Preferred Citation: Scull, Andrew. Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective. Berkeley:  University of California Press,  c1989 1989.

Chapter Four Moral Treatment Reconsidered

Chapter Four
Moral Treatment Reconsidered

Traditional histories of psychiatry saw in moral treatment the first of a series of "revolutions" that transformed social responses to the mentally ill, rescuing them from viciousness and neglect and ushering in a humane and rational response to the problems posed by mental disorder. The work of modern revisionists, from Foucault onwards, has on one level exhibited a fascinating convergence with these old-fashioned directionalist histories, accepting that moral treatment represents a decisive epistemological break in the history of Western responses to madness. But, of course, the revisionists have evaluated this rupture very differently and have sought to comprehend its origins and analyze its nature in very different ways.

The initial polemical excesses of Foucault's own reassessment, which simply stood the traditional interpretation on its head (urging that one see moral treatment as a "gigantic moral imprisonment"),[1] have been succeeded by a more complex and balanced view: a perspective that can recognize why one might reasonably prefer the manipulation and ambiguous "kindness" of Tuke and Pinel to the "coercion for the outward man, and rabid physicking for the inward man" that were for an earlier generation "the specifics for lunacy,"[2] but a perspective that is nevertheless aware of moral treatment's less benevolent aspects and its latent po-

Chapter 4 is reprinted from Psychological Medicine, Volume 9, 1979, pp. 421–28, by permission of the editor and of Cambridge University Press.

[1] Michel Foucault, Madness and Civilization (New York: Pantheon, 1965),, 278.

[2] Charles Dickens and W. H. Wills, "A Curious Dance Round a Curious Tree" (1852; reprinted in Charles Dickens' Uncollected Writings from Household Words [Bloomington and London: lndiana University Press, 1968], 2:382–83).


tential (all too soon realized) for deterioration into a repressive form of moral management.

The essay that follows represents my attempt, a decade ago, to grapple with a number of central and interrelated questions: How are we to make sense of traditional approaches to the mad, and in what do these consist? What, penetrating beneath the ideological accounts offered by the reformers themselves, are we to make of moral treatment? And, given the importance of the change it represents, how can we grasp its broader social roots and significance?

Since this paper appeared, Anne Digby has published a full-length study of the York Retreat, based on extensive and painstaking research in that institution's voluminous archives.[3] Her general assessment of the social origins, context, and significance of Tuke's version of moral treatment closely parallels (indeed is clearly indebted to) that offered here and in Chapter 3, though her subsequent analysis greatly broadens our understanding of the subsequent course of events at the Retreat and of the multiple ways in which the specifically Quaker character of the foundation influenced its unfolding history.

As I emphasize in what follows, even in an English context Tuke's was not an isolated achievement. Though it was the Retreat that made moral treatment famous in England, by the last years of the eighteenth century a number of madhouse proprietors were experimenting with generally similar approaches (just as, on the Continent, there were independent "discoveries" of the principles of moral treatment). Roy Porter, who has recently provided the first systematic synthesis of the history of madness in England from the late seventeenth to the early nineteenth century,[4] has cited the work of these other progenitors of moral treatment (among whom he numbers such figures as William Pargeter, John Ferriar, and Joseph Mason Cox) in support of a bold thesis: a rejection of the consensus (among traditionalist and revisionist alike) that "the eighteenth century was a disaster for the insane"[5] and a claim that Tuke's institution marked no radical switch in the handling of the mad, but rather exhibited substantial continuities with the practices of an earlier age.[6] Though I do not have the space to provide a detailed refutation here (and this is scarcely the occasion to do so), I think Porter is largely mistaken about

[3] Anne Digby, Madness, Morality, and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985); see also idem, "Moral Treatment at the Retreat, 1796–1846," in The Anatomy of Madness, 2 vols., ed. W. F. Bynum, R. Porter and M. Shepherd (London: Tavistock, 1985), 2:52–72.

[4] Roy Porter, Mind Forg'd Manacles: A History of Madness in England from the Restoration to the Regency (London: Athlone, 1987).

[5] Michael MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth Century England (Cambridge: Cambridge University Press, 1981), 230.

[6] Ibid., 277 and passim.


these matters.[7] Still, his book provides us with the most provocative and wide-ranging survey of Georgian madness we are likely to see for many years to come.

Moral Treatment Reconsidered

What most sharply distinguishes a propagandistic from an ideological presentation and interpretation of the facts is . . . that its falsification and mystification of the truth are always conscious and intentional. Ideology, on the other hand, is mere deception—in essence self-deception—never simply lies and deceit. It obscures truth in order not so much to mislead others as to maintain and increase the self-confidence of those who express and benefit from such deceptions.
The Social History of Art

The glory of the modern system [of asylum treatment] is repression by mildness and coaxing, and by solitary confinement.
Letters to Sir James Graham upon the Reform of the Lunacy Law

Tuke and Moral Treatment

We are all familiar with that traditional version of psychiatric history that celebrates it as a not always continuous, but ultimately triumphal procession toward the rational and humane forms of treatment presently practiced. In such accounts, the introduction of moral treatment always occupies a central place of honor: the legendary decision by Pinel to strike the chains from the raving maniacs in the Bicêtre; and the less dramatic but equally significant endeavors of William Tuke to provide humane care for insane Quakers at the York Retreat. It is with moral treatment that I shall be concerned in this essay. I shall try to explicate some of the central dimensions of its English version and to explore some of

[7] To cite just one problem with his argument, Thomas Arnold, Thomas Bakewell, Joseph Mason Cox, John Ferriar, William Perfect, and others, whose writings he uses to demonstrate that the treatment of the mad in the eighteenth century varied from the portrait drawn by previous historians, were all active in the period from the late 1780s through the first decade and a half of the nineteenth century. They can tell us little about practice in the era before moral treatment or (come to that) about eighteenth-century responses to madness. And Porter's further claim that William Battle (who did practice in the 1750s and 1760s) propounded "(albeit in a rather schematic and theoretical guise) the key ideas of Tukean moral therapy" (Porter, Mind Forg'd Manacles, 276) is an example, to use his own words, of the historian playing "silly priority games" and anachronistically reading the future back into the past.


its broader social roots and significance. For I take it that one of the more important contributions that a sociologist can make to the history of psychiatry is to break down some of the parochialism that marks most treatments of the subject and to show some of its connections with larger social movements and processes.

Tuke's development of moral treatment was not, of course, an isolated achievement, even in England. A number of other practitioners in the "mad-business" were experimenting with essentially similar approaches by the end of the eighteenth century. John Ferriar of the Manchester Lunatic Asylum had become convinced that "the first salutary operation in the mind of a lunatic" lay in "creating a habit of self-restraint," a goal that might be reached by "the management of hope and apprehension ..., small favours, the show of confidence, and apparent distinction," rather than by coercion.[1] And to cite just one other example, Edward Long Fox,[2] from whose Bristol madhouse Tuke recruited Katherine Allen (the Retreat's first matron), independently developed a system of classification and mild management that allowed the elimination of most of the "barbarous" and "objectionable" features found in most contemporary asylums. But it was Tuke's version of moral treatment that attracted attention, first from a stream of visitors, both English and foreign, and then from those Parliamentarians and others who had taken up the cause of lunacy reform. So it is to his work that I wish to give most of my attention, while recognizing that it forms part of a much broader shift in the methods used to comprehend and cope with madness.

Traditional Approaches to Madness

From a number of perspectives, I think Tuke's admirers are quite right to stress that his approach marked a serious rupture with the past, rather than simply a refinement and improvement of existing techniques. They go astray, however, when they accept at face value the account that Tuke and his followers provide of their activities. The advent of moral treatment is both something more and something less than "the triumph of humanism and of therapy, a recognition that kindness, reason, and tactful manipulation were more effective in dealing with the inmates of asylums than were fear, brutal coercion and restraint, and medical therapy."[3] It will not do simply to assert that Tuke replaced im moral with moral therapy; or to attribute the reformers' achievements to their superior

[1] J. Ferriar, Medical Histories and Reflections, vol. 2 (London: Cadell anti Davies, 1975).

[2] E. L. Fox, Brislington House, an Asylum for Lunatics Situated near Bristol, Lately Erected by Edward Long Fox, M.D. (Bristol: For the Author, 1806).

[3] William F. Bynum, "Rationales for Therapy in British Psychiatry: 1780–1835," Medical History 18 (1974):318.


moral sensibilities, while consigning their opponents to the status of moral lepers, people devoid of common decency and humanity.

On the contrary, the perception that the traditional ways of coping with lunatics in madhouses (even such tactics as the use of whips and chains to maintain a semblance of order) were inherently cruel and inhumane is by no means as simple and self-evident a judgment as both the reformers and later generations came to believe. The practices of the eighteenth-century madhouse keepers seem so transparently callous and brutal that we tend to take this judgment as unproblematic, as immediately given to any and all who have occasion to view such actions. But cruelty, like deviance, "is not a quality which lies in behavior itself, but in the interaction between the person who commits an act and those who respond to it."[4] Consequently, whether or not a set of practices is perceived as inhumane depends, in large part, on the world view of the person who is doing the perceiving. Practices from which we now recoil in horror were once advocated by the most eminent physicians and cultured men of their day. That the mad were chained and whipped in asylums in the eighteenth century was well known at the time. How could it be otherwise when, throughout the century, the doors of Bethlem were open to the public and the inmates exhibited to satisfy the impertinent curiosity of sightseers at a mere penny a time, and when standard treatises on the management of the mad advocated such treatment? Certainly, such practices were not something of which magistrates only became aware at the turn of the century. Yet it was only then that protests began to be heard that such treatment was cruel and inhumane.

To be sure, some of the treatment meted out to lunatics in private mad-houses was the natural product of an unregulated free market in madness—the consequence of the unchecked cupidity of the least scrupulous, of the incentives to half-starve and neglect pauper inmates, of the temptation to rely on force as the least troublesome form of control. But there is more to it than that. Even in situations where such factors were obviously inapplicable, lunatics were treated in ways that later generations were to condemn as barbaric and counterproductive and to find (as we do) virtually incomprehensible, almost by default attributing them to an underdeveloped moral sensibility, if not outright inhumanity.

The treatment of George III during his recurrent bouts of "mania" perhaps makes this point most dramatically and unambiguously. As Bynum has pointed out,

A great deal was at stake with this patient, and there is every reason to believe that Francis Willis, his sons, and other assistants treated the king in a manner which (in Willis' considered opinion) would most likely result in

[4] H. S. Becker, Outsiders: Studies in the Sociology of Deviance (Glencoe, Ill.: Free Press, 1963), 14.


the royal patient's recovery. Yet, as the Countess Harcourt described the situation, "The unhappy patient . . . was no longer treated as a human being. His body was immediately encased in a machine which left no liberty of motion. He was sometimes chained to a stake. He was frequently beaten and starved, and at best he was kept in subjection by menacing and violent language."[5]

Willis' approach was scarcely atypical. The eighteenth-century "trade in lunacy"[6] attracted a motley crew; but despite the heterogeneity of those engaged in the business, certain traditional approaches and techniques were widely employed—by medical and nonmedical men alike. As with the king, intimidation, threats, and outright coercion were commonly used to cow and subdue the madman, whose condition was viewed as a "display of fury and violence to be subdued and conquered by stripes, chains, and lowering treatments."[7] Most madhouse keepers operated on the assumption that "fear [was] the most effectual principle by which to reduce the insane to orderly conduct,"[8] on the grounds that it was "a passion that diminishes excitement . . . particularly the angry and irascible excitement of maniacs."[9] As eminent a man as William Cullen argued that it was "necessary to employ a very constant impression of fear, . . . awe and dread"—emotions that should be aroused by "all restraints that may occasionally be proper . . . even by stripes and blows."[10] Together with a more elaborate and sophisticated intellectual rationalization of these procedures, medicine simply provided its practitioners with a wider variety of tools for "coercing patients into straight thinking and accepting reason . . . 'vomits, purges, . . . surprize baths, copious bleedings and meagre diets.'"[11]

Within a few years of the Retreat's practices obtaining national attention, such treatment (or at least its open avowal) had come to seem unthinkable. The fundamental basis of this whole approach—the subjugation of the mad, the breaking of the will by means of external discipline and constraint, the almost literal battle between reason and unreason—had lost its former appearance of self-evidence and, indeed, was now

[5] Bynum, "Rationales for Therapy," 319.

[6] W. L. Parry-Jones, The Trade in Lunacy (London: Routledge and Kegan Paul, 1972).

[7] Richard Hunter and Ida Macalpine, Three Hundred Years of Psychiatry, 1535 to 1860: A History Presented in Selected English Texts (London: Oxford University Press, 1963), 475.

[8] Samuel Tuke, Manuscript memorandum of a visit to St. Luke's Hospital, 1812, reprinted in Daniel Hack Tuke, Chapters in the History of the Insane in the British Isles, (London: Kegan Paul and Trench, 1889), 90.

[9] William Cullen, First Lines of the Practice of Physic (Edinburgh: Bell and Bradfute, 1784), quoted in Hunter and Macalpine, Three Hundred Years of Psychiatry, 478.

[10] Ibid. Where such physical force was deemed necessary, he cautioned that stripes, "although having the appearance of more severity, are much safer than strokes or blows about the head" (ibid.).

[11] Ibid., 475.


seen as wholly inappropriate. I would suggest that a necessary condition for the emergence of such a changed perspective (and of the moral outrage that did so much to animate the lunacy reformers' activities) was a change in the cultural meaning of madness. And I think that such a change can indeed be shown to have occurred.

If, in seventeenth- and eighteenth-century practice, the madman in confinement was treated no better than a beast, that merely reflected his ontological status. For that was precisely what, according to the prevailing paradigm of insanity, he was. One of the most notable features of the prenineteenth-century literature on madness is

its almost exclusive emphasis on disturbances of the reason, or the higher intellectual faculties of man. Insanity was conceived as a derangement of those very faculties which were widely assumed to be universal to man; as a matter of fact, we sometimes find in the literature the presumed absence in animals of any condition analogous to insanity taken as proof that man's highest psychological function results from some principle totally lacking in other animals, that is, the soul.[12]

But this conception implied that in losing his reason, the essence of his humanity, the madman had lost his claim to be treated as a human being.

Intellectually, such notions did no violence to the dominant world view of the period. Indeed, they could be seen as a confirmation of perhaps its critical organizing principle—the idea of the continuity and gradation of nature in what Arthur Lovejoy has termed "the Great Chain of Being."[13] The very idea of a chain, with no discontinuities or gaps, implied that no rigid barriers existed between one part of creation and another, that there always existed intermediate forms. The division between apes and men was a permeable, not an absolute, one in eighteenth-century conceptions of nature, as attested by the denial of the concept of common humanity to a slave; the ready identification of apes and savages (even extending to speculation on fertile copulation between blacks and apes); the portrayal of criminals in animalistic terms; and the assimilation of the mad to the ranks of brute creation. As Bynum puts it, such notions were "built into the analytic tools with which eighteenth century Europeans classified man."[14] And in the case of lunatics, the apparent insensitivity of the furious maniac to heat or cold, hunger or pain, his refusal to abide clothing, and so on, were simply taken as confirmation of the correctness of the basic explanatory schema.

If a sociologist may be permitted to cite literary evidence in support of his case, it may be noted that Ophelia, in her madness, is described as

[12] Bynum, "Rationales for Therapy," 320.

[13] A.O. Lovejoy, The Great Chain of Being (New York: Harper, 1960).

[14] William F. Bynum, "Time's Noblest Offspring: The Problem of Man in the British Natural Historical Sciences" (Ph.D. dissertation, University of Cambridge, 1974), 344.


Divided from herself and her fair judgement,
Without which we are pictures [i.e., no more than external facsimiles of human beings] or mere beasts.[15]

In a similar vein, Pascal informs us, "I can easily conceive of a man without hands, feet, head (for it is only experience which teaches us that the head is more necessary than the feet). But I cannot conceive of a man without thought; that would be a stone or a brute."[16] "Expert" opinion concurs. John Monro, the physician to Bethlem from 1751 to 1791 and one of the two most eminent mad-doctors of the mid-eighteenth century, speaks of madness as involving "a total suspension of every rational faculty";[17] just as Andrew Snape, almost half a century earlier, had lamented "those unhappy People, who are bereft of the dearest Light, the Light of Reason."[18] In a revealing passage, Shape then goes on to say:

Distraction . . . divests the rational soul of all its noble and distinguishing Endowments, and sinks unhappy Man below the mute and senseless Part of Creation: even brutal Instinct being a surer and safer guide than disturb'd Reason, and every tame Species of Animals more sociable and less hurtful than humanity thus unmann'd.[19]

Eminent mad-doctors of the early nineteenth century continued to adhere to this position, arguing that "if the possession of reason be the proud attribute of man, its diseases must be ranked among our greatest afflictions, since they sink us from our preeminence to a level with the animal creatures."[20]

I suggest that the resort to fear, force, and coercion is a tactic entirely appropriate to the management of "brutes." Thus, when we look at the treatment of the insane prior to "reform," we must realize, as Foucault points out, that

the negative fact that the madman is not treated like a "human being" has a very positive meaning. . . . For classicism, madness in its ultimate form is man in immediate relation to his animality. The day would come when from an evolutionary perspective this presence of animality in madness would be considered as the sign—indeed the very essence—of disease. In

[15] William Shakespeare, Hamlet, act 4, sc. 5, lines 85–86.

[16] Blaise Pascal, Oeuvres Complètes (Paris: Gallimard, 1954), 1156.

[17] John Monro, Remarks on Dr. Battie's Treatise on Madness (London: Clarke, 1758), 7.

[18] Andrew Snape, A Sermon Preach'd Before the Lord Mayor, the Alderman, Sheriffs and Gouvenours of the Several Hospitals of the City of London, April 16, 1718 (London: Bowyer, 1718), 15.

[19] Ibid., 9–10. Elsewhere, he speaks of madmen who, with their "apish Gestures," prove that "something with a Human Shape and Voice may for many years survive all that was human besides" (ibid., 10).

[20] Joseph Mason Cox, Practical Observations on Insanity, 3d ed. (London: Baldwin and Murray, 1813), ix.


the classical period, on the contrary, it manifested the very fact that the madman was not a sick man . Animality in fact, protected the lunatic from whatever might be fragile, precarious, or sickly in man. . . . Unchained animality could be mastered only by discipline and brutalizing .[21]

The Rupture with the Past

It was this worldview that the nineteenth-century reformers and, indeed, society as a whole, were in the process of abandoning. Much of the reformers' revulsion on being exposed to conditions in contemporary madhouses derived from this changed perspective. For them, the lunatic was no longer an animal, stripped of all remnants of humanity.[22] On the contrary, he remained in essence a man; a man lacking in self-restraint and order, but a man for all that. Moreover, the qualities he lacked might and must be restored to him, so that he could once more function as a sober, rational citizen.

The beliefs that lie at the heart of the new approach to the insane—Tuke's moral treatment, as well as the much less well known equivalents developed by his contemporaries—differ so profoundly from those underlying traditional practices as to lend some credence to Michel Foucault's notion of a "rupture épistemologique." At the core of the eighteenth-century approach, as we have seen, was its view that the essence of madness was the absence, or the total perversion, of reason. "In the new system of moral treatment," by contrast, "madmen are not held to be absolutely deprived of their reason."[23] Tuke's whole system crucially depends upon "treating the patient as much in the manner of a rational being as the state of his mind will possibly allow"—a change so striking that it attracted much contemporary comment. In Sydney Smith's words, "It does not appear to them that because a man is mad upon one subject, that he is to be considered in a state of complete mental degradation, or insensible to feelings of gratitude."[24]

The emphasis on the lunatics' sensitivity to many of the same inducements and emotions to which other people were prone was associated, whether as cause or consequence, with other equally profound alterations in their treatment. What was seen as perhaps the most striking,

[21] Michel Foucault, Madness and Civilization (New York: Pantheon, 1965), 66–69.

[22] Cf. John Reid's complaint that in "either the public, or the minor and more clandestine Bethlems . . . such a mode of management is used with men, as ought not to he, although it too generally is, applied even to brutes," in Essays on Hypochondriasis and Other Nervous Affections, 3d ed. (London: Longman, 1893), 60.

[23] G. De la Rive, Lettre adressée aux rédacteurs de la Bibliothèque britannique sur un nouvel établissement pour la guérison des aliénés (Geneva: For the Author, 1798), quoted in Kathleen Jones, Lunacy, Law, and Conscience: The Social History of the Care of the Insane (London: Routledge and Kegan Paul, 1955), 61.

[24] S. Smith, "An Account of the York Retreat," Edinburgh Review 23 (1814): 189–98.


both at the time and subsequently, was the emphasis on minimizing external, physical coercion—an emphasis that has had much to do with the interpretation of moral treatment as unproblematically kind and humane. William Cullen articulated the eighteenth-century consensus when he contended:

Restraining the anger and violence of madmen is always necessary for preventing their hurting themselves or others; but this restraint is also to be considered as a remedy. Angry passions are always rendered more violent by the indulgence of the impetuous notions they produce; and even in madmen, the feeling of restraint will sometimes prevent the efforts which their passion would otherwise occasion. Restraint, therefore, is useful and ought to be complete.[25]

Tuke's dissent from this position was sharp and unequivocal: "Neither chains nor corporal punishment are tolerated, on any pretext, in this establishment."[26] Less objectionable forms of restraint might be necessary to prevent bodily injury, but they ought to be a last resort and must never be imposed solely for the convenience of the attendants. As a routine policy, those running an asylum ought "to endeavor to govern rather by the influence of esteem than of severity." The insistence upon "the superior efficacy . . . of a mild system of treatment," together with the elimination of "gyves, chains and manacles,"[27] had a profound effect on contemporary reformers, who saw Tuke's success at the Retreat as proof that the insane could be managed without what were now seen as harshness and cruelty.

Tuke's approach was not kindness for kindness' sake. From its architecture to its domestic arrangements, the Retreat was designed to encourage the individual's own efforts to reassert his powers of self-control. For instead of merely resting content with the outward control of those who were no longer quite human (which had been the dominant concern of traditional responses to the mad), moral treatment actively sought to transform the lunatic, to remodel him into something approximating the bourgeois ideal of the rational individual. From this viewpoint, the problem with external coercion was that it could force outward conformity, but never the necessary internalization of moral standards. The change in aim mandated a change in means. Granted, "it takes less trouble to fetter by means of cords, than by assiduities of sympathy or affection."[28] But "the natural tendency of such treatment is, to degrade the mind of the patient, and to make him indifferent to those moral feelings, which, under judicious direction and encouragement, are found capable, in no small degree, to strengthen the power of self-

[25] Cullen, Practice of Physic (1808 ed.), 2:312–13.

[26] Tuke, History of the Insane, 141.

[27] Ibid., vi. 171.

[28] Reid, Hypochondria, 303.

[29] Tuke, History of the Insane, 159–160.


restraint."[29] On purely instrumental grounds, then, "tenderness is better than torture, kindness more effectual than constraint. . . . Nothing has a more favourable and controlling influence over one who is disposed to or actually affected with melancholy or mania, than an exhibition of friendship or philanthropy."[30] Only thus could one hope to reeducate the patient to discipline himself. By acting as though "patients are capable of rational and honourable inducement" and by making use of the vital weapon of man's "desire for esteem " (which even lunatics were now seen as sharing), inmates could be induced to collaborate in their own recapture by the tortes of reason. "When properly cultivated," the desire to look well in others' eyes "leads many to struggle to conceal and overcome their morbid propensities: and, at least, materially assists them in confining their deviations within such bounds, as do not make them obnoxious to the family."[31]

The staff played a vital role in this process of reeducation: they must "treat the patients on the fundamental principles of . . . kindness and consideration."[32] Again, this was not because these were goods in themselves, but because

whatever tends to promote the happiness of the patient, is found to increase his desire to restrain himself, by exciting the wish not to forfeit his enjoyments; and lessening the irritation of mind which too frequently accompanies mental derangement. . . . The comfort of the patients is therefore considered of the highest importance in a curative point of view.[33]

Here, too, lay the value of work, the other major cornerstone of moral treatment, since "of all the modes by which patients may be induced to restrain themselves, regular employment is perhaps the most generally efficacious."[34]

By all reasonable standards, the Retreat was an outstandingly successful experiment. It had demonstrated, to the reformers' satisfaction at least, that the supposedly continuous danger and frenzy to be anticipated from maniacs were the consequence of, rather than the occasion for, harsh and misguided methods of management and restraint; indeed, that this reputation was in large part the self-serving creation of the madhouse keepers. It apparently showed that the asylum could provide a comfortable and forgiving environment, where those who could not cope with the world could find respite; and where, in a familial atmosphere, they might be spared the neglect that would otherwise have been their lot. Perhaps even more impressive than this was that, despite a conservative outlook that classified as cured no one who had to be readmitred to an asylum, the statistics collected during the Retreat's first fifteen years of operation seemed to show that moral treatment could restore a large proportion of cases to sanity.

[30] Reid, Hypochondria, 303–4.

[31] Tuke, History of the lnsane, 157.

[32] Ibid., 177.

[33] Ibid.

[34] Ibid., p. 156.


The Social Roots of the New Approach

But if one must grant the importance of the changing conceptions of insanity and its appropriate treatment as an intervening cause in the rise of the lunacy reform movement, one must also recognize that ideas and conceptions of human nature do not change in a vacuum. They arise from a concrete basis in actual social relations. Put slightly differently, the ways men look at the world are conditioned by their activity in it. The question we must therefore address—albeit briefly and somewhat speculatively—is what changes in the conditions of social existence prompted the changes we have just examined.

In a society still dominated by subsistence forms of agriculture, nature rather than man is the source of activity. Just as man's role in actively remaking the world is underdeveloped and scarcely perceived—favoring theological and supernatural rather than anthropocentric accounts of the physical and social environment—so too the possibilities for transforming man himself go largely unrecognized and the techniques for doing so remain strikingly primitive. In a world not humanly but divinely authored, "to attempt reform was not only to change men, but even more awesome, to change a universe responding to and reflecting God's will"—to embark on a course akin to sacrilege.[35] And where the rationalizing impact of the marketplace is still weak, structures of domination tend to remain extensive rather than intensive; that is, the quality and character of the work force are taken as fixed rather than as plastic and amenable to improvement through appropriate management and training.

But under the rationalization forced by competition, man's active role in the process presents itself ever more insistently to people's consciousness. This development is further accelerated by the rise of manufacturing—a form of human activity in which nature is relegated simply to a source of raw materials, to be worked on and transformed via active human intervention. More than that, economic competition and the factory system are the forcing house for a thoroughgoing transformation in the relation of man to man. For industrial capitalism demands "a reform of 'character' on the part of every single workman, since the previous character did not fit the new industrial system."[36] Entrepreneurs concerned to "make such machines of men as cannot err"[37] soon discover that physical threat and economic coercion will not suffice: men have to be taught to internalize the new attitudes and responses, to discipline them-

[35] H. Soloman, Public Welfare, Science and Propaganda in Seventeenth Century France (Princeton: Princeton University Press, 1972), 29–30.

[36] S. Pollard, The Genesis of Modern Management (Harmondsworth: Penguin, 1965), 297.

[37] Josiah Wedgwood, cited in N. McKendrick, "Josiah Wedgwood and Factory Discipline," Historical Journal 4 (1961): 46.


selves. Moreover, force under capitalism becomes an anachronism (perhaps even an anathema) save as a last resort. For one of the central achievements of the new economic system, one of its major advantages as a system of domination, is that it brings forth "a peculiar and mystifying . . . form of compulsion to labour for another that is purely economic and 'objective.'"[38]

The insistence on the importance of the internalization of norms, the conception of how this was to be done, and even the nature of the norms that were to be internalized—in all these respects we can now see how the emerging attitude toward the insane paralleled contemporaneous shifts in the treatment of other deviants and of the normal. The new attitude coincided with and formed part of what Peter Gay has dubbed "the recovery of nerve"[39] —a growing and quite novel sense that man is the master of his destiny and not the helpless victim of fate; and it had obvious links with the rise of "the materialist doctrine that people are the product of circumstance."[40] "Is it not evident," said James Burgh (and certainly it was to an ever-larger circle of his contemporaries), "that by management the human species may be moulded into any conceivable shape?"[41] The implication was that one might "organize the empirical world in such a way that man develops an experience of and assumes a habit of that which is truly human."[42]

This faith in the capacity for human improvement through social and environmental manipulation was translated in a variety of settings—factories, schools, prisons, asylums—into the development of a whole array of temporally coincident and structurally similar techniques of social discipline.[43] Originating among the upper and middle classes, for example, there emerged the notion that the education and upbringing of children ought no longer to consist in "the suppression of evil, or the breaking of the will."[44] With the growth of economic opportunity and social mobility, the old system of beating and intimidating the child to compel compliance came to be viewed as a blunt and unserviceable technique, for it

[38] M. Dobb, Studies in the Development of Capitalism (New York: International Publishers, 1963), 7.

[39] Peter Gay, The Enlightenment: An Interpretation, vol. 2, The Science of Freedom (New York: Knopf, 1969), 6.

[40] B. Fine, "Objectification and the Bourgeois Contradictions of Consciousness," Economy and Society 6 (1977): 431.

[41] J. Burgh, Political Disquisitions, vol. 3 (London: Dilly, 1775), 176.

[42] Helvetius, quoted in Fine, "Objectification," 431.

[43] Michael Ignatieff, "Prison and Factory Discipline, 1770–1800: The Origins of an Idea" (Paper presented at the Annual Meeting of the American Historical Association, 1976); Foucault, Madness and Civilization; idem, Discipline and Punish (London: Allen Lane, 1977).

[44] J. H. Plumb, "The New World of Children in Eighteenth Century England," Past and Present 67 (1975): 69.


ill prepared one's offspring for the pressures of the marketplace. The child needed to be taught to be "his own slave driver," and with this end in view, "developing the child's sense of emulation and shame" was to be preferred to "physical punishment or chastisement."[45] John Locke, the theoretician of these changes, said:

Beating is the worst, and therefore the last Means to be used in the Correction of Children. . . . The Rewards and Punishments ..., whereby we should keep Children in order are of quite another kind. . . .  Esteem and Disgrace are, of all others, the most powerful Incentives to the Mind, when it is once brought to relish them. If you can once get into Children a Love of Credit and an Apprehension of Shame and Disgrace, you have put into them the true principle.[46]

The essential continuity of approach is equally manifest in the methods and assumptions of the early-nineteenth-century prison reformers. Crime had been seen as the product of innate and immemorial wickedness and sin. Now, however, the criminal was reassimilated to the ranks of a common humanity. As Fine puts it, "The prisoner was to be treated as a person, who possessed a reason in common with all other persons, in contrast to animals and objects. However hardened the prisoner was, beneath the surface of his or her criminality an irreduceable reason still remained."[47] In consequence, as lunatics were for Tuke, they were "defective mechanisms" that could be "remoulded" through their confinement in a penitentiary designed as "a machine for the social production of guilt."[48] And for such purposes (again the parallel with moral treat-

[45] Ibid., 67, 69.

[46] John Locke, Educational Writings (London: Cambridge University Press, 1968), 152–53, 183. Note the stress on putting them into children. Locke's educational doctrines acquired an ever greater popularity among the upper and middle classes in the latter half of the eighteenth century. Plumb draws attention to the fact that "by 1780 John Browne could make one of the principal virtues of the expensive academy for gentlemen's sons that he proposed to set up a total absence of corporal punishment" (Plumb, "New World of Children," 70). (Interestingly, one of William Tuke's early philanthropic endeavors, prior to setting up the York Retreat, had been the establishment of Ackworth, a school for girls.) Seen in the context of these slightly earlier changes, Samuel Tuke's comment that "there is much analogy between the judicious treatment of children and that of insane persons" takes on a new significance (Samuel Tuke, Description of the Retreat: An Institution near York for Insane Persons of the Society of Friends [1813], facsimile ed., ed. Richard A. Hunter and Ida Macalpine [London: Dawsons, 1964], 150). In practice, the analogy was to extend even further. When Locke's doctrines (and their intellectual descendants) were modified to accommodate the children of the poor, they spawned the rigidities of the monitorial system: Andrew Bell's "steam engine of the moral world," and Joseph Lancaster's "new and mechanical system of education." When the techniques of the small, upper-class Retreat were adapted to the "requirements" of the mass of pauper lunatics, moral treatment was transformed into a set of management techniques for a custodial holding operation.

[47] Fine, "Objectification," 429.

[48] Michael Ignatieff, A Just Measure of Pain: The Penitentiary in the Industrial Revolution in England (New York: Pantheon, 1978), 213.


ment is clear) prison reformers plainly perceived that "gentle discipline is more efficacious than severity."[49]

The new practices, which had their origins in the wider transformation of English society, were shared, developed further, and given a somewhat different theoretical articulation in the context of the lunatic asylum. As in the wider world, so too in the lunatic asylum: one could no longer be content with the old emphasis on an externally imposed alien order, which ensured that madness was controlled, yet which could never produce self-restraint. Control must come from within, which meant that physical violence, now dysfunctional, became abhorrent.[50] The realization of the power that was latent in the ability to manipulate the environment and of the possibility of radically transforming the individual's "nature" was translated in the context of madness into a wholly new stress on the importance of cure. It represented a major structural support of the new ethic of rehabilitation. As the market made the individual "responsible" for his success or failure, so the environment in the lunatic asylum was designed to create a synthetic link between action and consequences, such that the madman could not escape the recognition that he alone was responsible for the punishment he received. The insane were to be restored to reason by a system of rewards and punishment not essentially different from those used to teach a young child to obey the dictates of "civilized" morality. Just as those who formed the new industrial work force were to be taught the "rational" self-interest essential if the market system were to work, the lunatics, too, were to be made over in the image of bourgeois rationality: defective human mechanisms were to be repaired so that they could once more compete in the marketplace. And finally, just as hard work and self-discipline were the keys to the success of the urban bourgeoisie, from whose ranks Tuke came, so his moral treatment propounded these same qualities as the means of reclaiming the insane.

[49] J. Howard, The State of the Prisons (Warrington: Egres, 1778), 8.

[50] Cf. Michel Foucault's comment on the attractions of the Panopticon to the bourgeoisie "It is not necessary to use force to constrain the convict to good behaviour, the madman to calm, the worker to work, the schoolboy to application, the patient to observation of the regulations . . . no more bars, no more chains, no more heavy locks" (Foucault, Discipline and Punish, 202).


Chapter Four Moral Treatment Reconsidered

Preferred Citation: Scull, Andrew. Social Order/Mental Disorder: Anglo-American Psychiatry in Historical Perspective. Berkeley:  University of California Press,  c1989 1989.