Emmanuel Movement
The Emmanuel Movement was a psychologically-based approach to religious healing introduced in 1906 as an outreach of the Emmanuel Church in Boston, Massachusetts. In practice, the religious element was de-emphasized and the primary modalities were individual and group therapy. Episcopal priests Elwood Worcester and Samuel McComb established a clinic at the church which lasted 23 years and offered both medical and psychological services. The primary long-term influence of the movement, however, was on the treatment of alcoholism.
Religious background: Worcester and McComb
Elwood Worcester was the originator of the Emmanuel movement philosophy. He was raised in an educated middle-class family which fell into poverty as a result of business reversals and the death of Worcester's father. After high school, Worcester went to work at a railway claim-department office. One day, while alone in the office, he had an experience of the room filling with light and heard the words, "Be faithful to me and I will be faithful to you." After discussing the experience with his priest, Algernon Crapsey, he became convinced that he was called to the ministry. At the time he was supporting his family, but he later entered Columbia University on scholarship and earned a bachelor's degree with highest honors.As a candidate for orders Worcester was required to attend a recognized seminary, in spite of his own conviction that he would be better prepared by attending a German university. He was able to satisfy the requirements for the first two years of General Seminary in New York by studying the texts and passing examinations. He then graduated from the Seminary after only one year of full-time attendance and immediately left for Germany to enter the University of Leipzig. After an initial year devoted to classical studies, he spent two years studying with Franz Delitzsch, foremost Hebraist of the day, and psychologists Wilhelm Wundt and Gustav Theodor Fechner. In his autobiography, Worcester recalled that the liberal German academic tradition, which "tends to weaken and remove the false opposition which has grown up between the things of the mind and the things of the Spirit," was the inspiration for much of his later work.
After his ordination in 1891, Worcester became chaplain and professor of psychology and philosophy at Lehigh University in Bethlehem, Pennsylvania. His indecision between academic and parish work was resolved by a call to a historic parish in Philadelphia, St. Stephen's. One of his parishioners at St. Stephens was noted neurologist S. Weir Mitchell, who became a close friend and a source of guidance in the application of depth psychology to ministry. After 8 years Worcester moved on to Emmanuel Church in Boston. The next year he was joined by Samuel McComb as associate rector. McComb was raised in Belfast, Ireland and educated at Oxford. He had been a professor of church history at Queens University in Ontario and served as minister of Presbyterian churches in England and New York City, before being ordained in the Episcopal Church. A popular speaker and an excellent writer, he became the primary spokesman for the movement during its active years.
Medical background: Cabot, Pratt, Putnam and Coriat
Boston was the center of a local "medical psychotherapy" tradition going back to the 1890s when William James, Josiah Royce, Hugo Munsterberg and Boris Sidis developed individualized techniques for the relief of mental distress. The psychiatric professionals of the 19th century, alienists and neurologists, were primarily concerned with severe pathology such as schizophrenia and mania. Little attention was paid to milder mental conditions. The New England psychopathologists, in contrast, dealt with the problems of those who were more or less functional but unhappy. They treated patients with anxiety or depression or in the grip of compulsive behaviors. James Jackson Putnam, Harvard's first professor of diseases of the nervous system and a founder of the American Psychoanalytic Association, was influenced by this tradition of eclectic therapy. He saw the Emmanuel movement, with its synthesis of psychology and "moral" treatment, as a positive development. His support was important in the reception of the movement by the orthodox medical community.Dr. Richard C. Cabot, in 1905, concluded that he didn’t have enough information to make exact diagnoses of his patients at the Massachusetts General Hospital clinics. He didn’t know where they lived or worked, what they worried about or ate for dinner. He believed it was important to understand his patients’ economic situation, what toxins they may have been exposed to and how they were handling the stress of daily life. With his own money, he hired a nurse, Garnet Isabel Pelton, to serve as Mass General’s first social worker. Then, in 1907, Dr. Cabot hired Ida Maud Cannon, who later held the title of Chief of Social Service at the hospital. Together, Cabot and Cannon led the development and growth of the first social services department in a hospital in the United States. Cabot became chief of medicine at Massachusetts General Hospital from 1912 until his retirement, was an innovator in both medical education and psychosocial medicine. He introduced the first weekly "Grand Rounds," now traditional in teaching hospitals. Cabot wrote popular books on counseling, ethics and religion which reflected his continuing loyalty to the philosophy he had learned under Josiah Royce.
Dr. Joseph Pratt received his degree in medicine from Johns Hopkins University School of Medicine, where he studied under William H. Welch and Sir William Osler. He joined Cabot's tuberculosis clinic at Massachusetts General Hospital in 1903. From 1927 he served as chief of medicine at the Boston Dispensary and professor at Tufts University School of Medicine. The Pratt Diagnostic Clinic at Tufts Medical Center is named in his honor. Although tuberculosis was then endemic in urban areas, treatments in vogue were labor-intensive and available mainly to the affluent. If there was any hope of offering this sort of care to the poor, Dr. Pratt realized that working with groups of patients and care-givers would be necessary. He also had a lifelong interest in the influence of psychosocial factors on physical and mental illness, so he had confidence in the value of integrated support systems.
Dr. Isador Coriat was a Tufts neurologist/psychopathologist whose major professional influence was Morton Prince. Unlike most of his medical colleagues, Coriat was the son of Jewish immigrants of limited means. He had entered medical school directly from the public school system and began his medical career at Worcester State Hospital under Dr. Adolf Meyer. As a member of the first generation of American psychoanalysts, he was a link between 19th century experimental psychology and 20th century dynamic psychiatry.
Early projects
In 1905, Dr. Pratt asked Elwood Worcester if Emmanuel Church could offer any support for a project to improve the care of tuberculosis patients living in the poorest sections of Boston. Dr. Pratt hoped to encourage rest, optimal nutrition and fresh air through classes and home visits. Emmanuel Church provided both meeting space and the entire funding of the project, but there was no clergy involvement or religious component.Encouraged by the success of the tuberculosis class, Worcester consulted local neurologists about the possibility of similar work among the "nervously and morally diseased." He assured them that he was not attempting to establish any new doctrine, but only to give each patient the best opportunity possible for health and well-being. The response was positive. Dr. James Putnam presided over the first meeting to plan the new project. Cabot and Coriat served as speakers and medical advisors.
These preliminary meetings developed into the "Weekly Health Conference." Each meeting began with hymns and prayers, and included a lecture by a medical doctor or member of the clergy. The techniques of suggestion and auto-suggestion were a strong component of their psychology, but the approach was eclectic. Spiritual lectures often reflected New Thought influence. The formal program was followed by an hour of fellowship, at which there was only one rule: no mention of disease was allowed.
In 1908 a fire destroyed much of the town of Chelsea. Worcester, McComb and members of the church moved quickly to assist those left homeless. They rented one of the few homes left standing and turned it into the "Emmanuel Relief Station", offering food and clothing. Next they arranged for the help of doctors in treating burns and wounds, and provided instruments and supplies. The house was also used for the care of women during and after childbirth. After the relief station closed, the parish expanded the care offered at their primary location to include some medical services.
With the expansion of the Social Services Department, the church needed a full-time worker to supervise the projects. Courtenay F. Baylor, a former insurance salesman who had come to Elwood Worcester for help with his own problems a few years earlier, was hired in 1912. His role grew over time to that of a lay psychotherapist.
Years of growth
Ladies Home Journal published a series of articles written by Elwood Worcester in 1908-9 introducing his ideas to a national audience. The first book about the movement, Religion and Medicine, The Moral Control of Nervous Disorders by Worcester, McComb and Isador Coriat, appeared in 1908. The book went through nine printings in its first year of publication as the popularity of the movement grew.Four components made up the primary approach to therapy. The church continued to offer large lectures and classes, primarily devoted to what would now be termed "functional" illness. There was a clinic, held under the auspices of the church and staffed by physicians, which offered some traditional medical care. The third component, unique at the time, offered the services of "lay therapists" who were trained on the job by Worcester, McComb and others. Treatment consisted of a relatively brief form of analysis, support and direction for making changes in the patient's life, and the use of suggestion to relieve symptoms. Therapy was reinforced by volunteers who visited the patients at home.