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Premidterm_Summaries - Images of beginning The"birth of the...

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Images of beginning: The "birth" of the asylum, the "birth" of psychiatry Digby, Anne, "Moral treatment at the Retreat, 1796-1846," in Bynum, W.F., et al., eds., The Anatomy of Madness , vol. 2, pp. 52-72. Study Guide: 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. HISTORICAL CONTEXT: - William Tuke: founder of the Retreat - Moral Treatment: 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. THERAPEUTIC ENVIRONMENT: - 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. LAY THERAPY: - 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 to maintain. - “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) SOCIAL THERAPY: - 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 mentally ill. 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.
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