Although Philippe Pinel (1745–1826) made significant contributions to nosology and research methodology, he was a clinician at heart and is universally acclaimed today for the humanitarian reforms he introduced in mental healthcare, symbolised by the dramatic act of striking off chains. But Pinel's unchaining was, at first, judiciously implemented and far from indiscriminate. He lived through troubled times where revolutionary fervour in France had given way to the excesses of The Reign of Terror. The Bicêtre Hospital under his direction was (correctly) suspected of harbouring ‘Enemies of the Revolution’, priests and returned émigrés masquerading as lunatics; but it was also suspected of confining sane prisoners of the Ancien Régime and labelling them mad. According to Pinel:
‘During a massacre in the prisons, brigands forced their way into the Bicêtre under the pretext of setting free some victims of the ancient tyranny…they went from ward to ward brandishing arms and interrogating detainees, passing over them if madness was obvious. But one of the secluded who was kept in chains, caught their attention with his bitter complaints. Wasn't it odious that he was kept in irons and confused with other madmen? He denied that one could reproach him with the least extravagance; it was, he added the most revolting injustice.’
‘The sight of those armed men with their confused shouting, faces illuminated with wine vapours, stirred up the patient's rage, who grabbed one of their sabres with a strong arm and began thrusting it from left to right, drawing blood; and if one hadn't been able to master him quickly, he would have avenged the whole of outraged humanity. That barbarous howling horde returned him to his ward and blushingly seemed to give way to the voice of justice and experience.’
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