A Bioethical Inquiry into the Moral Treatment Movement Open Access

Putney, Sarah B (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/3484zh57t?locale=en


This paper employs both a general historical approach and a case study of the Northern Indiana Hospital for the Insane in Logansport, Indiana, during its first two decades (1888 - 1908) to examine the "moral treatment" of patients through a bioethical lens. These twenty years comprise the tenure of moral-treatment practitioner Joseph Goodwin Rogers, M.D., the hospital's design engineer and first medical superintendent. A distinguished expert in the design of mental hospitals, which were commonly called asylums, Dr. Rogers subscribed to the concerns expressed by the French physician Phillippe Pinel, who is still popularly celebrated for freeing the patients of the Bic ê tre Hospital in Paris from their chains, and is known by medical historians for publishing the first nosology of mental illness. Asylum doctors like Rogers were familiar with Pinel's ground-breaking description of the methods of moral treatment (" traitement moral" ), which was emerging in some Parisian, English, and Scottish mental hospitals in the late eighteenth and early nineteenth centuries. This asylum-based method became the leading medical treatment for the mentally ill in Europe and America throughout the nineteenth century and into the twentieth, yet the moral treatment movement is now largely forgotten, poorly understood, and misinterpreted. The reader unfamiliar with this chapter of medical history may be surprised to learn of the significant ethical motivations that drove and shaped this therapeutic movement. Benevolence, as distinct from beneficence, is identified as the leading ethical concept in the moral treatment movement as it unfolded in the U.S. and Indiana. The case study of the Northern Indiana Hospital for the Insane examines primary records including monthly and biennial reports from Dr. Rogers to the board of trustees and the governor, letters from Rogers to families of patients, and published works by Rogers shedding light on his bioethical approach to the challenges of caring for the state's mentally ill effectively and benevolently within limited means. In the final chapter, the similarity of pragmatism (as developed by William James and John Dewey in particular) to Rogers's ethics is discussed, and questions for further study are identified.

Table of Contents

Table of Contents

Chapter 1 1

Chapter 2 10

Chapter 3 39

Chapter 4 70

Chapter 5 102

Bibliography 119

Table of Illustrations

State Insane Asylum, Indianapolis, c. 1890 58

Kirkbride Plan 59

Longcliff Hospital Administrative Building, Rear View, c. 1905 62

Lake at Longcliff Hospital, c. 1900 63

Joseph Goodwin Rogers, c. 1885 70

Joseph G. Rogers and Family, c. 1890 75

Longcliff Ball 1904 77

Doorknobs from Longcliff Hospital, c. 1890 79

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