Even before Greek and Roman civilization collapsed under the impact of the barbarian onslaught in the fifth century, the Dark Ages in psychiatric history had already begun. The scientific approach to mental disorder which Galen had advocated at the end of the second century had gradually been abandoned, and physicians had returned to the primitive superstitions which had dominated man’s mind before the classical era. Abnormal behavior was divorced from medicine and associated once again with the supernatural and the magical. Demonol- ogy, which had been rife in primitive society, reappeared in full force, modified only slightly to conform with the theology of the time. The mind of man was pictured as a theater of war in which invisible spirits fought to gain possession of the soul, and treatment of the mentally ill was once again put in the hands of priests instead of physicians.During the early part of the medieval period victims of mental disorder were usually confined in monasteries. Generally speaking, they were handled in a kindly manner, and treatment consisted of prayers, holy water, sanctified ointments, the breath or spittle of priests, touching of relics, and visits to holy places. In some monasteries and shrines the priests sought to exorcise the demons by the gentle “laying on of hands.” These procedures were often mingled with crude naturalistic ideas derived from Galen and Hippocrates. For example, one of the unpalatable prescriptions read: “For a fiend-sick man: when the devil possesses a man or controls him from within with disease, a spew-drink of lupin, bishops- wort, henbane, garlic. Pound these together, add ale and holy water.” And here is one of the incantations that recalls Hippocrates’ theory of hysteria: “I conjure thee, oh womb, in the name of the Holy Trinity, to come back to the place from which thou shouldst neither move nor turn away without further molestation, and to return, without anger, to the place where the Lord has put thee originally.”These relatively mild procedures were gradually replaced by more and more violent measures. The priests became convinced that incantations and laying on of hands were not powerful enough to exorcise the devil. Believing that it was Satan’s pride which originally led to his downfall, they tried to strike back by hurling at him the foulest epithets and most obscene curses they could devise: “May all the devils that are thy foes rush forth upon thee, and drag thee down to hell! . . . May God set a nail to your skull, and pound it in with a hammer, as Jael did unto Sisera! . . . May God hang thee in a hellish yoke, as seven men were hanged by the sons of Saul” (From Thesaurus Exorcismorum). Treatment of this kind was apparently successful in many cases, probably because the patients were highly suggestible and believed so implicitly in demonology that they gave up their most obvious symptoms. A striking example of the suggestibility of the age can be found in the “psychic epidemics” which took place from about the tenth century on. The two major forms of this “mass madness,” dancing mania and lycanthropy, are described under another topic, MASS HYSTERIA.Unfortunately those who “treated” the mentally disturbed did not limit themselves to verbal attacks on the devil. The theologians of the time came to believe that demons could be driven out only by administering physical punishment. They therefore used every conceivable torture to make the bodies of “madmen” so uninhabitable that not even a demon would want to reside in them. They flogged, starved, chained, and branded them mercilessly, adding physical suffering to their mental anguish until their condition became so hopeless that they pleaded with God to release them through death.The era came to a tragic climax in the fifteenth and sixteenth centuries, partly as a result of the doctrine of demoniacal possession and partly as a reaction to the ravages of a series of storms, pestilences, floods, and especially the Black Death, which destroyed millions of lives and disrupted the entire fabric of society. The populace attributed all these terrible catastrophes to supernatural causes and sought to root out the spirit of Satan which had invaded the land. They came to believe— with the theologians—that demonic possession took two forms: some victims were unwillingly seized by the devil as divine punishment for sins, while otherswere actually in league with the devil. The latter group were supposed to have signed a pact with Satan which gave them supernatural powers of many kinds. They could cause famines, floods, impotence, and sterility. They could ride through the air, drive their enemies mad, and turn themselves into animals at will. At first the group who were unwillingly seized by the devil were considered mentally disturbed and were subjected to the practices of exorcism. However, by the end of the fifteenth century mental illness had itself been equated with sin (especially sexual sin), and both groups were considered heretics and witches.Witches were blamed for every personal and social calamity that occurred, and in 1484 Pope Innocent VIII issued a bull in which he exhorted the clergy of Europe to use every means of detecting them. Ten years later two Dominican friars named Johann Sprenger and Heinrich Kraemer were authorized to root out the evil in northern Germany. To assist them in this work, they issued a manual entitled Malleus Malef- icarum (The Witches’ Hammer) which became the “bible” for witch-hunters for two and a half centuries. The first part of the book asserted the existence of witches: “True faith teaches us certain angels fell from heaven and are now devils.” The second part described the signs to be used in detecting them, such as pigment spots or areas of anesthesia on the skin, which were supposed to have been left there by the “devil’s claw” as proof that he had sealed a pact with them. The third part dealt with the legal procedures to be applied in examining and sentencing the witches.In accordance with the Malleus, special assistants tested suspected witches by pricking all parts of their bodies in order to find insensitive areas. Another method was to shout biblical passages in the ears of women undergoing convulsions. If they responded in any way,this was taken as a sign that they were possessed, since the demon was indicating that he had been frightened by the word of the Lord. Even delusions were taken as proof of possession, since they were believed to result from a pact with the devil: “The devil has extraordinary power over the minds of those who have given themselves up to him, so that what they do in pure imagination they believe they have actually and really done in the body” (from the Malleus). The work of the devil usually took a sexual form. Invisible demons called incubi were believed to have intercourse with women, and others called succubi seduced men. Women, however, were thought to be the chief offenders: “All witchcraft comes from carnal lust, which is in women insatiable . . . wherefore for the sake of fulfilling their lusts they consort even with devils” (from the Malleus). Once they were apprehended, they were subjected to the most agonizing tortures to elicit a confession. This was the accepted way of obtaining sure proof of witchcraft. Many of the victims could not endure the pain inflicted on them and confessed to anything the inquisitors sought to prove —and if they were forced to name accomplices, these unfortunate individuals were tortured until they also confessed to misdeeds. Every confession, no matter how outlandish, was accepted by the learned judges. James I of England, for example, sought to prove that witches were to blame for the tempests that beset his bride on her voyage from Denmark. In the course of the investigation, a Doctor Fian was apprehended and, after wedges had been driven under his fingernails and his legs had been crushed in the “boots,” he finally confessed that more than a hundred witches had put to sea in a sieve to produce the storms. (A. D. White, 1896)The belief in witchcraft was reinforced by the fact that the victims were frequently mentally ill, or became mentally ill as a result of the inhumane treatment they received. The prevailing attitude toward “madness” was one of fear, and many of these disturbed individuals had been turned out by their families. Reduced to wandering about the countryside in rags, their unkempt appearance and haunted look fed the suspicions that were directed against them. Many of them were afflicted with hysteria, and were so suggestible that they accepted the symptoms of this disorder—the anesthesias—as evidence that they were actually in league with the devil, and as a result some of them freely claimed the extraordinary powers attributed to them. Those who suffered from severe depression or involutional melancholia became afflicted with delusions of sin and sought relief from their burden of fancied guilt by elaborating on their evil doings. Stone (1937) cites this example in point:“A certain woman was taken and finally burned, who for six years had an incubus devil even when she was lying in bed at the side of her husband. ... The homage she has given to the devil was of such a sort that she was bound to dedicate herself body and soul to him forever, after seven years. But God provided mercifully for she was taken in the sixth year and condemned to the fire, and having truly and completely confessed is believed to have obtained pardon from God. For she went most willingly to her death, saying that she would gladly suffer an even more terrible death if only she would be set free and escape the power of the devil.”About fifty women were brought before the judges for every man. At their trials they were stripped of their clothes, their torture marks were exposed, their hair was shaven so that no devils could hide in it, and they were brought into court backward lest they cast an evil eye on the judges. If they were convicted, they were executed in one of three ways. Some were beheaded or strangled and then burned, some were mutilated before being burned, and others were burned directly at the stake.An appalling number of people were put to death during the fifteenth and sixteenth centuries when witchcraft rose to its peak. Both the Roman and Reformed churches carried out this practice, in Europe and in the American colonies as well. The executions were rationalized as an act of mercy that freed the victim from the clutches of the devil. The extent of this man-made holocaust is indicated by this statement from Bromberg (1937):“A French judge boasted that he had burned 800 women in 16 years on the bench; 600 were burned during the administration of a bishop in Bamberg. The Inquisition, originally started by the Church of Rome, was carried along by Protestant churches in Great Britain and Germany. In Protestant Geneva 500 persons were burned in the year 1515. In Treves some 7,000 people were reported burned during a period of several years.”Although the execution of witches continued until near the end of the eighteenth century, voices began to be raised against demonology during the sixteenth century. In Switzerland Paracelsus rejected the doctrine and maintained that the dancing mania was due to a diseased condition which should be treated. In France Montaigne asserted that witches were more deranged than guilty. In Spain Juan Luis Vives insisted that attempts should be made to understand the emotions of the mentally ill, and that they should be treated with understanding and compassion. In Germany Johann Weyer, a physician, published a book in which he claimed that most witches were sick in body or mind, and that their afflictions were due to “natural causes.” In England Reginald Scot devoted his life to exposing the “erroneous novelties and imaginary conceptions” of demonology. In his book Discovery of Witchcraft (1584) he pointed out, “These women are but diseased wretches suffering from melancholy and their words, actions, reasoning and gestures show that sickness has affected their brain and impaired their powers of judgment.”The writings of these men were placed on the Index Expurgatorius, and their books were publicly seized and burned. But gradually the churchmen themselves joined the critics. One of the great theologians who led the way was St. Vincent de Paul (1576-1660), who risked his life to declare; “Mental disease is no different to bodily disease and Christianity demands of the humane and powerful to protect, and the skilful to relieve the one as well as the other.” Within a century after this courageous and insightful utterance, demonology was clearly on the wane and the modem era of psychiatry had begun. See GALEN, HIPPOCRATES, WEYER, MASS HYSTERIA.