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A Model Institution

The Retreat at York<br /><br />

Image of the Retreat at York in England, one of the pioneers of moral treatment of the insane, whose work influenced the decision to create a new kind of asylum in New York in 1815. 

Thomas Eddy

Portrait of Thomas Eddy (1758-1827), governor and then president of the board of governors of New York Hospital, who was the prime moving spirit behind the creation of a new asylum at Bloomingdale in 1821.

Reception Room in Green Hall -- 1880

Picture of reception hall in the newly opened Green Hall (1880) illustrating the home or hotel-like environment of the Bloomingdale as well as the luxury afforded to better-off patients. The books, crafts, and sedate visiting all bespeak the environment that "moral treatment" strove to create.

Margaret Fuller

Margaret Fuller, a leading light of the American Transcendental movement, and an enthusiastic supporter of the work of Pliny Earle.

At the same as the New York Hospital was beginning to systematically address the mentally ill,  important changes in the treatment of such patients were being introduced in France at  l'Hôpital Bicêtre and later Hospice de la Salpêtrière  in Paris by physician Philippe Pinel and in Britain at the Retreat at York, a Quaker institution, where Samuel Tuke was the leading figure.  The approach in both cases, seemingly arising independently (and not unrelated to the thinking in New York that had led to the construction of a new facility there in 1808), was based on the conviction that the mentally ill, even when their behavior seemed incoherent and violent, were most susceptible to cure if they were treated as if they were rational beings, not treated like animals or violent criminals, chained up in cells, tightly restrained, and subjected to corporal punishment.  There was also growing skepticism as well about the efficacy of the medical treatment employed until then -- bleeding, blistering, starvation diets, and the like. things. Rather, a kindler, gentler approach to resocializing them in a calm and encouraging environment, it was believed, would not only achieve better results, but was what principles of humaneness and morality required.  This movement was closely associated with Quakerism, and many of its most important early practitioners, including some of its most zealous exponents on the staff and board of the Bloomingdale were themselves Quakers. 

It was the British experience that came to be best known in the United States, thanks among other things to the publication of an abridged version of Tuke's Description of the Retreat in 1813This account of the Retreat had a strong impact on Thomas Eddy, a governor and later president of the board of New York Hospital, a committed Quaker and impressive promoter of public philanthropy in New York.  In 1815, at a special meeting of the board, he proposed a new series of rules, whose spirit is aptly summed up by his insistence that  "the power of judicious kindness [ought] to be generally exercised... and it is not till after other moral remedies are  exercised, that recourse should be had to restraint, or the power of fear on the mind of the patient." He concluded with a proposal that would lead to the creation of the Bloomingdale: "a further and more extensive improvement has occured to my mind, which I conceive, would very considerably conduce towards affecting the cure, and materially ameliorate the condition,and add to the comfort of the insane... I would propose that a lot, not less than ten acres, should be purchased by the Governors, conveniently situated, within a few miles of the city, and to erect a substantial building,  on a plan calculated for the accomodation of fifty lunatic patients; the ground to be improved in such a manner as to serve for agreeable walks, gardens, etc., for the exercise and amusement of the patients..."[1]

At the time of its creation, the Bloomingdale was one of only two institutions in the United States attempting to implement the experience of the Retreat.  The other was the Friends' Asylum in Frankford, Pennsylvania.[2] In the decades that followed, many other institutions would follow in its footsteps, visiting it and  calling upon its attending physicians for advice as they worked to create their own asylums.

When Eddy proposed the new facility, he conceived of it as supplementing the program in the city, rather than replacing it.  The Asylum moved quickly move beyond the goals that Eddy conceived for it, however, and became the sole facility of the hospital for treating the mentally ill.  As we have noted already, its early medical directors, particularly Macdonald, Wilson, and Earle, pushed far toward the ideals of “moral treatment,” in the design of a residence that was variously likened to a palace, a hotel, or a home rather than a prison or even a hospital, in the design of beautiful gardens where patients could stroll, sit in peace, or admire the breathtaking views, in the creation of recreational facilities — stables, playing fields, and a bowling alley, in the organization of social events and excursions into the surrounding countryside, in the provision of worship services and Bible reading, in the creation of a well-supplied library and subscriptions to the latest periodical literature, in first tentative steps toward vocational therapy, and, under Earle’s administration, in the implementation of a school and lecture series.

Earle’s administration probably represents the high point of this process.

One observer, describing his incredible dedication to his calling, wrote: "Dr. Earl [sic] is disposed to go farther than any almost any physician with whom I have ever conversed, in the employment of moral means to restrain the insane, and in the rejection of all physical force in the government of the asylum. A revolution has taken place in the treatment of the Insane within a very few years…"

He described a conversation with the doctor:

"Here in this Asylum Dr. Earl [sic] is immured, finding all his society and all his enjoyment within these walls. I said to him, 'Do you become so accustomed to association with the demented, as to get over this melancholy that hangs like a cloud around me the moment I enter these walls?'"

"'Certainly,' he replied, 'and why not? There is great an amount of actual enjoyment among the hundred and twenty patients here as you will find in society at large. A few of them are wretched, but the great majority of them are comparatively happy.'"

"'In ten minutes,' said he, 'we can assemble a circle of educated, intelligent and refined ladies and gentlemen; and you shall spend an evening with them, as we often do, without once observing an indication of insanity among them. They will converse on any subject, play at cards, dance, or engage in any social amusements to which they have been accustomed, and you will not suspect them of being less sensible than those in society who pursue the same pleasures.'" [3]

Earle attracted the admiring attention of some of the leading enlightened figures of his day, like William Ellery Channing or Margaret Fuller. In an article for the New York Tribune, Fuller wrote enthusiastically of his administration: "Under his care, the beautifully situated establishment at Bloomingdale loses every sight of the hospital and prison, not long since thought to be inseparable from such a place. It is a house of refuge where those too deeply wounded to keep up that semblance or degree of sanity which the conduct of affairs in the world at large demands may be soothed by gentle care, intelligent sympathy, and a judicious attention to their physical welfare into health, or at least, into tranquility." She went on to speak of the almost divine powers of this man, "truly a 'good physician,' the touch of whose hand seemed to possess a talismanic power to sooth."[4]

Earle himself had enormous confidence in the ability of these techniques to cure most of his patients, as did many supporters of “moral treatment” during this period. He would come to have less confidence in the approach in his later years, publishing a gloomy critique of the notion of curability.[5]

“Moral treatment” itself would experience a similar trajectory during the century. The pioneering work of the Friends’ Retreat and the Bloomingdale was rapidly emulated by others, and became the leading ideal for treatment of the mentally ill in the 19th century. By the end of century, however, it was beginning to collapse in practice, as much greater numbers of patients were crowded into large municipal and state asylums where care was centralized for purposes of economy and efficiency. In such a setting, the close personal attention required by “moral care” was simply not feasible. In the century that followed, philosophical and methodological changes — eugenic rather than moral explanations of mental illness, Freudianism, and later psychopharmacology pushed treatment in different directions.

The last several decades have also seen a number of critiques or at least less enthusiastic analysis of “moral treatment.” Writing from a sociological perspective, Andrew Scull in Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective cautions against taking the movement’s own propaganda about heroic and humanitarian striking off of the chains at face value, arguing that what was really happening was a changing social understanding of mental illness, in which instilling internalized individual fear of loss of social status and esteem was seen as more efficacious for controlling mental illness that was instilling fear of physical punishment, suggesting that while the latter approach made more sense to the thinking of traditional agrarian societies, this new approach was viewed as a more convincing approach in emerging capitalist society.[6] For Michel Foucault, in Madness and Civilization, “moral treatment” was a new form of mental rather than physical violence, designed to impose a particular view of social normality on the eccentric.[7] Robert Castel, in ”Moral treatment. Mental Therapy and Social Control in the Nineteenth Century,” that, in place of the 18th century’s treatment of the insane as animals “moral treatment” substituted their treatment as children, making them the powerless dependents of the paternalistic and dominating “father” at the head of the institution.[8]

However one may choose to view "moral treatment," it seems clear that this movement, which gave birth to the Bloomingdale and of which this asylum was an influential exponent in America, represented a major milestone not only in the evolution of psychiatric medicine but in social understanding of the nature of the individual personality.



[1] Thomas Eddy, Hints for Introducing an Improved Mode of Treating the Insane in the Asylum,  New York, 1815, p.12-17.

[2] Russell, p.197.  

[3] Irenaeus, “An Hour in an Insane Asylum,” New York Observer and Chronicle, May 24, 1845.

[4] Margaret Fuller, ”St. Valentine’s Day — Bloomingdale Asylum for the Insane, New York Daily Tribune, Feb. 22, 1845, p. 1.

[5] Gerald N. Grob, “Earle, Pliny.” American National Biography Online, February 2000, http://www.anb.org/articles/12/12-00241.html.

[6] Andrew Scull, Andrew. Social Order/mental Disorder : Anglo-American Psychiatry in Historical Perspective, Berkeley: University of California Press, c1989, p. 80-94.

[7] Michel Foucault, Madness and Civilization; a History of Insanity in the Age of Reason, New York: Vintage Books, 1973, p.241-273.

[8] Robert Castel, "Moral Treatment: Mental Therapy and Social Control in the Nineteenth Century," in Cohen, Stanley and Scull, Andrew, eds. Social Control and the State, Oxford: Martin Robertson, 1983, p.254-264.