Philippe Pinel

Pinel’s work is considered the precursor to psychiatry. In the late 18th century, he overhauled the asylum system of Paris with his groundbreaking ideas about mental health.

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  Welcome to Stuff You Missed in History Class, a production of iHeart Radio.

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  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. I love those, honestly. I kind of do, too. It's one of those things where I had him scribble 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 to talk about French people, because we are talking about Philippe Pinel today, whose work is considered the precursor of modern psychiatry.

• 3:37Speaker 03

  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, 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. But if you hear something outdated, and you're like, ah, I didn't think they would say that, just because it comes from that writing. Right. It's that writing. Yeah.

• 4:21Speaker 03

  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, et cetera. So I don't want to just ditch them entirely, so just know. So when you hear something and you go, yuck, that's what's up. So Philippe Pinel was born in Jeanquière, France, on April 20, 1745. There are multiple towns and villages in France named Jeanquière, and the one where Pinel was born is about 700 kilometers or 435 miles due south of Paris. Pinel was born into a family of doctors. His father, Philippe Francois Pinel, was a surgeon, and his mother, Elizabeth Dupuy,

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  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 west of Jeanquière. 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'Esquie. His degree was in mathematics, although Pinel's plan at that point was to pursue a life in theology. He enrolled in theology school in Toulouse 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.

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  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 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 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

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  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 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 unique set of observational data, which he studied to identify patterns in disease progression.

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  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 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. And after four years in Montpellier, Pinel moved on to Paris in 1778. And once again, he did not jump right into practicing medicine because he wasn't licensed there. In Montpellier, he had supported himself by working as a tutor, and he did the same in Paris.

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  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. 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 treated mental health conditions. This, depending on whose account you read, was getting into a legally fuzzy area where

• 8:40Speaker 03

  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 was given a job that would change his life, when he became the physician of infirmaries at Bissetre Hospital. He started work a month later. Bissetre 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 Louis XIII died while it was still under construction, and his plans for it were not carried out.

• 9:24Speaker 03

  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 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 ill in some way.

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  For them, Bissetra 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, and it also housed homeless patients and the city's poor. 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.

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  Many of 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 Proussin, 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 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 he believed that

• 11:33Speaker 03

  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 Proussin. He instituted a policy of treating their illnesses instead of just confining them. So, under Pinel, the patients at Bissetra 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. Uh, there were some exceptions. We're going to talk about those in just a bit. He also established hygiene standards for this facility, and he made sure that patients

• 12:16Speaker 03

  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.

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  Guess who's back in the house? The old gays return for season two of Silver Linings, their hit podcast from iHeart's Ruby Studio in partnership with ViiV Healthcare. Just wait until you hear what hosts Robert McMillan and Jess A. have in store this time around. They strut back down memory lane, navigating life, love, loss, and everything that shaped them along the way. And as usual, someone just might break into song. From leather bars to bathhouses, dance floors to drag brunch, nothing stays off limits. These are the kinds of insights that can only come from experience. So listen to your elders, honey, and discover the silver linings you can take with you. All sass, zero filter, and decades of perspective from four friends proving that queer joy

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  First thought is like, wow, how are we going to do all this? Hey, everybody, it's Tracy from Stuff You Missed in History Class. That's Alan Goya, a planning engineer at AT&T. He's talking about Intuit Dome, home of the Los Angeles Clippers, where every seat, screen, phone, and transaction is connected with AT&T fiber and 5G, defining the fans' experience. And Alan's master plan made it all possible. It was could rival anything that was already built, and that takes quite a bit of people and different teams to all be on the same page. That includes field services manager Drexel Jones. His team made sure it all came together and held up on game day. Through what Alan's whole crew designed, we connected the event visitors to the world.

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  It turned out that Pinel's approach to dealing with his patients was very successful. In the course of a year under his leadership at Bissetre, 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 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 is a very different scenario for someone

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  who had been categorized as mad than what would typically be expected. 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, Pinel read a paper at the Society for Natural History. The Thermadorian Reaction, 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

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  to include allocating money to build facilities where people with mental illness would get treatment instead of just being confined 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 Bissetre over one year ago, the Division for Madmen attracted my special attention. I had undertaken some preliminary studies and felt the strong urge to try every means of restoring alienated reason. Thus,

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  I looked upon Bissetre as a source of new enlightenment and instruction, and a most welcome opportunity to contribute to 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 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 contribute so much to the recovery of reason."

• 21:05Speaker 03

  So he claimed that at that point, without already instituting their cleanliness policies as much as he 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 people might find themselves in such a place, stating, quote, "A large gathering of madmen inspires an undefinable thoughtful tenderness when one realizes that their present state derives only from a vivid sensitivity and from psychologic qualities that we value highly." So he describes things like people having fallen into despair through difficult

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  circumstances, or broken hearts, or religious or military fervor. He also describes very talented people as often having a very sensitive nature, something that he says he does not want to discourage. But he also says that, quote, "Investigators, or 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, "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."

• 22:28Speaker 03

  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 remember and understand that these are just people, just like them, who had often experienced some kind of trauma or agitation. Pinel'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. I would also say it kind of reinforces that stereotype that creative people are prone to mental illness.

• 23:10Speaker 03

  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, 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 the American Journal of Psychiatry in 1992, Doraby Weiner noted, quote, "The inference is obvious. His sponsors in the Committee of Public Instruction and in the Paris Hospital

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  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." 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 alienation, to offer a classification system for all known medical conditions. And this book became a foundational text for French medical students.

• 24:37Speaker 03

  Naturally, Pinel's success gained a lot of attention. Over the course of just two years, he completely changed Bissetre. And as a consequence, he was asked to move to the Hospice de la Salpatrière as chief physician, in the hope that his methods would be similarly successful there. Salpatrière was a much larger project. Bissetre had about 1,000 patients when he arrived there, and Salpatrière had 8,000. Additionally, Salpatrière was a women's facility. This was the last job that he would ever had, 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 Salpatrière, Pinel refined the treatments that he had

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  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. 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. 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

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  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 "Tremont Moral." That translates directly to moral treatment, but to be clear, it doesn't mean morality. It means psychology. And it's something that he had done at Bissetre as well. We really cannot overstate how radical this was, but not because Pinel was the first person ever to think of it. This was not a case where he just came up with the idea of humane 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

• 26:48Speaker 03

  of patients, including patients with mental health conditions. Additionally, during the time Pinel was working on his approach, an English Quaker named William Tuke was similarly inspired to initiate a change in approach. But what really set Pinel 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, accepting the risk of potential failure, 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.

• 27:31Speaker 03

  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 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," till he started doing it. They just weren't perceived in that way. And this also went back to his days at Bissetre, and he included data for every patient that included things 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,

• 28:12Speaker 03

  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 when Pinel was doing most of his work in 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 useless garbage. So his inclusion of cranial measurements was actually a way to prove that. He later wrote of his collected data

• 28:53Speaker 03

  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 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.

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  So YouTube Premium, it takes something you already love, that being YouTube, and it makes it even better. Not just the experience, but the content, the creators.

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  Yeah, folks, a YouTube Premium experience gives you access to exclusive YouTube features and benefits, and these are real game changers for us.

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  Oh yeah, that includes what is not limited to ad-free viewing of YouTube. Imagine, no more ads popping up in the middle of videos or at the end of videos, uninterrupted videos.

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  And now think about this, let's say you're using YouTube on the go, you're exercising, you're washing dishes, you can have YouTube playing in the background with Premium, which means you can keep listening while your screen is locked.

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  Also, you can download videos offline, so you don't even need Wi-Fi connection to watch your stuff.

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  I love this on plane flights.

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  Ben, how have you been using YouTube Premium?

• 30:30Speaker 05

  Oh, man. Well, Matt, you know, I like to take a night walk and YouTube Premium is perfect for this because of the background play. So I can pull up a documentary about the neighborhood I'm walking around in, put the phone in my pocket, and still hear everything perfectly.

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  Amazing.

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  So don't delay. Sign up now for your free trial. Terms and conditions apply.

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  Guess who's back in the house? The old gays return for season two of Silver Linings, their hit podcast from iHeart's Ruby Studio in partnership with ViiV Healthcare. Just wait until you hear what hosts Robert McMillan and Jess A. have in store this time around. They strut back down memory lane, navigating life, love, loss, and everything that shaped them along the way. And as usual, someone just might break into song. From leather bars to bathhouses, dance floors to drag brunch, nothing stays off limits. These are the kinds of insights that can only come from experience. So listen to your elders, honey, and discover the silver linings you can take with you. All sass, zero filter,

• 31:33Speaker 03

  and decades of perspective from four friends proving that queer joy only gets better with age on the podcast that never gets old. Listen to Silver Linings, available on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 31:51Speaker 06

  Okay, chicken nugget fans, I've got huge news. The new Burger King Chicken Nuggets just dropped, and they are the crispiest, the juiciest, and the tastiest chicken nuggets ever at Burger King. Burger King heard that a lot of you didn't like the old chicken nuggets, so they got to work and reinvented them. To go along with the new chicken nuggets, a lot of the sauces were reinvented too, because better chicken nuggets deserve better sauces. We're talking new buffalo sauce, honey mustard, sweet and sour, and even a whole new option too, the new special savory sauce, which is only available for a limited time at participating US restaurants. I mean, you need to taste it all for yourself. This

• 32:34Speaker 06

  new chicken nugget, reinvented based on real feedback, is made with 100% white meat chicken and is now better than ever. You gotta try the new Burger King Chicken Nuggets and sauces today.

• 32:47Speaker 03

  For any small business owner, there's a moment when you realize the next hire could be the difference between staying busy and actually growing. The challenge is finding the right person without wasting time sorting through candidates who aren't the right fit. That's where Indeed Sponsored Jobs comes in. When workplace chaos hits and you need someone who can step in and make a difference, this is a job for Sponsored Jobs. It helps put your job in front of candidates who match the criteria that matter most to you, whether that's skills, experience, certifications, or location. And you're certainly not alone in using Indeed. Join the 3.3 million employers worldwide that use Indeed to connect with quality talent that fits their needs. That's millions of businesses turning to Indeed

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  to help solve hiring challenges and find people who can help drive results. Spend less time searching and more time actually interviewing candidates who check all your boxes. Less stress, less time, more results. Get your $75 sponsored job credit today at indeed.com/podcast. Terms and conditions apply. Hiring now? Then this is a job for Indeed Sponsored Jobs.

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• 34:40Speaker 03

  Blue, you can DIY trusted ADT home security in a snap. Head to ADT.com/BLU to build your system today. And to hear more about home protection and other grown-up topics, check out new episodes of Grown Up Stuff on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

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  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. 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

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  men," including 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, "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

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  bow to the will of the directors. But one must avoid any unnecessary constraints and use only enough force to restrain them." As an example, he describes a soldier who is, quote, "obsessed with the thought of his imminent departure. He refuses to go into his cell or go to bed because he is certain that he will be called to duty at any moment." Pinel 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 be tied down, and if that did not subdue him, the director might resort to chains. But Pinel also describes a system in which the goal is to get the patient out of the restraints

• 37:18Speaker 03

  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 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. 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

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  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 1806 book is a general description of mental health conditions from Pinel'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 principally distinguished from the beasts that perish, the human form is frequently the most remarkable attribute that he retains of his proud distinction.

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  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 which connected his ideas in just series and mutual subserviancy 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, insomuch that with equal probability he may fancy 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

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  or a disturber of its tranquility. Impatient of restraint and disposed to expend the unusual effervescence of his spirits in roving and turbulence, coercion 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 and deprivation of his usual gratifications. Cooperating with a morbid excitement of his nervous functions, he gives himself up

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  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 and revenge, if the latter he withdraws from society, shuns the plots and embagglements 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. Pinel then goes on to describe the way that if such maladies, as he's described,

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  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 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 Pinel's work is that he kind of ignored the possibility of some of the physiological reasons for people to develop problems with their mental health.

• 41:35Speaker 03

  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 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 Thury, who was Pinel's colleague at the university, were talking about brain chemistry. But Pinel argued against physical causes of madness, writing in 1801, quote, "Derangement

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  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 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 edition of his Medico Philosophical Treatise, he writes,

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  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? 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 Ordre National de la Légion d'Or, France's most prestigious honor.

• 43:48Speaker 03

  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 Seule Patrière on December 25, 1826. He was buried at Pere Lachaise. One aspect of Pinel's life and work that 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, Cyprian Pinel, who followed his father's path and became a psychiatrist. According to Cyprian's account, during Philippe Pinel's early months at Bissetre, when

• 44:33Speaker 03

  the reign of terror was still playing out, an official from the Paris commune named Georges Couteau arrived at the facility looking for traitors. He believed that anti-commune activists were being housed at the asylum under the guise of being mentally unwell. And according to the account, Couteau, quote, "Wished to see and personally questioned 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 allocations to put in baths.

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  After seeing the reality of Bissetre and learning of Pinel's plans to unchange people, Couteau 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 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 been completely made up by the editor. We just don't know.

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  It 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 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.

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  Additionally, Pinel's writing and 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 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

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  work as a "moral imprisonment" in which those in treatment were controlled with more subtle forms of manipulation. 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 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.

• 48:05Speaker 03

  Which is obviously its own problem. In a preface written to a 1961 English translation of A Treatise on Insanity, Paul F. Cranefield, 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 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

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  the laboratory. It is for this reason that Pinel is not truly modern. Pinel has sometimes been praised as a practical man who had 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 and 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, and for his great humanity." I thought that was kind of the best, most even keel read of his situation that I found

• 49:30Speaker 03

  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. 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 book when reading it to my kids." But which is always such a fun way to read a children's story. "But when your episode about Frederick

• 50:13Speaker 03

  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 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 archaeologists, and kept him penned up in the kitchen while we were out. Sidebar, that's also what George Lucas's dog was named. So when they make the joke, we 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

• 50:55Speaker 03

  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 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 tags 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 sanity throughout the week, Andrew."

• 51:33Speaker 03

  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 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 congratulations on having some very gorgeous pups. If you would like

• 52:16Speaker 03

  to write to us and tell you how your pets have destroyed your house or anything else that strikes you fancy, you can do that at [email protected]. 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 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.

• 52:49Speaker 03

  Stuff You Missed in History Class is a production of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 53:03Speaker 03

  A rare disease diagnosis can change your life, but it doesn't have to define your future. In season seven of Untold Stories: Life with a Severe Autoimmune Condition, host Martine Hackett continues the conversation with people living with MG, CIDP, and the broader rare disease community, exploring what comes after diagnosis through stories of hope, progress, and connection. Produced by Ruby Studio in partnership with Argenx. Listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. You ever show up late to the game and your friends already saved your seat, your drink, even a plate? That's looking out. That's having your back. And that's exactly what AT&T does with the AT&T Guarantee. They know staying connected matters, so they

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  Zepbound is a prescription medicine used with a reduced calorie diet and increased physical activity to help adults with moderate to severe obstructive sleep apnea, OSA, and obesity to improve their OSA. Zepbound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15-milligram injection. Zepbound contains trisepatide and should not be used with other trisepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children. Don't share needles or pens or reuse needles. Don't take if allergic to it, or if you or someone in your family had medullary thyroid cancer, or if you've had multiple endocrine neoplasia syndrome type 2. Tell your doctor if you get a lump or swelling in your neck. Stop Zepbound and call your doctor if you have severe stomach pain or a serious allergic reaction. Severe

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• 55:38Speaker 00

  Hola a todos. Soy Jamie Lynn Segler. Cuando me diagnosticaron tenía veintitantos años y todo mi mundo cambió por completo. Pero con el tiempo decidí que no iba a permitir que eso frenara mi vida. Quise tomar las riendas. Y después de hablar con mi médico sobre mis opciones, la elección para mí fue obvia. Boom, SOS KISSIMTA. Obtenga más información sobre KISSIMTA o fotumab en kissimta.com.

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