Philip Pinel biography. Philippe Pinel - biography and interesting facts from life. Moral sadism - replacing shackles

PSYCHIATRY

Psychiatry (from the Greek psyche - soul; iatreia - treatment) is the science of mental illness, their treatment and prevention.

In ancient times, mental illness was understood as a result of the influence of “supernatural forces, as possession by an evil or good spirit.

Later, with the development of natural philosophy of the ancients, natural ideas about the causes of diseases of the body and brain were formed.

The first shelters for the mentally ill began to appear at Christian monasteries in Byzantium (IV century), Armenia and Georgia (IV-VI centuries), and Islamic countries (IX century).

In Western Europe during the Middle Ages, attitudes towards the mentally ill were determined by religious ideology. The mentally ill were accused of voluntary union with the devil. Since the 13th century. They began to be imprisoned in special institutions (not hospitals) to isolate the insane. There, the patients were kept in handcuffs, without basic amenities, chained and tortured, and starved. It happened that mentally ill people were burned at the stake of the Inquisition under the pretext of fighting witches and heresy.

The attitude towards the mentally ill as possessed by an evil spirit persisted in Western Europe until the end of the 18th century, when the development of science was powerfully influenced by French materialism of the 18th century. and the French bourgeois revolution.

The reorganization of the care and treatment of mentally ill patients is associated with the activities of Philippe Pinel (Pinel Philippe, 1745-1826), the founder of public and clinical psychiatry in France. During the revolution, he was appointed chief physician of the Bicetre and Salpetriere psychiatric institutions in Paris. The possibility of progressive reforms carried out by F. Pinel was prepared by the entire course of socio-political events. Pinel was the first to create human conditions for the mentally ill in a hospital, removed their chains (Fig. 141), developed a system for their treatment, attracted them to work, and determined the main directions for the study of mental illness. For the first time in history, the mentally ill were restored to their human and civil rights, and mental institutions began to turn into medical institutions - hospitals.

The ideas of F. Pinel were developed by the English psychiatrist John Conolly (Conolly, John, 1794-1866), who fought for the elimination of mechanical restraint measures for patients in psychiatric hospitals.

At the beginning of the 19th century. psychiatry began to develop as an independent natural scientific clinical discipline. The training of psychiatrists began in psychiatric hospitals, and then in medical faculties of universities.

In the Russian Empire, the first psychiatric institution was opened in Riga in 1776. After the zemstvo reform of 1864, the construction of comfortable psychiatric hospitals expanded significantly. In 1835, at the medical faculties of Russian universities, professors-therapists began to teach a separate course in psychiatry, which later began to be taught at special departments: in St. Petersburg (1857), Kazan (1866), Moscow (1887) and other cities of the country.

Great influence on the successful development of psychiatry from the mid-19th century. The evolutionary theory of Charles Darwin and the doctrine of reflex developed by Russian physiologists I.M. Sechenov and I.P. Pavlov had an impact.

At the same time, psychiatry, more than any other field of medicine, was influenced by idealistic movements in philosophy. This “was most clearly manifested in Germany, where” feudalism did not give up its positions for a long time. In German philosophy of the early 19th century. idealistic trends prevailed. In psychiatry, they manifested themselves in the views of the “psychic” school, which defined mental illness as the result of a person’s evil will or sinfulness. In the middle of the 19th century. Another idealistic school of “somatics” came to the fore. Believing that the soul is immortal and cannot be sick, somaticians considered mental illness as a disease of the body, that is, the material shell of the soul.

At the end of the 19th century, idealistic trends in psychiatry revived and manifested themselves most widely in psychoanalytic schools.

In Russia big influence Democratic revolutionaries influenced the development of psychiatry, which determined the predominance of natural scientific trends both in this and other areas of medicine in our country.

Among the world's leading psychiatrists is Sergei Sergeevich Korsakov (1854-1900), one of the founders of the nosological trend in psychiatry, founded at the end of the 19th century. German psychiatrist Emil Kraepelin (Kraepelin, Emil, 1856-1926), as opposed to the previously existing symptomatic direction.

S. S. Korsakov was the first to describe a new disease - alcoholic polyneuritis with severe memory disorders (1887, doctoral dissertation “On alcoholic paralysis”), which already existed during the author’s lifetime. called “Korsakov psychosis.” He was a supporter of freedom for the mentally ill, developed and put into practice a system of keeping them in bed and monitoring them at home, and paid great attention to the issues of preventing mental illness and organizing psychiatric care. His “Course of Psychiatry” (1893) is considered a classic and has been reprinted many times.

A great contribution to the development of psychiatry was also made by J. Esquirol, J. Charcot and P. Janet (France), G. Models, J. Jackson (England), B. Rush (USA), W. Griesinger, E. Crepellnn ( Germany), V. M. Bekhterev, V. X. Kandinsky, P. P. Kashchenko, V. P. Serbsky, P. B. Gannushkin (Russia).

Philippe Pinel born in a small village in the French commune of Jonquière. Philip's parents, uncle and aunt were doctors. He studied at the Faculty of Medicine in Toulouse, and then for another four years at the Faculty of Medicine in Montpellier. He moved to Paris in 1778.

For about 15 years, the physician had to earn his living by working as a writer, translator, and editor, since the restrictive rules of the old regime prevented him from practicing medicine in the capital. He failed twice entrance tests to continue studying. In the second competition, the jury members emphasized Philippe’s “mediocrity” in all areas of medical knowledge, which is in clear contradiction with Pinel’s further achievements.

In 1784, Philip became the editor of a not very well-known medical publication, the Gazette de santé. The doctor was also famous among natural scientists, as he regularly published in the Journal de physique. Around this time, the scientist developed an interest in the study of mental illness. This was due, in part, to the fact that his friend had “nervous melancholy,” which transformed into “mania” and led to suicide.

Pinel began looking for work in private institutions for the treatment of insanity in Paris. For five years, Philip worked in one of the famous sanatoriums, collecting information about mental illness.

After the French Revolution, the physician held a prominent position at the Bicêtre Hospital. At that time, it housed about four thousand prisoners who had committed minor offenses, patients with syphilis, pensioners, as well as about two hundred mentally ill people. At the hospital, Pinel achieved the removal of shackles from the mentally ill, gave them freedom of movement around the hospital, and this led to significant improvements in their well-being.

Contribution to medicine

Philippe Pinel rejected the prevailing opinion at that time that the reason mental illness was the “inhabitation of demons.” According to Pinel, predisposing factors to the occurrence of mental illness are, in particular:

• unhappy love;
• inner sadness;
• fanatical dedication to the cause;
• religious fears;
• revolutionary events;
• violence;
• large unrealized ambitions;
• financial failures.

Pinel believed that psychological intervention should be individualized and not based solely on diagnostic category. The psychiatrist proposed a humane principle of caring for the mentally ill, called “moral treatment.” He expressed respect and warm feelings for his own patients, visited them several times a day, had long conversations and wrote everything down. Pinel advised compassionate medical care during rehabilitation period, emphasized the need physical exercise, compliance with hygiene rules. In addition, he contributed to the introduction into psychiatric practice of maintaining and preserving patient histories.

In addition to psychiatry, the famous physician also worked in the field of internal medicine. He believed that research methods in medicine should be analytical in nature, as well as in the natural sciences. The scientist classified diseases into several classes: febrile states, hemorrhages, neuroses, phlegmasia, as well as diseases caused by organic lesions.

Performance evaluation

According to Russian psychiatrist Yu.S. Savenko, as a scientific practice and as a science, psychiatry took place only after the reform of Philippe Pinel, i.e. after removing the chains from the mentally ill, as well as removing police officials from senior positions in hospitals. These principles (partial denationalization and voluntariness) are still relevant in psychiatry.

Life and art

Initially he prepared for the profession of a priest and only in his thirtieth year began to study medicine. In 1792, he was appointed physician at the Paris institution for the insane, Bicêtre. In Bicêtre, Pinel performed an act of humanity that became famous: he obtained permission from the revolutionary Convention to remove the chains from the mentally ill.

Pinel gave patients freedom of movement throughout the hospital grounds, replaced gloomy dungeons with sunny, well-ventilated rooms, and offered moral support and good advice as a necessary part of treatment.

Pinel's act of humanity was crowned with success: fears that the insane, not chained, would turn out to be dangerous both for themselves and for those around them, were not justified. Many people who had been locked up for decades experienced significant improvements in their well-being in a short period of time, and these patients were released.

Soon, at the initiative of Pinel, patients from other institutions were also freed from chains (in particular, the Parisian hospital for women with mental disorders Salpêtrière), and in Europe the principle of their humane maintenance, with the provision of freedom and the comforts of life, became widespread. This achievement, firmly associated with the name of Philippe Pinel, brought him recognition throughout the world.

Pinel also became widely known as the author scientific works in the field of psychiatry. His treatise on mental illness (1801) is considered a classic work; in France, Pinel is the founder of the scientific school of psychiatrists. In addition to psychiatry, he also worked in the field of internal medicine and in 1797 published the essay “Nosographie philosophique”, which argued that the method of research in the field of medicine should be analytical, as in the natural sciences. This work went through 6 editions over the course of twenty years (in 1797, 1803, 1807, 1810, 1813 and 1818), was translated into German and played a major role in the development of rational medicine. For many years, Pinel occupied the department of hygiene at the Paris Faculty of Medicine, and subsequently - internal diseases.

Ratings

Matt Muijen, speaking about the process of transforming mental health care in Europe, notes that in this process, the influence of specialists, mainly psychiatrists, who acted as champions of change, such as Pinel in France in the 19th century and Basaglia in Italy in the 20th century, apparently played a decisive role century. They proposed concepts for new models of humane and effective assistance, revolutionary for their time, displacing unsatisfactory and inhumane traditional services. Their real achievement was their ability to motivate policymakers to support these concepts and persuade colleagues to implement them, thereby opening up the possibility of real and lasting change.

According to Yu. S. Savenko, psychiatry took place as a science and scientific practice only after Pinel’s reform - after the chains were removed from patients and the police rank was eliminated as the head of the hospital. As Yu. S. Savenko notes, these two principles (the principle of voluntariness and partial denationalization) remain relevant in psychiatry to this day; Without their observance, the objectivity of diagnosis and expert opinions and the effectiveness of treatment drop sharply.

Scientific works

• Pinel Ph. Traité médico-philosophique sur l'aliénation mentale, ou la Manie. Paris: Richard, Caille et Ravier, an IX/1800 (“Medico-philosophical treatise on mania”).
• Pinel Ph. Observations sur le régime moral qui est le plus propre à rétablir, dans certains cas, la raison égarée des maniaques // Gazzette de santé. 1789 (“Observations on mental conversion, which can in some cases restore the darkened mind of maniacs”).
• Pinel Ph. Recherches et observations sur le traitement des aliénés // Mémoires de la Société médicale de l’émulation. Section Médecine. 1798 (“Investigations and Observations Concerning the Moral Treatment of the Insane”).

© I. B. Yakushev, P. I. Sidorov, 2013 UDC 616.89:93:92 Pinel

I. B. Yakushev, P. I. Sidorov Philip PINEL and PSYCHIATRY OF THE END OF THE 18TH - EARLY 19TH CENTURIES

Northern State medical University, Arkhangelsk

The article analyzes the socio-economic prerequisites that contributed to the separation of psychiatry into an independent medical discipline, which determined its ideological basis and methodological content. The prevailing ideological concepts and methodological priorities of psychiatry of this era are examined using the example of the views of F. Pinel, his students and contemporaries.

Key words: mental disorder, mental medicine, psychiatry, Pinel, idealism, materialism

PHILIPPE PINEL AND THE PSYCHIATRY OF LATE XVII - EARLY XIX CENTURIES

I.B. Yakushev, P.I. Sidorov

The article analyzes the social economic premises promoting the psychiatry to distinguish to independent medical specialty with its own intellectual base and methodological filling. The mental concepts and methodological priorities ofpsychiatry prevailing in this epoch using the example ofviews of F. Pinel, his disciples and contemporaries are considered.

Key words: psychic disorder, mental medicine, psychiatry, Ph. Pinel, idealism, materialism

Periodically repeated analysis by researchers of the stages of development of mental medicine (MM) and psychiatry (P) is inevitable: each scientific generation reveals new facts, applying new methodological ideas to them. This can lead to breaking down theories and revising the principles of organizing knowledge. Obviously, “the essence of scientific research comes down not only to the establishment and explanation of new facts and phenomena, but also to attempts to fit newly discovered data into speculative theoretical constructs.”

The end of the 18th century was marked by the separation of medicine into a separate specialty of medicine. “Psychiatry is finally being included in the realm of medical knowledge and practices to which it was previously relatively alien.” This circumstance was largely associated with the reorganization of the care and treatment of the mentally ill (MP), implemented by the French doctor F. Pinel. “After Pinel and Tuke, psychiatry became a branch of medicine with a special style.” These changes were prepared by the evolution of socio-economic relations in Europe, which at that time had formed into an ensemble of developing trajectories of capitalist content

In the bimodal scheme, which was directly related to MM throughout its existence, namely priests - healers, a third factor appeared - psychiatrists. The emergence of this specialty was based on the idea of ​​​​the development of G. Hegel's triad: the opposition in MM of the thesis of priests-idealists to the antithesis of healers-materialists led not to a synthesis, but to a syncretic compromise conditioned by the practical expediency of the current moment with the formation of a new thesis - a trend of psychiatrists. The absence and impossibility of a correct synthesis of the concepts of priests and healers influenced the formation of internal contradictions and ideological duality P The emergence and development of a third force, which turned the bimodal structure into a trimodal one, occurred in the algorithm of Hegel's philosophy, which, having bifurcated the integrity of Dasein, guaranteed the bimodal schism of any newly emerging category with its internal contradictions of mutually exclusive and mutually presupposing possibilities. P, combining some positions of the parties of priests and healers, turned out to be internally contradictory, dualistic due to its use in different proportions, depending on the style, priorities, values ​​of the current era, the principles of both concepts of the Unified

I. B. Yakushev - Ph.D. medical sciences, associate professor department ([email protected]); P. I. Sidorov - academician RAMS, dr med. Sciences, Prof., Rector (info@nsmu .ru) .

The existence and struggle of two opposing ideologies and their polar methodologies within this category turned it into another bimodal system, leading to the anti-entropic functioning of P as a system, when both components of its trajectories entered a period of oscillation around the general trend, and then one, then the other of they gained relative dominance. At moments of mutual intersection of the trajectories of priests and healers, P left the area of ​​​​predominant influence of one resonance, being influenced by another, and the mutual influence of resonances overlapped. Stochastic instability of the system arose, optimizing its self-organization. Since the end of the 18th century, the complex of sciences and knowledge associated with P as a discipline studying the origin and therapy of mental disorders (MD) has become the subject of interest and effort not only of philosophers (as theorists of MM) and general practitioners (as its practitioners), which has been the case until now, but psychiatrists, who combined in their specialty the intellectual constructs of philosophers and the practical skills of physicians.

In the era of developing capitalism, the problem of PR increasingly found itself in the circle of secular interests of the social trend, increasingly falling out of the field of influence of the church: “The more insane people fell into the sphere of authority of administrative bodies, the less enlightened the church needed them as witches and possessed people - neither theological grounds, nor to demonstrate their earthly power." At the end of the 18th century, in the French city of Beauvais, there was a charity house maintained by Franciscan monks, where PBs also found shelter. In 1790, the shelter was disbanded, the patients were transferred to Clermont-en-Oise, and the prefectoral administration of the department entered into an agreement with the founder of the shelter on the maintenance of the hospital at the expense of municipal funds. In July 1795, the shelter in Charenton, which belonged to the Order of the Hospitallers, was closed. In 1797, it was reopened and nationalized under the Directory with the aim of transferring the PB there from the Hôtel-Dieu asylum, and the leadership was entrusted to a former monk of the Premonstratensian order. In accordance with the provisions of the Napoleonic Code, the supervision of the PB was entrusted to the prefectures, which abolished the traditional religious part of this aspect

Absolutist institutions with an isolating regime were closed during the French Revolution: in March 1790, in pursuance of the “Declaration of the Rights of Man and Citizen,” a resolution of the Constituent Assembly was issued - within 6 weeks to release prisoners by the will of the king, and in the case of the PB - to check them condition by officials and doctors, and then placed in medical institutions or let go. Later, this declaration turned into a farce: instead of building new hospitals, the old ones were closed.

The MM of England and France increasingly correlated their tasks with issues of hygiene and the social aspect of improving the lives of the poorest segments of the population, which was in the interests of the economic expansion of a self-organizing capitalist civil society, while in the MM of Germany no importance was attached to social issues: the interests of monarchy and absolutism prevailed here . “While in France and England the bourgeoisie was aware of its class position, the bourgeoisie of Germany found itself in the wake of romantic-irrational thinking, without having had time to go through the school of rationalism.”

The name of the Frenchman F. Pinel (1745-1826) is associated with the revolution in Petrograd: he became a doctor who removed the chains from Petrograd (Pinel was not a pioneer, but went down in history in this capacity, apparently because his revolution coincided chronologically and declaratively - freedom, equality, fraternity - with the French Revolution) Pinel was almost the same age as I. Kant, but his worldview was formed taking into account the influence of Diderot's determinism, Condillac's sensationalism, and La Mettrie's materialism. At the same time, Pinel’s activities and scientific views indicate the influence of the natural philosophy of F. Schelling. "Medical and philosophical treatise on mental disorder or mania" by Pinel K. Derner considers "an attempt to integrate and consolidate the bourgeois-liberal achievements of the revolution on the path of social reform - against the restoration of feudal institutions and rationalistic thinking, against everything that contributes to the further development of the revolution." Pinel placed P between medicine and the science of managing state and society, believing that for the public good a strong government is necessary, which “can find important recommendations in his book.” He spoke about the class of aristocrats and the lower class as risk groups: for them the likelihood of developing PD is high, since the former “shun physical work”, and the latter “are in debauchery and poverty.” Pinel considered both of these social factors to be the most important etiologically for manifestations of PR In the spirit of Rousseau, he believed that society generates its own illnesses. The ideals and priorities of the socially strengthening and increasingly influential third estate determined for Pinel the criterion for educating the individual and norms in P: it is the bourgeois, according to his theory, who turn out to be the social class most protected from PR , since the life and occupations of this class are different from the life values ​​of those classes whose emergence and status were conditioned by feudalism and at this stage have fallen into decline. Work as a means of preventing PD and a method of its therapy have become for Pinel important factor associated with the era of capitalism. Such a judgment would have been unthinkable in the era of feudalism. The values ​​of the bourgeois economic order determined the content and methodology of this period of time

It is customary to speak of Pinel as an ideological materialist, and there are reasons for this: he criticized the idealistic unity of reason according to Winckelmann. Pinel did not consider it advisable to create a religious atmosphere in psychiatric hospitals, prohibiting the giving of religious books to “melancholics from piety”, recommending the imprisonment of “righteous women” who consider themselves divinely inspired and try to convert others to their faith,” thus stating the social and medical threat posed by inducers of potential mental epidemics. However, the ideology of the French psychiatrist was not clearly materialistic. Pinel believed that PD is a disorder of the will, the uncontrolled power of instincts , not explainable by external reasons (“mania without delirium” in him is a disorder of the will in pure form) Pinel did not propose to neglect the ethics of religion, which he considered an important component of the treatment of PD, allowing one to instill norms of social content in the PD, confirming this thesis with clinical examples. The psychiatric hospital in his interpretation was an area of ​​morality, “a sphere of religiosity without religion.” Most common cause PR Pinel considered moral shocks, only allowing for relevance physical reasons, in particular head injuries - etiological factor physical properties by importance and frequency of occurrence

His PR follows the psychological: “How can I allow the blood circulation in the brain and the various degrees of excitation and decline of its functions to be sufficient to reveal the secret of the location of thinking and its disorders? In the spirit of E. Condillac, who denied the possibility of the existence of innate ideas in of a person and attributing his development to the influence of the environment, Pinel noted the influence of the environment on the formation of psychopathological predisposition. His statement of the influence of the “moral” factor on the manifestation and formation of PD determines the syncretic duality of the views of the psychiatrist in his conceptual affiliation with healers or priests. Pinel said that the doctor should have an idea about personality in premorbidity, but refrained from pathological-anatomical and pathophysiological hypotheses: “Anatomical studies have not revealed anything regarding the localization and nature of mental illness.” He argued with the German psychiatrist W. Greding, who believed that the cause of PD is changes in the skull and brain, suggesting variety of loci of pathology: “The primary place of mania is in the stomach and intestines, and from this center the disease radiates to the mind.” Pinel spoke about "... the need to entrust the mentally ill to the care of strangers, thus removing them from the ordinary environment." This judgment states the similarity of his ideology with the views of the contemporary German P: the same concept is taken here with the opposite sign. Some doctors used the whip for " restoring the patient’s connections with the outside world,” Pinel used the hospital ward and occupational therapy for this purpose: “Regular exercises change the painful direction of thoughts, helping to restore mental activity, but sometimes he resorted to psychological pressure on patients: “. ..dressed in such a way as to plunge the patient into horror, with a burning gaze, a thunderous voice, surrounded by a crowd of servants armed with loudly rattling chains. Soup is placed in front of the madman and the order is given to eat it overnight if he does not want to be treated with the most cruel Thus, after this, everyone leaves, leaving the madman in painful hesitations. After long hours of mental struggle, he decides to take food." These techniques belong to the arsenal of priests, not healers. Pinel believed that "the scene of the first contact of a doctor with his patient is a ceremonial, a demonstration of strength." He, like his German contemporaries, believed that the “moral cause” of a disease is subject to the measures of suggestion, advising doctors to approach PD with “. ..a frightening appearance, with a firmness capable of striking the imagination and convincing of the futility of resistance." Pinel was no less a priest than the idealistic psychiatrists of contemporary Germany, using not the whip, but its virtual effect on PB. Healers preferred the materialistic substrate of medicines, priests - Pinel's idealistic concept of words and good deeds (punishments) was also very restrained in relation to drug therapy: “The straitjacket,” he wrote, “has the value of an educational measure,” agreeing with German psychiatrists who used it for the same purpose. ice water(Pinel also recommended dousing PB cold water, but - in the spirit of humanism of the Age of Enlightenment - “no rudeness or insults,” Autenrith’s mask and Darwin’s chair: “As a repressive measure, they are sufficient to subjugate general rule labor capable of it, a madwoman, to overcome refusal to eat, to curb women who are crazy in their minds, possessed by something like restless and eccentric stubbornness." : “In most cases, the fundamental principle of curing mania is to first resort to energetic suppression and then move on to benevolence.” The point is not how true this is, but that the materialistic approach he declared was disguised from the doctor himself natural philosophical priesthood in the spirit of Schelling: with the transfer of healing initiatives to nature

Pinel owns the classification of PD: 1. Mania; 2. Mania without delirium; 3. Melancholy; 4 . Dementia; 5 . Idiocy. This classification is also a product of idealism: Pinel distinguished between

illness according to the content of experiences at the level of symptoms, outside the nosological concept, without highlighting the material substrates of PR. Later, however (1818), he created a different classification, into which he introduced elements of pathogenetic structuring, highlighting “neuroses of cerebral functions,” again denoting the dualism of views as the Basic methodological approach Pinel's creation of the classification was a deduction in the spirit of R. Descartes, due to which its nosographic appearance was the result of an abstract idea arising from similar features characterizing the same PR

In the style of Pinel’s ideas, the activities of his contemporaries F. Voisin (1794-1872) took place, who applied Pinel’s reforms to children’s P, who almost exclusively materialistically believed that “having the symptoms, it is necessary to determine the location of the disease. Thanks to the information provided by physiology, medicine is able to cope with this problem”, and J. Falret (1794-1870), who began with pathological and anatomical research (dissertation “Medical-surgical observations and proposals”, 1819; report “Information obtained from autopsies of the mentally ill, which can contribute to the diagnosis and treatment of mental illnesses ", 1823), but became disillusioned with them. Materialistic attempts to search for the etiology of PD in the morphological substrate, as capitalism strengthened, acquired scientific legitimacy, pushing aside deductive conclusions in P. In 1820, E. Georges wrote a report “On the autopsy of the bodies of the mentally ill,” examining 300 autopsies of the bodies of PD at the Salpêtrière Hospital. The report marked the beginning discussions about the organic and mental causes of PD In 1821, J. Deleuze (1789-1879) and F. Fauville (1799-1888) presented a report “Discussions on the causes of madness and the nature of their action with the application of research on the nature and special location of this disease "The morphological inductive research of the healers demonstrated results that made it possible to draw conclusions that often ran counter to the deductive constructions of the priests, whose ideology still had the authority to oppose empirical methodology, which was once again manifested by the conceptual dualism of the French P

"During the first third of the 19th century, medical, drug treatment. And vice versa, a practice called “moral treatment” was actively developing, which corresponded to the concept of the priests. “Moral treatment” arose at the end of the 18th century and opposed the concept of “ physical treatment", combining all methods of influencing PB, while "physical treatment" meant only the influence on PB of medications and restoratives

The monograph “On Mental Illnesses” by J. Esquirol (1772-1840) became the basis for the further development of P. His classification contained 5 classes of mental illness, which differed slightly from Pinel’s system: 1. Lipemania (Pinel’s melancholy); 2. Mania; 3 Monomania; 4 Dementia; 5 Idiocy Esquirol believed mental asylum a grotesque reflection of society, since human passions are represented by the PB ("the most interesting members of society") in contrast to the social decency of a society of mentally healthy persons. The Republican social system, which provides ample opportunities for human base passions, became for Esquirol a negative factor ("dangerous innovations") in relation to the potential for the occurrence and progression of PR, in contrast to the monarchy. He connected the political status of the state with the social, defiant

he is worried, since in this case the power of morality and religion, in his opinion, is minimized, which contributes to the growth of PR. Among the therapeutic measures he uses are the same methods of intimidation, cold douches, straitjackets, threats painful treatment- the use of “priestly” measures of a more idealistic moral and educational nature than materialistic measures in the spirit of healers. At the same time, Esquirol was already more focused than Pinel on the materialistic concept of the origin of PD, considering lipemania, idiocy, and dementia to be diseases of the brain. In relation to mania and monomania, he did not talk about the substrate of the brain. Esquirol believed that the mystery of madness will remain an eternal mystery of nature , and the debut of PR is the result of the socio-somatic biography of the subject, subordinate to the triad: heredity - constitution - experiences childhood, considering the family, church, and state as institutions for the prevention of PR. Esquirol considered monomania a disease of his time, PR caused by progress, a “mental illness of civilization,” causing such manifestations as selfishness, exaltation, passions, and slow development of the soul. Monomania in his interpretation is unusual actions that go beyond social norms

Thus, the absence and impossibility of a correct synthesis of methodologies and priorities of materialistic and idealistic concepts during the emergence of P at the end of the 18th century influenced the formation of systemic internal contradictions and ideological dualism of this discipline in this era, which was manifested by the views of F. Pinel and his contemporaries-psychiatrists, who adhered to a syncretic approach to solving problems of PR, the Pinel era gradually gravitated more and more towards materialist ontology and methodology. The ideology of this time was focused on socio-economic realities and the capitalist system of values ​​and priorities

LITERATURE

1. Stochik A. M., Zatravkin S. N. Medical Faculty of Moscow University in the 18th century. 2nd ed. - M., 2000. - P. 110

2. Foucault M. Psychiatric power. Course of lectures given in

Collège de France in the 1973-1974 academic year. - St. Petersburg. , 2007. - P. 22, 25, 173.

3. Foucault M. History of madness in the classical era. - M.; St. Petersburg ,

1997. - P. 330, 483, 489-490, 496-497.

4 . Derner K. Citizen and Madness. - M., 2006. - S. 196-197, 219,

5 . Hauser A. Socialgeschichte der Kunst und Literatur. - Munich,

1953.- Bd 11,- S. 1-4.

6. Gruhle H. // Handbuch der Geisterkrankheiten / Hrsg. Von O. Bum-

ke. - Berlin, 1932 .- Bd 9. -S. 19-21.

7. Zur Geschichte der Psychiatrie im 19 Jahrhundert / Hrsg . Von A.

Thom. - Berlin, 1984. -S. 7, 168.

8 . Pinel Ph. Traite medico-philosophique sur lalienation mentale, ou la

manie. - Paris, 1800. - P 61, 222, 268, 291.

9 . Leibbrand W. Romantische Medizin. - Hamburg, 1937.

10 . Pinel F. Medical and philosophical teaching about mental illness. -

St. Petersburg , 1899. - P. 66, 72, 154. 11. Kannabikh Yu. V. History of psychiatry. - M.; Minsk, 2002. - pp. 163-167.

12 . Voisin F. Des Causes morale et physiques des maladies mentales et de quelques autres affections telles que Thusterie, la nymphomanieet le satyriasis. - Paris, 1926. - P 329.

The name of Philippe Pinel (Pinel, Philippe), the founder of public, clinical and scientific psychiatry in France, is widely known, mainly due to his efforts that changed the care of the insane and the very situation with homes for the mentally ill. Pinel's main action was that for the first time in the history of medicine he removed the chains from the mentally ill, thereby transforming psychiatric institutions from places of imprisonment into medical institutions.

The fate of this man developed in an amazing way. He was born on April 20, 1745 in Saint-André d'Alerac, a town in the Tharpe department, in the south of France, in the family of a hereditary doctor. His father and grandfather were doctors. His mother died when he was 15 years old. Of seven children, he was the eldest. Philip received his secondary education at a Jesuit college and was preparing for the priesthood. At that time, secondary education was based mainly not on the exact sciences, but on ancient and modern literature, philosophy and languages. Pinel grew up on the works of the sensualists Locke and Condillac, and later became interested in Rousseau and Voltaire, becoming a follower of their philosophy. After graduating from college in 1767, Philip moved to Toulouse. Wanting to correct the imbalance in his education, he entered the university at the Faculty of Physics and Mathematics. His dissertation “On the reliability that mathematics gives to judgments in the sciences,” defended for a master's degree, provides us with the interests of Pinel at that time.

Having successfully graduated from the University of Toulouse in 1770, Pinel worked as a college teacher and did not even think about becoming a doctor. However, as they say, the ways of the Lord are mysterious. Feeling compassion for sick, infirm people, Pinel made an unexpected decision that ran counter to his current plans - he entered the Faculty of Medicine. His goal was very clear - to help those suffering. Having defended his doctoral dissertation at the University of Toulouse on December 22, 1773, a year later he moved to the University of Montpellier. Pinel studied zoology a lot and even competed with the famous Cuvier, laying claim to the department of comparative anatomy, re-opened in 1795 in Paris. In Montpellier, he earned money by writing dissertations to order, which speaks of his medical erudition and intelligence. There he also became friends with the future famous chemist and minister of Napoleon I, Chaptal, whom he advised to study Montaigne, Plutarch and Hippocrates. In Pinel’s life, a special role was played by his knowledge in English, which made it possible to get acquainted with the rich and original medical literature of England; in particular, he translated Cullen's works into French.

Having completed medical education, Pinel moved to Paris in 1778. A young doctor lives there modestly, rents a furnished room, works hard and often earns extra money by giving private lessons in mathematics. By the way, in his later works Pinel did not forget about mathematics. For example, in 1785 he made a report at the Academy of Sciences “On the application of mathematics to the human body in general and to the mechanics of dislocations.” He is also actively interested in philosophy: he visits the salon of the widow of Helvetius, where Lavoisier, Condorcet, Cabanis, Franklin and Delanbert gather. He was unable to receive the highest medical degree of that time, “docteur regent” (doctor regent), although many of those for whom he wrote dissertations did. The topic on which he “failed” was a curious one, it was called “On horseback riding and rider hygiene.”

Philippe Pinel founded and edited from 1784 to 1789 the Gazette de Santéў (Newspaper on Health), which is still published today. In it he publishes articles on hygiene and psychiatry. In 1787, he wrote an article that was the forerunner of a new science - geopsychology. The article was entitled “Are not attacks of melancholy more frequent and more dangerous in the first winter months?” In this article, he pointed out the connection between some mental disorders and seasonality and climate. In 1790, his article “Medical Discourses on the Condition of Monks” appeared; in 1791 - “Indication of the most reliable method for the treatment of mental illnesses that occur before old age.” Many generations of doctors read his “Analytical Methods Used in Medicine” (1798). But his work on the treatment of psychiatric patients brought him greater fame, for which he was elected a member of the French Academy in 1803.

It must be emphasized that only in the 80s, when Pinel was almost 40 years old, did he become interested in psychiatry. He diligently studies everything that ancient and modern authors wrote on this issue, since his language training is beyond praise. While working as a psychiatrist in the private hospital of Dr. Belhomme, Pinel conceived what would later be called “the great idea of ​​humane treatment of the mentally ill and treating them not with violence, but with persuasion.” In 1792, he was elected to a municipal position, acquired his own apartment and got married. Pinel was short and strongly built. His intelligent and lively face, covered with a network of wrinkles, resembled a face sculpted by an ancient sculptor. With his appearance, Pinel reminded people of a Greek sage.

On August 25, 1793, Pinel was appointed to the post of chief physician of the Bicetre hospital, near Paris, intended for elderly disabled people and mental patients. Well-known dramatic events took place here, which led to the fact that Pinel’s name was inscribed on the tablets of the history of psychiatry.

Old asylums for the insane have a bad reputation: London's Bedlam, Vienna's Norrenturm, Paris's Salpêtrière have become household names. But the most sinister and most terrible of all was Bicêtre. This castle was founded in 1250 under Saint Louis. For several centuries it passed from hand to hand, changing its owners. Repeatedly in troubled times it was destroyed; robbers and thieves settled in its ruins; this place was considered cursed. In 1632, Louis XIII brought it into relative order and set up a hospital for the disabled in it; soon an educational home for orphans was added to it. However, the children did not survive in it; they all died. In 1657, Bicêtre became part of the General Hospital. To save money, it simultaneously served as an almshouse, an insane asylum and a state prison. In the first year, up to 600 people entered the almshouse: old people over 70 years old, disabled people, incurable patients, paralytics, epileptics, idiots, scabies and the sick venereal diseases, orphans who were not separated by gender or age. The conditions of their detention were terrible: they lay in unheated rooms, 8-13 people in one straw bed; the food was bad, but even that was not enough for many; dirt, insects, corporal punishment were all commonplace. There were not enough staff in Bicetre. So, for 800 people there were 83 ministers (one specifically for the destruction of lice) and 14 nurses. In the worst situation were venereal patients, who were mercilessly beaten and tortured, apparently because they dared to contract a shameful disease. Eventually, by order of the Convention, they were transferred to another hospital.

It must be said that progressive figures in medical science and legal scholars condemned the vicious practice of keeping people in such houses. The inspector general of hospitals and prisons throughout France, Jean Colombier (1736-1789), should rightly be counted among Pinel’s ideological predecessors, since in 1785 he presented a 44-page report: “Instructions on the methods of treating the mentally ill.” This report contains the words: “...beating the sick should be considered an offense worthy of exemplary punishment.” Two years before Colombier's death, a similar report was presented (in 1787) by a commission headed by academician J.-S. Bailly (1736-1793). The commission included Lavoisier, Laplace and Jacques R. Tenon (1724-1816) - a famous surgeon, anatomist and oculist. However, all these decrees, instructions and reports remained in the cabinets of the Ministry of Internal Affairs. The revolution that broke out in France did not allow us to pay attention to the situation of the mentally ill and alleviate their plight. In 1791, the government formed a new hospital commission. Appointed to it are: Cabanis, Jacques Cousin (1739-1800), professor of physics at the Collège de France, patron of Pinel from the moment of his arrival in Paris, and Michel Touré (1757-1810), member of the Medical Society, first director of the newly created medical school of Paris (Ecole de Santeў), also one of the people close to Pinel. It must be especially emphasized that no commissions with their investigations and reports led to practical results.

There were 443 prisoners in the Bicetre prison in 1792. Along with the criminals, there were also victims of royal tyranny, among whom were priests and emigrants; In this heterogeneous environment, pederasty flourished. In one of the departments there were children from 7 to 16 years old with signs of molestation and subjected to sexual violence. More than a hundred prisoners sat in eight punishment cells located at a depth of 5 meters underground, where the rays did not penetrate daylight; 33 doors separated these unfortunates, chained to the wall, from the outside world. The National Assembly, to its credit, demanded the closure of this monstrous prison, but they did not have time to implement the resolution. In September 1792, Bicêtre, like other Parisian prisons, became the scene of a nightmarish lynching; A crowd of Parisians, intoxicated by revolutionary fervor, reviewed the prisoners' cases and killed 166 of 443 people, including 33 children. 51 prisoners were released. This is the brief history of Bicêtre, where the psychiatric department was located, which Pinel was invited to head.

The department for the mentally ill, isolated from epileptics and idiots, consisted of 172 cells, on average no more than two square meters each, there were no windows, light penetrated only through the door opening; In some places the beds were attached to the walls, but more often they were troughs with rotten straw. The patients were chained not only by their arms and legs, but also by their necks. The staff consisted of 17 people. If quiet patients lay 6 people on one “bed” in large wards and were not subjected to repression, then there were no differences in the treatment of restless mentally ill patients and criminals; they were considered harmful, dangerous and unnecessary, and were treated cruelly. There is no need to talk about treatment, since it simply did not exist yet.

Dr. Pinel was a daily witness to the unsatisfactory situation of the mentally ill and the barbaric attitude towards them, which, of course, could not leave him indifferent. He could not accept the fact that sick people were treated more harshly than imprisoned murderers; that they are kept like dogs, tied with chains to hooks, their hands locked in handcuffs, kept in dark, damp rooms, without any medical care. Pinel constantly appealed to the Paris Commune for permission to remove the chains from the mentally ill.

One of the main opponents of Pinel's reformations was the paraplegic1 Couthon, chairman of the Paris Commune, the main supplier of victims to the scaffold. Couthon is a close friend of Robespierre, executed along with him, brutally suppressed the uprising in Lyon, and proposed to the Convention a prairie law that greatly simplified the judicial procedure: making it possible for the revolutionary tribunal to condemn 40-50 people to death a day. The same Kuthon who executed not only people, but also buildings. The villain was carried around the city in the arms or on a stretcher by gendarmes, and he hit the walls of houses with a hammer, and these houses had to be destroyed, otherwise he rode a tricycle wooden bicycle, looking for victims. Couthon suffered from severe headaches and nausea, but this did not stop him from being one of the most active members of the Convention. The principle of replacement or compensation: if your legs are paralyzed, you need to strengthen your will - can be traced to Kuton. The paralytic Couton had an iron will, he did what Minister Necker, academician Bailly and others could not do. When Couton was brought into the Bicetre department, where there were violent patients chained to the walls and a terrible sight was revealed to his gaze, he said to Pinel: “Citizen, do what you know, but you yourself must be crazy if you want to release these madmen from their chains.”

On the same day, Pinel ordered the unchaining of 12 patients. The first of them was chained for 40 years; he was considered especially dangerous because... killed a servant with shackles. Having received freedom, he ran around the “ward” all day, and from that moment his violent attacks stopped. The second was released, chained for 36 years, his legs were cramped. He died without noticing his release from his bonds. The third was chained for 12 years. He soon recovered and was discharged. But the poor fellow was unlucky: he intervened in politics and was executed. The fourth, Chevenger, was chained for 10 years. This man had extraordinary physical strength and was a threat to secession. After his release and communication with Pinel, he soon changed and after some time began to help Pinel in the hospital. It is known that he saved Pinel's life several times. One day, on the street, a crowd attacked Pinel, shouting: “At the lamp!” The doctor was saved by Chevenger, who accompanied him.

In addition to removing the chains, Pinel achieved the introduction into practice of keeping the mentally ill in a hospital regime, medical rounds, medical procedures and many other things that the sick needed. In 1798, the chains were removed from the last patients of Bicêtre, thus putting an end to a terrible injustice that was contrary to the elementary principles of human humanity.

The Convention did not share Pinel's revolutionary actions. He was in bad standing with the revolutionary authorities; They thought that Pinel was holding enemies of the people under the guise of mental illness. Dr. Pinel systematically refused to hand over to the revolutionary tribunal those who were in his hospital due to mental illness, although in the eyes of the then authorities they were politically unreliable. To accusations of hiding criminals, Pinel replied that these suspicious people were actually mentally ill. It is well known that opposition to the authorities at that time required considerable civil courage; anyone could be sent to the scaffold without trial. Couthon once said to Pinel: “Citizen, I will be with you tomorrow in Bicêtre, and if you are hiding enemies of the revolution, then woe to you.” The next day he was brought to the hospital, and he tried to identify the “criminals.” Having achieved nothing, he retreated in the arms of the gendarmes.

At the initiative of Couthon, Pinel was removed from his position. Two years later, on May 13, 1795, he was appointed senior physician at the Salpêtrière hospital, where he introduced reforms similar to those of Bicêtre. It is noteworthy that the warden Pussin, Pinel's former assistant in Bicêtre, moved with him to the Salpêtrière, where monuments to him and Pinel were subsequently erected. In 1794, Pinel published his Philosophical Nosography, which was noted by the Paris Academy of Sciences as one of the works that do credit to French science. Pinel's monograph has been translated into several foreign languages and for 25 years served as a reference book for students. Bisha recognized its importance. At the Salpêtrière, Pinel continued his clinical observations, which were used in his Treatise on Mania (1801). In the same year he was elected professor and from 1795 to 1822 he headed the department of internal medicine and psychiatry at the Paris Medical School (Ecole de Sante). His lectures were popular with students. The symptom named after him, observed in active pulmonary tuberculosis, dates back to this time: sharp pain in chest and the upper half of the abdomen with slight pressure with your fingers on the neck in the area where the vagus nerve passes.

During autopsy, no evidence was found in the brains of mentally ill patients. pathological changes, Pinel put forward the theory of “moral” determination of mental disorders. What is meant here is that, as a result of traumas such as grief, dissatisfaction with one’s life, loss of a loved one, etc., the psyche can suffer significantly. Hysteria, this touchstone on which psychiatrists have honed their skills since ancient times, also did not go unnoticed by Pinel. He classified hysteria as a group of neuroses considered in the categories of physical and (or) moral disorders nervous system, which more or less corresponds to the modern division into functional and organic disorders. He found hysteria in both women and men, and believed that nymphomania (or “rabies of the uterus”) in women corresponded to satyriasis (painfully increased libido with a feeling of constant sexual dissatisfaction) in men. Thus, Pinel renewed old ideas about the importance of sexual factors in the etiology of hysteria. His main achievement in the field of hysteria research was the rejection of English neurological theories of more than two centuries ago and the creation of a theory that allowed the possibility of hysterical disorders without organic changes in the nervous system.

In 1803, Pinel was elected to the Academy to replace Cuvier, in the section of zoology and anatomy. Pinel acquired a small estate, where he was engaged in gardening and, with less success, breeding merino sheep. Until the end of his life he remained a liberal and a leftist, for which in 1822 he was included in the list of professors dismissed from service. Three years later he married again.

The great man and physician Philippe Pinel died of pneumonia on October 26, 1826 in Salpêtrière. One of the most humane people, who was the pride of French and world psychiatric science, has passed away. Pinel was an extremely modest man, he did not attach any special significance to the great work he accomplished. He was neither ambitious nor vain, and was devoid of any selfishness. Pinel was buried in the Père Lachaise cemetery in Paris; There is a bronze statue of him at the entrance to the Salpêtrière hospital. The work to which Dr. Pinel gave his life was continued by his student Esquirol.