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The Puritans on Medication for Mental Illness

David Murray
David Murray
2013 15 May

The Puritans not only accepted the existence of medical causes for depression and other mental disorders, but they also proposed various medical remedies. Admittedly, some of their “treatments” were extremely primitive, but they clearly understood that there was some physical or medical elelement to some depressions.

After listing various spiritual and social remedies, Richard Baxter says “If other means will not do, neglect not medicine.”  Just as in our own day, there was sometimes significant resistance to medication. Baxter’s solution? Force it down their throats!!

Though they will be averse to it, as believing that the disease is only in the mind, they must be persuaded or forced to it. I have known the lady deep in melancholy, who a long time would neither speak, nor take physic, nor endure her husband to go out of the room, and with the restraint and grief he died, and she was cured by physic put down her throat with a pipe by force.

While we would probably end up in prison if we tried such methods, Baxter’s basic insights on the role of medication and doctors are sound and have abiding value:

1. Choose a physician who is specially skilled in this disease, and has cured many others. He advises against consulting young men and busy men who don’t have time to sit down and carefully listen to the depressed person’s story. Interestingly, Baxter didn’t have any hang-ups about calling this a disease and grouping it with other physical illnesses: “The thinking faculty is diseased and become like an inflamed eye, or a foot that is sprained or out of joint, disabled for its proper work.”

2. Medicinal remedies and theological are not usually to be given together by the same hand. He does allow for exceptions to this, but as a general rule he says that if you have access to “an ancient, skillful, experienced, honest, careful, circumspect physician, neglect not to use him.”

3. The root of depression is in the blood and is often accompanied by other physical problems. Baxter believed that the blood carried the human spirit, and that if the blood was diseased, so was the human spirit, and other organs that the blood served. Although we might laugh at Baxter’s archaic understanding of the human body, his instincts were right, in seeing physical causes and consequences of this “mental” disease [and maybe he's not so far off the truth after all: A blood test for mental illness]

4. Sometimes depression is caused by sudden shock. Baxter had seen otherwise sound-minds “suddenly cast into melancholy by a fright, or by the death of a friend, or by some great loss or cross, or some sad tidings, even in an hour.” Baxter said that this proved that the cause was not always found in the body, but his understanding of the mind/soul/body connections helped him to see that even the shocking impact of such news or events on the mind impacted the body too.

But the very act of the mind doth suddenly disorder the passions, and perturb the spirits; and the disturbed spirits, in time, vitiate the blood which containeth them; and the vitiated blood doth, in time, vitiate the viscera and parts which it passeth through; and so the disease beginning in the senses and soul, doth draw first the spirits, and then the humours [bodily fluids], and then the parts, into the fellowship, and soul and body are sick together.

5. The physician and pastor need great skill to know where the depression started. He must find out if it began “in the mind or in the body; and if in the body, whether in the blood, or in the viscera, for the cure must be fitted accordingly.”

6. Even if the depression have a psychological cause, medication can still have a role in curing it.

Though the disease begin in the mind and spirits, and the body be yet sound, yet physic [medication], even purging, often cureth it, though the patient say that drugs cannot cure souls, for the soul and body are wonderfully co-partners in their diseases and cure; and if we know not how it doth it, yet when experience telleth us that it doth it, we have reason to use such means.

7. Even if the depression was caused by demonic influence, medication may help to drive the devil out.

It is possible physic might cast him [the devil] out, for if you cure the melancholy, his bed is taken away, and the advantage gone by which he worketh. Cure the choler, and the choleric operations of the devil cease. It is by means and humours in us that he works.

Editorial Note:
One modern editor of Baxter’s writing says of this section:

“Of course Baxter was as unaware of modern biochemisty and physiology as he is of modern pharmacology. Nevertheless his insights are still valuable today.

It may be appropriate to summarize this section of Baxter’s work as follows: those with depression of a spiritual nature, require spiritual counsel. Those whose depression is a result of somatic illness need medical care to correct that cause. People who suffer from endogenous depression may require both spiritual and medical treatment, depending on their case. Baxter’s advice about physicians is pertinent at this point."

Other posts in this series:

7 Questions about suicide and Christians
Mental illness and suicide: the Church awakes
Pastoral thoughts on depression
The problem with “mental illness”
Double Dangers: Maximizing and Minimizing Mental Illness
A Medical Test for Mental Illness
The Puritans and Mental Illness