The Middle Ages

The Greek clinical-empirical tradition survived in the early Middle Ages among Arab Muslims and European Christians, although it later succumbed to religious intolerance. In Europe, monk-physicians, like Cassiodorus (490-585), upheld humane treatment and emphasized the Hippocratic empirical tradition. By the twelfth century, that tradition had given way to a more theological-non-empirical bent. Thus, Roger Bacon, arguing that empirical observation was required for knowledge and that mental illnesses had natural aetiologies, suffered the censure of the church and the condemnation of his colleagues at Oxford University. From the fourteenth century onwards, the Inquisition silenced empiricism as heresy, by intimidating or even killing its advocates.

A similar tension played out in the Middle East. The Hippocratic tradition was exemplified by Rhazes ( ad 865-925), a Persian equivalent of Roger Bacon. Adamantly believing that observation was the best guarantor of truth, he ran afoul of the theological status quo, was denounced, and ended his life in penury. Avicenna ( ad 980-1037) took a more diplomatic approach and prospered as a moderate synthesizer of Greek, Roman, and religious traditions. His medical synthesis, the Canon of Medicine, engendered near-Galenic respect for centuries, transmitting the view regarding mood disorders that 'undoubtedly the material which is the effective producer of mania is of the same nature as that which produces melancholia'.

The early Islamic tradition, like its Christian counterpart, was humane in its treatment of the mentally ill. The first asylums for the mentally ill, for instance, were built in the eighth century in Fez, Morocco, and in Baghdad. Others were soon added in Cairo and Damascus. As the Baghdad Caliphate became more dogmatic and antirationalistic, the Hippocratic tradition in medicine found refuge in the rival Andalucian Caliphate of Spain, where European and Islamic cultures mixed with fecundity. The first European hospital exclusively organized for the mentally ill was inaugurated in 1409 in the Spanish city of Valencia (for a review of this period, see Alexander and Selesnick(2)).

Beginning in the sixteenth and seventeenth centuries, the Enlightenment gave impetus to medical progress in Europe. The eighteenth century witnessed a flowering of the revival of the clinical-empirical tradition in medicine, with advanced descriptions of mania and melancholia, such as the following by Richard Mead (1751) (quoted by Jackson(3)):

Medical writers distinguish two kinds of Madness, and describe them both as a constant disorder of the mind without any considerable fever; but with this difference, that the one is attended with audaciousness and fury, the other with sadness and fear: and that they call mania, this melancholy. But these generally differ in degree only. For melancholy very frequently changes, sooner or later, into maniacal madness; and, when the fury is abated, the sadness generally returns heavier than before.

Eighteenth-century medical descriptions were disconnected from one another, however, and many were accompanied by hastily erected classification systems and aetiological speculations.

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