Revisiting the earliest moral therapists and the potential for community in empowering recovery.
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WOMEN WHO INSPIRE
(In honor of Women’s History Month, we invited our contributors to write about the women who inspire them.—Ed.)
Among the computers and shelves of books in my study sits a small simple icon of the woman who most inspires me: St. Dymphna, the embodiment of the wounded healer. Dymphna was born in Ireland to a royal family sometime in the 7th century. Braving the fierce opposition of her pagan father, she was baptized without his knowledge or obvious approval. Dymphna’s mother was stunningly attractive and seems to have been a protective figure until her untimely death. Dymphna inherited her mother’s beauty, and her father, mad with grief and unnatural desire, demanded his daughter become his wife.
A kindly priest, Gerebernus, helped her escape across the sea to Antwerp. Once in Belgium, they made their way to the village of Gheel and took refuge at the Chapel of St. Martin of Tours, dedicating themselves to doing good works. Dymphna’s father was able to track her down and again demanded she surrender to him in marriage. Dymphna bravely kept up her resistance, and, in a fit of rage and lust, the king ordered his servants to slay Dymphna’s priest protector while he lopped off his own daughter’s head.1 Though left out of the more sanitized versions of her life, Rubin reports that sight of Dymphna’s head rolling toward the chapel cured 5 villagers of their insanity, as the first act of a healing power, her legend, and the reality of Gheel were to radiate across years and miles.2
The outline of this story derives from the 13th century when a canon, Pierre, of the Church of St. Aubert at Cambrai wrote the first life, “Vita,” of the future saint. He records that Dymphna had been the object of devotion at Gheel and the subject of an oral history that he took as the basis for his writing. No less a religious source than the Catholic Encyclopedia dismisses the narrative as without historical truth. Indeed, the Christian virgin faced with the choice between illicit union and death in faithfulness to Christ was a trope of ancient hagiography. This lack of fact in our scientific age makes the centuries of impact the legend has had on the mentally ill and those who care for them even more inspiring.1
From the earliest mention of the saint in medieval liturgy and clerical scholarship, Dymphna was recognized as the patron of the mentally ill. Perhaps even before her veneration began at Gheel, the city was a haven for individuals then called “lunatics.” The mutual cultural interactions are now untraceable, yet it is easy to understand their spiritual association. Gheel is the exemplar and the progenitor of community psychiatry, just as Dymphna was once both a patient and a caregiver in the village.
For centuries, the residents of Gheel have opened their homes to those with serious mental illness, providing literal and psychological shelter, protection, warmth, and support to individuals who otherwise might be either institutionalized or marginalized. The families of Gheel are not mental health professionals, nor do they receive extensive specialized training. Their exceptional gift for caring for those with psychiatric disorders springs from their natural compassion, religious faith, and solidarity in a moral community. These are virtues mental health professionals; the friends and relations of individuals with serious mental illness; and, most critically, the larger society can aspire to emulate.
Since the 1850s, psychiatrists, including some of the leaders of American psychiatry such as Pliny Earle, MD,3 have made a clinical pilgrimage to Gheel and written academic articles about their journeies.4 In his analytically informed chapter on Dymphna and Gheel, Rubin underscores that the citizens of the small Belgian town provided moral treatment to those with mental illness long before Pinel and Tuke.2 And, as several more recent studies have found, this model community delivers a quality of humanistic integrated care nearly a millennium before modern psychiatry, with all its technology, recognized its value.5
Dymphna’s influence is also felt at an individual level by many of us who have either struggled with mental illness or suffered in solidarity with our friends, family, and patients. Rev. Peter Marty describes what Dymphna’s example taught him about empathy for his brother living with schizophrenia on the streets of Chicago.6 In this troubled time, the courage and conviction of a young, traumatized woman and the humble history of the earliest moral therapists have much to teach us all about the potential for community in empowering recovery.7
Dr Geppert is a professor in the Department of Psychiatry and Internal Medicine and director of ethics education at the University of New Mexico School of Medicine in Albuquerque. She is the lead ethicist for the western region and director of education, Veterans Administration National Center for Ethics in Health Care, and an adjunct professor of bioethics at the Alden March Bioethics Institute of Albany Medical College, and she serves as the ethics editor for Psychiatric TimesTM.
1. Kirsch JP. St. Dymphna. In: The Catholic Encyclopedia. Appleton Company; 1909.
2. Rubin B. St. Dymphna and the lunatics: the advent of moral community psychiatry. In: Meltzer F, Elsner J, eds. Saints: Faith Without Borders. University of Chicago Press; 2011:191-210.
3. Earl P. Gheel. Am J Psychiatry. 1994;151(6 Suppl):16-19.
4. Webster J. Notes on Belgian lunatic asylums, including the insane colony of Gheel. J Psychol Med Ment Pathol. 1857;10(5):50-78.
5. Goldstein JL, Godemont MM. The legend and lessons of Geel, Belgium: a 1500-year-old legend, a 21st-century model. Community Ment Health J. 2003;39(5):441-458.
6. Marty PW. St. Dymphna and her legacy of care. The Christian Century. December 30, 2021. Accessed February 1, 2022.
7. van Bilsen HP. Lessons to be learned from the oldest community psychiatric service in the world: Geel in Belgium. BJPsych Bull. 2016;40(4):207-211.
Is there a woman who inspires you? Write to us at PTeditor@mmhgroup.com for a chance to contribute to our Women Who Inspire series.