A medieval attitude to suicide

I had always thought that suicide was made illegal in medieval times due to religious disapproval until suicidal people were finally freed from the risk of prosecution by the 1961 Suicide Act.

It turns out the history is a little more nuanced, as noted in this 1904 article from the Columbia Law Review entitled “Is Suicide Murder?” that explores the rather convoluted legal approach to suicide in centuries past.

In the UK, the legal status of suicide was first mentioned in a landmark 13th Century legal document attributed to Henry de Bracton.

But contrary to popular belief about medieval attitudes, suicide by ‘insane’ people was not considered a crime and was entirely blame free. Suicide by people who were motivated by “weariness of life or impatience of pain” received only a light punishment (their goods were forfeited but their family could still inherit their lands).

The most serious punishment of forfeiting everything to the Crown was restricted to those who were thought to have killed themselves “without any cause, through anger or ill will, as when he wished to hurt another”.

There are some examples of exactly these sorts of considerations in a British Journal of Psychiatry article that looks at these cases in the Middle Ages. This is a 1292 case from Hereford:

William la Emeyse of this vill, suffering from an acute fever which took away his senses, got up at night, entered the water of Kentford and drowned himself. The jury was asked if he did this feloniously and said no, he did it through his illness. The verdict was an accident.

We tend to think that the medieval world had a very simplistic view of the experiences and behaviour that we might now classify as mental illness but this often wasn’t the case.

Even the common assumption that all these experiences were put down to ‘demonic possession’ turns out to be a myth, as possession was considered to be a possible but rare explanation and was only accepted after psychological and physical disturbances were ruled out.

The echoes of the Prozac revolution

The Lancet Psychiatry has a fantastic article giving a much needed cultural retrospective on the wave of antidepressants like Prozac – which first made us worry we would no longer be our true selves through ‘cosmetic pharmacology,’ to the dawning realisation that they are unreliably useful but side-effect-ridden tools that can help manage difficult moods.

From their first appearance in the late 1980s until recently, SSRIs were an A-list topic of debate in the culture wars, and the rhetoric, whether pro or con, was red hot. Antidepressants were going to heal, or destroy, the world as we knew it.

Those discussions now feel dated. While antidepressants themselves are here to stay, they just don’t pulse with meaning the way they once did. Like the automobile or the telephone before them, SSRIs are a one-time miracle technology that have since become a familiar—even frumpy—part of the furniture of modern life.

At some point recently, they’ve slid into the final act of Mickey Smith’s wonder-drug drama. And in the aftermath of that change, many of the things that people used to say about them have come to sound completely absurd.

It’s a wonderful piece that perfectly captures the current place of antidepressants in modern society.

It’s by author Katherine Sharpe who wrote the highly acclaimed book Coming of Age on Zoloft which I haven’t read but have just ordered.

Link to ‘The silence of prozac’ in The Lancet Psychiatry.

Oliver Sacks has left the building

CC Licensed Photo from Wikipedia. Click for source.Neurologist and author Oliver Sacks has died at the age of 82.

It’s hard to fully comprehend the enormous impact of Oliver Sacks on the public’s understanding of the brain, its disorders and our diversity as humans.

Sacks wrote what he called ‘romantic science’. Not romantic in the sense of romantic love, but romantic in the sense of the romantic poets, who used narrative to describe the subtleties of human nature, often in contrast to the enlightenment values of quantification and rationalism.

In this light, romantic science would seem to be a contradiction, but Sacks used narrative and science not as opponents, but as complementary partners to illustrate new forms of human nature that many found hard to see: in people with brain injury, in alterations or differences in experience and behaviour, or in seemingly minor changes in perception that had striking implications.

Sacks was not the originator of this form of writing, nor did he claim to be. He drew his inspiration from the great neuropsychologist Alexander Luria but while Luria’s cases were known to a select group of specialists, Sacks wrote for the general public, and opened up neurology to the everyday world.

Despite Sacks’s popularity now, he had a slow start, with his first book Migraine not raising much interest either with his medical colleagues or the reading public. Not least, perhaps, because compared to his later works, it struggled to throw off some of the technical writing habits of academic medicine.

It wasn’t until his 1973 book Awakenings that he became recognised both as a remarkable writer and a remarkable neurologist, as the book recounted his experience with seemingly paralysed patients from the 1920s encephalitis lethargica epidemic and their remarkable awakening and gradual decline during a period of treatment with L-DOPA.

The book was scientifically important, humanely written, but most importantly, beautiful, as he captured his relationship with the many patients who experienced both a physical and a psychological awakening after being neurologically trapped for decades.

It was made into a now rarely seen documentary for Yorkshire Television which was eventually picked up by Hollywood and made into the movie starring Robin Williams and Robert De Niro.

But it was The Man Who Mistook His Wife for a Hat that became his signature book. It was a series of case studies, that wouldn’t seem particularly unusual to most neurologists, but which astounded the general public.

A sailor whose amnesia leads him to think he is constantly living in 1945, a woman who loses her ability to know where her limbs are, and a man with agnosia who despite normal vision can’t recognise objects and so mistook his wife’s head for a hat.

His follow-up book An Anthropologist on Mars continued in a similar vein and made for equally gripping reading.

Not all his books were great writing, however. The Island of the Colorblind was slow and technical while Sacks’s account of how his damaged leg, A Leg to Stand On, included conclusions about the nature of illness that were more abstract than most could relate to.

But his later books saw a remarkable flowering of diverse interest and mature writing. Music, imagery, hallucinations and their astounding relationship with the brain and experience were the basis of three books that showed Sacks at his best.

And slowly during these later books, we got glimpses of the man himself. He revealed in Hallucinations that he had taken hallucinogens in his younger years and that the case of medical student Stephen D in The Man Who Mistook His Wife for a Hat – who developed a remarkable sense of smell after a night on speed, cocaine, and PCP – was, in fact, an autobiographical account.

His final book, On the Move, was the most honest, as he revealed he was gay, shy, and in his younger years, devastatingly handsome but somewhat troubled. A long way from the typical portrayal of the grey-bearded, kind but eccentric neurologist.

On a personal note, I have a particular debt of thanks to Dr Sacks. When I was an uninspired psychology undergraduate, I was handed a copy of The Man Who Mistook His Wife for a Hat which immediately convinced me to become a neuropsychologist.

Years later, I went to see him talk in London following the publication of Musicophilia. I took along my original copy of The Man Who Mistook His Wife for a Hat, hoping to surprise him with the news that he was responsible for my career in brain science.

As the talk started, the host mentioned that ‘it was likely that many of us became neuroscientists because we read Oliver Sacks when we started out’. To my secret disappointment, about half the lecture hall vigorously nodded in response.

The reality is that Sacks’s role in my career was neither surprising nor particularly special. He inspired a generation of neuroscientists to see brain science as a gateway to our common humanity and humanity as central to the scientific study of the brain.

Link to The New York Times obituary for Oliver Sacks.

Pope returns to cocaine

Image from Wikipedia. Click for source,According to a report from BBC News the Pope ‘plans to chew coca leaves’ during his visit to Bolivia. Although portrayed as a radical encounter, this is really a return to cocaine use after a long period of abstinence in the papal office.

Although the leaves are a traditional, mild stimulant that have been used for thousands of years, they are controversial as they’re the raw material for synthesising powder cocaine.

The leaves themselves actually contain cocaine in its final form but only produce a mild stimulant effect because they have a low dose that is released relatively gently when chewed.

The lab process to produce the powder is largely concerned with concentrating and refining it which means it can be taken in a way to give the cocaine high.

The Pope is likely to be wanting to chew coca leaves to show support for the traditional uses of the plant, which, among other things, are used to help with altitude sickness but have become politicised due to the ‘war on drugs’.

Because of this, recent decades have seen pressure to outlaw or destroy coca plants, despite them being little more problematic than coffee when used in traditional ways, and consequently, a push back campaign from Latin Americans has been increasingly influential.

However, two previous Popes have been cocaine users. Pope Leo XIII and Pope Pius X were drinkers of Vin Mariani, which was essentially cocaine dissolved in alcohol for its, er, tonic effect.

Pope Leo XIII even went as far as appearing in an advert for Vin Mariani, which you can see in the image above.

The advert says that “His Holiness THE POPE writes that he has fully appreciated the beneficient effects of this Tonic Wine and has forwarded to Mr. Mariani as a token of his gratitude a gold medal bearing his august effigy.”

But being a Latin American, the new Pope seems to have a much more sensible view of the drug and values it in its traditional form, and so probably won’t be giving away some of the papal gold after having a blast on the liquid snow.

Link to BBC News story.
And thanks to @MikeJayNet for reminding me of the historical connection.

Context Is the New Black

The New Yorker has one of the best articles I’ve ever read on the Stanford prison experiment – the notorious and mythologised study that probably doesn’t tell us that we ‘all have the potential to be monsters’.

It’s a study that’s often taught as one of the cornerstones of psychology and like many foundational stories, it has come to serve a purpose beyond what we can confidently conclude from it.

Was the study about our individual fallibility, or about broken institutions? Were its findings about prisons, specifically, or about life in general? What did the Stanford Prison Experiment really show?

The appeal of the experiment has a lot to do with its apparently simple setup: prisoners, guards, a fake jail, and some ground rules. But, in reality, the Stanford County Prison was a heavily manipulated environment, and the guards and prisoners acted in ways that were largely predetermined by how their roles were presented. To understand the meaning of the experiment, you have to understand that it wasn’t a blank slate; from the start, its goal was to evoke the experience of working and living in a brutal jail.

It’s a great piece that I can probably do little to add to here, so you’re best off reading it in full.

Link to The Real Lesson of the Stanford Prison Experiment.

An alternative history of the human mind

Nautilus has an excellent article on a theory of consciousness that is very likely wrong but so startlingly original it is widely admired: Julian Jaynes’ theory of the bicameral mind.

Based on the fact that there is virtually no description of mental states in the Ancient Greek classic The Iliad, where the protagonists are largely spoken to by Gods, Jaynes speculates that consciousness as we know it didn’t exist at this point in time and people experienced their thoughts as instructions from external voices which they interpreted as gods.

His book is a 1976 is a tour de force of interdisciplinary scholarship and although the idea that humans became conscious only 3,000 years ago is extremely unlikely, the book has been hugely influential even among people who think Jaynes was wrong, largely because he is a massively creative thinker.

Consciousness, Jaynes tells readers, in a passage that can be seen as a challenge to future students of philosophy and cognitive science, “is a much smaller part of our mental life than we are conscious of, because we cannot be conscious of what we are not conscious of.” His illustration of his point is quite wonderful. “It is like asking a flashlight in a dark room to search around for something that does not have any light shining upon it. The flashlight, since there is light in whatever direction it turns, would have to conclude that there is light everywhere. And so consciousness can seem to pervade all mentality when actually it does not.”

The Nautilus article is a brilliant retrospective on both Jaynes as a person and the theory, talking to some leading cognitive scientists who are admirers.

A wonderful piece on a delightful chapter in the history of psychology.

Link to Nautilus article on Julian Jaynes.

A visual history of madness

The Paris Review has an extended and richly illustrated piece by historian Andrew Scull who tracks how madness has been visually depicted through the ages.

Scull is probably the most thorough and readable historian of madness since the death of the late, great Roy Porter, and this article is no exception.

Modern psychiatry seems determined to rob madness of its meanings, insisting that its depredations can be reduced to biology and nothing but biology. One must doubt it. The social and cultural dimensions of mental disorders, so indispensable a part of the story of madness and civilization over the centuries, are unlikely to melt away, or to prove no more than an epiphenomenal feature of so universal a feature of human existence. Madness indeed has its meanings, elusive and evanescent as our attempts to capture them have been.

By the way, most of the illustrations in the web article seem to be clickable for high resolution full screen versions, so you can see them in full detail.

Link to Madness and Meaning in Paris Review.