blockheads, roundheads, pointy heads: intellectual disability and the brain before modern medicine

BLOCKHEADS, ROUNDHEADS, POINTY HEADS: INTELLECTUAL DISABILITYAND THE BRAIN BEFORE MODERN MEDICINE

C. F. GOODEY

Recent work on the conceptual history of intellectual disability has pointed to a disconti-nuity in the seventeenth century, identifying the concept as essentially modern in a moreradical sense than mental illness or physical disability. However, Galenist accounts of in-tellectual impairment were clearly connected (via anatomy) to neurology, which could betaken as prima facie evidence that Galenism shares with modern medicine one of its basicexplanatory approaches to intellectual disability. Close textual examination does not bearout this counter-claim, at least as far as the conceptual apparatus itself is concerned.However, it does reveal a degree of continuity in the medical mind-set as discourses ofmonstrosity were transposed from the domain of anatomy to that of post-Cartesian psy-chology. © 2005 Wiley Periodicals, Inc.

How did premodern doctors conceive the links between psychology on the one hand andneurology and anatomy on the other? Various writers have investigated the treatment by clas-sical and Renaissance medical writers of this topic (Manzoni, 2001; Rocca, 1997; Wiberg,1914/1996), but there has been little discussion of one particular theme on which they heldclear views: that is, the relationship of intellectual or cognitive performance to head size, headshape, and the layout of the cranial sutures.

I shall try to fill this gap. However, I want also to place it in the broader context of theemergence of modern concepts of “intellectual disability” (formerly mental retardation ormental handicap). Recent writing has raised questions of continuity and rupture in its long-term conceptual history. Three historiographical approaches can be discerned, though there isonly room here to state them crudely (for the start of a deeper theoretical investigation, seeStainton & McDonagh, 2001):

1. A biological-cum-psychological concept of intellectual disability has always ex-isted, describing roughly the same group of people; the concept thus crosses histor-ical boundaries. This is the commonsense starting point always assumed, rarely the-orized, in the little conceptual history that has been done on the topic (see, forexample, Scheerenberger, 1983).

2. The positive biological and psychological phenomenon of intellectual disability hasalways existed, but its conceptual history only starts with its scientific discoveryand description in modern times. This has the same positive starting point as posi-tion 1 but rules out the primitives who lacked modern medical and psychologicalexpertise (for example, Kanner, 1967).

3. Intellectual disability is only a modern phenomenon. There may be transhistoricalbiological characteristics but not psychological ones, and the intellectually dis-abled people we recognize are not necessarily the same people as the “fools” our

Journal of the History of the Behavioral Sciences, Vol. 41(2), 165–183 Spring 2005Published online in Wiley Interscience (www.interscience.wiley.com). DOI 10.1002 /jhbs.20081© 2005 Wiley Periodicals, Inc.

C. F. GOODEY studied at the University of Cambridge and is currently a research associate at the SocialScience Research Unit, University of London Institute of Education, and an associate lecturer in the socialscience faculty of the Open University. He has published extensively on the pre- and early modern historyof psychological concepts, especially those concerning human intelligence and intellectual disability. He isalso an advisor on inclusive education to U.K. governmental organizations and is a founding member ofHuman Genetics Alert, the United Kingdom’s voluntary watchdog body on the new biotechnology.

165

forebears recognized. Here the notion of rupture appears in a strongly construc-tivist form, such that “once upon a time there were no mentally retarded people”(Mans, 1998).

The particular form of position 3, which I myself have argued (Goodey, 2004), amounts tothe following. Galen and his Renaissance interpreters could not have described anything wemight recognize as intellectual disability. First, its conceptual origins belong in law, political the-ory, and, above all, theology, not in medicine. If intellectual disability existed before modernmedicine, it was not as a medical concept. And second, it is essentially modern; not only was itthe offspring of disciplines other than medicine, it emerged from them and eventually becamean object of doctors’ anxiety only as Galenism was dying. The intellectually disabled person andthe “natural fool” of earlier times were each created by quite separate sociohistorical contextsand, more importantly for present purposes, were described by quite different characteristics.Break intellectual disability down into its discursive components and they are all attached tosome essentially modern theoretical principle. Intellectual disability assumes that the disabledmind can be known separately from the disabled body (Cartesian dualism); that the intellectu-ally disabled are a statistical abnormality (psychiatric pathology); that a specific intellectualability defines the human species, thus rendering their membership dubious (natural history);that intellectual disability is biologically caused (nature as determinism); and that it confers onthe individual a permanent identity lasting from birth to death (phenomenal-type discourses ofpersonhood). What does all this say about our knowledge of actual people? Put some peoplewith learning difficulties in a time machine, send them to Rome or even early medieval England,and ask a doctor of that time if they correspond to people he would call “fools,” and the answerwill rarely be yes, though similar time experiments would yield positive results with physicallydisabled people and with a significant number of the mentally ill.

Associating psychology with neurology and anatomy, however, poses a challenge to thisconstructivist position. Some Galenist texts explicitly deal with the links between intellectualimpairment of some kind and the head, skull, or brain. The very idea that such a relationshipis possible implies some long-term historical continuity. It suggests both a conceptual dis-tinction between intellectual processes and their bodily organ, and some degree of causalityin that relationship, and the brain is the one organ that, more than any other, might be thoughtpermanently to fix our personal identity. This suggests that Galen or a European Galenist ofthe Renaissance could have recognized in the people thus identified the characteristics we rec-ognize in our own intellectually disabled people, or at least a significant overlap. My accountof Galen and Galenism on the relationship between psychology and anatomy does indeed leadme eventually to conclude that the idea of conceptual rupture as simply stated in position 3 isnot justifiable, but also—as we shall see—that the particular challenge to it set out above isnot justifiable either.

GALEN AND THE SOURCES

I shall be dealing mainly with medical texts, rather than physiognomics as a whole.Elements of classical physiognomics, the theory and practice of reading a person’s characterfrom bodily signs and especially the head, found their way into the medical textbooks of theRomans, including Galen’s. Medieval writers’ increasing acquaintance with Galen stimulateda new interest in the classical sources of his physiognomics. So early modern Europe had twotextual traditions: one medical and Galenist with embedded physiognomic elements, the otherpurely physiognomic.

166 C. F. GOODEY

Like psychology today, physiognomics provided a theoretical link from the realm of na-ture to that of morals and behavior, and a practical guide for policing them. Greek and Romansocial elites used it to recruit new colleagues to schools of thought and public office, to provethe stupidity or degeneracy of opponents, and to select wives, servants, and wet nurses(Agrimi, 2002; Frischer, 1982). In the thirteenth century, physiognomics was on the curricu-lum of the first universities at Bologna and Paris, and as a diagnostic tool, it contributed totheir role in training intellectuals to administer the rapid expansion of papal and state power.In the sixteenth century, it was an archetype of “useful” humanist knowledge, a practical eth-ical skill for civic leaders that also provided social integration and advancement for the intel-lectuals who taught it. Countless physiognomic manuals, often printed in tabular form (theequivalent of a modern manager’s bullet points), supplied “short-cuts to certainty” about peo-ple in public life (Tsounas, 1998). This “pure” physiognomics drew inferences from head sizeand shape to human character, morals, and behavior, though unlike its medical variant, it didnot discuss events inside the brain, nor did it describe causes in the modern biological sense.A certain head shape might be an external sign of “stupidity,” a condition that could largelybe reduced to laziness and physical inertia (the word was equally used of muscles and limbs)and was associated with unfitness for the individual’s social calling.

The medical texts examined below were somewhat different. In addition to externalsigns, they discussed certain material operations and conditions internal to the brain, particu-larly the balance of the four “elements” and their “qualities” (hot, cold, wet, dry). In Galen,the material form taken by a specific imbalance of these elements amounted as such to a spe-cific impairment. The classic text in this respect was the systematic discussion that takes upbook 3 of On Affected Places (1965a). It was much used by later authors, either directly or inthe form transmitted by Ibn Sina. Here Galen listed the impairments very precisely. Theywere: coma, apoplexy, paralysis, catalepsy, vertigo, lethargy, carus (lethargy in its extremeform), melancholy, epilepsy, and phrenitis. He neither gave these any general overarchingheading nor made a clear distinction between intellectual and physical. As well as the four el-ements, and especially in medieval and Renaissance Galenism, there were other kinds of in-ternal material: the brain’s substance, the spaces or “ventricles” that substance encloses, andthe intangibly fine yet material “animal spirits” (“soul spirits”). These material constituentsof the brain and the activities of the intellect (dianoia) itself, plus the size and shape of thehead, were all to be taken together as signs, not of the patient’s moral character as such, butof cerebral health, which had, nonetheless, a moral inflection.

Health was a question of balance. Now the idea of balance would seem to be based on fluc-tuation and thus transience, rather than permanence. A defective mixture of elements and hu-mors could be temporary, as it was in fevers, or it could be something much longer-term. Buttenacious as the mixture may have been, even if it lasted from birth to death, it amounted sim-ply to a disposition. And inasmuch as it suggested differences among individuals, the differencewas in degree rather than in kind, and did not raise problems about their membership of thespecies “rational animal,” to use the archetypal scholastic description of man. Nor did explana-tions of long-term states differ essentially from explanations of that which was temporary.Structure and size of the head, and thus of the brain, were as important as internal balance. Butwhile it seems common sense that imbalance might be transient, the idea that the anatomicalstructure of the head belongs to a realm of transience seems curious, at least to us. There couldhardly be anything less transient, more permanent about our bodies than the shape and size ofour heads. The idea might have seemed less curious to contemporaries, for two reasons.

First of all, there were metaphysical constraints on applying the notion of permanence tohuman character. For Aristotle, the fact that a given human characteristic is permanent, even

BLOCKHEADS, ROUNDHEADS, POINTY HEADS 167

if it belongs to each and every member of the species, is not enough to qualify it as an es-sential property of that species. That is because the very notion of permanence suggests aneed to keep checking that the characteristic is still there (1960, p. 482). In Aristotelian terms,the “essential property” of what it is to be human must a priori lack incompatible elements,and is therefore already proof against any need for checking. Likewise, for Christian philoso-phers, our divinely created “intellective” soul, which was perfect and free from organic or ma-terial influences, could not be described as “permanent,” since this would imply that it be-longs in the temporal sphere, subject to natural rather than divine determination. This hadsome influence on contemporary descriptions of the less perfect, earthbound “organic” soul,which informed the body and the senses. In short, permanence did not necessarily indicateidentity in the way it tends to for us.1

Second, physiognomics and the theory of elements and humors did not just exist along-side each other; they jointly inhabited the same explanatory realm. According to the widelyknown pseudo-Aristotelian textbook on the subject, body and soul interact, and so the bodyis subject to sympathetic change: “When there is a change in the disposition (hexis) of thesoul, it simultaneously changes the shape (morphe) of the body; conversely when there is achange in the shape of the body, it changes the disposition of the soul” (Aristotle, 1936, p.104). Admittedly, the illustration of this point went no further than “grieving people withgloomy faces and happy people with cheerful ones.” However, the author was not making thetrivial point that grief and happiness cause certain facial expressions. Rather, he was demon-strating the synchronicity of the two as proof of the sympathetic interaction between psychicand bodily states. In Renaissance texts, mental or behavioral phenomena and bodily ones suchas head shape belong on the same side of the signifier/signified divide: they signify, alike, anunderlying constitutional (im)balance. Physiognomists did not necessarily take the sign to besomething physical and the signified something mental, or vice versa (Tsounas, 1998).

Galen discussed head shape in four works (1965b, 1965c, 1965d, 1965e). The “suitable”(oikeios) head shape for a healthy brain is an elongated sphere, “slightly depressed at thesides” (1965d, p. 751). Unsuitable shapes were due to an absence of cranial sutures. AHippocratic author had originally described four different arrangements of the cranial sutures,without saying whether one was more suitable than another (Hippocrates, 1979a, p. 182). Theonly Hippocratic author to attach a value to a particular arrangement claimed, in another text,that four sutures were healthier than three, though he did not say why (1979b, p. 284), whileAristotle later claimed that humans have more sutures than other animals, on his usual as-sumption concerning biological structure that more means better (1937, pp. 70, 154). Noneof these texts discusses intellect or character. The first of the two Hippocratic authors visual-ized each of the sutural arrangements as a letter of the Greek alphabet. Galen, followed bydozens of Renaissance commentators, copied this descriptive device. The healthy brain sits ina skull where one suture (the coronal) runs across the front of the skull from one side to theother, down to just in front of the ears; another suture (the lambdoid) runs parallel to it acrossthe back; and a third (the sagittal) runs down the middle from front to back, joining the othertwo at their respective midpoints. Viewed from above and from the side, the arrangement ofsutures thus resembles an H. There are unsuitable skulls, however, where the coronal sutureis missing and likewise the frontal projection. Viewed from above and from the front, the re-sulting arrangement is a T. In others, the lambdoid suture and, thus, the rear projection are

168 C. F. GOODEY

1. Legal suppositions of permanent incompetence on the whole came before medical ones. Effectively, however,these too were latecomers, not being acted upon by the judiciary until the end of the sixteenth century (seeNeugebauer, 1996). And the exact characteristics of the legally designated “idiot” were scarcely modern; most likelythey were the ad hoc invention of predatory guardians.

missing; viewed from above and from behind, the arrangement is a T again. In yet other un-suitable skulls, both the frontal and rear projections are missing. In this case, the sagittal su-ture is still in place, but it is intersected by a single transverse suture running across the mid-dle of the skull. Viewed diagonally, this arrangement is an X.

Galen’s description of sutural layout appears in On Bones (1965c) and On the Use ofParts of the Body (1965d), of which the second is the more extensive. Here he described theunsuitable shape where one or another eminence was missing as a “pointy head.” He saidnothing about impairment of the intellect (dianoia), which in any case was for Galen not theunitary possession of an individual human type (a thoroughly modern concept that it wouldbe anachronistic to read back into the original), but a continuous series of intellectual states.However, in addition to the suitable shape (the elongated sphere) and the three types of ex-cessively pointy heads:

It is possible for a fourth type of pointy head to be imagined, albeit not to exist, whichmeasures longer from ear to ear than from front to back. If this type were to exist, itwould not accord with nature and would be the opposite of spherical: its length wouldbecome its depth. Now so great a deviation from the natural could not exist; it would bea monstrosity rather than just a pointy head, and would not be capable of life. . . . Eitherthe front or the rear eminence might be absent, or indeed both at the same time, but notto such an extent that some of the brain itself is missing. (Galen, 1965d, p. 754)

Galen went on to complain that the Hippocratic author did not mention this other headshape, although as the type is only hypothetical, it is unclear why his predecessor should havedone so. According to Galen, “missing some of the brain” would make the creature unviable,just as missing some of the heart or liver would. The “monstrosity” here is anatomical: Galenmade no mention of the intellect or its impairment at precisely this point. He did, however,cite here the pointy head and lame, bandy legs of Thersites, a character from Homer’s Iliadwho in Book 2 steps out from the ranks to attack the Greek leaders’ warmongering. Homerwas linking physical deformity with oppositional, defeatist politics in the way a pro-war car-toonist might do today. This may have implied a link between body and psyche, thoughHomer presented the psychic deformity only in external, behavioral terms, which involved“playing” the fool and was clearly Thersites’s own moral responsibility.

Although the sutural layout is not mentioned in the other two texts, it is implied in theappearance here too of pointy heads. The first of these texts, The Art of Medicine, I shalldiscuss in due course. The second, the Commentary on the Epidemics 6 of Hippocrates, wasa relatively obscure text. Here Galen did indeed make a connection between intellectualfunctions and head size: “It seems that matters to do with the intellect are clearly harmedin those whose head is too large or too small” (Galen, 1965e, p. 818). The intellect (in itsGalenist sense) of a large head is usually “faulty,” though the Athenian political leaderPericles, whose head was notoriously big, was “an extremely alert thinker” (sunetotatos).The intellectual defect of a small head, however, is invariable. One should try to avoid read-ing this through the lens of mind-body dualism. In a small head, states of intellect aremerely one sign among others, including, for example, “small eyes, stuttering and prone-ness to anger,” of the main object of concern: namely, the overall health of the cerebralorgan and its proportionality to the other organs, to the neck and chest, and ultimately tothe whole body. A large head indicates a long and, therefore, weak neck. The teeth of theupper and lower jaws do not fit: “Such people constantly have headaches and ears that weepwith a thin and watery or purulent and stinking matter producing much evil superfluity”(Galen, 1965e, p. 822). This relates to the sutures, whose function is precisely to evacuatefluids from the brain.


Galen only discussed intellect in relation to shape and size in the one passage quotedabove about “matters to do with the intellect being harmed.” The difference between exces-sively large and small heads, he continued, is that in a large head “the brain and medulla beingbigger, there is a large flow of spirit (pneuma) and room for it; the opposite is the case withsmall brains.” Here as elsewhere Galen was reticent about the neurological aspects of intel-lect and intellection: he said merely in the most general terms that they are dependent on thequality and mixture of the spirit (Rocca, 1997). One might almost say he was uninterested.Indeed, why might he have been interested in the first place? He was concerned with thehealth of each “principle” or main bodily organ; the state of the intellect was important onlyas a secondary indicator of the health of this particular organ, the brain.

GALENIST ELABORATIONS

This section requires some initial caveats. First of all, most late medieval and Renaissancereferences to head shape outside of anatomical compendia are to be found in the many com-mentaries on The Art of Medicine, the reason being that this text had held a central place onthe medical educational curriculum from the twelfth century onward. In fact, of the four textsof Galen’s that discuss head shape, it has the least to say on the subject. Commentaries on TheArt of Medicine nevertheless cross-reference to the other three texts. Second, these commen-taries often contain more extensive discussions of the connection between physiognomy andintellectual abilities or impairments than any of Galen’s originals. It is not possible to be com-prehensive. Third, I have not pursued the theme into the wider medical literature beyond thecommentaries. And finally, because I want to focus on the theme of continuity or rupture be-tween Galenism and modern medicine on intellectual impairment, I deal with the Galenistcommentaries en bloc. In fact, they arrived in distinct waves and in distinct historical settings(see Joutsivuo, 1999, pp. 33–38). Nevertheless, while there were many issues that they dis-puted, on our particular topic, they largely shared their understanding (if not the fine detail oftheir interpretation) of the sources.

The commentators’ sharper focus on impairment came from their interest in what hap-pens inside the brain. In addition to “elements” and “humors,” they speculated about brainsubstance, the cerebral ventricles and the operation of the animal spirits. What contempo-raries called the “internal senses,” roughly corresponding to what we would call “cognitiveactivity,” were organic to these material entities. The substance of the brain was a containerfor the ventricles, perceived as spaces that cognitive activity inhabits (Manzoni, 2001, p. 37).With elaborated descriptions of the animal spirits came an elaborated description of the in-ternal senses. And the sensitive, organic soul was now conceptualized somewhat separately;it was a stable “psychological object” in Danziger’s (1997) sense. Consequently, there was agreater sense of its precise location in the brain. While Galen had made vague asides aboutthe soul residing in the brain substance, the commentators’ organic soul had specific opera-tional roles in specific cerebral ventricles.

With this greater interest in the internal conditions of the brain and its operations camemore elaborate accounts of the relationship between size and shape. The optimum head sizewas usually a mean. Some writers claimed that Aristotle attributed excellence to small heads,though in fact this was merely an inference from what he had to say about the intellectual con-notations of dwarfism, where the head seems large in proportion to the body (1937, p. 369).For Galen, as we have seen, a small head was invariably defective. Galen himself had referredto “spirit” in this context only in passing, but later Galenists speculated more about the rela-tionship between size and the (internal) characteristics of the animal or “soul” spirits and the

170 C. F. GOODEY

cerebral substance through which they move. Their sources were mainly Arab. According toIbn Ridwan in the tenth century, the reason why “smallness, as Galen testifies, is the essen-tial sign of a bad brain composition” is because in a small brain there is a “constriction of thechannels and ventricles . . . since the animal spirits cannot have the due space in the brain thatwould let them move freely to their completed operations” (1523a, p. 94); the formula was re-peated by Ibn Sina (1522, p. 134). This constriction led, according to the sixteenth-centurycommentator Giovanni Argenterio, to the spirits being compacted, “burning up” because theybecome excessively dry. Correspondingly, the large head tends to be excessively humid (1566,p. 215). All these material phenomena were linked to the five senses and to muscular activ-ity: Argenterio’s contemporary Oddo degli Oddi remarked that a small head leads to a “small-ness in the nerves relating to the [external] senses; all the senses are weak and the operationsof motion are weak” (1574, p. 118).

If a large brain, by contrast, is not necessarily faulty, that is because such insoluble prob-lems of constriction do not arise. According to Galeazzo di Santa Sofia, writing at the start ofthe fifteenth century, the large brain “has the merit of a good composition, with open chan-nels in which clear spirits pass freely from one to another without much confusion of images”;however, “it is far from well-tempered because there is an abundance of material relativeto . . . the virtue, [which] cannot cope with the great amount of material” (1533, p. 102).2 InJean Riolan’s commentary of 1578, a large head might indicate “an incapacity (impotentia)of nature, which cannot produce material” (1631, p. 41). A large brain has so much room thatthe animal spirits can get lost. However, this is not necessarily the case, whereas in a smallbrain the limit on the amount and mobility of the spirits is definitive.

The emphasis on internal conditions created space for debate about the causal relation-ship between these conditions (brain substance and/or animal spirits) on the one hand andwhat Argenterio called “things further back,” “structure rather than temperament,” on theother (1566, p. 219). The very existence of such a debate seemed to sharpen the focus on thecognitive performances of the internal senses. Even if it is of fundamental importance for sizeand shape to be proportionate (according to Martin Akakia, the head “must have symmetrywith the rest of the body”), this external structure may not be decisive. Akakia, professor ofmedicine at Paris in the mid-sixteenth century, said that “brain substance [in a small head] isnecessarily little, the ventricles narrow and the animal spirits few and insufficient for theirfunctions. . . . [but] while they are imperfect, they are not necessarily faulty, as long as thesoul can properly apprehend and render intelligible the images of things and pay attention”(1544, p. 101). However, it may not be able to pay attention for long, nor conceive of some-thing difficult, since where “cogitations are long and drawn out, more spirits are expendedthan the faculty of the brain ventricles can supply” and, thus, the faculty becomes tired sooner.

When the theory of ventricular localization entered medieval European medicine, it hadthe similar effect of enhancing the internal senses as a conceptually separable realm of inves-tigation. This theory linked specific cognitive functions with specific cerebral ventricles.Variations in the size of the latter were observable externally, by head shape. In the simplestform in which the theory appears, imaginatio belongs in the front ventricle, cogitatio in themiddle one, and memoria in the rear. As Rocca (1997) notes, Galen had placed spirit and in-tellect (dianoia) in the ventricular system in general. All three cognitive functions are men-tioned in his works, but he was vague about allocating particular functions to particular ven-tricles. His main observation was that the ventricles as a whole store and distribute psychic


2. As understood by most Renaissance authors (though not by its original source, Ibn Sina), “virtue” is tantamountto “faculty,” the power or force by which the internal senses operate.

pneuma through the nervous system. Given the centrality of the soul in medieval and earlymodern theory, it is no surprise to find the sharply outlined version, and its threefold associ-ation of the ventricles with imagination, cognition, and memory, coming from one of the earlyChristian fathers, Nemesius, who was also a doctor and a Galenist (Moreni, 1987, p. 68). Amore elaborated schema came from Ibn Ridwan, though he did not use it to relate head shapeto cognitive processes within the brain; this relationship, and its prominence in early modernpsychological theory, was due rather to the later, more complex version of Ibn Sina.

This period, then, gave rise to an expanded account of cognitive performance and im-pairment and of its material and organic aspects. What, more precisely, were the characteris-tics of such impairment? The question must be considered in the light of certain fundamentaldisputes of the time, some of which we have already come across.

First, there was the classical discourse of proportionality. This led to arguments over pri-ority between size and shape. Giovanni Sermoneta, an early fifteenth-century commentator,described how some of his colleagues regarded size as most important because the head hadto be proportionate to the size of the rest of the bodily organs, while others had thought it asecondary issue on the grounds that it is better for the head to be perfectly shaped but smallsized than proportionately sized but imperfectly shaped. For example, although imaginationis housed in the front ventricle, a correspondingly large frontal eminence would not neces-sarily indicate a greater power of imagination; in fact, the opposite might be true (Sermoneta,1498, p. 53).

Second, there were disputes about precedence between structure and internal conditionssuch as balance, mixture, and so on. Santorio Santorio, writing in 1611, explained how someearlier commentators had claimed that “the cause of wisdom (prudentia) in man is a varietyin the structure of the brain,” while others had replied that balance is prior: “the bad structure,and the pointy head . . . have their origin in bad mixture,” and “narrowness of the brain” ismerely a trigger or “proximate” cause of impairment (1632, p. 214).

Thirds, an important issue for ventricular theory was whether an injury to part of thebrain affects the rest of it, or whether it remains localized in one of the ventricles with thedamage being restricted to that part. This exact question could also be asked of the three in-ternal senses, housed in the ventricles. There was a further problem. If injury did affect thewhole cognitive process, then would this also harm the intellective soul, and could it do sowithout making it seem as if the creator was responsible for harm? This theological issue in-volved the sutures too, since the lack of an eminence, caused by the lack of a suture, mightcreate impairments similar to an injury to that part. Ugo Benzi, writing at the beginning of thefifteenth century, claimed that an absence of one or another eminence, or of a section of it,did not necessarily indicate “weakness” of brain matter (1498, p. 21). Others, as we shall see,assumed a positive answer.

What were the precise characteristics that cognitive impairment displayed? Certainlynothing like an absence of abstract thinking. A regular pattern runs from Pietro d’Abano inthe late thirteenth century, through the various commentaries on Galen’s Ars Medica, toSantorio in the early seventeenth century. Small-headed people were by disposition “fearful”and “stupid, inattentive (stolidi, temerarii)” (Jeremie de Dryvere, 1547, p. 108); they were un-stable, by turns “stolidos and ecstaticos” (d’Abano, 1565, p. 119); or they were “inconstantand fearful” (Benzi, in Giovanni Manardi, 1541, p. 195). Big heads, being too humid, are “stu-pid (stulti ac fatui) and have the “leaden wit (ingenium)” of “the lazy and somnolent man”(Riolan, 1631, p. 41); the bigger the brain the colder it is, “thus actions are dulled . . . and welook upon big heads as dull (hebetes), mindless (amentes) and full of catarrh” (d’Abano,1565, p. 119).

172 C. F. GOODEY

The “actions” referred to are those of the nervous system as a whole: unlike the modernmodel of intellectual disability, they are a seamless blend of physical, cognitive, and moral.Dryvere, Benzi, and the first quotation of d’Abano employ the classic descriptive terms formelancholy, the paradigmatic impairment of the internal senses. Riolan’s “stupidity” and“leaden wit” were secondary symptoms of a character type defined above all by laziness andsomnolence; elsewhere in the same commentary, he used the word stupid also to describe thepurely physical motion of the animal spirits (1631, p. 56). Of the terms in the second quota-tion from d’Abano, hebes usually described defects of the five external senses and, only byextension (moreover, rarely before the seventeenth century), the three internal ones; amentiawas mainly symptomatic of certain stages in acute physical disease. These same terms couldalso describe temporary states of mental illness and, once again, melancholy. The moral as-pect of “stupidity” (stoliditas, stultitia, fatuitas) appears in the laziness and in the “ridiculousbehaviour” of Thersites (Riolan, 1631, p. 41). The category distinction between this and thesocial or occupational role of the jester is weak. It is true that we find phrases such as “withsound intelligence (ingenium) and sound moral habits (mores)” used by Giovanni da Monte(1554, p. 132), professor of medicine at Padua in the mid-sixteenth century, but as the gen-eral context here and elsewhere shows, this did not necessarily imply a category distinction.

The commentators dealt with shape in a similar way. For example, Sermoneta describedhow “when the forehead is bigger [than the rest], it indicates a ponderousness extending tostupidity (stultitia), and when it is broad it indicates a paucity of discretion” (1498, p. 53). Heillustrated this with “the pointy head of Thersites the fool”: the norm was practical wisdom(prudentia), its opposite the stupidity (stultitia, fatuitas, stoliditas) indicated by Thersites’spointy head. Or imperfect shape might indicate a nonlocalized impairment “in all the princi-pal actions of reason such as imaginatio, cogitatio and memoria” (Oddi, 1574, p. 118). Butonce again we need to ask: What was the actual content of this stupidity? Writers throughoutthe period, when commenting on shape, tended to illustrate it with conditions such asapoplexy (du Laurens, 1628, p. 8; Santorio, 1632, pp. 191, 214) or epilepsy (Oddi, 1574, p.119). Argenterio, in claiming that “those who are fatuous, stolid, mindless or otherwise badlyturned out have a deficient head structure” (1566, p. 218), took his examples for this fromGalen’s standard list mentioned above (1965a): coma, apoplexy, paralysis, catalepsy, vertigo,lethargy, carus, melancholy, epilepsy, and phrenitis. Fatuity, stupidity, and mindlessness, hesaid, were “symptomata and effects of [these] diseases.”

Furthermore, the symptoms were treatable. And if balance and mixture could interact withmorphology, then therapy might be appropriate, even for things as seemingly determinate asskulls. The Hippocratic author of Airs, Waters, Places described a country inhabited by macro-cephali who used cranial molding on their children from birth (1923, p. 110) because of “cus-tom,” which valued longer heads more highly. Ibn Ridwan recommended the binding of mal-formed heads in infants (in Wiberg, 1914/1996, p. 16). Gian Filippo Ingrassia, writing around1550, noted that in this therapeutic sense “custom,” nurture, can become nature (1603, p. 61).Renaissance authors also noted the practice of cranial molding in the Indies.3 According toGiulio Cesare Aranzi, even the monstrous, sutureless skull could be cured, albeit “with greatdifficulty”: he cross-referenced this comment to Galen’s On Affected Places because it was amatter of “knowing, predicting and curing affected places,” thus setting Galen’s “impossible”type within the “possible” realm of a disease model (1579, p. 15). These ideas about therapycontrast with the biological determinism and incurability that dominate modern intellectual


3. Of course, abnormal head shape is today still seen as treatable with cranioplasty, not to mention New Age kine-siology, but it is no longer usually connected with intellectual development.

disability. The idea of a medicina mentis goes back to Galen himself and his Stoic forebears.In Christianized Galenism, providential cure was a further possibility.

A revival of interest in Ibn Rushd (Averroes) led some sixteenth-century authors to the ideathat the parental act of generation endows each individual fetus with an “informative virtue,”with its own composition that differentiates among individuals (Jacquart, 1994). To us, this be-gins to look like an inherited rule of nature, something stronger than a changeable disposition.The intellective soul remains divinely generated, but the informative virtue may allow a degreeof bestiality to enter it via the soul’s organic parts. It can cause conditions such as achondropla-sia, in which the excessively large head will also “signify a defect (depressio) of the rationalsoul” (in Wielgus, 1973, p. 122). However, it was precisely the awareness of a continuity be-tween fetus and living creature, suggesting for us a biologically determined personhood, thatwould more likely have suggested for contemporaries the creature’s plasticity and have rein-forced the belief that its moral-intellectual state was responsive to cure, medicinal or providen-tial. As Santorio, the late summarizer of many of these arguments, pointed out, no impairment,even ab utero, can affect the individual’s prior status as a “rational being”: the disposition is, inAristotelian terms, “accidental” and not “essential” to being human (1632, p. 207).

On the one hand, then, no intellectually disabled type, in the sense that we might under-stand, appears in Galenist medicine. On the other hand, cognitive impairment was neverthe-less typical for some human types. It appeared in the psychological stereotyping of existingsocial groups such as women, non-Europeans, and the lower social classes.

Ibn Ridwan had already said that women kept their hair as they got older because awoman’s brain has excess humidity, which damages intellectual functions (1523b, p. 12).Women’s cranial sutures were narrower than men’s and therefore had poorer drainage effi-ciency. According to Oddi, “people who have narrow sutures, women for example, are some-what crazy (dementiores)” (1574, p. 122). Aristotle had said that women had smaller brainsthan men, and fewer sutures (1937, p. 155); Dryvere, drawing on Galen’s recently rediscov-ered Roman predecessor Aulus Cornelius Celsus (1772, p. 468), claimed that this deficiencygave women harder skulls (1547, p. 115). However, pioneers of Renaissance anatomy such asAndreas Vesalius claimed that women’s skulls were not always different from men’s(1543/1725, p. 15), and others, such as Caspar Bartholin in 1611, insisted that the number andlayout of sutures was exactly the same in both (in Todd & Lyons, 1924, p. 327). As for size,d’Abano referred to unnamed (and possibly nonexistent) ancient authors who had argued thatwomen were “wiser and more prudent than men” and that since women also had smallerheads, smallness could therefore not be a defect. This was his chance to propose the opposite:that women’s “wisdom” and “prudence” are just a devious cunning, not the proper masculineversion (1565, p. 114). Luca Tozzi, writing toward the end of the seventeenth century (he wasthe last published commentator on The Art of Medicine) and quoting Aquinas’s assertion thatpeople with small heads are impetuous and aggressive, used the smallness of the female headto clinch this point (1711, p. 28).

Celsus (1772) had claimed that monstrous crania, devoid of sutures and thus abnormallyshaped, occur more often in warm climates. He was talking about “Ethiopians,” who exhibitedthe same tendency to anger and impetuosity as women and the same hardness of the cranium(the street myth that black people have hard skulls survived through the twentieth century andmay still be circulating today).4 This was taken up by Renaissance anatomists such as Ingrassia

174 C. F. GOODEY

4. Gratiolet, a leading anatomist of the nineteenth century, was still noting that sutural closure occurs earlier in“Negroes and the lower races of mankind” (in Todd & Lyons, 1924, p. 342), while Todd himself divided his com-prehensive twentieth-century study of cranial sutures into separate sections for “white” and “Negro stock.”

(1603, p. 65) and Alessandro Benedetti (1998, p. 242). Some doctors, claiming that Galen’s“impossible” type could exist in real life, located it in places where the inhabitants were exoticand different, such as the Indies (for example, Girolamo Cardano, in Hofmann, 1625, p. 216).

Links between unusual structure and impairment of the internal senses appeared moststarkly in terms of social class. The masses in general were the touchstone of deformity, phys-ical and moral. The commentators’ most usual illustration in this respect was again Thersites,whom we have already seen adapted to various physiognomic and behavioral interpretations.He qualified for this role because he was seen as the only non-noble character in the Iliad tohave a speaking role. His folly was linked directly by Santorio to the shape of his skull: “InHomer the head of Thersites, because it is pointed and badly shaped, is called fatuus” (1632,p. 191). Riolan, on the other hand, saw him as having a small head, which indicated “rash andheedless judgement, on account of the paucity of spirits” (1631, p. 41). Da Monte had a dif-ferent angle again: Thersites’s skull was of Galen’s unsuitably sutured X type, which led tohim being “not so much stupid as useless in all things, as having neither an anterior nor a pos-terior eminence” (1554, p. 130).

Da Monte added here several other types of skulls in addition to Galen’s, linking themto particular imbalances of elements and impaired operations of the animal spirits. Several ofthese were associated with social class. One was typical of wage-laborers (baiuli). Here therear eminence may be sound, but something is lacking from the frontal one. This damages oneof the internal senses, the imaginatio, which is located in the front ventricle and whose taskis to “apprehend” information coming from the five external senses and to combine particu-lars; from here it goes on to damage the cogitatio, whose reasoning operations (discursus,ratio) are performed in the adjacent, middle ventricle. Second, there were slaves, such asAesop. In him, the rear eminence was missing entirely, but the frontal eminence only partlyso. This explained how he could be “lazy and of weak motion” but at the same time “cleverand very wise” (ingeniosus et prudentissimus). Third, there was the contemporary jester,whose mix of intellectual and moral characteristics induced in da Monte a tone of disgust:

The ninth [and lowest] grade has a small head, out of shape on both sides, lacking any em-inence, and so in all operations they are the worst; foul and deformed, they are the most dis-proportional, and have bad inclinations (mores). Of these Ianelus, the Cardinal of Ferrara’sfool, had less wisdom than a dog. He was a mimic, with a crippled hand and a large headresembling a vegetable. He was quick to anger and always looking for a fight, now with thisperson, now with that. He did not know anyone’s name or anything at all, and I think he didnot have a rational soul, since all his operations were like a dog’s. (1554, p. 120)

Read through a modern lens, this seems simply to be a picture of monstrosity set in intel-lectual terms. It must be remembered, however, that people like Ianelus (“Little Johnny”) had aformal slot in the landed household economy, and that as a whole they were recruited from so-cial groups—poor peasants, people of short stature, black people—who were already assumedto have psychological characteristics corresponding to the jester’s occupational role. LittleJohnny was a historically recorded figure, whom da Monte had probably observed firsthand.

These suggestions about gender, race, and class may seem like a historicist application ofsome modern clichés about identity. But while it is true that early modern psychology assumedthe intellectual inferiority of everyone who was not a white upper-class male—so far, so mod-ern—it did not have as its ultimate reference point for this inferiority, as we do, a separate, sta-tistically abnormal, intellectually disabled population. To put it another way, doctors of the latemiddle ages and Renaissance, and the social elite to which they belonged, did, in fact, see apopulation whose disability (which, in fact, they saw chiefly as moral) consisted in their beingunable to think “abstractly” or reason logically, but that population was the majority: it was


everyone except males of a certain social standing. Only later was a specifically intellectual el-ement isolated (the moral aspect having been sublimated within it) and applied to a categorywhose degree of pathology was inversely proportionate to its size. On the one hand, the cogni-tive impairments organically linked to certain material states of the brain cannot easily be madeto fit modern typologies of intellectual disability, while on the other hand, some of the impair-ments now seen as characteristic of intellectual disability were then characteristic of people oc-cupying inferior social roles.5 The intellectual disability of the modern period, under whatevername, can thus be seen partly as a distillation of previously existing stereotypes of socially in-ferior beings in whom a degree of intellectual inferiority was inscribed.

ANATOMY, MONSTROSITY, PERSONAL IDENTITY

If, then, intellectual disability is essentially modern, did medicine merely receive it from theearly modern politico-theological matrix in which it was born? Or were there elements within themedical mind-set itself that positively assisted in that reception? To answer this question, we needto look at (a) the changing relations between the “natural,” the “unnatural,” and the “preternatu-ral” and (b) emerging discourses of personhood, and at the connections between the two.

Impairments of the internal senses, as described by the commentators, were not objectsof pathology in the same way that intellectual disability now is. They were simply unusual,unnatural only in the limited Aristotelian sense that their causes remained within the realm ofnature. They were not “preternatural,” against nature. A simultaneous counter-current hadbegun, however, in which there was a conceptual fusion between the unnatural and the pre-ternatural, and it is in this sense that we can occasionally find some ingredients of an emerg-ing intellectual disability under the then-current terminology. In Galen, “preternatural” re-ferred to causes of disease coming from the environment, from outside the human body. Earlymodern Galenists largely restricted these preternatural causes to God or, more often, theDevil. In the latter case, the cause did not just exist outside nature but ran counter to it. A util-itarian anxiety about consequences, in this case, of demonic activity in the world (expressedalso in anxiety about witchcraft), was increasing during the period immediately before the sci-entific revolution of the later seventeenth century. In this period, the relationship betweenmonstrosity and cranial morphology became closer.

Galen had dismissed the possibility of a sutural pattern in which “the length of the headbecomes its depth” (the extreme X-shape). For him, this meant that some brain material mightbe missing, in which case the creature could not live. The later theory of ventricular localiza-tion of the internal senses, however, created the possibility that a specific part of the brainmight be missing. The effects might be limited to that part and thus less injurious. CertainGalenists claimed to have observed Galen’s “impossible” type of skull in living humans.D’Abano said it might exist “in some monstrous dwarf ” (1565, p. 120). Such beings were“rare,” “more or less unviable” (ut invitalia), but not downright impossible. Benzi subse-quently claimed not only to have observed Galen’s impossible type in a child of four inBologna, but to have measured the child’s skull (1498, p. 20r).

The evolution of impossibility into possibility seems, however, to owe much to the devel-opments in anatomy launched by Vesalius’s De Humani Corporis Fabrica (1725). He claimedcurrent empirical evidence of his own for “a beggar going around in Bologna who has a squarehead somewhat broader than it is long, [and] in Genoa . . . a boy of about three whose head

176 C. F. GOODEY

5. In the twentieth century, Crookshank was still pursuing a theory that saw physical and mental “homologies” link-ing so-called mongoloid imbeciles with the inhabitants of Mongolia, orangutans, and the English working classes(1931, p. 329).

sticks out on either side” (p. 16). A child with the same shaped head could be seen wanderingaround Venice, deformed in other parts of his body; more significantly for us, Vesalius calledthis child (albeit not the others) amens, “mindless,” though what amentia may have meant tohim can only be surmised in the light of my previous discussion. Hofmann, for example, par-aphrasing Vesalius, named its chief symptoms as “catarrhs and apoplexy” (1625, p. 218).

Since Vesalius opposed the idea of a link between cognitive faculties and specific cere-bral ventricles, we must look elsewhere for an explanation of why he thought this a possibletype. He may have insisted on its viability because he wanted to point out the variety of typesand individuals, which was consistent with his Lutheran approach to the body as evidence ofGod’s authorship of each individual human (see Cunningham, 1997, p. 225). He also claimed,in a way that evoked Hippocrates, that head shapes differ from region to region because ofdiffering practices in laying down infants to sleep.

Several authors repeated the Bologna story, whether Benzi’s or Vesalius’s. The emphasiswas usually physiological. Nevertheless, Vesalius’s psychological embellishment of the case ofthe Venetian boy was repeated by others. Gabriele Falloppio replaced amens with stolidus(1561, p. 4). Johannes Schenk extracted it from its anatomical context and introduced it intothe existing genre of monstrosity literature, alongside routine lists of physiological monstersalready familiar to the contemporary reader (1584, p. 25). He classified “skulls without suturesor with the sutures obliterated” with two-headed monsters, conjoined twins, and “Blemmyes”(a much-cited tribe of people with faces in their chests). He added to this list the “completelymindless (amens)” Venetian child, which he said was “without sutures” rather than, as Vesaliushad it, of the extreme X-type. (This elision of the two types became common; Benedetti notedthat “in Padua at a public dissection we saw a solid, seamless cranium: such heads are knownas ‘dog’s heads’ . . . and are said to be very firm and pain-resistant” (1998, p. 244).) None ofthe other creatures on Schenk’s monstrosity list carried this psychological terminology, and inthe monstrosity literature as a whole, it only made stray appearances.

The phenomena, such as conjoined twins, among which Schenk placed the suturelessskull tended to belong in the category “unnatural” rather than preternatural or diabolic.Renaissance Galenism had placed Galen’s “suitable” H-shaped arrangement of sutures underits own heading of the “natural” (naturalis). The word natural did not necessarily indicate astricter kind of categorization than “suitable.” And “unnatural” still signified, as it had donefor Aristotle, an unusual and exotic manifestation of nature itself (Vesalius noted that suturesalso close up in the skulls of old people), rather than an exclusion from it. However, at a cer-tain (late) stage the unnatural pointy-head shape—clearly based on the commentary traditiondiscussed above—came to be applied to other creatures that came from outside that traditionand had already long been thought of as preternatural. One such was the basilisk, an emblemof the devil. Of medieval origin, this hybrid of a cock with a serpent, which could kill yousimply by its stare, made increasing appearances in the early modern period (by 1600, it wasreported as killing people on a regular basis). Alexander Ross, author of a widely circulatedcatalog of freaks published in 1652, added to the existing conventional description a pointyhead (p. 144).6

This example demonstrates the fusion between preternatural and unnatural, or at least anew confusion, about the boundary lines. Just as the preternatural basilisk acquired morpho-logical characteristics from the unnatural types described by Galen, so there was a new hesi-tancy about the status of the latter. The two T-shapes, as well as the moderate X-shape, had


6. This is not particularly strong evidence for a process of change, since I cannot claim that this is the first time it hap-pens. However, I have not read descriptions or seen drawings of the basilisk with a pointy head from before this date.

been merely unnatural, whereas the extreme X-shape, being allegedly unviable, might havesuggested preternaturality. But the Vesalian anatomists clearly saw the latter as occurring witha degree of regularity. What did this mean for its categorization in relation to nature? Schenk,as we have seen, placed it unreservedly in the context of the unnatural. Ingrassia reinterpreted“unviable” (invitalis) to mean “unlikely to survive,” but rather than categorizing this type asunnatural, he described it as “quasi- [tamquam] preternatural”—and brought in the ever-flex-ible Thersites to illustrate the point (1584, p. 64). Classification was “uncertain” in suchcases. Vesalius himself had already displayed this hesitancy:

The other unnatural head shapes can sometimes be seen even among perfectly re-spectable citizens, though one rarely finds them in cemeteries. However, they would beseen to occur often if we could investigate the cemeteries of people living in the StyrianAlps, since the inhabitants’ heads are deformed not only in this way but also in furtherways that are more outlandish. (p. 16)

By “other,” he clearly meant the T-shapes and the moderate X-shape. His train of thoughthere seems to pursue a continuum from these respectable peers of his to the oafish mon-strosity of thyroid-deficient Alpine peasants, thus emphasizing the variety of types. Yet thissame departure from convention, from the tripartite division of natural, unnatural, and pre-ternatural, could be seen as the start of a bipartite mind-set. A polarization has begun, inwhich the unnatural shape is categorically uncertain; to use anachronistic terms, it has to beassigned as either normal or abnormal.

The occasional addition of a cognitive terminology to cranial monstrosity in this processoccurred at a time when, in any case, the distinction between unnatural and preternatural wasbeginning to fade. Degree of regularity is precisely what establishes abnormality for a mod-ern physician or psychologist. The fusion of the unnatural with the preternatural is so com-plete in modern medicine as to be unrecognizable as such: today, they simply form a singlecategory, the “abnormal.” Historically, the fusion coincided with the rise of natural historyand a concern with the logical definition of species membership, as well as with new theoriesof personhood. The preternatural, that which lay outside nature because of its diabolic origins,when translated into a scheme of theologically justified natural history, might become thatwhich lay outside the species.

This anxiety about the borderline between humans and the other animals to some extentbridges the gulf between Renaissance and Enlightenment versions of the chain of being. Itwas no antiquarian whim that led the great Enlightenment (and Calvinist) physician HermanBoerhaave to republish Vesalius and his anatomist contemporary Bartolomeus Eustachius.The latter had opened his book on the anatomy of the skull with a blast against previous writ-ers on anatomy who maliciously confused the cranial sutures of humans with those of apes.What else but malice, in its deepest theological sense of opening the way to atheism, couldaccount for their blurring of the dividing line between humans and other animals? The newanatomists favored the empirical evidence supplied by dissection wherever it clashed withGalenist theory, even if they saw their work as defending that theory in its broader principles.Thus, Eustachius cast his opponents as anti-Galenists who, in respect of cranial sutures, per-versely followed the ancient master without empirical justification—i.e., precisely where hehad been wrong.

It was well known, said Eustachius (following Vesalius), that Galen could only everhave dissected animals, so his description of the sutures was inaccurate. In humans, the su-tures “as drawn on the page most elegantly imitate the multiform lines of the geographer,”whereas in apes “they are obscure, so that for the most part they in no way or scarcely de-

178 C. F. GOODEY

serve the name of sutures” (1707, p. 151). Galen’s description fitted the simplicity of thesimian skull. Sutures in the human skull are varied and individual, such that the two armsof the lambdoid suture will often be of unequal length (this variability from one individualto another, the key to the new anatomy based on observation and personal experience, ex-plains the reference to geographers’ lines). It was precisely Eustachius’s need to keep hu-mans separate from apes, on grounds of the individual anatomical variety of the former,that made him insist on the viability of Galen’s impossible type (“I publicly dissected fif-teen skulls in one day where the coronal suture was absent,” 1707, p. 148). In the medievalbestiary, the monkey had been, like the basilisk, emblematic of the devil. The deceptivesimilarity of its sutural layout was not a similarity at all but a crude and ridiculous imita-tion of the elegant variety of the human skull. This point had a directly moral content forEustachius. Again, it recalled the behavior of the jester. It also evokes modern tendenciesin applied psychology to explain away the abilities of intellectually disabled people as mereimitation rather than the real thing.

If Eustachius expressed moral difference in anatomical terms, another medical man,John Locke, in one of modern psychology’s ancestral texts, expressed a similar moral dif-ference in terms of the natural history of the mind. He defined “changelings,” a term justthen coming to replace “natural fool” and echoing earlier accounts of children exchanged bywitches in the cradle or born from the devil’s semen, as a separate species midway betweenhumans and apes. In their case, the post-Cartesian and strictly demarcated species differencewas that the body is of human appearance while it “hath no rational soul” (1975, p. 570). Inthis expression of theology as natural history, “changelings” came to have a fixed, perma-nent, birth-to-death identity based on their absence of reason. This identity was the obverseof, and perhaps a prerequisite for, the personal identity theory that Locke constructed for rea-soning individuals whose species essence was “moral man,” and which he famously ap-pended to the second edition of the Essay (Goodey, 2001). When the Renaissance da Montelooked at Little Johnny and when the proto-modern Locke looked at the changeling, neitherwas asking the psychologist’s question, “What does an intellectual disability look like?” butrather the theologian’s question, “What would it look like for an apparently human creaturenot to have a rational soul?” Da Monte asked it in the Galenist terms described above. Lockeasked it in terms already framing the modern “intellectual disability” I outlined at the start:the human mind is a separate, autonomous realm of nature, an item in natural history; thisnatural history defines species with the strictness of logical classes; there is convergence be-tween the unnatural and the preternatural (the beginnings of the modern “abnormal”); andthere is a phenomenal-type account of personhood. In this sense, it may be that beneath thefirst of the above questions, with its scientific-looking appearance, psychology is still reallyasking the second.

In that case, it is not the Renaissance conceptual models of cognitive impairment,even when matched to head shape and cranial sutures, that show evidence of historicalcontinuity from then till now; it is medical writers’ discussion of and attitudes to mon-strosity that do so. The continuity may therefore be less scientific or conceptual than an-thropological: something in the mind-set of the doctor. Of course, doctors eventually jet-tisoned Galenist medicine as such.7 As for physiognomics, to the extent that it survived, itstrayed from classical tradition and took its own path. And the whole point of Locke’s doc-


7. Some of the issues were still pursued later but translated into developmental terms. For example, in the late nine-teenth century, there was still an argument as to whether microcephaly was caused by premature cranial synostosis orwhether premature synostosis is a consequence rather than the cause of imperfect brain development. Those who be-lieved the first hypothesis had a habit of performing craniectomies, sometimes fatally (Shuttleworth, 1881, p. 241).

trine of the changeling was that it refutes physiognomics. A deformed body is preciselynot a sign of deformed character; the mind is quite capable of being deformed on its ownaccount. Nevertheless, the new conceptual model of a disability described in strictly in-tellectual terms emerged partly with the aid of older, conventional physiognomic dis-courses; and if it did so, it was because of a certain shift in the relationship between doc-tors and monsters.

One example is Nicholas Culpeper’s English translation and commentary on Galen’s Artof Medicine published in 1652. This was the same year in which Ross gave the basilisk apointy head, and also the year when a demonic sense was introduced in the “changeling”through the English translation and publication of Luther’s Table Talk (see Goodey &Stainton, 2001). Culpeper more than once interpolated “fools” into Galen’s text (that is, notmerely in his own accompanying commentary). Galen had simply said, for example:

A small head is the proper indication of a poor brain condition. A large head, however,does not necessarily indicate a good condition. But if it has become strong because thepower residing in it has created matter that is useful as well as abundant, that is a goodsign; if however because of abundance alone, that is not a good sign….

Culpeper’s translation ran:

A Very smal Head is a proper Indication of a vicious Brain, and yet a great Head dothnot necessarily declare a strong Brain; If there be not capacity enough in the Skull tohold the Brain, or a sufficient quantity of Brain, the Man must needs be a Fool.(Culpeper, 1652, p. 11)

It is not clear whether this was Culpeper’s historiographical assumption (he supposedGalen would have constructed a typology of “fools” if asked to clarify), or whether it was an or-ganic development of late Galenism (in straying from translation into exegesis, he thought hewas improving on the original). Culpeper’s other works show that he was quite capable of faith-ful translation. Nor, once again, can we really tell whether the symptoms that Culpeper saw inhis fool would have had much in common with those we identify in today’s intellectual disabil-ity. His novelty was simply to introduce a substantive person or type into texts that previouslyhad only contained strings of adjectives, whose range of reference was mainly to melancholyand mental illness, occasionally fleshed out by some quasi-mythical illustration. Along with thedeterministic implications of “must needs be,” perhaps absorbed from theological discourses ofpredestination, Culpeper’s substantive “fool” already resonates with the “changeling” and withthe theory of personal identity that was to achieve fuller expression with Locke.

CONCLUSIONS

It may now be possible to look at some longer-term pattern in these conceptual shifts. Iam still not convinced that the premodern doctor would have recognized as his “fools” the“intellectually disabled people” I sent him in the time machine. On the other hand, the notionof rupture—that medicine’s conceptual and diagnostic approach simply stops and starts anewin the late seventeenth century—is clearly not right.

I have suggested that for evidence of some continuity in the conceptual history of in-tellectual disability, we should look not at the person so labelled but at the mind-set of thedoctor, where the image of disability has been molded and remolded. The Hippocratic doc-tors simply talked about four kinds of arrangement of the sutures. Galen added a hierarchyof values: one kind is “suitable” or exemplary, three are defective, and he criticized his pred-

180 C. F. GOODEY

ecessors for not describing a fifth type that would be monstrous; even so, said Galen, thisfifth type can only exist in the imagination. Some Renaissance Galenists then amplified thispicture with the claim that they had actually seen an example of this type even if it didn’tlive for long: they can exist in reality. Someone who says “There isn’t” is followed by some-one else who has to say, “Yes there is.” The urge to seek out monstrosity constitutes the ac-tual process of its invention. Thus too with the early historiography: Benzi cited his prede-cessor d’Abano as saying that he had seen one when in fact d’Abano had only said that itmight exist (1565, p. 20r).

This dialectic consists of an ever-recurring exhaustion of doctors’ state of wonder at theseparateness of monsters from the rest of nature, and a consequent urge to propose and ex-plore boundaries beyond which to make new, outlandish discoveries. Medicine, over the longhistorical term, has had a shamanistic role: doctors have revealed the existence of the invisi-ble or inconceivable, and in so doing they have reinforced their right to decision-making pow-ers over inclusion and exclusion from nature, not to mention social institutions. The block-head is inconceivable (Hippocrates); the inconceivable becomes conceivable but unviable(Galen); the conceivable but unviable becomes viable but wondrous (Benzi). And once latenineteenth-century physicians claimed to see sutural anomalies in the skulls of people withDown syndrome, the viable but wondrous had became the mundane but abnormal(Shuttleworth, 1881).8 In this passage from inconceivable to merely pathological, the wonderof nature is constantly lost and then rediscovered in precisely the form that was the previouslimiting case. The limiting case would be a wonder if it could exist, then, presto, it does.

The dialectic I have described began with anatomy alone. As it crossed the historical di-vide of the late seventeenth century, fools or “changelings” of demonic origin entered themind-set. Culpeper’s text itself is an example of how the anatomical blockhead of theRenaissance became the metaphorical blockhead of modern colloquial discourse. The very actof translating a major teaching text, the Ars Medica, into English was a radical move.9 In hispreface, he castigated the elite College of Physicians that ruled medicine at the time, com-plained about their insistence on Latin as a way of preserving their social and political posi-tion, and scoffed at their obscurantist theorizing and calculated esotericism. He applied thetrope of monstrosity and species exclusion precisely to this professional elite, to their reac-tionary defense of “that Monster TRADITION, who seldom begets any Children but theyprove either Fools or Knaves, and this makes them so brutish . . .” One of their obscurantisttricks was their custom of putting a deformed skeleton on show, “a monster in the first room,”in order to impress new patients (Culpeper, 1651, p. 139). The irony of the situation is thatCulpeper himself, when he inserted his “fool” into Galen’s text, was contributing to that side-ways branching of the dialectic that was to continue with Locke’s changelings. A monstrosityeventually came about that belonged in a separate and strictly intellectual sphere, and whichhad a much more rigorously determined and excluded identity than the monstrosity of theskeleton in the traditional doctor’s waiting room. Far from being, as the latter had been, ademonstration of God’s power to endow nature with a rich tapestry of wonders (“monster”comes from monstrare, to show), monsters characterized by a permanent incapacity for reasondemonstrated now the power of the devil. In this lies the modernity of intellectual disability.


8. Shuttleworth’s (1881) photograph of the brain of “an idiot of the mongoloid type” may also have been intendedto show a skull in which there is only one suture (Wellcome Institute for the History of Medicine, Historical ImagesCollection V0030015).

9. The Method of Healing had been translated into English before, but The Art of Medicine, unlike the former, wasone of the two main textbooks on every curriculum (the other being Ibn Sina’s Canon) and thus impinged on the pol-itics of medical education.

REFERENCES

Agrimi, J. (2002). Ingeniosa scientia naturae: Studi sulla fisiognomica medievale. Florence: Tavarnuzze.Akakia, M. (1544). Claudii Galeni Pergameni ars medica, quae et ars parva. Venice: Vaugris.Aranzi, G. (1579). Hippocratis librum de vulneribus capitis. Lyons: Cloquemin.Argenterio, G. (1566). In artem medicinalem Galeni. Turin: Monte Regali.Aristotle. (1937). On the parts of animals. London: Heinemann.Aristotle. (1936). Physiognomics. Minor Works. London: Heinemann.Aristotle. (1960). Topics. London: Heinemann.Benedetti, A. (1998). Historia corporis humani sive anatomice. Florence: Giunti.Benzi, U. (1498). Expositio super libros Tegni Galieni. Venice: n.p. Celsus, A. (1772). De re medica. Paris: Didot. Crookshank, F. (1931). The mongol in our midst. New York: Dutton.Culpeper, N. (1651). A key to Galens method of physick. London: Cole.Culpeper, N. (1652). Galens art of physick. London: Cole.Cunningham, A. (1997). The anatomical Renaissance. Aldershot: Scolar.d’Abano, P. (1565). Conciliator controversiarum, quae inter philosophos et medicos versantur. Venice: Giunta.da Monte, G. (1554). In artem parvam Galeni explanationes. Venice: Constantinus.Danziger, K. (1997). Naming the mind: How psychology found its language. London: Sage.de Dryvere, J. (1547). In tecnhe Galeni clarissimi commentarii. Lyons: Godefridus.du Laurens, A. (1628). Annotationes in artem parvem Galeni. Opera omnia. Frankfurt: Fitzer.Eustachius, B. (1707). Opuscula anatomica. Leiden: Van der Linden. Falloppio, G. (1561). Observationes anatomicae. Venice: Ulmus.Frischer, B. (1982). The sculpted word: Epicureanism and philosophical recruitment in ancient Greece. Berkeley:

University of California Press.Galen, C. (1965a). De locis affectis. Opera omnia, 8. Hildesheim: Olms. Galen, C. (1965b). De ossibius. Opera omnia, 2.Galen, C. (1965c). De usu partium. Opera omnia, 3.Galen, C. (1965d). Ars medica. Opera omnia, 1. Galen, C. (1965e). Commentary on Hippocrates Epidemics 6. Opera omnia, 17. Goodey, C. (2001). From natural disability to the moral man: Calvinism and the history of psychology. History of

the Human Sciences, 14, 1–29.Goodey, C. (2004). “Foolishness” in early modern medicine and the concept of intellectual disability. Medical

History, 48, 289–310. Goodey, C., & Stainton, T. (2001). Intellectual disability and the myth of the changeling myth. Journal of the History

of the Behavioral Sciences, 37, 223–240.Hippocrates. (1923). Airs, waters, places. Hippocrates I. London: Heinemann.Hippocrates. (1979a). On injuries of the head. In E. Littre (Ed.), Opera omnia (Vol. 3). Amsterdam: Hakkert.Hippocrates. (1979b). Places of man. In. E. Littre (Ed.), Opera omnia (Vol. 6). Amsterdam: Hakkert.Hofmann, C. (1625). Commentarii in Galeni de usu partium corporis humani. Frankfurt: n.p. Ibn Ridwan. (1523a). Galeni liber qui techni inscribuntur . . . cum commento Haly Rodoam. Venice: n.p.Ibn Ridwan. (1523b). Liber totius medicinae. Venice: n.p. Ibn Sina. (1522). Liber canonis totius medicinae. Lyons: Myt.Ingrassia, G. (1603). In Galeni librum de ossibus commentaria. Palermo: Maringhi.Jacquart, D. (1994). La physiognomie a l’epoqué de Frederic II. Micrologus, 2, 19–37.Joutsivuo, T. (1999). Scholastic tradition and humanist innovation. Helsinki: Finnish Academy.Kanner, L. (1967). A history of the care and study of the mentally retarded. Springfield: Thomas.Locke, J. (1975). An essay concerning human understanding. Oxford: Clarendon.Manardi, G. (1541). Annotationes in artis medicinalis Galeni. Basle: n.p.Mans, I. (1998). Zin der zotheid: Viijf eeuwen cultuurgeschiedenis van zotten, onnozelen en zwakzinnigen.

Amsterdam: Bakker.Manzoni, T. (2001). Il cervello secondo Galeno. Ancona: Il Lavoro. Moreni, M. (1987). Nemesii Emeseni De natura hominis. Leipzig: Teubner.Neugebauer, R. (1996). Mental handicap in medieval and early modern England: Criteria, measurement, care. In D.

Wright & A. Digby (Eds.), From idiocy to mental deficiency: Historical perspectives on people with learningdisabilities (pp. 22–43). London: Routledge.

Oddi, O. (1574). In librum artis medicinalis Galeni. Venice. Riolan, J. (1631). In artem parvam Galeni commentarius. Paris: Langlaeus.Rocca, J. (1997). Galen and the ventricular system. Journal of the History of the Neurosciences, 6, 227–239.Ross, A. (1652). Arcana microcosmi. London: Newcomb.Santa Sofia, G. (1533). Libellus familiarium introductionum in artem parvam Galeni. Hagenau: Kraut.Santorio, S. (1632). Commentaria in artem medicinalem Galeni. Lyons: Caffin.Scheerenberger, R. (1983). A history of mental retardation. Baltimore, MD: Brookes.Schenk, J. (1584). Observationes medicae de capite humano. Basle: Grafenberg.

182 C. F. GOODEY

Sermoneta, G. (1498). Quaestiones subtilissimae. Venice: Scotus.Shuttleworth, G. (1881). Some of the cranial characteristics of idiocy. London: Kolckmann.Stainton, T., & McDonagh, P. (2001). Chasing shadows: the historical construction of developmental disability.

Journal on Developmental Disability, 8, ix–xvi.Todd, T., & Lyons, D. (1924). Endocranial suture closure, its progress and age relationship. American Journal of

Physical Anthropology, 7, 325–384.Tozzi, L. (1711). In artem medicinalem Galeni. Opera omnia, Vol. 2. Venice: Pezzana.Tsounas, V. (1998). Doubts about other minds and the science of physiognomics. Classical Quarterly, 48, 175–186.Vesalius, A. (1725). De humani corporis fabrica. Leiden: Du Vivie. (Original work published 1543)Wielgus, S. (1973). Quaestiones Nicolai Peripatetici. Mediaevalia Philosophica Polonorum, 17, 122–130.Wiberg, J. (1996). The anatomy of the brain in the works of Galen and Ali Abbas. Islamic Medicine, 40. (Original

work published 1914)


blockheads, roundheads, pointy heads: intellectual disability and the brain before modern medicine

Documents