Students of the history of psychiatry have usually been uncomfortable writing about the early modern period because the categories used to describe mental states were often religious rather than secular and scientific. This has, David Lederer suggests, left the false impression of a radical disjunction between medieval and modern ideas about madness. Describing what he calls "spiritual physick," Lederer shows that while ideas and practices in the sixteenth and seventeenth centuries were certainly very different from ours, one can see them evolve, if one looks closely enough.
This book started as an effort to reconstruct the operations of cult shrines in the Duchy of Bavaria dedicated to the treatment of madness. Using the manuscript miracle books from two shrines, Lederer has mined biographical information about sufferers, including symptoms, attempted cures and votive offerings. Lederer uses this material to demonstrate how early modern people thought, not only about why they were suffering but also what they needed to do to obtain relief. He shows, for example, how people sought relief for a patient's suffering by promising to make a pilgrimage.
In addition to describing the operations of these shrines, the book also provides a broader view of "spiritual physick" in society. Because he focuses on a particular time and place, he is able to present a complex description of the relations between church, state and popular beliefs. During this period, he notes, Europeans perceived themselves to be in the midst of both a material and spiritual crisis. Among the responses to this, aimed at uniting society, Bavarian authorities proselytized for the use of confession and even criminalized noncompliance with a yearly requirement. Requirements like this meant that "religion and government interwove into the same coarse sackcloth ." Despite the repressive motives of secular authorities confession achieved huge popularity through its consoling function.
In the seventeenth century the pendulum swung and authorities sought to secularize responses to madness. Again Lederer's focus on a particular locale allows him to show that this was not a simple process. In Bavaria, with increased secular authority over the regional church, religious explanations for psychic suffering fell under attack. Ironically, in responses to possession and exorcism, moderate clergy played a significant role in this, not by challenging the epistemological framework that allowed for the possibility of demonic intervention, but by arguing legalistically for other possibilities, such as insanity. The efforts of secular authorities to develop uniform procedures for burials ran into considerable popular opposition because of profound religious concerns about burying suicides in hallowed ground. By contrast the general population, while still holding religious views of madness, were quite willing to avail themselves of government efforts at institutional confinement, when it allowed them to avoid the burdens of home care.
Lederer's tightly focused account succeeds admirably in conveying the complex evolution of the care of the mentally ill in a particular time and place. I would only warn more "general readers" that some background in European history of the period is needed to put this account in context.
Edward M. Brown, Brown University, Providence RI