John Locke (1632-1704)
At a time when mental illness was considered a somatic disease involving lesions of the brain, many 19th century psychiatrists were heavily influenced by John Locke’s blank slate idea. This idea suggests that the brain is void of knowledge at birth and everything is learned through sensory organs. Therefore, in order to have developed a mental illness, there had to have been a break in the relationship between nature, society, and the person.
It was reasoned that because insanity was developed through bad behavioral patterns and an inappropriate environment, the first step to treatment would involve the creation of a new environment. Treatment at home was inadvisable because the doctor could not change the environment to meet the needs of the patient; treatment at a hospital or an institution was preferred because the patient could be exposed to both a proper environment and moral treatment (Grob, 1991).
Philippe Pinel (1745-1826)
Pinel was the first to take steps toward humane care for the mentally ill. “Moral” treatment, in this context, was dervied from the idea that physicians offered their patients the care equal to that of a parent while keeping in mind the principles of genuine philanthropy.
Specifically, Pinel began the move toward socializing the mentally ill by taking the necessary steps to ensure comfortable living conditions, good food, gentle and calm attendants, work therapy with pay, and recreation and educational opportunities.
Like other “moral treaters” as they were called, Pinel held the belief that the mentally ill were human beings who deserved kind and understanding physical care along with respect and the right to personal self-esteem and dignity (Miller & Blanc, 1967).
Dorothea Dix (1802-1887)
While it is widely believed that Dorothea Dix was a hero for freeing the insane from chains, her actions had a negative impact on the living conditions in asylums. Many “mad” people were kept in jails and poorhouses because there were not enough asylums for everyone and most families did not have the money for private asylums. After Dorothea Dix advocated for freeing mentally ill patients from chains in jails and poorhouses, asylums went downhill. Asylums became overcrowded and many people were place in them who were dying from old age or had muscular or physical problems. These people took over the beds and could not be discharged because they could not survive on their own. The focus of the asylums transferred from treating the mentally ill patients to treating patients who did not necessarily suffer from a mental illness (Whitaker, 2009).
Grob, G. N. (1991). The chronic mentally ill in America: The historical context. In V. Fransen (Ed.) Mental health services in the United States and England: Struggling for Change, (pp. 3-17). Princeton, N.J., US: Robert Wood Johnson Foundation.
Miller, D., & Blanc, E. (1967). Concepts of “moral treatment” for the mentally ill: Implications for social work with posthospital mental patients. The Social Service Review, 41, doi: 10.1086/642033
Whitaker, R. (2009). Deinstitutionalization and neuroleptics. In Y. O. Alanen, G. dC. Manuel, A. S. Silver, & B. Martindale (Eds.) Psychotherapeutic Approaches to Schizophrenia Psychoses: Past, Present, and Future, (pp. 346-356). New York, NY, US: Routledge/Taylor and Francis Group.
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