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Reform, Moral Management and the York Retreat

TOPIC 4 (WEEK 5): INTRODUCTION
This seminar focuses on asylum and lunacy reform and the ‘birth’ of moral management or treatment, exploring the special case of the York Retreat, founded in 1792 and opening in 1796. Concerns about conditions of care for the mentally ill – and accusations of brutality – came to a head in the late 18th century. This resulted in the setting up of reformed institutions of which the Retreat is a prime example, as well as a broader response in government, which initiated commissions of inquiry, reports and finally acts of parliament aimed at lunacy reform and the establishment of a system of public asylums. The reform of lunacy dovetailed with other humanitarian reform movements of the period, as well as reflecting an increased faith in institutional care and the role of doctors. It also raised big issues of funding, management and responsibility, and the question of how far mental illness was curable or merely manageable. Moral treatment (and later the non-restraint movement) has been widely regarded as a positive, progressive step forward in treating mental illness. However, Foucault (who we’ll look at more closely in the next but one session) and some historians, such as Scull, challenge this view. I will also take you through legislative developments as well as introducing you to a third form of asylum, the charitable, voluntary asylum, which was prompted by reform initiatives and support for institutional solutions. There is very rich scholarship on this subject, as the reading list indicates. We will devote several weeks to the large subject area of asylums.
Make sure you all read the Tuke document, 'Description of the Retreat' and two at least of the key readings, marked** below, and start to dip into the literature on asylum historiography.
The fourth Gallery, York Retreat (1887)
 
QUESTIONS
  1. How did the Tukes arrive at their system of moral treatment and how was this put into practice at the York Retreat?
  2. Did the York Retreat mark a 'revolution' or a continuing trend in approaches to the treatment of insanity?
  3. How would you evaluate the rationale, significance and success of moral treatment?
  4. Was the introduction of moral management a purely progressive development?
  5. Did Bethlem stand for 'bad' and the Retreat as 'good' in terms of asylum care?
DOCUMENTS
 
**Samuel Tuke (1784-1857), ‘Description of the Retreat’ (1813) and ‘Report From the Committee On Madhouses in England’ (1815) in Allan Ingram (ed.), Patterns of Madness in the Eighteenth Century: A Reader (Liverpool University Press, 1998), pp. 235-45. The entire text of 'Description' is available on-line; please read through ch. V on 'Moral Treatment' (type Tuke, Samuel, Retreat in library catalogue)
 
John Conolly, The Treatment of the Insane Without Mechanical Restraint (1856, fascimile edn., Richard A. Hunter and Ida Macalpline (eds) 1973). e-book
The Retreat near York (1813)
 

READING

MORAL MANAGEMENT AND REFORM

KEY READING: Read 2-3 of the following chapters or articles, marked ** 

**Roy Porter, Mind-Forg’d Manacles: A History of Madness in England from the Restoration to the Regency (London: Athlone, 1987; Penguin edn, 1990), ch.4. Multiple copies in library and e-book

 **Anne Digby, ‘Changes in the Asylum: The Case of York, 1777-1815’, Economic History Review, 2nd series, 37 (1983), 218-39 (a useful discussion of the York Asylum, i.e. not The Retreat). e-journal

**Anne Digby, 'The Changing Profile of a Nineteenth-Century Asylum: The York Retreat’, Psychological Medicine, 14 (1984), 739-48. e-journal

 **Barry Edginton, 'Moral Architecture: The Influence of the York Retreat on Asylum Design', Health and Place, 3 (1997), 91-99. e-journal

 **Andrew Scull, ‘Moral Treatment Reconsidered: Some Sociological Comments on an Episode in the History of British Psychiatry’, in Madhouses, Mad-Doctors, and Madmen, pp.105-20. e-book

 

FURTHER READING: 

Roy Porter, Madmen: A Social History of Madhouses, Mad-Doctors and Lunatics (Stroud: Tempus, 2004), ch. 4.

*Anne Digby, ‘Moral Treatment at the Retreat, 1796-1846’, Anatomy of Madness II, pp. 52-72. 

* Anne Digby, Madness, Morality and Medicine: A Study of the York Retreat (Cambridge University Press, 1985).

Akihito Suzuki, ‘The Politics and Ideology of Non-Restraint: The Case of the Hanwell Asylum’, Medical History, 39 (1995), 1-17. 
e-journal

Louise Wannell, 'Patients' Relatives and Psychiatric Doctors: Letter Writing in the York Retreat, 1875-1910', Social History of Medicine, 20 (2007), 297-313. e-journal

Jonathan Andrews et al., The History of Bethlem (London and New York: Routledge, 1997), ch. 23, ‘Bethlem and the 1815 Select Committee’. ch. 23.

William F. Bynum, ‘Rationales for Therapy in British Psychiatry, 1780-1835’, in Madhouses, Mad-Doctors, and Madmen, pp. 35-57. e-book

Vieda Skultans, English Madness: Ideas on Insanity 1580-1890 (London: Routledge & Kegan Paul, 1979), ch. 4 ‘The Moral Managers’, pp. 52-68.

Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (London: Tavistock, 1967, or other editions), ch. 9 ‘The Birth of the Asylum’. e-book, multiple copies in library or buy on Amazon

Dora B. Weiner, ‘”Le geste de Pinel”: The History of a Psychiatric Myth’, in Micale and Porter, Discovering, pp. 232-47.

 

INTRODUCTION TO ASYLUMS: HISTORIOGRAPHY

**Jonathan Andrews, ‘The Rise of the Asylum in Britain’, in Deborah Brunton (ed.), Medicine Transformed: Health, Disease and Society in Europe 1800-1930 (Manchester University Press, with the Open University, 2004), pp. 298-330. Multiple copies in library and available via Talis

**Roy Porter, ‘Madness and Its Institutions’, in Andrew Wear (ed.), Medicine in Society (Cambridge University Press, 1992), pp. 277-301. e-book

*Andrew Scull, The Most Solitary of All Afflictions: Madness and Society in Britain, 1700-1900 (Yale University Press, 1993), chs 2-4. Multiple copies in library

Roy Porter, ‘Shaping Psychiatric Knowledge: The Role of the Asylum’, in Roy Porter (ed.), Medicine in the Enlightenment (Amsterdam and Atlanta, GA: Rodopi, 1995), pp. 255-73. Multiple copies in library

Leonard D. Smith, ‘Cure, Comfort and Safe Custody’: Public Lunatic Asylums in Early Nineteenth-Century England (Leicester University Press, 1999) OR Leonard D. Smith, Lunatic Hospitals in Georgian England, 1750-1830 (New York: Routledge 2007). e-book

*Roy Porter, ‘Madness and Society in England: The Historiography Reconsidered’, Studies in History, 3 (1987), 275-90. e-journal

*Andrew Scull, ‘The Domestication of Madness’, Medical History, 27 (1983), 233-48. e-journal