Alex Fairlamb is an Education Consultant and has experiences as a Trust T&L Network Lead and Senior Leader in charge of T&L and Professional Development. Alex is an Honorary Fellow of the Historical Association and a member of the Secondary Committee. @lamb_heart_ tea and Alex Fairlamb Consultancy –
Today, attitudes towards mental health are thankfully changing. As part of this change and with the aim of raising awareness, more focused days and months have been mapped into our calendars across the year. An example of this is Male Mental Health Day on 19th November, and so it felt timely to write a blog about how we can weave mental health into our curriculums.
Multiple statistics about the number of people who experience mental health problems can be found on reputable websites such as: Key facts and statistics about mental health | Mind. One thing that does seem stark and clear is that in spite of attitudes changing towards mental health, it appears to still have a bit of a stigma attached to it; it remains still a taboo subject in some contexts or one that is less readily discussed than other medical conditions. Perhaps if we better understand the history of mental health, we can help students to see how progress has been made in this area and that whilst the causes of poor mental health (such as smartphone use etc) might be unique to this time period, that actually mental health has always existed. Through greater representation of the experiences of people who have experienced poor mental health – or have falsely been accused of having a mental health condition for nefarious reasons – it might help to greater raise awareness of this topic and open up further dialogue.
This blog will focus on the period 1050-1900.
Why weave it in?
Over the past few years, a great amount of work has taken place to diversify curriculums so that multiple lenses that make up the kaleidoscope of our past are studied. One aspect of this has been ensuring that protected characteristics, such as disability, are included in our study of the past. Moreover, with the publication of Elinor Cleghorn’s ‘Unwell Women’, alongside the fact that we already have GCSE specifications focusing on medicine through time, it seems appropriate that the history of mental health should feature within our curriculums.
To clarify, we all have mental health and experience points at our life where we experience difficulties. Each person has their own lived experience. If experienced over the long term, this can be classified as a disability, but it is not always a disability. This blog is therefore mindful that mental health may transcend into disability history at times, but at others it may not. How this is framed with students is important and will require additional reading.
What key aspects can be woven into existing curriculum topics?
With already crowded curricula, this would be an understandable response: where do I create the space for this? An approach that I advocate would be weaving it into the existing enquiry questions and topics that you teach when appropriate and meaningfully to do so.
What can we learn about mental health in the medieval period? 1050-1500
If we use the broad timeframe of 1050-1500, at this time it was believed by some that mental health was a sickness caused by supernatural forces such as by devils and bad spirits resulting in a possession. For some, it was something that a person experienced as they were stuck in purgatory or it was the result of being born under a Saturn moon which then caused a madness to emerge. However, there is also evidence that there was the belief that it was caused by a ‘humoral imbalance, intemperate diet and alcohol intake, overwork, and grief’[i] and too much pressure inside the head. With regards to women’s health, Trotula of Salerno published works which included the term ‘hysteria’ demonstrating that there was some study carried out in this field. However, it’s worth remembering that on the whole women we’re regarded as mentally and physically inferior compared to men, and therefore that they were more susceptible to certain mental health conditions (such as melancholy) as a result of their anatomy.
Treatments for mental health conditions were given depending on what the physician (if they could afford one) or person diagnosing them believed had caused the condition. If it was believed that the mental health condition was caused by evil spirit, then trepanning would be a suggested form of treatment. For humoral imbalances, bloodletting might be used for when it was believed there was too much blood. If the person was experiencing melancholy, believed to have been brought on by black bile, would be a change in diet. For diagnoses that believed it was related to diet and/or alcohol, then liquid remedies would be offered such as waters and syrups in the hope of improving the body’s constitution. The work of Richard Napier (1597-1634) would be a case study to explore in greater detail. Interestingly, the National Archives[ii] interestingly explores the account of Emma de Beston and archival material to determine that treatment in the past was not as brutal and uncaring as we might have supposed. However, this must also be weighed against treatments such as exorcism were used for women experiencing ‘hysteria’, which began to bleed into their condition being the result of sorcery.
The creation of Bethlehem Hospital (Bedlam) in 1247 resulted in the first institute that provided care for patients with mental health conditions during the 1300s. Below, Historic England describes Bedlam:
Those who became patients were usually the poor and marginalised, sometimes believed to be dangerous, who lacked friends or family to support them.
The hospital regime was a mixture of punishment and religious devotion – chains, manacles, locks and stocks appear in the hospital inventory from this time. The shock of corporal punishment was believed to cure some conditions, while isolation was thought to help a person ‘come to their senses’. At the same time, it was a religious duty to care for and feel compassionate for people afflicted by madness[iii]
This would be an interesting point for discussion in terms of contrasting with the other hospitals in England and the care provided there, and how those rejected from such hospitals may have ended up elsewhere. Most mental health care was carried out in the home and community.
Where would this fit in KS3?: Everyday lives of ordinary people (when studying living conditions), public health and medicine during this period, delving into the mental health conditions of some monarchs (such as Henry VI)
Where would this fit in KS4: Public Health and the History of Medicine, Warfare (impact of it on mental health)
What can we learn about mental health in the Renaissance period? (1500-1700)
During this period, there was a greater focus on science, but religion was still a powerful force and most of society continued to believe in much as they had in the previous period. Whilst some physicians and others began to consider alternative causes and treatments (such as mental health doctors who had an interest in dissection and anatomy began to consider that the damaged nerves may be a cause of mental health conditions) attitudes and therefore practice was slow to change. As a result, during this period the beliefs about the causes of mental health remained fairly similar. With the religious turbulence of this period and the resulting witch craze, we seen an increase in the persecution of women as their mental health conditions were conflated with sorcery and being in cahoots with the devil. This is explored in greater depth by Tasca et al (2012)[iv] who write that ‘The inquisitor finds sin in mental illness because, he says, the devil is a great expert of human nature and may interfere more effectively with a person susceptible to melancholy or hysteria.’ The uterus is blamed for many conditions ranging from fits to melancholy. The result of all this is that, for women, many health conditions (both physical and mental) are misdiagnosed and left untreated.
Due to limited developments in the understanding of the causes of mental health, treatments from the previous period largely continued including bloodletting and trepanning. With women’s mental health conditions often being linked to the uterus, practices such as trying to coerce the womb to a different position were used.
With care and hospitals, Historic England tells us that from 1619 ‘Helkiah Crooke became the Bethlem’s first medically qualified ‘keeper’[v] It is during this period that private ‘madhouses’ develop as ‘madness was increasingly seen as the loss of a person’s reason, rather than a defect of their soul or their body. It could be restored through ‘moral treatment’: gentle discipline, order and well-intentioned manipulation. And where better to do this than in an orderly, well managed, small private madhouse, with its family atmosphere and controlled environment?’[vi] The result was 45 private institutions and a few houses for ‘pauper lunatics.’ There were different types such as ‘voluntary’ and ‘moral asylums.’ Within places where paupers resided, corruption was not unheard of nor were poor living conditions alongside cruel treatment. Later licensing laws aimed to mitigate against this. Historic England do point out that very few people had any form of institutionalised care in the 1700s and so continued to mainly be the responsibility of care in the home and community or ‘some were on the streets – mentally ill beggars were nicknamed ‘Tom o’Bedlams’[vii]
Where would this fit in KS3?: Everyday lives of ordinary people (when studying living conditions), public health and medicine during this period, delving into the mental health conditions of some monarchs
Where would this fit in KS4: Public Health and the History of Medicine, Elizabeth I (society, the extent to which it was a golden age, treatment of vagabonds), Restoration England, Warfare (impact of it on mental health)
What can we learn about mental health in the Enlightenment/Industrial period? (1700-1900)
It is in this period that we see beliefs about the causes of mental health begin to change. Of particular note is the development of neurology and the idea of a ‘nervous breakdown’. Hysteria notably changes to being an issue caused by nerves rather than the uterus, and at times is broadened to men (who are seen as ‘weak’). The Science Museum tells us that in terms of treatment ‘Neurological treatments for mental illness included hypnosis, electrotherapy and the ‘rest cure’. These could be carried out in doctors’ offices, health spas or patients’ homes. But expensive neurological therapies were only available to the wealthy. For ordinary people with nervous illnesses, there were nerve tonics.’[viii]
With regards to treatment, if the nerves were determined to be the cause of the condition, then there was hope of treatment and a cure (see above). For hysteria, additional treatments included pills, anti-hysteria water and electropathic belts. Interestingly, we see a continuity in suggestions of diet changes being a form of treatment too as well as a use of smelling salts to prevent a wandering womb as Hippocrates prescribed. Whilst trepanning was still used, this practice began to decline, and bloodletting faded too.
Looking at care provision, in the 1800s the asylum system expanded quickly and vastly, and a Lunacy Commission was created. These asylums were seen as places of confinement and had varying structures, segregated men from women and were staffed by attendants. Notably during this period, women were particularly vulnerable to being placed within an asylum due to severe Victorian values which reinforced particular ways of being and roles within society. Women could be placed in an asylum for reasons such as requesting a divorce or if a spouse saw this as an opportunity to be rid of his wife. These situations were possible if people were well connected.
Where would this fit in KS3?: Everyday lives of ordinary people (when studying living conditions), public health and medicine during this period, delving into the mental health conditions of some monarchs (George III)
Where would this fit in KS4: Public Health and the History of Medicine, Warfare (impact of it on mental health)
Where to find out more…
Websites: See reference list
Scholarship:
- Unwell Women – Elinor Cleghorn
- Medieval Military Medicine – Brian Burfield
- A Cultural History of Medicine in the Later Medieval Period – Iona McCleery
- The Victorian Asylum – Sarah Rutherford
[i] Kroll, J. and Bachrach, B. (1984) Sin and mental illness in the Middle Ages. Available online at: Sin and mental illness in the Middle Ages – PubMed
[ii] Cunningham, S. (2019) Medieval mental illness and care in the community: Emma de Beston’s case, 1383. Available online at: [ARCHIVED CONTENT] Medieval mental illness and care in the community: Emma de Beston’s case, 1383 – The National Archives blog
[iii] Historic England (no date given), From Bethlehem to Bedlam: England’s First Mental Institute. Available online at: From Bethlehem to Bedlam: England’s First Mental Institution | Historic England
[iv] Tasca, C. et al (2012) Women and Hysteria in the History of Mental Health. Available online at: Women And Hysteria In The History Of Mental Health – PMC
[v] Historic England (no date given) Mental Illness in the 16th and 17th Centuries. Available online at: Mental Illness in the 16th and 17th Centuries | Historic England
[vi] Ibid
[vii] Ibid
[viii] Science Museum. From Nerves to Neurosis. Available online at: From nerves to neuroses | Science Museum
OBHD 