• ADHD books published by NorthEast Books & Publishing, by Association for Youth, Children and Natural Psychology
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History of Psychiatry and Medical Psychology: With an Epilogue on Psychiatry and the Mind-Body Relation by Edwin R. Wallace, John Gach

This book chronicles the conceptual and methodological facets of psychiatry and medical psychology throughout history. There are no recent books covering so wide a time span.

A History of Psychiatry: From the Era of the Asylum to the Age of Prozac by Edward Shorter

Psychiatry has gone through many twists and turns from the days of oppressive and abusive insane asylums, through various movements within the field, into the modern day of psychopharmacology. This book details the history of psychiatry through the centuries.

Madness and Civilization: A History of Insanity in the Age of Reason, by Michel Foucault

One of the leading intellectuals of the twentieth century and the most prominent thinker in post-war France, Foucault's work influenced disciplines as diverse as history, sociology, philosophy, sociology and literary criticism.

Clinical Psychology: Science, Practice, and Culture, by Andrew M. Pomerantz

Pomerantz examines the many aspects of clinical psychology in a personal, thorough, and balanced manner. This new edition includes over 350 new references and offers comprehensive and up-to-date coverage of the subfields of clinical psychology, including clinical assessment, psychotherapy, ethical and professional issues, current controversies, and specialized topics.

Page updated: April 4, 2015

History of Psychiatry: Moral Management movement

Successful non-pharmaceutical treatment of mental health disorders, 1800s

William Tuke, found of the moral management approach to treating mental illness. Pinel, co-founder of the moral management, non-pharmaceutical method of treatment

Quaker William Tuke founded the moral management movement, a humane and effective non-pharmaceutical approach to treating serious mental illness in the early 1800s. The focus was on practicality, self-discipline and positive human interactions, as well as attention to what were discerned to be spiritual needs of the individual.

French psychiatrist Philippe Pinel (1745-1826) was also involved with the development of the moral management mental health treatment approach.

What was Moral Management in Mental Health Treatment?

During the early part of this period of humanitarian reform, the use of moral management are wide-ranging method of treatment that focused on a patient's of social, individual, and occupational needs became relatively widespread. This approach, which stemmed largely from the work of Pinel and Tuke, began in Europe during the late eighteenth century and in America during the early nineteenth century. Rees (1957) described the approach this way:

The insane came to be regarded as normal people who had lost their reason as a result of having been exposed to severe psychological and social stress. These stresses were called the moral causes of insanity and moral treatment aimed at relieving the patient by friendly association, discussion of his difficulties and the daily pursuit of purposeful activity; in other words social therapy, individual therapy, and occupational therapy. (Carson, et al., 2000. pp. 306-307).

Human Treatment of Those with Mental Illness

Changes at Williamsburg's Public Hospital reflected this change in attitude. First, the hospital was renamed the Williamsburg Lunatic Asylum to reflect "the view that the mentally ill were innocent victims who required protection from Society" (Zwelling, 1985, p. 30). Treatment regimes were also changed. There were fewer physical restraints, more open wards, and opportunities to practice positive activities such as farming and carpentry. Social activities, some involving members of the opposite sex, were incorporated into the daily activities of the patients.

Moral treatment in asylums was actually part of a broader movement in which more humane treatment of physical illness in hospitals was being provided for patients, usually people from the poorer classes (Luchins, 1991). A great deal more emphasis was placed in both the general hospitals and asylums on the patient's moral and spiritual development and on rehabilitation of their "character" than on their physical or mental disorders, perhaps because very little effective treatment was available for these conditions at the time. The treatment or rehabilitation of the physical or mental disorders was usually through manual labor and spiritual discussion along with humane treatment.

Effectiveness of Moral Management and Further Historical Information

Moral management achieved a high degree of effectiveness - all the more amazing because it was done without the benefit of the antipsychotic drugs used today and because many of the patients were probably suffering from syphilis, the then-incurable disease of the central nervous system. In the 20-year period between 1833 and 1853, Worcester State Hospital's discharge rate of patients who had been ill less than one year before admission was 71%. Even for patients with a longer pre-admission disorder, the discharge rate was 59 Percent. (Bockhoven, 1972).

BBC History under the heading William Tuke (1732-1822) describes the development of the moral management mental health treatment that Tuke and Pinel's pioneered in this way,
Tuke was "appalled by what he saw" in the insane asylums of that time period. In the spring of 1792, he appealed to the Society of Friends (Quakers), Tuke was a Quaker, "to revolutionise the treatment of the insane." In 1796 he collected enough money to open the York Retreat for the care of the mentally ill. BBC continues, "This was the first of its kind in England, and pioneered new, more humane methods of treatment for the mentally ill." Inmates' chains were removed, more-pleasant housing was provided, along with "decent food". A programme involving therapeutic use of occupational tasks was also initiated. "Tuke's work was contemporary with similar groundbreaking work in France by Philippe Pinel, although the two acted independently of each other," according to the BBC presentation of this period in the history of psychological or psychiatric treatment.

Professor of Psychology and Director of the Clinical Adult Psychology Graduate Program at Southern Illinois University Andrew M. Pomerantz, Ph.D. describes the work of William Tuke, "Tuke opened up the York Retreat, a residential treatment center where the mentally ill would would always be cared for with kindness, dignity and decency." Pomerantz states that by labeling the facility a "retreat" "suggests a fundamentally different approach" than what was being practiced during that time period. "Good food, exercise and friendly interactions with staff," were part of the atmosphere that contributed to the success of the moral management treatment approach.

In France, Pinel was similarly interested in "improving the conditions" of the mentally ill rather than "locking them away".

The moral management approach as promulgated by William Tuke is described in this way, "Self-discipline became central to moral treatment, and asylum reformers of the time took Tuke’s approach as a model." (Science Museum's History of Medicine). Moral treatment, Science Museum states, "became one of the most influential practices in European asylums of the 1800s," linking Tuke’s approach with Pinel.

References for History of Psychology - Moral Management

1. Carson, Robert. C., Butcher, James, N., Mineka, Susan, (2000). Abnormal Psychology and Modern Life (11th Edition) (off-site link) - Boston: Allyn & Bacon. pages 43-45.

2. Pomerantz, A. (2012). Clinical Psychology: Science, Practice, and Culture. (off-site link).

3. Tuke, William (1732 - 1822). BBC History. Retrieved May 3, 2013. http://www.bbc.co.uk/history/historic_figures/tuke_william.shtml

4. Tuke, William (1732-1822). Science Museum's History of Medicine, London, England. Retrieved May 4, 2013. http://www.sciencemuseum.org.uk/broughttolife/people/williamtuke.aspx

Further Reading on Moral Management

Foerschner, A.M. (2010). The History of Mental Illness: From "Skull Drills" to "Happy Pills". Student Pulse.

Moral Management. (2011, November). Everything About Psychology Blog.

Pinel, P. A Treatise on Insanity. 1962. (1962). (off-site Amazon link).

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Mental Health Treatment - A Closer Look at Psychopharmacology - Let the Buyer Beware! by Louis Kirby, MA

Appeal to Mental Health Professionals for professional non-pharmaceutical treatment options and clinical studies

NAMI - Mental Health Disorder Recovery

The Medical Model of mental health. Psychiatric labeling and what can be done to prevent stigma of mental illness.