Medieval mental health

Saffron and ostrich liver were prescribed but so were exercise, gardens, animals, socialising, and music

by Katherine Harvey  BIO

All images from the Codex Manesse (1300-40) and courtesy Heidelberg University Library

is a historian, writer and reviewer, specialising in medieval history. An honorary research fellow at Birkbeck, University of London, she teaches for both Birkbeck and the Open University, and her work has been published in academic journals and popular periodicals. Her books include The Fires of Lust: Sex in the Middle Ages (2021) and The Medieval Guide to Healthy Living (2026). She lives in London.

Early one morning in the late 12th century, Bishop Hugh of Lincoln arrived in the Hertfordshire village of Cheshunt. There, he was immediately surrounded by a crowd of people, who begged him to help one of their neighbours. And so, dismounting from his horse, he went to the man’s house, where he was confronted by the disturbing sight of a possessed man ‘lying prostrate with his head tied to a post and each of his hands to great stakes fixed in the ground.’ Despite these restraints, the man constantly writhed around, rolling his eyes, gnashing his teeth, and sticking his tongue out. To Hugh, as to the local onlookers, the diagnosis was clear: this unfortunate sailor had been possessed by a demon and could be cured only by an exorcism. Once the necessary rituals were performed, he was ‘delivered from the demon [and] … after living devoutly for some years, finally made a good and peaceful end.’

For Hugh’s biographer, Adam of Eynsham, the incident was worth recounting because it demonstrated not only that the future saint had healing powers, but that he was a brave and compassionate man (in sharp contrast to the local bishop, who had ‘galloped away as if pursued by the Furies’, rather than face a possessed man). But, to us, the story – full of fear, cruelty and superstition – sums up both everything that was wrong with medieval attitudes to mental illness, and the apparent uselessness of medieval medicine in the face of serious illness.

And yet, as is so often the case when studying the distant past, the reality was rather more complicated. Influenced by stories of demonic possession (and there are lots of them, especially in saints’ lives and miracle collections), I long assumed that our ancestors’ attitudes to, and experiences of, mental health were completely different to our own – and that they would have little sympathy with our fast-growing mental health crisis. But when I turned my attention away from religious texts, and began to research medieval ideas about healthy living, I soon came across medieval people who discussed mental health in ways that felt far more familiar to me.

The similarities were particularly apparent in medical writings, which outline a sophisticated argument that mental wellness was at the heart of a healthy lifestyle. According to the dominant humoral system of medicine, health was achieved by keeping four bodily fluids (blood, phlegm, black bile, and yellow bile) in balance. The best way to do this was through careful management of the six non-naturals, a set of external factors that had a direct impact on the human body, and that included many of our modern preoccupations, such as diet, exercise and sleep, as well as the emotions.

This last factor featured prominently in regimens (how-to books about healthy living, which were extremely popular in late-medieval Europe), in which people were warned that, for the sake of their health, they must control their emotions. According to the 14th-century Sevillian physician Juan de Aviñón, ‘it is necessary that a man that wishes to preserve his health will not become angry, nor irritated, nor worried as much as possible, because once he does so he greatly harms his body.’ Similarly, the Bavarian physician Arnold von Bamberg warned that emotional dysregulation could disrupt an individual’s eating habits, exercise routine and ability to sleep; a person who did not pay sufficient attention to his feelings would inevitably end up needing medical treatment. And it seems that people did blame their bodily ailments on mental travails. For example, in 1395, when the Italian politician and wool merchant Niccolaio Martini was ill with a high fever, he told his friend Margherita Datini that ‘he came down with this illness after getting very upset’ about the result of a recent election.

Too much responsibility could make a person ill, with high-status men thought to be at particular risk

Certain emotions were so detrimental to health that they could cause sudden illnesses, or even death. Fear was especially dangerous: among the miracles performed by the hand of St James (which was kept at Reading Abbey from the mid-12th century) was the cure of Alice, an Essex clerk’s daughter who saw a ghost when milking sheep on Good Friday. Her terror caused the blood to freeze around her heart, and so confused her senses that she suffered a temporary fit of mania and threw herself into a fire. Anger, which warmed and dried the body, was also unhealthy; as a chronic problem, it would (in the words of one mid-15th-century German regimen) ‘consume the body swiftly, so that the man meets a short end’, while a serious temper tantrum could prove fatal. One chronicler claimed that Henry I’s final illness was caused by a dispute with his daughter, the English king being ‘provoked by these irritations to anger and bitter ill-feeling, which were said by some to have been the origin of the chill in his bowels and later the cause of his death’.

Fear and anger were usually acute emotions, quick to come and go, but medical experts also warned about the dangers of chronic emotional distress. One of my favourite medieval images compares the mind to a bent bow which, although strong, cannot survive continual strain, so that ongoing ‘disputes in the household’ could ‘shorten a person’s years’. Just as we worry about stress, medieval people recognised that too much responsibility could make a person ill, with high-status men thought to be at particular risk. In an English conduct book written around the turn of the 13th century, Daniel of Beccles claimed that a master ‘lives like a toiling ant’; his ‘pressing worries gnaw at his gut and burden his shoulders’, and his mind is ‘always focused on calamities’. The........

© Aeon