The Shadow of Insanity from Hippocrates to Victorian Psychiatry

The ghostly, mysterious, mighty and shady presence of madness, or insanity, throughout history has been acquiring, in fact, a large amount of diverse meanings.

Should one be asked to write down only a few of the mental and physical manifestations related to madness in history, then, depression, anxiety, nervousness, hopelessness, fears, emptiness, uselessness, obsession, sleeplessness, epilepsy, mental instability, psychopathy, nervous breakdown, mental invalidity, love-sickness, dementia, manias would be only some of the numerous labels used to call and identify an endless quantity of symptoms which outline the existence of any sort of mental fragility, varying, of course, ad infinitum.

Since the seventeenth-century, all the symptoms listed above have been categorized as nervous illnesses, whereas, in other historical periods, all these different labels might have been assembled under other nomenclatures, such as, for instance, hysteria or insanity, which both had — as I will try to demonstrate — a very strong impact on Victorian popular culture, especially from the 1860s.

However, leaving here the terminological issue aside, what should be kept in mind is that what is conventionally considered to be mad today was not necessarily and forcibly deemed to be mad yesterday, and the other way round.

Thus, we will here focus our attention on the historical evolution of “madness” as a concept, and I will take into account — specifically — the impact it had on Victorians. Psychiatry, the alleged highest level of knowledge related to the human unconscious sphere, was a creation of the Victorian age, when innumerable new medical theories were moulding the collective idea related to the controllability of one’s mental processes.

Scientists invested their time to demonstrate that their eyes could penetrate people’s brain and could understand its varying and unforeseeable processes dictated by sentiments, instincts and sensations; and women, in this regard, were considered more biologically geared towards enabling senses and affections to command their actions and reactions. Insanity, for a very long time investigated, was — in Victorian time — often applied to explain and justify inexplicable murders, social rebellions and gendered requests.

Madness, and its consequent acts of delirium, has not only always aroused enormous and intense curiosity in society, but it has also been carefully observed and deeply studied. One could now say that delirium — one of the visible manifestations of madness — is the condition of being unable to reason and act due to inner confusion.

Madness, in other words, appears to be an illness of the soul, a fragility of the mind, a sort of personal burden. At the end of the nineteenth-century, after centuries of medical research, one of the most important minds in the study of insanity, Sigmund Freud, defined what he generally used to call hysteria: he stated that it manifested itself through acts of alteration, either permanent or temporal, of mental faculties; in fact, as Freud argued, “[…] these attacks are nothing but phantasies projected and translated into motor activity and represented in pantomime. It is true that these phantasies are unconscious but otherwise, they are of the same nature as those that may be observed directly in day-dreams or revealed by an interpretation of nocturnal dreams”.

Metaphorically speaking, madness might be compared to a gloomy and foggy landscape, to mental opacity and blindness, to a heavy black curtain over the eyes, separating and isolating the individual from the surrounding reality.

In 1854, Sir Daniel Noble (1810-1885) defined insanity as “a perversion of ideas”. Similarly, according to the legal point of view offered by Paolo Zacchia (1584-1659), considered not only one of the founders of European legal medicine, but also a revolutionary jurist that introduced several innovations in the field of the legal handling of psychopathology, madness was an effective incapability to distinguish between reality and fantasy, between dreamy hallucinations and visible truth.

One of the most effective visual representations of this apparently clear definition can be observed in ‘Don Quixote’ by Gustave Doré (1832-1883), the well-known nineteenth-century painter who — similarly to other numerous painters in history, such as Michelangelo, Van Gogh, Edward Munch or Salvador Dalí — made the attempt at sketching the mysterious shape of madness and its delirious effects.

The French painter succeeded in giving material and visible borders to madness and to do that, not by chance, he chose to draw the hallucinations of one of the most famous visionary characters in the history of literature — Don Quixote — during one of his innumerable dreamlike visions influenced by reading: the presence of a book in the painting and the fact that Don Quixote is reading it are two fundamental details in our discussion. In fact, Doré’s masterpiece shall be taken into consideration again in the following chapter in connection to the possible effects of literature on nerves and mind and the numerous Victorian’s obsessions in relation to that.

In the painting by Doré, madness appears the contact zone between a distorted blindness of the mind and an invented reality, which embraces — in this specific case — Don Quixote, lost in a hurricane of misleading and deviated affirmations of falsehood and untouchable nothingness.

While speaking about a possible history of madness, it seems inevitable to go back to the very origins of the history of medicine. Thus, the following short reference to Greek medicine — humoral medicine, to be precise — is not a useless deviation, since the theory of temperaments, based on humoral medicine, was often applied to explain and justify several human behaviours, influenced by the four elements at the core of human humours: blood, black and yellow bile and, finally, phlegm.

It was Hippocrates, the father of medicine, and his provision that helped the theory of humours and humoral therapy develop rapidly. Humoral medicine included diet, physical exercise and massages, meant to cure different kind of illnesses, such as, for instance, madness or, more specifically, hysteria. What Hippocrates had in mind was, in other words, the restoration of the harmony and of the equilibrium in the patient’s body.

Greek epistemology offered new interpretations of madness, supported, for example, by Plato and Socrates, who thought that madness could actually be a new possible way to see and interpret reality. While reason remained for many the only possible instrument to achieve knowledge, for others it was madness itself that might provide humanity with the right key to open the door of human wisdom.

Subsequently, Hippocratic humoral medicine was moulded by the ideas of Rufus of Ephesus, an important Greek doctor, and it was further significantly reinterpreted by Galen, who focused his attention on spirits, rather than on humours. According to him, when the vital blood, supplied with crucial elements coming from recently ingested food, reached the brain, via the carotid artery and the aorta, it was then immediately sent to the nerves, responsible for motions and, above all, for personal sensations. Therefore, Galen, as well as Hippocrates, was convinced that there was a very strong relationship between food, blood, brain, nerves and sensations.

One might thus conclude that food — both liquid and solid — was long perceived, in ancient Greece, fundamental in order to maintain a healthy nervous system. Nonetheless, this idea did not remain within Greek borders only and the link between good food and good health soon spread all around Europe.

Several other physicians used Greek thinkers’ ideas and enriched the latter with their own interpretations. For instance, according to Bernard de Mandeville (1670-1733), Dutch physician and philosopher, famous in Britain for his studies on nervous illnesses, the functioning of the brain, and consequently of nerves, had a direct connection with the quality of food and the efforts made by the stomach to extrapolate the best from food itself.

In other words, while unhealthy and poor blood might mean poor temperaments, healthy blood might foster a strong personality. Being convinced that humans were constantly struggling to win against passions and likely to fail to follow reason, Bernard de Mandeville wrote that the suffering of the brain was the main cause of the interruption of the act of thinking, leaving space, as a result, to hysteria and to any kind of possible mental instability. Thus, not only for Hippocrates and Galen, but also for Bernard de Mandeville and many other physicians and philosophers in history, madness, or mental fragility in general, should have been absolutely imputed to the quality of food and, of course, of blood, which would become — in the nineteenth-century — the core of several terrifying discourses upon inheritance and transmission of genes and traits from one generation to the other.

Leaving Greek theories and their long historical influence aside, according to Edward Shorter, Professor in the History of Medicine at the University of Toronto, it was only when psychiatry — with its diverse and numerous therapies — was shaped and became one of the most important Victorian medical branches for the comprehension and interpretation of the human inner world that madness, or hysteria, achieved effective status of curable pathology within those institutions called asylums. However, asylums were just the result of a very long history of houses and institutions devoted to the cure (or isolation) of madness.

According to Andrew Scull, in fact, it was already during the Byzantine Empire that the very first hospitals for the insane started to be built. These hospitals seemed to be anything but oases in the middle of the desert. In fact, the insane was often enchained at the walls of the hospital and brutally beaten, something that would be, in the years to come, considered very good for patients’ health by Avicenna (980-1037), Persian philosopher and a great contributor to the history of medicine and to the treatment of depression.

Soon after the Edict of Milan in 313 — when the Byzantine Empire progressively got closer and closer to Christianity — drastic and violent exorcisms for mad people became part of the Christian rites of purification, which was expected to heal people suffering from madness or from any possible form of possession.

The idea of madness connected to demonic possession was a common belief during the Byzantine Empire: Christian religion and its fear of evil, especially until the sixteenth-century, rapidly became common and contributed to the diffusion of obsessions throughout the entire Middle Ages.