Moral Treatment: A New Therapeutic Model

Organized sports and bicycling were also popular. These activities were believed to assist recovery, as they broke up the monotony of asylum life.

In the late nineteenth century, Rockwood Asylum underwent a drastic change in treatment philosophies. Begun under the guidance of the third Superintendent Dr. William Metcalf, and continued by Dr. Charles Kirk Clarke, moral treatment was used as a framework to improve the lives of patients under the asylum’s care.

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Members of the Rockwood Bicycle Club, 1885. Made up of both staff and patients. Courtesy of KPH Collection on loan from the Archives of Ontario to the Providence Care Hospital Archives.

Moral treatment was never explicitly defined by its practitioners. The practice of moral treatment began at the beginning of the nineteenth century, influenced by everchanging European and North American views on how the mentally ill should be treated. Pliny Earle, an American physician aptly explained the philosophy behind moral treatment, remarking in 1845 that this framework’s primary objective was to “… treat the patient, so far as their condition will possibly admit, as if they were still in the enjoyment of the healthy exercise of their mental faculties.”[1] Physicians and alienists (a nineteenth century term for psychiatrists) who believed in moral treatment disapproved of restraining and sedating patients, common occurrences in the first part of the 1800s. Moral treatment was intended to be holistic, and incorporate healing into every part of a patient’s life. From dawn until dusk, practitioners of moral treatment strictly scheduled a patient’s day, with activities chosen because of their therapeutic benefits.[2] Ideally a patient undergoing moral treatment would hold a job at the institution, take part in a variety of recreational “amusements”, exercise frequently, eat a healthy diet, attend religious services, and cultivate appropriate interests. This busy schedule was meant to distract the patient from their own mind, allowing for optimal healing to take place.[3]

 

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Rotary Push Mower, used at Rockwood as a treatment tool, from the Museum of Health Care collection (Acquisition Number: 000003391)

During Dr. Clarke’s time as Superintendent of Rockwood (1885-1905), he incorporated aspects of moral treatment into the lives of his patients. A large majority of individuals receiving care worked around the institution. Work was divided by gender, with male patients completing building projects and landscaping tasks, and female patients responsible for the majority of the cleaning, laundry and mending duties (there were men employed to clean the male wards, as female patients were not allowed to enter these spaces).[4] By creating a workforce out of the patient population, the institution was able to cut costs for domestic help, a welcomed benefit of this model.

When the patients were not working, they were encouraged to exercise. In 1890, daily physical culture classes were implemented at Rockwood for the people who did not work at physically demanding jobs.[5] Every patient who was physically able was recommended to walk around the grounds at least once a day.[6] Recreational activities were also seen as imperative to recovery. Patients were entertained by the staff minstrel and drama troupes in the purpose built O’Reilly Hall[7], received musical instruction from both a specifically hired instructor and Clarke himself,[8] and read in the library. Patients deemed well-behaved took trips around the lake in a steam yacht once a week in the summer months and attended circuses and community fairs in the city of Kingston[9]. Organized sports and bicycling were also popular. These activities were believed to assist recovery, as they broke up the monotony of asylum life.[10]

 

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O’Reilly Hall, Rockwood, Christmas c. 1900. Courtesy of the John S. Patton collection located at Queen’s University Archives.

Moral treatment is today considered by some to be the first practical effort for responsible care of the mentally ill.[11] The ideological focus could be seen as a precursor to current views on healthy lifestyle choices, and can be commended for its distaste of contemporary medicines and surgical procedures (which consistently did more harm than good). Moral treatment may have been a step in the right direction, but it was by no means perfect. Scholar Danielle Terbenche states that moral treatment was designed for men and only adapted for women[12], a viewpoint that is relevant to the experiences of female patients at Rockwood, living under this system. Although Superintendents who subscribed to moral treatment philosophies may have attempted to utilize the ideology to benefit all patients at the institution, women were still expected to fulfil what was believed to be a “natural” caregiver role. For example, in addition to domestic work, female patients were often expected to watch other patients who were suicidal to ensure they did not act on their urgings.[13] These imposed responsibilities derailed some of the therapeutic effects of the moral system, a topic that will be further discussed in my forthcoming manuscript.


About the Author : Victoria Bowen

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Victoria Bowen is the 2019 Margaret Angus Research Fellow. Victoria recently finished her undergraduate degree at Queen’s University, and will be returning to Queen’s in the fall to begin her Master’s in Art History. This summer, Victoria will be developing a manuscript that examines Rockwood Asylum in the late nineteenth century, focusing on the impact gender had on the experiences of patients at the institution. 

Citations

[1] J. Sanbourne Bockoven, Moral Treatment in American Psychiatry (New York: Springer Publishing Company INC, 1963): 70.

[2] Suzanne M. Peloquin, “Moral Treatment: Contexts Considered” The American Journal of Occupational Therapy 43:8 (1989): 538.

[3] Bockoven, 70.

[4] Bruce R. Thomson, 125 Years of Keeping People Healthy (Produced by the Kingston Psychiatric Hospital, April 1981): 16.

[5] Danielle Terbenche, “‘Curative’ and ‘Custodial’: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906” The Canadian Historical Review 86:1 (2005): 38.

[6] James E. Moran, Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec and Ontario (Montreal: McGill- Queen’s University Press, 2000): 95.

[7] Karl Rainer Baehre, The Ill-Regulated Mind: A Study in the Making of Psychiatry in Ontario, 1830-1921, ProQuest Dissertations and Thesis (1985): 380.

[8] Terbenche, 39.

[9] Ontario Inspector of Prisons and Public Charities, Annual Report of the Medical Superintendent of the Asylum for the Insane, Kingston for the Year Ended 30th September 1888 (Toronto: Warwick and Sons, 1889): 94, accessed June 07, 2019, https://archive.org/details/annualreport19onta/page/n2.

[10] Moran, 95.

[11] Bockoven, 13.

[12] Terbenche, 37.

[13] Ontario Inspector of Prisons and Public Charities, Annual Report of the Medical Superintendent of the Asylum for the Insane, Kingston for the Year Ended 30th September 1887 (Toronto: Warwick and Sons, 1888): 94, accessed June 07, 2019, https://archive.org/details/annualreport18onta/page/n2.

 


Bibliography

Baehre, Karl Rainer. The Ill-Regulated Mind: A Study in the Making of Psychiatry in Ontario, 1830-1921. ProQuest Dissertations and Thesis (1985).

Bockoven, J. Sanbourne. Moral Treatment in American Psychiatry. New York: Springer Publishing Company, INC (1963). Accessed Online. https://hdl.handle.net/2027/mdp.39015072209912

Ontario Inspector of Prisons and Public Charities. Annual Report of the Medical Superintendent of the  Asylum for the Insane, Kingston, for the Year Ended 30th September 1887. Toronto: Warwick and  Sons, 1888. Accessed Online. https://archive.org/details/annualreport18onta/page/n2

Ontario Inspector of Prisons and Public Charities. Annual Report of the Medical Superintendent of the  Asylum for the Insane, Kingston, for the Year Ended 30th September 1888. Toronto: Warwick and  Sons, 1889. Accessed Online. https://archive.org/details/annualreport19onta/page/n2

Moran, James E. Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec and Ontario. Montreal: McGill-Queen’s University Press, 2000.

Peloquin, Suzanne M. “Moral Treatment: Contexts Considered”. The American Journal of Occupational Therapy 43:8 (August 1989): 537-544. Accessed June 09, 2019. https://pdfs.semanticscholar.org/0212/9d9b464192b4345b05aa5ea79fb69eeb1dd4.pdf

“Philippe Pinel.” Encyclopaedia Britannica. Accessed July 15, 2019. https://www.britannica.com/biography/Philippe-Pinel

Terbenche, Danielle. “Curative and Custodial: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906.” The Canadian Historical Review 86:1 (2005): 29-52. Accessed May  15, 2019. DOI: https://doi.org/10.1353/can.2005.0091.

Thomson, Bruce R. 125 Years of Keeping People Healthy. Produced by the Kingston Psychiatric Hospital,  April 1981.


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