The narrative of the Hebrew book of Samuel took place about 3000 years ago. Early on in the career of King David, his life was frequently threatened by his predecessor, King Saul, and he had to flee from Saul. Once, he escaped to Achish, king of the nearby land of Gath (1 Samuel 21: 10-15). The servants of Achish warned him that this was David who had slain ‘tens of thousands’. On hearing this, David became very much afraid of Achish as he was in his territory: ‘So he feigned insanity in their presence… and acted like a madman, making marks on the doors of the gate and letting saliva run down his beard.’ This charade had the desired effect: Achish said to his servants, ‘Look at the man! He is insane! Why bring him to me? Am I so short of madmen that you have to bring this fellow here to carry on like this in front of me? Must this man come into my house?’ David escaped, and left Gath.

Two Hebrew words for insanity or madness are used in this passage: halal and shaga. Both were used to refer to insanity but halal was perhaps less formal.

There are several insights of relevance to current psychiatry that can be drawn from this story. Mental illness (madness) and its manifestations was clearly recognised as an entity 3000 years ago; it was everyday and unexceptional. Simulated mental illness was also recognised as a possibility: the signs of madness David enacted, although quite ingenuous, were convincing to the authorities in Gath. The insanity that David mimicked was deliberate (not factitious disorder) - ‘he pretended’. Insanity, including psychotic behaviour, was a phenomenon frequent enough for the king to exclaim, with exasperation, that he already had enough madmen in his kingdom. The purpose of simulation, saving his life and escape from the kingdom, was entirely successful and resonates with what may be found among prisoners today.

This excerpt from the book of Samuel advocates a more circumspect application of psychiatry to sacred texts. As in our world, rubbing shoulders with the mentally ill in the times of the Hebrew kings was commonplace, a perfectly ordinary, if irritating, part of life. Simulation of insanity, then as now, could even be used to escape from the consequences of sanity, such as punishment. We are tempted, when examining ancient, ‘sacred texts’ to think that people in early times had no concept of mental illness, and therefore we use our sophisticated knowledge, skills and insights to reinterpret their accounts as manifesting our modern signs of specific mental illnesses; we tend to impose our psychiatry, sometimes inappropriately. This can be a mistake: both the writer of the text and the main actor, David, in this story had a clear idea of madness and its manifestations. They also knew that this behaviour was not mad, but feigned. Because what is written seems strange to us, even incomprehensible, does not necessarily imply that it reveals mental illness.