1 00:00:01,360 --> 00:00:04,320 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,400 --> 00:00:14,280 Speaker 1: of iHeartRadio. Hello and welcome to the podcast. I'm Holly Frey. 3 00:00:14,560 --> 00:00:18,400 Speaker 1: And I'm Tracy V. Wilson. This is yet another episode 4 00:00:18,660 --> 00:00:20,620 Speaker 1: of I don't know how it got on my list. 5 00:00:21,840 --> 00:00:24,280 Speaker 1: I love those, honestly. I kind of do, too. It's 6 00:00:24,320 --> 00:00:26,280 Speaker 1: one of those things where I had him scribbled down 7 00:00:26,340 --> 00:00:27,960 Speaker 1: on a piece of paper and I went back and went, 8 00:00:28,380 --> 00:00:30,720 Speaker 1: who's this guy? Let me look him up. Wait, why 9 00:00:30,800 --> 00:00:34,019 Speaker 1: have we not done this before? But it includes many 10 00:00:34,040 --> 00:00:36,880 Speaker 1: of my favorite things. There's a little bit of medical advancement, 11 00:00:36,900 --> 00:00:39,839 Speaker 1: a little bit of social reform, people getting things a 12 00:00:40,420 --> 00:00:45,080 Speaker 1: little bit wrong, and the French Revolution. Lots of opportunities 13 00:00:45,120 --> 00:00:48,140 Speaker 1: to talk about French people, because we are talking about 14 00:00:48,220 --> 00:00:52,140 Speaker 1: Philippe Pinel today, whose work is considered the precursor of 15 00:00:52,200 --> 00:00:57,550 Speaker 1: modern psychiatry. He overhauled the asylum system in Paris starting 16 00:00:57,630 --> 00:01:01,170 Speaker 1: in the late 18th century, and his ideas about mental 17 00:01:01,190 --> 00:01:05,140 Speaker 1: health conditions were groundbreaking, also very wrong in some ways, 18 00:01:06,080 --> 00:01:09,170 Speaker 1: but very progressive for his time. Heads up, we are 19 00:01:09,209 --> 00:01:12,050 Speaker 1: going to be reading from a number of texts which 20 00:01:12,110 --> 00:01:15,710 Speaker 1: are from the late 1700s, early 1800s, and even some 21 00:01:15,770 --> 00:01:20,110 Speaker 1: 20th century ones that refer to that work. And thus, 22 00:01:20,390 --> 00:01:22,760 Speaker 1: there's some terminology in the mix that we probably would 23 00:01:22,780 --> 00:01:24,759 Speaker 1: not use today. For the most part, I have tried 24 00:01:24,780 --> 00:01:29,000 Speaker 1: to be really judicious in selection to avoid anything truly offensive. 25 00:01:29,980 --> 00:01:33,339 Speaker 1: But if you hear something outdated... And you're like, oh, 26 00:01:33,440 --> 00:01:35,459 Speaker 1: I didn't think they would say that just because it 27 00:01:35,580 --> 00:01:38,960 Speaker 1: comes from that writing. Right. It's that writing. Yeah. And 28 00:01:39,100 --> 00:01:41,199 Speaker 1: there are some sections that I want to read because 29 00:01:41,240 --> 00:01:46,720 Speaker 1: they're important in setting up really what was going on, 30 00:01:46,890 --> 00:01:50,730 Speaker 1: how Philippe Pinel thought, etc. So I don't want to 31 00:01:50,770 --> 00:01:53,910 Speaker 1: just ditch them entirely. So just know. So when you 32 00:01:53,930 --> 00:01:57,540 Speaker 1: hear something, you go, yuck, that's that's what's up. So 33 00:01:57,600 --> 00:02:03,840 Speaker 1: Philippe Pinel was born in Jonquière, France, on April 20th, 1745. 34 00:02:03,840 --> 00:02:07,730 Speaker 1: There are multiple towns and villages in France named Jonquière, 35 00:02:07,970 --> 00:02:10,609 Speaker 1: and the one where Pinel was born is about 700 36 00:02:10,610 --> 00:02:15,590 Speaker 1: kilometers or 435 miles due south of Paris. Pinel was 37 00:02:15,650 --> 00:02:20,250 Speaker 1: born into a family of doctors. His father, Philippe-François Pinel, 38 00:02:20,290 --> 00:02:23,680 Speaker 1: was a surgeon, and his mother, Elisabeth Dupuis, came from 39 00:02:23,720 --> 00:02:26,200 Speaker 1: a family that had a lot of doctors in it. 40 00:02:27,240 --> 00:02:32,360 Speaker 1: When Philippe was young, his father started practicing medicine in Saint-Paul-Cap-de-Joux, 41 00:02:32,460 --> 00:02:36,030 Speaker 1: which is about 14 kilometers or 8.7 miles to the 42 00:02:36,150 --> 00:02:41,270 Speaker 1: west of Janquière. After getting his early education in Le Var, 43 00:02:41,370 --> 00:02:45,030 Speaker 1: west of Saint-Paul-Cap-de-Joux, he then moved even farther west to 44 00:02:45,110 --> 00:02:50,530 Speaker 1: Toulouse to attend Collège de l'Esquire. His degree was in mathematics, 45 00:02:50,610 --> 00:02:53,310 Speaker 1: although Penel's plan at that point was to pursue a 46 00:02:53,350 --> 00:02:58,450 Speaker 1: life in theology. He enrolled in theology school in Toulouse 47 00:02:58,550 --> 00:03:01,410 Speaker 1: in 1767, but then he changed his mind before long, 48 00:03:01,840 --> 00:03:04,800 Speaker 1: decided he was going to join in the family profession, 49 00:03:04,820 --> 00:03:07,840 Speaker 1: and he went to medical school, staying in Toulouse to 50 00:03:07,880 --> 00:03:11,210 Speaker 1: do it. And during this time, he focused a lot 51 00:03:11,530 --> 00:03:14,790 Speaker 1: of his energies on learning about botany. That was something 52 00:03:14,870 --> 00:03:17,280 Speaker 1: he would love for the rest of his life. And 53 00:03:17,380 --> 00:03:20,600 Speaker 1: botany naturally goes along with a medical degree, particularly at 54 00:03:20,620 --> 00:03:24,360 Speaker 1: this point in France. But this wasn't only because of 55 00:03:24,400 --> 00:03:27,589 Speaker 1: his affinity for plants or necessarily the way they could 56 00:03:27,610 --> 00:03:31,050 Speaker 1: be used in medicine. Because at this point, botanical gardens 57 00:03:31,130 --> 00:03:34,870 Speaker 1: were often as much a place of gathering and socializing 58 00:03:35,210 --> 00:03:38,770 Speaker 1: for science-minded people as cafes were. And so he would 59 00:03:38,810 --> 00:03:41,220 Speaker 1: visit the botanical garden and find people he could talk 60 00:03:41,240 --> 00:03:43,860 Speaker 1: to about things. And that continued for pretty much the 61 00:03:43,900 --> 00:03:46,950 Speaker 1: rest of his life. He graduated from medical school in 62 00:03:46,970 --> 00:03:50,420 Speaker 1: Toulouse in 1773, and then he moved on to his 63 00:03:50,480 --> 00:03:56,460 Speaker 1: advanced medical education in 1774, this time in Montpellier. During 64 00:03:56,520 --> 00:04:00,260 Speaker 1: his time in Montpellier, which lasted for four years, Pinel 65 00:04:00,320 --> 00:04:03,390 Speaker 1: started a pattern of personal research, and he would repeat 66 00:04:03,430 --> 00:04:07,590 Speaker 1: this pattern throughout his life. He started visiting hospitals and 67 00:04:07,650 --> 00:04:10,740 Speaker 1: spending time with patients. He would listen to their stories 68 00:04:10,820 --> 00:04:13,840 Speaker 1: and take copious notes, and he started to compile all 69 00:04:13,860 --> 00:04:18,760 Speaker 1: of this information into detailed records. Over time, he developed 70 00:04:18,800 --> 00:04:21,900 Speaker 1: relationships with long-term patients, and then he was able to 71 00:04:21,980 --> 00:04:25,160 Speaker 1: track the progression of their illnesses. That gave him a 72 00:04:25,260 --> 00:04:29,240 Speaker 1: unique set of observational data, which he studied to identify 73 00:04:29,339 --> 00:04:33,669 Speaker 1: patterns in disease progression. This was all because while he 74 00:04:33,850 --> 00:04:37,650 Speaker 1: had gotten a medical degree in Toulouse, that meant that 75 00:04:37,710 --> 00:04:41,230 Speaker 1: he could only practice in Toulouse. He was not licensed 76 00:04:41,270 --> 00:04:45,330 Speaker 1: to practice elsewhere. So in Montpellier, he instead observed and 77 00:04:45,370 --> 00:04:51,270 Speaker 1: studied patients rather than offering hands-on care as a physician. Yeah, 78 00:04:51,300 --> 00:04:52,800 Speaker 1: and a lot of that was stuff that he was 79 00:04:52,830 --> 00:04:55,240 Speaker 1: doing in his free time in addition to the medical 80 00:04:55,279 --> 00:04:58,880 Speaker 1: studies that he was doing in Montpellier. After four years 81 00:04:59,000 --> 00:05:04,150 Speaker 1: in Montpellier, Pinel moved on to Paris in 1778. Once again, 82 00:05:04,270 --> 00:05:06,930 Speaker 1: he did not jump right into practicing medicine because he 83 00:05:06,990 --> 00:05:11,779 Speaker 1: wasn't licensed there. In Montpellier, he had supported himself by 84 00:05:11,839 --> 00:05:14,440 Speaker 1: working as a tutor, and he did the same in Paris. 85 00:05:15,180 --> 00:05:17,520 Speaker 1: That math degree that he got early on meant that 86 00:05:17,560 --> 00:05:19,620 Speaker 1: he had a skill that meant he could make money 87 00:05:19,640 --> 00:05:23,690 Speaker 1: almost anywhere as a tutor. He supplemented his income with 88 00:05:23,750 --> 00:05:27,950 Speaker 1: additional work as well, including translating medical texts into French. 89 00:05:28,529 --> 00:05:30,950 Speaker 1: He also dabbled in journalism as an editor. And I 90 00:05:30,990 --> 00:05:32,930 Speaker 1: say dabbled, but that's not accurate. He did this for 91 00:05:32,970 --> 00:05:36,240 Speaker 1: a long time. He worked for a couple of Parisian 92 00:05:36,320 --> 00:05:39,760 Speaker 1: science journals. Over his time in Paris, there are two 93 00:05:39,779 --> 00:05:42,960 Speaker 1: that he's associated with. One is Gazette de Santé, that's 94 00:05:43,020 --> 00:05:46,630 Speaker 1: Health Gazette, and the other is Journal de Physique. He 95 00:05:46,670 --> 00:05:49,690 Speaker 1: also worked as a consultant for a private facility that 96 00:05:49,770 --> 00:05:55,030 Speaker 1: treated mental health conditions. This, depending on whose account you read, 97 00:05:55,089 --> 00:05:57,830 Speaker 1: was getting into a legally fuzzy area where he was 98 00:05:57,990 --> 00:06:03,210 Speaker 1: sort of practicing medicine, but it seems like being carefully 99 00:06:03,270 --> 00:06:06,250 Speaker 1: labeled as an advisor or consultant was doing a lot 100 00:06:06,270 --> 00:06:08,680 Speaker 1: of legal heavy lifting, and I don't think he was 101 00:06:08,750 --> 00:06:14,320 Speaker 1: actually hands-on with patients. Then on August 6, 1793, he 102 00:06:14,360 --> 00:06:16,380 Speaker 1: was given a job that would change his life when 103 00:06:16,440 --> 00:06:21,420 Speaker 1: he became the physician of infirmaries at Bicetre Hospital. He 104 00:06:21,440 --> 00:06:25,310 Speaker 1: started work a month later. Bicetre was originally built as 105 00:06:25,350 --> 00:06:28,630 Speaker 1: a military hospital under King Louis XIII. That was in 106 00:06:28,650 --> 00:06:31,170 Speaker 1: the first half of the 1600s. and it was part 107 00:06:31,190 --> 00:06:34,830 Speaker 1: of a project that was overseen by Cardinal Richelieu. But 108 00:06:34,950 --> 00:06:38,650 Speaker 1: Louis XIII died while it was still under construction, and 109 00:06:38,750 --> 00:06:42,050 Speaker 1: his plans for it were not carried out. Instead, it 110 00:06:42,089 --> 00:06:46,330 Speaker 1: was folded into a bigger hospital project as a men's hospital. 111 00:06:46,350 --> 00:06:49,650 Speaker 1: It did not stay a men's hospital, though. It became 112 00:06:49,730 --> 00:06:52,990 Speaker 1: a prison for a while, and then an asylum for 113 00:06:53,050 --> 00:06:57,190 Speaker 1: mentally ill patients. And that's what it was when Pinel 114 00:06:57,250 --> 00:07:03,380 Speaker 1: worked there. Incidentally, today, Bissetra is a modern hospital facility. Yeah, 115 00:07:03,430 --> 00:07:05,730 Speaker 1: they weren't all mentally ill patients, but that was a 116 00:07:05,770 --> 00:07:08,690 Speaker 1: big part of what they were trying to manage when 117 00:07:08,730 --> 00:07:12,270 Speaker 1: he was there. Because there were an estimated 1,000 patients 118 00:07:12,430 --> 00:07:16,370 Speaker 1: at Bissetra at the time. And the seventh ward contained 119 00:07:16,750 --> 00:07:21,220 Speaker 1: one-fifth of that population, 200 men, all categorized as mentally 120 00:07:21,360 --> 00:07:25,190 Speaker 1: ill in some way. For them, Bicêtre might be better 121 00:07:25,230 --> 00:07:29,210 Speaker 1: described as incarceration rather than any sort of treatment facility. 122 00:07:29,790 --> 00:07:31,540 Speaker 1: This was not a place where people were sent to 123 00:07:31,560 --> 00:07:33,960 Speaker 1: get better. It was more about keeping them out of 124 00:07:33,980 --> 00:07:37,680 Speaker 1: the public eye. So Pinel was not only there, as 125 00:07:37,760 --> 00:07:40,760 Speaker 1: I said, to work with the patients that were categorized 126 00:07:40,820 --> 00:07:44,770 Speaker 1: as mentally ill. This was a public hospital for men, 127 00:07:45,030 --> 00:07:47,830 Speaker 1: and it also housed homeless patients and the city's poor people. 128 00:07:48,500 --> 00:07:51,690 Speaker 1: But Pinel did take a very special interest in men 129 00:07:51,750 --> 00:07:55,170 Speaker 1: who had been sent there because of a diagnosis of madness. 130 00:07:55,730 --> 00:07:58,590 Speaker 1: And often the men that had been categorized that way 131 00:07:59,010 --> 00:08:02,100 Speaker 1: had been pronounced as possessed by a member of the clergy, 132 00:08:02,190 --> 00:08:05,780 Speaker 1: and so they were all treated as dangerous. Many of 133 00:08:05,840 --> 00:08:08,800 Speaker 1: them spent all of their time chained up, with only 134 00:08:08,840 --> 00:08:11,240 Speaker 1: enough length in the chain for them to move around 135 00:08:11,260 --> 00:08:15,270 Speaker 1: their very tiny rooms. The governor of the hospital was 136 00:08:15,350 --> 00:08:19,780 Speaker 1: a man named Jean-Baptiste Poussin, And Pinel conferred closely with 137 00:08:19,820 --> 00:08:22,660 Speaker 1: him to get as much information about the patients as possible. 138 00:08:23,320 --> 00:08:26,220 Speaker 1: He compiled all of this information into a table and 139 00:08:26,240 --> 00:08:30,780 Speaker 1: started to work through a classification system, adapting his knowledge 140 00:08:30,820 --> 00:08:34,240 Speaker 1: of how plants were classified to similarly try to form 141 00:08:34,280 --> 00:08:38,179 Speaker 1: a more nuanced way of diagnosing his patients, rather than 142 00:08:38,240 --> 00:08:41,959 Speaker 1: just simply saying that they were mad. He did not 143 00:08:42,000 --> 00:08:45,140 Speaker 1: refer to patients as mad or as mentally ill. He 144 00:08:45,179 --> 00:08:49,500 Speaker 1: described their condition as a state of mental alienation because 145 00:08:49,540 --> 00:08:52,700 Speaker 1: he believed that they had been alienated from their reason. 146 00:08:53,620 --> 00:08:56,359 Speaker 1: And Pinel approached their care the same way he had 147 00:08:56,420 --> 00:09:00,220 Speaker 1: the patients that he befriended in Montpellier. He built up 148 00:09:00,260 --> 00:09:03,400 Speaker 1: trust with them over time by listening to them, in 149 00:09:03,450 --> 00:09:07,729 Speaker 1: addition to consulting with Poussin. He instituted a policy of 150 00:09:07,830 --> 00:09:13,300 Speaker 1: treating their illnesses instead of just confining them. So under Pinel, 151 00:09:13,420 --> 00:09:16,579 Speaker 1: the patients at Bicetre were moved out of their prison-style 152 00:09:16,620 --> 00:09:20,850 Speaker 1: confinement and into rooms with as much natural light as possible. 153 00:09:21,400 --> 00:09:23,750 Speaker 1: And he did not chain patients up as a matter 154 00:09:23,770 --> 00:09:26,630 Speaker 1: of course. There were some exceptions. We're going to talk 155 00:09:26,650 --> 00:09:30,410 Speaker 1: about those in just a bit. He also established hygiene 156 00:09:30,470 --> 00:09:33,370 Speaker 1: standards for the facility, and he made sure that patients 157 00:09:33,450 --> 00:09:37,469 Speaker 1: received regular warm baths. And he started offering the kind 158 00:09:37,510 --> 00:09:42,340 Speaker 1: of treatments that would today be called something like occupational therapy. 159 00:09:42,760 --> 00:09:45,360 Speaker 1: He worked with each patient to help them overcome the 160 00:09:45,559 --> 00:09:50,030 Speaker 1: obstacles that were keeping them from doing everyday things. We 161 00:09:50,070 --> 00:09:52,390 Speaker 1: will talk about how this worked out after we take 162 00:09:52,429 --> 00:10:05,680 Speaker 1: a quick sponsor break. It turned out that Pinel's approach 163 00:10:05,780 --> 00:10:09,580 Speaker 1: to dealing with his patients was very successful. In the 164 00:10:09,660 --> 00:10:12,580 Speaker 1: course of a year under his leadership at Bicetre, the 165 00:10:12,640 --> 00:10:16,339 Speaker 1: hospital saw the annual patient mortality rate drop from 50% 166 00:10:16,340 --> 00:10:22,270 Speaker 1: to less than 13%. That's a huge jump. And really, 167 00:10:22,290 --> 00:10:26,059 Speaker 1: this was largely due to just keeping them and their 168 00:10:26,100 --> 00:10:30,160 Speaker 1: surroundings clean. Because if you have disease and you're not cleaning, 169 00:10:30,179 --> 00:10:33,979 Speaker 1: there's no way to control it. But the hospital's patients 170 00:10:34,140 --> 00:10:38,559 Speaker 1: also had another surprising outcome. A number of them were 171 00:10:38,660 --> 00:10:41,840 Speaker 1: able to return to their lives outside of the hospital. 172 00:10:41,860 --> 00:10:45,250 Speaker 1: This was a very different scenario for someone who had 173 00:10:45,260 --> 00:10:48,490 Speaker 1: been categorized as mad than what would typically be expected. 174 00:10:49,300 --> 00:10:52,980 Speaker 1: For the vast majority that entered the asylums as patients, 175 00:10:53,100 --> 00:10:55,520 Speaker 1: the expectation was that they were just going to live 176 00:10:55,540 --> 00:10:59,620 Speaker 1: there until they died. This approach was also inherently political. 177 00:11:00,040 --> 00:11:03,500 Speaker 1: On December 11, 1794, while he was in the middle 178 00:11:03,520 --> 00:11:07,250 Speaker 1: of his work to reform hospital practices, Pinnell read a 179 00:11:07,290 --> 00:11:12,280 Speaker 1: paper at the Society for Natural History. The Thermidorian Reaction, 180 00:11:12,420 --> 00:11:15,720 Speaker 1: which was the event that ended Robespierre's reign of terror 181 00:11:15,960 --> 00:11:18,980 Speaker 1: and Jacobin rule in France, had taken place in the 182 00:11:19,140 --> 00:11:21,740 Speaker 1: summer of that year. So this was a time when 183 00:11:21,800 --> 00:11:26,000 Speaker 1: France was redefining its identity, and Pinel wanted that identity 184 00:11:26,059 --> 00:11:29,830 Speaker 1: to include allocating money to build facilities where people with 185 00:11:29,870 --> 00:11:33,470 Speaker 1: mental illness would get treatment instead of just being confined 186 00:11:33,510 --> 00:11:37,020 Speaker 1: and forgotten. He was already in good standing with the 187 00:11:37,059 --> 00:11:39,480 Speaker 1: organization as he had been a member and even served 188 00:11:39,559 --> 00:11:43,610 Speaker 1: as secretary for a brief period. And he had specifically 189 00:11:43,750 --> 00:11:47,030 Speaker 1: asked to give this presentation. So his talk that day 190 00:11:47,170 --> 00:11:50,309 Speaker 1: opened with, and of course this is translated, when I 191 00:11:50,350 --> 00:11:53,630 Speaker 1: was appointed physician of the infirmaries at Bissetra over one 192 00:11:53,670 --> 00:11:57,590 Speaker 1: year ago, the division for Mad Men attracted my special attention. 193 00:11:58,670 --> 00:12:01,810 Speaker 1: I had undertaken some preliminary studies and felt the strong 194 00:12:01,970 --> 00:12:07,390 Speaker 1: urge to try every means of restoring alienated reason. Thus, 195 00:12:07,590 --> 00:12:10,699 Speaker 1: I looked upon Bucetra as a source of new enlightenment 196 00:12:10,770 --> 00:12:14,500 Speaker 1: and instruction and a most welcome opportunity to contribute to 197 00:12:14,540 --> 00:12:18,939 Speaker 1: the public usefulness. But successive changes in the administration of 198 00:12:18,980 --> 00:12:23,500 Speaker 1: Paris hospitals have deprived me of several facilities. I have 199 00:12:23,559 --> 00:12:27,420 Speaker 1: neither baths nor showers. these were only authorized a few 200 00:12:27,480 --> 00:12:31,560 Speaker 1: days ago. I have therefore restricted my activities this year 201 00:12:31,640 --> 00:12:34,579 Speaker 1: to a thorough study of the true nature and varieties 202 00:12:34,700 --> 00:12:37,990 Speaker 1: of madness, to the effort of obtaining for the insane 203 00:12:38,250 --> 00:12:41,910 Speaker 1: everything that might improve their condition, and especially to a 204 00:12:41,950 --> 00:12:45,510 Speaker 1: search for fixed principles derived from nature on which to 205 00:12:45,570 --> 00:12:49,490 Speaker 1: base their management and supervision, which contributes so much to 206 00:12:49,530 --> 00:12:53,750 Speaker 1: the recovery of reason. So he claimed that at that point, 207 00:12:53,850 --> 00:12:58,390 Speaker 1: without already instituting their cleanliness policies as much as he 208 00:12:58,410 --> 00:13:01,170 Speaker 1: had wanted, that one-eighth of the men that he had 209 00:13:01,270 --> 00:13:04,230 Speaker 1: already treated with his approach had recovered and were no 210 00:13:04,270 --> 00:13:07,809 Speaker 1: longer categorized as mad. He made the case that it's 211 00:13:07,970 --> 00:13:11,820 Speaker 1: almost impossible not to be compassionate when you consider the 212 00:13:11,880 --> 00:13:15,870 Speaker 1: reasons behind people might find themselves in such a place, stating, quote, 213 00:13:16,370 --> 00:13:21,750 Speaker 1: a large gathering of madmen inspires an undefinable thoughtful tenderness 214 00:13:21,850 --> 00:13:25,640 Speaker 1: when one realizes that their present state derives only from 215 00:13:25,679 --> 00:13:30,480 Speaker 1: a vivid sensitivity and from psychological qualities that we value highly. 216 00:13:31,440 --> 00:13:34,560 Speaker 1: So he describes things like people having fallen into despair 217 00:13:34,640 --> 00:13:40,100 Speaker 1: through difficult circumstances or broken hearts or religious or military fervor. 218 00:13:40,890 --> 00:13:44,089 Speaker 1: He also describes very talented people as often having a 219 00:13:44,190 --> 00:13:47,210 Speaker 1: very sensitive nature, something that he says he does not 220 00:13:47,250 --> 00:13:56,079 Speaker 1: want to discourage. But he also says that, quote, investigators, artists, orators, poets, geometers, engineers, painters, 221 00:13:56,160 --> 00:13:59,600 Speaker 1: and sculptors pay an almost annual price to the hospice 222 00:14:00,000 --> 00:14:04,420 Speaker 1: for the insane. He also said in his speech that, quote, 223 00:14:04,460 --> 00:14:07,199 Speaker 1: man is most often led from the free use of 224 00:14:07,280 --> 00:14:10,410 Speaker 1: reason to madness by overstepping the limits of his good 225 00:14:10,490 --> 00:14:15,090 Speaker 1: qualities and of his generous and magnanimous inclinations. So he's 226 00:14:15,130 --> 00:14:19,070 Speaker 1: making the case that patients labeled as mad and put 227 00:14:19,110 --> 00:14:22,570 Speaker 1: in asylums got there because of the same qualities that 228 00:14:22,590 --> 00:14:25,620 Speaker 1: they are often praised for so that the audience would 229 00:14:25,670 --> 00:14:29,180 Speaker 1: remember and understand that these are just people just like 230 00:14:29,240 --> 00:14:33,040 Speaker 1: them who had often experienced some kind of trauma or agitation. 231 00:14:33,060 --> 00:14:39,260 Speaker 1: Pinnell's description and discussion is obviously limited and problematic given 232 00:14:39,720 --> 00:14:43,100 Speaker 1: what we know today about mental health conditions. It does 233 00:14:43,200 --> 00:14:46,860 Speaker 1: not consider at all things like brain chemistry, for example. 234 00:14:46,880 --> 00:14:51,340 Speaker 1: I would also say it kind of reinforces that stereotype 235 00:14:51,360 --> 00:14:57,000 Speaker 1: that creative people are prone to mental illness. At the 236 00:14:57,040 --> 00:15:00,260 Speaker 1: same time, though, a really important step in garnering a 237 00:15:00,420 --> 00:15:07,060 Speaker 1: more nuanced view of these kinds of patients in post-Jacobin France. Yeah, 238 00:15:07,120 --> 00:15:09,720 Speaker 1: his whole thing was like, I'm going to humanize these 239 00:15:09,760 --> 00:15:13,590 Speaker 1: people who are human so that we can start considering 240 00:15:13,630 --> 00:15:17,650 Speaker 1: how to care for them best. Also in 1794, and 241 00:15:17,810 --> 00:15:21,070 Speaker 1: just a few days after that impassioned lecture at the 242 00:15:21,110 --> 00:15:24,790 Speaker 1: Society of Natural History, Pinel was appointed as an assistant 243 00:15:24,830 --> 00:15:29,380 Speaker 1: professor at the new revolutionary Paris Health School. Writing for 244 00:15:29,410 --> 00:15:33,900 Speaker 1: the American Journal of Psychiatry in 1992, Dora V. Wiener noted, quote, 245 00:15:34,220 --> 00:15:37,859 Speaker 1: the inference is obvious. His sponsors in the Committee of 246 00:15:37,940 --> 00:15:41,420 Speaker 1: Public Instruction and in the Paris Hospital Commission thought it 247 00:15:41,500 --> 00:15:46,250 Speaker 1: politic that their professorial candidate have some public exposure. So 248 00:15:46,290 --> 00:15:47,890 Speaker 1: that explains why he was like, I would like to 249 00:15:47,910 --> 00:15:50,250 Speaker 1: give a paper on the 11th if you have time. 250 00:15:51,510 --> 00:15:54,530 Speaker 1: A handful of months after he got that appointment, he 251 00:15:54,580 --> 00:15:58,670 Speaker 1: was promoted to full professor of internal pathology. And in 252 00:15:58,710 --> 00:16:01,910 Speaker 1: this role, in addition to teaching, he developed a textbook, 253 00:16:02,250 --> 00:16:07,740 Speaker 1: the Philosophic Nosography. So nosography is simply the classification of 254 00:16:07,820 --> 00:16:11,440 Speaker 1: conditions and diseases. And Pinel expanded on the work that 255 00:16:11,460 --> 00:16:13,780 Speaker 1: he had already been doing under his header of mental 256 00:16:13,860 --> 00:16:18,920 Speaker 1: alienation to offer a classification system for all known medical conditions. 257 00:16:19,340 --> 00:16:24,530 Speaker 1: And this book became a foundational text for French medical students. Naturally, 258 00:16:24,550 --> 00:16:27,720 Speaker 1: Pinel's success gained a lot of attention. Over the course 259 00:16:27,740 --> 00:16:31,640 Speaker 1: of just two years, he completely changed Bicetre, and as 260 00:16:31,700 --> 00:16:34,820 Speaker 1: a consequence, he was asked to move to the Hospice 261 00:16:34,880 --> 00:16:38,680 Speaker 1: de la Salpêtrière as chief physician in the hope that 262 00:16:38,720 --> 00:16:43,050 Speaker 1: his methods would be similarly successful there. Salpêtrière was a 263 00:16:43,090 --> 00:16:47,670 Speaker 1: much larger project. Bicetre had about 1,000 patients when he 264 00:16:47,730 --> 00:16:53,290 Speaker 1: arrived there, and Salpêtrière had 8,000. Additionally, Salpêtrière was a 265 00:16:53,380 --> 00:16:57,090 Speaker 1: women's facility. This was the last job that he would 266 00:16:57,130 --> 00:17:00,250 Speaker 1: ever have, not because he died especially young, but because 267 00:17:00,290 --> 00:17:02,830 Speaker 1: he decided to devote the rest of his career to 268 00:17:02,890 --> 00:17:07,340 Speaker 1: treating patients there. And during his time at Salpêtrière, Pinel 269 00:17:07,430 --> 00:17:09,619 Speaker 1: refined the treatments that he had used at the men's 270 00:17:09,640 --> 00:17:14,600 Speaker 1: facility and further developed his two-pronged approach, one focusing on 271 00:17:14,640 --> 00:17:17,939 Speaker 1: their physical well-being and the other on their mental well-being. 272 00:17:18,869 --> 00:17:21,689 Speaker 1: On the physical side, it included the same sort of things, 273 00:17:21,869 --> 00:17:26,310 Speaker 1: hygiene standards for the facility, regular hygiene for the patients themselves, 274 00:17:26,540 --> 00:17:30,500 Speaker 1: and careful management of their diet. On the mental side, 275 00:17:30,600 --> 00:17:33,080 Speaker 1: he sought to give patients a sense of community and 276 00:17:33,140 --> 00:17:37,139 Speaker 1: support by grouping them into small units that lived together, 277 00:17:37,160 --> 00:17:38,980 Speaker 1: so they had sort of their own little social groups. 278 00:17:39,580 --> 00:17:45,159 Speaker 1: He also continued his occupational therapy practices, including teaching employable skills. 279 00:17:45,820 --> 00:17:47,900 Speaker 1: So his idea was like, if I can get these 280 00:17:47,940 --> 00:17:51,639 Speaker 1: people cured enough to reintroduce them back into life outside 281 00:17:51,660 --> 00:17:53,810 Speaker 1: of this facility, I want them to also be able 282 00:17:54,130 --> 00:17:58,950 Speaker 1: to make a living for themselves. He also prescribed regular exercise. 283 00:17:59,330 --> 00:18:03,630 Speaker 1: And he called this course of therapy that translates directly 284 00:18:03,710 --> 00:18:08,300 Speaker 1: to moral treatment. But to be clear, it doesn't mean morality. 285 00:18:08,480 --> 00:18:11,580 Speaker 1: It means psychology. And it's something that he had done 286 00:18:11,600 --> 00:18:15,850 Speaker 1: at Bicetre as well. We really cannot overstate how radical 287 00:18:15,910 --> 00:18:18,710 Speaker 1: this was, but not because Pinnell was the first person 288 00:18:18,770 --> 00:18:20,850 Speaker 1: ever to think of it. This was not a case 289 00:18:20,869 --> 00:18:23,790 Speaker 1: where he just came up with the idea of humane 290 00:18:23,890 --> 00:18:27,110 Speaker 1: treatment of patients with mental illness all on his own. 291 00:18:27,910 --> 00:18:31,620 Speaker 1: There had absolutely been members of the medical community before 292 00:18:31,700 --> 00:18:35,679 Speaker 1: him who had suggested the idea of humane treatment of patients, 293 00:18:36,480 --> 00:18:40,660 Speaker 1: including patients with mental health conditions. Additionally, during the time 294 00:18:40,720 --> 00:18:44,320 Speaker 1: Pinnell was working on his approach, An English Quaker named 295 00:18:44,380 --> 00:18:49,380 Speaker 1: William Tooke was similarly inspired to initiate a change in approach. 296 00:18:50,010 --> 00:18:53,330 Speaker 1: But what really set Pinnell apart, and the reason that 297 00:18:53,369 --> 00:18:57,169 Speaker 1: he's so frequently referred to as the father of modern psychiatry, 298 00:18:57,310 --> 00:19:01,310 Speaker 1: was action. He made the leap from theorizing about this 299 00:19:01,350 --> 00:19:05,350 Speaker 1: to actually practicing it. accepting the risk of potential failure, 300 00:19:05,810 --> 00:19:10,169 Speaker 1: particularly adapting what had been small experiments for others into 301 00:19:10,430 --> 00:19:15,430 Speaker 1: really wide-scale institutional reforms. His work directly improved the lives 302 00:19:15,470 --> 00:19:19,720 Speaker 1: of thousands of patients. And Pinel continued to have good 303 00:19:19,760 --> 00:19:22,800 Speaker 1: results treating patients in this way, and he set the 304 00:19:22,859 --> 00:19:26,560 Speaker 1: standard of capturing all possible information about those in his 305 00:19:26,619 --> 00:19:30,399 Speaker 1: care to track their progress. I know it sounds wild, 306 00:19:30,440 --> 00:19:32,620 Speaker 1: but there really was not the same level of, like, 307 00:19:33,060 --> 00:19:35,379 Speaker 1: I have a file on this patient. I'm going to 308 00:19:35,440 --> 00:19:39,100 Speaker 1: note everything about them while they're under my care until 309 00:19:39,140 --> 00:19:42,520 Speaker 1: he started doing it. They just weren't perceived in that way. 310 00:19:43,340 --> 00:19:45,879 Speaker 1: And this also went back to his days at Bucetre, 311 00:19:46,100 --> 00:19:49,380 Speaker 1: and he included data for every patient that included things 312 00:19:49,440 --> 00:19:53,100 Speaker 1: like their ages, their temperature, and he would compare that 313 00:19:53,140 --> 00:19:56,000 Speaker 1: to the temperature of the building at the time, which 314 00:19:56,080 --> 00:19:59,219 Speaker 1: is a very interesting thing to do, their diagnoses. And 315 00:19:59,340 --> 00:20:04,389 Speaker 1: he also included measurements of their heads. Now, this is 316 00:20:04,470 --> 00:20:07,250 Speaker 1: not because he believed in phrenology. It was, in fact, 317 00:20:07,410 --> 00:20:11,340 Speaker 1: quite the opposite. Phrenology was really just coming into being 318 00:20:11,460 --> 00:20:14,100 Speaker 1: when Pinel was doing most of his work and his writing, 319 00:20:14,540 --> 00:20:17,580 Speaker 1: but it built on a 1790s idea that came out 320 00:20:17,600 --> 00:20:22,450 Speaker 1: of Austria called craniology. This, in case you have never heard, 321 00:20:22,470 --> 00:20:27,150 Speaker 1: is like basically saying people who are prone to, you know, violence, madness, 322 00:20:27,210 --> 00:20:29,570 Speaker 1: et cetera, you can just tell by looking at the 323 00:20:29,609 --> 00:20:32,169 Speaker 1: way their head is shaped. And Pinel thought this was 324 00:20:32,270 --> 00:20:36,100 Speaker 1: useless garbage. So his inclusion of cranial measurements is, was 325 00:20:36,160 --> 00:20:38,960 Speaker 1: actually a way to prove that. He later wrote of 326 00:20:39,000 --> 00:20:41,800 Speaker 1: his collected data of skull measurements that it would, quote, 327 00:20:41,900 --> 00:20:45,430 Speaker 1: appear to confirm the opinion, which I have already advanced, 328 00:20:45,770 --> 00:20:49,730 Speaker 1: that intense mental affections are the most ordinary causes of 329 00:20:49,810 --> 00:20:53,430 Speaker 1: insanity and that the heads of maniacs are not characterized 330 00:20:53,490 --> 00:20:56,790 Speaker 1: by any peculiarity of confirmation that are not to be 331 00:20:56,850 --> 00:21:01,040 Speaker 1: met with in other heads taken indiscriminately. We are going 332 00:21:01,080 --> 00:21:04,280 Speaker 1: to talk about some needed nuance when examining the stories 333 00:21:04,359 --> 00:21:06,640 Speaker 1: of Pinel's work. But before we do that, we will 334 00:21:06,680 --> 00:21:09,600 Speaker 1: take a break to hear from some of the show's sponsors. 335 00:21:19,440 --> 00:21:22,679 Speaker 1: One aspect in all of this information about Pinel that 336 00:21:22,720 --> 00:21:27,190 Speaker 1: requires some nuance is the characterization of him as breaking 337 00:21:27,250 --> 00:21:30,390 Speaker 1: the chains of all the people under his care transforming 338 00:21:30,430 --> 00:21:33,949 Speaker 1: them from inmates to patients. There is even a very 339 00:21:34,070 --> 00:21:37,270 Speaker 1: famous painting by Tony Robert Fleury from the late 19th 340 00:21:37,310 --> 00:21:41,490 Speaker 1: century depicting him doing so. That was at the women's hospital. 341 00:21:42,130 --> 00:21:45,470 Speaker 1: But he did not release all of his patients from shackles. 342 00:21:46,190 --> 00:21:48,820 Speaker 1: In instances where he believed a patient was a danger 343 00:21:48,980 --> 00:21:54,040 Speaker 1: if left unshackled, they remained confined and tethered. He included 344 00:21:54,100 --> 00:21:56,690 Speaker 1: examples of this in the essay that he read aloud 345 00:21:56,750 --> 00:22:00,470 Speaker 1: in 1794 that we quoted earlier, mentioning several cases of 346 00:22:00,510 --> 00:22:04,910 Speaker 1: what he described as, quote, agitated and violent men, including 347 00:22:05,090 --> 00:22:07,070 Speaker 1: one who had been in that state for more than 348 00:22:07,150 --> 00:22:10,929 Speaker 1: four decades, so chained up for that long. He is 349 00:22:11,020 --> 00:22:14,060 Speaker 1: very detailed in his descriptions of the behavior of the 350 00:22:14,119 --> 00:22:17,199 Speaker 1: men in these examples that he thinks warrant the use 351 00:22:17,240 --> 00:22:21,639 Speaker 1: of shackles, explaining why these patients were so very dangerous. 352 00:22:22,390 --> 00:22:24,340 Speaker 1: He wrote of the need to try to avoid this, 353 00:22:24,619 --> 00:22:27,740 Speaker 1: but also to be willing to do so if necessary. Quote, 354 00:22:28,500 --> 00:22:31,400 Speaker 1: one of the fundamental principles of the conduct one must 355 00:22:31,520 --> 00:22:35,340 Speaker 1: adopt toward the insane is an intelligent mixture of affability 356 00:22:35,460 --> 00:22:39,640 Speaker 1: and firmness. When they are obstinate, one must sound totally 357 00:22:39,720 --> 00:22:43,480 Speaker 1: authoritative and unshakable so as to convince them to bow 358 00:22:43,540 --> 00:22:47,320 Speaker 1: to the will of the directors. But one must avoid 359 00:22:47,420 --> 00:22:51,959 Speaker 1: any unnecessary constraints and use only enough force to restrain them. 360 00:22:53,010 --> 00:22:56,020 Speaker 1: As an example, he describes a soldier who is, quote, 361 00:22:56,150 --> 00:23:00,040 Speaker 1: obsessed with the thought of his imminent departure, who refuses 362 00:23:00,100 --> 00:23:02,440 Speaker 1: to go into his cell or go to bed because 363 00:23:02,500 --> 00:23:04,620 Speaker 1: he is certain that he will be called to duty 364 00:23:04,660 --> 00:23:09,609 Speaker 1: at any moment. Pinnell describes the soldier becoming agitated to 365 00:23:09,650 --> 00:23:12,369 Speaker 1: the point where he threatens staff, at which point the 366 00:23:12,410 --> 00:23:16,970 Speaker 1: director steps in and threatens restraint. Then the soldier would 367 00:23:16,990 --> 00:23:19,590 Speaker 1: be tied down, and if that did not subdue him, 368 00:23:19,650 --> 00:23:23,649 Speaker 1: the director might resort to chains. But Pinnell also describes 369 00:23:23,730 --> 00:23:26,030 Speaker 1: a system in which the goal is to get the 370 00:23:26,070 --> 00:23:28,750 Speaker 1: patient out of the restraints by checking in on their 371 00:23:28,790 --> 00:23:32,040 Speaker 1: mental state over a course of days and releasing them 372 00:23:32,119 --> 00:23:36,060 Speaker 1: when they've calmed down, as was promised. Yeah, that's another 373 00:23:36,119 --> 00:23:37,920 Speaker 1: part of it is that he would explain to them 374 00:23:38,060 --> 00:23:40,379 Speaker 1: what they're doing and why and be like, when you 375 00:23:40,420 --> 00:23:43,850 Speaker 1: are no longer dangerous, this will absolutely end. But you 376 00:23:43,869 --> 00:23:45,670 Speaker 1: and I have to work together to get to this point. 377 00:23:47,040 --> 00:23:52,710 Speaker 1: In 1801, he published Medico-Philosophical Treatise on Mental Alienation or Mania. 378 00:23:53,430 --> 00:23:56,929 Speaker 1: This book was republished in 1809 with additional material and 379 00:23:57,090 --> 00:23:59,770 Speaker 1: also with the mania word cut out of the title. 380 00:24:00,760 --> 00:24:03,720 Speaker 1: In the years between those two editions, he also published 381 00:24:03,820 --> 00:24:06,959 Speaker 1: another book, A Treatise on Insanity, in which are contained 382 00:24:06,980 --> 00:24:10,399 Speaker 1: the principles of a new and more practical nosology of 383 00:24:10,440 --> 00:24:13,570 Speaker 1: maniacal disorders than has yet been offered to the public. 384 00:24:14,080 --> 00:24:18,250 Speaker 1: exemplified by numerous and accurate historical relations of cases from 385 00:24:18,290 --> 00:24:22,270 Speaker 1: the author's public and private practice. The introduction to the 386 00:24:22,270 --> 00:24:26,250 Speaker 1: 1806 book is a general description of mental health conditions 387 00:24:26,290 --> 00:24:30,470 Speaker 1: from Pinnell's point of view. This is a long passage, 388 00:24:30,590 --> 00:24:34,379 Speaker 1: but it really shows how he perceived diseases of the mind. Quote, 389 00:24:34,920 --> 00:24:37,700 Speaker 1: of all the afflictions to which human nature is subject, 390 00:24:37,780 --> 00:24:41,060 Speaker 1: the loss of reason is at once the most calamitous 391 00:24:41,200 --> 00:24:45,119 Speaker 1: and interesting. Deprived of this faculty by which man is 392 00:24:45,240 --> 00:24:49,350 Speaker 1: principally distinguished from the beasts that perish, the human form 393 00:24:49,410 --> 00:24:52,929 Speaker 1: is frequently the most remarkable attribute that he retains of 394 00:24:52,990 --> 00:24:57,790 Speaker 1: his proud distinction. His character as an individual of the 395 00:24:57,830 --> 00:25:02,800 Speaker 1: species is always perverted, sometimes annihilated. His thoughts and actions 396 00:25:02,880 --> 00:25:06,680 Speaker 1: are diverted from their usual and natural course. The chain 397 00:25:06,720 --> 00:25:10,939 Speaker 1: which connected his ideas in just series and mutual subserviency 398 00:25:11,040 --> 00:25:15,180 Speaker 1: is dissevered, His feelings for himself and others are new 399 00:25:15,400 --> 00:25:19,659 Speaker 1: and uncommon. His attachments are converted into aversions and his 400 00:25:19,720 --> 00:25:24,810 Speaker 1: love into hatred. His consciousness even is not unfrequently alienated 401 00:25:24,930 --> 00:25:27,770 Speaker 1: in so much that with equal probability he may fancy 402 00:25:27,810 --> 00:25:32,350 Speaker 1: himself a deity, an emperor, or a mass of inanimate matter. 403 00:25:33,270 --> 00:25:35,810 Speaker 1: Once the ornament and life of society, he is now 404 00:25:35,880 --> 00:25:39,280 Speaker 1: become a stranger to its pleasures or a disturber of 405 00:25:39,340 --> 00:25:44,119 Speaker 1: its tranquility. Impatient of restraint and disposed to expend the 406 00:25:44,220 --> 00:25:48,730 Speaker 1: unusual effervescence of his spirits in roving and turbulence, coercion 407 00:25:48,750 --> 00:25:51,810 Speaker 1: of the mildest kind adds fury to his delirium and 408 00:25:51,930 --> 00:25:56,490 Speaker 1: colors with jealousy or suspicion every effort of friendly or 409 00:25:56,550 --> 00:26:00,850 Speaker 1: professional interest in his fate. His personal liberty is at 410 00:26:00,910 --> 00:26:03,780 Speaker 1: length taken from him and taken from him perhaps by 411 00:26:03,840 --> 00:26:08,560 Speaker 1: his nearest relative or dearest friend, retaining his original sensibility 412 00:26:08,660 --> 00:26:11,980 Speaker 1: or rendered more acutely sensible by opposition to his will 413 00:26:12,100 --> 00:26:16,650 Speaker 1: and deprivation of his usual gratifications. Cooperating with a morbid 414 00:26:16,710 --> 00:26:20,210 Speaker 1: excitement of his nervous functions, he gives himself up to 415 00:26:20,380 --> 00:26:26,080 Speaker 1: all the extravagances of maniacal fury, or sinks inexpressibly miserable 416 00:26:26,160 --> 00:26:30,439 Speaker 1: into the lowest depths of despondence and melancholy. If the 417 00:26:30,540 --> 00:26:35,240 Speaker 1: former he resembles in ferocity, the tiger, and meditates destruction 418 00:26:35,280 --> 00:26:39,700 Speaker 1: and revenge— if the latter he withdraws from society, shuns 419 00:26:39,940 --> 00:26:43,240 Speaker 1: the plots and inveiglements which he imagines to surround him, 420 00:26:43,420 --> 00:26:46,740 Speaker 1: and fancies himself an object of human persecution and treachery, 421 00:26:47,400 --> 00:26:51,419 Speaker 1: or a victim of divine vengeance and reprobation. Thank you 422 00:26:51,440 --> 00:26:53,910 Speaker 1: for reading that long passage, Tracy. I did not mean 423 00:26:53,970 --> 00:26:57,750 Speaker 1: to foist that on you. Pinnell then goes on to 424 00:26:57,790 --> 00:27:01,450 Speaker 1: describe the way that if such maladies, as he's described, 425 00:27:01,609 --> 00:27:05,470 Speaker 1: aren't identified and treated, a person will inevitably fall into 426 00:27:05,510 --> 00:27:08,540 Speaker 1: a state where they resemble a human in form only. 427 00:27:09,300 --> 00:27:10,879 Speaker 1: And he goes on to say that the history of 428 00:27:10,940 --> 00:27:13,740 Speaker 1: mental illness is also a history of the human mind, 429 00:27:13,820 --> 00:27:17,500 Speaker 1: because the difficulty of understanding things you cannot always see 430 00:27:17,540 --> 00:27:20,899 Speaker 1: in physical form, like a bodily injury, has meant that 431 00:27:20,940 --> 00:27:24,280 Speaker 1: humans have not always considered mental illness something in the 432 00:27:24,320 --> 00:27:26,760 Speaker 1: realm of science. and have come up with a number 433 00:27:26,800 --> 00:27:29,460 Speaker 1: of explanations for it that are not based at all 434 00:27:29,560 --> 00:27:33,000 Speaker 1: in scientific thought. This is an interesting point of view, 435 00:27:33,060 --> 00:27:36,179 Speaker 1: because one of the long-term criticisms of Pennell's work is 436 00:27:36,200 --> 00:27:38,939 Speaker 1: that he kind of ignored the possibility of some of 437 00:27:39,030 --> 00:27:43,290 Speaker 1: the physiological reasons for people to develop problems with their 438 00:27:43,330 --> 00:27:46,469 Speaker 1: mental health. His writing covers a lot of ground regarding 439 00:27:46,510 --> 00:27:49,690 Speaker 1: the cause and effect of life events that might cause 440 00:27:49,750 --> 00:27:53,470 Speaker 1: someone to experience a degradation in their mental health, but 441 00:27:53,490 --> 00:27:56,850 Speaker 1: he never really considers physical causes. And this is sort 442 00:27:56,869 --> 00:28:00,730 Speaker 1: of odd because there had been writing about some of 443 00:28:00,770 --> 00:28:03,629 Speaker 1: the physical causes for mental conditions going all the way 444 00:28:03,670 --> 00:28:07,470 Speaker 1: back to Hippocrates and Galen for a long time. This 445 00:28:07,510 --> 00:28:09,950 Speaker 1: was based on the idea of the four humors, but 446 00:28:10,050 --> 00:28:14,910 Speaker 1: in Pinel's own time, scientists like Antoine Lavoisier and even 447 00:28:15,130 --> 00:28:19,610 Speaker 1: Michel-Augustin Theret, who was Pinel's colleague at the university, were 448 00:28:19,670 --> 00:28:25,340 Speaker 1: talking about brain chemistry. But Pinnell argued against physical causes 449 00:28:25,440 --> 00:28:30,000 Speaker 1: of madness, writing in 1801, quote, derangement of the understanding 450 00:28:30,060 --> 00:28:33,899 Speaker 1: is generally considered as an effect of an organic lesion 451 00:28:33,940 --> 00:28:38,080 Speaker 1: of the brain, consequently as incurable, a supposition that is, 452 00:28:38,380 --> 00:28:41,880 Speaker 1: in a great number of instances, contrary to anatomical fact. 453 00:28:42,780 --> 00:28:46,790 Speaker 1: Of course, he was absolutely wrong on that. Yeah, he 454 00:28:46,830 --> 00:28:50,210 Speaker 1: was so adamant, too. And I have a theory about why, 455 00:28:50,270 --> 00:28:55,320 Speaker 1: but we'll discuss that on Friday. because it's just my theory. Now, 456 00:28:55,380 --> 00:29:00,810 Speaker 1: he does, however, acknowledge some physiological causes for mental illness, 457 00:29:00,890 --> 00:29:03,010 Speaker 1: but what I am about to read is going to 458 00:29:03,050 --> 00:29:06,450 Speaker 1: elicit a big sigh. It certainly did for me when 459 00:29:06,490 --> 00:29:08,940 Speaker 1: I first read it. In the preface for the 1809 460 00:29:08,940 --> 00:29:13,940 Speaker 1: edition of his Medico-Philosophical Treatise, he writes, quote, one can 461 00:29:13,980 --> 00:29:17,520 Speaker 1: accept that in simple cases, mental and physical management can 462 00:29:17,560 --> 00:29:20,940 Speaker 1: bring about a full recovery in a given time. But 463 00:29:20,980 --> 00:29:23,360 Speaker 1: in how many other cases does one have to resort 464 00:29:23,400 --> 00:29:27,980 Speaker 1: to certain internal or external remedies depending on age, gender, 465 00:29:28,050 --> 00:29:32,530 Speaker 1: the underlying cause, or indeed varieties in the individual constitution? 466 00:29:33,350 --> 00:29:36,730 Speaker 1: How complicated are the ailments which can come from the 467 00:29:36,770 --> 00:29:41,340 Speaker 1: suppression of menses or from their natural cessation? whereupon mental 468 00:29:41,420 --> 00:29:47,350 Speaker 1: illness sets in? That's right, ladies, menopause equals mental illness. Oh, dear. 469 00:29:50,870 --> 00:29:55,430 Speaker 1: In 1804, Pinel received the Order Nationale de la Légion d'Odeur, 470 00:29:55,570 --> 00:29:59,470 Speaker 1: France's most prestigious honor, Incidentally, that was just two years 471 00:29:59,570 --> 00:30:02,890 Speaker 1: after Napoleon Bonaparte established that award, so he was a 472 00:30:02,910 --> 00:30:06,330 Speaker 1: very early recipient. And Pinel worked right up until the 473 00:30:06,370 --> 00:30:08,950 Speaker 1: end of his life. He died at Hospice de la 474 00:30:09,010 --> 00:30:13,650 Speaker 1: Salle Patrière on December 25th, 1826. He was buried at 475 00:30:13,690 --> 00:30:17,469 Speaker 1: Père Lachaise. One aspect of Pinel's life and work that 476 00:30:17,510 --> 00:30:20,890 Speaker 1: can make it difficult to really analyze his impact is 477 00:30:20,930 --> 00:30:26,290 Speaker 1: the sort of legendary hero status he achieved. In 1849, Chambers' 478 00:30:26,410 --> 00:30:29,820 Speaker 1: Edinburgh Journal published a story about Pinel that was told 479 00:30:30,060 --> 00:30:34,600 Speaker 1: to the editor by Pinel's son, Scipion Pinel, who followed 480 00:30:34,640 --> 00:30:39,280 Speaker 1: his father's path and became a psychiatrist. According to Scipion's account, 481 00:30:39,380 --> 00:30:43,110 Speaker 1: during Philippe Pinel's early months at Bicetre, when the reign 482 00:30:43,130 --> 00:30:46,710 Speaker 1: of terror was still playing out, an official from the 483 00:30:46,810 --> 00:30:51,670 Speaker 1: Paris commune named Georges Couton arrived at the facility looking 484 00:30:51,750 --> 00:30:56,500 Speaker 1: for traitors. He believed that anti-commun activists were being housed 485 00:30:56,620 --> 00:31:00,160 Speaker 1: at the asylum under the guise of being mentally unwell. 486 00:31:00,960 --> 00:31:04,370 Speaker 1: And according to the account, Coudon, quote, wished to see 487 00:31:04,470 --> 00:31:08,530 Speaker 1: and personally question the lunatics one after another. But to 488 00:31:08,570 --> 00:31:12,590 Speaker 1: all his questions, he received but insults and sanguinary addresses 489 00:31:12,990 --> 00:31:16,330 Speaker 1: and heard nothing amidst the confused cries and mad howling, 490 00:31:16,650 --> 00:31:20,530 Speaker 1: but the chilling clank of chains reverberating through the disgustingly 491 00:31:20,610 --> 00:31:23,900 Speaker 1: dirty and damp vaults. Remember, this was before he got 492 00:31:24,880 --> 00:31:29,120 Speaker 1: allocations to put in baths. After seeing the reality of 493 00:31:29,180 --> 00:31:33,350 Speaker 1: Bicetre and learning of Pinel's plans to unchange people, Coton 494 00:31:33,550 --> 00:31:36,890 Speaker 1: asked Pinel if he wasn't himself mad to even consider 495 00:31:37,310 --> 00:31:40,950 Speaker 1: giving these men their freedom from shackles. And Pinel's reply 496 00:31:41,010 --> 00:31:44,950 Speaker 1: was allegedly, quote, citizen, I am convinced that these lunatics 497 00:31:44,990 --> 00:31:48,860 Speaker 1: have become so unmanageable solely because they have been deprived 498 00:31:48,940 --> 00:31:51,640 Speaker 1: of air and liberty. And I venture to hope a 499 00:31:51,700 --> 00:31:55,760 Speaker 1: great deal from a thoroughly different method. This sounds so 500 00:31:55,840 --> 00:31:59,120 Speaker 1: cool and very quippy, but is this story true? We 501 00:31:59,140 --> 00:32:04,590 Speaker 1: don't know. I mean... His son could have told this 502 00:32:04,610 --> 00:32:06,810 Speaker 1: story as a great family story, or it could have 503 00:32:06,830 --> 00:32:08,870 Speaker 1: been completely made up by the editor. We just don't know. 504 00:32:09,430 --> 00:32:12,490 Speaker 1: It's certainly, though, added to the mystique of Pinel in 505 00:32:12,510 --> 00:32:16,590 Speaker 1: the 19th century. Incidentally, this account then goes on to 506 00:32:16,630 --> 00:32:21,350 Speaker 1: tell how Pinel systematically started releasing people from their shackles. 507 00:32:21,410 --> 00:32:23,870 Speaker 1: He had a whole plan in place. He had essentially 508 00:32:23,950 --> 00:32:28,310 Speaker 1: what were their version of straitjackets ready in case things 509 00:32:28,370 --> 00:32:32,640 Speaker 1: went awry, and a team of people... It talks about 510 00:32:32,680 --> 00:32:36,060 Speaker 1: the great success that he achieved in trusting his patients, 511 00:32:36,520 --> 00:32:39,400 Speaker 1: but also assuring them that the staff could always confine 512 00:32:39,440 --> 00:32:43,020 Speaker 1: them and reinstate their shackles if they needed to. This 513 00:32:43,060 --> 00:32:47,710 Speaker 1: whole thing is very obviously a very romanticized account, referring 514 00:32:47,770 --> 00:32:52,990 Speaker 1: to Pinel repeatedly as a liberator. Additionally, Pinel's writing and 515 00:32:53,070 --> 00:32:56,110 Speaker 1: work have been debated more or less constantly in the 516 00:32:56,150 --> 00:32:59,550 Speaker 1: last 200 years. Some of this is just the natural 517 00:32:59,750 --> 00:33:04,190 Speaker 1: offshoot of his techniques being really pioneering and consequently not 518 00:33:04,290 --> 00:33:07,940 Speaker 1: fully thought out in a lot of ways. Supporters point 519 00:33:08,120 --> 00:33:12,460 Speaker 1: out just how progressive his work was and how relevant 520 00:33:12,520 --> 00:33:16,640 Speaker 1: a lot of his ideas still are. One particularly strong 521 00:33:16,700 --> 00:33:22,770 Speaker 1: detractor was 20th century philosopher Michel Foucault. Foucault argued that 522 00:33:22,890 --> 00:33:26,770 Speaker 1: though Pinel might have done away with physical shackles for 523 00:33:26,810 --> 00:33:32,070 Speaker 1: his patients, he merely replaced them with psychological shackles, describing 524 00:33:32,110 --> 00:33:35,710 Speaker 1: his work as a, quote, moral imprisonment in which those 525 00:33:35,780 --> 00:33:38,960 Speaker 1: in treatment were controlled with more subtle forms of manipulation. 526 00:33:39,580 --> 00:33:43,940 Speaker 1: According to Foucault's logic, in becoming compliant with doctors, patients 527 00:33:43,960 --> 00:33:49,560 Speaker 1: were becoming alienated from themselves. Yeah, there's a whole... zone 528 00:33:49,600 --> 00:33:53,200 Speaker 1: of study you can go about, Michel Foucault's thoughts on Pinel. 529 00:33:53,640 --> 00:33:56,750 Speaker 1: And everything, really. Everything, yes. He had big thoughts about 530 00:33:56,770 --> 00:33:58,490 Speaker 1: a lot of things. But like, I got to this 531 00:33:58,530 --> 00:34:01,530 Speaker 1: point where he's kind of making the case that great 532 00:34:01,610 --> 00:34:06,370 Speaker 1: societies have always had people with some form of mental illness. 533 00:34:06,430 --> 00:34:08,210 Speaker 1: And in a lot of places, they were just like 534 00:34:08,230 --> 00:34:11,009 Speaker 1: the fun people at the party. Like, he's essentially like, no, 535 00:34:11,070 --> 00:34:14,549 Speaker 1: it's cool. We don't need treatment. Oh, dear. Which is 536 00:34:14,750 --> 00:34:19,890 Speaker 1: obviously its own problem. In a preface written to a 537 00:34:19,870 --> 00:34:24,390 Speaker 1: 1961 English translation of A Treatise on Insanity, Paul F. Cranfield, 538 00:34:24,450 --> 00:34:27,029 Speaker 1: who was working in the Department of Psychiatry at Albert 539 00:34:27,070 --> 00:34:30,910 Speaker 1: Einstein College of Medicine at the time, summed up Pinel's legacy, 540 00:34:31,010 --> 00:34:35,730 Speaker 1: good and bad, this way, quote, Brilliant observation plus neglect 541 00:34:35,790 --> 00:34:39,069 Speaker 1: of basic science. In this, we find the glory and 542 00:34:39,110 --> 00:34:43,370 Speaker 1: the weakness of the Paris Clinical School. The first attribute 543 00:34:43,410 --> 00:34:46,680 Speaker 1: placed Paris, and with it the psychiatry of Pinel, in 544 00:34:46,719 --> 00:34:50,500 Speaker 1: a leading position in world medicine. The second trait led 545 00:34:50,540 --> 00:34:54,360 Speaker 1: to the eventual decline of the school. Paris lost its 546 00:34:54,430 --> 00:34:56,690 Speaker 1: place to a group who thought and observed in the 547 00:34:56,750 --> 00:35:01,069 Speaker 1: hospital and thought and experimented in the laboratory. It is 548 00:35:01,110 --> 00:35:05,190 Speaker 1: for this reason that Pinel is not truly modern. Pinel 549 00:35:05,230 --> 00:35:07,830 Speaker 1: has sometimes been praised as a practical man who had 550 00:35:07,930 --> 00:35:12,049 Speaker 1: too much sense to waste time spinning philosophical systems. To 551 00:35:12,110 --> 00:35:15,110 Speaker 1: praise him thus is to praise him for his defects, 552 00:35:15,530 --> 00:35:18,610 Speaker 1: the very defects which prevented the hospital medicine of Paris 553 00:35:18,950 --> 00:35:22,430 Speaker 1: from taking the next step in creating the laboratory medicine 554 00:35:22,510 --> 00:35:26,850 Speaker 1: of today. Pinel we praise rather for his virtues, for 555 00:35:26,890 --> 00:35:31,170 Speaker 1: his effectiveness as an administrator, for his skill as a psychotherapist, 556 00:35:31,570 --> 00:35:35,040 Speaker 1: and for his great humanity. I thought that was kind 557 00:35:35,060 --> 00:35:39,040 Speaker 1: of the best, most even keel read of his situation 558 00:35:39,060 --> 00:35:41,549 Speaker 1: that I found in any of the scholarship I looked at. 559 00:35:43,290 --> 00:35:47,950 Speaker 1: And that is Philippe Pinel, who captures my imagination in 560 00:35:47,989 --> 00:35:53,010 Speaker 1: a variety of ways. Yeah. I have the best dog story. Oh, good. 561 00:35:53,350 --> 00:35:57,239 Speaker 1: In listener mail. This is from our listener, Andrew. And 562 00:35:57,320 --> 00:35:59,520 Speaker 1: it makes me chuckle. And I love it so much. 563 00:36:00,150 --> 00:36:03,010 Speaker 1: Andrew writes, Hi, Holly and Tracy. I have been listening 564 00:36:03,050 --> 00:36:05,489 Speaker 1: to your fantastic podcast for well over a decade now 565 00:36:05,550 --> 00:36:07,629 Speaker 1: and have thought about emailing in a few times over 566 00:36:07,670 --> 00:36:10,989 Speaker 1: the years. Most recently regarding popcorn and my need to 567 00:36:11,030 --> 00:36:14,920 Speaker 1: correct some of the historical Thanksgiving facts in the popcorn 568 00:36:14,960 --> 00:36:18,140 Speaker 1: book when reading it to my kids, which is always 569 00:36:18,180 --> 00:36:21,200 Speaker 1: such a fun way to read a children's story. But 570 00:36:21,239 --> 00:36:23,860 Speaker 1: when your episode about Frederick Walton and his invention of 571 00:36:23,920 --> 00:36:26,739 Speaker 1: linoleum hit, I knew I had to tell you this story. 572 00:36:27,510 --> 00:36:30,210 Speaker 1: Many years ago, in our first house, our little kitchen 573 00:36:30,250 --> 00:36:33,770 Speaker 1: had flooring that I always said was linoleum. One night 574 00:36:33,790 --> 00:36:35,610 Speaker 1: while I was out, I received a call from my 575 00:36:35,690 --> 00:36:38,529 Speaker 1: wife who had just returned home. The first thing out 576 00:36:38,550 --> 00:36:42,440 Speaker 1: of her mouth was, Indy ate the kitchen floor. You see, 577 00:36:42,540 --> 00:36:45,340 Speaker 1: we named our dog Indiana, Indy for short, after our 578 00:36:45,380 --> 00:36:48,200 Speaker 1: favorite archaeologist and kept him penned up in the kitchen 579 00:36:48,219 --> 00:36:53,089 Speaker 1: while we were out. Sidebar. Sidebar. That's also what George Lucas' 580 00:36:53,130 --> 00:36:56,310 Speaker 1: dog was named. So when they make the joke, we 581 00:36:56,350 --> 00:37:00,250 Speaker 1: named the dog Indiana in the third movie. That's what 582 00:37:00,270 --> 00:37:03,589 Speaker 1: it's about. Anyway, back to Indy the dog. And that night, 583 00:37:03,690 --> 00:37:06,110 Speaker 1: he decided to live up to his namesake and started 584 00:37:06,170 --> 00:37:09,290 Speaker 1: digging through the floor, starting in the middle and continuing 585 00:37:09,390 --> 00:37:13,010 Speaker 1: outward until there were only a few inches of border left. Thankfully, 586 00:37:13,070 --> 00:37:15,210 Speaker 1: he did not swallow any of it and was happy 587 00:37:15,230 --> 00:37:18,200 Speaker 1: just tearing it to shreds. But nonetheless, our kitchen was 588 00:37:18,239 --> 00:37:21,320 Speaker 1: a disaster. When my dad and I went to replace it, 589 00:37:21,489 --> 00:37:23,870 Speaker 1: I said it was linoleum, and that's when he taught 590 00:37:23,890 --> 00:37:26,750 Speaker 1: me that linoleum and vinyl flooring are not the same thing. 591 00:37:27,469 --> 00:37:30,910 Speaker 1: Needless to say, we opted to replace it with ceramic tile. 592 00:37:31,550 --> 00:37:34,330 Speaker 1: Attached as pet tacks are pictures of Indy posing on 593 00:37:34,370 --> 00:37:37,779 Speaker 1: his new flooring and our current puppy, Hunter, hugging his 594 00:37:37,820 --> 00:37:40,100 Speaker 1: favorite toy. Thanks for all you do in keeping my 595 00:37:40,180 --> 00:37:45,060 Speaker 1: sanity throughout the week, Andrew. Indy is a supermodel of dogs, 596 00:37:45,160 --> 00:37:50,240 Speaker 1: by the way. He is this gorgeous, fluffy... largely black, 597 00:37:50,300 --> 00:37:55,379 Speaker 1: but with these beautiful like cream and tawny patches. That 598 00:37:55,440 --> 00:37:58,580 Speaker 1: is a dog of my heart. He is beautiful. And Hunter, 599 00:37:58,620 --> 00:38:01,180 Speaker 1: don't even get me started. I'd be powerless in the 600 00:38:01,200 --> 00:38:04,890 Speaker 1: face of that cute puppy. And your tile looks completely intact. 601 00:38:04,930 --> 00:38:08,290 Speaker 1: So I see that that plan worked perfectly. Thank you 602 00:38:08,330 --> 00:38:10,810 Speaker 1: so much for sharing this cute story and your beautiful 603 00:38:10,830 --> 00:38:13,970 Speaker 1: dog pictures. I'm literally just gazing at them like lovingly 604 00:38:14,030 --> 00:38:16,750 Speaker 1: right now because they're so cute. I would say I 605 00:38:16,770 --> 00:38:18,300 Speaker 1: need a dog, but I don't have a dog life. 606 00:38:18,840 --> 00:38:22,100 Speaker 1: Sure love dogs, though. And these two are spectacular. So 607 00:38:22,120 --> 00:38:25,719 Speaker 1: congratulations on having some very gorgeous pups. If you would 608 00:38:25,760 --> 00:38:27,239 Speaker 1: like to write to us and tell you how your 609 00:38:27,260 --> 00:38:29,790 Speaker 1: pets have destroyed your house or anything else that strikes 610 00:38:29,810 --> 00:38:35,150 Speaker 1: your fancy, you can do that at HistoryPodcast at iHeartRadio.com. 611 00:38:35,590 --> 00:38:37,410 Speaker 1: If you would like to see the sources we used 612 00:38:37,450 --> 00:38:39,910 Speaker 1: for this or any episode, you can see them all 613 00:38:39,930 --> 00:38:43,680 Speaker 1: at MissedInHistory.com, where we have all of our sources listed 614 00:38:43,700 --> 00:38:46,540 Speaker 1: in the show notes for every episode. You can also 615 00:38:46,739 --> 00:38:48,660 Speaker 1: subscribe to the show if you haven't done that before. 616 00:38:49,160 --> 00:38:51,529 Speaker 1: That's easy to do on the iHeartRadio app or anywhere 617 00:38:51,550 --> 00:38:59,529 Speaker 1: you listen to your favorite podcasts. Stuff You Missed in 618 00:38:59,550 --> 00:39:03,270 Speaker 1: History Class is a production of iHeartRadio. For more podcasts 619 00:39:03,310 --> 00:39:07,450 Speaker 1: from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever 620 00:39:07,510 --> 00:39:08,930 Speaker 1: you listen to your favorite shows.