Psychology and Mental Illness in the Middle Ages

Walters Art Museum, Creative Commons

There is a common perception assumes that demonic possession, witchcraft, and superstition defined mental illness, and religion dominated study of the mind. However, the reality is much more subtle.

By Martyn Shuttleworth
Historian of Science

Beyond Aristotle

From the perspective of modern psychology and psychiatry, it is too easy to look back into the past and assume that it is a modern science, albeit with roots in the Renaissance and the Enlightenment. Before this period of European history lay the Middle Ages, often called the Dark Ages, a period where common perception assumes that demonic possession, witchcraft, and superstition defined mental illness, and religion dominated study of the mind. However, the reality is much more subtle.

The Roots of Psychology and Psychiatry

Modern psychology has developed rapidly, transforming from a discipline regarded as pseudo-scientific to a true science in just over a century. Any psychology student can quote Freud and Skinner, recognizing that psychology has gradually become quantitative rather than speculative.

Delving back further, many point to the Scientific Revolution and the 18th Century Enlightenment, as periods where the study of the mind truly began. Philosopher-psychologists such as Descartes (1596-1650) and Kant (1724-1804) studied the mind, the soul, and the nature of thought, as psychology began to diverge from theology, albeit still possessing a strong root in philosophy and metaphysics.

Travelling back even further through the ages, we can look to the Islamic scholars of the Islamic Golden Age (c. 750-1250CE). Polymaths such as Avicenna (c. 980-1037CE) and Al-Hazen (965-1040CE) were amongst the first academics to study the mind and recognize psychiatry, proposing that mental illnesses were diseases rather than spirits or of divine/satanic provenance. We can also step away from the Euro-centric perspective and look at the influence of India, China, Persia, and other cultures where the study of the mind, and its relationship to the self, the universe, and perception were important.

Western Europe, the Dark Ages, and Byzantium

In Europe, there is a huge gap in the development of psychology and psychiatry between the Classical period, where scholars such as Aristotle and Plato first began to study the nature of thought and mind, and the Renaissance. Commonly known as the Dark Ages, from the 6th to the 13th Centuries, this period began when the Roman Empire fell into a terminal decline, a period that we automatically associate with superstition and fear. It ended with the work of the great Renaissance men, whose studies into anatomy and willingness to challenge the church laid the groundwork for the Scientific Revolution and the Enlightenment itself, where the great empiricists would finally start to probe the mind.

However, was the human mind really neglected during the Middle Ages? Was this really an age of superstition, witch-hunts, and demonic possession? In reality, the name ‘Dark Ages’ is slightly misleading, even for the Early Middle Ages spanning the 5th to the 10th Centuries. Although war, famine, and disease restricted scientific endeavor in Europe, many philosophers and theologians contributed to the body of human knowledge.

Scholars such as St. Augustine, Thomas Aquinas, and Roger Bacon made some astute observations about the inner workings of the human mind, providing a foundation for the Renaissance. In the East, the Byzantine Empire preserved the knowledge of the Greeks, and philosophers such as the Jewish Symeon Seth (11th Century) and Niketas Stethatos (c. 1000-1090CE) studied the nature of dreams and emotions, as well as studying mental disorders and the brain.

Understanding the work of these scholars requires looking at the history of Europe after the Fall of Rome, in the 5th Century. At this time, Europe was shattered by political, socio-economic, and cultural instability, which brought hardship, famine, disease, and war. It also ushered in the domination of Christianity, so it is little surprise that the first scholars studying the mind were also theologians holding to Biblical values.

The Early Middle Ages

For the entire period spanning the decline and fall of the Roman Empire, until the first glimmerings of the Renaissance, the theology and doctrines of the Christian church held sway in most of Western Europe. The growth of Catholicism and Eastern Orthodoxy drove Paganism and other beliefs to the periphery, delineating between Christians and non-Christians in much the same way that Greeks looked down upon uncivilized barbarians.

Psychiatry and Christian Scholasticism

Although there is some disagreement about the extent of the Middle Ages, they are regarded as the period from the fall of the Roman Empire and the sacking of Rome by the Goths, in 467CE, to the capture of Constantinople by the Turks, in 1453. During this period, Europe went through a number of upheavals, socially, economically, and politically, as the stability brought by the Romans crumbled.

During this period of human history, the study of the physical world was largely guided by Christian doctrine, and scholars usually referred to biblical interpretations as the starting point for study. They built philosophical treatises around Christianity or, alternatively, were too afraid to challenge the status quo, lest they be branded as heretics and punished. In general, scientific study regressed markedly in Western Europe during this period.

The Psyche and Divinity

The study of the mind was slightly different, largely because thought and soul were inextricably linked. Psychology was described in theological terms, based upon the idea that thought and perception; the psyche, were part of religion and connection between deity and soul. The study of the mind was certainly not neglected during the Middle Ages. In fact, many theologians and scholars focused upon such studies as part of the quest to understand the link between humanity and divinity.

Largely, the Ancient Greeks concentrated upon abstraction and reasoning, with their impersonal, bickering gods perhaps a reflection of their society. By contrast, the Christian idea of the immortal soul led to a focus on the individual as the central figure. Because every person possessed an immortal soul, they were significant and worthy of ‘salvation.’

The Western European theologians drew upon the Judaic ideas of the nature of God, namely that God was the perfect creator, transcending the physical realm. Humans were the pinnacle of creation, and were regarded as higher than animals, capable of thought but also possessing a soul that linked every individual human to the divine. In Alexandria, these Judaic ideas fused with Greek philosophy and, from this fusion of cultures and philosophies, the Christian attitude to the philosophy of the mind and soul arose. This paradigm would shape the prevalent attitudes towards the mind for centuries.

According to the new Christian beliefs, man had an inner spirit, the Πνεύμα, which was separate from the soul and the body, perhaps reflecting the beliefs of Christians in the tripartite nature of God. This encouraged a certain amount of introspection, but this was also tempered by the idea of Christian fellowship brought about by shared worship. This particular slant towards an inward-looking, introspective belief is more apparent in the modern Greek Orthodox Church, which still blends Christian theology with the philosophy of the Ancient Greeks and Oriental mysticism.

St Augustine (354-430CE), the First Western Psychologist

Into this Christian belief system arrived St. Augustine, often labeled as the first psychologist, although he was also a superb philosopher who studied political systems and the idea of morality. Augustine derived much of his knowledge from his earlier life, where he studied the great Greek philosophers before converting to Christianity at the age of 33.

Europe in Turmoil

Adopting a monastic life, he devoted himself to study, and his work spanned the transformation of European thought as it moved away from the influence of the Greeks and Romans to the new Judeo-Christian society.

During this period of history, Western Europe was in turmoil as the Roman Empire fell, and barbarian raids, war, famine, and disease shaped society. Against this backdrop, and with the destruction of everything he knew, Augustine ceased trying to make sense of what was happening. Instead, in a quest for stability, he instead tried to visualize a perfect, peaceful society, in a reflection of Plato’s Republic.

This particular period of history provided the spark for his interest in psychology as he tried to reconcile his new, Christian beliefs with the world around him, combining the abstraction of Plato with the pragmatism of Aristotle. Overall, Augustine had difficulty in reconciling the paradise and spiritual riches promised by Christian doctrine with the intense suffering he saw around him.

Philosophy, Psychology and Theology

This conflict drove his interest in the study of the human mind, because he believed that the mind was the interface between the divine and earth, something he pointed out in his treatise, Confessions. Adopting an introspective line, he reasoned that studying the mind would allow him to understand the divine. In many ways, Augustine was the first philosopher to propose that humans had an ‘inner self,’ believing that a healthy person has inner unity, whereas inner disunity led to inner malady. Trained in rhetoric, Augustine used his Confessions to relate his own life and struggles, but he cleverly used this to paint a wider picture, that an individual can escape materialism and find spirituality and salvation.

As a neo-platonist, Augustine touched upon many psychology-based areas, blending them with philosophy and theology. For example, he touched upon the motivations of infants, as well as memory, the origins of grief, and the unconscious desires and motivations of dreams. Augustine pointed out that infants are self-centered and not socially aware. He also argued that the fear of punishment was a barrier to learning in children, because fear of castigation curbed curiosity, which he believed was the easiest way to learn. When discussing grief and emotions in general, he portrayed these as part of his wider idea of inner turmoil and the battle between God and self. Augustine looked at mind-body, believing that both were essential for making up a person, with the mind superior and the body inferior.

The Dualism of Memory and Dreams

Augustine believed that memory was the single-most important aspect of the mind, because it was the root of psychological functioning. He reasoned that all skills and habits derived from memory, and that even animals must have the power of recall if they are to function. Expanding upon this, he proposed a dual memory, reasoning that there were distinctions between recognition and recall. Humans only remember the images of things in sensory memory, but the mature of these images would be obscured in the affective memory.

This dual memory was based upon the principle that a recalled memory was different from the original. For example, the recollection of an event would not necessarily carry the same emotions as felt at the time, therefore recognition and recall were different processes.

He developed this interesting duality because he recognized that the processes behind memory were extremely complex, namely that some things were easily recalled, some took a little effort to find, and others refuse to come forth. Some memories are orderly and sequential, whereas others are disorganized and overwhelming.

He even looked at the paradox of forgetfulness: if something is forgotten but later remembered, how do you know that it is knowledge you possessed but forgot? To overcome this paradox, Augustine added that there must be a memory for forgotten things that works alongside the memory. Finally, Augustine believed that humans were born with some innate knowledge, although he rejected the idea of carrying knowledge from previous existences, as this did not match his theological worldview.

Augustine looked at the nature of dreams, recognizing that thought and impulses that are suppressed while awake can be extremely strong in dreams. He argued that there was no sin in dreams, so they should not affect the conscience of a Christian, but he also pointed out that past experiences could arise in dreams. Memory could be buried in the unconscious mind, and resurface in dreams, where they could not be tempered by thought or reason.


Predestination and Inner Turmoil

Augustine also looked at the issue of predestination, namely that an all-knowing, omnipotent God potentially takes away free will if it knows what you are to do. Augustine believed in free will, proposing that it lay at the core of the human being and that an individual had the freedom of choice to obey or deviate from God’s plans. A person has control of their thoughts, and therefore can choose to exercise will and self-discipline or choose to follow lust, this carnal desires battling against spirit. This creates habits based upon past experiences and the grace of God was needed to help man break away from compulsion and base urges.

He proposed that all people had an internal struggle, a battle of the inner self against God, and he extrapolated that to mean that the struggles and chaos of the world around him were also manifestations of that particular conflict. He believed that character defects and defense mechanisms fueled this inner turmoil between what a human should do and how the should behave against how they actually acted.

Augustine believed that love lay at the center of happiness, that desire led to disorder and that this was the source of suffering: for example, the desire for something that you cannot have fuels inner anguish. He believed that they key to repairing this damage was through the development of unconditional love, which would reorder the mind.

Naturally, he also had some ideas that were incorrect and based upon theology, namely that curiosity stemmed from original sin and could be spiritually dangerous. Naturally, the idea of original sin led him to believe that all humans were born sinners, often referring back to his own childhood. This view would influence the church for centuries, and may have hampered studies into the mind until the dawn of the Renaissance.

Psychiatry and Saints

In modern society, we often tend to study the individual in the context of the individual, looking at the differing desires, needs, and cognitions that influence each and every one of us. In the Middle Ages, this was not necessarily the case, and the hardships faced by Europeans led them to look at individuals as part of a wider picture, based in the battle of good against evil. Mental illness was not seen as something that affected an indivdual, but as a condition that played a role in humanity’s conflict between virtue and vice.

Salvation and Sinners – Collective Psychology

After Augustine, wider events affected the study of the human mind and of science in general. Science and philosophy usually prosper in wealthier societies, because an affluent society can afford to let philosophers, scholars and poets enrich culture. Conversely, a poorer society is concerned with more pragmatic things, and the tribulations of the Early Middle Ages acted as a breeding ground for superstition rather than science.

After the fall of the Roman Empire, at the end of the 5th century, the works of scholars laid forgotten as humanity stopped looking for models and trying to understand the natural processes of the physical world. Instead, they turned to magic and superstition, searching for supernatural explanations for phenomena they did not understand.

The Visigoths, Vandals, Huns and other barbarians laid waste to Europe, and a plague in the Sixth Century finally destroyed the Roman dominance of Europe. In a changing, increasingly brutal world, as is often the case, religion came to dominate as people flocked to the idea of salvation after life, some hope to provide purpose to the suffering present on earth. Allegory and biblical explanations began to replace reasoning and curiosity as people sought entry to the afterlife. This affected psychology and the study of the mind, as many mental disorders, notably depression and anxiety, became tied with sin and demonic possession.

The Early Middle Ages was a morbid society, with death and eternal torment reflected in the attitudes and the art of the time, including paintings and the sculptures adorning cathedrals. The fear of the end of the world was a prevalent theme, and we can postulate that this led to some of the societal mental conditions present at the time, such as self-punishment, asceticism, self-flagellations, pilgrimages, and processional worship. Others demonized non-Christians, especially Jews and Muslims, blaming them for the series of torments sent by God.

The Decline of the Individual

Reality was seen as a hierarchy flowing from creator, down through angels and humanity, to the lowest intelligence and inanimate objects of creation. Mental illness was seen as a disorder in this progression. Nemesius, Bishop of Emesa, in Syria (c. 390CE), wrote On the Nature of Man, promoting this view, which dominated Medieval thought. People were rarely seen as individuals, rather as part of a collective fighting for salvation or damnation.

The domination of allegory and symbolism in European thought filtered into art, and scholars, dominated by clerics, began to talk of man as a whole, rather than individuals, seeing humanity as the battleground between virtue and vice, good and evil. Thus, mental illness was not defined by its effect on an individual person but as a condition, affliction, or punishment.

Because people were rarely seen as individual personalities, there was little discussion of mental illnesses, although it must be emphasized that the theoretical writings of Augustine and other scholars told us little about how people were actually treated, as most sufferers would belong to the lower classes.

Monasteries and Mental Care

It would be extremely unfair to claim that Early Middle Age society was completely insensitive to medical needs, even mental. Many monasteries provided medical facilities for their own members, pilgrims, and travelers, and the Byzantine Eastern Church actually used these to treat the poor and the crippled, as part of their charitable duties. Indeed, in the Sixth Century, the hospital set up by the monk, Theodosius, near Jerusalem, may have had a section for the mentally ill. This appeared to be unparalleled in Western Europe.

Otherwise, little is known about psychology and psychiatry in the Early Middle Ages, with virtually no information surviving, especially concerning the poorer classes and rural populations. It is likely that the mentally ill were kept at home, supported by friends and community and treated with herbs and other folk remedies. Some may have been considered to be possessed by demons, and exorcised.

Magic and contagious disease were seen as the root of mental disturbances amongst the populace, so a combination of amulets and other magical items drove out evil magic or spirits. The Church continuously condemned such pagan practices, but they persisted. As an example, epilepsy was often treated with saintly relics, and people travelled huge distances to various shrines and holy places.

Priests played some role in treating the sick, and this probably included mental conditions. As stated in many books, originally written in the monasteries on the fringes of the Celtic World, notably Ireland and Wales, priests tried to cure like with like, so they might combat despair with hope, and aggression with peace. As part of a confessional, priests may have become therapists with some insight into the human mind gained through experience. Throughout history, the idea of the shaman or priest as spiritual healer, including the mind, is a common one. This is likely to have been the case in the Early Middle Ages.

The Late Middle Ages

Towards the end of the Middle Ages, withthe revival in learning underway, the study psychology of individuals began to replace the collective psychology of earlier periods. Hospitals dedicated to the treatment of mental illness became more common, as psychology and psychiatry began to take forms that are more recognisable to modern practitioners.

Gilbertus Anglicus and Bartholomew

The Renaissance also saw information popularized to the masses and leaving the centers of learning, albeit most knowledge was available only to the affluent, but it was no longer the name of academics separated from society. Gilbertus Anglicus (1180-1250), in his Compendium medicinae added new mental disorders, notably auditory and visual hallucinations, irrational phobias. He also suggested treatments for these disorders, concentrating on building self-confidence and developing a therapeutic relationship.

Bartholomew (1203-1272), in De proprietatibus rerum described that sadness, business pressures, dread, danger, foreboding, and too much studying could lead to insanity, possibly one of the first incidences of recognizing stress as a contributor to mental illness. Bernard de Gordon (c. 1260-1318), in Montpellier, subdivided melancholia into stages, a progression from hidden melancholia to outward and then complete melancholia, leading to withdrawal and social isolation and dysfunction.

Under English law of the early 12th century, some protection and provision for care was given to the insane, whether congenital or as a result of the onset of mental illness, and some credence was given to classical beliefs concerning mental illness, so it was not all possession and driving out demons. The law, based upon Roman law, regarded the insane as often incapable of making decisions and also exempting them from punishment, because insanity was seen as a punishment in itself.

Hospitals and Reinventing the Individual

A few hospitals with the mission of treating the mentally ill sprang up in the twelfth and thirteenth century, possibly as a result of the more enlightened views imported from the Islamic world and Byzantium. Metz, France, in 1100, Milan, Italy, 1111, with Sweden, London, and Florence and Northern Germany also seeing institutions, although it was likely that these relied upon isolation, especially of violent inmates.

In the 15th Century, Spain, under the influence of the Islamic moors, set up a number of mental hospitals, and care was likely provided by religious orders. St Bartholomew’s had a number of inmates, and is one of the few hospitals that allows us to see the nature of some of the illnesses. Records report hallucinations, breakdowns, epilepsy, insomnia, and a number of other cases that would be familiar to modern psychiatrists. They were allegedly cured by the miraculous intervention of St. Bartholomew, although little else is said about the exact nature of the treatments.

Some of the great and the good also reported mental conditions, although it is likely that their treatment was better than the common person. Charles VI of France suffered bouts of insanity, 13th Century Italian artist, Opicinus de Canistris suffered melancholic bouts as, it is believed, did Chaucer, his Book of the Duchess allegedly autobiographical recounting of his own melancholia. The English poet Thomas Hoccleve talked of his melancholia in his poem, The Complaint: it seems that artists and poets were just as prone to depression as they are now.

The Late Middle Ages set the groundwork for the Renaissance, as Europe began to climb out of superstition and religious dominance. Social mobility once again became easier, albeit difficult, with the feudalism apparent for centuries eroding in the face of a new, mercantile class with the wealth to challenge hereditary nobility.

The Early Renaissance and Aquinas – The Culture of Learning

During the 8th Century, the 8th Century saw a revival of learning, as Charlemagne and the Carolingian Dynasty provided the stability for educational institutions to flourish. Although this empire was fairly short-lived, it provided a foundation for the Early European Renaissance of the 12th Century, when scholars such as Thomas Aquinas began to study metaphysics and the mind.

Renaissance and Aquinas

It is tempting to assume that, after Augustine and until the Renaissance, little progress at all was made and society became dominated by the illiterate, and there is certainly some truth in that outlook. However, two brief periods of enlightenment occurred, namely the Carolingian Renaissance of the Late 8th and Early 9th Centuries, and the First Renaissance of the 12th Century.

The Caroligian Dynasty, spanning the reigns of Charlemagne and Louis the Pious, saw an increase in the number of schools as the rulers tried to improve literacy. This period saw a revival in classical knowledge, art, and architecture, as esteemed scholars underpinned a cultural and societal revival.

Huge schools, attached to monasteries and cathedrals developed, under the auspices of the Carolingian dynasty, and the work of the Roman authors was again taught. Grammar, rhetoric and logic, were taught alongside arithmetic, geometry and music, in great schools such as Chartres, Orleans, and Auxerre. This period certainly enriched western civilization, although the effects were short-lived and restricted to the clergy and nobility. However, the development of schools, curricula, and a standardized form of Latin remained.

When the Carolingian Empire declined, at the end of the 9th Century, feudalism again emerged, dominated by nobility interested only in using the church for an outward show of power. This included the Crusades, which although brutal and intended as little more than a land-grab, started the flow of ideas from Islamic and Byzantine lands into Europe. The Knights of St. John and the Knights Hospitalers also established centers for healing sick pilgrims, including the mentally ill.

This influx of ideas began to shape thought, as scholars again began to explore the mind, building upon the work of the Greeks, Romans, and Arabs. Foremost amongst these was Thomas Aquinas, a polymath who explored the mind and body.

The Early European Reniassance

The culture of learning was reestablished in Europe in the 11th Century, under the auspices of monasteries. The First European Renaissance, of the 12th Century saw European society start to climb out of its mentality of despair, as society and the economy started to improve. Unlike the earlier Carolingian Renaissance, which was largely limited to the upper echelons of society, this Renaissance was inclusive, driving cultural and societal changes that would underpin the later Renaissance.

Minds such as William Conches (1090-1154), with an interest in anatomy, especially the brain, and Bishop John of Salisbury and John of Bloise were fascinated by medicine. Hildegard of Bingen wrote a number of medical books, and she touched upon the notion of insanity and mental illness, describing them via the four humors, as with the Roman thinkers.

Thomas Aquinas

Thomas Aquinas (1225-1274), influential in so many areas of learning, including philosophy, theology, and natural science, blended Judeo-Christian ideas with the rediscovered knowledge of the Ancient Greeks that arrived in Europe via Arabic translations. In His De Anima, he noted some beliefs about the mind, believing it to be divided into:

  1. Organic: The organic faculties, governing growth, nutrition, and healing
  2. Sensory: This governs how we interact with and perceive the world. The cognitive aspect governs the five senses; the appetitive; and the motor
  3. Rational: The rational faculties govern thought and reasoning. He believed that the passive intellect, namely how the mind perceives information received by the senses, and the active intellect; namely the abstract processes of the mind that the mind then rationalizes to perform actions suiting the greater good.

He did also believe in the influence of the supernatural and astrology, but such beliefs were not uncommon.

Like most classical scholars, he divided mental illness into melancholia, mania, and depression, and he believed that pleasure, sexuality, and seeking pleasure were distinct aspects of the human personality. He also believed that intellect and reasoning had to be pure and unblemished, as a divine aspect in humanity, so mental diseases had to have a somatic disorder one founded in underlying problems with the body.

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