A History of Madness in Sixteenth-Century Germany. (Reviews).

H. C. Erik Midelfort, A History of Madness in Sixteenth-Century Germany.

Stanford: Stanford University Press, 1999. xvi + 22 pls. + 438 pp. $55. ISBN: 0-8047-3334-1.

Comparisons between Martin Luther and Paracelsus are rare in any context, let alone on the subject of madness. In the skilled hands of H. C. Erik Midelfort, however, this juxtaposition can be made to reveal an astounding amount of information about sixteenth-century attitudes on the subject. The same might be said of this entire book, which pulls together a stunning array of sources and academic disciplines with the same fruitful results. This diversity is important to Midelfort, who wishes to convey the confusion and ambiguity of the times as well as the most influential ideas on individuals considered mad and generally weird. Such a project would be impossible without his extensive learning in the areas of medicine, law, and theology as well as social and cultural history. For this breadth of learning allows Midelfort to escape some of the many anachronistic (usually theoretically based) snares that have limited most modern scholars' direct access to past attitudes and experiences regarding madness. The spe cter of Michel Foucault in particular floats over this work, but historiographical debates consistently take a back seat to Midelfort's attempts to understand sixteenth-century madness in its own terms -- hence too the general use of "madness" rather than modern clinical terms.

One of his central findings is that almost everyone during the era lived in a moral universe, where natural causes for madness coincided with metaphysical ones. Within these parameters, though, a myriad of interpretations were possible. Luther and Paracelsus, for instance, shared the traditional interpretation of disease as a divine punishment for sin but each focused on different aspects of madness for different purposes. Luther saw madness in both the blind rage of Satan and the unwitting misdeeds of certain Old Testament patriarchs (especially Lot, Isaac, and Jacob), positing a state of unreason for the former and a type of insanity defense for the latter. Paracelsus, meanwhile, predictably pursued materialist and chemical remedies for madness (which he nonetheless viewed as spiritual illusions). Midelfort is especially persuasive in his careful interpretation of the notoriously obscure metaphors of Paracelsus.

The depth of the author's learning and the precision of his analysis similarly serve him well in discussions of medical and legal debates about madness. In each of these chapters, he consistently stresses the multiplicity of expert opinions, so as to avoid any "flattening out" of such controversies as the "Galenists" versus the "Paracelsans." Then as now, academics rarely reached complete consensus on any topic, particularly one as multi-faceted as madness. Nor was "progress" or modernization an irreversible process: the discoveries of Vesalius and others notwithstanding, the more syncretic Galenic approach actually gained more adherents over the course of the sixteenth century. The same reversion might be ascribed to legal definitions of insanity, which were heavily influenced by expert medical and theological experts.

"Popular" attitudes about madness are naturally more difficult to ascertain but Midelfort makes four mostly successful forays in search of the same. In the book's first chapter, he demonstrates three different approaches based on different types of evidence. First he presents a case study of the depressed and suicidal Flemish painter Hugh van der Goes, followed by descriptions of the apparently unique late medieval phenomenon of St. Vitus's dance (an uncontrollable leaping and spinning), and finally the topic of demonic possession. Each of these discussions contains numerous items of interest, but the chapter's lack of cohesiveness leaves the reader somewhat confused as to the principal argument -- which might in fact be one of Midelfort's goals, i.e., avoiding facile generalization about an age as complicated as our own. Another chapter, on pilgrimages, confirms that madness had a significant presence in sixteenth-century Germany, accounting for 5-35% of the petitions at shrines throughout the empire. My own favorite chapter describes the rise of the fool in literature as well as in actual courts (where they were more celebrated for their complete freedom of speech than for their supposed wisdom). The only part of the book that is nor up to its otherwise consistently high standards is the final chapter, a comparison of two hospitals' treatment of the mad. The subject of madness does not even surface until more than half-way through the chapter and disproportionate attention is devoted to the Protestant Landgrave of Hesse at the expense of the bishopric of Wurzburg. As in the rest of the book, though, Midelfort has clearly done his homework and thus even this chapter has much valuable information on early modern social institutions and public welfare.

In addition to all of the accomplishments already mentioned, this book is written in a clear, jargon-free style, with vivid descriptions of the agonies suffered by melancholic individuals as well as of the physicians and theologians who sought to relieve them. Specialists and general readers alike will find new insights into not just the history of madness but our own understanding of mental illness today.