Moral Treatment

1788

William Tuke (1732–1822), Philippe Pinel (1745–1826), Vincenzo Chiarugi (1759–1820)

Humans were recast as creatures of logic during the European Enlightenment. Madness was reconceptualized as a result of a loss of reason rather than an imbalance in humors. With this, there was a subsequent change in the treatment of the mad: instead of bleeding or purging, treatment methods were intended to help restore patients to their reason. This was termed moral treatment.

The first moral treatment was initiated in Italy in 1788, where the physician Vincenzo Chiarugi instituted reforms that outlawed the use of chains and beatings, and he often used opium to calm patients. The French physician Philippe Pinel became the director of the Bicêtre Insane Asylum in Paris in 1792 and used Enlightenment principles to develop new policies of humane treatment, believing that such treatment would help restore reason. The patients were released from their shackles and treated with respect and dignity, with great success.

At about the same time in England, the Quakers, concerned about the treatment of members who were suffering from mental disorders, opened the York Retreat. Under the leadership of William Tuke, the retreat was organized with the belief that mental illness was a state from which a person could recover with the right treatment. The retreat’s staff employed an attitude of benevolence and personal care, and they provided opportunities for patients to engage in useful tasks in order to nurture them back to health.

In the United States, alienists (precursors of psychiatrists) also adopted moral treatment, including new forms of restraint such as the crib, where the patient had to lie still because there was no room to move. The rationale was that as the patient calmed down, he would gradually be restored to his senses, and his reason would return.

By the 1830s, moral treatment was the standard of care in most American asylums, and as long as the patient population was small, there were many successes. By the late nineteenth century, however, the asylum population had greatly increased while financial and community support for them decreased. Thus by the end of the nineteenth century the majority of asylums had become warehouses of the insane.

SEE ALSO Bedlam (1357), Antipsychotic Medications (1952)

Frontispiece, An inquiry into the effects of ardent spirits upon the human body and mind by Benjamin Rush, 1812. Rush was one of the signers of the Declaration of Independence and one of the founders of moral treatment in the United States.