Philippe Pinel
Philippe Pinel (French: [pinɛl]; 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".
Philippe Pinel
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.[1]
"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.
Publications[edit]
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.[5]
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.”
[6]: 136 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.[6]: 137 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.[6]: 141 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.
[7]: 207
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.[6]: 149 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.[7]: 204
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.[6]: 150–151 An instance where this type of species of mental derangement occurs where a mechanic, who was confined at the Asylum de Bicetre, 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.[6]: 152–153 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.[6]: 156
The third mental derangement is called mania with delirium. It is mainly characterized by indulgence and fury, and affects cognitive functions. Sometimes it may be distinguished by a carefree, gay humor that can venture off path in incoherent and absurd suggestions. Other times it can be distinguished by prideful and imaginary claims to grandeur. Prisoners of this species are highly delusional. For example, they would proclaim having fought an important battle, or witness the prophet Mohammad conjuring wrath in the name of the Almighty. Some declaim ceaselessly with no evidence of things seen or heard while others saw illusions of objects in various forms and colors.[6]: 156–157 Delirium sometimes persists with some degree of frenzied uproar for a period of years, but it can also be constant and the paroxysm of fury repeat at different intervals.[6]: 158 The specific character of mania with delirium is the same as mania without delirium in the sense that it can either be continued or cyclical with regular or irregular paroxysms. It is marked by strong nervous excitement, accompanied by a deficit of one or more of the functions of the cognitive abilities with feelings of liveliness, depression or fury.[6]: 159
The fourth mental derangement is called dementia, or otherwise known as the abolition of thinking. The characteristics include thoughtlessness, extreme incorrectness, and wild abnormalities. For instance, a man who had been educated on the ancient nobility was marching on about the beginning of the revolution. He moved restlessly about the house, talking endlessly and shouting passionately on insignificant reasons. Dementia is usually accompanied by raging and rebellious movement, by a quick succession of ideas formed in the mind, and by passionate feelings that are felt and forgotten without attributing it to objects.[6]: 160–162 Those who are in captive of dementia have lost their memory, even those attributed to their loved ones. Their only memory consists of those in the past. They forget instantaneously things in the present – seen heard or done. Many are irrational because the ideas do not flow coherently.
[8]: 417
The characteristic properties of dementia are that there is no judgment value and the ideas are spontaneous with no connection.[6]: 163 The specific character of dementia contains a rapid progression or continual succession of isolated ideas, forgetfulness of previous condition, repetitive acts of exaggeration, decreased responsiveness to external influence, and complete lack of judgment.[6]: 164
The fifth and last mental derangement is called idiotism, or otherwise known as “obliteration of the intellectual faculties and affections.”[6]: 165 This disorder is derived from a variety of causes, such as extravagant and debilitating delight, alcohol abuse, deep sorrow, diligent study, aggressive blows to the head, tumors in the brain, and loss of consciousness due to blockage in vein or artery. Idiotism embodies a variety of forms. One such form is called Cretinism, which is a kind of idiotism that is relative to personal abnormalities. It is well known in the Valais and in parts of Switzerland.
[9]: 318 Most people who belong in this group are either deficient in speech or limited to the inarticulate utterances of sounds. Their expressions are emotionless, senses are dazed and motions are mechanical. Idiots also constitute the largest number of patients at hospitals. Individuals who have acute responsiveness can experience a violent shock to the extreme that all the activities of the brain can either be arrested in an action or eradicated completely. Unexpected happiness and exaggerated fear may likely occur as a result of a violent shock.[6]: 165–166 As mentioned previously, idiotism is the most common among hospital patients and is incurable. At the Bicetre asylum, these patients constitute one fourth of the entire population. Many die after a few days of arrival, having been reduced to states of stupor and weakness. However, some who recover with the progressive regeneration of their strength also regain their intellectual capabilities. Many of the young people that have remained in the state of idiotism for several months or years are attacked by a spasm of active mania between twenty and thirty days.[6]: 168 The specific character of idiotism includes partial or complete extermination of the intellect and affections, apathy, disconnected, inarticulate sounds or impairment of speech, and nonsensical outbursts of passion.[6]: 172
In his book Traité médico-philosophique sur l'aliénation mentale; ou la manie, published in 1801,[10] Pinel discusses his psychologically oriented approach. This book was translated into English by D. D. Davis as a Treatise on Insanity in 1806, although Davis substituted Pinel's introduction for his own, leaving out among other things Pinel's strong praise for Alexander Crichton. Pinel's book had an enormous influence on both French and Anglo-American psychiatrists during the nineteenth century. He meant by alienation that the patient feels like a stranger (alienus) to the world of the 'sane'. A sympathetic therapist living in that world might be able to journey into the patient's experience, understand the 'alienated', their language, and possibly lead them back into society.[3]: 284
In 1802 Pinel published La Médecine Clinique which was based on his experiences at the Salpêtrière and in which he extended his previous book on classification and disease.
Pinel was elected to the Académie des Sciences in 1804 and was a member of the Académie de Médecine from its founding in 1820. He died in Paris on 25 October 1826.[11]
Clinical approach[edit]
Psychological understanding[edit]
The central and ubiquitous theme of Pinel's approach to etiology (causation) and treatment was "moral," meaning the emotional or the psychological not ethical. He observed and documented the subtleties and nuances of human experience and behavior, conceiving of people as social animals with imagination.[12][13]
Pinel noted, for example, that: "being held in esteem, having honor, dignity, wealth, fame, which though they may be factitious, always distressing and rarely fully satisfied, often give way to the overturning of reason". He spoke of avarice, pride, friendship, bigotry, the desire for reputation, for conquest, and vanity. He noted that a state of love could turn to fury and desperation, and that sudden severe reversals in life, such as "from the pleasure of success to an overwhelming idea of failure, from a dignified state—or the belief that one occupies one—to a state of disgrace and being forgotten" can cause mania or 'mental alienation'. He identified other predisposing psychosocial factors such as an unhappy love affair, domestic grief, devotion to a cause carried to the point of fanaticism, religious fear, the events of the revolution, violent and unhappy passions, exalted ambitions of glory, financial reverses, religious ecstasy, and outbursts of patriotic fervor.[12]