The signs and causes of melancholyRichard Baxter
(posthumously compiled by Samuel Clifford, minister of the Gospel in 1716 AD)
In 1716 AD, Samuel Clifford, minister of the Gospel posthumously compiled a collection of writings of Richard Baxter, preacher for a church. As noted above, Baxter viewed madness as a spiritual problem, not a bodily or physical one. He correctly viewed the cause of madness as sin and "wounds of the conscience". He correctly charged the insane as being "guilty of voluntary active Self-pollution" who willfully sinned, then suffered the pains of their conscience. Baxter notes that cognitive dissonance from unrepented sin, can lead to delusion, paranoia, depression and laziness. "I would warn all young Persons to live modestly, and keep at a sufficient distance from Objects that tempt them to carnal Lust . . . For I can tell them by the sad Experience of many, that venerous Crimes leave deep wounds in the Conscience; and that those that were never guilty of Fornication, are oft cast into long and lamentable Troubles, by letting Satan once into their Phantasies . . . especially when they are guilty of voluntary active Self-pollution". Baxter notes the symptoms as self condemnation due to personal sinful conduct, paranoia that others are constantly talking about them and laziness. "Melancholy Persons are commonly exceeding fearful . . . Their Fantasie most erreth in aggravating their Sin, or Dangers or Unhappiness... They are continual Self-Accusers, turning all into matter of Accusation against themselves ... They are still apprehending themselves forsaken of God . . . and that it is now too late to repent or find Mercy ... suspicious of every Body that they see whispering ... given to Idleness, either to lie in Beds, or to sit unprofitably by themselves". Baxter's cure is as puzzling as it is opposite to what is needed. Having already stated that personal sin is the cause of madness, he suggests diversion from consciousness of sin and lots of personal attention, rather than repentance and social isolation as mandated in Matthew 18. "A great part of their Cure lieth in pleasing them, and avoiding all displeasing Things, as far as lawfully can be done ... divert them from the Thoughts which are their Trouble ... Suffer them not to be long alone, get sit Company to them". As a preacher, Baxter should have known better than to suggest this. When someone is in sin, it justifiably makes them feel bad and under the condemnation of hell. The only cure is repentance and forgiveness from God. Baxter's cure for a fornicator who feels condemned by God, for example, would be to have the sinner think about fields of flowers and sunsets rather than his sin. This is equivalent to what is done today in chemical psychiatry where drugs are used to take away bad feelings of the conscious. Baxter also suggests that the sinner should be given lots of undue attention and never left alone. This is opposite to what Jesus said in Matthew 18, where the unrepentant sinner is to be socially isolated. Baxter's system of "diversion and love bombing" does work on the melancholy, but it achieves this in a manner opposite to what the Bible commands. It is like giving a screaming, disobedient and rebellious child who refuses to obey the parent, a candy, in order to shut them up, rather than a good spanking. We are commanded to repent of sin, not ignore it and think of flowers and rainbows. When the sinner sees those around him engage in coddling and reassurance, without discipline, it is like giving that candy to the rebellious child. When many people spend time with a melancholy sinner it sends the message: "Don't feel bad about your sin, we are all here spending time with you in order to remove your bad feelings without repenting." This obvious truth is what Baxter understood 300 years ago! (The signs and causes of melancholy, Richard Baxter, 1716 AD)
"Baxter recorded in his autobiography (Reliquix Baxteriance . . . published .. . by Matthew Sylvester, 1696) that like many clergymen of his time he was in the early years of his ministry 'forced .. . by the Peoples Necessity to practise Physick . . . no Physician being near'. Later when he had become famous for his wisdom he was 'troubled . . . with multitudes of melancholly Persons, from several Parts of the Land . . . I know not how it came to pass, but if men fell melancholly I must hear from them or see them (more than any Physician that I know)'. From this experience he formulated 'Three Counsels' which seemed to him of special importance in the prevention of mental illness : 'I. That we must very much take heed lest we ascribe Melancholy Phantasms and Passions to God's Spirit'; '2. I would warn all young Persons to live modestly, and keep at a sufficient distance from Objects that tempt them to carnal Lust . . . For I can tell them by the sad Experience of many, that venerous Crimes leave deep wounds in the Conscience; and that those that were never guilty of Fornication, are oft cast into long and lamentable Troubles, by letting Satan once into their Phantasies . . . especially when they are guilty of voluntary active Self- pollution'; '3. I advise all . . . to take heed of placing Religion too much in Fears, and Tears, and Scruples'. Many of his psychiatric observations scattered in almost 200 separate works were gathered posthumously into one volume for the benefit of those 'who are either Afflicted with Melancholy themselves; or desirous to relieve and assist Others under such a Disorder', since 'There is not any where yet Publish'd, that we know of, so full, and distinct, and orderly a Consideration of this Case'. Baxter's distinction between patients 'rationally sorrowful for Sin' and those with 'Hurt or Error of the Imagination' would be made today in terms of neurotic or reactive and endogenous or psychotic depression; while sorrow, as he pointed out, is easily mistaken for depression especially where the cause is not immediately apparent. Among the signs of melancholy he included ideas of reference, and that many 'think that never any one was as they are', an expression of patients' distress with which every psychiatrist is familiar. His cardinal rule for treatment was to 'put them in a Pleased condition' — the reverse of medical treatment which consisted essentially in administering discomfort, pain and shock. His idea that patients might comfort 'others, that are in deeper Distresses than themselves' was the germ from which later developed group therapy as well as the employment of recovered patients as psychiatric aides; and the 'pretty Diversion to send to them some Person . . . to dispute .. . with them' might be explained in terms of Freud's interpretation that depression is anger turned inwards and is relieved when it can find an outlet." (300 years of Psychiatry, Richard Hunter, 1963, p240)
The signs and causes of melancholy, Richard Baxter, 1716 AD
Richard Baxter (1615-1691)
Nonconformist divine and author
The signs and causes of melancholy. With directions suited to the case of those who are afflicted with it. Collected out of the works of Mr. Richard Baxter, for the sake of those, who are wounded in spirit. By Samuel Clifford, minister of the Gospel, 1716 London, Cruttenden & Cox (pp. xivii + 128) pp. 5-19, 120-2, 125-7
THE SIGNS AND CURE OF MELANCHOLY
Melancholy Persons are commonly exceeding fearful . . . Their Fantasie most erreth in aggravating their Sin, or Dangers or Unhappiness . . . They are still addicted to Excess of Sadness, some weeping they know not why, and some thinking it ought to be so; and if they should Smile or speak merrily, their Hearts smite them for it, as if they had done amiss . . . They are continual Self-Accusers, turning all into matter of Accusation against themselves, which they hear or read, or see, or think of; quarrelling with themselves for every thing they do, as a contentious Person doth with others. They are still apprehending themselves forsaken of God . . . and that it is now too late to repent or find Mercy . . . They never read or hear of any miserable Instance, but they are thinking that this is their Case .. . And yet they think that never any one was as they are: I have had Abundance in a few Weeks with me, almost just in the same Case; and yet every one saith, never any one was as they. They are utterly unable to rejoyce in anything : They cannot apprehend, believe or think of any thing that is comfortable to them . . . They are still displeased and discontented with themselves; just as a peevish froward Person is apt to be with others . . . and suspicious of every Body that they see whispering . . . They are much averse to the Labours of their Callings, and given to Idleness, either to lie in Beds, or to sit unprofitably by themselves. Their Thoughts are most upon themselves, like the Mill-stones that grind on themselves when they have no Grist; so one Thought begets another. Their Thoughts are taken up about their Thoughts; when they have thought irregularly, they think again what they have been thinking on . . . Their Thoughts are all perplexed . . . They are endless in their Scruples . . . Hence it comes to pass that they are greatly addicted to Superstition . . . They have lost the Power of Governing their Thoughts by Reason; so that if you convince them that they should cast out their Self-perplexing unprositable Thoughts, and turn their Thoughts to other Subjects, or be vacant, they are not able to obey you . . . They can think of nothing but what they do think of, no more than a Man in the Tooth-Ach, can forbear to think of his Pain . . . The very Pain of their Fears, doth draw their Thoughts to what they fear. As he that is over desirous to Sleep, is sure to Wake; because his Fears and Desires keep him Waking: So do the Fears and Desires of the Melancholy cross themselves .. .
A great part of their Cure lieth in pleasing them, and avoiding all displeasing Things, as far as lawfully can be done . . . If you know any lawful thing that will please them in Speech, in Company, in Apparel, in Rooms, in Attendance, give it them. If you know at what they are displeased, remove it. I speak not of the distracted who must be mastered by Force, but of the sad and Melancholy : Could you put them in a pleased Condition you might Cure them.
As much as you can, divert them from the Thoughts which are their Trouble; keep them on some other Talk or Business; break in upon them, and interrupt their Musings; raise them out of it, but with loving Importunity : Suffer them not to be long alone, get sit Company to them, or them to it; especially suffer them not to be Idle, but drive or draw them to some pleasing Work, which may stir the Body and employ the Thoughts . . . It's an useful way if you can, to engage them in comforting others, that are in deeper Distresses than themselves : For this will tell them, that their Case is not singular, and they will speak to themselves, while they speak to others.
And it would be a pretty Diversion to send to them some Person that is in some Error, which they are most against, to dispute it with them, that while they confute their Wits to convince them and confute them, it may turn their Thoughts from their own Distress. Forestus tells us, that a Melancholy Patient of his, who was a Papist, was Cured when the Reformation came into that Country, by eager and oft disputing against it. A better Cause may better do it.
If other means will not do, neglect not Physick; and tho' they will be averse to it, as believing that the Disease is only in the Mind, and that Physick cannot Cure Souls, yet they must be persuaded or forced to it. The Soul and Body are wonderful Co-partners in their Diseases and Cure, yet when experience telleth us, that it doth it, we have Reason to use such means. I have known a Lady deep in Melancholy, who a long time would neither speak, nor take Physick; nor endure her Husband to go out of the Room; and with the Restraint and Grief he Died, and she was Cured by Physick put down her Throat, with a Pipe by Force.
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