The Popes and Science

An examination of the methods for the care of the insane in the Middle Ages brings out clearly the fact, that the modern generation may learn from those old Catholic humanitarians, whose hearts and whose charity served so well to make up for any deficiencies of intellect or of science the moderns would presume them to have labored under. There are said to be three great desiderata for the intelligent care for the insane:

First: The open door system, permitting patients who are not violent, and who can be trusted even though they have many queer notions, to come and go at will.

Second: The after care treatment of those who have been insane, to the end that they may not be compelled to go back to strenuous lives of toil; and above all, that they may not be forced into the too harrassing conditions of which their mental breakdown originally was born.

Third: A colony system by which patients of lowered intelligence may be cared for in the country, far away from the stress of city life, and where, without the cares of existence pressing upon them, they may be surrounded by gentle, patient, kindly friends who will make every allowance for their peculiarities and strive to help them in their up-hill struggles.

These desiderata are so absolutely modern that they have only been formulated definitely with the beginning of the twentieth century. Notwithstanding this apparent newness, I think that it will not be difficult to show that the old-time methods of caring for the insane partook, to a greater degree than would be suspected at the present time, of these desirable qualities that modern science has come to recognize as so indispensable for the rational care of the mentally unbalanced. In saying this I do not wish to claim for the Middle Ages accomplishments beyond their deserts. My idea is rather to write an interpretation; to make clear from what we know of the details of the care of the insane in the fourteenth and fifteenth centuries, that unconsciously those generations, in their large-hearted charity, anticipated what is best in our present system.

The first record in English medical literature of a home for the insane is that of Bethlehem Royal Hospital, London, which has become famous under the familiar shortened name of Bedlam, meaning a house or place of confusion. Bethlehem was a general hospital into which during the fourteenth century insane patients were admitted. There is a historical record to the effect that at the beginning of the fifteenth century a royal commission investigated the methods of treating the insane in vogue there, because there had been complaint of abuses in the institution. Practically every century since there have been written corresponding records of similar investigations. The trouble seems always to have been that there were too few attendants properly to take care of insane patients, and thus they had to be placed in confinement in various ways, which inevitably led to abuses.

For a generation or longer after each exposure by a committee of inspection, the evils of this system would be more or less tolerable; then they would become unbearable once more and another investigation would be demanded. I would like to feel that we have progressed in all respects beyond these hit and miss methods, but any one familiar with the present situation in the matter is quite well aware that there are still many abuses that need correction, and inspection committees find many suggestions to make and sometimes gross evils to stigmatize.

Bedlam seems, however, to have always been as well and as humanely conducted as the spirit of the times demanded. It must not be forgotten that according to well authenticated tradition, a very large part of the hospital's income was obtained by the collection of fees for the admittance of visitors who came to be amused by the vagaries of the insane. The number visiting the asylum for this purpose must have been enormous, for, though only a penny was charged for admission, the resulting revenue is said to have amounted to four hundred pounds sterling a year, showing that nearly one hundred thousand persons had visited the institution.

From generations that were pleased to derive morbid amusement out of the misfortunes of others, humanitarian care of the insane could not be reasonably expected; but in view of this custom it is difficult to understand how there could have been at this period any great abuse of patients, in the matter of severe punishments or inhuman restraint.

Some of the customs of the old-time hospitals were interesting. It was believed that the one chance for an insane patient to recover lay in trusting him somewhat, allowing him even to go unattended outside the walls at times. Patients in Bedlam were permitted to go out alone after they improved in health, and if they were poor they were allowed to obtain their living by means of begging. In order that they might more easily work upon public sympathy, they were permitted to wear tin plates fastened to their arms. The wearers of these were called "Bedlams," or "Bedlamites" or "Bedlam beggars," and tradition says that they received much more consideration than ordinary beggars.

It may appear that this was dangerous liberty, but the ordinary person is apt to consider as dangerous the open door treatment of the insane which most alienists now hold to be the most commendable feature of present day treatment. It seems reasonable that to permit patients to go into the open air and sunshine was better than confining them in the hospital, and doubtless the insignia which they wore especially commended them to the care and alms and sympathy of the people.

Much has been said with regard to the alleged neglect and abuse of the insane during the period of exorcism, because of the misunderstanding of the cause of the disease. There are persons who consider neurasthenia and major-hysteria as more or less modern forms of nervous diseases, but it is more than probable that they existed with considerable frequency in the olden time. Many of these cases would be cured by strong suggestions, that is, by the treatment usually given to supposed possessed persons, and as we know that the best possible treatment for certain forms of major-hysteria is to frighten the patient (the earthquake at San Francisco cured a dozen persons who had not been regarded as able to walk, some of them for years), it is probable that a goodly number of the patients of the past were cured by the rather heroic measures sometimes devised. Sir Thomas More mentions such cases, and though himself eminently humane, commends this method of treatment "in which such patients were severely scourged and thoroughly aroused from their willfulness."

When psychiatrists talk slightingly of the old-time methods of caring for the insane, it is well to recall that, considering the conditions and limitations of scientific knowledge, they seem to have done very well in those times. It has been the custom of critics to hold up to ridicule that insane patients were sometimes taken to special shrines in order that their ills might be cured by the direct interposition of Heaven; or that the devil supposed to possess them, might be driven out. It must not be forgotten, however, that such procedures were of supreme utility in mild cases viewed merely from the human standpoint, and without any appeal to the supernatural. The journey to a favorite shrine, undertaken under conditions that gave variety to life and new interests, together with the hope aroused while there, were sufficient to help the patient physically and, not infrequently, mentally.

Some of the most distinguished specialists in mental diseases in Germany, France and England are on record as believing that one of the most helpful agencies in the relief of certain symptoms of mental disturbance, and even the cure of milder forms of insanity, is confidence in the Almighty as expressed by prayer. At a meeting of the British Medical Association two years ago, this idea was expressed very forcibly by a distinguished specialist, and was concurred in by a number of those at the meeting of the Section on Mental Diseases. He said:

"As an alienist and one whose life has been concerned with the suffering of the mind, I would state that of all hygienic measures to counteract disturbed sleep, depressed spirits and all of the miserable sequels of a distressed mind, I would undoubtedly give the first place to the simple habit of prayer. * * * Such a habit does more to calm the spirit and strengthen the soul to overcome mere incidental emotionalism than any other therapeutic agent known to me."

The medieval peoples realized this, and finding it beneficial, used it to decided advantage in a large number of cases.

Occasionally some very striking developments resulted from pilgrimages made for the cure of the insane. A typical instance is to be found at the shrine of St. Dympna in Belgium. Many persons in various stages and differing forms of mental derangement were accustomed to go or be taken to the shrine of this Irish girl missionary, whose martyrdom had so elevated her in the estimation of the people of the neighborhood that they thought her tomb worthy of special reverence. The sufferers who journeyed thither frequently lingered for some time in order to invoke the aid of the Saint, and, if possible, secure her intercession for the relief of their ailments. Many of them were found to get along better in the quiet of the little village than they had done in their homes, and as they were simply quartered among the people of the village, their friends were able for a trifling pecuniary consideration to secure their maintenance there for an indefinite period, in the hope that what the Saint had not granted at the beginning might be obtained by more assiduous devotion at her shrine. At first the friends probably intended to come back and take the patients away, but after a time, finding that they got along so well near the shrine, they gradually learned to leave them there entirely. Thus originated the famous insane colony at Gheel which has in recent years been the subject of more attention on the part of alienists the world over than almost any other therapeutic method of our time. This medieval invention of caring for the non-violent insane, especially those of low grades of intelligence, in the midst of small families, where none of the cares of life burden them and where they have occupation of mind and body and certain human interests, such as might appeal to their weakened intelligence, is probably the ideal method of caring for such patients. Certain it is that it is much better than the large institutional system, the invention of succeeding centuries, from which we are now trying to get away as fast and as far as possible.

The Gheel mode of caring for the insane is really the colony system that is now universally recognized as the most favorable mode of treatment for these patients. It seems not unlikely that there was much more of this practice during the Middle Ages in Europe than we have any idea of.

With regard to the serious accusations so often made against the people of the Middle Ages for their cruelty to the insane, not much apology will be needed by those who know anything about the treatment of the insane, even in quite recent times. Measures of rigid restraint were employed for dangerous cases. Patients who had shown manifestations of violence were likely to be chained. Severe and unusual punishments were sometimes inflicted. Of all this there is no doubt. Abuses crept into institutions. The insane were sometimes brutally treated or hideously neglected. These, however, are objections that can be urged against our system of taking care of the insane in many places even at the present day. In certain states, in order to lessen the expense of caring for the insane, they are kept in departments in the Poor Houses, and every now and then a legislative committee of investigation tells the story of appalling evils that have been discovered. It was not because they thought that possessed people deserved punishment, nor because they hoped thus to get the devils to go out of them, that the medieval generations allowed such things in their asylums, but because human nature will neglect its duties toward the ailing unless carefully superintended, and because regular attendants become hardened in their feelings sooner or later, when they serve only for pay, and the result always is the abuse of patients.

In proportion to the number of patients cared for, there was much more need for restraint in those old days than at present. As a rule, during the Middle Ages prisons and asylums were few. Only the violently insane, who already had actually committed some serious crime or threatened to, were kept in the asylums. For these restraint is needed even at the present time. We have learned to apply milder measures by employing many more attendants, but even that has come only in the last generation or two. The milder cases of insanity were not kept in asylums, but were allowed to wander about the country, or were cared for in their families with a devotion of which one finds no example at the present time; or if the insane person belonged to a noble family, very often the patient was kept in the house of a retainer and gently cared for. The fact that the milder cases were allowed to wander about the country might seem to be dangerous, but is not so serious as is ordinarily thought. Only a limited number of insane patients are likely to be violent, and these, as a rule, show manifestations of it early in the history of their affection. It was the frequent meeting with these harmless insane, as they were to be encountered in the many places through which he wandered professionally in England, that enabled Shakespeare to make his pictures of insane characters so true to life, that even at the present day we are able to recognize from his marvelous description exactly the form of insanity that was present.

In a word, these generations of the Middle Ages builded better than they knew in this matter of the care of the mentally afflicted, as in everything else which they took up for serious consideration. They did only the most obvious things, and what they could not very well help, under the circumstances, and yet very often the solutions of grave problems which they hit upon so naturally, proved to be as efficient as, indeed sometimes practically identical with, those we have reached by much more elaborate methods. This story of the treatment of the insane in the Middle Ages deserves careful study. I have given only a few suggestions for the interpretation of certain methods of action on their part, apparently very different from our ideas, yet in reality anticipating our most recent conclusions.

What many people have not been able to forgive the generations of the Middle Ages, and especially the ecclesiastics of the centuries before our own, is that as educated men and leaders of the people they should have accepted the view that mental diseases may, in some of their forms at least, be due to possession by the devil or some other spiritual interference with the working of the human intellect. During the latter half of the nineteenth century, it became the custom among the educated to scoff at any possible manifestation of this kind. The interference of the spiritual world with any of man's actions came to be looked upon as absurd, except by those who still clung to old-time beliefs and thought that new fashions in opinion might very well prove almost as variable as do corresponding fads in the realm of dress or of interests. The difficulty in the matter was that the generations of the latter nineteenth century lost their faith, to a great extent, in the existence of a spiritual world, and consequently it was easy to laugh at those who had found the interference of such a world as not only possible, but actual, in a great many affairs in human life. As a matter of fact, when we realize how many utterly inexplicable phenomena the earlier centuries tried to explain this way, it is not surprising to find their explanation sometimes wrong.

It is very easy, to my mind, for men of our generation to be too hard in their judgments of the men of the Middle Ages with regard to the curious phenomena, psychic, spiritistic and occult, which, with all our advance in science, are still almost as obscure to the eye of the intellect as they were seven centuries ago. The medieval generations saw a great many things that they could not explain happening round them, and attributed them to spiritual agencies. We have learned since that many of these things are merely natural, and must not be considered as due to anything else than the ordinary laws of nature. We have not eliminated belief in the spiritual world, however, and there is still a large proportion of mankind who think that they see, even in the matter-of-fact world around them of the present day, many signs of interference in human affairs by agencies distinct from those of human beings and quite independent of matter. It is easy to dismiss this side of the question with a shrug of the shoulders and say that it need not be taken into account. A man who does this easily succeeds in convincing himself that there are no evidences for spiritual manifestations in our life, and that the stories with regard to them are all nonsense.

It is curious, however, that anyone who investigates and does not merely dismiss at once, is very prone to come to a contrary conclusion, even though all his training and the traditions of his education are opposed to such an admission. There are many prominent scientists who have allowed themselves to be drawn into the investigation of spiritualistic manifestations so-called. Very few of them have come away from their investigations entirely convinced that there was nothing in them. Frauds they have found; sleight-of-hand impositions they have exposed; but apart from all these, there is a residue of phenomena which they cannot explain and which convinces many of them of the existence and the mundane action of forces independent of matter. The men who come to these conclusions are not only the ignorant, nor the over-credulous, but frequently representative leaders in scientific thought–men who are known to be thoroughly capable of weighing evidence, prominent lawyers and judges, above all, men who are accustomed to investigation as most painstaking scientists and faithful students of nature.

A few examples will illustrate this. Mr. Alfred Russell Wallace, the co-discoverer with Darwin of the theory of natural selection, has a name in the scientific world that places him among the leaders of scientific thought. For many years he has been convinced that spiritualism contains in itself truths that deserve careful investigation, and he for one is persuaded that the neglect of investigation of this subject, on the part of recent generations, is one of the most serious mistakes, from a purely scientific standpoint, that they have made. Sir William Crookes, whose brilliant theories with regard to the fourth stage of matter, radiant matter, would seem to have quite appropriately prepared him for the proper investigation of existences even beyond the domain of the attenuated substances with which he had been so much concerned, is another of the prominent scientists of the day who confesses to a belief in the truth of spiritualistic phenomena. He made his first publication on the subject more than a quarter of a century ago. When a score of years after this he was elected as the President of the British Association for the Advancement of Science, the most prominent scientific body in Great Britain, and, it may be said, in the English-speaking world, he recurred in his Presidential address to the subject of spiritualism, and said that in the meantime he not only had not changed his mind with regard to the truth of certain spiritualistic phenomena, but had even become more convinced than he was originally.

These are prominent English scientists, and Englishmen are supposed to be more conservative, less likely to be influenced by personal motives, and less prone to be led astray by imaginative influences, than their colleagues on the Continent. Besides these two whom we have mentioned, there is a third one, of quite as great prominence, Sir Oliver Lodge, who is also a convert to belief in the reality of certain spiritual manifestations, and other names might readily be mentioned. Over in France, the most prominent of living physiologists, Professor Charles Richet, who is well known for investigating work of a high order and successful original research that has made his name familiar throughout the medical world at least, is another modern scientist who cannot but think that there is something in spiritualistic manifestations. The latest convert to these notions is an even more surprising addition to such a group of witnesses to the possibility of the interference of spirits with human affairs. This is no less a person than Lombroso, the well-known writer on criminology, who has recently confessed that certain tests made by him showed beyond all doubt that there were influences at work quite independent of human powers, and showing the existence of a world apart from matter. This immaterial world evidently interpenetrates, and may interfere with things in the material world as we know it.

In a word, it may be said that if a man wants to keep the spiritual side of things out of his purview of life, he may do so by refusing to investigate any evidence that would demonstrate the existence of spiritual forces in the world around him. The heavy price, however, that he pays for absolute certainty and peace of mind in this matter–is peremptory refusal to investigate. If he gives himself up to investigations, he comes inevitably to the conclusion that there is something in the belief in the existence of spirits all round us, and of the possibility of their interference in the ordinary affairs of life. It is true that after he has come to this conclusion he may not be able to demonstrate it to others. His conviction of it, however, will be none the less absolute because of this. His adhesion to the new belief may seem to many people absurd. He will accept this view of his state of mind quite calmly, and apparently enjoy the compensation of finding the absurdity to be in the other point of view. It matters not how distinguished a scientist he may be, he comes out of investigation of spiritual phenomena persuaded of the existence of a spiritual world.

This persuasion seems to come by some form of intuition not quite dependent on the ordinary processes of intelligence. It is as if spirit called to spirit across the abyss, from the immaterial to the material, as if somehow we obtained a conviction of the existence of spirits around us by the very sympathy of our natures and their relationship to the immaterial world, rather than by the ordinary avenues of intelligence. It is, in a word, a telepathy, the other agent in which is not material, but quite independent of matter, yet somehow is able to set up those vibrations in the ether which affect brain cells, and thus bring about communications, as Sir William Crookes explains the curious phenomena in this line that occur between human beings. Such an explanation may easily be dismissed as highly imaginative and altogether theoretic. As a student of psychology now for many years, it has appealed to me, however, as the only possible hypothesis that gives any plausible explanation of the curious conversions which so inevitably result from sympathetic attempts at investigation of the possibility of spirit interference in mundane affairs.

How far this persuasion of spiritual interference in ordinary human affairs has gone, will not be realized except by those who are familiar with some of the literature which has been made in the last twenty years on the subject of psychical research. Not long since, a distinguished European professor of physical science went so far as to warn people of the dangers there might be in dismissing the opinion that other intelligences than those of men could interfere for the abrogation of certain natural laws. This may be scoffed at as the height of credulity, and may be received in sceptical mood by those who refuse to look into such matters, because they know a priori that they cannot be true! It is hard, however, to differentiate the attitude of mind of such persons from that which Galileo deprecated so much, in that letter of complaint to Kepler, in which he said so bitterly that they refused to look through his telescope and demolished, as they thought, his observations by logical conclusions from what they knew already. It is to be remarked that it was not ecclesiastics of whom he was talking at this time, but professors of science at the University of Pisa, who were quite as unsympathetic towards certain of his astronomical discoveries as were any of the ecclesiastics of his time.