The Course of God’s Providence

William Cayley Jr, MD, MDiv

Fam Med. 2022;54(3):236-237.

DOI: 10.22454/FamMed.2022.809870

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Book Title: The Course of God’s Providence

Author: Phillipa Koch

Publication Information: New York, New York University Press, 2021, 280 pp., $39.00

Assessing and integrating patient spirituality into the health care encounter can build trust and rapport, broadening the physician-patient relationship and increasing its effectiveness.”1

Family medicine, the generalist specialty of the whole person, has long been receptive to spirituality in medicine. Clinical reviews acknowledge the role of spirituality in health care,1 and primary care researchers have contributed significantly to the study of spirituality and health.2 However, medical research has generally addressed spirituality as a category of belief or behavior, rather than engaging with the content of spiritual beliefs per se.3,4 Spirituality is often treated as one of several coping strategies rather than an integral part of understanding the nature of disease and suffering. In The Course of God’s Providence, Phillipa Koch engages with the scholarly work on post-Enlightenment understandings of sickness to argue that 18th century protestants in the United States and Europe did not divorce religious and medical explanatory models, but instead believed their faith in God’s providence should motivate their response to suffering and their work in the world (p. 1).

The book’s first chapter, “Wholesome Words,” takes its title from a pastoral manual of the same name by the Puritan pastor Cotton Mather.5 Using examples from a variety of such 18th century manuals, Dr Koch explores the ways pastoral writers integrated physical and spiritual experiences of suffering with lived experience using the resources of Protestant faith and examples from Biblical writings. In the face of ever-present sickness and suffering, a commitment to narrating disease in relation to divine providence provided both a source of comfort and a means to contemplate issues of sin, repentance, and ultimate meaning in one’s own life. The second chapter, “Writing Sickness, Witnessing Providence,” turns from pastoral manuals to the journals and letters of individuals grappling with personal illness or familial loss. Here again, “narrating sickness” was understood as an important task in placing one’s own life and struggles within a broader spiritual framework. The third chapter, “Experience and the Soul in Eighteenth Century Medicine,” explores 18th century Protestant writings on the relationship between medicine, theology, and health. Not only was the 18th century a time during which a general consensus on the relationships between health, disease, and physiology was lacking, it was also a time during which professional medical practitioners were criticized both for being overly theoretical and overly interested in profit. Dr Koch specifically details the efforts of Cotton Mather in support of smallpox inoculation and the medical writing of John Wesley6 as examples of efforts to ground medical practice both in the empirical experience of day-to-day life and health, and in relationship to a broader theological vision of life. The final two chapters explore the interplay between theology, spirituality, health, and suffering, specifically in the areas of public health (“Providence and Benevolence in Philadelphia’s Yellow Fever Epidemic”) and child-bearing (“Medicine, Providence and Nature in Eighteenth-Century Maternity”).

The Course of God’s Providence is a work of academic history, and as such the style, tempo, and depth may be more familiar to historians than to physicians. However, for those who value an accurate understanding of evidence at the granular level and a nuanced approaches to suffering, this work provides an important corrective to the popular narrative of a divorce between theology and spirituality on the one hand and medicine and health care on the other. Advocates of evidence-based medicine may be particularly surprised to find that in the 1800s it was actually the pastoral writers who emphasized practical medical outcomes over the influences of philosophical medical theory. Dr Koch also makes the important point that scholarly study of illness narratives has tended to focus on contemporary writing and discount sickness narratives from earlier centuries (p. 56), and the pastoral manuals and sickness narratives she explores in the first two chapters are helpful in bringing these narratives from the 17th century to our attention. Most importantly, Dr Koch reminds us that spiritual and theological resources are not merely strategies for coping, rather they have historically been used to place suffering in a broader context of meaning and to guide personal growth and care for others.

Made confident by medical developments of recent centuries, we have often assumed that our present response to suffering is more effective, more courageous, more active, more secular than that of previous eras. By attending to sickness and health in history, however, we are challenged to see both the people of the past and ourselves differently” (p. 196).


  1. Saguil A, Phelps K. The spiritual assessment. Am Fam Physician. 2012;86(6):546-550.
  2. Lucchetti G, Granero AL. Spirituality and health’s most productive researchers: the role of primary care physicians. Fam Med. 2010;42(9):656-657.
  3. Borges CC, Dos Santos PR, Alves PM, et al. Association between spirituality/religiousness and quality of life among healthy adults: a systematic review. Health Qual Life Outcomes. 2021;19(1):246. doi:10.1186/s12955-021-01878-7
  4. Lucchetti G, Koenig HG, Lucchetti ALG. Spirituality, religiousness, and mental health: A review of the current scientific evidence. World J Clin Cases. 2021;9(26):7620-7631. doi:10.12998/wjcc.v9.i26.7620
  5. Mather C. Wholesome words. A visit of advice, given unto families that are visited with sickness. Boston: Henchman; 1713.
  6. Wesley J. Primitive physic: or an easy and natural method of curing most diseases. Philadelphia: Pritchard and Hall; 1789.

Lead Author

William Cayley Jr, MD, MDiv

Affiliations: University of Wisconsin School of Medicine and Public Health, Prevea Family Medicine Residency, Eau Claire, WI

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