A History of Madness in Sixteenth-Century Germany.
This is an immensely learned and rich work by a leading historian of early-modern Germany. Utilizing a wide range of sources--from theology, medicine, jurisprudence, the arts, and popular culture--Midelfort explores the ways in which madness was explained, experienced, and treated from the late fifteenth to the early seventeenth century. In his approach to madness, Midelfort wisely refrains from imposing present-day psychiatric categories on the past. Equally critical of Foucault, Midelfort seeks to understand early-modem madness on its own terms by exploring its imagery and "language." He found "no single hegemonic language," but rather "conflicting and competing modes of Renaissance madness" (16). Madness in this account was both a construction of elite culture and a very "real" phenomenon afflicting ordinary people. He pursues this multifaceted madness in the institutions (courtrooms, hospitals, princely courts, pilgrimage shrines, etc.), theoretical debates, and different social strata of the Renaissance. The resulting work goes beyond madness to provide important new insights into the social, cultural, and intellectual history of the era.
Madness in the sixteenth century was both more and less than it is today. On the one hand, fewer mental conditions were "medicalized" and seen as mental illnesses. Conditions now labeled "schizophrenia" or "manic-depression" were often seen in moral and religious terms. On the other hand, in the context of the Reformation and Counter-Reformation, the world itself seemed to be descending into madness. Midelfort shows that the concept of madness was central to thinkers as divergent as Luther and Paracelsus, both of whom used it as a metaphor for articulating the sinfulness and disorder of the world. Sin produced mental afflictions, but the reverse was also true: sin itself was a kind of madness, and the devil its source. At the same time, Luther was perfectly capable of viewing certain mental maladies as mere illness and pragmatically recommended such prosaic remedies as "exercise, good company, wine, food, and music" (90). He also shared with Renaissance humanists and physicians the belief that madness could have its "exalted" forms as sources of creativity, wisdom, and religious revelation.
Luther's eclecticism was typical of the Renaissance, an era in which religious and medical conceptions of madness coexisted, and when treatment could range from exorcisms and prayer to purgings and bleedings. The eclecticism and complexity of Renaissance madness, while not a surprise to scholars of early-modern psychiatry, is explored with great skill, depth, and originality. Midelfort provides an extraordinary window onto madness among ordinary people with a range of sources, including the novel use of the miracle books kept by pilgrimage shrines. In its general outlines, the picture is at odds with Foucault's "Great Confinement" thesis. For example, mad pilgrims, unlike Foucault's merry medieval wanderers, had often been confined beforehand, and the pilgrimage consisted of a "formal ritual" in which, in search of a miracle cure, groups of relatives and/or neighbors escorted the mad person to a saint's shrines. Foucault argued that the early-modem period witnessed a new attempt to repress madness with the c onfinement of social deviants in the prisons and workhouses of the absolutist states. Midelfort's comparative study of a Protestant and a Catholic Hospital (Haina in Protestant Hesse and Wurzburg's Juliusspital), by contrast, emphasizes the benevolent care of the "helpless" in institutions modeled upon monastic life. Alongside a life of prayer, work, and "lessons," these hospitals provided comfort and an abundant diet to the desperately poor and disabled. As such, they were "so attractive that people clamored to be admitted" (365). Of the two hospitals, it was, surprisingly, the Catholic Juliusspital that introduced a new therapeutic model of treatment, whereas Haina remained more rooted in a medieval tradition of caregiving. The daily lives of the patients, however, were indistinguishable in the two hospitals.
Midelfort detects two epidemiological trends of the sixteenth century: the rise of melancholy, and then demonic possession in the latter part of the century. In the case of melancholy, the trend was above all the result of an increased emphasis on this illness among academic physicians (see below). But by the end of the century, the term starts to appear as well in hospital records and even in miracle books. It seems the concept of melancholy was being popularized. But whether and how the popular understanding and experience of melancholy diverged from their elite origins is not explored. Midelfort does, however, address this issue in his analysis of demonic possession. This section provides a fascinating window onto popular religiosity and madness and casts new light on the broader issue of the relationship between popular and learned culture. The epidemic of witch-hunting coincided in time with the rise of demonic possession, and the two phenomena were partially connected. But unlike witchcraft, which was "defined, prosecuted, and routinized" (70) from above, demonic possession was less easily shaped and controlled by elites. It thus afforded troubled, usually pious women (and, to a lesser degree, men) a genuine "cultural idiom" to express otherwise prohibited feelings and internal religious conflicts.
Midelfort's chapters on medicine and law provide new insights into, and reinterpretations of, their respective fields. He revises the prevailing view of sixteenth-century medicine and psychology as stagnant and dominated by the theory that madness was rooted in the "melancholy humor (black bile)." To the contrary, the field of academic "psychiatry" underwent significant development from the crude empiricism of the early part of the century, through the rediscovery of Galenic medicine and the rising focus on melancholy, to sophisticated "firsthand, eyewitness case histories" (179) by the end of the century. The chapter on insanity and the law centers on a masterful rereading of a standard figure in histories of psychiatry: Johann Weyer. Weyer is famous for his early defense of witches as mentally disturbed. Midelfort shows that Weyer's ideas on witchcraft, which forced jurists to begin considering medical testimony in such cases, had a broader, hitherto unconsidered, impact on the law. This was in the area of the insanity defense. Contrary to common assumptions, the insanity defense, Midelfort shows, was not specific to the modern era. Its origins lay in Roman law. Sporadically applied in the late Middle Ages and fifteenth century, the insanity defense was "rema[d]e ... along medical lines" (217) in the sixteenth century. "[Medical] language and medical consultation entered the law of insanity" (223) as jurists adopted the discursive terms Weyer had developed in the witchcraft controversy.
Midelfort's study is a tour de force of erudition, whose treatment of early-modern madness (in scope and depth) is unmatched in its field. The theoretical stance of the work, however, is problematic. It is one thing to reject, on both theoretical and empirical grounds, the simplifications of "the Foucaultian perspective." It is quite another thing to conclude that issues of "power" are irrelevant to the study of madness. Midelfort is correct to take the traumas of the mad seriously. But those "real" mental afflictions were not only products of a particular culture (as he shows). The power dynamics and conflicts of families, communities, and other institutional contexts were central to both the naming and experience of madness. Despite the book's introductory discussion, the relationship between ideology/image and reality/experience of madness remain undertheorized. This gives rise to some unresolved contradictions. Talk of hospital "cure rates" (What exactly was being cured? An illness? Socially abnormal beh avior? The trauma of earlier abuse and poverty?) seems to belong in a different book from one that elsewhere analyzes madness as "idiom" and "language." Midelfort rejects a gender analysis because he found relative "gender equity" in diagnostic statistics. This misses the point. Whatever the numbers, the section on demonic possession in particular cries out for such analysis. These problems, however, should not detract from the enormous achievement of the study, which is sure to become the standard work in its field.
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|Publication:||Journal of Social History|
|Article Type:||Book Review|
|Date:||Sep 22, 2000|
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