The Influence of Physical Causes Upon the Moral Faculty: How Founding Father Benjamin Rush Revolutionized Our Understanding of Mental Health
By Maria Popova
“It is now the most vitally important thing for all of us, however we may be concerned with our society, to try to arrive at a clear, cogent statement of our ills, so that we may begin to correct them,” the theologian Thomas Merton wrote to Rachel Carson in his letter of appreciation, commending her for diagnosing one of the most pernicious maladies of our civilization. “Otherwise,” he warned, “our efforts will be directed to purely superficial symptoms only, and perhaps not even at things related directly to the illness.”
Few visionaries have diagnosed more societal ills, more accurately and more presciently, or devised and championed more effective treatments, than Benjamin Rush (January 4, 1746–April 19, 1813).
Half-orphaned at the age of five and raised by his widowed mother, Rush was thirty when he signed the Declaration of Independence. He had graduated from what is now Princeton sixteen years earlier and had been a practicing physician for seven years. He would go on to became George Washington’s Surgeon General and America’s preeminent physician and most influential public health champion. He would advocate for public schooling and for opening education to women, Africans (who, in an era of enslavement and complete political disenfranchisement, were yet to be African American), and immigrants who spoke no English. He would rail against racism and capital punishment, found the nation’s first rural college, and help black clergymen establish two of the nation’s first churches for black congregations. In the final stretch of his life, in his collection of pithy assessments of the founding fathers, he would encapsulate himself in only three words: “He aimed well.”
But Rush’s most profound contribution to progress was arguably something different, springing from this selfsame devotion to equality — the groundwork he laid for modern notions of and practices regarding mental health, or what we now know as psychiatry, clinical psychology, and addiction medicine, based on his then-countercultural insistence that mentally ill people are still, first and foremost, people. A century before Nellie Bly’s paradigm-shifting exposé “Ten Days at the Madhouse,” at a time when mental asylum patients were housed in rat-infested stables, habitually brutalized by guards, and chained to the floor until they “improved,” Rush advocated for honoring their humanity and dignity in treatment, pioneering forms of psychiatric care closely resembling the modern. At the heart of his ethos and its revolutionary enactment in medicine was a fiery rebellion against the Cartesian mind-body divide. A century before William James proclaimed that “a purely disembodied human emotion is a nonentity”, a quarter millennium before scientists began understanding now our minds and our bodies converge in the healing of trauma and that mental illnesses like anxiety are deeply embodied experiences, and with the birth of neuroscience still more than half a century away, Rush believed that physical, emotional, mental, moral, spiritual, and political health, as well as public and private health, were interleaved into one indivisible ecosystem of wellbeing.
This was a radical notion, and Rush was a radical man epochs ahead of his time. He knew it, and he was content to pay the price. Two centuries before Bertrand Russell exhorted in the seventh of his ten commandments of critical thinking — “Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric.” — Rush wrote:
The most acceptable men in practical society, have been those who have never shocked their contemporaries, by opposing popular or common opinions. Men of opposite characters, like objects placed too near the eye, are seldom seen distinctly by the age in which they live. They must content themselves with the prospect of being useful to the distant and more enlightened generations which are to follow them.
More than two centuries later, this extraordinary and underappreciated man is reinstated to his rightful place in the canon of civilizational advancement in Rush: Revolution, Madness, and Benjamin Rush, the Visionary Doctor Who Became a Founding Father (public library) by Stephen Fried — my first and foremost writing mentor, whose research intern I had the pleasure of being long ago, spending countless hours squinting at microfilm of 19th-century newspapers in exchange for two subway tokens a week and his immense wisdom on writing and scholarship.
Fried writes of Rush — a lean, tall, handsome, “promiscuously opinionated young fellow” with lively blue-gray eyes and a blond-brown ponytail trailing his noticeably large head — and the heart of his uncommon genius:
Unlike the pedigreed doctors who had trained him in America, Scotland, England, and France, Dr. Rush was a medical and political prodigy from a middle-class family on the humbler side of Philadelphia. He had lost his father, a gunsmith, at the age of five, leaving him and his five siblings to be raised by their mother, who opened a package goods store and tavern just down the street from Benjamin Franklin’s print shop and post office. But because of young Rush’s astonishing mind — besides total recall, he had what he referred to as the “peculiar happiness” of being able to synthesize and humanize disparate ideas into searing rhetoric — he had finished school at thirteen, graduated from the College of New Jersey (now known as Princeton) at fourteen, finished medical training in Edinburgh and London at twenty-two, and begun practicing and teaching medicine at twenty-three. He was still single in his late twenties because his family had convinced him it would be bad for his career to marry before thirty.
Rush seemed to understand people unusually well for a man so young, and his analysis moved easily from politics to religion to medicine to the calculus of liberty.
Rush would go on to churn his country’s revolution, political and social, by diagnosing the gravest ills of his culture — nowhere more astutely than in a landmark speech he delivered before the American Philosophical Society on February 27, 1786, just after his fortieth birthday. Titled “The Influence of Physical Causes Upon the Moral Faculty,” the speech examined the physical basis of what we now call mental illness — a notion foreign in an era when all psychiatric disorders were considered a function of vice, moral weakness, and personal failure. Against the favor of his time, Rush insisted that “melancholy and madness, in all their variety of species, yield with more facility to medicine, than simply to polemical discourses, or to casuistical advice.”
Rush begins with a necessary definition, distinguishing between morality and conscience — a distinction he likens to that between sensation and perception. He writes:
The moral faculty… is quick in its operations, and like the sensitive plant, acts without reflection, while conscience follows with deliberate steps, and measures all her actions by the unerring square of right and wrong.
As I consider virtue and vice to consist in action, and not in opinion, and as this action has its seat in the will, and not in the conscience, I shall confine my inquiries chiefly to the influence of physical causes upon that moral power of the mind, which is connected with volition, although many of these causes act likewise upon the conscience, as I shall show hereafter. The state of the moral faculty is visible in actions, which affect the well-being of society. The state of the conscience is invisible, and therefore removed beyond our investigation.
Noting that medicine has already identified a physical basis of such mental faculties as memory, judgment, and imagination, Rush argues that morality, too, has physical correlates. Aware of just how countercultural this proposition is at the time, he presages:
Men who have been educated in the mechanical habits of adopting popular or established opinions will revolt at the doctrine I am about to deliver, while men of sense and genius will hear my propositions with candour, and if they do not adopt them, will commend that boldness of inquiry, that prompted me to broach them.
Rush goes on to enumerate the effects of various physical conditions and habits — climate, weather, diet, alcohol, exercise, sleep — on mental states. Centuries before our understanding of the gut-brain connection and the advent of what we now call functional medicine, he illustrates his insight into the relationship between food and mood with a charming anecdote:
One of the worthiest men I ever knew, who made his breakfast his principal meal, was peevish and disagreeable to his friends and family, from the time he left his bed till he sat down to his morning repast; after which, cheerfulness sparkled in his countenance, and he became the delight of all around him.
But even more notable is his reach, perhaps inadvertent and intuitive, into the Eastern contemplative traditions of nondualism. Among the various physical habits and faculties he considers essential to moral development, he includes two rather Buddhist concepts: solitude and silence. Long before Hermann Hesse extolled solitude as the forge of destiny, Rush writes:
I hope I shall be excused in placing SOLITUDE among the physical causes which influence the moral faculty, when I add, that I confine its effects to persons who are irreclaimable by rational or moral remedies… Where the benefit of reflection, and instruction from books, can be added to solitude and confinement, their good effects are still more certain… Connected with solitude, as a mechanical means of promoting virtue, SILENCE deserves to be mentioned in this place.
He goes even further in his daring conception of holistic health. Centuries before Oliver Sacks revolutionized medicine by illuminating the powerful effects of music on neurologic function, Rush contributes to the canon of great minds extolling the power of music:
The effects of music, when simply mechanical, upon the passions, are powerful and extensive. But it remains yet to determine the degrees of moral ecstacy, that may be produced by an attack upon the ear, the reason, and the moral principle, at the same time, by the combined powers of music and eloquence.
Observing that in every culture, “the most accomplished orators have generally been the most successful reformers of mankind,” he adds the literary arts to the arsenal of morally beneficial human endeavors:
The language and imagery of a Shakespeare, upon moral and religious subjects, poured upon the passions and the senses, in all the beauty and variety of dramatic representation; who could resist, or describe their effects?
Given this interplay of the physical and the psychic, Rush marvels at the intricately interconnected structure of the human mind and its incessant dialogue with the body:
From a review of our subject, we are led to contemplate with admiration, the curious structure of the human mind. How distinct are the number, and yet how united! How subordinate and yet how coequal are all its faculties! How wonderful is the action of the mind upon the body! Of the body upon the mind!
In this yet-unmined relationship, Rush sees golden potential for improving human flourishing and moral development:
The extent of the moral powers and habits in man is unknown. It is not improbable, but the human mind contains principles of virtue, which have never yet been excited into action. We behold with surprise the versatility of the human body in the exploits of tumblers and rope-dancers… We feel a veneration bordering upon divine homage, in contemplating the stupendous understandings of Lord Verulam and Sir Isaac Newton; and our eyes grow dim, in attempting to pursue Shakespeare and Milton in their immeasurable flights of imagination. And if the history of mankind does not furnish similar instances of the versatility and perfection of our species in virtue, it is because the moral faculty has been the subject of less culture and fewer experiments than the body, and the intellectual powers of the mind.
Noting the advances of medicine in “mitigating the violence of incurable diseases” — from the alleviation of fevers to the proto-vaccination developed to curb smallpox, which had claimed more lives in the preceding century than all wars combined and which has since been completely eradicated — Rush argues that similar advances are to be made in alleviating psychic suffering through moral development:
A physical regimen should as necessarily accompany a moral precept, as directions with respect to the air — exercise — and diet, generally accompany prescriptions for the consumption and the gout… Medicine… has penetrated the deep and gloomy abyss of death, and acquired fresh honours in his cold embraces. — Witness the many hundred people who have lately been brought back to life, by the successful efforts of the humane societies, which are now established in many parts of Europe, and in some parts of America. Should the same industry and ingenuity, which have produced these triumphs of medicine over diseases and death, be applied to the moral science, it is highly probable, that most of those baneful vices, which deform the human breast, and convulse the nations of the earth, might be banished from the world. I am not so sanguine as to suppose, that it is possible for man to acquire so much perfection from science, religion, liberty and good government, as to cease to be mortal; but I am fully persuaded, that from the combined action of causes, which operate at once upon the reason, the moral faculty, the passions, the senses, the brain, the nerves, the blood and the heart, it is possible to produce such a change in his moral character, as shall raise him to a resemblance of angels — nay more, to the likeness of GOD himself.
Rush’s conviction that the mind is manageable and healable through the body would soon be elevated by the mightiest, most intimate motive fulcrum: personal experience. Two decades after delivering his visionary speech, he would watch his eldest child descend into mental illness — a devastation that would inspire him to compose the first American book on “diseases of the mind.” In his superb biography, Fried writes:
Through it all, Benjamin Rush contended openly and engagingly with the same challenge he had put to the new nation: how to be a man of science, a man of liberty, and a man of faith — all while striving to be a good friend, husband, and father of nine children. Rush was a medical pioneer and a political pathfinder, donating his time, his money, even, at times, his sanity for the causes he worried were beyond the reach of laws. His life and writings provide a guided tour through the most public and private moments of the Revolution and the creation of America, seen through the eyes — first awestruck, then frustrated, and finally worldly wise — of a physician and reformer who was, in every sense, revolutionary.
He also understood, as a physician and scientist, how many things he knew for certain would later be proved wrong; how many diseases, medical and social, could appear to be cured but later recur. In this was the “peculiar happiness” of cautious optimism, the comfort and discomfort of the truly long view.
Had I read Fried’s Rush before the year’s end, it would have crowned my favorite books of 2018. Mercifully, a chronicle of a 200-year past so masterly that it will endure for at least 200 years into the future is impervious to the time-strained omissions of any mortal.
Published January 17, 2019