Philippe Pinel

Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of iHeartRadio. Hello and welcome to the podcast. I'm Holly Frey.
And I'm Tracy V. Wilson. This is yet another episode
of I don't know how it got on my list.

(00:21):
I love those, honestly. I kind of do, too. It's
one of those things where I had him scribbled down
on a piece of paper and I went back and went,
who's this guy? Let me look him up. Wait, why
have we not done this before? But it includes many
of my favorite things. There's a little bit of medical advancement,
a little bit of social reform, people getting things a
little bit wrong, and the French Revolution. Lots of opportunities

(00:45):
to talk about French people, because we are talking about
Philippe Pinel today, whose work is considered the precursor of
modern psychiatry. He overhauled the asylum system in Paris starting
in the late 18th century, and his ideas about mental
health conditions were groundbreaking, also very wrong in some ways,

(01:06):
but very progressive for his time. Heads up, we are
going to be reading from a number of texts which
are from the late 1700s, early 1800s, and even some
20th century ones that refer to that work. And thus,
there's some terminology in the mix that we probably would
not use today. For the most part, I have tried
to be really judicious in selection to avoid anything truly offensive.

(01:29):
But if you hear something outdated... And you're like, oh,
I didn't think they would say that just because it
comes from that writing. Right. It's that writing. Yeah. And
there are some sections that I want to read because
they're important in setting up really what was going on,
how Philippe Pinel thought, etc. So I don't want to

(01:50):
just ditch them entirely. So just know. So when you
hear something, you go, yuck, that's that's what's up. So
Philippe Pinel was born in Jonquière, France, on April 20th, 1745.
There are multiple towns and villages in France named Jonquière,
and the one where Pinel was born is about 700
kilometers or 435 miles due south of Paris. Pinel was

(02:15):
born into a family of doctors. His father, Philippe-François Pinel,
was a surgeon, and his mother, Elisabeth Dupuis, came from
a family that had a lot of doctors in it.
When Philippe was young, his father started practicing medicine in Saint-Paul-Cap-de-Joux,
which is about 14 kilometers or 8.7 miles to the

(02:36):
west of Janquière. After getting his early education in Le Var,
west of Saint-Paul-Cap-de-Joux, he then moved even farther west to
Toulouse to attend Collège de l'Esquire. His degree was in mathematics,
although Penel's plan at that point was to pursue a
life in theology. He enrolled in theology school in Toulouse

(02:58):
in 1767, but then he changed his mind before long,
decided he was going to join in the family profession,
and he went to medical school, staying in Toulouse to
do it. And during this time, he focused a lot
of his energies on learning about botany. That was something
he would love for the rest of his life. And
botany naturally goes along with a medical degree, particularly at

(03:20):
this point in France. But this wasn't only because of
his affinity for plants or necessarily the way they could
be used in medicine. Because at this point, botanical gardens
were often as much a place of gathering and socializing
for science-minded people as cafes were. And so he would
visit the botanical garden and find people he could talk

(03:41):
to about things. And that continued for pretty much the
rest of his life. He graduated from medical school in
Toulouse in 1773, and then he moved on to his
advanced medical education in 1774, this time in Montpellier. During
his time in Montpellier, which lasted for four years, Pinel
started a pattern of personal research, and he would repeat

(04:03):
this pattern throughout his life. He started visiting hospitals and
spending time with patients. He would listen to their stories
and take copious notes, and he started to compile all
of this information into detailed records. Over time, he developed
relationships with long-term patients, and then he was able to
track the progression of their illnesses. That gave him a

(04:25):
unique set of observational data, which he studied to identify
patterns in disease progression. This was all because while he
had gotten a medical degree in Toulouse, that meant that
he could only practice in Toulouse. He was not licensed
to practice elsewhere. So in Montpellier, he instead observed and

(04:45):
studied patients rather than offering hands-on care as a physician. Yeah,
and a lot of that was stuff that he was
doing in his free time in addition to the medical
studies that he was doing in Montpellier. After four years
in Montpellier, Pinel moved on to Paris in 1778. Once again,
he did not jump right into practicing medicine because he

(05:06):
wasn't licensed there. In Montpellier, he had supported himself by
working as a tutor, and he did the same in Paris.
That math degree that he got early on meant that
he had a skill that meant he could make money
almost anywhere as a tutor. He supplemented his income with
additional work as well, including translating medical texts into French.

(05:28):
He also dabbled in journalism as an editor. And I
say dabbled, but that's not accurate. He did this for
a long time. He worked for a couple of Parisian
science journals. Over his time in Paris, there are two
that he's associated with. One is Gazette de Santé, that's
Health Gazette, and the other is Journal de Physique. He
also worked as a consultant for a private facility that

(05:49):
treated mental health conditions. This, depending on whose account you read,
was getting into a legally fuzzy area where he was
sort of practicing medicine, but it seems like being carefully
labeled as an advisor or consultant was doing a lot
of legal heavy lifting, and I don't think he was
actually hands-on with patients. Then on August 6, 1793, he

(06:14):
was given a job that would change his life when
he became the physician of infirmaries at Bicetre Hospital. He
started work a month later. Bicetre was originally built as
a military hospital under King Louis XIII. That was in
the first half of the 1600s. and it was part
of a project that was overseen by Cardinal Richelieu. But

(06:34):
Louis XIII died while it was still under construction, and
his plans for it were not carried out. Instead, it
was folded into a bigger hospital project as a men's hospital.
It did not stay a men's hospital, though. It became
a prison for a while, and then an asylum for
mentally ill patients. And that's what it was when Pinel

(06:57):
worked there. Incidentally, today, Bissetra is a modern hospital facility. Yeah,
they weren't all mentally ill patients, but that was a
big part of what they were trying to manage when
he was there. Because there were an estimated 1,000 patients
at Bissetra at the time. And the seventh ward contained
one-fifth of that population, 200 men, all categorized as mentally

(07:21):
ill in some way. For them, Bicêtre might be better
described as incarceration rather than any sort of treatment facility.
This was not a place where people were sent to
get better. It was more about keeping them out of
the public eye. So Pinel was not only there, as
I said, to work with the patients that were categorized
as mentally ill. This was a public hospital for men,

(07:45):
and it also housed homeless patients and the city's poor people.
But Pinel did take a very special interest in men
who had been sent there because of a diagnosis of madness.
And often the men that had been categorized that way
had been pronounced as possessed by a member of the clergy,
and so they were all treated as dangerous. Many of

(08:05):
them spent all of their time chained up, with only
enough length in the chain for them to move around
their very tiny rooms. The governor of the hospital was
a man named Jean-Baptiste Poussin, And Pinel conferred closely with
him to get as much information about the patients as possible.
He compiled all of this information into a table and

(08:26):
started to work through a classification system, adapting his knowledge
of how plants were classified to similarly try to form
a more nuanced way of diagnosing his patients, rather than
just simply saying that they were mad. He did not
refer to patients as mad or as mentally ill. He
described their condition as a state of mental alienation because

(08:49):
he believed that they had been alienated from their reason.
And Pinel approached their care the same way he had
the patients that he befriended in Montpellier. He built up
trust with them over time by listening to them, in
addition to consulting with Poussin. He instituted a policy of
treating their illnesses instead of just confining them. So under Pinel,

(09:13):
the patients at Bicetre were moved out of their prison-style
confinement and into rooms with as much natural light as possible.
And he did not chain patients up as a matter
of course. There were some exceptions. We're going to talk
about those in just a bit. He also established hygiene
standards for the facility, and he made sure that patients

(09:33):
received regular warm baths. And he started offering the kind
of treatments that would today be called something like occupational therapy.
He worked with each patient to help them overcome the
obstacles that were keeping them from doing everyday things. We
will talk about how this worked out after we take
a quick sponsor break. It turned out that Pinel's approach

(10:05):
to dealing with his patients was very successful. In the
course of a year under his leadership at Bicetre, the
hospital saw the annual patient mortality rate drop from 50%
to less than 13%. That's a huge jump. And really,
this was largely due to just keeping them and their

(10:26):
surroundings clean. Because if you have disease and you're not cleaning,
there's no way to control it. But the hospital's patients
also had another surprising outcome. A number of them were
able to return to their lives outside of the hospital.
This was a very different scenario for someone who had
been categorized as mad than what would typically be expected.

(10:49):
For the vast majority that entered the asylums as patients,
the expectation was that they were just going to live
there until they died. This approach was also inherently political.
On December 11, 1794, while he was in the middle
of his work to reform hospital practices, Pinnell read a
paper at the Society for Natural History. The Thermidorian Reaction,

(11:12):
which was the event that ended Robespierre's reign of terror
and Jacobin rule in France, had taken place in the
summer of that year. So this was a time when
France was redefining its identity, and Pinel wanted that identity
to include allocating money to build facilities where people with
mental illness would get treatment instead of just being confined

(11:33):
and forgotten. He was already in good standing with the
organization as he had been a member and even served
as secretary for a brief period. And he had specifically
asked to give this presentation. So his talk that day
opened with, and of course this is translated, when I
was appointed physician of the infirmaries at Bissetra over one

(11:53):
year ago, the division for Mad Men attracted my special attention.
I had undertaken some preliminary studies and felt the strong
urge to try every means of restoring alienated reason. Thus,
I looked upon Bucetra as a source of new enlightenment
and instruction and a most welcome opportunity to contribute to

(12:14):
the public usefulness. But successive changes in the administration of
Paris hospitals have deprived me of several facilities. I have
neither baths nor showers. these were only authorized a few
days ago. I have therefore restricted my activities this year
to a thorough study of the true nature and varieties

(12:34):
of madness, to the effort of obtaining for the insane
everything that might improve their condition, and especially to a
search for fixed principles derived from nature on which to
base their management and supervision, which contributes so much to
the recovery of reason. So he claimed that at that point,
without already instituting their cleanliness policies as much as he

(12:58):
had wanted, that one-eighth of the men that he had
already treated with his approach had recovered and were no
longer categorized as mad. He made the case that it's
almost impossible not to be compassionate when you consider the
reasons behind people might find themselves in such a place, stating, quote,
a large gathering of madmen inspires an undefinable thoughtful tenderness

(13:21):
when one realizes that their present state derives only from
a vivid sensitivity and from psychological qualities that we value highly.
So he describes things like people having fallen into despair
through difficult circumstances or broken hearts or religious or military fervor.
He also describes very talented people as often having a

(13:44):
very sensitive nature, something that he says he does not
want to discourage. But he also says that, quote, investigators, artists, orators, poets, geometers, engineers, painters,
and sculptors pay an almost annual price to the hospice
for the insane. He also said in his speech that, quote,

(14:04):
man is most often led from the free use of
reason to madness by overstepping the limits of his good
qualities and of his generous and magnanimous inclinations. So he's
making the case that patients labeled as mad and put
in asylums got there because of the same qualities that
they are often praised for so that the audience would

(14:25):
remember and understand that these are just people just like
them who had often experienced some kind of trauma or agitation.
Pinnell's description and discussion is obviously limited and problematic given
what we know today about mental health conditions. It does
not consider at all things like brain chemistry, for example.

(14:46):
I would also say it kind of reinforces that stereotype
that creative people are prone to mental illness. At the
same time, though, a really important step in garnering a
more nuanced view of these kinds of patients in post-Jacobin France. Yeah,

(15:07):
his whole thing was like, I'm going to humanize these
people who are human so that we can start considering
how to care for them best. Also in 1794, and
just a few days after that impassioned lecture at the
Society of Natural History, Pinel was appointed as an assistant
professor at the new revolutionary Paris Health School. Writing for

(15:29):
the American Journal of Psychiatry in 1992, Dora V. Wiener noted, quote,
the inference is obvious. His sponsors in the Committee of
Public Instruction and in the Paris Hospital Commission thought it
politic that their professorial candidate have some public exposure. So
that explains why he was like, I would like to
give a paper on the 11th if you have time.

(15:51):
A handful of months after he got that appointment, he
was promoted to full professor of internal pathology. And in
this role, in addition to teaching, he developed a textbook,
the Philosophic Nosography. So nosography is simply the classification of
conditions and diseases. And Pinel expanded on the work that
he had already been doing under his header of mental

(16:13):
alienation to offer a classification system for all known medical conditions.
And this book became a foundational text for French medical students. Naturally,
Pinel's success gained a lot of attention. Over the course
of just two years, he completely changed Bicetre, and as
a consequence, he was asked to move to the Hospice

(16:34):
de la Salpêtrière as chief physician in the hope that
his methods would be similarly successful there. Salpêtrière was a
much larger project. Bicetre had about 1,000 patients when he
arrived there, and Salpêtrière had 8,000. Additionally, Salpêtrière was a
women's facility. This was the last job that he would

(16:57):
ever have, not because he died especially young, but because
he decided to devote the rest of his career to
treating patients there. And during his time at Salpêtrière, Pinel
refined the treatments that he had used at the men's
facility and further developed his two-pronged approach, one focusing on
their physical well-being and the other on their mental well-being.

(17:18):
On the physical side, it included the same sort of things,
hygiene standards for the facility, regular hygiene for the patients themselves,
and careful management of their diet. On the mental side,
he sought to give patients a sense of community and
support by grouping them into small units that lived together,
so they had sort of their own little social groups.

(17:39):
He also continued his occupational therapy practices, including teaching employable skills.
So his idea was like, if I can get these
people cured enough to reintroduce them back into life outside
of this facility, I want them to also be able
to make a living for themselves. He also prescribed regular exercise.
And he called this course of therapy that translates directly

(18:03):
to moral treatment. But to be clear, it doesn't mean morality.
It means psychology. And it's something that he had done
at Bicetre as well. We really cannot overstate how radical
this was, but not because Pinnell was the first person
ever to think of it. This was not a case
where he just came up with the idea of humane

(18:23):
treatment of patients with mental illness all on his own.
There had absolutely been members of the medical community before
him who had suggested the idea of humane treatment of patients,
including patients with mental health conditions. Additionally, during the time
Pinnell was working on his approach, An English Quaker named

(18:44):
William Tooke was similarly inspired to initiate a change in approach.
But what really set Pinnell apart, and the reason that
he's so frequently referred to as the father of modern psychiatry,
was action. He made the leap from theorizing about this
to actually practicing it. accepting the risk of potential failure,

(19:05):
particularly adapting what had been small experiments for others into
really wide-scale institutional reforms. His work directly improved the lives
of thousands of patients. And Pinel continued to have good
results treating patients in this way, and he set the
standard of capturing all possible information about those in his

(19:26):
care to track their progress. I know it sounds wild,
but there really was not the same level of, like,
I have a file on this patient. I'm going to
note everything about them while they're under my care until
he started doing it. They just weren't perceived in that way.
And this also went back to his days at Bucetre,
and he included data for every patient that included things

(19:49):
like their ages, their temperature, and he would compare that
to the temperature of the building at the time, which
is a very interesting thing to do, their diagnoses. And
he also included measurements of their heads. Now, this is
not because he believed in phrenology. It was, in fact,
quite the opposite. Phrenology was really just coming into being

(20:11):
when Pinel was doing most of his work and his writing,
but it built on a 1790s idea that came out
of Austria called craniology. This, in case you have never heard,
is like basically saying people who are prone to, you know, violence, madness,
et cetera, you can just tell by looking at the
way their head is shaped. And Pinel thought this was

(20:32):
useless garbage. So his inclusion of cranial measurements is, was
actually a way to prove that. He later wrote of
his collected data of skull measurements that it would, quote,
appear to confirm the opinion, which I have already advanced,
that intense mental affections are the most ordinary causes of
insanity and that the heads of maniacs are not characterized

(20:53):
by any peculiarity of confirmation that are not to be
met with in other heads taken indiscriminately. We are going
to talk about some needed nuance when examining the stories
of Pinel's work. But before we do that, we will
take a break to hear from some of the show's sponsors.

(21:19):
One aspect in all of this information about Pinel that
requires some nuance is the characterization of him as breaking
the chains of all the people under his care transforming
them from inmates to patients. There is even a very
famous painting by Tony Robert Fleury from the late 19th
century depicting him doing so. That was at the women's hospital.

(21:42):
But he did not release all of his patients from shackles.
In instances where he believed a patient was a danger
if left unshackled, they remained confined and tethered. He included
examples of this in the essay that he read aloud
in 1794 that we quoted earlier, mentioning several cases of
what he described as, quote, agitated and violent men, including

(22:05):
one who had been in that state for more than
four decades, so chained up for that long. He is
very detailed in his descriptions of the behavior of the
men in these examples that he thinks warrant the use
of shackles, explaining why these patients were so very dangerous.
He wrote of the need to try to avoid this,
but also to be willing to do so if necessary. Quote,

(22:28):
one of the fundamental principles of the conduct one must
adopt toward the insane is an intelligent mixture of affability
and firmness. When they are obstinate, one must sound totally
authoritative and unshakable so as to convince them to bow
to the will of the directors. But one must avoid
any unnecessary constraints and use only enough force to restrain them.

(22:53):
As an example, he describes a soldier who is, quote,
obsessed with the thought of his imminent departure, who refuses
to go into his cell or go to bed because
he is certain that he will be called to duty
at any moment. Pinnell describes the soldier becoming agitated to
the point where he threatens staff, at which point the
director steps in and threatens restraint. Then the soldier would

(23:16):
be tied down, and if that did not subdue him,
the director might resort to chains. But Pinnell also describes
a system in which the goal is to get the
patient out of the restraints by checking in on their
mental state over a course of days and releasing them
when they've calmed down, as was promised. Yeah, that's another
part of it is that he would explain to them

(23:38):
what they're doing and why and be like, when you
are no longer dangerous, this will absolutely end. But you
and I have to work together to get to this point.
In 1801, he published Medico-Philosophical Treatise on Mental Alienation or Mania.
This book was republished in 1809 with additional material and
also with the mania word cut out of the title.

(24:00):
In the years between those two editions, he also published
another book, A Treatise on Insanity, in which are contained
the principles of a new and more practical nosology of
maniacal disorders than has yet been offered to the public.
exemplified by numerous and accurate historical relations of cases from
the author's public and private practice. The introduction to the

(24:22):
1806 book is a general description of mental health conditions
from Pinnell's point of view. This is a long passage,
but it really shows how he perceived diseases of the mind. Quote,
of all the afflictions to which human nature is subject,
the loss of reason is at once the most calamitous
and interesting. Deprived of this faculty by which man is

(24:45):
principally distinguished from the beasts that perish, the human form
is frequently the most remarkable attribute that he retains of
his proud distinction. His character as an individual of the
species is always perverted, sometimes annihilated. His thoughts and actions
are diverted from their usual and natural course. The chain

(25:06):
which connected his ideas in just series and mutual subserviency
is dissevered, His feelings for himself and others are new
and uncommon. His attachments are converted into aversions and his
love into hatred. His consciousness even is not unfrequently alienated
in so much that with equal probability he may fancy

(25:27):
himself a deity, an emperor, or a mass of inanimate matter.
Once the ornament and life of society, he is now
become a stranger to its pleasures or a disturber of
its tranquility. Impatient of restraint and disposed to expend the
unusual effervescence of his spirits in roving and turbulence, coercion

(25:48):
of the mildest kind adds fury to his delirium and
colors with jealousy or suspicion every effort of friendly or
professional interest in his fate. His personal liberty is at
length taken from him and taken from him perhaps by
his nearest relative or dearest friend, retaining his original sensibility
or rendered more acutely sensible by opposition to his will

(26:12):
and deprivation of his usual gratifications. Cooperating with a morbid
excitement of his nervous functions, he gives himself up to
all the extravagances of maniacal fury, or sinks inexpressibly miserable
into the lowest depths of despondence and melancholy. If the
former he resembles in ferocity, the tiger, and meditates destruction

(26:35):
and revenge— if the latter he withdraws from society, shuns
the plots and inveiglements which he imagines to surround him,
and fancies himself an object of human persecution and treachery,
or a victim of divine vengeance and reprobation. Thank you
for reading that long passage, Tracy. I did not mean
to foist that on you. Pinnell then goes on to

(26:57):
describe the way that if such maladies, as he's described,
aren't identified and treated, a person will inevitably fall into
a state where they resemble a human in form only.
And he goes on to say that the history of
mental illness is also a history of the human mind,
because the difficulty of understanding things you cannot always see
in physical form, like a bodily injury, has meant that

(27:20):
humans have not always considered mental illness something in the
realm of science. and have come up with a number
of explanations for it that are not based at all
in scientific thought. This is an interesting point of view,
because one of the long-term criticisms of Pennell's work is
that he kind of ignored the possibility of some of
the physiological reasons for people to develop problems with their

(27:43):
mental health. His writing covers a lot of ground regarding
the cause and effect of life events that might cause
someone to experience a degradation in their mental health, but
he never really considers physical causes. And this is sort
of odd because there had been writing about some of
the physical causes for mental conditions going all the way

(28:03):
back to Hippocrates and Galen for a long time. This
was based on the idea of the four humors, but
in Pinel's own time, scientists like Antoine Lavoisier and even
Michel-Augustin Theret, who was Pinel's colleague at the university, were
talking about brain chemistry. But Pinnell argued against physical causes

(28:25):
of madness, writing in 1801, quote, derangement of the understanding
is generally considered as an effect of an organic lesion
of the brain, consequently as incurable, a supposition that is,
in a great number of instances, contrary to anatomical fact.
Of course, he was absolutely wrong on that. Yeah, he

(28:46):
was so adamant, too. And I have a theory about why,
but we'll discuss that on Friday. because it's just my theory. Now,
he does, however, acknowledge some physiological causes for mental illness,
but what I am about to read is going to
elicit a big sigh. It certainly did for me when
I first read it. In the preface for the 1809

(29:08):
edition of his Medico-Philosophical Treatise, he writes, quote, one can
accept that in simple cases, mental and physical management can
bring about a full recovery in a given time. But
in how many other cases does one have to resort
to certain internal or external remedies depending on age, gender,
the underlying cause, or indeed varieties in the individual constitution?

(29:33):
How complicated are the ailments which can come from the
suppression of menses or from their natural cessation? whereupon mental
illness sets in? That's right, ladies, menopause equals mental illness. Oh, dear.
In 1804, Pinel received the Order Nationale de la Légion d'Odeur,

(29:55):
France's most prestigious honor, Incidentally, that was just two years
after Napoleon Bonaparte established that award, so he was a
very early recipient. And Pinel worked right up until the
end of his life. He died at Hospice de la
Salle Patrière on December 25th, 1826. He was buried at
Père Lachaise. One aspect of Pinel's life and work that

(30:17):
can make it difficult to really analyze his impact is
the sort of legendary hero status he achieved. In 1849, Chambers'
Edinburgh Journal published a story about Pinel that was told
to the editor by Pinel's son, Scipion Pinel, who followed
his father's path and became a psychiatrist. According to Scipion's account,

(30:39):
during Philippe Pinel's early months at Bicetre, when the reign
of terror was still playing out, an official from the
Paris commune named Georges Couton arrived at the facility looking
for traitors. He believed that anti-commun activists were being housed
at the asylum under the guise of being mentally unwell.

(31:00):
And according to the account, Coudon, quote, wished to see
and personally question the lunatics one after another. But to
all his questions, he received but insults and sanguinary addresses
and heard nothing amidst the confused cries and mad howling,
but the chilling clank of chains reverberating through the disgustingly
dirty and damp vaults. Remember, this was before he got

(31:24):
allocations to put in baths. After seeing the reality of
Bicetre and learning of Pinel's plans to unchange people, Coton
asked Pinel if he wasn't himself mad to even consider
giving these men their freedom from shackles. And Pinel's reply
was allegedly, quote, citizen, I am convinced that these lunatics

(31:44):
have become so unmanageable solely because they have been deprived
of air and liberty. And I venture to hope a
great deal from a thoroughly different method. This sounds so
cool and very quippy, but is this story true? We
don't know. I mean... His son could have told this
story as a great family story, or it could have

(32:06):
been completely made up by the editor. We just don't know.
It's certainly, though, added to the mystique of Pinel in
the 19th century. Incidentally, this account then goes on to
tell how Pinel systematically started releasing people from their shackles.
He had a whole plan in place. He had essentially
what were their version of straitjackets ready in case things

(32:28):
went awry, and a team of people... It talks about
the great success that he achieved in trusting his patients,
but also assuring them that the staff could always confine
them and reinstate their shackles if they needed to. This
whole thing is very obviously a very romanticized account, referring
to Pinel repeatedly as a liberator. Additionally, Pinel's writing and

(32:53):
work have been debated more or less constantly in the
last 200 years. Some of this is just the natural
offshoot of his techniques being really pioneering and consequently not
fully thought out in a lot of ways. Supporters point
out just how progressive his work was and how relevant
a lot of his ideas still are. One particularly strong

(33:16):
detractor was 20th century philosopher Michel Foucault. Foucault argued that
though Pinel might have done away with physical shackles for
his patients, he merely replaced them with psychological shackles, describing
his work as a, quote, moral imprisonment in which those
in treatment were controlled with more subtle forms of manipulation.

(33:39):
According to Foucault's logic, in becoming compliant with doctors, patients
were becoming alienated from themselves. Yeah, there's a whole... zone
of study you can go about, Michel Foucault's thoughts on Pinel.
And everything, really. Everything, yes. He had big thoughts about
a lot of things. But like, I got to this
point where he's kind of making the case that great

(34:01):
societies have always had people with some form of mental illness.
And in a lot of places, they were just like
the fun people at the party. Like, he's essentially like, no,
it's cool. We don't need treatment. Oh, dear. Which is
obviously its own problem. In a preface written to a
1961 English translation of A Treatise on Insanity, Paul F. Cranfield,

(34:24):
who was working in the Department of Psychiatry at Albert
Einstein College of Medicine at the time, summed up Pinel's legacy,
good and bad, this way, quote, Brilliant observation plus neglect
of basic science. In this, we find the glory and
the weakness of the Paris Clinical School. The first attribute
placed Paris, and with it the psychiatry of Pinel, in

(34:46):
a leading position in world medicine. The second trait led
to the eventual decline of the school. Paris lost its
place to a group who thought and observed in the
hospital and thought and experimented in the laboratory. It is
for this reason that Pinel is not truly modern. Pinel
has sometimes been praised as a practical man who had

(35:07):
too much sense to waste time spinning philosophical systems. To
praise him thus is to praise him for his defects,
the very defects which prevented the hospital medicine of Paris
from taking the next step in creating the laboratory medicine
of today. Pinel we praise rather for his virtues, for
his effectiveness as an administrator, for his skill as a psychotherapist,

(35:31):
and for his great humanity. I thought that was kind
of the best, most even keel read of his situation
that I found in any of the scholarship I looked at.
And that is Philippe Pinel, who captures my imagination in
a variety of ways. Yeah. I have the best dog story. Oh, good.

(35:53):
In listener mail. This is from our listener, Andrew. And
it makes me chuckle. And I love it so much.
Andrew writes, Hi, Holly and Tracy. I have been listening
to your fantastic podcast for well over a decade now
and have thought about emailing in a few times over
the years. Most recently regarding popcorn and my need to
correct some of the historical Thanksgiving facts in the popcorn

(36:14):
book when reading it to my kids, which is always
such a fun way to read a children's story. But
when your episode about Frederick Walton and his invention of
linoleum hit, I knew I had to tell you this story.
Many years ago, in our first house, our little kitchen
had flooring that I always said was linoleum. One night
while I was out, I received a call from my

(36:35):
wife who had just returned home. The first thing out
of her mouth was, Indy ate the kitchen floor. You see,
we named our dog Indiana, Indy for short, after our
favorite archaeologist and kept him penned up in the kitchen
while we were out. Sidebar. Sidebar. That's also what George Lucas'
dog was named. So when they make the joke, we

(36:56):
named the dog Indiana in the third movie. That's what
it's about. Anyway, back to Indy the dog. And that night,
he decided to live up to his namesake and started
digging through the floor, starting in the middle and continuing
outward until there were only a few inches of border left. Thankfully,
he did not swallow any of it and was happy
just tearing it to shreds. But nonetheless, our kitchen was

(37:18):
a disaster. When my dad and I went to replace it,
I said it was linoleum, and that's when he taught
me that linoleum and vinyl flooring are not the same thing.
Needless to say, we opted to replace it with ceramic tile.
Attached as pet tacks are pictures of Indy posing on
his new flooring and our current puppy, Hunter, hugging his
favorite toy. Thanks for all you do in keeping my

(37:40):
sanity throughout the week, Andrew. Indy is a supermodel of dogs,
by the way. He is this gorgeous, fluffy... largely black,
but with these beautiful like cream and tawny patches. That
is a dog of my heart. He is beautiful. And Hunter,
don't even get me started. I'd be powerless in the

(38:01):
face of that cute puppy. And your tile looks completely intact.
So I see that that plan worked perfectly. Thank you
so much for sharing this cute story and your beautiful
dog pictures. I'm literally just gazing at them like lovingly
right now because they're so cute. I would say I
need a dog, but I don't have a dog life.
Sure love dogs, though. And these two are spectacular. So

(38:22):
congratulations on having some very gorgeous pups. If you would
like to write to us and tell you how your
pets have destroyed your house or anything else that strikes
your fancy, you can do that at HistoryPodcast at iHeartRadio.com.
If you would like to see the sources we used
for this or any episode, you can see them all
at MissedInHistory.com, where we have all of our sources listed

(38:43):
in the show notes for every episode. You can also
subscribe to the show if you haven't done that before.
That's easy to do on the iHeartRadio app or anywhere
you listen to your favorite podcasts. Stuff You Missed in
History Class is a production of iHeartRadio. For more podcasts
from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever

(39:07):
you listen to your favorite shows.

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