Moral Treatment Research Articles

Tradition, Morality and Solidarity in Durkheim’s Theory

This article examines Durkheim’s approach to the interrelationship of tradition, morality and solidarity. One of its basic claims is that Durkheim was an epistemological and methodological rationalist, but not an ontological one. It means that he grounded rational and scientific knowledge about social reality, which itself, to his mind, is not rational. It concerns directly his treatment of tradition, morality and social solidarity. In spite of all Durkheim’s statements about the decline of traditionalism in contemporary societies, he affirmed sometimes that traditional behaviour in general is almost identical to a moral one. We can see it namely in his reasoning about the close affinity and nearly identical character between “collective habits” and true morality. In industrial societies, according to him, two types of traditions coexist, namely old, “traditional” traditions inherited from the past on the one hand, and new, “rational” traditions, on the other hand. His statements about the alternation of historical periods dominated by traditions and ideals contains a kind of sketch on the philosophy of history, partly explaining the phenomena of time compression and time distension in different periods of social development. Durkheimian theory may be interpreted as a fruitful contribution to the present-day understanding of the processes of modernization. 

A Service Member's experience of Acceptance and Commitment Therapy for Moral Injury (ACT-MI) via telehealth: “Learning to accept my pain and injury by reconnecting with my values and starting to live a meaningful life”

Acceptance and Commitment Therapy for Moral Injury (ACT-MI) has been proposed to help individuals move towards their values in the presence of moral pain. The current case study is the first using ACT-MI and the first telehealth moral injury treatment application. ACT-MI was delivered to a Service Member in his early 30's over twelve (90-min) telehealth individual psychotherapy sessions. The Service Member reported significant changes engaging with his values and moral pain over the course of treatment. He found the intervention to be highly acceptable, particularly in comparison to previously completed trauma-focused treatments. His experience of the intervention, conceptual rationale for ACT-MI, and treatment implications are discussed.

The invisible woman: Susan Carnegie and Montrose Lunatic Asylum.

In 1779, Susan Carnegie (1743-1821) persuaded the Town Council of Montrose, Scotland, to build a safe haven for those suffering from both poverty and mental illness. As a result, Montrose Lunatic Asylum became not only the first public asylum in Scotland, but among the first in the English-speaking world. Carnegie - born 175 years before women could vote - championed a humane and science-based response to mental illness. Montrose Asylum practised moral treatment a decade before Tuke and Pinel. As a champion of the new mental science, her enduring influence resulted in the hiring of the young W.A.F. Browne. Her story enriches the current wave of scholarship on Scottish psychiatry in particular, and on women in psychiatry in general.

Casas de Locos: The Treatment of the Mentally Ill in the Hispanic World Before the Enlightenment.

Before the Enlightenment, the mentally ill in the Hispanic world received standard medical care. After the foundation of the first hospital for specific treatment for mentally ill in Valencia in 1409, a number of hospitals opened their doors to patients with mental illness across the Iberian Peninsula during the 15th century. This model of medical care for people with mental illness was carried to America and the Philippines soon after the arrival of the Spaniards. The treatment for the mentally ill in the Hispanic World influenced the development of Pinel's moral treatment and the care of the mentally ill during the Enlightenment. This article will explain the circumstances leading to the foundation of a number of specific hospitals for the mentally ill in the Hispanic territories as well as the kind of care that these patients received at the so-called casas de locos.

Behind the Legend of Dorothea Dix Rests a Woman ‘Famous but Unknown’

Behind the Legend of Dorothea Dix Rests a Woman ‘Famous but Unknown’

APA’s 13 Founders Were Dedicated to Specialty Still Trying to Find its Way

APA’s 13 Founders Were Dedicated to Specialty Still Trying to Find its Way

175 Years of Caring: A Celebration

Back to table of contents Previous article Next article From The PresidentFull Access175 Years of Caring: A CelebrationAltha StewartM.D.Altha StewartSearch for more papers by this authorM.D.Published Online:28 Dec 2018https://doi.org/10.1176/appi.pn.2019.1a23In 1844, 13 superintendents of our young country’s institutions for people with mental illness came together for the purpose of improving the lives of the individuals under their care. The founders of what they named the Association of Medical Superintendents of American Institutions for the Insane were proponents of moral treatment—the idea that society should provide psychosocial care in a humane environment. One of the founders, Dr. Thomas Kirkbride, devised an architectural plan used in the building of many asylums for decades to come that featured natural light and abundant fresh air surrounded by spacious landscapes.One hundred and seventy-five years later, the American Psychiatric Association—the flower of that first meeting in 1844—is marking a milestone in its remarkable history. A high point of the year will be a gala at San Francisco City Hall during APA’s 2019 Annual Meeting.The celebration in San Francisco means a lot to me—and not just because it marks the culmination of my presidential year.Remembering our roots is dear to me because I trained in Philadelphia and spent a career doing the kind of work in public mental health systems originally envisioned by the founders of what became APA. Today, there is a renewed emphasis on the social determinants of health—which I have tried to underscore during my presidency—and an understanding that real recovery depends on understanding the social context in which a person lives. I like to think that Thomas Kirkbride would smile on this development. But owning our history also means owning the fact that sometimes we have fallen short of our ideals. “Not everything that is faced can be changed,” James Baldwin famously wrote. “But nothing can be changed that is not faced.” We need to face the fact that racism mars our country’s history from its colonial beginnings and even the history of our profession. One of APA’s founders, Dr. Francis Stribling, insisted there be a Committee on Asylums for Colored Persons, assuring the segregation of treatment by race. In addition, there is no publicly available evidence that in the 1950s APA supported overturning school segregation in the case Brown v. Board of Education. In response to a request by a prominent African-American member, Dr. Charles Prudhomme, to file an amicus brief in the case, he was told to “withdraw from involvement in the case and remain aloof from such a political issue.” Dr. Prudhomme went on to become APA vice president in the 1970s. In May 1969, a group of black psychiatrists led by Dr. Chester Pierce came to a meeting of the APA Board of Trustees demanding that APA acknowledge racism as a mental health problem and work to desegregate all public and private mental health facilities in the United States. Understanding and facing our past can help us shape the future. We have an exciting opportunity to learn more about our history at the Annual Meeting in San Francisco, where APA and the APA Foundation will be sponsoring a special historical scientific program track. The track will include sessions on the history of psychiatry divided into four separate eras. Here are the four historical eras and their faculty chairs: The advent of organized medicine in caring for people with mental illness (colonial times-1844): John Oldham, M.D.The dawn of the modern era: reforms in care and treatment (1844-1944): Jeffrey Geller, M.D., M.P.H.Advancing diagnosis, treatment, and education (1944-present): Carolyn Robinowitz, M.D.Shaping the future of psychiatry: breakthroughs in research and delivery of clinical care (looking ahead): Josh Gordon, M.D., director of the National Institute of Mental Health.Additionally, the history track will include a session on the history of global psychiatry chaired by Dr. Tsuyoshi Akiyama and sessions on the history of psychiatry as related to our minority and underrepresented groups. Those groups are American Indian, Alaska Native, and Native Hawaiian psychiatrists; Asian American psychiatrists; black psychiatrists; Hispanic psychiatrists; IMG psychiatrists; LGBTQ psychiatrists; and women psychiatrists. Look for detailed information in upcoming issues of Psychiatric News.Finally, I would like to suggest that all of us have a stake in the history of our profession and can participate in its preservation. Last year, APA and the APA Foundation opened the Melvin Sabshin, M.D., Library and Archives at APA’s new headquarters in Washington, D.C. I invite you to search your personal archives for historical documents, books, and artifacts that might be worthy of preservation. Information about the library’s acquisition policy can be obtained by emailing [email protected] You can also help support the library through its Adopt-a-Book program.The history of our profession belongs to all of us. I look forward to celebrating it with you! ■ ISSUES NewArchived

Michel Foucault and Western Medicine

The article analyzes Michel Foucault’s philosophical ideas on Western medicine and delves into three main insights that the French philosopher developed to expose the presence of power behind the veil of the conventional experience of medicine. These insights probe the power-disciplining function of psychiatry, the administrative function of medical institutions, and the role of social medicine in the administrative and political system of Western society. Foucault arrived at theses insights by way of his intense interest in three elements of the medical system that arose almost simultaneously at the end of the 18th century - psychiatry as “medicine for mental illness”, the hospital as the First and most well-known type of medical institution, and social medicine as a type of medical knowledge focused more on the protection of society and far less on caring for the individual. All the issues Foucault wrote about stemmed from his personal and professional sensitivity to the problems of power and were a part of the “medical turn” in the social and human sciences that occurred in the West in the 1960s and 1970s and led to the emergence of medical humanities. The article argues that Foucault’s stories about the power of medical knowledge were philosophical stories about Western medicine. Foucault always used facts, dates, and names in an attempt to identify some of the general tendencies and patterns in the development of Western medicine and to reveal usually undisclosed mechanisms for managing individuals and populations. Those mechanisms underlie the practice of providing assistance, be it the “moral treatment” practiced by psychiatrists before the advent of effective medication, or treating patients as “clinical cases” in hospitals, or hospitalization campaigns that were considered an effective “technological safe-guard ” in the 18th and most of the 19th century.

Dlaczego tolerować religię?

The majority of legal systems in Western democracies accord special treatment to religions, e.g. exemptions from generally applicable laws if they conflict with religious convictions. Other beliefs do not usually enjoy such far‑reaching tolerance on the part of the state. The article raises the question of how granting such privilege to religious views can be justified. Arguments of some philosophers (e.g. Thomas Hobbes’) which suggest that an intolerant attitude might sometimes be disadvantageous are in fact only instrumental, and do not prove that tolerance is a moral virtue. This last claim only follows from the arguments of John Stuart Mill and John Rawls, who exemplify two basic approaches in ethics, i.e. utilitarianism and deontology. None of the analyzed arguments for freedom of conscience and religion distinguishes between religious and other beliefs, which suggests that the existing differences in their moral and legal treatment cannot be justified. Therefore, the question arises of whether legal regulations regarding religious and other beliefs should not be equated, so that religious views are not privileged.

On the Theoretical Reconstruction of Durkheim’s Interpretation of Morality

This article offers the theoretical reconstruction of the treatment of morality by the classic of French and world sociology Emile Durkheim (1858–1917). Based on Durkheim’s texts, the author strives to show that, contrary to some modern interpretations, he was neither an anti-Kantian nor an anti-utilitarian. He constantly criticized both Kant and utilitarianism, but was strongly influenced by both theoretical positions. This influence was both “negative,” as an opposition to these positions, and “positive,” as a sort of their reproduction, continuation and development. Durkheim did not reject Kant’s views and utilitarianism (especially, in its eudemonist version), but relied on them seeking to realize their theoretical synthesis. The means of such a synthesis was a sociological approach to morality, in which society is treated as an entity that combines duty and good, immanent and transcendent principles in morality. The evolution of Durkheim’s interpretation of the elements, or characteristics of morality, as well as the connection of morality with religion and other social institutions, are considered. The author have analyzed Durkheim’s idea of the autonomy of sacredness in morality, of its irreducibility to the religious sacredness; hence the principal possibility of secular morality. According to Durkheim, morality is of a fundamental importance for society, it underlies all social institutions and social transformations

Chaplaincy, Spiritual Care and Moral Injury: Considerations Regarding Screening and Treatment.

Moral injury is a complex trauma related syndrome involving a correlation of biological, psychological, social, and spiritual symptoms that can have substantial impact upon health and well-being. This paper argues for a holistic bio-psycho-social-spiritual approach to moral injury, by including chaplaincy in the screening and treatment of moral injury among actively serving military members and retired veterans. As part of the moral injury treatment process, and in alignment with the World Health Organization's Spiritual Intervention Codings, a new technique is proposed, “Pastoral Narrative Disclosure” (PND), as a guide for chaplains and others trained in spiritual care to assist those suffering from moral injury.

Mechanisms of Moral Injury Following Military Sexual Trauma and Combat in Post-9/11 U.S. War Veterans.

Objective: Moral injury may result from perpetration-based and betrayal-based acts that violate deeply held norms; however, researchers and clinicians have little guidance about the moral injury syndrome's specific developmental pathways following morally injurious events. The present study's objective was to examine the direct and indirect pathways proposed in a frequently cited model of moral injury (1) in relation to two types of military-related traumas [experiencing military sexual trauma (MST) and combat exposure].Methods: Secondary analyses were conducted within a sample of post-9/11 veterans at a Southwestern Veterans Health Care System (N = 310) across two time-points. Structural equation modeling tested the direct and indirect pathways from MST and combat to a PTSD-depression factor via betrayal, perpetration, guilt, and shame.Results: Betrayal accounted for the association between MST and PTSD-depression (β = 0.10, p < 0.01, 95% CI = 0.01 − 0.11) and perpetration accounted for the association between combat and PTSD-depression (β = 0.07, p < 0.05, 95% CI = 0.02 − 0.14). The indirect path from combat to shame to PTSD-depression was significant (β = 0.16, p < 0.01, 95% CI = 0.07 − 0.28) but the path through guilt was not. The specific indirect paths through perpetration or betrayal to shame or guilt were non-significant.Conclusions: Betrayal and perpetration are associated with PTSD-depression following MST and combat. Results suggest multiple pathways of moral injury development following different military traumas and morally injurious events. Implications for moral injury conceptualization and treatment are discussed.

Provider perspectives on a novel moral injury treatment for veterans: Initial assessment of acceptability and feasibility of the Impact of Killing treatment materials.

We assessed whether treatment providers specializing in evidence-based treatment for posttraumatic stress disorder found the Impact of Killing (IOK), a novel treatment for moral injury among combat veterans, acceptable, and feasible. Ten providers from a large veterans administration (VA) medical center were provided with materials from IOK. We audio-recorded a semistructured interview with each provider where we elicited open-ended feedback as well as asked five structured questions about the relative advantage, compatibility, complexity/simplicity, trialability, and observability of IOK. All providers found IOK feasible, acceptable, and something they could incorporate into their existing practice. Providers reported that the spiritual and moral concerns addressed in IOK were novel, and that self-forgiveness and making amends were critical components promoting healing from moral injury not emphasized in other treatments. Among trauma providers, IOK was found acceptable and feasible, offering a novel approach to addressing moral injury among combat veterans.

Moral expansiveness short form: Validity and reliability of the MESx.

Moral expansiveness refers to the range of entities (human and non-human) deemed worthy of moral concern and treatment. Previous research has established that the Moral Expansiveness Scale (MES) is a powerful predictor of altruistic moral decision-making and captures a unique dimension of moral cognition. However, the length of the full MES may be restrictive for some researchers. Here we establish the reliability and validity of a reduced moral expansiveness scale, the MESx. Consistent with the full version, the MESx is strongly associated with (but not reducible to) theoretically related constructs, such as endorsement of universalism values, identification with all humanity, and connectedness to nature. The MESx also predicted measures of altruistic moral decision-making to the same degree as the full MES. Further, the MESx passed tests of discriminant validity, was unrelated to political conservatism (unlike the full MES), only mildly associated with the tendency to provide socially desirable responses, and produced moderate reliability over time. We conclude that the MESx is a psychometrically valid alternative for researchers requiring a short measure of moral expansiveness.

Occupational therapy in the Fourth Industrial Revolution

Background.While occupational therapy’s inception was from the Arts and Crafts movement and the moral treatment movement with war veterans, the profession has evolved to requiring a professional entry-level master’s degree to practice, and involves complex relationships with clients across the life span. Throughout history, a consistent impact of each industrial revolution has been the loss of jobs to automation. This consequence is even more profound today with the exponential growth of innovations and automation.Purpose.The objectives of this article are to (a) set the context by reviewing the evolution, or five eras, of occupational therapy in Canada; (b) present what is meant by the “Fourth Industrial Revolution”; and (c) examine the technological innovations faced by occupational therapists and our clients as we enter the “sixth” era of occupational therapy in Canada.Key Issues.Although occupational therapy, as a profession, has low risk for automation, a great number of our clients will not be able to reskill fast enough to keep up with job market requirements. Telerehabilitation, the Internet of Things, virtual reality, 3-D printing, robotics, artificial intelligence, and autonomous vehicles are challenging ways occupational therapists provide services to clients.Implications.It is recommended that occupational therapists engage with disciplines beyond current typical connections, as our expertise is called upon to advocate for ourselves and our clients who are end users of these technologies.

Pemberitaan Pidato Pribumi Anies Baswedan Pada Media Indonesia.Com dan Okezone.Com

Okezone.com in the case of speeches that professed indigenous words by DKI Jakarta Governor Anies Baswedan. This research uses descriptive qualitative method with framing analysis from Robert N. Entman which consists of define problems, diagnose couses, make moral judgement and treatment recomendation. The theory used to see the truth in the context of framing analysis study is the second stage of agenda setting from Mc Combs. The results of this study are Media Indonesia.com and Okezone.com in presenting news about indigenous speeches by Anies Baswedan are not neutral. In accordance with the second stage of agenda setting Mc Combs that highlighted is attribute. The attribute referred here is indigenous word which refers to the Dutch designation to demean Indonesian citizens, indigenous words discriminate race and ethnicity, indigenous words can divide Indonesian citizens, and indigenous words not worthy of saying.

Mind Perception of Robots Varies With Their Economic Versus Social Function.

While robots were traditionally built to achieve economic efficiency and financial profits, their roles are likely to change in the future with the aim to provide social support and companionship. In this research, we examined whether the robot’s proposed function (social vs. economic) impacts judgments of mind and moral treatment. Studies 1a and 1b demonstrated that robots with social function were perceived to possess greater ability for emotional experience, but not cognition, compared to those with economic function and whose function was not mentioned explicitly. Study 2 replicated this finding and further showed that low economic value reduced ascriptions of cognitive capacity, whereas high social value resulted in increased emotion perception. In Study 3, robots with high social value were more likely to be afforded protection from harm, and such effect was related to levels of ascribed emotional experience. Together, the findings demonstrate a dissociation between function type (social vs. economic) and ascribed mind (emotion vs. cognition). In addition, the two types of functions exert asymmetric influences on the moral treatment of robots. Theoretical and practical implications for the field of social psychology and human-computer interaction are discussed.

Sources of moral injury among war veterans: A qualitative evaluation.

Service members deployed to war are at risk for moral injury, but the potential sources of moral injury are poorly understood. The aim of this qualitative study was to explore the types of events that veterans perceive as morally injurious and to use those events to develop a categorization scheme for combat-related morally injurious events. Six focus groups with US war veterans were conducted. Analysis based on Grounded Theory yielded two categories (and eight subcategories) of events that putatively cause moral injury. The two categories were defined by the focal attribution of responsibility for the event: Personal Responsibility (veteran's reported distress is related to his own behavior) versus Responsibility of Others (veteran's distress is related to actions taken by others). Examples of each type of morally injurious event are provided. Implications for the further development of the moral injury construct and treatment are discussed.

From moral treatment to modern music therapy: On the history of music therapy in Vienna (c. 1820–1960)

ABSTRACTThis article outlines the historical evolution and precursors of modern music therapy in Vienna from c. 1820 to 1960. The first section describes early attempts to purposefully integrate music into Viennese psychiatry and highlights the groundbreaking work of Bruno Goergen (1777–1842), who around the year 1820 deliberately incorporated music into psychiatric institutions based on his dedication to the ideals of “moral treatment” and “no-restraint” psychiatry. Shortly thereafter, the first medical dissertations on the therapeutic effect of music began to be published in Vienna. Around 1850, the emergence of an “active” form of “music therapy” (in the broadest sense) is recognizable; during the same time period, physicians began taking their patients’ musical preferences, education, and disposition into account. However, as university medicine became firmly rooted in the standards of experimental science, physicians increasingly lost their interest in music. The second section gives an overview of several cultural movements that emerged in the first half of the twentieth century and inspired the pioneers of music therapy in Vienna, paving the way for the foundation of modern Viennese music therapy in 1958. Among these were the life reform movement, the curative rhythm and dance movement, and anthroposophy, as well as psychotherapy and progressive music-educational concepts. At the conclusion of this article, the main traits of the history of music therapy in Vienna and some of the pervading premises of Viennese music therapy are summarized.

\u2018Darker than the Dungeon\u2019: Music, Ambivalence, and the Carceral Subject

Music’s sanctioned role in the day-to-day running of the ‘late-modern’ prison is to ensure wellbeing and compliance of prisoners, with most regimes facilitating access to music through the form of radios, cd’s, and cassette players. As a result, music often comes tied to judgements by the regime about prisoners’ conduct, with incentive systems allowing the regime to confiscate earned possessions under certain conditions. In this way, the role of music in prison is often continuous with the mechanisms of carceral control, with its ‘humanising’ or ‘therapeutic’ effects being defined as a luxury to be earned through good behaviour and critical engagement with one’s moral and psychological treatment. By tracing the history of music during the birth of the modern prison in the nineteenth century, this paper asks how music became incorporated into the discourse and technology of the emerging carceral state. Drawing principally on the work of Michel Foucault, this paper seeks to explore the relationship between music and ‘the self’ as it is applied to carceral subjects. Foucault shows how the expansion of the carceral state at the end of the nineteenth century relied on the production of knowledge about the subject through the application of disciplinary techniques. By exploring the construction of the self through the discourse of music at the end of the eighteenth century and in the published works of carceral reformers at the end of the nineteenth century, this paper seeks to explore the role that music played within this period of carceral expansion. The discussion will focus on the ways in which music acts as a conduit for forms of carceral power through its relationship with the self.