The strength of moral treatment as a mechanism for the management and regulation of patient behavior was found in the subtly controlling environment that it created. By limiting the world of the patients to the asylum grounds while seemingly providing them with extensive freedom through the right to walk the grounds and participate in regular daily activities such as meals in a dining room, the moral asylum led to the gradual abandonment of the brutal methods of management associated with older institutions for the insane.
Mental illness, however, is not a simple disease making the healing utopia created by nineteenth century physicians insufficient in managing and curing the mentally ill. Reality pushed against the ideological notions of moral therapy to reveal that benevolent treatment was not always easy or possible. There were situations where physically restrictive measures, through medicine and mechanical restraints, were necessary.
Moral therapy did unchain madness from its dark cell, it did create more humane methods of treatment, but it could not negate the necessity of restraints. Physician's reluctant acceptance of this proves that there was and is no simple or universal answer for the question of how to humanely treat the insane. Psychiatrists and society as a whole are still struggling with the best ways to manage people who fall outside of socially accepted standards of behavior. In many instances there are no suitable treatment centers for modern America's insane population. An article recently published by National Public Radio reveals that prisons are among the primary holding places for the insane, but they are ill-equipped to handle the such inmates. Cook County Jail in Illinois tries to provide therapy and medication for their mentally ill inmates, but openly acknowledges that their facilities and resources are inadequate for both custodial and curative care. When insane inmates get violent there is often no other recourse for officers than to use leather restraints on the patient.
Conversely, Western State Hospital in Staunton, Virginia relies on the model of moral therapists to aid its treatment policies. In 2013 the psychiatric hospital downsized and opened a new campus. The construction and situation of the new hospital follows many of the guidelines of asylum construction from the era of moral therapy. Mirroring the language of nineteenth century moral therapists, facility director Doctor Jack Barber stated that the new hospital allows for “[n]atural light, views to the outside landscape, different kinds of space, so that you can be more or less stimulated, [and] private rooms so you have a sanctuary.” There are even courtyards set up for patient use and classrooms within the facility.
The question of how to manage the insane provokes controversy today just as it did in the nineteenth century. Society tends to cringe at the thought institutionalization equating it with twentieth century lobotomies and uninformed images of brutal conditions involving chains and straight jackets. But rejecting institutionalization in favor of poorly funded community mental health clinics means that most mentally ill people do not have access to the kind of treatment and care that they need. Instead they end up in jail or on the streets, a practice that moral therapists of the nineteenth century sought to end. While America has rejected large, state-run asylums, the legacy of moral therapy continues to influence psychiatric practice. In Cook County Jail the restraints used on inmates replicate the padded chains and rooms of the moral asylum. At Western State Hospital, the idea of a utopia for the mind based on patient's surrounding environment has guided the creation of new facilities. Moral therapists may not have been able to negate every seemingly brutal practice of the eighteenth century with their asylums, but they made advances that can still be useful today.
Mental illness, however, is not a simple disease making the healing utopia created by nineteenth century physicians insufficient in managing and curing the mentally ill. Reality pushed against the ideological notions of moral therapy to reveal that benevolent treatment was not always easy or possible. There were situations where physically restrictive measures, through medicine and mechanical restraints, were necessary.
Moral therapy did unchain madness from its dark cell, it did create more humane methods of treatment, but it could not negate the necessity of restraints. Physician's reluctant acceptance of this proves that there was and is no simple or universal answer for the question of how to humanely treat the insane. Psychiatrists and society as a whole are still struggling with the best ways to manage people who fall outside of socially accepted standards of behavior. In many instances there are no suitable treatment centers for modern America's insane population. An article recently published by National Public Radio reveals that prisons are among the primary holding places for the insane, but they are ill-equipped to handle the such inmates. Cook County Jail in Illinois tries to provide therapy and medication for their mentally ill inmates, but openly acknowledges that their facilities and resources are inadequate for both custodial and curative care. When insane inmates get violent there is often no other recourse for officers than to use leather restraints on the patient.
Conversely, Western State Hospital in Staunton, Virginia relies on the model of moral therapists to aid its treatment policies. In 2013 the psychiatric hospital downsized and opened a new campus. The construction and situation of the new hospital follows many of the guidelines of asylum construction from the era of moral therapy. Mirroring the language of nineteenth century moral therapists, facility director Doctor Jack Barber stated that the new hospital allows for “[n]atural light, views to the outside landscape, different kinds of space, so that you can be more or less stimulated, [and] private rooms so you have a sanctuary.” There are even courtyards set up for patient use and classrooms within the facility.
The question of how to manage the insane provokes controversy today just as it did in the nineteenth century. Society tends to cringe at the thought institutionalization equating it with twentieth century lobotomies and uninformed images of brutal conditions involving chains and straight jackets. But rejecting institutionalization in favor of poorly funded community mental health clinics means that most mentally ill people do not have access to the kind of treatment and care that they need. Instead they end up in jail or on the streets, a practice that moral therapists of the nineteenth century sought to end. While America has rejected large, state-run asylums, the legacy of moral therapy continues to influence psychiatric practice. In Cook County Jail the restraints used on inmates replicate the padded chains and rooms of the moral asylum. At Western State Hospital, the idea of a utopia for the mind based on patient's surrounding environment has guided the creation of new facilities. Moral therapists may not have been able to negate every seemingly brutal practice of the eighteenth century with their asylums, but they made advances that can still be useful today.