Perceptions of Madness

Sarah K. Hitchen, PhD student Manchester Metropolitan University

For many people with schizophrenia and other serious mental disorders, the people who initially identify that something is wrong are not medics, but family members.[1] A quick internet search reveals numerous websites and fact sheets providing information and advice for family and friends who are concerned that a loved one has developed a serious mental illness.[2] We can trace the idea that human beings instinctively recognise mental disorder in others back to the early modern period. In the seventeenth-century, the perceptions of friends and family were as important in identifying mental illness as they are today. An excellent example of this can be found in the autobiographical writings of Oxfordshire gentlewoman, Dionys Fitzherbert (c.1580 – c.1641)

A surgery where all fantasy and follies are purged, https://www.repository.cam.ac.uk/handle/1810/298391, CCBY 4.0

Between 1608 and 1610, Dionys described an extended period of significant emotional and psychic distress.  She writes of an hallucination, imagining that ‘Charterhouse Yard … should flow with the matter that came out of my mouth, and did assuredly think all the bed and clothes were as wet with it as might be’.[4] She suffered delusions in which she believed that she was not her parents’ child, but was the long dead-sister of a friend.[5] She encountered suicidal thoughts and at the same time she feared that her family would have her put to death.[6] Her thoughts were confused and fractured. Just like many people who suffer from severe mental illness today, Fitzherbert did not recognise that she was unwell. In fact, she believed that she was suffering from a spiritual affliction.[7] Her family and friends, however, were frightened by her behaviour, and believing her to be mentally ill placed her in the care of doctors.

human beings instinctively recognise mental disorder in others

But how did Fitzherbert’s family know she was mentally ill? After all, as Kate Hodgkin tells us, the seventeenth century was a time during which there was only a fine line between madness and religious despair.[8] It was the family’s perception of Fitzherbert’s behaviour that was key. Knowing her as well as they did, Fitzherbert’s relatives were able to identify her mental illness because they identified Dionys’s thoughts and behaviours as ‘bizarre’. In 1958 psychiatrist H. C. Rumke coined the phrase the ‘praecox feeling’, or the ‘praecox experience’, which referred to ‘a characteristic feeling of bizarreness experienced by a psychiatrist while encountering a person with schizophrenia’. [9] Although never formally made part of diagnosis, Rumke argued that the ‘praecox feeling’ was a central part of the diagnostic experience and this notion was echoed by psychiatrists throughout Europe during the twentieth century.[10] This feeling of bizarreness was also experienced by the non-medically trained. In the 1960’s psychiatrist Wilhelm Mayer-Gross said that the words ‘bizarre’, ‘queer’ and ‘absurd’ were often used to convey ‘the reaction of the non-schizophrenic towards the patient’.[11] Although use of the ‘praecox feeling’, has declined as a diagnostic element, it is still referred to by psychiatrists today, some of whom believe it to be ‘a real determinant of medical decision making in schizophrenia’.[12]

In a Lunatic Asylum, T.Bowes (1735). Wellcome Collection CC BY 4.0

Is this the feeling that Dionys Fitzherbert’s relatives experienced? If so the idea that human beings instinctively know when a person is suffering severe psychic distress, and the way that it seemingly transcends space and time provides us with a clear link between perceptions of madness in the past and modern experiences of mental illness.

This research is part of a PhD funded by the North West Consortium Doctoral Training Partnership (NWCDTP) 


[1] Kim Runkle, ‘Psychosis: Responding To A Loved One In The Face Of Uncertainty’, Nami.Org, 2019 <https://www.nami.org/Blogs/NAMI-Blog/June-2019/Psychosis-Responding-to-a-Loved-One-in-the-Face-of-Uncertainty&gt; [Accessed 12 October 2021].

[2] ‘Are You Worried About Someone’s Mental Health? Fact Sheet’, Mindcharity.Co.Uk, 2011 <https://www.mindcharity.co.uk/wp-content/uploads/2015/10/are_you_worried_about_someones_mental_health_factsheet.pdf&gt; [Accessed 12 October 2021], ‘Living With – Schizophrenia’, Nhs.Uk, 2021 <https://www.nhs.uk/mental-health/conditions/schizophrenia/living-with/&gt; [Accessed 12 October 2021], ‘Mental Illness – Family And Friends – Better Health Channel, Betterhealth.Vic.Gov.Au, 2019 <https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mental-illness-family-and-friends&gt; [Accessed 14 October 2021].

[3] Unknown author Le médecin guarissant Phantasie [digital image] <https://www.repository.cam.ac.uk/handle/1810/298391&gt; [Accessed 12 October 2021].

[4] David Booy, Personal Disclosures: An Anthology Of Self-Writings From The Seventeenth Century (Aldershot: Ashgate, 2002), p. 309.

[5] Booy, Personal Disclosures, p. 310.

[6] Booy, Personal Disclosures, pp. 311-312.

[7] Kate Hodgkin, ‘Fitzherbert, Dionys (C.1580-C.1641)’, ODNB, 2019 <https://doi-org.mmu.idm.oclc.org/10.1093/odnb/9780198614128.013.112759&gt; [Accessed 15 June 2021].

[8] Katharine Hodgkin, Women, Madness And Sin In Early Modern England: The Autobiographical Writings Of Dionys Fitzherbert (Farnham: Ashgate, 2010), p. 58.

[9] Tudi Gozé and others, ‘Reassessing ‘Praecox Feeling’ In Diagnostic Decision Making In Schizophrenia: A Critical Review’, Schizophrenia Bulletin, 45.5 (2018), p. 966.

[10] J. Parnas, ‘A Disappearing Heritage: The Clinical Core Of Schizophrenia’, Schizophrenia Bulletin, 37.6 (2011), p. 1125.

[11] Wilhelm Mayer-Gross, Martin Roth and Eliot Slater, Clinical Psychiatry, 3rd edn (London: Baillière, Tindall & Cassell, 1969), p. 276.

[12] Gozé et al, ‘Reassessing’, p. 966.

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