The Conclusion draws together the book’s various thematic strands: the perceived primacy of the ‘reason’, the right of its possessors to rule, the exculpatory effect of a frenzy diagnosis, and the high cost paid by those who received one. It returns to the larger question posed at the outset: whether the organ of the brain and the faculties of the mind were seen as constitutive of ‘personhood’ in pre-1700s England. The responses to frenzy which we have encountered in this book suggests that they were. The operations of the mental faculties known as ‘reason’, ‘will’, and ‘memory’ (or simply the ‘wits’) were located in (and often colloquially identified with) the brain. The functionality and continuity of these faculties was integral to the maintenance of legal, social, and spiritual personhood. Yet what troubled frenzy’s witnesses the most, the Conclusion argues, was the way it disrupted its sufferers’ predictable ways of being in the world – the values they had once held dear, the ways they had once looked and spoken. It was a disease which had the power to change friends, neighbours, and loved ones beyond recognition.

The Introduction situates the book’s contribution in relation to the historiographies of madness, medicine, emotion, selfhood, and personhood. While mania and melancholy have enjoyed perennial scholarly interest, the same cannot be said of early modern frenzy. The Introduction offers some thoughts as to why frenzy has been neglected, and reflects on some of the conceptual and methodological difficulties which accompany its study. It explains the book’s scope (and limits), and offers short summaries of its six chapters. Sketching out the book’s central claim – that frenzy had devastating effects on personhood, and that these effects drove its early modern observers to unpick the tangle of mind, soul, and brain – it engages with recent claims about the emergence of a distinctively modern ‘cerebral self’. It sets out to test the claim that the possession of certain ‘psychological features, such as memory, consciousness, and self-awareness’ was not constitutive of ‘personhood’ until the end of the seventeenth century.

Chapter 1 tracks frenzy’s trajectory as a medical diagnosis between 1500 and 1700. It offers an introduction to frenzy as it was understood by eight medical practitioners, four of whom came of age in a time of relative stability in English medicine (1560–1640) and four in a time of rapid change (1640–1700). It shows how, from the mid seventeenth century, the old humoral definition of frenzy was altered to fit new medical philosophies – chemical, mechanistic, and corpuscular – and new models of human physiology. Tracing the contours of the disease over two centuries, it highlights points of continuity as well as change. Throughout this period, it argues, theorists from diverse schools explained frenzy’s effects with reference both to the solid structures of the body and the fluids which flowed through them. This chapter argues that it was the devastating effects of brain disease which galvanized medical theorists to seek to explain disorders of the mind as disruptions of material ‘animal spirits’.

Consideration of possible alternatives to child abuse as an explanation for skeletal abnormalities during a child abuse investigation is an essential element of due diligence by all healthcare professionals involved in these cases, including and, in particular, radiologists.

Conditions which may have features resembling sequelae of child abuse include bone fragility states, conditions with metaphyseal abnormalities resembling classical metaphyseal lesions and conditions featuring subperiosteal new bone formation. Further suspicion for child abuse may be raised when there are associated extraskeletal mimics of abuse, such as skin lesions.

This chapter explores a range of genetic, nutritional and other acquired disorders which may present in this fashion.

Chapter 5 begins to draw the reader into the core case studies of the book. The movement of colonial education into the provincial countryside is revealed with a focus on the Puebla-Tlaxcala valley. This helps to build a local-regional component into the theory of learningscapes in An Unholy Pedagogy. Education is shown to be an introduced and foreign system of instruction, though it incorporated indigenous practices from collegians’ influence, and this didactic trajectory bordered the wholistic and preordained expertise of Ibero-Christian systems of learning. Though examining Christian official records, the chapter also seeks local identity and community efforts to navigate regional impacts with the introduced, augmented systems. One core note is that locals participated in the Mesoamerican countryside’s encounter with texts and architects. Against a tragic backdrop, towns established convents via skilled labourers’ hands under the discretion of Indigenous church people. The chapter studies the concept to placemaking in an account of Motolinía, reading against the hagiographic take to note how these active decades of church growth identified local participation and agency in planning developments and using the grounds of new convents and courtyards. A new provincial learningscape takes shape in this portion of the book, with the shining examples drawn from the Indigenous towns of Huexotzinco, Calpan, and Quauhquechollan.

A brief conclusion ties together central themes of the book - deception, blame, and stigma - and reflects on how this history of a long-forgotten epidemic can shed light on everyday life hundreds of years ago in ways that resonate with modern disease experiences.

The first substantive chapter uses a drinking song to tell the story of a man who travels to London from the countryside to attend an annual fair. As he cavorts with a prostitute behind a tent, she picks his pockets and he must leave the city with nothing to show for his time at the fair except a raging case of the pox. The chapter follows the fictional prostitute and the man through the streets, using actual medical cases and advertisements to piece together what each would have felt as their symptoms developed, as well as their desperate attempts to find affordable treatment. The main aim of the chapter is to establish much-needed context for the remainder of the book, both about the disease and about London’s ever-growing market in remedies for it. The chapter shows that those selling pox cures and those selling sex embodied the very same urban threats in writing of the era: in ballads and in medical writing, both prostitutes and purveyors of pox remedies were presumed to be deceptive, self-serving, and sexually aggressive. Their very existence personified the unbridled consumption and unchecked vice of the big city.

This chapter shows how the competitive market for cures outlined in the initial two chapters of the book shaped healers’ self-promotion on the page and negotiations of care in consultation rooms. It begins with a servant maid who allegedly infected the children under her care by sweating near them in a shared bed. A venereal healer took the case, but the maid obstructed his clinical work by repeatedly lying to him. She likely feared for her reputation and her job. Because a diagnosis of venereal disease was deeply shameful, patients like the maid were said to be unreliable narrators. The chapter recovers the intimate details of thirty-two such encounters and how healers brandished their expertise by claiming to navigate the constraints of allegedly dishonest patients. Because patients’ words were so unreliable, they instead turned to obversions of bodies to diagnose disease in ways that foreshadowed clinical practices of the 1800s. And yet, the majority of these cases end with words. Confessions of lurid trysts and scandalous relationships confirmed the existence of unlawful sex, and therefore that cases were venereal, which further validated healers’ diagnostic know-how.

As discussed in Chapter 1, the primary focus of this book is on the potential of neurotechnology to support the rehabilitation of convicted persons by improving risk assessment and risk management – rather than on its potential for diagnosing and treating mental or brain disorders. Still, in some cases, neurorehabilitation might well become conducive or even crucial to the improvement of mental health in forensic populations. Brain stimulation to attenuate aggressive impulses might serve to reduce the mental distress experienced by some persons subject to these impulses. Furthermore, aggression can be a symptom of a recognised mental illness, such as a psychotic disorder, or may be a core feature of a disorder, as in intermittent explosive disorder. Diminishing aggression using neurotechnology could in such cases be relevant to the person’s mental health, which appears to be an interest protected by human rights law. For example, Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognises a “right to the highest attainable standard of physical and mental health”.

Galen system is based on three pillars: the affected body part, the type of qualities imbalanced, and the degree of imbalance. Therefore, he only distinguishes between mental illness and impaired consciousness when there is a difference between these two entities in any of these three pillars. Thus, he distinguishes phrenitis from melancholia but not from mania. The emphasis on the system, on the other hand, enables him a very tight notion of disease, where symptoms, mechanisms, affected organ and treatment are closely linked.

Like their forerunners, post-Hellenistic doctors also grappled with the unclear boundaries between healthy versus pathologic sleep, and consciousness-unconsciousness. Furthermore, they incorporated new diseases and redefined others - like lethargy - that were specifically associated with this process. Celsus considered sleep as all-or-nothing phenomenon, without recognising different depths. Regarding mental capacities, he subsumed most of them in his idea of mens/animus. Aretaeus, on the other hand did conceive different depths of sleep, and his eclectic method enabled him to find alternative pathophysiological explanations to characterise several of its main features. Similarly, although his organization of mental capacities varied according to what he was explaining, the opposition gnômê-aisthêsis was important in his idea of mind.

4 Post-Hellenistic authors present a more compartmentalised idea of diseases in general and of impaired consciousness in particular. Unlike the Hippocratics, who barely discussed mental illness, these authors did distinguish impaired consciousness from mental illness through a classificatory system of dichotomic oppositions, additionally they discussed new conditions which are not mentioned in the HC. In most theorisations, perceptions play an increasingly relevant role to understand these conditions.

Some Hippocratic doctors regarded sleep as a healthy process, and some as a pathological one; some of them struggled to distinguish between hallucinations and nightmares, and some between deep dreamless sleep and total loss of consciousness. This chapter explores how different treatises from the Hippocratic corpus navigated these ambiguities, how they explained different depth of sleep (i.e. different levels of consciousness), and how such understanding relates to their views on mental capacities (which they subsumed in concepts such as phronesis, sunesis, gnômê, and nous).

A diachronic look at the contrast between mental illness and impaired consciousness among these ancient doctors shows a trend towards a more compartmentalised idea of these conditions, a stronger notion of disease, and a progressive abstract framing of clinical findings into theoretical classificatory models and comprehensive pathophysiological systems.

Contrary to mainstream scholarship’s opinion, the Hippocratic corpus presents many cases of impaired consciousness, but only a few of mental illness. By looking at three study cases, this chapter describes how these doctors understood conditions where patients act weirdly or were not their usual selves, and how they construed the notion of disease.

In face of the difficulty of establishing clear biological boundaries between sleep and the other forms of impaired consciousness, the sociological and anthropological analyses can provide hints as to where those limits were set in real life. The terminological analysis suggested a common feature that persisted throughout the different authors and periods: different levels of consciousness (from drowsy to hyperactive, and from delirium to koma) where always related to the impairment of mental capacities, regardless of the way in which each medical writer grouped or understood them.