maintained that the environment acts upon an individual in a suggestive
manner through the nervous systems. Therefore, a supportive,
constructive environment (milieu) was considered helpful for reprogramming
the nervous systems of persons undergoing treatment. This was especially
emphasized in cases of mental illness.
Therapeutic milieu was an important factor
in the treatment program at Still-Hildreth Osteopathic Sanitorium and
other progressive institutions of that era. Cayce referred several
persons suffering from major mental illness or severe neurological disease
to Still-Hildreth. The premise upon which Still-Hildreth was founded
was stated by the founder of osteopathy, A. T. Still. "Dr. Still
had said to me time and again that when our profession could have property
of its own, with proper surroundings and environment, a large percentage
of the insane could be cured through osteopathic treatment." (Hildreth,
1938, pp. 247-248)
The Still-Hildreth Sanitorium was located
on nearly four hundred acres which contained a lake and bathhouse
and afforded excellent facilities for walking, swimming, skating,
fishing, baseball, tennis and croquet. Indoor recreation consisted
of reading, dancing, cards, checkers, chess, billiards, moving pictures,
"Each patient is given the
largest degree of freedom that his condition allows. Every effort
is exerted to make him feel at home and realize that the sole purpose
of his residence here is to get well. Kindness and gentleness
in dealing with patients are rigorously enforced." (Still-Hildreth
Guide and Explanation, undated)
The chiropractic mental hospitals
of the same era used a similar approach. The practice of manual
medicine was combined with a therapeutic environment.
"As for Clear View, there were
factors which this writer believes contributed to its success between
1926 and 1951. First, although the environment was austere, offering
no more than marginal comforts, the institution was managed with a firm
hand within the limits of its economic resources by its Matron, Mrs.
Marie Hender. There existed a tight control over patient management
along with a no-nonsense atmosphere which translated into a strong and
positive therapeutic milieu. Patients knew they were there to
get well and not to spend a useless life.
By contrast, state hospitals were then
not much better than prisons .... Overcrowding, neglect and often
brutal treatment in an environment of despair made state hospitals
places to avoid like the plague. By contrast, a clean, well-managed
facility in which there was considerable individual attention offered
a refreshing refuge to those who could afford private care for their
loved ones." (Quigley, 1983, p. 71)
The use of therapeutic milieu
in these institutions echoed the moral treatment movements of the
nineteenth century. These movements protested the horrible treatment
of the insane and demanded that programs based upon the humane treatment
of patients be implemented. Moral treatment was conceived of
"... a system based upon the theory of corrective experience,
and implemented by molding the physical and social environment of
the hospital. The goal of moral management was the reconstruction
of damaged brain tissue by resocialization, by influencing the physical
organ through the medium of the mind. The pivot of this system was
education and the imposition of regular habits of life and work, appropriate
mental stimulation, orderly thinking, and correct values .... By regulating
the milieu in order to impose absorbing tasks and civilized social
intercourse, it was hoped that pernicious habits and associations
would be broken while correct and socially acceptable patterns of
thought and behavior would be fostered.... it is here that modern
psychiatrists find some of the earliest examples of therapeutic milieus."
(Caplin, 1969, pp. 26-30)
In these early attempts at "socioenvironmental
therapy," the physical setting was considered so important that the
internal design of the asylums was a highly specialized area of expertise.
The therapeutic effects of light, spatial arrangement, and temperature
on the patients were given a high priority.
Bockoven's definition of moral treatment
includes a discussion of the "spiritual" dimension of this approach:
"... [moral treatment] meant compassionate and understanding
treatment of innocent sufferers. Even innocence was not a prerequisite
to meriting compassion. Compassion was extended to those whose
mental illness was thought due to willful and excessive indulgence
in the passions." (1963, p. 12)
The Cayce readings insist that
compassion, as manifested in gentleness, kindness, patience, and caring,
is a profound expression of spirituality and an essential aspect of
therapeutic environment. A therapeutic environment should be considered
more than just a clean facility with adequate programs for exercise
and recreation. Spiritual qualities, as manifested by the staff,
provide the basis for the therapeutic process. This can be demonstrated
by comparing the rather opulent facilities at Still-Hildreth with the
relatively plain facilities at Clear View. Both institutions insisted
upon close supervision by caring attendants combined with manual medicine.
The stated therapeutic efficacy of each institution (in terms of published
cure rate) was essentially equal, suggesting that fancy facilities were
not essential in providing an effective therapeutic milieu.
The stated objective of founding the
Forest Park Chiropractic Sanitorium coincides so closely with Cayce's
suggestions about the importance of spiritual ideals in maintaining
a therapeutic milieu, a direct quotation from The Chiropractic Psychopathic
Sanitorium News (1925) is appropriate to emphasize the role that spiritual
values played in these institutions.
"Business is analogous to the
human body. The chemist may analyze every atom of the human body
... but there is still something which the chemist cannot analyze, and
which cannot be perceived by any of the senses. It is this something
that puts life into the various elements and makes of the otherwise
dead materials a living body. In the human body we call this something
the Spirit, Life or Soul. In business we call it a principle,
or ideal, and sometimes an OBJECTIVE.
As in the human body, we may have in
business all of the necessary elements for success. There may
be ample buildings, sufficient machinery, plenty of capital, markets
for the product, together with the demand for additional quantities
of the product, plenty of laborers to do the work, and yet unless there
is that something which we call an OBJECTIVE, an Ideal, or maybe a Soul,
lacking, the business will not succeed ....
The ideal which leads to success is basically
and fundamentally - SERVICE. By this we do not mean Service selfishly
and doggedly rendered, but Service that to all outward manifestations
and purposes is rendered for its own sake and none other. Of course,
in every case of Service there is always a corresponding return, which
may or may not be measured in dollars and cents, but which is in practically
all cases of business measured in this manner .... Our OBJECTIVE
then, is not the building of a great business that will amass for us
fortune, as individuals, but it is the building of a great institution
that will offer hope, health and happiness to the thousands of people
now suffering from mental trouble, and also to the many thousands who
may yet become afflicted.
To the accomplishment of this OBJECTIVE
we have dedicated our lives."
A. G. Hildreth 's account of
the founding of Still-Hildreth Sanatorium is in essential agreement
with the spirit of the objective just quoted. A reading of his
book, The Lengthening Shadow of Dr. Andrew Taylor Still (1938), will
provide the reader with a sense of the altruistic nature of the founder
of osteopathy and the deeply spiritual foundation of this profession.
The primary physical considerations
for a therapeutic environment as outlined in the Cayce readings are
cleanliness and access to fresh air and sunshine (a rural setting
was often recommended). The therapeutic value of being close
to nature is a theme often repeated in the readings. Sitting
quietly in a pine grove or walking along a beach at the ocean were
specific activities mentioned in the readings. The spiritual
experience of relating directly to nature should not be underestimated
when these activities are integrated into a holistic model.
The interpersonal dimension of a therapeutic environment is equally
Bockoven, J. S. (1963). Moral Treatment In American Psychiatry.
New York: Springer Publishing.
Caplin, R. B. (1969). Psychiatry And The Community In Nineteenth-Century
America. New York: Basic Books, Inc.
Hildreth, A. G. (1938). The Lengthening Shadow Of Dr.
Andrew Taylor Still (3rd ed.). Kirksville, Missouri: Osteopathic
Quigley, W. H. (1983). Pioneering Mental Health: Institutional
Psychiatric Care In Chiropractic. Chiropractic History, 3(1), 69-73.