15.09.35, Katajala-Peltomaa and Niiranen, eds., Mental (Dis)Order in Later Medieval Europe

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Elizabeth Mellyn

The Medieval Review 15.09.35

Katajala-Peltomaa, Sari, and Susanna Niiranen, eds. Mental (Dis)Order in Later Medieval Europe. Later Medieval Europe, 12. Leiden: Brill, 2014. pp. x, 284. ISBN: 978-9-004-26414-4 (hardback).

Reviewed by:
Elizabeth Mellyn
University of New Hampshire, Durham

The history of madness in medieval and early modern Europe has held scholarly imaginations in thrall since Lawrence Babb and the Warburg triumvirate of Erwin Panofsky, Fritz Saxl, and Raymond Klibansky first explored cultural representations of psychic states like melancholy in European art, literature, and philosophy in the 1950s and 60s. [1] Their work encouraged other scholars to use madness and its manifestations as a vivid analytical lens for the history of European culture. At roughly the same time, scholars sympathetic to the anti-psychiatry movement brought the history of madness into the socio-political realm, using it to expose the darker side of psychiatry and its origins. From this vantage point, Michel Foucault famously argued that the afterbirths of the modern European state and its repressive social, political, and medical regimes were pernicious social constructs like deviance, disorder and mental illness, on the one hand, and, on the other hand, coercive institutions designed to rehabilitate or "treat" those afflicted with them like prisons, workhouses, and asylums. [2]

The ten essays that make up the edited volume Mental (Dis)Order in Later Medieval Europe draw deeply from these two historiographical schools with some adjustments to methods and goals. Most usefully, the volume broadens the categorical catchment area from madness to the larger historically sensitive parallel constructs of wellbeing/lack of wellbeing, balance/imbalance, moderation/immoderation, and order/disorder. Each essay is a brief case study in how late medieval people of varying stripes defined these cultural constructs and dealt with those who violated them. The result is a descriptive rather than analytical synthesis of mental disorder in western Christian Europe between the thirteenth and sixteenth centuries. Although the essays offer fruitful comparisons between northern and southern Europe, the volume falls short of making an argument, breaking new methodological ground or forging new conceptual paths. Readers will find the analytical theater broadened, but essentially unchanged.

The first two chapters focus on medical theories of disorder found in the theoretical and practical output of university-trained physicians. In the first chapter, Timo Joutsivuo explores how physicians understood and treated the disease melancholy. Based on the case studies of three famous fourteenth-century physicians, Joutsivuo observes that by the fourteenth century, learned physicians had fully embraced the ancient Greek "holistic" concept of health as well as Galen's theory of complexion. They recognized the interdependence of mind and body and acknowledged a relationship between innate characteristics and environmental factors that contributed to the relative balance or imbalance of humors in a body. They also believed that a body's constitution changed with age. In this view, the human constitution was inherently unstable; disorder was always imminent. Physicians then were custodians and restorers of bodily and mental stability. Their main instruments were the six environmental, physiological, and psychological factors that could both bring health or cause illness. Armed with this materialist psychology, physicians tended to shy away from religious, moral, or magical explanations for disease or methods of cure.

But university-trained physicians did not universally downplay supernatural explanations for mental disorders. Catherine Rider argues that beginning in the thirteenth century and particularly in the fifteenth, some learned physicians became less hostile to the idea that external demonic as opposed to natural forces might play a causal role in diseases that provoked disordered mental and behavioral states. Moreover, advocates of this approach were more willing to accept that diseases like melancholy, mania, or epilepsy might bestow special powers of prediction, knowledge, or artistic inspiration on their sufferers.

Historians of medieval medicine who have read the Warburg authors on the history of melancholy--Nicoud, Salmón, and especially Brann--are not likely to find either of these essays novel. [3] Furthermore, Rider's claim that physicians' increasing interest in demons, prophecy, and mental disorder "probably reflects broader religious and intellectual changes" taking place in the late fourteenth and early fifteenth centuries summarily glosses over important fifteenth-century intellectual movements, namely the reception of the pseudo-Aristotelian Problemata coupled with the renowned medically-trained Florentine Platonist Marsilio Ficino's marriage of this tradition with Platonic notions of divine frenzy. [4]

The third, fourth, and fifth chapters shift the conversation from the medical to the religious realm and the focus from disorders of the body to those of the soul. Lurking behind each of these contributions is Foucault's notion that whether the mentally ill were depicted as symbols of sin, deviancy, hope, or sanctity, all representations of mental disorder had moral, coercive, and didactic ends. In the medieval context, they were designed to set men and women on the path of Christian righteousness and to celebrate the glory of God.

In his essay, Marko Lamberg examines a collection of 192 exempla from the Swedish monastery at Vadstena to explore medieval attitudes to anger, a Janus-faced emotion that was seen both as socially disruptive and beneficial in the context of religious warfare. And yet, Lamberg argues that ordinary men and women generally believed unbridled anger was a sin, a disorder of the soul, and an affront to the Christian way of life. Anger, as sermons, saints' lives, and miracle collections attest, alienated a person from society and God; it destabilized households and communities as well as the immortal souls of those afflicted with it. The aim of some medieval exempla, then, was to understand the nature of anger and its consequences so that it might be tamed, a view that he believed was an expression of a general "European ideology."

Gerhard Jaritz then trains his sights on religious image cycles in Central Europe from the late thirteenth to early sixteenth centuries to reveal a "visual discourse" of madness. Mental disorder in religious images, he finds, was commonly embodied in three types of people--the epileptic, the demonically possessed and natural fools. Where both men and women regularly appeared as epileptics, women were more frequently used to represent possession and men to represent fools. Jaritz offers no explanation for the gendering of these types, something that surely warrants deeper investigation. Moreover, medieval artists tended to use the same physical features and facial expressions to depict the mentally disordered, including baldness, nakedness, distorted physiognomy, gaping mouths, or the exposure of tongue and teeth. Negative though these representations were, they were designed to provoke a range of emotions in viewers from revulsion at sin, to pity at human misfortune, to hope in the healing power of God and the saints.

The arguments of these essays are somewhat obvious given the moralizing lenses the authors peer through. The religious literature and art they examine is didactic, dealing largely in ideal types designed to bring Christian teaching to life. It is not surprising then that representative examples of anger and madness are simplistic and negative. One is left wondering the degree to which any of these depictions bear any resemblance at all to how medieval men and women actually experienced, interpreted, and addressed overwhelming emotions, mental illness, or demonic possession in their daily lives. Though written for a later period, the work of MacDonald, Midelfort, and Lederer would have offered good models for how to make religious literature and imagery reveal something of lived experience. [5]

Sari Katajala-Peltomaa's essay revisits the claim that demonic possession in the Middle Ages was a physical as well as a spiritual disturbance and therefore warrants examination from a corporeal as well as a theological perspective. Based on a study of thirteenth- through fourteenth-century northern and central Italian canonization processes, she demonstrates that possession tended to manifest itself in the bodies and minds of the possessed through florid mental disorders, unusual physical signs, and bizarre if not violent behavior. She also found that many cases of possession made an explicit connection between improper Christian conduct and certain spaces or objects. Demons, for example, could enter the body by means of impure water or on food if pious conduct like crossing oneself did not accompany eating and drinking. Once inside, they wreaked havoc on a person's mental and physical stability causing raving madness, melancholy, epilepsy, and uterine suffocation. These disorders were not considered permanent. Rather, medieval men and women believed acts of Christian devotion and the intercession of saints had the power to restore mental, physical, and spiritual stability to individuals and the communities in which they lived. Katajala-Peltomaa mentions in passing that these mental and physical disturbances also caused social disorder--a claim that is minimally and superficially sketched out.

Chapters six and seven shift the discussion from normative, theoretical to more practical, popular attitudes to mental disorders. Jussi Hanska explores the complex and often conflicting opinions to the use and abuse of alcohol in the thirteenth century through the Cronica of Salimbene de Adam, a Parma-born Franciscan who dedicated a large part of his work to studying the wines of Italy and France. Like food, wine was a crucial part of biological, social, and cultural life. The starving poor sought to eat and drink what they could while, among the elite, the consumption of fine food and wine was a sign of status. From a moral perspective, however, immoderate consumption of wine fell under the purview of gluttony, a deadly sin. Salimbene argued that drunkenness, the fruit of immoderation, was widely perceived to be the "gate through which other sins, especially those of the flesh, entered into man's soul." Like the excessive anger and demonic possession of earlier chapters, Hanska argued that it threatened mental and social disorder.

In the most coherent and persuasive contribution to the volume, Susanna Niiranen compares two recipe collections, one compiled between the thirteenth and fourteenth centuries in Montpellier, the other in fifteenth-century Sweden, to capture practical pharmacological approaches to coping with and curing mental disorders. Transmitted largely in the vernacular and influenced by the learned humoral tradition, Niiranen claims that these sources were like bridges between professional-lay, learned-popular, written-oral, and high-low traditions. Furthermore, although they included recipes for melancholy, lunacy, and the falling sickness, they tended not to distinguish mental disorders from other physical ailments. It is perhaps for this reason that they were devoid of moralizing or negative labels to identify sufferers of mental disorders. The aim of these collections was not to teach or admonish but merely to help ordinary men and women alleviate pain in the course of their daily lives.

Chapter eight, nine, and ten take up the theme of disorder in the social and political domains. Iona McCleery examines the work of melancholic king Duarte of Portugal (r. 1433-1438), the Loyal Counsellor, to explore how a monarch defined and tried to attain well-being (contentamento) as well as the connections he drew between monarchical contentamento and the overall health of a kingdom. By his own admission, Duarte suffered from a "general and pervasive sadness" that he identified as melancholy. Although he acknowledged the physiological aspects of his malaise and applied Greco-Roman approaches to restoring his physical health accordingly, he believed moral and spiritual remedies were the most efficacious treatments. The maintenance of his health, moreover, was tantamount to high politics; he firmly believed that by eradicating the disorder from his own mind and body he maintained and promoted order throughout his kingdom.

Historians of late medieval and early modern Europe will raise an eyebrow at McCleery's claim that "political historians still pay limited attention to royal illness and medical historians have been slow to take on board the political implications of medieval belief in the 'body politic' metaphor" (178). Scholars such as Kantorowicz, Midelfort, Sánchez, and Aram have all explored the political, medical, and cultural challenges European courts and royal families faced when their crowned heads were thought to be mentally ill. [6] Historians of medicine may also wonder at McCleery's claim that "the history of medicine has long been a history of power: the power of doctors, institutions, and states over the personal lives and happiness of individuals" (187). Katharine Park, Harold Cook and others have gone a long way toward re-evaluating the nature of power relations in what has come to be called the medical marketplace. The one-sided Foucaultian model is surely too simplistic. [7]

Sophie Oosterwijk looks not at the monarch, but rather at the social and political chaos left in the wake of a monarch's death through the lens of the Danse Macabre, a powerful symbolic reminder that Death, the great equalizer, cuts down all people regardless of age, sex, or status. She argues that although the Danse Macabre was typical among the trove of late medieval memento mori, its popularity only really took off after 1422, in the wake of the deaths of both the English king Henry V and the French king Charles VI. These "national traumas," she claims, "probably" led to the creation of two famous Danse Macabre mural cycles, one in the cemetery of Les Saints Innocents in Paris in 1425-25 and the other at Old St. Paul's Cathedral in London. The purpose of these scenes, in her view, was not so much to remind people of the fear, pain, and inevitability of death, but rather to warn people of what could happen to them if they died "unexpectedly...in a state of sin." The message again seems to be that the great remedy for social and political chaos was righteous Christian living both on an individual and societal scale.

The volume ends on Kirsi Kanerva's intriguing examination of thirteenth- and fourteenth-century Icelandic attitudes to ghosts. Kanerva draws together many of the themes running through the volume as a whole, namely, the medieval connection between mind, body, and soul and thus the intimate relationship between mental, physical, and spiritual disturbances, the disruption of social and political order that these disturbances threatened to cause, and, finally, the championing of righteous Christian living as the balm for all forms of disorder. According to medieval Icelanders, so Kanerva argues, disturbances of the mind, body, and soul were often caused by malignant external forces. They believed that the intense fear they experienced in the presence of ghosts caused madness, disease or death. Kanerva observes too that social status determined one's susceptibility to malignant forces. Heroes and the elite were thought to be more capable of staving off mental disequilibrium.

Many of these case studies offer interesting glimpses into how late medieval Europeans defined disorder broadly understood and tried to tame or at least cope with it. Overall, however, the volume is plagued by historiographical and conceptual problems. First, there are troubling gaps in relevant scholarship. Foucault's provocative yet largely ahistorical work on madness generated an explosion of reassessments and revisions in the 1980s and 90s, the decades in which the histories of madness, deviance, and mental disorder in the fifteenth through the eighteenth century experienced something of a renaissance in their own right. [8] Less concerned with constructing narratives of progress or decline, historians in this camp, sought to uncover sources that would allow them to capture the lived experience of madness in medieval and early modern societies. To that end, they mined the rich legal and administrative archives of Europe, sifted through the case books of numerous doctors, and pored over the records of Europe's early mental hospitals to catch ordinary men and women in collaboration with legal, professional, and ruling authorities in the act of solving the practical problems that the many faces of madness brought to their households and communities. [9] This conceptually sophisticated scholarship is almost entirely absent. Katajala-Peltomaa and Niiranen claim to have captured lived experiences of disorder, but the evidence, which remains grounded in literary or professional normative and theoretical representation does not bear it out.

To be sure, revisionist histories of mental disorder in the Middle Ages have been slower to emerge largely because administrative, institutional, and juridical sources are far less plentiful for this period. The medieval lived experience of madness still tends to reside in normative and representational rather than archival sources. That said, none of the authors tackle disorder in the legal realm, for example, an approach which may have anchored some of the moralizing, literary, medical, and theological sources on which the study is built. [10]

This volume will be of interest to historians of mental disorder, deviance and concepts of health and well-being during the late Middle Ages largely for the sources that are examined, but overall it adds color to an already fecund scholarly landscape.



1. Lawrence Babb, The Elizabethan Malady: A Study of Melancholia in English Literature from 1580 to 1642 (East Lansing: Michigan State University Press, 1951); Raymond Klibansky, Erwin Panofsky, and Fritz Saxl, Saturn and Melancholy: Studies in the History of Natural Philosophy, Religion, and Art (New York: Basic Books, 1964).

2. Michel Foucault, Histoire de la folie à l'âge classique: Folie et déraison (Paris: Plon, 1961); ibid., Madness and Civilization: A History of Insanity in the Age of Reason (New York: Vintage Books, 1973).

3. Marilyn Nicoud, Les régimes de santé au Moyen Âge: naissance et diffusion d'une écriture médicale, XIIIe-XVe siècle (Rome: École française de Rome, 2007); Fernando Salmón, "From Patient to Text? Narratives of Pain and Madness in Medical Scholasticism," in Between Text and Patient: The Medical Enterprise in Medieval and Early Modern Europe, Florence Eliza Glaze and Brian K. Nance, eds. (Florence: Sismel, 2011): 373-395; Noel L. Brann, The Debate Over the Origin of Genius During the Italian Renaissance (Leiden: Brill, 2002). See also, Pedo Gils Sotres "The Regimens of Health," in Western Medical Thought from Antiquity to the Middle Ages, ed. Mirko D. Grmek (Cambridge: Cambridge University Press, 1998): 291-318.

4. For the reception of the pseudo-Aristotelian Problemata and problem literature in the Renaissance see Klibansky, Panofsky, and Saxl, Saturn and Melancholy, and Ann Blair, "The Problemata as a Natural Philosophical Genre," in Natural Particulars: Nature and the Disciplines in Renaissance Europe, eds. Anthony Grafton and Nancy Siraisi (Cambridge, MA: MIT Press, 1999): 171-204.

5. Michael MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England (Cambridge: Cambridge University Press, 1981); H. C. Erik Midelfort's A History of Madness in Sixteenth-Century Germany (Stanford: Stanford University Press, 1999); David Lederer, A Bavarian Beacon: Religion and the State in Early Modern Europe (Cambridge: Cambridge University Press, 2009).

6. Ernst H. Kantorowicz, The King's Two Bodies: A Study in Political Theology (Princeton: Princeton University Press, 1998); H. C. Erik Midelfort, Mad Princes of Renaissance Germany (Charlottesville: University Press of Virginia, 1994); Magdalena S. Sánchez, The Empress, the Queen, and the Nun: Women and Power at the Court of Philip III of Spain (Baltimore: Johns Hopkins University Press, 1998); Bethany Aram, Juana the Mad: Sovereignty and Dynasty in Renaissance Europe (Baltimore: Johns Hopkins University Press, 2005).

7. See, for example, Katharine Park, Doctors and Medicine in Early Renaissance Florence (Princeton, N.J.: Princeton University Press, 1985); Harold Cook, The Decline of the Old Medical Regime in Stuart (Ithaca, NY: Cornell University Press, 1986); Matthew Ramsey, Professional and Popular Medicine in France, 1770–1830: The Social World of Medical Practice (Cambridge: Cambridge University Press, 1988); Laurence Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford: Clarendon Press, 1997); Gianna Pomata, Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore: Johns Hopkins University Press, 1998); David Gentilcore, Healers and Healing in Early Modern Italy (Manchester: Manchester University Press, 1998).

8. For accounts of this reorientation see W. F. Bynum, Roy Porter, and Michael Shepherd, eds. The Anatomy of Madness: Essay in the History of Psychiatry (London: Tavistock Publications, 1985-1988); Arthur Still and Irving Velody, eds., Rewriting the History of Madness: Studies in Foucault's "Histoire de la folie", (London: Routledge, 1992); Colin Jones and Roy Porter, eds. Reassessing Foucault: Power, Medicine, and the Body (London: Routledge, 1994).

9. Notable studies include, Anne Digby's Madness, Morality, and Medicine: A Study of the York Retreat, 1796-1914 (Cambridge: Cambridge University Press, 1985); Roy Porter Mind Forg'd Manacles: A History of Madness in England from the Restoration to the Regency (Cambridge: Harvard University Press, 1987); Colin Jones, The Charitable Imperative: Hospitals and Nursing in Ancien Régime and Revolutionary France (London: Routledge, 1989); Ann Goldberg, Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and German Society, 1815-1849 (New York: Oxford University Press, 1999); Lisa Roscioni, Il governo della follia: Ospedali, medici e pazzi nell'età moderna (Milan: Bruno Mondadori, 2003); R. A. Houston, Madness and Society in Eighteenth-Century Scotland (Oxford: Oxford University Press, 2000); Jonathan Andrews and Andrew Scull, Customers and Patrons of the Mad-Trade: The Management of Lunacy in Eighteenth-Century London (Berkeley: University of California Press, 2003).

10. Wendy J. Turner's work would have been helpful on this count. See her edited volumes Madness in Medieval Law and Custom (Leiden: Brill, 2010) and Wendy Turner and Tory Vandeventer Pearman, eds., The Treatment of Disabled Persons in Medieval Europe: Examining Disability in the Historical, Legal, Literary, Medical, and Religious Discourses of the Middle Ages (Lampeter: Edwin Mellen Press, 2011).

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