Madness

American Protestant Responses to Mental Illness

Heather H. Vacek, Heather Campain Hartung

• Publisher: Baylor University Press
• Year: 2015
• Print ISBN: 9781481300582, 9781481300575
• eBook ISBN: 9781481304504
• Topic: Theology & Religion
• Subtopic: North American History

Madness is a sin. Those with emotional disabilities are shunned. Mental illness is not the church's problem.

All three claims are wrong.

In Madness, Heather H. Vacek traces the history of Protestant reactions to mental illness in America. She reveals how two distinct forces combined to thwart Christian care for the whole person. The professionalization of medicine worked to restrict the sphere of Christian authority to the private and spiritual realms, consigning healing and care--both physical and mental--to secular, medical specialists. Equally influential, a theological legacy that linked illness with sin deepened the social stigma surrounding people with a mental illness. The Protestant church, reluctant to engage sufferers lest it, too, be tainted by association, willingly abdicated care for people with a mental illness to secular professionals.

While inattention formed the general rule, five historical exceptions to the pattern of benign neglect exemplify Protestant efforts to claim a distinctly Christian response. A close examination of the lives and work of colonial clergyman Cotton Mather, Revolutionary era physician Benjamin Rush, nineteenth-century activist Dorothea Dix, pastor and patient Anton Boisen, and psychiatrist Karl Menninger maps both the range and the progression of attentive Protestant care. Vacek chronicles Protestant attempts to make theological sense of sickness (Mather), to craft care as Christian vocation (Rush), to advocate for the helpless (Dix), to reclaim religious authority (Boisen), and to plead for people with a mental illness (Menninger).

Vacek's historical narrative forms the basis for her theological reflection about contemporary Christian care of people with a mental illness and Christian understanding of mental illness. By demonstrating the gravity of what appeared--and failed to appear--on clerical and congregational agendas, Vacek explores how Christians should navigate the ever-shifting lines of cultural authority as they care for those who suffer.

1

Making Theological Sense out of Suffering, Sin, and Sickness

Cotton Mather

The Design of all this Essay, is to Lead the Reader unto HIM. . . . The Cure of a Sin-Sick SOUL, is that all Invalids ought to reckon their Grand Concern. . . . “Adverse health, the threat to and death of members of the body is considered rather terrible. But of all things which can happen to man, the worst is illness or loss of the mind. If we seek so diligently for medication for the sick body, why not with greater care work hard to find what cures and revives the mind?”

—Cotton Mather, 17241

In the winter of 1703, Cotton Mather lingered beside his wife’s deathbed. Falling ill after a miscarriage, Abigail Phillips Mather had hovered near death for months. As spring approached, the smallpox epidemic that infected many Bostonians and afflicted Mather’s children and neighbors settled into the already weakened body of his beloved wife. Navigating the epidemic as both a minister and the head of a household, Mather recalled the weight of providing care. “The little Creatures,” he wrote of his sick children, “keep calling for me so often to pray with them, that I can scarce do it less than ten or a dozen times in a day; besides what I do with my Neighbors.”2 His children’s suffering troubled the clergyman, and paying pastoral visits kept him busy. “But the most exquisite of my Trials,” he confessed, “was the Condition of my lovely Consort.” As his wife lay in the “Pangs of Death,” the minister offered spiritual preparation for the transition to the world to come and comforted her with “lively Discourses upon the Glory of Heaven.”3 Concern for her soul shaped Mather’s care, but so did marital devotion. “Two Hours before my lovely Consort expired,” he recalled, “I kneeled by her Bed-Side, and I took into my two Hands, a dear Hand, the dearest in the World. With her then in my Hands, I solemnly and sincerely gave her up unto the Lord; and in token of my real RESIGNATION, I gently putt her out of my Hands, and laid away a most lovely Hand, resolving that I would never touch it any more!”4 Illness and death were constants in Mather’s life. Both physical and mental ailments caused distress for those he cared for, and agonized wrestling with human suffering appeared throughout his diary. The musings prompted by such episodes reveal another side of the colonial leader often remembered as an inflexible and sanctimonious Puritan.5 They also offer insight into Protestant views of illness in colonial America.

Cotton Mather (1663–1728) held a keen curiosity about the natural world that, alongside deep Christian faith, shaped his interest in health and healing. Thirteen of Mather’s fifteen children preceded him in death; illness took the lives of his first and second wives. His third wife suffered debilitating mental torment that often manifested in violent outbursts toward Mather.6 The clergyman’s inquisitiveness about sickness and healing arose not only from observing illness in those he loved but also from his desire to rid himself of a physical ailment—a stammer.7 His efforts grew, too, from a desire to make sense of suffering and evil. Exploring sickness and investigating remedies connected his faith to existential hardships. Primarily, though, as a devout Puritan, he investigated health and disease to understand better God’s good creation. Mental illness proved part of that exploration.

Mather found the investigation of mental distress particularly important, and he attended to madness practically, scientifically, and theologically. “If we seek so diligently for medication for the sick body,” the clergyman wondered, citing a Dutch physician, “why not with greater care work hard to find what cures and revives the mind?”8 The melancholy of his parishioners, the “distraction” of fellow ministers, illness among his household staff, and his third wife’s outbursts all shaped the leading New Englander’s perceptions of mental distress. Science proved a tool for deepening practical and theological understandings. Rather than viewing faith and reason as separate realms, Puritans like Mather saw both as gifts from a gracious God, gifts to be deployed simultaneously.9 Within that unity of knowledge, Mather worked hard to demonstrate scientific and theological connections. Deeper comprehension of the natural world, he hoped, would bring closer communion with God’s will, for himself and all New Englanders.10

The third-generation Puritan minister and theologian descended from one of the most prominent families in colonial New England.11 After graduating from Harvard College, Mather served Second Church (Old North) in Boston, preaching weekly to the largest congregation in the colonies. In June of 1690, at age twenty-seven, he was the youngest man elected a Fellow of Harvard College. A prolific writer, he published more than 450 works on a wide variety of subjects, including a history of the colonies, commentary on political developments, an exploration of witchcraft, a reconciliation of theology and science, and medical advice.12 The sources for Mather’s works proved as broad as his subjects, and in that written legacy, Mather drew from European and ancient intellectual traditions. In 1710, for example, the minster populated his brief Essays to Do Good with insight from Scripture, early Christian apologists, and theologians of the European Reformation.13 He also reached beyond Christian sources for the volume, drawing on legal theory, the philosophy of Socrates, and the ancient Greek physician Hippocrates. With good reason, and like his Puritan forebearers, Mather claimed broad authority, and his opinions reached far. While his fellow colonists did not agree with him on all subjects, he serves as an authoritative colonial voice in a number of areas, including on matters of religion and health.

Mather’s faith, ministry, and intellectual pursuits developed under the umbrella of American Puritan religious, intellectual, and social convictions. A theology anchored in the notion of covenant framed all aspects of Puritan life. God, colonial Calvinists asserted, covenanted to redeem humanity. Humans, in response to God’s gracious act of salvation in Christ, covenanted to live in proper relationship with God and in mutual obligation to one another. For individual believers, this meant that true faith involved a daily obedience to the Law of God given in Scripture, and a continual effort to remedy sinfulness.14 A sense of God’s sovereignty and providence figured prominently in that covenantal framework. All aspects of life fell within bounds of the covenants, and believers viewed successes and failures as either divine blessings or punishment. Each appeared as just rewards for human actions. That Puritan theological backdrop prompted both Mather’s inquiry and shaped his understanding of the suffering brought by illness.15

In the final years of his life, Mather compiled a medical journal, The Angel of Bethesda. Written in 1724 and published posthumously, the text ranked as the only comprehensive medical volume in the colonial period.16 In it, he explored causes and cures for scores of ailments, including mental maladies. Always focused on the divine, the minister’s medical account was interspersed with assertions of God’s sovereignty and God’s ability to heal. Mather viewed sickness and health in light of his Christian beliefs, and he entwined theological and medical observations. He laced theological writings with images of disease, and he mixed discussions of health with prayers. The prominent intellectual assumed that attending to one’s own health and the welfare of others constituted part of a Christian life.

That a clergyman authored a medical volume shows the authoritative role religious leaders played in a wide range of arenas during the colonial era. Mather’s work looms large in Puritan thought, an intellectual and religious tradition that shaped how Americans viewed the world around them in coming centuries, including issues of health and disease. More specifically, Mather’s theological reflections about mental illness featured many of the presuppositions of later Protestant thought about illness. His work included assertions of the role of sin (original and individual) in sickness; it evinced a concern with the state of one’s soul; and it also betrayed belief in supernatural causes of mental disease. Within a century and a half after Mather’s lifetime, Americans defined madness as more a medical than a spiritual problem, but suspicions of supernatural influence persisted. The colonial-era minister attempted to claim mental disturbances as valid religious concerns.17 Integrating medical and spiritual matters, his work displayed presumed connections between disturbances of the body, mind, and soul. Unlike later believers, Mather embraced scientific theory without forfeiting a sense of God’s sovereignty. As a result, within the context of colonial health and healing, Mather’s story offers a telling example of early American thought about sickness in general and mental illness in particular.

From the colonial era on, Americans attributed mental maladies to a combination of supernatural, moral, and medical causes. While the balance of those factors shifted over time, all three elements were present in Mather’s assessment. When faced with mental distress, in the centuries after Mather’s death, American Protestants debated the right relationship between the authority of science and medicine on one hand and religious and spiritual healing on the other. They explored theological and medical diagnoses, and assessed religious and medical cures. As they did so, prevailing social norms shaped their conclusions. Mather’s thought introduces the basic components of an exploration that continued in the following centuries.

Madness and Melancholy: A Dismal Spectacle!

In February of 1724, Mather’s diary marked the completion of The Angel of Bethesda. He prayed (with characteristic immodesty) that the volume might “prove one of the most useful Books that have been written in the World.”18 He drew the title of his comprehensive medical treatise from a New Testament passage about the healing power of Jesus Christ:

Now in Jerusalem by the Sheep Gate there is a pool, called in Hebrew Bethesda, which has five porticoes. In these lay many invalids—blind, lame, and paralyzed. One man was there who had been ill for thirty-eight years. When Jesus saw him lying there and knew that he had been there a long time, he said to him, “Do you want to be made well?” The sick man answered him, “Sir, I have no one to put me into the pool when the water is stirred up; and while I am making my way, someone else steps down ahead of me.” Jesus said to him, “Stand up, take your mat and walk.” At once the man was made well, and he took up his mat and began to walk. (John 5:2-9, NRSV)

Mather called his The Angel of Bethesda “an ESSAY upon the Common Maladies of Mankind,” and, in it, he implored Christians to care for their teeth, bodies, and minds, all gifts from God. By combining scientific wisdom, theological reflection, and practical advice, the preacher hoped the volume would bring believers to the pool of healing.

Spanning more than sixty chapters, Mather’s account described the symptoms of and offered remedies for a variety of ailments including vertigo, gout, intestinal worms, toothaches, and sore throats.19 His advice spanned “lesser inconveniences” (“To Fasten the Teeth, Chew Mastick, often”; “For a Stinking Breath, Wash the Mouth often with a Decoction of Myrrh in Water”; “To take out the Marks of Gunpowder, Shott into the Skin, Take fresh Cow-dung, and having warmed it a Little, apply it as a thin Poultis, to the Part affected”) as well as life-threatening conditions like smallpox and consumption (tuberculosis).20 The volume drew from an extensive collection of contemporary and ancient medical literature, and a combination of folk and medical wisdom filled its pages. Most chapters noted treatments to relieve suffering, but a handful addressed prevention and the general maintenance of good health.21

Mather’s attention to mental illness appeared in chapters on “Madness” and “Melancholy.” The space allotted to those two afflictions demonstrated that he found mental disorders as worthy of attention as physical ailments. The minister’s account described the symptoms of mania and melancholy briefly; it then speculated about causes and turned to recommended treatments. Missing in his presentation was any attempt to justify the reality of those conditions, indicating that defining madness and melancholy as illness evidently offered no challenge for his audience.22

In his brief characterization, Mather named madness a “DISMAL Spectacle!” He set it in contrast to human reason and compared the “calamity” of madness to “reason” and “enlightenment.” The minister pointed to God as the gracious giver of those more rational powers and rued the presence of disordered thought and action. Madness, he observed, ca...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Series Introduction
• Contents
• Acknowledgments
• Introduction: Christianity and Mental Illness
• 1. Making Theological Sense out of Suffering, Sin, and Sickness: Cotton Mather
• 2. Christian Vocation and the Shape of the Secular Profession: Benjamin Rush
• 3. Advocating for the Helpless, Forgotten, and Insane: Dorothea Dix
• 4. Reclaiming Religious Authority in Medicine: Anton Boisen
• 5. A Passionate Plea to Engage Finds Lukewarm Reaction: Karl Menninger
• Conclusion: Suffering, Stigma, and Hospitality
• Notes
• Bibliography
• Index