Freeing People with Mental Illness from Chains 1793 – Treatment, Not Punishment

In 1801, French physician Philippe Pinel described in “A Treatise on Insanity”, his book on mental illness, the terrible treatment endured by patients in French asylums: “The blood of manic patients was sometimes taken so wastefully that one might wonder whether it was the patient or the doctor who was mad.” (presumably for phlebotomy ).

When Pinel became director of Bicêtre Hospital in 1793, he argued that mental disorders should be regarded as illnesses, rather than punished as sinful behaviour or possession by an evil being.

The idea of treating patients with kindness was revolutionary at a time when asylum patients were beaten, chained, starved, spun in chairs until they vomited and sometimes displayed like animals.

Pinel learned much from hospital superintendent Jean-Baptiste Pussin, who advocated treating patients with sincere concern. Around 1793, Pussin and Pinel removed the chains from several Bicêtre asylum patients, carefully observed their progress and saw improvement in many. Pinel prohibited harsh punishments and insisted on better nutrition, rehabilitation services for staff and carefully maintained patient records. He also believed the hospital needed intelligent, compassionate staff who could work more effectively with patients with mental illness. As a result of this approach, hospital deaths fell dramatically, and the number of discharged patients increased. In 1795, Pinel became director of Salpêtrière Hospital, Europe's largest asylum. He successfully introduced similar reforms there and became known as one of the founders of psychiatry. Pinel called his humane approach “traitement moral” (moral treatment), emphasising that an initial psychological stage of “approaching patients with concern” should precede physical treatment.

Other asylum reformers of the period included English Quaker William Tuke, who created a retreat for people with mental illness in 1792, and Italian physician Vincenzo Chiarugi, who promoted humane treatment while heading a hospital in Florence in 1788.

Description of the article image: The facility formerly known as Buffalo State Asylum was designed in 1870 by architect Henry Hobson Richardson. It housed patients with mental illness until the mid-1970s, with patients separated by sex.

Historical figures mentioned in the article: William Tuke (1732–1822), Philippe Pinel (1745–1826), Jean-Baptiste Pussin (1745–1811), Vincenzo Chiarugi (1759–1820)

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