The Retreat
Encyclopedia
The Retreat, commonly known as the York Retreat, is a place in England
for the treatment of people with mental health needs. Located in Lamel Hill
in York
, it operates as a not for profit
charitable organisation
.
Opened in 1796, it is famous for having pioneered the humane treatment and moral treatment
that became a model for asylums
around the world. Founded by William Tuke
, it was originally run by and for Quakers but gradually became open to everyone. It inspired other progressive facilities such as the American Brattleboro Retreat
, Hartford Retreat
and Friends Hospital
. The present day Retreat seeks to retain the essence of early moral treatment, while applying the principles to a modern healthcare setting.
of a person could never be extinguished. A specific trigger was the death in 1790 of a Quaker, Hannah Mills
, a few weeks after she had been admitted to the York Asylum (now known as Bootham Park Hospital
). The asylum had not let her friends or family visit her, and they became suspicious. Visiting afterwards to investigate the conditions, the Quakers found that the patients were treated worse than animals.
The Quaker William Tuke
was enlisted and took charge of a project to develop a new form of asylum. He appealed to Quakers, personal acquaintances and physicians for funds. He spent two years in discussion with, and issuing explanatory statements to, the local Quaker group (York Monthly Meeting), working out the fundamental principles of the proposed institution. Tuke and his personal physician, Timothy Maud, educated themselves about the current views on "madness" and its treatment. Tuke's conviction, however, was in the importance of benevolence and a comfortable living environment encouraging reflection. Tuke also worked with architect John Bevans to design the new building.
The Retreat opened in 1796 in the countryside outside York. It was planned to take in about 30 people but started with just three, then eight. Unlike mental institutions of the time, there were no chains or manacles, and physical punishment was banned. Treatment was based on personalized attention and benevolence, restoring the self-esteem and self-control of residents. An early example of occupational therapy
was introduced, including walks and farm labouring in pleasant and quiet surroundings. There was a social environment where residents were seen as part of a large family-like unit, built on kindness, moderation, order and trust. There was a religious dimension, including prayer. Inmates were accepted as potentially rational beings who could recover proper social conduct through self-restraint and moral strength. They were permitted to wear their own clothing, and encouraged to engage in handicrafts, to write, and to read books. They were allowed to wander freely around The Retreat’s courtyards and gardens, which were stocked with various small domestic animals.
There was some minimized use of restraint. Door locks were encased in leather, the bars on windows made to look like window frames, and the extensive gardens included a sunken wall that was impassable yet barely visible. Straitjackets were sometimes used, at least initially, as a threat or a last resort There was little formal medical involvement and an apothecary
, Thomas Fowler
, served as physician. He gave the standard medical treatments "ample trial" but reluctantly and "courageously" abandoned them as failures. Fowler worked with George Jepson, the first superintendent of the retreat, and the two gradually concluded that the use of usual fear tactics actually made patients worse, and allaying patient's fears helped them. Jenson was said to have been authoritative yet patient, attentive, observant, kind, and open to new ideas due to limited formal medical training. He arrived at the same time as a talented Quaker nurse Katherine Allen, and the two married in 1806, thus heading the Retreat together.
The approach of The Retreat was widely derided at first. William Tuke noted that "All men seem to desert me." However, it became a model around the world for more humane and psychologically-based approaches. The work was taken on by other Quakers, including Tuke's son Henry Tuke
who co-founded the retreat, and Samuel Tuke who helped popularize the approach and convince physicians to adopt it in his 1813 book Description of the Retreat near York. In doing so, Samuel Tuke popularized his use of the term moral treatment
that he had borrowed from the French "traitement moral" being used to describe the work of Pussin and Pinel
in France (and in the original French referring to morale in the sense of the emotions and self-esteem, rather than rights and wrongs). The term came to refer to a number of moves towards more humane approaches that occurred toward the end of the 18th century in the context of Enlightenment
thinking, including also the work of Chiarugi in Italy. Ideas of "moral" management were incorporated, and used for various therapeutic and custodial purposes, in asylums and therapeutic communities around the world.
In 1847 the first formal "medical" superintendent was appointed. Moral therapy was gradually replaced by medication, special diets and hydrotherapy
. The size of the institution grew and the formerly close-knit community ethos was left behind. In addition, both Quaker influence and the number of Quaker patients decreased through the century. After the initial period for which it is best known, therefore, there were marked changes in management, therapy and client groups.
Between 1880 and 1884, most patients of The Retreat were under 50, single, and non-Quaker. A majority have been assessed today as having met criteria for a diagnosis of schizophrenia
or a mood disorder
. The majority experienced delusions, with the most common being of persecution, grandeur and guilt, whilst about a third had religious content. Just under a third of patients were suicidal. Drug therapy was commonly prescribed. Just over a third of patients had a history of assault on other patients or asylum staff. About a tenth of patients were force-fed at some stage during their stay. About a half of patients were discharged within a year of admission, with the prognosis
being better for patients with a mood disorder than for schizophrenia, but just under a third remained in the asylum for five or more years.
, post-traumatic stress, eating disorder
s, personality disorder
s and medical personnel with addictions or mental disorders. There are still no locked doors or restraints used.
The Retreat states that it provides mental healthcare that is unique to the person and values highly its original ethos. Although you do not have to have any connection to the Quakers to work at or receive healthcare from The Retreat, there are still a number of employees who have a Quaker religious background and The Retreat has a Quaker chaplain
.
The Retreat remains a Quaker ministry
. The Yorkshire General Meeting of Friends suggests names for the Board of Governors and appoints four members of the Benevolences Committee. All Governors are Friends. The burial ground of the York Friends Meeting is on the grounds of The Retreat.
and Samuel Tuke (grandson of William Tuke
) are buried in the Quaker
cemetery found within the grounds.
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
for the treatment of people with mental health needs. Located in Lamel Hill
Lamel Hill
Lamel Hill, once known as Heslington Hill, is located to the south-east of the centre of York. It is the location of The Retreat and of the northern part of Walmgate Stray. It is best-known for having been the location of a Parliamentary gun-emplacement aimed at Walmgate Bar in the City Walls...
in York
York
York is a walled city, situated at the confluence of the Rivers Ouse and Foss in North Yorkshire, England. The city has a rich heritage and has provided the backdrop to major political events throughout much of its two millennia of existence...
, it operates as a not for profit
Non-profit organization
Nonprofit organization is neither a legal nor technical definition but generally refers to an organization that uses surplus revenues to achieve its goals, rather than distributing them as profit or dividends...
charitable organisation
Charitable trust
A charitable trust is an irrevocable trust established for charitable purposes, and is a more specific term than "charitable organization".-United States:...
.
Opened in 1796, it is famous for having pioneered the humane treatment and moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
that became a model for asylums
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
around the world. Founded by William Tuke
William Tuke
William Tuke was an English businessman, philanthropist and Quaker. He was instrumental in the development of more humane methods in the custody and care of people with mental disorders, an approach that came to be known as moral treatment.-Career:Tuke was born in York to a leading Quaker family...
, it was originally run by and for Quakers but gradually became open to everyone. It inspired other progressive facilities such as the American Brattleboro Retreat
Brattleboro Retreat
The Brattleboro Retreat is a private, not-for-profit mental health and addictions hospital that provides comprehensive inpatient, outpatient, partial hospitalization and intensive outpatient services for children, adolescents and adults....
, Hartford Retreat
The Institute of Living
The Institute of Living is a mental health center in Hartford, Connecticut which merged with Hartford Hospital in 1994. The hospital was built in 1823, and was opened to admissions in 1824. Eli Todd was its first director. The hospital cost $12,000 to build and could serve up to 40 patients at a time...
and Friends Hospital
Friends Hospital
Friends Hospital, located in Philadelphia, Pennsylvania, is recognized as one of the premier mental hospitals in the United States.Founded by Quakers in 1813 as "The Asylum for Persons Deprived of the Use of Their Reason," and later known as the "Frankford Asylum for the Insane," it was the first...
. The present day Retreat seeks to retain the essence of early moral treatment, while applying the principles to a modern healthcare setting.
History
The York Retreat developed from the English Quaker community both as a reaction against the harsh, inhumane treatment common to other asylums of that era, and as a model of Quaker therapeutic beliefs. A common belief at the time was that the mad were wild beasts. The recommended medical practices included debilitating purges, painful blistering, long-term immobilization by manacles, and sudden immersion in cold baths - all administered in regimes of fear, terror and brutality. But the Quakers maintained that the humanity and inner lightInner light
Inner Light is a concept which many Quakers, members of the Religious Society of Friends, use to express their conscience, faith and beliefs. Each Quaker has a different idea of what they mean by "inner light", and this also varies internationally between Yearly Meetings, but the idea is often...
of a person could never be extinguished. A specific trigger was the death in 1790 of a Quaker, Hannah Mills
Hannah Mills
Hannah Mills was a Quaker from Leeds, England, whose treatment and death in 1790 while confined in the York Asylum is recognised as having led to the development of the York Retreat, which pioneered the moral treatment of mental illness that became a model for progressive practices...
, a few weeks after she had been admitted to the York Asylum (now known as Bootham Park Hospital
Bootham Park Hospital
Bootham Park Hospital is a psychiatric hospital, part of NHS North Yorkshire and York. It is located in the Bootham district of York and is a Grade I listed building.-History:...
). The asylum had not let her friends or family visit her, and they became suspicious. Visiting afterwards to investigate the conditions, the Quakers found that the patients were treated worse than animals.
The Quaker William Tuke
William Tuke
William Tuke was an English businessman, philanthropist and Quaker. He was instrumental in the development of more humane methods in the custody and care of people with mental disorders, an approach that came to be known as moral treatment.-Career:Tuke was born in York to a leading Quaker family...
was enlisted and took charge of a project to develop a new form of asylum. He appealed to Quakers, personal acquaintances and physicians for funds. He spent two years in discussion with, and issuing explanatory statements to, the local Quaker group (York Monthly Meeting), working out the fundamental principles of the proposed institution. Tuke and his personal physician, Timothy Maud, educated themselves about the current views on "madness" and its treatment. Tuke's conviction, however, was in the importance of benevolence and a comfortable living environment encouraging reflection. Tuke also worked with architect John Bevans to design the new building.
The Retreat opened in 1796 in the countryside outside York. It was planned to take in about 30 people but started with just three, then eight. Unlike mental institutions of the time, there were no chains or manacles, and physical punishment was banned. Treatment was based on personalized attention and benevolence, restoring the self-esteem and self-control of residents. An early example of occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
was introduced, including walks and farm labouring in pleasant and quiet surroundings. There was a social environment where residents were seen as part of a large family-like unit, built on kindness, moderation, order and trust. There was a religious dimension, including prayer. Inmates were accepted as potentially rational beings who could recover proper social conduct through self-restraint and moral strength. They were permitted to wear their own clothing, and encouraged to engage in handicrafts, to write, and to read books. They were allowed to wander freely around The Retreat’s courtyards and gardens, which were stocked with various small domestic animals.
There was some minimized use of restraint. Door locks were encased in leather, the bars on windows made to look like window frames, and the extensive gardens included a sunken wall that was impassable yet barely visible. Straitjackets were sometimes used, at least initially, as a threat or a last resort There was little formal medical involvement and an apothecary
Apothecary
Apothecary is a historical name for a medical professional who formulates and dispenses materia medica to physicians, surgeons and patients — a role now served by a pharmacist and some caregivers....
, Thomas Fowler
Thomas Fowler
Thomas Fowler was an English inventor whose most notable invention was the thermosiphon which forms the basis of most modern central heating systems....
, served as physician. He gave the standard medical treatments "ample trial" but reluctantly and "courageously" abandoned them as failures. Fowler worked with George Jepson, the first superintendent of the retreat, and the two gradually concluded that the use of usual fear tactics actually made patients worse, and allaying patient's fears helped them. Jenson was said to have been authoritative yet patient, attentive, observant, kind, and open to new ideas due to limited formal medical training. He arrived at the same time as a talented Quaker nurse Katherine Allen, and the two married in 1806, thus heading the Retreat together.
The approach of The Retreat was widely derided at first. William Tuke noted that "All men seem to desert me." However, it became a model around the world for more humane and psychologically-based approaches. The work was taken on by other Quakers, including Tuke's son Henry Tuke
Henry Tuke
Henry Tuke co-operated with his father in the reforms at the Retreat asylum in York, England.He was the author of several moral and theological treatises which have been translated into German and French.-Historic ship:...
who co-founded the retreat, and Samuel Tuke who helped popularize the approach and convince physicians to adopt it in his 1813 book Description of the Retreat near York. In doing so, Samuel Tuke popularized his use of the term moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
that he had borrowed from the French "traitement moral" being used to describe the work of Pussin and Pinel
Pinel
Pinel is the surname of:* Raquel Pinel, Spanish football forward currently playing for Valencia CF in the Spanish league* Marcel Pinel , French footballer* Suzanne Pinel, CM is a Canadian children's entertainer and citizenship judge...
in France (and in the original French referring to morale in the sense of the emotions and self-esteem, rather than rights and wrongs). The term came to refer to a number of moves towards more humane approaches that occurred toward the end of the 18th century in the context of Enlightenment
Age of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
thinking, including also the work of Chiarugi in Italy. Ideas of "moral" management were incorporated, and used for various therapeutic and custodial purposes, in asylums and therapeutic communities around the world.
In 1847 the first formal "medical" superintendent was appointed. Moral therapy was gradually replaced by medication, special diets and hydrotherapy
Hydrotherapy
Hydrotherapy, formerly called hydropathy, involves the use of water for pain-relief and treating illness. The term hydrotherapy itself is synonymous with the term water cure as it was originally marketed by practitioners and promoters in the 19th century...
. The size of the institution grew and the formerly close-knit community ethos was left behind. In addition, both Quaker influence and the number of Quaker patients decreased through the century. After the initial period for which it is best known, therefore, there were marked changes in management, therapy and client groups.
Between 1880 and 1884, most patients of The Retreat were under 50, single, and non-Quaker. A majority have been assessed today as having met criteria for a diagnosis of schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
or a mood disorder
Mood disorder
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature...
. The majority experienced delusions, with the most common being of persecution, grandeur and guilt, whilst about a third had religious content. Just under a third of patients were suicidal. Drug therapy was commonly prescribed. Just over a third of patients had a history of assault on other patients or asylum staff. About a tenth of patients were force-fed at some stage during their stay. About a half of patients were discharged within a year of admission, with the prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
being better for patients with a mood disorder than for schizophrenia, but just under a third remained in the asylum for five or more years.
Services
The Retreat is now an independent hospital with 160 beds, including 100 for the elderly. It offers specialist services, including rehabilitation for psychosisPsychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
, post-traumatic stress, eating disorder
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
s, personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
s and medical personnel with addictions or mental disorders. There are still no locked doors or restraints used.
The Retreat states that it provides mental healthcare that is unique to the person and values highly its original ethos. Although you do not have to have any connection to the Quakers to work at or receive healthcare from The Retreat, there are still a number of employees who have a Quaker religious background and The Retreat has a Quaker chaplain
Chaplain
Traditionally, a chaplain is a minister in a specialized setting such as a priest, pastor, rabbi, or imam or lay representative of a religion attached to a secular institution such as a hospital, prison, military unit, police department, university, or private chapel...
.
The Retreat remains a Quaker ministry
Christian ministry
In Christianity, ministry is an activity carried out by Christians to express or spread their faith. 2003's Encyclopedia of Christianity defines it as "carrying forth Christ's mission in the world", indicating that it is "conferred on each Christian in baptism." It is performed by all Christians...
. The Yorkshire General Meeting of Friends suggests names for the Board of Governors and appoints four members of the Benevolences Committee. All Governors are Friends. The burial ground of the York Friends Meeting is on the grounds of The Retreat.
Notable figures
Joseph RowntreeJoseph Rowntree
Joseph Rowntree may be:*Joseph Rowntree , English grocer and educational reformer*Joseph Rowntree , son of the above, English chocolate manufacturer and philanthropist...
and Samuel Tuke (grandson of William Tuke
William Tuke
William Tuke was an English businessman, philanthropist and Quaker. He was instrumental in the development of more humane methods in the custody and care of people with mental disorders, an approach that came to be known as moral treatment.-Career:Tuke was born in York to a leading Quaker family...
) are buried in the Quaker
Religious Society of Friends
The Religious Society of Friends, or Friends Church, is a Christian movement which stresses the doctrine of the priesthood of all believers. Members are known as Friends, or popularly as Quakers. It is made of independent organisations, which have split from one another due to doctrinal differences...
cemetery found within the grounds.