Philippe Pinel

Philippe Pinel was born in Languedoc, France, in 1745 to a medical family. Despite his initial desire for a religious career, he enrolled in the local Faculty of Medicine. He was dissatisfied with his medical education however, and began to explore mathematics and physical sciences before moving to Paris to further his medical career. He failed in applying for a scholarship for poor students to train medically in Paris, and became disillusioned with the Parisian medical system as a whole and argued it was oriented around elitist and professional medicine.

Pinel was employed as a medical journalist, and the editor of the Gazette de santé in 1784 where he published articles exploring hygiene and mental disorders. Following a friend of Pinel’s tragic experience with mental illness, Pinel began to be interested in mental illness, which led him to apply for a job at an asylum in Paris, where he became a physician, but could not reach higher status due to his lack of a Parisian medical qualification. In 1792 he became chief physician of Bicêtre in Paris, and found the conditions for patients dreadful, with many physically chained and some put on display for public demonstration. Due to the declining influence of Parisian medicine as a result of the French Revolution, the following year, Pinel was promoted and began to implement his ideas of human treatment, leading to the infamous unchaining of the patients. Pinel saw mental illness as the result of excessive exposure to social and psychological stresses, and in some cases, of heredity and physiological damage, differing from the preconceived notions of mental illness. In 1795 Pinel was appointed chief physician of the Hospice de la Salpêtriè, where he presided over 5,000 pensioners, aged women, and chronically ill patients. He also worked as a professor of medical pathology.

Pinel’s legacy is one of a transformer of asylum practice and one of the founders of moral treatment. Pinel believed that people under his care should be treated like patients rather than like animals or criminals, as they previously were. His “moral treatment” is perceived as the first attempt at individual psychotherapy, and employed methods of gentleness, understanding, and goodwill. He did not agree with violent techniques, and emphasised the importance of hygiene, physical exercise, and a programme of purposeful work for patients. Many of his methods are still in use today.

In 1798 Pinel published his Nosographie philosophique (“Philosophical Classification of Diseases”) where he distinguished various psychoses and described, among other phenomena, hallucination, withdrawal, and a variety of other symptoms. Pinel was insistent upon a philosophy grounded medicine, and spoke of the philosophical foundations of a medicine of insanity. His works emphasised the systematic classification of disease, and believed that a given disease was “an indivisible whole from its commencement to its conclusion, a regular ensemble of characteristic symptoms.” Nosographie did not go without its criticisms, for example that Pinel’s classification symptoms grouped some unrelated disorders, and that he paid little attention to morbid anatomy.

See Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century,  for more info, who explores Pinel’s role in context, and looks at the importance of sensationalist philosophy and the impact of the Rosseauan sentimentality on a therapy which sought to isolate “lunatics” from the corrupting influences of civilisation.