The Cure of Folly: A re-interpretation based on the life and times of Hieronymus Bosch The Cure of Folly, c. 1488. Oil on panel. Museo del Prado, Madrid, Spain; PD-old-auto-expired 22 The Pharos/Autumn 2019 Stanley N. Caroff, MD, and Rosalind M. Berkowitz, MD Dr. Caroff is Emeritus Professor, Department of Psychiatry, challenge orthodoxies of the Middle Ages as new worlds Corporal Michael J. Crescenz VA Medical Center and the were discovered by naval explorers and classical knowl- University of Pennsylvania Perelman School of Medicine, edge was recovered, translated, and available to the public Philadelphia, PA. through the invention of the printing press, c. 1440.13 Contradictions abounded as medieval superstition and Dr. Berkowitz (AΩA, SUNY Upstate Medical University, dogmatic scholasticism gave way to empirical observa- 1973) is a Hematologist/Oncologist in private practice in tion.14 However, death and despair from age-old scourges Moorestown, NJ. of internecine warfare, crushing poverty, famine and epi- demic disease remained rampant.13 he 15th century painting known as the Cure of Folly, The power of the Roman Catholic Church to provide the Stone of Madness, or The Stone Operation, at- solace and enforce social order was weakening due to tributed to Hieronymus Bosch (c. 1450–1516), has internal schism, corruption, the Protestant Reformation, Tfascinated physicians for decades. Stimulating a broad and fears of an Islamic invasion following the fall of range of speculation on its psychological or medical mean- Constantinople to Turkish forces in 1453.13 Faced with un- ing, this curious artwork is often portrayed as a glib, satiri- certainty, anxiety, and depression amidst dramatic social cal anachronism depicting a farcical procedure to cure a change and perceived threats to Christianity and Western behavioral disorder perpetrated by a charlatan on a gullible civilization, people were vulnerable to being misled and patient.1-12 Amusing as it is, this interpretation may be too turned to apocalyptic fantasies and conspiracy theories limited and not in keeping with the zeitgeist of Bosch’s as the year 1500 approached. Scapegoats were sought in- legacy of imagery, which he used to illustrate the everlast- ternally as Islamophobia, anti-Semitism, and the belief in ing hellish consequences of sinful behavior. Therefore, witchcraft and demonic possession swept through Europe, a further analysis of the Cure of Folly was conducted to providing fuel for the Inquisition and the slaughter of ascertain whether a broader message of the painting had thousands.1,13,15 been overlooked. Bosch and his contemporaries lived and worked during It is essential to consider the cultural milieu of the a critical juncture between the late Middle Ages and the artist’s life, scope of work, and times five centuries ago Early Renaissance. His reaction to the changing cultural to properly interpret the painting. Within this historical climate is portrayed in his surviving paintings, most of context, a broader meaning emerges that the very idea that which were sponsored as church altarpieces. Addressing deviant human behavior could be fixed by a simple surgi- primarily orthodox religious and devotional themes, Bosch cal procedure was inherently foolish, immoral, sinful, and broke with tradition by integrating and projecting surreal susceptible to abuse. This more serious moral interpreta- internal fantasies, and alchemical and astrological imagery, tion is reinforced by a later painting attributed to Pieter as much as literal scriptural events. His work drew on the Bruegel the Elder, which illustrates and extrapolates the travails, proverbs, legends and symbolism of everyday life dangerous consequences of unproven procedures on the in the Netherlands. brain becoming accepted and applied indiscriminately. His whimsical and nightmarish allegorical paint- This analysis of the paintings of Bosch and Bruegel may ings, which slipped into obscurity until popularized by have implications for the ethical and scientific practice of Surrealists and Jungian psychologists in the last century, psychosurgery by contemporary investigators. prompted historically-biased speculations that the artist was heretical, perverse or suffered from psychosis, ergot- Bosch ism or alcoholism.1,3,9 However, evidence indicates that A brief history of Bosch’s life and times is important Bosch was a prominent, successful, and popular artist in understanding the background of his painting. Born who married well and joined a prestigious lay religious Jerome van Aken, Bosch was a member of a well-known confraternity, The Brotherhood of Our Lady. His work family dynasty and workshop of painters in the provin- was admired and imitated by his peers, especially for his cial Netherland town of s’Hertogenbosch, from which lurid depictions of diabolical monsters, chimeras, demons, he took his professional surname. He was an influential and devilry. He received commissions from leaders of both early representative of the Northern Renaissance school of clergy and the ruling nobility who displayed his paintings painting during a turbulent, watershed period in Western prominently in churches and palaces throughout Europe. civilization. An information revolution was beginning to The Pharos/Autumn 2019 23 The Cure of Folly Bosch’s work and its Stones in the head meaning Bosch’s allegory of madness, Although the absence of dates or folly, resulting from stones in and signatures on most of the the head had wide cultural cur- several dozen paintings attrib- rency as an idiomatic metaphor uted to Bosch make authentica- or figure of speech at the time, tion problematic, the works that and still does today such as refer- do survive illustrate consistent ences to someone having “rocks stylistic themes and iconography in his head,” or ”lost his marbles,” that were likely familiar within Evidence suggests that stones the social, folklore, and literary were considered as a cause of traditions of the Netherlands neuropsychiatric conditions such during his lifetime.16 The Cure of as epilepsy, headache, and be- Folly was but one relatively minor havioral disorders extrapolating unsigned work and its attribution from attempts to alleviate distress to Bosch has been questioned. by finding and removing stones, There has been prodigious schol- foreign bodies, or tumors else- arship in art history concerning where in the body.6,10-12 Modern Bosch and his contemporaries, day reports of idiopathic brain but given the barriers of culture, stones (calcifications and tumors) language, customs and time, found post-mortem have been Trepanation, from Hans von Gersdorff, Feldbuch the hidden meanings he wished der Wundartznei, 1517, Strasburg, Germany. invoked as real-world correlates to convey to his peers through PD-old-auto-expired of this idea, though there are few the symbolism in this and other historical sources documenting paintings remain opaque and may be uncertain.16 autopsies to support this as a rationale at the time.10,12 Within the scope of his commissions, Bosch painted The operation in the Cure of Folly recovers flowers, not as a social critic and moral authority representing the stones, the implication of which remains unclear. Much diversity of human behavior through sin, immorality, and has been made of the possible symbolism and semantics, foolishness and the inevitable spiritual consequences. whether “flower head” was another derogatory term for a Although his response to the moral crises of his time fool, or whether the “golden flower of wisdom,” or the long reveres traditional Christian doctrine and liturgy, his ico- sought “philosopher’s stone” can be found in the mind of nography transgressed ecclesiastical conventions and took a fool. Perhaps, finding flowers reflects the irrationality of on a veneer of social commentary including disdain for the procedure with the joke being on the surgeon for spu- hypocrisy and using imagery from everyday secular life riously seeking stones in the first place. 14,15,16 and the natural world to appeal to a broader audience of It is unclear but considered doubtful that operations like common people. this to remove stones to alleviate mental illness or intellectual The Cure of Folly should be understood not as an enter- disability were actually attempted or widely used in this era, taining diversion depicting a humorous apocryphal medical although medical treatises of the time do contain anecdotal travesty, but rather as a critique of physicians and medical testimonials and illustrations of how trepanation for insanity practice within the theological and moral code. The Cure or headaches might be performed, and human skulls have been of Folly may be seen as a corollary to the Seven Deadly Sins found bearing marks of surgery. 5,6,11,14,16 There may have been and Four Last Things. In the latter, Bosch depicts everyday charlatans who took advantage of the desperation of people scenes of people engaged in behaviors exemplifying sins with behavioral disorders and the cultural cliché linking stones of anger, vanity, lust, sloth, gluttony, avarice, and envy in a with foolishness by performing sham cures, palming stones and round tableau or tabletop with Jesus Christ watching and displaying them after incising the scalp, although documented judging from a central eye. In the four corners, Bosch il- evidence of this has been hard to find.5 This spectacle may lustrates in roundels the consequences of these behaviors have been painted, or staged, as comedic entertainment or as progressing through death, judgment, heaven, or hell. an advertisement for services by itinerant barber-surgeons.5,16 24 The Pharos/Autumn 2019 The Cure of Folly The central figure is a plump, ostentatiously dressed fig- Consistent with the social, spiritual and moral implica- ure restrained in a chair with a bulging money bag at his side tions of the Seven Deadly Sins and Four Last Things and presumably for payment undergoing a surgical procedure to other paintings by Bosch, the extraction of the proverbial remove stones from an incision in his head. Thanks to the stone of madness must also convey a moralistic warning for ornate gothic script surrounding the picture, we know his physicians.