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“Of Stupidity Or Folly”: Thomas Willis's Perspective on Mental Retardation

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“Of Stupidity Or Folly”: Thomas Willis's Perspective on Mental Retardation 555 Arch Dis Child: first published as 10.1136/adc.87.6.558 on 1 December 2002. Downloaded from PAEDIATRIC LESSONS FROM THE PAST “Of stupidity or folly”: Thomas Willis’s perspective on mental retardation A N Williams ............................................................................................................................. Arch Dis Child 2002;87:555–558 “Mental retardation” is a modern term for an age old considered to be marked out by God and not problem. The descriptions of paediatric cases contained stricken by disease”.7 Willis’s first published description of mental within the works of Thomas Willis (1621–75) have been retardation was in his Cerebri Anatome (1664), his increasingly recognised for their insight into seventeenth monumental work on comparative brain anat- century child health practices. omy. In it he presented a case of a child demonstrating cerebral atrophy (fig 1) who is .......................................................................... described as being “foolish from birth”.8 n two of his major works Willis comments on SUBSEQUENT DESCRIPTIONS mental retardation; this review illustrates from In 1663 or 1664 Willis gave a series of lectures, Ihis writings his understanding and manage- which were attended by the philosopher John ment of this condition. Locke (1632–1704) and by the natural philos- Thomas Willis (1621–75), Sedleian Professor of opher and chemist Robert Boyle (1627–1691), Natural Philosophy at Oxford and a founding Fel- both of whose notebooks still survive. In a lecture low of the Royal Society, left a body of work that on Sleep and Wakefullness, Boyle recounts defined mid seventeenth century medicine.1 He is Willis’s description of an autistic savent: credited with inventing the word neurology.2 He is rightly remembered primarily for his astute observations of adult neurological conditions and “I have heard of an idiot in the County of for describing the functional significance of the Suffolk who accustomed to watch and arterial anastemosis at the base of the brain, now count the chimes of clocks and bells, could immortalised with his name. with complete certainty tell the hour of the Recent interpretations of Willis’s work have led day without any clock: Indeed he could tell to a growing appreciation of his significant the quarter just as if he had consulted a contributions to paediatric neurology, a specialty watch. He could do this in the fields founded approximately three centuries after his beyond the sound of the bell, by simply http://adc.bmj.com/ death. A previous paper has concentrated on his murmuring to himself and imitating the 3 paediatric neurology cases. sound of a clock.”9 Willis’s writings afford a fascinating insight into the clinical rationale of the seventeenth cen- tury physician in their management of paediatric In his lectures Willis hypothesised that cases. stupidity was caused by exhausted animal spirits that affected the imagination and Given our own limited understanding of men- 10 tal retardation, Willis’s work is a poignant memory. He subsequently developed his on September 25, 2021 by guest. Protected copyright. reminder of the challenges we face three centu- argument at some length in a later work “de ries later. anima Brutorum” (“Of the Soul of Brutes”) (1672). In it he devoted an entire chapter to MENTAL RETARDATION mental deficiency, entitled “Instructions and 11 The phrase “learning difficulty” is far less pejora- Prescripts for the cure of Stupidity or Folly”. tive and stigmatising than the term “mental This is one of the earliest systematic descriptions 12 retardation” used by both the ICD-10 and the of mental deficiency. DSM-IV.TR.45 In the UK “learning difficulty” is Although other commentators reviewing the used synonomously with mental retardation, but chapter have interpreted the folly section as 13 in the United States it is used to refer to what indicative of schizophrenia, there have been few were known as “specific learning difficulties”, other comments on Willis’s description of See end of article for that is, dyslexia. stupidity—mental retardation. Indeed the only author’s affiliation long term influence of this chapter was Willis’s ....................... Thus our use of the term “learning difficulty” in this wider context may be more dishonest than description of an adult case of “stupidity” which Correspondence to: the term “stupidity” used by Willis. Certainly in had resolved after a fever; in later centuries this Dr A N Williams, our own practice none of us would dare to use gave rise to fever therapy or inoculation with Consultant Paediatrician, malaria.14 North Warwickshire PCT, Willis’s term. Irrespective of the definition, St Nicolas Park Clinic, mental retardation is still a challenging aspect of Willis’s thoughts were heavily influenced by Windermere Avenue, paediatric care, with most cases still having no Pierre Gassendi (1592–1655) whom he frequently Nuneaton CV11 6HH, UK; definable cause or effective treatment.6 cited. Indeed the title “de anima brutorum” (the [email protected] However, the seventeenth century view was Soul of Brutes) reflects a direct influence of Gas- Accepted 16 July 2002 very different from that held today and surpris- sendi’s writings. Gassendi claimed that animals ....................... ingly, perhaps, more compassionate: “Fools were must have souls since they show evidence of www.archdischild.com 556 Williams Arch Dis Child: first published as 10.1136/adc.87.6.558 on 1 December 2002. Downloaded from Figure 1 Plate of congenital cerebral atrophy and its accompanying text (with permission from the Wellcome Library, London). memory, reason, and similar traits.13 Gassendi called this the that is, reading and writing, thereby adding a wider interpret- Soul of Brutes, which is also present in man, as an inferior soul ation of the different learning difficulties as defined by Willis in whom there is also a superior or rational soul. Willis’s dis- within his first category. tinction between foolishness and stupidity was in essence the presence of a thought disorder in the former. CAUSAL FACTORS In our present day practice a detailed history is recognised as “Stupidity or folly, tho it chiefly belongs to the rational the most important component in any paediatric Soul, and signifies the defect of the Understanding and assessment.16 Judgement, nevertheless it is not improperly placed Willis clearly recognised and described many different among the Diseases of the Head or of the Brain: to wit causes: hereditary,congenital, and acquired. He recognised the as much as that Eclips of the superior soul, proceeds hereditary nature “as when fools begat fools—the reason to http://adc.bmj.com/ from the Imagination and the Memory [being] injured: wit is clear enough, to wit the same weak particles flowing and the failing of these depends upon the faults of the from the constituting animal organs in the son, which were in animal Spirits, and of the Brain it self.”11 the father”.11 But Willis also felt that the cause could be accidental: “It Willis believed that stupidity was not only caused by frequently happens that wise and might ingenious men, beget exhausted animal spirits affecting the imagination and mere sots, which sometimes so fall out for these reasons. memory; he clearly pointed out “that the brain itself is found Either that the Parents spend their Spirits in Study and too on September 25, 2021 by guest. Protected copyright. to be first in fault”.11 He commented on how brain size, shape, much thinking, or weaken and enervate the Body through texture, and “evil conformation of the Brain as to its pores and intemperance, luxury and ill living.”11 passages” were important causes and affected the function of Willis supported this with his opinion regarding parental the brain, the spirits, or both. factors: “Persons that are stupid we may imagine, sometimes an “Those who are born of parents broken with old age, excess of some manifest quality in the Brain, as chiefly or of such as are not yet ripe or are too young, or of of moisture and cold, for which reason Children and drunkards, soft or effeminate men, want a great and aged Persons are often wont to be affected with a liberal ingenuity or wit. Nor does there happen a less Dulness of the Senses: sometimes a texture too gross detriment to them of the Animal Faculty whose fires are and earthy, so that the Spirits cannot easily irradiate it, or make Tracts for themselves. To this gross Texture of the Brain some born of Rusticks are frequently Table 1 Willis’s Degrees of Stupidity11 obnoxious, so that in some Families looking back up on (1) “Some being wholly unfit for Learning, and the liberal Sciences many generations, you will scarce find one wise or are apt enough to mechanical arts.” 11 witty man.” (2) “Others, tho incapable of both these, yet readily comprehend Agriculture and Country Affairs.” (3) “Others incapable in a manner of all business, can be taught Willis’s categorisation of the degrees of stupidity as “some only those things that regard eating and drinking, and the persons are accounted unfit as to the comprehension of all common way of living.” things, Others only to some”11 is expanded further by him (4) “Others being mere Dolts, scarce understand any thing at all, (table 1). or do any thing with Knowledge.” Interestingly, in an earlier translation, also by Pordage (1683),15 “learning” was expanded to “learning of letters”— www.archdischild.com Thomas Willis’s perspective on mental retardation 557 Arch Dis Child: first published as 10.1136/adc.87.6.558 on 1 December 2002. Downloaded from obnoxious to evil attentions of the brain as the palsie, “Therefore they are to be instructed in all things by an Epilepsie, Carus [insensibility], convulsions and the like assiduous and very diligent Master, and the same so that to be born of parents who have a sound mind in things are to be inculcated again and again.
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