Esquirol, Jean-Étienne-Dominique

   (1772–1840)

   Founder of the French tradition of psychiatric nosology, Esquirol was born in Toulouse into a noble family—his father was president of the chamber of commerce—and began his medical studies there in 1792. In 1799, he went up to Paris and started auditing Philippe Pinel’s courses at the Salpêtrière hospice. "It was that day that decided his fate," wrote psychiatrist René Semelaigne (1855–1934) many years later in his dictionary of French psychiatrists. "These two elite beings felt their mutual attraction to each other. Esquirol became Pinel’s favorite student. Each day, Esquirol went to the Salpêtrière, accompanying his chief on rounds, helping him in his work. It was Esquirol who wrote [Pinel’s] treatise of Clinical Medicine (La Médecine clinique), the first edition of which came out in 1802 (I, p. 126). As a result of all these interruptions, only in 1805 at age 33 did Esquirol manage to defend his doctoral dissertation on The Passions . . . as a Cause of Mental Illness (Les Passions considérées comme causes . . . de l’aliénation mentale) and graduate with an M.D. He argued, as Pinel had done, for the gentle treatment of those with mental illness and said they were not unlike patients with other kinds of medical illnesses. In 1811, Esquirol joined Pinel on the medical staff of the Salpêtrière, where he remained until 1825 when the post of chief-physician at the national asylum in the Paris suburb of Charenton became vacant. Meanwhile, in 1802 Esquirol began taking a few wealthy patients into his private house across from the Salpêtrière. In 1827, he moved this establishment to vast new grounds at Ivry, and in his later years divided his time between Charenton and his private sanatorium, where he regularly entertained his students with memorable meals. (Semelaigne remembered Jacques-Joseph Moreau, called Moreau de Tours [1804–1884], at age 80, speaking almost with tears in his eyes of those Sunday dinners.) Although Esquirol was much involved with medical education (he initiated France’s first course of psychiatry lectures in 1817) and with the reform of France’s asylums, in retrospect he has mainly been remembered for his attempts to refine psychiatric diagnosis with such terms as "monomania" and "lypemania" (see Psychosis: Emergence: Esquirol’s monomania, [1816, 1838]; Depression: Emergence: lypemania [1820]). In a three-volume work, On Mental Illness (Des maladies mentales), published in 1838, he reprinted a number of his earlier essays, bringing some of them up to date. Esquirol really represents the beginning of all classification in psychiatry, given that William Cullen had so little experience and classified on the basis of abstract principles.