Who was the person most responsible for the early spread of moral treatment?

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The methods of Pinel and Tuke, calledmoral treatmentbecause they emphasized moral guidance and humane and respectfultechniquesPatients with psychological problems were increasingly perceived as potentially productive human beings whose mentalfunctioning had broken down under stress.The person most responsible for the early spread of moral treatment in the United States was Benjamin Rush (1745–1813),Rush developed humane approaches to treatment (Rush, 2010; Whitaker, 2002). For example, he required that the hospitalhire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regularwalks.Rush’s work was influential, but it was a Boston schoolteacher named Dorothea Dix (1802–1887) who made humane care apublic and political concernDix went from state legislature to state legislature and to Congress speaking of the horrors she had observed at asylums andcalling for reform. Dix’s campaign led to new laws and greater government funding to improve the treatment of people withmental disordersEach state was made responsible for developing effective public mental hospitals, orstate hospitals,all of which intended tooffer moral treatment.A popular feature of moral treatment was the “lunatic ball.” Hospital officials would bring patients together to dance andenjoy themselvesThe Decline of Moral TreatmentSeveral factors led to a reversal of the moral treatment movementOne factor was the speed with which the movement had spread. As mental hospitals multiplied, severe money and staffingshortages developed, recovery rates declined, and overcrowding in the hospitals became a major problem.Another factor was the assumption behind moral treatment that all patients could be cured if treated with humanity anddignity.An additional factor contributing to the decline of moral treatment was the emergence of a new wave of prejudice againstpeople with mental disorders. As more and more patients disappeared into large, distant mental hospitals, the public came toview them as strange and dangerousIn turn, people were less open-handed when it came to making donations or allocating government funds.Many of the patients entering public mental hospitals in the United States in the late nineteenth century were poor foreignimmigrants, whom the public had little interest in helping.Public mental hospitals were providing only custodial care and ineffective medical treatments and were becoming moreovercrowded every year. Long-term hospitalization became the rule once again.

The Early 20thCentury: The Somatogenic and Psychogenic PerspectivesSomatogenic perspective•The view that abnormal psychological functioning has physical causesPsychogenic perspective•The view that the chief causes of abnormal functioning are psychological.

Dorothea Dix played an instrumental role in the founding or expansion of more than 30 hospitals for the treatment of the mentally ill. She was a leading figure in those national and international movements that challenged the idea that people with mental disturbances could not be cured or helped. She also was a staunch critic of cruel and neglectful practices toward the mentally ill, such as caging, incarceration without clothing, and painful physical restraint. Dix may have had personal experience of mental instability that drove her to focus on the issue of asylum reform, and certainly her singular focus on the issue led to some important victories.

Dorothea Lynde Dix was born in Hampden, Maine, in 1802. Evidence suggests she may have been neglected by her parents, and she appears to have been unhappy at home. She moved to Boston in 1814 to live with her wealthy grandmother. Dix had only attended school sporadically while living with her parents, but in early adulthood, with limited options for women in the professions, Dix became a schoolteacher. She established an elementary school in her grandmother’s home in 1821, and 3 years later, published a small book of facts for schoolteachers that proved extremely popular. By the time of the Civil War, Conversations on Common Things; or, Guide to Knowledge: With Questions had been reprinted 60 times. Written in the style of a conversation between a mother and a daughter, and directed at the young women who dominated the teaching profession, the book reflected Dix’s belief that women should be educated to the same level as men.

She went on to publish several other works, including books of religious poetry and fictional texts featuring moral lessons. Dix’s record of publications and the social circles accessible to her through her grandmother’s significant wealth allowed her to mix with some of the brightest and most influential thinkers of her time. She associated with Ralph Waldo Emerson and worked as a governess for William Ellery Channing, the so-called “Father of Unitarianism.”1

In 1831, Dix opened a secondary school in her own home. She frequently suffered from bouts of illness, especially during the winter, developing a cough and general fatigue. By 1836, her intense commitment to teaching and demanding workload seemed to have taken its toll. She began to dwell on the idea of death, and felt overwhelmed by her physical illnesses. Biographer David Gollaher, the first scholar to have access to all of her papers, has suggested that she suffered from depression at several times during her life, and that she experienced a type of mental breakdown during this period.2

Perhaps her own struggles helped make her a more compassionate advocate for people who had been diagnosed as mentally unstable or insane. Certainly her ill health ended her teaching career and brought her into a new circle of contacts. Emerson, Channing, and Dix’s physician encouraged her to take a restorative trip to Europe, and made the necessary introductions on her behalf. She convalesced in England for more than a year at the home of politician and reformer William Rathbone. During her stay, she met prison reformer Elizabeth Fry, and Samuel Tuke, founder of the York Retreat for the mentally ill. She returned to Boston in 1837, just after the death of her grandmother. The inheritance she received enabled her to support herself fully and devote her time to reform and charitable work.

In 1841, Dix volunteered to teach Sunday school classes to female convicts in East Cambridge Jail. During her visits she saw people with mental illnesses who had been treated inhumanely and neglectfully, and she became determined to improve conditions. She began to investigate the treatment of the mentally ill in Massachusetts, and in 1843 submitted her first “memorial” to the state legislature, an excerpt of which is republished here. These pamphlets were the only means by which a woman could participate in political life in America. Women were barred from voting, could not hold office, and did not present such testimonials themselves before the legislature—a male representative had to read the text aloud. Although she had significant political influence and promoted the education of women, Dix never joined the wider feminist movement or lent her public support to their cause. She has also been criticized for her views on slavery and her resistance to abolitionism.

This memorial reveals how Dix worked within the conventions of her time to carve a role for herself in public life and draw attention to the horrendous treatment of the mentally ill in prisons, almshouses for the poor, and asylums. Ideals of femininity characterized women as having a special responsibility to the most vulnerable members of society, and a moral authority superior to men’s. At the same time, women were supposed to be protected from images and experiences of suffering and degradation. Dix was able to use her vivid and upsetting descriptions to powerful effect, damning the existence of these abuses and shaming political leaders into taking action on her behalf, and on behalf of the “inmates” of these institutions.3

The model of care that Dix supported, “moral treatment,” was developed from the work of French psychiatrist Philippe Pinel and from new practices used at hospitals such as England’s York Retreat. Her tireless work and dramatic testimonials highlighted the appalling conditions in existing institutions and promoted the inherent value of compassionate care.

References

1. Wood AG. Dorothea Lynde Dix. In: Garraty JA, Carnes MC, eds. American National Biography. New York, NY: Oxford University Press; 1999:635–637.

2. Gollaher D. Voice for the Mad. New York, NY; London, England: The Free Press; 1995:93.

3. Michel S. Dorothea Dix; or, the voice of the maniac. Discourse. 1994; 17:48–66. [Google Scholar]

Who created moral treatment?

What is the concept of moral treatment?

Which person advocated for the more humane treatment of the mentally ill?

Who was the first doctor to argue that asylum patients should be treated with sympathy and kindness rather than with chains and bearings?