ART AND IMAGES IN PSYCHIATRY SECTION EDITOR: JAMES C. HARRIS, MD The Cure of Folly Tis not amiss to bore the skull with an instrument, to let out the fuliginous vapors....Guinerius cured a nobleman in Savoy by boring alone... by means of which, after two years [of] melancholy and madness, he was delivered. Robert Burton, Anatomy of Melancholy, 16521(p450) repanning is the removal of a piece of bone from a simpleton from the country. A corpulent patient is tied the skull without damage to the underlying blood to a chair and looks out plaintively toward the viewer; his T vessels, meninges, and brain. It may be the world’s clogsareneatlystowedbeneaththechair.Attheright,abored oldest known surgical procedure, having been practiced nun with a closed book resting on her head leans on an ex- throughout the world since the late Paleolithic period. The pensive table whose base is a giant flower bulb. In the cen- earliest detailed account is from Hippocrates2 (ca 460 to 355 ter, a cleric holding a drinking mug looks on. At the left, a BC) in the fifth century BC; it was to be performed for wounds farcical surgeon wears a monk’s cowl and an official badge of the head within 3 days following a contusion and within of a city messenger; he has an inverted funnel over his head 2 weeks for suspected infections. Modern recognition of its and a uroscopy flask at his side as he wields a scalpel. It is historical importance began in 1865 when an American dip- not a stone but a flower that he removes; another one lies lomat, Ephraim George Squier (1821-1888), brought a skull on the table. Simpletons were referred to as tulip heads, and from an Inca burial site near Cuzco, Peru, to Paul Broca, having a bulb in your head was synonymous with having Professor of External Pathology and Clinical Surgery at the a stone. University of Paris, to authenticate therapeutic trepanning The entire process is clearly an elaborate deception, abet- by the Incas.3 After careful personal review and consulta- ted with seeming seriousness by the religious orders, whose tion, Broca confirmed that a surgical procedure had taken spiritual calling is suspect here. Human gullibility is one of place and that bone healing was consistent with postopera- the major themes in Bosch’s work. He uses his art to make tive survival.4 Subsequent discoveries of Neolithic trepan- othersawareoftheirfolly,contrastingitwithhishermitpaint- ning in France heightened Broca’s interest and resulted in ings where meditation, struggle, and self-reflection, not sur- his publishing more scientific reports on prehistorical trepa- gery, provide the means to eliminate folly. Bosch’s unique- nationthanonthecorticallocalizationoflanguage,4 forwhich ness is in breaking with traditional biblical illustration to find he is best known. Trepanning was primarily practiced for his own expressive language.6 He must have struggled with head wounds but also for epilepsy and headache. Its use for his imaginary world and protected himself from it with his mental illness was far less common and largely anecdotal. religious beliefs. This world seems filled with discord, power As Burton1 proposes, such use was based on beliefs about struggles, and deceit. Bosch was famous in his time; King the evacuation of vapors. Philip II of Spain admired his work and purchased several In the 16th century, Hieronymus Bosch (ca 1450- paintings for his Escorial palace. 1516), one of the best known Netherlandish artists of the In later centuries, Bosch has been enjoyed more for his Renaissance era, satirized trepanning. He was a member exaggerated imagery and imaginative constructions. In the of the Brotherhood of Our Lady, an elite group of clerics, 20th century, he was rediscovered by the surrealists, who aristocrats, landowners, and administrators. This largely considered him an influence. Depth psychologists have been lay religious group, formed at the end of the Middle Ages, drawn to his imagery as early examples of active imagina- insisted that religion be a part of everyday life.5 tion and propose that such spontaneous imagery should be Bosch’s religious works include altarpieces and paint- examined carefully to heighten self-awareness and gain in- ings of desert hermits, who wrestle with their inner demons. sight into self-deception, now, perhaps, allowing us to re- His secular and humanistic works deal with the deadly sins, move the metaphorical stones or tulips from our own heads. especiallygluttonyandlust;thesocialvicesofidleness,drunk- enness, and vanity; or human frailties, such as folly and de- James C. Harris, MD ceit. The Cure of Folly (Extraction of the Stone of Madness) falls into the latter group of paintings. It is thought to be REFERENCES an early work, completed probably around 1475, although the date is uncertain. It is the forerunner of what have come 1. Burton R. The Anatomy of Melancholy. London, England: Cripps and Lod; 1652:450. to be known as “stone of madness” paintings that became 2. Hippocrates. On Head Wounds. Hanson M, trans. Berlin, Germany: Akademie Ver- lag; 1999. popular during the following century by artists such as Jan 3. Gross CG. Trepanation from the Paleolithic to the Internet. In: Arnott R, Finger S, van Hemessen, Pieter Bruegel, and Pieter Huys.5 The op- Smith CUM, eds. Trepanation: History, Discovery, Theory. Lisse, the Nether- lands: Swets and Zeitlinger; 2003:307-322. eration was to remove an imaginary “stone of folly” believed 4. Schiller F. Paul Broca: Founder of French Anthropology: Explorer of the Brain. Ox- in popular lore to be a cause of stupidity or madness. ford, England: Oxford University Press; 1992. Bosch’s The Cure of Folly carries an inscription in Dutch 5. Southgate MT. The cure of folly. JAMA. 2003;289:13. 6. Vandenbroeck P. Hieronymus Bosch: the wisdom of the riddle. In: Koldeweij J, vernacular, which in translation reads, “Master cut the stone Vandenbroeck P, Vermet B, eds. Hieronymus Bosch: The Complete Paintings and out quickly/My name is Lubbert Das.”6 He is identified as Drawings. Rotterdam, the Netherlands: NAi Publishers; 2001:100-193. (REPRINTED) ARCH GEN PSYCHIATRY/ VOL 61, DEC 2004 WWW.ARCHGENPSYCHIATRY.COM 1187 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021.