Philippe Pinel

1 PHILIPPE PINEL MEDICO-PHILOSOPHICAL TREATISE ON MENTAL ALIENATION Second Edition, entirely reworked and extensively expanded (1809) 2 CONTENTS Translators’ Preface ______________ Preface Introduction Plan First Section I. Intrinsic or hereditary Alienation. II. Influence of a depraved upbringing on lapses of reason. III. Extreme irregularities in life style likely to produce alienation. IV. Spasmodic passions liable to lead to alienation. V. Debilitating or oppressive passions. VI. Cheerful or out-going passions considered as capable of deranging reason. VII.A melancholic constitution, common cause of the most extreme deviations and most exaggerated thoughts. VIII. On some physical causes of mental alienation. Second Section I. Disorders of physical sensitivity in mental alienation. II. Disturbances in the perception of external objects in alienation. III. Disturbances in thought processes in alienation. IV. Disturbances in memory and the principle of association of ideas in alienation. V. Disturbances of judgement in psychiatric patients. VI. Emotions and other affective states typical of psychiatric patients. VII. Disturbances of the imagination in mental alienation. VIII. Character changes in alienation. 3 Third Section I. Maniacal Insanity or general delirium The specific characteristics of maniacal insanity. Is an episode of periodic maniacal insanity a form of chronic insanity? Can maniacal insanity with delirium always be cured? Can maniacal insanity exist without a disturbance in understanding? An example of a kind of maniacal attack without delirium (manie sans délire). Maniacal Insanity without delirium (manie sans délire) marked by blind fury. Another example of maniacal insanity without delirium. II. Melancholia, or selective delirium Popular meaning of the term melancholia. Melancholia regarded as mental alienation. Two opposite forms which melancholic delirium may take. Can melancholia degenerate, after a few years, into insanity? Variety of melancholia leading to suicide. III. Dementia, or abolition of thought The most salient features of dementia sometimes observed amongst the general public. Ideas which are inconsistent with one another, and unrelated to outside objects. Example to clarify the difference between dementia and maniacal insanity. IV. Idiocy, or obliteration of the intellectual and emotional faculties The French language deficiencies for expressing the different degrees of alienation. Form of idiotism produced by strong and unexpected affections. Idiocy, a species of alienation common in the hospices and sometimes cured by an attack of maniacal insanity. Principal features of the physical and mental character of the Swiss Cretins. General remarks about the different kinds of alienation. 4 Fourth Section I. General plan and internal arrangement of the Hospice for the Mentally Ill. II. On methods currently used to control the Insane. III. Necessity of maintaining consistent order in hospices for the mentally ill, and of studying their character traits. IV. The importance and extreme difficulty of establishing firm order in a service or the Mentally Ill. V. Paternalistic supervision to be exercised in the preparation and distribution of meals. VI. Disastrous consequences of the shortages which occurred in Year IV in the Hospices for the Mentally Ill. VII. Varied physical exercise, or routines of mechanical work, a fundamental rule of every hospice for mentally ill patients. VIII. General precepts to be followed in mental treatment. IX. Precautions called for by extreme exaltation of religious opinions. X. Extreme restriction to be placed on communication of Deranged patients with people outside. XI. Supervision measures required with certain perverse or uncontrollable characters. XII. Precepts to follow in the management of Melancholic Patients. Fifth Section I. On the practice of striking Deranged Patients as a means of curing them. II. Is the practice of frequent blood-letting in mental illness based on enlightened experience? III. On Treatment by brisk immersion of Deranged Patients in cold water. IV. Treatment to be followed during the first phase of Maniacal Insanity. V. On the use of remedies of varying activity, designed to support general measures of treatment. VI. Considerations relating to medical treatment in the second and third stages of maniacal delirium. 5 VII. Critical ending of alienation sometimes produced by spontaneous eruptions. VIII. Difficulty and importance of deciding, in particular cases, whether derangement is curable. A remarkable example. IX. Prudent measures to be taken in discharging convalescent mental patients. Sixth Section I. Rules followed at the Salpêtrière hospice for mentally ill patients to keep the registers and construct the tables. II. Deranged patients admitted with no information regarding their previous state, and patients treated elsewhere before admission to the hospice. III. Predisposition to Mental Alienation according to age, marital status, or celibacy. IV. Varying incidence of Alienation depending on its causes. V. Treatment method for Demented Patients suggested by the nature of the precipitating cause and confirmed by the calculation of probabilities. VI. Length of treatment needed for preventing relapses. VII. Relapses occurring after cure and discharge from the hospice. VIII. Regarding the proportion of successes and failures in the treatment of alienated patients. IX. Doubtful success of treatment in cases of Alienation with inconclusive diagnostic signs and symptoms. X. General result of treatment of deranged patients at the Salpêtrière in the years 1806 and 1807. Seventh Section I. Periods of life when Insanity from mental causes is most likely to develop. II. Varieties of head dimensions, and choice of parts to draw. III. Case of alienation that became incurable through accidental causes. 6 Foreword Philippe Pinel, Treatise on Mental Alienation, 1809 Dora B. Weiner Ph. D., Professor of the Medical Humanities & History, UCLA Why translate, for the first time, the second edition of a Treatise published in French two hundred years ago? Because it provides historians of medicine and psychiatrists in the English-speaking world with an authoritative overview of mental illnesses as they were understood at the birth of modern psychiatry. This work, by Philippe Pinel (1745-1826), the founder of psychiatry in France at the time of the French Revolution, made the author world-famous. But he became known mainly as the doctor who freed the insane from their chains—which is true mainly in a symbolic way: his assistant Jean Baptiste Pussin did so three years before Pinel followed suit. In 1806, an English translation of the first edition of his Treatise of 1800 appeared: this was one year after Napoleon had defeated the British at Austerlitz. No wonder the translator, a patriotic obstetrician from Sheffield, called France “a vast Bicêtre,” the asylum for insane men where Pinel served as physician in 1793-1795. Further bad luck befell Pinel in the English-speaking world after the publication, in 1813, of Samuel Tuke’s Description of the Retreat a York ‘Now we understand Pinel,’ the English public seemed to say; ‘Pinel is the French Tuke.’ And so Pinel entered the English-language literature of psychiatry as the French counterpart of a rich Quaker tea merchant, and the twins “Tuke-Pinel” have appeared together in the Anglo-American medical literature for two centuries, while the obstetrician D.D.Davis’s wretched translation is still quoted. as the only available English version of the Traité médico-philosophique de l’aliénation mentale ou la manie of 1800. By that year, Pinel had been professor of internal medicine at the reformed Paris medical school for five years and had published his Philosophic Nosography, the textbook in which all French medical students learned diagnosis and the clinical approach, and that went through six editions in twenty years. Pinel was also about to be elected to the Academy of Sciences, an honor he took very seriously since he believed 7 that medicine could only progress by adopting the scientific method. What is most important for the present book, however, is that Pinel was appointed physician-in-chief of Salpêtrière Hospice, the huge Parisian establishment for mentally ill women, in 1795, and he served in that position for thirty-one years, until his death. By 1809, the date of the second edition of the Traité, Pinel had important new information to present to the medical, scientific and indeed to the socio-political world. He had conducted what he calls an “experiment” with the help of his assistant A.J. Landré-Beauvais. They had, over almost five years, 1802-1805, closely examined some one thousand mentally ill women hospitalized at the Salpêtrière, or about to be admitted. The doctors elaborated and published a Table of data that classified these women into the four traditional categories of mania, melancholia, dementia and idiocy, but also used personal information and a differential diagnosis. But the real purpose of the experiment was to calculate the probability of cure. The focus on cure tells us that this professor, medical scientist and administrator was first of all a doctor. The omnipresence of case histories in the present text serves to prove this point, as well as to enliven the argument. But his finding, that only about 9% of the women surveyed in 1802 were curable, revealed troubling problems. Pinel was a pioneer who had broadened the purview of medicine, proclaiming that the mentally ill are not

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