Georgian “Madness” and Melancholy

philippe_pinel_a_la_salpetriere_

Dr. Philippe Pinel at the Salpêtrière, 1795
by Tony Robert-Fleury

In the eighteenth century, “madness” was used as a catch-all description for just about any type of mental illness, from depression to full-blown psychosis and mania. The causes were much debated, not just by medical men either. Some saw madness as a physical problem (an imbalance of the humours), others as a psychological problem (a response to grief or stress), a moral problem (a breakdown in behaviour caused by licentious excess, drink or drugs), or even a spiritual one (brought on by excessive religious zeal or occasioned by demonic possession).

Depressive or Genius?

Depression, or melancholia, was especially common amongst the better educated. Indeed, foreigners sometimes referred to it as ’The English Disease’. Yet, following Aristotle, it could also be viewed as conferring a mark of special genius or imaginative power.

The name comes from the idea that it was caused by an excess of black bile in the body. In the Aristotelian view, such an excess produced a tendency towards suspicion and fear of others, coupled with a general darkness of outlook and misanthropic view of the world. Yet melancholics were also credited with strong intellectual powers, acute perception, a powerful critical faculty and great expressiveness in communication. Indeed, you could hardly be accepted as a great artist or poet unless you were also somewhat melancholic in your personality.

Could Madness be Cured?

Everyone weighed into the debate, from professional medical men through ‘empirics’ (non-qualified practitioners) to clergymen like John Wesley, the founder of Methodism. They disagreed over treatments and causes and whether madness should be seen as an incurable descent into irrationality, or an understandable, and curable, response to some overwhelming stimulus or life event. Did madness somehow reduce you to an animal-like state or was it a disease like any other?

Certainly few, if any, of the treatments available for most of the century were likely to do much good, save via a placebo effect. It is also clear that those judged mad amongst the lower classes were much more likely to be incarcerated than their social superiors. At the same time, private asylums could be notably profitable businesses. What went on in them varied from the luxurious to the horrific. Still, the fact that enough people were prepared to pay highly to make certain ‘mad-doctors’ rich shows how common mental illnesses were amongst the better-off. It is also true that it took little effort to have a troublesome or unwanted family member confined for life under the guise of being mad — so long as you could pay the fees demanded. The romantic novel’s stereotype of the mad wife in the attic was not always very far from the truth.

Much has been written on the evils and cruelty of certain eighteenth and nineteenth-century practices in madhouses and asylums, but the reality was, I believe, far more complex, with every kind of response from vicious disdain to empathy and genuine kindness. It’s a vast topic, and one I intend to return to more than once. However, to start on a lighter note, here’s a list of supposed causes of madness amongst those confined in London’s Bedlam Hospital in 1810[1]. The numbers indicate the number judged to have been driven mad by each item:

Causes of Madness

It is clear that, in the eighteenth century, mental illness was most usually seen as essentially similar to physical illness, at least to the extent that both could be traced to an actual event or a tangible bodily dysfunction. The table below shows that clearly. There are no mentions of invisible psychological factors, such as neuroses. Their time had yet to come. The only inner, intangible causes listed are emotions such as pride, jealousy, fear or love.

What this seems to reflect is a view that madness is as madness does. Diagnosis was based on observable behaviour. A person was judged mad if he or she acted in ways commonly held to indicate insanity. Madness was not, in itself, unnatural, let alone culpable. Thus the mad person was only in need of custodial treatment if his or her behaviour became socially outrageous or was otherwise unacceptable. The ‘village idiot’ might be taunted and mocked, but no one thought he or she should be locked away. Rich eccentrics often flourished and were typically viewed with a good degree of indulgence.

Cause Number of Cases
Misfortunes, troubles, disappointments, grief 206
Religion and Methodism 90
Love 74
Jealousy 9
Pride 8
Study 15
Fright 51
Drink and intoxication 58
Fevers 110
Childbed 79
Obstruction 10
Family and heredity 115
Contusions and fractures of the skull 12
Venereal 14
Smallpox 7
Ulcers and scabs dried up 5

I love the idea that someone thought more people had been driven mad by Religion and Methodism than by drink, venereal disease and head injuries put together! Childbed presumably refers to what we would term post-natal depression, still sadly common today. It’s interesting too that Heredity was seen as producing only half the number of cases of insanity as Misfortunes and griefs. Doesn’t that argue for a refreshing doubt about the commonplace notion that mental illness is usually congenital?

Fright makes some kind of sense, I suppose, at least if it refers to overwhelming and irrational phobias. But what about Love being apparently some seven times more likely to drive you insane than Jealousy? How would fevers make your sanity collapse? And what on earth was meant by Obstruction? People driven mad by constant constipation?

Much food for thought here — so long as the Study doesn’t drive you over the edge!


  1. Quoted in Madmen: A Social History of Madhouses, Mad-Doctors and Lunatics, Roy Porter, Tempus, Stroud, 2006.  ↩

About William Savage

Independent researcher and author of mystery stories set in Georgian Norfolk.
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7 Responses to Georgian “Madness” and Melancholy

  1. amo says:

    I wonder if “obstruction” has something to do with the practice of bloodletting – the idea that flow needs to be released, else a blockage causes disease.
    And what on earth do “ulcers and scabs dried up” have to do with mental disturbances?

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    • You could be right about ‘obstruction’. For the others, my own guess, for what it’s worth, is that they were tending to look at whatever happened to the person just before the onset of ‘madness’ as the cause. If someone had been extremely itchy and scratching furiously, they might link that to the kind of nervous tics some mental patients develop.

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  2. noelleg44 says:

    Would love to hear more about specific mental institutions! Of course, some physicians treated hysteria right in their offices!

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    • 18th-century medics more often went to people in their homes, especially the better-off. Dealing with sickness was a domestic affair, which was why madness was so feared. If the patient became too violent or uncontrollable, staying at home (and hidden) was no longer possible. The (very) few public or charitable asylums that existed were only for the poor — and conditions in them could be dreadful. Hence the profit to be made from private asylums, where the wealthy could ‘deposit’ their problem relatives and free themselves from embarrassment.

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  3. I’ve just been dipping into Robert Burton’s the Anatomy of Melancholy, published 1630s and there’s a lot there which is similar to what you lay out here. It’s an extraordinary, very long book!

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