Historical Perspectives

Phillipe Pinel and William Tuke

Hospitals for the mentally ill in North America were not much better than those in Europe. The Public Hospital in Virginia (built in 1773) was the first in the United States dedicated solely to the treatment of mental illness. The treatment was designed to help patients “choose” to be rational. Techniques employed to achieve this end included shock treatment, drug treatment, blistering, starvation, and other torturous methods.

health careBy the time French physician Phillipe Pinel (1745-1826) was placed in charge of La Bicêtre, a hospital for the insane of Paris, treatment methods of the eighteenth century were in dire need of reform. Pinel asked for, and was granted, permission to try an experiment with the patients of the hospital. He wanted to treat them with kindness and concern instead of disdain and viciousness. He had chains removed, rooms cleaned, order restored, and activities planned. Kindness in place of abuse proved to be a great remedy. So great was the success of La Bicêtre that Pinel tried his method in a second hospital. Results were also rewarding in that instance! About the same time as Pinel was reforming hospitals in France, William Tuke was doing similar work in England. Tuke also believed that a caring atmosphere was superior to the then prevalent brutal and dehumanizing one. Eventually news spread to other parts of the world and into the United States. Slowly views were changing from the possession view of abnormal behaviour to the belief that the mentally ill are normal people who have lost their reasoning power as a result of psychological, physical, or social stress. Treatment, therefore, was aimed at addressing the stressors though kindness, discussion, and therapy. In North America, this movement was referred to as moral management. Moral management was very effective considering that the underlying causes of most mental illnesses were unknown.