The subject of this imaginative and stimulating book is the rise and decline of “spiritual physic”—the one form of “mental health care,” as David Lederer calls it, that was under the custody of Catholic clergy. Its context was the Catholic Reform of the late sixteenth and seventeenth centuries; it approached insanity as a spiritual disturbance and so embraced a broader range of disorders than academic psychiatry—another sixteenth-century innovation; its practitioners were parish priests, in the first instance, but also Jesuit confessors the clergy attached to pilgrimage shrines. Spiritual physic was, in short, the “cure of souls” applied to mental disorder and as such the first form of mental health care made available to the population at large. This characterization is anything but anachronistic: if the label jars, it is to sensitize readers to radical otherness of early modern attitudes toward mental illness and its cures. Only by jettisoning the universalizing truth-claims and diagnostic categories of modern psychiatry can one grasp the inner workings of spiritual physic and its functions in society, politics, and culture.

To do this, Lederer draws on a rich variety of Bavarian sources, including some two thousand “case histories” scattered among the records of the duchy's fiscal bureaus (Rentämter) and in miracle books maintained at the shrines of Beata Alta at Pürten and St. Anastasia at Benediktbeuren, both of which specialized in the miraculous cure of mental afflictions. These sources describe the complex interplay of power relations, intellectual currents, and religious mentalities that shaped elite and popular responses to mental disorder. At one level, for example, Lederer's narrative is about the exercise of state power. As he shows in chapter two, the trajectory of spiritual physic in Bavaria followed the arc of confessionalization in its most heavy-handed phase, when dukes Wilhelm V (1579-1597) and Maximilian I (1597-1651) promoted communion, penance, and the new technique of auricular confession, both as instruments for the enforcement of orthodoxy and for the consolation of troubled souls. Together with shriving and penance, therefore, spiritual physic was implicated in the fundamental ideological processes of early modern state building—the reification of the self, the isolation of the individual as an object of domination, and internalization of emotional controls, and the conflation of orthodoxy with obedience to authority. For some it was all too much: the penitential regime aroused such guilt in already unstable Katharina Rieder that she felt compelled to surrender herself “to the devil totally and completely” (p. 229). But Rieder's exception proves the rule. To judge by the crescendo of penance and confession at the shrines at Pürten, Benediktbeuren, and elsewhere, the Bavarian disciplinary campaign appears to have been a success.

Lest this all seem too Foucauldian, Lederer also warns against interpreting spiritual physic simply as an emanation of “power/knowledge.” The disciplinary ambitions of the Bavarian duchy always surpassed its means, as Lederer shows toward the end of chapter two; moreover its ideology of Bavaria Sancta—the subject of chapter three—had the perverse effect of endorsing a religious practice, pilgrimage, that offered ludic release from the moral strictures of daily life at home. If Bavaria's disciplinary regime succeeded, Lederer argues, it was because ordinary believers found that auricular confession offered them “a welcome opportunity to voice personal insecurities and seek … consolation in an otherwise rigid moral climate” (p. 284). Thus attitudes toward mental illness were shaped by the interaction of elites and plebes, and in this Lederer echoes an argument advanced by Marc Forster and Heinrich R. Schmidt, that Baroque Catholic spirituality is inexplicable without accounting for popular demands for religious and emotional satisfaction. The power of these forces and the inadequacies of Foucault's account are nowhere more apparent than in chapter six, on the segregation and confinement of the mentally insane. The Bavarian state actively promoted the foundation of hospices, but as Lederer shows, local communities were the driving force behind the segregation of the chronically insane. Similarly, the state's aims were often frustrated when they ran afoul of communal norms. Attempts by the ducal Aulic Council to redefine suicides as mentally insane and therefore eligible for churchyard burial, for example, came to grief when communes resisted the interment of such bestial apostates in their parish churchyards.

Episodes such as these are typical of the interactions that shaped the decline of spiritual physic. Lederer's fifth chapter brilliantly reconstructs a change of heart concerning “religious madness” among Bavaria's governing elites, who shifted gradually away from diagnoses of demoniac possession and, consequently, from exorcism—the therapy of last resort in the manual of spiritual physic. The attitudes of ordinary Bavarians, perhaps inevitably, are harder to pin down. The centerpiece of this book, chapter four, analyzes the varieties of mental affliction recorded in the miracle books of Beata Alta and Anastasia. Lederer uses these data to argue, rightly, that ordinary Bavarians distinguished subtly among many causes of insanity, including somatic disorders, shock, demonic temptation, and possession. More problematic is his contention that this phenomenology of mental illness also attests to the perceived efficacy of spiritual physic—an interpretation that comes perilously close to conflating consumption with consent. Elsewhere, Lederer seems to argue by sleight of hand: enthusiasm for pilgrimage becomes enthusiasm for frequent communion, which in turn becomes evidence for the popularity of spiritual physic. To his credit, Lederer acknowledges the variety of reasons for going on pilgrimages. Still, one could deduce the opposite conclusion: at a pilgrimage shrine, the contrite Bavarian could obtain her Beichtzettel without having to reveal her sins to her parish priest—who was, after all, both the exclusive local supplier of spiritual physic and the principal enforcer of moral discipline and Catholic orthodoxy. If the popularity of spiritual physic were behind pilgrimage, moreover, why did the traffic at shrines peak in the eighteenth century, by which time spiritual physic had gone into decline? None of this is meant to suggest that Lederer's interpretations are mistaken, but to point up the difficulties involved in reconstructing popular mentalities from evidence structured by the interests and agendas of elites.