Claire Litt //
“I brought You my son, who has a mute spirit. And whenever it seizes him, it throws him down; he foams at the mouth, gnashes his teeth, and becomes rigid.”
(Mark 9:17-16:20, NKJV)
Following the publication of the fifth edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, a number of philosophers published articles criticizing the psychiatric discipline’s objective to classify disorders as diverse and numerous as the people suffering from them (for example, Ninnis, 117). The changes made in the DSM-5 include the subsumption of Asperger’s Syndrome by Autism Spectrum Disorder, the creation of Hoarding Disorder (formerly lumped with OCD), and the reclassification of low-mood caused by bereavement as depression (Grohol, “DSM-5 Released”). Despite the fact that the people afflicted by these conditions experienced no changes in their symptoms, the morning after the DSM-5 was published, they woke up with entirely new psychological diagnoses. On the surface, the APA spent 14 years and $20-25 million to consult with over 400 scientists in order to make a few name changes; in reality, they reasserted their power to control the language we use to diagnose the mentally ill, and their sole authority to cure them (“DSM–5: Frequently Asked Questions”).
Philosophers’ criticisms of contemporary practices of classifying mental illnesses are contrasted with some historians’ inclinations to correct past ‘misunderstandings’ of mental health using modern scientific labels. This is particularly true of historical phenomena that are now viewed with incredulity, such as when ‘mad’ people were cured via an exorcism that caused the source of their madness, a demon, to fly out of its host’s mouth (Figure 1). After analyzing descriptions of demonic possession, many of which contain seemingly readily identifiable symptoms of modern psychiatric illnesses or neurological disorders, one article concludes, “It is our belief that severe mental illness such as schizophrenia, bipolar disorder, and epilepsy will also have existed in the Middle Ages” (Espí Forcén, Espí Forcén, 277-278). This raises an important distinction, because while the sorts of symptoms and behaviours that we now associate with mental illnesses almost certainly existed in the medieval ages, mental illness and all of its various categorical distinctions had not yet been invented. If an individual suffered from schizophrenia in a society that had no word for schizophrenia – indeed, in which there was no medicalized concept of mental illness – did that individual have schizophrenia at all? Of course not. Laughable though it may seem to us today, we must take seriously the medieval diagnosis of demonic possession.
Somewhere out there is an individual who had Asperger’s Syndrome yesterday but who has Autism today simply because a group of American Psychiatrists deleted the name of his or her diagnosis from their manual. The new criteria for Autism is so restrictive that many people formerly diagnosed with Aspergers are now left with no diagnosis at all (“What Happened to Asperger’s?”). It would be wrong to say that this individual really had Autism all along, or that we’ve just recognized that they are actually neurotypical. To do so would imply a different definition of Autism as it was historically defined before 2013, and erase the lived experience of the person who had been told they had Asperger’s. Although this is a contemporary example, the same principle applies to people who lived thousands of years ago.
To label a demonically-possessed medieval person as schizophrenic makes them intelligible to us in our modern language – it is a benefit to us because we can fit this historical person into our reality, which does not take seriously the diagnosis of ‘demonic possession’. However, it is a disservice to our historical figure who has been stripped of the very real realities of their life simply because they are no longer realistic to us. Historical and modern diagnoses can reference the same atemporal phenomena and define them differently, highlighting the tension that exists between our need to have a way to refer to a phenomena and the slippage that occurs between the words we use and the realities that they describe. If language constitutes realities, then the past holds realities that are historically valid although we no longer subscribe to them. Long before the invention of the APA and the DSM-5, the Church was the authoritative body on spiritual and corporal health. It is not that people today must believe that demons used to exist, but rather that medieval people existed in a world that supported the existence of demonic possession and the efficacy of religious exorcism as a curative treatment. If historians’ duty is to history, is it not also to represent people not as we want to view them now, but as they would have understood themselves?
The language we use to define and describe what we now refer to as mental illness or neurological disorders has never stopped changing, and has always had significant consequences for those implicated. At the heart of the issue is the fact that invisible problems are more easily subject to the vicissitudes of language. A medieval and modern person would likely agree on a diagnosis for a broken leg, where as the “mentally ill” have historically been defined by prevalent temporal concerns and the shifting belief systems of society. They have been viewed as “touched” by God, as allegorical figures of truth, as social contagions, as people who must be set upon the Ship of Fools and sailed away, or relegated to confinement, as morally enlightened and morally degenerate (Foucault, 12). Freudian theories that emphasized nurture and childhood experiences, and the psychoanalytical theories of the 1970s that sought to find ‘meaning’ in mental illness have all been overturned in the last decade in favour of a theory of biological determinism – that the ‘madness’ is in our genes. But this, of course, is just the language of the moment.
“Saint Francis Performs an Exorcism” Bibliothèque nationale de France, NAF 28640, f, 84r. Bonaventure, Vie et miracles de saint François d’Assise. c. 1480. Page 172. https://www.wdl.org/fr/item/14425/view/1/172/.
“DSM–5: Frequently Asked Questions.” DSM–5: Frequently Asked Questions, American Psychiatric Association, 2008, http://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions.
Espí Forcén, Carlos and Fernando Espí Forcén. 2014. “Demonic Possessions and Mental Illness: Discussion of selected cases in Late Medieval Hagiographical Literature.” Early Science and Medicine Vol. 19, (No. 3), 258-279.
Foucault, Michel. 1988. Madness and Civilization. Random House.
Grohol, J. (2013). DSM-5 Released: The Big Changes. Psych Central. Retrieved on December 5, 2018, from https://psychcentral.com/blog/dsm-5-released-the-big-changes/.
Iosif, Despina. 2011. ““I Saw Satan Fall Like Lightning from Heaven.” Illness as Demon Possession in the World of the First Christian Ascetics and Monks.” Mental Health, Religion & Culture 14 (4): 323-340. doi:10.1080/13674671003598832.
Ninnis, Drew. 2016. “Foucault and the Madness of Classifying Our Madness.” Foucault Studies No.21 117-137.
Scull, Andrew. 2016. Madness in Civilization. Princeton University Press.