The Cayce Health Database -

THERAPEUTIC ENVIRONMENT

     Cayce 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, and music.

     "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 as:

"... 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 important.

REFERENCES

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 Enterprises, Inc.

Quigley, W. H.  (1983).  Pioneering Mental Health: Institutional Psychiatric Care In Chiropractic. Chiropractic History, 3(1), 69-73.