Am J Psychiatry 1992; 149:725-732
Copyright © 1992 by American Psychiatric Association
Philippe Pinel's "Memoir on Madness" of December 11, 1794: a fundamental text of modern psychiatry
DB Weiner
Department of Psychiatry and Biobehavioral Sciences, UCLA 90024.
Philippe Pinel's "Memoir on Madness" can now be precisely dated. It was
read to the Society for Natural History in Paris on Dec. 11, 1794, soon
after the fall of the Jacobin dictatorship. It is thus a political
document, an appeal to the Revolutionary government to build asylums where
the mentally ill could be decently treated. It is translated here for the
first time. Philippe Pinel (1745-1826) served as "physician of the
infirmaries" at Bicetre, the public hospice for men near Paris, from 1793
to 1795. In the "Memoir on Madness" he explains his "psychologic
treatment," the principles of the humane method that made him the founder
of psychiatry in France. Pinel states that mental illness is often curable.
To arrive at a diagnosis, the physician must carefully observe a patient's
behavior, interview him, listen carefully, and take notes. He must
understand the natural history of the disease and the precipitating event
and write an accurate case history. Diagnosis and prognosis can then be
made. Periodic patterns of mental illness can be helpful for therapy.
Usually only one faculty is affected. Patients with delusions may be
malicious or murderous. They may have to be restrained; it was Pinel's
assistant, Jean Baptiste Pussin, who removed the chains from the insane men
at Bicetre Hospice in 1797 and replaced them with strait-jackets. Pinel
followed suit at the Salpetriere, the public hospice for women, 3 years
later. Pinel here states that one must "dominate agitated madmen while
respecting human rights."
