Mental Health in Pre-Urban Europe

Yesterday I found a really cool piece in Slate Star Codex on mental illness.

Among the many pleasures of that piece were some fascinating observations about mental illness prior to urbanization.

Mental health care during the colonial era was surprisingly non-terrible. Mental illness seemed to be pretty well-understood and nobody was accusing psychotics of being witches or trying to beat the demons out of them or anything. Most of the mentally ill lived with families or in their own houses, where other members of the community supported them as best they could. Some were given jobs, with the understanding that they needed the support and their idiosyncrasies would be excused. Some would wander off, and there was a general understanding among colonial towns that if they found a mentally ill person wandering they would return them to their town of origin, who had the ultimate responsibility of caring for them. A few very violent people were locked away, usually in the basements of general hospitals or in prison cells. Getting somebody committed for mental illness was an informal process usually involving finding the friendly local magistrate and explaining why it was a good idea. But this option seems to have been used judiciously, and the incarcerated individuals managed to avoid most abuse and torture. Cramer describes it as “gloriously idyllic…mental illness appears to have been rare, and small town life tolerated all but the ‘furiously mad’ to live in the community.”

This confirms a lot of my experience as a pastor of a church on a corner with a lot of group homes. It confirms some of what I saw growing up near “Dutch Hill” in Paterson/Prospect Park. Community care is often the best care. The whole person is cared for.

It is also interesting looking at rates of psychosis.

To this I would add that even today immigrants get schizophrenia at rates up to four times those of non-immigrant populations, though nobody agrees whether this is because the genetically vulnerable are more likely to immigrate or because immigration is a very stressful experience. Even today, developing countries seem to have less schizophrenia than developed countries do (although of course this is hard to prove with certainty). The idea of a tenfold increase in psychosis over the past few centuries is jarring but not entirely outlandish, and does a lot to explain why the mental health system is so much larger and more relevant now.

Mental Illness isn’t just a disease that hits a certain element of the population. Community factors matter.

CS Lewis Chronological Snobbery

At the same time I’m reading CS Lewis’ The Problem of Pain. Here’s a piece on our chronological snobbery.

5. The larger society to which I here contrast the human ‘pocket’ may not exist according to some people, and at any rate we have no experience of it. We do not meet angels, or unfallen races. But we can get some inkling of the truth even inside our own race. Different ages and cultures can be regarded as ‘pockets’ in relation to one another. I said, a few pages back, that different ages excelled in different virtues. If, then, you are ever tempted to think that we modern Western Europeans cannot really be so very bad because we are, comparatively speaking, humane—if, in other words, you think God might be content with us on that ground—ask yourself whether you think God ought to have been content with the cruelty of cruel ages because they excelled in courage or chastity. You will see at once that this is an impossibility. From considering how the cruelty of our ancestors looks to us, you may get some inkling how our softness, worldliness, and timidity would have looked to them, and hence how both must look to God.

6. Perhaps my harping on the word ‘kindness’ has already aroused a protest in some readers’ minds. Are we not really an increasingly cruel age? Perhaps we are: but I think we have become so in the attempt to reduce all virtues to kindness. For Plato rightly taught that virtue is one. You cannot be kind unless you have all the other virtues. If, being cowardly, conceited and slothful, you have never yet done a fellow creature great mischief, that is only because your neighbour’s welfare has not yet happened to conflict with your safety, self-approval, or ease. Every vice leads to cruelty. Even a good emotion, pity, if not controlled by charity and justice, leads through anger to cruelty. Most atrocities are stimulated by accounts of the enemy’s atrocities; and pity for the oppressed classes, when separated from the moral law as a whole, leads by a very natural process to the unremitting brutalities of a reign of terror.
Lewis, C. S. (2001). The Problem of Pain (pp. 58–59). New York: HarperOne.

We are blessed with drugs and treatments for mental illness that genuinely help people, but as we can see we have in this case opted for a chemical solution to remedy something that past generations to some degree remedied with community and love. Why then are we so surprised when many of us pursue a chemical solution (alcohol, pot, heroine, etc.) to remedy our pains for lack of love or community?

We remain desperate creatures in need of rescue.