Perceptions of insanity in medieval England
Body and Mind Seminar, Department of Geriatric Medicine, Keele University, April 1998

In 1981 Norman St John Stevas, Conservative MP for Aldershot, famously called Mrs Thatcher 'the leaderene'. It was a neologism full of redolence, and one that was not entirely lost on the Conservative Party, although, of course, it was not for another nine years that the penny finally dropped. Mrs Thatcher, by contrast, immediately saw the point. She was not amused and put an end to any hopes that St John Stevas still entertained of further political preferment. What Mrs Thatcher had recognized was a potent notion in Judaeo-Christian culture. It is recorded in the Gospel according to St Mark, chapter 5, that Jesus went into the country of the Gadarenes and cured a madman by casting out the devils within him into a herd of swine. The swine forthwith stampeded and fell to their deaths in the Sea of Gallilea. St John Stevas' amusing allusion to the Gadarene swine reminds us of the enduring perception of madness as possession in the western world.

Needless to say, it was a perception that was prevalent throughout the Middle Ages. In a Christian society that perceived of a cosmic struggle between good and evil, madness was evidence of a battle lost. It was, then, a moral malady and it was natural that remedies for the condition were spiritual. Thus, in the Christian formulation the distaff of madness was not rationality or normality but holiness. And, indeed, it was a fine line that divided the two states. Many a saint's life, the Jeffrey Archers of the Middle Ages, hinged upon upon the imminent descent of the hero into moral turpitude and the resultant insanity.

The eighth-century Life of Guthlac by Felix is a typical example from England (Colgrave 1956). Guthlac was a scion of the Mercian royal family. He received an education in arms in the household of his father and at the age of fifteen commenced a career of rapine and slaughter that was the proper activity of any young man of breeding. He was successful and enjoyed social approbation; for nine years he was the terror of his neigbourhood as the leader of a gang of thugs (albeit a saintly one who, it is alleged, returned a third of his booty to the rightful owners). When he was twenty-four, however, he experienced a crisis. Foresaking his former life and companions, he entered the monastery of Repton in Derbyshire and began a rigorous spiritual training. He did not fit in, though - the other monks and nuns complained of his self-righteousness in refusing to drink beer with them - and after a while he left to live alone (that is, only with servants) on the Island of Crowland in the Lincolnshire fen. There for a number of years he was assailed by demons who constantly screamed at him and was troubled with visions. In modern terms all of this appears pathological. Nevertheless, Guthlac overcame all of his infernal opponents through the power of prayer and became famous for his ability to cure insanity through exorcism.

The story is, of course, early and it no doubt contains many topoi. But it does illustrate a perception of madness, madness as possession, which was recognized throughout the Middle Ages. It was, however, not the only perception, and, in England at least, not the most common. Classical notions of humoural imbalance were probably never entirely lost in the West, and by the thirteenth century they had become the standard explanation of a host of psychiatric conditions in medical treatise and encyclopaedias. In England works by Gilbert Anglicus, Batholemew Anglicus, and Bernard de Gordon summarized ancient learning on the subject as it was transmitted through Islamic scholars. All three were widely known and read by academic doctors and physicians alike (Clarke 1975, 85; Kroll 1973; Neugebauer 1979).

Beyond the experts, such high falutin ideas were no doubt largely meaningless. There is, however, a remarkable amount of evidence to show that a somatic understanding of mental illness was the norm in English society. Sometime in the reign of Henry III (1216-1272) the crown assumed the right to the guardianship of congenital idiots. This was no medieval welfare service; it was predatory feudal kingship extending its rights to wardship where personal service could not be rendered. It was in short a means of making money. The result was that all cases of insanity were examined to determine whether the king had an interest or not. The means employed was the inquisition. Now, this is not to be confused with the auto da fe; we are not talking about the burning of lunatics. The inquisition was a routine instrument of government that differed little from the modern coroner's inquest. A commissioner was appointed to investigate the matter in question and he caused a jury of twelve local men to be enpanelled. The jurors were chosen for their knowledge of the subject and answered the questions put to them on oath. A verdict was received, and the commissioner proceeded to interview the subject. A ruling was then delivered, and a report was made to Chancery where the wardship provisions were determined (Roffe and Roffe 1995).

The sophistication of the process is illustrated by the case of Emma de Beeston (CIM 1957, no 227). Emma was an inhabitant of King's Lynn in Norfolk who in 1378 was afflicted with insanity. She was old at the time (I have been unable to determine her exact age) and senility is a likely cause, although other diagnoses cannot be ruled out. An inquisition was ordered in 1382, in which it was determined that she had not been an idiot from birth, but had been insane for four years. She had no lucid intervals, and the king ordered her person, lands, and goods in King's Lynn to be entrusted to her kinsman Philip Wyth during her infirmity. The decision, however, was challenged. Emma, supported by the mayor of Lynn and several other townsmen, claimed that the inquisition had been suborned by Philip Wyth and unnamed accomplices who hoped to benefit from a surmise of her idiocy. Emma, seemingly not questioning her inadequacy, petitioned for her guardianship to be granted to twlve burgesses unconnected with either party.

In 1383 a second inquisition was held in the church of St Benedict in Lincoln finally to determine her state of mind. The examination is recorded in detail.

The justices examined her in all other ways that they could devise and found that she was not of sound mind, having neither sense nor memory nor sufficient intelligence to manage herself, her lands, or her goods. 'As appeared from inspection, she had the face and countenance of an idiot.' Almost every modern doctor will be familiar with this procedure. The approach was common sense, pragmatic. The questions asked of Emma de Beston were carefully tailored to her experience and circumstances. Assessment of her general awareness is linked to memory tests, simple skills, and general knowledge.

For the record, Emma herself was placed in the guardianship of her kinsman, but her property was managed by four burgesses on her behalf. She never regained her sanity, dying in 1386 unaware of her surroundings. Emma's case is unusual in the extent of the documentation. But the same pragmatism and empiricism inform the vast majority of cases for which records survive. There are over 300 inquisitions relating to insanity in the Public Record Office covering the period 1280 to 1500. Many returned a verdict of congenital idiocy and give no further details. Some seventy or eighty cases, however, found post-natal insanity, and frequently detail the circumstances. They are illuminating. In some cause and effect were difficult to miss.

Where there was no such obvious cause, an attempt was still found to find a physical explanation. More often there was no obvious causation. Even then, though, there were generally no appeals to supernatural influences. In only two cases has the influence of evil spirits been invoked, and then, in one at least, to be dismissed.

Many others cases could be cited. It is true that the subjects were holders of land, but all but the very poorest are represented in these inquisitions (Roffe and Roffe 1995). We cannot doubt, then, that the verdicts that their fellow inhabitants gave preserve the perceptions of the common run of medieval people. Madness was overwhelmingly perceived as a disorder of the body and brain. Such empiricism might be considered its own virtue today. To a commonsense fashioned by a culture steeped in scientific rationalism, the rejection of oscurrantist notions can only spell enlightenment and, some might add, progress. As an historian, however, I must sound a note of caution. Just how effective was a somatic understanding of mental illness in representing, and therefore coping with, the affliction? The answer, I think, must be, not very well.

Where insanity was perceived as a disorder of the body, therapies were basic. Those recommended were the typical dietary, herbal, and surgical regimes of classical medicine (Clarke 1975). The regulation of diet was mostly effected through the use of spices in cooking. It is fallacy that medieval food was highly spiced to cover up the taste of tainted meat. Pepper, cumin, cardoman, cinnamon, cloves, and the like were perceived as the esential regulators of the different humours. Insanity was treated by changing the balance (Arndt 1998). Surgical techniques were more basic being limited to bleeding. In practice the most widely used expedient was confinement in chains.

By contrast, metaphysical representations of mental illness could be far more effective. I don't want to suggest here that belief in devils could in any way mimic modern psychiatric therapies. It has been claimed by some that demonologies, that is hierarchies of devils, constituted a more or less systematic taxonomy of mental states (Clarke 1975). In fact, the sources of such works were more traditional and theological than empirical. Nevertheless, the perception of mental illness as a metaphysical disorder addressed the person and the mind. By investing the experience of madness with meaning, it could confer a control that would otherwise be absent.

The case of Margery Kempe exemplifies the point. More than any other individual in the Middle Ages, her experiences, thoughts, and feelings are known, for in her 60s she caused to be written down her life in what is effectively the first autobiography in English (Windeatt 1985). Her story is a remarkable one. She was born in the 1370s, oddly enough like Emma de Beeston, in King's Lynn. The daughter of a mayor of the town, she married well, but with her first confinement she suffered what would now be called postpartal pyschosis. After eight months or so, she had recovered sufficiently for her to resume her role as a wife. She was to bear her husband a further 13 children, and, until its failure, she also ran a brewing business. However, from this time her behavious became increasingly eccentric.

For most of her contemporaries, there was no doubt that she was mad: 'the Neighbour from Hell' is a cliche which might well have been coined in King's Lynn to describe this its most famous inhabitant. Margery was a constant irritation to all who came in contact with her, being variously described as ill-behaved, puffed up with 'pretense and hypocrisy', or merely physically sick. Margery was clearly aware of these possibilities. At various points in her story she describes herself as 'like a mad woman', 'a drunk woman', 'without reason', living 'high above her bodily wits'. She too recognized her initial illness as insanity, but there she departed from her fellows. What others saw as misfortune or nuisance, Margery interpreted as an intimation of damnation. Thereafter, her life became a constant struggle with the devil to realize her spiritual essence. Where she faltered, she did not seek remedies in medicine, but found her consolation in divines. Dame Julian of Norwich, among others, reassured her that her experience was no mere vanity. What for most were symptoms of disease were for Margery actions in a cosmic drama.

And through that drama, Margery attained in later life the peace that she craved. Her problems were largely those of a hard life of sex, child bearing, and hard work in a male dominated society (Porter 1988). By representing them in metaphysical terms, she invested them with meaning. She thereby gained a degree of control of her destiny that society denied her. Thus, she freed herself, eventually, from the round of child bearing. She realized herself as an individual both within her family and within society generally. And she placed herself in a tradition of pietism which put her in touch with a wider world of meaning formerly absent in her humdrum daily life. Margery Kempe's perception of her madness was, in short, a liberation. The price of empiricism was all too often literally chains.

Arndt, A, 1998, 'The Spices of Medieval Life: Tainted Meat, Tainted Theories?', Haskins Society Journal, 8, forthcoming.

CIM 1957, Calendar of Inquesitions Miscellaneous Preserved in the Public Record Office, iv, 1377-1388, Public Record Office (London).

Clarke, B, 1975, Mental Disorder in Earlier England (Cardiff).

Colgrave, B, (ed.), 1956, Felix's Life of Guthlac (Cambridge).

Kroll, J, 1973, 'A Reappraisal of Psychiatry in the Middle Ages', Archives of General Psychiatry, 29, 276-83.

Neubegauer, R., 1979, 'Medieval and Early Modern Theories of Mental Illness', Archives of General Psychiatry, 36, 477-83.

Porter, R, 1988, 'Margery Kempe and the Meaning of Madness', History Today, February 1988, 39-44.

Roffe, D, Roffe, C, 1995, 'Madness and Care in the Community: a Medieval Perspective', BMJ, 311, 1708-12.

Windeatt, B. A. (trans), 1985, The Book of Margery Kempe (London).

ã David Roffe, 2000.