Mental illness is not a modern problem, but a human one; the great plague proves it.

Without doubt, the world today is far less gruesome, violent and volatile than it ever has been in countries such as the UK. Because of this, we would anticipate the rates of mental illness to be much lower today than they ever have been. However, because we certainly can’t dig our ancestors back up and ask them about their mentalities, it’s easy to presume from their stoic, stiff-lipped portraits and photographs that depression, anxiety and trauma never plagued them. This would suggest that mental illness is just a fantasy of a weak, modern generation, rather than something unavoidably tied in with the evolution of the human psyche. In my opinion, this misconception is worth debunking, and is routed from little more than a lack of coverage on historic cases of mental illness. The few times that they are acknowledged, it’s important to remember that it is done so through the window of a far less progressive and knowledgeable time. ‘Insanity’ could be interpreted as a woman refusing to have children, and ‘lunacy’ as a man returning from battle with post traumatic flashbacks. Asylums were filled with societies undesirables, all while thousands of hollow, helpless individuals walked the streets unsupported, only dissuaded from ending their lives by religious threats of eternal damnation.

Often the argument that our predecessors never endured mental challenges is also fuelled by looking for information in the wrong places. Census statistics show a drastic increase in reports of mental illness from the 1800s to the present day, which would suggest that there are just more mentally ill people now, or an influx of false diagnoses. This is decidedly as untrue as claiming that there are more LGBT people in 2020 than there were in 1820. The numbers are likely the same, proportionate to the population; the only difference being an increased awareness and social acceptance. In the early 1800s, a US census recorded less than 1 insane person (labelled as a person incarcerated in a psychiatric hospital for a severe psychiatric disorder) per 1000 people, whereas this increased to 1.8 in 1880, 3.4 by 1950 and 15 by 1990. This is surely counterintuitive, as the average person in 1990 probably had far less to objectively worry about than a person in 1820, if we examine just their difference in quality of life. Our ancestors suffered immensely by todays standards, but the grim truth is that they often suffered silently, or were not considered disruptive enough to be given ‘treatment’ while their plight went undocumented in the pages of history. If you weren’t a ‘lunatic’ in an asylum, you were not recorded as being mentally ill. If you were female, poor or non-white it was also highly likely for you to be illiterate, leaving few personal accounts behind from the vast majority of the population, who’s struggles went unseen and unheard as a result.

Due to these methodical errors, we cannot claim that mental illness is a modern problem, whilst stating that the world today is so much easier than the world 200 years ago. Human beings have not changed in their nature; our biological predispositions to stress and cognitive responses to trauma are no different. If the world is easier to live in today, we should be seeing a decrease in prevalence of mental illness, not an increase. As a result, it is reasonable to presume that while diagnoses have gone up, actual prevalence of mental illness has not. It’s probably stayed static throughout human history, spiking during periods of great stress.

For me, when I think of periods of great stress for Europe, my mind conjures up images of countless chapters throughout history ravaged by famine, war and disease. But perhaps the most evidence of psychological problems among a historic population comes from one of the most turbulent periods in modern human history; the period of Europe’s ‘Great Plague.’ The prevalence of documented ‘insanity’ within census records during this time is of course an unreliable source of information due to issues I’ve discussed, but to look into individual accounts and cultural influences is incredibly enlightening, proving that despite a lack of knowledge and understanding, psychological disturbance was as common in medieval England as it is today. Our ancestors were as vulnerable as we are; making their survival all the more inspiring.

In the 1600s, Europe faced one of its deadliest epidemics in history, as the great plague – also known as the black death – struck down a huge chunk of the continent’s population, including 15% of the city of London in mere weeks. It’s almost impossible to imagine something as apocalyptic as this happening today. To be surrounded constantly by death, disease and suffering; quite literally stumbling over abandoned corpses on your doorstep each day while attempting to maintain a sense of normality. To know always how uncertain your future is – that you or your loved ones could be dead within a week – is a perfect example of a traumatic event. The sheer amount of loss is unthinkable, that some individuals such as Eyam’s Elizabeth Hancock had to bury six of her children and her husband in the span of eight days. The scale of death was so great in fact that in some remote areas or heavily populated towns, there was nobody left to bury the mounting dead, and bodies had to be unceremoniously abandoned to wild animals or discarded in mass graves known as plague pits. There are so many of these pits in London that they allegedly shaped the construction of the underground subway, which curves and meanders to avoid mass graves where bones are packed too thickly to bore through.

Nobody knew at this time how to treat the plague, rendering it a death sentence. Doctors abandoned their patients for fear of infection, while priests refused to perform last rites for the dying; something truly devastating, as the medieval population believed that this essentially condemned a dying person to hell. Superstition was rife at the time, and some saw the plague as a kind of divine judgement, acting out through self-harm as they marched out in public whipping themselves in a frenzied, emotional state to repent their sins. The levels of anxiety that must have been felt to elicit such a response are not entirely shocking, when considering that many of these people had lost everyone they knew to a bloody demise and were in a state of complete desperation. However, it would be difficult to witness someone obviously traumatised from loss and whipping himself in public in the modern day, and not call that person mentally ill.

We have little means to judge our ancestor’s sensational reactions to this disaster, as records show that as the plague moved from place to place, people behaved no differently to how we would if such an event occurred today. Many were depressed, demoralised, terrified, and maddened. Crime rates skyrocketed as a result, and accounts of what we may now consider mania are well documented, as wild partying and morally questionable debauchery gripped entire towns, law and order breaking down. Fear of falling ill was so great that parents stopped tending to and visiting their own children, opposing the most basic evolutionary instinct to protect ones young. A relentless need for answers led many to desperation, committing atrocities such as sacrifices, burnings and massacres largely targeted at the Jewish community, who were blamed for the outbreak. They served as a fitting scapegoat in a time of intense paranoia, due to their faith requiring that they practise a high standard of hygiene; leaving them largely untouched by the disease.

The mental state of those who fell ill was also incredibly volatile. Cell necrosis caused by internal haemorrhaging would have an intoxicating effect on the nervous system of an infected person, sometimes causing a state of insanity in their final days, ranging from suicidal depression to delirium. This left a percentage of the population severely mentally unstable as well as physically suffering at all times as the infection spread, leaving those who would ultimately survive exposed to levels of madness that would ordinarily be hidden away from society.

Following the plague, death became an obsession for generations to come. The focus of the arts became incredibly macabre, incorporating objects and images depicting rot and decay, reminding the population that death is inevitable. Many living comparably good lives ultimately expressed a total preoccupation with death; something still listed as a DSM symptom of depression to this day. It is suspected that many of the artists responsible for plague-time art were haunted by the sights they witnessed on a daily basis, and used their platforms as a means of creative expression, resulting in a number of graphic depictions of rotting corpses outliving their creators and their subjects alike. Some scholars believe that the sheer amount of death during this period would not be as startling to desensitized medieval peasants as it would be in the modern age, as life was often incredibly dangerous for them, but first-hand accounts show otherwise; that those alive at the time – while becoming somewhat accustomed to it – were not unaffected by the carnage that surrounded them, nor desensitised. The words of Francesco Petrarch express the mood of this period well:

“O happy people of the next generation, who will not know these miseries and most probably will reckon our testimony as fable! Empty houses, derelict cities, ruined estates, fields strewn with cadavers and a horrible and vast solitude encompassing the whole world. I cannot say this without shedding many tears. Where are our sweet friends now? What abyss has swallowed them? The human race is nearly extinct, and it is predicted that the end of the world is soon at hand.”

The fears of many such as Petrarch, that the end was nigh, were proved false when eventually the plague died out, lacking enough living hosts to continue it’s spread. Many however were left guilt ridden for having survived and forced to completely rebuild shattered lives, many having lost entire families, or communities. Imagining the social impact of an estimated third of modern Europe simply ceasing to be only partially puts the disruption the outbreak caused into perspective. The world had just had to continue turning while death lurked around every corner, as leaving for safer climes was not an option, the threat of falling ill and dying was constant and debilitating, and yet somehow life had to persevere. It is thought from several personal accounts that this was achieved not because mental illness simply didn’t exist, nor because the medieval people were cold and unfeeling, but through denial and cognitive dissonance. To express such apathy in times of great stress is an indicator of a strong internal emotional response, serving as a protective shell. Viktor Frankl summarises this with the quote “no one weeps for any of the dead, for instead everyone awaits their own impending death”, illustrating how terror had gripped them so intensely that their reaction was merely that of trauma and anxiety, not carelessness. In Frankl’s own words; “an abnormal reaction to an abnormal situation is normal behaviour.”

Because of this defence mechanism – often seen today as a symptom of PTSD – many survivors after the plague ended attempted to repress it, forcing it from their memory as a means of coping with the horror that had taken place. This psychological phenomenon is not uncommon and occurred again after the 1918 TB outbreak that claimed millions of lives. This may perhaps explain why the average high school student now knows more about the great plague of the 1600s than they do about the far more recent 1918 TB epidemic; survivors simply forced it from their conscious memory. We see this reflected in the fact that much of the plague-based art and imagery I previously mentioned appeared a couple of decades after the plague ended, not in the immediate aftermath. To forget was the only way to keep living, as the human brain is simply not equipped to process such a magnitude of death and suffering. Historians suggest this repression of emotions may have led to an increase in suicides during this period, although the predictable spike was largely staved off due to ‘self-murder’ being illegal during medieval times.

Evidence of the psychological responses of medieval people during plague times tells a profoundly different story to that which statistics would have us believe. Quite predictably, during extremely difficult times human beings reacted in the same way as they do today; many succumbed to trauma. Mania, depression, violence and apathy became extremely common place, and yet illnesses of the mind were not understood enough to be documented. With this said, the great plague of the 1600s serves as a reminder and an example of the strain that trauma can have on the human psyche, despite our most basic instincts to continue through times of great struggle. Our ancestor’s perseverance is an inspiring feat, but to undermine their psychological suffering is the opposite of what Petrarch would have wanted. The fact that many continued living while battling depression and great anxiety makes their feat all the more remarkable; they were just like us, and they survived such horrors to tell the tale. This period in history can be seen as a strong example illustrating how mental illness and distress is no weakness of the present generation, nor a modern problem; but rather a profoundly human one.

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