What Is Moral Treatment?

In psychiatry, the era of moral treatment refers to a particular swing in attitudes toward treating mentally ill people from the end of the 18th century to the first half of the 19th century. First practiced in England by the religious Quaker group, moral treatment meant treating inmates of psychiatric asylums with respect and giving them ordered routines to follow every day. This calmer, gentler way of interacting with those suffering from mental illness was in stark contrast to the previous method used, which was to lock people up without anything to do each day merely to keep their illness away from others in society.

The Quakers are a religious group which performed charitable acts as part of their religious convictions. At the end of the 18th century, a group of Quakers ran a psychiatric asylum in York, England, under a new system of rules called moral treatment. Previously, in both England and in places like the United States, asylums were places where people with mental illnesses were locked up and in some cases, tied up permanently. Although some asylum inmates did manage to get better and get out of of incarceration, the general view was that most cases of madness were not curable, and so little effort was made to cure the patients.

Moral treatment brought about a massive shift in the way psychiatric institutions were run, from the 1800s onward. The Quakers in York treated the patients with respect, and allowed them to talk to the psychiatrists as individuals who mattered. The boredom and lack of stimulation, which may previously have made many cases of illness worse, was replaced by a structured daily routine.

This routine involved doing productive work like growing vegetables in the garden or sewing. Patients also spent time every day doing interesting leisure activities, like reading. In this way the Quakers wanted to foster a sense of calm and security in the patients, and also so the patients could behave as normally as possible, and have a chance to stick to accepted standards of social behavior.

Other countries recognized the benefits of moral treatment over the previous cruel and chaotic system, and began implementing it in their own institutions. The Americans, for example, adopted moral treatment in the early to mid 1800s. Psychiatric asylums were built out in calming countryside, and patients received properly nourishing food, and intellectual stimulation. These key concepts of moral treatment are still in use in modern psychiatric institutions.