Philippe Pinel and His “Medico-Philosophical Treatise on Mental Alienation or Mania”

Philippe Pinel’s Medico-Philosophical Treatise on Mental Alienation or Mania is a collection of his case studies in which he analyzes each of his patients. Using each case from his studies, he describes four main categories of madness that he discerned: “maniacal insanity,” “melancholia,” dementia, and idiocy (Pinel 54). Maniacal insanity, according to Pinel, is typically temporary, sometimes chronic, and frequently curable. Pinel described melancholia as “a dreamy taciturn manner, touchy and suspicious, with a desire to be left alone” (Pinel 62). In the treatise, dementia is viewed as something that gradually erodes the victim’s thoughts and cannot be cured. Finally, idiocy is present when the intellect of an individual never fully developed.

Pinel’s most famous means of therapy was finding the root of a patient’s mental distress and addressing in through theatrical means. For example, Pinel had a patient who was suffering from the delusion that they were going to be sent to the guillotine (Pinel 133). His method for curing the patient was staging a trial in which the patient was found innocent so they were not sentenced to death (Jay 66). Some of the cures were not successful, but the theatrical process brought the doctor and the patient closer together, alleviating some of the patients stress and symptoms.

Pinel’s research and treatment was based on the idea that humans are essentially benevolent beings who are inclined toward kindness. However, this inviting method was backed by the threat of punishment to prevent mischief or abuse of trust. This punishment usually took the form of physical restraint or solitary confinement. A famous example of this methodology took place at Bicêtre Hospital. Pinel was treating the most violent patient in the hospital and offered to remove his restraints (Jay 70). The patient questioned the offer, but Pinel assured the patient that he had men ready to come into the room at any moment. This small reassurance allowed for productive interactions between Pinel and the patient because (according to Pinel) the patient felt less dangerous than he would have in a typical reaction with another person (Pinel 81-82).

The image above, “Philippe Pinel à La Salpêtrière” by Tiny Robert-Fleury (Wikimedia), is a piece from the Romantic period that portrays Pinel freeing the mentally ill from their chains.  This is a dramatization of what Pinel actually did, but it does carry some truth. Pinel is known now for his forward looking, therapeutic methods.

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Jay, Mike, and Bárbara Rodríguez Muñoz. This Way Madness Lies: The Asylum and Beyond. Thames & Hudson, 2016.

Shiraev, Eric. A History of Psychology: A Global Perspective. SAGE, 2011.

Pinel, Philippe. Medico-Philosophical Treatise on Mental Alienation. Vol. 2, Wiley-Blackwell, Accessed 8 April.