The Healing Power of Moral Treatment

woman holding a worried teenage girls's hands, offering her support.
image: iStock / Getty

In 1796, English Quaker, William Tuke, founded the York Retreat at Lamel Hill in York, UK. Its purpose was to help people recover from mental health problems, but with one difference from the norm at the time. The treatment they received came to be known as moral treatment. Its philosophy was kindness. And it was highly successful.

It was a reaction against the seemingly inhumane and brutal asylums at the time, where one of Tuke’s own family members had spent some time. In these asylums, people suffering with depression were locked away and treated as ‘mad’.

Patients lived at the York Retreat. Their treatment was personalised, gentle, and compassionate. The underlying principles were kindness, trust, and order.

Patients lived as family, helping each other in their day-to-day living. Each person was shown trust, autonomy, respect and kindness and he or she in turn offered the same to others. This was the moral treatment – not only were they treated with kindness, but kind was the way they treated each other. 

Receiving and giving kindness in how they thought of, spoke to, and treated each other was their medicine. And it was just the tonic they needed. It significantly aided their healing. It even encouraged the re-building of sometimes fragile self esteem.

The York Retreat was so successful that moral treatment spread throughout Europe and the USA in the 19thcentury and even into the early 20th century.

Psychiatrists were so taken by its power that they wrote that it must lead to ‘organic changes in brain matter’, which is something we know to be true today.

It was a dominant way to treat depression for over a hundred years, yet few people today have even heard of it. I hadn’t either and I speak on kindness! It wasn’t until I stumbled across it while researching for a chapter on how kindness benefits mental health for one of my books (The Five Side Effects of Kindness) that I realised that our modern research into the power of kindness to heal is partly a rediscovery.

Why are we only rediscovering it now? It’s because moral treatment began to decline in the early 20th century as modern medicines became popular. Over the past century, modern Western medicine has been incredibly successful and has saved and extended countless lives from infections to heart disease, stroke, cancers, and many other serious conditions. It also became the norm for treating mental health conditions.

The dominant view evolved from moral treatment, with a focus on how a person’s treatment and their own attitudes and behaviour could help themselves, to that of receiving a pill. Treating depression by altering brain chemistry fast became the norm.

While anti-depressants are highly successful and even life saving for some people, they’re not effective for everyone. Perhaps we might expand our range of treatments to bring moral treatment back into the fold.

There’s now no question from recent research that kindness is a tonic for mental health. Indeed, numerous scientific studies now shown that kindness practices boost happiness and protect against depression.

For example, studies that invite volunteers to carry out acts of kindness over the course of a day, a week, or even a month or more, all show that those being kind become happier as a consequence. They also turn out to become happier than people they are compared against who are not asked to do acts of kindness, typically known as ‘control groups’.

Similarly, studies show that people who do regular volunteering work have much lower rates of depression than the general population. It’s not that people who are less likely to be depressed are more likely to volunteer, which some have argued is the case (and it is partly true), but that giving in the service of others is actually protective against depression.

Feelings induced by kindness buffer some of the effects of stress. They don’t eliminate it, but help us become more resilient to stress. In so doing, a build-up of stress is less likely to occur at a level that might trigger depression.

And the belief by early 20th century psychiatrists that moral treatment must lead to ‘organic changes in brain matter’ is being born out in modern research. Compassion and kindness based meditation practices like the Tibetan Buddhists’ Loving Kindness meditation (metta) impact on regions of the brain associated with positive emotion and empathy, and also reduce activity in some stress processing regions.

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  1. Zoe on March 3, 2022 at 11:57 am

    Great blog David. I’d never heard of moral therapy.
    Thank you for bringing it back into modern day consciousness ☺️
    Love your work!

    • David Hamilton on March 3, 2022 at 12:02 pm

      Thanks Zoe. I hope it comes back into mainstream again. 🙂

    • Katie Van Horne on March 3, 2022 at 2:43 pm

      Dear David, Thank you for this. Really Beautiful. Am paraphrasing/guessing here on the exact question asked of the Dalai Lama, yet I do remember his response: “I would say my religion is Kindness.”
      From very early childhood, I saw how kindness and tenderness worked watching a sister with her older sister, and the effect of that stayed with me.
      One time I approached Dzigar Kongtrul Rinpoche, feeling hurt, depressed, anxious and stumped regarding my occupation, and worrying about even asking the question. I remember now again after reading this piece this morning, how he received the question with the same kind of kindness, and gently turned my thinking to a simple possible, doable, equanimous, sympathetically joyful, compassionate approach (encompassing the 4 immeasurables, when reflect on it here) and opened up my thought patterns with how both thankful and practical real kindness felt inside my being, sitting there, then proceeding from there, felt re-membered, really, at a pivotal time. The kindness of of the moment, from early in my life, countless other moments, came back and reframed a capacity of interconnection and opening, innate in each of us.

  2. Helen Hamilton on March 3, 2022 at 12:27 pm

    I myself have suffered from depression and anxiety all my adult life. I have now been on medication constantly for 13 yrs to keep me feeling ok but it really bothers me that I have to do this but I’m so scared of going back into the black hole.
    I can understand how kindness could help these conditions. Your blog was really interesting and your email yesterday was just exactly what I needed to read as I was having a really bad day. So thank you David for your kindness.

    • David Hamilton on March 3, 2022 at 12:47 pm

      Hi Helen, I am so sorry to hear that you’ve suffered with depression and anxiety for so long. Having had experience with depression myself earlier in my life, I know how tough and wearing it can be. You know, one of my dear friends, several years ago, having suffered with severe depression learned about the power of volunteering. She and her husband joined a charity that ‘befriended’ people who were struggling with depression. It involved meeting occasionally with someone as a ‘sponsor’ and offering them support. It was transformational for her because she noticed that in shifting her focus onto the needs of another suffering person, it brought her awareness away from her own pain. I only mentioned this in case something like this might be an option for you.

      But regardless, here is my prayer for you today. It’s a version of the Tibetan Buddhists’ Loving Kindness meditation (metta): May you find happiness and the causes of happiness, and be free of suffering and the causes of suffering.

      It’s a daily prayer you might say for yourself and even wish on others too.

      Oh, and thank you for your kind words about my blog and daily boost email. 🙂

      • Helen Hamilton on March 3, 2022 at 6:11 pm

        Yes I may look into something like that David when my circumstances change as I’m living with my brother at the moment and my life is a bit up in the air. I will repeat the metta and hopefully it may help. Thank you again.

  3. Linda on March 3, 2022 at 3:38 pm

    I am really enjoying these lovely articles more often. I have read several of your books and I am currently reading “Why Woo Woo Works”. I find it very interesting and informative. Keep doing what you are doing as you are helping many. Thanks so much.

  4. Nathan on March 3, 2022 at 3:46 pm

    Hi David.

    I have known about moral treatment since medical journalist Robert Whitaker spoke about it in his book “Mad in America” which he wrote in 2002. I read it in 2012. I heard it was highly successful in small groups where intensive loving support could be offered. But when mainstream psychiatry tried to bring into mainstream use on a large scale it proved too difficult to offer enough healing support.

  5. Nathan on March 3, 2022 at 4:11 pm

    Hi David,

    What are your thoughts on treating manic depression (bipolar) that can create manic states that are excessively high & positive in some ways, and depressive states that are excessively low & negative? Would a realistic balanced attitude be more suitable than a more idealistically positive one?

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