Esquirol

Jean-Étienne Esquirol (1772-1840) was one of Pinel’s students at Salpêtrière. Although he imbibed his master’s therapeutic nostrums and helped to disseminate them through his many students, his principal contribution to the history of psychiatry is his revision of the orthodox nosology of mental disorders.

An inmate of Bethlem Hospital in 1814, who has been identified as William Norris, from Jean-Étienne Dominique Esquirol's Des maladies mentales. Brussels: Libraire médicale et scientifique de JB Tircher, 1838 [Institute of Psychiatry Historical Collection h/Esq]From the time of Galen, humouralism had dominated discussions of all types of disorder. Mania, melancholia, dementia and idiocy were the four categories of disorder which had to accommodate all types of symptoms. Esquirol initiated the modern classification of disorders. He inched away from the vague concept of melancholia to the modern concept of depression through the intermediate concept of ‘lypemania’, which had the merit of being less imprecise than that of melancholia. According to him, lypemania was ‘a disease of the brain characterised by delusions which are chronic and fixed on specific topics, absence of fever, and sadness which is often debilitating and overwhelming’. This definition was criticised at the time for being too expansive, as it overlapped with paranoid and delusional states.

However, it was precisely in the area of paranoia, via ‘monomania’, that Esquirol made his most crucial distinctions. Esquirol defined monomania as the overvaluation of a single idea, as opposed to the excess of all brain functions apparent in mania. Monomania could be accompanied by delusions or hallucinations, but with the intelligence preserved. For alienists this distinction was important because it helped them determine which cases could be ‘cured’. His description of one type of monomania, which he defined as ‘intellectual’, corresponds closely to our understanding of paranoia:

There are monomaniacs who do not appear insane, whose ideas retain their natural associations and whose reasoning is logical and their speech coherent, often lively and full of spirit … However irrational their actions might be, the monomaniacs have more or less plausible arguments to justify them, in the manner that one might say they are rational madmen.

This copy was owned by John Conolly. The plate depicts an inmate of Bethlem Hospital in 1814, who has been identified as William Norris.

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