esquirol.html

         Jean-Etienne-Dominique Esquirol was born in Toulouse on February 3, 1772. He studied there and completed his education at Montpellier. His father was a wealthy wholesale cloth-merchant. Jean-Etienne Esquirol resembled his father in important respects. He had both a sense of high social standing, which would put him at ease in crucial dealings with men in power, and a deeply ingrained seriousness and sense of obligation to those who could not fend for themselves.
         After working for two years as a health officer in Narbonne and studying medicine for a time in Montpellier, he went to Paris in search of a carreer. He arrived in Paris in 1799 where he worked at the Salpêtrière and became a favorite student of Philippe Pinel.
        To enable Esquirol to take up the intensive study of insanity in an appropriate setting, Pinel reportedly put up the security for the house and garden on rue de Buffon where Esquirol established a maison santé or private asylum in 1801 or 1802. Esquirol's maison was quite successful, being ranked, in 1810, as one of the three best such institutions in Paris. In 1827 a Paris newspaper wrote:

'Who has not heard about the excellent treatment that the doctor gives to lunatics, the care and attention of which they are the object? But who does not also know that it is impossible to be admitted [to Esquirol's maison] on the rue de Buffon for less than 10 or 15 francs a day? …To see madhouses risen to such extraoridnary prices, one would be tempted to believe that insanity is a privilege and that, without being a bureaucrat or a capitalist, it is inadvisable to rave. However, the janitor, the bricklayer, and the errand-boy are allowed to go crazy just like the others for, if equality is anywhere, it is assuredly in human misery. Ah well, what I wish for then is low-cost alsylum, an inexpensive Esquirol' [Goldstein, 1987, 141]

         In 1805 he published his thesis titled Des Passions considérées comme causes, symptômes et moyens curatifs de l'aliénation mentale ['The passions considered as causes, symptoms and means of cure in cases of insanity']. Esquirol, like Pinel, believed that the origin of mental illness lies in the passions of the soul and was convinced that madness does not fully and irremediably affect a patient’s reason. Des Passions sought to provide a speculative hypothesis on the nature of psychiatric disorders. It is a crucial text for understanding the origin of modern psychiatric theory [Gauchet & Swain, 1999, 19].
          Esquirol was made "médicine ordinaire" at the Salpêtrière in 1811, following the death of Pussin, Pinel's trusted concierge. Pinel chose Esquirol because he was "a physician…devoted exclusively to the study of insanity," arguing that with his many years of maison de santé experience he was the only man suited for the job.
          Esquirol saw the question of madness as institutional and national. This was especially true for the poor where he saw the state, with the help of doctors, playing an important role . He also saw an important role for doctors in caring for people accused of crimes who were declared not responsible by reason of insanity. In public controversies over this question he promoted the usefulness of the diagnosis of monomania. By taking such an active role in these public matters, his fame eclipsed that of his teacher Pinel [Weiner, 1999, 325-6].
         In 1810, 1814 and 1817 Esquirol, at his own expense, toured facilities for lunatics throughout France. In 1818 following these trips Esquirol wrote a short memoir that he presented to the minister of the interior and a more detailed description of his findings that he published in the Dictionaire des sciences médicales. These two articles constitute a virtual manefesto for a new medical specialty to care for the mentally ill. In these articles he argued that insanity should be treated in special hospitals. 'A lunatic hospital is an instrument of cure,' he asserted. Since all expertise in the care of the insane was to be found in Paris, according to Esquirol, it was logical that a central state bureaucracy ought to govern the care of the insane. He proposed that a the ministry of the interior construct a twenty special hospitals distributed evenly throughout France. Finally he insisted that physicians with special training should be 'the vital principle of a lunatic hospital. It is he who should set everything in motion; ...The physician should be invested with an authority from which no one is exempt' [Goldstein, 1987, 130-2].
         In 1817, under the restored Bourbon monarchy, Esquirol initiated a course in maladies mentale in the makeshift quarters of the Salpêtrière dining hall. This was perhaps the first formal teaching of psychiatry in France [Saussure, 1946,365]. At this time he was neither a professor at the Paris faculty or the chief physician at a Paris hospital, but merely a médicine ordinaire. Nonetheless he was reported to have been one of the clinical instructors to whose hospital visits "students flock with a kind of frenzy." He had many very distinguished students.
          During the Restoration, Esquirol increasingly distanced himself from his mentor, Pinel. In 1818, in what Gladys Swain has seen as a denunciation of Pinel's revolutionary ideals, Esquirol wrote that 'the ideas of the times [ie. the Revolution] were to give great importance to ... [his] deliverance of the mad who were chained at the Bicêtre. The success obtained by this learned doctor and friend of the unfortunate became a trophy for the agitators.' Distinguishing himself from Pinel in this way helped Esquirol win favor with the reactionary government of the time. When, in 1823, Pinel and other liberals were forced from the Faculty of Medicine by the government, Esquirol was promoted to the position of Inspector General of the Faculty of Medicine [Postel, 1998, 80-3].
         At the behest of the minister of internal affairs, he undertook a nationwide survey, visiting all the institutions throughout France where mental patients were confined. From his observations he painted a dramatic picture:

I have seen them naked, clad in rags, having but straw to shield them from the cold humidity of the pavement where they lie. I have seen them coarsely fed, leacking air to briethe, water to quench their thirst, wanting the basic necessities of life. I have seen them at the mercy of veritable jailers, victims of their brutal supervision. I have seen them in narrow dirty, infested dungeons without air or light, chained in caverns where one would fear to lock up the wild beasts that luxury-loving governments keep at great expense in their capitals [Weiner, 1994, 234].

The rhetoric of this description suggested that someone was needed to rescue the mentally ill. Esquirol soon stepped forward to do that. In 1822 he was appointed inspector general of medical faculties, and in 1825 director of Charenton Hospice. He became the main architect of the national law of 1838 that instituted departmental asylums for all needy French mental patients and that is still in force today [Weiner, 1994, 234].
He died in 1840.

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Under the Old Regime the Maison nationale de Charenton had housed the pensionnat of the Brothers of Saint-Jean-de-Dieu, which received lunatics on a charitable basis or for a fee and was also regularly used by the King as a prison for those seized by lettre de cachet. Tainted by this latter function, and on shaky grounds anyway after the state confiscation of monastic lands, the institution was closed by the Convention on June 30, 1795. Families were ordered to claim their insane relatives, totally indigent patients were transferred to the Petites Maisons hospice and the brothers were expelled. Two years later the Directory reopened it in fully secularized form, decreeing that'the hospice of the commune of Charenton, near Paris, known as a refuge for madmen, shall be restored to its initial purpose,' and furthermore that it be turned into a model institution of its kind, a national showcase. The new Charenton was intended to replace the lunatic wards of the Hôtel-Dieu, whose therapeutic techniques were considered old-fashioned and inadequate [Goldstein, 1987,113, Weiner, 1993, 272].
A new era seemed to be opening for the mentally ill. On December 23 1797, the government appointed F.S. de Coulmiers, a former cleric and member of the Poverty Committee, as the first director, with a Dr. Gastaldy from Avignon as physician. Although de Coulmiers publicized Charenton as having all sorts of amenities, applications were very few. Finally in 1802 Chaptal, horrified by he saw on a visit to the Hôtel-Dieu, insisted that all mental patients be transfered out and lodged inspecialized institutions. According to Gladys Swain, 'This marks the birth of the asylum' [Weiner, 1993, 273]