Phillippe Pinel And The Advent Of The Moral Treatment Of The Mentally Ill Essay, Research Paper

Throughout history, mankind has been afflicted with disease and failing health. They have ranged from infections to broken bones to psychopathologies. How mankind treats his weaker brethren is a true reflection of the culture in which he or she resides. To treat the sick poorly denotes selfishness and egocentrism whereas to treat the ill humanely denotes gentleness and self-sacrifice. Sometimes, however, barbaric treatment of the ill, mental illness in particular, is a result of ignorance. The different are scorned, feared, made an object of amusement for their actions and beliefs. They were, and perhaps still are, regarded as buffoons whose strange behaviour and rants are considered a novelty. Apocalyptic prophets, those claiming to be the new Messiah, and loonies who feel that the CIA is the cause of winter are laughed at and belittled (though I for one would not be laughing so hard should the Ragnarok arrive come year 2000 A.D.) The Dark Ages especially were marked with this kind of mentality with regards to the mentally ill, who were considered social misfits and were condemned in the same manner as criminals, prostitutes and the like. This no doubt exacerbated their health, and a vicious cycle of depravity arose out of experienced depravity. Even more cruel were the demonological exorcisms and witch trials that were born out of ignorance of the mentally ill. While there were small advances in the treatment of the mentally ill, such as Hippocrates fathering the concept of somatogenesis and Vincent de Paul+s methodology of treating the depraved and lunatics, it wasn+t until Phillipe Pinel unchained the |inmatesX at La Bicetre, a large asylum in Paris that the humane treatment of the mentally ill took hold.

Demonology was the first, and for hundreds of years, the most influential rationale of mental illness. Demonological thinking was apparent in Babylonia, China, Greek, and Egypt. In Babylonia, there was a specific demon for every disease . The Hebrews believed that aberrant behaviour was caused by possession by spirits who were able to enter the body after God in his infinite wrath removed his protection from the individual possessed. The normal treatment for illness would be to exorcise the demons from the body by making the host uninhabitable. This would include dousing with holy water, proximity to holy relics, or more extreme measures like flogging, torture and starvation.

In the fourth centure A.D., Hippocrates dismissed supernatural causes for disease . He was the first somatogenecist (I hope that that+s spelled correctly). He claimed that all diseases had a bodily, natural cause, and therefore all diseases have a bodily, natural cure. He dismissed the divine providence of monks, clerics and magicians. A natural causation and treatment theory became the foundation of Pinel+s work more than twenty-one centuries later.

The death of Galen, the last of the greek physicians trying to preserve the Hippocratic tradition, in the second century ushered in the Dark Ages of medicine, where, once again, ignorance and fear reigned supreme. Demonology returned with the explosion of the Christian religion. It was considered that peoples+ madness was affected by the moon, and that is where the terms |lunaticX and |lunacyX are derived from. That mentality graduated into an obsession with the devil, and an effort to cleanse the populace of His influence. Thus began the infamous witch hunts. Pope Innocent VIII demanded that every member of the clergy focus his attention on relieving Europe of Satan. He ordered two Dominican monks, Johann Sprenger and Heinrich Kraemer, to act as inquisitors. Two years later, they published the manual Malleus Maleficarum (the witches+ hammer). This was a comprehensive tome on witchcraft with descriptions of how to determine whether or not someone was a witch, and what the punishment/treatment should be. Of course, it was mostly women who were accused of witchcraft, as The Malleus reads:

All witchcraft comes from the carnal lust which is in women insatiable, and that three general vices appear to have special dominion over wicked women, namely, infidelity, ambition, and lust. Therefore, they are more than others inclined towards witchcraft who more than others are given to these vices…Those amoung ambitious women are more deeply affected by their filthy lusts.

Pinel never accepted such supernatural explanations, always believing in natural causes and explantions of all diseases. He explains demonology as such:

…Can we suppose the demoniacs, whose histories are recorded in theological writings, to be any more than extravagant maniacs? We need only visit a lunatic asylum in order to appreciate justly the nature of their pretended inspiration. In a word, demoniacs of all descriptions are to be classed wither with maniacs or melancholics. What more calculated to excite in weak minds such chimerical fancies than mania without delirium, conjoined to and chiefly consisting in a propensity to acts of maniacal extravagance?…

Witch hunting and demonology gradually declined during the renaissance, with rulers such as Queen Christina and Louis XIV dismissing the notion of witches . This brought about the beginning of the lunatic asylums in Europe. There were no discriminating requirements for admittance into an asylum other than being considered a social misfit. Once in the asylum, though, mental health usually deteriorated in the depraved environment. The most infamous of these asylums was the Priory of St. Mary of Bethlehem. Founded in 1243, it was handed over to London by order of Henry VIII in 1547 to be a hospital for the mentally ill. The conditions at the hospital were so deplorable that the popular contracted name for the hospital, Bedlam, became a descriptive term meaning utter confusion and chaos. In fact, until the nineteenth century, Bedlam was considered quite a tourist attraction where the upper classes could pay admission and view the antics of the violent inmates. Hogarth painted such a scene in one of his more famous paintings, whose name unfortunately eludes me at this time.

It was such a state that La Bicetre, a large asylum in Paris, France, was in when Philippe Pinel was put in charge of it.

…On entering upon my duties at that hospital, everything presented to me the appearance of chaos and confusion. Some of my unfortunate patients labored under the horrors of a most gloomy and desponding melancholy. Others were furious, and subject to the influence of a perpetual delirium. Some appeared to possess a correct judgement upon most subjects, but were occasionally agitated by violent sallies of maniacal fury, while those of another class were sunk into a state of stupid idiotism and imbecility…

Pinel+s first act upon arriving at Le Bicetre was to attempt to classify every patient+s disease. To do that, however, he would have to come up with a classification system or use Felix Plater+s archaic system which was developed almost two hundred years earlier, and relied heavily on demonology. Pinel chose the former, and came up with the classifications of Moral Insanity, Monomania, Mania, and Incoherence with various subsets of each. Consistent with the egalitarian philospohy which was the cause of the French Revolution raging at the time of Pinel+s era, he believed that mental patients were normal people who should be treated with dignity and respect. Therefore, he went before the Commune, the new government which assumed control of France shortly after Louis VII was overthrown, and pleaded to be allowed to remove the chains and shackles from his patients. After George Couthon, leader of the Commune was satisfied that Pinel was not hiding enemies of the state at Le Bicetre, he granted Pinel+s request. And so was commited le geste de Pinel, where he unchained some of the patients and treated them with kindness, sympathy, and psychological therapy. The changes in the patients was shocking. Those who were violent became calm, those who were melancholic lightened their mood. This approach became known as le traitement moral, or moral treatment.