Cullen’s importance thus lay in reintegrating the mental into medical discourses on madness. His teachings proved highly influential.
The break with earlier (Boerhaavian) somatic theories of madness was clear by 1780. In his Observations on the Nature, Kinds, Causes and Prevention of Insanity, Lunacy or Madness (1782-86), Thomas Arnold, who had studied under Cullen before taking over a Leicester madhouse, constructed a nosology (taxonomy) of insanity on the basis of the Lockean philosophy of mind, distinguishing ‘ideal insanity’ (hallucination) from‘notional insanity’ (delusion). Acknowledging his debt to ‘our British Psychologists, such as Locke, Hartley, Reid, Priestley, Stewart, Kames’, Alexander Crichton’s An Inquiry into the Nature and Origin of Mental Derangement (1798) similarly argued that psychiatry should be based on the philosophy of mind.
This emerging model of madness as a psychological condition pointed to an alternative target for psychiatric enquiry: rather than the organs of the body, the doctor had to address the patient’s psyche, as evidenced by his behaviour. The case-history approach this entailed demanded the transformation of the old craft of minding the insane into the pursuit of systematic psychological observation. The years after 1770 brought a spurt in psychiatric publishing along these lines by owners of private madhouses, for instance William Perfect’s Methods of Cure, in Some Particular Cases of Insanity (1778). Initially such houses had been rather secretive, but this changed, as new thinking demanded and prized the observation of individual patients and the publicization of findings. The handling by Francis Willis of George III’s first bout of madness (1788-9) similarly highlighted the psychological—and the recovery of the ‘mad king’ bred optimism.
The close of the century brought a remarkable marriage across enlightened Europe between newpsychological thinking and reformist practice in what has been called ‘moral therapy’. Its leading British exponent, the York Retreat, has already been discussed in Chapter 5. Another pioneer was the Florentine physician, Vincenzo Chiarugi, encouraged by the reforming activities of the enlightened Grand Duke of Tuscany, Peter Leopold. Expounded in On Insanity (1793-4), a major three-volume text, Chiarugi’s medico-psychiatric theories held that bodily states influenced the mind via the activities of the senses and the nervous system at large. His notion that the ‘sensorium commune’ mediated between the intellect and the senses, between soul and body, offered a psycho-physiological solution to the old Cartesian problem of mind/body dualism. Pondering the aetiology of insanity, Chiarugi backed the Enlightenment view that mental conditions were acquired rather than inherited, and held out high hopes for cure, not primarily by medical means but through humane management. Repudiating the use of force, he touted the superior efficacy of ‘moral control’, a therapy of psychological ascendancy over the patient established by the physician through character, expertise, and moral example.
21 The Florentine physician, Vincenzo Chiarugi (1759-1820) introduced moral treatment into Italy; engraving by de Lasimo, 1804.
In Paris the physician Philippe Pinel pioneered similar psychological approaches at the Bicetre, the main public madhouse for men, and the Salpetriere, its female counterpart. His stress on psychogenic factors rested upon enlightened foundations: empirical observation failed to discern any underlying structural abnormalities in lunatics’ brains when examined post mortem. Moreover, philosophically, Pinel was an idéologue, influenced by Locke’s thinking as radicalized by Condillac. Contrary to Locke, however, his traitement moral was directed to the affective, as opposed to the intellectual, side of the psyche.
Whilst retaining the traditional division of insanity into melancholia, mania, idiocy, and
The break with earlier (Boerhaavian) somatic theories of madness was clear by 1780. In his Observations on the Nature, Kinds, Causes and Prevention of Insanity, Lunacy or Madness (1782-86), Thomas Arnold, who had studied under Cullen before taking over a Leicester madhouse, constructed a nosology (taxonomy) of insanity on the basis of the Lockean philosophy of mind, distinguishing ‘ideal insanity’ (hallucination) from‘notional insanity’ (delusion). Acknowledging his debt to ‘our British Psychologists, such as Locke, Hartley, Reid, Priestley, Stewart, Kames’, Alexander Crichton’s An Inquiry into the Nature and Origin of Mental Derangement (1798) similarly argued that psychiatry should be based on the philosophy of mind.
This emerging model of madness as a psychological condition pointed to an alternative target for psychiatric enquiry: rather than the organs of the body, the doctor had to address the patient’s psyche, as evidenced by his behaviour. The case-history approach this entailed demanded the transformation of the old craft of minding the insane into the pursuit of systematic psychological observation. The years after 1770 brought a spurt in psychiatric publishing along these lines by owners of private madhouses, for instance William Perfect’s Methods of Cure, in Some Particular Cases of Insanity (1778). Initially such houses had been rather secretive, but this changed, as new thinking demanded and prized the observation of individual patients and the publicization of findings. The handling by Francis Willis of George III’s first bout of madness (1788-9) similarly highlighted the psychological—and the recovery of the ‘mad king’ bred optimism.
The close of the century brought a remarkable marriage across enlightened Europe between newpsychological thinking and reformist practice in what has been called ‘moral therapy’. Its leading British exponent, the York Retreat, has already been discussed in Chapter 5. Another pioneer was the Florentine physician, Vincenzo Chiarugi, encouraged by the reforming activities of the enlightened Grand Duke of Tuscany, Peter Leopold. Expounded in On Insanity (1793-4), a major three-volume text, Chiarugi’s medico-psychiatric theories held that bodily states influenced the mind via the activities of the senses and the nervous system at large. His notion that the ‘sensorium commune’ mediated between the intellect and the senses, between soul and body, offered a psycho-physiological solution to the old Cartesian problem of mind/body dualism. Pondering the aetiology of insanity, Chiarugi backed the Enlightenment view that mental conditions were acquired rather than inherited, and held out high hopes for cure, not primarily by medical means but through humane management. Repudiating the use of force, he touted the superior efficacy of ‘moral control’, a therapy of psychological ascendancy over the patient established by the physician through character, expertise, and moral example.
21 The Florentine physician, Vincenzo Chiarugi (1759-1820) introduced moral treatment into Italy; engraving by de Lasimo, 1804.
In Paris the physician Philippe Pinel pioneered similar psychological approaches at the Bicetre, the main public madhouse for men, and the Salpetriere, its female counterpart. His stress on psychogenic factors rested upon enlightened foundations: empirical observation failed to discern any underlying structural abnormalities in lunatics’ brains when examined post mortem. Moreover, philosophically, Pinel was an idéologue, influenced by Locke’s thinking as radicalized by Condillac. Contrary to Locke, however, his traitement moral was directed to the affective, as opposed to the intellectual, side of the psyche.
Whilst retaining the traditional division of insanity into melancholia, mania, idiocy, and
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