The following will be a look at the history of pastoral care in the Church, with the help of the authors of Modern Psychopathologies: A Comprehensive Christian Appraisal. Strictly speaking, Christian pastors have always been psychologists in the most literal sense; that is, they are those who study the soul. As Christians, their principles were derived primarily from scripture rather than scientific study. Origen of Alexandria, one of the Church’s earliest theologians, described the pastor as a physician of souls to whom Christians should confess their sin. This becomes necessary because Adam’s fall into sin has resulted in a universal, corporate alienation from God, leaving us in the grip of sinful desires, and both the guilt and corruption of these desires can only be healed by regeneration and faith.
Origen helpfully describes the complex set of dispositions that can influence how the Christian experiences his emotions and desires:
“I do not think it is possible to explain easily or briefly how a soul may know herself; but as far as we are able, we will try to elucidate a few points out of many. It seems to me…that the soul ought to acquire self-knowledge of a twofold kind: she should know both what she is in herself, and how she is actuated; that is to say, she ought to know what she is like essentially, and what she is like according to her dispositions. She should know, for instance, whether she is of good disposition or not, and whether or not she is upright in intention; and, if she is in fact of an upright intention, whether, in thought as in action, she has the same zeal for all virtues, or only for necessary things and those that are easy; furthermore, whether she is making progress, and gaining in understanding of things, and growing in the virtues; or whether perhaps she is standing still and resting on what she has been able to achieve thus far; and whether what she does serves only for her own improvement; or whether she can benefit others, and give them anything of profit, either by the word o teaching or by the example of her actions…And the soul needs to know herself in another way – whether she does these evil deeds of hers intentionally and because she likes them; or whether it is through some awareness that, as the Apostle says, she works what she would not and does the things she hates, while on the contrary she seems to do good deeds with willingness and with direct intention. Does she, or example, control her anger with some people and let fly with others, or does she always control it, never give way to it with anyone at all? So too with gloominess: does she conquer it in some cases, but give way to it in others, or does she never admit it at all?”
St. Augustine likewise describes sin as a corruption or disorder of desire:
“The person who lives a just and holy life is one who…has ordered his love, so that he does not love what it is wrong to love, or fail to love what should be loved, or love too much what should be loved (or love too little what should be loved more), or love two things equally if one of them should be loved either less or more than the other, or love things either more or less if they should be lobed equally. No sinner, qua sinner, should be loved; every human being, qua human being, should be loved on God’s account; and God should be loved for himself. And if God is to be loved more than any human being, each person should love God ore than he loves himself. likewise, another human being should be loved more than our own bodies, because all these things are to be loved on account of God whereas another person can enjoy God together with us in a way in which the body cannot, since the body lives only through the soul, and it is the sol by which we enjoy God. All people should be loved equally.”
Gregory the Great went on to outline different temperaments and qualities o character. He acknowledged that exhortation should be given according to the specific case and person. “One and the same exhortation is not suited to all.” The pastor’s exhortation must b “adapted to the character of the hearers, so as tobe suited to the individual in his respective needs, and yet never deviate from the art of general edificcation.” He provided a classification system of for systematizing different sorts of states and characters one ought to take into consideration when providing counsel.
“In addition to the categories of gender, age and social position, these included such categories as joyful and sad, wise and dull, impudent and timid, insolent and fainthearted, impatient and patient, kindly and envious, sincere and insincere, hale and sick, fearful and impervious, taciturn and loquacious, slothful and hasty, meek and choleric, humble and haughty, obstinate and fickle, gluttonous and abstemious, generous and thieving, discordant and peacemakers. These categories evidence both conditions of the souls due to sinful vices and conditions due to what might be called temperament.”
Celtic writers, many times following John Cassian or Gregory, articulated penitential books whose purpose was to care for the soul of the Christian. Writing in the sixteenth century, Ignatius of Loyola discussed the soula s being prone to “desolation” and said that it was only through “consolation” that the restoral of the soul could take place:
“I call it consolation when the soul is aroused by an interior movement which causes it to be inflamed with love of its Creator and Lord, and consequently can love no created thing on the face of the earth for its own sake, but only in the creator of all things…I call consolation any increase of faith, hope and charity and any interior joy that calls and attracts to heavenly things, and to the salvation of one’s soul, inspiring it with peace and quiet in Christ our Lord. I call desolation all that is contrary to the third rule, as darkness of the sol, turmoil of the mind, inclination to low and earthly things, restlessness resulting from many disturbances and temptations which lead to loss of faith, loss of hope, and loss of love. It is also desolation when a soul finds itself completely apathetic, tepid, sad, and separated, as it were, from its Creator and Lord. For just as consolation is contrary to desolation, so the thoughts that spring from consolation are the opposite of those that spring from desolation.”
Later Protestants, especially among the Puritans, tended to focus on the spiritual causes of depression or melancholy, and directed the individual towards scripture in these cases. Indeed, in general, Christian pastors have been primarily concerned about the spiritual causes of depression. These desires result from an inordinate desire of worldly things that are subject to loss, rust and decay, rather than contentment with the spiritual provision of God. The Didache, for example, bids us confess our sins in order to alleviate a bad conscience.
The Bigotian Penitential insisted that confession should take into account “the age and sex of the penitent, his training, his courage, with what force he was driven to sin, with what kind of passion he was assailed, how long he continued in sin and with what sorrow and labor he afflicted.” The Penitential of Columban from the 7th century said “For even the physicians of bodies prepare their medicines in various sorts. For they treat wounds in one way, fevers in another, swellings in another, bruises in another, festering sores in another, defective sight in another, fractures in another, burns in another. So therefore the spiritual physicians ought also to heal with various sorts o treatment the wounds, fevers, transgressions, sorrows, sicknesses and infirmities.”
The Puritan Richard Baxter’s “Christian Directory” is one of the most comprehensive Puritan works on pastoral care. The Puritans believed that we are sick because of our sin, spiritually, and that those who are regenerated are still sick but progressively become better. On the other hand, some Christian theologians acknowledged that mental illness could come from physiological sources. Origen of Alexandria writes:
“First let us inquire how he who has been cast into darkness and repressed by an impure and deaf and dumb spirit is said to be a “lunatic,” and for what reason the expression to be a “lunatic” derives its name from the great light in heaven which is next to the sun, which God appointed “to rule over the night.” Let physicians then, discuss the physiology o the matter; inasmuch as they think that there is no impure spirit in the case, but a bodily disorder, and inquiring into the nature of things let them say, that the moist humours which are in the head are moved by a certain sympathy which they have with the light of the moon, which has a moist nature…It is evident that this disorder is very difficult to cure, so that those who have the power to cure demoniacs sometimes fail in respect of this, and sometimes with fastings and supplications and more toils, succeed.”