“I fear I am not in my perfect mind”: Mental health and the perception of madness in Shakespearian England

Article by Hannah McCann.

In Shakespeare’s plays, ‘madness’ plagues many of the characters. It is thought that the work of John Hall, a physician and Shakespeare’s son-in-law, influenced the playwright’s depiction of mental illness to some degree. 

Physicians could explain some mental illnesses by drawing on ancient ideas. The concept of the four humours, created by Hippocrates and Galen, was extremely influential in shaping theories around mental illnesses. In the 16th and 17th century, they believed that the body and the mind were both connected. The mind did not cause ‘madness’ but was a symptom of a physical ailment. In The Anatomy of Melancholy from 1621, Robert Burton identified the illness of ‘melancholy’, which we would label as depression. He described it as a ‘fear’ and ‘despair’ that emerged without an external cause.  He suggested that ‘melancholy’ was caused when one of the four humours, black bile, was out of balance with the others. Shakespeare would often create characters that had symptoms of depression, such as Hamlet and Romeo, with another one stating that “I know not why I am so sad.”

On the other hand, they also believed that supernatural forces could cause mental health problems – such as the person being possessed by the Devil or evil spirits. They thought that the disorderly behaviour of witches was caused by a mental affliction due the presence of the Devil. 

The practice of trepanation, the first documented surgery by mankind, involved cutting a hole in the skull to allow these spirits to escape the mind. This was a common treatment for mental illness throughout history. Remarkably, there were also some treatments for mental illness that we would recognise today, with clergy offering counsel to those in distress. Those with ‘melancholy’ were asked to seek ‘good company’ and to distract their minds with their work. 

Another of Shakespeare’s characters, from the tragedy of King Lear, is Edgar who disguises himself as a ‘Bedlam beggar’. The ‘Bedlam beggar’ was a common sight in the streets of 17th century England. Those who had mental illnesses could beg legally so were often seen homeless in towns and villages. The term ‘Bedlam’ comes from the word Bethlem, short for Bethlehem. This was a reference to the mental hospital of the Priory of St Mary of Bethlehem which had been founded in 1247 in London. The hospital, infamous for its abuse and neglect, used punishment alongside religious practices to ‘cure’ its patients. It was also a way to keep dangerous ‘lunatics’ away from the rest of the population. 

The use of the ‘Bedlam beggar’ in Shakespeare’s play was important as it made the audience, both peasants and royalty alike, sympathetic to the pain and suffering of Bedlam patients. Shakespeare describes their ‘roaring voices’ and the turmoil that they experienced. 

It is hard to understand now, looking back on the practices carried out at Bedlam hospital, but they were trying to help their patients. They had a religious obligation to help the ill, but they lacked understanding of causes and treatments of metal health illnesses. The hospital had less than 30 patients by 1620 as only those who lacked family or friend’s support were sent to the hospital. Many people with mental illnesses were treated in their own homes by physicians, like John Hall. There were many reforms and inquiries carried out at the hospital by the monarchy to deal with the sporadic corruption of hospital officials.

Shakespeare’s plays give historians a valuable insight into the perception of mental illness in the 17th century. Shakespeare drew on contemporary fears and ideas which offer a reflection of society at the time. These extremely useful sources should not be dismissed simply because they are fiction.