Schizophrenia. Orna Ophir

to say torturous.

      This “othering” of madness and of madmen would remain common practice throughout history, even up to our age. As such, it has become a cause and justification for a categorically different theorization of and engagement with those who happen to experience non-ordinary states of mind, hear voices, have visions or persecutory ideas, while exhibiting unusual behavior that expresses them or leads up to them.

Early Modern Madness: God, Satan, Witches, and Poison

One night, I said there was a great clap of Thunder like the shot of a Piece of Ordnance, came down directly over my Bed; and that the same night, a while after, I heard like the voice of two Young Men singing in the Yard, over against my Chamber; which I said were Devils in the likeness of Men, singing for joy that they overcome me; and in the morning as I was going to rise, the Scripture in the 10^th. of Heb. And the last words of the 26^th. Verse, was suggested to me from Heaven (as I thought) There remains no more Sacrifice for sin; and this delusion remained with me as an Oracle all along; that by this miracle of the Thunder, and the Voice and the Scripture, God revealed to me that I was Damned. (From A Narrative of God’s Gracious Dealing with that Choice Christian Mrs. Hannah Allen, 1683)⁷²

      Traumatic experiences, bad dreams and suicide attempts, fear of enchantment and of witches stealing milk from breasts, were among the symptoms associated with madness in Europe between 1500 and 1700. As Elizabeth Mellyn, an expert on mental illness in early modern Italy, amply documents, at the time, Europe displayed extremely varied representations of madness.⁷³ Fools, melancholic artists, brooding scholars, obsessive lovers, mad prophets, and the divinely or demonically possessed were commonly described, in great detail. Based on extensive sources in legal archives, doctors’ casebooks, and the first written records of Europe’s first mental hospitals, Mellyn concludes that, while in early modern Europe madness was thought of as more somber and gloomy than in the Middle Ages, characterized mainly by anguish, sorrow, and torment (and perceived quite literally as dark, involving melancholia or black bile, the dark influence of Saturn, fears of darkness and perils of the night), institutional and therapeutic strategies to treat the insane remained more or less unchanged, geared toward restoring original harmony and a natural equilibrium. Although voyages to the New World led to interest in exotic drugs, the excitement about a chemical cure failed in challenging the authority of Galen’s doctrine of the humors. It was still widely believed that both natural and supernatural forces had an impact on the human body and soul, so that madness could be caused by terrestrial as well as celestial, even demonic, spiritual factors. Thus, healers of insanity included universitytrained physicians, but also priests, exorcists, alchemists, astrological or occult healers, remedy sellers, tooth drawers, snake charmers, and plain charlatans. Some early modern hospitals treated the severely disturbed, while monasteries and convents continued to offer hospitality to the insane, mainly to protect the material and spiritual integrity of their respective communities. For the criminally insane, prison, it seems, was the default option.

Most learned physicians treated their mentally disturbed patients by balancing the six non-naturals, prescribing therapeutic baths, as well as traditional remedies such as powerful emetics, purgatives, and bloodletting. The goal was not just to restore humoral balance in the body, it was also to create a harmony between the inner and outer worlds of those who suffered from madness.

      In the cases treated by Richard Napier, the famous early modern physician, witches, demons, and spirits were believed to be the instigators of madness, alongside physical causes such as pathogenic diets and emotional distress in the form of sadness, fear, jealousy, loss of love, or of one’s estate. When reporting on his observation and treatment of an insane woman, Napier notes:

      CASE 16959: Agnes Olny of Tebworth in Chalgrave, 38 years. Wednesday 19 May 1602, 9:45 am … the husband for his furious and insane wife. Senseless. Has no use of her wits & light headed … A frantic woman. Mad & laughs & misterms [i.e., uses the wrong words]. First had good motions & now worse & worse. About 3 years since delivered of a child which by means of an unskillful midwife perished & rent the woman that she ever after continued lame & could never since hold her water. Upon this day sennet [i.e., upon the seventh day] about 12 of the clock she began to wax mad when Sun and Moon came both to be in Gemini & Mercury dispositer [a technical term in astrology] of both the lights. A thick muddish water. [Treatment information, including Latin phrase meaning “God for this sick little woman, may Satan be crushed under Christ’s feet, and may my medication be blessed, so that she may be freed from this distraction of mind and also be greatly and powerfully consoled, and with compassion and blessing.”] (From Selected Cases in Full, From Simon Forman’s and Richard Napier’s Medical Record)⁷⁴

      Other medieval doctors operated in similar ways: when confronted with a young man who imagined himself to be a priest, delivering sermons to imaginary congregants, the Italian physician Bartolomeo Montagnana (c.1380–1452) diagnosed melancholy. In order to rid the man of his delusions (corruptas imaginationes), Montagnana prescribed conversation, music, and light entertainment, and for the rest, instructed him to avoid the company of monks (particularly those wearing black robes).⁷⁵

A notable change in the way health and illness were understood at this time was further introduced by the Swiss-born physician Paracelsus (1493–1541), who was the first to refute the widely accepted Greek idea that diseases were caused by humoral imbalances. Paracelsus argued instead that diseases were caused by poisons, and cure could be delivered by powerful chemical agents.⁷⁶ Nonetheless, his innovative ideas took on only gradually, and in his work entitled Diseases that Deprive Man of His Reason, Paracelsus also attributed madness to witchcraft, astral influence, sinful imagination, and, once again, disordered humors.⁷⁷ Paracelsus’ treatments included bloodletting based on the humoral theory, alongside chemical therapy in the form of powerful drugs, made of silver, iron, mercury, lead, gold, pearls, coral, sulfur, or sapphires. These were considered as toxins to be used to fight other toxins, following Paracelsus’ famous idea that “All things are poison, and nothing is without poison; the dosage alone makes it a poison.” Increasingly, opiates were deemed the most effective when treating mental disorders.⁷⁸

      Just as he was unable to fully liberate himself from the stronghold of Galen’s humoral doctrine, Paracelsus also remained influenced by the ancient idea that celestial bodies (the planets and stars) exerted powerful forces on all terrestrial forces of nature, which could be harnessed to heal the body and mind. Furthermore, the ethical dimension that remained from Galenic medicine was still widely held, and the belief that immoral behavior led to an imbalance in the body, making it weak and penetrable by hostile forces, was popular. Preventive measures thus included both bodily and spiritual hygiene. In most cases, the physical body and the metaphysical soul were largely seen as treatable. While physicians aimed to restore balance in the body by manipulating the six non-naturals, the clergy used “soul remedies” like confession, communion, pilgrimage, and exorcism, the latter mostly as a remedy of last resort to balance out the disturbances of the soul.⁷⁹

The early moderns thus understood madness as being either the result of an imbalance in the body, or as an infiltration by a foreign hostile force – whether in the natural form of a poison or in the supernatural guise of demons and evil spirits. The imbalance of humors and their qualities was further attributed to changes in the external, terrestrial, or celestial environment, and was at times seen as deriving from the mad person’s unregimented behavior (such as disorganized diet, sleep, exercises, etc.). A disequilibrium of the body was itself considered a possible precondition for a qualitative change, caused by the invasion of the foreign agent that caused the madness in question. According to the first interpretation, sanity could be restored by reinstating quantitative balance. According to the second, the different quality – and the invasive, foreign element – needed to be expelled in toto.

Modern Madness: A Disease Entity, a Natural Kind

      Some of my unfortunate patients labored under the horrors of a most gloomy