Moral treatment
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Moral treatment marks a period in psychiatry during the late eighteenth and early nineteenth centuries where asylums began to offer humane care to the mentally ill.
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[edit] History
[edit] France
Philippe Pinel (1745-1826), referred to by some as the "father of psychiatry", is known as the instigator of this movement. In 1793, Pinel became the chief physician at La Bicêtre, an aslym in Paris for male patients. This hospital is typically credited as the first site of mental health reform. Pinel argued that the patients were sick people whose illnesses should be treated with sympathy and kindess rather than chains and beatings. He unchained them and allowed them to move freely about the hospital grounds, replaced the dark dungeons with sunny, well-ventilated rooms, and offered support and advice.
Pinel's approach proved remarkably successful. Patients who had been shut away for decades were now enjoying fresh air and sunlight and being treated with dignity. Many improved greatly over a short period of time and were released. Pinel later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière. This institution housed 6700 women, with the mentally ill in chains. As he had done at Bicêtre, here Pinel removed the chains from the women and instituted reforms. He believed that chains and dugeons only helped to persist insanity. Removing the chains and treating the patients like people helped them to begin the process of healing. Pinel's student and successor, Jean Esquirol (1772-1840), went on to help establish 10 new mental hospitals that operated on the same principles.
[edit] England
An English Quaker named William Tuke (1732-1819) brought similar reforms to northern England. In 1796 he founded the York Retreat, a rural estate where about 30 mental patients lived as guests in quiet country houses and were treated with a combination of rest, talk, prayer, and manual work. The efforts of the York Retreat centered around minimizing restraints and cultivating moral treatment.
The entire Tuke family became known as some of the founders of moral treatment. They created a family-style institution where the director was the father, his wife was the mother, the keepers were the older siblings, and the mentally ill were the children. All patients performed chores around the asylum to give them a sense of contribution. There was a daily routine of both work and leisure time. If patients behaved well, they were rewarded. If patients behaved poorly, they were punished. The patients were told that treatment depended on their conduct. In this sense, the patient's moral autonomy was recognized.
[edit] United States
The person most responsible for the early spread of moral treatment in the United States was Benjamin Rush (1745-1813), an eminent physician at Pennsylvania Hospital. He limited his practice to mental illness and developed innovative, humane approaches to treatment. He required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regular walks. He also suggested that it would be theraputic for doctors to give small gifts to their patients every so often. Rush is widely considered the father of American psychiatry and wrote the first American treatise on mental illness and organized the first American course in psychiatry.
A Boston schoolteacher, Dorothea Dix (1802-1887), made humane care a public and a political concern in the United States. In 1841 Dix visited a local prison to teach Sunday school and was shocked at the conditions for the inmates. She subsequently became very interested in prison conditions and later expanded her crusade to include the poor and mentally ill people all over the country. She spoke to many state legislatures about the horrible sights she had witnessed at the prisons and called for reform. Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment.
[edit] Criticism
In the 1960's, many criticized this glorification of the history of psychiatry. Particularly, Michel Foucault argued that Pinel's moral treatment was really a new form of moral imprisonment. Foucault was interested in ideas of “the other” and how society defines normalcy by defining the abnormal and its relationship to the normal. A patient in the asylum had to go through four moral syntheses: silence, recognition in the mirror, perpetual judgment, and the apotheosis of the medical personage. The mad were ignored and verbally isolated. They were made to see madness in others and then in themselves until they felt guilt and remorse. The doctor, despite his lack of medical knowledge about mental illness, had all powers of authority and defined insanity. Thus Foucault argues that the asylum is "not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged, and condemned." (Madness and Civilization 158)
