Pioneer of Moral Treatment: Isaac Bonsall & the Early Years of Friends Asylum as Recorded in Bonsall’s Diaries 1817-1823

By David S. Roby, M.D.
1982

Background

The Quaker belief in the divine principle in every person promoted a compassionate, supportive attitude towards the mentally ill. As early as 1671, George Fox, the English founder of the Society of Friends, suggested that "Friends seek a place wherein persons distracted or troubled of mind" could find refuge. Although such a Quaker institution was established shortly thereafter, it was short lived. In 1796, William Tuke revived the cause and founded the Retreat at York, England, which provided humane, "moral" treatment of the mentally ill. Thomas Scattergood, a Philadelphia Quaker, visited the institution and was favorably impressed. In 1811 he proposed to the Philadelphia Friends that they build a similar institution for "such of our members as may be deprived of the use of their reason." In 1812, a committee of seven Philadelphia Quakers was chosen to implement the plans for an asylum for the mentally ill. One of the seven was Isaac Bonsall, then aged 47, a successful farmer. In the ensuing five years, Bonsall’s efforts, concern, and personality must have impressed his fellow Quakers, for in 1817, "after mature deliberation" by the Managers, Isaac Bonsall and his wife Ann were appointed the first Superintendent and Matron of Friends Asylum.

The Bonsall Diaries

During his seven-year tenure as Superintendent of Friends Asylum, Isaac Bonsall kept a daily journal, meticulously and legibly written in a large ledger book. The two volumes, which are now kept in the Quaker Collection of the Haverford College Library, trace the development of the new institution from the time that Isaac Bonsall and his wife Ann arrived at their home in 1817 until their departure in 1823.

Many of the notations in the diaries are devoted to observations about the planting of crops, seasonal changes, visitors, the weather, and other details which are of passing interest to us today. The sections of most lasting interest and value deal with the patients, Bonsall’s attitude toward them, and his reflections on their care.

Moral Treatment of Mental Illness

Insanity has existed since antiquity, but societal attitudes towards the mentally ill and the character of institutional care have improved considerably. For many centuries, the mentally ill were social outcasts, and even considered to be spiritually damned. Social isolation, chains, physical restraints, and punishment were common methods of "containment." The Quakers’ exalted view of the individual was all encompassing: the mentally ill were to be embraced and supported, just as other souls were. Their beneficent attitude toward the mentally ill is reflected in the original plans of Friends Asylum, influenced by the Retreat in York, England, founded by the Quaker William Tuke in 1796. In the 1818 Annual Report to the Contributors, the Board of Managers noted that "toward every description of cases…whether the disease was longer or more recent duration, or whether the symptoms were mild or severe, treatment the most soothing and gentle, was uniformly extended." In the same report, they attributed the improvement of many of the patients to:

…the Healthfulness of the situation, the opportunities for recreation furnished to the patients in the spacious yards connected with the house, as well as their using the exercise of waling upon the premises and of riding in the vicinity; with employment of the men in the garden and fields, and o the women in suitable female occupations…The retired situation the farm, and the intervention of prohibitory rules afford to the patients a protection from the gaze of the idle curiosity…a privacy calculated to inspire their troubled minds…they are indeed regarded as men and brethren.

Bonsall’s diaries provide valuable insights into his personal interpretation of the philosophy of "moral treatment." Like the Managers, he placed much importance on the location of the Asylum on 56 acres near Frankford set apart from the community, and internally self-sufficient, with its own crops and wood supply. He conveys the mood of a protective retreat when he writes:

There were more visitors than expected, and many of them are anxious to see the patients. But we tell them that it is inadvisable…because the sight of strangers increases the patients’ distress and anxiety. The patients are placed here to have their afflictions alleviated, and not be exhibited to others as spectacles. [The visitors] understands how it would be with themselves, or their near connections, and that they also would not approve of strangers seeing them.

The grounds included cultivated land, exercise yards, and a scenic "serpentine walk" through the adjoining woods. Bonsall felt that the serenity and physical beauty of the asylum had a spiritually uplifting effect. He wrote of one patient:

Frances T. continues to be depressed over her separation from her husband…She could not make me sensible of her agony. I took her over to the attic windows and showed her the Delaware River, and the surrounding country. Although she did become more quiet, she did not seem to be much interested in the scenery.

Friends Asylum provided a supportive, nurturing, sheltered environment. This engendered a new sense of security in several patients, who had been withdrawn and self-conscious about their mental illness.

Hannah J. mentioned that the first time she went from here [Friends Asylum] to [Quaker]meeting, it was very mortifying. She was humbled to be looked upon as one of the insane riding in the crazy carriage. But after getting to the meeting, she felt sweet peace, and from that period, she desired to attend whenever possible.

John M. is quiet and pretty well reconciled; he says that he has ten times the sense he had when he first came here.

Lydia C.’s sister came to see her, and said that she considered her much improved. Lydia C. said that she was pleased with the place, and that the Family [the asylum staff took a great deal of pains to interest her by conversation.

Five of the patients had a pleasant ride in the carriage…most of the patients are much delighted with such excursions, and we are pleased to find them gratified.

The debilitating effects of chronic confinement and physical retrain are illustrated by Bonsall’s account of the patient, Reuben H."

Who had been kept chained for some years before coming here [to Friends Asylum’, and [on arrival’ was so weak that he could barely walk…We have allowed him to go without any confinement, and today the keeper took him on a walk through the woods. He behaved well, and even jumped over a pretty high fence in preference to climbing it."

Bonsall seems heartened by the patient’s favorable response to trust and increased freedom. The patient's ’leaping over a fence implies not only improvement in his physical well being.

The "Divine Principle"

Although Bonsall never states explicitly the principles of "moral treatment," a compassionate concern is apparent in many of the activities described. For example, talking with the patients was an important aspect of their care. It provided insight into the patients’ thinking and illness, and allowed each patient to express his own "divine principle."

I try to watch for favorable opportunities to enter into conversation with the patients, individually and sometimes collectively...James W. is very talkative, and monopolizes all the conversation himself, which is a strain.

I had the most rational conversation with John H. that I ever had. He seems quite intelligent, and states many facts relative to his fathers’ business, his fathers’ successes, and his want of it. Mot of what he said, I knew to be correct. It was truly a pleasure to discover such rationality.

We had allowed him to eat at our table to afford him all the facilities in our power to keep his mind calm and aid his recover.

Hannah J. was pleasant and said some clever things.

William P.B. is bewildered and strange in his ideas.

Frances T. is more quiet, but insists that she has no brains, and that her left hand and arm are dead, and that she does not sleep any.

Hartley L. although not troublesome evidences symptoms of insanity.

At times, Bonsall writes, perhaps with bemusement, of the patient’s logic in explaining their own behavior.

Hannah J. picked out the wool from her quilt, and when asked why, she said, "she had nothing else to do."

Lydia C. was so noisy that the nurse had her removed into the garret. William P.B. hearing her made a great noise also. When we talked to him the following day, he said in extenuation that he had never been outdone by any other person, and he was not willing to be so then by her.

Improvements in Patients

Bonsall was fortunate to observe dramatic improvement in many of the patients at Friends Asylum. Of the 66 patients admitted during its first three years, 25 were discharged as much improved or cured. This is all the more remarkable given the chronicity of most patients received. For as Benjamin rush state,"the longer the remote and predisposing causes (of mental illness) have acted upon the brain, the more dangerous the disease."

However, Bonsall could also appreciate relatively modest gains in a patient’s condition.

Sarah W. , aged about 56, has been insane 26 years…She has not walked or talked in three years, and during that time, she would not let her family see her eat…Sarah W. ate several times in the presence of the nurse, and answered some simple questions by saying "no."

Although Bonsall was pleased when patients showed "spiritual enlightenment," and joined the local Quaker meeting, he also appreciated progress in other areas.

We are now reduced to only 15 patients, and they are at present pretty clever. We occasionally read the scriptures and sometimes other books to the patients. Some of them give attention, and appear satisfied. Others will not attend to anything of the kind. ‘

Returning Home

It appears that although the Quaker philosophy had a seminal influence in establishing Friends Asylum, the scope of "moral treatment" went beyond spiritual redemption of the mentally ill. The patients were treated with respect, and encouraged to participate in various activities, and ultimately return home.

Joseph W. was taken away, and although he is not much better of his insanity than when he came, he has improved considerably in his bodily health, conduct and conversation. He was extremely vulgar and obscene when he came. However, his wife was so desirous to have him home that she sent for him, fit or not fit. We had hoped by a longer continuance, although he might not be cured of hi insanity, there was reason to expect the establishment of habits to make him less troublesome.

This concept of an extended outpatient visit as a trial run prior to discharge continues to be very useful today.

We took Hannah J. to the City to her sisters to spend a few days in order to see whether she possesses the strength of mind sufficient to admit of her discharge.

Bonsall recognized that hospitalization, even in a supportive environment, was stressful for the patients, and that they yearned for home.

Hannah J. is rather depressed, and very anxious to return to her friends. I tired to promote cheerfulness and resignation, and told her that we only wished her continuance until her mind was sufficiently strengthened to go home with safety to herself. As soon as we believed it best for her, we should promote her going.

On the other hand, he describes one patient who wrote a letter to her brother reading in part as follows:

"I think I have been mending ever since I came here and indeed I do not know how I could well help it, for I live well and have the care of the best of friends. They allow me privileges that I know I do not merit, but is their goodness and I hope they will have their reward. Sometimes I look towards home and think I ought to be there, and if my nights were as flattering as my days, it would be best to go home, but it is quite otherwise. When I lay down, my poor head seems altogether confused. I cannot tell how but I think it is rather better than it was and a fear seizes me that if I went home now I might get back to the spot where I was. I am quite contented to stay longer and think I would be happier here than anywhere else."

Patient Profiles

When the asylum was first opened, it was the hope of the Managers to admit "recent cases," patients whose illnesses had not progressed to the chronic stage, at least until the institution became better established. They found, however, that this was not possible, and "there were introduced to the care of the institution, at the threshold of the experiment, several patients, whose cases embraced variety of character; under the unhappy influence of which, nearly all of them had labored for many years." The 1818 Annual Report noted that their "restoration" was "extremely unpromising" and that there was "little amendment" to be seen at first.

When a patient was admitted to Friends Hospital, Bonsall noted the geographical area and source from which the patient came, the patient's age, and the duration and nature of the mental illness. So, for example, he notes on 5-20-1817 the admission of Hannah S., the first patient:

…who is about 48 years of age, has been inane about 11 years, and appears to be melancholy cast.

The psychiatric and behavioral problems described include affective disturbances, with depression, suicidal ideation and intent, thought disorders, and personality disorders. Other specific symptoms encountered include suspicion, insomnia, exhibitionism, obscene language, destructive and manipulative behavior. Bonsall shows considerable patience and perseverance in trying to support, understand and cure these patients.

Hannah J. had been very troublesome in our absence. She broke a new Windsor and a pane of glass, and afterwards two more panes. I inquired of her why she did so. She replied, "because she was confined." She had never been accustomed to confinement. In the course of the night, my wife and I came down twice to ascertain how she was doing… [Later] Although we had secured her hands by straps, she was very mischievous…being disposed to do all the injury to the building in her power, and not manifesting any subjection whatever…Hannah J. seemed more quiet this morning, and manifested more submission, but the change was not so great as to warrant releasing her from her present confinement…Hannah J. appeared so quiet, and begged to have the jacket-coat off, and promised to do no more mischief. We accordingly took it off and she behaved very well.

Bonsall seems to bear no recrimination against patients who misbehaved, and is eager to give them another chance. "Reuben H. was somewhat noisy and broke one pane of glass, but afterward, he acknowledged that he had done wrong, and would not break any more. The hand straps were then taken off, and he has done no further injury since."

Another time he sent one patient whom he had grown to trust on an errand into Frankford to purchase some oats. When night came and "neither Harley L., the horse, or the cart had come back," Bonsall rode seven or eight miles searching for him without success. When the patient's father came to visit two days later, they went into the city "for the purpose of making an examination in the different rendezvous occupied by the soldiers":

After searching a long time…he was found much intoxicated. All the money I had sent by him gone, and several dollars had to be paid for his discharge. With some difficulty his father and Andrew got him home…This morning Harley L. manifested so much sorrow on account of his misconduct and professing a very weak mind and rather an obliging disposition, concluded his elopement to have been the effect of a sudden paroxysm of insanity. We did not confine him, but let him enjoy nearly his usual liberty. I kept him near me most of the day working at the hay, and he performed better than usual. In the course of the day he mentioned that he expected to have been confined to his room until sixth day next and then dismissed by the Managers.

Destructiveness

Bonsall retains this optimistic trust in the patients, even when his own wife was physically injured "Deborah L. scratched my wife with her nails, and with her hand gave [her attendant] a blow. She was also very obscene in her language."

William S. made considerable noise after breakfast, and my wife went to him and tried to quiet him. He threatened to strike her, but she told him she did not intend to offend him. He desisted and walked with her . . . After dinner, he became noisy and struck William G., and seized and tore his shirt. Salts were given. We had been informed the William S. would sometimes strike at persons, especially if only one was present. As soon as he discovered too, he would desist and submit.

A great deal of violence and destructiveness was encountered, for there were no effective psychopharmacological agents.

William P.B. has gotten so loud that we concluded that he must be fastened down on his bedstead. He manifested a most ferocious disposition, by far exceeding anything I had ever conceived any human being capable of. He looked truly terrific. However, when he saw several of us, he was secured without actual attempt to injure us.

Bonsall tried to calm the violent patients by conversation and diversion. "William P.B. was so agitated that we could not keep and clothes on him. I talked to him in a very soothing manner, and offered him a walk in the yard." However, later that day, after the walk, Bonsall note s that when the resident doctor gave William P.B a drink from a glass tumbler, he "bit the tumbler into pieces." Despite the patient’s paroxysmal outbursts, two days later Bonsall writes:

William P.B. appeared quiet, and so desirous to be released from his confinement . . . He did not blame us for his confinement in that his conduct had made it necessary. He hoped we would forgive him. I told him I freely forgave him – that we had done what we had done because it appeared necessary, but as his disposition had now changed, he should be released.

Bonsall manages to maintain a balanced assessment of the patient William P.B., despite further episodes of violence and destructiveness.

William P. B. has been uniformly during his present state of mind very affectionate to me, and did not say anything very bad to my wife. Although I do not consider him safe to be released from all confinement, I have consented to take off the waistcoat . . . and enter on a trial of good behavior. [Thereafter] he behaved in a very wild way which made it necessary to have him fastened down . . . Although he seems quiet now, and promises not to do mischief, he has so often deceived us that we cannot place a s much confidence in him as before. In the afternoon, however, the sleeves were taken off . . . The following morning William P.B. manifested a degree of wildness which indicated the commencement of another paroxysm. We however let him have the liberty to go out with the other men to their work in the woods. They did not lay him under any particular restraint, intending during this spell to try the effect of liberty with strict watching but without letting him know that we were apprehensive of a change . . . [two days later] This morning William P.B. was so bad as to make it necessary to fasten him down on his bed. We had continued his liberty during this period of disease longer than was proper, in hopes it would have a beneficial effect. Now however, we think that an earlier confinement would be best.

Occupation as Therapy

Patients were urged to participate in the activities and labors of the institution. Bonsall believed that work was therapeutic. The Managers of the Asylum who wrote that "no feature in the treatment of the insane is more highly valued that occupation, systematically applied and judiciously carried out supported his belief. Work is the law of our nature which demands expression in the insane no less than in the sane."

Bonsall shows the influence of the "work ethic" when he equates increases patient industriousness with increased well being.

Hannah S. has almost everyday worked at sewing, knitting, ironing, and other work . . . Joseph has gained strength and seems willing to do little turns at work, but is not able to do much. Deborah is also quite willing to work, but very slow and stupid about taking directions. John is too lazy to do almost anything.

John H. is excessively lazy. There is no persuading him to work. He pleads weakness. We propose trying the effect of medicine. John H is so lazy that he cannot be prevailed to look upon other patients working. We are inclined to suppose that laziness is one of the most prominent feature in the character of his disease . . . [One month later] Samuel Raleigh undertook to make John H. work. He first tried the shower bath, but without effect. He then took him to the woodpile and tried to induce him to carry a few sticks, which he refused to do. He then got a rope and tied a number of sticks to his back and made him walk up stairs with it. He repeated this several times until John consented to carry sticks in his arms. [Thereafter} John H. carried several armfuls of wood, and pounded considerable quantity of brick . . . John H worked most of the afternoon, and his disposition to work increases . . . John H. is now one of our best workers, and in other respects improves much.

Acceptance and Understanding

Despite Bonsall’s own personal values, he showed a remarkable acceptance of the patients, even when their behavior was quite offensive.

I think I have not stated heretofore in what his [John H.’s] "filth" consisted. He would mix his excrement with his urine, and rub this mixture over his body, and other parts of his person. Frequently his excrement is made into cakes, and placed between papers, and then put into either his pockets or between his clothes. While he was allowed the use of his trunk, he deposited considerable among his clothes placed therein.

Bonsall’s description of the patient’s coprophilia is objective and non-judgmental. Although the images portrayed by Bonsall may evoke revulsion in the mind of the reader, Bonsall’s complete acceptance and support of the patient is all the more impressive.

Bonsall tried to understand the cause of mental illness, and the factors which exacerbated or ameliorated the disease. He notes that:

Rueben H., aged 26 years has been insane for nearly six years. It is said that he is frequently afflicted with spasms. His insanity is supposed to have been occasioned by and blow in the fore part of the skull which fractured the bone.

Here Bonsall recognizes the probable causative role of the patient’s head trauma, and probable post-traumatic seizures. Bonsall observed the patient’s behavior systematically, and tried to identify factors which influenced them favorably or unfavorably.

The patients had a ramble in the woods, and when Mary got within sight of R. Morris' mill dam, the falling of the water appeared to unsettle her and produce a degree of wildness.

Hannah J. had been kept on a low diet for sometime past, not being allowed to eat meat or butter, but today Dr. Griffits directed us to feed her more generously . . . [Thereafter} Hannah J. was very noisy and used much bad language, which induced us to conclude that she must be restricted in the use of meat, and other things with a stimulating effect . . . Hannah J. has been more uniformly mischievous since the doctor ordered that she should have meat and butter than while her diet was still restricted. Strong food may be best for such violent cases of insanity, but I very much doubt it.

Lydia C. complained much that the doctor did not give her any medicine. My wife suggested to the nurse to prepare pills of bread and to disguise them with a small portion of allspice. These were administered night and morning, and after taking the pills, Lydia thought herself much better.

Deborah L. was more noisy and violent and was placed in a dark room which composed her to a considerable degree.

Two of his brothers came to see him, and although they acted very prudently, we were of the opinion it was the main cause to the return of his disease . . . How much better it would be for the friends of the patients and particularly near relatives to stay away.

Hydrotherapy

Long before hydrotherapy became a clinically accepted method of calming difficult patients, Bonsall was experimenting with baths and showers.

Hannah J. was very violent and noisy until placed in the bath, when she became calm and rational.

Hannah S. entered the warm bath with much reluctance, and so continually manifests such dissatisfaction with being put into it, with no apparent beneficial good effects as yet resulting from it. We remain at a loss whether to continue the use of it in the particular case or abandon it . . . He is fearful the unfavorable consequences will ensue the use of hydrotherapy. He is so strongly prejudiced against it that is doubtful under these circumstances it ought to be used with equal constancy. This will require reflection.

Hannah S. had the cold shower bath and the warm shower bath alternatively continued, which with other treatments, has evidently had an enlivening effect.

Restraints

It was not unusual for the patients to require physical restraint. The staff tried to use the device appropriate to the patient’s disturbance. Restraining devices included the "jacket waistcoat," "hand straps," "hand and leg straps," and seclusion rooms. The last were fashioned ad hoc as the managers had declined funds to build a "seclusion room." Bonsall laments:

Hannah J. is a very noisy patient, the noise she makes has a considerable effect on the other patients, which makes it necessary to separate them as much as possible. We had to lock her up for the night in one of the small rooms, without securing her in any other way . . . We have very much regret that the fund of the institution will not admit the erection of some building detached from the present for the noisy patient. It is out of our power to make a separation, and but little hope of cure or much alleviation while they remain so near to one another.

Bonsall shows his concern and sympathy for the violent patient when he describes "Hannah E. who attempted to injure herself."

We placed the hand straps on the just before going to bed, and removed them in the morning. Finding that the buckles had marked the skin, we proposed substituting the sleeves, and have chosen the softest pair for the purpose.

At times, Bonsall is unsure of how much restraint is appropriate. This is illustrated by a probable suicidal gesture by the patient:

Hannah e. either attempted or pretended to cut her throat with a case knife. . She drew it across he throat, and upon examination, no mark appeared. We supposed therefore that it was rather pretended to frighten us. It will however excite more care on our part to prevent if possible such and unhappy catastrophe.

Bonsall as Administrator

The process by which Isaac Bonsall was selected as the first superintendent of the Friends Asylum is not recorded in the early minutes. To our knowledge, he had no prior experience working with the mentally ill. To this credit was his important standing in the Society of Friends at the time. He was a recorded minister of the Society at Uwchla Meeting, near Phoenixville in Chester County, and had gained some administrative experience as Clerk of the Robeson Monthly Meeting in Berks County.

The selection of Bonsall was probably influenced by his knowledge of farming, for the role of superintendent also included the supervision of the Asylum’s livestock and the planting, care and harvesting of the crops which fed the "Family." In addition, he was obviously recognized as a hardworking, tenacious individual with organizational abilities and great compassion. These qualities were necessary to oversee the moral treatment of mental patients.

Bonsall dedicated himself to every aspect of the Asylum’s operation, including grounds, finances, public relations, and the status of each patient. Bonsall was reluctant to spend time away from the hospital, for fear something unfortunate might happen while he was away.

This day, the contributors meet. I should have been willing to travel a great distance to meet them, had I been in almost any other situation than superintendent. However, I concluded on that account that I ought best to stay away.

At a later date, Bonsall notes:

I went to the quarterly meeting, as the Family seemed in a safe state to leave with our trusty and careful caretakers.

At times, Bonsall felt the Quaker managers of the asylum could be more helpful during their visits by conversing with the patients.

It would be of particular advantage to the institution if the managers would come to see the institution more often in an individual capacity . . . The visiting managers who were here believed it best not to go much among the patients, and when in their company, to say little to them.

As if this cautious side of the managers was not frustrating enough, on other occasions, the visiting managers was a source of occasional disagreements.

Some of the managers were unwilling to have poplar trees planted in the yards lest those disposed to commit suicide should avail themselves of that means. I should not have entertained that fear, as there are other facilities, and whoever should superintend this institution would either have such patients well watched of secured by hand straps, so as to effectually prevent such a catastrophe.

The cold was considerable, and a large fire was made in each wing, the visiting managers having requested it be done . . . We feel sorry that this expense would be incurred, as the patients are all fit, and could be in their respective day rooms. We find that they keep themselves covered at night, and have plenty of covering. These two stoves consume about as much wood as all of our fires together. I had remonstrated against it, but submitted in the directions given.

Bonsall’s immediate family was also deeply committed to the Asylum. His wife, the former Ann Paul, shared the domestic responsibilities of the entire institution, and also participated in the care of the patients. As stated above, she incurred both physical and verbal abuse from the patients. At one time Bonsall comments:

My wife’s charge is heavy, for there is but one female domestic. My wife got through washing and drying the clothes with no help, and then had to attend to cooking.

It is interesting that the yearly reports of the Asylum acknowledge Isaac and Ann Bonsall as co-Superintendents of the Friends Asylum. The Quakers were far ahead of their time in according women an equal place of respect (although women were not elected as Managers until 1968). There is no question that Ann Bonsall was just as deeply committed to the management of Friends Asylum. Bonsall’s daughter Sydney also was involved inpatient care, and would take patients on walks, and participate in other hospital activities.

Friends Asylum served as model for other American and European mental institutions. Bonsall notes visits by physicians from distant places who were planning to build similar asylums or retreats.

We were visited by R. Sullivan who is interested in establishing an asylum near Boston for insane persons. He manifested considerable satisfaction in the building and the condition of the grounds.

Thomas Eddy and Thomas Taylor, two governors of New York Hospital, came to take a view of the asylum, having contemplated building a large house for insane persons in the neighborhood of New York, starting the next spring. They were shown nearly all the building, and given any other information which might assist them.

Doctor Rufus Wynan from Boston was referred by Thomas Eddy from New York, visited with a view to manage a similar institution. We showed him the house and grounds, and the apparatus used for the insane. He was informed of the most essential things relative to the government of the concern.

Other visitors came with "new" ideas about the treatment of mental illness. For example, in January of 1818, one of the Managers brought in a device that might be considered an early form of electric therapy.

Caleb Cresson presented us with an electrical machine with considerable apparatus. I suppose the whole very complete, and a valuable present.

Of course, Bonsall met with the families of patients, and tried to establish a therapeutic liaison with them . . .

William’s father and mother say that they have not seen their son so well for a considerable time. His looks denote a complete restoration.

Unfortunately, at times, the family would not approve of the Asylum’s treatment plans.

James T. took away his son Isaac, who is much improved. We are inclined to suppose that he might have been restored to health, but his father and mother’s impatience induced them to take him away. The cost of $4/week no doubt had considerable operation. I fear the will retrograde at his paternal abode, so as to lose all he had gained here.

Unfortunately, Bonsall’s final years, as Superintendent of Friends Hospital produced in him some doubts about the worth of their work.

The present Family of boarders are the most uninteresting we have had for a long time. Nearly all of them are considered incurables . . . Unless new objects [patients] are introduced, there will be little to encourage the managers or us in the prosecution of the concern.

In the 1823 Annual report, the following passage appeared:

Isaac and Ann Bonsall, who have been Superintendent and Matron of the Asylum, from the opening of the institution to the present tie, and whose service have been satisfactory to the Managers, have signified their desire of being released from their charge. Edward Taylor and Sarah, his wife, of upper Freehold, New Jersey, have been appointed to succeed them. These Friends are expected to enter in their duties in the beginning of the fifth-month next.

(Ann Bonsall died, seven years later, in 1830. Isaac died while attending the Indiana Yearly Meeting with his son on October 3, 1831.)

Working primarily with his own natural instincts and compassion and guided by Samuel Tuke’s booklet about the retreat in England, Bonsall developed the theory of "moral treatment" into an effective program. While other American institutions were still chaining their patients and exposing them to public display, Bonsall treated the Asylum’s patients as his equals, referring to them as the "Family" and to the Asylum building as the "House." Although he was not a physician, and in fact, at times disagreed with some of the treatments prescribed by the attending physicians, Isaac Bonsall deserves a place of recognition in the history of American psychiatry and psychiatric hospitals.

About the author

Dr. David Roby’s first exposure to Friends Hospital came in 1970 – 1972 when, as a conscientious objector to the war in Vietnam, he served alternative service as a psychiatric assistant. He continued to work in this capacity at the Hospital from 1972 to 1978 while attending Temple University School of Medicine. While working as a PTA, David Roby became aquatinted with a fiercely loyal Hospital volunteer, Ada Rose. A convinced Friend, Ada designed and was the first editor of Jack and Jill magazine. She was known and loved throughout Friends Hospital as the "Quaker in residence," and personally catalogued and protected the early materials from the Asylum, including Bonsall’s personal diaries.

David S. Roby is now on the Neurology staff of Jeanes Hospital in Philadelphia.

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