Historical approach to madness

Historical approach to madness

Doctor Philippe Pinel breaking down the chains of the insane.

© Photo RMN-Grand Palais - Bulloz

Publication date: September 2008

Historical context

Born into a family of surgeons, the most illustrious of French alienists, Philippe Pinel (1745-1826), received a doctorate from the Faculty of Medicine of Toulouse in 1773. He had to wait for the Revolution and the reorganization of medicine to begin with, very late, a brilliant career.

Entered as a general practitioner in Bicêtre, he implemented the treatment of mental alienation - which would become psychiatry - by freeing from their chains the madmen of Bicêtre and, two years later, the mad women of La Salpêtrière. In his Medico-philosophical treatise on mental alienation, it introduces the concept of moral treatment. Thanks to him, the fool becomes a "subject", in accordance with the republican values ​​defined in the Declaration of the rights of man and of the citizen. This liberating Pinel will be, throughout the XIXe century, a real myth, far from the historical truth.

The philosopher Michel Foucault indeed shows that with the "good" Philippe Pinel, the asylum of the XIXe positivist century is part of a conformist vision and becomes the place of moral and social standardization: it "is not a place of observation, diagnosis and therapy; it is a judicial space where you are accused, tried and condemned ". For Hegel however, "it belongs above all to Pinel to have discovered this remainder of reason in the insane, to have discovered it there as containing the principle of their cure and to have directed their treatment according to this principle".

Image Analysis

On August 25, 1793, Philippe Pinel was appointed chief physician of Bicêtre by decree of the National Convention. With his supervisor Jean-Baptiste Pussin (1745-1811), he decides to free from their chains the men who are interned there for mental alienation. This humanist and mythical gesture of Pinel was immortalized in the following century by the painter Charles-Louis Müller (1815-1892). “Female” replica of Müller's canvas, the painting by Tony Robert-Fleury (1838-1911) represents the famous alienist delivering the demented prisoners at the Salpêtrière hospital where he took up his post on 24 floréal year III (13 May 1795).

Standing on the left, the doctor is dressed in a long black frock coat and a cocked hat. He holds a cane in his left hand. Kneeling at his feet, a woman kisses his right hand with devotion. Pinel witnesses the rescue of a lunatic with absent-minded gaze, who abandons herself in total indifference to the care of the warden who takes off her chains. In the background, a skinny woman writhes on the floor, in the throes of a fit of dementia. On the right, a few shackled madmen await their release. Behind the doctor, a small number of curious people witness this extraordinary scene. Like Charles-Louis Müller, Tony Robert-Fleury has decided to represent "in glory" the author of this humanitarian act.


Insanity was not always considered a mental illness: the outlook on it varied according to the cultural context of the time. Thus, at the dawn of the Renaissance, the madman was a major figure as evidenced by the works of Hieronymus Bosch (circa 1453-circa 1516) or Pieter Bruegel the Elder (circa 1525-1569), but also the literary theme and pictorial of La Nave des Fous imagined by the Strasbourg writer Sébastien Brant (1458-1521) in 1494. Madness then fascinates because we attribute to it disturbing powers and esoteric knowledge: images of the apocalypse, of buffoonish bestiality, connivance with the powers of Evil … However, in theIn praise of madness, Erasmus already sees in it a fatal error attributable to the weaknesses and illusions of men: "This one, uglier than an ape, sees himself as beautiful as Nirée [...]; this other thinks he is singing like Hermogenes, when he is the donkey in front of the lyre and his voice rings as false as that of the rooster biting his hen. "

If the Renaissance lends a cosmic dimension to madness that allows those affected by it to discover strange worlds, the classical age will silence the madman by defining a social norm that distinguishes reason and unreason. In 1656, the creation of the General Hospital in Paris ushered in the era of "great confinement": the madman was interned alongside delinquents, debauched, marginalized and beggars, that is to say all those who constitute a burden on society. At the end of the XVIIIe century, mad people were isolated and grouped together in asylums: the medicalization of madness, considered as a mental illness, was then possible.

  • madness
  • medicine
  • Bruegel the Elder (Pieter Bruegel)
  • Bosch (Jerome)
  • Foucault (Michel)


Michel CAIRE, "Philippe Pinel in 1784. A" foreign "doctor in front of the Faculty of Medicine of Paris", in History of medical sciences, XXIX, n ° 3, 1995.Michel FOUCAULT, History of madness in the classical age, Paris, Plon, 1961 François LELORD, Freedom for fools: the novel by Philippe Pinel, Paris, Odile Jacob, 2000.Philippe PINEL, Medico-philosophical treatise on mental alienation or mania, 1800.Claude SILVESTRE, Philippe Pinel's "medico-philosophical treatise on mental alienation" and the philosophy of the Enlightenment, Paris, n ° 884, 1968.

To cite this article

Alain GALOIN, "Historical approach to madness"

Video: BBC Mental A History of the Madhouse FULL DOCUMENTARY