Fantastic Illusions
- Caliesha Harris
- Mar 14
- 13 min read
Updated: Sep 18
The Rise of Modern Psychiatry in Revolutionary France
Writer: Caliesha Harris, M.A., Ph.D Candidate
There has always been madness in Paris. Depending on when you lived or who you were, this may or may not have been a problem. Certainly, as the Enlightenment wore on, contemporary reactions and understandings of madness found themselves in flux. The purpose of my article is to centre the work of Philippe Pinel. In popular culture, Pinel is remembered as the “father of modern psychiatry” who pioneered ethical, humane treatment of the mad. Whereas his predecessors believed in bloodletting and purging to cure insanity, Pinel advocated for treatments targeting the patient’s mind [1]. He is also (incorrectly) remembered for striking the chains off prisoners at Bicêtre Hospital. The notion that the mad or mentally ill deserve to walk among society, whether or not they are actively engaged in treatment, has its roots in this decision to provide ethical treatment for patients once hidden away in asylums. Pinel’s work at Bicêtre provides insight into how the medical field functioned in the years before, during, and after the French Revolution. I argue the Revolution provided an opportunity for physicians like Pinel to implement medical reforms that the absolutist doctrine had previously restricted. Pinel’s focus on religion as a cause for insanity rather than a cure demonstrates how religion was beginning to become defined as irrational in the French Enlightenment. Moreover, his focus on insanity as induced by religion shows how contemporary attitudes toward both Christianity and madness were shifting, with the latter setting the stage for twenty-first century norms—including the classification, diagnosis, and treatment of mental illness.
I use the term physician and alienist, rather than psychiatrist, to avoid anachronism. Although Pinel’s work does seem to fit into modern conceptions of psychiatry, it was not understood in this way until the mid-nineteenth century. At the time, the terms ‘moral medicine’ or ‘alienism’ would have been more commonly used [2].The term ‘mental illness’ would be out of place in a discussion of the Enlightenment period. Pinel himself distinguished between delirium, fanaticism, lunacy, mania, and melancholia as unique forms of insanity. Pinel also uses aliénation mentale as a blanket term when referring to any mental patient who feels alienated from sanity [3]. He believed aliénation mentale was more accurate than madness because the latter "can stretch out over all errors” [4]. By opting for specific, scientific terms, Pinel helped to medicalize insanity [5].
Pinel worked as the chief physician of Paris’ Bicêtre Hospital. He drew from classical influences and positioned himself in an established, learned tradition of Greek medicine [6]. Like his predecessors, Pinel believed that a madman’s mind was divided between his illness and his sense of self [7]. Just as Aristotle encouraged maintaining harmony between two opposing forces, Pinel emphasized counterbalancing one’s diseased passions with other powerful passions [8]. The most common mental ailment, according to Pinel, was “fantastic illusions.” He attributes this to a lesion of the mind. More often than not, these illusions took on a religious nature [9]. If religion was determined as the cause of madness, Pinel maintained that a madman’s mind would be split between his religious impulses and his sense of self. Thus, to recover his sanity, he was to reject his religious side. The staff would bring this about through theatrics. Staff at Bicêtre would stage elaborate plots to “shock” the patient’s mind out of its divide, effectively reverting to a sane state of mind [10]. The patient would have no idea that these shocks were planned [11]. For Pinel, this was a way to foster secularism through treatment. If madness divides the mind, and the alienist can diagnose religion as a cause for madness, then a physician can, in good faith, encourage secularism as treatment.
Underscoring this change of thought was an increasing awareness of healthcare and the responsibilities of hospitals. In 1676, Louis XIV mandated a general hospital to be built in every city in France [12]. The majority of these hospitals tended to function more like workhouses, where societal outcasts took refuge. A century later, in 1764, dépots de mendicité were created for the able-bodied poor [13]. The Société Royale de Médecine was created in 1776 as an official royal body [14]. As early as the 1780s, efforts were made by the Paris Academy of Sciences to reform medicine [15]. In 1785, they appointed an investigative committee to examine the care at the Hôtel-Dieu, which famously had the highest death rate of any contemporary hospital in all of Europe [16]. Many of the committee’s recommendations revolved around the hospital’s conditions. Cross-infection occurring with neighbouring communities, and the crowded, undignified wards were among their main concerns [17]. Cost proved to be a major obstacle in addressing these concerns. In response, the committee suggested the adoption of a public funding system, like that of England [18]. These reforms appear to be in line with values emphasized in the Revolution, though perhaps none is as telling as the committee’s written conclusion. “The great work of our hospitals,” these scientists wrote, “will be the result of general enlightenment” [19].
Indeed, before the Revolution, some physicians struggled to justify helping the insane, since they were perceived so lowly. According to the 1789 Instruction, written by two members of the Société Royale de Médecine, the insane were classified as the weakest and most horrific members of society. The best way to deal with lunatics, the Instruction recommended, was to surveil and incarcerate them. Such attitudes, as we will see, were not universal [20]. As the Revolution swept through Paris, however, so too did the winds of change. The beginning of the 1790s was characterized by scientific fascination. Doctors and laypeople rapidly sought out medical knowledge [21]. Revolutionaries attempted to dismantle the old medical system by modernizing the curriculum and converting Catholic charities once intended as poor houses into hospitals fit for treatment and medical research [22]. Once the old regime fell, these men seized the opportunity to enact medical reforms. In the past, Pinel had struggled to impress the Paris Faculty of Medicine. This changed once the Revolution began and the organization gradually lost its influence [23]. Men from pro-Revolutionary groups like the Idéologues stepped into these organizations to replace bureaucrats from the old regime [24]. As various medical institutions of the old regime came under new, more favourable leadership, Pinel was able to utilize his connections to advance his career. His friends advanced too. In each of their respective roles, these men sought to reform the medical system into one grounded in analytical and clinical secularism [25].
Pinel’s understanding of the body follows the tradition of vitalism popularized at Montpellier, where he studied in the 1770s [26]. Vitalists advocated for holistic, empirical observation over experimentation [27]. They believed in a sensibility, or vital principle, isolated from one’s physical biochemistry that induced life [28]. While some saw this as an interpretation of metaphysics, others understood it as an important medical doctrine. According to this theory, sensibilities interact with their environment in moral and physical ways [29]. Mania, for instance, was believed to be caused by moral and physical causes interacting. The brain would produce physical symptoms in response to moral circumstances, which would lead to diseased organs [30]. Vitalists maintained that the passions could either suppress or trigger diseases in the body [31]. To cure an imbalance of the passions, a physician would try to elicit a response that emphasized the lacking passion. Pain or terror was seen as a way to “jolt” the patient back to a sane state of mind [32]. Eliciting fear, for example, was believed to counteract excessive excitement [33]. This is how Pinel justified his Revolutionary treatments. If a patient’s madness was caused by the fear of being executed by the Committee of Public Safety, the treatment was to read up on Revolutionary literature, thus balancing his fear and excitement of Revolutionary actions.
According to Pinel’s count, there were 113 madmen at Bicêtre in 1795. He attributes each patient’s insanity to one of four causes: Thirty-four were driven mad by domestic misfortunes, twenty-four by matrimonial problems, thirty as a consequence of the Revolution, and twenty-five by religious fanaticism [34]. The first two are harder to discuss because they function on a case-by-case basis. By contrast, the latter two categories rely on a more singular origin. Pinel classifies melancholics as related to madmen because they are both obsessed with one exclusive idea [35]. From the fear of acting blasphemously to the terror of being executed via guillotine, these types of insanity revolve around an individual whose attention is wholly consumed by the anxiety of acting in the wrong way. For the majority of people, these fears were not entirely unfounded. Throughout the Terror, approximately 17, 000 citizens were sentenced to death. Hundreds of thousands were imprisoned across France. Unlike England, France had no habeas corpus—just about anyone, it seemed, could be accused of counter-Revolutionary sentiments and face arbitrary arrest. When the Committee of Public Safety introduced the “Law of Suspects” in 1793, these fears intensified [36]. For both Revolution and religion-induced insanity, secularism was touted as the solution. Secularism encouraged people to understand the events of the Terror rationally and scientifically, counteracting the lasting fear and anxiety they experienced [37].
In one instance, Pinel describes a missionary who believed it was his duty to kill his family, saving them from the torments of the “other world” [38]. According to Pinel, the missionary believed it was “his special mission to save the world by the baptism of blood” [39]. Interestingly, Pinel notes that the missionary’s delusions were entirely based on religion. Other than these matters, “he appeared to be in perfect possession of his reason” [40]. Since religion was seen as the cause of his madness, Pinel believed secularism was the best cure. He ordered the missionary to hear the poems of Voltaire read aloud. The treatment was ineffective. The missionary allegedly insulted the poem’s reciter, and “invoked the Almighty vengeance to send down fire from heaven to consume a blasphemer” [41]. Pinel vowed never to repeat the treatment. After this incident, however, things seemed to change. The missionary was so well behaved at Bicêtre that he was allowed to leave solitary confinement after ten years. Once out, he attempted to assassinate the governor with a shoemaker’s knife and killed two of his fellow patients. Pinel does not comment on why the treatment was ineffective. He concludes that the missionary had only succeeded in making his confinement irreversible [42].
Adopting Revolutionary values as treatment was not an isolated incident. Pinel describes an incident in 1795 where, as a result of his “Revolutionary zeal,” the governor of Bicêtre ordered the hospital to remove “the external objects of worship" [43]. This included removing images of the Virgin Mary and sacred furniture. When patients protested, the governor responded by shattering religious artifacts beyond recognition [44]. He also brought national cockades for the patients to wear, encouraging those who “love liberty” to adorn themselves [45]. Despite his failure to treat the missionary with Voltaire, Pinel continued to believe he could treat religious enthusiasts by having them read philosophy. By doing so, Pinel believed he could effectively divert his patients’ minds from their religious obsessions.
Regardless of its contemporary effectiveness, the lasting impacts of Pinel’s work are undeniable. Written evidence from the early nineteenth century demonstrates a significant shift in the perception of religion. For alienists writing in the 1820s and 30s, it was widely accepted that the Revolution played a significant role in the rise of insanity [46]. Likewise, many understood religion as a thing of the past, with alienists like Jean-Étienne Dominique Esquirol writing that “religious fanaticism which caused so much insanity formerly, has now lost all its influence” [47]. How can this be when over a fifth of the insanity cases at Bicêtre were caused by religion? Religious insanity must have decreased as secularism increased. Based on the evidence collected here, it appears that secularism was already on the rise as early as 1789. The Revolution undoubtedly aggravated these circumstances, but it did not wholly cause them. Dechristianization, it seems, was already in effect to some degree [48]. In the end, it is undeniable that the Revolution had a profound impact on Paris’ medical community. Historians may never know just how far-reaching these impacts were, but one thing is for certain: in the span of half a century, madness went from being something that doctors were unconcerned with, to something people were imprisoned for, and finally to something that deserved moral treatment in a medical facility. The rate at which French society became medicalized was directly related to the Revolution, as was a growing belief in the irrationality of religion. By emphasizing secularism as a cure for insanity, Pinel argued that the most fantastic illusion of all was none other than religion itself. His methods may not have stood the test of time, nor were his conclusions universally accepted, however, Pinel’s efforts to implement humane and innovative treatment for what is now recognized as mental illness are invaluable to the history of psychiatry and modern day thinking.
Endnotes
[1] Jill Harsin, “Gender, Class, and Madness in Nineteenth-Century France.” French Historical Studies 17, no. 4 (1992): 1053-1054. https://doi.org/10.2307/286842; Ian Goldstein, “The Transformation of Charlatanism, or the Moral Treatment,” in Console and Classify: The French Psychiatric Profession in the Nineteenth Century. (Chicago: The University of Chicago Press, 1987): 65. [2] Ronen Steinberg, “Trauma and the Effects of Mass Violence in Revolutionary France: A Critical Inquiry.” Historical Reflections/Réflexions Historiques 41, no. 3 (2015): 37.
[3] Dora B. Weiner, “The Madman in the Light of Reason, Enlightenment Psychiatry, Part II: Alienists, Treatises, and the Psychologic Approach in the Era of Pinel,” in History of Psychiatry and Medical Psychology. (Boston, MA: Springer US, 2008): 284.
[4] Philippe Huneman, “From a Religious View of Madness to Religious Mania: The Encyclopédie, Pinel, Esquirol.” History of Psychiatry 28, no. 2 ( 2017): 153. https://doi.org/10.1177/0957154X17690301.
[5] Philippe Huneman, “Montpellier Vitalism and the Emergence of Alienism in France (1750–1800): The Case of the Passions.” Science in Context 21, no. 4 (2008): 642. doi:10.1017/S0269889708001981.
[6] Philippe Pinel, A Treatise on Insanity: in which are contained the principles of a new and more practical nosology of maniacal disorders than has yet been offered to the public. (Sheffield: Printed by W. Todd for Cadell and Davies, 1806): xxx-xxxi.
[7] Huneman, “From a Religious View of Madness to Religious Mania,” 155.
[8] Goldstein, “The Transformation of Charlatanism, or the Moral Treatment,” 97.
[9] Pinel, A Treatise on Insanity, 73.
[10] Huneman, “From a Religious View of Madness to Religious Mania,” 156.
[11] Goldstein, “The Transformation of Charlatanism, or the Moral Treatment,” 84.
[12] Petteri Pietikainen, Madness: A History. (Oxon: Routledge, 2015): 176.
[13] Pietikäinen, “The Age of Asylum,” 177.
[14] Sean M. Quinlan, “Introduction: Morbid Undercurrents—Medicine and Culture after the Revolution,” in Morbid Undercurrents: Medical Subcultures in Postrevolutionary France, 2. Cornell University Press, 2021. http://www.jstor.org/stable/10.7591/j.ctv1fkgbmz.6.
[15] Louis S. Greenbaum, “Science, Medicine, Religion: Three Views of Health Care in France on the Eve of the French Revolution.” Studies in Eighteenth-Century Culture 10, no. 1 (1981): 375. https://doi.org/10.1353/sec.1981.0021.
[16] Greenbaum, “Science, Medicine, Religion,” 375-376.
[17] Ibid, 377.
[18] Ibid, 378.
[19] Ibid, 378.
[20] Pietikäinen, “The Age of Asylum,” 178. [21] Quinlan, “Introduction: Morbid Undercurrents—Medicine and Culture after the Revolution,” 5.
[22] Ibid, 2.
[23] Goldstein, “The Transformation of Charlatanism, or the Moral Treatment,” 69-70. [24] Ibid, 70.
[25] Klaus Doerner, “The Revolution and the Emancipation of the Insane,” in Madman and the Bourgeoisie. (England: Basil Blackwell Publisher Limited, 1981) 123.
[26] Doerner, “The Revolution and the Emancipation of the Insane,” 127; Weiner, “The Madman in the Light of Reason, Enlightenment Psychiatry, Part II,” 295.
[27] Charles T. Wolfe and Motoichi Terada. “The Animal Economy as Object and Program in Montpellier Vitalism.” Science in Context 21, no. 4 (2008): 539. doi:10.1017/S0269889708001956; Steinberg, “Trauma and the Effects of Mass Violence in Revolutionary France,” 35.
[28] Wolfe and Terada. “The Animal Economy as Object and Program in Montpellier Vitalism,” 540.
[29] Huneman, “Montpellier Vitalism and the Emergence of Alienism in France (1750–1800),” 618.
[30] Ibid, 625.
[31] Ibid, 623.
[32] Steinberg, “Trauma and the Effects of Mass Violence in Revolutionary France,” 35.
[33] Huneman, “Montpellier Vitalism and the Emergence of Alienism in France (1750–1800),” 630.
[34] Pinel, A Treatise on Insanity, 113.
[35] Ibid, 141.
[36] Jeffrey Freedman, “The Dangers Within: Fears of Imprisonment in Enlightenment France.” Modern Intellectual History 14, no. 2 (2017): 345; 362. doi:10.1017/S1479244315000463.
[37] Steinberg, “Trauma and the Effects of Mass Violence in Revolutionary France,” 41.
[38] Pinel, A Treatise on Insanity, 76.
[39] Ibid, 76-77.
[40] Ibid, 77.
[41] Ibid, 76.
[42] Ibid, 77.
[43] Ibid, 79.
[44] Ibid, 81.
[45] Ibid, 80. [46] Steinberg, “Trauma and the Effects of Mass Violence in Revolutionary France,” 40.
[47] Etienne Esquirol, Mental maladies: A Treatise on Insanity. Philadelphia: Lea and Blanchard, 1845): 47.
[48] L.W.B. Brockliss, “Medicine, Enlightenment and Christianity in Eighteenth-Century France: The Library Evidence” in Medicine and Religion in Enlightenment Europe. Edited by Ole Peter Grell and Andrew Cunningham. (New York: Routledge, 2017): 103.
Bibliography
Primary Sources
Esquirol, Etienne. Mental maladies: A Treatise on Insanity. Philadelphia: Lea and Blanchard,
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Pinel, Philippe. A Treatise on Insanity: in which are contained the principles of a new and
more practical nosology of maniacal disorders than has yet been offered to the public. Sheffield: Printed by W. Todd for Cadell and Davies, 1806.
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Brockliss, L.W.B. "Medicine, Enlightenment and Christianity in Eighteenth-Century France: The Library Evidence." In Medicine and Religion in Enlightenment Europe, 101-119. Edited by Ole Peter Grell and Andrew Cunningham. New York: Routledge, 2017.
Doerner, Klaus. "The Revolution and the Emancipation of the Insane," in Madman and the Bourgeoisie, 119-138. England: Basil Blackwell Publisher Limited, 1981.
Freedman, Jeffrey. "The Dangers Within: Fears of Imprisonment in Enlightenment France." Modern Intellectual History 14, no. 2 (2017): 339-64. doi:10.1017/S1479244315000463.
Goldstein, Ian. Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Chicago: The University of Chicago Press, 1987.
Greenbaum, Louis S. “Science, Medicine, Religion: Three Views of Health Care in France on the Eve of the French Revolution.” Studies in Eighteenth-Century Culture 10, no. 1 (1981): 373–91. https://doi.org/10.1353/sec.1981.0021.
Harsin, Jill. “Gender, Class, and Madness in Nineteenth-Century France.” French Historical Studies 17, no. 4 (1992): 1048–70. https://doi.org/10.2307/286842.
Huneman, Philippe. “From a Religious View of Madness to Religious Mania: The
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Huneman, Philippe. “Montpellier Vitalism and the Emergence of Alienism in France
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Pietikainen, Petteri. Madness: A History. Oxon: Routledge, 2015.
Quinlan, Sean M. “Introduction: Morbid Undercurrents—Medicine and Culture after the Revolution.” In Morbid Undercurrents: Medical Subcultures in Postrevolutionary France, 1–20. Cornell University Press, 2021. http://www.jstor.org/stable/10.7591/j.ctv1fkgbmz.6.
Steinberg, Ronen. “Trauma and the Effects of Mass Violence in Revolutionary France: A Critical Inquiry.” Historical Reflections/Réflexions Historiques 41, no. 3 (2015).
Weiner, Dora B. “The Madman in the Light of Reason, Enlightenment Psychiatry. Part II. Alienists, Treatises, and the Psychologic Approach in the Era of Pinel.” In History of Psychiatry and Medical Psychology, 281-303. Boston, MA: Springer US, 2008. https://doi.org/10.1007/978-0-387-34708-0_8.
Wolfe, Charles T., and Motoichi Terada. “The Animal Economy as Object and Program in Montpellier Vitalism.” Science in Context 21, no. 4 (2008): 537–79. doi:10.1017/S0269889708001956.
Figures, in Order of Appearance
Tony Robert-Fleury, Pinel, médecin en chef de La Salpêtrière, délivrant des aliénés de leurs chaînes, 1876, Oil on Canvas, 355x505 cm.
https://commons.wikimedia.org/wiki/File:Philippe_Pinel_%C3%A0_la_Salp%C3%AAtri%C3%A8re.jpg
Jacques Rigard, The Royal Hospital of Bicestre, c. 1720-1750, Engraving Print. The Cleveland Museum of Art. https://www.clevelandart.org/art/1924.693
Pierre-Antoine Demachy, Une exécution capitale, la place de la Révolution, c. 1793, Oil on Canvas, 37 x 53.5 cm. Musée Carnavalet, France.
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