http://hpy.sagepub.com/History of Psychiatry

http://hpy.sagepub.com/content/21/1/38The online version of this article can be found at:

 DOI: 10.1177/0957154X09338334

2010 21: 38History of PsychiatryLouis C Charland

Science and morals in the affective psychopathology of Philippe Pinel  

Published by:

http://www.sagepublications.com

can be found at:History of PsychiatryAdditional services and information for    

  http://hpy.sagepub.com/cgi/alertsEmail Alerts:

 

http://hpy.sagepub.com/subscriptionsSubscriptions:  

http://www.sagepub.com/journalsReprints.navReprints:  

http://www.sagepub.com/journalsPermissions.navPermissions:  

http://hpy.sagepub.com/content/21/1/38.refs.htmlCitations:  

What is This? 

- Mar 4, 2010Version of Record >>

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Science and morals in the affective psychopathology of Philippe Pinel

Louis C CharlandUniversity of Western Ontario, Canada

Abstract Building on what he believed was a new ‘medico-philosophical’ method, Philippe Pinel made a bold theoretical attempt to find a place for the passions and other affective posits in psychopathology. However, his courageous attempt to steer affectivity onto the high seas of medical science ran aground on two great reefs that still threaten the scientific status of affectivity today. Epistemologically, there is the elusive nature of the signs and symptoms of affectivity. Ethically, there is the stubborn manner in which fact and value are intermingled in affectivity. Both obstacles posed insuperable difficulties for Pinel, who never really managed to extricate his affective psychopathology from the confines of the Lockean intellectual paradigm.

KeywordsAffectivity, emotions, moral treatment, passions, Pinel, psychopathology

Nos passions sont les principaux instruments de notre conservation; c’est donc une entreprise aussi vaine que ridicule de vouloir les détruire;

c’est contrôler la nature, c’est réformer l’ouvrage de Dieu.Jean-Jacques Rousseau

Émile, ou De l’Éducation (1762)

Emergence of affective psychopathologyTowards the end of the eighteenth century, the passions assumed a central role as both causes and characteristic signs and symptoms of madness (Berrios, 1985; Radden, 1996). Philippe Pinel played an especially important role in these developments. However, from the start, Pinel’s new clinical concern with the passions was hampered by the widely accepted intellectualist conception of madness inherited from Locke. In a manner of speaking, the new affective psychopathology emerged ‘inside’ the Lockean paradigm of madness. This point has not been sufficiently appreci-ated in the extensive historical scholarship on Pinel, or the history of affective psychopathology.

Article

Corresponding author:Louis C Charland, Departments of Philosophy and Psychiatry & Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 3K7. Email: charland@uwo.ca

History of Psychiatry21(1) 38–53

© The Author(s) 2010Reprints and permission: http://www. sagepub.co.uk/journalsPermission.nav

DOI: 10.1177/0957154X09338334http://hpy.sagepub.com

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 39

The theoretical picture that emerges is one of tension and struggle. Based on extensive clinical observation, Pinel knew that psychopathology could not proceed without ascribing a central role to the passions and other affective phenomena. But at the same time, he could not bring himself to abandon the Lockean paradigm entirely; he was unable to countenance fully the possibility that there might be a separate and unified class of affective disorders, distinct from disorders of the intellect. Consequently, for Pinel the theoretical problem posed by the existence of affective disorder ulti-mately constituted an anomaly within the Lockean intellectualist paradigm. Affective disorders did not yet form a distinct paradigm of their own. That development only came with the creation of J.C. Prichard’s ‘moral’, or ‘emotional’, insanity (Berrios, 1999: 111–16; Shorter, 2005: 213, 239–40).

The term ‘moral’ (moral) played an especially problematic role in all these developments. Its ambiguities are generally recognized by Pinel’s French commentators (Foucault, 1961; Gauchet and Swain, 1980; Pigeaud, 2001; Postel, 1981; Swain, 1977). However, those nuances and their implica-tions tend to be insufficiently appreciated by English-speaking commentators (Goldstein, 2001; King, 1964; Porter, 1987; Reise, 1969; Scull, 1993; Weiner, 1999). Until recently, this problem was compounded by the fact that there existed no English translation of the second edition of Pinel’s famous Traité sur l’aliénation mentale (Pinel, 1809). There was only the infamously bad English translation of the first, much smaller, edition of his treatise, the Traité sur l’aliénation mentale, ou la manie (Pinel, 1801). Leading historians openly call this first translation a ‘betrayal’ (Weiner, 2000).

This unfortunate situation has left English-speaking scholars of Pinel with inadequate access to his mature theory. Fortunately, a full-length, unabridged translation of the second, much larger and revised edition of Pinel’s Traité is now available in English (Pinel, 1809/2008). As a result, English-speaking scholars now have access to Pinel’s definitive views on moral treatment and psycho-pathology. The new translation is especially helpful in the area of affectivity, since it permits an accurate English rendition of Pinel’s pioneering efforts to provide a scientific account of the role of affectivity in psychopathology. Indeed, it is seldom recognized that, along with Sir Alexander Crichton, Pinel is among the first medical writers to scientifically distinguish feelings (sentimens),1 emotions (émotions) and passions (passions) in the effort to construct a comprehensive psycho-pathology that includes affectivity. The point is invariably lost on English scholars of Pinel’s work. Nor has it been adequately documented by Pinel’s numerous French commentators.

Inside the Lockean paradigmPinel strongly encourages us to read Locke and his French expositor, Condillac, in order to prepare ourselves philosophically for what he has to say in the Traité. Following Locke, it was common to view madness as stemming from a problem in the association of ideas, resulting in erroneous judge-ment (Berrios, 1996: 87, 293–4; Goldstein, 2001: 50; Porter, 1987: 188–91; Scull, 1993: 71–2; Shorter, 1997: 30). Locke argues that the mad ‘put wrong Ideas together, and so make wrong Propositions’ (quoted in Goodey, 1994: 223). Their madness lies in the fact that they ‘joined together some Ideas wrongly, they mistake them for Truths’ (quoted in Goodey, 1994: 222). Crucially, according to Locke, the mad ‘do not appear to have lost the Faculty of Reasoning entirely’ (p. 222). They simply ‘argue right from wrong Principles’ and ‘make wrong Propositions’ (p. 222). The problem lies in ‘the violence of their Imaginations’, which leads them to take their ‘Fancies for Realities’ (p. 222). Locke cites the example of ‘a man fancying himself to be a King’ (p. 222). Madness on this view is therefore essentially delusion, an altered and abnormal intellectual state.

It is important to note that, according to Locke, the mad have not entirely ‘lost the Faculty of Reasoning’ (quoted in Goodey, 1994: 222). Rather, they ‘have joined together some Ideas very wrongly, they mistake them for Truths’ (p. 222). Madness, then, is not always total. Based on clinical

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

40 History of Psychiatry 21(1)

evidence, Pinel argues that madness is sometimes curable, and often resolves on its own. For this reason, he prefers to refer to madness as ‘mental alienation’ (aliénation mentale); a straying (égare-ment) from reason. In a related discovery, Pinel also argues that ‘manie’ is not the genus for mental alienation, but instead only one of its species. As a result, he changes the title of his Treatise from Traité médico-philosophique sur la manie, ou l’aliénation mentale (Pinel, 1801) to Traité médico-philosophique sur l’aliénation mentale (Pinel, 1809).

Finally, in a crucial discovery that bears directly on the distinction between affectivity and intel-lect, Pinel argues that Locke is wrong to suppose that madness is always necessarily intellectual in nature. He observes that there can be affective lesions that leave intellectual processes and reason-ing largely intact (Pinel, 1809: 102, 155–60).2 This is ‘manie sans délire’, also called ‘folie raison-nante’ (Pinel, 1809: 80, 93). Note, however, that this theoretical gesture in the direction of a genuine type of affective disorder by no means implies that Pinel acknowledges or believes in the existence of a unified faculty of affectivity. In addition, unlike manie, mélancolie, démence and idiotie, this affective variety of mental alienation does not, strictly speaking, represent a genuine species of mental disorder (Pinel, 1809: 138, n.1). Pinel seems unclear about its overall status.

Two philosophical assumptions Pinel’s clinical methods of observation were largely inspired by Hippocrates, who initiated the descriptive method (méthode descriptive) in medicine (Pinel, 1797: ij, viij; 1801: xj, 2, 8; 1804, 10; 1809: xiii, 2, 137–8; see also Pigeaud, 2001: 117, n.5 and 188, n.10) . Indeed, Pinel’s aim was to do for mental alienation what Hippocrates had done for acute physical conditions. Accordingly, he undertook to observe and describe the natural history of mental alienation in individual patients with as little speculation as possible, paying careful attention to detail. Those details were not lim-ited to the patient’s physical and mental condition, but also included the organization of the social environment in which the patient was housed, as well as diet, and even the seasons and daily weather (Pinel, 1801: 1, 15, 30, 34; 1804: 11, 351–3; 1809: 229–36).

In addition to being a great admirer of Hippocratic medicine and its methods, Pinel was a child of the Enlightenment. It should therefore occasion no surprise that his methods of observation were also framed in those terms. In this second case, he was very much influenced by the epistemology of Locke and, especially, Condillac (Goldstein, 2001: 77, 90–6; Pigeaud, 2001: 232–5; Riese, 1969: 73–101). The goal here was to ground all clinical diagnostic terms and categories in sense experience, building complex general terms by abstraction, out of simpler terms derived from notions that had a clear basis in observation (Pinel, 1797: viij, x, xj, xvj; 1804: 1–15, 351–2). In La Médecine clinique, Pinel (1804: 9) summarizes the process this way:

The path of the human spirit in this as in other areas of research must always be to proceed from the simple to the complex, and to consider by means of the way of analysis, first less complicated objects, and then to rise to the others, in a wisely managed progression. There is no other way to arrive at clear and precise ideas of diseases.

And, in the Traité, he adds:

Perceptions formed at the same time, and others which follow them in regular order, can constitute a natural association of ideas and are often brought together in the mind. But we also have the ability to detach one or more perceptions or ideas from those which were associated with them, and we find another place for them in a new combination which will be all the more solidly established because this association

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 41

will be based on a great number of links. This is what is called abstracting, and is the foundation of the different methods in common use in natural history and, consequently, in medicine. The word abstraction in this case is far from indicating a primitive function of the understanding, as English and French authors have imagined, since it is a necessary sequence of the principle of the association of ideas. (Pinel, 1809/2008: 47, n.3; original italics)

A consequence of the adoption of this epistemological philosophical approach to the descriptive psychopathology of affective signs and symptoms is that general terms for which a firm and unequivocal sensory basis cannot be found should be treated with caution, or even maybe simply avoided or abandoned. As we shall see, this turns out to be a theoretical desideratum of some con-sequence for general terms like ‘passion’, ‘emotion’, ‘feeling’ and ‘affective’. Because of their elusive nature, the descriptive psychopathology of the signs and symptoms associated with affec-tive states proves to be far more impoverished than those of the intellectual states. Thus, even from the earliest days of clinical psychiatry, there is a theoretical recognition that affectivity is a ‘poor relation’ of the intellect (Berrios, 1985).

Jointly taken, the above two philosophical assumptions define Pinel’s proposed new medical method of clinical observation. Accordingly, he refers to his special brand of medicine and clinical science as ‘philosophical medicine’ (médecine philosophique). Clearly, he believed that his new approach was innovative. This is probably why the appellation ‘médico-philosophique’ occurs in so many of his titles (Pinel, 1797, 1801, 1804, 1809). Note that Pinel is not simply a physician who specializes in the study of mental alienation. He is, of course, certainly that, but much more. By the time the second edition of his Traité appears, he is a famous medical scientist with a national and international reputation. He has made contributions to general medicine and is especially famous for his nosological studies of physical disease and his observational studies in clinical medicine (Weiner, 1999: 267–300). It is important to recognize that, as a general medical scientist, Pinel’s goal was to find a home for psychiatry within medicine (Weiner, 1999: 376).

It is now possible to state the main thesis of this essay. It is that Pinel’s general project for a philosophical medicine that incorporates the new clinical science of mental alienation encounters serious obstacles when he attempts to find a theoretical philosophical place for the passions in his psychopathology. Specifically, the clinical need to acknowledge and incorporate the passions as both signs and symptoms and causes of mental alienation is hard to reconcile with the philosophi-cal assumptions of Pinel’s overall medical project in nosology and clinical medicine. The problem is that the passions and other affective posits prove recalcitrant to the method of analysis.

The above epistemological problem with the passions is compounded by another, perhaps even more fundamental, difficulty, but this time in the area of ethics. That problem is that the passions are inextricably ethical in nature, thus potentially threatening the scientific integrity of any medical theory in which they are supposed to play major role. Now it is true that Pinel begins his clinical investigation into the role of the passions in psychopathology, promising, with Crichton, to consider only their medical aspects, leaving their connection to morality and ethics aside (Charland, 2008a). However, that distinction begins to disintegrate under his sharp clinical gaze, as he starts to narrate how the passions actually figure in mental alienation, in all its rich clinical detail. The issue reaches its apex in the apparently interminable debates that have arisen over the meaning of the term ‘moral’ (moral) in Pinel’s moral treatment (Goldstein, 2001: 80–101; Grange, 1961: 443; King, 1964; Shorter, 1997: 19–20; Weiner, 1999: 16, 51, 367). These two combined problems explain the rather ambiguous and confusing status of the passions in Pinel’s Traité, as well as the reasons why he hesitates to consider them full-fledged signs of mental alienation.

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

42 History of Psychiatry 21(1)

Passions and other affective posits

Pinel employs the term ‘passion’ (passion) regularly throughout the Traité. It figures importantly in his table of contents and occurs regularly in the body of his text. He appears to consider the passions as a species of affective state in general, and refers to this more general class as ‘moral affections’ (affections morales). Two other species of affective state, or ‘affections morales’, are mentioned in the Traité. These are ‘emotions’ and ‘feelings’. No attempt is made to formally define or distinguish these terms. Hence the attempt to determine their exact meaning must rely on careful exegetical analysis and paying close attention to circumstances and context of use.

Affections moralesThe ‘affections morales’ include ‘passions’, ‘émotions’ and ‘sentimens’. It is interesting to ask in virtue of what common characteristics or essence these latter states are all instances of moral affec-tions. Why are passions, emotions and feelings, all ‘affections morales’? Pinel never poses the question. Nor does he seem to care. He considers all these terms to be rather abstract, general terms. As such, they have only loose ties to sensory experience and observation. In the end, the indispensability and practical utility of these affective terms in describing clinical phenomena is apparently sufficient to justify their use. Thus, no formal attempt to define affective terms and posits is undertaken in the Traité as a whole. One interesting explanation is that Pinel believed that such an investigation was premature at this stage (Goldstein, 2001: 94, n.103).

Somewhat paradoxically, there are numerous references to ‘affections morales’ in the Traité, but no corresponding acknowledgement that there is or may be a unified faculty of affectivity in any traditional sense. Yet, there is evidence that, as a class, the ‘affections morales’ form a distinct domain of mind in at least one sense. They are said to be distinct from ideas (idées) with which they are often contrasted (Pinel, 1809: 71, 74, 155, 179, 180). However, Pinel never really explains the basis of this contrast; that is, he never tells us in what respect the ‘affections morales’ are all differ-ent from ideas. The situation is further complicated by the fact that Pinel does refer to ‘affective faculties’ (facultés affectives) on at least two occasions in the Traité (Pinel, 1809: 156, 181). But that is very different from saying or admitting that there is a distinct faculty of affectivity. In sum, Pinel never explicitly endorses the standard trilogy of mind according to which the soul (âme, esprit) can be divided into three distinct faculties or powers, namely, cognition, connation and affection (Hilgard, 1980; Radden, 1996). So, in speaking of ‘affections morales’, Pinel is not com-mitted to the existence of faculty of affectivity, even though he can countenance the existence of affective faculties, loosely speaking.

The use of the expression ‘affections morales’ is sometimes accompanied with a list of specific affective states. Some examples are: a deep chagrin, an unrequited love, an extreme exaltation of religious principles, a profound immorality (Pinel, 1809: 4). Other examples include: frustrated ambition, religious fanaticism, and unhappy loves (Pinel, 1809: 457). In such cases, there is no clear indication that the states in question are passions. Nor is there any reason for concluding that they are emotions or feelings. They are simply listed as examples of ‘affections morales’. Yet these very same states are sometimes also referred to as ‘passions’. Indeed, by ‘affections morales’ Pinel often seems to mean ‘passions’. This has led some commentators to suggest that the terms are synonymous or identical in his work (Goldstein, 2001: 94; Grange, 1961: 443). But clearly they are not. For as we have just seen, while all passions are moral affections, not all moral affec-tions are passions.

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 43

Passions

Consider now a list of passions that Pinel (1809: 81) provides: anger, hate, wounded pride, desire for vengeance, extreme disgust with life, and an irresistible tendency to suicide. Now some of these notions are not easily identifiable with, or traceable to, distinct names for passions, strictly speak-ing. Other examples of affective states that fall within the affective domain but do not appear to be directly tied to discrete passions with specific names can be gleamed from another list of examples (p. 457): domestic chagrins, impediments to a strongly desired marriage, consequences of the revo-lution, fanatical zeal and terrors of the afterlife. It is even more interesting that this last list consists of general categories of passions which can lead to alienation, not individual tokens of specific individual instances of a given passion. These are among the passional causes of mental alienation: they represent general categories, or ‘kinds’, of passions.

Clearly, Pinel does not feel compelled to restrict himself to traditional or standard names for passions when considering the influence of affective states on mental alienation. Nor, apparently, does he mind stretching the term ‘passion’ to include them. So, although there appear to be cases where the ‘affections morales’ Pinel is concerned with are directly tied to existing names for pas-sions, at other times they are not. Yet he often refers to them indiscriminately as ‘passions’. To complicate things, when Pinel is discussing the passions as causes of mental alienation, he often uses the term ‘affections morales’ interchangeably with ‘passions’ (pp. 10, 12, 457). Hence the tendency to think that the two are synonymous.

The passions are Pinel’s most important and central affective posit. It is a central thesis of his psychopathology that, when they get too intense or become too inflexible, passions can easily degenerate into mental alienation (pp. 28, 34, 81, 104, 150, 153). This occurs when passions get too stormy (orageuses) or vehement (véhémentes), or when they generate too much ardour (fou-gueuses) and get too lively (vives), fleeting (fugaces) or carried away (emportées). However, within limits, the passions are normally healthy. The passions, moreover, are not simply passive. They are also active and move us to action.

EmotionsThe second most important affective posit in Pinel’s affective psychopathology is emotion (émo-tion). He is concerned with emotions – especially ‘lively emotions’ (émotions vives) – because they are among the contributing causes of mental alienation. These emotions are sudden and intense commotions (commotions) of the mind and body that can sidetrack or disturb reason and the imagi-nation (Pinel, 1809: 155, 180). Indeed, when Pinel mentions emotions, he normally specifies that they are ‘lively’ (pp. 31, 32, 172, 278, 350, 372). Another adjective he uses when referring to emo-tions is ‘emportées’, suggesting that we can be ‘carried away’ or ‘swept away’ by them (pp. 104, 172). At times, emotions are also said to be disorganized (désordonnées) and occur without any real cause (sans cause réelle), which further highlights their disruptive nature (pp. 155, 180). Finally, unlike passions, which can endure and grow for years, emotions appear to be of short dura-tion, with sudden onset (pp. 155, 179).

Because of their sudden onset and short duration, emotions can also play a positive role in treat-ing mental derangement. Accidentally, or through artificial induction, they can help to shock patients back to reason (pp. 150, 372). This they do by snapping or breaking the fixed chains of ideas and faulty associations that underlie and sustain delusions. A good example of this can be seen in melancholia:

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

44 History of Psychiatry 21(1)

Experience has shown the effect of a few simple remedies for avoiding the return of melancholic bouts which lead to suicide, but it has often also shown their ineffectiveness, and at the same time the benefit of strong and vivid emotion in providing a solid and lasting change. (Pinel, 1809/2008: 133)

Distinction between passions and emotionsThe above example also offers an important clue behind Pinel’s reasons for distinguishing passions and emotions. Consider his definition of melancholia. It consists of a fixed and exclusive delusion directed at a single idea (délire exclusif), linked to a dominant passion (passion dominante). In Pinel’s words: ‘A certain set of ideas prevails which delights the imagination and binds itself to a dominant passion.’ (Pinel, 1809/2008: 131; Pinel, 1809: 346, see also 94).

Melancholia, then, has two components. There is an intellectual component; namely, the fixa-tion on a single idea, and there is a dominant passion that accompanies and sustains that intellectual fixation. In such a case, a sudden emotional shock can disrupt and break one or more of the ties that bind these components together. In other words, an emotion can be used to alter or break the hold of a passion. Hence, passions and emotions are different.

There are other differences between passion and emotion. While passions are sometimes calm, emotions are usually lively, at least in this context. Finally, while emotions may have a cause, they do not appear to have objects in the manner that passions do. In the language of philosophers, they lack intentionality. All of this makes passions and emotions very different.3 Note that on this account it is possible for some passions and emotions to have the same name. For example, ‘anger’ (colère) is sometimes said to consist only in a brief moment of fury (furie) (Pinel, 1809: 100). This is anger, the emotion. At other times, ‘anger’ (colère) can be viewed as a longstanding passion that extends over years (pp. 25–7). This is anger, the passion.

Anger, the emotion, is sometimes said to be accompanied by an ‘irascible character’ (un caractère irascible). This might be called its characteristic emotional tone or affective form. For what seems to be important about emotions in Pinel’s psychopathology is really their form, not their specific intentional content – what they are about. It is the physiological form – the kind of shock (secousse) – of the emotion that has a causal function in psychopathology, not its intel-lectual content. Indeed, different contents can cause and be accompanied by the same general kind of shock. Thus, the emotional form – or tone – of fear (the emotion) can be the same, even though the object of that fear – what it is about – may be different.

The same distinction between form and content can be made regarding the passions. For while Pinel acknowledges that the passions may have numerous and very different individual objects and associated ideas, and while they may also vary infinitely in their individual expression and modi-fications, there is nonetheless a shared physiological form – reflected in their ‘simple’ physio-gnomical expression and visceral character – which it is the job of psychopathology to understand. No matter what the content of those passions may be, it is in virtue of this form, and not their intel-lectual content, that the passions function as causes and symptoms of mental alienation. However, while the notion of content seems to play no clear role in Pinel’s psychopathology of the emotions, it most assuredly does play a role in his psychopathology of the passions. In that latter case, content plays a pivotal role in devising moral treatment plans and in conducting moral treatment itself.

Some of Pinel’s most important commentators appear to misconstrue the relation between pas-sion and emotions in his thought, or fail to see that there is such a distinction in the first place (Goldstein 2001; Weiner 1990, 1999). For example, in a discussion on the role of the passions in Crichton, Pinel and Esquirol, Dora Weiner appears to state that the passions are violent emotions

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 45

that lie beyond a patient’s control: ‘emotions of such a violence that the patient cannot master them’ (Weiner, 1999: 321; author’s translation). In the light of the evidence adumbrated above, this seems incorrect as an account of the relation between passions and emotions in Pinel. Nor, inciden-tally, is it an adequate account of the relation between passions and emotions in Crichton, who explicitly distinguishes between the two (Charland, 2008b).

Jan Goldstein (2001: 94–119) is another commentator who discusses Pinel’s views on the pas-sions. Yet she omits the fact that both Crichton and Pinel distinguish passions from emotions and that the distinction is important clinically for both of them. However, passions and emotions are different affective constructs for Pinel, and they have different roles in his psychopathology, as demonstrated above. It is interesting that few traces of this distinction remain in Esquirol, who appears to treat passions (passions) as the main agents in generating affective shocks (secousses). Unlike Pinel, he does not refer to these as ‘emotions’. Instead, he refers to ‘passions’ (Esquirol, 1805/1980: 82).

SentimensThere is one affective posit left which we must consider. This is feeling (sentiment). Pinel refers to feelings in the singular (sentiment) and in the plural (sentimens) in only a few places in the Traité. As ‘affections morales’, feelings are sometimes contrasted with ideas, which are intellectual posits (Pinel, 1809: 267). In one example Pinel (p. xxiij) refers to feelings of joy (sentimens de joie) that arise in connection with the pleasures of art and science. Feelings can also sometimes be mixed (un sentiment mixte), such as when we admire an author as well as his work. In another example, Pinel mentions the profound feelings (sentimens profond) of maternal tenderness that women have for children (p. 278). In a manner that is reminiscent of Rousseau, he observes that such feelings are innately given, a product of nature. The maternal feeling of attraction is a deep one, since it can survive even in mental derangement.

Like emotions, feelings can have a distinct affective tone. For example, at one point Pinel refers to feelings of pride (sentimens d’orgueil) in one of his clinical case studies (p. 285). He discusses that manner in which a patient is caught in an ‘inner struggle’ (combat intérieur) between opposing feelings (sentimens contraires). The struggle arises because of a tension between the patient’s feel-ings of pride and her feelings of gratitude for her attendants. Along with feelings of pride and grati-tude, Pinel also mentions feelings of attachment as well as the resentment that a patient can feel if repressive measures are used to limit their freedom of movement (p. 186).

These are the main kinds of feeling referred to in Pinel’s Traité. Note that almost all the exam-ples he provides appear to be affective in nature, which suggests that feelings in this case are a sub-class of moral affections in general.4 Feelings of this affective sort play an important part in Pinel’s overall psychopathology of affectivity, as evidenced by the example of inner struggle alluded to above. But note that inner struggles can also occur among opposing or divergent pas-sions, and between passions and ideas (Pinel, 1809: Sections 38, 117, 167, 196, 225, 228, 285).

Nature and classification of the passionsAccording to Pinel (1801: xxij–xxxix; 1809: 28, 34), the passions are among the major causes of mental alienation. They also figure among the signs and symptoms of mental alienation (Pinel, 1809: 55–127). Finally, the passions also have a curative role in moral treatment (Pinel, 1809: 251–65). In the Traité, he proposes a three-fold classification of the passions.

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

46 History of Psychiatry 21(1)

First, there are the spasmodic passions (passions spasmodiques) which include anger, fright or fear, intense pain and sudden joy. As their name suggests, these passions can cause alienation because of their sudden and sometimes repeated spasmodic character (pp. 25–7). Second, there are the debilitating or oppressive passions (passions débilitantes et oppressives). Examples of these passions include grief, hate, dread, regrets, remorse, jealousy, envy and despair (pp. 27–34). These passions often cause mental alienation when they are suddenly interrupted or frustrated by other, equally intense, but contrary, passions. Third, there are the gay or effusive passions (passions gaies ou expansives). Examples of these passions include joy, pride, love, religious adulation or admira-tion. Great intensity appears to be the hallmark of these passions insofar as mental alienation is concerned (pp. 35–9).

It is a hallmark of Pinel’s account that the passions straddle the ‘physical’ and ‘moral’ divide. On the ‘physical’ side, they have a basis in the viscera. On the ‘moral’ side, they have both intel-lectual and affective components. He writes: ‘The passions in general are a set of unknown varia-tions in physical or mental sensitivity which we can only untangle and to which we can only allocate distinctive characters through external signs’ (Pinel, 1809/2008: 30). Note that the pas-sage asserts that we can only know the passions through their characteristic external signs. In keeping with the popular physiognomy of his time, Pinel locates these external distinguishing signs in the human face:

However conflicting some of them may appear, like anger, fear, the sharpest pain, or sudden joy, they [the passions] are marked above all by various spasms of the muscles of the face, and in general are manifest through prominent features which poets, sculptors and painters of the first order have studied very deeply. The practiced eye of the anatomist can point out the muscles, which through isolated actions or their simultaneous or successive contractions, serve to express the passions of which I am speaking, just as they do for everything that stirs us. Pinel, (1809/2008: 30)

Consider, for example, the physiognomy – or characteristic external signs – of anger:

… a red and inflamed face, or else a livid pallor, wild and sparkling pupils, raised eyebrows, wrinkled forehead, lips pressed against one another especially in the middle, a kind of smile of indignation and disdain, clenching of the jaws, sometimes with grinding of the teeth, and bulging of the veins in the neck and temples. (Pinel, 1809/2008: 10–11)

This description of the physiognomy of anger is meant to capture its ‘simple’ (simple) unadulter-ated form only. Other expressions are possible and will vary depending on circumstances. The list of these is interesting and introduces some of the intellectual and affective components of anger and passions generally: ‘The nature of the object that excites anger, as well as any accessory ideas that get conjoined with it, together with the influence of co-occurring passions and varying degrees of sensitivity on the part of the subject, may lead to very different expressions of this passion.’ (Pinel, 1809/2008: 10–11). Anger, then, is typically excited by an object. In the language of philo-sophers, it is an intentional state about a putative state of affairs in the world. In addition, anger can also manifest itself with accessory ideas (idées accessoires). So anger has at least two intellectual components, both of which appear to be cognitive in nature, namely, an intentional object, and one or more associated ideas. To these intellectual components of anger we must add extreme irascibil-ity. Anger of this sort impedes the free and proper operation of judgement and is often a prelude to more serious mental disorder (Pinel, 1809: 26).

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 47

Recall that anger is classified as a ‘spasmodic passion’ (passions spasmodique). It clearly can degenerate into mental disorder, where it can lead to delirium with fury (délire furieux), stupor or dementia (p. 26). Other spasmodic passions that can lead to mental derangement include the feel-ing of horror or vivid fright as well as the last reaches of despair. While Pinel acknowledges it is hard to view these terms as synonyms, they are all nonetheless modifications of a common pas-sional form. This is due to the fact that they all share a great conformity in physiognomic expres-sion: ‘… the brow furrows from top to bottom, there is a lowering of the eyebrows, the bright and shifting pupils contract, and the nostrils flare open and are raised. The distress can sometimes be so profound that there is a lapse of reason.’ (Pinel, 1809/2008: 11). In keeping with his classifica-tion of these passions as ‘spasmodic’, Pinel refers to their corresponding muscular facial configu-rations as ‘spasms of facial muscles’ (spasmes des muscles de la face).

It is because they all have a common, shared, physiognomical form that the above passions are individual modifications of the same general passional form. In contrast to these outward manifes-tations of the passions, which are largely located in the face, the internal workings of the passions are situated in the viscera. Indeed, it is not only the passions, but also alienation itself, that can be traced to the viscera: ‘les viscères de l’abdomen’ (pp. 113, 142, 454). Disturbances at this level are communicated to the brain by a process of sympathetic irradiation through the nervous system (pp. 113, 142 n.2). Pinel does not go into details. Instead he relies heavily on his contemporaries, physiologists like Crichton and Cabanis (Goldstein, 2001: 94, 251–2; Pigeaud, 2001: 189–202; Weiner, 1999: 77, 117). Thus, like many other thinkers of his time, Pinel locates the seat of the passions in the viscera. Following Crichton, he also believes that the passions have relatively dis-tinct formal characteristics at this level. Each passional type has a distinct physiological profile.

After the spasmodic passions, Pinel turns to the ‘debilitating and oppressive’ passions (passions débilitantes ou oppressives). These include: chagrin, hate, fear, regret, remorse, jealousy, envy. We saw above that excessive irascibility was one of the defining affective characteristics of anger. Profound chagrin also has its own affective defining characteristics, as do the other passions. It is interesting to list these ‘external’ characteristics (caractères extérieures) in detail. Many are explic-itly affective, though they might not qualify as ‘external’ in any accepted contemporary sense:

The external features of deep chagrin are in general a feeling of languor, great reduction in muscular strength, loss of appetite, facial pallor, a sense of fullness and oppression, laboured breathing sometimes broken with sobs, greater or lesser drowsiness, and finally a sombre stupor or a very violent delirium. (Pinel, 1809/2008: 11)

How then do chagrin and other such passions degenerate into mental disorder? The primary deter-minant appears to be intensity, sudden switches from one passion to another, or the impact of contrary passions (Pinel, 1809: 28). Joyful and effusive passions can also degenerate into mental disorder, if they become sufficiently intense. Within proper boundaries they are healthy and help stimulate the understanding. But there are also times when, due to their extreme intensity, they can overturn reason (p. 34). Such cases can occur with other effusive passions when they exceed their proper limits and are carried to their highest degree.

Despite praising Crichton’s work on the passions, Pinel does not adopt his classification of the passions. Esquirol claims that Pinel’s classification is largely inspired by Moreau de la Sarthe (Esquirol, 1838: 57). Certainly there are important resemblances between the two schemes (Moreau, 1803: 709–22). The debt to Crichton is less straightforward. Crichton’s classification builds on several basic physiological passional forms, and then traces their individual modifications as

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

48 History of Psychiatry 21(1)

they evolve into higher forms. His basic passions are joy, grief and sorrow, fear, anger, love. In this scheme, classification is ultimately by homology rather than analogy or resemblance (Charland, 2008b). Esquirol seems content to adopt this strategy of classification by homology (Esquirol, 1805/1980: 21). Pinel, apparently, is less convinced. In comparison, Pinel’s classification seems less theoretically motivated and rigorous, although, like Crichton and Esquirol, he puts heavy emphasis on uncovering the form of the passions.

Theoretical status of affectivity How do the passions and other affective posits relate to the more general notion of affectivity? Pinel’s approach to this issue is framed in terms of the method of analysis he adopts from Locke and Condillac. Analysis (analyse) starts with the careful and repeated observation of the most basic sensory signs and symptoms of mental alienation.5 First, there is the problem of distinguishing what is essential to the disease process from what is merely accidental and collateral (Pinel, 1797: xiij, xxiij; 1804: 1–15, 351–2; 1809: 2, 130, 137). Theoretical categories and general terms are eventually required in order to group observations. These are arrived at, where possible, by a proc-ess of abstraction. This involves delineating the characteristic signs and symptoms of the different species of mental alienation. Thus, all theoretical terms and categories must be grounded in experi-ence in order to be deemed scientifically legitimate.

It follows from this that a theoretical posit for which characteristic signs and symptoms of the required sort are problematic or not forthcoming must be treated with caution. According to Pinel, this is the case with the passions and other affective posits. In the following passage, he states this point clearly with regard to affective posits in their capacity as causes of mental alienation. In the first part of the passage, Pinel states the conditions under which the search for putative signs and symptoms must be carried out: ‘the historical recording of this data must be subjected to a sound and consistent method, and the observer must have especially stressed the distinctive characters of alienation arising from the different faults in understanding and will’ (Pinel, 1809/2008: 54). He then warns us that not all such putative ‘caractères distinctifs’ are necessarily adequate for the construction of general terms and diagnostic categories required for the study of mental alienation:

[It] must be warned that the secondary varieties of this illness, arising from the diversity of the causes, the greater or lesser severity of the symptoms, the differences of the objects of the delirium, or the particular nature of the affective state, cannot provide specific characters, for some symptoms which appear dia-metrically opposed may exist in the same patient under different circumstances and at different stages of the mental alienation: this is enough to indicate the principles I have followed in this classification in order to make it accurate and complete. (Pinel, 1809/2008: 54)

This passage suggests that not all ‘specific characters’ (caractères spécifiques) qualify as ‘distinct characters’ (caractères distinctifs). Only signs and symptoms associated with, or derived from, lesions of the understanding (entendement) or the will (volonté) qualify. Surprisingly, then, affectiv-ity and its posits are excluded from the list of true signs and symptoms (caractères propres) of mental alienation and its diverse species (diverses espèces). They are important as accessory symptoms and even causes of mental alienation, and certainly their presence must be carefully noted and docu-mented. But they are of secondary epistemological and scientific value. The reason, presumably, is that the true nature of affective posits and constructs is harder to determine and verify observationally through ‘sensible signs’ (signes sensibles) (Pinel, 1797: ij, viij; Pinel, 1809: Sec. IX, Sec. 356).

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 49

The second-hand epistemological status of affectivity in Pinel’s overall nosology and psycho-pathology becomes amply evident when we consider how he defines and characterizes mental alienation itself: ‘alienation is but a general denomination designed to express disturbances of the cerebral or intellectual functions’ (Pinel, 1809/2008: 408). In this intellectual conception of mad-ness, there are only two genuine faculties. These are the faculty of the understanding (entendement) and the faculty of the will (volonté). Affectivity is not mentioned (p. 3).

So, despite all the attention he pays to affective posits and processes in his account of the causes and characteristic signs and symptoms of mental alienation, Pinel apparently does not countenance the existence of a full-fledged faculty of affectivity. Strictly speaking, mental alienation itself is limited only to lesions of the understanding and the will (pp. 2–3, 6, 55, 56, 457). Admittedly, in the Traité, Pinel does sometimes refer to ‘affective faculties’ (facultés affectives), but in the plural (pp. 150, 186). In fact, he seems more comfortable with talk of affective operations (opérations) and functions (fonctions) of the mind (pp. 55, 57). He also speaks very generally of the ‘moral faculties’ (facultés morales) (pp. 98, 150, 155, 469, 474, 485). However, he never endorses the thesis that there may be a unified faculty of affectivity that subserves the diverse moral affections and posits he discusses. Evidently, we are still within the Lockean intellectualist paradigm.

Moral problems with moral treatment We have seen that Locke and Condillac were among Pinel’s most important philosophical influ-ences. Their views on epistemology were largely responsible for his decision to base his psycho-pathology in observable, sensible facts (Pinel, 1809: 2–3). Another major philosophical influence on Pinel, but of a very different sort, was Cicero.

Pinel is profuse in his praise for this Roman orator and mentions him at several key points in the Traité, notably in relation to the passions and so-called ‘sicknesses of the soul’ (maladies de l’Âme): ‘One can hardly speak of human passions as illnesses of the soul without having immediately in mind Cicero’s Tusculan Disputations and the other writings which this splendid genius has devoted to morals, drawing on all the experience of his mature years.’ (Pinel, 1809/2008: 20 n.2).

Cicero, then, was important because of his philosophical contributions in the area of the pas-sions and their therapy. But those contributions were not merely of historical interest, as the next passage clearly indicates; they were of immediate relevance to Pinel and the kind of moral treatment he outlines in the Traité. This is because, in Pinel’s view, there are cases where moral treatment would be well advised to emulate the ethical therapy of the passions advocated by Cicero. What is needed in such cases is a kind of ‘moral’ – that is, ethical – reform of the passions:

The deep sensitivity that is so typical of the general character of the insane, makes them susceptible to the liveliest emotions and the most concentrated chagrins, while also exposing them to relapses. But is this not one more reason to conquer one’s passions following the counsel of wisdom, and to fortify one’s soul by the ethical maxims of the ancients? The writings of Plato, Plutarch, Seneca, Tacitus, and the Tusculan Disputations of Cicero are far more effective for cultivated souls than clever formulations and combina-tions of tonics and spasmodics. (Pinel, 1801: 36)

Cicero’s writings on the passions were therefore of immediate philosophical and medical relevance to Pinel. Some commentators acknowledge this important influence on Pinel (Pigeaud, 2001, 245, 268–89). Some seem not to mention it at all (Goldstein, 2001; Porter, 1987; Scull, 1993). Others discuss it in passing but never explore its significance (Weiner, 1999: 264–265). Certainly, this was a matter with significant consequences for Pinel’s overall conception of the passions in

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

50 History of Psychiatry 21(1)

psychopathology. At issue was the question whether moral treatment must sometimes stray beyond the boundaries of medicine, strictly speaking, and encroach into the domain of morals.

Pinel was not simply a medical scientist and doctor. He was also a moralist who was deeply con-cerned with the state of public morality in his country, and deeply moved by the bloody aftermath and terror of the revolution. In examining the medical credentials of his efforts to reform the treatment of the insane at the Salpêtrière and elsewhere, we must never lose sight of the fact that he was a com-mitted humanist and political reformer (Goldstein, 2001: 105–19; Weiner, 1999: 115–24). This cre-ated ‘moral’ problems for his moral treatment. To what extent was it really a medical therapy that should be carried out by medical professionals? At stake was nothing less than the scientific integrity of Pinel’s entire project to chart the contours of the descriptive psychopathology of affectivity.

What then are the limits of the ethical and political ideals that motivated Pinel’s medical reforms when it came to the ‘moral’ care and treatment of the insane? Clearly, Pinel’s moral treatment was not an ethical therapy derived from a fixed set of ethical rules of conduct. This is why he took great care to distinguish his own clinical ‘medical’ moral treatment from the therapeutic practices of the York Retreat, which were based on Quaker morality and religious ethical principles (Charland, 2007). But this does not mean that Pinel was not also a ‘moral’ – that is, ethical – reformer in his own right. The question is to what extent his reformist ethical ideals infused his moral treatment. This is a point on which Pinelian scholarship is often silent or inconsistent.

For example, in her celebrated study of Pinel, Dora Weiner claims that, unlike Esquirol, Pinel was never a moralist: ‘Esquirol allows himself expressions like “the disgusting filthiness of those imbeciles” – a type of judgment we do not find in Pinel.’ [‘Esquirol se permet des expressions comme “la malpropreté dégoûtante des imbéciles” – type de jugement que l’on ne trouve pas chez Pinel.’] (Weiner, 1999: 319). She describes Pinel’s primary task as one of understanding his patients without moralizing about them: ‘Il comprend. Il ne fait pas la morale. Pinel ne juge per-sonne’ [‘He understands. He does not moralize. He does not pass judgment.’] (Weiner, 1999: 244). But how then are we to understand the point of remarks like the following?

Within domestic situations humanity presents a perpetual contrast between vices and virtues … I refrain from publicising to the wide world examples of this kind, of which some are a credit to the human race, but many others make a disgusting picture, and seem a disgrace to humanity. (Pinel, 1809/2008: 12)

It is interesting that there are many examples in the Traité where vice (vice) is explicitly mentioned in relation to the causes of mental alienation: sexual excesses, drunkenness, gluttony and other forms of sensual intemperance and overindulgence. In addition to these more bodily oriented forms of immorality and debauchery, certain excesses of passion are also considered to be vices that are detrimental to reason. These include excessive jealousy, excessive ambition, megalomania, exces-sive religious devotion.

In fact, the Traité contains a long list of clinical vignettes and case histories that amply illustrate the detrimental effects of vice and immorality on mental health (Pinel, 1809: 22, 29, 36, 68, 69, 198). Usually, Pinel does not morally judge the afflicted directly, but he does not condone their behaviour either. Quite the contrary: he makes it abundantly clear that such behaviours lead to disordered passions, which, in turn, can lead to insanity. In this context, it is simply understood that individuals should abstain as much as possible from the temptations to indulge in such behaviours, which are judged both medically and ethically objectionable. In effect, the recommendations of medicine serve to lend support to those of morality (pp. 28, 491–2).

Excessive pride and vanity get special mention in the Traité. They are two passions which are especially inimical to moral treatment (pp. 21, 33, 117, 266, 298, 299, 303, 491). They make

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 51

patients disrespectful and resistant to the authority of the treating physician. This is crucial, since subservience and submission to authority (un ascendant moral), as well as trust (confiance) are important preconditions for the success of moral treatment (pp. 251, 283, 292). Obviously, the attempt to right such wayward passions is partly an ethical exercise; at least to the extent that it involves an effort to eliminate ‘bad’ and socially inappropriate passions, and instil balanced passions that are more socially appropriate. Therefore, although it may not be ethical by design, moral treatment is de facto an ethical therapy nonetheless. A sound and healthy mind is a ‘moral’ one; that is, one that follows the dictates of morality (la morale, les mœurs).

Weiner herself appears to concede so much when she asserts that, in the final analysis, Pinel’s moral treatment hinges on the moral judgement of the treating physician: ‘En dernière analyse, le traitement dépend du jugement moral du médecin’ (Weiner, 1999: 16). She then goes on to say that Pinel is ‘an eminently moral man’ (un homme éminemment moral). But what exactly does the word ‘moral’ mean in this context?

Like many other leading commentators on Pinel, Weiner suggests that the term ‘moral’ in ‘traitement moral’ means ‘psychological’ (psychologique) (Shorter, 2005: 180–1; Weiner, 1999: 51). Later she goes on to qualify that the French term ‘moral’ – in this sense, in this context – does not imply any ethical judgement (Weiner, 1999: 367). But then what is the point of insisting that Pinel is ‘an eminently moral man’ (un homme éminemment moral)? Surely, this cannot simply mean he is a ‘psychological’ man! But if not, then Weiner is guilty of equivocation or inconsist-ency. Weiner is not alone in facing this problem, which is certainly not of her own doing. It has to do with the term ‘moral’ (moral) itself.

There are several senses of the term ‘moral’ (moral) that can be discerned in Pinel’s work. First, there is ‘moral’ in the sense of ‘le moral’, meaning what is psychological or mental (mentale) as opposed to what is physical (physique). That usage is enshrined in the title of Cabanis’ famous work, Rapport du physique et du moral (Goldstein, 2001: 78; Pigeaud, 2001: 220–1). The other major sense of ‘moral’ that Pinel uses has to do with ethics and ‘la morale’ (Pigeaud, 2001: 245, 268–89). A third sense of the term ‘moral’ is arguably involved in the reference to ‘moral faculties’ (facultés morales). Moreover, there is also a fourth possible sense; for example, when a reference is made to ‘moral affections’ (affections morales), meaning affective posits like passions, emotions and feelings. Finally, fifth, in this context it is common to find the general expression ‘moral sci-ences’ (sciences morales). No wonder there is such confusion. Note that these ambiguities also occur in English, for example, in the work of Hume.

Medicine and moralityAs a medical doctor, Pinel believes that he must study the passions in a manner that is supposed to steer clear of ethics. He proposes to consider them in abstraction from all questions of morality: ‘les considérant en abstraction de toute question de moralité’ (Pinel, 1809, p. xxij). In adopting this strategy, he follows Crichton to the letter (Crichton, 1798: III.1.99; but see Charland, 2008a). At the same time, when it comes to determining the causes of mental alienation and its moral treat-ment, Pinel finds that clinically he cannot ignore the ethical aspects of the passions.

Clearly, Pinel wants to distinguish his medical brand of moral treatment from the religious ethical moral treatment practised at the York Retreat. Yet he is apparently not entirely clear, nor seemingly very perturbed, about the extent to which his own moral treatment is so closely tied to morality – a point not lost on Foucault, who accuses him of being a moral reformer in medical disguise (Foucault, 1961). Certainly, for Pinel, there is an intimate connection – actually, a convergence – between the goals of medicine and morality. He explicitly refers to the ‘support medicine lends to morals’ (Pinel,

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

52 History of Psychiatry 21(1)

1809/2008: 11). The matter is apparently so important that he concludes the Traité on this theme: ‘[O]ne cannot deny medicine the benefit of working powerfully towards the return of a sound moral-ity, giving an account of the evils which result from its neglect’ (Pinel, 1809/2008: 188).

Hence, a healthy mind must live according to the dictates of morality if it is to remain healthy. This does not mean that the passions are inherently bad, or that we should try to eradicate them. Quite the contrary – following Rousseau, Pinel’s view seems to be that the passions are in fact inherently good and actually essential to our survival. It is their misuse and excess which lead to mental alienation. The solution, then, is to master the passions, not to eliminate them, as Descartes so thoughtfully advised: ‘nous n’avons rien à éviter que leurs mauvais usages ou leurs excès …’ (Descartes 1650/1990: Article 211, p. 176).

Notes1 This is the plural spelling in the 1809 edition of the Traité. In the singular, the spelling is ‘sentiment’.2 References to Pinel (1809) refer to page numbers in the original Brosson edition. A new edition of that

work is now available (Garrabé and Weiner, 2005). All translations are by the author, unless taken from the published translation (Pinel, 1809/2008), or indicated otherwise.

3 This conforms to the position outlined in the Encyclopédie (Diderot and d’Alembert, 1785/1995) where the entry for ‘Passion’ receives 11 pages compared with the entry for ‘Emotion’ which receives only several lines. ‘Movements of the pulse’ is the example of ‘émotion’ that is provided.

4 There is also the feeling of one’s existence: ‘sentiment intérieur de sa propre existence’ which functions as a criterion of insanity in Pinel’s theory (Pinel, 1809: 78, 122, 176, 180, 470, 471). However, it is not clear whether this kind of feeling is affective in nature.

5 The term ‘symptom’ (symptôme) in Pinel’s usage does not appear to be clearly or exclusively tied to reports of inner states, as it is now. In La Médecine clinique, symptoms (symptômes) are said to impact on the senses (frappent les sens), suggesting that they are perceptible phenomena (Pinel, 1804: 5). In this way, they are similar to signs (signes) like pulse, bodily temperature, breathing and physiognomic facial traits (Pinel, 1797: vj; 1804, 2–5). On this matter Pinel is undoubtedly influenced by the semiotic theory of signs of Landré-Beauvais (Pinel, 1809: xxiii n.2). Like Pinel, Landré-Beauvais was inspired by Condillac’s insistence that all scientific terms must be based on and derived from sensory experience. He argues that a sign is a conclusion or judgement (conclusion, jugement) that the mind infers from symptoms observed by the senses (Landré-Beauvais, 1818: 3). On this view, ‘diagnostic’ signs are said to be ‘characteristic’ (caractéristiques) when they are essential to (propres) and inseparable from (inséparables) a particular disease (Pinel, 1797: xiij, xxiij; 1804: 1–15, 351–2; 1809: 130, 137).

References

Berrios GE (1985) Psychopathology of affectivity: Conceptual and historical aspects. Psychological Medicine 15: 745–758.

Berrios GE (1996) A History of Mental Symptoms. Cambridge: Cambridge University Press.Berrios GE (1999) Introduction to ‘J.C. Prichard and the Concept of Moral Insanity’ (Classic Text No. 37).

History of Psychiatry 10: 111–116.Charland LC (2007) Benevolent treatment: moral treatment at the York Retreat. History of Psychiatry 18:

61–80.Charland LC (2008a) A moral line in the sand: Alexander Crichton and Philippe Pinel on the psychopathol-

ogy of the passions. In: Charland LC and Zachar P (eds) Fact and Value in Emotion. Amsterdam: John Benjamin, 15–33.

Charland LC (2008b) Sir Alexander Crichton on the psychopathology of the passions. History of Psychiatry 19: 275–296.

Crichton A (1798) An Inquiry into the Nature and Origin of Mental Derangement, Vol. 2. London: Cadell & Davies.Descartes R (1650/1990) Les passions de l’âme. Paris: Librairie Générale Française.

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from

Charland 53

Diderot D and d’Alembert [J le R] (eds) (1785/1995) Encyclopédie, ou Dictionnaire raisonné des sciences, des arts et métiers. Available at: http://gallica/bnf.fr.

Esquirol E (1805/1980) Des Passions. Paris: Librarie des Deux Mondes. Esquirol E (1838) Des Maladies Mentales. Paris: Baillière.Foucault M (1961) Folie et déraison: Histoire de la folie à l’âge classique. Paris: Plon.Garrabé J and Weiner D (2005) Philippe Pinel. Traité médico-philosophique sur l’aliénation mentale, sec-

onde édition, entièrement refondue et très augmentée (1809). Présenté et annoté pas Jean Garrabé et Dora Weiner. Paris : Les Empêcheurs de penser en rond.

Gauchet M and Swain G (1980) La Pratique de l’esprit humain: l’institution asilaire et la révolution démocra-tique. Paris: Bibliothèque des sciences humaines.

Goldstein J (2001) Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Chicago: Chicago University Press.

Goodey CF (1994) John Locke’s idiots in the natural history of the mind. History of Psychiatry 4: 215–250.Grange KM (1961) Pinel and eighteenth century psychiatry. Bulletin for the History of Medicine (Sept.–Oct.,

No. 35): 442–453.Hilgard ER (1980) The trilogy of mind: Cognition, affection, and connation. Journal of the History of the

Behavioral Sciences 16: 107–117. King LS (1964) A note on so-called ‘moral treatment’. Journal of the History of Medicine (July): 297–298.Landré-Beauvais AJ (1818) Séméiotique, ou traité des signes des maladies, 3rd edn. Paris: Brosson.Moreau de la Sarthe J (1803) Histoire naturelle de la femme, suivie d’un traité d’hygiène, appliquée a son

régime physique et moral aux différentes époques de sa vie. Paris : Chez Duprat, Letellier et comp.Pigeaud J (2001) Aux Portes de la psychiatrie: Pinel, l’ancien et le moderne. Paris: Aubier.Pinel P (1797) Nosographie philosophique, ou la méthode d’analyse appliqué a la médecine, Vol. 1. Paris:

Maradin. Librairie du Capelet.Pinel P (1801) Traité médico-philosophique sur la manie, ou l’aliénation mentale. Paris: Caille et Ravier.Pinel P (1804) La Médecine clinique rendue plus précise par l’application de l’analyse, ou Recueil et résult-

ants d’observations sur les maladies aiguës, faites à la Salpêtrière, 2nd edn. Paris: J.A. Brosson.Pinel P (1809) Traité médico-philosophique sur l’aliénation mentale, 2nd edn. Paris: Brosson.Pinel P (2008) Medico-Philosophical Treatise on Mental Alienation, translation by Hickish G, Healy D, and

Charland LC of Traité médico-philosophique sur l’aliénation mentale, 1809. Oxford: Wiley-Blackwell.Porter R (1987) Mind Forg’d Manacles: A History of Madness in England from the Restoration to the

Regency. London: Athlone.Postel J (1981) Genèse de la psychiatrie: Les premiers écrits de Philippe Pinel. Paris: Le Sycomore.Radden J (1996) Lumps and bumps: Kantian faculty psychology, phrenology, and twentieth century psych-

iatric classification. Philosophy, Psychiatry, Psychology 3(1): 1–14.Reise W (1969) The Legacy of Philippe Pinel: An Inquiry Into Thought On Mental Alienation. New York:

Springer.Scull A (1993) The Most Solitary of Afflictions: Madness and Society in Britain, 1700–1900. New Haven, CT:

Yale University Press.Shorter E (1997) A Short History of Psychiatry. New York: Wiley.Shorter E (2005) A Historical Dictionary of Psychiatry. Oxford: Oxford University Press.Swain G (1977) Le Sujet de la folie: Naissance de la psychiatrie. Toulouse: Privat. Weiner DB (1990) Mind and body in the clinic: Philippe Pinel, Alexander Crichton, Dominique Esquirol, and

the birth of psychiatry. In: Rousseau GS (ed.) The Languages of Psyche: Mind and Body in Enlightenment Thought (Berkeley: University of California Press), 331–402.

Weiner DB (1999) Comprendre et soigner: Philippe Pinel (1745–1826). La Médecine de l’esprit. Paris: Fayard.Weiner DB (2000) Betrayal! The 1806 Translation of Pinel’s Traite médico-philosophique sur l’aliénation

mentale, ou la manie. Generus 57: 42–50.

by Pepe Portillo on June 3, 2014hpy.sagepub.comDownloaded from