Medieval mental health

Medieval Europe often viewed mental distress through a religious lens, associating conditions like severe agitation or erratic behavior with demonic possession. For example, in the late 12th century, Bishop Hugh of Lincoln was called to help a sailor tied to stakes, believed to be possessed. His biographer described the event as proof of Hugh’s saintly powers, contrasting his compassion with the local bishop’s fear. While such accounts suggest superstition, they reflect only part of medieval mental health attitudes. Religious texts frequently depicted mental illness this way, but other sources reveal a more nuanced understanding focused on lifestyle and balance.

Medieval medicine relied on the humoral theory, which claimed health depended on balancing four bodily fluids: blood, phlegm, black bile, and yellow bile. To maintain this balance, people followed the six non-naturals—external factors like diet, exercise, sleep, and emotions. Emotional control was especially emphasized; for instance, the 14th-century physician Juan de Aviñón warned against anger, irritation, or worry, as these could harm the body. Similarly, Arnold von Bamberg noted that poor emotional regulation disrupted eating, exercise, and sleep, often requiring medical treatment. This system framed mental and physical health as deeply interconnected.

Certain emotions were considered so harmful they could cause illness or even death. Fear, for example, was linked to sudden physical collapse; Alice, a 13th-century clerk’s daughter, reportedly froze from terror after seeing a ghost, leading to a temporary fit of madness. Chronic anger was also dangerous, as it ‘consumed the body swiftly,’ shortening life. King Henry I of England (1068–1135) was said to have died from a dispute with his daughter, which provoked anger and illness. Even brief emotional outbursts, like a temper tantrum, could prove fatal. These beliefs highlight how medieval people connected mental states to physical wellbeing.

Medieval texts warned that excessive responsibility could harm health, particularly for high-status individuals. Daniel of Beccles, writing around 1300, described a master’s life as relentless, with ‘pressing worries gnawing at his gut’ and his mind ‘focused on calamities.’ Similarly, the French knight Jean II Le Meingre (1366–1421), known as Boucicaut, was advised to reduce his workload to avoid illness. Monks also suffered from stress; Matthew, a 13th-century monk at Rievaulx Abbey, complained of exhaustion and bone pain from his duties, while Alexander de Langley at St Albans Abbey experienced ‘fits of raving’ from overwork before collapsing from studying too much.

Anxiety and depression, called melancholia, were recognized in medieval Europe. The Tuscan merchant Francesco Datini (1335–1410) described his life as perpetually unhappy, worrying constantly about business and the Black Death. His wife Margherita urged him to relax, noting his ‘extreme melancholy.’ King Duarte of Portugal (1391–1438) also suffered from melancholia, which he linked to his duties during a plague outbreak. Monks were especially vulnerable to acedia, a form of spiritual sloth that left them ‘half-dead’ in spirit. Symptoms included persistent low mood, disinterest in life, and even hallucinations of demons or black shapes.

Medieval doctors treated melancholia by addressing an excess of black bile, one of the four humors, which was thought to cloud the brain. Treatments included purging the excess humor with syrups of warming ingredients like cinnamon and liquorice, or massaging with warm oils to restore balance. Patients were also advised to engage in joyful activities, such as walks, music, and socializing. Taddeo Alderotti, a 13th-century physician, prescribed these for Obizzo II d’Este, lord of Ferrara (1247–93), who had suffered from melancholy and insomnia for over two years. Joy was prized not just as a cure but as a cornerstone of health, believed to moisturize the body and improve vitality.

Medieval people used substances and objects believed to alter mood or mental state. Saffron was thought to provoke joy, though one Welsh recipe (c. 1400) cautioned against overconsumption ‘in case you die of happiness.’ Other remedies included oregano, fennel, and ostrich liver, though the latter’s benefits are unclear. Precious stones were also recommended; Abbess Hildegard of Bingen (1098–1179) suggested looking at an onyx or placing a sapphire in the mouth to calm sadness or anger. These remedies were typically combined with lifestyle changes, reflecting a holistic approach to mental health.

Medieval regimens promoted socializing, pets, and cultural activities as remedies for mental distress. Francesco Datini found solace in his friendship with lawyer Lapo Mazzei, who used humor to lift his spirits. Pets like cats, dogs, and birds were popular companions, with even bishops and kings keeping monkeys or ferrets for comfort. Reading was encouraged, but cheerful books were preferred; one friar was warned against ‘horrible stories depicting martyrdoms or death.’ Music was also valued; in the 1390s, Bologna sent a musician and storyteller to a dying lawyer’s son to distract him from worry. These approaches mirror modern social prescriptions for mental wellbeing.