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Individual differences |
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The Retreat, commonly known as the York Retreat, is an institution in England providing support and treatment for individuals experiencing mental illness. Opened in [1796, it is famous for having pioneered the humane treatment and moral therapy 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 and its ethos and practices changed over the decades. Located on Lamel Hill in York, it operates as a not for profit charitable organisation.
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 specific trigger was the death in 1790 of a Quaker, Hannah Mills whilst in the York Asylum (now known as Bootham Park Hospital). Her death was attributed to poor treatment.
The Retreat was set up specifically to show, by contrast with the York Asylum, the advantages of enlightened methods. It was so successful that this led to the establishment of a House of Commons review which in 1814 recommended the reform of existing mental hospitals
William Tuke took charge of the project. He had difficulty persuading members of the local Quaker group (York Monthly Meeting) to allocate money for the undertaking, spending two years issuing explanatory statements describing the fundamental principles of the proposed institution. The principles William Tuke formulated during those years were to become the essence of moral treatment, a revolutionary concept in the treatment of the mentally ill.
With the help of the architect John Bevans The Retreat opened in 1796. It started as a small institution for about 30 people. Treatment consisted of occupational therapy including walks and farm labouring; pleasant and quiet surroundings; and a social environment where patients were seen as part of a large family-like unit. Kindness, moderation, order and trust replaced the mechanical restraints and attempts to 'cure' that were common elsewhere. There was a religious dimension, including prayer. Inmates were accepted as 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 Retreat did not engage in medical practice or teaching, and the role of physician was taken by an apothecary, Thomas Fowler.
In 1847 the first 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 reduced 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 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.
The Retreat offers services for people through a range of mental health programmes, including specialist services for people with eating disorders and personality disorder. It also has rehabilitation services for people with psychosis and psychiatric services for older adults. 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 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.
- ↑ Harriman, P.H.(1961) Dictionary of Psychology.Peter Owen
- ↑ Borthwick, Annie, Holman, Chris; Kennard, David; McFetridge, Mark; Messruther, Karen and Wilkes, Jenny (2001). The relevance of moral treatment to contemporary mental health care. Journal of Mental Health 10 (4): 427 - 439.
- ↑ B Edginton (2003) The design of moral architecture at The York Retreat. Journal of Design History, 16(2):103-118
- ↑ Tuke, Samuel  (1996). Description of the Retreat, London: Process Press. ISBN 1-89920904-2.
- ↑ Digby, A. (1984) The changing profile of a nineteenth-century asylum: the York Retreat Psychological Medicine, Nov;14(4):739-48.
- ↑ Renvoice, EB. & Beveridge, AW. (1989) Mental illness and the late Victorians: a study of patients admitted to three asylums in York, 1880-1884 Psychological Medicine, Feb;19(1):19-28.
- Digby, Anne (1985). Madness, Morality and Medicine: A Study of the York Retreat 1796-1914, Cambridge: Cambridge University Press. ISBN 0521260671.
- Tuke, Samuel  (1996). Description of the Retreat, London: Process Press. ISBN 1-89920904-2.
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