Anatomie des Wahnsinns: Geisteskrankheit im medizinischen Denken der fruhen Neuzeit und die Anfange der pathologischen Anatomie (review)

Increasingly, the beginning of modern medicine is the subject of fresh investigation. The picture is somewhat obfuscated, however, by the splendor of the Renaissance, which has caused many academic physicians and practitioners to be overshadowed—first by Vesalius’s momentous work, and later by Paracelsus’s new medical philosophy and controversial speculations.

In the introductory chapter of Anatomie des Wahnsinns Michael Kutzer, from the Institute of the History of Medicine of the University of Mainz, discusses the peculiar epistemological position of mental illness in early modern times: on the one hand, it was seen as belonging to the realm of the body; on the other, it was thought to be caused by devilish influences. As the product of witchcraft and possession, it was the concern of theology, ethics, and law. Views of mental illness remained solidly founded on Hippocrates’ humors and Galen’s spiritus (the latter a catchall word particularly resonant with the Christian view of the soul as immune from illness due to its immortality).

By the end of the sixteenth century, Kutzer tells us, a more naturalistic perspective was gaining ground. Many still adhered to the Hippocratic and Galenic views of the influence of black bile, the heart, and the abdominal organs on mental aberrations and spoke of the “anima sensitiva” and the “anima rationalis” and of the localization of perception, reason, and memory in the anterior, middle, and posterior cerebral ventricles, respectively. Yet anatomo-pathological findings from autopsies (discussed by Vesalius, Willis, Stensen, Sylvius, and others), and from surgery, slowly led to the favoring of a new “ontological” siting of mental disease over the diffuse humoral etiology. While the traditional triad of phrenitis, mania, and melancholia continued to be taught, even in the prestigious medical faculties of Padua, Montpellier, Paris, and Oxford, the anatomo-pathological findings were beginning to lead to innovations—which seeped all the way down to medical theses by students influenced by the unorthodox teaching of their masters. ¹ New conditions were being described—the nostalgia, for example (characterized by sadness, anxiety, lack of appetite and sleep, and longing for home), that was recognized to affect Swiss mercenaries stationed abroad.

Especially important to theory was Descartes’s concept of “res extensa” (as opposed to “res cogitans”), embodied in the idea of the pineal gland as the organ of contact between mind and body. Following his path, others attributed this function to different portions of the cerebral matter, such as the “corpus callosum” and the “centrum ovale.” Increasingly, mental illness was regarded as a somatic disease, a malfunction of the “sensorium commune.” Pathological findings in various organs came to be considered etiological causes of mania and, especially, of melancholia (which was equated to malfunction of the spleen).

Kutzer attributes the real paradigmatic change in psychological physiology of the early modern epoch to the “Cartesian turn” toward a somatic etiology of mental illness, even though it was not yet solidly grounded in scientific data. To support his argument he has painstakingly excerpted pertinent passages from many works (mostly in Latin), and has provided a vast bibliography of primary and secondary sources. Anatomie des Wahnsinns is a welcome addition to the historiography of the tortuous advancement of medicine toward experimental science, and a valuable discussion of the sources of the increasing biological orientation in psychiatry.