Pieter Brueghel’s drawing illustrates victims of a neurological condition, then called Saint Vitus Dance, going on a pilgrimage to Echternach (now in Luxembourg but previously part of the Holy Roman Empire).
Today we use terms such as Sydenham chorea, infectious chorea or rheumatic chorea for their condition, which follows streptococcal infection. The resultant damage causes distressing involuntary major muscle spasms.
But why ‘St. Vitus Dance’?
St. Vitus was a relevant evocation for people in the sixteenth century, as they were familiar with earlier, superficially similar, outbreaks whose aetiology is nonetheless far more complicated. ‘Dancing mania’ occurred in several places in Europe during the medieval era and seems to have been at its height between the fourteenth and sixteenth centuries.
Groups of people would start dancing and be unable to stop until they were injured, exhausted or both. As this article from The Lancet points out:
On one thing contemporary and modern writers have agreed: those who danced did so involuntarily. They writhed in pain, screamed for help, and begged for mercy.
At the time, people attributed the dancing to a curse from saints such as St John the Baptist or St. Vitus. Tellingly, the outbreaks could be ritualistic or seasonal such as the one where several women visited the chapel of St Vitus in Drefelhausen annually. Or else outbreaks of a similar practice called ‘tarantism’ in Italy which only happened in summer.
Later commentators suggested that mould-poisoning could have been responsible. Ergot grows on rye and some other grasses and produces ergotamine, which causes muscle spasms, fever and hallucinations in the manner of LSD or psilocybin. Dancing mania happened in communities, and it is reasonable to think they would mostly have been drawing from the same food source.
However, that would not explain the people who declined to join in. In addition: the dancing events took often lasted longer than an ergotamine event would have; ergotism was identifiable at the time and called ‘St. Anthony’s Fire’; and ergotism can leave people with permanent injuries arising from gangrene. Such injuries are not mentioned in the texts.
There was a very well attested outbreaks of dancing in 1374 which affected what is now west Germany, northeastern France and the Netherlands, centred around the Rhine and its estuaries. In Germany the outbreak was called ‘St. John’s Dance’. As Waller notes, the dancing “spread in the areas most savagely hit earlier in the year by the most devastating deluge of the 14th century”.
An even larger outbreak occurred in 1518 in Strasbourg (modern France, but then in the Holy Roman Empire). Most accounts say that the outbreak started with one identifiable woman and that others then joined in. Waller, again, points out that:
the people of Strasbourg and its environs were similarly experiencing acute distress in 1518, after a succession of appalling harvests, the highest grain prices for over a generation, the advent of syphilis, and the recurrence of such old killers as leprosy and the plague.
The authorities tried interventions. In Strasbourg they didn’t discourage the dancing but instead hired professional dancers and musicians to join in. Distressingly, the effect was to increase the size and frenzy of the crowd. In this way, indulgent endorsement was proven to be counterproductive.
Religious interventions in the form of prayers to St. John the Baptist or St. Vitus, or pleas to God to exorcise Satan and his demons were more successful.
Commentators are still conflicted about the precise cause of the dancing manias, but most believe that it was a Mass psychogenic illness, also known as mass sociogenic illness, mass psychogenic disorder or, more informally, mass hysteria.
Balaratnasingam and Janca distinguish MPI from generic collective delusions by the presence of physical symptoms. Adolescents and children are generally more vulnerable to it than the old.
It’s hard to deny that the dancing mania was marked by social contagion exacerbated by stress. Outbreaks occurred along trade routes or reoccurred in the same areas – where people had knowledge of the format, in other words. Beliefs and behaviour can travel just like pathogens.
The stress element is understandable. The medieval life was extraordinarily hard compared to ours. Between the beginning of the Little Ice Age in around 1300, through recurring visits of the Black Death to the dawn of the Reformation, the people of Europe had to cope with a great deal of uncertainty and change.
If dancing mania was socially contagious this would explain how prayer helped. God may not exist, but the power attributed to Him is still potent in the mind of a believer.
Bartholomew has also pointed out the role of travelling dancers. After the Black Death (1340s) there were all manner of what we would regard as fundamentalist religious cults, such as flagellants. The groups travelled, and were disliked by the authorities for their destabilising effect and their religious independence.
Whether the dancing was taken up by previously normal civilians or insular travelling cults, I agree with Waller that they still:
provide an object lesson in the power of our beliefs and expectations to shape the expression of psychological distress. In an age dominated by genetic explanations, the dancing plagues remind us that the symptoms of mental illnesses are not fixed and unchanging, but can be modified by changing cultural milieus.
So we could say that distress is the basic underlying driver, and the manifestation of that distress is marked by the era in which it occurs. In many ways this highlights the difficulties that psychiatrists have that doctors don’t. A basic cause – a pathogen – produces a more or less stable set of symptoms. But a psychiatrist who tries to inflict such a rigid schema on human reactions without taking the environment into account is doomed to fail.
Dancers were sometimes violent to those who refused to join them. Some had a fierce reaction against the colour red and some railed against pointed shoes; while both of these may seem random to us, I think these may have been more plainly understood at the time as tokens of fashion, extravagance and vanity. By picking on other people in all these ways, the dancers could make their own moral purity clearer – virtue signalling the medieval way.
Balaratnasingam and Janca summarise the potential for psychogenic reactions by saying that “the prevalence of ‘threat’ within the modern sociocultural climate is likely to increase the incidence of the condition, and this could result in serious implications for health services”. The lesson that we can take from history is, it seems, that we can’t take anguish at face value.