Pinel
Philippe Pinel
Achievements: Advances in the care of the mentally ill
Born: April 20, 1745; Saint-Andre, Tarn, France
Died: October 25, 1825; Paris, France (Aged 80)
Field & Discipline: Medicine; Physician
Language: French
Father: Dr. Pinel
Mother: Elizabeth Dupuy
Siblings: Unknown
Spouse: 1) Jeanne Vincent; 2) Marie-Madeleine Jacquelin-Lavallee
Children: by Vincent: 3 sons
Education: College de Lavaur; College de l'Esquille, Toulouse; University of Toulouse
Major Work:
"Nosographie philosophique" (1798)
"Traite medico-philosophique e l'alienation mentale" (1801,"Medicophilosophical Treatise on Mental Alienation")
"Clinical Medicine" (1802)
Life & Times:
After gaining his degree in 1773, Pinel went to Montpellier where he attended lectures at the medical school and observed clinical practice at the hospitals. He supported himself through his studies by tutoring in mathematics, writing medical articles and ghosting doctoral theses.
In 1778 he went to Paris where he continued his studies and met [met] Franklin*, an event which led him for a while to contemplate emigrating to America.
In 1783 the illness of a close friend led Pinel to take an interest in mental diseases and he began to visit mental patients in private institutions and to write and translate articles on the subject. He had already thought about more humane treatment for the mentally ill, something which had earlier been advocated by the Italian anatomist [influenced by] Valsava*, but the profession rejected his suggestions.
In 1793, when he was appointed physician at the Paris Bicetre hospice, Pinel began to put these ideas into action. He ordered the chains to be removed from the insane, an action afterwards commemorated in popular prints.
Pinel was a moderate revolutionary and during the period of Terror in the French Revolution he did what he could to help his friends amongst whom was the philosopher the [a pal of] Condorcet*.
In 1794 he became a professor at one of the newly established medical institutes and a year later was made became chief physician at the Salpetriere, one of the large public hospitals in Paris. He worked primarily on classification, at the time a major preoccupation in several scientific fields.
His anatomical work and his job as a professor of medical pathology at the medical institute gave him a firm belief that observation and analysis of symptoms made a classification of disease possible. This was in contrast to the older view that a patient was diseased, rather than suffering from a specific disease.
In 1798 Pinel published his "Nosographique philosophique". He introduced five classes of diseases: fevers, inflammations, haemorrhages, neuroses and organic lesions, with subdivisions in each category. His work was written as a textbook and was one of the most influential of its time.
The anatomist [influenced] Bichat* recorded his debt to Pinel and a generation of physicians, among whom [influenced] Broussais* became the most eminent, introduced close clinical observation and analysis of findings into their clinical practice. Pinel amended his findings through several editions although he never recognised puerperal fever as a specific condition.
He made an attempt to produce tables of probability for the occurrence of several diseases, their course of development and their prognoses. In this he anticipated the later work of [anticipated] Louis* who applied what he called ‘numerical’ method to the data he collected.
Although he recognised the place of psychosomatic thought in the progress of disease, and conducted experiments to test the efficacy of medicines, Pinel's clinical therapy was not innovative. He would not use quinine, even for malaria, or prescribe opiates for pain. However, he adopted the new technique of percussion and the use of the stethoscope, introduced by [used instrument by] Laennec*. He also established a clinic at the Salpetriere in 1799 where the first vaccination in Paris was administered.
In his work with the mentally ill, Pinel was a true pioneer. In 1799 he published a resume of his research and in 1801 brought out his "Traite medico-philosophique e l'alienation mentale" ("Medicophilosophical Treatise on Mental Alienation") which helped to establish psychiatry as a distinct branch of medicine. Although he kept the old classifications of manic, melancholic, demented and idiotic, he made distinctions within these categories.
One of his most important advances was to reject all metaphysical speculation about mental disease and to attack the idea of demonic possession. He thought disorders
of the emotions were the primary cause of mental dysfunction, and also considered the influence of heredity, a disposition to morbidity and individual sensitivity.
In his treatment with the mentally ill, he undertook what amounts to the first attempt at individual psychotherapy. He rejected violent measures such as purging and bleeding and advocated treating patients gently but firmly with sympathetic goodwill.
He anticipated modern psychiatric care in many of his beliefs, such as the importance of physical exercise and good hygiene, the provision meaningful work therapy for the patient and setting aside time to discuss their lives and emotions with them.
He extended his reforms to training for those caring for the mentally ill and with the administration of the institutions in which they were confined, with inmates housed according to their category of illness.
Pinel's observations helped to stimulate research into the brain by [work influenced] Gall* & Spurzheim*, and by the anatomical work of [work influenced] Combe*. Pinel was an honoured member of the medical establishment in France.
Assessment: Pinel is remembered today for his pioneering attempts to introduce humane treatment for the mentally ill and for paving the way for psychiatry as a
separate discipline.
Oneliner: Phillippe Pinel, mental health pioneer
Bibliography:
- Ackerknecht, Erwin H, Medicine at the Paris Hospital 1794-1848, John Hopkins Press, Baltimore, 1967.