Pinel, Philippe
Pinel, Philippe
Modern psychiatry was born of the efforts of few great pioneers. Among them, Philippe Pinel (1745–1826) stands out: his was the first major achievement, at once scientific and humanitarian, in the treatment of insanity.
The oldest of seven children, Pinel was born to pious Roman Catholic family in a small village in the Tarn in southern France. His grandfather and father were physicians; his mother, a very strong character, dominated his youth. Her death, when Pinel was only 15, moved him to take orders. H joined the Oratorians but soon left monastic life, becoming instead deeply imbued with the ne philosophical outlook of Locke, Condillac, Voltaire, and Rousseau.
Pinel was a brilliant student and a great admirer of the classics, of Hippocrates, and of Plutarch; h read Greek, Latin, and also English, from which he was to translate some of the works of his co temporary, William Cullen.
Initially Pinel studied in the Faculty of Letters at Montpellier, but he was above all interested in natural science and mathematics. Personal acquaintance with Paul Joseph Barthez, a renowned pphysician of the faculty at Montpellier, led him tohysician of the faculty at Montpellier, led him study medicine. Studious, reserved, and simple in tastes, Pinel had few friends, but those he ha were close ones, especially Jean Antoine Chaptal, the future scientist. Pinel’s erudition made a variety of careers possible, but once he arrived at Paris he decided to devote himself to psychiatry.
Pinel’s career is inseparable from its political context: The French Revolution made it a duty to protect all individuals, even the insane, against enslavement by others. Pinel first became professor of medical physics, but he was next appointed physician of the hospital of Bicetre, the ancient grange aux gueux (“beggars’ farm”) at the gates of Paris, where “the insane … are treated as criminals, by mercenaries, contrary to either reason or humanity.” Pinel denounced this state of affairs, asserting, “I am convinced that the only reason these insane people are so intractable is that they are deprived of air and liberty” (Semelaigne 1888, p. 35). At that time they were, in fact, kept chained.
Thanks to his persistent efforts, reason triumphed over prejudice, and soon the insane were no longer regarded as possessed by demons, but as mentally ill. This was certainly Pinel’s greatest achievement. However, he refused to accept the excesses of the revolutionary movement: churches were being robbed, and Pinel from within his hos pital coolly condemned the raging iconoclasts and the powerful authorities who supported them. During one uprising the mob was about to hang him; he was saved by the vigilance of a recently “unchained” patient whom he had taken into his personal service.
Beginning in 1795, Pinel held a position at the Salpetriere hospital in Paris. There too he had t start from the ground up, replacing the orderlies, refurbishing the sordid rooms, and eliminating the use of chains. His psychiatric researches led to two fundamental works, La nosographie philosophique (1798), awarded a prize by the Directory, and Le traité médico-philosophique sur Xaliénation mental (1801), his major work. He had a wide audience among medical students; although not eloquent and sometimes absent-minded, Pinel was greatly appreciated in scientific quarters.
The fundamental innovations to be found in Pinel’s works are of several kinds. First, he insisted on the humanitarian treatment of patients. He had a humane, moral attitude toward the mentally ill, having long talks with them in which he “skillfully gave them a drive that they thought was due t their own initiative” (Semelaigne 1888, p. 118 He substituted understanding and gentleness for violence, strait jackets for chains, and insisted on the temporary nature of even this restraint.
Second, he made administrative changes. He distributed patients in several pavilions according to their condition, thus foreshadowing the dynamic organization of the psychiatric hospital of today. He also urged that asylums be governed by physicians.
Finally, he made innovations in therapy. He tried to diversify the treatment of the “raving” patients according to the etiology of their disease. He saw to it that they had games and music to amuse them. “Skill,” he said, “consists less in the use of remedies than in the deeply judicious art of using or not using them at the right times” (ibid., p. 102) He completely rejected unnecessary bleedings and sudden cold baths but made good use of warm, sleep-inducing baths. In addition to such physical measures, he had workshops set up for therapeutic purposes, paying the patients wages. He advocated having farms—to be worked and managed by th convalescent patients—attached to asylums. Far in advance of his time, he proposed the establishment of institutions for convalescents in transition between the hospital and the outside world; this innovation was developed further by his students.
The doctrine that Pinel had worked out was not universally accepted after his death. Although the basic elements of his approach were applied, they were applied incompletely and without the effort and commitment he had had. We do not know if this failure was due to postrevolutionary political reaction, to a lack of medical men capable of carrying on his work, or to the absence of a sufficientl elaborated theoretical structure. In any case, only today are the foundations laid by Pinel being properly developed.
P. Sivadon and P. Sabourin
[For discussion of the subsequent development of PineVs ideas, seeClinical psychology; Mental disorders; Mental disorders, treatment of; Psychiatry.]
WORKS BY PINEL
(1798) 1818 La nosographie philosophique: Ou, la meihode de l’analyse appliquee a la me’decine. 6th ed. Paris: Brosson.
(1801) 1962 A Treatise of Insanity. New York: Hafner. ? First published as Le traité médico-philosophique sur l’aliénation mentale.
WORKS ABOUT PINEL
Courbon, P. 1927 Pinel psychiatre. Annales médicopsychologiques 85, part 2:30–52.
Foucault, Michel (1961) 1965 Madness and Civilization: A History of Insanity in the Age of Reason. New York: Pantheon. ? First published as Folie et déraison: Histoire de la folie à I’âge classique.
Lechler, Walther H. 1960 Neue Ergebnisse in der Forschung uber Philippe Pinel. Thesis, Univ. of Munich ? This work is the result of research conducted by Pierre Chabbert and Walther H. Lechler.
Pinel, C. 1860 Philippe Pinel. Journal of Psychological Medicine and Mental Pathology 13:184–205.
Semelaigne, RenÉ 1888 Philippe Pinel et son oeuvre au point de vue de la medécine mentale. Paris: Imprimeries Réunies.