Under the Enlightened concern of Grand Duke Pietro Leopoldo in Florence, Italian physician Vincenzo Chiarugi instituted humanitarian reforms.
[2] The ex-patient Jean-Baptiste Pussin and his wife Margueritte, and the physician Philippe Pinel (1745–1826), are also recognized as the first instigators of more humane conditions in asylums.
[5] Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms.
Pussin and Pinel's approach was seen as remarkably successful and they later brought similar reforms to a mental hospital in Paris for female patients, La Salpetrière.
There was an emphasis on the selection and supervision of attendants in order to establish a suitable setting to facilitate psychological work, and particularly on the employment of ex-patients as they were thought most likely to refrain from inhumane treatment while being able to stand up to pleading, menaces, or complaining.
In 1796, with the help of fellow Quakers and others, he founded the York Retreat, where eventually about 30 patients lived as part of a small community in a quiet country house and engaged in a combination of rest, talk, and manual work.
Rejecting medical theories and techniques, the efforts of the York Retreat centered around minimizing restraints and cultivating rationality and moral strength.
Interest in mental illness was a feature of the Edinburgh medical school in the eighteenth century, with influential teachers including William Cullen (1710–1790) and Robert Whytt (1714–1766) emphasising the clinical importance of psychiatric disorders.
In 1816, the phrenologist Johann Spurzheim (1776–1832) visited Edinburgh and lectured on his craniological and phrenological concepts, arousing considerable hostility, not least from the theologically doctrinaire Church of Scotland.
George and Andrew Combe exerted a rather dictatorial authority over the Edinburgh Phrenological Society, and in the mid-1820s manipulated the de facto expulsion of the Christian phrenologists.
His achievements with this style of psychiatric practice were rewarded with his appointment as a Commissioner in Lunacy for Scotland, and by his election to the Presidency of the Medico-Psychological Association in 1866.
Browne's eldest surviving son, James Crichton-Browne (1840–1938), did much to extend his father's work in psychiatry, and, on 29 February 1924, he delivered a remarkable lecture The Story of the Brain, in which he recorded a generous appreciation of the role of the phrenologists in the early foundations of psychiatric thought and practice.
A key figure in the early spread of moral treatment in the United States was Benjamin Rush (1745–1813),[9] an eminent physician at Pennsylvania Hospital.
He required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regular walks.
However, Rush's treatment methods included bloodletting (bleeding), purging, hot and cold baths, mercury, and strapping patients to spinning boards and "tranquilizer" chairs.
Making this argument stick has been described as an important step in the profession's eventual success at securing a monopoly on the treatment of "lunacy".
By the mid-19th century in England, the Alleged Lunatics' Friend Society was proclaiming that the new moral treatment was a form of social repression achieved "by mildness and coaxing, and by solitary confinement"; that its implication that the "alleged lunatics" needed re-educating meant it treated them as if they were children incapable of making their own decisions; and that it failed to properly inform people of their rights or involve them in discussion about their treatment.
Asylum "nurses" and attendants, once valued as a core part of providing good holistic care, were often scapegoated for the failures of the system.
[13] From the mid 20th century, however, a process of antipsychiatry and deinstitutionalization occurred in many countries in the West, and asylums in many areas were gradually replaced with more local community mental health services.
Thus Foucault argues that the "moral" asylum is "not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged, and condemned.
[17] The moral treatment movement is widely seen as influencing psychiatric practice up to the present day, including specifically therapeutic communities[18] (although they were intended to be less repressive); occupational therapy[19] and Soteria houses.