Saturday, July 9, 2016

Citizen Pinel Orders Removal of the Chains (1876)

Tony Robert-Fleury: Citizen Pinel Orders Removal of the Chains of the Mad at the Salpêtriére

Philippe Pinel (20 April 1745 – 25 October 1826) was a French physician who 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 also made notable contributions to the classification of mental disorders and has been described by some as "the father of modern psychiatry". An 1809 description of a case that Pinel recorded in the second edition of a textbook on insanity is regarded as the earliest evidence for the existence of the form of mental disorder known as dementia praecox or schizophrenia in the 20th century by some although Kraeplin is accredited with its first conceptualisation.

Soon after his appointment to l'Hôpital Bicêtre, 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 (1745-1811). 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.

Although Pinel always gave Pussin the credit he deserved, a legend grew up about Pinel single-handedly liberating the insane from their chains at Bicetre. 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 Bicetre 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. [Wikipedia]

Tony Robert-Fleury’s painting turned a historical incident in the all-male Bicêtre of 1793 into a saltier version at the women’s asylum of the Salpêtriére, sometime after 1795. As reported by Pinel’s son, his father had been confronted by Georges Couthon, an official of the Commune during its Reign-of-Terror phase. Couthon was seeking “hidden traitors” to bring to trial. Pinel led him to the cells of the most seriously disturbed, where Citizen Couthon’s attempts at interrogation were greeted with “disjointed insults and loud obscenities.” It was useless to prolong the interviews. Couthon turned to Pinel and asked:

“Now, Citizen, are not you mad yourself to think of unchaining such animals?” Pinel replied:

“Citizen, I am convinced that these lunatics have become so unmanageable solely because they have been deprived of air and liberty….” “Well, then do as you like with them, I give them up to you. But I fear you may become victim of your own presumption.”

The official left, and Pinel removed the chains. He freed twelve of the most violent as an experiment, but, as a safeguard, took care to have made an equal number of “long-sleeved waistcoats fastened at the back” (later to be called straightjackets) should the freed lunatics prove unmanageable. His plan worked, and when Pinel moved his operation from the Bicêtre to the Salpêtrière in 1795, his novel mixture of carrot and stick went with him. He launched the asylum model of firm but supportive care, a model that had the rights of man as its base.

A degree of liberty, sufficient to maintain order, dictated not by weak but enlightened humanity, and calculated to spread a few charms over the unhappy existence of maniacs, contributes, in most instances, to diminish the violence of the symptoms, and in some, to remove the complaint altogether. [FASEB Journal]

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