From a Religious View of Madness to Religious Mania: the Encylopédie, Pinel, Esquirol
Philippe Huneman
Abstract.
This paper focuses on the shift from a view of insanity imprinted by the religious understanding of madness, to an aspect of religion as it is seen in the nascent psychiatry, especially French alienism, according to which the kinds of madness that have religious overtones are, strangely, very difficult to cure. I first sketch what has been a traditional religious framework for understanding madness, exemplified among others by Pascal. Then, I demonstrate that in several entries of the Encyclopédie dealing with madness, such a view is quite salient, while it is less relevant in other entries, where a more medical understanding of madness that can be traced back to the physiology of French vitalists is present. Then I argue that with the alienist framework elaborated by Pinel on these vitalistic foundations, the religious view of insanity vanishes. Eventually I question the status of these lunacies with a religious component by Pinel, then by Esquirol, for whom the religious mania is explicitly a vestige from the past, but, implicitly, religion is in a subtle manner a hard to cure component of many mental conditions.
Taking for granted that madness is a mental illness is, as we know, a historically established platitude: the work of Michel Foucault, Gladys Swain, Andrew Scull, and Dora Weiner—among others—hasbeen decisive in this regard (Foucault 1961, 2003,Scull 1968, 1993, Swain 1978, Swain and Gauchet 1985, Weiner 2001). We also know that the moment of this medicalization of madness corresponds, more or less, to the emergence of alienism at around the time of the French Revolution. Yet madness—the set of “behaviors” and “experiences” which fall under this designation—is a part of the human experience; and literature in its moral or philosophical capacities tried to give meaning to its mysteries well before psychiatry came into being and made it its exclusive domain.
Being a large category of experience, madness was long understood within the framework of religious ideas. The ideas of destiny, fault, and error intermingled with each other in a general framework of understanding, which included the idea that nature itself—and human nature in particular—is corrupt. This is why the Revelation and Christ were scandals. These facets of the religious understanding of madness partially disappeared with the psychiatric approach developed by Pinel, and then Esquirol. It is thus troubling to note that, for Pinel and then for Esquirol, in the list of mental problems, being too faithful (in the religious sense) appeared as a disease —and notably, as one of the most severe kinds of disease. With Pinel, a number of extremely serious cases in his Treatise on Insanity werepatients affected by religious obsessions or deliriums with religious connotations. As for Esquirol, his text On mental diseases argued that “demonomania”—named in accordance with the phraseology and nosology that he himself created—or the madness of religious delirium is one of the most difficult to cure: “Cases of madness defined by religious ideas (…) are rarely curable” (Esquirol 1838, I, p. 115, below MM). It thus raises the intriguing question of how in fifty years, between the contemporaries of Diderot or D’Alembert and Esquirol’s psychiatric clinic, religion could go from its status as the major element of the conceptual framework of madness, to being regarded as the occasion for an extremely severe form of psychopathology.
To sketch out this history, I will focus on the texts concerningmadness in the Encylopédie, as well as on writings by the first alienists. I will first show how the essential elements of a religion-based perception—which we can connect to the major texts about medical nosology written at around the same time by François Boissier de Sauvages or William Cullen—are seen in the articles about madness by d’Aumont; while those by Ménuret, a vitalist physician, already reflect a more medicalized view. I will then show how Pinel built on that to form a theory that renounces the most fundamental points of the religious understanding of madness. Then, I will consider religious madness and will lay out three(non-exclusive) hypotheses that account for its specific status. The last section will look at the instances of religion in Esquirol’s and Georget’s respective theories of madness (Esquirol 1805, 1838, Georget 1820).
The Religious Framework for Thinking About Madness
Traditional Elements
Traditionally, as Pigeaud usefully reminds us (Pigeaud 2002), madness comes from two areas. “Frenzy” and “dementia” fully belong to medicine—in that they are often grouped with certain known organic diseases, like fever. Non-frenetic forms of madness, such as melancholy or the set of symptoms that came to be viewed as mania in the 18th century, pertain to moral philosophy—since one finds in them neither a substrate nor a physical cause; and in this sense, the most appropriate help one can give to the patient is of a philosophical nature[1]. An essential part of madness—the one that most clearly goes against ordinary medicine—thus pertains rather to a moral tradition than to medicine.This distinction goes back to Greek Antiquity, to Celsus and Areteus, and essentially does not contain religious elements.
The religious meaning appears when we bring in the idea that (human) nature is corrupted. If madness is and creates exception, and if on the other hand the norm is corruption, then non-corruption—well-adjusted reasoning, goodwill, etc.—will be an exception and will appear as scandalousand therefore as madness. Christ’s teaching and life are a scandal ; for worldly beings, the life suggested by Christ is madness: in this sense, the Christian experience confers an essential relativity to the very definition of madness. “The cross: scandal and madness for some, salvation for others”, wrote the famous theologianLemaîtrede Sacy in his translation of the New Testament, in the summary of Corinthians 1.1[2]. There is a specifically Christian dialectic for madness, which Pascal summarized best in the following form: “Men are so necessarily mad that it would be another kind of madness not to be mad”(Pensées).
But I am not trying to portray a “Christian” perception of madness; and an allusion to Pascal would certainly be insufficient if such were my intention. I am simply pointing out a contribution that the Christian experience made to the many angles of the experience of madness which have been lumped together since the beginning of ancient Greek morals and medicine. This contribution consists in looking at madness in light of the Christic scandal, from which two radical consequences can be drawn: madness is widespread (“all humans are mad”), and madness is consubstantial with Truth (“the wise man is mad,” to cite Pascal again). These are certainly two radical positions which cannot both be upheld—which is why there is not a Christian “conception” of madness, but rather a dimension, or a tonality. Christian by nature, this tonalitytainted the discourses surrounding madness for a long time, in a manner that was massive enough for it to be present in the background of the use of the term throughout the classical age.
Of course, we must not over-interpret Pascal here. The idea of a madness so consubstantial with human nature that it ultimately affects those who would seem farthest away from it appears to be found, in a different manner, in Chamfort shortly afterwards: “There are more madmen than wise; and even among the wise, there is more folly than wisdom” (Maxims, 368). One could see in these reflections a resurgence of ancientskepticism rather than a Christian perception. Human beings are mad—in the sense that they prefer the short term to the long term, do not make use of their reason, believe to know things when they do not know how to assess the elements that would be able to justify their knowledge, etc. And as Vauvenargues said, someone who is familiar with madness in human nature will have the tendency to put its most startling forms into perspective, because each human being ultimately succumbs to madnessather own scale: “Caligula’s follies hardly surprise me; I have known, I believe, many men who would have made their horses consuls if they had been Roman emperors.” (Maxims, 383).
I am not however claiming that this skepticism constitutes the background for Pascal’s assertion. Indeed, as for the skeptic the madness of men is de facto, the wise man can and must remove himself from it. He must measure his statements against empirical evidence—just as on the moral level he must setgoals that meet what he hopes for and can accomplish: an ideal of generalized commensurability guides the steps of the wise man, and separates him from human folly. But nothing here calls to mind the element of “scandal” (hence, the consubstantiality of madness and truth). “Madness” in the skeptic understanding is not a reversible term; it indicates a condition that is de facto widely shared, but in a stable manner—and this condition is surmountable.
Thus, in Pascal’s quote, the word “necessarily” refers to our corrupted nature; in contrast, the wisdom of the Ancients—or even of Montaigne whoPascal rightly and often paraphrases, mentions, or caricatures—would have certainly been able to complain about how the majority of men are mad, but their statement would not have had the value of a necessary natural fact. But Pascal rather echoes a saying in Corinthians: “Has not God made foolish the wisdom of the world?” (Corinthians 1, 20). This is how he gestures towards a religious idea of madness.
I have lingered on this point because such “reversibility” and “generality” of madness seem, by contrast, to be excluded from the modern medical understanding of madness: if madness is essentially considered as an “abnormality”, its difference from non-madness is unequivocal, and the state of madness cannot be generalized (as long as the norm always bears a statistical connotation of “majority”). However, if we look at texts that predate the birth of psychiatry by only a few decades, we still find traces of this Christian dimension of madness. And so I turn to the texts from the Encylopédie.
Moral and medical insanity in the Encylopédie
The articles by d’Aumont in the Encylopédieinclude two “Madness” entries: the first, “Folie (Morale)”, essentially examines the type of madness that is relevant to philosophers and moralists, according to the classic bipartition we have already discussed; the second, “Folie (médecine)” examines the other kind of madness. Granted, the text is ambiguous and the duality can meaneither a duality of possible viewpoints on madness, or a duality of the types of madness. Whatever the case may be, this duality still echoes the ancient division.
The article “Madness (Morals)” paints a picture of madness while it was at the same time being abandoned by doctors (this to the benefit of the anthropological framework that we will describe below). For the author, being mad means moving away from reason—not in full consciousness, like a “slave to a violent passion”; but “in a very confident way, and strongly persuaded that one is following reason” (D’Aumont 1765c, p. 56). However, this persuasion does not seem specific to a category of humans, and can pertain to each of us in different degrees. The fact that in society some are confined and others are free is simply contingent: according to d’Aumont, those whom we confine to hospitals seem to have “a less common type of madness” than others—a type of madness that does not “enter into the order of society”. Otherwise said, there is an essential relativity to the concept of madness—a relativity in regard to local beliefs, social norms, clan tastes—which prevents it from becoming an authentic disease concept.
The skeptical point about the relativity of the concept of madness boils down to this insight: madness is essentially excess (“all excess is madness”), andeach excess supposes a point of comparison. However, this vocabulary of excess—which haunts all of the literature about madness—justifies here a critical vision of the concept: madness is a question of viewpoint. This is why d’Aumont highlights the Christian reversibility between madness and wisdom: what seems mad to the world is reasonable to the wise man. The world is mad: the order of society is the “combination of human follies,” so that madness “enters into the order of society” (D’Aumont 1765c, p. 58).
Consequently, the classic bipartition derived from antique medicine between physical madness and moral madness, between fever or frenzy deliriums and melancholy or sad passions, has no value in itself: within the “houses” (as they call places where madmen are confined), many people are morally mad; while in the world, many are physically mad (like Molière’s “imaginary sick”). This bipartition is only discursively useful for the encyclopedist: it enables him to organize his articles on the subject. This entry is then followed by “Madness (medicine)”. D’Aumont presents madness here as “a type of lesion of the animal functions” (D’Aumont 1765c, p.58), and compares it to mania, melancholy, and delirium. Such division is not so firm in practice; and in a general manner throughout all of the Encyclopédie, it is difficult to draw out a true classification of mental illnesses. In the articles he devotes to them, D’Aumont distinguishes “delirium” and “frenzy,” the latter being accompanied by fever (d’Aumont 1765a; Berrios 1999). This is very close to the classic distinction between mania and phrenesis, which is taken from ancient medicine. But while the first article, “Madness (morals)” insists on the “excess” aspect—while drawing the relativist consequences that I have highlighted—“Madness (medicine)” suggests that “madness” is the “depravity of the thinking faculty.” However, the two approaches are easily articulated: in a very general manner, depravation and excess seem to raise a globally moral approach to mental condition. Besides this, they also share the same relative character: excess is relative to a certain measure, and depravation supposes having identified what is appropriate, or what is common sense; but, within a Christian framework, one says that common sense or common thinking is already corrupted—which means that depravity is in itself only a relative fact.
Whatever the case regarding these nuances, the three types of madness mentioned by d’Aumont—mania, melancholy, delirium—instantiate “the error of the understanding which judges falsely, during observation, about things regarding which everyone thinks in the same manner” (D’Aumont 1765c, p. 56). We can compare this with Boissier de Sauvages: “The mad are currently deprived of reason, or persist in an obvious mistake; and this constant mistake of the soul, manifested in their judgments, their imagination and their words, constitutes the character of this class [of diseases]” (Boissier de Sauvages 1772, VIII, p. 3). At the same time, Cullen puts forth an analogous definition: all “vesania” (psychosis)are founded on false judgment (Cullen 1784, §1529); but more precisely, delirium establishes itself on a “false or mistaken judgment, from an awaked person, about the relationships of most frequently encountered objects, and upon which everybody holds the same judgment” (Cullen 1784, §1531). In his taxonomy, Boissier de Sauvages indicates a difference between theoretical error, which is common, and practical error, the only one at play in madness—for example, the madman who imagines his friends are enemies (1772, VIII, § 15). The criterion here seemsexternal to the content of the belief: simply put, a theoretical error does not have a negative effect on the subject himself,while practical errors concern those things on which our social life is founded: everyday relationships, common beliefs, etc. D’Aumont and Cullen’s insistence on “what everyone thinks” leads us to Boissier's notion of practical error, placing the accent on the presence of social norms[3].
Sauvages, whose Nosology is constantly cited by the Encylopédie,claims that even though madness is a disease that constitutes the eighth class of diseases (named the “class of vesania”), it is understood as depravity: “When the principal symptom is a depravity of imagination or judgment, of will or desire, it’s madness, what the Latins called vesaniae because these functions are not sane” (Boissier de Sauvages 1772, VIII, § 351, p. 322). This amounts to equating madness and vice: certain people are “sick from a vice that the soul has contracted” (Boissier de Sauvages 1772, VIII, § 21, p.14, we underline)[4]. In other words, we move from madness as error—thus, essentially, epistemic pathology—to madness as a fault of the will—said that is, moral pathology. Although it was the subject of a medical treatise, madness as depravity is still not fully a medical topic.
For all that, depravity according to Sauvages is naturally combined with the lexicon of excess: depraved, the will pushes judgment to lose its sense of proportions and of measure, wallowing in imaginary measures. Thus, among the classes of vesanias, Sauvages invents a third class named “oddities (bizarreries) - morositates” that is characterized by a particular error: small things are appreciated with too much pleasure; or the inverse: the oddity is “too much of adesire for or an aversion towards something” (our italics)—here, the will is depraved since the subject “prefers a small good to a large one” (1772, VIII, p. 192)[5].
We thus see in these examples taken from the doctors in the Encylopédie that elements of the religious vision of madness had very much seeped into pre-Pinelian medicine.