Looking Back

Madness and care in the community: a medieval perspective

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7021.1708 (Published 23 December 1995) Cite this as: BMJ 1995;311:1708
  1. David Roffe, codirector, Sheffield hundred rolls project**a,
  2. Christine Roffe, lecturerb
  1. Department of History, University of Sheffield, Sheffield S10 2TN
  2. Department of Geriatric Medicine, Hope Hospital, Salford M6 8HD
  1. Correspondence to: Dr D Roffe

    Care in the community for insane people today is more a matter of expert provision than communal support. In consequence, although they are no longer confined to hospital, mentally ill people largely remain marginalised in a society that does not have the resources, nor often the inclination, to take responsibility for their care. The experience of insane people in medieval England seems to have been of a different order, as shown by a particularly well documented case dating from 1383. From the late 13th century congenital idiots were protected by law. Care of lunatics, by contrast, was primarily the responsibility of the family. However, where the family could not or was unwilling to provide, provision was made by the crown. Through the instrument of the inquisition, the diagnosis and social circumstances of each case were determined by commissioners in consultation with a local jury and all interested parties, including the subject himself or herself. The best interests of the subject remained a prime concern, and the settlement that was ordained was tried and enforced in law. The process was confined to those with real or personal estate, but it encompassed poor as well as rich and proved, through the close identity of the local community with the process, to be a sophisticated and effective mechanism for maintaining and sustaining insane people. Unlike today, care in the community was a communal activity that ensured a truly public provision for those who could not look after themselves.

    On Friday 31 July 1383 commissioners duly empowered by the king summoned Emma de Beston of King's Lynn, Norfolk, to appear before them in the church of St Benedict in Lincoln in order to assess her state of mind. The record of the interrogation that followed is the most detailed account of the methods used …

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