Psychiatric therapy in Georgian Britain

Abstract

Background. This paper examines the emergence of ‘moral treatment’ in British psychiatry.

Method. Re-examining a range of largely well-known sources, this article begins by outlining the social and intellectual shifts entailed by the secularization of madness at around 1660. The boundaries of various schools of psychiatric treatment are distinguished according to: (a) how much moral autonomy they accord the insane patient; and (b) whether they promote ‘body’ or ‘mind’ first (are ‘somatopsychic’ or ‘psychosomatic’). I have also incorporated newly-discovered material that proves the existence of ‘classical moral treatment’, or therapeutic argumentation.

Results. The paper outlines four distinct models of psychiatric treatment: ‘classical moral treatment’; the ‘pious fraud’; ‘charismatic stewardship’; and ‘moral treatment’. Neither the ‘pious fraud’ nor ‘charismatic stewardship’ allowed that the patient was morally autonomous – rather, lunatics were stereotyped as animals. After the 1780s, some psychiatrists began practising in ways that understood the patient as being capable of some rationality. But none of these practitioners saw ‘moral’ therapies to be independent of the body's workings – they used: (a) psychological methods to ease the administration of physic; and/or (b) psychological and medical remedies interchangeably. The Tukes, who developed the famous asylum ‘The Retreat’ at York, were the first to find successful ways to make psychological means predominate in therapy.

Conclusion. The Tukes of York are reinstalled in their position as founders of moral treatment as a therapy aimed at the autonomous human mind.