The Rise and Decline of Moral Treatment

By the late 18th century, however, attitudes toward persons with mental illness began to moderate. In place of punishment and warehous- ing, reformers proposed moral treatment: teaching individuals to live in society by showing them kindness, giving them opportunities to work and play, and in general treating mental illness more as a moral rather than medical issue. The stun- ning successes that resulted convinced the public that mental illness was curable. The first American hospital designed to provide moral treatment, the Friends’ (or Quakers’) Asylum, was founded in 1817.

Despite this strong beginning, moral treatment in the end could not compete with medical models of mental illness. Because those who promoted moral treatment continued to use the language of medicine to talk of illnesses and cures, medical doctors could argue successfully that only they should control this field. In addition, because moral treatment required only kindness and sensitivity, which theoretically any professionals could offer, no professional group could claim greater expertise than doctors. As a result, by 1840, doctors largely had gained control over the field of mental illness both in the United States and Europe.

As care gradually shifted from laypersons to doctors, custodial care began to replace moral treatment. This shift reflected the growing belief that illness was genetic and untreatable, as well as the public’s greater interest in controlling people with mental illnesses—especially if they were poor, nonwhite, or immigrant— rather than treating them.

By the 1870s, moral treatment had been abandoned. Yet the number of men- tal hospitals continued to grow exponentially. Historians re- fer to this change, and similar but earlier developments in Europe, as the Great Confinement.

Benjamin Rush, the “father of American psychiatry,” invented this device to treat mental illness through removing distractions from the patient.