Both psychiatry and psychology have their roots in ancient practices and belief systems, which traced insanity back to the treatment of emotional disorders. Ancient Egyptians and Mesopotamians, more specifically, believed that all diseases, including mental ones, were the result of demonic influences on the soul.

Later, Greeks and Romans tried to create a rational approach to mental disorders by labeling them mental illnesses and writing texts examining their many manifestations. Nevertheless, most Greeks and Romans also believed that mental problems were caused by evil spirits, or the wrath of the Furies, the Greek goddesses of vengeance.

Trepanning also had its roots in the ancient world. Scientists have found many prehistoric skulls, which indicate that trepanning, or cutting a hole into a person’s skull, has been in practice since 10,000 BC. These prehistoric skulls have been found all over the world, in isolated geographic locations, indicating that prehistoric populations practiced trepanning independently of each other. This means that since the beginning of human history, people have been cutting into the head, opening a small hole in the skull.

But the question remains, why? Some early trepanned skulls indicate trauma, so perhaps it was performed as a treatment for injury. It may also have been performed as a healing method for headaches or epilepsy, to relieve the pressure within the skull. Other theories indicate that by cutting a hole on the top of ones skull, early populations believed that it would allow spirits to enter the soul, and to give the recipient magical powers.

On the other side of the coin, however, ancient trepanning may have been performed as a way to cure insanity, as it had been done in the Middle ages under the guise of cutting out stones of madness from the individual’s skull.

Cutting out Stones

After the Greco-Roman world was conquered by Christianity, insanity and mental illnesses went practically untreated. Those with mental disorders were compassionately taken care of physically, but their psychological needs or problems were not dealt with. In the Early Middle Ages, this compassionate attitude changed. Those with mental illnesses were no longer looked at as poor souls needing someone to take care of them. Mental illness was once again, as it had been hundreds of years prior, seen as a direct result of demonic possession of the soul and evil influences.

The prevailing theory that insanity was caused by evil demons made it necessary to treat, if not cure, the mentally ill. In the 15th, 16th, and as late as the 17th centuries, a group of charlatans came to the forefront to cure the diseases of the mind. These quacks were often men and women untrained in the medical sciences. Among them were astrologers, chemists, monks, nuns, alchemists, jugglers and street peddlers, all who claimed to have the cure for mental illness.

Mental illness, they said, was the result of a small stone inside the brain, and they could cure this disorder by trepanning the skull, and letting out the stone. It made sense, to a point, that an individual could produce mental results through physical intervention in the brain. Thus developed a mythical stone of madness, after removal of which, the insanity would be cured.

The great artist Hieronymus Bosch immortalized the scene of a physician trepanning the skull to remove stones in his painting The Cure of Folly, otherwise known as The Extraction of the Stone of Madness. This painting depicts the scene with a dry wit and sarcastic view of the removal of the stone of madness. The “doctor” in the scene is wearing a funnel hat, an early symbol of madness, indicating that he is also insane. He is trepanning the skull of a patient, in order to retrieve the stone from within the patient’s skull.

The rest of the painting is ripe with symbols of folly, foolery, madness and insanity. As a whole, the painting depicts not only the insanity of cutting out the “stone of madness” from a patient’s skull, but also reflects the reality of the situation. Bosch finished his painting around 1494, when charlatans and quacks came out in droves to cut into people’s heads. His painting is a sharp critique on the ridiculousness of it all.

Link to More Invasive Procedures

Whether ridiculous or not, the practice of removing stones from the heads of the insane continued as late as the 20th century, when practitioners would produce a small stone after the procedure, stating that they had removed it from within the brain.

It is not hard to see, that if removing stones was performed as late as the 20th century, how the practice of lobotomy could have developed. The theory that mental illness had a physical basis, rather than the result of demonic possession or evil influences, was sure to produce a more invasive form of cure for the insane. Lobotomy, which sought to cure mental illness through direct intervention and damage of the brain tissue, was a logical expansion of the cutting of stones and trepanning.

Luckily not all physicians of the mind went the same route as the stone-cutters (or the lobotomizers, for that matter). The fields of mental health developed into psychology and psychiatry, each of which focused on the mental health of the individual, although focused on treating the patient in different ways.

But this does not mean that trepanning is a dead science. It is commonly used in neuroscience, as well as in surgical procedures for injured patients. There are also modern alternative therapy groups, which advocate trepanning as a cure for a number of mental maladies. The recurrent use of trepanning is continuing a human tradition, started over 10,000 years ago with the earliest human. Whether to relieve headache pressure, let out demons in the skull, or to remove the stone of madness, trepanning is a fundamental part of our history of using medicine to better the human condition.

References

Franck, Irene M., and David M. Brownstone. Healers. New York: Facts on File, 1989.

Hollingham, Richard. Blood and Guts: A History of Surgery. New York: St Martin’s Press, 2008.

Shorter, Edward. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. John Wiley & Sons, 1997.