revealing light on our ancestors’ attitude toward the mentally sick. In relation to these predestined victims sadistic behavior was right and proper, so much so that it could be publicly avowed and rationalized in terms of current scientific theories.
So much for what would have happened to me, if I had become mentally sick in the eighteenth, or even the first half of the nineteenth, century. If I had lived in the sixteenth century, my fate might have been even worse. For in the sixteenth century most of the symptoms of mental illness were regarded as supernatural in origin. For example, the pathological refusal or inability to speak was held to be a sure sign of diabolic possession. Mutism was frequently punished by the infliction of torture and death at the stake. Dumb devils are mentioned in the Gospels; but the evangelists made no mention of another hysterical symptom, localized insensibility to pain. Unfortunately for the mentally ill, the Early Fathers noticed this curious phenomenon. For them, the insensitive spots on the body of a mentally sick person were “the Devil’s stigmata,” the marks with which Satan branded his human cattle. In the sixteenth century anyone suspected of witchcraft would be systematically pricked with an awl or bodkin. If an insensitive spot were found, it was clear that the victim was allied with the devil and must therefore be tortured and burned alive. Again, some mentally sick persons hear voices, see visions of sinister figures, have phantasies of omnipotence or alternatively of persecution, believe themselves to be capable of flying, of being subject to metamorphosis into animals. In the sixteenth century these common symptoms of mental derangement were treated as so many statements of objective fact, so many confessions, explicit or implicit, of collaboration with the Enemy. But, obviously, anyone who collaborated with the Devil had to be tortured and burned alive. And what about the neurotics, particularly the female neurotics, who suffer from sexual illusions. “All witchcraft,” proclaim the learned clerical authors of the
Doctor Johann Weier, who has been called the Father of Psychiatry, had the humanity, courage and common sense to assail the theories and hellish practices of the Catholic theologians and magistrates, and the no- less-ferocious Protestant witch-hunters of his time. But the majority even of well-educated men approved the crimes and follies of the Church. For having ventured to treat the witches’ confessions as symptoms of mental illness, Weier was regarded as a diabolical fellow traveler, even a full-blown sorcerer. That he was not arrested, tortured and burned was due to the fact that he was the personal physician of a ruling prince. Weier died in his bed; but his book was placed on the Index, and the persecution of the mentally ill continued, unabated, for another century. How many witches were tortured and burned during the sixteenth century is not exactly known. The total number is variously estimated at anything from one hundred thousand to several millions. Many of the victims were perfectly sane adherents of the old fertility cult which still lingered on in every part of Europe. Of the rest, some were persons incriminated by informers, some the unhappy victims of a mental illness. “If we took the whole of the population of our present-day hospitals for mental diseases,” writes Dr. Zilboorg, “and if we sorted out the cases of dementia praecox, some of the senile psychoses, some of those afflicted with general paralysis, and some of the so-called involution melancholies, we should see that Bodin (the great French jurist, who denounced Dr. Weier as a sorcerer and heretic) would not have hesitated to plead for their death at the stake, so similar and characteristic are their trends to those he describes. It is truly striking that the ideational contents of the mental diseases of four hundred years ago are so similar to those of today.”
In the second half of the seventeenth century the mentally sick ceased to be the prey of the clergy and the theologically minded lawyers, and were left instead to the tender mercies of the doctors. The crimes and follies committed in the name of Galen were, as we have seen, almost as monstrous as those committed at an earlier period in the name of God. Improvement came at last in the closing years of the eighteenth century, and was due to the efforts of a few nonconforming individuals, some of them doctors, others outside the pale of medicine. These nonconformists did their work in the teeth of official indifference, sometimes of active official resistance. As corporations, neither the Church nor the medical profession ever initiated any reform in the treatment of the mentally sick. Obscure priests and nuns had often cared for the insane with kindness and understanding; but the theological bigwigs thought of mental illness in terms of diabolic possession, heresy and apostasy. It was the same with the medical bigwigs. Strait jackets, Brisk Vomits and systematic terrorism remained the official medical policy until well into the nineteenth century. It was only tardily and reluctantly that the bigwigs accepted the reforms initiated by heroic nonconformists, and officially changed their old, bad tune.
Reform began almost simultaneously on either side of the Channel. In England a Quaker merchant, William Tuke, set up the York Retreat, a hospital for the mentally sick, in which restraint was never used and the psychological treatment was aimed, not at frightening the patients, but at bringing them back from their isolation by persuading them to work, play, eat, talk and worship together. In France the pioneer in reform was Doctor Philippe Pinel, who was appointed to the direction of the Bicetre Asylum in Paris at the height of the French Revolution. Many of the patients were kept permanently chained in unlighted cells. Pinel asked permission of the revolutionary government to set them free. It was refused. Liberty, Equality and Fraternity were not for lunatics. Pinel insisted, and at last permission was grudgingly given. The account of what followed is touching in the extreme. “The first man on whom the experiment was tried was an English captain, whose history no one knew, as he had been in chains for forty years. He was thought to be one of the most furious among them. His keepers approached him with caution, as he had in a fit of fury killed one of them on the spot with a blow from his manacles. He was chained more rigorously than any of the others. Pinel entered his cell unattended and calmly said to him, ‘Captain, I will order your chains to be taken off and give you liberty to walk in the court, if you will promise me to behave well and injure no one.’ ‘Yes, I promise,’ said the maniac. ‘But you are laughing at me…’ His chains were removed and the keepers retired, leaving the door of his cell open. He raised himself many times from the seat, but fell again on it; for he had been in a sitting posture so long that he had lost the use of his legs. In a quarter of an hour he succeeded in maintaining his balance and with tottering steps came to the door of his dark cell. His first look was at the sky, and he exclaimed, ‘How beautiful, how beautiful!’ During the rest of the day he was constantly in motion, uttering exclamations of delight. In the evening he returned of his own accord to his cell and slept tranquilly.”
In Europe the pioneer work of Tuke and Pinel was continued by Conolly, Esquirol and a growing number of their followers in every country. In America, the standard bearer of reform was a heroic woman, Dorothea Dix. By the middle of the century many of the worst abominations of the old regime were things of the past. The mentally ill began to be treated as unfortunate human beings, not as Objects. It was an immense advance; but it was not yet enough. Reform had produced institutional care, but still no adequate treatment. For most nineteenth- century doctors, things were more real than thoughts and the study of matter seemed more scientific than the study of mind. The dream of Victorian medicine was, in Zilboorg’s phrase, to develop a psychiatry that should be completely independent of psychology. Hence the widespread and passionate rejection of the procedures lumped under the names of Animal Magnetism and Hypnotism. In France, Charcot, Liebault and Bernheim achieved remarkable results with hypnosis; but the intellectually respectable psychiatrists of Europe and America turned their backs on this merely psychological treatment of mental illness and concentrated instead on the more “objective,” the more “scientific” methods of surgery.
It had all happened before, of course. Cutting holes in the skull was an immemorially ancient form of psychiatry. So was castration, as a cure for epilepsy. Continuing this grand old tradition, the Victorian doctors removed the ovaries of their hysterical patients and treated neurosis in young girls by the gruesome operation known to ethnologists as “female circumcision.” In the early years of the present century Metchnikoff was briefly a prophet, and autointoxication was all the rage in medical circles. Along with practically every other disease, neuroses were supposed to be due to intestinal stasis. No intestine, no stasis—what could be more logical? The lucky neurotics who could afford a major operation went to hospital, had their colons cut out and the end of their small intestines stitched to the stump. Those who recovered found themselves with yet another reason for being neurotic: they had to hurry to the bathroom six or eight times a day. Intestinal stasis went out with the hobble skirt, and the new vogue was focal infection. According to the surgical psychiatrists, people were neurotic not because of conflicts in their unconscious mind, but because of inflammation in their tonsils or abscesses at the roots of their teeth. The dentists, the nose-and-throat men set to work with a will. Toothless and tonsilectomized, the neurotics, needless to say, went on behaving just as neurotically as ever. Focal infections followed intestinal stasis into oblivion, and the surgical psychiatrists now prefer to make a direct assault upon the brain. The current fashion is shock treatment or, on great occasions, prefrontal lobotomy. Meanwhile the pharmacologists have not been idle. The barbiturates, hailed not so long ago as panaceas, have given place to Chlorpromazine, Reserpine, Frenquel and
