem Hospital—more commonly known as Bedlam, the world’s first mental asylum—became a public institution, transferred to the city of London in 1547. While there was probably little to be praised in terms of humane treatment and comfortable accommodations, Bedlam continued to expand into the 17th century to meet what seemed to be a growing need to house the severely mentally ill.

Physicians of the day sought to describe and understand this new phenomenon, but their methods, sources, and interpretations were thoroughly mixed. Their reliance on classical Greek and Latin terms of mental disturbance resulted in a liberal blend of (their interpretation of) the old ideas with the new reality, and though they attempted to draw distinctions between conditions, they were far from clear. The cause was usually assumed to be organic. The common attribution of madness to an imbalance of the four humors shows the strong influence of the classical medical understanding. (The use of the term melancholy as a name for mental illness in general or a particular variety of it is a prime example). Insanity might also be explained by the stars under which one was born. Some authors distinguished between organic madness and spiritual madness caused by demonic influence. Still others focused on mental states that could in turn affect the body.

Obviously, early observers of madness were far from a uniform hypothesis as to its nature and cause. Nevertheless, these sources do contain some revealing descriptions and suggestions. Andrew Boorde recommended that the patient be kept from “musynge and studieng,” (implying very obviously a literate madman), and likewise Thomas Cogan, a physician and head master of a grammar school,  advised against “studying in the night” deeming “wearinesse of the minde”  worse than “wearinesse of the bodie.” Sir Thomas Elyot noted a “sorowe,” or “hevynesse of mynde” which affected the memory and the ability to reason properly, relating it to such experiences as the death of a child and even disappointed ambition. Christopher Langton saw “sorrow” as a chronic condition, the most serious of four “affections of the mynde” that could “make great alteration in all the body.” Philip Barrough’s description of melancholy, (which he calls “an alienation of the mind troubling reason”), mentions mood swings, suicidal thinking, hallucinations, and paranoid delusions—in short, some of the most characteristic features of major psychosis which might be diagnosed alternately as bipolar or schizophrenia today. Timothy Bright’s Treatise of Melancholie contains the idea that being “over-passionate,” put one at risk for mental disease.

By far the longest and most famous book on the topic in the early modern period was The Anatomy of Melancholy by Robert Burton, first published in 1621. It was essentially a collection all the information he could find on mental disease—both past and present—and therefore (unfortunately) contributed greatly to the confusion of terms, translating as “madness” a whole variety of words from Latin and Greek sources. Despite his mistake, which allowed him to find English madness scattered throughout history, it seemed to him a particularly pressing problem in his day. He noted among his “chief motives” for writing the book “the generality of the disease, the necessity of the cure, and the commodity or common good that will arise to all men by the knowledge of it.” Burton’s description of his society as a “world turned upside downward” is loaded with colorful yet tragic examples of apparent inconsistency and injustice—in a word, sources of anomie common to modern life. One can hypothesize that the inclusion of such a description of the contradictions within culture, in a work that is dedicated to the understanding of what is deemed a medical illness with an essentially organic cause, is related to Burton’s sense that the two phenomena—anomie and mental illness—are related. Indeed, some of the mental symptoms of melancholy “common to all or most”—“fear and sorrow without a just cause, suspicion, jealousy, discontent, solitariness, irksomeness, continual cogitations, restless thoughts, vain imaginations”—begin to make sense if mental illness is seen as stemming from fundamental problems with identity caused by anomie. Some of these symptoms appear identical to the causes of melancholy which fall under Burton’s general category of “passions and perturbations of the mind.” Ambition and related passions like envy and emulation figure prominently here, but most striking of all is the inclusion of love—the cause, apparently of a special madness called “love-melancholy” which afflicted primarily men of the upper classes.

But perhaps the greatest early chronicler of madness was William Shakespeare. Dr. Amariah Brigham and Dr. Isaac Ray, (two of the most important figures in 19th century American psychiatry), each devoted an extensive article in the early years of the American Journal of Insanity (today the American Journal of Psychiatry) to the consideration of his work. They saw in his plays, (in particular King Lear and Hamlet), such accurate portrayals of insanity that they were certain he must have drawn his inspiration at least partly from first-hand observation. Whatever might be said today in criticism of the method of these doctors, who had no qualms about using literary study to supplement clinical observation, it is significant that the mental illness they observed in their asylums was the same as that which Shakespeare brought to life in his tragedies more than two and half centuries earlier.

Apparently, the medical understanding of madness, lunacy, insanity, melancholy—whichever name one chooses—had not advanced very far from the time of Shakespeare to the middle of the 1800’s. “But,” most of us would confidently assume and assert, ”since then we have come a long way, we know so much more now.” But do we? Certainly at the time when Brigham and Ray were writing about Shakespeare, serious psychiatric establishments were already taking shape in a number of modern nations. The growth that has taken place since the 19th century within this medical specialization in terms of publications, practitioners, institutions, associations, research, and treatments would have been difficult to imagine. But are we really any closer to identifying a cause, or having a cure to offer to those who suffer from mental illness?

Note: For more, see Liah Greenfeld’s Mind, Modernity, Madness, Chapter 5.