The Retreat, York, England
The Retreat was founded in 1792 by William Tuke, a Yorkshire Quaker, and opened in 1796. It has the distinction of having been the first establishment in England where mental illness was regarded as something from which a person could recover, and patients were treated with sympathy, respect and dignity.
The Retreat had a profound influence on public opinion, resulting ultimately in fundamental reform of the laws relating to mental illness and its treatment.
It occupies a central place in the history of psychiatry. Every textbook on the subject mentions the unique part played by it in the reshaping of attitudes to people who are mentally ill.
The Retreat opened in 1796 in the countryside outside York. Unlike mental institutions of the time, there were no chains or manacles, and physical punishment was banned. Treatment was based on personalised attention and benevolence, restoring the self-esteem and self-control of residents. An early example of occupational therapy was introduced, including walks and farm labouring in pleasant and quiet surroundings. There was a social environment where residents were seen as part of a large family-like unit, built on kindness, moderation, order and trust. There was a religious dimension, including prayer. Inmates were accepted as potentially 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.
There was some minimised use of restraint. Door locks were encased in leather, the bars on windows made to look like window frames, and the extensive gardens included a sunken wall that was impassable yet barely visible. Straitjackets were sometimes used, at least initially, as a last resort.
The approach of The Retreat was widely derided at first. William Tuke noted that "All men seem to desert me." However, it became a model around the world for more humane and psychologically-based approaches. The work was taken on by other Quakers, including Tuke's son, Henry Tuke who co-founded the Retreat, and Samuel Tuke who helped popularise the approach and convince physicians to adopt it in his 1813 book Description of the Retreat near York. In doing so, Samuel Tuke popularized his use of the term ‘moral treatment’. The term came to refer to a number of moves towards more humane approaches that occurred toward the end of the 18th century in the context of Enlightenment thinking. Ideas of ‘moral’ management were incorporated, and used for various therapeutic and custodial purposes, in asylums and therapeutic communities around the world.
In 1847 the first formal ‘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 decreased through the century. After the initial period for which it is best known, therefore, there were marked changes in management, therapy and client groups.
Much of this early vision of a humane treatment for mental illness was lost as the 19th century progressed and the mentally ill were housed in increasingly large and impersonal asylums. Although the ﬁrst half of the 20th century saw some attempts to humanize these institutions, it was not until the 1950s that the zeitgeist for the mentally ill began to change. Factors which can be seen to have contributed to this included the founding of the English National Health Service, the emergence of sociological studies of the toxic nature of large institutions, and the (re)discovery of a humane and egalitarian model of care in the shape of the therapeutic community experiments during and following the second world war.
Although you do not have to have any connection to the Quakers to work at 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 'Resident Friend'.
The Retreat remains a Quaker ministry. All Governors are Friends. The burial ground of the York Friends Meeting is on the grounds of The Retreat.