Philippe Pinel

PINEL, Philippe (1745–1826), a French physician of the era of the Great French Revolution who removed the chains from psychiatric patients, thereby taking the first important step toward the further progress of theoretical and practical psychiatry. After graduating from the medical faculty in Montpellier, Pinel arrived in Paris in 1777, where he initially engaged in translating and tutoring. Moving in the circles of the progressive intelligentsia, he became close friends with Cabanis, a prominent representative of revolutionary medical thought who demanded, on behalf of the "third estate," radical reforms of the Parisian hospitals, which were characterized by extreme overcrowding and unsanitary conditions. The plight of psychiatric patients was especially severe; they were completely deprived of medical care, and restless patients ("the violent") were confined in the casemates of Bicêtre and Salpêtrière alongside criminal offenders and vagrants. Starting in 1784, Pinel edited the first hygienic journal (Gazette de santé) and at the same time began practicing psychiatry in a private asylum where one of his friends was kept. Already after the Revolution, appointed upon Cabanis's recommendation to the post of physician at Bicêtre (and shortly thereafter at Salpêtrière), Pinel performed the act that immortalized his name: he freed psychiatric patients from their chains, established a therapeutic regime, medical rounds, patient walks, and organized occupational therapy processes, which occupied a major place in his theoretical views on the therapy of psychoses. Despite the fact that Pinel still permitted the use of the straitjacket, the reform he carried out presented such a striking contrast to former barbarism that Pinel's name invariably served as the banner of progressive currents in institutional psychiatry throughout the 19th century. The logical culmination of Pinel's ideas was the reform by the Englishman Conolly, who entirely abolished all coercive measures (the "no restraint" system). Together with his direct pupil and assistant Esquirol, Pinel is one of the founders of psychiatry as a science. In this regard, a major role was played by Pinel's monograph: Traité médico-philosophique sur l'aliénation mentale ou la manie (Paris, 1801). It set forth the first theoretical foundations of institutional psychiatry, building planning, placement of patients by wards, and so forth. Although Pinel does not directly refer to the philosophers of the French Enlightenment, all his views are permeated by their scientific-methodological premises: he taught the strictly empirical study of patients, abstention from any metaphysical hypotheses in psychiatry, and the like. In addition to the aforementioned work on psychiatry, he authored a textbook on internal diseases that went through a number of editions (Nosographie philosophique ou méthode de l'analyse appliquée à la médecine, vols. I–II, Paris, 1798).