Philippe Pinel and the Dawn of Psychiatry

In the times of Philippe Pinel, it was normal for the “mentally ill” to be chained to the walls or to be inflicted with physical punishment. This doctor managed to regulate psychiatric institutions and propose a new way of understanding mental pathologies.

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Philippe Pinel is considered the father of psychiatry in France. His great contribution was to have approached people considered “mentally ill” with a more human vision. Also to have proposed a novel categorization of mental illnesses, which laid the foundations for modern classifications.

Pinel had the pragmatism and sufficient discipline to make a thorough observation of sick people and develop systematic notes. All this provided guidelines for the clinical treatment, as well as for the classification of the different mental manifestations.

“A deluge of troublesome studies, of vain compilations written in the proper language of schools, and with that fury of explaining everything, is a common defect in almost all sciences.”

-Philippe Pinel-

Thanks to Philippe Pinel, psychiatric institutions abandoned several cruel practices in France. He also presented a set of hypotheses about the causes of mental problems and emphasized the importance of offering comprehensive treatment.

Philippe Pinel, a difficult start

Philippe Pinel was born in Jonquières (France), on April 25, 1745. He was the son of a modest surgeon. He completed his basic studies at the school of Lavaur and then embraced the religious career. During his time in the seminary, he learned classical languages. However, it did not last there long.

When leaving the religious life went to study mathematics and medicine to Toulouse. There he received his doctorate in 1773, when he was 28 years old. Shortly after, he went to Montpellier, where he became familiar with the approaches of Boissier de Sauvages and Barthez.

It was not easy to start medical practice. Initially, to sustain himself, he developed degree theses for rich and lazy students. None of them had novel approaches. In 1778, he moved to Paris and survived by giving private mathematics classes and writing medical articles.

A new stage

Philippe Pinel also translated several medical works, during his first years in Paris. Among them, the elements of practical medicine of Cullen. In principle he did not attend patients, but in 1786 he had the opportunity to treat some mental patients, in the asylum of Dr. Belhomme.

Pinel’s main objective was to have a somewhat more comfortable economic life. At first, he wanted to link up with some academic institutions, but he did not succeed. He also sought to become a doctor of the “Mesdames”, who were the aunts of Louis XVI. Neither did he succeed.

He sympathized with the French Revolution, which broke out in 1789, but later distanced himself from political activity during the time of terror. However, he made friends with Thouret and this helped him to be appointed doctor in the hospice of Bicêtre. There he worked from 1793 to 1795.

A new psychiatry

At the Bicêtre hospice there was a caretaker, not a doctor, whose name was Jean-Baptiste Pussin. Although he was not in charge of the treatment of the sick, Pussin had implemented several measures on his own that caught the attention of Philippe Pinel.

Pussin applied what was called a moral treatment to the inmates. It started from the idea that all of them kept intact a part of their reason and went to that facet to try to improve. He also thought that the sick should not be subjected to cruel treatment.

Pussin found in Philippe Pinel a great ally and vice versa. The latter requested permission not to tie the sick with chains, since at that time this was a daily practice. At first, he did not succeed, but then George Couthon heard it. He was paralyzed and still visited the hospice to meet Pinel’s requests.

Big changes

Philippe Pinel was appointed head of the Salpêtrière hospital in 1795. There he began to implement reforms similar to those he had advanced in the hospice of Bicêtre. He forbade the sick to be bound with chains and made several improvements in the quality of psychiatric internment.

He introduced a psychological perspective in the treatment of the sick. His methods were precursors of what would later be individual psychotherapy. He believed that mental illness included physical aspects and also “moral problems”. The latter should be treated through the dialogue with the patient.

Pinel worked all his life to regulate psychiatric hospitalization. Before him, the function of the “madhouse” was similar to that of a prison. Likewise, he defined four basic mental illnesses or “vesanías”: simple melancholy, mania, idiocy and dementia.

In 1801, he published the medical-philosophical treatise on mental alignment. This is the direct antecedent of modern psychiatric diagnostic manuals. It was decorated by Napoleon and his successors. In 1822, he was dismissed from his post and died in Paris four years later.