Schizophrenia. Orna Ophir

by 1000–1250 CE, they were being used as textbooks in emerging medical schools. One of the most famous circulating medical encyclopedias of the later Middle Ages was the Canon of Medicine, written by the Persian physician Ibn Sina (980–1037), better known by his Latinized name, Avicenna.

      According to Ibn Sina, the brain is divided into three parts, each with a distinct function. The imaginative faculty is located at the front of the brain and processes the information received by the senses. This sensory data is then passed on to rationality, the central brain faculty, which forms it into concepts and judgments. Finally, memories are stored at the back of the brain, as images literally imprinted in its wet matter.⁵⁶ Mental illnesses, Ibn Sina concludes, are caused by humoral or anatomical abnormalities in one or more of these three areas.

      As in the tradition that began with Celsus, in these medical texts, three main conditions were associated with madness: frenzy (frenesis), mania (mania), and melancholy (melancholia). Yet, few treatments were available for them. When the body was the target, the proposed treatment was based on the idea that opposites cure. Hence if madness was attributed to heating of the brain, coolness was prescribed. In such cases, shaving the head and drenching it in water or oil was a prescribed remedy. Cutting open the artery in the head for bloodletting was another.⁵⁷

      But in medieval times, madness was not always understood to be naturally caused by imbalance of the humors. When symptoms were bizarre – when the individual had hallucinations and delusions, or, for that matter, started to bark like a dog or crow like a rooster – doctors suspected the cause to be demonic, or in any case, supernatural.⁵⁸ While demons were not believed to be able to infiltrate the sacred, incorruptible soul, some medieval physicians accepted that they could manipulate the mind by entering the body surreptitiously. By producing erroneous images, demons could confuse the imagination and impair a person’s reason, such that the affected individual was no longer able to correctly use the information provided by the senses.⁵⁹

Based on the literature of the time, Trenery and Horden suggest that although “demoniacs” were associated with abnormal powers, convulsions, blaspheming, abhorrence of sacred objects, and aggression, distinctions were not always made between demonic possession, on the one hand, and other forms of madness, on the other. Both involved wild gestures, violence, twisted facial expressions, and shouting, that phenomenologically or descriptively speaking, remained indistinguishable or, at least, overlapped.

      In Nebuchadnezzar’s Children: Conventions of Madness in Middle English Literature, the late Canadian medievalist Penelope Doob divides popular literary portrayals of madness into three different classes: that of the “Mad Sinner,” the “Unholy Wild Man,” and the “Holy Wild Man.”⁶⁰ All three, she argues, were influenced by the popular biblical figure of Nebuchadnezzar, who, as we saw, was punished by being degraded into bestial existence. Madness was a form of “otherness,” which triggered various responses, including “fascination, fear, laughter, pity, and revulsion.”⁶¹ From the eleventh century onward, all those who were excluded from what came to be known as Christendom (including Jews, Saracens, and heretics) risked being accused of thinking and acting “differently.” Any deviance was classified as a major defect, confusion, or madness. In fact, the vernacular, for the “other” was “maniac,” “insane,” or “fol” (i.e., madman, in French), among other terms.⁶²

      Medieval art, moreover, depicted the demoniac with disheveled hair and torn clothes, while the demon itself was often shown entering or leaving its victim through the mouth, in line with the New Testament story of the Gerasene demoniac, retold at the beginning of this chapter. As Sander Gilman claims in Seeing the Insane,⁶³ to be represented, this “otherness” of the mad required some form of physical marking or wild appearance, such as a lack of clothes, hairiness, a staff in the hand, or a hunched stance. These signs served to visually set the afflicted apart from the common people or the normal. The Ship of Fools, an image that was born in the Middle Ages, captures both the otherness and the isolation of the mad thus depicted and, de facto, cast out.⁶⁴

A telling example of this “otherness” of medieval madness is the story of Margery Kempe, with which we opened this segment. Since the rediscovery of The Book of Margery Kempe in 1934, historians have been particularly interested in using this text to explore the medieval connections between madness, divine inspiration, and mysticism.⁶⁵ Kempe, who was born around 1373, describes how she “went out of her mind” after the birth of her first child. By her own account, for about eight months, the devil placed in her mind a terrifying fear of eternal damnation, as she saw and heard devils speak (or, rather, holler) with flamed tongues. She describes feeling herself to be a passive object intruded on by sinister spiritual forces, understanding everything she did or experienced from there on as being caused by these intruding external forces.

      Margery Kempe continued to have visions and hallucinations for the rest of her life. She recalls that she “saw our Lady faint and fall down and lie still upon the ground” and, even more significantly, notes that she experienced herself to be “a madwoman, crying and roaring.”⁶⁶ Her eccentric behavior was interpreted by her contemporaries either as a result of an “evil spirit” tormenting her body, or as the consequence of a “strange bodily affliction.”⁶⁷ She describes others who suffered from similar conditions – crying loudly, being violent, hitting and biting to the point of being restrained and shackled – as being “deranged.”⁶⁸

      This kind of unruly beastly behavior was also recorded much earlier, during the Byzantine period. As Trenery and Horden note, the emperor Justin II (r. 565–578) is described as having lost his reason, resembling an animal, and, therefore, being restrained.⁶⁹ Like in the earlier Greco-Roman or Hellenistic period, in Byzantium, madness was seen both in the Galenic medical humoral tradition (as an “illness coming from the cranium” and, hence, in natural terms) and in supernatural terms (as a result of possession by spirits). What distinguished the East more strongly from the West during this period was the different appreciation of the so-called “holy fool.” Indeed, at the time, the madness of the holy fool was considered a form of piety distinct from insanity. These “mad” individuals radically avoided the attention of admirers of their “holiness,” and instead served to “critique the corrupt norms of the society around them” in unique, if exemplary, ways.⁷⁰

Even though holy fools also existed in Medieval Islam⁷¹ (and restraint or beating of the insane was not unusual there either), these supernaturalistic approaches coexisted with the heavy influence of Galenic learning, with its naturalistic, somatic, and ethical conceptions of mental illness. The latter involved an alternative treatment altogether, which relied on modulating the six non-naturals (air, food and drink, rest and exercise, sleep and waking, excretion and retention, and handling the emotions). This kind of treatment also included creating relaxing surroundings for the afflicted individual, with soothing sounds and scents.

      In earlier times, in the West and East, both under Christian and Muslim rule, the chronically mad were often placed in the same category as infants and, hence, were mainly cared for by their families or communities. However, during the Middle Ages, institutional social and medical care for the mad began to emerge. Treatments were based on humoral remedies, such as purging, to restore equilibrium, while sedation and confinement in cells were practiced with violent patients.

      Throughout the period, whenever madness was defined as “otherness,” that is, as a wholly separate category of being, possibly caused by demons and spirits, the treatment aimed at either “extracting” the madness – exorcising or expelling it – or at protecting its “holiness.” In both scenarios, the question of the person’s morality was central. By contrast, when the madness was seen as the result of a natural imbalance in the body, caused by either too much or too little of a particular substance or material quality – and, hence, not as the sign of a categorically different metaphysical condition or, alternatively, of a moral defect or, rather, perfection – treatments were meant simply to restore the original balance. That said, to unprepared modern-day eyes, some of the means to bring back such a state of natural equilibrium (e.g., by bloodletting,