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Bulletin of the History of Medicine 77.3 (2003) 704-706



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Jackie Pigeaud. Aux portes de la psychiatrie: Pinel, l'Ancien et le Moderne. Paris: Aubier, 2001. 379 pp. €21.00 (paperbound, 2-70072199-3).

What were the assumptions and preoccupations of late eighteenth-century physicians concerning mental illness? Jackie Pigeaud's book places these doctors "at the doors to psychiatry."1 Long concerned with medical themes in ancient literature, Pigeaud documents a "veritable renaissance" of Greek and Roman medical learning in the Enlightenment, when physicians translated, reedited, understood, and cited the classical authorities (p. 242). In order to make his task manageable, he uses Philippe Pinel as his guide for the selection and rank-ordering of sources that can inform the modern reader about the debt of the eighteenth century to classical authors concerned with mental illness. That is a good choice, for Pinel, a well-educated "man of his times" (p. 81), was, as the title informs us, an "ancient" but also a "modern." He clearly stated his debt to antiquity throughout [End Page 704] the twenty-odd published and reedited volumes and the scores of articles that constitute his opus. His acknowledgments are specific and consistent, and thus Pigeaud has but to follow his chosen guide.

Pinel ranked Hippocrates highest, as his lifelong model for diagnosing patients in the context of their environment, including their home and family, and of the "epidemic constitution" prevalent at the moment of the illness. Like his contemporaries, Pinel admired Hippocrates' belief in Nature's healing powers, leading him to the "expectant" therapeutic method and a reticence to use strong medications. The other classical authors Pinel ranked highest were Celsus, Aretaeus, and Caelius Aurelianus. Pigeaud accepts these choices as typical for physicians of the Enlightenment, but adds his own favorites, with comments and references—for example, Asklepiades of Bythnia and his student Themison, to whom Pinel paid little heed.

But Pigeaud is no mere antiquarian: he also explores the main preoccupations of these eighteenth-century physicians with issues central to their own time, such as the psychology of mental illness, the struggle between mechanism and vitalism, the action of the "passions" on the human body, the scientific worth of Mesmer's "magnetic fluid," or the purpose of Kant's essay on the "Maladies of the Head."

Whenever the author engages with the thought and writings of Pinel, his book changes in tone and becomes intensely personal. Pigeaud has obviously read every page of Pinel, whom he admires for bringing psychiatry into the purview of modern medicine. He takes the critical biography by this reviewer as his starting point,2 thereby obviating the need to reexamine Pinel's life and work. Rather, Pigeaud embarks on a wide-ranging exploration of at least a score of puzzling and controversial issues: what exactly was the relationship of Pinel to Condillac? or to Cabanis? did he really place madness in the epigastrium? did he accept the German concept of coenaesthesis (Selbstbewusstsein)?

Involved in Pinel's preoccupations, Pigeaud carries these deep into the classical literature. For example, Pinel's lifelong sorrow and guilt over the suicide of a young friend in 1783 becomes a discussion of Socrates' death. A strange passage about methods of treating depression in ancient Egypt becomes a lengthy comparison of Egyptian versus Greek influence on modern times. This last part of the book leads to what Pigeaud calls "intimate history, tied to readings and rumination" (p. 359).

Readers who view the classics as the source of Western medical thought will find valuable references, quotes, and allusions that connect the ancients to the eighteenth century. Friends of the Enlightenment will discover a rich literary and philosophical context of medical ideas—a context heavily weighted in favor of France, whereas Pinel himself would have referred more fully to Great Britain and to the sciences, particularly natural history. Mainly, readers will understand [End Page 705] Pigeaud's admiration for Pinel, who "applied Hippocrates' approach to the hospice" (p. 242) and thus boldly entered the nineteenth century.

 



Dora B. Weiner...

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