I have a student who is writing a paper on the early treatment of the insane. It is generally acknowledged in textbooks -- and paintings -- that Philippe Pinel was the first to release the insane from their chains. However, I read somewhere that this stemmed from an account by Pinel's son in a biography of his father, and that it was Pinel's successor at Bicetre who actually was the first to unchain the inmates. Can anyone shed some light on this issue for us?

-- Nancy Innis (ninnis@uwo.ca), March 27, 2001

Answers

I do not know for sure, but it is true that many use Scipion Pinel's _Traite complete du regime sanitaire des alienes_ (1836, and sorry about the lack of accents) as their main source for Philippe Pinel's work. I have never heard before the claim that it actually fabricated facts about Philippe Pinel's contribution (only that it exaggerated and over-glorified their significance), but it is certainly possible. One way to find out would be to go to the "horse's mouth," so to speak: Philippe Pinel's _Traite medico-philosophique sur l'alienation mentale; ou, La manie_ (1801)_, or even his earlier _Nosographie philosophique; ou, La methode de l'analyse appliquee a la medecine_ (1797), and see if he mentions the "striking off" of the chains himself. Copies of both are available in the Fisher Rare Book Library at U. Toronto.

-- Christopher Green (christo@yorku.ca), March 29, 2001.

You might also investigate: Weiner, Dora B. (1994). “Le geste de Pinel”: The history of a psychiatric myth. In R. Porter & M. Micale (Eds.) Discovering the history of psychiatry. New York: Oxford University Press.

-- Joseph Druker (Joseph.Druker@med.va.gov), March 31, 2003.

Is this will bring you an answer?

LIBERTÉ POUR LES INSENSÉS - LE ROMAN DE PHILIPPE PINEL François LELORD Psychologie-Psychiatrie 15.09 € / 99 F February 2000 2-7381-0680-3 216

The eighteenth-century French doctor Philippe Pinel is regarded as the founder of modern psychiatry. At a time when mental illness was generally considered to be a form of possession by the devil, he was the first to affirm that it was a disease in every way comparable to an organic disorder, and to insist on giving his patients clinical examinations. He also advocated isolating patients suffering from mental illness in a separate institution, in order to provide them with better medical care. In this biography, François Lelord brings to life a great medical figure of the Enlightenment. He traces Pinel’s life through the upheavals of the French Revolution culminating with his nomination as head supervisor of Paris’ Hôpital de la Salpetrière — the greatest professional success of his career. He gives detailed accounts of Pinel’s work with the mentally ill and of his struggle for a more humane medicine, and recounts the doctor’s discussions with Condorcet and Thomas Jefferson. Nor does Lelord neglect the great man’s love life, which was seriously jeopardised by the Reign of Terror. Michel Foucault was known for his virulent criticism of the modern medical practice of locking up patients — especially psychiatric patients — and trying to exercise maximum control over them. Perhaps the time has come to rediscover Pinel’s work and the major step forward that it represented.

François Lelord is a psychiatrist and the author of Contes d’un Psychiatre Ordinaire. He is the co-author, with Christophe André, of Comment Gérer les Personnalités Difficiles and L’Estime de Soi.

-- Rock Faulkner (rock.faulkner@umontreal.ca), April 02, 2003.

It occurs to me that most of the biographies written on Philippe Pinel somehow have the character of a hagiography. Usually they describe a man of science and reason, but also a filanthropist who had the courage to defend the rights of the mentally ill. This is a very romanticised picture of the man.

The history of Pinel, and the patients of the Salpetriere has to be seen in the context of the french revolution: the church, who had been there throughout the middle ages as founder of the universal christian ethics, had lost it's moral impact.

Let's take a closer look then at the therapies of Pinel. There was for instance the famous 'tea-time' exercise. Once a week, all the mentally disturbed from the Salpetriere were gathered in the main office of Pinel himself. Tea and cookies were served and Pinel observed the behaviour of his patients. These patients knew what was expected from them, so they tried to behave as 'normal people', passing the cookies and the sugar, drinking their tea with the pinky up.

There's a lot of this kind of examples in the therapeutic practice of not only Pinel, but also for instance, in that of his Belgian collegue Joseph Guislain. The main intuïtion of Pinel and Guislain was that, among the whole population of the asylums, there was one group to be considered as 'treatable'. The question arises then: treatable for what? It's quite important that Guislain uses the term 'aliénation morale', and not 'mentale'. The main goal of Pinel and Guislain was to retrain these people in the moral sense of the word. Psychiatry appears as the defender of the same ethics, that used to be founded in the supernatural, the metaphysics of Catholic religion. Now, ther's no longer God who is the founder of ethics. It's science now!! But it's the same ethical system!

Take a look for instance at the development of the shock-treatment: the most popular way of using shock in therapy was the use of cold water (a sudden shower). Theoretically, this treatment was based on the theory of overheated body-fluids. But by the time Pinel and Guislain used these therapies, the function of the central nerve system was known, and so the theory of the body-fluids was left. But the therapy didn't disappear. It seemed to be quite effective to calm down patients that didn't behave like they were supposed to.

Another example is the mill to pump up the water to the different floors of the institute. Keeping the mill going was the work of the patients. But it wasn't sold as work. It was called therapy. It's obvious that the main goal of this therapy was an economic one. Thus creating a place for the mentally disturbed in society: they (Pinel a.o.) didn't seem to be interested in what kind of illness their patient suffered from. Their main interest seemed to be social retraining.

One last example, which I found with Guislain: he describes the conditions of a poor farmer with his family (wife and 10 children). The man -so Guislain stated- suffered from a disease that only appeared in the lower classes: it was called 'ambition'. According to Guislain this disease could easily be cured. He took away the man from his family and held him in the institute for about a year. After that year, so Guislain writes, it was sufficient to confront the poor man with his family (who had been practically without sources of income, since their father had been away) to cure him instantly. Again: moral retraining. Saying that these people were ill and had to be treated was a way of expressing that came with the rationalism of the revolution. It should be considered to be a coincidence that psychiatry arises from medical science. Both Pinel and Guislain were doctors.

In short: it appears to me that the story of Pinel is merely an illustration of the way a society always reacts in a conservative way. It is not a coincidence that Psychiatry begins at the very moment the church loses its influence on the moral scene of Europe. Psychiatry seems to canalize this loss into a new born institution that was merely interested in morals then in illness. The use of medical terms appears then as a thin varnish that had to cover up the real intentions of these filanthropists.

You have to excuse my English. I'm Belgian and dutch speaking.

-- marc teuwens (marc.teuwens@pandora.be), July 17, 2003.