On Madness
Introduction by Juris Lidaka
Bartholomew says: "Madness (amentia) is the same as mania (mania), according to Platearius [Practica brevis, II.6 (Venice edition)]. Mania, in turn, is an infection of the anterior section of the cerebrum, with loss of imagination, just as melancholy is an infection of the medial section of the cerebrum, with loss of reason, as Constantine says in his book, On melancholy. Melancholy, he says, is suspicion ruling the mind, brought on by fear and sadness. These emotions differ based on the various kinds of harm they do to [normal] functioning; in mania, it is the imagination which is principally damaged, while in the other [melancholy] it is the reason."
Ancient Medical Theories, Medieval Applications
The Middle Ages are often viewed as a period when people explained madness just as result of demonic possession. But as David and Christine Roffe showed in 1995, common sense attitudes toward insanity were widespread in the Middle Ages. Authors like Bartholomew, but also Gilbert the Englishman and Bernard of Gordon, summarized ancient medicinal theories for their thirteenth-century contemporaries.
Bartholomew relies on works by Arabic authors translated for him by scholars like Constantine the African. In this passage he is indirectly citing Ishaq ibn ‘Imran. But he also cites Platearius, an Anglo-Norman physician who belongs to the Salernian medical tradition of the twelfth century.
As the Roffes indicate, medieval physicians recommended “dietary, herbal, and surgical regimens.” Modern medical advice also refers to diet, medications (sometimes processed “herbal” materials), and even surgery as methods to combat depression and other mental disturbances.
So, what does Bartholomew say? He takes his definition of madness, or rather mindlessness, from Platearius. His anatomy of the cerebrum comes from Constantine the African, On Melancholy, who held that different kinds of madness affect different parts of the brain.
Causes of and Cures for Madness
Madness has various causes, according to Bartholomew, including:
- melancholy-inducing foods
- strong wine that disrupts the humors
- bad air
- anxiety and overwork
- infection from a poisonous bite
- disorderly humors
Bartholomew lists varying behaviors and treatments, though he is clear that the mad must be controlled so they do not hurt themselves or others. If you look at what he says, do you see any mention of demonic possession? This shows that common popular views that suggest medieval physicians attributed madness to demons exclusively are exaggerated and misleading. Among the cures for madness that Bartholomew suggests are restraints and surgery, but also music, moderate exercise, and freedom from anxiety. He emphasizes most of all (maxime) a convalescence free from fear.
Melancholy
One important word in Bartholomew's text is “melancholy.” In modern usage it can be a synonym for sadness. In earlier times it referred to severe mental depression and included other mental illnesses as well. It was used so much more that in the mid-seventeenth century Robert Burton produced a very lengthy discussion of it, entitled The Anatomy of Melancholy.
The word “melancholy” comes orginally from the Greek words for “black bile,” one of the four humors. It passed through the centuries into Latin, French, and then to English. In the process it lost its connection to humoral theory and became a more general term for depression and mental illness.
"In the popular mind the Middle Ages was a period of unreason in which belief in possession was a commonplace, and indeed the perception has coloured many scholarly examinations of insanity in former centuries...In recent years several studies have shown that common sense attitudes to insanity were widespread. Classical notions of humoral imbalance were probably never entirely lost in the West, and by the 13th century they had become the standard explanation of a host of psychiatric conditions in medical treatises and encyclopaedias. In England works by Gilbert Anglicus, Bartholomew Anglicus, and Bernard de Gordon, which summarised ancient learning on the subject as it was transmitted through Islamic scholars, were widely known and read by academic doctors and physicians alike. In intractable conditions like epilepsy, spells and incantations were halfheartedly, perhaps at times sarcastically, stipulated, but the recommended treatments were otherwise the typical dietary, herbal, and surgical regimens of classical medicine." 1
1. David and Christine Roffe, “Madness and Care in the Community: A Medieval Perspective,” British Medical Journal, 311 (1995) 1708-1712.
M. Dols, "Insanity in Byzantine and Islamic Medicine," Dunbarton Oaks Papers 38 (1984) 135-148.
Robert Burton, The Anatomy of Melancholy 
Stanley W. Jackson, Melancholia and Depression: From Hippocratic Times to Modern Times, New Haven, CT, 1986.
Raymond Klibansky, Erwin Panofsky, and Fritz Saxl, "Melancholy in Medieval Medicine, Science and Philosophy," in Saturn and Melancholy, London 1964, pp. 67-123.