Medico-Philosophical Treatise on Mental Alienation

December 20, 2024

This is a thoughtful and well done translation of the second edition of Pinel’s treatise, which is generally known in English as the Treatise on Insanity. The translators note that Daniel Davis’ 1806 translation of the book’s first edition was poorly done, and that the second, expanded edition was never translated into English until this edition was published in 2008.

The translators include an introduction describing how they translated certain terms from the French, and why they chose the words they did. This helps the reader understand nuance and avoid misunderstanding, and it shows how seriously the translators took their job.

Pinel is well known to students of medicine and psychology as the man who had the radical idea of treating the insane as human beings. Prior to him, inmates of public mental institutions were kept in chains, neglected, mistreated, and often considered incurable. Pinel removed the chains, listened to his patients, pieced together their life stories and the events that triggered their “alienation,” and carefully recorded their pathological thought patterns and the distortions in their perceptions. Over time, he devised courses of treatment tailored to each patient’s diagnosis and disposition, and many of these treatments were effective.

The term alienation, which was a general term for insanity from the late 1700s through the 1800s, is interesting in itself as it shows the perspective of the doctors treating the illness. The patient was alienated from his or her reason.

Pinel notes that many, if not most, of the cases he encountered in the public hospitals in Paris could be traced to a combination of disposition and circumstance. Those who were unusually sensitive and perceptive were often driven to madness by chronic mistreatment, such as abuse at home, or by sudden shocks, such as a loss of fortune, a violent attack, or a betrayal in love.

In these cases, reason is unseated by violent emotion, and the form of madness depends in part on the patient’s innate disposition. Some become manic, violent, furious and destructive. Their thoughts range all over the place without restraint and their destructive tendencies are directed outward against the world. They talk a lot and have periods of extreme agitation. These he calls the manic.

Others become brooding, obsessive, and lethargic, turning their destructive tendencies inward. They talk little, are indifferent to their surroundings and have periods of extreme lethargy. They tend to focus on a single idea, such as loss or betrayal, and their destructive tendencies are focused inward. Pinel calls these the melancholic.

Both mania and melancholy are marked by symptoms of delirium, which may include both hallucinations and strongly held beliefs in things that aren’t true, such as the idea that one is being persecuted or that one is fatally ill.

Pinel also describes two other categories of alienation, which he terms dementia and idiocy. The first is characterized by problems of memory and reasoning, the second by a general lack of thought and weakness of perception. These can be organic in nature, or they can be brought on by emotional trauma. Sometimes the cause is unintentionally self-inflicted, as in the case of a wealthy young man who went mad after months of living an austere, monk-like life of self denial.

This book makes a fascinating read as Pinel lays out general descriptions of different types of madness and then goes on to discuss specific cases. The case studies generally describe the patient’s family background and disposition, the event or conditions that triggered their insanity, the symptoms they displayed, the treatment they received, and the outcome.

Pinel notes that alienation is often chronic and episodic, meaning it persists over time but the symptoms come and go. Many cases previously thought to be incurable are either curable or manageable when the doctor takes the time to understand the patient. Cases caused by severe shock such as grief, violence, betrayal and financial ruin, often have a good prognosis with one interesting exception.

Those who go mad from religious fervor often prove incurable. In those cases, Pinel notes, the doctor is arguing against God and cannot win. Pinel recounts some unfortunate cases of patients believing they’re damned.

This is an interesting read all around, both for Pine’s humane approach to the suffering and for the cases he describes. Because it’s broken into short sections, it’s suitable for reading in short bursts. You can pick it up and put it down whenever, and you will always find something to arouse both thought and feeling.