Medieval and Early Modern Theories
of Mental Illness
Richard Neugebauer, PhD
\s=b\ Historians of medieval and early modern psychiatry have
utilized limited source materials in their research. They have
focused on printed works, particularly formal treatises by cele-
brated authors, and neglected manuscript collections. The
resulting histories depict early European psychiatric thought as
dominated by demonology.
Examination of the archives of an early English legal incompe-
tency jurisdiction flatly contradicts this picture. Starting in the
13th century, the English government conducted mental status
examinations of psychiatrically disabled individuals, using
commonsense, naturalistic criteria of impairment; private,
supervised guardians were appointed for such persons. Further-
more, etiological theories entertained by royal officials and
laymen relied on physiological and psychological notions of
psychiatric illness. These findings raise serious questions about
conventional accounts of this period and underline the need for
more research using original manuscripts.
(Arch Gen Psychiatry 36:477-483, 1979)
Since strong
taken a
the appearance of psychiatry as a medical specialty
at the end of the 18th century, its practitioners have
interest in its historical origins. However,
only recently has the field of psychiatric history become
conscious of itself as a historical subdiscipline. George
Mora characterized this juncture as "a transitional stage in
psychiatric historiography, half-way between the amateur
and the scholarly perspective,"1'"81 and recommended a
search for new evidential, methodological, interpretive,
and conceptual approaches. The present article introduces
evidence bearing on medieval and early modern psychiatric
ideas and attitudes, derived from heretofore unexamined
manuscript collections in British archives.
In the last 25 years, psychiatric historians have begun to
redefine the framework of their investigations and to
expand their use of source materials. Prior to the 1950s,
Accepted for publication June 20, 1977.
From the Psychiatric Epidemiology Training Program, Division of
Epidemiology, School of Public Health, Columbia University, New York.
Reprint requests to Psychiatric Epidemiology Training Program, 100
Haven Ave, Tower III, Apt 20E, New York, NY 10032 (Dr Neugebauer).
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
work in psychiatric history was devoted largely to biogra¬
phies of renowned pioneers in the field-; surveys of early
psychiatric theories, evaluated ahistorically in terms of
their successful anticipation of 20th-century ideas3; and
narrative, institutional histories of illustrious mental
hospitals.4 More recent studies, by physicians and profes¬
sional historians, have relied less on a "great man" theory
of medical history to explain psychiatric progress and
placed greater emphasis on the immediate historical and
intellectual context in which psychiatric ideas evolved.
Similarly, current analyses of 19th-century American
mental institutions stress the importance of social,
economic, and political factors in the growth of these
facilities.5"' In the same vein is Ackerknecht's suggestion
that medical historians adopt a "behaviorist" approach to
their subject by conducting a "more critical analysis of
what doctors did in addition to what they thought and
wrote."s<p21i) Finally, attention has also turned to explora¬
tions of the varying social roles and social niches available
to the mentally ill in past societies. George Rosen's exam¬
inations of "the place of the mentally ill, however defined,
in societies at different historical periods, and the factors
(social, psychological, cultural) that have determined it"
epitomizes this new direction.9(p x" In the larger perspec¬
tive, these varied developments form part of a general,
interdisciplinary trend in the health and social sciences and
in the humanities, giving rise to such other subspecialties
as psychohistory and the history of the family.
In general, 19th- and 20th-century studies have bene¬
fited most from these postwar changes, while research on
earlier periods has lagged behind. The present status of
Gregory Zilboorg's A History of Medical Psychology (1941),3
specifically his chapters on the Middle Ages and the
Renaissance, illustrates this problem well. Zilboorg depicts
these periods as dominated by demonological theories of
mental illness. Only a handful of studies published since
the war have critically reappraised Zilboorg's interpreta¬
tion or brought new evidence to bear on these centuries. As
a consequence, this negative assessment of early European
 psychiatrie thought has become an established orthodoxy
in most psychiatric textbooks10<p4) and general histories of
psychiatry."
The evidence introduced here will be assembled to
highlight contradictions and discrepancies with Zilboorg's
account of the medieval and early modern period. In view
of the continuing force of Zilboorg's interpretation this
approach is hardly an attack on a straw man. In fact, a
specific critique of Zilboorg is particularly appropriate
since his work remains the most commonly assigned text in
history of psychiatric courses in medical schools and
psychiatric residency programs.12
Zilboorg portrays medieval ideas and attitudes toward
the insane as some dismal mixture of superstition, cruelty,
and abuse, premised on a demonological theory of madness.
In his view both educated men and "the man in the
street"3(pl40) believed psychiatric illness was supernatural
in origin. It was proof of a pact with Satan or of assault by
him or his earthly agents: "Not all accused of being witches
and sorcerers were mentally sick, but almost all mentally
sick were considered witches, or sorcerers or be-
witched."3<pl53) Torture and exorcism were the therapeutic
modalities of choice.
Zilboorg's picture of the medieval era is not uniformly
bleak. He does note the presence of some more enlightened,
rationalistic thinkers: "Occasionally one heard voices
denying the devil's power to produce mental disease—John
of Salisbury, the Archbishop of Lyons, Agobard and
Abelard were among these."3(pl33) Zilboorg acknowledged,
too, that on occasion common folk appreciated the natural
origins of mental illness: "People... differentiate^]
between a natural mental illness and a supernatural
one>'3(pi39). anc[ ^at there were "some [hospitals] even for
the mentally 1."3( 134> However, these developments repre¬
sented merely those inevitable exceptions that prove the
rule. The rule remained: demonological assumptions
prevailed in medieval thought, popular attitudes, and
treatment.
In his chapter on the 16th century, Zilboorg explored the
ideas of several humanists and physicians, notably Juan
Vives, Paracelsus, Cornelius Agrippa, and Johan Weyer.
These men adopted a more scientific and humane attitude
toward mental illness and the mentally ill. Indeed, "Weyer
stands out as the true founder of modern psychiatry."3(pZ261
Yet in Zilboorg's view, these thinkers represented really
the vanguard of a future age, rather than revolutionaries
who transformed their own. Their ideas were ignored or
openly ridiculed by their contemporaries, and the Euro¬
pean witch-craze reached its height only in the mid-17th
century. Weyer "did not acquire a true following until
almost a century after his death"3<p235) in 1588. Thus, in
Zilboorg's scenario, demonology continued to dominate
European thought until well into the 17th century.
In the August 1973 issue of this journal, Jerome Kroll13
launched a serious attack on Zilboorg's version of medieval
developments in psychiatry. Kroll cited numerous ways in
which Zilboorg, as well as other, later physicians writing
general histories of psychiatry, omitted, underestimated,
or mangled historical evidence. At the same time, Kroll put
forward what he believed was a more balanced account of
medieval developments. He restored Bartholomaeus, a
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
13th-century monk who attributed insanity to natural
causes, whom Zilboorg dismissed as "a voice from a very
remote past or from just as remote a future" to the position
of a "most respectable and widely read member of one of
the two intellectually dominant [religious] orders of the
period."13'"2781 On the subject of medical opinions, Kroll
noted that medieval academic medical "works were based
on the physiological theories of Galen and were free of
concern with demonology. In fact, no major medical work,
taught at the universities prior to the 14th century pays
attention to demonology." "The foundation of medieval
medical psychology," so Kroll argued, "was biological not
demonological."13(p281) Nor were medieval clerics the
demon-obsessed sadists portrayed in conventional histo¬
ries: "Much evidence exists to suggest that the Inquisi¬
tion's interest in witchcraft—and its inevitable corollary
insanity—was belated and secondary. Indeed, there is
evidence that the Church traditionally was rather indif¬
ferent to the presence of bewitched persons."13(p280) While
"the concern of the populace with demons appears to have
been considerably higher"13'"282' than that of clerics and
medical men, the differences in attitude were not that
great. The ordinary man attributed "mental and spiritual
illnesses... as much to overwork, overeating and overin¬
dulgence in sexual activity as to climatic conditions, magic,
spells and demonic possession."13<p281) Finally, to counter¬
balance the graphic accounts of torture and exorcism
provided in standard histories, Kroll introduces this brief
description of the Netherlandic town of Gheel:
Since the 12th century and probably before, the townspeople of
Gheel have taken into their homes and cared for the mentally ill
and retarded persons who were brought to the shrine of St.
Dymphna for cures.13lp282)
Citing Rosen, Kroll also draws attention to the corporate
responsibility for care of the insane exercised by certain
medieval towns. In general, therefore, Kroll maintained
that naturalistic theories about the causes of madness and
humane treatment of the insane was a central rather than
a peripheral or exceptional feature of medieval European
life. In fact, Kroll suggests that demonology was relatively
unimportant throughout most of the Middle Ages and that
it assumed real prominence only in the late 15th, 16th, and
early 17th centuries.
In the following pages I will sketch the procedures and
practices of an English legal incompetency jurisdiction
that operated in the medieval and early modern period.
The records of this institution create an entirely different
picture of early European ideas and attitudes toward
mental illness than that put forward by Zilboorg and lend
weight to Kroll's reinterpretation of the medieval period.
No reference to this institution appears in psychiatric
histories, with the single exception of a brief but valuable
discussion in Hunter and Macalpine's Three Hundred
Years of Psychiatry. 14(p92> This omission is probably
explained by the fact that most information concerning
this institution is available only from manuscript collec¬
tions, a source psychiatric historians have largely ignored.
A major purpose of my discussion is to draw attention to
the existence and value of such documents for psychiatric
history.
The English Crown's right and duty to protect mentally
 impaired subjects, irrespective of their tenurial status,
existed from at least as early as the 13th century. The first
document we possess on the subject, known as Prerogativa
Regis, 15<l:226> dates from the second half of that
century.le<pl82> This document, which may have been
written by a Crown official, sets forth various royal powers
and prerogatives, including the king's authority over
mentally disabled persons. The mentally disabled are
divided into two categories: natural fools or idiots and
persons non compos mentis. Section 11 of Prerogativa Regis
discusses natural fools. It reads in part as follows:
The king shall have the custody of the lands of natural fools taking
the profits of them without waste or destruction and shall find
them their necessaries .... And after the death of such idiots he
shall render it to the right heirs, so that such idiots shall not alien
nor their heirs ... be disinherited.
Section 12 pertained to persons non compos mentis:
Also, the King shall provide, when any that before time hath had
his wit and memory happen to fail of his wit, as there are many per
lucida intervalla that their lands and tenements shall be safely
kept without waste and destruction and that they and their
household shall live and be maintained competently with the
profits of the same, and the residue besides their sustentation
shall be kept to their use, to be delivered unto them when they
come to right mind; so that such lands and tenements shall in no
wise be aliened and the King shall take nothing to his own use.
A fool was an individual of retarded intellectual develop¬
ment whose mental capacities never progressed beyond
child's.1""1381 The more restrictive term natural fool or idiot
referred specifically to congenital subnormals18 and, as the
language of section 11 indicates, their deficiencies were
considered permanent. Natural, meaning from birth,
contrasted, on the one hand, with types of natural mental
impairment arising postnatally, for example, impairments
developing with age,17'""1371381 and, on the other, with
disorders caused by "accidents." In legal writing, "acci¬
dents" included such things as sickness and grief.19'2471 An
anonymous early 16th-century legal dictionary summed up
the meaning and synonymity of natural fool and idiot as
follows:
Idiot is he that is a fool natural from his birth and knows not how
to account or number 20 pence, nor cannot name his father or
mother, nor of what age himself is, or such like easy and common
matters; so that it appears he has no manner of understanding or
reason, nor government of himself, what is for his profit or
disprofit.20(f11'7'')
The phrase non compos mentis was the first term used in
royal writs concerned with mental disability matters and
was far more general and inclusive than natural fool. In
section 12, it appears to include all mental disabilities,
except for congenital disorders. Persons non compos mentis
might experience periods of temporary remission-lucid
intervals—or recover completely.
For reasons that are not altogether clear, by the 15th
century the term lunatic had replaced the phrase non
compos mentis in legal discussions and in the administra¬
tive implementation of section 12. At the same time, too,
idiot, rather than natural fool, became the preferred term
for congenital subnormals.2122
The Crown's rights and duties regarding such persons
differed markedly, depending on their official diagnostic
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
status. According to Prerogativa Regis, the king was
entitled to the custody and the revenues of idiots' lands.
This language was interpreted more broadly by later 15th-
century authors so as to include custody of idiots' bodies
and of all their real and personal estate.22 During the
period of custody, the king was to protect the idiot's
property from exploitation and to provide him with life's
necessities. However, any rents and profits collected by the
Crown during the idiocy, in excess of the costs of the fool's
upkeep, were considered a legitimate source of royal
revenue.
Lunatics fared much better. Revenues from their estates
during their period of disability did not belong to the
Crown. Royal guardianship of a lunatic's body and supervi¬
sion of the lands had to be exercised solely for the lunatic's
benefit. The king protected the lunatic's estate from waste
and destruction and sustained him and his family with
estate revenues. Any income not expended on the family's
maintenance and estate repairs were returned on the
lunatic's recovery. Thus, with idiots, the king acted as
guardian but profited from the exercise of this responsi¬
bility. For lunatics, the Crown provided more extensive
protection but at no charge to the individual subject.
Although in legal theory the Crown itself exercised these
rights and responsibilities over idiots and lunatics, matters
were altogether different in practice. The Crown's legal
incompetency administration rarely, if ever, entailed
a direct royal supervision or confinement of the insane.
Rather, from an early date the king transferred his
custodial authority over the insane to private individuals
who entered into bonds with the Crown, committing them
to responsible execution of their trust. In this sense, the
Crown's legal incompetency jurisdiction served as a
clearing house for private but monitored guardianship of
the insane.
This legal incompetency jurisdiction enjoyed a virtually
uninterrupted administrative history from the late 13th
century to the present.23 From the 13th century down to
1540, this jurisdiction was exercised through the Court of
Chancery. During at least part of this period, members of
the king's Chamber, acting informally and often on an ad
hoc basis, handled the actual administration of these
matters.24·'275") In the 16th century, this authority over
idiots and lunatics was vested in the Court of Wards and
Liveries, a legal court erected by two statutes in 1540 and
1542. As its name suggests, this court was created
primarily for the protection of underage heirs of deceased
feudal tenants in chief of the king. However, section 26 of
the founding statute established that the Court "shall have
authority by this act to survey govern and order all and
singular idiots and natural fools now being in the kings
hands or that hereafter shall come and be in the kings
hands."15'**8061 Although only idiots are mentioned, luna¬
tics were also included within this jurisdiction.
For over 100 years Wards officials were responsible for
all important judicial, financial, and administrative
matters pertaining to idiots and lunatics. In February of
1646 the Court of Wards and Liveries ceased its operations
because of the upheavals and instability associated with
the outbreak of the English Civil War. The Court was
officially abolished by statute in 1660,5 ,[']:2',!" and its
 jurisdiction over the mentally ill was transferred back to
Chancery, where it has remained.251""474"4751 At present, the
Court of Protection is in charge of such matters.23
This legal incompetency jurisdiction was designed as
much for the protection of property as of persons. As a
consequence, only disturbed individuals with personal or
real estate were brought to the attention of the medieval
Chancery or the Court of Wards and Liveries. Yet persons
with quite small holdings were referred to this jurisdiction.
The Court of Wards' archives,26 supplemented by those
from Chancery,27 are sufficiently extensive and complete
to establish highly reliable estimates of the social class
composition of its psychiatric population. Only 40% of its
cases belonged to the landed gentry or came from the great
aristocratic families. Of the remainder, many were trades¬
men, yeomen, and other agricultural workers. Since
widows and heiresses could hold property in their own
right, approximately 20% of all cases involved women. The
majority of these women were below gentry rank and some
of them were poor, elderly spinsters. The haphazard
survival of medieval Chancery records makes it impossible
to offer similarly precise statistics for the earlier period.
Nonetheless, the extant records suggest quite clearly that
the medieval jurisdiction also handled numerous cases
below gentry rank.2830 It is important to keep this social
composition in mind in the following discussion. It means
that the psychiatric ideas we will be examining were
applied to and came from various social classes and occupa¬
tional groups in medieval and early modern England. They
are not the ideas of an educated few constructed solely for
the benefit of the privileged minority.
Examinations of persons thought to be mentally disabled
were called inquisitions de lunatico inquirendo 3°<1:139> or de
idiota inquirendo.3U"232) (These inquisitions are entirely
unrelated to the institution of the same name set up by the
Catholic Church.) Such examinations were initiated by
royal commissions, by local government officials known as
escheators, who were drawn from the ranks of the county
gentry, or by private persons seeking an eventual grant of
the custody.32'""3·72·801 After the founding of the Court of
Wards, almost all inquisitions were issued in response to
petitions from individual subjects. Inquisitions were
probably conducted along much the same lines, irrespective
of their origin. The local royal official, or the commis¬
sioners, directed the sheriff of the appropriate county to
summon a jury on an appointed day. After 1540, the Court
of Wards' own local official, the feodary, who was usually a
gentleman, joined these proceedings.32'"1401 By statutory
regulation, the sites for inquisitions were to be "convenient
and open places"15'213421 and the jurors to be "good people
and lawful, which be sufficiently inherited and of good
fame, and of the county where the inquiry shall be."15(l:3681
A minimum of 12 men were chosen as the jury,15'3!'*41
although it was usual to include several more to insure
agreement among 12.
The evidence taken by the government officials in the
presence of this county jury focused on three basic ques¬
tions. First, was the individual, alleged to be an idiot or a
lunatic, in fact mentally ill; if so, then "from what time,
and how and in what manner, and [did he enjoy] lucid
intervals"? Next, what lands and other property did he
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
possess and which of these had he aliened during the time
of his illness? Finally, who and how old was his next
heir?31"12331 The inquisition findings were written on parch¬
ment and the document returned to Westminster within
the month.
Surviving evidence suggests strongly that the tests for
idiocy administered at the inquisitions remained essen¬
tially the same throughout the medieval and early modern
period. They were designed to measure the subject's
orientation, memory, and intellect at rudimentary levels.
The examination of Emma de Beston for idiocy in July
1383 is typical:
The said Emma, being caused to appear before them, was asked
whence she came and said that she did not know. Being asked in
what town she was, she said that she was at Ely. Being asked how
many days there were in the week, she said seven but could not
name them. Being asked how many husbands she had had in her
time she said three, giving the name of one only and not knowing
the names of the others. Being asked whether she had ever had
issue by them, she said that she had had a husband with a son, but
did not know his name. Being asked how many shillings there were
in forty pence, she said she did not know. Being asked whether she
would rather have twenty silver groats than forty pence, she said
they were of the same value. They examined her in all other ways
which they thought best and found that she was not of sound mind,
having neither sense nor memory nor sufficient intelligence to
manage herself, her lands or her goods. As appeared by inspection
she had the face and countenance of an idiot.281*127"128'
Similar questions were asked of alleged idiots two
centuries later and the 16th-century law dictionary cited
earlier may have drawn on these practices for its definition
of idiot. The ability to recognize coins, and to perform
simple numerical functions in relation to these coins or in
the abstract, was particularly common. At his examination
in 1615, Thomas Pope was said to have been "very well able
to discern and know the difference of all pieces of silver of
the Queen's coin and the perfect value of them from xiid to
an half-penny."33(f618r> Similarly, the commissioners who
examined the alleged idiot German Bradshaw in 1597
reported that he "numbered 20 forwards and backwards
and counted money and divided and discerned the
same."34·12"7") Other individuals were tested to establish
their literary levels.35
By the late 16th century, if not earlier, official examina¬
tions also explored the subject's daily life and habits. The
commissioners sent to examine Thomas Pretyman in 1599
wanted to know, for example, if he was "an orderly man"
who "keeps an orderly house and frequents the church and
is admitted in the church to receive Holy Communion with
the rest of his neighbors."36(f i4i»)
If an individual demonstrated an acceptable level of
numeracy and performed well in other areas, the exam¬
iners appear to have pushed their inquiry further in an
effort to assess the man's judgment and discretion
regarding specific problems facing him in life. Ambrose
Bennett was asked to tackle the following series of ques¬
tions in his 1628 examination for idiocy:
I... questioned him about several things for his estate. He
directly informed me that he had £200 a year annuity or better
out of the land conveyed to Sir Simon Bennett his brother, granted
him during his life and a legacy of £ 2000 or £ 3000 in ready
money. But said it was not fit for him to [word illegible] his whole
 estate. Myself inquiring how he did employ his estate he said that
he paid his mother as I take it where he was last for his board after
the rate of £120 a year and being asked what remained of his
£200 annuity he said £80. Then what he did with that, he
answered he maintained himself and a man, being asked what he
did with his two thousand pounds legacy he said he put it out to
interest, being asked how much interest of two thousand pounds
would yearly yield him he said one hundred and three-score pounds
a year, being asked what he would do with his estate growing so
rich he said he would give it when he died amongst his friends that
used him best and having many poor friends that he must do for I
asked him what he paid now for his board, he said he told his
brother that he should have nothing until his death and then he
would requite him, I asked him how he would get his annuity of his
brother if he did not pay him he said he had an entry upon his land
if he paid not his half years payment at the day or within a quarter
of a year, after I told him he was very skillful in his estate.37
It is more difficult to establish the lunacy criteria
employed in this jurisdiction. Inquisitions and related
records were required to report their verdict but not the
specific questions or methods used to determine it. While
some extant idiocy examinations contained verbatim
exchanges between commissioners and the alleged idiot,
this practice was apparently not adopted in lunacy matters.
The reason for this difference in practice is not known.
Indeed, this finding may be just an artifact of irregular
manuscript survival. In any case, the unfortunate conse¬
quence is that we remain very much in the dark regarding
exact official criteria for making a "differential diagno¬
sis."
Despite these difficulties, the general features of 16th-
and 17th-century lunacy examinations are discernible.
First, by definition, to be considered lunacy the condition
had to commence postnatally. Second, references to luna¬
tics, such as Beaton Norcott alias Norden, as "somewhat
defective in her memory and understanding by reason of
sickness and old age,"38 indicate that lunatics, too, were
evaluated for intellectual deficits. However, no surviving
evidence suggests that specific numeracy or literacy tests
were administered. On the other hand, lunacy examina¬
tions do contain frequent references to the subject's
possibly disturbed thoughts or behavior, suggesting a small
difference in emphasis from idiocy inquisitions. John
Davies' examination found him to be "sometimes distem¬
pered in his mind and actions."39<fl03r) Nicholas Goodridge
was considered sane because "upon sight of his sober and
discreet carriage and behavior" it appeared that he was "a
man of good discretion and understanding. "«Kf 447r) Similar¬
ly, Gregory Bexwell "carried himself in a very civil and
quiet manner and likewise governed his estate beseeming
a man of judgment and understanding."41
Assuming that we are not dealing with an archival
artifact, this failure to employ clearly distinct criteria for
idiocy and lunacy is not altogether surprising. For fiscal
reasons, the medieval Crown favored minimal use of
lunacy inquisitions, and evidence discussed elsewhere42
indicates that the Crown may have thwarted a full elabo¬
ration of a separate medicolegal category of lunacy as an
adjunct of this policy. Although this royal, fiscal bias
disappeared in the latter 16th century, legal traditionalism
probably helped to perpetuate these ambiguities.
What is most impressive about these various measures of
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
mental competency, from the point of view of psychiatric
history, is their matter of fact, commonsense tone. There is
not the slightest suggestion that the disturbances being
explored required any kind of supernatural explanation.
However, the use of naturalistic criteria for determining
mental status is not in itself proof of the absence of
superstition. These criteria were culturally and psycholog¬
ically, if not logically, compatible with theories of demono¬
logical cause. At Emma de Beston's idiocy inquisition her
14th-century examiners concluded that her impairment
resulted from "the snares of evil spirits."28<4:l251 Zilboorg
made a similar point when he observed that "the few who
were fortunate enough to be considered 'naturally' ill were
for centuries treated with exorcisms."3'"1301 But Emma's
inquisition is unique among our records. All other extant
inquisitions appeal only to natural phenomena of various
sorts or to the activity of God in their efforts to explain the
cause of the impairment. When the inquisitions attribute
the mental impairment to God, they do so with the routine
phrase "by the visitation of God."43'"1861 This phrase repre¬
sented merely a conventional manner of speech used for
describing unexpected or inexplicable events. It did not
reflect a substantive belief in direct divine responsibility
for illness. In any case, it was hardly a demonological
explanation for the disorder.
Physical illness or injury were the most common expla¬
nations advanced. The commission that inspected John
Fitzwilliam in July 1490 dated his mental disability from
the time he was "gravely ffl."»«*»«) ^he examiners of John
Norwich in 1502 concluded that "he has lost his reason
owing to a long and incurable infirmity."30,3:406) John Gore's
lunacy, established by an inquisition of June 2, 1626, was
ascribed to "an illness which he had before that
time."27(C142/422/281 On the other hand, Bartholomew de
Sakevill's mental derangement, confirmed by a jury on
Sept 18, 1291, was attributed to a "blow received on the
head."29'51791
Sudden emotional shocks were also conceived of as
possible causes of insanity. A 1366 jury concluded that
Robert Barry's insane violence had been "induced by fear
of his father."28(3:2361 James Benok's inquisition of Aug 18,
1568, found that "he became ... afflicted by reason of a
fright on 20 October 1556 and has so continued from that
time to the present."27'01427148'151
So far we have examined the general psychiatric distinc¬
tions set forth in Prerogativa Regis, the specific tests of
competency employed at inquisitions, and the etiological
explanations offered in inquisition findings. With the
single exception of Emma de Beston's inquisition in 1383,
these extant documents, which extend over several centu¬
ries, contain no demonological explanations of mental
illness. However, it is possible that we are looking at
enlightened, official glosses on more primitive beliefs.
Although the inquisitions represented the findings of a
county jury, the royal commissioners could have exercised a
controlling influence on the final language of these docu¬
ments. Perhaps the jury, together with the original peti¬
tioner, concluded that the individual under examination
was a genuine lunatic. But they may have held very
different ideas on the nature of his condition and its causes
than those entertained by the commissioners. They may
 have viewed the illness as a form of possession or the result
of a witch's curse. To explore this possibility, we require
some more direct evidence of popular ideas and atti¬
tudes.
As noted earlier, after 1540 the great majority of
inquisitions were initiated by petitions from private
persons. Many petitions survive from the 17th century and
a handful from the 16th. The social class of petitioners was
similar to that of the Court's psychiatric population. They
were tradesmen and yeomen as well as gentry and nobility.
Doubtless, many petitioners were illiterate and had their
appeals to the Court written by London solicitors.
Nevertheless, the great diversity among petitions makes
evident that while solicitors may have given order to their
clients' ideas, they did not alter their content.44
Extant 16th-century petitions tend to be brief and to the
point. Writing directly to the master of the Court of
Wards, the petitioner reported the existence of a lunatic or
idiot who was "in no sort... able to help himself"45 and
requested custody of the disabled individual. Once again,
the tone of this petition, in discussing and describing
mental disability, is completely matter of fact. Apparently,
these men had little difficulty accepting mental illness at
face value as an impairment of functioning. Early 17th-
century petitions confirm this impression. In a petition of
1618 a possible lunatic, Thomas Gamull, was described as
"distracted of his wits"46; another alleged lunatic was said
to be "distempered and weakened in his senses"47; a third,
"fallen into the distemper of lunacy"48; and a fourth, to be
suffering from an "infirmness of mind."49 These
descriptions refer to some weakness or disturbance of the
mind; none of them appeal to a supernatural, demonic
agency to account for these difficulties.
The petition format did not call for any explanation of
the origin or cause of the lunacy. Nevertheless, some
petitioners volunteered their views. Most commonly, they
ascribed the mental disturbance to some prior physical
illness. The alleged lunatic Henry Williams was said to
have been "visited with extreme sickness being 72 years
[old]... the extremity of which long and tedious sick¬
...
ness, with want of natural rest has much weakened and
debilitated his head, in so much that he is in great fear of
lunacy."50 When a relative of Richard Bowater petitioned
for his custody, he explained that Richard, aged 70, had
suffered from "a burning fever by means whereof and of
his old age ... he sometimes is deprived of his memory and
for the time becomes distracted."51 In another case, it was
suggested that the man's "distraction did rather proceed
by some distemperature of diet and drink."52 Here, the
petitioner appears to have some type of toxic psychosis in
mind.
Prolonged grief or highly stressful life events were also
advanced as possible causes. In 1622 the well-to-do gentle¬
woman Elizabeth Gate became "subject to a deep melan¬
choly and discontent" so, petitioners said "by reason of her
husband's death and his sale of all his lands to about
£1,500 per annum and the care of her children and want of
maintenance."53 The insanity of the tradesman Thomas
Parsons was attributed to his economic misfortunes and
his resulting despair. "Out of a desire to augment his
estate for the better maintenance of himself, his wife and
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
family," Parsons extended credit to some subordinates, but
they defaulted on their repayments. Then Parsons, "en¬
tering into consideration with himself how himself and his
poor wife and family might hereafter be relieved and his
own debts satisfied, and finding no means to accomplish
the same for want of such debts as were due to himself, he
became discontent and troubled in mind in so much as he
grew weak in judgment.... Since which time he is become
mad and lunatic... he being now in Bedlam."54 William
Burrishe's disorder was somewhat more ambiguous. Ap¬
parently, he was "put in great fear by thieves breaking
into his mother's house in the night." From that night
onward he "became distract and speechless most times" of
his subsequent life.55<f 443r>
The precipitating stress was not always located in
external calamities or internal bodily disorders but in the
sufferer's own mind. Thus, according to his brothers,
Edmund Francklyn suffered from a "melancholy sickness
and some touch of remorse of conscience." Eventually, his
self-accusations drove him mad.56
The English Crown's legal incompetency jurisdiction
was a far cry from Zilboorg's witch-hunting clergy. That
jurisdiction was premised on the government's responsi¬
bility to protect subjects who, by reason of mental impair¬
ment, were unable to protect themselves. The medicolegal
categories of lunacy and idiocy describe these conditions in
purely naturalistic terms. Similarly, the questions adminis¬
tered at inquisitions measured impairment through en¬
tirely rational, commonsense tests of orientation, numer¬
acy, and so on. Etiological notions followed the same
pattern. With the single exception of Emma de Beston, the
mental illness of persons brought within the purview of
this jurisdiction was attributed to natural, even psycholog¬
ical causes: fever, head injury, grief, and anxiety. Further¬
more, these views of mental illness were not the monopoly
of the ruling elites and reserved for members of their own
class. The persons who entertained such views and the
individuals to whom they were applied came from a wide
range of social classes.
Clearly, this legal incompetency evidence suggests that
Zilboorg overestimated the appeal of demonology as an
explanation of mental illness in medieval and Renaissance
Europe. But a crucial question remains: overestimated by
how much! By enough to make demonological appraisals of
mental illness the exception rather than the rule? At
present, we just do not know. The evidence suggests, too,
that men such as Vives and Weyer were not the originators
of naturalistic notions of mental illness, but aggressive
advocates of a long-established habit of thought. From this
perspective, Weyer ceases to be a revolutionary, seeking to
transform the medieval view of mental illness, and
becomes a scout, surveying new terrain to be incorporated
eventually into the older domains of psychiatry.
These records leave us with another major research
question. If both natural and supernatural explanations of
bizarre conduct and ideation were available to medieval
and early modern Englishmen, what factors, intrinsically
characteristic of the behavior, contextual, or sociological in
nature, determined the choice of label? A similar problem
confronts anthropologists working in cross-cultural psy¬
chiatry since it is increasingly clear that non-Western
 societies also entertain both psychiatric and supernatural
interpretations of deviant behavior.57 The usual explana¬
tion offered in historical studies—that "witch" was
reserved for women and for the poor—fails to account for
the presence of both groups among Court of Wards cases.
The evidence assembled here indicates that this sociolog¬
ical explanation of the labeling process is inadequate, at
least in its present crude form.
Whatever the final resolution of these issues, the
archives of the English legal incompetency jurisdiction
demonstrate the serious hazards involved in the past and
current neglect of manuscript sources, at least for the
earlier periods in psychiatric history. Of course Zilboorg
himself could not be expected to consult such sources
directly, but he shows no appreciation of the fact that such
sources might exist or would, if consulted, substantially
alter his conclusions. Later authors have continued
Zilboorg's prejudices in favor of printed documents to the
detriment of scholarship in psychiatric history. Before we
can begin ä full reappraisal of Zilboorg's interpretation,
there is need for a new round of research. The writing of
authors less well known than Vives and Paracelsus must be
examined. Furthermore, a vast array of institutional
archives remains untouched. More imaginative research
strategies must be developed for locating early diaries,
manuscript treatises, family papers, physicians' case
books, police records, and county, municipal, and parish
documents bearing on treatment of the insane. If these
legal incompetency archives are any indication, the real
history of psychiatry and mental illness, of doctors and
patients, remains to be written.
This investigation was supported in part by Public Health Service award
1-F01-MH57359-01 from the National Institute of Mental Health and by a
research training fellowship (Public Health Service award 2-T01-MH13043-
04) from the Psychiatric Epidemiology Training Program, Columbia
University.
Eda Rak assisted in the preparation of this manuscript.
Citations from reference 24 as well as from references 33-41, 44, and 46-56
appear by permission of the Controller of H. M. Stationery Office.
References
1. Freedman AM, Kaplan HI, Sadock BJ: Comprehensive Textbook of
Psychiatry: II, ed 2. Baltimore, Williams & Wilkins Co, 1975.
2. Semelaigne R: Les Pionners de la Psychiatrie Francaise avant et apr\l=e`\s
Pinel. Paris, Bailli\l=e`\re,1930-1932.
3. Zilboorg G: A History of Medical Psychology. New York, WW Norton &
Co, 1941.
4. O'Donoghue EG: The Story of Bethlehem Hospital From Its Foundation
in 1247. London, T. Fisher Unwin, 1914.
5. Dain N: Concepts of Insanity in the United States, 1789-1865. New
Brunswick, NJ, Rutgers University Press, 1964.
6. Rothman DJ: The Discovery of the Asylum: Social Order and Disorder
in the New Republic. Boston, Little Brown & Co, 1971.
7. Grob GN: Mental Institutions in America: Social Policy to 1875. New
York, Free Press, 1973.
8. Ackerknecht EH: A plea for a "behaviorist" approach in writing the
history of medicine. J Hist Med 22:211-214, 1967.
9. Rosen G: Madness in Society: Chapters in the Historical Sociology of
Mental Illness. New York, Harper & Row Publishers, 1968.
10. Kolb LC: Modern Clinical Psychiatry, ed 8. Philadelphia, WB Saun-
ders Co, 1973.
11. Alexander FG, Selesnick ST: The History of Psychiatry. New York,
Harper & Row Publishers, 1966.
12. Werman D: The teaching of the history of psychiatry. Arch Gen
Psychiatry 26:287-289, 1972.
13. Kroll J: A reappraisal of psychiatry in the middle ages. Arch Gen
Psychiatry 29:276-283, 1973.
14. Hunter RI, Macalpine I: Three Hundred Years of Psychiatry, 1535\x=req-\
1860: A History Presented in Selected English Texts. London, Oxford
University Press, 1963.
Downloaded From: http://archpsyc.jamanetwork.com/ by a University of Manitoba User on 06/19/2015
15. Luders A, Tomlins TE, France J, et al: Statutes of the Realm. London,
Record Commission, 1810-1822.
16. Fisher HAL (ed): The Collected Papers of Frederic William Maitland.
Cambridge, Cambridge University Press, 1911, vol 2.
17. Whittaker WJ (ed): The Mirror of Justices. Seldon Society. London,
Quaritch Ltd, 1895, vol 7.
18. Cowell J: Ideot, in The Interpreter of Words and Termes. London,
1701.
19. Coke E: The First Part of the Institutes of the Laws of England: or, A
Commentary Upon Littleton, ed 19, Hargrave F, Butler C (eds). London,
Clarke & Son, 1832.
20. An Exposition of Certaine Difficult and Obscure Words and Termes.
London, 1615.
21. Manuscript Collection. Cambridge University Library. Ee.5.22.ff
354r-355r.
22. Manuscript Collection. Cambridge University Library. Hh.2.1.ff 16v\x=req-\
18r.
23. Hunt DG, Phillips JF: Heywood & Massey, Court of Protection
Practice, ed 7. London, Stevens & Sons, 1954.
24. Public Record Office, Chancery Lane Branch, London. Exchequer,
King's Remembrancer, Various Accounts, E.101/415/3, memoranda 1 Oct 15
Henry VII.
25. Holdsworth WS: A History of English Law, ed 3. London, Methuen &
Co Ltd, 1922, vol 1.
26. Public Record Office, Chancery Lane Branch, London. Wards
Archives.
27. Public Record Office, Chancery Lane Branch, London. Chancery
Inquisitions Post Mortem, Series II (Henry VII to Charles II).
28. Calendar of Inquisitions Miscellaneous (Chancery) Preserved in the
Public Record Office (Henry III-12 Richard II). London, HMSO, 1916-1957,
vols 1-4.
29. Calendar of Inquisitions Post Mortem and Other Analoguous Docu-
ments Preserved in the Public Record Office (Henry III-15 Richard II).
London, HMSO, 1904-1974, vols 1-16.
30. Calendar of Inquisitions Post Mortem and Other Analoguous Docu-
ments Preserved in the Public Record Office, Series II (Henry VII). London,
HMSO, 1898-1955, vols 1-3.
31. Fitzherbert A: Nouvelle Natura Brevium. London, 1553.
32. Bell HE: An Introduction to the History and Records of the Court of
Wards and Liveries. Cambridge, Cambridge University Press, 1953.
33. Public Record Office, Chancery Lane Branch, London. Wards 9/92.
34. Public Record Office, Chancery Lane Branch, London. Wards 9/86.
35. Public Record Office, Chancery Lane Branch, London. Wards 10/67,
Examination of Mrs Katherine Tothill.
36. Public Record Office, Chancery Lane Branch, London. Wards 9/87.
37. Public Record Office, Chancery Lane Branch, London. Wards 10/51,
certificates.
38. Public Record Office, Chancery Lane Branch, London. Wards 10/42,
pt 2, certificate of Feb 3, 1627.
39. Public Record Office, Chancery Lane Branch, London. Wards 9/93.
40. Public Record Office, Chancery Lane Branch, London. Wards 9/88.
41. Public Record Office, Chancery Lane Branch, London. Wards 10/34,
petitions, certificate of Nov 19, 1622.
42. Neugebauer R: Treatment of the mentally ill in medieval and early
modern England: A reappraisal. J Hist Behav Sci, to be published.
43. Madge SJ (ed): Abstracts of Inquisitions Post Mortem for the City of
London: Tudor Period: II. 4-19 Elizabeth 1561-1577. Index Library. London,
British Record Society, 1901, vol 26.
44. Public Records Office, Chancery Lane Branch, London. Wards 9/214\x=req-\
219.
45. Hatfield House, Cecil Papers, p 227.
46. Public Records Office, Chancery Lane Branch, London. Wards 10/26,
pt 1, petition of Feb 12, 1618.
47. Public Records Office, Chancery Lane Branch, London. Wards 10/29,
pt 2, petition of Oct 15, 1622.
48. Public Records Office, Chancery Lane Branch, London. Wards 10/23,
petition of Oct 25, 1624.
49. Public Records Office, Chancery Lane Branch, London. Wards 10/36,
pt 2, petition of Feb 6, 1637.
50. Public Records Office, Chancery Lane Branch, London. Wards 10/43,
pt 2, petition of Aug 6, 1629.
51. Public Records Office, Chancery Lane Branch, London. Wards 10/26,
pt 1, petition of May 11, 1620.
52. Public Records Office, Chancery Lane Branch, London. Wards 10/36,
pt 2, petition of May 9, 1631.
53. Public Records Office, Chancery Lane Branch, London. Wards 10/34,
petition of Feb 9, 1622.
54. Public Records Office, Chancery Lane Branch, London. Wards 10/28,
pt 1, petition of Nov 29, 1620.
55. Public Records Office, Chancery Lane Branch, London. Wards 9/85.
56. Public Records Office, Chancery Lane Branch, London. Wards 10/26,
pt 1, petition of Nov 17, 1617.
57. Murphy JM: Psychiatric labeling in cross-cultural perspective. Science
191:1019-1028, 1976.