The treatment of mental illnesses has undergone remarkable progress, although ancient methods were, in many cases, crude and cruel (Pearce, 2020). For centuries, erroneous beliefs linked mental disorders to supernatural causes, such as madness inflicted by Greek gods, medieval demonic possession, or even concepts like witchcraft and the "furies of the womb." In this context, popular beliefs dominated medical thought until the 17th century, when, during the Enlightenment, new theories about the causes of mental disorders began to emerge. According to Pearce (2020), physicians started to suspect that many of these disorders could be related to organic problems in the brain, including GPI and hysteria.
In this regard, key figures such as Thomas Willis (1621 - 1675) and Thomas Sydenham (1624 - 1689) introduced the idea of a "nervous distemper" or "spiritus animalis" (pneuma psychikon in Greek), a condition affecting certain vulnerable patients (Pearce, 2020). However, most psychiatrists of the time firmly believed that organic lesions could not be the cause of mental disorders, and the predominant approach remained focused on concepts such as possession and supernatural madness. The treatments of that era, though violent and ineffective, were designed to contain outbursts of disordered behavior, common in both organic and psychotic disorders. According to Pearce (2020), the figure of the madman was considered a separate creature, closer to bestiality than to humanity.
Asylums, which initially began as monasteries providing shelter for the mentally ill, transformed into private institutions in the 18th century, primarily accessible to the wealthy (Pearce, 2020). However, the treatment methods were brutal: physical punishments, bloodletting, and purging were common practices, and patients were often confined to cells, subjected to straitjackets, or even chained to walls. The conditions for the mentally ill in these asylums were deplorable. Alongside vagrants and social offenders, they were deprived of humane care. According to Pearce (2020), this scenario reflects the dehumanizing treatment that mentally ill individuals received at the time, a situation that, fortunately, has changed over time.
Biography
Philippe Pinel (1745–1826) was born in Jonquières (Tarn), France, on April 20, 1745, into a family with a medical background, as his father was also a physician, specifically a surgeon (Guerri, n.d.; Medina, 2011). From an early age, he excelled in his academic training, starting with studies in Latin and religion at a religious boarding school in Lavaur (Guerri, n.d.). Although he initially pursued theology teaching, he soon realized that his true calling was not in religion, which led him to move to Toulouse to study medicine and mathematics, obtaining his doctorate in 1773 (Guerri, n.d.). In his early professional years, he struggled to make a living (Medina, 2011). To sustain himself, according to Sánchez (2019), he began writing theses for wealthy students, although these works lacked innovative ideas.
In 1778, he moved to Paris, where he survived by giving private mathematics lessons and translating medical articles (Medina, 2011; Sánchez, 2019). In 1784, he took over the direction of the "Gazette de Santé2, where he also translated medical writings, such as those of Cullen, which allowed him to develop his own work, "Nosographie Philosophique", notably similar to the texts he translated (Guerri, n.d.). In 1789, he became involved in the French Revolution, an event that would profoundly influence his life and career. In the following years, he began treating mentally ill patients at Monsieur Belhomme's asylum and at the Bicêtre hospice until 1795. This experience provided him with a unique perspective on the treatment of mental disorders. According to Guerri (n.d.), his approach was based on treating patients with greater humanity and respect, eliminating many of the cruel and outdated practices that had been used in asylums and hospices until then.
During this period, the practices of Jean-Baptiste Pussin had a significant influence on Pinel (Guerri, n.d.). Pussin, known for his charitable and humane treatment of patients, became a role model for Pinel, who adopted both his observational approach and his benevolent methods in patient care. Following his example, Pinel decided to free patients from their chains and began studying the symptoms of mental illnesses and disorders in greater detail. This led to the systematic preservation of medical records and relevant documents. According to Guerri (n.d.), this rigor in his work earned him the title of founder of psychiatry in France.
He also eliminated bloodletting and other ineffective or cruel practices from therapies, focusing on improving patients' mental health through a more positive approach, which included the use of reinforcement messages and appropriate reasoning in cases of delirium (Guerri, n.d.). However, he did not entirely discard other methods that are now considered inhumane, such as starvation therapy or suffocation in water troughs with patients tied up. Guerri (n.d.) mentions that, in addition to his achievements in treating mental illnesses, he also worked as an adjunct professor of medical physics and hygiene at the new Paris Health School from 1794 onward.
From 1795 until the end of his career and life, he served as a physician at the Salpêtrière (Guerri, n.d.). During this time, he contributed to the development of pathological anatomy and the creation of a classification system for mental illnesses, which was documented in his work "Traité Médico-Philosophique sur l’aliénation Mentale" in 1801 (Guerri, n.d.). In this treatise, he classified mental illnesses into four categories: simple melancholy, mania, dementia, and idiocy (Medina, 2011). Additionally, according to Guerri (n.d.), he argued that the causes of mental disorders could be physical, hereditary, or mostly moral, distinguishing intense passions and excesses as primary triggers.
In its first edition, the title included the subtitle "La Manie", but this focus changed in the second edition when Pinel shifted his emphasis to mental illnesses, paying particular attention to behavior and the varying degrees of mental disorders and disturbances (Guerri, n.d.). This demonstrates his opposition to the prevailing methods of treating the mentally ill at the time. For this reason, he is considered a true precursor of reform and change in mental health regulations. According to Guerri (n.d.), his work and proposals were finally recognized in the legal field with the enactment of the law of June 30, 1838.
Pinel’s fame and prestige were so great that, in 1805, he was awarded the Legion of Honor by Napoleon and appointed as the Emperor’s Medical Consultant (Guerri, n.d.). He served the Empire until the beginning of the Restoration when he was honored with the Order of Saint Michael in 1818. These were years of great recognition for Pinel. However, in 1822, he was dismissed from his position as a professor at the Ministry of Health, and later, he faced a difficult battle against arteriopathic dementia, an illness that accompanied him until his death in 1825 in Paris. Despite the personal challenges he faced, Pinel’s influence remains undeniable. According to Guerri (n.d.), his innovative approach, particularly his more humane vision of treating mental illnesses, left a profound mark not only in his country but worldwide, impacting generations of mental health professionals.
Biography
Guerri, M. (s. f.). Biografía de Philippe Pinel (1745-1826). Psicoactiva.com. Recuperado 9 de enero de 2025, de https://www.psicoactiva.com/biografias/philippe-pinel/
Medina, N. M. (2011, mayo 20). Philippe Pinel y las Bases del Diagnóstico Psiquiátrico Moderno. Corporación de Radio y Televisión Española. https://www.rtve.es/noticias/20110520/philippe-pinel-y-las-bases-del-diagnostico-psiquiatrico-moderno/433802.shtml
Pearce, J. M. S. (2020, junio 4). The Beginnings of Humane Psychiatry: Pinel and the Tukes. Hektoen International. https://hekint.org/2020/06/04/the-beginnings-of-humane-psychiatry-pinel-and-the-tukes/Sánchez, E. (2019, mayo 6). Philippe Pinel y los Albores de la Psiquiatría. La Mente es Maravillosa. https://lamenteesmaravillosa.com/philippe-pinel-y-los-albores-de-la-psiquiatria/
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