‘out of their mind’.
The re-ascription of madness as, at bottom, a bodily disorder was systematized in the teachings of Herman Boerhaave. In true Cartesian manner, that highly influential Leiden professor and his many disciples, notably Albrecht von Haller, maintained that the essential symptoms of madness lay in beliefs which, though lacking objective existence, were mistaken for reality. These delusions had a physical source—melancholy for instance resulted from the ‘dissipation’ (evaporation) of the most volatile parts of the blood and the thickening of its ‘black, fat and earthy’ residue, causing lethargy. Friedrich Hoffmann, professor of medicineat Halle, already discussed in Chapter 2 , developed a comparable solidist psychopathology based on the vessels, fibres, and pores.
With this somatic turn, the nervous system became the focal point of enquiry and explanation. Followers of Pitcairn, in particular his fellow Scot George Cheyne, speculated about the sympathy of the vascular and nervous systems with the brain. Imaging of the nerves as hollow pipes or as wires conveying waves or electrical impulses produced theories in which disordered thoughts and mood-swings were put down to some defect of the digestive and nervous systems, which led to slackness, excessive tension, or obstruction. The fervent Newtonian Nicholas Robinson maintained in his A New System of the Spleen (1729) that it was the nerve fibres which controlled behaviour; pathological laxity in them was the primary cause of melancholia. ‘Every change of the Mind’, he insisted, ‘indicates a Change in the Bodily Organs. ’ Far from being a matter of malingering on the one hand or ‘imaginary Whims and Fancies’ on the other, insanity was thus a genuine malady, rooted in ‘the real, mechanical Affections of Matter and Motion’.
In the New World, Benjamin Rush of Philadelphia, the physician officially acknowledged by the American Psychiatric Association as the ‘father of American psychiatry’, held that practically all mental disorders were due to vitiated blood. His systematic remedy was bloodletting.
The psychological turn
After 1750 a theoretical transformation came about, owing in part to the growing uptake of those philosophical theories of sensation and perception promoted by the empiricist philosopher John Locke and furthered by the philosophe Condillac. Replacing Cartesian innate ideas with a model of the mind as originally a blank sheet of paper, John Locke, as we have seen, had suggested in his Essay on Human Understanding (1690) that madness was due to faulty associations in the processes whereby sense data were transformed into ‘ideas’. Lockean (mis)-association of ideas became central to new thinking about madness, above all in Britain but also in France.
Lockean thinking was then medicalized in part through William Cullen, doyen of the flourishing medical school set up in 1726 at Edinburgh University, who produced a more psychological paradigm of insanity. Basically imputing madness to excessive irritation of the nerves, Cullen held that the precipitating cause of derangement lay in acute cerebral activity. Insanity ( vesania ) was a nervous disorder, which arose when there was ‘some inequality in the excitement of the brain’, and he coined the term ‘neurosis’ to denote any illness consequent upon such a disorder of the nervous system (by Freud’s day, of course, the meaning of ‘neurosis’ had utterly changed). Yet, within this somatic model, insanity was also for Cullen an ‘unusual and commonly hurried association of ideas’, leading to ‘false judgement’ and producing ‘disproportionate emotions’—in other words, it was a mental disorder, albeit one grounded in dynamic neurophysiology. The psychological inspiration for this came from Cullen’s friend, the philosopher David Hume, who held Lockean sense impressions and associations of ideas fundamental to all intellectual operations.
The re-ascription of madness as, at bottom, a bodily disorder was systematized in the teachings of Herman Boerhaave. In true Cartesian manner, that highly influential Leiden professor and his many disciples, notably Albrecht von Haller, maintained that the essential symptoms of madness lay in beliefs which, though lacking objective existence, were mistaken for reality. These delusions had a physical source—melancholy for instance resulted from the ‘dissipation’ (evaporation) of the most volatile parts of the blood and the thickening of its ‘black, fat and earthy’ residue, causing lethargy. Friedrich Hoffmann, professor of medicineat Halle, already discussed in Chapter 2 , developed a comparable solidist psychopathology based on the vessels, fibres, and pores.
With this somatic turn, the nervous system became the focal point of enquiry and explanation. Followers of Pitcairn, in particular his fellow Scot George Cheyne, speculated about the sympathy of the vascular and nervous systems with the brain. Imaging of the nerves as hollow pipes or as wires conveying waves or electrical impulses produced theories in which disordered thoughts and mood-swings were put down to some defect of the digestive and nervous systems, which led to slackness, excessive tension, or obstruction. The fervent Newtonian Nicholas Robinson maintained in his A New System of the Spleen (1729) that it was the nerve fibres which controlled behaviour; pathological laxity in them was the primary cause of melancholia. ‘Every change of the Mind’, he insisted, ‘indicates a Change in the Bodily Organs. ’ Far from being a matter of malingering on the one hand or ‘imaginary Whims and Fancies’ on the other, insanity was thus a genuine malady, rooted in ‘the real, mechanical Affections of Matter and Motion’.
In the New World, Benjamin Rush of Philadelphia, the physician officially acknowledged by the American Psychiatric Association as the ‘father of American psychiatry’, held that practically all mental disorders were due to vitiated blood. His systematic remedy was bloodletting.
The psychological turn
After 1750 a theoretical transformation came about, owing in part to the growing uptake of those philosophical theories of sensation and perception promoted by the empiricist philosopher John Locke and furthered by the philosophe Condillac. Replacing Cartesian innate ideas with a model of the mind as originally a blank sheet of paper, John Locke, as we have seen, had suggested in his Essay on Human Understanding (1690) that madness was due to faulty associations in the processes whereby sense data were transformed into ‘ideas’. Lockean (mis)-association of ideas became central to new thinking about madness, above all in Britain but also in France.
Lockean thinking was then medicalized in part through William Cullen, doyen of the flourishing medical school set up in 1726 at Edinburgh University, who produced a more psychological paradigm of insanity. Basically imputing madness to excessive irritation of the nerves, Cullen held that the precipitating cause of derangement lay in acute cerebral activity. Insanity ( vesania ) was a nervous disorder, which arose when there was ‘some inequality in the excitement of the brain’, and he coined the term ‘neurosis’ to denote any illness consequent upon such a disorder of the nervous system (by Freud’s day, of course, the meaning of ‘neurosis’ had utterly changed). Yet, within this somatic model, insanity was also for Cullen an ‘unusual and commonly hurried association of ideas’, leading to ‘false judgement’ and producing ‘disproportionate emotions’—in other words, it was a mental disorder, albeit one grounded in dynamic neurophysiology. The psychological inspiration for this came from Cullen’s friend, the philosopher David Hume, who held Lockean sense impressions and associations of ideas fundamental to all intellectual operations.
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