Traité médico-philosophique sur laliénation mentale (French Edition)

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The use of lost concepts like chagrin and misanthropy which once featured prominently in our efforts to understand ourselves, might hopefully act as a reminder that there have been other ways to see some of the issues at stake. Looking back can sometimes make visible the way forward — reculer pour mieux sauter. While advocating an awareness of the passions as triggers to insanity, Pinel holds in conjunction all possible triggers to the conditions his patients evince, noting the physical changes in bodily functioning which he argues may lead on to secondary mental changes, and then outlining case histories in which events and circumstances that lead to powerful passions such as chagrin or anger trigger identical mental disorders to those that seem to have physical antecedents.

First and famously he advocates moral treatment. As translators we have had to struggle with this term [9]. While it is often translated as psychological treatment, and the word psychology had been in existence from , the idea of a psychotherapy did not come into existence before Freud and Janet almost a century later, and using a term like psychological treatment risks importing ideas into the mix that were just not available to Pinel.

The term behaviour therapy maps well onto what he actually did, and behaviour therapists now cite him as the originator of their discipline [10] , but equally this is a 20 th century term that risks misleading. We have opted in most instances for mental treatment as a way forward.

This is a concept that can accommodate psychodynamic, behavioural and other possibilities. There are at least three versions of this story in ancient medicine, of which the best known may be the Stratonica story. In this version, Seleucus, the King of Syria, then in his sixties is given the young Stratonica in marriage.

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Pinel makes clear his approval of clinical skill of this kind and his book is an attempt to build on this approach. Finally he also advocates the use of a new institution purpose built to treat the mentally ill — one that he refers to as a hospice, which his pupil Esquirol later called an asylum. This would differ from the facilities in which the mad were previously confined in that patients would be separated according to the state of their disorder, would have their treatment plans tailored to their state, and where they might not only have their wits restored but where they might have had the opportunity to consolidate their recovery.

At a time when the height of fashion is to advocate treatment at home and to avoid admission to any kind of facility, Pinel offers a persuasive case against home treatment See para — , — , , , , He is confident in the capacities of an enlightened institution, with responsible people at its head, to improve the lot of the afflicted. He contrasts such an institution with the kinds of facilities previously available, such as the Hotel Dieu, where patients were likely to be brutalised by unsupervised care staff and debilitated by the treatment and procedures advocated by medical staff.

It was a facility where recoveries were consolidated through work, and this example led on to the tradition of asylum farms and sewing rooms.

Traité médico-philosophique sur laliénation mentale (French Edition)

But in part we have also opted for hospice rather than asylum, as the latter has been so stigmatised in our day that another word is needed to convey the benefits that enlightened institutional care might offer. To deny any possible benefits is fashionable but in a wider frame of reference risks looking more like a romantic denial of illness itself. This book can be read on many different levels.

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On one level there are a series of human dramas Pinel so deftly sketches. He is first and foremost a clinician — one of the first modern clinicians, as Dora Weiner brings out in her preface to this volume and in her biography of Pinel [14]. On another level there is his articulation of the merits of the public domain, and its institutions, guided by the latest science. This is not just a matter of public versus private monies but rather as he makes clear a matter of the progress that can be expected when competing interests are brought to the light of day — a public morality that will be built on the progress of science.


In our own day confidence in public science is low. Crignon and A. Rey, it was funded by the French National Research Agency www.

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Between and , some of them have elaborated or involved in the international project "Anthropos". Today, medical practice and biomedical research have raised numerous questions that are discussed both within the public arena and specialized fields. With regard to these questions, the network Philosophy and Medicine would like to highlight their historical roots and offer an understanding of these questions which is based on a long-term perspective.

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The network also pays attention to the social and cultural variety which becomes obvious in the answers given to these questions. It studies political and moral norms that provide ground for this phenomenon. Finally, the network Philosophy and Medicine wants to promote a reflective approach of theseissues. As a matter of fact, philosophy and medicine have interlinked histories.

The language of medicine, its ways of reasoning, its visions of the human, have contributed to shape philosophy.