Moral Treatment

by Stephanie Carpenter

“ Pubescent insanity." In 1889, this is the diagnosis given to Amy Underwood, a seventeen-year-old with a history of erratic behavior. After her exhausted parents commit her to a northern Michigan psychiatric hospital, Amy must fend for herself among patients and doctors whose motives she doesn't understand. But as she adapts to the hospital, she grasps her predicament. She will either be "cured" and sent back to her parents' stifling home-or she'll become a chronic patient, cut off from the outside world. Can she find another path forward?

The asylum's aging superintendent, "the doctor," oversees every aspect of the growing hospital...or so he thinks. A long-time practitioner of the moral treatment, he believes the insane can be cured with good food, sufficient rest, wholesome influences-and morphine as necessary. But these remedies are unreliable, and those closest to the doctor are impatient for change.

A dual coming-of-age story, Moral Treatment vividly imagines a moment of idealism, crisis, and transition in mental health care in the United States.

Genres: Fiction, Historical Fiction

374 pages, Paperback

Published February 25, 2025

About the author

Stephanie Carpenter’s first book, Missing Persons, won the Press 53 Award for Short Fiction and was released in Fall 2017. Her prose has appeared in The Missouri Review, Witness, Nimrod, Big Fiction, The Crab Orchard Review and elsewhere. She holds an MFA from Syracuse University and a PhD in Creative Writing and American Literature from the University of Missouri. She teaches creative writing and literature at Michigan Tech University, in the northernmost reaches of Michigan’s Upper Peninsula.

Reviews

[Alena · Rating 3 out of 5]

A fascinating bit of historical fiction about a real mental health facility in Traverse City, Michigan. It's a topic I find really interesting and the author clearly researched the topic well. I'm not sure I appreciated the plot and characters as much as the topic but I did enjoy the book.

[Nancy · Rating 4 out of 5]

In 1889, teenage girls were not to run wild through the woods. Even if they had no friends and were escaping a series of losses. After Amy came across lumbermen who offered her whiskey and took her on their lap with unwanted attention, her parents took action.

Two doctors diagnosed her as insane. Amy was taken to an asylum where she was to be rehabilitated with the humane ‘moral treatment,’ promoted by founding father and physician Benjamin Rush and Dorothea Dix. Kindness, beautiful settings, walks, light labor, a stable environment were hallmarks of the treatment.

But part of Amy’s treatment was also isolation from family, with no letters or visits. And doses of morphine administered at bedtime.

Amy had lost her mother to suicide. Her father married Amy’s aunt, then his lumbering job took them to Northern Michigan. Amy had lost her friends and known world. She developed worrisome habits, but in 1889 no one connected her losses to her behavior.

The head doctor at the asylum was fighting his own demons. The younger doctors threaten his authority with new ideas–brain operations, eugenics, and sterilization of the insane. He fights for funds to improve the hospital’s leaky roof and to hire adequate professional staff. The burden of his job weighs heavy on him.

We watch Amy respond to her distressing and baffling environment. We see her loneliness and hurt, her need for love, her inability to trust. Her naivety. Her powerlessness. We understand that she is not insane, but reacting to a series of losses.

We encounter the other patients at the asylum, including the religious zealot who gives up eating, Amy’s new friend, a teenage girl with a history of abuse, and the doctor’s wife who understands what it is like to be institutionalized and who treats Amy as if she were any sane, normal girl.

Informed by the author’s deep research into the mental health treatment of women in the 19th c., and inspired by a historical asylum near Traverse City, Michigan, Moral Treatment is is a haunting read.

Thanks to Caitlin Hamilton Summie Marketing and Central Michigan Press for a free book.

[Claire Bartholomew · Rating 3 out of 5]

This book is based on a notorious hospital for psychiatric patients in Traverse, Michigan in the 1880s. The story centers on Amy Underwood, a seventeen-year-old whose father and stepmother have her institutionalized due to a history of "erratic behavior." We go back and forth between her perspective at the hospital and the perspective of the head doctor, who of course truly believes that the treatments he prescribes will work and are humane.

I have mixed feelings about this book. I feel like it was trying to communicate powerful and necessary messages about the barbaric nature of psychiatry treatment (both in the past and today), how women's valid reactions to horrible trauma were (and still are) pathologized as insanity, and how often medical advancements occur through the exploitation of vulnerable populations and condescension masquerading as charity. It's interesting to see how the head superintendent thinks his hospital is far superior to other hospitals in terms of its humane treatment of its patients, simply because his attendants are slightly less physically violent and aggressive with the patients. But all of these messages don't come all the way across, and I felt like I had to fill in the blanks for myself. This is a heavy book - trigger warnings galore - and it felt like it moved slowly for me. It's definitely well written, but kind of feels like a history book. The bright spot was definitely Amy's friendships with those on the ward, and the power they found with each other.

Thank you to NetGalley and Caitlin Hamilton Marketing & Publicity, for Central Michigan University Press, for the advanced reader's copy in exchange for an honest review!

[Gretchen Augustine · Rating 5 out of 5]

Moral Treatment blankets me in many of my past and present interests: women’s health, mental health and Traverse City. Set mostly in a remotely located state mental hospital in the late 1800s, the story follows a girl hospitalized for “pubescent insanity” and her attending physician, who follows the tenets of “moral treatment.” The writing is dense and compelling. I do wonder, at times, if my familiarity with the renovated/repurposed Traverse City State Hospital and my existence as an ob/gyn help me build this world in my imagination. My empathy for both characters, though, speaks otherwise.

I find both main characters rich. At first they seem set in their convictions. But both develop and grow nicely throughout the storytelling. I also find the commentary on sexism and societal norms to be interesting. Amy is present in a world where she has limited options as a teen girl. But she and other women around her increasingly grow their presence in the world. I empathize with both the doctor and his wife, too. I understand the compulsion to give everything to your patients — which can lead physicians to mental illness — and I deeply feel his wife’s desire for him to have work-life balance.

I can’t concisely convey why I found this one so great. Perhaps the average reader would find this a 4, given my interest in the material.

[Carole at From My Carolina Home · Rating 2 out of 5]

This is a difficult book to review. The subject matter of treatment of the mentally ill in the late 1800s is tough enough, but I did not care for the writing style. This author does not use quotation marks, so it was difficult to understand what was spoken out loud by a character, and what were thoughts in an internal dialogue. There are some graphic points in detailing the self harm done by the main character Amy, and a difficult section of abuse by care providers. The plot entails an unnamed doctor (referred to as ‘the doctor’, all lower case) who believed that good food and adequate rest along with ‘wholesome influences’ could cure the mentally ill. Those influences included trust by the doctor and his wife, along with meaningful work. But as we all know, mental illness is much more complex than that. I also found it difficult to see how Amy was progressing in her treatment. As a character study type of book, the action moves very slowly, and sometimes was boring. So, I don’t think I can recommend this book, but if that kind of writing style and difficult subject matter is not off-putting, and you have an interest in historical treatment of the mentally ill, you might get something out of it. For me, it wasn’t a hit.

[Katie · Rating 5 out of 5]

Last book of spring break—A Moral Treatment by Stephanie Carpenter. Such an interesting and thoughtful novel set in the last 1800s at a northern Michigan psychiatric hospital (TC peeps will recognize that setting). Highly recommended!

[Elaine · Rating 4 out of 5]

3.5 stars. felt more like a snapshot of a turn of the century asylum than a true novel, although the characters are fictional. Although I did not find a real forward drive to the plot, I was interested to learn what was to become of Amy and Letitia.

[Kasey Hedstrom · Rating 1 out of 5]

The topic is fascinating and the author obviously researched; however, the writing style was off putting. There are no quotation marks for dialogue which made it difficult to follow along. There just didn’t seem to be an engaging story here - it felt more like an explanation.

[Alicia Primer · Rating 3 out of 5]

Such an interesting topic. But I was ready for the asylum myself after struggling through another book with no quotation marks.

[Margie · Rating 2 out of 5]

I picked up this novel in Michigan after visiting the former insane asylum in Traverse City. I was interested to see how Amy, a 17 year old patient was treated in the 1889. Supposedly this hospital has instituted humane treatment for the mentally ill, but Amy has a horrible experience. She does not receive letters from home, is given a scratchy blanket, is bored out of her mind, goes on forced walks around the ground, has her food stolen right off her plate by a creepy patron called Skeleton Woman because she is so excruciatingly thin. I can't say this is quite the humane treatment I expected to read about. It seems that the doctors do not see her regularly and there is no attempt to figure out what is bothering her.

I would not recommend this book. It is simply too depressing. The so-called humane treatment was anything but. Amy is neglected, put in isolation, restrained, and the doctor makes no attempt to really get to know her. She steals a photograph of a young boy and carries it around with her since it gives her comfort. It’s the only thing she has. Yet, that is taken away and she is severely punished.

The doctor is visited by a donor who wants to see the wards. The worst ones smell like human waste. The visitor is appalled. It is hard to imagine how awful things were for these poor souls. They are given narcotics at night to calm them.