Friends Hospital, Philadelphia
Friends Hospital is a mental health facility in Philadelphia, USA. It was founded by Quakers in 1813 as Friends Asylum for the Relief of Persons Deprived of the Use of Their Reason, and was the first private psychiatric hospital in the US and the oldest continuously functioning one.
Its original mission statement was “to provide for the suitable accommodation of persons who are or may be deprived of the use of their reason, and the maintenance of an asylum for their reception, which is intended to furnish, besides requisite medical aid, such tender, sympathetic attention as may soothe their agitated minds, and under the Divine Blessing, facilitate their recovery.”
This was at a time when people believed it was not possible to cure mental illness. Patients were locked away, often in chains, and subject to punishment, not treatment. It was considered good entertainment to pay a shilling to visit Pennsylvania Hospital on Sunday afternoon and view the madmen and women chained up in the basement. This ran strongly counter to the Quaker belief in That of God in Everyone.
The driving force behind the establishment of Friends Hospital was Thomas Scattergood, known as the Mournful Prophet, because he suffered from depression. As a travelling minister, he visited York in the UK in 1794 and saw for himself The Retreat, founded by William Tuke in 1796, and its practice of ‘moral treatment’ of mental patients. So impressed was he at the kindness and care shown that (as he later wrote in his diary) he ‘vented a few tears.’
Scattergood brought back this new vision of treatment, based on compassion and conversation. By 1813 Philadelphia Yearly Meeting had appointed a committee to raise funds and organize the construction. Samuel Tuke, grandson of William, was a committee member and published a book about the Retreat to raise funds for the new hospital. In it he wrote that the typical treatment of the time was, “too frequently, calculated to depress and degrade, rather than to awaken the slumbering reason or to correct its wild hallucinations.”
In Friends Hospital, every patient was given a private room with a window. They would be free to walk about the wooded grounds and were encouraged to work in the gardens, on the farm and in the kitchens.
Every patient was brought to the hospital through the front door, as a way of treating them with equal dignity and respect. In order to protect their privacy, they were recorded in the day book, meticulously kept by the hospital’s first superintendent, Isaac Bonsall, by their first name and the first initial of their surname, and only family, friends and staff were permitted to visit them. The hospital was run as a community, with staff and patients eating together around a dining room table.
There was very little medical understanding of mental illness at the time. Friends Hospital was at the forefront of experimentation, and some of the treatments tried out by Bonsall and his colleagues were undoubtedly cruel by today’s standards. These included applying plasters to the shaved heads of patients made from the dried bodies of Spanish flies, and the frequent application of electric shocks.
Although initially, only Quaker patients were admitted to Friends Hospital, in 1834, the care was extended to non-Quakers, partly in order to raise their income. Generally speaking they admitted patients who had only recently become ill, as it was believed that they had the greatest chance of being cured.
Friends Hospital became a model for other hospitals, such as the State Lunatic Hospital in Harrisburg, which opened in 1851, to be run expressly on the ‘Quaker model’. A nursing school attached to Friends Hospital trained psychiatric nurses up to the 1930s.
In 1998, the Hospital and its grounds were named a National Historic Site, in recognition of its leadership in the evolution of behavioural healthcare in America.
Until 2005, seventy percent of its board members were Quakers and all major decisions were made by consensus, in line with the Quaker business model. In 2005, it switched to a for-profit model, with 80% being sold off and 20% of the ownership devolving to the Thomas Scattergood Foundation, a Quaker-based foundation set up with the proceeds of the sale.
Friends Hospital continues to be run according to its original mission statement. The moral approach to care today means involving the patient in decisions about their own care, and emphasising occupational, creative and horticultural therapy.