The link above leads to a Wikipedia article on the history of mental illness; I am specifically referring to the first few paragraphs of the section on the Modern period, 16th to 18th centuries.
When Malvolio is deemed insane by Olivia's court and locked away to be further harassed and abused by Maria, Toby, Andrew, and the Clown, his desperation to convince them of his sanity seemed slightly disproportionate, even given that he was locked in a dark closet. It led me to wonder what the repercussions of being deemed mentally ill were in the society within which the play is set. What I found in this wiki article revealed a great deal about how horrific the trio's prank actually is: individuals at that time who were mentally ill were (when not made victims of witch-hunts) interned at poorhouses, workhouses, jails, or sometimes private mad houses. As a member of the lower class, Malvolio's fate would likely have been one of the first three options, a significant and terrible downgrade from his comfortable living situation with Olivia and company. The prank is much crueler when regarded in this context--whether or not they would have allowed it to go that far, I am certain Malvolio believed wholeheartedly in the possibility of such a total ruination of his life, and would have experienced a proportionate quantity of abject terror at the prospect.
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