Margery Kempe (1) was born in 1373 in King's Lynn near Norfolk, England. She was well to do and traveled widely, including to Rome. When she was in her early 60s, she dictated an account of her life to a scribe. This account is considered by some scholars to be the first autobiography written in English. Kempe was psychotic for much of her adult life, and her account reveals that medieval England had a complex understanding of the origin of mental illness, viewing it primarily as sickness. Except for a disconcerting convention of referring to herself in the third person—in particular, using the term "said creature"—Kempe's words in translation are easily accessible to the modern reader.

Following the birth of the first of her 14 children, Kempe had a postpartum psychotic episode. She dictated, "And soon after … this creature went out of her mind and was amazingly disturbed and tormented with spirits for half a year, eight weeks and odd days.

"And in this time she saw, as she thought, devils opening their mouths all alight with burning flames of fire, as if they would have swallowed her in, sometimes pawing at her, sometimes threatening her, sometimes pulling her and hauling her about both night and day during the said time. And also the devils called out to her with great threats, and bade her that she should forsake her Christian faith and belief, and deny her God, his mother and all the saints in heaven, her good works and all good virtues, her father, her mother, and all her friends. And so she did. She slandered her husband, her friends, and her own self. She spoke many sharp and reproving words; she recognized no virtue nor goodness: she desired all wickedness; just as the spirits tempted her to say and do, so she said and did. She would have killed herself many a time as they stirred her to, and would have been damned with them in hell, and in witness of this she bit her own hand so violently that the mark could be seen for the rest of her life. She also pitilessly tore the skin on her body near her heart with her nails, for she had no other implement, and she would have done something worse, except that she was tied up and forcibly restrained both day and night so that she could not do as she wanted.

"And when she had long been troubled by these and many other temptations, so that people thought she should never have escaped from them alive, as she lay by herself and her keepers were not with her, our merciful Lord Christ Jesus—ever to be trusted, worshipped be his name, never forsaking his servant in time of need—appeared to his creature who had forsaken him, in the likeness of a man, the most seemly, most beauteous, and most amiable that ever might be seen with man's eye, clad in a mantle of purple silk, sitting upon her bedside, looking upon her with so blessed a countenance that she was strengthened in all her spirits.

"And presently the creature grew as calm in her wits and her reason as she ever was before, and asked her husband, as soon as he came to her, if she could have the keys of the buttery to get her food and drink as she had done before. Her maids and her keepers advised him that he should not deliver up any keys to her, for they said she would only give away such goods as there were, because she did not know what she was saying, as they believed.

"Nevertheless, her husband, who always had tenderness and compassion for her, ordered that they should give her the keys. She took food and drink as her bodily strength would allow her, and she once again recognized her friends and her household, and everybody else who came to her in order to see how our Lord Jesus Christ had worked his grace in her. Afterwards this creature performed all her responsibilities wisely and soberly enough."

Kempe continued to have psychotic symptoms throughout the remainder of her life, although she sometimes viewed them as spiritual gifts: "Sometimes she sensed sweet smells in her nose; they were sweeter, she thought, than any earthly sweet thing ever was that she smelled before, nor could she ever tell how sweet they were, for she thought she might have lived on them if they had lasted.

"Sometimes she heard with her bodily ears such sounds and melodies that she could not hear what anyone said to her at that time unless he spoke louder. These sounds and melodies she had heard nearly every day for twenty-five years when her book was written, and especially when she was in devout prayer, also many times while she was at Rome, and in England, too.

"She saw with her bodily eyes many white things flying all about her on all sides, as thickly in a way as specks in a sunbeam; they were very delicate and comforting, and the brighter the sun shone, the better she could see them … . And many times she was afraid what they might be, for she saw them at night in darkness as well as in daylight."

Kempe appears to have struggled with knowing which of her experiences were real and which were delusions or hallucinations: "And sometimes those that people think were revelations are deceits and illusions, and therefore it is not appropriate to give credence too readily to every stirring, but wait steadfastly and prove if they be sent from God.

"Sometimes she was greatly depressed about her feelings—when she did not know how they should be understood for many days together, because of the dread that she had of deceptions and delusions—so that she thought she wished her head had been struck from her body until God, of his goodness, explained them to her mind."

Kempe appears to have assumed that it was her duty to assist others with mental illness: "As the said creature was in a church of St. Margaret to say her devotions, there came a man and knelt behind her back, wringing his hands and showing signs of great distress. She, perceiving his distress, asked what was troubling him. He said things were very difficult for him, because his wife had just had a baby, and she was out of her mind. 'And, lady,' he said, 'she doesn't know me or any of her neighbours. She roars and cries, so that she scares folk badly. She'll both hit out and bite, and so she's manacled on her wrists.'

"Then she asked the man if he would like her to go with him and see her, and he said. 'Yes lady, for God's love.' So she went off with him to see the woman. And when she came into the house, as soon as that sick woman who had lost her reason saw her, she spoke to her seriously and kindly, and said she was most welcome to her.

"And when other people came to her, she cried and gaped as if she would have eaten them, and said that she saw many devils around them. She would not willingly allow them to touch her. She roared and cried so, for the most part of both day and night, that people would not allow her to live amongst them, she was so tiresome to them. Then she was taken to a room at the furthest end of the town, so that people should not hear her crying. And there she was bound hand and foot with chains of iron, so that she should not strike anybody.

"And the said creature went to her each day, once or twice at least; and while she was with her she was meek enough, and heard her talk and chat willingly, and without any roaring or crying. And the said creature prayed for this woman every day that God should, if it were his will, restore her to her wits again. [She] prayed for her recovery until God gave her her wits and her mind again. And then she was brought to church and purified as other women are."

Kempe's account provides the modern reader with a unique opportunity to hear the voice of a woman with serious mental illness who lived 600 years ago and to correct some of our misconceptions about the treatment of persons with mental illness in the past.

The author thanks Edwin D. Craun, Ph.D., James Krag, M.D., and Marigail Wynne, M.D.

Ms. Craun works at Valley Community Services in Staunton, Virginia. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.