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ORIGINAL ARTICLE

Undiagnosing St Joan Downloaded from http://journals.lww.com/jonmd by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1A WnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 07/28/2023

She Does Not Need a Medical or Psychiatric Diagnosis James Phillips, MD,* Brian Fallon, MD,† Salman Majeed, MD,‡ Keith Meador, MD,§ Joseph Merlino, MD,|| Hunter Neely, MD,¶ Jenifer Nields, MD,* David Saunders, MD, PhD,† and Michael Norko, MD* Abstract: This article traces the history of Joan of Arc through her brief life that includes leading an army in defense of France at the age of 17 and ending with her death at the stake at the age of 19. In her activities, St Joan reported that she was guided by voices and visions in which she communicated with venerated spiritual figures such as St Michael and St Margaret. Questions have arisen about the nature of these experiences, and various medical and psychiatric diagnoses have been offered by contemporary experts. In our effort to evaluate the diagnostic proposals, we have examined the incidence of voices and visions in the Middle Ages, and we have followed that with a review of nonpathologic voice-hearing in our own era. We then move on to an analysis of some proposed medical and psychiatric diagnoses, all of which we find unconvincing. With this background, we argue that St Joan does not warrant a medical or psychiatric diagnosis. Such a conclusion, however, leaves us with another issue, that of Joan's achievements. How do we understand an adolescent being able to lead an army? Addressing this question proves more difficult than deciding whether St Joan warrants a diagnosis. In addition to her achievements in the war against Britain, Joan of Arc stands out as both the most documented person in Western civilization up until her era, and as the only person who has been both condemned and canonized by the Catholic Church. Key Words: Psychiatry, Joan of Arc, diagnosis, history, medieval, voices (J Nerv Ment Dis 2023;211: 559–565)

METHODS The principal source of information about St Joan's life is the voluminous documentation of her trials: the Trial of Condemnation in 1431 and the Trial of Rehabilitation in 1456, all found in the archives of France. Our narrative of her life and experiences is based on information from the two trials. For this article, we have relied mainly on three documents: the trial reports themselves, found in T. Douglas Murray, Jeanne D’Arc, Maid of Orléans, Deliverer of France (1902); the Web site, www.Jeanne-darc.info, founded in 1997 by Søren Bie as a free Web site containing all available information about St Joan; and, finally, Regine Pernoud and Marie-Veronique Clin, Joan of Arc: Her Story (1998). In France Pernoud was considered the grande dame of Medieval and St Joan–related history. The official Latin text of the trials was discovered in the official archives of France and brought to light and translated into modern French by Jules Quicherat in the 1840s. The work was translated into English and edited by T. Douglas Murray in 1902. *Yale University School of Medicine, New Haven, Connecticut; †Columbia University School of Medicine, New York, New York; ‡Penn State Hershey Medical Center, Hershey, Pennsylvania; §Vanderbilt University, Nashville, Tennessee; ||Downstate College of Medicine, Brooklyn, New York; and ¶UC Davis Medical Center, Sacramento, California. Send reprint requests to James Phillips, MD, Yale University School of Medicine; 88 Noble Avenue, Milford, CT 06460. E‐mail: james.phillips@yale.edu. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0022-3018/23/21108–0559 DOI: 10.1097/NMD.0000000000001654

Finally, we have benefited from Mark Twain's Joan of Arc (Twain, 1896), for which he did extensive research in France and which he considered the best of his books and the one that afforded him the most satisfaction.

Introduction Let us begin by turning this introduction over to Mark Twain, who offers us a stark description of St Joan's beginning: In Joan of Arc at the age of sixteen there was no promise of romance. She lived in a dull little village on the frontiers of civilization: she had been nowhere and had seen nothing; she knew none but simple shepherd folk; she had never seen a person of note; she hardly knew what a soldier looked like; she had never ridden a horse, nor had a warlike weapon in her hand; she could neither read nor write; she could spin and sew; she knew her catechism and her prayers and the fabulous histories of the saints, and this was all her learning. That was Joan at sixteen (pp 441–442). How St Joan of Arc emerged from this modest beginning we will leave for further consideration. We begin this essay on St Joan by placing her in the historical context in which her extraordinary experiences occurred. They were both like and unlike other Medieval, mystical phenomena, and correspondingly, her fellow countrymen and her Church both praised her and condemned her. Among her other achievements, she stands as both the most documented person in Western civilization up until her era, and as the only person who has been both condemned and canonized by the Catholic Church.

Historical Background Joan of Arc's (Jeanne d'Arc's) story took place in the context of the Hundred Years War, dated somewhat arbitrarily between 1337 and 1453 and consisting of a series of conflicts and wars between the Plantagenet rulers of England and the Valois rulers of France. Beginning with the Norman conquest of England by William the Conqueror in 1066, France and England disputed the role of each in France over the ensuing centuries, involving both property and titles. During this period, France itself was a loose confederation of principalities, often with unclear boundaries. In the early 15th century, after a period of minimal wartime activity, Henry V of England won important victories at Agincourt (1415) and Normandy (1417–1418). Those victories awarded him as his wife, Catherine, daughter of the French Charles VI. He declared that their son would become Henry VI and would be king of the dual monarchy, England and France. That gesture disinherited Catherine's brother Charles, the dauphin, who was to become Charles VII of France. After the English victories, they occupied almost all of northern France, including Paris. Directly south of Paris, on the Loire River, the city of Orléans was the last stronghold between England and southern France. The conquest of Orléans was Henry V's next goal. It was at the English siege of Orléans that Joan's story begins.

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