Psychiatry. F. Pinel - the founder of public and clinical psychiatry in France
April 20 - an important date for the entire psychiatric community. On this day in 1745, Philip Pinel was born in the south of France - a person, with the name of which binds the beginning of a major reform in psychiatry. Reforms, first created the prerequisites for scientific clinical psychiatry and humane attitude towards people with the peculiarities of the psyche.
Who is Philip Pinel
"Pinel's Epoch" - this phrase has become a symbol of time when a suffering person was recognized in the mentally ill, and not a dangerous animal; When the chains were removed from the unfortunate prisoners of "crazy houses". And "Crazy Houses" finally became not prisons, but with clinics where they were treated (as they strengthened), and did not repress the patients with the most cruel ways. Patients became the object of attention of medicine and scientific psychiatric thought. All this is associated with the name of Philip Pinel.
Pinel was a man versatilely educated: he studied at first in the seminary, then at the university in Toulouse, which was absorbed by the philosophical trends of the Epoch of Enlightenment. In 1778, a thirty-year-old Pinel comes to Paris on foot and without money, but with hopes and wide plans. He did not foresee what role he was to play in psychiatry of the end of the 18th century and the beginning of the 19th century ...
What were psychiatric hospitals to Pinel
But in order to assess the scale of the Pinel initiative, first we turn to the conditions in which conditions were kept to the "Pinel era". This, for example, says Michel Foucault, a philosopher and historian, a representative of the direction of antipsychiatry:
"Created (and this happens throughout Europe) large insulators, which give the shelter not only to madness, but also a number of extremely unhabled, - at least in our opinion, among themselves individuals; they are placed in poor people with disabilities, unfortunate old people, poor, convinced tuneevans, venereal patients, various libertines, those who families or royal authorities seek to protect against public punishment, wasteful fathers of the family, runaway priests - in a word, all those who are in relation to The laws of the mind, morality and society show signs of damage. It is for these considerations that the government opens a common hospital in Paris, bistener, Salpetner; A little earlier than this kind of prison of the former leproseria in Saint-Lazar creates sv. Vincent de Paul, and soon Charanton ... These institutions have no medical destination ... "
These "shelters", where the criminals, tramps, incurable syphilicists and mentally illness were mixed, appeared in historical descriptions equally gloomy and hopeless. Stone walls and windows with lattices, people lying on rotten straw, chained chains, severely beaten by the wardens for any "wency". Hunger and cold, rats, screams and moans of people who distracted from tortures, pads and chains, dark stone headsets ... Naturally, no one recognized the "insane" patients and did not deal with their treatment. Moreover, as Yuri Channabih notes in his book "History of Psychiatry", in this hell loved to visit the idle public and for a reasonable fee to have the entertainment of the spectacle of suffering and madness, as if in Zveztsi. Yes, Philip Pinel was to begin his work in such an environment ...
The hospital in London, known as poor
Okov exemption
Further, the history and legend, facts and beautiful speculation are inseparable. Appointed in 1793 to the Hospital-Case Beetrol, Pinel starts reform and begins to free people with mental disorders from chains. The rumors about such innovation are suspicious of the authorities, and the organizer of Revolutionary Tribunals Georges Caton is coming to the bisteter, suspecting that political enemies can be hidden between "perceived". Caton was paralyzed, and his huge body carried two, sterning it to an invalid chain. The Terrible paralytik tried to interrogate them, but besides the wild swearing and the screams did not achieve anything. He was taken, and Phillip Pinel he threw: "You yourself are probably preserved if you are going to pull these animals from the chain."
As soon as Koton left, Pinel freed several dozen patients. Wild and embittered prisoners suddenly became quite quiet and grateful patients. There are, of course, in this story, the shade of a beautiful legend, there are doubts of historians that Kouthon visited the bisetr, however, the legendary in this story only focuses on the enormous importance (including symbolic) Pinele's case, which thoroughly, for human attitude towards mentally ill, which is almost It did not find a wide understanding and recognition. In Salpetner, a female hospital, Pinel also began the release of prisoners, which a few melodraumatically captured the famous picture of R. Fleuri "Pinel in Salpetner". One way or another, but even Aura legends does not detract from, and emphasizes his initiatives, all the use of a real and symbolic gesture indicating the beginning of a new psychiatry. After all, legends appear only when the event carries a special semantic load.
R. Flery. Pinel in Salpetner
Moral sadism - to shift Okovaam
Of course, the story is more difficult, slower and not as theatrical and beautiful, as legends (even inside the scientific community). Pinel did not come suddenly as the Messiah, on the gloomy land. His reforms were historically ripened and were brewing. Even before the "Pinel's era" there were humane approaches to suffering mental illnesses. It is enough to remember guesthouses at Charterton and Sanlie hospitals in France, open by the Order of John. Or York "refuge" in England, based on Tyuk, belonging to the Chickery sect. This hospital was a good attitude towards sick, and good food, care, clean and pleasant atmosphere. There were also rooms for classes and games of patients, gardens for walking. In public and medical thoughts, for many years already discussed what was the glory of the pinel. It is surprising that the York refuge in the world was almost not known. All local initiatives did not change general affairs. The news of the reforms, of course, could only go from there, where there is a professorship department, from a large cultural center. The center of the then European culture was Paris, the presence of the department and the scientific community - these happy circumstances helped the pinnel to influence the entire current civilized world, although not immediately. Not immediately ...
By the way, the critical historians of psychiatry pay attention to the fact that in the psychiatry of the Pineel's era (and later), people with mental illness, having freed from the iron oks, were captured by the Okok moral assessment and moral punishment. Rough pseudomedicine methods of "treatment" were now used in a moral context. Michelle Foucault writes:
"The souls no longer cooled, but he was punished - it had to be used now not when the patient is" groped ", but if he made a misconduct; Even in the middle of the XIX century, Lör will send his heart souls to the head and try at this moment to establish a dialogue with them, demanding that their faith is only nonsense. "
"In the new world of the hospitals, in this punishing world of morality, madness became mainly the fact of the human soul, her guilt and its freedom. (...) But this psychologicalization is only an external manifestation of a more hidden and deep process - a process by which madness turns out to be immersed in the system of moral values \u200b\u200band repression. It is enveloped by a punitive system, where madness, young, is approaching in his rights to the child, and where the madness with the fault inspired by him turns out to be originally connected with the vice ".
Michel Foucault claims that it was the "moral sadism" of a new type of clinic created all the most famous "psychology" madness with his secret spiritual shots and flour. It seems that this is still extremely unilateral assertion, although based on the correct indication of the vicious communication of psychiatry and philistine moralism that does not have a medical meaning. But with moralism in psychiatry, it was necessary to fight in the XX century.
Results of the Pinel and Psychiatry Principles
Meanwhile, the fact that was the essence of Philip Pinel's business, left him as a testament to future generations, who continued the humanization of psychiatry. I will present a brief summary of his case, following the mainly instructions of the historian Psychiatry of Yuri Cannabiha:
- Prison regime with jackets and chains are subject to decisive exile from hospital help. It is necessary to create a favorable setting for the treatment of psychosis.
- measures of constraints of patients, for example, "violent", should be soft and always health based (only temporary binding to bed, strait shirt, in extreme cases isolator).
- Understanding that the situation and the psychological atmosphere of the clinic are crucial in the healing of the suffering soul.
- The need for scientific activity in the clinic, as a well-maintained institution, including conducting records of observation of patients, medical history. It is necessary to find out the causes of the disease, the search for effective therapy.
- Psychiatry should be built on objective observations and a natural-scientific basis, avoiding metaphysics and dependence on foggy philosophical hypotheses.
These are the first and necessary principles of clinical psychiatry. It is with this approach, as historians noted, for the first time a person with a mental illness appears in its original image, not distorted by humiliation, fear of beatings, bite and complete alienation from human communication and understanding. Unfortunately, the story shows that the bright ideas are encountered on prejudice and the kossiness of others, so that conscious in the 18th century far from being fully implemented fully and today ... The era of Pinel, of course, did not eliminate all the contradictions in the practice of the content and treatment of mentally ill. The fight against the remaining measures of violent constraint of patients is associated with the name of John Conole, but this is another era and a different topic.
Pinel School
And yet: it is essential that Pinel was not a lonely comet "in a circle of shine calculated", but created a school of psychiatrists, a scientific tradition. Among his students was the famous Jean-Etienne Dominic Eskirol, the result of which was the "law on mentally ill" 1838. This is the first legislative act, taking into account the rights of mentally ill and, in particular, requiring a compulsory act of medical examination in a psychiatric clinic.
Jean-Etienne Dominic Eskirol
Eskirol headed the first psychiatry department in the world, which has become a separate sector of medical science since then. If the systematics of the disease created by his teacher Pinelem, a little developed and archaic, then the systematics of the Escire is a significant step forward. An increasing accumulation of accurate clinical observations and their analysis is all the foundation of new science. Thickets behind the exercise there are those who were his students and founders of psychopathology of only 19th century: George, Beiarz, Moro, Morel ...
What we call modern psychiatry was hardly possible without the Pinel's era, without his bold and humane reform of psychiatry at the turn of the 18th and 19th centuries, when the thoughts about such reform are not only the philistine majority, but also many doctors seemed madness, and then And just stupid.
Life and art
Originally prepared for the profession of a priest and only at the thirtieth year of life engaged in the study of medicine. In 1792, he was appointed by the doctor of the Paris establishment for the sacrificed bisteter. In the bisetra, Pinel made an act of humanity, which became famous: overthrown at the revolutionary convention, permission to remove the chains with mentally ill.
Pinel provided patients with freedom of movement through the hospital territory, replaced the dark dungeons by sunny rooms with good ventilation and offered moral support and good tips as the necessary part of treatment.
The certificate of humanity Pinel was crowned with success: concerns that were insane, not chained in chains, will be dangerous for themselves, and for others, they were not justified. In the well-being of many people who were in decades, there were significant improvements in a short time, and these patients were issued to freedom.
Soon the patients of other institutions (in particular, the Paris Hospital for Women were also released from the chains. mental disorders Salpetner), and in Europe received the dissemination of their humane content, with the provision of freedom and vital amenities. This achievement, persistently associated with the name of Philipp Pinel, brought him recognition throughout the world.
Pinel received wide fame as well as the author of scientific papers in the field of psychiatry. His treatise on mental illnesses (1801) is considered to be classic; In France, Pinel is the founder of the scientific school of psychiatrists. In addition to psychiatry, also worked in the field of internal medicine and in 1797 issued an essay of Nosographie Philosophique, which argued that the method of research in the field of medicine should be analytical, as in the natural sciences. This work for twenty years has registered 6 editions (in 1797, 1803, 1807, 1810, 1813 and 1818), was translated into German and played big role in the development of rational medicine. Over the years, Pinel has occupied hygiene under the Paris Medical Faculty Cafedra, and subsequently internal diseases.
Estimates
Matt Muienz, speaking about the process of transformation of psychiatric assistance in Europe, notes that in this process, it obviously played the influence of specialists, mainly psychiatrists, who performed fighters for change, such as Pinel in France in the XIX century of Bazalia in Italy in XX century. They offered the concepts of new models of humane and effective help, revolutionary for their time, displacing unsatisfactory and inhuman traditional services. Their real achievement was the ability to encourage politicians to support these concepts and convince colleagues to implement them, thereby opening the possibility of real and persistent changes.
According to Yu. S. Savenko, Psychiatry took place as science and scientific practice only after Pinel reform - after removal from patients with chains and eliminate police officer as the hospital chief. As Yu. S. Savenko notes, these two principles (the principle of voluntaryness and partial denationalization) remain in psychiatry so far; Without their observance, the objectivity of the diagnosis and expert conclusions and the effectiveness of treatment.
Scientific works
- Pinel pH. Traité Médico-Philosophique Sur L'Aliénation Mentale, Ou La Manie. Paris: Richard, Caille et Ravier, An IX / 1800 ("Medico-Philosophical Treatise on Mania").
- Pinel pH. OBServations Sur Le Régime Moral Qui Est Le Plus Propre à Rétablir, Dans Certains Cas, La Raison Égarée des Maniaques // Gazzette de Santé. 1789 ("Observations about the mental circulation that may in some cases restore the permanent Manyak mind").
- Pinel pH. RECHERCHES ET OBSERVATIONS SUR LE TraIement Des Aliénés // Mémoires de La Société Médicale de l'émulation. Section Médecine. 1798 ("Research and observations about the moral treatment of mentally ill").
The name of Philipp Pinel (Pinel, Philippe), the founder of public, clinical and scientific psychiatry in France, is widely known, mainly due to its efforts that changed the content of the insane and the very situation with the houses for mentally ill. The main promotion of Pinel was that for the first time in the history of medicine, he took off the chain with mentally ill, thereby turning psychiatric institutions from prison sentences into medical institutions.
The fate of this person was an amazing way. He was born on April 20, 1745 in St. Andre D "Alerak, the place of the TarP Department, in the south of France, in the family of a hereditary doctor. Father and grandfather His doctors. Mother died when he was 15 years old. From seven children he was senior. The secondary education Filipp received in the Jesuit college and was preparing for the San of the clergy. At that time, the secondary education was based mainly not on the exact sciences, but on ancient and modern literature, philosophy and languages. Pinel has grown on the works of Sensuals of Locke and Kondilla, and afterwards Rousseau And Voltaire, becoming a follower of their philosophy. After graduating from the college in 1767, Philip moved to Toulouse. Want to fix the skew in his education, he entered the university to the physico-mathematical faculty. His thesis "On the reliability that mathematics gives judgments in the sciences", Protected to the Master's degree, provides us with the interests of Pinel at that time.
Successfully graduating from the Toulouse University in 1770, Pinel works as a teacher in college and does not even think about the career of the doctor. However, as they say, the paths of the Lord are non-defined. Testing compassion for sick, weak people, Pinel adopted an unexpected decision coming against his current plans, and entered the medical faculty. His goal was extremely clear - to help the suffering. Defending on December 22, 1773 doctoral dissertation in Toulouse University, in a year he goes to University of Montpellier. Pinel was engaged in a lot of zoology and even competed with the famous Cuvier, claiming newly open in 1795 in Paris by the Department of Comparative Anatomy. In Montpellier, he worked as writing the dissertations to order, which speaks of his medical erudition and mind. In the same place, he became friends with the future famous chemist and the Minister of Napoleon I Shattale, who was advised to learn Montenex, Plutarch and Hypocrat. In the life of Pinel, the knowledge of the English language was played a special role, which made it possible to get acquainted with the rich and original Medical Literature of England; In particular, he translated to french Overactions Kullen.
Complete medical educationPinel in 1778 moves to Paris. The young doctor lives there modestly, removes the furnished room, it works hard and often worries private lessons in mathematics. By the way, in your later works, Pinel about mathematics did not forget. For example, in 1785, he did a report at the Academy of Sciences "On the use of mathematics to the human body in general and to the mechanics of dislocation." He is also actively interested in philosophy: visits the widow salon Gelving, where Lavoisier gather, Condorce, Kabanis, Franklin and Dellanber. Higher medical degree of that time "Docteur Rungent" (Dr. Regent) he could not get, although many of those who he wrote the dissertations received. The topic on which he "failed," was curious, it was called "about horse riding and horseman hygiene."
Philipp Pinel founded and edited from 1784 to 1789 "Gazette de Santeў" ("Newspaper about Health"), which is published to this day. In it, he publishes articles on hygiene and psychiatry. In 1787, he wrote an article that was the forerunner of the new science - geopsychology. The article was called whether Melancholy attacks are in the first winter months more frequent and more dangerous. " In this article, he indicated the connection of some mental disorders with seasonality and climate. In 1790, his article "Medical arguments on the state of the monks" appears; In 1791, "indicating the most faithful method for the treatment of mental illnesses that have come to old age." Many generations of doctors read it " Analytical methodsapplicable in medicine "(1798). But he was greatly fameded by work devoted to the content of psychiatric patients, for which mainly in 1803 he was elected by a member of the French Academy.
It is necessary to emphasize that only in the 80s, when the pin was almost 40 years old, he began to be interested in psychiatry. He diligently studies everything that the ancient and new authors wrote on this issue, the benefit of his language training above all silence. Working a psychiatrist in the private hospital of Dr. Beloma, Pinel originated, as she would be called, "the great idea of \u200b\u200bhumane passion with mentally ill and treat them is not violence, but by conviction." In 1792, he was elected to the municipal position, got his own apartment and married. Pinel was low growth, strong addition. His smart and living face, covered with a network of wrinkles, resembled a face flattered by an ancient sculptor. With his appearance, Pinel reminded to people of Greek sage.
On August 25, 1793, Pinel was appointed to the position of chief doctor of the Bisetre Hospital (Bicetre), which is under Paris, intended for the elderly people with disabilities and mental patients. The famous dramatic events that led to the fact that the name of Pinel was inscribed on the history of psychiatry were written.
Old houses for insane waves of bad glory: London Poils, Viennese Norrenturhorts, Paris Salpetner has become nominated with names. But all the bisteter was terrible and terrible. It was founded by this castle in 1250 with the Holy Louis. For several centuries, he passed from hand to hand, changing his owners. Repeatedly in troubled times he was destroyed; In his ruins, robbers and thieves settled, the place was considered to be fruned. In 1632, Louis XIII led him to a relative order and made a hospital in it for the disabled, soon the educational house for children of orphans was attached to him. However, the children did not survive in it, everyone died. In 1657, the bistener became part of the General Hospital. To save money, he simultaneously served as a jade, a crazy house and a state prison. In the very first year, up to 600 people got into the wilderness: old people older than 70 years old, disabled, incurable patients, paralytics, epileptics, idiots, scabies and patients with venereal diseases, orphans, which neither by sex, neither age were not divided. The conditions for their content were terrible: they lay in unheated premises of 8-13 people in one bed of straw; Food was bad, but also that many launched; Dirt, insects, corporal punishments - all this was the usual thing. Personnel in the bisetra lacked. So, 800 people had 83 ministers (one specifically for the destruction of lice) and 14 nurses. In the worst position there were venereal patients who were mercilessly beat and tied, apparently because they were sick with a shameful disease. In the end, the order of the convention was transferred to another hospital.
It must be said that the progressive figures of medical science and lawyers were condemned by the vicious practice of the content of people in such houses. The general inspector of hospitals and prisons of the entire France Jean Kolombier (1736-1789) must be counted for the ideological predecessors of Pinel, since in 1785 the report was submitted to 44 pages: "Instructions on the ways of handling mentally ill." This report contains words: "... the beating of patients should be considered as a misdemeanor, worthy of exemplary punishment." Two years before the death of Kolombeye, a similar report was presented (in 1787) by the Commission, which was headed by Academician J.-S. Bayie (1736-1793). The Commission included Lavoisier, Laplace and Jacques R. Tenon (1724-1816) - a famous surgeon, an anatom and oculist. However, all these decrees, instructions and reports remained in the cabinets of the Ministry of the Interior. The revolution bursting in France did not allow to draw attention to the situation of the mentally ill and facilitate their fate. In 1791, the government forms a new hospital commission. It is appointed: Kabanis, Jacques Cousse (1739-1800), Professor of Physics in College de France, Pinel's patron at the time of his arrival in Paris, and Michel Tour (1757-1810), a member of the medical society, the first director of the newly created medical school of Paris (ECOLE DE SANTEў), also one of the people close to the pinnel. It is necessary to emphasize that no commissions with their investigations and reports have not led to practical results.
In the bistetra prison in 1792 there were 443 prisoners. Along with the criminals there were also victims of the royal arbitrariness, among whom were priests and immigrants; In this tremendous medium, pudrheal flourished. In one of the departments there were children from 7 to 16 years old with traces of plants that were subjected to sexual violence. More than a hundred prisoners were sitting in eight carcers who were at a depth of 5 meters under the ground, where the rays of daylight did not make themselves; 33 doors separated these unfortunate, chained to the wall, from external world. The National Assembly, to his honor, demanded the closure of this monstrous ultrasound, but the ruling did not have time to perform. In September 1792, the bistener, like other Parisian prisons, became the Arena of the Nightwall Samoy; The crowd Parisian, twisted by the revolutionary ugar, revising the cases of prisoners, killed 166 of 443 people, including 33 children. The 51 prisoner was released. Such is briefly the story of the bisteter, where there was a psychiatric department, headed which Pinel was invited.
The separation for mentally ill, isolated from epileptics and idiots, consisted of 172 cameras, on average no more than two square meters each, there were no windows, the light penetrated only through the door hole; Silence beds were attached to the walls, but more often it was a trough with rotten straw. The patients were chained not only by arms and behind their feet, but also for the neck. The staff consisted of 17 people. If the quiet patients lay 6 people on one "bed" in large wards and repressions were not subjected, then there were no differences in the circulation of restless mentally ill and criminals, they were considered harmful, dangerous and unnecessary, they were brutally treated. It does not have to talk about treatment, as it has not yet existed.
Dr. Pinel was a daily witness to the unsatisfactory situation of the mentally ill and barbaric relations to them, which could not, of course, leave him indifferent. He could not put up with the fact that the sick people are more severely treated than to the conclosed killers; What they contain, like dogs, are tied with chains to hooks, grip hands with handcuffs, contain in dark raw rooms, do not have any medical care. Pinel was constantly addressed to the Paris commune for resolving the chains with mentally ill.
One of the main opponents of Pinel's reformations was paraplegic1 Koton, Chairman of the Paris Commune, the chief supplier of victims on the scaffold. Caton - a close friend of Robespierre, executed with him, severely suppressed a rebellion in Lyon, who proposed the presidential law to the Convention, an extremely simplified judicial procedure: who gave the opportunity to condemn the revolutionary Tribunal to death for 40-50 people per day. The same Katon, who executed not only people, but also buildings. The villain was carried around the city on the hands or stretchers of the gendarme, and he beat the hammer on the walls of the houses, and these houses had to destroy, otherwise he traveled on a three-wheeled wooden bike, looking for victims. Caton suffered strong headaches, nausea, nevertheless, it did not prevent him from being one of the most active member of the convention. The principle of replacement or compensation: if the legs are paralyzed, it is necessary to strengthen the will - you can trace the couoton. Paralitic Caton possessed the Iron Will, he did something that Minister Necker, Academician Bayei, and others were not able to do. When Cuton was brought to the busement department, where the terrible patients were chained to the walls and his gaze opened a terrible spectacle, he said Pinel: "Citizen, Do what you know, but you yourself must be crazy if you want to pull these insane chains. "
On the same day, Pinel ordered to freeze 12 patients. The first one was chained for 40 years, he was considered particularly dangerous, because killed the chanda of the minister. Having received freedom, he ran through the "Chamber" all day, and from the moment the attacks of a richness ceased. The second was released by chained chains for 36 years, his legs were reduced. He died, not noticing his liberation from Path. The third was bought for 12 years. He soon recovered and prescribed. But the poor thing was not lucky: he intervened in politics and was executed. The fourth, heinee, was chained for 10 years. This man possessed an extraordinary physical force, was a thunderstorm department. After liberation and communicating with Pinelem, he soon changed and after some time began to help the pinel in the hospital. It is known that he saved the pinel's life several times. Once on the street, the crowd pounced on Pinel with a scream: "On the lantern!" The doctor was saved by a Sheser, who accompanied him.
In addition to the removal of chains, Pinel has made the introduction into practice of the content of the mental hospital regime, medical details, medical procedures and many other things, in which patients needed. In 1798, chains were removed from the last diseased bisteter, so it was an end to the terrible injustice, contrary to the elementary principles of human humanity.
The Convention did not share the revolutionary actions of Pinel. He was on a bad account with the revolutionary authorities; Thought that Pinel holds under the guise of the soulless enemies of the people. Dr. Pinel systematically refused to give out the revolutionary Tribunal of those who were in his hospital on the occasion of the mental illness, although in the eyes of the then power they were politically unreliable. On charges of hiding criminals, Pinel replied that these suspicious people actually mentally ill people. It is well known that opposition to the authorities at that time demanded considerable civilian courage, anyone could send them to the scaffold without trial and investigation. Katon somehow said the pinel: "Citizen, I will be in the bistener tomorrow, and if you hide the enemies of the revolution, then grief to you." The next day he was brought to the hospital, and he tried to identify "criminals." Nothing having achieved, he retired on the hands of gendarmes.
At the initiative of Cuton Pinel was dismissed. Two years later, on May 13, 1795, he was appointed a senior doctor to Salpetnerier's hospital, where he conducted reforms similar to the reforms of the bisteter. It is noteworthy that the supervisor Pussen, a former assistant Pinel in the bisetra, moved to Salpetner with him, where he subsequently put monuments and pinel. In 1794, Pinel issued his "philosophical nosographic", which was noted by the Paris Academy of Sciences as one of the works that honor the French science. Pinel's monograph was translated into several foreign languages And for 25 years he served as a desk book for students. Its value recognized Bisha. In Salpetner, Pinel continued its clinical observations, which were used in his "Treatise about Mani" (1801). In the same year, he was elected a professor and from 1795 to 1822 he was heading the department of internal diseases and psychiatry in the Paris Medical School (Ecole de Sante). His lectures were popular with students. By this time refers to him named after the symptom, observed with the active tuberculosis of the lungs: a sharp pain in chest And the upper half of the abdomen with a slight pressure with his fingers on the neck in the field of progressing nerve.
Without finding no pathological changes in the brain in the brain, Pinel put forward the theory of "moral" determinism of mental disorders. Here it is meant that, due to such injuries, as, for example, disadvantaged, dissatisfaction with your life, loss close man And others, the psyche can suffer significantly. Hysteria, this donel, in which ancient times honed his mastery of psychiatrists, was also not ignored to Pinel. He ran hysteria to the group of neuroses, considered in categories of physical and (or) moral disorders nervous systemthat more or less corresponds to modern separation on functional and organic disorders. He found hysteria both in women and in men, and believed that nymphomania (or "rabies of the uterus") in women corresponds to satyriasis (painfully increased sexual attraction with a sense of permanent sexual dissatisfaction) in men. Thus, Pinel resumed the old ideas about the meaning of sexual factors in the etiology of the hysteria. His main merit in the field of study of the hysteria was the rejection of English neurological theories of more than two hundred years ago and the creation of the theory allowing the possibility of hysterical disorders without organic changes in the nervous system.
In 1803, Pinel was elected to the Academy to Kuwier, in the section of zoology and anatomy. Pinel acquired a small estate where he was engaged in gardening and with less success in the breeding of Merino. By the end of the life, he remained liberal and left, for which in 1822 he got into lists dismissed from the service of professors. Three years later, he married again.
The Great Man and Philip Pinel died from the inflammation of the lungs on October 26, 1826 in Salpetner. One of the humaneous people who have resolved the pride of French and world psychiatric science left his life. Pinel was an extremely modest person, he did not attach some particular importance to the great cause he committed. He was neither ambiguous, nor Tanched, was deprived of all kinds of korestoloby. Pinel was buried at the Paris Cemetery of Per Lashez; At the entrance to the hospital, Salpetner is his bronze statue. The point that Dr. Pinel gave his life, continued his student Escire.
PSYCHIATRY
Psychiatry (from Greek. Psyche - Soul; IATREIA - Treatment) - Science of mental illness, treatment and prevention.
In deep antiquity, mental illnesses were understood as the result of the impact of "supernatural forces, as an obsession with an evil or good spirit.
Later with the development of the anti-philosophy of the ancients, natural ideas about the causes of body and brain diseases were formed.
The first shelters for mentally ill steel began to appear in Christian monasteries in Byzantium (IV century), Armenia and Georgia (IV-VI centuries), Islam countries (IX century).
In Western Europe, during the Middle Ages, the attitude to the mentally patients was determined by the religious ideology. The mentally ill was accused of voluntary union with the devil. Starting from the XIII century. They began to sharpen in special institutions (not hospitals) for insulation of insane. There, patients contained in handcuffs, without elementary amenities, were caught with chains and were subjected to torture, they murilied hunger. It happened that mentally ills were burned on the bonorants of the Inquisition under the pretext of the struggle against witches and heresy.
Attitude towards mentally ill, as an obsessed evil spirit, was maintained in Western Europe until the end of the XVIII century, when the development of sciences experienced the powerful influence of French materialism XVIII century. and the French bourgeois revolution.
The reorganization of the content and treatment of mentally illness is associated with the activities of Philip Pinel (Pinel Philippe, 1745-1826) - a common manner of public and clinical psychiatry in France. Waiting for the revolution, he was appointed Chief Physician of Psychiatric Biscuit (BiceTre) and Salpetnerier (Salpetriere) in Paris. The possibility of progressive transformations conducted by F. Pinelem was prepared by all the progress of social and political events. Pinel first created human conditions for mentally ill conditions in the hospital, took off the chains from them (Fig. 141), developed the system of their treatment, attracted to "work, identified the main directions of studying mental illnesses. For the first time in history, mentally patients were restored in their human history. and civil rights, and mental institutions began to turn into medicinal - hospitals.
The ideas of F. Pinel developed an English psychiatrist John Conole (Conolly, John, 1794-1866), which fought for the elimination of measures of mechanical constraint of patients in psychiatric hospitals.
At the beginning of the XIX century. Psychiatry began to develop as an independent natural-scientific clinical discipline. In psychiatric hospitals, and then at the medical faculties of universities began training of psychiatrists.
In the Russian Empire, the first psychiatric institution was opened in Riga in 1776. After the Zemskoy reform of 1864. The construction of well-maintained psychiatric hospitals has significantly expanded. In 1835, at the medical faculties of universities in Russia, professor therapists began to read a separate course of psychiatry, which was subsequently taught at special departments: in St. Petersburg (1857), Kazan (1866), Moscow (1887) and other cities of the country.
A great influence on the successful development of psychiatry from mid-XIX century. The evolutionary theory of Ch. Darwin and the doctrine of the reflex developed by the Russians: Physiologists I. M. Sechenov and I. P. Pavlov.
At the same time, psychiatry, more than any other area of \u200b\u200bmedicine, has experienced the effect of idealistic flows in philosophy. The most "it was brightly manifested in Germany, where" feudalism for a long time did not give up his position. In the German philosophy of the beginning of the XIX century. Idealistic flows prevailed. In psychiatry, they manifested themselves in the views of the School of Psychics, which determined mental diseases as a result of an evil will or sinfulness of a person. In the middle of the XIX century. Another idealistic School of Somatakov has come true. Believing that the soul is immortal and do not hurt, somatic considered mental illness as body disease, i.e., the material shell of the soul.
At the end of the XIX century, idealistic flows in psychiatry were revived and most widely manifested in psychoanalytic schools.
In Russia, revolutionaries-Democrats had a large influence on the development of psychiatry, which determined the predominance of natural-scientific trends both in this and in other areas of medicine in our country.
Sergey Sergeyevich Korsakov (1854-1900) is owned by Sergey Sergeyevich Korsakov (1854-1900), one of the founders of the nosological direction in psychiatry laid down, at the end of the XIX century. The German psychiatrist Emil Farter (Kraepelin, Emil, 1856-1926), in contrast to the previously existing symptomatic direction.
S. S. Korsakov first described a new disease - alcoholic polyneurite with pronounced memory disorders (1887, the doctoral dissertation "On alcohol paralysis"), which was already in the life of the author. Named "Corsakov psychosis." He was a supporter of the disappointment of mentally ill, developed and implemented a system of their bed maintenance and surveillance at home, paid great attention to the issues of warning mental diseases and psychiatric care organizations. His "Psychiatry Course" (1893) is considered classic and repeatedly reprinted.
The great contribution to the development of psychiatry was also made by J. Eskirol, J. Charco and P. Jean (France), Models, J. Jackson (England), B. Rush (USA), V. Grzizinger, E. Cre Pelnn ( Germany), V. M. Bekhterev, V. X. Kandinsky, P. P. Kashchenko, V. P. Serbsky, P. B. Gannushkin (Russia).
Philippe Pinel by Anna M. Merimee
Quotes: 1. A very long experience teaches us that this is the most faithful and real means to restore the patients with the right thinking, and that the noble nobility, relating to the contempt for physical work and rejecting the very thought of him, unfortunately, through this forever It remains in his nonsense. 2. "... However, at the first opportunity it is necessary to free patients from the conclusion and keep them all day in air ... no need to rape and hurry."
Achievements:
Professional, social position:French psychiatrist and doctor.
The main contribution (than known):Philipp Pinel, proposed a more humane approach to psychological care and care for mental ills, which was defined as "moral treatment". Pinel made a lot to highlight psychiatry in a separate industry of medicine. He made a significant contribution to the classification of mental disorders and was recognized as the "Father of Modern Psychiatry". Pinel was also one of the first clinicians who believe that medical truths should be obtained from clinical experience.
Deposits:
Psychiatry.Pinel abandoned the prevailing popular opinion, according to which the cause of the mental illness was the University of Demons.
He argued that mental disorders can be caused by a number of factors, including psychological or social stresses, congenital diseases, physiological injuries, physical condition and heredity.
Pinel carefully observed and described in detail all the subtleties and nuances of human experiences and emotions. He determined psychosocial factors predisposing for mental illness, such as unhappy love, inner mountain, devotion to their work brought to fanaticism, religious fears, violence and unfortunate passions, high ambitions, financial failures, religious ecstasy, as well as outbreaks of patriotism.
He noted that the state of love can turn into rage and despair, can lead to mania or mental alienation. " He also talked about the links of mental illnesses with such human manifestations as greed, pride, friendship, intolerance, vanity.
Moral treatment.Pinel offered a new non-violent approach to the care of mentally ill, which was called "moral treatment", which is more likely to social and psychological in its content.
He resolutely played for a humane treatment of mentally ill, including friendly relations between the doctor and the patient.
Its method of handling the patients was noted soft, understanding and goodwill. He opposed violent methods, although when it was necessary, he did not hesitate, applied restrictive measures or violent feeding.
Pinel expressed warm feelings and respect for his patients: "I can't not tell my enthusiastic impressions about their moral qualities. Nowhere, except for the novels, I have not seen such desired spouses, more delicate fathers, passionate lovers, clean, generous patriots, than I saw in hospitals for mentally ill ".
Pinel visited every patient, often several times a day. He led with them long conversations and everything carefully recorded.
He recommended caring medical care during recovery, emphasized the need for hygiene, exercise, as well as programs for targeted productive work for mentally ill.
In addition, he contributed to the development of psychiatry by introducing the purpose of treatment and research into the practice of conducting and maintaining detailed disease.
Pinel also achieved the introduction of hospital regime, medical details, treatment procedures.
Removed chains with mentally ill.
Pinel appealed to the Revolutionary Committee for permission to remove the chains from some patients as an experiment, as well as give them the opportunity to walk outdoors. When these measures turned out to be effective, he was able to change the conditions in the hospital, and stop traditional methods Treatment, which included bleeding, cleaning laxative and physical violence.
In 1798, the French doctor Philip Pinel in the Paris Crazy House Bicêtre, removed the chain from patients who were called "crazy."
Psychotherapy.His practice of individual interaction with patients in a humanistic and understanding manner was the first well-known practice of individual psychotherapy.
Medicine. Pinel was known mainly for its contribution to internal medicine, especially for its authoritative classification of diseases given in the textbook "Philosophical Nosography" (1798). He divided diseases into five classes: fever, phlegmasias, hemorrhages, neurosis, as well as diseases caused by organic lesions.
In addition, Pinel worked as a doctor consultant in hospitals and patients in private.
Pinele's contribution to medicine also includes data on development, forecast and frequency of occurrence various diseases and experimental estimates of the effectiveness of drugs.
Pinel under clinical medicine, philosophical nosography (1798), served as a standard textbook for 2 decades, while several schools of clinical medicine of the 19th century, were based on the theory outlined in it ..
Administration. In addition, Pinel took care of the proper management of psychiatric institutions, including introduced the practice of training personnel.
In 1799, in Salpetner, Pinel created a clinic in which the vaccinations made and conducted the first vaccination in Paris in April 1800.
Honorary titles, awards: Cavalier of the Order of the Honorary Legion (1804).
Main works:Nosographie Philosophique (Philosophical Nosography) (1798), Recherches et Observations Sur Le Traement Moral Des Aliénés (Research and Observations about the moral treatment of mentally ill) (1798), Traîte Medico-Philosophique de L'Aliénation Mentale (Medical and Philosophical Treatise on Mental Alienation or mania (1801).
A life:
Origin:Pinel was born in St. Andre, in the Department of Tarn in the south of France. He was the son of Philip Francois Pinel a doctor of surgeon. His mother, Elizabeth Dupyui, took place from the family in which there were many pharmacists and doctors. He had two brothers Karl and Pierre Louis, who also became a doctor.
Education:The initial formation of Pinele, at the beginning of the De Lavor college, and then in College de L'Esquille in Toulouse, was in the field of literature. During his studies, he experienced a strong influence of encyclopedists, in particular, Jean-Jacques Rousseau (1712-1778). Later, deciding on a career in the field of religion, he in July 1767 entered the Faculty of Theology in Toulouse. However, in April 1770, he left him and transferred to the medical faculty of the university in Toulouse. December 21, 1773 He received a MD degree and from 1774 continued his medical education at the University of Montpellier, the leading medical school of France. There, for four years, he visited medical school and hospitals.
Influenced:Pinel was a student of Abbot de Kondilla, and Hippocrates was a model of service in medicine for him.
The main stages of professional activity:In 1778, Pinel moved to Paris, where he began working, as a publisher, a translator of scientific literature and a teacher of mathematics.
He spent 15 years earning his life as a writer, translator and editor, because the faculty of the University of Paris did not recognize the degree obtained in such a provincial city as Toulouse. He twice lost in the competition, who could provide him with funds to continue their studies. During the second contest, the jury emphasized his mediocre knowledge in all areas of medicine. These estimates, so much did not coincide with its future achievements, which could be caused by political motifs.
Frustrated, Pinel was even going to emigrate to America. Pinel sympathized with the revolution and in the 1780s Pinel was invited to the salon Madame Gelving. After the revolution, the friends with whom he met in the salon Madame Gelving, came to power.
In 1784, Pinel became the editor of a not very prestigious publication "Health newspaper", in which he published a number of articles, mainly related to hygiene and mental disorders.
At about the same time, he began to demonstrate an increased interest in learning mental illness. The basis of this interest was personal motives. His friend fell into the state of "nervous melancholy", which grew into mania and as a result led to suicide.
On August 25, 1793, on the protection of his friends Pierre Jean Georges Kabanis and Michel-Augustina Thouuret, Pinel was appointed head physician and director of the crazy house bisetr in Paris.
He worked there before the revolution, collecting observations about mental disorders and developing their radical views on the nature of treatment. In the same place, he began to implement his radical ideas for the treatment of mentally ill, who at that time were still chained in the chains and stayed in the dungeon.
On May 13, 1795, he became the head physician of Hospice Salpetner, who represented at the time, a big village, with a common hospital for 5000 patients and a 600-seater hospital for women, with bureaucracy, a huge market and Lazareits.
There, he continued his policy of the "Magazine Magazine" and held many important reforms in the field of treatment of mentally ill similarly to those conducted in the bisetra. Pinel remained in Salpetner to the end of his life.
From 1794 to 1822, Pinel was also a professor of hygiene and pathology at the University of Paris, where he trained a new generation of specialists in the field of mental illness, including his son, who became a leading expert on this issue.
After 1805, Pinel for several years was a personal doctor of Napoleon Bonaparte, but rejected the proposal to become a court doctor, as it would distract him from work as a clinical doctor, a scientist and a teacher.
He became a cavalier of the Order of the Honorary Legion in 1804.
In 1804, Pinel was elected to the Academy of Sciences and was a member of the Academy of Medical Sciences since its foundation in 1820.
In 1822, he was withdrawn by the government from the post of Professor of the University due to its past links with persons participating in the revolution.
The main stages of personal life:In 1792, Pinel married Zhanna-Vincent. From their two sons, one, Charles (r. 1802), was a lawyer, and the other SCIPIon became a specialist in the field of mental illness. Pinel widowed in 1811 and in 1815 married Marie-Madelena Jaclin-Lavalle.
He died of pneumonia in Paris on October 25, 1826. At the time of his death, Pinel still actively worked in Salpetner.
He was buried in the Cemetery of Per Lashez in Paris, France.
Statue in his honor stands in Salpetner in Paris.
Raisinka: Removing chains with mentally ill is widely covered in the media and was presented in painting. That is what made him a national celebrity. However, some researchers believe that Pinel only followed the example of Pussin and the Italian doctor Vincenzo Chiarugi. In fact, they freed psychiatric patients from chains before Pinel. As a professor of medicine, Pinel was obliged to attend the execution of Louis XVI. This shocking experience, he told in a letter to Brother Louis on the same day, January 21, 1793. Pinel met with Benjamin Franklin, when the famous American scientist came to France. Pinel was low growth and strong addition.