Digby, Anne, "Moral treatment at the Retreat, 1796-1846," in Bynum, W.F., et
The Anatomy of Madness
, vol. 2, pp. 52-72.
Moral Treatment at the Retreat
– Anne Digby
With this report, Digby aims to give a detailed analysis of moral treatment as practiced at the
Retreat during its first 50 yrs. Of existence.
founder of the Retreat
treatment for mentally ill focused on rational and emotional, not organic
causes of insanity.
Minimal medical treatment, focused on instilling self-esteem.
This was accomplished through a system of rewards and punishments for patients – almost
like the discipline performed on kids.
Keep in mind throughout that most sources of info on asylums of this sort come from the
therapists, not the patients.
achitecture intentionally avoided ‘prison’ look.
The quakers believed the insane maintained
their basic humanity, so creating respectable conditions for them would speed recovery.
Ideas behind Retreat architecture:
comfort, economy, subtle yet strong safety precautions.
medical knowledge of the staff was fairly poor, but their job had more of an emphasis on
compassion, character, and ability to related to and form relationships with patients.
George Jepson – Retreat superintendent 1797:
had medical background, but focused the
mission of the retreat on character rather than medicine.
As time went on, the
increased number of patients upset the small staff-patient ratio, and
much of the personal attention was lost
EXTERNAL RESTRAINT, SELF-CONTROL:
upon arrival at the Retreat, all physical restraints removed.
It was important that all patients
were treated and spoken to as if they were totally rational thinkers.
Seclusion and physical restraint within the Retreat were kept to a minimum – only used when
one became violent and posed a physical threat to the community that the staff was working
“The Retreat…has not considered it wise to pledge itself to the non-restraint practice as a
principle, conceiving that there may still be exceptional cases in which mild restraint is the
best and kindest as well as the most scientific mode of dealing with them.” (p. 61)
lots of therapy centered around mundane manual labor (Occupational Therapy)
the importance of this facet of the therapy was not the intrinsic ultimate value of the activity,
but the patient’s enjoyment during the process
MEDICAL & MORAL TREATMENT
at the time, medicine did not have anything real to off to the process of rehabilitation of the
The medications provided quick relief from the chronic symptoms of mental
illness (hot/cold baths, topical bleeding, etc.)
having medicine involved was very important to the retreat’s credibility to the community.
Lunatics Act of 1845 – declared that the superintendent of an asylum needed medical