Freeing the Insane

Abstract

THIS CONTEMPORARY photogravure of Tony Robert-Fleury’s 1876 painting famously depicts Pinel Freeing the Insane. Completed more than three quarters of a century after the event, it portrays several stock figures in the tradition of asylum art: a woman (on the ground) tearing at her clothing, 2 huddled melancholics, a tense maniac, and a woman (at right) with a vacant stare chained to the wall.1 In the center is a limp and passive woman, whose stance emphasizes her unthreatening nature. She is being freed from her chains as the commanding figure of Dr Philippe Pinel looks on. This scene in Robert Fleury’s painting is often said to have taken place during the French Revolution as a psychiatric parallel to larger political events: the rights of man extended to the (female) inmates of a mental asylum. In fact, however, Pinel unchained the female patients at Paris’s Salpetriere hospital in 1800.2 He did not entirely abandon physical restraints, but when necessary, he confined the more agitated and potentially dangerous patients to the gentler control of the recently popularized strait-jacket. This was part of a widespread asylum reform movement that began during the late 18th century and continued well into the 19th.3 Lay asylum superintendents and early medical “alienists” (psychiatrists) in Italy, England, France, and the United States contributed to humanizing the treatment of the insane by making confinement less brutal and treatment more gentle and interactive. Pinel in particular spent a great deal of time with his patients, listening attentively as he recovered their life histories. His was a newly sympathetic attitude toward the insane: he tried to make contact with their remaining vestiges of reason, rationally reconstruct their mental world, and—after a momentary act of identification—lead them back to sanity.4 Dr Pinel freeing the insane in the courtyard of the Salperiere. Gravure by Goupil after the painting by Robert-Fleury. Courtesy of the National Library of Medicine. Thus, while the scene in Robert-Fleury’s painting did not literally represent a moment during the French Revolution, it did capture the spirit and the deeper political sentiments of that revolutionary age. The new “moral therapy” developed by Pinel and his contemporaries in the reformed asylums was fundamentally based on the idea of freeing mental patients’ trapped humanity. This liberation allowed for a therapeutic doctor–patient alliance that was sensitive to the life situations and social circumstances of the “madmen” and “madwomen,” who were formerly treated as subhuman. This was appreciated by the young Sigmund Freud, who looked at Robert-Fleury’s painting when he attended J. M. Charcot’s lectures at the Salpetriere during the winter of 1885–1886. As Freud said, “In the hall in which he gave his lectures there hung a picture which showed ‘citizen’ Pinel having the chains taken off the poor madmen at the Salpetriere. The Salpetriere, which had witnessed so many horrors during the Revolution, had also been the scene of this most humane of all revolutions.”5(p17–18)