During the last half of the 18th century and the first half of the 19th century, a psychosocial approach to mental disorders called moral therapy became popular. The term moral didn’t stand so much for a code of conduct as you might expect, but instead it meant “psychological” or “emotional”. Its basic principles included treating institutionalized patients as normally as possible in a setting that encouraged and reinforced normal interaction.
How moral therapy came into existence
Moral therapy as a treatment originated with the French psychiatrist Philippe Pinel (1745-1826). A former patient, Pussin, was working in a Parisian hospital when Pinel took over. Pussin had already instituted remarkable reforms, perhaps because he remembered being shackled as a patient himself. Pussin persuaded Pinel to go along with the changes. And Pinel did. Not only did he reform this hospital, but also a women’s hospital, where a humane and social approach produced “miraculous” results.
William Tuke followed Pinel’s lead in the United Kingdom, Benjamin Rush, often considered the founder of American psychiatry, introduced moral therapy in the United States for the first time. Not long after, moral therapy became the treatment of choice in the leading hospitals.
The miraculous results of moral therapy
Before moral therapy came into existence, asylums were already quite common, but were more often a type of prison than not. The rise of moral therapy made asylums habitable and even therapeutic. In the US, in 1833, 32 patient were given up as incurable. These patients were then treated with moral therapy, cured, and released to their families. Of 100 patients who were highly aggressive before treatment, no more than 12 continued to be violent a year after beginning treatment.
The decline of moral therapy
Unfortunately, after the mid-19th century, humane treatment of psychiatric patients declines because of a convergence of factors. It was widely recognized that moral therapy was most effective when the number of patients in an institution was 200 or less, which allowed for a lot of individual attention.
However, patient loads in the existing hospitals started to increase; some of the hospitals grew to a 1000, 2000 and more. This was caused by the quickly growing population in the United States at the time. It was short after the Civil War and immigrants flooded to the country. These immigrant groups were thought not to deserve the same privileges as the “natives” (whose ancestors had often immigrated only 50 or 100 years earlier!), so they were not given moral
treatment even when there was sufficient personnel.
A second reason for the decline of moral therapy has a rather unlikely source. The great crusader Dorothea Dix (1802-1887) campaigned endlessly for reform in the treatment of the insane. She used to be a teacher who had worked in many institutions. She knew firsthand how awful the many of the insane were treated and she made it her quest to make the American population aware of this problem.
Her work became known as the mental hygiene movement. As her career drew to a close many years later, she was acknowledged as a hero of the 19th century. However, a consequence of Dix’s efforts were a huge increase in the number of mental patients. This increase led to a rapid transition from moral therapy to custodial care – hospitals became very much understaffed.
The final blow to the practice of moral therapy was the decision, in the middle of the 19th century, that mental illness was caused by brain pathology and therefore couldn’t be cured.
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Source: Barlow, D.H., & Durand, V.M. (2009) Abnormal psychology: an integrative approach (5th Edition). Wadsworth Cengage Learning.