Philippe Pinel
1745-1826
French Physician and Psychiatrist
Philippe Pinel revolutionized the treatment of the insane by insisting upon "moral management" instead of violence and incarceration. He was among the first psychiatric doctors who believed that mental illness was curable and that mental patients would respond positively to sympathetic care. Today, Pinel is credited with inventing the mental hospital, and with it, the idea that mental illness can be treated.
The son of a doctor of modest income and the eldest of seven children, Pinel was born in a small village in southwest France. He studied mathematics at the university at Toulouse before taking a medical degree at Montpelier. Pinel's early career as a physician was spent in a private family clinic, and in 1793 he was appointed physician at Bicêtre, a public mental asylum that housed 800 men. Despite the great impact he was to have upon the mentally ill and the field of psychiatry in general, Pinel was described as shy and retiring.
With his appointment at Bicêtre, Pinel earned the title of "the liberator of the insane." He freed the patients—really inmates—from their chains and dungeons, stopped clinicians from punitive measures such as whipping and bloodletting, and ordered that no further violence be used against the patients. Before Pinel, the insane had been considered a threat to society because the nature of their illnesses was not yet understood. Insanity was considered to be a biological disease, and as such, not treatable with the medical technologies and theories of the day. But Pinel argued that insanity was often a curable disorder. Some of Pinel's contemporary psychiatrists, including William Tuke in England and Chiarugi in Italy, were also exploring humane methods of treating the mentally ill.
The empathy that Pinel extended to sufferers of mental illness directly reflects the ideals of the French Revolution (1787-1799), which effected the near-total transformation of French politics and culture at this time. Revolutionary ideals included the concept that all men were created equal and should alike be allowed to strive for liberty. Pinel extended these concepts to the mentally ill, so that his liberation of the insane served as a powerful symbol of the "New France." Further, the zeal for social reform and sympathy for the disadvantaged spurred by revolutionary politics also inspired Pinel's decision to improve the living conditions of the mentally ill.
Pinel's method of curing mental illness followed a simple philosophy that at the time was a radical departure from his culture's approach to insanity. At Bicêtre, and later at the insane asylum for women at Salpêtrière, he demonstrated that deranged patients often responded sanely if they were treated as capable of "normal" behavior. His method of therapy worked towards the total rehabilitation of a patient, which was marked by his or her re-entrance to society. In the hospitals he oversaw, Pinel confirmed that a respectful approach to a patient and his or her problems earned the patient's trust and therefore enabled the doctor to learn more about the nature of the illness. He insisted that a doctor to the insane must live among them to be able to sufficiently observe and learn about their problems.
Pinel's achievements include the publication in 1798 of Philosophical Classification of Diseases, which described many psychotic symptoms, and the 1801 publication of Treatise on Moral Management, which contains the basic philosophy of his approach to insanity. During his career, besides serving at the hospitals at Bicêtre and Salpêtrière, Pinel was elected to a professorship of hygiene and pathology at the Ecole de Medicine and named as a consulting physician to Napoleon. His most famous student, Esquirol, continued the tradition of "moral management" and furthered the work that Pinel started by observing and classifying different mental illnesses.
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