Medic@

Presentation by Serge NICOLAS Professor of history of psychology and experimental psychology. University Paris Descartes - Institut de psychologie. Editor-in-chief of L’Année psychologique Laboratoire Psychologie et Neurosciences cognitives. CNRS – FRE 2987. 71, avenue Edouard Vaillant 92774 Boulogne-Billancourt Cedex, France.

Translation by Karine DEBBASCH

PINEL: THE FOUNDER OF MODERN PSYCHIATRY

Philippe Pinel (1745-1826) always shared Cabanis’ (1757-1808) views on medicine; he actually chose to entitle his most famous book Traité médico-philosophique de l'aliénation mentale (Medico-Philosophical Treatise on Mental Alienation) (Year IX, 1800). This book[1] had been anticipated for some time in contemporary medical and philosophical circles as large excerpts had already been presented to a students’ society and at the Académie des sciences between 1796 and 1800. It is divided into six sections that are intended to present the bases and the rules of moral treatment. In the first section, Pinel presents a study on periodic or intermittent mania[2] (pp. 7-47), which he considered as the paradigmatic form of mental alienation. In the second section, he states the principles and rules of the moral treatment of the insane[3] (pp. 48-105), consisting in modifying the patient’s imagination and feelings by exerting moral influence on him or her, thus triggering fear and respect. It would then become possible to act on the body, where the epigastric trouble was considered to lie. In the third section, devoted to anatomical research on cranial deformities of the insane[4] (pp. 106-134), he demonstrates that the various forms of mental alienation are hardly ever linked with organic lesions of the brain (except in the case of idiotism). In his fourth section, he addresses the division of mental alienation into different categories[5] (pp. 135-176) so as to shed light on those which could best be treated. Adopting Condillac’s method, he defines five types of mental alienation: melancholy, mania without delirium, mania with delirium, dementia or abolition of thought, and idiotism or obliteration of the intellectual and emotional faculties[6]. In the fifth section, Pinel focuses on inside police and surveillance to be established in asylums (pp. 177-226). In the sixth section, he mentions principles of medical treatment (pp. 227-304) for those patients whose moral treatment has failed. Pinel’s book constitutes a historical landmark[7]: French psychiatry started to develop after its publication.

FROM THE FOUNDATION OF THE ANNALES MÉDICO-PSYCHOLOGIQUES (1843)…

Pinel’s successors continued the programme that Cabanis had initiated and were the first figures of the emerging disciplines of French psychiatry. His classification of mental disorders was adopted by his celebrated pupil Étienne Esquirol (1772-1840), the architect of the famous French law on internment (June 30, 1838), who developed Pinel’s conception of monomanias as an aspect of melancholy (see Des maladies mentales considérées sous les rapports médical, hygiénique et médico-légal, 1838. On-line in Medic@ : ), and also by Étienne Georget (1795-1828), who individualized mental confusion as a characteristic of acute dementia.

The first issue of the Annales Médico-Psychologiques appeared in 1843 ; Jules Baillarger (1809-1890), Laurent Cerise (1807-1869) and F.A. Longet (1811-1871) founded this journal to study mental and nervous disorders, as indicated in the subtitle: "Journal of the anatomy, physiology and pathology of the nervous system, especially destined to gather together all the documents concerning the science of the relationship between physical and moral states, mental pathology, forensic medicine of the insane, and the clinical study of neuroses". Then, in 1852, the Société médico-psychologique was founded. These two events were part of Cabanis' and Pinel's legacy. Along with the creation of the Annales médico-psychologiques in 1843 came the organization of an association of psychiatrists, which marked the beginning of a professional identity. Cerise was responsible for articles dealing with general medical and psychological questions, Baillarger for articles dealing with mental pathology and Longet for those dealing more specifically with the anatomy and physiology of the nervous system. In the introduction that Cerise wrote for the first issue of January 1843, one may read that this «journal of the anatomy, physiology and pathology of the nervous system, especially destined to gather together all the documents concerning the science of the relationship between physical and moral states, mental pathology, forensic medicine of the insane, and the clinical study of neuroses», is not the fruit of an original idea of the creators'; it is part of Pinel's legacy. At the beginning of the 1840s, psychiatry was a science that had yet to be constituted; creating the Annales was the first step in this direction. Right from the start, the new journal was open to debates. In the very first issues, after the publications of L. F. Lélut (1804-1877), there was a controversy over hallucinations, in which Alfred Maury (1817-1892), Louis Calmeil (1798-1895) and Alexandre Brierre de Boismont (1797-1881) participated. Many other disputes and discussions followed this first debate in the history of the journal[8], especially related to the work of the Société médico-psychologique, which was published in the Annales. In fact, the journal and the Société were to become closely linked.

…TO THE CREATION OF THE SOCIÉTÉ MÉDICO-PSYCHOLOGIQUE (1852)

In the first issue of January 1843 , Baillarger suggested the creation in France of an association of psychiatrists, which he mentioned under the name Société médico-psychologique in July 1843[9]. But the project lay dormant. In 1845, Bénédict-Augustin Morel (1809-1873) in turn declared his wish that such a medical society existed; its purpose would be to study all that is related to the pathology and physiology of the nervous system, to work at improving insane asylums, and also to keep its members abreast of all that was done and published in the field of psychiatry in other countries. It was in this context that, in 1846, Baillarger mentioned again his initial project, insisting on its relevance: «the necessary conditions for studying many aspects of mental diseases can only be obtained through an association of physicians working together to find the solutions to questions that they have already discussed » . He declared at the same time that the publication of the work of such an association could be undertaken by the Annales. Having gathered numerous subscriptions, Baillarger and Cerise announced in the first Annales issue of the year 1848   that the Société médico-psychologique had been created in Paris on December 18, 1847. «The organization that has just been created is comprised not only of most of the physicians whose lives are devoted to the study and treatment of insanity, but also of a fixed number of physiologists, administrators, scholars, jurisconsults, moralists and philosophers whose work is more or less directly linked with the knowledge or governance of man as a moral and intellectual entity» . The rules had even been discussed and adopted by a committee of founding members; the goal they wished to reach had been thus defined: «The Société's purpose is to study and improve mental pathology. It encompasses in its work all the accessory sciences that can favor its progress» . But the political circumstances and the Revolution of 1848 stopped the official creation of the Société. Incidentally, it was also in 1848-1849 that changes in the publication policy were made: it was decided that the anatomy and physiology of the nervous system and the relationship of body to mind, along with other metaphysical topics, would be left out, so that the journal might concentrate more on mental diseases. The subtitle of the Annales was changed into: «Journal destined to gather together all the documents concerning mental alienation, neuroses, and the forensic medicine of the insane» . Additionally, after 1849, the two sections entitled «general medico-psychological points » and «physiology» were permanently suppressed. The journal was thus becoming purely «alienist».

Only a few years later the Annales published the report of a committee comprised of Amédée Dechambre (1812-1886), Édouard Carrière (1808-1883) and Claude-François Michéa (1815-1882), whose responsibility it was to prepare new rules and to do what was necessary to constitute at last a largely interdisciplinary Société médico-psychologique . On April 26, 1852, the founders met and nominated the officers. They elected Guillaume-Marie-André Ferrus (1784-1861) as President, and Pierre-Nicolas Gerdy (1797-1856) as Vice-President. Dechambre, the famous journalist, was nominated Secretary General; Brierre de Boismont (1798-1881), secretary-treasurer; Michéa, archivist secretary. The editorial board was made up of Buchez, Baillarger and Cerise. The Société médico-psychologique held its first session on June 28, 1852 . From the day that the Société was founded, the editors in chief of the Annales always considered it among their first duties to publish the minutes of the Société's meetings, which Baillarger and his collaborators did for a period of 48 years, followed by Ritti for 35 years, and so on. Reading the successive volumes of the Annales allows one to have insight into the historical evolution of «alienism» and also to have access to many of the founding papers in psychiatry.

LIST OF THE PRESIDENTS OF THE SOCIÉTÉ MÉDICO-PSYCHOLOGIQUE (1852-1937)

1852-53 FERRUS 1853-54 GERDY 1854-55 BUCHEZ 1855-56 PARCHAPPE 1856-57 PEISSE 1857-58 BAILLARGER 1858-59 CERISE 1859-60 TRÉLAT 1861 BRIERRE DE BOISMONT 1862 A. GARNIER 1863 DELASIAUVE 1864 MOREAU DE TOURS 1865 GIRARD DE CAILLEUX 1866 F. VOISIN 1867 JANET 1868 BROCHIN 1869 CONSTANS 1870-71 LASÈGUE 1872 FALRET 1873 LUNIER

1874 LOISEAU 1875 BLANCHE 1876 DUMESNIL 1877 BILLOD 1878 BAILLARGER 1879 LUCAS 1880 LEGRAND DU SAULE 1881 LUYS 1882 DALLY 1883 MOTET 1884 FOVILLE 1885 DAGONET 1886 SEMELAIGNE 1887 MAGNAN 1888 COTARD 1889 FALRET 1890 BAILLARGER 1891 BOUCHEREAU 1892 ROUSSEL 1893 CHRISTIAN

1894 A. VOISIN 1895 MOREAU DE TOURS 1896 CHARPENTIER 1897 P. GARNIER 1898 MEURIOT 1899 J. VOISIN 1900 MAGNAN 1901 JOFFROY 1902 MOTET 1903 BALLET 1904 BRUNET 1905 VALLON 1906 BRIAND 1907 DENY 1908 SÉGLAS 1909 LEGRAS 1910 ARNAUD 1911 SÉRIEUX 1912 KLIPPEL 1913 R. SELEMAIGNE 1914-16 VIGOUROUX

1917 CHASLIN 1918 COLIN 1919 DUPAIN 1920 TRÉNEL 1921 PACTET 1922 TOULOUSE 1923 ANTHEAUME 1924 TRUELLE 1925 ROUBINOVITCH 1926 SOLLIER 1927 LEGRAIN 1928 LEROY 1929 Pierre JANET 1930 CAPGRAS 1931 CLAUDE 1932 MARCHAND 1933 G. DUMAS 1934 MIGNOT 1935 Th. SIMON 1936 VURPAS 1937 CHARPENTIER

Notes

[1] For a recent facsimile re-edition of the original edition: Pinel, Ph. (2006). Sur l’aliénation mentale. Traité médico-philosophique (1800). Paris: L’Harmattan. – Also see on-line, Gallica’s website, the Year IX edition [ http://gallica.bnf.fr/ark:/12148/bpt6k432033 ] and the second edition of 1809 [ http://gallica.bnf.fr/ark:/12148/bpt6k76576g ].

[2] This section is a re-edition of an earlier text: Pinel, Ph. (1797, Year V-VI). Mémoire sur la manie périodique ou intermittente. Mémoires de la Société Médicale d’Émulation, 1, 94-119. [BIUM shelf mark: 90.090]

[3] This, too, is the re-edition of an earlier text: Pinel, Ph. (1798, Year VI-VII). Recherches et observations sur le traitement moral des aliénés. Mémoires de la Société Médicale d’Émulation, 2, 215-255.

[4] This is the edition of a paper that was read at the Académie des Sciences on March 7, 1800 (Ventôse 16 Year VIII).

[5] This is the re-edition of an earlier text: Pinel, Ph. (1799, Year VII-VIII). Observations sur les aliénés et leur division en espèces distinctes. Mémoires de la Société Médicale d’Émulation, 3, 1-26.

[6] In the second edition (1809) Pinel proposes the following classification: "If one constantly observes and carefully studies their symptoms, one can establish a general classification, and differentiate them according to fundamental alterations to their understanding or their will, notwithstanding their innumerable variety. A more or less intense delirium on almost any object is, for a number of lunatics, associated with an agitated, maniacal state: such is the definition of mania. The delirium can also be exclusive and confined to a given series of objects, and be associated with a form of stupor and with deep, vivid emotions: it is what we call melancholy. Sometimes a general debility affects the intellectual and emotional faculties, as is the case in old age, constituting what is called dementia. Finally, an obliteration of reason with short, automatic periods of anger is called idiotism. These are the four types of mental turmoil generally referred to under the label mental alienation" (Pinel, p. 5). See Pinel, Ph. (2005). Traité médico-philosophique sur l’aliénation mentale (2nd edition, 1809). Paris: Les empêcheurs de penser en rond/ Le Seuil. [BIUM shelf mark: 189.059]

[7] For a biograph yand an analysis of Pinel’s work: Pigeaud, J. (2001). Aux portes de la psychiatrie. Pinel, l’ancien et le moderne. Paris: Aubier. [BIUM shelf mark: 185777 / Cupboard 5 HM Psychiatry 23] - Postel, J. (1998). Genèse de la psychiatrie. Les premiers écrits de Philippe Pinel. Le Plessis-Robinson: Institut Synthélabo. [BIUM shelf mark: 176122] - Sémelaigne, R. (2001). Philippe Pinel et son œuvre au point de vue de la santé mentale. Paris: L’Harmattan. [BIUM shelf mark: 232931-47] - Weiner, D. B. (1999). Comprendre et soigner. Philippe Pinel (1745-1826). La médecine de l’esprit. Paris: Fayard. [BIUM shelf mark: 233230-8 / Cupboard 5 HM Psychiatry 14]

[8] Ritti, A. (1902). Histoire des travaux de la Société médico-psychologique (1852-1902). Annales Médico-Psychologiques, 8th series, volume 16, sixtieth year, 27-131 [ http://www.bium.univ-paris5.fr/histmed/medica/page?90152x1902x16&p=27 ].

[9] To see the history of the Société’s creation: Dowbiggin, I. (1989). French psychiatry and the search for a professional identity: The Société Médico-Psychologique, 1840-1870. Bulletin of the History of Medicine, 63 (3) 331-355. [BIUM shelf mark: 110.014A]