Moral treatment and the therapeutic community

Abstract

History can serve as a useful tool for better understanding contemporary mental health programs. At present, much interest is directed at apparent parallels between 19th century moral treatment and modern milieu therapies, especially the therapeutic community. A common emphasis on a humane living environment is typically cited as the major parallel between the treatments. However, on closer examination, it appears that moral treatment and the therapeutic community exemplify different conceptions of what constitutes a humane living environment. Moreover, the two overall treatment philosophies differ significantly. These differences are tied to the historical contexts and responses to cultural stress in the mid-19th and mid-20th centuries, and consequent conceptions of mental well-being. A heretofore overlooked, but suggestive parallel between the treatments, which may help explain their efficacy, is the importance of peer self-help as a therapeutic tool. However, whereas the therapeutic community actively encourages peer self-help, 19th century asylum superintendents were unaware of its value.