Bloodletting and purging

Domain XVI · Historical, discredited & harmful

What it is

Bloodletting (removing blood) and purging (provoking evacuation of the bowel or stomach) were standard treatments for many illnesses, mental disorder among them, for well over two thousand years. The Science Museum Group says bloodletting was known to Ancient Egyptian, Greek, Roman and Islamic…

Format

• Session number and length follow the client's needs and the setting.
• Humoral antiquity. Hellebore was praised as a purge for madness by Galen, Pliny and Caelius Aurelianus, and mentally afflicted people were sent to Anticyra or Phocis, where the plant grew, to be purged. Classical medicine paired purging with bleeding inside the four-humour model. Robert Burton's…

Who practises it, and how they are trained or regulated

• In psychiatry the practice became an institutional routine. At Bethlem, a witness told the 1815 Committee on Madhouses that the apothecary had described treatment as consisting "simply in bleeding and purging freely in the spring months", a "standing regulation" adopted "from long custom". The witness, an inspector of naval hospitals, was asking about the naval patients sent to Bethlem for the cure of insanity; when…

Evidence status, as the guide reports it

• Medieval and early-modern routine. Bleeding and purging were applied seasonally and to whole groups of patients. The best-documented example is Bethlem's spring regimen, described in evidence to the 1815 Committee on Madhouses; the same witness reported being refused a treatment journal for…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• compliance without trust. Working: the client corrects you freely.
• smugness about the past; graphic detail. Working: trainees question current routines.
• re-traumatisation; overexposure in public storytelling. Working: engagement feels meaningful, not distressing.
• retaliation; collusion inside teams; the client caught between clinicians. Working: the practice stops and clients are protected.
• lecturing; shaming the client's beliefs; the session turning into a debate. Working: the client asks evaluative questions themselves.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.