314 Abnormal Psychology
family members and friends and discovered that he was able
to induce a trance state. He identified a trance as nervous
sleep and coined the term hypnosisfor the induced state (see
Braidism,Oxford English Dictionary).
Moral Management and the Association Model
Although Philippe Pinel is often credited with having initi-
ated reform in institutions for the insane, agitation for reform
had begun before him in many countries where general insti-
tutional conditions had been deteriorating. In 1796, in re-
sponse to widespread publicity generated by investigations of
deplorable institution conditions, the English philanthropist,
William Hack Tuke (1732–1822) persuaded the Society of
Friends, to found the Retreat at York, planned as a therapeu-
tic environment for mentally ill Quakers. Tuke instituted a
system known as moral management, based on humanitarian
care, moral (i.e., psychological) treatment, minimal restraint,
and constructive activities.
The principles of moral management followed the con-
cepts of eighteenth century moral philosophers, and the
British concept of “associationism,” that psychological states
and processes are sequentially determined by prior experi-
ence and governed by the laws of association. Individual
differences were explained as a consequence of differing par-
ticular sequences of experiences, especially those of educa-
tion. This view led to the optimistic belief that, based on
proper education, it would be possible to plan a utopian soci-
ety to achieve a universal social harmony.
Associationism owed a debt to John Locke (1632–1704)
who, in his An Essay Concerning Human Understanding
(1700) stated that all our ideas come from experience, first
from sensation and secondly from reflection upon the ideas
furnished by sensation. Locke believed that in ordinary
thought, one idea normally succeeds another by “natural” or
rational connections. But, according to Locke, occasionally
ideas become fortuitously associated by their contiguity,
which explains how even reasonable people may come to
hold unreasonable beliefs. Locke suggested that mental
disorders are extreme instances of such unreasonable beliefs.
Although this “association model” of psychopathology
attributed sensory defects and abnormalities of movement to
structural defects in the nervous system, it explained
insanity—peculiar ideas, aberrant and incoherent thought
processes, inappropriate emotions, and bizarre behaviors—as
attributable to chains of irrational associations established by
unfortunate learning situations. Sanity was considered a mat-
ter of coherent, rational thought processes and of self-control,
with the proper use of the will in the service of reason to
control emotions and to guide action. (This view has a long
history—Plato held it and stressed the importance of inner
governance.) Insanity results from unfortunate experiences,
lack of discipline, and self-indulgence, hence it can be cured
by reeducation (Plato, 1894a).
The association model provided the rationale for moral
management. People affected with insanity, according to this
view, should be removed from the pernicious influence of
their homes and environments. They should be placed in a
well-ordered social milieu designed to gently but firmly reha-
bilitate them to the norms of society by an orchestration
of therapeutic relearning experiences and provision of firm
moral guidance in order restore mental health.
Small asylums, modeled on the York Retreat, sprang up in
Britain and the United States. Managers were often physi-
cians but also ministers, because insanity was attributed to
psychological, not biological, causes. Persons who provided
therapy for the insane had come to be known as “alienists”
because they dealt with the problems of the alienated mind.
Physical restraint and drugs were minimized in favor of
kindly supervision and methods designed to reeducate and to
instill appropriate behavior and self-discipline. Religious ser-
vices were available, although patients who tended to reli-
gious brooding might not be permitted to attend. Practitioners
made little attempt to determine specific causes for the psy-
chopathology. These measures, intended to induce habits of
self-control, did not always work, as many patients were self-
destructive or violent to others, which made restraint neces-
sary at times.
William Battie (1704–1776), an English alienist and an
early advocate of moral management, was the first in Britain to
teach psychiatry to medical students. In hisA Treatise on Mad-
ness(1758), Battie made a distinction between “original” (i.e.,
organic) and “consequential” (or acquired) madness. He be-
lieved that mental disorder could be cured if patients were
treated in an asylum where they were isolated from family and
friends, were attended by asylum staff rather than their own
servants, and were managed by efforts to check their “unruly
appetites” and divert their “fixed imaginations.”
Philippe Pinel (1745–1826), the French alienist, founded a
school of psychiatry at the Salpêtrière, where he trained a
generation of psychiatrists, including Esquirol, who spread
his ideas throughout Europe. Pinel has been considered
the founder of modern psychiatry because he wrote the first
textbook of psychiatry,Traité Médico-Philosophique sur la
Manie(Pinel, 1806). Pinel is also credited with having inau-
gurated the humane care of the institutionalized insane, based
the claim that he removed the chains from the insane patients
at the Bicêtre. Weiner (1979) points out that, in fact, this
was done by Pussin, who successfully replaced chains with
straitjackets for incurable mental patients at Bicêtre. Pinel