London, United Kingdom (Winter 2018)
|Painting of the York Retreat by George Isaac Sidebottom, a patient at the retreat in the 1890s and early 1900s. Image from the retreat archives (RET/2/1/7/5), courtesy of the Welcome Collection|
On 15 March 1790 Hannah Mills, a recently widowed young woman suffering from “melancholy,” was admitted to York Asylum. Less than one month later, on April 29, Hannah died, isolated and alone, her friends and family having been refused permission to visit her. The death of a patient in such circumstances was by no means uncommon. Eighteenth century mental patients were housed in chronically underfunded, neglected facilities and struggled to survive as best they could in cramped and squalid conditions. York Asylum, for example, had been designed for only fifty-four patients. By the time Hannah was admitted it housed nearly 200 who were cared for by only seven members of staff. A single bedchamber was normally shared by six to seven inmates. The treatment they received was intentionally inhumane, for the mad, having abandoned the essential human capacity of reason, were perceived as bestial creatures. Patients were routinely restrained with chains and subjected to harsh physical and psychological punishments. In such circumstances, where neglect and abuse were routine and disease was rife, it is no surprise that death stalked the hallways of York Asylum. Hannah Mills was one of over 300 patients who died between 1777 when the asylum was founded and 1814 when a national investigation revealed the scale of deprivation in the hospital.1
We know very little about the life of Hannah Mills, and the actual circumstances of her death remain a mystery. Hannah was not an important person and the death of yet another lunatic caused no great outcry. The desperate calls for an inquiry by her friends and family were easily brushed aside. Yet, against all odds, her name has been remembered because although the tragic fate of Hannah Mills was greeted with indifference by most of society, it provoked profound outrage among the small community of Quakers of which she had been a member. Several local Quakers, led by William Tuke, resolved to ensure that future members of their community would not suffer like Hannah and set about constructing their own institution for the treatment of the mentally ill. This institution would stand as the antithesis of everything York Asylum represented. It would reject violence and restraint as methods of treatment, it would provide spacious and comfortable accommodation, it would encourage patients to develop themselves, providing the opportunity for useful work, and it would endeavor to treat its patients with dignity and respect. By 1792 Tuke had gathered enough funds and attempted to make this dream a reality buying a small tract of land in the countryside around York- sufficient to accommodate thirty patients- and establishing it as a refuge for those “who had lost their reason” and were shunned by society. This institution, founded by a small nonconformist group, would, in a few short decades, help to revolutionize treatment of the mentally ill. It was the York Retreat.2
The York Retreat was founded on the conviction that the mentally ill ought to be treated, as much as possible, with a dignity and respect normally accorded to human beings. In 1792 this approach to treatment was revolutionary. When William Tuke first resolved to found an institution for the care of the mentally ill he visited several hospitals in order to better familiarize himself with existing treatment. In one such institution, St. Luke’s Hospital, he encountered at first hand the brutality with which asylum inmates were treated and recoiled in horror. One image that forever haunted him, and which was altogether typical, was the fate of a young woman whom he found lying on a bed of dirty straw, naked, and chained to the wall of her cell. Such treatment was in accordance with eighteenth century medical practice. It was commonly believed that the mad, being close to animals, could not feel cold easily and had no need of clothes. Restraint was routinely recommended, not only for reasons of safety, but also as a form of treatment that might encourage the insane to develop obedience and docility. This meant that patients were usually chained. Other treatments included “debilitating purges, painful blistering….and sudden immersion in cold baths – all administered in a ‘regime of fear’ governed by terror and brutality.”3
The Retreat entirely rejected such methods and promoted as an alternative what came to be known as “moral treatment.”4 It was guided by the belief that the mad, although they may have lost their “reason,” had not lost their humanity. They retained an instinctive “moral sense” and it was the function of treatment to foster the development of this sense through nurturing and familial care.5 Violence and restraint were, uniquely for the period, completely abandoned as forms of treatment and physicians and staff were instructed instead to treat patients with kindness and care. Moral treatment aimed to promote autonomy rather than docility, encouraging patients to develop their moral sense through useful work. Chatard characterises this treatment as a “primitive form of affective conditioning with benevolence at its core.”6 It sought to work on the passions of the patient by encouraging positive behavioral change. Inmates in the nearby York Asylum could spend a typical day chained to a wall while patients in the York Retreat were encouraged to pursue useful labor in the workshops provided on site, to go for walks on the spacious grounds of the retreat, to care for animals, or to take up a variety of sports and leisure activities (one “lunatic ball” sparked considerable interest and amusement in national papers). The retreat was conceptualized as a family that included both staff and patients. Staff ate meals with patients and were encouraged to form close bonds.
The methods of the York Retreat were initially greeted with ridicule and bemusement. However the moral treatment pioneered in Tuke’s retreat appeared to embody the ideals of a new enlightened humanism and relatively quickly earned the respect of many people. Moral treatment, as noted by contemporaries, seemed to prove more effective than traditional therapies and, by the 1820s, had won the support of significant sections of the medical community. Consequently the York Retreat, initially founded as a small religious therapeutic community for only thirty patients, developed into an internationally renowned psychiatric hospital, which exerted a considerable influence on the institutional development of mental health treatment. Several other progressive hospitals were directly inspired by it such as the Brattlebro Retreat and Hartfort Retreat in the United States.
The York Retreat helped revolutionize the design and architecture of care. Tuke was keen to locate his institution in the countryside, believing that closeness to nature and open space could be therapeutic. For Tuke the asylum was not simply a place of confinement but a “therapeutic instrument” itself.7 This innovation, so unusual in the eighteenth century, soon dominated asylum design. By comparing the cramped urban confinement of an ancient psychiatric hospital such as Bedlam to the spacious grounds of the York Retreat, we see a sharp division between two historic eras of psychiatric care. Asylums after the York Retreat were routinely built in large open and rural spaces. The “particular form of the retreat” remained wholly unique – for York was breaking new ground and remains a historical curiosity in this sense – but the “model” it developed would set the tone of psychiatric care for decades to come.8
In this, as in many other ways, the York Retreat helped inaugurate a more progressive age. There were, of course, considerable limitations to the institution. As Foucault famously argued, moral treatment was itself coercive and encouraged conformism to certain repressive norms of bourgeois behavior. Yet, undeniably, the mind-forged manacles the retreat forced upon its patients were still preferable to the very real manacles inmates of the York Asylum had been held in. It remains famous today as one of the most important and revolutionary psychiatric institutions in the world and symbolizes a humanistic tradition we may still learn from.
- L.C. Chatard, ‘Benevolent theory: moral treatment at the York Retreat’ History of Psychiatry, Vol. 18, No.1, (2007) pp.61-80
- A. Digby, ‘Changes in the Asylum: The Case of York, 1777-1815’, The Economic History Review, New Series, Vol. 36, No. 2 (May, 1983), pp. 218-239
- B. Edginton, ‘The Design of Moral Architecture at the York Retreat’, Journal of Design History, Vol. 16, No. 2 (2003), pp. 103-117
- S. Tuke, The Retreat: Description of an Institution Near York for Insane Persons of the Society of Friends (Philadelphia, 1813)
- The scale of deaths in the York Asylum became a national scandal since, in the course of the investigation, it became apparent that the level of mortality had been deliberately under-reported with the complicity of physicians. Officially the asylum reported 222 deaths whereas an enquiry later estimated the true number at 322. Subsequent burial investigations suggested that 322 was itself an underestimate. See Digby, A. ‘Changes in the Asylum: The Case of York, 1777-1815’, The Economic History Review, New Series, Vol. 36, No. 2 (May, 1983), p.223
- For the origins of the retreat see Tuke, S. The Retreat: Description of an Institution Near York for Insane Persons of the Society of Friends (Philadelphia, 1813) pp.17-23
- Chatard, L.C. ‘Benevolent theory: moral treatment at the York Retreat’ History of Psychiatry, Vol. 18, No.1, (2007) p.64
- The term ‘moral treatment’ is used by Samuel Tuke, the son of William, who wrote an influential account of the retreat in 1813. Samuel was influenced by the French psychiatrist Pinet who coined the term.
- Restraint was employed occasionally for reasons of safety but not as a form of treatment.
- Chatard p.137
- Edginton, B ‘The Design of Moral Architecture at the York Retreat’, Journal of Design History, Vol. 16, No. 2 (2003) p.111
- Edington p.114
BENINIO McDONOUGH-TRANZA completed a BA in History at University College London and an MA in Global History at Free University Berlin & Humboldt University Berlin. He has worked on the history of psychiatry and the social history of medicine in Europe.