Philippe Pinel

Philippe Pinel (1745-1826) was, arguably, the first psychiatrist. This has to be a qualified statement because a number of ‘alienists’ (the term itself deriving from Pinel’s ‘mental alienation’) in Britain, France, Germany and Italy were coming to the same conclusions about the causes and most efficacious treatment of insanity at the same time.

However, Pinel was the first both to theorise and to put his theory into practice, and thus his writings gained immediate authority. He made a powerful impression on John Conolly, who read his work, and Esquirol’s, in the original French.

ITable showing the food received by patients at Salpêtrière, from: Philippe Pinel. Traité m?dico-philosophique, sur l’aliénation mentale. Paris: Antoine Brosson, 1809 [Institute of Psychiatry Historical Collection h/Pin]n Pinel’s writings and career there are several features which were to impress themselves on the subsequent history of both psychiatry and psychotherapy. Both the hospitals where he worked (the Bicêtre and the Salpêtrière) were public, rather than private, and did not look after wealthy patients.

Pinel had no magic therapies to offer: his ‘moral treatment’ consisted of a routine of regular activity, work, a clean and quiet environment and humane treatment of patients by attendants. Asylums in the following century attempted, with greatly varying degrees of success, to follow this prescription. He inaugurated the collection of statistics on his patients, as shown here.

Although he is associated in the collective imagination with the image of unchaining the patients at the Bicêtre in a way that appealed to a populace inflamed with the passions of the French Revolution, neither he nor any other alienist could afford to abandon mechanical restraint altogether; they could, however, seek to make it less degrading. Much depended on the commanding presence of the alienist, who could instil obedience in his patients.

There were other aspects of Pinel’s practice which did not re-emerge until the twentieth century. One was an imaginative approach to what would now be called psychotherapy, using dramatic performance. In one famous case, that of a tailor who was convinced that he had been accused of causing the execution of Louis XVI, the patient was ‘acquitted’ at the end of a mock trial, which apparently cured him of his delusions. Although Pinel rejected the ancient notion that insanity was caused by demonic possession, he had no new nosology of mental disorders to offer.

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