Recovery From Schizophrenia: Psychiatry And Political Economy

MADNESS AND THE INDUSTRIAL REVOLUTION 103the York Asylum under circumstances that suggested neglect or ill treatment.Designed for 30 patients and primarily made available to Quakers, the cost oftreatment at the York Retreat ranged from eight to fifteen shillings a week.Accommodation for personal servants was provided at a further fee. Theestablishment was clearly not intended to be for the poor.Under the direction of William Tuke, a 60-year-old tea and coffee merchant, astyle of non-medical care was developed that, like Pinel’s approach, came to becalled moral treatment. Believing that most deranged people could be rational ifnot provoked by harsh treatment or cruelty, the Tukes encouraged the exerciseof patients’ self-control as an alternative to the use of external restraint.Punishment for inappropriate behavior was avoided, but minor privileges wereawarded to those who conformed to the attendants’ wishes. Chains were neverused and straight waistcoats rarely, and then only to prevent a patient hurtinghimself or herself or other residents. The iron sashes of the windows weredisguised to look like wood. Patients were expected to dress in their best clothesand take part in all usual social activities—tea parties, reading, writing, sewing andgardening. Work was felt to be essential in fostering patients’ self-control and selfesteem.Drugs were seldom used, and exercise, warm baths and a generous diet of“meat, bread and good porter” were felt to be most useful in quieting patients andensuring good sleep. 3 BEFORE MORAL TREATMENTThe revolutionary nature of moral treatment at the York Retreat becomes evidentwhen it is set against conventional care of the time. At the nearby York Asylum,where Hannah Mills had died, abuses were exposed by investigations conductedsome years after the opening of the Retreat. “Flogging and cudgelling” wereroutine, and patients were “verminous and filthy.” 4 Behind a partly hidden door,a visitor in 1814 discovered a series of small cellsin a very horrid and filthy condition…the walls were daubed withexcrement; the air-holes, of which there was one in each cell, were partlyfilled with it.Upstairs he found a roomtwelve feet by seven feet ten inches, in which there were thirteen womenwho, [the keeper] told me, had all come out of those cells that morning….I became very sick, and could not remain longer in the room. I vomited. 5Charles Dickens characterized asylum care of this period as follows:Coercion for the outward man, and rabid physicking for the inward man,were the specifics for lunacy. Chains, straw, filthy solitude, darkness, and