Moral treatment
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| - | :''see [[French psychiatry]]'' | ||
| - | '''Philippe Pinel''' ([[April 20]], [[1745]] - [[October 25]], [[1826]]) was a French physician who was instrumental in the development of a more humane approach to the custody and care of [[psychiatric hospital|psychiatric patients]], referred to today as [[moral treatment]]. He also made notable contributions to the [[classification of mental disorders]] and has been described by some as "the father of modern psychiatry". In modern commentary, [[Michel Foucault|Foucault]]'s influential book, ''[[Madness and Civilization|Madness and Civilization]]'' focuses on Pinel, along with [[William Tuke|Tuke]], as the driving force behind the shift from physical to mental oppression. | ||
| - | == Biography == | + | '''Moral treatment''' was an approach to [[mental disorder]] based on humane [[psychosocial]] care or [[moral]] discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from [[psychiatry]] or [[psychology]] and partly from [[religious]] or [[moral]] concerns. The movement is particularly associated with reform and development of the [[psychiatric hospital|asylum]] system in Western Europe at that time. It fell into decline as a distinct method by the 20th century, however, due to overcrowding and misuse of asylums and the predominance of biomedical methods. The movement is widely seen as influencing certain areas of psychiatric practice up to the present day. There has been criticism that the approach blamed or oppressed patients according to the standards of a particular [[social class]] or [[religion]]. |
| - | He was born in [[Saint-André]], [[Tarn]] the son and nephew of physicians. After receiving a degree from the faculty of medicine in [[Toulouse]], he studied an additional four years at the Faculty of Medicine of [[Montpellier]]. He arrived in Paris in [[1778]]. | + | ==See also== |
| - | + | * [[Deinstitutionalisation]] | |
| - | He spent fifteen years earning his living as a writer, translator, and editor because the restrictive regulations of the old regime prevented him from practicing medicine. The Paris faculty did not recognize a degree from a provincial university like Toulouse. He failed twice in a competition which would have awarded him funds to continue his studies. In the second competition the jury stressed his ‘painful’ mediocrity in all areas of medical knowledge, an assessment seemingly so grossly incompatible with his later intellectual accomplishments that political motives have been suggested. Discouraged, Pinel considered emigrating to America. In 1784 he became editor of the not very prestigious ''[[Gazette de santé]],'' a four-page weekly.<br><br> | + | * [[Moral insanity]] |
| - | At about this time he began to develop an intense interest in the study of [[mental illness]]. The incentive was a personal one. A friend had developed a ‘nervous melancholy’ that had ‘degenerated into mania’ and resulted in [[suicide]]. What Pinel regarded as an unnecessary tragedy due to gross mismanagement seems to have haunted him. It led him to seek employment at one of the best-known private sanatoria for the treatment of insanity in Paris. He remained there for five years prior to the Revolution, gathering observations on [[insanity]] and beginning to formulate his views on its nature and treatment. | + | |
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| - | Pinel was an Ideologue, a disciple of the [[Étienne Bonnot de Condillac|abbé de Condillac]]. He was also a clinician who believed that medical truth was derived from clinical experience. [[Hippocrates]] was his model. | + | |
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| - | During the 1780s Pinel was invited to join the salon of [[Madame Helvétius]]. Pinel was in sympathy with the Revolution. After the revolution, friends he had met at Madame Helvétius’ salon came to power. In August 1793 Pinel was appointed "physician of the infirmeries" at [[Bicêtre Hospital]]. At the time it housed about four thousand imprisoned men--criminals, petty offenders, syphilitics, pensioners and about two hundred mental patients. Pinel’s patrons hoped that his appointment would lead to therapeutic initiatives. His experience at the private sanatoria made him a good candidate for the job. | + | |
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| - | Soon after his appointment to 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]], onto the staff of the hospice. | + | |
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| - | Appreciating Pussin’s outstanding talent, Pinel virtually apprenticed himself to that unschooled but experienced custodian of the insane. His purpose in doing this was to "enrich the medical theory of mental illness with all the insights that the empirical approach affords. What he observed was a strict nonviolent, nonmedical management of mental patients came to be called [[moral treatment]], though psychological might be a more accurate translation of the French ‘moral’. | + | |
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| - | Although Pinel always gave Pussin the credit he deserved, a legend grew up about Pinel single-handedly liberating the insane from their chains. This legend has been commemorated in paintings and prints. In fact Pinel condoned the use of threats and chains when other means failed. It was Pussin who replaced iron shackles with straitjackets at Bicêtre in 1797, after Pinel had left for the Salpêtrière. Pinel followed Pussin's example three years later, after bringing Pussin to the Salpêtrière. | + | |
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| - | While at Bicêtre Pinel did away with bleeding, purging, and blistering in favor of a therapy that involved close contact with and careful observation of patients. Pinel visited each patient, often several times a day, and took careful notes over two years. He engaged them in lengthy conversations. His objective was to assemble a detailed case history and a natural history of the patient's illness. In his book ''Traité médico-philosophique sur l'aleniation mentale; ou la manie'', published in [[1801]], Pinel discusses his psychologically oriented approach. This book was translated into English by [[David Daniel Davis|D. D. Davis]] as a ''Treatise on Insanity'' in [[1806]]. It had an enormous influence on both French and Anglo-American psychiatrists during the [[nineteenth century]]. | + | |
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| - | In 1795, he became chief physician of the [[Hospice de la Salpêtrière]], a post that he retained for the rest of his life. The Salpêtrière was, at the time, like a large village, with seven thousand elderly indigent and ailing women, an entrenched bureaucracy, a teeming market and huge infirmaries. Pinel missed Pussin, and in 1802 secured his transfer to the Salpêtrière. Pinel created an inoculation clinic in his service at the Salpêtrière in 1799 and the first vaccination in Paris was given there in April 1800. A statue in his honour stands outside the Salpêtrière. | + | |
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| - | In [[1795]] Pinel was also appointed as a professor of medical pathology, a chair that he held for twenty years. He was briefly dismissed from this position in 1822, with ten other professors, suspected of political liberalism, but reinstated as an honorary professor shortly thereafter. | + | |
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| - | 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 establishes him as the last great [[nosology|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]]. | + | |
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| - | 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. | + | |
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| - | 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]] in [[1826]]. | + | |
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Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns. The movement is particularly associated with reform and development of the asylum system in Western Europe at that time. It fell into decline as a distinct method by the 20th century, however, due to overcrowding and misuse of asylums and the predominance of biomedical methods. The movement is widely seen as influencing certain areas of psychiatric practice up to the present day. There has been criticism that the approach blamed or oppressed patients according to the standards of a particular social class or religion.
See also
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