Moral Treatment of the Mentally Ill in the 19th and 20th Centuries


Towards the beginning of the nineteenth century, methods used when caring for the mentally ill began to experience certain changes. The institutions set up to care for the mentally ill people termed the nineteenth-century as the enlightenment period since it brought with it the moral treatment approach for people with mental illness. However, before the nineteenth century individuals suffering from mental illness had to be cared for by members of their families. The family members silently attended to the mentally ill individuals needs in the countryside. It was as a result of the alleged threats associated with the mentally ill which caused an impetus in the way the mentally ill could be cared for.

Moral treatment which was seen as a product of the moral enlightenment regime was finally implemented in the early nineteenth century. This treatment method had its impacts on the quality of care given to the mentally ill. In the past, attention was not given to the attendants, but it was directed towards the responsibility assumed by the medical superintendents. Yet, it was through the mentally ill attendants that the moral treatment could be realized. This is because the moral treatment therapy could only be achieved through interpersonal association.

Given that the attendants to the mentally ill individuals were the regular companions of such patients, they are considered to be essential to the triumph of the moral treatment approach. The role played by medical superintendents was no longer considered important. This paper highlights the moral treatment of the mentally ill in the 19th and 20th centuries.

Moral treatment

The adoption of the moral treatment method in the nineteenth and twentieth centuries saw patients suffering from mental illnesses as individuals. According to Freeman (1998) assertions, an individual mentally ill patient has the potential of restoring and recovering back to sanity. The concept of moral treatment is believed to have originated from England in the middle of the eighteenth century. It stemmed from the achievements of Dr. John Munro and Dr. William Battie. The famous Retreat York which was a non-medical reforming institution equally established its moral mental illness treatment reputation under Henry Tuke guidance.

The moral treatment method has an essential feature that requires the mentally ill patients to be psychologically managed rather than being mechanically restraint or confined. The philosophical grounds for the moral treatment might be attributed to the enlightenment period which started from the beginning of the nineteenth century. During this period, the liberalism ideals influenced human beings. Individuals’ rights ensured that people had to adopt more humanitarian ideals and reject the superstitious beliefs. Most of these ideals were projected by the notions of equality, fraternity and liberty as well as the revolution of France.

Although the exact moral treatment origin in France is difficult to pinpoint, Phillipe Pinel was the great liberator and initiator of the moral mental illness treatment method. Basically, Pinel through moral treatment, managed to free all the mentally ill patients from Salpetriere and Bicetre hospital chains. Away from being similar to the wild beasts, Pinel made deduced observations that the mentally ill patients were basically sick and for them to recover, they needed the assistance of more humane treatment approach. In fact, Pinel asserted that, despite being seen as punishable delinquents, the insane are patients with distressing states. Hence, their mentally ill states deserve all the considerations and care because of the suffering humanity.

The moral treatment method proved to be very successful in treating the mentally ill patients. For example, under the moral treatment approach, patients are set free from the mechanical restraints. However, these mentally ill individuals are not allowed to be idle. The new regime of the 19th and 20th centuries had two pillars which required that the mentally ill patients should be benevolently treated and engaged in any occupation. The occupations should be either useful or diverting. The success in implementing the moral treatment approach was reported at the Crichton Royal Hospital. In this mental illness institution, the psychologically disturbed patients were given a variety of pastime games including dancing and shuttle cock as well as other types of work. The patients were standardized in issues relating to social communication, hygiene and dressing codes. In the elegantly furnished luxurious apartments, only the free-paying and wealthy mentally ill patients were housed. Bartlett and Wright (1999) claim that such patients participated in the drawing and theatrical classes, but did not carry out any work.

The expenses incurred by the poor but mentally ill and pauper patients were recovered through engaging them into bake house, sewing room, laundry and garden laboring. The moral treatment system was defended by Scull (1989) who claimed that rather than restraining the mentally ill, but labor active patients in confined rooms, their labor could be devised and used in the conservation of the institutional resources. They ought to be freed up and engaged in social activities that might help restore their sanities.

Moral treatment also entailed training and supervising the mentally ill patients. Since they are human beings, the psychologically disturbed individuals are believed to require a totally different type of attendant. Those responsible must be caring, loving and should be willing to guide and teach the patients without causing any harm to them. Moral treatment necessitates that the attendant should act like guides, friends and teachers of the mentally ill patients. The relationship existing between the attendants and the suffering patients is considered as an essential element in the success of moral treatment.

By referring to the mentally distressed patients as mad, the caretakers used atrocious and merciless means to treat such groups. In essence, individuals and groups alleged to be caring for the psychologically unwell people started to campaign against the kind actions taken when handling mad people. The fair treatment advocates mainly came from the United States, England and France. For instance, Tuke and Pinel are still remembered as the strong advocates for fair treatment of the mentally ill patients. They became concerned to the unsympathetic cure of the psychologically ill individuals in Europe and therefore, strongly supported the use of pleasing surroundings and standard schedule checks as a moral psychological illness cure therapy. Instead of applying physical means such as chaining, beating and confining the mentally ill patients, Pinel and Tuke called for reforms in matters that related to the treatment of such patients. Some of the proposed moral treatment reforms included pleasant conversation, walks, recreation, patience and kindness.

Before the emergence of moral treatment, physicians believed that mental illnesses were caused by nervous system defects. Such mental illnesses could only be treated or corrected by applying several treatments to the bodies of the patients. The cure included respite, electrical motivation and hydrotherapies. Medical thinking changed from 1890 to 1918 when physicians realized that mental diseases could be cured through understanding the illness psychologically. The reforms that Pinel and Tuke advocated were meant to reject the customary medical interventions which hardly allowed mentally ill patients to be engaged moral treatment methods such as free conversation, light manual labor, gaming and reading.

Boris Sidis applied moral treatment to cure the mentally ill patients. A combination of the somatic treatment with the modern moral mental illness treatment therapy assisted the health institutions in restoring the unconscious memories of the psychologically disturbed individuals. Unlike in the public mental health institutions, moral mental illness treatment in the private asylums was much better. For instance, mentally ill patients found in public hospitals displayed suicidal or violent behaviors even prior to being hospitalized. They lacked voluntary commitments while such rehabilitating institutions were dirty, overcrowded and had an unpleasant smell. The poorly paid staffs were left with no choices, but to treat mentally ill patients harshly. The rich but mentally ill patients escaped the harsh treatment as they were morally treated at the physicians’ homes. The surrounding environments thus facilitate the recovery of morally treated psychologically ill patients.

The success of the previous mental illness treatment therapies

While they lacked reasons to back up their claims, the perceptions of the medieval as regards to the mental illness resulted from the belief that the insane descended to the animal status. As a result of this, the mentally ill were treated like wild beasts. The belief continued into the remaining years of the eighteenth century whereby mentally disturbed individuals were thought to be possessed and thus were separately confined. Before the moral treatment came into being, the Britain asylums were used to house the mentally ill since they were social control covenant centers. Nothing much was done to rehabilitate the mentally ill individuals.

In the British and French mental illness institutions, the keepers or caretakers were responsible for chaining the insane inmates, and they impeded them from any social activities. This was to ensure that mechanically restrained and stopped from escaping. Besides, the mentally ill keepers had the rights to discipline any troublemakers and were hardly asked to show some grace when exercising their duties and authorities over the mentally ill. A part from the asylum treatment system, other treatment methods for the mentally ill individuals included incarceration and imprisonment. These mental illness treatment methods were very ineffective. For instance, in the case of imprisonment, there were no clear lines drawn between criminality and mental illness. On the other hand, relation with means also called incarceration in the private insane homes was deemed unsuccessful because mentally ill individuals and groups were managed by unprincipled mad doctors who only wanted to make profits from the unfortunate psychologically ill victims.

From mental illness literature, it is apparent that moral treatment therapy has been more successful in treating mentally ill patients than the previous modes of treatments. In fact, the traditional mental treatment therapies such as electrical stimulation, rest, medical intervention, incarceration and imprisonment only worsened the conditions of the patients as they were mechanically restrained from participating in social activities, light labor, free conversation, reading and gaming. Confining, beating and chaining the mentally ill patients just hindered their restoration and recovery from the mental illnesses. For instance, after World War One, it became apparent that electrical stimulation and baths could not cure mental illnesses. This coupled with the mentally ill patients’ autopsies’ failure to show brain injuries left many people anxious to know the validity of the somatic illness explanations. It is with emergence and success of moral treatment that other somatic treatment methods were considered to be redundant and ineffective in treating mentally ill patients.


Despite not being very successful in treating mental illnesses, the traditional therapies were overtaken by moral treatment. This mode of treating mental illnesses provided a valid base for a humanistic approach to the handling and treating of the mentally ill patients. Moral treatment put more emphasis on the interpersonal associations. This implies that, the caretakers should be observed as guides, teachers and moral advisors to the mental ill patients. Thus, the administrators should avoid using brutal means namely chaining and punishing those who are mentally ill. They should be properly trained on how to handle and morally treat the psychologically disturbed patients.

According to Murphy (2003), mechanical restraints and brutal acts should not be used when treating mentally perturbed individuals. In fact, since the victims are human beings, humane approaches should be drawn on. The caretakers must ensure that mentally individuals are given better clothing, fed and housed properly. Furthermore, mentally ill people should be recognized, kept amused, allowed to carry out light duties, socialize, read and play games.


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Freeman, Hugh. “Mental Health Policy and Practice in the NHS: 1948-79”. Journal of Mental Health, vol.7 no.3 (1998): 225-40.

Murphy, Elaine. “The Administration of Insanity in England 1800 to 1870”. In Roy Porter and David Wright, The Confinement of the Insane: International Perspectives, 1800-1965, UK: Cambridge, 2003.

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana Press, 1999.

Rothman, David. “The Enduring Asylum”. In Phil Brown, Mental Health Care and Policy, Boston: Routledge and Kegan, 1985.

Scull, Andrew. Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective. Berkeley, CA: Berkeley, 1989.