The Origins of Psychiatry amidst Progress, Humanism, and Power

The history of psychiatry is a peculiar and complex field. It is about the perception of an infirmity, the possibilities of a treatment, the vicissitudes of sufferance. From a broad perspective, diversity is one of the most remarkable features that characterizes such interesting domain of research. Besides the perpetual change in the discipline’s focus, theoretical foundations, public image, and institutional role, psychiatry’s history itself has been approached from a great variety of intellectual viewpoints. Cultural theorists, psychologists, sociologists, historians, literary critics, feminist advocates, practitioners as well as many others have all had, and are having, their say about psychiatry’s famous and infamous past. Not surprisingly, in looking at the fragmentation of the field, some authors have claimed that there is no history of psychiatry, but several histories (Micale & Porter, 1994, p. 4). 

Hôpital Général dit la Salpêtrière

Yet, amid this rich–though sometimes confusing–diversity, there is an episode capable of generating an overall consensus. With the consolidation of a collective memory comes the necessity to address urgent questions such as: When does the history of psychiatry begin? Where should we place the space of genesis? What is the act that marks the commencement of the discipline? In answering these questions, historians point out a common foundational moment: Philippe Pinel’s mythical gesture of freeing the insane at Bicêtre in 1793 and at Salpêtrière in 1795. According to the canonical framework, Pinel (1745–1826) opposed the malevolent Couthon, a member of the Committee of Public Safety during the French Revolution, and bravely ordered to strike the chains off the violent maniacal patients (Weiner, 2011a, p. 281). It is this alleged liberation that, with the publication of the influential Traité and the systematic application of the moral treatment, is said to initiate modern psychiatry.

Philippe Pinel demanding the removal of chains from the insane at Bicetre. A painting by Charles Muller

Pinel, therefore, came to be understood in the conventional narrative of the discipline as the man of providence. Before him there was the confusion of madness, after him there is the warranty of care (Quétel, 2012, p. 247). Indeed, for a long time Pinel’s gesture, work, and personality have been subject to a profound opera of glorification (Vandermeersch, 1994, p. 224). The removal of the shackles is portrayed in sumptuous paintings, streets and squares in Paris recite the name of Pinel, his statue stands at the entrance of the Salpêtrière, his death is periodically honoured by the French medical society, and his face appeared even on postage stamps (Weiner, 1994).  Such efforts tell us a lot of how Pinel’s act came to acquire political meanings, participating in the broader project of the “history of civilization” (Sabourin, 1994, p. 139). Nowadays, this famous act is widely considered a myth crafted by Pinel’s eldest son Scipion together with his pupil Esquirol (Swain, 1977, p. 47). Nonetheless, the image of the chain–breaker persists in contemporary historiography and there is still large agreement in recognizing Pinel as the founding father of psychiatry (Garrabé, 2017; Pietikäinen, 2015; Porter, 2002; Shorter, 1997).    

This mythe d’origine holds an eminent place in the history of the discipline. What appears controversial, however, are the different meanings assigned to the episode. In fact, Pinel’s figure represents the focal point of a fierce, long–lasting, and extensive debate about the purpose of psychiatric care, its scientific status, and its therapeutical ambitions. Taking into consideration a fair sample of the major historical overviews presented by European and North–American authors from 1880s until today, it is possible to delineate three historiographical positions in interpreting Pinel’s act. According to a first position, the liberation of the insane represents the abandonment of superstitions with the culmination of scientific progress (Bromberg, 1954; Selling, 1940; Semelaigne, 1888, 1894; Zilboorg & Henry, 1941). For a second group of historians, on the other hand, Pinel’s gesture conceals the deployment of a subtle and capillary power which inaugurates a new era of subjugation of madness to the medical gaze (Castel, 1977; Foucault, 1961; Gauchet & Swain, 1980; Postel, 1981). Ultimately, a third account looks at the work of the French physician as a genuine act of humanity that opened the doors of knowledge and care (Chazaud, 1996; Weiner, 1999; Porter, 1997, 2002). Philippe Pinel, the man of the gesture, the man of the foundation, thus appears in the historiography as a malleable character (Gineste, 2004). He is at the same time the Illuminé who brought rationality to the study of madness, the Policier who disclosed an apparatus of control, the Bienfaiteur who bestowed benevolence for a new period of therapeutical concerns.

References

Bromberg, W. (1954). Man above humanity: A history of psychotherapy. Philadelphia: Lippincott. 

Castel, R. (1977). L’Ordre psychiatrique: L’âge d’or de l’aliénisme. Paris: Les Èditions de Minuit.

Chazaud, J. (1996). Vous avez dit Pinel? Bicentenaire de l’arrivée de Philippe Pinel à l’hôpital de la Salpêtrière. Histoire des Sciences Médicales, 30(2), 173-177.

Foucault, M. (1961). Folie et Déraison: Histoire de la folie à l’âge classique. Paris: Librarie Plon.

Garrabé, J. (2017). La place de l’histoire dans l’enseignement de la clinique mentale. L’Évolution Psychiatrique, 82(3), 443-468. doi-10.1016/j.evopsy.2017.03

Gauchet, M., & Swain, G. (1980). La pratique de l’esprit humain: L’institution asilaire et la révolution démocratique. Paris: Gallimard.

Gineste, T. (2004). Le lion de Florence: sur l’imaginaire des fondateurs de la psychiatrie, Pinel (1745-1826) et Itard (1774-1838). Editions Albin Michel.

Micale, M. S., & Porter, R. (1994). Discovering the history of psychiatry. New York: Oxford University Press.

Pietikäinen, P. (2015). Madness: A history. London: Routledge.

Porter, R. (1997). The greatest benefit to mankind: A medical history of humanity. London: Fontana Press.

Porter, R. (2002). Madness: A brief history. Oxford: Oxford University Press.

Postel, J. (1981). Genèse de la psychiatrie: Les premiers écrits psychiatriques de Philippe Pinel. Paris: Le sycomore.

Quétel, C. (2012). Histoire de la folie: De l’Antiquité à nos jours. Paris: Tallandier.

Sabourin, P. (1994). Pinel et son geste ou l’autre chaîne des désirs. In J. Garrabé, Philippe Pinel. Paris: Les Empêcheurs de penser en rond. (pp. 139-156).

Selling, L. S. (1940). Men against madness. New York: Greenberg Publisher.

Semelaigne, R. (1888). Philippe Pinel et son oeuvre au point de vue de la médecine mentale. Paris: Imprimeries Réunies.

Semelaigne, R. (1894). Les grands aliénistes français (Premiere Tome). Paris: Steinheil Editeur.

Shorter, E. (1997). A history of psychiatry: From the era of the asylum to the age of Prozac. New York: Wiley.

Swain, G. (1977). Le sujet de la folie: Naissance de la psychiatrie. Toulouse: Edouard Privat Editeur.

Vandermeersch, P. (1994). “Le mythes d’origine” in the History of Psychiatry. In M. S. Micale & R. Porter, Discovering the history of psychiatry. New York: Oxford University Press. (pp. 219-231).

Weiner, D. B. (1994). “Le geste de Pinel”: The history of a psychiatric Myth. In M. S. Micale & R. Porter, Discovering the history of psychiatry. New York: Oxford University Press. (pp. 232-245).

Weiner, D. B. (1999). Comprendre et soigner: Philippe Pinel (1745-1826): la médecine de l’esprit. Paris: Fayard.

Weiner, D. B. (2011). The Madman in the Light of Reason. Enlightenment Psychiatry. Part II. Alienists, Treatises, and the Psychologic Approach in the Era of Pinel. In E. R. Wallace & J. Gach, History of psychiatry and medical psychology: With an epilogue on psychiatry and the mind-body relation. New York: Springer. (pp. 281-303).

Zilboorg, G., & Henry, G. W. (1941). A history of medical psychology. New York: W.W. Norton.

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