Insanity in Thedas

Madness or possession?
For several Ages the concept of insanity in Thedas did not exist - it was solely believed to be the result of demonic possession. It was not until the creation of the Circles that the general populace in the Imperium (as it was then) began to understand the nature of demonic possession. By understanding possession it was clear to mages that the malady of insanity was very different. Even after this revelation religion was still connected to mental illnesses in mages and non mages alike and even in this, the Dragon Age, this belief pervades, though not entirely. The prevalence of help for such people varies, but generally most of the afflicted would be subjected to ridicule and hunting (because of fear that they were possessed) or simply left to their own devices, with no care or treatment offered. Thus, any treatment mentioned is for those lucky (or unlucky in many causes) enough to receive such attention. In Andrastian countries because of the fear of magic it would actually be more likely to come across one of the mentally afflicted rather than a mage or Abomination. Ghouls are sometimes mistaken for the afflicted too.

Role of the Chantry
The Chantry's opinion of the diagnosis and treatment of mental illnesses is the dominating practice in Thedas. The reach and control of this religion means that their methods are often deemed the only way to deal with this malady. As the hub of most Thedosian's belief the Chantry gathered the insane to them as they did mages and in many ways did not treat them differently - though some would argue that the non magical malady rendered those afflicted with a better life than that of a mage.

The Chantry's Beliefs
Most Andrastian states have the following general beliefs regarding the causes of mental illnesses; There are, of course, those Andrastian states who have added upon the general view and have developed something more fitting with their culture and environment.
 * Supernatural causes such as demons and demonic possession.
 * Witchcraft and sorcery.
 * Mass hysteria.
 * Melancholy and stress.

Antiva
Most believe it is demonic possession and they burn them or drown them.

The Anderfels
Many people in the Anderfels believe that a "stone of madness" exists inside the skulls of the mentally deranged - a stone caused by the taint in the Blighted lands. One common treatment to cure this madness is to remove the "stone."

Rivaini
Madness is believed to be the result not from divine punishment or demonic possession, but from natural causes.

Most of the mentally ill are kept at home with their families in familiar environments. Specific laws state that communities are expected to care for the insane, and, as such, many of these communities have developed enlightened, humane, and sometimes amusing strategies to accommodate mental disorders among their citizens. One attempt to integrate the mad into society is known as the Feast of Fools, traditionally celebrated at the beginning of spring. On a chosen day, everyone is deemed a fool and madness becomes the acceptable standard of behavior. This reversal of normalcy cleverly helps to reduce the fears about mental disorders.

University of Val Royeaux
In the Dragon Age at the Val Royeaux University some scholars began to regard mental disorders as the result of exposure to social and psychological stresses and, to a lesser extent, of heredity and physiological damage. They called for a more humane approach to the treatment of mental disorders. This ‘moral treatment’, as it had already been dubbed, included respect for the patient, a trusting and confiding relationship with the afflicted individual, decreased stimuli, routine activity and occupation, and the abandonment of old-fashioned treatments such as special diets, purgatives, and blood-lettings.

Tevinter
In the early days of the Imperium there were some who were enlightened. After studying the insane they came to the conclusion that melancholy resulted not from emotions such as rage, fear, and grief. They began the assessment of mental disorders and these were used throughout the Imperium, sponsored by the Shrines of the Old Gods and their priests carried out the assessments. They assessed habitus (appearance), orationes (speech), and casus (significant life events). Unfortunately, when the Blights began and the Purging of the Old Religion happened Archon Celstratius reinstated the idea of madness as a punishment from the Divine and possession of demons. The dangerously insane were incarcerated and locked away from society, often under horrendous living conditions, and usually in fortresses used for magical experiments.

Wilders
Various tribal cultures (such as the Avvar and Chasind in Ferelden and the Rivaini tribes) react in several ways. The Avvar believe that such people should be revered but also isolated and cared for. These Mearanach are "touched by Korth" and must remain so as they may have visions given to them by the gods. The Chasind see it as an ill portent and tend to leave them to roam in the swamps, the mad hermits allowed to simply exist. The Alamarri beliefs which the Avvar still hold to echo in the minds of the Chasind and they will not touch the Cràidhte (meaning "Afflicted") but neither will they help them or protect them. Instead they leave the gods to decide if the madman lives or dies.

Diagnosis and Treatment
Throughout Thedas, even between Andrastian states, there are cultural differences regarding the diagnosis and treatment of madness.

Orlais
Even in today's Orlais the stigma of the insane remains, their connection to demonic possession has not been entirely severed. Thus many treat those assailed as they do mages, they drag them to a Chantry where the Sisters and Brothers are to deal with them. Fortunately for those maligned the Chantry itself knows how to differentiate between mages and the mad, but outside of Orlais there are fewer Chantries per region. Some small Chantry's have sealed parts where they treat and look after the mentally ill, this is common practice in the Anderfels, Antiva and Nevarra. In Orlais there are "Asylums" built mainly for the wealthy. The poor who are afflicted tend to be relocated to Chantry's who can house them outside of the Empire. Treatments often include:


 * Lobotomy - this is a surgical procedure that renders the patient into a state that is similar to that of a Tranquil. However, many die during the barbaric procedure and the damage done means that the patient is rarely as functional as a Tranquil becomes. They lose most of the cognitive abilities.
 * Exorcism - a religious rite to purge the individual of the demon. This involves several things including:
 * Shaving the Chantry sigil into the head-hair.
 * Drinking ice-cold water.
 * Blood-letting (and the use of leeches which were burned)
 * Prayer and confession.
 * Mechanical Restraints - using chains, pillories, straight jackets
 * Magical Restraints
 * Herbal treatments (usually "downers" and drugs that subdue)
 * Lyrium - this is controversial because it is suspected it causes mental instability in non mages.

Madness caused by demons
Where it is believed to be the result of demon possession a trinity of treatments is used.
 * Supplication: Coaxing and begging the demon out of the possessed person.
 * Defamation: If supplication was unsuccessful, the next option would be to insult the demon out.
 * Tribulation: If insulting the demon also failed, the next form of treatment would involve making the possessed individual so uncomfortable that the demon would not want to remain there. It would be under these circumstances where torturous treatments such as immersion in hot water, and immersion in sulphur fumes would be used.

Other Andrastian States
These include the Anderfels, the Free Marches, Nevarra, Antiva and Ferelden. The diagnosis in these parts of the world varies, but not greatly. They are quicker to blame demons and learn upon their Andrastian faith and methods and so the physical purging of the ailment is preferred. Unlike Orlais they rarely have asylums and the chantries that do house the afflicted are not as well supported by donations. The treatments are more archaic, though they also use the same demon possession treatments as Orlesians.
 * purges
 * whipping


 * extracting "stone of madness"
 * ‘hot and cold baths’, ‘bath of surprise’ – calming effect
 * burning until death

Rivain
The most humane treatment of those with mental illnesses are found amongst the Rivaini. The diagnosis is more of a consensus of friends and family and the treatment is communal. They have more rights and more control over their life and they are looked after as children are. The witches, shaman and sorcerers often diagnose and give herbal treatments and tinctures. Treatments and methods for dealing with the afflicted are thus:
 * Trial - inquisition involving community, family and individual - to decide if they are insane


 * family care (in the community) or crown. Care in the community is a communal activity that ensures a truly public provision for those who cannot look after themselves.
 * humane treatments such as herbs, non violent restrictions, calming methods and hypnosis.
 * moral treatment - retreats, farm work (this is the influence of the Qun).

Tevinter
The Imperium's method for dealing with the insane is to use them as fodder. They are used, mainly, for magical experimentation and housed in fortresses such as Ath Velanis.

Insanity amongst the Qunari
Generally the Qun have a purpose for all, so why would this not include those who are mentally afflicted? Similar to the Chantry they believe is "correcting" the fault and have a method that is akin to Tranquility. However, the Qunari manipulate the afflicted mind using magic and/or herbs and natural remedies. This method renders the individual fit for a role in Qunari society. They literally "shape their mind" to fit. Some may consider this inhumane but it is far more precise than tranquility-like lobotomies and never kills the mind nor body. Then there is Qamek - a poison that essentially lobotomises people who refuse to convert to the Qun. However it is also used for extreme cases of mental illness. It leaves the subject as a mindless labourer/slave which Qunari call Viddath-bas.

Asylums
Very few houses of the insane exist, since they are expensive to run and only the Chantry and some educational institutions will pay for the upkeep of them. The first institution ‘for the humane care of the insane’ was created in northern Orlais by Duke Pascal Devivres. More humane treatments. The Orlesian philosopher (Duke Pascal) who founded the Institution linked madness to one's character, claiming that "no excellent soul is exempt from a mixture of madness" and declared that "there is no great genius without a tincture of madness."

Seizures
Once more it depends on the culture as to how seizures are treated. The causes are believed to be anything from physical (Rivaini/Tevinter) to the gods speaking to the afflicted (Wilders) and demon possession (Andrastian). Most Andrastians believe seizures to be a portent of insanity as well. However scholars in various universities are studying the Rivaini beliefs and are investigating the idea of there being a physical cause and in many cases there being no link to the afflicted.