Madness: A Brief History (6 page)

Towards a psychology

Late in the eighteenth century the British mad-doctor William Pargeter conjured up the maniac thus:

Let us then figure to ourselves the situation of a fellow creature destitute of the guidance of that governing principle, reason—which chiefly distinguishes us from the inferior animals around us. ... View man deprived of that noble endowment, and see in how melancholy a posture he appears.

Implicit in Pargeter’s moving depiction is, of course, the ideal from which the madman had fallen, the paragon of
homo rationalis.
Plato had gloried in the rational soul; medieval theologians had alternately praised and reviled human reason (faith was what a believer needed). Marsilio Ficino, Pico della Mirandola, and other writers of the Italian Renaissance held that man’s superiority to the animals on the Great Chain of Being lay in reason, further extolling the rational civilized male over women, children, and peasants. It was in the seventeenth century above all, however, that the mind became cardinal to philosophical models of man.

The seminal rationalist in that movement was René Descartes (1594-1650), who convinced himself that reason alone could rescue mankind from drowning in ignorance, confusion, and error. Descartes was born in Normandy and educated by the Jesuits, who introduced him to philosophy, mathematics, and physics. On 10 November 1619, in a quasi-mystical experience recorded in his
Discourse on Method
(1637), he dedicated his life to the pursuit of truth, resolving to be systematically sceptical about all received knowledge, so as to reconstruct philosophy on the basis of self-evident first principles. Building on the one thing which was beyond doubt—his own consciousness (
Cogito, ergo sum
: I am thinking, therefore I exist)—he aspired on that basis to establish principles so clear and distinct ‘that the mind of man cannot doubt their truth’.

Like all later ‘mechanical’ philosophers, Descartes was determined that the Ptolemaic/Aristotelian cosmos of ‘imaginary’ qualities and ‘fictional’ elements should be replaced by a ‘new philosophy’, solidly grounded in reality: one composed of particles of matter in motion obeying mathematical laws. Logic required the division of Creation into two radically distinct categories, matter, that is ‘extension’ (including body), and mind. Spiritual beings like angels aside, humans alone possessed conscious minds; the behaviour of animals was completely explicable in terms of matter and motion—they were sophisticated machines or automata, devoid of will, feeling, or consciousness. The
appearance
of such attributes in brutes was due to reflexes—the reflex concept was prominent in his pioneering mechanistic account of the nervous system.

Descartes equated mind with the incorporeal soul: it was what conferred upon humans their consciousness, moral responsibility, and immortality. Although, being immaterial, it could not be identified with or located in space (‘extension’), he held that the mind docked with the body at the pineal gland, a unitary structure seated in mid-brain. After Descartes’ death, different areas of the brain—including the
medulla oblongata
(Malpighi, Willis), the
corpora striata
(Vieussens), and the
corpus callosum
(Lancisi)—were touted as the true seat of the soul by physicians unimpressed by the pineal gland.

Though Descartes thus radically rethought philosophy and medicine, he never explained to critics’ satisfaction how mind and body could actually interact—his speculative localization in the pineal gland merely seemed to compound the problem, both
physiologically and metaphysically. Mind had thus not been elucidated but had been rendered a mysterious ghost in the machine—though his account of the passions as mediating between mind and body was, in truth, more holistic than his mind/body dualism seemed to sanction. In many subsequent speculations about madness, mental disorder was put down to the complexities, or obscurities, of how mind and brain, or mind and body, touched base with each other. Jonathan Swift and other satirists diverted themselves with outlandish speculations as to how thoughts got distorted or derailed on their travels through the gland.

Overall, therefore, Cartesian dualism posed an audacious challenge—one with momentous medical consequences for reasoning about madness, since it implied that as consciousness was inherently and definitionally rational, insanity, precisely like regular physical illnesses, must derive from the body, or be a consequence of some very precarious connections in the brain. Safely somatized in this way, it could no longer be regarded as diabolical in origin or as threatening the integrity and salvation of the immortal soul, and became unambiguously a legitimate object of philosophical and medical enquiry.

While Descartes was not one himself, his thinking encouraged materialists, who went further and denied the reality of anything at all in the universe except matter. To orthodox Christians, the most threatening such materialist was Thomas Hobbes (1588-1679), who drew inspiration from Galileo and Descartes and played on the shocking implications of a mechanistic physiology and a materialist and reductionist psychology.

Hobbes deemed the universe a material continuum, utterly devoid of spirit, under a God who was characterized primarily by power. Knowledge was derived exclusively from sense impressions, and behaviour determined by physical laws of matter in motion, grounded in self-preservation: emotion was, in reality, motion. This materialist reading of human action as moved entirely by external sense-inputs permitted Hobbes to dismiss religious beliefs about spirits and witches as hallucinations spawned by the fevered operations of the brain. By extension, religion itself was a form of delusion. Insanity was thus erroneous thought caused by some defect in the body’s machinery.

In his
Essay Concerning Human Understanding
(1690), John Locke too, like Hobbes, mounted a critique of Platonic or Cartesian innate ideas or pure reason, and taught that all ideas originate from sense impressions (via sight, taste, touch, hearing, smell). Originating like a blank sheet of paper
(tabula rasa
), the mind is informed and shaped by experience and nurtured by education.

False beliefs—amongst these Locke included ‘witches’ and ‘goblins’—are the products of mis-associations of ideas. Madness is thus neither diabolical nor humoral but essentially delusional, a fault in cognition rather than in will or passion. ‘Mad Men’, explained Locke, ‘put wrong Ideas together, and so make wrong Propositions, but argue and reason right from them; But Idiots make very few or no Propositions, but argue and reason scarce at all.’ In due course, Lockean thinking, so highly esteemed in the Enlightenment, would form the basis of new secular and psychological approaches to understanding insanity. The implied equation he drew between delusion and faulty education instilled optimism: the mad could be retrained to think correctly.

Amongst seventeenth-century philosophers, madness was thus increasingly identified not with demons, humours, or even passions, but with irrationality, in models of mind which made the guarantee of soundness of mind the rational self. Despite this championing of reason, however, mental order and disorder remained Sphinxian mysteries. Paradoxically, the riddles of psyche/soma affinities had been reopened by the great clarifications Descartes had struggled to effect. Addressing hysteria, the notable eighteenth-century physician William Heberden thus expressed a reluctance to dogmatize about the root-causes of such mysterious, chameleon-like conditions, on account of ‘our great ignorance of the connexion and sympathies of body and mind’. The attempts of later thinkers to resolve these intractable, even maddening, dilemmas will be explored in Chapter 6.

To reason with a lunatic is folly

(George Man Burrows,

Commentaries on Insanity,
1828)

Stigma

All societies judge some people mad: any strict clinical justification aside, it is part of the business of marking out the different, deviant, and perhaps dangerous. Such ‘stigma’, according to the American sociologist Erving Goffman, is ‘the situation of the individual who is disqualified from full social acceptance ’. Stigmatizing—the creation of spoiled identity—involves projecting onto an individual or group judgements as to what is inferior, repugnant, or disgraceful. It may thus translate disgust into the disgusting and fears into the fearful, first by singling out difference, next by calling it inferiority, and finally by blaming ‘victims’ for their otherness.

This demonizing process may be regarded as psychologically and anthropologically driven, arising out of deep-seated and perhaps unconscious needs to order the world by demarcating self from other, as in the polarized distinctions we draw between Insiders and Outsiders, Black and White, Natives and Foreigners, Gay and Straight, Pure and Polluted, and so forth. The construction of such ‘them-and-us’ oppositions reinforces our fragile sense of self-identity and selfworth through the pathologization of pariahs.

Setting the sick apart sustains the fantasy that we are whole. Disease diagnosis thus constitutes a powerful classificatory tool, and medicine contributes its fair share to the stigmatizing enterprise. Amongst those scapegoated and anathematized by means of this cognitive apartheid, the ‘insane’ have, of course, been conspicuous. This polarizing of the sane and the crazy in turn spurred and legitimized the institutionalizing trend which, as will be discussed in Chapter 5, gathered momentum from the seventeenth century.

Witty fools?

Folk wisdom has assumed that madness is as madness looks, a view which, in its turn, has been bolstered by artists and writers. In jokes and on the stage, the insane have standardly been depicted as strange and dishevelled—as ‘wild men’, with straw in their hair and their clothes threadbare, ripped or fantastical, or sometimes wearing barely a stitch. Further conventions have rammed such messages home. Just as the cuckold was known by his horns, so it was standard for the fool to be portrayed as disfigured by a stone protruding from his forehead, the ‘stone of folly’: the character flaw was thus written all over the face. Jesters and stage buffoons bespoke folly too, through their cap and bells, bladder and pinwheel, motley and hobbyhorse. Got up in a similar ‘uniform’ of their own, ex-patients of Bethlem Hospital tramped the highways, licensed to beg—their numbers being swollen by opportunistic sane mendicants who, like Edgar in
King Lear,
masqueraded as Bedlamites. They might sing for their supper, and their songs were even printed as ‘Bedlam ballads’:

I’ll bark against the Dog-Star

I’ll crow away the morning,

I’ll chase the moon till it be noon

And I’ll make her leave her horning...

9
John Donaldson, a poor idiot who lived in the eighteenth century and who made it his habit to walk before funeral processions at Edinburgh.

In the culture of madness ‘reality’ and ‘representations’ endlessly played off each other. What a crazy world in 
which the poor had to pretend to be mad in order to get a crust!

Certain stereotypes have exercised a powerful and lasting fascination. Alongside those models already mentioned in Chapter 2—for instance, the hubristic hero punished by the gods by loss of his reason—Greek thinkers advanced the idea of divine madness in the artist, ‘inspired’ (literally ‘filled with spirit’) or touched by a divine ‘fire’. Notably in the
Phaedrus,
Plato spoke of the ‘divine fury’ of the poet, and works attributed to Aristotle (384-322 bc) sketched the profile of the melancholy genius, whose solitary discontent fired his imagination to produce works of originality.

Such views were revived in the Renaissance by Ficino and other humanists; to dub a poet ‘mad’ was, in the conventions of the age, to pay him a compliment. Michael Drayton thus praised the dramatist Kit Marlowe:

For that fine madness still he did retain,

Which rightly should possess a poet’s brain.

Shakespeare for his part suggested in
A Midsummer Night’s Dream
that ‘the lunatick, the lover and the poet are of imagination all compact’, and thus described the act of creation:

The poet’s eye in a fine phrensy rolling

Doth glance from heav’n to earth, from earth to heav’n

And, as imagination bodies forth

The forms of things unknown, the poet’s pen

Turns them to shape, and gives to aiery nothing

A local habitation and a name.

And similar views were later rhymed after the Restoration by John Dryden:

Great wits are sure to madness near allied,

And thin partitions do their bounds divide.

Visiting what was facetiously dubbed the ‘Academy of Bedlam’, the diarist John Evelyn found one inmate ‘mad with making verses’. It was a standard crack: writers were supposedly mad, and those who were mad suffered from the
cacoethes scribendi,
the writer’s itch.