Editing Philippe Pinel (section)

== Clinical approach ==

=== Psychological understanding ===
The central and ubiquitous theme of Pinel's approach to [[etiology]] (causation) and treatment was "moral," meaning the emotional or the psychological not ethical. He observed and documented the subtleties and nuances of human experience and behavior, conceiving of people as social animals with imagination.<ref name="Gerard1998">{{cite journal|doi=10.1002/(SICI)1520-6696(199723)33:4<381::AID-JHBS3>3.0.CO;2-S|title=Chiarugi and Pinel considered: Soul's brain/person's mind|year=1997|last1=Gerard|first1=Donald L.|journal=Journal of the History of the Behavioral Sciences|volume=33|issue=4|pages=381–403}}</ref><ref>Philippe Huneman [http://philippehuneman.files.wordpress.com/2011/04/huneman.pdf “Animal Economy” Anthropology and the Rise of Psychiatry from the ‘Encyclopédie’ to the Alienists] in Anthropology of the Enlightenment. Wolff L., Marco Cipolloni M. (ed.), Stanford University Press, ch. 14, 2007</ref>

Pinel noted, for example, that: "being held in esteem, having [[honor]], [[dignity]], [[wealth]], [[celebrity|fame]], which though they may be factitious, always distressing and rarely fully satisfied, often give way to the overturning of reason". He spoke of [[avarice]], [[pride]], [[friendship]], [[bigotry]], the desire for [[reputation]], for [[Conquest (military)|conquest]], and [[vanity]]. He noted that a state of [[love]] could turn to [[anger|fury]] and [[despair (emotion)|desperation]], and that sudden severe reversals in life, such as "from the pleasure of success to an overwhelming idea of [[failure]], from a dignified state—or the belief that one occupies one—to a state of disgrace and being forgotten" can cause mania or 'mental [[Social alienation|alienation]]'. He identified other predisposing psychosocial factors such as an unhappy love affair, domestic grief, devotion to a cause carried to the point of [[fanaticism]], religious fear, the events of the revolution, violent and unhappy passions, exalted ambitions of [[Glory (religion)|glory]], financial reverses, religious ecstasy, and outbursts of [[patriotic]] fervor.<ref name="Gerard1998" />

=== Treatments ===
{{more citations needed section|date=February 2013}}
Pinel developed specific practical techniques, rather than general concepts and assumptions. He engaged in therapeutic conversations to dissuade patients from delusions. He offered benevolent support and encouragement, although patients who persistently resisted or caused trouble might be threatened with incarceration or punishment if they were not able to control themselves.

Pinel argued that [[psychological intervention]] must be tailored to each individual rather than be based solely on the diagnostic category, and that it must be grounded in an understanding of the person's own perspective and history. He noted that "the treatment of insanity (l’aliénation mentale) without considering the differentiating characteristics of the patients [la distinction des espèces] has been at times superfluous, rarely useful, and often harmful", describing the partial or complete failures of some psychological approaches, as well as the harm that the usual cruel and harsh treatments caused to patients before they came to his hospital. He saw improvement as often resulting from natural forces within the patient, an improvement that treatment could at best facilitate and at worst interfere with.<ref name="Gerard1998" />

Pinel’s approach to medical treatments has been described as ambiguous, complex, and ambivalent. He insisted that psychological techniques should always be tried first, for example "even where a violent and destructive maniac could be calmed by a single dose of an antispasmodic [he referred to opium], observation teaches that in a great number of cases, one can obtain a sure and permanent cure by the sole method of expectation, leaving the insane man to his tumultuous excitement... ...and [furthermore] seeing, again and again, the unexpected resources of nature left to itself or wisely guided, has rendered me more and more cautious with regard to the use of medications, which I no longer employ—except when the insufficiencies of psychological means have been proven."

For those cases regarded as psychologically incurable, Pinel would employ baths, showers, [[opium]], [[camphor]] and other antispasmodics, as well as [[vesicant]]s, [[cauterization]], and [[bloodletting]] in certain limited cases only.<ref>Bangen, Hans: Geschichte der medikamentösen Therapie der Schizophrenie. Berlin 1992, Page 15 {{ISBN|3-927408-82-4}}</ref> He also recommended the use of [[laxatives]] for the prevention of nervous excitement and relapse.

Pinel often traced mental states to [[physiological]] states of the body, and in fact could be said to have practiced [[psychosomatic medicine]]. In general, Pinel traced organic causes to the [[gastrointestinal]] system and [[peripheral nervous system]] more often than to brain dysfunction. This was consistent with his rarely finding gross brain [[pathology]] in his post-mortem examinations of psychiatric patients, and his view that such findings that were reported could be correlational rather than causative.<ref name="Gerard1998" />

=== Management ===
Pinel was concerned with a balance between control by authority and individual liberty. He believed in "the art of subjugating and taming the insane" and the effectiveness of "a type of apparatus of fear, of firm and consistent opposition to their dominating and stubbornly held ideas", but that it must be proportional and motivated only by a desire to keep order and to bring people back to themselves. The [[straitjacket]] and a period of [[seclusion]] were the only sanctioned punishments. Based on his observations, he believed that those who were considered most dangerous and carried away by their ideas had often been made so by the blows and bad treatment they had received, and that it could be ameliorated by providing space, kindness, consolation, hope, and humor. {{citation needed|date=February 2013}}

Because of the dangers and frustrations that attendants experienced in their work, Pinel put great emphasis on the selection and supervision of attendants in order to establish a custodial setting dedicated to norms of constraint and liberty that would facilitate psychological work. He recommended that recovered patients be employed, arguing that "They are the ones who are most likely to refrain from all inhumane treatment, who will not strike even in retaliation, who can stand up to pleading, menaces, repetitive complaining, etc. and retain their inflexible firmness." Pinel also emphasized the necessity for leadership that was "thoughtful, philanthropic, courageous, physically imposing, and inventive in the development of maneuvers or tactics to distract, mollify, and impress" and "devoted to the concept of order without violence", so that patients are "led most often with kindness, but always with an inflexible firmness." He noted that his ex-patient and superintendent Pussin had showed him the way in this regard, and had also often been better placed to work with patients and develop techniques due to his greater experience and detailed knowledge of the patients as individuals.<ref name="Gerard1998" />

=== Moral judgments ===
Pinel generally expressed warm feelings and respect for his patients, as exemplified by: "I cannot but give enthusiastic witness to their moral qualities. Never, except in romances, have I seen spouses more worthy to be cherished, more tender fathers, passionate lovers, purer or more magnanimous patriots, than I have seen in hospitals for the insane, in their intervals of reasonableness and calm; a man of sensibility may go there any day and take pleasure in scenes of compassion and tenderness". He argued that otherwise positive character traits could cause a person to be vulnerable to the distressing vicissitudes of life, for example "those persons endowed with a warmth of imagination and a depth of sensitivity, who are capable of experiencing powerful and intense emotions, [since it is they] who are most predisposed to mania".<ref name="Gerard1998" />

Pinel distanced himself from religious views, and in fact considered that excessive religiosity could be harmful.

However, he sometimes took a moral stance himself as to what he considered to be mentally healthy and socially appropriate. Moreover, he sometimes showed a condemnatory tone toward what he considered personal failings or vice, for example noting in 1809: "On one side one sees families which thrive over a course of many years, in the bosom of order and concord, on the other one sees many others, especially in the lower [[social classes]], who offend the eye with the repulsive picture of debauchery, arguments, and shameful distress!". He goes on to describe this as the most prolific source of alienation needing treatment, adding that while some such examples were a credit to the human race many others are "a disgrace to humanity!"<ref name=Charland2008>Louis C Charland (2008) A moral line in the sand: Alexander Chrichton and Philippe Pinel on the psychopathology of the passions. In [https://books.google.com/books?id=srjhDCaBJ94C&q=alienation+pinel Fact and value in emotion] By Louis C. Charland, Peter Zachar</ref>