-A. LorenzoA Treatise On InsanityThe compilations of works and experiences were written by Philippe Pinel, who was a psychiatrist during the late 18th to the early 19th century contributed greatly to the development of the medical philosophy of Moral Treatment. Pinel is regarded by history as the “father of modern psychiatry†and one of the founders of Moral Treatment, or otherwise known as Moral Therapy, whose goal was to cure insanity by titillating the intellectual properties and emotional properties of the patient, rather than physically and psychologically punishing the patient. Unlike the physicians of the time, Pinel tried to break away from the conservative and chained techniques of medical treatments on lunatics and this can be manifested in his works La Bicetre as well as in the asylum for destitute women known as Salpetriere.
Prior to his positions as a physician in these two asylums, he played a significant role in the development of the French Revolution as he was an editor of the Gazette de Sate, and joined the intellectual life of the salons, even meeting the acquaintance of men such as Cabanis and Condorcet, both of whom would play a key role in the Revolution. It is evident that Pinel was influenced by the concepts of the Enlightenment, particularly the works of Locke, Voltaire and medical thinkers such as William Battie, who published the Treatise on Madness in 1758. One can see the manifestation in Pinel’s works as well as how he addresses his patients.
Like many physicians in Europe, Pinel was an advocate of the Enlightenment and its humanitarian reforms instead of the ancient regimen of medical physicians during pre-Revolutionary France. He saw his patients as individuals worthy of inclusion in the human fraternity, under the auspices of Revolutionary ideology and philosophy. Pinel followed the dead of Pussin and made it known that patients should be treated with kindness and mercy rather than chains and physical abuse, and unchained the residents of La Bicetre, allowing them to wander freely around the hospital grounds. Additionally, his Moral Treatment also mandated that patient’s quarters should be sunny and well ventilated instead of being dark dungeons. After he made similar reforms in La Salpetriere, his students and followers would later establish 10 new mental hospitals throughout France while complying with the ideology of Moral Treatment.
Pinel’s history as an editor for a paper, medical physician, director of two large asylums and one who had some manner of political clout in the revolution is manifested in his writings in A Treatise on Insanity. His choice of words and linguistic skills are that of a skilled writer, and subjective reasoning are quintessential to that of the late 18th century, particularly regarding his view on personal rights and fraternal bonds. He writes A Treatise on Insanity namely because of his personal abhoration towards the works on the deranged and lunatics, namely is seen in page 166 of the book Medicine and Western Civilization, “On my entrance upon the duties of that hospital, everything presented to me the appearance of chaos and confusion. Some of my unfortunate patients laboured under the horrors of most gloomy and desponding melancholy,†and his innate will to change that status quo as seen in page 167, “I determined upon adopting such a variety of measures, both as to discipline and treatment, as my patients required and my limited opportunity permitted.†By this he regards to his system of Moral Treatment, which would then become the founding pillar of modern psychiatry in therapeutic communities and occupational therapy.
From reading Philippe Pinel’s work, I can’t help but realize that he writes this book as a personal witness to the horrid conditions of medicine in the past, and writes to be heard by future generations of physicians, to influence the future of psychiatry and in the overall treatment of patients not just as cases, but as human beings. He tries to instill in the writer a sympathetic view towards the patient, through the specific cases he mentions and the lives that could have been saved had Moral Treatment been utilize. He writes, like all medical authors before him, to shed light in understanding of human mind concerning insanity and what can be done to help the situation. This can be seen in paged 168, “The facts which I have thus collected are now submitted to the consideration of the public, in the form of a regular treatise. Few subjects in medicine are so intimately connected with the history and philosophy of the human mind as insanity. There are still fewer where there are so many errors to rectify and so many prejudices to remove. It is on the other hand to be lamented, that regular physicians have indulged in a blind routine of inefficient treatment, that regular physicians have indulged in a blind routine of inefficient treatment, and have allowed themselves to be confined within the fairy circle of agement of the mind. Thus, too generally, has the philosophy of this disease, by which I mean the history of its symptoms, of its progress, of its varieties, and of its treatment in and out of hospitals, been most strangely neglected.â€
Some of the outside factors that might be shaping and influencing Philippe Pinel’s approach towards the treatment of deranged patients are the Enlightenment, the understanding of social etiquette, and the political discourse in his time, namely the fall of an absolute monarchy and the rise of a republican government. Considering the fact that Pinel was an editor for gazette that helped spread revolutionary and enlightenment ideas, it isn’t surprising that he implemented those same revolutionary ideals towards his patients in La Bicetre and La Saltpetriere. An example of this was how he freed all his patients from the chains of bondage that once contained them, he dictated that all cells be well-lit, as well as cleaned and allowed the patients to wander about the hospital grounds. This correlates to the core enlightenment ideals of the universal rights of humans, and manifested the new ways of the Republic, considering that the old custom of beating patients, chaining patients and placing them in dark dungeons were prevalent during the age of the absolute monarchy.
This of course is an example of how Pinel’s procedures were affected by political discourse, one example of this was when the governor came to the asylum and told the patients of their innate rights as fraternal brothers and dictated to them to tear down the images of the Virgin Mary, which once was revered by the patients prior to the Revolution. Pinel allowed this to happen, and made witness of how the humanity of the deranged was still intact, and made point of the progress of Moral Treatment. Pinel’s view stressed that mental disorder was not due to physical distortion of the human brain, but by hyper imaginations, by sensitivities and stressed the necessity to treat the patient with sympathy and patience in order to titillate their intellect and moral will vis-à -vis Moral Treatment.
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