History part Deux--Moral Treatment

Northampton State hospital was created during the rise in the “Moral Treatment” movement of mental health care. This philosophy was defined by the idea that ill people were still people, and by treating them the way humans ought to be treated and also giving them work to help them be productive. In short, words often used to describe the movement: “sympathy, kindness, authority and control.” Religion was often a central theme. Due to campaigning in the US after a woman was horrified at the state of inmates at a prison and then generalized her complaints to include the poor and mentally ill; the US set aside a great deal of funding towards the mentally ill that lasted in a period from 1841-1881. Most states required the building of asylums to help treat the mentally ill. Many state asylums were created that followed the Kirkbride Plan, a common form of moral treatment.

The whole design was to keep people comfortable. The building let in lots of lights and air. The people moved about freely and therapists often lived on site, developing strong personal relationships with their patients. Many, like Northampton State Hospital started with names like the “Northampton Lunatic Asylum” which at the time had positive connotations. They were a restructuring of the past and the era of a new, humane view of the ill. The plan was for small curative setups and dreams that most people, given time, will get better.

Unfortunately, due to the stigma of the “locked away” aspect of care, the public views on State Hospitals and the mentally ill began to shift. Also, there started to show that for many patients, “Moral treatment” was not enough. Little consideration had been taken into account that it could be permanent. Lastly, many of the asylums became so overcrowded that they did not have the resources to follow the philosophy of care needed to make even mild cases succeed. The asylums also became a place to house the poor and elderly, furthering the overcrowding problem. Eventually public funding diminished, but the patients remained in the care, resulting in much of the tragic stigma and dark history associated with this time-period of mental healthcare.

Even in its glory days, the moral treatment philosophy had critics, especially among many of the mildly ill who were insulted and angered by the insinuation that their illness was the result of them not being moral enough, not being strong enough, etc. Many were angry at the fact that they were not given any say in their treatment, and felt that the hospitals were a form of social repression made to teach the ill that they must follow the rules like children. One such dissent group formed in the UK was the Alleged Lunatic’s Friend Society (ALFS)

Some consider moral treatment to be the “glory days” of mental health care. Supposedly, it was a time period where the mentally ill were treated like people and were cared for and tended to. It was a time when states allocated funds to ensuring that the ill had somewhere to go to be treated, and the treatment was humane and focused on the patient feeling useful. For some patients the style did indeed work; but that may be influenced by how diseases that affected the mind were diagnosed at the time--after all one might wind up there for being poor or in a hysterical state. Also, many relapses were found later to have been recorded as new patients, thus inflating the numbers of "cured" and disregarding the ones released too soon.

Next post will be up shortly and will cover the deinstitutionalization. That will not be so long as this and will be followed by a post with statistics about homelessness and how it relates to the above program. I thought I'd provide some context for some of the things I will say first, and wanted to stress that the NoHo Assylum wasn't meant to be a bad place.