New novel shows just how ‘moral’ 19th-century psychiatry was

“Moral Treatment,” by Stephanie Carpenter, an assistant professor of creative writing at Michigan Technological University, is a mystifying historical novel set at the former Northern Michigan Asylum in Traverse City during the latter part of the 19th century.

The book was published by Central Michigan University Press and was the first work chosen for its Summit Series Prize, which will be awarded annually. It revolves around the lives of two teenage patients, Amy and Letitia, who form an unusual friendship.

Letitia often steals the show, much like Randle McMurphy, the famous protagonist in Ken Kesey’s “One Flew Over the Cuckoo’s Nest.”  Like McMurphy, Letitia often pays the piper for her unruliness.

“Letitia has physical scars and experiences post-traumatic stress,” Carpenter said.

The book’s title is derived from the moral treatment model, an international movement that emerged in the late 18th century, emphasizing a more humane treatment model for the mentally ill that moved away from shackles and disturbing treatment regimens.

The Northern Michigan Asylum followed the Kirkbride Plan, named after Thomas Kirkbride, a psychiatrist who designed mental hospitals. The hospitals, built to his specifications, featured separate wings for men and women, private rooms and wards with plenty of sunlight and ventilation.

Kirkbride hospitals were also noted for providing opportunities for on-site work and beautiful grounds. They were somewhat self-sufficient, with gardens, dairy barns and animal husbandry. The idea was that mental illness could be remediated through humane care and that patients would get better in the proper physical environment. In her book, Carpenter describes daily walks outdoors and the building’s picturesque location, which was within a quarter mile of Grand Traverse Bay.

However, electric shock therapy and lobotomies were still performed on patients.

This is the situation 17-year-old Amy and Letitia find themselves thrown into when they’re institutionalized for their antisocial activities and erratic behavior.

Carpenter said she used contemporary medical books and documents of the era to describe treatments and processes, which adds to the novel’s historical accuracy.

Although the treatment protocol may have been more humane, the residents were kept under lock and key. The intentions of the doctor and assistant medical personnel are shown in the book to be well-meaning within the context of late-19th- and 20th-century treatment procedures for mental illness. Despite that, the book can be horrifying at times for modern readers.

Carpenter, who grew up in Traverse City, went to middle school across the street from the Northern Michigan Asylum. It opened in 1885 and was decommissioned in 1989 when treatment focus became more community-based and psychiatric drugs became common.

If you’d like to learn more about the asylum’s history, nonfiction books on the subject include Dr. William A. Decker’s “Northern Michigan Asylum: A History of the Traverse City State Hospital,” the most comprehensive book on the asylum, and Heidi Johnson’s “Angels in the Architecture,” which the author calls “a photographic elegy to an American asylum.” I also recommend Nancy Tomes’ “The Art of Asylum Keeping: Thomas Story Kirkbride and the Origins of American Psychiatry.”

Today, the asylum has been developed into condominiums, restaurants, shops and businesses. Visitors can take tours of the sprawling campus to see where patients lived, worked and interacted. For the adventurous, overnight accommodations are available in restored cottages.

While writing “Moral Treatment,” Carpenter was given a private tour of the asylum by one of the developers.

“It was kind of a quiet place, but there are still obvious marks of the residents and how the spaces were used, like the movie projector booth and the artwork patients left behind,” she said.

It’s uncanny how accurately Carpenter’s imaginative writing captures what it was like to be held in an asylum, especially when there are so few personal accounts of patients’ daily life. The book pulls you into the tedious daily life of the patients, from treatment to dining and entertainment.

“Since I had very little access to any treatment records, I had to think about the physical surroundings and how it would affect them,” she said.