Pinel 1754-1826 on Treatment of Illness from “Moral Causes”

Out of the era of the post French Revolution, we learn about Philippe Pinel (1754–1826), one of the founding fathers of what would later become psychiatry and psychopathology.

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“Pinel is important because of his method: he was the founder of the clinic, that is to say, of the determined and systematic approach through which mental illness acquired its distinctive status, institutions, and treatment.

With regard to theory, he took a rather peculiar stance: he remained skeptical of any form of theory that, as far as he was concerned, moved too rapidly away from observation. Hence one cannot talk about Pinelian theory. Rather, he proposed a pragmatic approach, a form of know-how (savoir-faire) that enters history under the name of the “moral treatment” (traitement moral). This approach accords with his views on etiology. (Verhaeghe, 2008. p 93)”

He distinguishes between three groups of pathogenic factors / causes of illnesses:

  • • Physical causes (trauma, organic diseases);
  • • Hereditary causes (debility);
  • • Moral causes.

Deeming the first two practically incurable, he concentrates on the third group, which can be inferred to as describing psychological pathology. His ensuing treatment model recalls the Hippocratic idea of illness, in which illness is the body’s healthy defensive reaction to an imbalance, and whose normal result is health. This is not unlike much of the philosophy of traditional medicine which we also embrace today.

It is clear that such a conception of illness has important repercussions for the way the person who was then called the “alienist” responds. Pinel sums this up in three basic rules:

  • • He has to wait;
  • • He has to avoid any intervention that disturbs the natural course of the illness (because its ultimate goal is health);
  • • He must help the illness progress.

It is precisely this last that constitutes the “moral treatment.”

This principle of “waiting” instead of leaping immediately into trying to “cure” or “treat” or solve a problem” or to “eliminate the pain”, with regards to working with mental issues was also clear in the decades prior to Pinel. The creation of the 18 century Magazin by Moritz, das Erfahrungsseelenskunde, centered also around the same premise of observing without premature judgment, or looking for explanation. Moritz also wrote about the need for “moral doctors” to work with individuals seen as societal deviants.

This is also in line with the principles of the Paradoxical theory of Change in Gestalt Therapy, written by Arnold Beisser in the 1970s.

With regards to psychological health and working with patients with psychological and psychosomatic issues, this attitude of being patient, of observing and understanding the client’s symptoms, and allowing the client to understand his/her situation in order to support the change process, without premature intervention is crucial for therapeutic change in psychotherapy.

The magic pill that solves the problems immediately, does no magic in helping the client work through with the goal of dealing permanently to alleviate the symptoms of depression, anxiety and other inter- and intra-personal issues.

Bibliography

Verhaeghe, P. (2008). On being normal and other disorders: A manual for clinical psychodiagnostics. Karnac Books.