The Moral Method

Kingston's Rockwood Asylum, 1920.

The Upper Canada Herald of July 18, 1831 reports on a visit to a mental asylum in Connecticut that claimed a high rate of cure: 

During our late visit to the United States, we had the satisfaction of examining ‘The CONNECTICUT RETREAT FOR THE INSANE,’ at Hartford. Having been politely favoured by a friend in New York with a letter of introduction to DOCTOR TODD, Physician to the institution, we were very kindly received by that philanthropic and intelligent gentleman, to whose skillful and humane treatment the inmates of the retreat owe a debt of lasting gratitude. The building, which is a neat specimen of modern architecture, is situated on a commanding eminence, overlooking the Town of Hartford, the beautiful Connecticut River, and the surrounding country to a great extent.

The ‘moral and intellectual treatment’ observed in the Retreat is thus explained in the annual report of the visiting committee: ‘The first business of the Physician, on the admission of a patient, is, to gain his entire confidence. With this view he is treated with the greatest kindness, however violent his conduct may be,—is allowed all the liberty which his cue admits of, and is made to understand, if he is still capable of reflection, that, so far from having arrived at a madhouse where he is to be confined, he has come to a peaceful residence, where all kindness and attention will be shown him, and where every means will be employed for the recovery of his health. In case coercion and confinement become necessary, it is impressed upon his mind, that this is not done for the purpose of punishment, but for his own safety, and that of his keepers. In no case is deception on the patient employed, or allowed,—on the contrary the greatest frankness, as well as kindness forms a part of the moral treatment. His case is explained to him, and he is made to understand, as far as possible, the reasons why the treatment to which he is subjected has become necessary. By this course of intellectual management, it has been found, as a matter of experience at our Institution, that patients who had always been raving when confined without being told the reason, and refractory, when commanded instead of being entreated, soon became peaceable and docile.’ The success of this treatment will appear from the fact, that of twenty-three cases admitted in one year, twenty-two recovered, affording the extraordinary proportion of 91 per cent.

This claimed cure rate is striking in comparison to what we see from the means we employ today: a cure rate of zero. Modern psychiatry holds that all mental illness is incurable, generally only gets worse over time, and can only be controlled with drugs.

Yet the claimed cure rate in Connecticut is confirmed by other sources.

“By 1837, Eli Todd at the Hartford Retreat had cured 91.3 percent of his recent cases, and Woodward at Worcester had discharged more than 82 percent as recovered.” (McGovern, C.M., The Masters of Madness: Social Origins of the American Psychiatric Profession. 1985, Hanover Press: University Press of New England).

These statistics have been challenged on the grounds that they do not account for readmissions—cures may only have been temporary. But the same accusation can be, and is, levelled against the claims for the current chemical treatments doing any good. Does the improvement in symptoms persist? This is a matter of some debate—long-term studies have rarely been done.

Why did we abandon this method for something manifestly worse?

The simple answer is that we did not abandon the method, consciously. The system required a high standard of behavior from staff, and power corrupts. Absolute power corrupts absolutely, and the warden of a madhouse has absolute power over his charges. The system worked miracles within the first generation, so long as the founders were still in charge. Over time, it naturally degenerated into all the horrors of the “asylum” system we so recently have been trying to eliminate.

Kingston’s own Rockwood Asylum for the Criminally Insane, the very memory of which is now largely suppressed, was probably built in imitation of the Connecticut model. Set in leafy, semi-rural grounds on the shores of Lake Ontario to produce the same pleasant, calming vistas as the Connecticut retreat.

But the essential element by then was lost. The “moral treatment,” as it was called, was based on religion; it was ultimately based on the model of Gheel, Belgium, and the shrine of St. Dymphna. The most successful early examples, in Britain and the US, were founded and run or at least inspired by the Quakers.

This is a model that could not be secularized. A first generation of administrators might still have been guided by some personal moral vision; but this was not institutionalized. Subsequent staff would have no particular moral motivations or religious training. They were in it for a living; or else for the opportunity to exercise power. The moral element of the moral treatment was gone, and all that was left was coercion and confinement. And warehouses full of growing numbers of patients without hope.

The fact that the approach has been called “the moral treatment” has led to an unfortunate misconception that patients were coerced and thought to be “immoral.” This is a kind of “black legend” that advocates of the medical model of mental illness have been able to use against it; from the beginning, the medical lobby opposed this “moral model."

The “moral treatment” means treating the patient as a moral being, competent to make their own choices—the very opposite of coercion. The core precept of the treatment, often repeated, was “Patients are normal, rational beings.” If they are suffering or acting strangely, they are reacting to some real problem they are facing. Removing them from their current environment, and putting them in a calm one, essentially solves the problem. “Patients are given structured, ordered, regular work and socialization in an attractive, family-like environment.”

It may take some time to calm down; and if they then return to the poisonous life situation they had been facing, problems may return. That was dealt with in the original Gheel model: recovered patients could choose to stay on and take up their life in the town.

It is the true madness that we do not return, as expeditiously as possible, to this moral model, the model of Gheel.

Do not suppose that this would be expensive. It would be vastly cheaper than our current approach. Psychiatric drugs for life are not free. And a recovered, fully-functioning citizen is a net financial gain to government and the taxpayer. Not to mention, the actual treatment involves productive work.

The method, to work long-term, must be religious in nature. Missing this was the mistake last time. Nevertheless, any supposed problem with the separation of church and state is easily overcome with goodwill: government funds need only be available without discrimination regardless of the particular denomination wanting to set up such a colony, as “faith-based charities” are now funded by government in the United States.