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BMJ. 2007 August 25; 335(7616): 403.
PMCID: PMC1952499
Medical Classics

A Treatise on Madness

John Beard, foundation year 2, University Hospital Birmingham

William Battie (1703-76) was one of the most eminent psychiatrists of 18th century Britain. Educated at Eton and Cambridge, Battie was a fellow of the Royal Society and a fellow and later president of the Royal College of Physicians. He was reputed both for his scholarly work (including an edition of Aristotle's Rhetoric) and his anatomical demonstrations. Yet it was the “mad business,” as he described it, that really caught his imagination. Already a governor at Bethlem Hospital and owner of two other private institutions, Battie was the founding physician of St Luke's Hospital in 1751. Situated opposite and in competition with Bethlem, he hoped that this new asylum would bring an unprecedented standard of care for the insane. Indeed, it could be argued that at St Luke's attempts were made, for the first time, at the structured “management” of mentally ill people.

Treatise on Madness was a seminal work in psychiatry. Although there were important earlier works, such as Timothy Bright's Treatise of Melancholy (1586) and Robert Burton's Anatomy of Melancholy (1621), Battie's work was the first specifically on “madness.” It arrived at a time when psychiatry, still far from an established discipline, continued to experience therapeutic stagnation and professional apathy. It was Battie's intention to remove some of the antiquated ideas about insanity, many of which, he believed, stemmed from the physicians at Bethlem. Instead he admired the physiological advances of medical theorists such as Hermann Boerhaave and Albrecht von Haller and looked to utilise them in his practice.

A number of Battie's convictions stand out. He promoted the idea that mentally ill people should not be detained just to protect patients and society. Moreover, patients could derive direct therapeutic benefit from spending time in a psychiatric institution. In contrast to much scepticism regarding the curability of mental illness, Battie asserted that madness was “as manageable as many other distempers.” Finally, Battie proposed a division of madness into “original” and “consequential” illnesses, forerunners to the “organic” and “functional” terms used to this day.

Battie's ideas were not entirely well received. The Bethlem physician John Monro took issue with a number of Battie's central tenets in his reply Remarks on Dr Battie's Treatise (1758). Monro endeavoured to counter all of Battie's assertions and ultimately concluded that it was for “the impartiality of the publick to determine between the Treatise and the Remarks.” Indeed the public, as well as the medical profession, did give increasing attention to the subject of madness and madhouses. Furthermore, the internal debate gave rise to several more psychiatric texts. As a result psychiatry was given much needed impetus as a discipline, and Battie's Treatise was in many ways the catalyst.


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