Mental Illness in the Middle Ages: A New Perspective

Misconceptions About Medieval Mental Health

Treatments for illnesses in the Middle Ages often sound gruesome to modern readers. Medicine was nowhere near as advanced as it is today, so often, treatments were recommended that we know today were not only unhelpful but actively harmful, such as bleeding and the application of leeches.

Treatment of mental illnesses is often considered to have been even worse; downright nasty, and often with the intention of being so. An actual look at the sources, however, throws a different light on it and reveals a far more balanced picture.

Healing the Mind by Healing the Body

It has to be noted that many treatments for mental illness in late medieval England were, to modern ears, pretty gruesome; it does not seem that this was the intention, any more than it was the intention for treatments of physical illnesses. Often the primary treatments against a mental illness were those against physical ailments, for a very good reason: there was a belief that a diseased mind could not heal in a diseased body. Very often, therefore, the assumption was that a mental illness came from a physical illness, be it one that was known or one that was previously unrecognised. Often, it seems that it was considered that mental illness was caused by the sufferer’s body being in some way overworked: too much pressure on the head, too much blood in the veins, too much food in the stomach. The treatments were then designed to cure these suspected causes.

The Case of Henry VI: Royal Treatment

A very good example of this is Henry VI, who famously suffered from mental illness and, in 1453, had a breakdown that left him catatonic for over a year. Naturally, the country’s best physicians were sent for and tried all they could to help him. A list of proposed treatments for Henry’s illness survives; treatments that appear to have all been administered to the king, and information about them for the later part of the year 1453 and the year 1454, the years during which the unfortunate king was catatonic.

Remedies and Their Real Intentions

These were notable for being very similar to treatments used for physical ailments: laxatives, baths, gargles, and bloodletting. Others are more obscure, and though similar language was used for physical illnesses, the medicine they referred to may have differed somewhat: ‘soothing medicines,’ ‘waters,’ and ‘syrups.’ What can be said, though, is that, while they may not all have been very comfortable, some were intended to soothe the patient, and none of them was used to deliberately cause pain or “punish” the unfortunate king or others who were given similar treatments.

It can be argued that Henry VI is hardly a very common case, as he had access to the best physicians and the most advanced health care available at the time, and much worse treatment may have been dealt to those of lesser status and less money who suffered from mental illness. However, the little evidence there is suggests this was not the case. It may even have been the opposite. Henry VI was an extreme case. For everyone else, even nobles and rich men and women, who were less strongly afflicted, there were other treatments, treatments that even to a modern mind promise more success.

The Theory of Humours and Personality Types

These had a lot to do with the famous idea of the body being made of four humours, and that an imbalance of these humours could cause not only physical illness but also an imbalance of spirit. These four humours were blood, phlegm, black bile, and yellow bile, and each of these humours, or fluids, was connected with a personality type: sanguine, phlegmatic, melancholy, and choleric. While it was accepted that every person was different, with some leaning more towards melancholy and others to a phlegmatic nature, it was considered that if there was an imbalance caused by something, these traits would become more extreme. If they became too extreme, they would make a person mentally ill. A melancholy person might, for instance, despair of life itself; a choleric person might, like Henry VI’s grandfather, Charles VI, become murderous.

To prevent this, there were some fairly easy measures in place, some of which sound barbaric to us while others sound like common sense.

Balancing the Humours: From Blood to Salad

An example of the former is what was done in the case of someone who was considered too sanguine, which was meant to indicate too much blood in comparison to the other humours. The solution was the most famous of medieval treatments for physical and mental illnesses, like bleeding a patient and, as such, removing the supposedly surplus blood from the body. The treatment for a surplus of black bile, considered to lead to melancholy behaviour, was much more mellow and much more in sync with what today would be recommended for depression, if not as a sole treatment: a change in diet.

Interestingly, what was recommended as healthy for a person suffering from excessive melancholy—in more modern terms, a person suffering from depression—was what even today would be seen as a very healthy diet: a diet with a lot of vegetables, especially salad, which was thought to absorb black bile.

This did not cure any depression, but the healthy effect of a good and balanced diet, even on mental health issues, has long since been proven. It is therefore not surprising that similarly good effects were noted by medieval physicians treating patients for melancholy.

A Thoughtful, Though Limited, Approach

Then, medieval treatment for mental illnesses varied from case to case. They could be gruesome, yet at other times, they could be both non-invasive and, even by modern standards, helpful. What can be said, though, is that whatever the treatment was, it always was thought out and with the best intentions at heart.