2013-01-13

Considerations on Mental Illness from St. Teresa

Book of the Foundations
by St. Teresa of Avila
Chapter VII - Treatment of Melancholy Nuns

1. These my sisters of St. Joseph's in Salamanca, where I am staying while writing this, have pressed me much to say something about the treatment of melancholy; for, however careful we may be not to admit nuns subject to it, the disease is so subtle that it counterfeits death whenever it is necessary, and accordingly we do not find it out till it is too late. I think I have said something about it in a little book of mine : I do not remember: if I speak of it now there can be no harm, if our Lord will be pleased to help me to do it aright. It may be that I have said it already at some other time: I would say it a hundred times if I thought I could once say anything that would be of any use. The devices which this temper searches out for the purpose of doing its own will are so many that it becomes necessary to look into them, to enable us to bear with it and control it, lest it should do a mischief to others.

2. It is to be observed that they are not all so troublesome who are subject to melancholy; for humble and gentle persons thus afflicted, though very troublesome to themselves, never do any harm to others, especially if they have good sense. And, moreover, there are varieties of this temper. I verily believe that Satan lays hold of it in some people as a means whereby to draw them to himself if he can, and he will do so if they are not very careful: for, as the chief work of this temper is to bring reason under its control, which then becomes obscured, what then, under such conditions, will our passions not do? They who have no reason, it seems, must be mad, and so it is; but in those of whom we are now speaking the evil has not gone so far, and it would be a much less evil if it had; for to be obliged to live as a reasonable person, and treat another as reasonable who has no reason, is an unendurable hardship. Those who are altogether sick of this malady are to be pitied, but they do no harm; and, if there be any means whereby they may be kept under control, those means are fear.

3. Those in whom this evil, which is so hurtful, has only begun, though it may not have gained so much strength, yet as it has the same nature and source, and because it grows from the same root, it must be treated in the same way if other remedies be not sufficient; the prioresses must have recourse to the penances in force in the order, and strive to bring under subjection nuns who thus suffer, that they may feel they are never, and in nothing, to do their own will; for if they find that their clamour, and the despondency into which Satan casts them for the purpose of driving them if he can to destruction, can at any time prevail, they are lost, and one sister in this state is enough to disquiet a monastery. As the poor soul has nothing in herself that can help her to defend herself against the suggestions of the evil one, the prioress must be very watchful in her direction of her, not only outwardly but inwardly also, for reason, which in the sickly sister is already darkened, ought to be the more clear in the prioress, that the devil, making use of this weakness, may not bring that soul under his own power.

4. The matter is dangerous; for at times this temper is so overbearing as to conquer reason, and there is no sin then, as there is none in madmen, whatever disorders they may commit; but it is necessary that those sisters who are not so overcome, in whom reason is only weakened, not lost altogether, and who are good at other times, should not, on those occasions when they are afflicted, begin to take any liberties, lest they should be unable when well to control themselves, for the cunning of Satan is fearful. And accordingly, if we look into it, we shall find that what they are most given to is the doing of their own will, saying whatever comes into their head, observing the faults of others that they may hide their own, and amusing themselves with that wherein they find pleasure; in short, they are like a person without the power of self-restraint. Then, with passions unmortified, and everybody bent on having their own way, what will be the result if there be none to control them?

5. I say it again, for I have seen, and have had much to do with, many persons troubled with this disease, that there is no other remedy but to conquer them by every way and means in our power. If words be not enough, have recourse to penances, and let them be heavy if light penances will not do: if one month's imprisonment be not enough, let them be shut up for four; you cannot do their souls a greater service. For, as I said before, and say again, it concerns them to understand this: though once or occasionally they may not be able to restrain themselves, it is not a confirmed madness, whereby all blame is taken away; though it may be so at times, yet it is not so always, and the soul is in great danger unless, as I say, they are so deprived of their reason as to do or say those things which they do or say when they cannot help themselves. It is of the great compassion of God that those who are thus disordered are obedient to their superior, for all their good consists in that amid the dangers I speak of. And, for the love of God, let her, whoever she may be, that reads this, look into it, for it may perhaps concern her salvation.

6. I know some who very nearly lost their senses, but who are so humble in spirit, and so afraid of offending God, that, though in secret they waste away in weeping, yet do only what they are commanded, and bear their infirmity like the others. But this is a greater martyrdom, and they will therefore have a greater glory, and in this life their purgatory that they may not have it in the next. But I say it again, that they who will not do this with a willing heart must be compelled to submit by the prioress, and they must not delude themselves by their indiscreet devotions in their disorderliness so as to be a trouble to all their sisters. It must be done, because of another very grave evil over and above the danger to the weak sister herself: for when the others see her, to all appearance in good health, not knowing what her soul suffers interiorly from the violence of her disorder—we are naturally so miserable—they will all think themselves subject to melancholy, that they may be borne with in the same way: moreover, Satan will make them think so, and the havoc he will then make will be, when found out, very difficult to undo. So important is this that no negligence ought to be tolerated in the matter, and the melancholy sister, if disobedient to the superior, must suffer for it as if she were in her right mind, and nothing must be forgiven her; if she speaks in an unbecoming manner to any of her sisters she must be punished as the others, and for every imperfection of the same kind.

7. It seems unjust to punish the sick sister, when she cannot help herself, as if she were well: so does it also to bind madmen and to correct them, instead of leaving them free to kill everybody. Trust me, for I have tried it, and I believe have had recourse to many remedies, but never found any other than this. And the prioress who, out of pity, will have allowed these to begin with taking liberties, will not be able to bear with them in the end; and when she comes to correct them she will find that much harm has been done to the others. If madmen are bound and chastised to keep them from killing people (and that is rightly done; yea, and seems a great kindness, because they cannot help themselves), how much more must these sickly sisters be looked after, that they, with the liberties they take, may not do harm to the souls of others! And I really believe that the mischief comes very often, as I am saying, from a spirit undisciplined, wanting in humility, and badly trained, and that the melancholy temper is not so strong as this. I say it is so in some, for I have seen them obey, and control themselves in the presence of one they fear; why, then, not do as much for God?

8. I am afraid that Satan, under the pretence of this temper, seeks to gain many souls. It is more common in our day than it used to be; the reason is that all self-will and licence are now called melancholy. I have therefore thought that in these houses, and in all houses of religion, this word should never be uttered, because it seems to bring licence with it, and that the disorder it implies should be called a serious illness—and how serious it is!—and treated accordingly; for it is very necessary at times to correct the peccant humours by the use of medicines to make them tolerable; and the sister should be in the infirmary, and be made to understand that when she comes out to join the community she must be humble like everybody else, and that if she is not her melancholy shall be no defence for her, because that is necessary for the reasons I have given, and I might give more. It is necessary that the prioress, but without letting them know it, should treat them with great tenderness, like a true mother, and search out every means she can to cure them.

9. I seem to be contradicting myself for I have been hitherto saying that they are to be severely dealt with. So I say again; they should never be allowed to feel that they may have their own way, neither should they have it, it being a settled thing that they shall be obedient, for the evil consists in their feeling that they can have liberty. However, the prioress may refrain from laying upon them a command which she knows they will disobey; because they are not strong enough to do violence to themselves; she should manage them and influence them by affection to do that which is required of them, in order, if possible, to make them submit out of affection, which will be far better and is generally successful when the prioress shows them much affection, and makes them feel it by her acts and words.

10. And the superiors must see that the best remedy within their reach is to employ them largely in the duties of the house, that they may have no opportunity of giving way to their imagination, for all the mischief is there; and though they may not do their work very well, their faults must be borne with, in order that there may be no occasion for bearing with greater after they shall have been ruined. I know this to be the most complete remedy that can be furnished them. Means also must be found to keep them in general from spending too much time in prayer, seeing that for the most part their imagination is weak, and that will do them much harm; if that be not done, they will be filled with fancies, which neither they nor those who may hear of them will ever be able to understand.

11. Care must be taken that they eat fish but rarely, and it is necessary also that they should not fast so much as the others. It may seem superfluous to give so much advice about this evil and none about any other, when the evils of our wretched lives are so grievous, especially those arising from the weakness of women. There are two reasons for it: the first is, they think themselves well, for they will not confess that they suffer from this disorder; and as their illness, not being a fever, forces them neither to keep their bed nor to call in the physician, the prioress must be their physician, for the disease is more hurtful to perfection than is theirs who, in danger of their life, remain in their beds.

12. The second reason is, that in other illnesses they either recover or die; but it is very rarely that people recover from this or die of it either, but they lose all sense, and that is a death which kills all the others. They carry about within themselves a cruel death of sorrows, fancies, and scruples, and therefore merit very much thereby, though they always call them temptations; for if they were once persuaded that all flows out of this one evil they would be greatly relieved, provided they made no account of it. Deeply, indeed, do I feel for them, and it is right that all who are living with them should feel for them in the same way, considering that our Lord might have visited us with a like affliction; and above all, bearing with them, as I said just now, without letting them know that we are doing so. May our Lord grant that I have found out what ought to be done with so grave a malady!


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