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.