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How and why did understandings of the causes of insanity change between 1660 and 1770?
The eighteenth century correlated with an increased emphasis towards moral treatment of the insane in certain places. Indeed, Horst Dilling contextualises this idea through the example of
Lubeck hospital where a ‘reform phase’ 1 led to an improved lifestyle for the insane through the values of charity and Christianity. Yet the treatment of the insane varied between institutions and
Lubeck cannot be used as an overall representation. This essay will thus highlight that any signs of change towards a more egalitarian understanding of what caused insanity were undermined by varying views. The cultural and social influences of literature helped involve the public with a greater awareness of insanity as a subject, but this did not necessarily equate to understandings of what caused the disease. Indeed, I will also explore how wider social issues could also exacerbate the ambiguity of the origins and nature of insanity. Richard Mead’s argument that there is ‘no disease more to be dreaded than madness,’ 2 might emphasise that eighteenth century medical works were ambivalent towards the causes of insanity. The subjective complexity of this psychological phenomena means that it is bold to claim that many positive changes did root out the causes of insanity even if sporadic signs of improvements were evident by 1770.
A typical method of categorising the insane, in order to potentially examine the causes of insanity, was through an asylum. However, as Michael Foucault argues these madhouses could simply be places of ‘confinement’ 3 , citing the example of the Hospital General in Paris, set up in the seventeenth century. The initial drive of asylums and madhouses appears to be partly a result of fear of the unpredictability of the behaviour of the insane. The idea of segregation appears
1 H. Dilling, ‘Care of the insane in Lubeck during the 17 th and 18 th centuries’, History of Psychiatry, 21 (2010) pg. 382.
2 R. Mead, ‘The Medical Works of Richard Mead’ (1762), from http://books.google.co.uk/books/about/The_medical_works_of_Richard_Mead_M_D.html?id=doBEAAAAcAAJ&redir_e sc=y, [Accessed 28/11/14], pg. 484.
3 M. Foucault, Madness and civilization: a history of insanity in the age of reason (Routledge, 2001), pg. 35.

2 | P a g e B e n H a r d y prominent rather than there being a motive of creating an institution to examine the causes of insanity as a social problem. Macdonald highlights this fear by stating how victims of insanity were
‘defined as terrifyingly wild and incomprehensible’ 4 , almost as a process of labelling and stigmatizing lunatics as incurable and naturally insane. However, the asylums could be used to develop sane characteristics. The example of the asylum in Zaragoza, investigated by Fernandez-
Doctor outlines how the insane were made to carry out tasks from 1766-68 such as sweeping and cooking 5 . These procedures are examples of humane, diligent jobs being implemented, suggesting to eighteenth century psychiatrists that the insane had practical worth, suitable for the wider society. Yet such signs of developing sanity within asylums are not replicated by Fernandez Doctor’s example of the mad house in Marseilles, where a doctor only visited for three years between 1699 and 1787.
6 As a result of such unprofessional statistics, it is difficult to deduce an idea of a changing attitude to the causes of insanity in light of such inconsistent methods of treatment. Marseilles may be an anomaly by lacking doctoral regularity, but one must question whether the asylum really could ‘postulate an agreed theory of consciousness and of mind/body relations’ or if it could achieve ‘scientific authority’ 7 as stated by Roy Porter. The asylum seems to represent a place of shelter and perhaps even ‘confinement’ for the insane, varying in levels of treatment dependent on the place, rather than being an institution where causes of insanity were tested scientifically and rigorously.
4 M. Macdonald, ‘Popular stereotypes of insanity’, in Mystical Bedlam (Cambridge University Press, 1981) pg.124.
5 A. Fernandez-Doctor, ‘Psychiatric care in Zaragoza in the eighteenth century’, in History of Psychiatry, 4 (15) (1993), pg. 390.
6 Ibid., pg. 385.
7 R. Porter, Min- forg’d manacles: a history of madness in England from the Restoration to the Regency, (Harvard
University Press, 1987), pg. 283.

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The uncertainty of the asylum’s representation as an analytic institution able to extrapolate the causes of insanity, does not mean that there were no attempts to coordinate experimentation and moral treatment, when examining the behavioural patterns of the insane. New technologies and moral management could help postulate theories concerning insanity. Andrew Scull underlines that ignorance still predominated amongst rising curiosities of treating the insane though. Scull describes new techniques such as using a hidden trapdoor that plunges an oblivious subject into a
‘bath of surprise’, and Benjamin’s Rush’s ‘tranquilizing chair’, designed to impose good behaviour on patients.
8 These examples highlight the unmedical nature of certain institutions within England, and that such experimenters were far from grasping the causes of insanity. Porter illustrates a more professional attempt of investigating the insane by referencing William Battie, who believed that
‘management’ would be more effective in understanding and treating the insane, as opposed to medicine.
9 As part of this ‘enlightened’ process, intensified contact between the physician and the patient would be necessary. Such a theory seemingly appears to represent a progression towards knowing the insane through conversation, thereby allowing for deduction of how the insanity originated. Since there is little contemporary material on the dialogues between patient and physician which Battie exclaimed, it is difficult to state how effective such procedures were, or if they regularly took place. This does not mean that some institutions did not considerately examine the insane. Anne Digby’s illustration of the asylum in York reflects ‘greater therapeutic optimism’ as mid—eighteenth century contemporaries began to challenge the traditional conception of the madman’s ‘distorted reasoning’, and that he was a ‘creature set apart, bestial rather than human’.
10 Traditional barriers of the early eighteenth century therefore had to be broken down in order to
8 A.T. Scull, ‘The Domestication of madness’, in Medical History, 27 (3) (1983), pg. 245.
9 R. Porter, ‘Shaping psychiatric knowledge’, in R. Porter 1946-2002, Medicine in the Enlightenment, (Atlanta, 1995) pg.
257.
10 A. Digby, ‘Changes in the asylum: the case of York, 1777-1815’, in The Economic History Review, 36 (2) (1983) pp. 220-
21.

4 | P a g e B e n H a r d y associate with the roots of insanity as a disease since the madmen did ‘not appear to…have lost the faculty of reasoning’ 11 according to John Locke. Such moral statements represent improved change from the technological innovations of Rush and others. Psychiatrists became more aware of the fact that they could control insanity through simple interaction and considerate words to the victim.
Literature could theoretically enhance this therapeutic attitude when assessing the causes of insanity, although it could also be counterproductive to such developments by representing the insane to the public in a fantastical, crazed manner as part of a dramatic piece of writing. The
German play ‘Bildung’ emerging during the eighteenth century created a ‘new sense of the self as something, inner, private and portent’ 12 according to Porter, as the protagonist enhances his psychological and moral growth with age. However, Porter’s assessment of the play is unlikely to relate with many eighteenth century public minds when reading and watching the play as an entertaining medium. It can also be suggested that only a select proportion of society would immerse themselves in literature with avid interest to the extent of examining the psyche and all its complex stipulations. I disagree with the idea of a literary profile narrating and dramatizing images that ‘doctors and other students developed, and even sometimes copied,’ 13 as an effective way of understanding insanity from a causal viewpoint. One of Rousseau’s examples, Racine’s
‘Andromaque’, published in 1688, depicting a woman lost out of her wits through love, 14 could postulate that humane stresses such as broken love can cause insanity. However the vast amount of eighteenth century literature regarding women raging in love seems to present a stereotype rather than a medical device of dealing with insanity. Such publications could potentially cause
11 Ibid., pg. 221.
12 R. Porter, Min- forg’d manacles: a history of madness in England from the Restoration to the Regency, pg. 282.
13 G. Rousseau, ‘Depression’s forgotten genealogy: notes towards a history of depression’, in History of Psychiatry, 11
(41) (2001), pg. 102.
14 Ibid., pg. 84.

5 | P a g e B e n H a r d y misogamy, in this case through gender issues. Well into the seventeenth century, there are examples of women being seen as inferior in terms of susceptibility to diseases such as hysteria because of their physical weakness as stated by a contemporary practitioner John Gregory. He claimed that ‘we naturally associate the idea of female softness and delicacy with a correspondent delicacy of constitution.’ 15 Such views represent naivety rather than expertise in researching the causes of insanity because it could affect anyone in society as a mental problem rather than being restricted to certain people. Thus the process of finding insanity causes seems to be undermined by tenuous stigmatization.
Alongside gender based theories of who insanity affects, wider social aspects reflected that 1770 did not represent a change towards a more complete understanding of the causes. The Hospital
General in Paris was partly set up to ‘supress beggary’, so consequently the poor were made to work to ‘avoid idleness, which is the mother of all evils’ 16 according to a contemporary. Such an idea is theoretically correct since physical activity can help develop mental strength or serve as a distraction to mental turmoil, yet the idea of ‘supressing’ lower classes reflects a totalitarian rather than therapeutic approach to the cause. Porter suggests that an increasing number of inmates in madhouses during the eighteenth century demonstrate a ‘symptom of society’s desire to ostracise social nuisances.’ 17 Around 1660, groups such as the Quakers and Ranters provoked suspicions because of their delirious actions which seemed to repudiate their social status. Instead of cooperating with such figures to understand their motives, and to understand why they acted so abnormally, it appears that ‘violent hatred’ predominated within society, especially when Quakers
15 G.B. Riise, ‘Hysteria at the Edinburgh infirmary: The Constitution and Treatment of a disease, 1770-1800’, in Medical
History, 32 (1998) pg. 2.
16 M. Foucault, Madness and civilization: a history of insanity in the age of reason, pg. 49.
17 R. Porter, ‘Lunatic ideas and the truth about asylums’, (October 1997), http://www.timeshighereducation.co.uk/103990.article [Accessed 27 November 2014].

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‘refused to doff their hats’ and ‘paraded naked’.
18 These tensions and instability within society hindered rather than developed the investigation of insanity’s causes. Rousseau mentions how, in some cases, ‘genuine diagnosable illness followed upon false, pretended illness.’ 19 This arguably represents a last resort to escape from miserable socio-economic conditions, thereby reflecting that overall patterns of change from 1660 to 1770 were affected by wider problems rather than just being a physician and patient related misunderstanding. Causes of insanity cannot be substantiated against such a backdrop.
In conclusion, it is apparent that although efforts such as therapeutic techniques were developed during the course of 1660 to 1770, there is no linear pattern of continuous progress to the extent that the causes of insanity were fully acknowledged. The disruption of social issues, including stigmatization of the insane in the public sphere, could have resulted from the insane being incomprehensible to many eighteenth century minds. Indeed, the subjectivity and ambiguity of examining insanity is due to the fact that it is was difficult to delve into the inner dark, depths of the insane minds. This consequently led to bizarre experimentations such as the ‘tranquilizing chair’ being performed. When exploring the casebooks of melancholy, Gowland makes it clear that one doctor’s ‘melancholic’ might be another one’s ‘hypochondria’ 20 . Indeed, attempts to improve treatment of the insane as well as identifying causes are not consistent between institutions and doctors. Digby’s example of York and the attempts to increase therapeutic management can be contrasted to Foucault’s example of confinement in the Paris General Hospital. Thus, it is difficult to
18 M. Macdonald, ‘Popular stereotypes of insanity’, pg. 129.
19 G. Rousseau, ‘Depression’s forgotten genealogy: notes towards a history of depression’, pg. 83.
20 A. Gowland, ‘The problem of early modern melancholy’, in Past and Present, 191 (2006), pg. 82.

7 | P a g e B e n H a r d y overwhelmingly argue that widespread changes can be explored when researching how and why the causes of insanity were specified.
Bibliography
Primary printed sources
Mead, R., The Medical Works of Richard Mead, (1762)
Secondary sources: books
Foucault, M., Madness and civilization: a history of insanity in the age of reason (Routledge, 2001)
Macdonald, M., Mystical Bedlam, (Cambridge University Press, 1981)
Porter, R., Madness: a brief history, (Oxford, 2003)
Porter, R. ,Medicine in the Enlightenment, (Atlanta, 1995)
Porter, R., Min- forg’d manacles: a history of madness in England from the Restoration to the
Regency, (Harvard University Press, 1987)
Scull, A., The most solitary of afflictions: madness and society in Britain, 1700-1900, (Yale, 1993)

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Secondary sources: articles
Digby, A., ‘Changes in the asylum: the case of York, 1777-1815’, in The Economic History Review, 36
(2) (1983), pp. 218-239
Dilling, H., ‘Care of the insane in Lubeck during the 17 th and 18 th centuries’, History of Psychiatry, 21
(2010), pp. 380-394
Fernandez-Doctor, A., ‘A psychiatric care in Zaragoza in the eighteenth century’, in History of
psychiatry, 4 (15) (1993), pp. 373-393
Gowland, A., ‘The problem of early modern melancholy’, in Past and present, 191 (2006), pp. 77-
120
Riise, G.B., ‘Hysteria at the Edinburgh infirmary: The construction and treatment of a disease, 1770-
1800’, in Medical history, 32 (1988), pp. 1-22
Rousseau, G., ‘Depression’s forgotten genealogy: notes towards a history of depression’, in History
of psychiatry, 11 (41) (2001), pp.71-106
Scull, A., ‘The domestication of madness’, in Medical history, 27 (3) (1983), pp. 233-248
Internet sources
Porter, R., ‘Lunatic ideas and the truth about asylums’, (October 1997), http://www.timeshighereducation.co.uk/103990.article [Accessed 27 November 2014]