Pinel, Philippe

   (1745–1826)

   One of the founders of modern psychiatry, Pinel was born into a medical family in a village near Castres in southwest France, graduating as doctor of medicine from Toulouse in 1773. In 1778, he came up to Paris, making a meager living as a medical journalist. In 1786, he received a staff post at the "Maison Belhomme," a boarding house for psychiatric patients owned by a non-physician. Pinel greeted the French Revolution in 1789, and between 1793 and 1795 found himself chief physician of the Bicêtre hospice, a large institution for men in need of care that also included a psychiatric division. Here, he attempted to introduce psychological treatments of various kinds (called moral treatment, or le traitement moral). To generally make the care of patients more benevolent, Pinel gave the nonmedical supervisor Jean-Baptiste Pussin (1746–1811) latitude to remove the chains from the patients (for which Pinel himself, rather inexactly, has historically received the credit). In 1794, he became a professor at the newly founded École de santé (health school) of revolutionary Paris, and in 1795 became the chief physician of the Salpêtrière hospice, the equivalent of Bicêtre for women, where he remained until his death. In addition to his enlightened techniques for the management of psychiatric hospitals, Pinel is remembered for his 1785 translation of William Cullen’s nosology (in French as Institutions de médecine pratique) and for a classification of mental illnesses in his big textbook, Medical-Philosophical Treatise on Mental Illness (Traité médico-philosophique sur l’aliénation mentale) (1801), one not based on Cullen.

   By the second edition of his Treatise in 1809, Pinel’s nosology had migrated from an emphasis on mania (which he understood as generalized insanity [délire général]) to include melancholia (or partial insanity [délire exclusif]); "dementia" (or "abolition of thought"), usually meaning in the writings of these older authors incoherent thought rather than loss of intelligence; and finally "idiotism" (or "obliteration of the intellectual and affective faculties"), either primary (from birth) or acquired. As French historian of psychiatry Jacques Postel points out, this second edition of Pinel’s book, which now included his experiences at the Salpêtrière, "showed the importance of relations with the family, the community and other patients in the origins, the duration, and the exacerbation of mental illness. He emphasizes discipline, the regulation of the patients’ daily lives, their rigorous classification, and the isolation of the most dangerous" (Postel, in Morel’s Dictionnaire biographique de la psychiatrie, p. 196). As for pharmacotherapy, Pinel held little of it: "Pinel was one of those physicians who reacted most strongly against the abuses of polypharmacy [multiple medications]," wrote René Semelaigne in 1888, a later-born psychiatrist whose family had memories of Pinel (Semelaigne, Pinel, p. 130). Of Pinel’s many pupils, Étienne Esquirol later became most noted.