In 1416, Thomas Hoccleve (c. 1368–1426) experienced an episode of severe mental illness. A clerk in the Office of the Privy Seal, he was also a key figure in 15th-century English literature: a court poet with close links to Chaucer. He recovered, but experienced significant ongoing stigmatisation, which dramatically affected his ability to work. In 1421–1422, Hoccleve directly addressed these issues in his poems My Compleinte and A Dialoge. The earliest autobiographical descriptions of mental illness in English, they provide a deeply personal and affecting picture of the social consequences of his condition and demonstrate astonishing introspection and psychological understanding.

In My Compleinte, Hoccleve describes briefly how others perceived him during the illness that ‘me oute of mysilfe caste and threwe’. He was seen as violent, restless and agitated; unable to converse sensibly. He made a relatively rapid recovery and remained well over the subsequent 5 years. However, those around him would not understand or accept this. Ostracised and shunned, he describes avoiding company, afraid he might say or do something that might be taken as a sign of relapse. He becomes increasingly anxious and introspective, checking in a mirror that he appears ‘normal’. His isolation increases feelings of depression and anxiety, but also makes him angry and impatient. He realises that by remaining out of sight, people will speculate that he is hiding ‘and am werse than I am’. Thomas comes to the conclusion that the only reliable way in which he can demonstrate his recovery is by conversing with them (‘By commvnynge is the beste assay’).

Having read Isidore of Seville's Synonyma, in which a personification of Reason comforts and advises a grieving man, Thomas realises that he must fight back and place less importance on the views of others. Although he cannot stop other people's gossip, he can take control and re-establish himself in society and as an author. To do this successfully, he has to convince his readers of his recovery, which he achieves in A Dialoge. Through discussions with a visitor, he argues that nobody can understand someone else as well as that person himself (‘he lyueth nat þat can knowe how it standith with another wight so wel as himself’). Thomas convinces his friend that he is fully recovered and can again be considered a reliable author.

In these poems Hoccleve demonstrates remarkable depth and complexity of thought regarding the social and psychological sequelae of mental illness, the nature of the self and the assessment of others. His ability to see himself as both subject and object, to separate mind from body and to understand that his perception might be distorted by his mental state are far removed from the commonly held views about medieval concepts of insanity and anticipate Descartes by over 200 years. His self-management techniques include bibliotherapy, mindfulness and cognitive reframing and provide inspirational evidence of how he was able to overcome the social consequences of mental illness.