Moral Treatment, also known as Moral Therapy or Management, was an approach to mental disorder based on humane psychosocial care and moral discipline. It emerged in the late 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religion or moral concerns. The movement was particularly associated with reform of the asylum system. It fell in to decline as a distinct method by the 20th century, however, due to rising numbers of patients and the predominance of biomedical methods. There has also been criticism that it blamed or oppressed patients according to the morals of a particular social class or religion. The movement is commonly seen as influencing psychiatric practice up to the present day, including specifically therapeutic communities^[1] and occupational therapy^[2] The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ... ... Psychosocial refers to ones psychological development in the context of a social environment. ... A moral is a one sentence remark made at the end of many childrens stories that expresses the intended meaning, or the moral message, of the tale. ... Psychiatry is a medical specialty dealing with the prevention, assessment, diagnosis, treatment, and rehabilitation of the mind and mental illness. ... Psychology (from Greek: ψυχή, psukhē, spirit, soul; and λόγος, logos, knowledge) is an academic/ applied discipline involving the scientific study of mental processes and behavior. ... A moral is a one sentence remark made at the end of many childrens stories that expresses the intended meaning, or the moral message, of the tale. ... A psychiatric hospital (also called, at various places and times, mental hospital or mental ward), is a hospital specialising in the treatment of persons with mental illness. ... Social class refers to the hierarchical distinctions between individuals or groups in societies or cultures. ... Therapeutic community is a term applied to a participative, group-based approach to long-term mental illness that includes group psychotherapy as well as practical activities, and which may or may not be residential with the clients and therapists living together. ... Occupational therapy refers to the use of meaningful occupations to assist people who have difficulty in achieving occupationally balanced lives. ...

History

Moral Treatment developed in the context of the Enlightenment and an increasing focus on individuality and rights. It has been argued that there was a secularization of madness from around 1660 and a Georgian era 'classical moral treatment' that preceded the moral treatment movement^[3]. In addition, the influential work 'Treatise on Madness' published in 1758 by William Battie, argued for the need to treat as well as confine insanity, and to consider the changeability and individuality of people and their symptoms, challenging the general perception that madness was a single inexplicable disease. In addition, in his An Essay Concerning Human Understanding, John Locke popularized the idea that there is a degree of madness in most people, because emotions can cause people to incorrectly associate ideas and perceptions, which can be difficult to correct through reasoning. Look up Enlightenment in Wiktionary, the free dictionary. ... Secularization or secularisation is a process of transformation as a society slowly migrates from close identification with the local institutions of religion to a more clearly separated relationship. ... The Georgian architecture of The Circus, Bath, built between 1754 and 1768 The Georgian era is a period of British history, normally defined as including the reigns of the kings George I, George II, George III and George IV, i. ... William Battie was a physician who published in 1758 the first lengthy book on the treatment of mental illness, A Treatise on Madness’, and by extending methods of treatment to the poor as well as the affluent, helped raise psychiatry to a respectable specialty. ... An Essay Concerning Human Understanding is one of John Lockes two most famous works, the other being his Second Treatise on Civil Government. ... This article is about John Locke, the English philosopher. ...

Italy

In the 1780s, Italian physician Vincenzo Chiarugi instituted improvements at the St. Bonifacio Hospital in Florence, Italy, including ensuring the removal of mechanical restraints, although his reforms were not well publicised.

France

The ex-patient Jean-Baptiste Pussin^[4] and the psychiatrist Philippe Pinel (1745-1826) are generally recognized as the first instigators of more humane conditions in asylums, part of what later became known as the moral treatment movement. In 1793, Pinel became the chief physician at La Bicêtre, an asylum in Paris for male patients. Pinel, following the lead of Pussin, argued that the patients should be treated with sympathy and kindess rather than, for example, chains and beatings. Following Pussin, 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. Jean-Baptiste Pussin (1746-1811) was a French tanner who was born in Lons-le-Saunier. ... This article or section does not cite its references or sources. ... The Bicêtre Hospital, located in Le Kremlin-Bicêtre, which is a commune in the southern suburbs of Paris, France. ... City flag City coat of arms Motto: Fluctuat nec mergitur (Latin: Tossed by the waves, she does not sink) Paris Eiffel tower as seen from the esplanade du Trocadéro. ...

Pinel's approach was seen as remarkably successful and he later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière. As he had done at Bicêtre, Pinel removed the chains and instituted reforms. Pinel's student and successor, Jean Esquirol (1772-1840), went on to help establish 10 new mental hospitals that operated on the same principles. The Pitié-Salpêtrière Hospital is a hospital in Paris. ... Jean-Etienne Dominique Esquirol (1772 - 1840) was a French psychiatrist. ...

England

An English Quaker named William Tuke (1732-1819) independently brought similar reforms to northern England, following the death of a fellow Quaker in a local asylum in 1790. In 1796 he founded the York Retreat, where about 30 patients lived as part of a small community in quiet country houses and engaged in a combination of rest, talk, manual work. The efforts of the York Retreat centered around minimizing restraints and cultivating rationality and moral strength. The Religious Society of Friends, commonly known as Quakers, or Friends, is a religious community founded in England in the 17th century. ... William Tuke (March 24, 1732-1822) was born at York. ... Motto (French) God and my right Anthem God Save the King (Queen) England() – on the European continent() – in the United Kingdom() Capital (and largest city) London (de facto) Official languages English (de facto) Unified  -  by Athelstan 967 AD  Area  -  Total 130,395 km²  50,346 sq mi  Population  -  2007 estimate... The Retreat is a not for profit charitable organisation in the United Kingdom. ...

The entire Tuke family became known as some of the founders of moral treatment^[5]. They created a family-style ethos and patients performed chores 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 they 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.

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 therapeutic for doctors to give small gifts to their patients every so often. Dr. Benjamin Rush, painted by Charles Wilson Peale, c. ... The Pennsylvania Hospital by William Strickland (1755) Pennsylvania Hospital is the first hospital in the United States. ...

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. Nickname: City on the Hill, Beantown, The Hub (of the Universe)1, Athens of America, The Cradle of Revolution, Puritan City, Americas Walking City Location in Massachusetts, USA Counties Suffolk County Mayor Thomas M. Menino(D) Area    - City 232. ... In education, teachers are those who teach students or pupils, often a course of study or a practical skill. ... Dorothea Lynde Dix (April 4, 1802 – July 17, 1887) was an American activist on behalf of the indigent insane who, through a vigorous program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums. ... Sunday school, Indians and whites. ...

Criticism

In the 1960s, many criticized any perceived glorification of the history of psychiatry. Particularly, Michel Foucault argued that Pinel's moral treatment was really a new form of moral oppression, replacing physical oppression. 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 the underlying processes, had all powers of authority and defined insanity. Thus Foucault argues that the 'moral' 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) Michel Foucault (IPA pronunciation: ) (October 15, 1926 – June 25, 1984) was a French philosopher and historian. ... Abnormality is a subjectively defined characteristic, assigned to those with rare or dysfunctional conditions. ... Michel Foucault Michel Foucault (October 15, 1926 – June 26, 1984) was a French philosopher and held a chair at the Collège de France, a chair to which he gave the title The History of Systems of Thought. His writings have had an enormous impact on other scholarly work: Foucault...

References