Philadelphia was at the heart of a mental health revolution in the 19th century. A Library Company exhibit tells that story.

Philadelphia was at the heart of a revolution. No, not the one you’re thinking of. This one revolutionized mental health treatment.

Before the era of asylums full of people deemed unfit to live in society, a small cohort of radical thinkers in the 19th century promoted an idea that was before its time: Mental illness is just like any physical disease, and can be cured.

What followed was a short-lived experiment in “moral treatment,” an approach to mental illness detailed in a Library Company exhibit that is open to the public at no charge through December.

“Hearing Voices: Memories from the Margins of Mental Health” tells the story of this treatment approach through the words and art of patients — including from within Philadelphia asylums.

“Hearing Voices,” also accessible online, covers the movement from its inception as an ideal to the reality that was far from it.

Before the 19th century, mental illness was commonly viewed as a moral failing or punishment from God, according to Rachel D’Agostino, the Library Company’s curator of printed books, who helped design the exhibit.

That meant treatment was a non-starter. “If it’s a punishment from God, then who are we to intervene?��� she said.

In the late 18th century, Philadelphia physician Benjamin Rush, a founding figure in American psychiatry, and contemporaries in Philadelphia, the United States, and Europe inspired by the Enlightenment started talking about treating people who were considered mentally ill — rather than just housing them away from society.

The new approach started with occupational therapy. Women spent time in the sewing room, and men worked in the print, cobbler or carpentry shops, said Sophia Dahab, the Library Company’s assistant curator of printed books, who also helped put the exhibit together.

“This would not only provide patients with a useful diversion that would take their minds off of their mental troubles,” she said, but would also create a way to financially sustain institutions.

Some asylums sold magazines written and printed by patients, she said.

Moral treatment changed how asylums were built. Proponents believed that patients needed exercise, sunlight and to spend time outdoors. Pennsylvania Hospital had a bowling alley and an orchard for psychiatric patients to explore.

In addition to therapeutic work, the hospital staged magic lantern shows a couple times a week — an early version of a projected slideshow — for entertainment and mental stimulation.

The moral treatment movement allowed people in asylums to express their feelings through art.

One asylum artist, Richard Nisbett, was born in England and in the 1770s moved to the West Indies, where he either owned or managed slaves. From there, he published articles sparring with Rush, an abolitionist, over slavery.

Nisbett eventually changed his views and moved to Pennsylvania. He drifted through jobs and was hospitalized repeatedly for erratic behavior.

During his time at Pennsylvania Hospital, a delusional Nisbett wrote poetry and painted under the care of Rush, the man he once debated vigorously.

“He wrote about and illustrated this fantasy world that he believed was real,” said Max Cavitch, associate professor of English at the University of Pennsylvania. “I think they’re interesting aesthetically, too, as early examples of what is now called outsider art.”

That Pennsylvania Hospital gave Nisbett paper, an expensive commodity at the time, reflects the influence of moral treatment, according to Cavitch. In a different institution or at a different time, Nisbett likely could not have expressed himself artistically.

Despite the ideals of the moral treatment philosophy, many patients used artwork and written narratives to describe a negative experience, according to Lindsey Grubbs, an assistant professor of health sciences at California State University-East Bay. “One of the most common themes that comes out is people who feel like they are not supposed to be there,” Grubbs said.

One of those people was Ebenezer Haskell.

Haskell’s 1869 book describes how a police officer barged into his home during breakfast one morning and arrested him. The officer took him to a doctor who declared him “insane.”

Haskell believed he was the victim of a family scheme involving a disagreement over money. Over the next two years, he spent time at Pennsylvania Hospital, where he attempted escape.

Haskell took his case to a court trial, where a jury declared him sane.

In his writings and drawings, he shared both what he witnessed in Philadelphia and heard was going on in asylums in other parts of the country — including forced feeding and so-called water therapy, among other barbaric treatments and restraints.

Exhibit curators hoped to share diverse voices from within asylums, but found that the privileges extended to white men such as Nisbett were not offered to many women or people of color.

Eventually, funding for moral treatment went away.

By the early 20th century, physicians from Philadelphia had moved on to a concept called eugenics. Instead of viewing mental illness as treatable, they blamed it on inherent traits. Many believed that the answer required eradicating illness through measures such as sterilization.

Using shoddy statistics, the eugenics movement also argued that people who weren’t of white Anglo-Saxon descent were more likely to have undesirable genetics traits, such as mental illness

The shift from moral treatment to a focus on inherited traits causing mental illness didn’t happen suddenly, said Diana Louis, an assistant professor of American culture at the University of Michigan.

“African American patients were always dealing with this narrative of their innate inferiority,” Louis said. “That was happening at the same time that moral treatment was emerging and before.”

The public discussion over how mental illness should be treated is not over yet, and neither are challenges about who gets access to quality and compassionate care.

Hearing Voices’ curators hoped that focusing on the perspective of patients would make the content more relatable. After touring the exhibit, some visitors have shared their family’s experiences with mental health and their search for treatment.

“When people come in to look at the exhibit, it’s not unfamiliar to them,” said D’Agostino, a co-curator. “The fact is that mental illness was here and it’s here now and it’s not going away.”