Robert Scott has a deep understanding of medieval people and the intimacies of their lives, and in this work explores matters that at first glance seem to be relevant only to that period. However, from a historical journey through the environmental, social, biological, spiritual, and psychological world of those living during the middle-ages, and their seeking of miracle cures, we are skillfully led towards the author’s contention that the process that emerges through this investigation has a timeless relevance.

A profound respect for those who struggled through the harrowing privations and suffering of the time prevents the author from accepting the view that the miracle cures described at the time were “rooted in ignorance, superstition, hearsay, speculation, and misinformation” (p. xxii). Instead, in Part 1 of the book, the reader is presented with rigorous and thorough research into the types of illness commonly experienced, the environmental factors, and the beliefs surrounding the causes of these maladies. Links between lifestyle: the terrible privations of both city and rural existence and the consequent myriad physical effects were not made at the time, and illness was seen as a punishment by God for sins committed by the hapless sufferer. Therefore, it seemed logical to invoke the intercession of saints as a way of delivering freedom from this shame and suffering.

Consequently, a highly ritualized process of concentrated spiritual and physical exercises developed in the form of pilgrimages to the shrines of saints. It was believed that the whim of the chosen saint could be invoked by intense spiritual exertion in the form of confession, unquestioning belief, fasting and silence. The author contends that it is these very practices and the inspiration of hope and belief in a cure that lead to most of the physical improvements reported.

In Part 2 the reader is once again drawn into the medieval world where the physical body is besieged with agues, that while having very different descriptions and names from present day, are identified by medical researchers as to the likely diagnoses. The author likens the role of stress in illness, and the effect of medieval lifestyle on emotions, social factors (in particular, shame), and social support, as the “health equivalent of a perfect storm, hastening the onset of illness and increasing its’ severity because of adverse effects on the immune system.”

The core of the author’s argument is that modern medical research now clearly demonstrates a link between hope and belief and improvement in health, therefore, he contends, it was the very act of planning and then embarking on pilgrimage that began the process of healing. Chapter 7 ‘Belief, Hope, and Healing’ presents a large body of research into beliefs held by patients, beliefs held by care providers, and a plethora of placebo studies, that provide a mountain of evidence to support the role of the mind in all kinds of healing phenomena. Classical conditioning, and the connections discovered between placebo induced pain relief and the release of endogenous morphines in the brain, brain-imaging studies of pain analgesia, and finally, evidence that depression and anxiety also appear to respond to placebo treatment. Altogether, this research affords compelling and powerful support for the reality of the pilgrim’s experience.

Further explanation for healing experiences is presented in Chapter 8 ‘Framing, confessing, Self-Efficacy, and Healing. Here the author suggests “Other lines of research point to features of pilgrimage that not only powerfully affect how people experience their bodily symptoms but also induce physiological changes that can contribute to recovery from illness” (p.148). The work of Albert Bandura and other cognitive psychologists shows that self efficacy helps determine goals we set for ourselves and commitment to pursuing those goals, which is exactly what was necessary for a medieval person to accomplish in planning a pilgrimage. In mobilizing self-efficacy, direct positive effects on health are experienced through appropriate life style choices. The author posits the idea that therefore, pilgrims enlivened sense of self-efficacy would strengthen their immune systems and increase their ability fight disease and infection.

A thought-provoking discussion follows about the connection between awareness and interpretation of bodily symptoms, and framing and the role it plays in determining our assessments of how we feel and experience physical symptoms. The author then looks at possible meanings of symptoms among the miracles of Lourdes. Links are made between confessing and improvements in the immune system, for example, the author cites writings of Freud and Breuer, who highlight the physiological accompaniments of repressed trauma and the relief that is gained through talking to anonymous listeners such as the priests along the route of the pilgrimage. He quotes, “….each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing to light the memory of the event by which it was provoked and by arousing its accompanying affect, and when the patient had described that event in the greatest possible detail and had put the affect into words” (p.166).

This reader found the book fascinating and informative, and felt a growing curiosity for more detailed descriptions of particular case examples with an analysis of present day interpretations such as that of the 14 year old girl in the first chapter. Overall, the author’s proposition was well argued and convincing, and gave respect and credibility to the pilgrims of the medieval period who claimed miracle cures from intercession by saints.