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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 Lamel Hill is a scheduled monument about south-east of the centre of York, England. It is near The Retreat and the northern part of Walmgate Stray, and in some medieval documents it is referred to as Siward's Mill Hill, or Siward's How Mill ...
in York, it operates as a
not for profit A nonprofit organization (NPO) or non-profit organisation, also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collective, public or social benefit, in co ...
charitable organisation A charitable organization or charity is an organization whose primary objectives are philanthropy and social well-being (e.g. educational, religious or other activities serving the public interest or common good). The legal definition of a ch ...
. Opened in 1796, it is famous for having pioneered the so-called " moral treatment" that became a behaviour model for asylums around the world with mental health issues. Founded by William Tuke, it was originally only for Quakers but gradually became open to everyone. It inspired other progressive facilities such as the US
Brattleboro Retreat The Brattleboro Retreat is a private not-for-profit mental health and addictions hospital that provides comprehensive inpatient, partial hospitalization, and outpatient treatment services for children, adolescents, and adults. Located just north ...
, Hartford Retreat and
Friends Hospital Friends Hospital is a psychiatric hospital located in Philadelphia, Pennsylvania, United States. Founded in 1813 by Quakers as The Asylum for the Relief of Persons Deprived of the Use of Their Reason, the institution was later renamed the Frankf ...
. The present day The Retreat seeks to retain the essence of early "moral treatment", while applying the principles to a modern healthcare setting. The Retreat withdrew from the delivery of inpatient services after 222 years on 31 December 2018.


History


Background

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 immobilisation 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 light of a person could never be extinguished. A trigger was the death in 1790 of a Quaker,
Hannah Mills Hannah Louise Mills, (born 29 February 1988) is a British competitive sailor and two-time world champion in the Women's 470 class, having won in 2012 and 2019. Mills won a silver medal for Team GB with her crew Saskia Clark in the 2012 Olym ...
, a few weeks after she had been admitted to the York Asylum (now known as
Bootham Park Hospital Bootham Park Hospital was a psychiatric hospital, located in the Bootham district of York, England. It was managed by the Tees, Esk and Wear Valleys NHS Foundation Trust. The main building is a Grade I listed building. History Construction and ...
). She was not allowed to have any visitation. The asylum had not let her friends or family visit her. This situation brought several concerns about the condition of Hannah's death. Therefore, this led William Tuke to think about The Retreat as a place where people should be treated equally. However, visiting afterwards to investigate the conditions, the Quakers found that the patients were treated worse than animals.Samuel, B
Quaker Tour of England: The Retreat Mental Hospital
QuakerInfo.com Retrieved 8 July 2017


Beginnings

Quaker William Tuke was enlisted and took charge of a project to develop a new form of asylum. His family enjoyed the tea and coffee merchant business. 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 personalised 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.


The Design

There was some minimal use of restraint. The design for the facility was to accommodate the patient by gender in separate bedrooms in a way specific to that patient treatment. 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 A straitjacket is a garment shaped like a jacket with long sleeves that surpass the tips of the wearer's fingers. Its most typical use is restraining people who may cause harm to themselves or others. Once the wearer slides their arms into the ...
were sometimes used, at least initially, as a threat or a last resort. There was little formal medical involvement and an
apothecary ''Apothecary'' () is a mostly archaic term for a medical professional who formulates and dispenses '' materia medica'' (medicine) to physicians, surgeons, and patients. The modern chemist (British English) or pharmacist (British and North Americ ...
, 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 George may refer to: People * George (given name) * George (surname) * George (singer), American-Canadian singer George Nozuka, known by the mononym George * George Washington, First President of the United States * George W. Bush, 43rd President ...
, 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. Jepson was said to have been authoritative yet patient, attentive, observant, kind, and open to new ideas in spite of his limited formal medical training. He arrived at the same time as a talented Quaker nurse
Katherine Allen Katherine Allen may refer to: * Katherine Allen (politician), American politician from Maine * Kate Allen (triathlete), Australian-Austrian triathlete * Kate Allen (Amnesty International), director of Amnesty International UK See also * Kate A ...
, and the two married in 1806, thus heading The Retreat together.


The Moral Treatment

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 (24 March 1755 – 11 August 1814) co-founded with his father, William Tuke, the Retreat asylum in York, England, a humane alternative to the nineteenth-century network of asyla, based on Quaker principles.Burial: "England & Wales ...
who co-founded The Retreat, and
Samuel Tuke Samuel Tuke may refer to: *Sir Samuel Tuke, 1st Baronet (c.1615–1674), English Royalist officer, playwright and nobleman *Samuel Tuke (reformer) Samuel Tuke (31 July 1784 – 14 October 1857) was a Quaker philanthropist and mental-health ref ...
who helped popularise the approach which convince physicians to adopt it in his 1813, book ''Description of The Retreat near York''. His book explained in detail about the approach to use the moral treatment method for restoring the self-esteem, and self-control in individual with mental issues. In doing so, Samuel Tuke popularised his use of the term moral treatment that he had borrowed from the French "traitement moral" being used to describe the work of
Pussin Jean-Baptiste Pussin (1746–1811) was a hospital superintendent who, along with his wife and colleague Marguerite, established more humane treatment of patients with mental disorders in 19th-century France. They helped physician Philippe Pinel app ...
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
Vincenzo Chiarugi Vincenzo Chiarugi (1759–1820) was an Italian physician who helped introduce humanitarian reforms to the psychiatric hospital care of people with mental disorders. His early part in a movement towards moral treatment was relatively overlooked unt ...
in Italy. Ideas of "moral" management were incorporated, and used for various therapeutic and custodial purposes, in asylums and therapeutic communities around the world. 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, it remains a Quaker ministry and has a Quaker Chaplain. The Yorkshire General Meeting of Friends suggests names for half of the Board of Trustee Directors. The burial ground of the York Friends Meeting House is in the grounds of the hospital.


Growth and change

Quaker as Friends Asylum in 1813, gained trust from the United States of America and had the opportunity to open the first private Friends Hospital which was a mental health facility on Philadelphia. During that time it was difficult to treat and impossible to cure mental health problems. In addition, Samuel's book with his explanation about the moral treatment gained trust from the community, and helped to raise money for the hospital. The
abolitionist Abolitionism, or the abolitionist movement, is the movement to end slavery. In Western Europe and the Americas, abolitionism was a historic movement that sought to end the Atlantic slave trade and liberate the enslaved people. The British ...
, John Candler, was appointed Superintendent in 1841. However the
Lunacy Act 1845 The Lunacy/Lunatics Act 1845 (8 & 9 Vict., c. 100) and the County Asylums Act 1845 (8 & 9 Vict., c. 126) formed mental health law in England and Wales from 1845 to 1890. The Lunacy Act's most important provision was a change in the status of menta ...
necessitated the appointment of a medically qualified superintendent and in 1846 the
John Thurnam John Thurnam (28 December 1810 – 24 September 1873) was an English psychiatrist, archaeologist, and ethnologist. In 1846 he was appointed Medical Superintendent of The Retreat, the Quaker psychiatric hospital near York. In 1848 he reported tw ...
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, while 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. As key people in the history of The Retreat, the names of Katherine Allen and George Jepson were given to two units at the hospital.


Current services

The Retreat continued to operate as an independent hospital into the modern era. However, on 31 December 2018, it withdrew from inpatient care with its remaining services for
eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating d ...
s and
personality disorder Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the individual's cultur ...
s now being run by the Schoen Clinic. The Retreat continues to run outpatient community psychological assessment, diagnostic and therapy services at the Tuke Centre, including an
Autism The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
and
ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inapp ...
service.


Notable figures

* Joseph Rowntree and
Samuel Tuke Samuel Tuke may refer to: *Sir Samuel Tuke, 1st Baronet (c.1615–1674), English Royalist officer, playwright and nobleman *Samuel Tuke (reformer) Samuel Tuke (31 July 1784 – 14 October 1857) was a Quaker philanthropist and mental-health ref ...
(grandson of William Tuke) are buried in the Quaker cemetery found within the grounds. *
Aubrey Hopwood Aubrey Hopwood (4 April 1863 – 25 October 1917) was a British lyricist of Edwardian musical comedy and a novelist and author of nonsense books for children. He co-wrote the lyrics for the musicals ''Alice in Wonderland'' (1886), ''A Runaway ...
(1863-1917), lyricist and author, died there.England & Wales, National Probate Calendar (Index of Wills and Administrations), 1858-1995 for Henry Aubrey Hopwood, 1918 Ancestry.com
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See also

* History of psychiatric institutions *
Mental health care A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a ...
* Quakers in Britain


References


Further reading

* *


External links


Official Website of The RetreatThe Retreat on History of York
* {{DEFAULTSORT:Retreat, The Psychiatric hospitals in England Hospitals in York 1796 establishments in England Quakerism in the United Kingdom Organisations based in York Quakerism in England Hospitals established in 1796 Private hospitals in the United Kingdom Religion and mental health