Religious Insanity in America:

The Official Nineteenth-Century Theory

William Sims Bainbridge, Harvard University

Sociological Analysis 1984, 45, 3:223-240

ABSTRACT

Throughout much of the nineteenth century, psychiatrists and ordinary citizens agreed that one of the chief causes of mental illness was religious excitement. Discovery of hitherto untouched data from the 1860 census, giving supposed cause of insanity for 2,258 inmates of 17 asylums, provides the opportunity for exploring the alleged role of religion in producing insanity. Enshrined in publications of the U.S. government and in the chief psychiatric texts as part of the official theory of madness, the idea of religious insanity may have served a number of functions for the new profession of psychiatry, as well as offering afflicted families an optimistic interpretation of mental problems. A mixture of medical, moral and religious ideas, the dominant psychiatric theory cast opposition to high-tension, sectarian religion in an apparently scientific context.

Religious Insanity in America

On July 16,1860, William S. Allen languished in the Tennessee state asylum at Nashville, a victim of religious excitement. A forty-five year old tailor from Virginia, Mr. Alien had been committed the year before and was but one of the 212 inmates and 30 staff who lived at the hospital. Rebecca Hester, fifty-two, was also a Virginia native driven mad by religion, while Ann J. Pickett, the wife of a physician, had lost her sanity to the Spiritualism craze of the 1850s. Methodist-Episcopal preacher, Thomas B. Craighead, was not among the 11 inmates crazed by religion, because his affliction was supposed to be hereditary. We know these intimate facts because Dr. William A. Cheatham, director of the institution, told them to Davidson County assistant marshal J. B. Corley when he came to count the residents for the 1860 census.

When I first discovered such records, quite by accident, I assumed that Cheatham or Corley had taken it upon himself to add these tidbits of information to an otherwise dull enumeration of the population. But then I found similarly rich reports from other institutions, learning, for example, that a victim of religious excitement known only as Moses wandered the halls of the asylum at Stockton, California. Further research revealed it was the official policy of the federal government to tabulate causes of insanity at the 1860 census and that the official psychiatric theory of the time considered religious excitement to be an important source of psychopathology.

Microfilm copies of the original census enumeration schedules are now available at a dozen federal archives around the country, and a growing body of social-scientific research has exploited this unexpectedly rich trove of data (Laslett, 1977; Johnson, 1978; Perlmann, 1979; Hirata, 1979; Bainbridge, 1982). A guide book recently published by the Bureau of the Census (1979) purports to give the full instructions to enumerators in 1860, but in fact this is an eviscerated abridgement. A graduate student, Lucia Benaquisto, has unearthed a copy of the extensive original instructions which state, in part:

In all cases of insane persons, you will write in the space where you enter the word "Insane," the cause of such insanity; and you will in every case inquire into the cause or origin thereof, and write the word - as intemperance, spiritualism, grief, affliction, hereditary, misfortune, etc. As nearly every case of insanity may be traced to some known cause, it is earnestly desired that you will not fail to make your return in this respect as perfect as possible. (Department of the Interior, 1860:16-17)

The instruction does not suggest religion, per se, but does name spiritualism, the prominent religious deviance of the 1850s. The published volume of summary statistics for the 1860 census (Kennedy, 1864) contains a long essay on insanity, written under the direction of the distinguished alienist and social scientist, Pliny Earle. Here, in the widely-read official report of the best social statistics of the time, the theory that religious excitement often caused insanity was stated at length and presented as fact.

However, only a single table of data from the 1860 enumeration of the insane was published, merely giving their numbers by state, "slave" and "free" A table reporting the supposed causes of insanity in a large number of cases came not from the census but from hospital reports previously summarized in a popular almanac (Earle, 1863). Apparently, the rich information about supposed cause recorded by the enumerators was never tabulated, and one purpose of this article is to bring these interesting data to scientific attention for the first time.

Of course, we need not accept the theory of mental illness reflected in the nineteenth-century etiological judgments. Indeed, the chief contemporary use of these data is ethnographic: to help us understand the theory of insanity which prevailed over a century ago and learn the role which religion played in it. While no society achieves full consensus in its views of madness (Edgerton, 1966; Finkel, 1976), the theory of religious insanity had the status of official truth for more than fifty years - promulgated by the leading psychiatrists and social scientists, accepted by popular media like the almanacs from which opinion leaders took their information, and enshrined by the census as the official position of the United States government.

Today, there are several theories about how religion might produce mental illness. Freudians tend to view religious dogmas as inherently delusional, thereby being the stuff of which madness is made (Freud, 1927, 1930; Roheim, 1955; La Barre, 1969, 1972; cf. Stark, 1971; Richardson, 1980). Kiev and Francis (1964) suggested that unresolved guilt aroused by deviant religious groups might undermine mental health, and other writers have emphasized the power of intense religious experiences (Allison, 1968). Psychiatrists and clinical psychologists often are among the most vehement opponents of contemporary cults, and the general public has been bombarded with pseudoscientific claims that deviant religion is psychopathological (e.g. Conway and Siegelman, 1979; cf. Kilbourne, 1983).

Psychiatric theories may serve four functions, quite apart from their capacity to explain the cold facts about insanity known at the time of their popularity. First, they may assist professionals in asserting special claims to power and status (Hollingshead and Redlich, 1958:163; Strauss et al., 1964). Second, they may be used as rhetorical tools to discredit political opponents and members of disvalued classes or subcultures (Gursslin et al., 1959; Goode, 1969; Medvedev and Medvedev, 1971). Third, they may be used as media through which the culture consensually expresses and modifies its basic conceptions of human nature and social values (Benedict, 1934; Ackerknecht, 1943; Opler, 1959; Edgerton, 1966; Bastide, 1972; Kiev, 1972). And fourth, they may provide legitimation for humane treatment and hope for patients and their families (Szasz, 1961; Parsons, 1964; cf. Haley, 1963). It may be that the theory of religious insanity served each of these.

Sociologists have long argued that science itself may have cultural roots in the very religious tradition to which the nineteenth-century alienists belonged (Westfall, 1958; Merton, 1970), and until the end of the period under consideration here, religion worked through science as much as against it (Gillispie, 1959; Toulmin, 1982). Religion provided Americans with an interpretive framework for understanding man and society, yet it was slowly giving way to secular perspectives. The alienists mixed piety and science in a way which aided this transition while condemning religious deviance, raising the alienists in status, and giving comfort to many sufferers.

This article will examine the newly discovered 1860 data on supposed cause of insanity, together with comparable statistics found in official reports and scientific publications of the time, in the light of these hypotheses. We will learn the psychological theory that encouraged alienists to believe that religion can cause nervous breakdowns, and we will consider a number of social functions this conclusion may have served.

Statistics on Religious Insanity

Persons labeled insane are found throughout the 1860 census manuscripts, and cases attributed to religion appear in many different residential contexts. For example, Moses Smith, a thirty-five year old shoemaker driven mad by religious excitement lived at the town poorhouse of Monson, Massachusetts. Galen Weston, a farmer who lived at home with his wife Judith in Duxbury, Massachusetts, had lost his wits to Spiritualism. While such cases are numerous, nationwide, they are rare in any given town, and a search for a large sample of uninstitutionalized insane would be prohibitively expensive. But in 1860 there were forty-two major insane asylums in the United States, and I was able to locate census records for every single one of them.

Despite the care with which the assistant marshals generally did their work, supposed cause is not given for twenty-four asylums. I think the cumbersomeness of the hospital records often made it very difficult to extract special information except in a concerted study such as the occasional statistical reports prepared by asylum directors or treasurers. Such reports typically described the patients who had been admitted during a given year, or all those admitted since the founding of the institution, while the census wanted data on the inmates present on the day of enumeration. Several of the asylums which do not give cause in the 1860 census did so in their own publications, and they may have found it far too inconvenient to redo the work on short notice for the census taker.

In one case, the Auburn Asylum for Insane Convicts in New York, the criminal offense of each inmate is named instead of cause of insanity, the enumerator having followed the instruction to report offense and date of conviction for all prisoners. The federal microfilms were not completely legible for the asylum at Taunton, Massachusetts, but a duplicate handwritten copy preserved in the Boston State House provided these data. Thus, for seventeen major asylums we now know what was believed to have caused insanity in 2,258 cases.

The summary volume of the 1860 census gave the supposed cause for fully 9,473 admissions to four hospitals in Massachusetts, New York, Pennsylvania and Connecticut. Of these, 740 or 7.8 percent were attributed to "religious excitement" (Kennedy, 1864:lxxxix). These data span three decades or more, and some individual patients were counted more than once because of readmissions to the hospital. Data from the seventeen asylums in 1860 represent a wider range of asylums, including recently built institutions in southern or western areas of the country, and they count actual persons, without duplication, at a single point in time. However, hospital reports are valuable both because they reach back further in time and because they were public expressions of professional psychiatric ideology aimed at political leaders and the general public.

Table 1 gives the percent of cases attributed to religion in approximately fifteen thousand cases, data taken from two of the most comprehensive hospital reports, three almanacs contemporary with the 1860 census, and the census itself.

TABLE 1
CASES OF HOSPITALIZED INSANITY ATTRIBUTED TO RELIGION
Sources of DataAsylumsDatesCases
Reported
Percent
Attributed
to Religion
Calhoun (ed.), 1837 Worcester, MA1833-364283.7%
Earle, 1848 Bloomingdale, NY1821-441,1867.8%
American Almanac, 1860Augusta, ME18589614.6%
American Almanac, 1861Augusta, ME18591176.0%
National Almanac, 1864Augusta, ME18621044.8%
National Almanac, 1864Concord, NH1862-63595.1%
National Almanac, 1864Taunton, MA1854-622,0485.4%
National Almanac, 1864Hartford, CT1824-634,080 6.3%
National Almanac, 1864Philadelphia, PA1841-622,3386.1%
National Almanac, 1864Harrisburg, PA1851-628241.3%
National Almanac, 1864Indianapolis, IN1848-612,01214.4%
National Almanac, 1864Jacksonville, IL1860-622885.2%
United States Census
Manuscripts, 1860
17 Asylums*18602,2586.1%
*Asylum (founded) state: Somerville (1818) MA, Staunton (1828) VA,
Worcester (1833) MA, Blackwell's Is. (1839) NY, Nashville (1840) TN,
Concord (1842) NH, Baltimore (1842) MD, Fulton (1851) MO,
Stockton (1851) CA, Mill Creek (1853) OH, Taunton (1854) MA,
Jackson (1855) MS, Newburg (1855) OH, Dayton (1855) OH,
Raleigh (1856) NC, Northampton (1858) MA, Kalamazoo (1859) ML

The first four annual reports of the State Lunatic Hospital at Worcester, Massachusetts, offered lists of all patients admitted, their identities hidden by code numbers, with a variety of information about each, including individual ascriptions of cause (Calhoun, 1837). They offer an obvious comparison with our census reports, reaching back to 1833 when the hospital was opened.

A retrospective report of very high scientific quality concerning the Bloomingdale asylum of New York City was issued in 1848 by Pliny Earle, aggregating the supposed causes of patients' insanity into 85 categories. The Bloomingdale report clearly counts separate persons, rather than tabulating the same patient repeatedly upon readmission to the hospital, and we can use Earle's data with great confidence because his many social-scientific publications reveal an accomplished statistician and a researcher of high professional standards.

Since colonial days, almanacs had been among the most important sources not only of statistical and scientific information but also of ideas and values from which Americans created a national culture. Thus it is very interesting that they confidently promulgated the theory of religious insanity, supporting it with statistics sufficiently official to be appropriated by the authors of the census volumes. In American Almanac and National Almanac, these data are included in reports on the operations of the various state governments in amongst lists of state officials and tables of budget expenditures.

Often, we find fragmentary comments which indict religion as a cause of insanity without giving us quite enough information to compute rates. Two examples from the 1860 American Almanac are the Indiana Hospital for the Insane and the Worcester Asylum, each of which appears in our table with data from another source. For the former we are told, "The alleged probable cause of insanity in 86 cases was religious excitement and anxieties; in 35, spiritual rappings; in 31, intemperance; in 23, tobacco," but we are told nothing about other causes nor are given, the total number of cases assigned a cause. Worcester reported twelve common supposed causes, with 289 cases attributed to religious excitement, 25 to Spiritualism and 10 to Millerism.

For the Maine Insane Asylum at Augusta the 1860 almanac says that 126 admissions occurred in the year following November 30, 1857, with no attribution of cause for 30 of these. Religious excitement accounted for 11 cases and Spiritualism for 3, meaning that a total of 14, or about 15 percent of the 96 assigned cases, were blamed on one or another manifestation of religion.

As Table 1 shows, the percent of cases attributed to religion which were assigned some sort of cause ranges from a low near one percent to a high of nearly fifteen. To be sure, doctors may have differed in their readiness to blame religion, so the rates could vary greatly across institutions. But most of the reports range narrowly around 6 percent, and the rate for the seventeen asylums is 6.1 percent.

The census records actually present approximately 300 different etiological comments. Indeed, an exact count is impossible because differences in spelling and grammar shade imperceptibly over into real differences in meaning. To get the total of 138 cases attributed to religion, I added together 57 cases of religious excitement, 53 of religion, 2 of religious perplexity, 1 of religious, 6 of Millerism, 17 of Spiritualism, and 2 of spirit rappings. Only two of the seventeen asylums, those in Baltimore and Kalamazoo, failed to contain patients whose illnesses were attributed to religion in some terms or other.

Nervous Breakdown from Overpowering Religion

To understand the hypothesis that religion could cause madness, we must discover the general etiological theory of which it was a part. Pliny Earle's essay in the 1863 National Almanac provides a succinct statement of the standard theory of insanity of his day:

inasmuch as insanity is almost uniformly a disorder connected with bodily debility, a fact apparently never learned until within the last half-century, it necessarily follows that all customs, habits, occupations, or other agencies whatsoever which exhaust the power of the brain and nerves, bringing the body to a weakened condition, may thus become the origin of mental disorder. Such influences are, indeed the ramified root from which insanity springs. (Earle, 1863:56)

In the summary volume of the 1860 census (Kennedy, 1864), Earle detailed the "principal methods by which the religious sentiment is aroused to that point at which it not infrequently results in the production of mental disorders," citing first the "extraordinary and spasmodic" religious revivals in which "the excitement, both mental and corporal, is long-continued, and necessarily produces nervous exhaustion - the condition most favorable for an attack of insanity." He also condemned the intensity of meetings of small church groups and especially warned against "solitary reading and meditation upon religious subjects, until personal demerit and its consequent punishment become the sole occupants of the thoughts, to the exclusion of those consolations which the spirit of Christianity guarantees" (pp. xc-xci).

Earle's admonition to ministers in the census volume likewise cited the healing as well as the pathogenic powers of religion:

By that denunciatory and, as appears to us, intemperate style of preaching, wherein the terrors and consequences of Divine wrath are portrayed with all the vigor and the force of a vivid imagination, giving over the minds of the young, the sensitive, the susceptible, and the strongly-conscientious, to the dominion of despondency and fear, the action of which is powerfully depressive to the vital energy, and, consequently, strongly promotive of an invasion of mental disorder; while the solemn and awe-inspiring rites of some services are sore trials to the minds of the sensitive and superstitious, contribute their influence to the subversion of reason, and would be even more frequently fatal but for their rapidly and strongly contrasting variations, so illustrative of the remedial power attributed to the administrators of these imposing ceremonies, which modifies their effect. (Kennedy, 1864: xci)

In 1841, after a visit to thirteen European asylums, Earle contended that religious excitement was a distinctively American cause of insanity, noting that none of 1,557 cases admitted to the Asylum at Charenton near Paris were attributed to religious excitement, compared with 53 of the 678 cases treated at the Massachusetts state hospital (Earle, 1841:119). He suggested that the more lively and widespread religious debates in the United States promoted insanity here, while a differentiation of the French into obediently superstitious' 'lower orders" and confidently unfaithful "higher orders" left no one prey there to private indulgence in religious obsessions. However, American psychiatric thought was an extension of British and French doctrines, and the theory of religious insanity took firm root in all three nations.

A Manual of Psychological Medicine by British doctors Bucknill and Tuke, was "by far the best general treatise upon insanity in the English language" (Earle, 1886:60). It "quickly became the standard work in the field" of American psychiatry (Dain, 1964:150), cited extensively even by the 1860 U.S. census publication (Kennedy, 1864:lxxxix). The fourth edition of this text holds religious excitement responsible for about 425 of 14,152 English asylum admissions and 20 of 2,068 French admissions (Bucknill and Tuke, 1879:91-93). The authors commented, "Doubtless, in many instances it was in reality the initial symptom of the disorder. Still we cannot for a moment doubt that the form in which religion is but too frequently presented is a serious cause of Insanity" (Bucknill and Tuke, 1879:99).

Supposed Causes of Insanity

The standard nineteenth-century theory of insanity had the marvelous capacity to connect under a few general principles the most diverse set of specific ideas. To see how it did so and to discover the conceptual context in which the idea of religious insanity flourished, we shall survey the main etiological categories revealed in the 1860 census data and in Earle's report of the Bloomingdale asylum covering 1821 to 1844. Table 2 gives supposed cause for the seventeen asylums and Bloomingdale, collapsed under large conceptual headings of the type used by Earle and his colleagues.

TABLE 2
SUPPOSED CAUSES OF INSANITY (Percent)
Cause of InsanitySeventeen Asylums:Bloomingdale Asylum:
MalesFemales Males Females
Religious excitement5.7 4.8 7.48.5
Spiritualism .9 .8 0 0
 
Pecuniary trouble 5.4 2.3 18.7 3.0
Disappointment 3.3 4.92.35.8
Domestic trouble3.710.73.2 8.7
Loss and grief1.64.7 2.3 5.4
Love1.2 .7 .1 .6
Fear 1.3 1.5 2.3 5.0
Other intense emotions2.22.1 3.6 3.4
 
Intemperance 15.0 4.4 14.14.0
Drugs 1.1 .9 .7 1.6
Masturbation 17.7 2.15.4 0
Sin and bad habits2.0 .61.31.4
 
Overexertion3.82.24.9 0
Hardship 1.0.4 0 0
 
Ill health11.8 21.9 21.6 15.7
Childbirth 0 8.2 0 18.9
Feminine problems07.7 013.7
Epilepsy 9.55.1 2.8.8
Paralysis.4.1 0 0
Injury4.11.1 5.8 .8
Exposure 1.3.5 1.3 0
 
Hereditary5.77.10 0
All other causes1.34.52.02.6
Total 100.0 100.3*99.8* 99.9*
Number of cases1,2301,028 689497
*Rounding error

Religious excitement and Spiritualism are shown separately, so we can see that Spiritualism was absent from Bloomingdale. This religious movement was a phenomenon of the 1850s, and thus could not be included in the earlier roster of causes. Males and females seem about equally prone to religious insanity, although there are opposite imbalances in the two sets of data.

If excessive intensity of religious emotions can cause madness, then overpowering feelings and experiences generated by family problems, occupational difficulties and other disasters of social life should also be pathogenic. The next section of Table 2 lists several categories of such social-psychological problems. In the technical language of the day, these, combined with religion, were known as moral causes.

Each of these categories includes many particular etiological comments. For example, Pecuniary trouble includes pecuniary embarrassment, loss of property, money matters and failure in business. Domestic trouble includes such family problems as abuse by husband, adultery, infidelity of wife, and recent marriage. Loss and grief includes death of children, death of husband, death of wife, loss of parents, and, in one case, witnessing brothers drown. The most common of the Other intense emotions was jealousy. Traditional sex roles are reflected in the fact that men were more apt to suffer from pecuniary or business trouble, while women more often suffered domestic problems plus loss and grief.

The gender differences in the next four categories of hedonistic self-indulgence also may reflect traditional sex roles, although the greater propensity of males to be accused of onanism may have physiological causes. Throughout the nineteenth and early twentieth centuries, medical science and religious moralism conspired to prohibit this autoerotic behavior.

The first superintendent of the Worcester Asylum, Dr. Samuel B. Woodward, fulminated against masturbation both in the Boston Medical and Surgical Journal and in a book titled Hints for the Young in Relation to the Health of Body and Mind. There he said, "From the hand of God himself we receive the noble attributes which distinguish us from the animals around us. This vice reduces us below their level" (Woodward, 1840:7). In Genesis we read that the sin of Onan was so wicked in the sight of the Lord that it was punished with death. But religion, like medicine, may merely have been the vehicle for a more broadly-based Puritanical culture.

Woodward's theory of how masturbation produced insanity provides an interesting contrast with Earle's analysis of religious insanity, because Woodward expressed an allegedly scientific discovery in the rhetoric of a thundering sermon:

It is a vice which excites, to the greatest activity, the strongest and most incontrollable propensities of animal nature; and these are rendered more active by indulgence, while the power of resistance and restraint is lessened by it in a tenfold degree. The moral sensibility becomes so blunted as to retain no ascendancy in the character, to control and regulate the conduct. Under such circumstances, the best resolutions to reform, and the firmest determination to abandon the habit, fail of accomplishment. In spite of himself, the victim sinks deeper and deeper in pollution, till he is overwhelmed at last in irretrievable ruin and disgrace. (Woodward, 1840:7)

Overexertion and Hardship are mixed categories describing cases in which the patient was believed to have succumbed to nervous exhaustion brought on by too much labor, mental or physical, or by terrible circumstances which are not readily assigned to one of the other categories in the table. From Ill health to Exposure we tabulate a large number of cases attributed to purely physiological causes. Official psychiatric nosology of the nineteenth century attempted to make a strict distinction between moral (or social-psychological) causes and physical causes. If moral causes exhausted or overtaxed the nervous system, physical causes attacked it directly or undermined it by debilitating vital organs of the body.

Many doctors considered the vices, as well as many forms of hardship and exertion, to be physical causes of insanity because the immediate effect is on the body, even if conscious human behavior is a more ultimate cause. When Edward Jarvis, one of the best social scientists of his century, placed Mesmerism among physical causes he was guided by the view current at the time that Mesmerism actually dealt in animal magnetism rather than social suggestion (Jarvis, 1852:23; cf. Darnton, 1970).

Another basic distinction, maintained by some alienists and ignored by others, described certain causes as predisposing and others as exciting (Earle, 1848:76; cf. Durkheim, 1897). In compiling his Bloomingdale data, Earle considered heredity to be the ultimate predisposing cause in many if not all cases, and the causes listed in Table 2 were all considered to be proximate exciting causes - final straws, as it were, breaking a naturally weak nervous system. In particular, Dr. Isaac Ray, director of several major asylums during his illustrious career, felt that persons who had inherited weakness of the nervous system should be especially careful to avoid the emotional dangers of religious revivals (Ray, 1863:191).

Etiology and Patient Characteristics

Data from the old records are quite adequate for many kinds of statistical analysis, and a brief survey of characteristics of patients assigned to different etiological categories is given here in Table 3. The table begins with cure rates for the Worcester and Columbus mental hospitals, reported in 1850 by Edward Jarvis. While "cure" here meant merely that the patient seemed improved and was discharged from the institution, rather than marking a complete end to the illness, inspection of cure rates for cases with different supposed causes should reflect real differences in the nature of the afflictions.

TABLE 3
COMPARISON OF SUPPOSED CAUSES OF INSANITY
CharacteristicPercent of Cases Possessing the Characteristic in Each of the Following Etiological Categories
ReligionPecuniaryDomesticIntemperanceMasturbationEpilepsyAll Cases
Reported cured by
  Jarvis (1850)
72.258.2-57.729.711.157.6
Female41.326.471.519.69.230.845.5
Irish-born18.415.215.339.110.811.215.9
German-born6.416.39.69.19.25.38.0
Under age 3023.911.711.113.445.847.626.9
Age 45 and over31.956.438.735.59.218.227.2
For 773 males:
   Farmers32183112182524.5
   Laborers17183336253525.2
The domestic category includes loss and grief as well as domestic trouble.
The final column includes all categories listed in Table 2.

The very high cure rate for religion suggests that interpersonal theories of mental illness might well apply to many of these cases. In contrast, the very low cure rate for epilepsy undoubtedly indicates serious neurological impairment. The low cure rate for masturbation suggests that these cases were back-wards schizophrenics unrestrained by social control, people apt to masturbate in full view of the hospital staff, their behavior being a sign not a cause of serious pathology. The other etiological categories included a wide range of problems, some of a temporary nature, whether episodic and leading to false announcements of cure or really ending in a restoration of health. For example, many cases of intemperance were delirium tremens brought to an end by the enforced sobriety of the asylum (Earle, 1848).

Social characteristics of cases attributed to religion in the 1860 census do not differ greatly from those of all inmates. A slight excess of males and of Irish-born, and a slim deficit of Germans, may represent nothing more than chance variations. The tendency for religious patients to be somewhat older than the average may actually have been minimized in the data by the high cure rate for this group, and an increase of interest in religion with advancing years is a familiar finding in modern research (Stark, 1968).

The census records give data on occupation for 773 of the males, but only 47 of them were in the religious category, so we cannot make much of the excess of farmers over laborers. One of the six clergymen among the inmates suffered from religious excitement and one of the two divinity students from religious perplexity. Two of the religious professionals had hereditary problems, while the others suffered from overtax of mind, hard study, loss of salary, and old age.

Table 3 suggests a range of future research on topics unrelated to religion. The proverbial intemperance of Irishmen, a myth given some substance by social-scientific research (Opler and Singer, 1956), shows up in an excess of Irish in the intemperance category. The excess of laborers among the intemperate may be explained by the fact that Irishmen constituted 29 percent of the laborers but only 1 percent of the farmers, although the causal direction of this association may go the other way.

Pecuniary and domestic problems afflict older persons who have had time to develop family responsibilities. As now, epilepsy manifested itself commonly in the early years, and the young age of masturbators may reflect not merely youthful sexual intensity but the onset of chronic schizophrenia in early adulthood. Except for Northampton and Blackwell's Island Asylum in New York City, the institutions were designed to cure cases of recent onset, while many chronic cases languished in poor houses, so we would not expect to find today's proportion of elderly inmates.

Religious Aspects of the Theory

The most comprehensive dissertation on religious excitement was Observations on the Influence of Religion upon the Health and Physical Welfare of Mankind, published in 1835 by Amariah Brigham, one of the most learned and progressive physicians of his day, founding editor of the first psychiatric journal in the United States. Brigham urged a mixture of good physical hygiene and religious moderation, believing "that whatever was established and enjoined by our Savior, is beneficial to mankind, and not injurious to health" (Brigham, 1835:104).

However, he surveyed the history of religious fanaticism and found it thoroughly antagonistic to Christ's teachings. In his view, protracted revival camp meetings were unhealthy and unscriptural, resulting "in the multiplication of diseases of the nervous system, in the increase of epilepsy, convulsions, hydrocephalus and insanity, and in a generation of men and women, weak and enfeebled in body and mind" (1835:178).

Brigham explained the psychological power of revivals and camp meetings in terms of the then-current theory of social imitation or sympathy (1835:256) which could produce mass hysteria (cf. Mackay, 1852; Le Bon, 1895). Thus, the spiritual manifestations allegedly experienced by participants in revivals were illusions and the consequence of an overtaxed nervous system. In a numbered, italicized, formal proposition he expressed the root concept of the theory of religious insanity: "I. All long continued or violent excitement of the mind is dangerous, because it is likely to injure the brain and nervous system" (1835:284). Because Brigham provided the classic medical-theological statement of the theory, I have reproduced his own prepositional summary here in Table 4.

TABLE 4
THE THEOLOGICAL-MEDICAL ARGUMENT OF AMARIAH BRIGHAM
First. The religious sentiment is innate in man; but as it often acts blindly, and to the injury of man, it needs the guidance of reason and knowledge.
Secondly. Christ established no ceremonies at all: he exacted virtuous conduct, not the observance of rites. The reformation of Luther abolished some of the ceremonies that had been improperly ingrafted upon Christianity, but not all. That they have ever been fruitful sources of discord, and ought to be relinquished.
Thirdly. Mankind are not at present under any kind of miraculous dispensation; that God has no supernatural dealings with men, that we can observe; and does not now impart the special influence of his Spirit to a few individuals and at particular times, as is claimed by modern revivalists. That this doctrine of revivalists, lies at the foundation of religious fanaticism, - is not essential to Christian faith or conduct, and if enforced by preachers and believed by the people, some form of this fanaticism will always disturb the church and the world.
Fourthly. That numerous meetings for religious purposes, night meetings, camp meetings, protracted meetings, etc., injure the health, - cause insanity, and other diseases, and ought to be abandoned as unscriptural, and very unreasonable in this age, when information on all subjects can be obtained by reading. That they produce and perpetuate great excitement, that is particularly dangerous to females, to mothers, and the rising generation.
Fifthly. The Sabbath is a day of rest for man and beast, and ought to be so regarded in practice.
Sixthly. That religious worship and the cultivation of devotional feelings, are beneficial to man, when not carried to an unreasonable extent.
Quoted from Brigham (1835), pages 330-331.

When Brigham first made these views public, "he brought upon himself a charge of skepticism and infidelity" (Hurd, 1916:361). Despite the piety in which they were couched, his psychological theories challenged popular religious notions, as did the entire enterprise of scientific study of the mind. In a popular book on mental hygiene, Dr. Isaac Ray was forced right at the beginning to consider the challenge psychiatry gave to the Christian theory of the soul, commenting that the idea the mind

could be affected by any merely physical conditions seemed to be degrading to its dignity, and indicative of the coarsest materialism. If the mind may be diseased, then it may perish, and so our hopes of immortality be utterly destroyed. This startling conclusion has been sufficient to deter the mass of mankind from admitting very heartedly the facts which physiological and pathological inquiries have contributed to this subject (Ray, 1863:1-2).

Those who held both religious and scientific views had long resorted to the hypothesis that the nervous system was the means by which the immortal soul expressed itself in the material world, that the brain was the instrument through which the soul plays its tune. Like Brigham, Ray says that madness may be produced by overexcited religious sentiments but not by the more sober and dignified variants of religion. Often he defends psychiatry against potential charges of infidelity, in an essay which is both scientific and theological. Despite these pious disclaimers, psychiatry and the social sciences have from the beginning played roles in eroding religious faith, and their theories do often challenge the doctrine of the soul (cf. Clock and Stark, 1965:289-306).

Psychiatry as a Tool of Social Control and Status Assertion

In the days of Brigham and Ray, psychiatrists opposed not religion in general but only its sectarian, high-tension varieties. Although Brigham criticized Catholic practice, the only denominations mentioned by name as causes of insanity in any of the reports examined by me are Spiritualism, Millerism and Mormonism, three deviant religious movements. The camp meetings, revivals and winter baptisms by total immersion attacked as unhealthy by Brigham and his colleagues were all practices emphasized by high-tension sects.

Sectarian tension has been described as deviance from the standards of the societal elite or the majority, marked by social separation, difference in beliefs and practices, and by mutual hostility between the sect and the more respectable society (Johnson, 1963; Stark and Bainbridge, 1979; Bainbridge and Stark, 1980). Tension is a fact not only of some religious organizations but also of some secular cultural movements. Throughout their history, schools of psychiatry have been marked by many of the features of sectarian religion, including not only strange beliefs and practices but also a marked tendency toward dogmatism and organizational schism.

It may be too much to conclude that psychiatry is a religion (cf. Frank, 1961; Tennov, 1976), because it lacks supernatural assumptions (Stark, 1981), but in many ways it presents direct competition to religion, and psychiatrists often function as evangelists who must first convert their congregation before ministering to its spiritual needs. In one of his many tirades against religion as a "shared delusion," Freud (1927) admitted that his own system might be an illusion of the same order, and the evolution of psychotherapies into religious or quasi-religious cults is today a well-known phenomenon (Rieff, 1966; Fodor, 1971; Wallis, 1976; Bainbridge, 1978).

The theory of religious insanity flourished in a period when medicine was largely unregulated, often pseudoscientific, and of dubious social status in the community (Kett, 1968). The alienists named here were highly educated men who had been given high public trusts as directors of asylums and chairmen of governmental commissions. While medicine groped toward respectable status, the alienists wished to be seen as scientists, scholars, humanitarians and community leaders. Yet they were doubly marginal. First, they were doctors when doctors were justly suspected of quackery. Second, they were alienists when their specialty was seldom included in medical educations.

In 1867, Pliny Earle told the Berkshire Medical Institute that a course in psychiatry was essential for the general practitioner, both to guide him in diagnosis and treatment and to give him information on mental hygiene with which to indoctrinate his community. In support, Earle conjured up vivid images of the danger to social status when unprepared doctors were called upon to testify in court upon the issue of mental competency:

some, with sufficient sagacity to perceive, after they went into court, the meshes of the net, and the cat beneath the meal, were wise enough to be very suddenly and unexpectedly called home before the court was ready for their testimony; while but too many others, supplying their deficiency of knowledge by a complement of confidence, have tied themselves to the Promethean rock with a cord of blunders, and the lawyers have torn from them, strip by strip, their bleeding flesh, until nothing was left but dry and disjointed bones, dangling and rattling in the wind. Were psychological medicine properly taught in the schools, such mistakes, which bring odium upon the profession, would not be likely to occur. (Earle, 1867:19)

But for the period under consideration here, medicine was generally taught in proprietary medical schools which set their own standards and seldom cooperated to provide organizational or conceptual coherence to their profession. As Kett commented, "Operating without outside restraint, their activities quickly took on molecular characteristics, bouncing about at random, smacking into each other, forming chance alliances, and breaking into still smaller particles" (1968:65). One sign of the almost universal desire among physicians to appear scientific and to assume a respected role in their communities was the almost perfect rate of participation (99.7 percent) of 1,319 Massachusetts doctors asked to carry out a state census of the insane and mentally retarded (Jarvis, 1855:15).

In his massive, influential Treatise on the Medical Jurisprudence of Insanity (1871), Isaac Ray argued that only experienced alienists could diagnose insanity and were the proper experts to testify in legal proceedings. Thus, the psychiatrists struggled to attain honor and status from elite and respectable sectors of American society. In terms of religion theory, they sought to reduce their tension with the sociocultural environment. The scorn for high-tension religion expressed through their theory of religious insanity served perfectly this attempt by the alienists to achieve low tension, and may in part have been a rhetoric designed with just this purpose in mind.

But there is more to it than that. However comfortable the alienists may have been with diagnoses of religious insanity, the published cases suggest that these judgments were usually made first by family and friends of the afflicted, with the doctors often merely accepting these lay diagnoses. Indeed, the enumeration instructions for the 1860 census assumed that most causes of insanity would be readily apparent to household members. Thus, the ideology of religious insanity was part of national culture, accepted by ordinary members of the community, as well as by national opinion leaders.

Some theorists in the labeling-theory or anti-psychiatry traditions would suggest psychiatry was merely used by families to punish deviant members and was an instrument of the community used to suppress religious deviance (Goffman, 1961; Scheff, 1966; Laing, 1967; Szasz, 1970). The high reported cure rate for religious insanity is consistent with this interpretation. But only a deep study of hospital records or autobiographical accounts could tell us for sure if some of those labeled insane merely held unpopular views.

The possibility remains that sometimes the alienists were right and religion was in some way the proximate cause of psychiatric disorder. So-called "hysterical states" in preliterate societies often involve delusions of spirit possession or other apparently religious experiences. I. M. Lewis (1971) interprets these phenomena as oblique redressive strategies, instrumental roles adopted by oppressed persons as means for forcing their families and neighbors to treat them better.

While hysterical use of supernatural symbolism is not an effective strategy in modern society, it probably still had its place in nineteenth-century America. Some hospitalized mental patients may have been hysterics dramatizing their struggle with social conditions through religion. Since hysteria is impossible without a suitably scripted role to play, religion would be properly implicated as an enabling cause.

Furthermore, it is clear that many symptoms of mental illness are really attempts by the patient to cope with a deep-seated problem. People beset with mental illness often fall back upon basic coping strategies rooted deep in their culture (Opler and Singer, 1956; Breen, 1968). Religion provides plans and interpretations for dealing with the greatest and most terrifying challenges of life (Stark and Bainbridge, 1980). Thus, some patients respond to their illnesses as religious problems, thereby manifesting symptoms of religious insanity, even though religion was a response rather than the cause of the problem (Bainbridge and Stark, 1979).

The idea that physical or emotional shocks could drive susceptible persons into madness was well-adapted to an age that held high hopes for the cure of insanity (cf. Langfeld, 1939). The asylums proliferated in this period, nurtured by propaganda that speedy removal of the afflicted to a place of care and rehabilitation could restore most to sanity (Rothman, 1971). An optimistic "cult of curability" dominated psychiatry, not incidentally helping the psychiatrists sell their services to the public (Earle, 1887).

If excessive religious excitement had caused a nervous breakdown, the calm environment of the idealized asylum, augmented by sober religious services, could heal nerves and restore sanity. The suspicions respectable people held of wild revivalists rendered the concept of religious insanity plausible and, in turn, facilitated their acceptance of psychiatry.

Conclusion

The official nineteenth-century theory of insanity was a marvel of eclecticism. The root concept was the idea that stress could exhaust a constitutionally weak nervous system. Were the stress great enough, even the strongest mind would succumb. The sources of stress and exhaustion were many but could be grouped under the headings physical and moral. Under the gross categories were finer ones, like religion, and within these were even finer divisions, like the 300 different etiological comments found in the census records. Thus the system possessed great flexibility, because one could focus either on general categories and over-arching concepts or on specific causes in particular cases.

The great flexibility of the system in turn permitted the high degree of consensus it achieved for the better part of the nineteenth century. A doctor who believed mental illness was mainly an inherited trait could happily agree with one who held that religious revivals and other social-psychological shocks were responsible, because the official theory fitted both ideas together in a way which minimized debate.

Everything was a matter of degree, because all popular ideas on madness were incorporated in a single ideological structure. The ordinary citizen and the trained physician could share the same perspective, because the most specific concepts in the system referred to every-day ideas like grief over the loss of a loved one, while the general structure of the theory gave it the appearance of a science fully comprehensible only to highly trained specialists.

The official theory of which the concept of religious insanity was a part may have had especially benevolent consequences for patients, not only because of its basic optimism, but also because it saw patients as individuals driven mad by very particular circumstances rather than as faceless multitudes swarming in vast herds named by a few diagnostic terms. The 300 different etiological terms used in the census records describe 2,258 human beings. Thus, on average, there are only eight people per concept, and in fact there were many instances of individuals possessing unique etiological comments. But by 1880, when we find 629 inmates in the census records for the Cleveland asylum, only six diagnostic terms are found, one for every hundred.

Throughout the nineteenth century, alienists worked to construct a system to categorize the forms of insanity, quite separate from the theory of causes - a typology based on symptoms (Bucknill and Tuke, 1879:142-305). The 1860 census report was able to assert: "The five great generic terms, Mania, Monomania, Melancholia, Moral (or Emotional) Insanity, and Dementia, constitute a grouping, which, for general purposes, is as good as any which has been devised" (Kennedy, 1864: lxxx).

The enumerator who visited the Mississippi asylum wrote such terms down for all the inmates, as well as the supposed causes. But by 1880, alienists were no longer expected to distinguish patients through a long list of distinct causes, so at the Cleveland asylum we find 3 inmates suffering from imbecility, 5 from dipsomania, 6 from paresis, 210 from melancholia, and 369 from mania. These technical terms gave added scientific luster to the psychiatric profession, although we can doubt they promoted deeper real understanding of insanity.

The system of supposed causes, including religious excitement, was not completely abandoned until well into the twentieth century. For example, patients sent from Alaska to the Oregon Asylum, and others in Washington state, were still described in this way as late as the 1930s. But as an official national ideology, the theory lost its dominance in the two decades after 1860, being replaced by pessimistic agnosticism and hereditary explanations, as the asylums developed into custodial institutions with far lower expectations of cure.

With the decline of the theory, American culture lost a doctrine of mental hygiene that mixed scientific and religious concepts with traditional moralism and humane optimism. The theory of religious insanity was a tool of low-tension religion against sects and revivals, and a means by which psychiatry promoted itself toward respectable scientific status. But for many Americans it also was a system which rendered madness comprehensible in familiar terms and offered considerable hope that the great suffering of insanity could be overcome.

NOTE

This project was supported in part by Harvard University and by the Center for Studies in Demography and Ecology, University of Washington. I wish to thank the National Archives and Records Service, General Services Administration, for providing the microfilms of census schedules which made this research possible.

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