PINEL, PHILIPPE

PINEL, PHILIPPE (1745–1826), French physician.

Philippe Pinel was born on 20 April 1745 in a farmhouse at Roques in southwestern France and died as physician-in-chief of Salpêtrière Hospice in Paris on 25 October 1826. His life thus spans a brilliant, but turbulent, era in French history, from the late Enlightenment to the Revolution and Napoleonic Empire, ending in the Romantic era. He belonged to a group of outstanding French physicians who formed the "Paris School": the clinician Jean-Nicolas Corvisart des Marets, the investigator Marie-François-Xavier Bichat, the surgeon Jacques Tenon, the administrator Michel-Augustin Thouret, the philosopher Pierre-Jean-Georges Cabanis, and the chemist and minister of the interior Jean-Antoine Chaptal. Pinel's achievement was the reform of the diagnosis and treatment of what he called "mental alienation." That he freed his women patients from their shackles—the feat for which he is universally famous—was an incidental detail of his humane attitude toward the mentally ill.

Born into a modest family of country doctors, Pinel owed his mastery of Latin and his love of learning to the village teacher and a fine humanistic education as scholarship student to a Catholic teaching order, the Brothers of the Christian Doctrine. He earned the M.D. degree in 1773 from the University of Toulouse. Judging this education mediocre, he moved to Montpellier where he spent four years reading, attending hospital rounds, and even presenting three papers on mathematics to the Montpellier Royal Academy of Sciences.

In 1778 he left for Paris where, for fifteen years, he eked out a living as translator, editor, and amateur researcher and author. The Revolution finally opened a career path commensurate with his talents. He was appointed as "physician of the infirmaries" at Bicêtre Hospice in 1793, then physician-in-chief of Salpêtrière Hospice in 1795. These two hospices were part of the so-called General Hospital created by King Louis XIV in the mid-seventeenth century to confine not only beggars, vagrants, and prisoners but also the destitute, ailing, and aged "deserving poor," including the mentally ill. Pinel lived and worked at the Salpêtrière for thirty-one years. Some four thousand women were confined there in his day, with about six hundred hospitalized at any one time, in the infirmary or on special mental wards. Pinel combined supervision of their care with teaching: he occupied the chair of internal medicine at the École de santé (the Paris Health School) starting in 1795, and he considered the training of young doctors essential. Another important step in his career was his election to the Academy of Sciences in 1803. But his fame derived from his writings and his teaching.

Pinel is usually credited with three books, the Philosophic Nosography (first published in 1798), the Medico-Philosophical Treatise on Mental Alienation (first published in 1800), and Clinical Medicine (first published in 1802). But he wrote much more, in particular long articles on key psychiatric concepts, published in the Dictionnaire des sciences médicales (Dictionary of the medical sciences). The book that brought him worldwide fame was the Treatise, unfortunately available in English only in one wretched translation.

At the Salpêtrière, Pinel created a clinical teaching service that the students prized. "With Corvisart we learned quickly," commented one of them, "with Pinel we really understood." Pinel focused on observation and diagnosis; on taking a careful patient history, knowing the natural history of the disease so as to arrive at a correct diagnosis and thus to make the right prognosis and establish the appropriate therapeutic regimen. He maintained the traditional categories of mania, melancholia, dementia, and idiocy, but he focused on mania—particularly on what he called "periodic mania." Commentators as diverse as the psychiatrist Gladys Swain (1945–1993) and the philosopher Georg Wilhelm Friedrich Hegel (1770–1831) admired his emphasis on the intervals of sanity that permitted a therapist access to the healthy person who was only intermittently deranged.

Between 1802 and 1805 Pinel conducted what he called an "experiment," namely the careful study of every patient admitted. He wanted to establish all possible criteria for curability. He developed a detailed plan for housing, observing, guiding, and occupying convalescents, calling this "moral treatment." This notion has been widely debated and generally misunderstood. Pinel never defined it clearly, nor did he sufficiently explore the continuing role of the therapist. But the main cause of misunderstanding is that the French moral does not translate into the English "moral" with its judgmental overtones. Traitement moral contrasts with traitement physique, meaning bodily and medical—rather than psychological—therapies. Owing largely to Pinel's belief in the curability of mental illness, the numbers of mental patients seeking admission to the asylum grew tenfold in all Western countries in the nineteenth century. Thus Pinel wrestled with a severe future problem. Unfortunately he did not train enough successors: that task fell to his star pupil Jean-Étienne-Dominique Esquirol. Nor did Pinel, or anyone else in early-nineteenth-century Europe or America, train professional nurses to replace the religious sisters. As a result, the asylum remained woefully understaffed.

Pinel's main achievement was to bring the condition of the mentally ill into prominence and thus attract the attention of the medical profession to the study and cure of what he called "mental alienation." He thus founded a new medical specialty, psychiatry. Critics charge that he was but a symbol and that the French Revolution created a call for patient rights and equal treatment that any reformer could have used. Such an assessment discounts Pinel's personal qualities: as clinical teacher, as author of books and of magisterial articles that helped define the vocabulary of the new psychiatric medical specialty, and as director of the first large modern asylum. Pinel should be considered a major founder of psychiatry.

See alsoCharcot, Jean-Martin; Nurses; Professions; Psychology.

bibliography

Primary Sources

Pinel, Philippe. Nosographie philosophique; ou, La méthode de l'analyse appliquée àla médecine. 2 vols. Paris, 1798. Subsequent editions published in 3 vols. in 1802–1803, 1807, 1810, 1813, and 1818.

——. Traitémédico-philosophique sur l'aliénation mentale. Paris, 1800. 2nd ed., 1809. English translation of 1st ed. as A Treatise on Insanity, translated by D. D. Davis, Sheffield, U.K., 1806. Critical version of 2nd ed., edited by Jean Garrabé and Dora B. Weiner, Paris, 2005.

——. La médecine clinique rendue plus précise et plus exacte par l'application de l'analyse. Paris, 1802. 2nd ed., 1804. 3rd ed., 1815.

——. The Clinical Training of Doctors: An Essay of 1793. Edited and translated, with an introductory essay by Dora B. Weiner. Baltimore, Md., 1980.

Weiner, Dora B. "The Apprenticeship of Philippe Pinel: A New Document, 'Observations of Citizen Pussin on the Insane."' American Journal of Psychiatry 136, no. 9 (1979): 1128–1134.

——. "Philippe Pinel's 'Memoir on Madness' of December 11, 1794: A Fundamental Text of Modern Psychiatry." American Journal of Psychiatry 149, no. 6 (1992): 725–732.

Secondary Sources

Postel, Jacques. Genèse de la psychiatrie: Les premiers écrits de Philippe Pinel. Paris, 1981.

Swain, Gladys. Le sujet de la folie: Naissance de la psychiatrie. Toulouse, France, 1977.

Weiner, Dora B. Comprendre et soigner: Philippe Pinel (1745–1826); La médecine de l'esprit. Paris, 1999. English translation as Observe and Heal: Philippe Pinel and the Birth of Psychiatry in the French Revolution. Alder-shot, U.K., forthcoming. Includes a 14-page bibliography of Pinel's writings.

Dora B. Weiner