It is usual for our self-complacent generation to consider that it was not until our own time that rational measures for the care of the insane were taken. Most of the text-books on mental diseases that touch at all on the historical aspects of the treatment question, are apt to say that the evolution of methods for the treatment and cure of the insane might be divided into four historical periods: First, the era of exorcism, on the theory that insane patients were possessed of devils. Second, the chain and dungeon era, during which persons exhibiting signs of insanity were imprisoned and shackled in such a manner as to prevent the infliction of injury upon others. Third, the era of asylums. Fourth, the present era of psychopathic wards in general hospitals for the acutely insane in cities, and colonies for the chronic insane in the country, which is only just beginning to develop. 

From this classification, the ordinary reader would suppose that nothing at all was done for the insane during the first two periods, except exorcism in one and confinement in the other. As a matter of fact, the number of the harmlessly insane has always been much larger than the violent, and the latter, indeed, constitute only a very small portion of the mentally ailing at any period. Exorcism, as a rule, was applied only to the violent and to the hysterical. In the asylums at all times there were a number of patients who were not chained or confined to any great degree, and unless one had shown some special violent manifestation, severe measures were not taken. It is the treatment of the great mass of the insane rather than of the few exceptional cases, that must be considered as representing the attitude of mind of the generations of the Middle Age toward the mentally afflicted, and not what they found themselves compelled to do because of their fear and dread of violence.

For those who were mentally afflicted in a mild degree, abundant suitable provision was made by the generations of the fourteenth and fifteenth centuries. When historical writers suggest the contrary, they are only making one of the usual assumptions from ignorance of the details. Because in some cases insanity was supposed to be due to possession by the devil, to say that, therefore, in all cases no provision was made for the insane is nonsense. It is comparatively easy to find, from records of the hospitals of the fourteenth and fifteenth centuries, that there were what we now call psychopathic wards for the acutely insane in the cities, and some colonies for the chronic insane in country places.

James J. Walsh, The Popes and Science (1908)


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