in occupational therapy what were some examples of moral treatment of the insane?

They were not held morally responsible but were subject to scorn and ridicule by the public, sometimes kept in madhouses in appalling conditions, often in chains and neglected for years or subject to numerous tortuous "treatments" including whipping, beating, bloodletting, shocking, starvation, irritant chemicals, and isolation.

Full Answer

What is moral treatment of the insane?

Moral treatment was a product of the Enlightenment of the late eighteenth century. Before then people with psychiatric conditions, referred to as the insane, were usually treated in inhumane and brutal ways.

How were the insane treated in the past?

Before then people with psychiatric conditions, referred to as the insane, were usually treated in inhumane and brutal ways. In France, England, and the United States, people who cared for the insane began to advocate for more kindly treatment. In France Philippe Pinel instituted what he called traitement moral at the Bicêtre hospital in Paris.

What is moral treatment and occupation?

In 1793, Phillipe Pinel began what was then called “Moral Treatment and Occupation”, as an approach to treating people with mental illness. He firmly believed that moral treatment meant treating one’s emotions. This Moral Treatment Movement then began to define occupation as “man’s goal-directed use of time, energy, interests, and attention”.

What was moral treatment like in an asylum?

Under moral treatment, the superintendent and keepers treated the patients as individuals, and helped them to try to regain control of themselves. Some important facets of moral treatment at the Asylum were connections with the community, religious oversight, and occupational therapy.

What is moral treatment in occupational therapy?

While the previous treatment model was associated with punishment, brutality and idleness, the moral treatment movement sought to encourage kindness and the therapeutic value of engagement in purposeful activities.

What was the moral treatment system?

Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns.

What was considered the essential element of the moral treatment of the insane?

The Article: The removal of the insane from home and former associations, with respectful and kind treatment under all circumstances, and in most cases manual labor, attendance on religious worship on Sunday, the establishment of regular habits and of self-control, diversion of the mind from morbid trains of thought, ...

What was included in Tuke's therapy known as moral treatment '?

Rejecting traditional medical intervention, Tuke emphasized the rural quiet retreat where insane people could engage in reading, light manual labor, and conversation.

Why is moral treatment important in occupational therapy?

The influence from the arts and crafts movement was to increase leisure and productivity through "hand and mind = health". The moral treatment movement helped facilitate the holistic point of view by actively involving the patients into the treatment.

What treatments were used in insane asylums?

To correct the flawed nervous system, asylum doctors applied various treatments to patients' bodies, most often hydrotherapy, electrical stimulation and rest.

What is moral treatment quizlet?

Moral Treatment. acknowledged the connection of the mind and body for health maintenance. Provided the mentally ill with. opportunity to function and adapt to their environments through a routine and activity engagement.

Is moral treatment still used today?

Combined with the diminishing belief in the significance of environmental factors on mental health, the decline in optimism surrounding asylums and mental health care meant that moral treatment fell into disuse by the 20th century.

When was the moral treatment movement?

Moral therapy originated in the Gheel colony, Belgium, during the 13th century, but it came to fruition in the 19th century through the efforts of Philippe Pinel (see Salpêtrière) and Jean Esquirol (1772–1840) in France; William Tuke (1732–1822) in England; and Benjamin Rush (1745–1813), Isaac Ray (1807–1881), and ...

Why did the moral treatment movement fail?

They found that overcrowding, insufficient funds, a decline in public opinion, and the emergence of new treatment theories led to the shift from moral treatment to mistreatment in American asylums.

In what era was the moral treatment movement valued more for mental disorders?

The rise of the moral treatment movement occurred in Europe in the late 18th century and then in the United States in the early 19th century. Its earliest proponent was Phillipe Pinel (1745-1826) who was assigned as the superintendent of la Bicetre, a hospital for mentally ill men in Paris.

What are the four humanely treatment advocated by Philip pineal?

Pinel did away with such treatments as bleeding, purging, and blistering and favoured a therapy that included close and friendly contact with the patient, discussion of personal difficulties, and a program of purposeful activities.

Who published the moral treatment of the insane?

The Moral Treatment of the Insane. By Amariah Brigham, Published in American Journal of Insanity, March 1847. Introduction: Amariah Brigham was the first superintendent of the New York State Asylum for the Insane in Utica. A leader in the field of moral treatment and the editor of “The Journal of Insanity,” Brigham here outlines his vision ...

How can an establishment for the insane be better managed?

We are satisfied that an establishment for the insane can be better managed, and with equal economy, by having an arrangement by which some attendants devote their time to the ordinary duties and labors of the halls, while others have nothing to do but to accompany the patients and endeavor to instruct and amuse them. The latter having nothing to do with any coercive measures, the patients do not become prejudiced against, and will readily hearken to their suggestions. Thus they serve as a constant guard, and by their presence and management, prevent outbreaks and disorder and make coercive measures, restraint and seclusion, rarely necessary.

Why did Joan of Arc burn?

The burning of Joan of Arc, and the thousands of supposed sorcerers, and which we now look upon with horror, was caused by the ignorance of the times. In fact, ignorance has ever been the worst of all diseases, and as relates to insanity much yet remains, and we should regard it among our highest duties to endeavor to dispel it, and to diffuse such a knowledge of insanity among all classes, as will prevent the recurrence of the enormities we have mentioned.

When was the first work on insanity published?

His first work on insanity, Traite Medico-Philosophique, was published in 1801 , and we do not hesitate to say, that we know not of any work on insanity superior to this, especially as improved by Pinel in the last edition; — none more worthy of our daily study. On perusing it, we almost lament to find that very little indeed has been added that may be called improvement in the moral treatment of the insane since his time. This work was early translated, and thus the views of Pinel respecting insanity and the proper treatment of the insane, were soon made known throughout the civilized world.

How did Melampus cure the daughters of Pretus?

Similar methods of treatment prevailed in ancient Egypt and Greece; the priests of the former country amused insane persons, and diverted their minds by music, and by pleasant walks in groves and gardens, filled with perfumes and flowers; and Melampus cured the daughters of Pretus, king of Argos, not with Hellebore as some have stated, but by bodily exercise , and by mysterious ceremonies that acted powerfully on the imagination.

What is the most salutary discipline?

Even the taking of food, retiring to bed, rising in the morning and at stated times, and conforming to stated rules in almost every thing, is a most salutary discipline. It requires, however, constant attention and vigilance, with the greatest kindness in the attendants upon a lunatic.

What did Brigham mean by rational amusements?

He envisioned them as fulfilling a task that would later be done by psychotherapists. Brigham emphasized “rational” amusements as part of treatment. The Utica institution had an extensive library, and the patients took part in various theatrical and musical presentations.

What is moral treatment?

Introduction to Moral Treatment. Moral treatment was the main way that the Asylum treated patients. As an 1825 history of the Asylum explained, “Although the use of drugs and medicaments is allowed, in almost every case, to be indispensible, less weight is attached to it in the Friends’ Asylum, than to moral treatment” ( Waln 15 ).

Who said moral treatment is a way to help mentally ill Quakers?

Historian Anne Digby countered that Quakers have always placed great importance on self-control, and she argued that moral treatment's coercive tactics would have seemed like a natural and familiar way to help mentally ill Quakers regain that self-control ( 68 ).

Why was moral treatment important to Quakers?

The Quaker founders of the Retreat and the Asylum defended and explained their use of moral treatment by arguing its efficacy. Moral treatment was not good because it was less violent, they wrote, it was good because it made the mentally ill "conform for the good of the community" ( Godlee 75 ). Scholar Fiona Godlee maintained that this focus on changing the outward behaviors of the patients to make them less obnoxious to the community contradicts Quaker faith and practice. Quakers are supposed to focus on the importance of inward changes of heart and making one’s behavior match one's inner life. For Godlee, moral treatment’s focus on the comfort of other people, as opposed to the cure of the patients, made moral treatment seem deeply un-Quaker. Historian Anne Digby countered that Quakers have always placed great importance on self-control, and she argued that moral treatment's coercive tactics would have seemed like a natural and familiar way to help mentally ill Quakers regain that self-control ( 68 ). The tension between these two viewpoints mirrors the tensions developing in American Quakerism, which would eventually lead to the Hicksite-Orthodox Schism.

Why are Quakers supposed to focus on moral treatment?

Quakers are supposed to focus on the importance of inward changes of heart and making one’s behavior match one's inner life. For Godlee, moral treatment’s focus on the comfort of other people, as opposed to the cure of the patients, made moral treatment seem deeply un-Quaker.

Why is moral treatment considered cruel?

Moral treatment was widely believed to be kinder than other types of treatment available to the mentally ill because it limited the use of physical restraint and did not condone corporal punsishment.

What does it mean to treat patients like rational beings?

Treating the patients like rational beings meant using restraint only as a last resort, to ensure the safety of the patient and those around him or her, not as a punishment. Under moral treatment, the superintendent and keepers treated the patients as individuals, and helped them to try to regain control of themselves.

Was moral treatment at the Asylum non-violent?

Although moral treatment at the Asylum was non-violent and focused on getting the patients to try to take control of their lives again, some of moral treatment’s manifestations could be cruel. For some examples of the cruel side of moral treatment, see the stories of Nathan Y. and Abraham S. in the Case Studies.

What are some therapeutic occupations that occupational therapists use?

Early occupational therapists introduced therapeutic occupations such as weaving, art, and bookbinding. These goal-directed activities were used to help individuals learn new skills to be productive, and derive therapeutic benefits of a balanced daily schedule.

What is occupational therapy?

Occupational Therapy and Mental Health. The mental health treatment journey requires a collaborative effort by many people — the individual, his or her caregivers, support providers, doctors, nurses, teachers, aides, counselors, therapists, and social workers. This collaborative process allows everyone to work together to reach a specific goal: ...

What is the primary goal of occupational therapy?

According to the American Occupational Therapy Association, the primary goal of occupational therapy is to support and enable each person’s “health and participation in life through engagement in occupation.”. “Occupation” does not solely mean work.

Where did occupational therapy originate?

Occupational therapy’s emergence can be found as far back as eighteenth-century Europe.

Where do mental health professionals work?

They practice in diverse settings, including hospitals, outpatient clinics, skilled nursing facilities, intermediate care facilities, home health, neonatal intensive care units, community programs and the workplace. Those who work in mental health can do so in residential hospitals, community-based mental health settings ...

Who wrote the book "Observations on the Deranged Manifestations of the Mind, or Insanity?

Spurzheim, Johann Gaspar. Observations on the Deranged Manifestations of the Mind, or Insanity. Boston: Marsh, Capen & Lyon, 1833.

How did the carriage help with mental health?

In addition to occupying the mind, riding helped strengthen the body and secure recovery from the physical disorders which physicians thought caused mental illness. The shocks and jolts of an early nineteenth-century carriage ride placed the activity among the ranks of “passive exercises.” These differed from active exercises in that the body was moved by outside forces rather than its own impulses; the exertion lay in maintaining one’s position. An educational magazine in 1837 concluded that carriage exercise was “very favourable to the re-establishment of convalescents who cannot yet take any active exercise,” because it “gives more vigour to the organs, without adding to the activity of their functions . . . and enjoys, in a very high degree, the advantages peculiar to passive exercises” (188). Similar effects on both mental and physical health were attributed to walking.

What animals were used in the Asylum?

Among the diversions introduced in 1835 were lambs, rabbits, and poultry that the patients could play with in their exercise yards. In 1813 Samuel Tuke recorded that the exercise yards at the York Retreat were supplied with rabbits, poultry, sea-gulls, and even hawks (63). Asylum experts saw befriending animals as a way to revive patients’ social feelings. One member of the Pennsylvania Hospital’s staff wrote of the benefits of animals in a letter to Asylum managers: “I love to see a patient adopt some animate pet, if it be but a mouse, and would encourage the disposition; it has a humanizing and happy influence. Attention to animals gives the insane an occupation and an interest in something out of themselves and their delusions, whilst in their isolated situation it becomes a source of pleasure to feel that some creature is dependent upon them for its comfort, and perhaps in return loves them” (First Month 1835).

What was the most conspicuous diversion in the asylum?

The most conspicuous diversion was the circular railroad introduced in 1835, which features in several engravings of the asylum’s facade. A letter from the Worcester State Lunatic Hospital inspired the railroad (Managers’ Minutes, First Month, 1835), and the managers modeled the device off of one that a Frankford Friend used to entertain his children (Seventh Month, 25, 1835). By pumping themselves around the tracks, patients got more strenuous exercise than they could riding in the carriage.

What was moral treatment?

Moral treatment was a product of the Enlightenment of the late eighteenth century. Before then people with psychiatric conditions, referred to as the insane, were usually treated in inhumane and brutal ways. In France, England, and the United States, people who cared for the insane began to advocate for more kindly treatment.

Who was the first person to advocate moral treatment?

In the United States, the first proponent of moral treatment was Benjamin Rush. A Philadelphia physician, Rush had been one of the signers of the American Declaration of Independence. For Rush, the hustle and bustle of modern life contributed to mental diseases.

Why did the dream of moral treatment die?

The dream of moral treatment died because of a combination of overcrowded hospitals along with the advent of eugenics and Freud around the turn of the twentieth century.

What did Dix insisted on?

Dix insisted that hospitals for the insane be spacious, well ventilated, and have beautiful grounds. In such settings, Dix envisioned troubled people regaining their sanity. In the 1840s and 1850s there was much optimism for the cure of insanity through kind treatment without restraints.

How did Freud influence American psychiatry?

As such, a new breed of psychiatrists influenced by the psycho-sexual developmental theories of Freud would have a new model of cure. Not in the environment of the rural retreat or asylum, but now on the couch in the psychiatrist’s office, patients could free associate about phobias and developmental blockages. Through personal insight guided by the psychiatrist, the patient became better. For Freud, ironically people who had unresolved developmental matters in the youngest years of life were the people who had the most severe forms of psychopathology, like schizophrenia. Because these patients were not amenable to insight therapy, they were not curable. They had best remain in the institution. The dream of moral treatment died because of a combination of overcrowded hospitals along with the advent of eugenics and Freud around the turn of the twentieth century.

Who advocated for more kindly treatment?

In France, England, and the United States, people who cared for the insane began to advocate for more kindly treatment. In France Philippe Pinel instituted what he called traitement moral at the Bicêtre hospital in Paris.

What was the perspective of the second half of the nineteenth century?

During the second half of the nineteenth century, the optimism surrounding moral treatment began to wane.

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.

Bibliography

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

What was the field of occupational therapy in the 1960s?

The field of Occupational Therapy kept growing. During the 1960’s, as medicine became “specialized”, so did OT. Occupational Therapists were also called upon and qualified to treat in the fields of pediatrics and developmental disabilities. And, with de-institutionalization came an even greater need to help mentally ill, physically infirmed, and developmentally challenged individuals become independent and productive members of society. It was Occupational Therapists that could easily fill this role, and the surge for competently educated therapists was on.

Why was it so hard to find occupational therapists during the Great Depression?

Following the Great Depression, however, it was difficult to find therapists due to low budgets and poor staffing of clinics.

What was the Rehabilitation Movement?

From the 1940’s through the 1960’s, the “Rehabilitation Movement” was in full force. With the thousands of injured soldiers (physically and mentally) returning home from the war, there was a surge in the demand for Occupational Therapists (or, OT’s as we now call ourselves). At this point, OT’s were not only treating the mentally ill who were already institutionalized, but began treating physical disabilities due to the injuries sustained in battle. Besides the mentally ill, the injured war veterans, OT’s also became called upon to treat an ever increasing number of survivors of “modern medicine’s miracles”. Now OT’s hit physical disabilities at high speed with the aforementioned, PLUS survivors of spinal cord injuries, amputations, traumatic brain injuries, and cerebral palsy.

What was the first method of treatment for mental illness?

In 1793, Phillipe Pinel began what was then called “Moral Treatment and Occupation”, as an approach to treating people with mental illness. He firmly believed that moral treatment meant treating one’s emotions. This Moral Treatment Movement then began to define occupation as “man’s goal-directed use of time, energy, interests, and attention”. Treatment for the mentally ill thus became based on purposeful daily activities. Pinel began advocating for, and using, literature, music, physical exercise, and work as a way to “heal” emotional stress, thereby improving one’s ability to perform activities of daily living (“ADL’s” as we now call them).

Why was it so hard to find occupational therapists?

Following the Great Depression, however, it was difficult to find therapists due to low budgets and poor staffing of clinics. But, then came World War I, which necessitated the use of every available therapist possible! It was this time that Occupational Therapists were called on to develop programs and treat injured soldiers, of which there were too many!

Why did moral treatment go extinct?

Unfortunately, during the 19th century, in the U.S., moral treatment almost became extinct in the chaos and aftermath of the Civil War. It became less of a priority and there seemed to be no one to carry on the ideas and insightful philosophies from Tuke and Pinel.

When did OT become medical?

In 1947 The journal, Occupational Therapy and Rehabilitation and the first major textbook, Willard & Spackman’s Principles of Occupational Therapy, were finally published. Occupational Therapists finally achieved medical status. This recognition provided other opportunities to gain financial support from the federal government for the education of OT personnel, and it provided leadership training skills for members of the American Occupational Therapy Association.

What is moral treatment?

Moral treatment. Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns. The movement is particularly associated ...

Who was the first physician to use moral treatment?

A key figure in the early spread of moral treatment in the United States was Benjamin Rush (1745–1813), an eminent physician at Pennsylvania Hospital. He limited his practice to mental illness and developed innovative, humane approaches to treatment. He required that the hospital hire intelligent and sensitive attendants to work closely ...

How did asylums change in the 19th century?

By the end of the 19th century and into the 20th, these large out-of-town asylums had become overcrowded, misused, isolated and run-down. The therapeutic principles had often been neglected along with the patients. Moral management techniques had turned into mindless institutional routines within an authoritarian structure. Consideration of costs quickly overrode ideals. There was compromise over decoration—no longer a homey, family atmosphere but drab and minimalist. There was an emphasis on security, custody, high walls, closed doors, shutting people off from society, and physical restraint was often used. It is well documented that there was very little therapeutic activity, and medics were little more than administrators who seldom attended to patients and mainly then for other, somatic, problems. Any hope of moral treatment or a family atmosphere was "obliterated". In 1827 the average number of asylum inmates in Britain was 166; by 1930 it was 1221. The relative proportion of the public officially diagnosed as insane grew.

What did Pinel mean by morality?

Pinel used the term "traitement moral" for the new approach. At that time "moral", in French and internationally, had a mixed meaning of either psychological/emotional (mental) or moral (ethical). Pinel distanced himself from the more religious work that was developed by the Tukes, and in fact considered that excessive religiosity could be harmful. He sometimes took a moral stance himself, however, as to what he considered to be mentally healthy and socially appropriate.

How did moral treatment affect asylum?

The moral treatment movement had a huge influence on asylum construction and practice . Many countries were introducing legislation requiring local authorities to provide asylums for the local population, and they were increasingly designed and run along moral treatment lines.

How many hospitals did Dix help establish?

Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment. Many asylums were built according to the so-called Kirkbride Plan .

What does Foucault say about moral asylum?

Thus Foucault argues that the "moral" asylum is "not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged, and condemned.".

Origins of Occupational Therapy

Assessments and Treatments

• When working with someone with a mental health condition, occupational therapists employ a variety of assessments. Once the necessary information has been obtained, the therapist creates a personalized occupational profile. This profile is used for goal-setting and treatment planning. Common areas of assessment include: 1. Activities of daily livin...

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