dementia, Pinel also developed new disease categories. His manie sans délire, later called folie raisonnante, outlined a partial insanity: sufferers would be mad on one subject alone. While the understanding remained sound, the personality was warped. Like other moral therapists, Pinel was an optimist: truly organic brain disease might be incurable, but functional disorders like melancholy and ‘mania without delirium’ were responsive to psychological methods. His Medico-philosophical Treatise on Mental Alienation or Mania (1801), which set out his thinking on the moral causation and treatment of insanity, was translated into English, Spanish, and German and proved highly influential.
22 Eight women representing the conditions of dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotic mania, and paralysis, in the gardens of the Salpêtrière Hospital, Paris; lithograph by A. Gautier, 1857.
Psychiatry French-style
Pinel’s favourite follower was Jean-Etienne Dominique Esquirol (1772-1840), whose Mental Maladies (1838) was the outstanding psychiatric text of his age. While asserting the ultimately organic nature of psychiatric disorders, Esquirol concentrated, like his mentor, on their psycho-social triggers. The diagnosis of ‘monomania’ was developed to describe a partial insanity identified with affective disorders, especially those involving paranoia, and he further delineated such conditions as kleptomania, nymphomania, and pyro-mania, detectable in advance only to the trained eye. A champion of the asylum as a therapeutic instrument, he became an authority on its design, and planned the National Asylum at Charenton, a suburb of Paris, of which he was appointed director. (It briefly housed the ageing Marquis de Sade.)
Translating into psychiatric practice the commitment of French hospital medicine at large to close clinical observation, Esquirol developed influential accounts, derived from extensive case experience, of illusion, hallucination, and moral insanity. He also trained up the next cohort of French psychiatrists, who then went on to plough furrows of their own: E. E. Georget wrote on cerebral localization; Louis Calmeil described dementia paralytica; J. J. Moreau de Tours was, as we shall see, a pioneer of degenerationism; while Jean-Pierre Falret and Jules Baillarger offered rival but complementary accounts of the manic-depressive cycle (the former called it folie circulaire, the latter folie a double forme).
Esquirol’s transformation of the classification and diagnosis of mental disorder was made possible by the abundance of data provided by asylums, enabling diagnosticians to build up clearly defined profiles of psychiatric diseases capable of being identified by their symptoms. Observation of asylum patients led to more precise differentiations in theory and practice—epileptics, for instance, became standardly distinguished from the insane. Esquirol himself produced an improved description of petit mal, and his pupil Calmeil described ‘absence’, distinguishing between passing mental confusion and the onset of a grand mal attack. Esquirol organized a special hospital for epileptics; by 1860, such institutions had also been founded in Britain and Germany, and in 1891 the first US hospital was established in Gallipolis, Ohio.
Similarly, the condition known as general paresis of the insane (one manifestation of tertiary syphilis) was elucidated in 1822 by Antoine Laurent Bayle. Although the micro-organism which causes syphilis had not yet been discovered—the bacteriological era lay ahead— the neurological and psychological features of GPI (notably euphoria and expansiveness), combined with the organic changes revealed by autopsy, supported Esquirol’s conviction that psychiatric disorders could be revealed using the techniques championed by such great French pathological anatomists as Laennec who had investigated tuberculosis and other internal
22 Eight women representing the conditions of dementia, megalomania, acute mania, melancholia, idiocy, hallucination, erotic mania, and paralysis, in the gardens of the Salpêtrière Hospital, Paris; lithograph by A. Gautier, 1857.
Psychiatry French-style
Pinel’s favourite follower was Jean-Etienne Dominique Esquirol (1772-1840), whose Mental Maladies (1838) was the outstanding psychiatric text of his age. While asserting the ultimately organic nature of psychiatric disorders, Esquirol concentrated, like his mentor, on their psycho-social triggers. The diagnosis of ‘monomania’ was developed to describe a partial insanity identified with affective disorders, especially those involving paranoia, and he further delineated such conditions as kleptomania, nymphomania, and pyro-mania, detectable in advance only to the trained eye. A champion of the asylum as a therapeutic instrument, he became an authority on its design, and planned the National Asylum at Charenton, a suburb of Paris, of which he was appointed director. (It briefly housed the ageing Marquis de Sade.)
Translating into psychiatric practice the commitment of French hospital medicine at large to close clinical observation, Esquirol developed influential accounts, derived from extensive case experience, of illusion, hallucination, and moral insanity. He also trained up the next cohort of French psychiatrists, who then went on to plough furrows of their own: E. E. Georget wrote on cerebral localization; Louis Calmeil described dementia paralytica; J. J. Moreau de Tours was, as we shall see, a pioneer of degenerationism; while Jean-Pierre Falret and Jules Baillarger offered rival but complementary accounts of the manic-depressive cycle (the former called it folie circulaire, the latter folie a double forme).
Esquirol’s transformation of the classification and diagnosis of mental disorder was made possible by the abundance of data provided by asylums, enabling diagnosticians to build up clearly defined profiles of psychiatric diseases capable of being identified by their symptoms. Observation of asylum patients led to more precise differentiations in theory and practice—epileptics, for instance, became standardly distinguished from the insane. Esquirol himself produced an improved description of petit mal, and his pupil Calmeil described ‘absence’, distinguishing between passing mental confusion and the onset of a grand mal attack. Esquirol organized a special hospital for epileptics; by 1860, such institutions had also been founded in Britain and Germany, and in 1891 the first US hospital was established in Gallipolis, Ohio.
Similarly, the condition known as general paresis of the insane (one manifestation of tertiary syphilis) was elucidated in 1822 by Antoine Laurent Bayle. Although the micro-organism which causes syphilis had not yet been discovered—the bacteriological era lay ahead— the neurological and psychological features of GPI (notably euphoria and expansiveness), combined with the organic changes revealed by autopsy, supported Esquirol’s conviction that psychiatric disorders could be revealed using the techniques championed by such great French pathological anatomists as Laennec who had investigated tuberculosis and other internal
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