SOURCE: "Shakespeare's Psychiatry—And After," in Shakespeare Quarterly, Vol. X, No. 3, Summer, 1959, pp. 335-52.

[In the following essay originally presented at the Folger Shakespeare Library in 1958, Overholser discusses how Shakespeare's characterizations of mental illness were informed by such aspects of the Renaissance worldview as astrology, witchcraft, and the bodily humors.]

We live in an age of psychology. Daily we read of mental mechanisms, of complexes, of the unconscious, of feelings of inferiority, of Freud and Jung, of psychosomatic medicine and of "tranquilizers". There is a growing public appreciation of the facts relating to mental disorder and to normal mental functioning, while the care of the mentally ill in hospitals and clinics receives much attention from legislative bodies and the general public. Today the mentally ill are looked upon as treatable, as sick, not of their own fault, and they are viewed with vastly greater compassion than was the case even seventy-five years ago.

In all ages men have been interested in human behavior and motivations, and have attempted in one way or another to explain mental peculiarities. We flatter our-selves that we understand much more about the vagaries of human behavior than we did even a quarter of a century ago, but there certainly are still many gaps in our knowledge. If with all our present understanding of psychology, of physiology and anatomy, of the effects of environment, early nurture and heredity, we still have much to learn, what should we expect of the attitudes and knowledge in the time of Shakespeare, now nearly 400 years ago? Just as today, there were then generally held beliefs on the nature, the causation and the treatment of mental disorder. It seems appropriate on the occasion of this, the anniversary of the birth of the great dramatist, to review some of the notions that were prevalent in his day and that, like everything else which was of common knowledge then, were familiar to him. In Elizabethan times there was, of course, no such word as "psychiatry", and the related word "psychology" was invented by a German only in the latter part of Shakespeare's life (1590). The word "psychiatry" so far has been traced back to 1817, but it did not gain common currency until the close of World War I.

There is no question that in Shakespeare's time, as in all periods of human history, there were persons who behaved in such a peculiar manner that they were considered to be abnormal. Some of the conditions were looked upon as proper subjects for treatment by the physician; whereas others, particularly those thought to be due to demoniacal possession, were held to fall within the domain of the clergy. Various terms were applied to the victims of mental illness. They were referred to as maniacs, as melancholics, as suffering from phrenitis, frenzy, lunacy or demoniacal possession. In viewing Shakespeare's delineations of madness and folly we must try to view them through the eyes of the medicine of that period. It is some of the medical ideas prevalent in his day that I [will present in this essay]. As a preliminary warning against the "contemporization" of history we may quote from Dr. Robert Willis, the translator of the works of Harvey:¹ "The interpretation which successive generations of men give to a passage in a writer some century or two old is very apt to be in consonance with the state of knowledge at the time, in harmony with the prevailing ideas of the day; and doubtless, often differs signally from the meaning that was in the mind of the man who composed it. The world saw nothing of the circulation of the blood in Servetus, Columbus, Caesalpinus or Shakespeare until after William Harvey had taught and written." Let us, then, try to assume for the nonce an Elizabethan state of mind and knowledge.

One branch of knowledge in Shakespeare's time had to do with astrology, that is, the influence of the planets upon human affairs.² The belief that the heavenly bodies influenced the lives of men and women is nothing new. It has a history—one to which there is no parallel—of 6000 years, and was held in Mesopotamia, India, China, ancient Greece, and in all of Europe during the Middle Ages and the Renaissance. Indeed, to the Elizabethan such a belief was entirely logical. The effects of the sun in furnishing light and warmth to the earth were manifest to all, and the waxing and waning of the moon, and the influence of that satellite upon the tides were familiar. Why, then, should not the other planets have an effect upon the earth and its inhabitants? In the philosophy of the time, the macrocosm, or universe, was inextricably linked with the microcosm, man. Even today, booklets purporting to give the horoscope of the curious purchaser based upon the sign of the zodiac under which he was born, are readily obtained, and in every large city one or more astrologers are listed in the telephone directory. In Shakespeare's day belief in astrology was widespread, and although a few writers such as Bacon had attacked astrologers they had done it on the basis of the trickery of the practitioners rather than upon the basic truth or falsity of the alleged science. The conjunction and the opposition of the planets at the time of a man's birth influenced the proportions of the humors which were found in his body, and therefore had to do with his temperament or "complexion"—choleric, sanguine, phlegmatic or melancholic. Indeed, the course of a man's life and his death were influenced by the stars, and could be predicted. Chaucer, for example, says:

For in the sterres, clerer than is glas,
Is writen, god wot, who-so coude it rede,
The deeth of every man, withouten drede
… but mennes wittes been so dulle,
That no wight can wel rede it atte fulle.³

Burton, author of The Anatomy of Melancholy, was said to be "an exact calculator of nativities", and reputedly predicted the date of his death by his horoscope. The planet Saturn, for instance, was looked upon as malign and as tending to cause an excess of black bile, thus producing melancholy. Most of the arguments that were alleged against astrology were theological in nature, but obviously the whole doctrine could hardly be refuted as long as the geocentric astronomy of Ptolemy held sway. It is interesting to note that the sun and the moon were numbered with the other five planets (Saturn, Jupiter, Mars, Venus, and Mercury).

The personal physician to Henry VIII and Elizabeth I, Thomas Vicary,⁴ believed in the influence of the moon and stars on the organs, and Dariot,⁵ another physician, wrote a volume on astrology. Elizabeth I, likewise, retained as one of her advisers John Dee, a notorious astrologer, and apparently was much guided by his advice. Astrology purported to teach the Elizabethan to know his friends and enemies, to prepare him for the future, and indeed to answer every question. Not only could astrology predict the success in life of individuals, but the planets were thought to have much to do with the proper times for bleeding, for gathering medicinal herbs, or for preparing the soil for planting. Chaucer speaks of the Doctor of Physic among his Canterbury pilgrims who was "grounded in astronomye" and "wel coude …fortunen the ascendent of his images for his pacient." It was true in the time of Shakespeare as well that astrology played an important part in the training of the physician; the balance of the humors, the outcome of the disease, and the nature of the herbs to be used in treatment were influenced by the planet under which the patient was born. Burton⁶ quotes Paracelsus as opining that a physician without the knowledge of stars cannot "either understand the cause or cure of any disease, either of this, or gout, nor so much as toothache; except he see the peculiar geniture and scheme of the party affected." He adds that "the constellation alone many times produceth melancholy, all other causes set apart." He gives instance "in lunatic persons that are deprived of their wits by the moon's motion", but adds, however, that the stars "do but include and that so gently, that if we will be ruled by reason they have no power over us; but if we follow our own nature and be led by sense they do as much in us as in brute beasts and we are no better." Sir Thomas Browne, the eminent physician, warned, "Do not reject or condemn a sober and regulated Astrology; there is more truth therein than in astrologers—; we deny not the influence of the Stars."⁷

Burton and Browne wrote soon after Shakespeare's death, although their views were those in vogue earlier; for example, Boorde⁸ speaks of "a lunatic which will be ravished of his wits once a moon, for as the moon doth change and is variable so be those persons mutable and not constant witted." Again, Vicary says, "Also the brain hath this property that it moveth and followeth the moving of the moon; for in the waxing of the moon the brain followeth upwards; and in the wane of the moon the brain descendeth downwards and vanisheth in substance of virtue, …and this is proved in men that be lunatic or mad …and also in men that be epulentic or having the falling sickness, that be most grieved in the beginning of the new moon and the latter quarter of the moon" (p. 17). It was generally believed, then, that the phases of the moon had much to do with mental illness, perhaps in causation but certainly in aggravation and amelioration. Webster, in his Duchess of Malfi, for instance, says, "Madmen act their gambols to the full of the moon."

Shakespeare was familiar with the terms "lunacy" and "lunatic" and with these other notions concerning the astrological influence upon behavior. Indeed, he makes over one hundred astrological allusions in his plays and sonnets, although he does not once use the word "astrology"; he uses instead "astronomy" consistently. Whether or not he believed in astrology is, however, an academic question. At any rate, we may be sure that Shakespeare's listeners were familiar with astrological beliefs, and that mention of such beliefs struck a responsive chord. For Shakespeare, says Wedel, "astrology was principally a convenient source for figures of speech".⁹

The influence of the planets, then, was considered to be one of the factors in what passed for psychiatric etiology in the Elizabethan period. Another factor was the supernatural one exemplified in witchcraft.

In Shakespeare's day the belief in witchcraft was universal, not only in England and Scotland, but on the Continent.¹⁰ Indeed, the excesses of the witch hunters in England and Scotland were relatively mild compared with the savagery exhibited in France and Germany. The belief in the power of the supernatural and its mediation by human beings stems from Scriptural days; it was thought that to deny witchcraft was practically to be an atheist. By the time of Henry VIII witchcraft, formerly punished, usually with penance, by the ecclesiastical courts, had been taken under the jurisdiction of the civil courts, and those convicted of witchcraft were treated often by execution as criminals. In 1563 under Elizabeth I a statute was enacted decreeing imprisonment for the first and death for the second offense of sorcery or any damage to property or persons by means of witchcraft; by the time of James I, in 1604, a still more rigorous law was passed. Estimates vary as to the number of persons executed on charges of practicing witchcraft; in the time of James I nearly half of all persons accused of witchcraft were hanged, and the numbers were in the thousands. Indeed, Matthew Hopkins, the "witch-finder", who poetically was himself hanged in 1647, alone caused the death of over 4000 witches! Such trials and executions were far from uncommon during Shakespeare's lifetime and for a long period following. This belief in the power of witches to do evil had a bearing, inter alia, on the interpretation of mental symptoms.

The witch, or less often the wizard, was in a compact with the devil, had power to evoke the devil and various spirits and through their power to cause damage, illness, and death. Glanvil says, "A witch is one who can do or seems to do strange things beyond the known power of art and ordinary nature, by virtue of a confederation with evil spirits. The strange things are really performed and are not all impostures and delusions."¹¹ Whatever baffled the physician in the line of illness was conveniently ascribed to witchcraft, just as today we hear of bacteria, viruses, allergies and "psychosomatic" illness. Many physical complaints such as sudden illnesses were laid to this cause, and fits, with or without loss of consciousness, were thought to be almost characteristic of bewitchment.¹² Some of the alleged victims vomited pins and nails, and there was much speculation as to how these foreign bodies could be introduced into the body of the subject. Actually, the fits, the vomiting of the pins, and the rest were largely due to an hysterical desire for attention by the highly suggestible, or the result of direct imposture. Not only were human beings the object of the witches' machinations; animals sickened and died, storms were brewed, fires were caused. The witches could summon spirits who in the form of succubi and incubi had carnal relations with humans, or could cause impotence, sterility or abortion. Witches, too, could bring about apparitions, could leave the room through a keyhole and go to distant places, or by the use of ointments make themselves invisible. The idea of the Witches' Sabbath was much more common on the Continent than in England, but many strange tales were told by witches in their alleged "confessions"; that they had attended revelries at which they had sexual relations with devils and perhaps even engaged in cannibalistic activities. These "confessions", as we read them today, are obviously the expression of delusions entertained by psychotic persons or statements extorted by severe torture. In short, almost any evil was attributed to the activities of these witches through their confederacy with the devil.

The modus operandi of bewitching was explained by Sir (Dr.) Thomas Browne, one of the best known physicians in the Stuart period, during a trial of witches in 1665:

… That the devil …did work upon the bodies of men and women upon a natural foundation, (that is) to stir up and excite such humors superabounding in their bodies to a great excess, whereby he did in an extraordinary manner afflict them with such distempers as their bodies were most subject to …these swooning fits were natural, and nothing else but that they call the mother [hysteria], but only heightened to a great excess by the subtility of the devil, cooperating with the malice of those which we term witches, at whose instance he doth these villainies.¹³

Another type of difficulty was supposedly caused by the witches, namely, the form of mental illness or madness known as demoniacal possession. King James I, in his Demonology, said,

They [the witches], can make folks to become phrenetic or maniac, which likewise is very possible to their master to do, since they are but natural sicknesses. And likewise they can make some to be possessed with spirits and so to become very demoniacs; and this last sort is very possible likewise to the devil their master to do, since he may easily send his own angels to trouble in what form he pleases any whom God will permit him so to use.¹⁴

One of the four general types of madness was called demoniacus, which Boorde says, in his Breviary of Health, is caused by the possession of the devil and is "worse than the maniac". He tells of a German woman who was brought to Rome while he was there and who was exorcised at St. Peter's. He commented that she must do penance or she will have eternal punishment and adds, as to the demoniacs, that "No man can help them but God and the King."¹⁵ If they did not respond to exorcism and prayer they were likely to be subjected to torture and imprisonment. It seems likely that when Shakespeare used such expressions as "He is sure possessed, Madam" (Twelfth Night) or "How long hath this possession held the man?" (Comedy of Errors), or "For nature so preposterously to err sans witchcraft could not be" (Othello), he was using something more than a mere figure of speech. We may note, too, that the witches in Macbeth have beards and disappear suddenly—two marks of the true witch.

Many volumes have been written on witchcraft in old England and new, as well as on the Continent, but time does not permit a full discussion of this interesting and tragic popular delusion. We should add, however, that there were those who spoke out against this belief. One of the most powerful of these was Johannes Weyer of Germany, a student of Henry Cornelius Agrippa.¹⁶ Reginald Scot,¹⁷ in England, based his attack on witchcraft largely upon Weyer's writings. Neither Weyer nor Scot, nor the few others who dared to speak out against witchcraft, however, denied the existence of spirits or the possibility that human being could make compacts with spirits. Sir Thomas Browne said in his Religio Medici.

For my part I have ever believed and do now know that there are witches. They that doubt of these do not only deny them but spirits and are obliquely and upon consequence a sort not of infidels but atheists.… I could believe that spirits use with men the act of carnality and that in both sexes.… I hold that the devil doth really possess some men, the spirit of melancholy others, the spirit of delusion others.¹⁸

The Malleus Maleficarum¹⁹ (1490), which may be referred to as the Bible of the witch-hunters, devoted a whole chapter to the method by which devils through the operations of witches sometimes actually possess men. Zilboorg has well said that if in reading this volume we substituted the word "patient" for "witch" we should have a veritable textbook of psychopathology.

The witch mania, partly under the influence of physicians like Cotta²⁰ and clergymen like Bekker²¹ and Hutchinson,²² gradually subsided about a century after Shakespeare, the last execution, indeed, occurring in 1684 in England. There was an execution in Scotland in 1711 and in 1712 a conviction in England which, however, resulted in a pardon. Finally in 1736 prosecutions for witchcraft were forbidden by an act of Parliament. This act, interestingly enough, is still in force, and as recently as 1944 [R. v. Duncan, 2 (1944) All E. R. 220] a conviction was had under it on the charge of "pretence to conjuration contrary to the Witchcraft Act". The court pointed out that the law does not refer to conjuration of evil spirits only but that it is the pretence which is the gist of the crime. At the time this Witchcraft Act was passed it may be noted that John Wesley, among others, lamented the decadence of a belief in witches. Indeed, he thought that giving up this belief was almost equivalent to giving up the Bible itself!

Passing from this topic we may say in summary that belief in witchcraft, like a belief in astrology, was prevalent in the time of Shakespeare; it certainly affected the interpretation of mental phenomena by the public, and very likely as well by Shakespeare himself.

So far we have considered what may be termed the extraneous influences which played upon man and influenced or governed his behavior and, indeed, his destiny. What of the anatomical and physiological beliefs of the time? How did the human organism function? Essentially, the beliefs were those which had been handed down from Galen, about 200 A.D. During the whole of the Dark Ages and of the Middle Ages his teachings had acquired almost the standing of a religious dogma, and to doubt what Galen had said about the structure or the function of the body or the treatment of its diseases was almost tantamount to heresy. Some brave souls, however, had dared to investigate and to doubt. Vesalius, by his careful dissections, had disproved many of the anatomical errors of Galen in the same year (1543), indeed, as Copernicus had begun the demolition of the geocentric basis of the existing astronomy. Harvey, the discoverer of the circulation of the blood, thought it wise to have the first edition of his work (1628) published in Germany rather than in England. He may have remembered what happened to Galileo and been mindful of the fact that Servetus, the discoverer of the pulmonic circulation, had been burned at the stake by Calvin's orders, even though it was actually for his theological views rather than on those on physiology!

The fundamentals of physiology, as they were still known in the time of Shakespeare, were briefly as follows.²³ The basic principle of life was known as the spirit or pneuma, and was drawn from the world spirit in the act of breathing, entering through the trachea into the lungs and then by way of what we now call the pulmonic vein to the left ventricle. Food was carried as chyle to the liver (the "shop of blood", as Lemnius²⁴ calls it) by the portal vein. It was there converted to blood and endowed in some unexplained way with natural spirit; this bestowed the power of growth and nutrition. Part of the bstrlood was supposed to go to the right side of the heart, where it gave off its impurities by way of what we now call the pulmonic artery, these being exhaled through the lungs. The venous blood, thus continually purified, ebbed to and fro in the veins for nutrition. A small part of this blood passed through invisible pores into the left ventricle, where it was mixed with air, thus becoming arterial blood and charged with vital spirit. This moved to and fro in the arteries, giving the function to the organs. If it reached the brain it became charged with the third kind of spirit, the animal spirit. This was carried from the brain through the nerves (which were thought to be hollow), and initiated the higher functions such as motion and sensation. According to the generally accepted scheme of things, there were four elements, namely, earth, cold and dry, water, cold and moist, air, hot and moist, and fire, hot and dry. These in turn were influenced by the humors, also four in number, these being blood, choler or yellow bile, phlegm, and black bile. Depending upon the mixtures of the elements and the proportion of the humors in the body there were various complexions or temperaments named after the humors, the sanguine, the phlegmatic, the choleric and the melancholic—words which are in common speech today as indicating the general temperament of individuals. If there was an equal counterpoise and balance of the elements and the humors the person was said to be "well-tempered", but if one predominated then he was "ill-tempered". Again, if the humors were in good balance the individual was "in good humor". It was this balance of the elements that Shakespeare had in mind when he made Antony say of Brutus:

His life was gentle; and the elements
So mixed in him, that Nature might stand up,
And say to all the world, 'This was a man!'

Burton, in his Anatomy of Melancholy, defines a humor as "a liquid or fluent part of the body comprehended in it for the preservation of it; and is either innate or born with us, or adventitious and acquisite" (p. 128). It is of some interest that within the last few years or so there has been a recurrence of the use of this term by the neurophysiologists, who now speak of neuro-humors.

Depending upon the predominance of one humor or another there were characteristic physical and psychological types. The sanguine man, for example, was handsome physically, had a happy outlook on life and considerable charm of personality. He was also, however, subject to violent lusts and passions and ran the risk of unrequited love, which might then give him melancholy. The choleric man, particularly the one born under Mars, was violent and shameless or else deceitful and conspiring; like Cassius in Julius Caesar, he might have a "lean and hungry look". The phlegmatic type was fond of luxury, and if he had been born under the moon might be a fool and a coward. The melancholy type was the one of which we read the most in Elizabethan literature. The first book by an English physician on mental diseases, Timothy Bright's Treatise on Melancholy, first published in 1586, which was probably well known to Shakespeare, was devoted entirely to the subject. Robert Burton's Anatomy of Melancholy (1621), one of the famous books of the English language, dealt exhaustively with the topic. Of Burton's work Sir William Osler said, "[It] is a great medical treatise, orderly in arrangement, serious in purpose, and weighty beyond belief with authorities."²⁵ Although it did not appear until five years after shakespeare's death, it is an omnium gatherum of the literature on the topic back to classical times; it certainly represents most of the views on mental disorder which prevailed in the Elizabethan period.

The melancholic man was supposed to be lean, with hard skin and dusky color, subject to various physical diseases and numerous psychological hazards. In general he slept badly, had fearful dreams, was timorous, full of fear, doubt, and distrust and one whom "nothing can please but only discontentment". Walkington speaks of the man of melancholic complexion as either God or demon and adds, "He is like a huge vessel on the rolling sea. It is either hoist up to the ridge of a main billow or else hurried down to the bottom of the sea valley"²⁶—a very suggestive passage, indicating that even in Shakespeare's day it was recognized that the alternating elation and depression of what today we call the manic-depressive temperament were common. Du Laurens said that melancholy men are witty, since "the humor causeth the divine ravishment or enthusiasm which stirreth men up to play the philosopher, poet, and also to prophesy".²⁷ It was generally believed also that the melancholy individual was particularly subject to demonic influence. Juan Huarte tells us that Aristotle says that all men who signalize themselves in science were melancholic; in his opinion the melancholic humor is the cause of integrity and constancy. This humor, which is hot and dry, he says, "gives us courage, pride, liberality, audacity, cheerfulness, and pleasantness".²⁸ Thus, it seems that the person possessed of what was termed "natural melancholy" had some very useful traits. Perhaps it was for this reason that we read in Elizabethan literature much more about this type of person than any other. Indeed Professor Lawrence Babb has written a comprehensive study entitled, The Elizabethan Malady²⁹ concerning the way natural melancholy was treated in the literature of the time.

There were cases, however, according to the writers, in which melancholy became "unnatural", that is, a form of mental illness, along with mania, phrenitis (the type of mental illness with fever, or as we should say today, delirium), demoniacal possession, and lunacy (the type occurring once in a moon). Du Laurens speaks of dotage, which was the general term for mental illness. "This", he says, "occurs when some of the principal faculties of the mind, as imagination or reason, is corrupted.… All melancholy persons have their imagination troubled." This condition is usually without fever because the humor is dry. If the humor becomes shut up in the ventricles of the brain, however, it causes falling sickness (epilepsy). In the melancholy dotage without fever the patient has for his ordinary companions "fear and sadness without any apparent occasion.… Dotage with fever if continued is called frenzy through inflammation of the brain and its membranes or of the muscles called diaphragma or phrenos" (p. 87). Under certain circumstances this or any of the other humors might become overheated, burned, or in the Elizabethan term, "adust".

Of the types of mental disorder not clearly due to extraneous influences, particularly of a supernatural nature, it was generally agreed by the writers of Shakespeare's time that the brain was at fault in cases of madness. Shakespeare, indeed, uses the phrase "brain-sick" several times, as in referring to "the bedlam brain-sick duchess" (2 Henry VI).

Another physical symptom of madness was thought to be the pulse, which was irregular or rapid (as it might well be at least in an excited patient). It is to this that Hamlet refers, for instance, when he says, "my pulse, as yours, doth temperately keep time", in attempting to prove that he is not truly mad. In other words, the Elizabethans interpreted mental illness largely on an organic basis. They described three cells of the brain, or ventricles, the anterior one being the seat of imagination, the middle one of reason, and the posterior one of memory. Although there a certain amount of compartmentalization was supposed, it is interesting that Huarte at least stated that all three faculties are united in each ventricle, thus anticipating the doctrine of the unity of the organism. The fourth ventricle was said to digest and refine the vital spirits and turn them into animal spirits, thus enabling them to give sense and motion to all parts of the body. Huarte makes the comment that it is fortunate that the liver is so far from the brain, "lest by the noise of the boiling and concoction of the food and obscurity and clouds cast on the animal spirits by the vapors, the rational soul should be discomposed in reasoning" (p. 130).

The causes of unnatural melancholy were numerous and various. Batman upon Bartholome, for example, lists "melancholy meats, strong wine that burneth the humors, passions of the soul, great study, the biting of a woode hounde [mad dog] or some other venomous beast, corrupt and pestilent air and corrupt humor."³⁰. Variuos types were described too, such as head melancholy, love melancholy, religious melancholy, widows' and nuns' melancholy, and the windy (flatulent) melancholy or hypochondriasis. As for the symptoms, Boorde tells us that the sickness is full of fantasies, "Thinking to hear or see. The patient may think himself God or that he is about to be damned" (fo. 78). Other symptoms described are suspicion, watchfulness, sighing, restlessness, and fearful dreams. The patient shuns the light, "for humors are contrary to light". The picture of the unnatural melancholy is, indeed, not unlike the clinical picture seen in depressions with a certain amount of agitation; then, as now, the danger of suicide was recognized. We hear more of melancholy than of the other types of mental illness in the Elizabethan literature, and relatively few descriptions of the actions of the maniac, of the phrenetic and of the demoniac are found. References to lunatics are found, particularly in connection with Bedlam, of which we shall speak later. The outlook for these mental conditions was rather guarded. Boorde, for instance, says that "madness may come by nature and kind and then is incurable, or else it may come by great fear or great study". Presumably, in the latter type the outlook is better. He continues: "Frenzy is with fever, so is not mania or madness. [Madness] comes of a corrupt blood in the head or of a bilious blood intrused in the head, or weakness of the brain which letteth [prevents] a man to sleep or turning upso down of the head which doth make the madness" (fo. 65).

Many of the milder cases were cared for outside of Bedlam, usually in the home, and the books are full of descriptions of the various sorts of treatment which should be given. First of all, since the condition was due to a perturbation of the humors, it was important that the patient should be relieved of them as much as possible. Consequently, we find bloodletting frequently prescribed, as well as various purges upward (that is, emetics) and downward. Burton says that it is the common practice of some men to go first to a witch and then to a physician. "Thus", he says, "if they cannot bend Heaven they will try hell." "If a disease is caused by incantation", he says, "it must be cured by it" (p. 383), although, he adds that others object to this statement. He speaks likewise of exorcisms, fire, suffum-igation, lights, cutting the air with swords, and of herbs and odors. Since the external senses are doors for impressions from the outer world, a pleasant house and apparel, music and pleasant sights, good studies and exercises, were recommended.

Bright³¹ speaks of ornamentation, of precious stones "which have a virtue against vain fears and baseness of courage", such as the carbuncle, chalcedony, ruby, and turquoise. He adds, "As for furious melancholy, I leave it to be cured as disease and sickness." Diet was considered to be important, since what was taken into the stomach affected the "decoction of the humors in the liver". Broths and syrups, for example, would moisten the humors. Various kinds of exercise were also prescribed.

As for the various remedies which were used, they were almost literally legion. Indeed, Burton devotes over forty pages to the topic of medicines. He evidently had some doubt in spite of all of this consideration, for he remarks that "Many an old wife doth more good than our bombast physicians", and again, speaking of the different prescriptions of various authorities he says, "But each man must correct and alter, to show his skill, every opinionative fellow must maintain his own paradox, be it what it will; the Kings rage, the Greeks suffer; they dote, and in the meantime the poor patients pay for their new experiments, the commonalty rue it." Although various precious stones and gold were sometimes used, the greatest emphasis was laid on herbs and simples. Polypharmacy was certainly the rage. Mithridates, electuaries, apozemes, and other compounds contained a huge number of constituents, so many, indeed, that Burton well remarks, "Three hundred simples in a julip, potion, or a little pill, to what end or purpose?" (pp. 563-606, esp. 563 and 571). As an example, consider the recipe for an apozema (decoction) given by Du Laurens:

Take of the roots of bugloss and elecampane, of the rinds of the roots of capers and tamarisk, of everyone an ounce, of the leaves of borage, hops, succory, fumitory, capillus Veneris, crops of thyme and balm, of each a handful, of anise, fennel, and citron seed, of each two drams, of the three cordial flowers, of the flowers, of oranges and epithymum, of each a pugill; boil them all in fountain water, and after you have strained out a pound and a half, put thereto of the syrup of hops two ounces, and as much of the syrup of fumitory, and make thereof an apozeme, clarify it and aromatize it with a dram of the powder of cinnamon or of electuarium de gemmis; it must be taken four mornings together. (P. 159.)

Many of the herbs used have little or no medicinal value, and the names of most of them are strange to us today, such as betony, borage, bugloss, and carduus benedictus. Others, like hops and marigold, are familiar to us in other connections. Black hellebore, recommended by the Greeks, was still in use. Burton remarks, "It was generally so much esteemed of the ancients for this disease among the rest that they sent all such as were crazed, or that doted, to the Anticyrians, …to be purged, where this plant was in abundance to be had. In Strabo's time it was an ordinary voyage; sail to Anticyra, a common proverb, to bid a dizzard or a madman to take hellebore." Another drug mentioned by Burton, although it is not found anywhere in Shakespeare's works, is tobacco, which had been introduced by Sir Walter Raleigh. Says Burton,

Tobacco, divine, rare, superexcellent tobacco, which goes far beyond all their panaceas, potable gold, and philosopher's stones, a sovereign remedy to all diseases. A good vomit, I confess, a virtuous herb if it be well qualified, opportunely taken, and medicinally used, but as it is commonly abused by most men …'tis a plague, a mischief, a violent purger of goods, land, health, hellish, devilish and damned tobacco, the ruin and overthrow of body and soul. (Pp. 577, 579)

Tobacco, or henbane of Peru, is described in Gerard's Herbal and is said to ease migraine and fits of the "mother". Gerard adds, "It purges up and down." One author, de Lancre (1612), accused witches of using tobacco, presumably to facilitate their trances, adding, "it makes their breath and bodies stink".³² With regard to the question of the fits it should be mentioned that the "mother", the matrix or the uterus was thought to move up and down, thus becoming suffocated and causing various symptoms which today we know under the name of hysteria. Shakespeare refers to this condition in King Lear, "Oh, how this mother swells up toward my heart. Hysterica passio! Down, thou climbing sorrow, thy element's below." One other drug is worthy of mention, namely, the mandrake or mandragora. Gerard says that there are many ridiculous tales about this herb, that it is said that when it is pulled from the earth it shrieks and that the roots have the shape of a man or a woman. "It hath drowsy and sleeping powers",³³ he says. Shakespeare has Iago say, for example:

Not poppy nor mandragora
Nor all the drowsy syrups of the world
Shall ever medicine thee to that sweet sleep
Which thou ow'dst yesterday.

As for the results of these drastic medications, statistics are not available. Evidently some patients at least survived!

What of the mentally ill who were so disturbed that they appeared to need institutionalization?³⁴ In Shakespeare's time there stood near the Bishop's Gate without the city wall of London a hospital, or asylum, for the mentally ill. Founded in 1247 as the Priory of St. Mary of Bethlehem, the house had from 1377 on been used for the care, or at least the confinement of mad, lunatic and distracted persons. The name had soon become corrupted from Bethlehem to Bethlem and thence to Bedlam, thus adding a picturesque and vivid word to the language. From the early days the institution was referred to as a hospital, but that fact should not mislead us into picturing it as having any resemblance to one of our modern establishments. The unfortunate people who were sent there were the more obviously deranged, but once they had entered within those walls they were looked upon as objects of scorn and derision. It is of interest as reflecting Shakespeare's humane attitude toward the mentally ill that in contrast with his contemporaries such as Peele and Middleton he rarely used the mentally deranged for comic relief. In employing the fool for comic purposes as he did, he was, of course, following the stage tradition of his times. Furthermore, the fool was a professional, and was often far from being mentally retarded.

In Bedlam the sexes were mingled; no attempts were made at any sort of sanitation, heating, or proper feeding. It was reported in 1631, for example, that the patients had had nothing for days but scraps, and "were like to starve". The inmates were chained and often whipped, kept in dark cells, and used as objects of entertainment for the public, who were allowed to visit for a fee.

Sir Thomas More tells of a man who had been put into Bedlam and afterwards "by beating and correction had gathered his remembrances to come again to himself". When the patient relapsed and made something of a nuisance of himself the Chancellor caused him to be bound to a tree in the street before the whole town, while constables "striked him with rods 'til they waxed weary." More then remarks, "Verily, God be thanked, I hear no harm of him now." Again, in Dekker's play The Honest Whore, one of the characters says, "Yes, forsooth I am one of the implements. I sweep the madmen's rooms and fetch straw for 'em and buy chains to tie 'em and rods to whip 'em. I was a mad wag myself here once but I thank Father Anselmo. He lashed me into my right mind again." This scene is laid in the "Bethlehem Monastery near Milan" but obviously refers to the Bethlehem Hospital. Such treatment as the patients received, then, was a combination of cruelty and systematic neglect. Fortunate, indeed, was the victim who survived. Darkness, it may be added, was considered a cure for frenzy, since as Batman says, "It takes away the imagination that cometh by the sight" (p. 88b).

A reference to the behavior and symptoms of the inmates is found in which Lavater says, "madmen which have utterly lost the use of reason, or are vexed by God's permission with a devil…do marvelous things, talk of many visions and divers other matters. Their sight deceiveth them, insomuch as they mistake one man for another: which thing we see by experience, in Bedlam houses where mad and frantic men are kept."³⁵

Presumably the prevailing treatment of the institutionalized mentally ill was a matter of common knowledge; accordingly we find a number of references in Shakespeare's plays: Rosalind's remark that "Love is merely a madness and deserves as well a dark house and a whip as madmen", Romeo's comment that "He is bound more than a madman", and Pinch's advice that "They must be bound and laid in some dark room".

One of the stock characters in Shakespeare's time was "Tom o' Bedlam". From time to time the governors had to relieve the crowding at Bedlam by discharging patients whose cure was, to say the least, doubtful. Thrown upon the world, homeless and without friends, these patients wandered about the countryside chanting wild ditties and wearing a fantastical dress to attract the notice and the alms of the charitable. Some of their actions are described in Edgar's soliloquy in King Lear thus:

… Bedlam beggars, who with roaring voices,
Strike in their numbed and mortified bare
 arms
Pins, wooden pricks, nails, sprigs of rosemary;
And with this horrible object, from low
 farms …
Sometimes with lunatic bans, sometimes with
 prayers,
Enforce their charity.

Among the half dozen "mad songs" in Percy's Reliques is one entitled, "Old Tom of Bedlam", which starts as follows:

Forth from my sad and darksome cell
Or from the deep abyss of hell
Mad Tom is come into the world again
To see if he can cure his distempered brain.³⁶

That songs of this sort were well known is indicated in a line from Ben Jonson's The Devil is an Ass: "Your best song's Thom o' Bet'lem." In another song with the same title, the subject sings that he has been

In durance soundly caged
In the lordly lofts of Bedlam,
On stubble soft and dainty,
Brave bracelets strong, sweet whips ding
 dong,
With wholesome hunger plenty.³⁷

These patients apparently had some sort of license, or at least were permitted by custom, to go begging, and wore about their necks a great horn. When they came to a house they would blow the horn and then put a stopple in it to contain the drink which might be given to them. This is apparently the reference in King Lear, "Poor Tom, thy horn is dry." So much was the "Bedlam begging" abused that in 1675 the Governors of Bedlam found it necessary to announce that no patients were discharged with a license to beg!³⁸

Bedlam was moved to a new building in 1674, and apparently steps were taken after that time to segregate the sexes. It is doubtful whether very much improvement had come about, however, by the time Hogarth, in the 1730's, was making his etchings of The Rake's Progress. His "Scene in Bedlam" is, of course, familiar to all. The beginning of humane care of the mentally ill in English hospitals dates from the founding of the York Retreat by the Quakers in 1792.

The question naturally arises, how much of astrology, of witchcraft, and of the humoral pathology did Shakespeare himself believe? It is difficult, if not impossible, to speak with finality on this question. He was perhaps the most accurate mirror ever held up to mankind, a keen observer, one who knew human nature, and who depicted it with truth. He was a dramatist, well attuned to the tastes and the knowledge of those who saw and would read his plays. He was, in every way, a man of his time. The general belief in the influence of the planets cannot have left him untouched, and yet it is significant that never once did he use the word "astrology". He introduced witchcraft, witches, and ghosts only on rare occasions. From anything in his writings we cannot estimate the extent to which he believed in the legends of his time.

As for a belief in the humoral pathology, there was no other pathology in his day. Galen's influence was still strong, even though Leonardo had ventured to doubt, and even though Vesalius had published his epoch-making studies of anatomy before Shakespeare's birth. The interesting speculation has been offered that Shakespeare knew something of the rumors of Harvey's work, even though the latter's studies of the circulation of the blood were not published until twelve years after Shakespeare's death. There are one or two references which may be used to bolster this speculation, but it is only speculation nevertheless.

As for mental illness, it seems reasonably clear that he viewed insanity, or madness, as a disease of the brain, due to various causes and possible of cure by medical means. Although he makes reference to the dark room and the chains and the beatings, he nevertheless has the physician in King Lear resort to what today we would call the prolonged sleep treatment for the successful cure of the ailing king. Shakespeare was a humane person, and he treats his mentally deranged characters with sympathy. His depictions of human nature and the struggles of human beings in the face of conflict and stress are vivid, and show a rare understanding of mental mechanisms.

It is interesting too to note that some of the beliefs which prevailed in Shakespeare's time are not entirely dead even today. There are those who still believe in the power of the planets to influence human affairs, and who consult astrologers for advice. As for witch-craft, there are areas of the United States, some of them not far from Washington, where a belief in the power of "hexing" to bring about evil or curative effects on human beings and on animals still flourishes. As for the humors, the word is being used again in neuro-physiology, although, of course, in a somewhat different sense from that which prevailed in the time of Shakespeare. Our everyday speech has been enriched by numerous words and phrases which originally referred to astrology, witchcraft, or the humoral pathology—consider disaster, lucky stars, jovial, mercurial, Saturnine, prestige, glamor, bewitch, choleric, splenetic, phlegmatic, sanguine, and melancholic, to mention only a few.

We have reviewed all too briefly some of the ideas prevalent in Elizabethan and Stuart times relative to the mental functioning, particularly the abnormal, of human beings. In the space of 350 years it might be expected that much has happened in the field of psychiatry, and, indeed, such is the case. Not only that; the progress in very recent years seems to be gaining speed, and to predict what may come about in the next 50 years would need a wise and rash man indeed. As knowledge has increased as to physiology and pathology, the need for reference to supernatural influences has waned. Diseases which were formerly ascribed to witchcraft we now know to be due to infections, new growths, or nutritional disorders. Although Michael Servetus (1553) had described the pulmonic circulation even before Shakespeare's birth and had been burned by order of Calvin for writing the book in which this discovery was announced, it was the revolutionary book of Harvey (1628) on the circulation of the blood that caused the first serious doubts concerning the humoral pathology. A few years later the theories of Harvey were completed by Malpighi's (1661) demonstration of the capillary circulation. The work of Boyle (1660), who demonstrated the weight of air and studied respiration and combustion, gave the coup de grace to the humoral theories, although formal physiology was not developed until the time of Claude Bernard in the middle of the nineteenth century. Later developments in the field of physiology and pathology came with the demonstration of the function of the so-called ductless glands, the study of the effects of the emotions by Cannon of Harvard (1915), and more recently still the studies of the chemistry of the nervous system, which promise to cast much further light on the subjects of neurology and human behavior. In the field of anatomy the phrenological theories of Gall and Spurzheim (1830) gave impetus to modern neurology, with the epoch-making work of Cajal (1900) and his successors on the structure of the nervous system, while the genetic formulations of Mendel (1860) have been applied to some degree to psychiatric problems in recent years. More recently, too, extensive studies have been made on the sociological and anthropological factors in the development of mental disorders.

Regarding the mentally ill, the sort of abuse that was meted out to the poor victims in Bedlam continued until the time of the French Revolution, when the increasing interest in human dignity and the rights of the individual stimulated the work of Chiarugi (1793) in Florence and Pinel (1801) in Paris. In addition to setting up principles of humane care, as did also Tuke at the York Retreat in England, Chiarugi and Pinel established the fact that mental illness is a medical problem rather than a theological or philosophical one. It was Pinel who urged what is known as moral treatment, that is, the application of pleasant surroundings and of kindly humane care, and the use of baths for sedation rather than extensive drugging.

Psychiatry, however, as we know it today, is much more recent than that. It started with Kraepelin (1883), the great German classifier, whose work was amplified by Bleuler and Jung, these latter developing their work on the findings of Sigmund Freud (1895), who in turn had been influenced by Charcot. It was Freud who gave us for the first time a true understanding of the dynamic power of the unconscious, and thus shed much light on the understanding of what the mental patient is attempting to express. It was he too who developed what is now known as psychoanalysis, an important method of psychotherapy, the basic principles of which have permeated in large measure the whole of psychiatry. Freud's work has been even more productive in the treatment of the neuroses, which formerly were as much a terra incognita as the psychoses, but recognized as treatable much later than were the more obvious mental disorders. What today is known as hysteria (in Shakespeare's time as the "mother") and the other neuroses, earlier referred to as the "vapors", for example, are, thanks to Freud, understood and treatable.

In this country psychiatry owes much to the work of Adolf Meyer of Baltimore and to William A. White of Washington, who emphasized the unity of the organism and the close interrelatedness of what we choose to differentiate as mental and somatic. Parallel with the development of psychiatry we have had that of psychology, starting with the experimental psychology of Wundt one hundred years ago and developing into the many-faceted specialty of today. Of particular interest in that field is the displacement of the earlier faculty psychology by the recognition today that mental processes are integrated and that the reason is not independent of the emotions—in deed, that much that passes for reasoning is emotionally motivated.

In the development of psychiatry the pendulum has swung to and fro, from the physical to the psychological and back, both in terms of explanation and of treatment. For many years following Shakespeare, mental peculiarities were looked upon as basically physical; then with the later rise of psychology emphasis was laid upon the psychological aspects. That there are many types with an organic basis is being called to our attention lately with the growing proportion of the elderly in our population. More recently there has been a growing interest in the chemical aspects, and much is being learned from the study of the so-called "tranquilizing" drugs and of the hallucinogenic substances which produce mental symptoms closely mimicking the classical types of certain psychoses. As psychology and psychiatry have developed, they have extended beyond the private practice of clinical psychiatry into other field such as industry, education and the law.

In treatment, substantial progress has been made; one of the most startling triumphs has been the cure of general paresis with malaria and later with penicillin. The newer drugs, too, have been valuable aids to other forms of treatment of the psychoses, such as individual and group psychotherapy; the value of psychotherapy in the neuroses has already been mentioned. With earlier recognition and treatment, and with the growing public understanding and sympathy, the outlook for improvement and cure of mental disorders has been substantially brightened.

There are still, however, many gaps in our knowledge. The relatively recent recognition of this fact by legislative bodies and private foundations has led to the allocation of large sums of money for the support of research into the various aspects—pathological, psychological, social, genetic, and economic—of causation, prevention and treatment. We may safely expect in the near future great advances along these lines. Psychiatry has come far since Shakespeare's day, but the road ahead is still long.

Notes

¹Works of William Harvey, M.D., tr. by Robert Willis (London 1847), p. lxiii.

² See C. A. Mercier, Astrology in Medicine (London 1914); C. Camden, Jr., "Elizabethan Astrological Medicine", Annals of Med. Hist, N. S., II (1930), 217.

³Student's Chaucer, ed. W. W. Skeat, "Tale of the Man of Lawe", 11. 194-203.

⁴ T. Vicary, True Anatomie of the Man's Bodie (London, 1587).

⁵ C. Dariot, Astrologicall Judgement of the Starres (London, 1598).

⁶Anatomy of Melancholy, ed. F. Dell and P. Jordan-Smith (New York, 1927), p. 180. For convenience, this and subsequent quotations are given by pages rather than by part, section, member, etc.

⁷ T. Browne, Pseudodoxia Epidemica (London, 1646), p. 231 (Book IV, ch. 13).

⁸ A. Boorde, Breviary of Healthe (London, 1552), folio 73.

⁹ T. O. Wedel, The Medieval Attitude toward Astrology (New Haven, 1920), p. 156.

¹⁰ A valuable compendium of the vast literature on this subject is by George Lyman Kittredge, Witchcraft in Old and New England (Harvard Univ. Press, 1929). See also

¹¹ J. Glanvil, Sadducismus Triumphatus, or Full and Plain Evidence Concerning Witches and Apparitions (London, 1681), Part II, p. 4.

¹² The following quotation from Dr. Louis B. Wright's volume, Middle Class Culture in Elizabethan England (Chapel Hill, N. C, 1935), p. 582, is à propos:

As the modern reader glibly interprets human conduct in terms of Freud, Jung, or whosoever may be his pet theorist, so the Tudor and Stuart citizen found satisfactory explanations in Bright, Wal kington, Huarte, Charron and other writers who elucidated the always interesting question of the reasons for man's behavior.

¹³ Cobbett's State Trials, VI (London, 1810), 647.

¹⁴Demonology (London, 1597), p. 47.

¹⁵ Boorde, Book 2 (Extravagantes), folios 5 and 7.

¹⁶ J. Weyer, De Praestigiis Daemonum (Basel, 1563).

¹⁷ R. Scot, Discovery of Witchcraft (London, 1584).

¹⁸ T. Browne, Religio Medici, 4th ed. (London, 1656), Sec. 30, p. 64. (1st ed., 1642.)

¹⁹ Transl, by Rev. Montague Summers (London, 1928).

²⁰ J. Cotta, The Triall of Witchcraft (London, 1616).

²¹ B. Bekker, The World Bewitched (tr. from Dutch) (London, 1695); also J. Webster (M.D.), The Displaying of Supposed Witchcraft (London, 1677).

²² F. Hutchinson, Historical Essay on Witchcraft (London, 1720).

²³ Cf. C. Singer, Short History of Medicine (Oxford, 1928).

²⁴ L. Lemnius, Preservation of Health (London, 1576), p. 89.

²⁵Yale Review, N. S., III (1914), 251.

²⁶ T. Walkington, The Optick Glasse of Humours (London, 1607), ch. 12.

²⁷ A. Du Laurens, A discourse of the Preservation of the Sight: of Diseases of Melancholy: of Rheumes and of Old Age, tr. R. Surphlet (London, 1599), p. 85.

²⁸ J. Huarte, Examen de Ingenios, or The Tryall of Wits, tr. Bellamy (London, 1698), pp. 139-140. (Earlier translation by Carew, 1594.)

²⁹ Michigan State College Press, 1951.

³⁰Batman upon Bartholome…De Proprietatibus Rerum (London, 1582), p. 89.

³¹ T. Bright, Treatise of Melancholy, 2nd ed. (London, 1613), p. 319. (1st ed., 1586.)

³² Quoted in S. A. Dickson, Tobacco—Panacea or Precious Bane (New York, 1954), p. 162. The author refers to de Lancre as a "demonographer extraordinary" and persecutor of witches (1612).

³³ J. Gerard, The Herball (London, 1597).

³⁴ See E. G. O'Donoghue, The Story of Bethlehem Hospital from its Foundation in 1247 (New York, 1915), esp. pp. 168 and 107.

³⁵ L. Lavater, Of Ghostes and Spirites Walking by Nyght (London, 1572), p. 13.

³⁶ T. Percy, ed., Reliques of Ancient English Poetry, 3rd ed. (London, 1775), II, 351. The editor comments (p. 350): "It is worth attention, that the English have more songs and ballads on the subject of madness, than any of their neighbours. Whether it is that we are more liable to this calamity than other nations, or whether our native gloominess hath peculiarly recommended subjects of this cast to our writers, the fact is incontestable."

³⁷Oxford Book of Light Verse (1938), p. 112 (said to date from 1615 in its original form).

³⁸ O'Donoghue, p. 138.