Middle English Mental Illness Terminology
The hierarchy of language resulting from the collision of Old English (OE) and Norman French after 1066 has greatly determined the register of terminology, including that of medical terms. After the Conquest, the English language became greatly derogated and Latin was increasingly prevalent as the prestigious language of both religious and secular learning; long used as the written language of the Church, Latin became important in the emerging universities of the Middle Ages. The continuance of Latin as "the language of learning in western Christian Europe" in the eleventh century coupled with the pejoration of English ("Medicine and the Care of the Sick" 306), meant that the gathering of new medical knowledge from other cultures in the eastern Mediterranean and the Middle East involved "an intensive translation campaign, concentrated on Latinizing the Arabic works both of Greek authorities like Galen and of important Arabic writers - Jews, Muslims, Persian, Christians - in the Islamic world" ("Medicine and the Care of the Sick" 306). Just as early medieval medical knowledge (based on a "core of Roman and Greek texts"), created and collected in "monasteries, courts, and ecclesiastic schools" ("Medicine and the Care of the Sick" 305), had been communicated in Latin, the later interest in a large number of disparate medical texts demanded Latinization. The importance of Latin to the learned culture of the Middle Ages is evident in the structure of the semantic field of terms relating to mental illness, both as used at the time, and in their evolution into Present Day English (PDE) terminology.
Medieval Madness and Morality
During the Middle Ages, diseases, particularly mental illness, were regarded in moral terms as punishment from God, and as a result, "It was widely believed that no purely physical cure would be effective unless the sin that originally caused the disease was forgiven" (Doob 36). As madness was increasingly perceived as the effect of physiology in the beginning of the Early Modern period, a large number of these Latin-derived medical terms for mental illness entered the English language. As a result, the majority of terms denoting mental illness in PDE were not in existence in the Middle English period, since it was not necessary to borrow terms such as "dementia," "insanity," and "delirium" from Latin until after the Early Modern period. Consequently, Middle English (ME) terminology used to refer to mental illnesses and those who suffer from them, was much more limited than that of PDE. Because madness in ME was not strictly a medical issue, the term itself, and its synonyms, could be used to describe a very wide range of aberrations: "In its narrowest sense, of course, the word [madness] refers [in medieval usage] to a mental and physical disorder, such as frenzy or mania, with natural causes and consequences and with physiological symptoms; it is in this sense that scientists and encyclopedists like Barthomoleus often use the word . . . But when reason implies not conformity to a norm but ideal conduct, unquestioning obedience to God, then madness encompasses us all, for the just man falls seven times daily, and even one sin suffices to justify the name of madness" (Doob 50). OE compounds like deofolseoc and feondgyld (demonical possession) are compelling examples of medieval assessments of mental illnesses and their source.
Early Modern Madness and Medicalization
The influx of Latin loanwords denoting mental illness corresponded with a medicalization of the condition and the growing belief in the necessity of institutionalization. Whereas in the Middle Ages "crazy people rarely had any special, formal provision made for them," in the Early Modern period "movements were activated which led for the next three centuries to mad people increasingly being segregated from sane society, both categorically and physically" (Porter 13, 14). As might be imagined, the terms used to designate the insane previous to this organized, Early Modern medical effort to identify and institutionalize those suffering from madness, are not now likely to be used in official, medical discourse. In fact, a chronological examination of some of the lexemes belonging to the semantic field of "madness" reveals that the later terms, particularly those borrowed from Latin, have continued to appear in "professional" discourse. Terms that come to us via OE, including "mad" and "witless" have distinctly pejorative connotations, particularly the latter. Another native term, "wood," and its noun form "woodness," denoting one who is "out of one's mind" has become obsolete, its obsolescence a clear indication of the term's extreme pejoration (OED, "wood," n. 1).
Some Terminology Compared
Overall, there were a number of terms used in the Middle Ages to refer to mental illnesses and those they afflicted, many of which were modifications of OE terms, including develseoc, unwitti, monthsik, while many other OE synonyms for madness, such as bręcseoc, gydig, and ylfig disappeared. The OE terms that survived betray the continuing association between madness and evil, foolishness or gender (monašseoc in OE denoted menstruation). The aforementioned native terms, "mad" and "witless," that have survived in PDE, could be used to describe mental derangement (OED, "mad," n. 1a; OED, "witless," n. 2), as well as to refer to foolishness and lack of wisdom (OED, "mad," n. 2; OED, "witless," n. 1). As the 1a OED definition of "mad" points out, "The word has always had some tinge of contempt or disgust, and would now be quite inappropriate in medical use, or in referring sympathetically to an insane person as the subject of an affliction." The early associations between mental illness, stupidity and sin have much to do with the purely colloquial meanings of the terms in PDE. Because of these negative connotations, which were connected to the moral dimensions of madness in the Middle Ages, new, elevated language became necessary for "official," medical discussions of mental illness. Indeed, the OED attestations for "mad" are increasingly literary over time (Shakespeare, Swift, Pope, Tennyson), whereas the "newer" ME terms borrowed from Latin, often via French, such as "lunatic," "mania," "amentia," and "melancholy," include attestations from medical texts. For example, "mania," which first appears c. 1400, can be found in J. Bulwer's Anthropometamorphosis in 1650 and Riviere's translation of Freud in 1925; "melancholy," which first appears as a pathological term c.1398, can be found in medical texts such as Robert Burton's 1621 text The Anatomy of Melancholy and J. Quincy's Lex. Physico-medicum from 1722. As mental illness became increasingly medicalized this crop of "elevated" loanwords gradually entered the English language, some of which, including "mania," continue to appear in medical assessments to this day. Many native terms have survived and are common in PDE, however, these terms are entirely colloquial, their derogatory meanings reflecting early estimations of the moral causes and effects of mental illness.
For Further Reading
Bynum, W.F. "Nosology." Companion Encyclopedia of the History of Medicine. Ed. W.F. Bynum and Roy Porter. London and New York: Routledge, 1993. 335-356.
Bynum, W.F, Roy Porter, and Michael Shepherd. Ed. The Anatomy of Madness: Essays in the History of Psychiatry. London and New York: Tavistock, 1985.
Doob, Penelope B. R. Nebuchadnezzar's Children: Conventions of Madness in Middle English Literature. New Haven and London: Yale UP, 1974.
Gelfand, Toby. "The History of the Medical Profession." Companion Encyclopedia of the History of Medicine. Ed. W.F. Bynum and Roy Porter. London and New York: Routledge, 1993. 1119-1150.
Goldstein, Jan. "Psychiatry." Companion Encyclopedia of the History of Medicine. Ed. W.F. Bynum and Roy Porter. New York: Routledge, 1993. 1350-1372.
"Medicine." Encyclopedia of the Middle Ages. Ed. André Vauchez et al. Trans. Michael Lapidge. 2 vols. Chicago and London: Fitzroy Dearborn, 2000.
"Medicine and the Care of the Sick." The Encyclopedia of the Middle Ages. Ed. Norman Cantor. New York: Viking, 1999.
"Medicine, History of." Dictionary of the Middle Ages. Ed. Stayer, Joseph. New York: Charles Scribner's Sons, 1987.
Millward, C.M. A Biography of the English Language. 2nd ed. New York: Harcourt, 1996.
Porter, Roy. A Social History of Madness: Stories of the Insane. 1987. London: Pheonix, 1999.
Skinner, Henry Alan. The Origin of Medical Terms. New York: Hafner, 1970.