In lieu of an abstract, here is a brief excerpt of the content:

Bulletin of the History of Medicine 74.4 (2000) 827-829



[Access article in PDF]

Book Review

Comprendre et soigner: Philippe Pinel (1745-1826): La médecine de l'esprit. Penser la Médecine


Dora B. Weiner. Comprendre et soigner: Philippe Pinel (1745-1826): La médecine de l'esprit. Penser la Médecine. Paris: Fayard, 1999. 479 pp. Ill. F. 160.00 (paperbound).

Comprendre et soigner (To understand and to treat: Philippe Pinel [1745-1826]: The medicine for the mind) is the result of many years of research on Pinel, universally regarded as the beginner of modern psychiatry, by Dora Weiner, a scholar who teaches history and human sciences at the University of California at Los Angeles. Weiner is closely involved with a group of French psychiatrists and historians attempting a reassessment of Pinel's life and work, which makes it natural for her book to have appeared in French.

Pinel was born in southern France and trained in medicine at Toulouse and Montpellier. In 1778 he moved to Paris, where he was influenced by the Idéologues, who were attempting to translate into concrete endeavors the theoretical postulates of the Enlightenment. Among their projects was a thorough reform of the care and treatment of the mentally ill, also advocated from different perspectives in various publications (Colombier and Doublet, 1785; Tenon, 1788; Cabanis, 1790; La Rouchefoucault-Liancourt, 1791). As a result of a series of events, in part related to the French Revolution, in 1793 Pinel was named "médecin des infirmeries" of Bicêtre. This institution, for approximately two hundred insane males who were kept in abysmal conditions, was a component of the Hôpital Général, founded in 1656 by Louis XIV and housing several thousand inmates who, regardless of their pathology, were all in need of public assistance. From the start, Pinel was helped in his task by the layman Jean-Baptiste Pussin who displayed considerable ingenuity in dealing with the inmates under his care. Pinel, together with Pussin, continued his program of reforms at the Salpétrière (for about two hundred female inmates) from 1795 on, progressively refining his insight into clinical matters.

Influenced by First Lines of the Practice of Physic (1777) of the Scottish physician William Cullen, who first coined the term neurosis and advocated a more humane attitude toward the mentally ill, Pinel published several important "mémoires" that eventually formed the nucleus of his Traité médico-philosophique sur l'aliénation mentale ou la manie (1801; hereinafter referred to as Pinel I); this was preceded by his Nosographie philosophique, ou méthode de l'analyse appliquée a la médicine (1798; continuously revised and expanded up to the fifth edition of 1818). His goal was threefold: to isolate, identify, and classify mental diseases. Under the influence of Cullen's simplified classification, he divided mental diseases into five categories: melancholia, nondelirious furor, delirium, dementia, and idiocy.

Among the basic principles established by Pinel at Bicêtre were an orderly and consistent set of rules; the assignment of new patients to wards of patients presenting a similar degree of mental impairment; the isolation of the unruly ones, and an emphasis on intimidating them by surrounding the physician with robust attendants and, if necessary, using straitjackets for short periods--followed [End Page 827] by establishing a personal relationship between staff and patient, and progressively granting more privileges up until the patient was discharged. The goal of this philosophy of treatment was the instilling of faith and hope in the patient, on the assumption that insanity was curable. Crucial to this goal was the use of "healthy" passions (Pinel II [see below], p. 151) to counteract the extreme perplexities, despondency, and despair of the melancholic patient (II, p. 104), so as to elicit a "combat intérieur" (II, pp. 208, 285)--in the firm conviction that in even the sickest patients a part of the mental process is still intact, and the therapist's intent should be to capitalize on this as a way toward improvement and, in...

pdf

Share