[Pythagorean diet]
This was a vegetarian diet, which, according to Goldstein [1987, 68],
he adopted in the belief that eating meet dulled the brain.
[One of his
relatives]
Goldstein indicates that it was Pinel who brought him to the lunatic
ward of the Hôtel-Dieu, where the treatment consisting of baths and
restorative nourishment seemed to calm him down.
[former Hôtel-Dieu]
The reputation of the Hôtel-Dieu was mixed at best. In Paris
under the old regime publicly funded treatment of the mentally ill occurred
only at the Hôtel-Dieu. There was one ward for thirty-two women and
another for forty-two men. As described after the Revolution, they were
kept three or four to a bed, where they ‘press against each other, gesticulate,
and quarrel, and are the garroted and restrained.’ Bleedings, purgings,
warm baths and cold showers were used to calm the agitated and weaken violent
patients into compliance. Once calm and compliant they were sometimes
declared cured and dismissed. After two six-week sessions failed
to provide a remission of symptoms, the patient was declared incurable
and sent to Bicêtre or the Salpêtrière for life. The
staff at the Bicêtre complained that as a result of excessive bleeding,
patients often arrived at that facility totally debilitated and unable
to eat [Weiner, 1993, 254, Goldstein, 1987,46].
[He
sent him, after twenty days, ]
Goldstein clarifies the apparent contradiction of putting him in the
Hôtel-Dieu and the sending him to the Pyrenees twenty days later,
by suggesting that it was the patient's anxious parents who insisted on
sending him to the family home, before the treatment was completed.
[Two days later he
was found dead]
Pinel clearly stated the impact of this tragedy on him:
"All civilized nations, though the varied in the influences of climate,
customs and way of life, will still have causes of mania in common , as
well as similar means of halting it's course. And why would the French,
like the English, not want to seek these means by way of observation and
experiment. But this type of study demands favorable circumstances. The
loss of a friend, who became insane through an excessive love for glory
[in 1783], as well as the inadequacy of all medications, and the impossibility
of controling him due to his deep sense of independence, enhanced my admiration
for the judicieux precepts of the ancients, and my regrets for not having
been able to follow them [Pinel, 1801, 50-1; translated by Edward M. Brown]."
Case 1: Useful effects of an energetic repression.
A soldier, still insane,
after having submitted to the usual treatment at the Hôtel-Dieu,
was suddenly seized by an obsessive idea of returning to the army. After
vainly attempting all gentle methods, we resorted to force to make him
return to his lodgings. During the night he broke everything to pieces
and was so enraged, that we had to tying him down. We let him
vent his fury for days. He always spoke in a furious tone, responding to
governor, whose authority he affected to despise, with nothing but invectives.
After eight days in this violent state, he appeared to realize that
he was not free to follow his whims. That morning, during the governor's
rounds, he took a more submissive tone, kissing his hand and saying, 'You
promised to give me freedom inside the hospital if I would be quiet.
Now, I call on you to keep your word.' Smiling, the governor expressed
the pleasure that he felt seeing him return to himself. He spoke softly
and immediately had all restraints, which would be, from then on,
superfluous or even annoying, removed. Seven months in the hospital sufficed
to consolidate the soldier's reason and he was returned to his family and
to the defense of his country without having experienced a relapse [Pinel,
1801, 58-9, trans. E. Brown].
Case 2: The benefit of strongly shaking the imagination of the insane in certain cases.
A young man, distressed by overthrow of the Catholicism in France and
preoccupied with religious ideas, became insane. After the usual treatment
at the Hôtel-Dieu, he was transferred to the Bicêtre. Nothing
equaled his dark misanthropy. He spoke only of torments of the next life
and thought that to escape them he must emulate the abstinence and mortification
of the ancient anchorites. He forbid himself all nourishment. By the fourth
day of that unshakable resolution, his state of listlessness was such that
we feared for his life. Friendly reprimands and urgent invitations were
in vain. He pushed away the soup that was served to him. He attempted to
remove the straw from his bed so that he could sleep on the plank.
Could the sinister course of his ideas be destroyed or counter-balanced
by any other means than by frightening him profoundly? It was with
that in mind that Citizen Pussin presented himself one evening at the door
of his room with frightening display. His eyes were on fire. His
voice thundered. He was surrounded by a group of attendants, armed with
strong chains, that they shook making a great noise. They put soup
beside the insane man and told him in no uncertain words to eat it during
the night, if he did not want to incur the most cruel treatments. They
retired and left him in a most painful of mind, fluctuating between the
idea of the punishment which menaced him and the frightening prospect of
the tourments of the afterlife. After an inner struggle of several hours,
the first idea prevailed and he decided to take his nourishment. They then
imposed a restorative regimen on him. He began to sleep and his strength
returned by degrees, as did the use of his reason. He managed in
this way to escape a certain death. It was during his convalescence that
he often confessed to me his cruel agitations and his perplexities during
the night of his test [Pinel, 1801, 59-60, trans. E. Brown].
A happy expedient used to cure a maniac
One of the most famous watchmakers
in Paris was infatuated with the fantasy of perpetual motion. To accomplish
this he worked without sleeping. His imagination became progressively more
exalted and, helped by the growing terrors that the storms of the revolution
aroused, he soon developed a true delusion. The overthrow of his reason
was marked by a singular peculiarity. He believed that his head had fallen
on the scaffold and that it had been tossed in with those of other victims.
The judges belatedly repented their cruel ruling and ordered that the
the heads be put back on their respective bodies. By mistake, however,
the head of one of his companions had been put on his shoulders. The thought
of this change of heads preoccupied him night and day, which led his family
to subject him to the treatment of maniacs at the Hôtel-Dieu.
He was then transfered to the insane asylum of Bicêtre. Nothing equaled
his loud, flamboyant bursts of joviality. He sang; he cried; he danced.
As he showed no propensity toward violence, we let him wander around the
asylum, to let off steam. 'Look at these teeth,' he constantly cried, 'mine
were handsome; these are rotten. My mouth was healthy; not it's infected.
What a difference between the hair I have now and what I had before the
head change!'
The most violent furor
succeeded this delirious gaiety. He was put into close confinement in his
quarters. He had violent fits of anger, during which he broke everything
around him. Toward winter his fits of anger began to abate and although
his ideas were still wild, he was no longer dangerous. We gave him freedom
in the interior of the asylum. The idea of perpetual motion cameback
to him in the midst of his mad wanderings. He continued to draw designs
for his machine on the doors and walls.
How could we detach
him from his fantasy, if not by the uselessness satiety of his efforts?
We engaged his family to send some watchmaking tools as well as some materials
to work on, such as plates of copper and steel, gears, etc. The governor
of the asylum did more. He allowed him to create a kind of atalier in his
antechamber, to work at his leisure. He redoubled his zealous labors, concentrating
all his attention on his work, forgetting mealtime. After around a month
of sustained work, worthy of success, our artist believed that he had followed
a false route. He broke his new machine into pieces and began again on
another plan. He worked for another two weeks. He reassembled all the parts,
believing he had found a perfect harmony among them, since they resulted
in continuous movement that he thought would continue. He exalted in his
triumph. He ran into the asylum and shouted like another Archimedes, 'I
have finally solved the famous problem, which has defeated the most brilliant
men!'
But a disconcerting
incident occurred in the midst of his triumphal declarations. The wheels
stopped. The so-called perpetual motion had lasted only a few minutes.
Confusion replaced his delirious joy. Th save his pride from a humiliating
confession, he declared that he could easily overcome the obstacle, but
that nevertheless, exhausted by his efforts, he was only going to occupy
himself with watchmaking.
There still remained one delusional idea to combat and destroy,
namely the imagined exchange of heads, which continued to recur to him
as he worked. A well planned stunt seemed appropriate to correct it. We
instructed another patient, who was somewhat of a joker, of the role he
was to play. We arranged for him to talk to the watchmaker and subtly turn
the conversation to the subject of the
famous miracle of Saint Denis, who carried his
head in his hands. The watchmaker strongly insisted on the possibility
of the fact and tried to confirm it by his own example. The other patient
broke into laughter and replied in a mocking tone,' Crazy man that you
are, how could Sant-Denis have kissed his own head? Was it with his heels?'
This unexpected and unanswerable reply struck the watchmaker forcefully.
He withdrew amid the laughter, which was provoked, and never again spoke
of the exchange of his head.
He then worked steadily
for months at his trade. His reason was strengthened. He was returned to
his family. For the last five years he has engaged in his profession, without
relapse.
