Pinel's reforms at Bicêtre

A painting and a statue show Philippe Pinel ordering chains removed from mental patients, and the story is usually set at Bicêtre in Paris in 1793. The scene is partly legend. His son Scipion probably inflated his father's part as liberator, and the first person to take patients out of chains there was the hospital's superintendent, Jean-Baptiste Pussin.

Pinel, born in 1745, had studied medicine at Toulouse and Montpellier and came to Paris in 1778, where he translated the works of William Cullen. In August 1793, aged 48, he was appointed senior physician at Bicêtre, in the year the Terror began. He and Pussin worked to reduce chains and other coercion, and together they developed what became known as moral treatment. Pussin often hired former patients as attendants, believing they would be gentler and more humane. Pinel moved to the Salpêtrière in 1795.

He described the method in his Traité médico-philosophique sur l'aliénation mentale, published in 1801 and translated into English in 1806. The insane, he argued, were sick people, not wrongdoers to be punished. He sorted mental derangement into five species: melancholia, mania without delirium, mania with delirium, dementia and idiocy. He did not give up restraint altogether. A violent patient was to be held no more than safety required, and for that, he wrote, the strait-waistcoat was generally enough.

The book cites Pussin by name and describes his methods. One patient had refused all food for four days and smashed his straw bed. Pussin appeared at his door one night with attendants carrying loudly clanking chains, then called off the scene, left a bowl of soup and ordered him to eat it by morning. After a night of hesitation the man ate it, and from then on he accepted a restorative diet.