Philippe Pinel et le secret des Anglais

Introduction

Philippe Pinel's Traité médico-philosophique de l’aliénation mentale (1800) is considered the foundational act of French psychiatry. Since the 1960s, it has been the subject of remarkable studies. Focusing on the difference between the two editions of the Traité regarding moral treatment, this article explores the contemporary issues raised by Pinel's work.

Method

Following the successive stages of Pinel's medical career: in Paris before his time at the Bicêtre hospital as a translator and a popularizer of medical literature with limited clinical experience, at Bicêtre where he met Pussin, and finally at La Salpêtrière where he was widely known. I study the evolution of his scientific medical project and his attempts to extend it to cover the question of insanity and, in particular, moral treatment. The two editions of the Traité reflect this evolution.

Result

Influenced by English texts on the efficacy of moral treatment of insanity, Pinel discovered it practiced at Bicêtre by Pussin and his wife. He writes about this effectiveness and presents its principles in the first edition of his Traité. These remained equivocal, combining gentleness and firmness, and cautiously encouraging the distraction of the insane. The second edition presents the result of the rationalized application of these principles at La Salpêtrière, in line with their initial scientific ambitions. Principles of moral treatment have become unequivocal and aim to act directly on the disease in spite of the patient: importance of the “single center of authority,” distraction imposed by sewing workshops, baths, and a “calculated” environment. I hypothesize that this systematization denatures the origins of the moral treatment, which consists of: 1/ the moral therapist's identification of a “rest of reason” in the lunatic; 2/ guiding the skillful, pragmatic application of social practices well identified at the time: reasonable consent to a just law and distraction in an emotional refuge, which reinstitute the alienated individual as an agent.

Discussion

I place my work in the continuity and updating of the work of G. Swain and M. Gauchet, resituated among the major interpreters of Pinel's work.

Conclusion

The evolution of moral treatment in Pinel's work illustrates the temptations and risks involved in substituting rational treatment for reasonable care.