Pinel Orders the Chains Removed from the Insane at Bicêtre

ART AND IMAGES IN PSYCHIATRY

SECTION EDITOR: JAMES C. HARRIS, MD Pinel Orders the Chains Removed From the Insane at Biceˆtre

HILIPPE PINEL (1745-1826) arrived in Paris, In 1849 during the Second French Republic, a time France, in 1778 after completing his medi- of renewed revolutionary vigor, Charles-Louis Muller (1815- cal studies in Toulouse and Montpellier. He 1892) was commissioned by the Academy of Medicine in tutoredmathematics,translatedmedicaltexts, Paris to create a heroic painting of Philippe Pinel for its meet- immersed himself in the study of natural his- ing room. The painting is probably based on Scipion Pinel’s toryP and the new empirical epistemology of John Locke suspect memorial address and his own heroic painting of and of Etienne Condillac, and edited the Gazette de sante´ his father. Muller had previously painted scenes from the (Journal of Health). The mismanagement of a friend’s mel- French Revolution; his best-known work is Last Roll Call ancholia, leading to his death, stimulated Pinel’s interest of the Victims of the Terror. A student of Antoine-Jean Gros, in mental illness. Subsequently, he worked as a consul- he may have modeled the composition on Gros’ Napo- tant at a private psychiatric clinic in Paris.1(pp68-69) He ex- leon’s Visit to the Plague House in Jaffa, which shows Napo- pressed interest in the psychological effects of popular treat- leon touching a patient who has been infected with the ments, such as those of Anton Mesmer (“medicine of the plague. Pinel is shown in a similar posture to that of Na- imagination”), without endorsing their explanations.1 In poleon, depicting science overcoming ignorance. 1793, appointed physician of the infirmaries at Biceˆtre, a In a touching scene, the painting shows Pinel liber- public hospice for men just outside of Paris, he brought atingtheinsanefromtheirchains(legestedePinel).3 Hestands the revolutionary inspiration of the Rights of Man, declared with young physicians and associates in a courtyard of Bi- by the French National Assembly in 1789, to the destitute. ceˆtre with the Paris skyline in the background. He orders The hospice contained 4000 residents. There were a man, possibly Pussin, to file off the iron cuffs holding the convicted criminals, political prisoners held by lettres de remaining chains to a frail elderly man’s arm. To the far right, cachet (imprisoned without trial on the authority of the a man dressed in rags points to his once-bound wrists; yet king), beggars who simulated disease to arouse pity, pa- another holds his shackles high in the air. Others— tients with physical handicaps, epilepsy, or chronic ill- tormented, disabled, or cognitively impaired—express ness, and elderly men; among them, 200 were charac- amazement at Pinel’s humanitarianism.3 Some are being terized as insane. These men lacked fresh air and sunlight helped to walk after periods of long confinement. Jean- in their cells, slept in beds made of straw, and received Etienne-Dominique Esquirol, Pinel’s successor, stands at only 1 meal each day. The most violent were chained to Pinel’s right intently observing the proceedings; with a red poles or ceilings. The few attendants were generally trained notebook and quill in hand, he documents Pinel’s activi- only in the use of force and punishment. ties. Although this painting is not historically accurate (the Pinel commenced his work during the First French Re- liberation did not occur in 1792, and Esquirol, never at public in the midst of the Reign of Terror. His elder son, Biceˆtre, did not arrive in Paris until 1799), le geste de Pinel Scipion Pinel (1795-1859), told a dramatic story in a me- signifies Pinel’s far greater therapeutic contribution: the in- morial address to the French Academy of Medicine in 1836 troduction of his moral (gentle but firm, and psychologi- about how his father had approached Georges Couthon, a cally sensitive) treatment. leading member of the Committee of Public Safety, in 1792 He said that if the physician engages the healthy part asking to remove the chains from the insane. The paralytic of the personality in treatment, a cure is sometimes pos- Couthoncametoinspectthe“wildbeasts,”questioningPinel’s sible. Indeed, in his first year at Biceˆtre, Pinel reported sanity for making the request and warning him, “[W]oe to that 25 of the 200 patients recovered. Pinel’s psychologi- you if you hide enemies of the people.”2 Scipion reported cal approach to treatment represents a paradigm change1 that more than 50 patients with various diagnoses were re- in the treatment of mental illness; we struggle, even to- leased from chains. The historian Dora Weiner, quoting day, to fully implement his humane vision. French sources,3,4 states that there is not a shred of truth to this story. There is no evidence that Couthon visited Biceˆ- James C. Harris, MD tre or was even in Paris at the time. In Pinel’s textbook Trea- 5 tise on Insanity, he clearly credits Jean Baptiste Pussin, REFERENCES governor of the ward for the insane at Biceˆtre, with this in- novation. Pussin dates the abolition of the chains to 17976; 1. Goldstein J. Console and Classify: The French Psychiatric Profession in the Nine- it was an empirical application of the moral (psychological) teenth Century. Chicago, Ill: University of Chicago Press; 2001. treatmentinitiatedbyPinel.Pussinalsoforbadephysicalpun- 2. Pinel S. Biceˆtre en 1792. Mem Acad Med. 1836;5:32-40. 3. Swain G. Le Sujet de la Folie. Toulouse, France: Privat; 1977:119-171. ishment by staff and thereafter used straitjackets for restraint. 4. Weiner DB. “Le geste de Pinel.” In: Micale MS, Porter R. Discovering the History Pinel used Pussin’s experience in developing his approach of Psychiatry. New York, NY: Oxford University Press; 1994:232-247. to treatment but “put order and precision into [Pussin’s] ob- 5. Pinel P. Treatise on Insanity. Davis DD, trans [1806]. Birmingham, Ala: Classics 5(pxlvi,xlix) of Medicine Library; 1983. servations” ; Pinel subsequently eliminated the chain- 6. Weiner DB. The apprenticeship of Philippe Pinel: a new document, “observa- ing of women at the Salpeˆtrie`re Hospice in Paris. tions of Citizen Pussin on the insane.” Am J Psychiatry. 1979;136:1128-1134.

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