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Moral Therapy

 

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There was a Dr. Samuel B. Woodward, Superintendent of the Worcester (Massachusetts) State Hospital, who played an important role in the development of moral therapy, a new treatment of people with mental illness in the 1830s and 1840s. Moral therapy consisted of kind, individualized care in a small hospital with occupational therapy, religious exercises, amusements and games. There was a large measure of repudiation of all threats of physical violence and an infrequent use of mechanical restraints. He stated that "if there is any secret in the management of the insane it is this: respect them and they will respect themselves; treat them as reasonable beings and they will take every possible pains to show you they are such. Give them your confidence and they will rightly appreciate it and rarely abuse it." (Worcester State Hospital Annual Report, 1839.) His approach included restoring hope, creating a new environment, paying attention to the individual and his particular psychological and physical needs and above all respecting the patient as a human being and showing him kindness and compassion.

In his annual reports Woodward claimed high rates of recovery. "In recent cases of insanity under judicious treatment as large a proportion of recoveries will take place as from any other acute disease of equal severity." (WSH Annual Report, 1835.) Between the years of 1833 and 1845 the percentage of recoveries of recent cases was from 82 to 91% annually. These figures were disputed later. Yet in the 1880s a long-term follow-up study by Dr. John G. Park, then Superintendent of Worcester State Hospital, found that over 58% of the people listed as recovered by Woodward between 1833 and 1846 had no further episodes of insanity in the next 50 years. (WSH Annual Report LXI, 1893.)

Other psychiatrists of Woodward's time also believed that people could recover from insanity in its early stages. Dr. Thomas S. Kirkbride, Superintendent of Pennsylvania Hospital for the Insane, wrote in 1842, "The general proposition that truly recent cases of insanity are commonly very curable may be considered fully established."