“Healthy Avenues of the Mind”: Psychological Theory Building and the Influence of Religion During the Era of Moral Treatment

OBJECTIVE: This article delineates the main psychological interventions used by American asylum superintendents practicing moral treatment between 1815 and 1875. Further, it explores the impact of Protestant religious ideas on specific aspects of moral treatment's theory and practice. METHOD: Asylum annual reports written by superintendents (physicians dedicated to the treatment of the mentally ill) were studied along with volumes of the American Journal of Insanity from its premier issue in 1844 through the 1890s. The writings of two laymen, Thomas Gallaudet and Horace Mann, both committed advocates of moral treatment, were also examined. RESULTS: The superintendents espoused complex theories about individual psychology and the nature of the self based on their observations. Protestant religious thought was a major influence, helping to catalyze original psychological propositions. Interesting resonances can be found between the superintendents' concept of a central agency, a governing “I” accounting for individual behavior, and ego psychologists' concepts of the organizing functions of the ego. CONCLUSIONS: Moral treatment did not produce a comprehensive psychotherapeutic system. Nonetheless, the superintendents voiced surprisingly modern psychotherapeutic insights. Religious worship as well as religious notions about the inviolability of the soul greatly influenced their views of patients. Rather than being an impediment to formulating psychological ideas, religious concepts proved to be a rich framework for evolving theories about aspects of patients' internal psychological functioning. (Am J Psychiatry 1998; 155:1001–1008)