Moral therapy and the problem of morale

The author reviews the history of moral therapy and the lessons and warnings it holds for modern psychiatry. Custodial management replaced moral therapy in this country in the late 1800s because of inadequate manpower and fiscal resources, a lack of charismatic leaders, the increasing lack of control over admissions and discharge, and other factors. One "solution" to the unacceptable conditions of custodial care was an increased faith in science and technology; humanistic medical science became scientism, and patients suffered. Morale is essential to the provision of moral therapy, and the increasing emphasis on somatic therapies has strained the union of morale and moral treatment. The author believes that the profession can reaffirm its identity and distinguish itself through the appropriate provision of humane, psychosocial care--the essence of moral therapy.