Philippe Pinel (; 20 April 1745 – 25 October 1826) was a French physician, precursor of psychiatry and incidentally a zoologist. He was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy. He worked for the abolition of the shackling of mental patients by chains and, more generally, for the humanisation of their treatment. He also made notable contributions to the classification of mental disorders and has been described by some as "the father of modern psychiatry".
After the French Revolution, Dr. Pinel changed the way we look at the mentally ill (or "aliénés", "alienated" in English) by claiming that they can be understood and cured. An 1809 description of a case that Pinel recorded in the second edition of his textbook on insanity is regarded by some as the earliest evidence for the existence of the form of mental disorder later known as dementia praecox or schizophrenia, although Emil Kraepelin is generally accredited with its first conceptualisation.
As the "father of modern psychiatry", he was credited with the first classification of mental illnesses. He had a great influence on psychiatry and the treatment of the alienated in Europe and the United States.
Early life
Pinel was born in Jonquières, the South of France, in the modern department of Tarn. He was the son and nephew of physicians. After receiving a degree from the faculty of medicine in Toulouse, he studied an additional four years at the Faculty of Medicine of Montpellier. He arrived in Paris in 1778.
He spent fifteen years earning his living as a writer, translator, and editor because the restrictive regulations of the old regime prevented him from practicing medicine in Paris. The faculty did not recognize a degree from a provincial university like Toulouse. He failed twice in a competition which would have awarded him funds to continue his studies. In the second competition, the jury stressed his ‘painful’ mediocrity in all areas of medical knowledge, an assessment seemingly so grossly incompatible with his later intellectual accomplishments that political motives have been suggested.Michel Caire, "Philippe Pinel en 1784. Un médecin "étranger" devant la Faculté de Médecine de Paris." In Histoire des Sciences Médicales vol XXIX, no 3 1995, pp 242 - 251 Discouraged, Pinel considered emigrating to America. In 1784 he became editor of the medical journal the Gazette de santé, a four-page weekly. He was also known among natural scientists as a regular contributor to the Journal de physique. He studied mathematics, translated medical works into French, and undertook botanical expeditions.
At about this time he began to develop an intense interest in the study of mental illness. The incentive was a personal one. A friend had developed a ‘nervous melancholy’ that had ‘degenerated into mania’ and resulted in suicide. What Pinel regarded as an unnecessary tragedy due to gross mismanagement seems to have haunted him. It led him to seek employment at one of the best-known private sanatoria for the treatment of insanity in Paris. He remained there for five years prior to the Revolution, gathering observations on insanity and beginning to formulate his views on its nature and treatment.
Pinel was an Ideologue, a disciple of the abbé de Condillac. He was also a clinician who believed that medical truth was derived from clinical experience. Hippocrates was his model.
During the 1780s, Pinel was invited to join the salon of Madame Helvétius. He was in sympathy with the French Revolution. After the revolution, friends he had met at Madame Helvétius’ salon came to power. In August 1793 Pinel was appointed "physician of the infirmeries" at Bicêtre Hospital. At the time it housed about four thousand imprisoned men—criminals, petty offenders, syphilitics, pensioners and about two hundred mental patients. Pinel’s patrons hoped that his appointment would lead to therapeutic initiatives. His experience at the private sanatoria made him a good candidate for the job.
The Bicêtre and Salpêtrière Soon after his appointment to Bicêtre Hospital, Pinel became interested in the seventh ward where 200 mentally ill men were housed. He asked for a report on these inmates. A few days later, he received a table with comments from the "governor" Jean-Baptiste Pussin. In the 1770s Pussin had been successfully treated for scrofula at Bicêtre; and, following a familiar pattern, he was eventually recruited, along with his wife, Marguerite Jubline, on to the staff of the hospice.
Appreciating Pussin's outstanding talent, Pinel virtually apprenticed himself to that unschooled but experienced custodian of the insane. His purpose in doing this was to "enrich the medical theory of mental illness with all the insights that the empirical approach affords". What he observed was a strict nonviolent, nonmedical management of mental patients that came to be called moral treatment or moral management, though psychological might be a more accurate term.
Although Pinel always gave Pussin the credit he deserved, a legend grew up about Pinel single-handedly liberating the insane from their chains at Bicêtre. This legend has been commemorated in paintings and prints, and has lived on for 200 years and is repeated in textbooks. In fact, it was Pussin who removed the iron shackles (but sometimes using straitjackets) at Bicêtre in 1797, after Pinel had left for the Salpêtrière. Pinel did remove the chains from patients at the Salpêtrière three years later, after Pussin joined him there. There is some suggestion that the Bicêtre myth was actually deliberately fabricated by Pinel's son, Dr Scipion Pinel, along with Pinel's foremost pupil, Dr Esquirol. The argument is that they were 'solidists', which meant then something akin to biological psychiatry with a focus on brain disease, and were embarrassed by Pinel's focus on psychological processes. In addition, unlike Philippe, they were both royalists.
While at Bicêtre, Pinel did away with bleeding, purging, and blistering in favor of a therapy that involved close contact with and careful observation of patients. Pinel visited each patient, often several times a day, and took careful notes over two years. He engaged them in lengthy conversations. His objective was to assemble a detailed case history and a natural history of the patient's illness.
In 1795, Pinel became chief physician of the Hospice de la Salpêtrière, a post that he retained for the rest of his life. The Salpêtrière was, at the time, like a large village, with seven thousand elderly indigent and ailing women, an entrenched bureaucracy, a teeming market and huge infirmaries. Pinel missed Pussin and in 1802 secured his transfer to the Salpêtrière. It has also been noted that a Catholic nursing order actually undertook most of the day to day care and understanding of the patients at Salpêtrière, and there were sometimes power struggles between Pinel and the nurses.
Pinel created an inoculation clinic in his service at the Salpêtrière in 1799, and the first vaccination in Paris was given there in April 1800.
In 1795 Pinel had also been appointed as a professor of medical pathology, a chair that he held for twenty years. He was briefly dismissed from this position in 1822, with ten other professors, suspected of political liberalism, but reinstated as an honorary professor shortly thereafter.
A statue in honour of Pinel now stands outside the Salpêtrière.
Publications In 1794, Pinel made public his essay Memoir on Madness, recently called a fundamental text of modern psychiatry. In it, Pinel makes the case for the careful psychological study of individuals over time, points out that insanity isn't always continuous, and calls for more humanitarian asylum practices.
In 1798, Pinel published an authoritative classification of diseases in his Nosographie philosophique ou méthode de l'analyse appliquée à la médecine. Although he is properly considered one of the founders of psychiatry, this book also establishes him as the last great nosologist of the eighteenth century. While the Nosographie appears completely dated today, it was so popular in its time that it went through six editions between its initial publication and 1818. Pinel based his nosology on ideas of William Cullen, employing the same biologically-inspired terminology of "genera" and "species" of disorder. Pinel's classification of mental disorder simplified Cullen's "neuroses" down to four basic types of mental disorder: melancholia, mania (insanity), dementia, and idiotism. Later editions added forms of "partial insanity" where only that of feelings which seem to be affected rather than reasoning ability.
The first mental derangement is called melancholia. The symptoms are described as "taciturnity, a thoughtful pensive air, gloomy suspicions, and a love of solitude". It is noted that Tiberius and Louis XI were subjected to this temperament. Louis was characterized by the imbalance between the state of bitterness and passion, gloom, love of solitude, and the embarrassment of artistic talents. However, Louis and Tiberius were similar in that they both were deceitful and planned a delusional trip to military sites. Eventually both were exiled, one to the Isle of Rhodes and the other to a province of Belgium. People with melancholia are often immersed with one idea that their whole attention is fixated on. On one hand they stay reserved for many years, withholding friendships and affection while on the other, there are some who make reasonable judgment and overcome the gloomy state. Melancholia can also express itself in polar opposite forms. The first is distinguished by an exalted sense of self-importance and unrealistic expectations such as attaining riches and power. The second form is marked by deep despair and great depression. Overall individuals with melancholia generally do not display acts of violence, though they may find it wildly fanciful. Depression and anxiety occurs habitually as well as frequent moroseness of character. Pinel remarks that melancholia can be explained by drunkenness, abnormalities in the structure of the skull, trauma in the skull, conditions of the skin, various psychological causes such as household disasters and religious extremism, and in women, menstruation and menopause.
The second mental derangement is called mania without delirium. It is described as madness independent of a disorder that impairs the intellectual faculties. The symptoms are described as perverse and disobedient. An instance where this type of species of mental derangement occurs where a mechanic, who was confined at the Asylum de Bicêtre, experienced violent outbursts of maniacal fury. The paroxysms consisted of a burning sensation located in the abdominal area that was accompanied by constipation and thirst. The symptom spread to the chest, neck, and face area. When it reached the temples, the pulsation of the arteries increased in those areas. The brain was affected to some length but nonetheless, the patient was able to reason and cohere to his ideas. One time, the mechanic experienced furious paroxysm at his own house, where he warned his wife to flee to avoid death. He also experienced the same periodical fury at the asylum where he plotted against the governor. The specific character of mania without delirium is that it can either be perpetual or sporadic. However, there was no reasonable change in the cognitive functions of the brain; only perversive thoughts of fury and a blind tendency to acts of violence.