Chapter 8 - The Construction of the Phrenitic in Larger Society

Summary

This chapter picks up on Chapter 6, and looks further into the history of the moralization of mental illness from the late antique period to the end of the Middle Ages, with the discourses focusing on the topics of debauchery, wine-consumption, sexual excess and general depravity in the case of phrenitis. The lines are those traced by the patristic material, among which Augustine stands out as the most prolific source; the moral allegory is then further elaborated in adaptation to the themes and concerns of medieval theology and the various developments in medical physiological concepts and pathological ideas. The chapter concludes with the figure of Falstaff, the Shakespearian character who best represents this early-modern outcome of 'ethical phrenitis' as a disease of squander, drunkenness and sexual licentiousness.

Metaphors of phrenitis

In the medieval era and up to modern times, narratives of ‘madness’ and derangement are maintained in a variety of genres: in popular culture, from satirical texts to tragedy, and in serious literature, including theological invective, pastoral texts and philosophical expositions. Phrenitis is a stable presence in these metaphorical, symbolic or hyperbolic presentations of mental health, especially in moralizing and exemplary applications. The key themes and forms are those which have already emerged in Chapter 6. In the case of Christian texts especially, this continuity is also to be understood in the light of traditional authority, in which Augustine is a central figure (although other models as well exerted an important influence).

Phrenitis as a Flaw of Reason

Phrenitis as a flaw of reason, an epistemological shortcoming, continues to be part of a long tradition of theological and philosophical arguments throughout the Middle Ages. Nicephorus I (ninth century ce) uses phrenitis to describe flawed, invalid argument: ‘For what is more foolish or mad than such things (ti gar ēlithiōteron toutōn ē manikōteron)? Because not even people who are afflicted by the disease phrenitis would make such remarks.’¹

The Byzantine philosopher Michael Psellus (eleventh century ce) engages polemically with his opponents by resorting to the Galenic account: ‘Some phrenitics … keep their sense perceptions intact (tas aisthēseis diasōizousi), only their reasoning being damaged (tēs dianoias monēs blabeiēs)’ (Opuscula psychologica, theologica, daemonologica 27.20–21). In a passage of his Poemata he chastises melancholics and phrenitics for their delirious opinions in particular: ‘For you are phrenitic (phrenitiais) and ill (noseis) in your unrestrained speech, or to put it more precisely, in your slander (loidorian)’ (21.254). The same parallel returns in the English Cistercian monk Aelred of Rievaulx (twelfth century ce), who elaborates on a classic account of dreaming:² ‘In sleep, when we are asleep in our body, the soul, being itself incapable of sleep, [finding itself] deprived of the sensorial stimulation through which it engages with bodies in real life, at this time is naturally taken to fantasies of bodies … as often happens to the phrenitic’ (Homiliae de oneribus propheticis Isaiae 2.6.32).³ Misunderstanding of God is also similar to mental obfuscation through phrenitis: ‘But the visions I saw, I saw not during dreams, nor in sleep, nor in phrenesis (non eas in somnis, nec dormiens, nec in phrenesi), … but … through the purity of my mind, … according to the will of God’ (thus the Benedictine scholar Hildegard of Bingen (eleventh–twelfth centuries ce), Scivias. Protestificatio 43); and so on.

The phrenitic and the drunk are coupled to exemplify flawed argumentation by William of Conches in his cosmological dialogue Dragmaticon philosophiae (eleventh–twelfth centuries ce) 2.6.7: ‘I am afraid that you will hear a philosopher who is always phrenitic before lunch and drunk afterward. For it is proper to the phrenitic and drunk that they appear to see everything moving through the commotion of their brain; hence he says that the earth was moving with all its buildings.’ The phrenitic has no judgement; his disease is the folly of trusting an enemy ‘who wants to cut our throat’ in the twelfth-century ce epic poem Troilus attributed to Albert of Stade.⁴ More subtly, William of Ockham (thirteenth–fourteenth centuries ce) distinguishes between individual and action. Phrenitics cannot have real agency: they are capable of action, but not of virtuous action ‘because it is obvious that every exterior act can be initiated by a phrenitic or a furious person, who cannot however commit any virtuous action in the present’.⁵ The philosopher also explores the pathological imagination of the phrenitic in relation to previous experiences in a more technical sense: ‘Fantasies sometimes result in an act of imagination and speech without any previous such act, just as is clear for phrenitics and those who rave’ (Quodlibeta Septem 3.20, p. 282.31).

The flawed senses of the phrenitic remain a topos in medieval epistemology and technical philosophical discussions; this is clear from the frequent use of the concept by Thomas Aquinas (thirteenth century). In his commentary on Aristotle’s Metaphysics, phrenitics are those whose ‘organ of phantasia is damaged’ and who thus fall into error.⁶ The comparison with sleepers returns a number of times (e.g. at Quaestiones disputatae de malo 3.9.79), and dormientes et phrenitici (‘those who are asleep and phrenitics’) become common philosophical exempla of flawed perception.⁷

The particular suitability of phrenitis for invective in philosophical and theological disputes, with their characteristic combination of intellectual and moral evaluation, ultimately carries over into the modern debates of theological Protestantism. Jean Calvin (sixteenth century) laments his opponents’ ‘calumnies or, rather, deliriums of phrenitics (phreneticorum deliria)’.⁸ Lawrence of Brindisi (sixteenth–seventeenth centuries ce) expands the moralizing metaphor to attack Luther and his followers: ‘phrenitis is typical of a mind that has no hope of health (phrenesis mentis est prope desperatae salutis); for it is touched by no care for just and honest virtue, none for the common good, but only for its own interest, someone who loves himself too much, who does everything only to please himself’.⁹ And elsewhere: ‘But, which is worse – although feverish like a phrenitic, he is convinced he is healthy when he is close to death (sed, quod peius est, febricitans hic phreneticus est, sanus sibi esse videtur, cum morti proximus sit)’.¹⁰ Thus ‘(Luther), like a phrenitic who raves against the doctor, rose against the Roman Pope (sed tanquam freneticus in medicum insaniens insurrexit in Romanum Pontificem) and attacked his judge with a thousand accusations, insults, calumnious charges’.¹¹ Speaking against the Lutherans generally, Calvin in turn said: ‘The Lutherans … are vertiginous men, Cyclopes, a faction of arrogant giants, phrenitics (frenetici), prodigious beasts, blind, desperately shameless … stupid and pompous and at the same time unaware.’¹²

It is worth noticing, when we consider these early-modern (post-medieval) references, that we are now operating within a historical context in which phrenitis has become firmly established in medical studies and practice as a brain inflammation, deprived of spiritual appeal and considered through the impartial lens of a morally neutral medical assessment. The discourses of theology, however, preserved the early Patristic use, safeguarding the elements of continuity in the appeal of this ‘common disease’, as Gregory of Nyssa had referred to it almost 1200 years earlier.

The Phrenitic Enemy

Theological invective, in fact, brings philosophical and moral flaws together. On the topic of heresy, Rudolf of St. Trond (ninth–tenth centuries ce) spoke of ‘simony, | which is the disease of phrenesis | and so fertile a cradle, | that it is a source of all kinds of heresy’.¹³ The Belgian abbot Philip of Hareng (eleventh–twelfth centuries ce) in his De silentio made phrenitis a centrepiece of his critical vocabulary, one of the keywords in the text, evoked again and again to the point of redundancy: ‘Nor will I offer the hellebore necessary to purge such a phrenesis (phrenesi necessarium purgationis helleborum non apponam)’ (56.1053.25) and so forth. An even more extended example is the polemical booklet by Rather, bishop of Verona (ninth–tenth centuries ce), entitled Phrenesis cuiusdam Ratherii, or The Phrenesis of a Certain Rather; the ironically self-deprecating title is aimed at his opponents Rodbert and Baldric, who had accused him, Rather, of all people, of being phrenitic. In the words of a commentator, ‘He ultimately hints that phrenesis is a literary madness, which all literati share in the eyes of lesser men who lack their higher wisdom.’¹⁴ Rather mentions phrenesis obsessively to support his invective in the text, always along the same lines: ‘O sick phrenesis! O phrenitic sickness, seated close to the judgement of the wise man! (uesana Phrenesis! o phrenetica prudentis iuxta arbitrium uesania!, 13.209.394)’ and so on and so forth. These idiomatic uses are so frequent and abundant as to approximate phrenitis/phrenesis to a general meaning ‘madness’, ‘illness’.

Phrenitis as Existential Malaise

With its general meaning as ‘acute, deadly illness’ in a corporeal sense, phrenitis is easily used as a symbol of a more universal existential malaise. Such a state of moral and psychological prostration is intended by Radboud of Utrecht (ninth–tenth centuries ce), bishop and biographer of the Anglo-Saxon missionary Saint Boniface, in the Uita Bonifatii Moguntini (uita secunda) when he writes in praise: ‘He restored to health those whom anger had turned phrenitic, hatred cephalargic, error scotomatic, impiety insane, arrogance epileptic, indolence lethargic, and all the passions of an erring mind, as much through the surgery of penitence as through the medicine of consolation’ (76.22). The nosological category and existential, emotional disturbance are here strictly connected. Radboud’s contemporary Odo of Cluny (ninth–tenth centuries ce), whose poem Occupatio speaks of the redemption of Christ, mentions frenesis in the same spirit as a false sovereign, a ‘pseudobasilla’, which subdues the world and turns men’s minds to chaos (5.297–99). The Byzantine scholar Joannes Tzetzes (twelfth century ce) even pictures himself as a metaphorical ‘phrenitic’, lost in a kind of nihilistic spleen: ‘Content with only bread and water and the most basic clothing, always deranged and mad from phrenitis, I repeat the words of Pindar and Solomon, “vanitas vanitatis” and “What is someone? What is no one? Human beings are the dream of a shadow”’ (Epist. 19.36.13).

Phrenitic Violence and Dangerousness

The paradigm of dangerousness – towards themselves and others – that marks ‘folk’ phrenitis as an active, visible behavioural disturbance in the early centuries also persists. Peter Damian (eleventh century ce), Epistulae 44.28.5 paints the destiny of a person affected by phrenitis in dark and tragic colours: ‘When he falls into a state of phrenesis and a condition of beastly fury, he hurls himself with immense fierceness away from the grip of the hands trying to hold him back, away from the chains, in all directions, and where the vortex spins most rapidly, there he dies, submerged by the gaping mouth of the foaming waters.’ These ill men are like beasts in their violence: ‘As his wife, with many others, assisted him as he lay in bed, he began to wail deeply, to emit barks (ululatus emittere), and as the frenitis became evident, to snort with muddled noises (garrire)’ (Epistulae 72.355.4). Bernard of Clairvaux (twelfth century ce) elaborates on the ‘dystonic’ aspect (as we might call it, with some anachronism) of self-hatred in these pathological cases, another feature of the phrenitic’s lack of awareness: ‘The phrenitic hates his own flesh (sic nimirum odit et phreneticus carnem suam) when he tries to move his own hand against himself, since the judgement of reason is asleep’ (Sermo de conuersione ad clericos 5.4).

In Epistularium 12.419, Guibert of Tournai (thirteenth century ce) suggests that one use a soothing manner with the violent phrenitic, while in De morte he describes such a patient as a threat to family and neighbours: ‘When the bile prevails, when the acute fever raves, do we not see the phrenitic become most ill? He grinds his teeth, wounds his own parents, strikes with his fists, attacks those who approach him with bites’ (131.274).¹⁵ The sword as symbolic prop returns, now for self-harm, in William of Auvergne (twelfth–thirteenth centuries ce), who describes the multifarious drive to death in such patients: ‘We see phrenitics throwing themselves on swords, and indeed looking for heights from which to hurl themselves, water to drown in, and fire to immolate themselves’ (Sermones de communi sanctorum et de occasionibus 46.162.80).¹⁶ The sword dilemma, in which the weapon in the madman’s hand is compared to the riches which corrupt our soul, is posed again at Sermones de sanctis 93.319.55: ‘If God takes away your riches and the like, he does so like a friend who takes a sword away from a phrenitic friend, so that he does not kill himself.’¹⁷ Aggressiveness is physical and – via allegory – verbal: ‘like evil phrenitics who bite with their teeth – which means, with offensive, harsh words – when people come to cure them with punishments and similar measures’ (Sermones de communi sanctorum et de occasionibus 16.57.14). The Czech Protestant theologian Jan Hus (fourteenth–fifteenth centuries ce) elaborates even further on the ethical implications of the sword motif:

It is an action of greater compassion to take away the sword from a phrenitic who wants to kill himself, than to give a sword to a persecuted person to defend himself from someone who wants to kill him. Because it would be worse if a man were to die at his own hand in such a way, than if one were killed by another; the first case would be deserving of condemnation, the second deserved and right.

(Defensio articulorum Wyclif, lectio 2.204.790)¹⁸

Animals

We have already encountered the dangerousness of the phrenitic represented as beastly behaviour, with biting and barking. Animality, a reduction to a feral state, belongs to the general imagery of irrationality and violence. William of Auvergne (twelfth–thirteenth centuries ce) is the first author in the sources preserved for us to refer to a real animal as ill with phrenitis: ‘An unrestrained horse (equus effrenatus), blinded by its own voracity, not only erupts into phrenesis through excessive fatness; an untamed horse runs away uncontrollable, meaning it does not obey the bit, and even turns its teeth against men’ (Sermones de tempore 263.462.53). In this image of the noblest animal, the horse, becoming ferociously deranged and ‘impatient to bite’, effrenatus, we can hypothesize an aural connection between frenus (‘restraint’, ‘bite’) and the phrenitis group of pathological terms – as is evident in another discussion of an equus frenosus, the pseudo-Augustinian Liber quaestionum veteris et novi testamenti (115.37). This text draws extensively on medical sources on phrenitis to sketch the hippiatric image: the animal suffers from a bodily imbalance involving fever, boiling blood, overheating and derangement, by which its body is impaired, frenatur corpus. We also read: ‘The soul should lead the body. If, on the other hand, the body releases the soul so that it may go where it likes, it sends it off to destruction, as a frenosus horse does an inept rider (with a Platonic image – praecipitat eum sicut equus frenosus neclegentem sessorem).’¹⁹

There is additional interest in the fact that our disease, unique among ancient forms of mental disorders, seems here to be able to affect animals as well, even if so far only figuratively.²⁰ Horses are most at issue, being the animal that was most prized and scrutinized in late-antique and especially Byzantine agronomic and veterinary writings, as the various Hippiatrica testify. In general, however, the point is that phrenitis has a physiological core which involves human beings and beasts alike. In the verses on phrenitis by the French reformer scholar Jean Gerson (fourteenth–fifteenth centuries ce), several parallels with animals explicitly return (Opera poetica 153.489):

When the affection disturbs the brain, the man becomes fatuizans,

finally it exacerbates, he suffers, and phrenesis emerges.

…

Not otherwise I saw them lead a horse,

in this way, pushed by the goad, a bull or a boar raves,

and the affection hits one’s judgement with the level of inebriation.

Not in a single way do the fumes of wine impact the person.

One is silent, one speaks, one is furious, one laughs piously,

one is awake, one sneezes; there is no rule.

The corporeal physicality of this disease seems to root it especially in biological, animal existence, something that finally becomes explicit in the modern development of a veterinary phrenitis.

Phrenitic Flaws of Character

In popular culture, phrenitis thus remains a metaphor for human flaws – individual as much as shared. It also maintains richly characterizing moral features which, although they connect only tangentially with the medical portrayals, concur with them in suggesting the survival of the disease in the collective consciousness.

Disease and Euphoria: ‘Freneticus gaudet in insania’

Augustine and other Church Fathers had reflected on the misplaced joy and grief of mental disorder. Thus John Chrysostom: ‘If they do not realize, but rejoice, do not be surprised. For the manic and those who suffer from phrenitis also commit many injustices, and do pitiful things, for which others weep for them, but they themselves laugh and revel in what happens.’²¹ The theme returns in various Christian authors: ‘The phrenitic rejoices greatly in his madness, laughs and cries over the one who is sane’ (Sedulius Scottus, ninth century ce),²² while the derangement of these ‘phrenitics’ is a kind of ecstatic dance according to Philip of Harveng (twelfth century ce): ‘Made prey to his internal phrenesis … he raves like a bacchant in the incurable oblivion of his damaged conscience.’²³ Such is the dross of humanity: ‘In hay there is chaff, in metals there is slag, and in oil lees. And so also among us there are people who rejoice while they do evil and exult in the worst things, and like phrenitics, laugh in wickedness and about their wickedness.’²⁴

The image of grotesque joy can be more picturesquely elaborated, as in William of Auvergne’s (twelfth–thirteenth centuries ce) paradoxically festive portrayal: ‘There are phrenitics who, while they are on their way to the place of martyrdom and to the infernal gibbet and such, sing, laugh, and rejoice and so forth, just as spingatores (musicians), singers and the like do.’²⁵ Phrenitics are like professional entertainers, their merriness forced and unnatural: ‘Who would say that he who laughs and raves in the joys of the phrenitic is blessed, just as these coreatores and expingatores are? For their laughter is that of the phrenitic.’²⁶ It is the doctor’s and the philosopher’s task to recognize the gravity of the situation: ‘The philosopher accordingly says: “The phrenitic sings and laughs, but the doctor cries and weeps” (ridet et cantat freneticus, sed plorat et luget medicus).’²⁷

Strength in Wickedness: The ‘male fortes phrenetici’

Just as they are deceived in thinking of themselves as happy, so too phrenitics foolishly trust in the great strength the disease gives them. Julian of Toledo (seventh century ce) preserves this concept: ‘For phrenitics usually think of themselves as stronger in their vigour, when nature itself appears to have just reached its lowest point of damage. But they do these and other such things not moved by vital sense but by a mortal dissolution of a morbid kind (non uitali sensu permoti, sed mortali dissolutione iam tabidi).’²⁸ The eleventh–twelfth century ce author Olbert of Gembloux calls this a phrenetica uel energumena insania, which belongs to the arrogance of human reason;²⁹ phrenitics are ‘too strong for their own good (male fortes phrenetici)’, killing their doctor, according to Rupert of Deutz, also eleventh–twelfth centuries ce.³⁰ The behavioural disturbance caused by phrenitis suits crowds, typified as it is as an expression of senseless and passive, yet violent strength, and humanity as a whole is metaphorically presented as a phrenitic mob acting with uncontrolled strength: ‘Theatrical crowd, phrenitic crowd, where are you rushing to? (Turba theatrica, turba phrenetica, quo properatis?; Bernard of Cluny, twelfth century ce).’³¹

Phrenitis, Vices and Emotions

Intense emotions are a trigger of affections as well as accompanying them; lypē was in fact an early keyword in narratives about phrenitic characters.³² John Peckham (thirteenth century ce), for instance, uses phrenitis to make sense of anger: ‘As in sleep or in phrenesis: for such wicked enjoyment is close to phrenitis, as is clear from the anger that comes from that enjoyment.’³³ So too William of Auvergne (twelfth–thirteenth centuries ce): ‘Likewise anger is an acute fever, from which a spiritual phrenesis derives’,³⁴ and Guibert of Tournai (thirteenth century ce): ‘Halt, phrenesis of anger (cessa, ire phrenesis)! Because the fervour of anger spares no one, heals no one.’³⁵ The physicality of anger is especially evident in Lawrence of Brindisi (sixteenth–seventeenth century ce), who describes health in a traditional manner as a matter of harmony between components, with phrenitis offering a fitting humoral metaphor: ‘The spirit affected by anger is a rabid dog, a fiery snake, a man suffering from phrenitis (homo phrenesi laborans).’³⁶

Emotional vices and despicable behaviour supported by emotions are also parallels to phrenesis: William of Auvergne turns to ‘avarice and arrogance and so forth, which are almost a continuous state of sleep, like phrenesis and the like’,³⁷ while Antonius Bonfini (fifteenth century ce) uses phrenitis to qualify the folly of adulterous behaviour: ‘What illness, what phrenesis could be greater?’³⁸

Specific temptations or strong drives may be in question. Sexual attraction and human lust, under the influence of a disproportionate sexual impulse, are compared to the lack of discernment in phrenitics: ‘From excessive sexual intercourse a man becomes blind and sometimes frenetic because of the voiding of his brain (ex nimia eius frequencia homo efficitur cecus et quandoque freneticus ex vacuacione cerebri)’,³⁹ while in a piece of fantastic anthropology we read of a strange people who practise cannibalism, gluttony, licentiousness and every sort of absurdity. They ‘suffer this without realizing, because of themselves and because of daemons living inside them, like those who suffer from phrenitis’.⁴⁰

Phrenitis in Narratives of Power, Control and Authority

Attacking the Doctor

This non-technical life of phrenitis tells us a great deal explicitly about institutional roles and power relationships. The ancient topos of the antagonism to medical figures and their advice was honed in Christian literature into its own allegory, which persisted throughout the centuries. The same images return in medieval theology, where the popular portrayal of the violent madman armed with a sword, a whip or the like continues to be emphasized as an attack on the doctor or caregiver. Thus John of Damascus (seventh–eighth centuries ce): ‘He came to those who hated, pursued those who were fleeing, did not readily blame the harsh, did not turn around the whip, but like the best of doctors, although insulted (hybrizomenos) by a phrenitic, even if spat upon, struck with blows, he brought healing.’⁴¹ Michael Psellus (eleventh century ce) elaborates on the pathological body: ‘like a phrenitis patient who blames or even whips the doctor, as [the doctor] handles his wounds, and presses on the swollen part with his fingers, and drives away the illness’.⁴² The divine help is refused: ‘And so, oh diseased, oh wounded, may the great doctor, the Samaritan doctor (medicus magnus, medicus samaritanus), kindly and patiently forgive you as you exasperate him, as if through phrenesis, and push away his hand (quasi per impatientissimam frenesim exasperas eum et manus eius repellis), while throwing against him the ignorance of your words.’⁴³ More pictorially vivid still, the phrenitic breaks vials and wastes fragrant ointments: ‘[Jesus] found the men to whom he had been sent, which is the Jews, to be phrenitics, and they broke the alabaster vial of the ointment that was to heal them, by whose scent people are saved (alabaustrum unguenti sue sanationis fregerunt ex cuius odore gentes sanati sunt).’⁴⁴ And ‘when he saw the phrenitics raving against the doctor with their teeth and nails, he imposed the salvific poultice of his words (salutiferum cathaplasma uerborum) on their heads and hearts (capitibus eorum et cordibus)’.⁴⁵ Phrenitics behave like feral beasts to the doctor,⁴⁶ while the world itself, the mundus, acts like a mad patient: ‘He came like a doctor, and was torn to pieces by this world as if by a phrenitic (ipse enim ueniens sicut medicus a mundo uelut frenetico dilaceratus est).’⁴⁷

The hand is a centre of dramatic attention. The act of biting the helping hand is a particularly iconic representation of the phrenitic confronting the doctor: ‘in the manner of a phrenitic, not only rejecting but even trying to bite the hand of the doctor (ac, more phrenetici, non solum repellens, sed et mordere tentans medici manu)’.⁴⁸ There is also the topos of the sinful hand: ‘He will see how diseased is that hand of his … while until now it seemed to him to be healthy and strong, just as if his hand, made insane through the violence of disease, like a phrenitic one, should begin to beat the true doctor.’⁴⁹ The zenith of pathetic (and baroque) elaboration on this theme is the ungrateful violence against another body part, the nourishing breast: ‘For bad children bite the breast – namely the preacher – killing their nurse, who is like a drinking cup for them, like phrenitics who maul the hand of the doctor, or like a rabid dog which devours the hand of someone offering it bread.’⁵⁰ Perhaps Jean Gerson’s (fourteenth–fifteenth centuries ce) combined allegory surpasses them all: ‘Which doctor will cure those who turn the health-giving antidote into a poison for themselves, who use the surgical knife as a death-bringing sword for cutting their own throat, who then rise up, like phrenitics, against the doctor and push him away with fists, kicks, sticks and pieces of wood?’⁵¹

Figures of Care and Authority

The doctor is identified, of course, with God or with spiritual guidance generally; in this figure, benignity and coercion are combined. Rather of Verona (ninth–tenth centuries ce) can thus rhetorically ask: ‘Who sends away a beloved child who is oppressed by phrenesis, without tying him up or even locking him up?’⁵² A recurring feature of this aggressive paternalism is the logical schism between ‘loving the patient’ and ‘hating’ the disease, the sin not the sinner, etc. Thus Philip of Harveng: ‘Feeling compassion and embracing the phrenitic, he only failed to love the phrenitis (in him) (miserans et amplectens phreneticum solam illius phrenesim non dilexit).’⁵³ Brotherhood is also invoked as an image of condescension: ‘Since we recognize that those who inflict wounds on us are labouring under phrenesis, we shall defeat the diseases of the furious and their bites by means of the virtue of patience, and we should strive to remain silent, insensible, facing our brother (insensibiles fratri quasi mortui taceamus).’⁵⁴

Jesus can also be doctor and medicine, however, in a quite concrete sense, as in the Christological elaboration preserved by Henry of Lancaster in his allegorical Livre de Seyntz Medicines.⁵⁵ In a digression, Henry prescribes a cure for a phrenitic – which is Christ himself: a freshly killed cockerel should be placed on the head, offering maximum contact with the skull covering the diseased brain. The bird is equated with the bloodied Christ, whose blood is a sign of human ingratitude but also balm, medicine and so forth:

Now if I am to be cured of this delirium, I shall have to take this cockerel, thus prepared, and place it on my weak head, to lift my spirits and to put me in my right mind … And the red cockerel is you, most sweet Jesus, who are, as I have said beforehand, physician and remedy, so that I beg you, dear sweet Master, that I might firmly think upon the red cockerel and through its power recover my wits in such a way that I think of nothing unless it be in you or of you or for you.

Pity, Condescension, Restraint

Paternalism and condescension are important iatrogenic emotions and attitudes in care relationships, which are revealing of the nature of medical interactions. John of Damascus (eighth century ce) develops the idea of the phrenitic’s inferiority to and dependence on the doctor, despite his apparent resistance to medical care, which should be disregarded: ‘When a small child insults you, you deem the insults worthy of laughter; and whenever a person out of himself with phrenitis says dishonourable words, you regard him as worthy more of pity than of hate.’⁵⁶ So too Sedulius Scottus (ninth century ce): ‘The doctor is annoying to the raving phrenitic, and the father to the disobedient son; one by trying to tie him up, the other by trying to kill him (molestus est medicus furenti frenetico, et pater indisciplinato filio; ille ligando, iste caedendo).’⁵⁷ Force and restraints are the other face of this medal: Michael Psellus emphasizes the involuntary nature of the necessary cure, proposing an authoritarian approach to these patients and the spiritually ill in general: ‘Then it was right (dikaion ēn), as with phrenitics, to cure these too this way against their will (akontas).’⁵⁸

Children, fathers and mothers are central actors here: ‘But like a most indulgent father towards his most beloved son who is labouring under phrenitis, so is he (God) towards his enemies.’⁵⁹ William of Auvergne, by contrast, shifts the point of comparison to motherly love, a social emotion rarely dignified by higher virtues in ethical discourses: God is ‘just like a pious mother with her phrenitic son, who ties him up so that he might not rage against her or others with his illness.’⁶⁰ All in all, the Christian God is of course the highest model of resilience with sinners. Thus, Lawrence of Brindisi (sixteenth–seventeenth centuries ce): ‘However Christ does not grow angry with him, like God against Moses and Aaron, but feels the utmost compassion, like a pious father or a most pious mother, who sees her most beloved child taken by phrenesis and insane.’⁶¹

Among Protestant Christian writers, John Wycliff (fourteenth century ce) seems to question the rightfulness of this involuntary treatment of another, even if this is a slave or a phrenitic: ‘A phrenitic must agree to be bound so as not to cause damage to himself; and so too any servant must agree (freneticus debet velle obligari ne inferat sibi damnum; sic debet quilibet servus velle).’⁶² In the same text, Wycliff discusses an anecdote in which ‘Petrus’ is phrenitic and poses a danger, and ‘Paulus’ intervenes to stop him, again constructing a sword scenario: ‘Given that Petrus is phrenitic and has a sword, and wants to manically attack another; and that Paulus is however nearby, seeing that there is no other better way to stop him, would it not be according to the rules of charity that he should take the sword away from Petrus against his will?’⁶³

The theme of love for phrenitics expressed through acts of coercion even develops into a case study for the philosophical discussion of free will, as reflected upon by Alexander of Hales (twelfth–thirteenth centuries ce),⁶⁴ and later by the Dutch Catholic theologian Cornelius Jansen (sixteenth century ce), who also finds the phrenitic a pertinent case study for ethical discussions of judgement and free will.⁶⁵ Several of these themes were already in place in early Christian morality and hagiographic preaching; the image of the phrenitic persists as an antonomastic subject of these suggestions and narratives, adapting its profile to changing morals and philosophies, and retaining an exemplary character sometimes approaching a caricature.

Individual and Prominent Patients

After Alexander the Great, as we have seen,⁶⁶ individual cases of phrenitis continue to be recorded by historians. Procopius (sixth century ce) recounted the story of one of the men of Justinian’s general Belisarius, Koutilas, who was wounded in the head during the Gothic wars. ‘The surgeon who was caring for him removed the weapon from his head, perhaps unwisely; when this happened, Koutilas fainted. When his membranes began to be inflamed, he was struck by phrenitis and died soon afterward.’⁶⁷ A wound is here the mechanical cause of inflammation of the membranes and phrenitis, a rare account of our disease fitting a military context.

In general, when more high-ranking individuals become phrenitic, greater emphasis is laid on grief and distress than on mechanical or material causes. This is also the case with the Eastern Roman emperor Justin I (518–27 ce); several testimonies are preserved regarding him. Evagrius Scholasticus refers to the emperor’s illness as due to a difficult turn of existential circumstances: ‘Once Justin heard the news, being incapable of healthy or sound thought because of this typhus and cancer, and unable to humanly bear this combination of events, he fell into a state of phrenitis and mania, understanding nothing of what happened afterward.’⁶⁸ The Byzantine scholar and theologian Joannes Zonaras (twelfth century ce) also recalls Justin’s death after he fell out of grace and became ill, explaining: ‘Because of this pain, for these reasons, he fell prey to the disease phrenitis and suffered pain even in his feet.’⁶⁹

A noblewoman mentioned by Geoffroy of Auxerre (twelfth century ce) in his Vita prima sancti Bernardi Claraevallis abbatis 4.33 is also said to have fallen ill with phrenitis after a personal loss: ‘Having incurred a phrenitis because of her pain at the death of her husband (cum post obitum uiri sui prae dolore phrenesim incurrisset), and having remained in this state for a long time, she was being held in chains and was taken to the same holy father in the above-mentioned town’; his blessing healed her. The Byzantine historian Ducas (fifteenth century ce) also mentions lypē, ‘grief’, as a cause of phrenitis-like disturbance to describe the humiliating disappointment and subsequent illness of the statesman Leontarios: ‘Having heard these things and having failed to catch his prey, like a lion with his head held low and dragging his tail in the dust, keeping it slack, through pain just as if he had become prey to phrenitis, keeping his head down, he stood there until the attack had finished.’⁷⁰

In these examples, an excessive emotional reaction is often the cause or trigger for phrenitis. As in the case of Justin, so too in several others as well the exceptional character or prominence of the patient may play a role. Galen is the illustrious precedent of a ‘great man’ falling prey to a disease which affects the mind but remains firmly embodied and is thus more dignified, one might say, than possession by mania or melancholia. There are other cases of the death of a notable person where an existential phrenitis is involved. I argued above that Plutarch’s account of the death of Marius, in which existential crisis and wine were involved, might be such a case. In his biography of Saint Poppo (ninth–tenth centuries ce), Onulphus of Hautmont (tenth–eleventh centuries ce) describes the saint’s death from phrenitis, mentioning a state of growing despair (languor in dies crescente).⁷¹ A comparable anecdote is found in John Zonaras (twelfth century ce), where it is again attributed to the final episode in the life of Alexander the Great: ‘Having washed himself, and having travelled towards Media with the intention of taking some rest, and having spent the night there in a village, and the following day as well, he began to run a fever. Becoming severely feverish and thirsty, he drank some wine and died from phrenitis’;⁷² several of the sources for Alexander’s death mention fever and wine drinking, elements which match other accounts of leaders’ deaths.⁷³ Nicophorus Gregoras (thirteenth–fourteenth centuries ce) reports similar circumstances in the death of a Byzantine emperor, dwelling specifically on his phrenitis:

As the king was proceeding against it at dawn and stopped around Nikaia, a terrible disease struck: I do not know if it should be defined as phrenitis or as epilepsy. It precipitated his hēgemonikon into a sense of oppression and narcosis, such as people whose brain is not in good health suffer when lightning strikes, when the environment is wetter and colder, and the brain brings about a flash before their eyes, and they find it impossible to bear these feelings and changes.⁷⁴

Exceptionality in a negative sense marks the phrenitic death narrated by William of Tyre (twelfth century ce), a homicide committed by a depraved individual, Robert. In his case phrenitis, envy and hatred work together to produce the crime: ‘The above-mentioned Robert, the author of so many crimes, was sick with an extended illness; and once his convalescence had begun, taken by a violent frenesis, he descended unawares into such impious evil.’⁷⁵ Even Erasmus of Rotterdam, finally, complains of having been falsely reported to have died phrenitic, a prank he recalls in a letter discussing his intellectual conflicts with some opponents: ‘The rumour was spread that I was so offended by that book of the Strassburger that I became phrenitic and died of it; nor do I doubt that this story was spread deliberately.’ The medical importance and learned tradition behind this disease, and perhaps its antiquity pure and simple, lent it a patina of solemnity which made it, among other things, a good narrative expedient to qualify the ends of kings and criminals, one of the places where medical and scientific prominence intersected with popular culture and historical projections, the former maintaining intelligibility by a wider public in this way, the latter acquiring lustre and credibility.

Folk Portrayals of Phrenitic Character

Intelligibility is confirmed by other anecdotes, not aimed at edification, where phrenitic patients are evoked. Consider this bit of information preserved in the Gesta Romanorum, a collection of tales and anecdotes of mixed provenience dated to the thirteenth century ce. This story is allegedly exchanged between two famous characters from the Gospels:

We read in a book about the colloquium of Peter with Jesus: ‘I once saw five men, whom I thought were phrenitic (quos quidem freneticos arbitrabar). I saw one eating the sand of the seashore so avidly that it came out of both his ears. I saw another standing in a sulphureous pit full of pitch, from which an unbearable stench exhaled, who for all his efforts could not satisfy his mouth with this smell. Third, I saw one lying down in a burning furnace, who could not get enough of the ardent heat, from which he was trying to catch the sparks to devour them. I saw a fourth, who was sitting on the pinnacle of the temple in order to catch the wind, and he always kept his mouth open, so that the wind could pass through it. I saw the fifth, who was taking anything he could get with each and every limb into his mouth and gobbling it up, and was continuously laughing at the other four. Many people saw these five men and were amazed at how they could behave in these ways.⁷⁶

Phrenitis seems to have become a colourful container for a variety of behavioural oddities, where megalomaniac enterprises, self-harm, nonsensical behaviour and, overarching everything, laughter and amazement at the spectacle are the common frame.⁷⁷ Other anecdotes have phrenitis as curse or punishment.⁷⁸ On the whole, these medieval popular tales show phrenitis infiltrating the consciousness of lower strata of the population. Not only non-professionals with some knowledge of medicine, or upper-class intellectuals, or clerics and churchgoers, but even the audience of folk tales – these groups would of course often intersect – would immediately understand the reference, at least on a general level.

A final popular theme emerging within this material is again prophecy. The thirteenth-century ce author John Peckam recognizes that ‘the souls of phrenitics, when they are close to departure, sometimes see what others cannot (animae etiam freneticorum, cum sint prope separationem, vident aliquando quae alii videre non possent)’,⁷⁹ and even Thomas Aquinas (Summa contra Gentiles 3.154) mentions the belief, partly rationalizing it: there are evil spirits (maligni spiritus) which can operate in human beings through various wonders, and prophecy is one of them. These daemons cannot really foresee the future, but one of their skills is that they can grasp premonitory signs of things better than people can. Through their characteristic sensitivity, phrenitics easily become a vehicle for this daemonic talent:

Now [the evil spirits] sometimes predict, indeed, by impressing the imagination, either during sleep, as when they show the signs of certain future events through dreams, or while one is awake, as is apparent in the case of people in a trance or in phrenitics, who foretell events to come

(sicut in arreptitiis et phreneticis patet, qui aliqua futura praenuntiant).

Astrology

Astrological beliefs are maintained in evident continuity with the previous tradition. The Egyptian astrologer Rhetorius (sixth–seventh centuries ce) draws a strong connection between phrenitis and the sun, resorting more to technical mathematical calculation than to the iconography of constellations: ‘The sun in the eighth degree causes an earlier death of a father, and also makes some phrenitic.’⁸⁰ The schematizations of the astrologers are sometimes also telling in regard to surviving concepts of the disease: in his De zodiaco, the Byzantine Joannes Camaterus (ninth century ce) sees phrenitis straightforwardly as a ‘pathos of the phrenes’, connects it with ugly behaviour and the action of daemons, and associates it with the early moon:

If mistress moon should come early,

while one is writing the horoscope at that time,

it predicts false words and thefts

and an infelicitous flight and a black-skinned goddess.

You could say it is daemons, or a bad fear;

it indicates magic, nonsensical words,

and the disease phrenitis or a pathos of the phrenes.⁸¹

The astrological tradition refers to phrenitis also in the later Arabic Abou Ma’shar al-Balkhî (Apomasar, eighth–ninth centuries ce).⁸² In a discussion of Cronos and its influences, we read: ‘If [this star] is spoiled [at the time of setting], it causes phrenitis and longer-lasting diseases’. Elsewhere, ‘if Aphrodite acts in conjunction with Ares, they indicate a terrible and acute disease such as phrenitis and the like’ (156 l. 12). Hildegard of Bingen (eleventh–twelfth centuries ce) traces a parallel between lunar phases and the health of the brain, whereby the sun and the moon exert a direct influence on human health: ‘When the moon is waxing, the human brain and the blood are subject to increase in the same period … The individual falls into phrenesis, to such an extent that it appears more indomitable than beasts.’⁸³

Legal and Canonical Aspects

The phrenitic had been already identified with the quintessentially incapacitated in earlier juridical texts. Turning to family law, Peter Damian (eleventh century ce)⁸⁴ asks whether someone who becomes phrenitic should maintain custody of another person:

For if a powerful king wants to grant custody of his young child to one of his princes, and afterwards, having fallen into a fury, this person salivates and exudes abundant mucus from his nostrils, and wants either to throw himself into a fire as a result of phrenitic temerity (frenetica temeritate) or to roll himself like a pig in a slough soiled with filthy mud, should [the king] not straightaway decline, and custody be revoked?

Thomas Aquinas⁸⁵ returns to the topic of repentance with reference to canonical rulings, discussing the extreme unction for phrenitics: ‘Hence we read in the Con. Carth. iv … that if a sick person who looks to repent is afraid because he is oppressed by the disease or has turned phrenitic (vel in phrenesim conversus fuerit) as the priest is invited to go to him, those who had heard him should give testimony.’⁸⁶

Problems of moral and spiritual accountability are posed by sleep and phrenesis in another discussion of canon law, where Thomas Aquinas proposes that a defect in one’s state of health might compromise the effect of baptism.⁸⁷ ‘When baptized, the person receives at the same time as charity also prudence and all the other virtues.’ But interference might occur there: ‘with the exception, perhaps, of some baptized people, like children, or people of wicked disposition, like idiots or phrenitics (sicut … morionibus et phreneticis)’.⁸⁸ By virtue of suffering from a bodily disease, conversely, the phrenitic is regarded as functioning under extenuating circumstances. For Alain of Lille (twelfth–thirteenth centuries ce), our disease might mitigate the guilt for a sin, although not excuse it completely, as in the case of homicide: ‘It alleviates capital sin, but does not excuse it (peccatum plenarie non excusat set alleviat).’⁸⁹

Associated with this is the opportunity to interfere with the phrenitic’s free will, which has legal consequences, aside from posing philosophical questions. In the twelfth-century ce summary of canon legislation Decretum magistri Gratiani, several references are made to phrenitis and incapacitation, including the well-known anecdote: ‘If someone meets an enemy who has turned phrenitic due to dangerous fevers (periculosis febribus freneticum factum) running towards a precipice, should he not exchange evil for evil and let him go, rather than tie him up as someone deserving to be corrected and looked after?’ (2.23.4.37).⁹⁰ The anecdote in Humbert of Romans (twelfth–thirteenth centuries ce) about a man who, lest he fall prey to frenesis, completes his will in advance, gives money to charity and organizes all his business, ought to be understood in a similar spirit.⁹¹

The information about the ‘insanity defence’ available to defendants in medieval criminal cases, finally, such as those from thirteenth- and fourteenth-century England analysed by Butler, confirms the trend.⁹² A certain Anabilla, wife of William Carter of Bulcote, for example, killed her own child but ‘was in a frenzy and feverish’ and generally out of her mind.⁹³

The Phrenitic Falstaff

We should conclude with another element, medical and popular, which had begun to emerge in late-antique medicine and progressively shaped some lay receptions of the disease: indulgent consumption, especially of wine and, connected with this, drunkenness, gluttony and debauchery generally. Wine is discussed as an element of dietetics and therapy by the Hippocratics, of course,⁹⁴ and various physicians in the subsequent tradition mention it as a powerful and potentially dangerous remedy, especially when mental disorder is involved. Galen seems to consider wine a possible trigger for phrenitis, as we have seen, and the debate about its suitability as a cure for the disease was divided between a few who would prescribe it in some cases, and those who find it too risky for oversensitive patients. For Galen, wine is like the doctor, powerful but as good as the precision of its use, while Caelius Aurelianus explicitly takes it as a differential factor for distinguishing the real phrenitic from the intoxicated individual.⁹⁵

In the survey of non-technical texts discussed in this chapter and in Chapter 6, wine abuse occurred in the cases of several prominent patients, a number of whom died in phrenesis while combating drunken grief – a concession to their high-class status, that through self-inflicted intoxication they remain more responsible for their own phrenitic state of health, as opposed to being entirely passive victims? Wine and drunkenness are a correlative and quite overt instance of the excesses and extremes generally displayed by the phrenitic, in whose portrayal drunkenness, ebrietas, is often included.⁹⁶

Thus Rupert of Deutz: ‘You drank powerfully, you mixed your drunkenness strongly, you forceful men, phrenitics (Potenter bibistis, fortiter ebrietatem miscuistis, uiri fortes, uiri phrenetici).’⁹⁷ Michael Psellus (eleventh century ce), by contrast, describes phrenitics as people who do not drink wine (perhaps because of their susceptibility to it): ‘For if someone who drinks only water … (this is the same as saying someone with dropsy or phrenitis)’,⁹⁸ while Peter Damian posits a group of ‘utterly miserable inebriated people, who boil like phrenitics, lose memory from their mind, think nothing good’ (ebriosi miserrimi | infremunt ut phrenetici | mentis perdunt memoriam, | nihil boni excogitant).⁹⁹ The traditional topos is not left unused by reformers like Jean Gerson (fourteenth–fifteenth centuries ce) with his colloquial reference to inebriation or phrenitis as he mounts a critique of the state of the Church: ‘just like a phrenitic or someone seduced by the worst inebriation of evil passions (tamquam freneticus vel ut pessima malarum passionum ebrietate seductus)’,¹⁰⁰ while in Jean Calvin (fifteenth century ce) the respite given by the anxious thoughts of one’s conscience are like sleep for the phrenitic or the drunk, who are comatose and troubled at the same time, vexed by nightmares.¹⁰¹

The motif of wine runs through the whole tradition. But one of the most picturesque instances came early, in Caesarius of Arles (fifth–sixth centuries ce). In his Sermones Caesarii uel ex aliis fontibus hausti, Caesarius had forged an exemplary caricature of the bad Christian, a kind of crass, drunken phrenitic (16.3.5):

For what kind of Christian is such that he hardly comes to church, and when he comes, he does not stand in the church and pray for his sins, but either talks about indictments or causes litigation and fights; and if he finds a seat, he drinks to the point of vomiting, and after he has got drunk, he stands up like a phrenitic and dances insanely in a diabolical way, jumps around and sings disgraceful words of carnal and lustful content?

We are far away here from the technical precision offered by medical texts, and fully in the realm of comic moralism. Yet the seeds of some of these forms of derangement were already present in the medical material. This inclusive profile and stereotype of ‘phrenitic’, with its extreme colours, buffoonish touches and popularization, is more than a simple curiosity. Instead, it illustrates an important point about the nature of disease survival: it is by virtue of such transverse discourses and elaborations that a nosological concept finds a vehicle through history. This is evident in the grotesque portrayal of gluttony and excess sketched by the medieval German satirist Sextus Amarcius (eleventh century ce), who in the third book of his Sermones speaks about the vices of luxury, greed and other overindulgence (3.1.70):

The glutton demands now a hen and now rice, and a fish is stuffed with hare for him, and cheese with eggs, yet refusing to be sated, he licks up a thousand foods. Nor does that phrenitic whirling foster any less unstable people (nec minus instabiles frenesis colit ille), such as the greedy man who prefers money to life when tasting a [poisonous] mushroom, henbane, aconite or hemlock.¹⁰²

True, it is not phrenitis as nosological concept that is evoked here. But neither is this yet the ‘frenesy’ of modern clichés about careerism, the consumerist life and so on. The technical term is used hyperbolically to qualify an ethical flaw or to evoke a character, a typology of flawed Mensch that the audience could recognize.

Perhaps the grandest and loudest picture of this ‘hybrid’ phrenitic in our tradition, returning to the comic, iambic construction which took its first steps in Roman poetry, is Shakespeare’s Sir John Falstaff, the buffoonish character who features in Henry IV (Part I and Part II), Henry V and The Merry Wives of Windsor (see Figure 8.1). Falstaff’s debauchery and his ultimately deadly illness are interwoven with medical accounts of phrenitis in their popularized version. He is fat as a consequence of his gluttony, drunken, and at once cowardly and smug. He is also wildly cheerful and engages in morally dubious behaviour involving money, women and wine. From the start, his health is in the spotlight. His urine is unhealthy,¹⁰³ and he speaks of his state of health (and that of Prince Hal, his fellow in crime) in the following ‘phrenitic’ terms:

This apoplexy, as I take it, is a kind of lethargy, an’t please your lordship, a kind of sleeping in the blood, a whoreson tinglin’ … it hath it original from much grief, from study, and perturbation in the brain. I have read the cause of his effects in Galen, it is a kind of deafness.

(my italics)

The casual mixture of medical suggestions from the tradition we have examined – the lethargy, the comatose blood, the excessive stimulation through study, the grief, the tingling – is given technical legitimacy by the reference to Galen. To us, it shows that Shakespeare or his audience would see these words as active references to current medical knowledge about phrenitis and enjoy the comic effect. Falstaff’s character is painted in terms of pathetic neediness, and his ‘grief’ finally explodes when he is repudiated by Prince Hal, now king, and forced to detach himself from his pathological double.¹⁰⁴ Falstaff will die, seemingly out of grief and rejection. The scene of his death has received much comment and suggested Socratic parallels. But no reader has thus far recognized in the pathological details and Hippocratic elements reported ‘before a tavern’, of all places, by the inn-keeper, Mistress Quickly, the literary elaboration of the final moments of a phrenitic (Henry V, Act ii, Scene iii):

  … for after

I saw him fumble with the sheets and play with

15flowers and smile upon his fingers’ ends, I knew

there was but one way; for his nose was as sharp as

a pen, and a’ babbled of green fields. ‘How now,

sir John!’ quoth I ‘what, man! be o’ good

cheer.’

…

I put my

hand into the bed and felt them, and they were as

25cold as any stone; then I felt to his knees, and

they were as cold as any stone, and so upward and

upward, and all was as cold as any stone.

NYM They say he cried out of sack.¹⁰⁵

HOSTESS Ay, that a’ did.

30BARDOLPH And of women.

Hostess Nay, that a’ did not.

Falstaff has crocydism, hallucinations and delirium; he yearns for wine and women – or no longer does so? – and displays the typical face, or Hippocratic facies of those who are about to die.¹⁰⁶ Not only is his portrayal enriched with technical language and concepts from the Hippocratic and Galenic traditions, widely present in the literary language of the period and in Shakespeare’s style, but he offers an incarnate illustration of how deeply and widely this panoply of flaws, weaknesses, bodily ailments and mental shortcomings had been absorbed by lay culture.¹⁰⁷ As a result, this phrenitic portrayal – unnamed as such – is efficiently understood by theatregoers as a plausible medical counterpoint to the tragicomic narration about old age, bodily and mental decline, moral depravity and so on and so forth.

Figure 8.1 ‘Last scene in the life of Sir John Falstaff’ (Shakespeare, Henry V, act ii, sc. iii). From an etching by George Cruikshank (Robert Brough, The Life of Sir John Falstaff: A Biography of the Knight from Authentic Sources.

Illustrated by G. Cruikshank, 1858).

In the reception of a general audience at the turn of the seventeenth century, in conclusion, a moral-medical narrative of the phrenitic was acquired, complete with physiological and anatomical details. The element of wine and drunkenness, marginal or conventional in the ancient sources (but returning from Seneca the Younger onwards as part of the figurative, picturesque fresco of the raving, acratic, ill-willed phrenitic), will be isolated as a subtype of medical phrenitis in modern times, in the key final phase in the life of our disease: the frenitis potatorum, or gin-phrenitis,¹⁰⁸ sustained and partly anticipated by the popular stories analysed here.

Conclusions

From the early centuries of our era, phrenitis (with its different labels: φρενῖτις, phrenesis, frenesis, phrenesis, frenesia, frenzy and cognates) gains a space of its own in the collective imagination at a variety of levels, technical and lay. Outside medicine, we find it across the whole range, from documentary sources, folk contexts and various non-medical genres (legal writing, astrology, comic works, lower ‘popular’ medicine, hagiographic narratives) to more elevated contexts (prudential, theological, philosophical, patristic). Of all ancient mental diseases, phrenitis becomes the quintessential spiritual and ethical ailment, more present and insisted upon than any other. This metaphorical and ethical phrenitis is endowed with a repertoire of characteristics modelled on 2,000 years of Greek, Roman and post-classical clinical observations and theoretical elaborations. Its strongly codified bodily portrayal (fever, hallucinations, visible behaviours, etc.) works to corroborate its allegorical reliability, allowing further discussion of key ethical topics such as voluntariness, responsibility, incapacitation and the like. Its rich and vivid manifestations, moreover, are striking and pictorial – the spastic movement, the aggressiveness, the grinding of the teeth, the foaming at the mouth, the frenzy, the hallucination – ever increasing the clarity of the syndrome. Some elements are emphasized and heightened, such as violence, dangerousness and bestial behaviour; a reluctance to accept help and complete lack of awareness; dysthymic joy and supernatural strength; and mob-like behaviour, which fits the topos of the deranged mob of Jews who executed Jesus, aggravated by foolish laughter and cheering at the height of their own misfortune. At the same time, a pathologization of the socially marginal becomes apparent. When Thomas Hobbes wrote that by his time, the sixteenth and seventeenth centuries ce, phrenitics had so to speak ‘replaced’ the possessed (by daemons),¹⁰⁹ he was lucidly exposing both the physiological turn in the understanding of this particular pathological experience and the identification of a state of metaphysical exception, possession, with a medical state of affairs.¹¹⁰

However difficult it is to make firm claims about the societal penetration of a medical concept, from what I have just described we can be certain that, from the early centuries of our era to the beginning of modern times, intellectuals and upper-class readers throughout the Empire and in medieval and early-modern Europe knew phrenitis as a key, dangerous disease. We can imagine that most well-read laymen did as well, if we can trust genres such as satire and Christian sermons. Moreover, throughout the medieval period we can infer that religious audiences and the general populace would understand, if not the technical details, at least the general profile of phrenitis as an acute, feverish, deranged pathology that caused people to behave uncontrollably, in a beastly and undignified way, with a causal and phenomenal location in the brain and the humoral body but also in the chest, or phrenes.