Quakers and Moral Treatment

William Tuke (1732 – 1822) was one of the pioneers of mental health treatment in the UK in the late 18th and early 19th centuries. Born into a prominent Quaker family in York, he rose to prominence through his acts of philanthropy. After witnessing the terrible conditions at the public Asylum in York, and following the death of a Quaker woman called Hannah Mills in 1790, Tuke set out to revolutionise the way in which those who were labelled as insane were treated. He collected funds and in 1792 the York Retreat opened. William knew nothing about mental health when he founded The Retreat but, in keeping with a Quaker ideology of equality, patients were treated like equal human beings, who were accorded respect.

William Tuke, Etching by C. Callet, 1973, Wellcome Collection

The Retreat used almost entirely moral practices in the treatment of their patients, a predominantly social form of treatment. Moral treatment has been defined as the minimal use of restraint, the building up of rationality and moral strength. This was achieved through giving patients a form of moral autonomy, whereby they were informed their actions would determine their treatment, Positive behaviour was rewarded, negative behaviour was met with minimal use of restraint and sanctions. They had a community ethos, and patients were given a daily routine of both work, in the form of chores, and leisure time. In this way, patients experience of madness was treated through placing patients in a humane and caring social environment that put an emphasis on social interaction. There was one exception to moral treatment which was advocated by Samuel Tuke (Grandson of William Tuke): “there is, however, one remedy, which is frequently employed at the Retreat, and which appears to have been attended with the happiest effects; and that is the warm bath…”.

This system of moral treatment – where patients were treated compassionately as individuals – was apparent in the structure of the York Retreat. The building of The Retreat was overseen by architect John Bevans; however, as he had no experience in asylum construction, he had worked largely from plans developed by William and Henry Tuke themselves. The asylum was designed with the idea that patients would be classified and separated along the lines of gender and severity of illness amongst other factors. The building was also “laid out with walks, wooded glades, gardens and orchards the original eleven acres of land had been extended to twenty-seven by 1839: this formed a tranquil setting in which patients could hope to regain their serenity”. This was the idea of the ‘therapeutic landscape’- described as places with health promoting properties. These spaces sought to improve the mental health of patients by removing them from the stresses of everyday life through their confinement in an ordered, harmonious, and calming place of sanctuary- i.e. the asylum.

The Retreat at York, c.1796, Wikipedia

The rise of therapeutic landscapes as a treatment methods shows the more compassionate side of the asylum over history, in which individuals were cared for as patients rather than inmates. Therapeutic landscapes could include both internal and external spaces; the internal includes the design of rooms and spaces such as airing courts while external spaces depended much on the siting of the asylum, which tended to be in more rural, ‘pure’, spaces.; Foucault linked this to the banishing of madness from urban spaces, in an ‘out of sight, out of mind’ mind-set.

Samuel Tuke, Etching by C. Callet, 1973, Wellcome Collection

The York Retreat felt that patients could be both rational and controllable as long as they were not aggravated by hostility. The Tukes had exercised non-restraint long before it became commonplace, and a book written by Samuel Tuke (published in 1813) has been described as doing more to improve the mental health care and treatment and to develop psychiatry than any doctor did. Patients at The Retreat were never punished for failing to control their behaviour, and methods were used which utilised trust. Medical methods were replaced with a prescription of good food, fresh air and exercise; as a direct contrast to the restraint, confinement and semi-starvation which was often offered elsewhere at the time. Occupational therapy was also encouraged at the Retreat, such as caring for animals or tending the garden, so that the patients may learn self-control; in contrast to the ‘brutalising coercion and restraint’ practiced in the vast majority of asylums at the time. As Dr Abercrombie stated: “as soon as the situation of the patients admits of it, mental occupation should be deemed of the first importance”.

However, it must be said that both private and public asylums did have the same goals. Tuke introduced moral treatment with the York Retreat and this was shown to work, and at that time was seen as progressive. The asylum ideal, which has been defined as a rural setting with fresh air which offered patients peace and quiet, was not just one for the private asylums, but it was much easier for private asylums to achieve. Although both were operating in the same time periods, the key difference between the two were that public asylums were put under pressure early on by issues of overcrowding which severely limited their capacity to provide either a therapeutic landscape or even suitable care to their patients. There is a view that the psychiatric asylum buildings became a form of scapegoat, with all the failings of the system being placed on facilities that were ‘not fit for purpose’. In this way all of the blame was attributed to ‘dilapidated piles of bricks and mortar’ rather than at the chronic understaffing and other such issues which plagued asylum history.

For some light reading on William Tuke and the Retreat at York, see The Retreat, York, England. For an in-depth look at psychiatric asylum past, present, and future see Josh’s PhD Thesis!

By Josh Green

Josh completed his PhD at the University of Southampton in 2017. His research focused on former psychiatric asylum sites and their continued presence in the UK, looking at themes such as memory, stigma, conservation, and governance. Josh’s haphazard career has led to his contribution to the Department of Health’s advisory document “Health and Wellbeing”, serving ice-cream, dolphin conservation work, teaching at universities and secondary schools, and working in museums. As well as the history of psychiatric asylums, Josh’s interests are wide ranging and include health policy, prison hulks, and quakers, amongst seemingly endless other things.