Chiarugi and Pinel considered: Soul's brain/person's mind

Journal of the History of the Behavioral Sciences

Volumn 33, Issue 4, 1997, Pages 381-403

  Gerard, Donald L ^a,b  

^a ALBERT EINSTEIN COLLEGE OF MEDICINE   (United States)

^b NONE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0347171139     PISSN: 00225061     EISSN: None     Source Type: Journal    
DOI: 10.1002/(sici)1520-6696(199723)33:4<381::aid-jhbs3>3.0.co;2-s     Document Type: Article

References (40)

1. Dora B. Weiner, "Le geste de Pinel: The History of a Psychiatric Myth," in Discovering History of Psychiatry, Roy Parker and Mark S. Micale, eds. (New York: Oxford University Press, 1994), 240-241.
2. Philippe Pinel, Traité Médico-Philosophique sur L'Aliénation Mentale ou la Manie (Paris: Richard, Caille et Ravier, 1801).
3. Dora B. Weiner, "Philippe Pinel's 'Memoir on Madness' of December 11, 1774: A Fundamental Text of Modern Psychiatry," American Journal of Psychiatry 149(1992): 725-732.
4. Vincenzio Chiarugi, Della Pazzìa in Genere, e in Specie - Trattato Medico-Analitico, con una Centuria di Osservazioni (Firenze: Presso Luigi Carlieri 1793 Tomo I, 1794 Tomi II e III). Vincenzio Chiarugi, Saggio Teorico-Pratico sulle Malattie Cutanee Sordide (Firenze: Stamperia di Pietro Allegrini, 1799).
5. Vincenzio Chiarugi, Della Pazzìa in Genere, e in Specie - Trattato Medico-Analitico, con una Centuria di Osservazioni (Firenze: Presso Luigi Carlieri 1793 Tomo I, 1794 Tomi II e III). Vincenzio Chiarugi, Saggio Teorico-Pratico sulle Malattie Cutanee Sordide (Firenze: Stamperia di Pietro Allegrini, 1799).
6. Lorenzo Marri Malacrida and Emiliano Panconesi, Vincenzio Chiarugi, His Times and His Book on Sordid Cutaneous Diseases (Firenze: Edizione Riviste Scientifiche 1989), 35. Though this is a bilingual text, the title is given in English.
7. George Mora, "Vincenzio Chiarugi (1759-1820) and his Psychiatric Reforms in Florence in the Late Eighteenth Century," Journal of the History of Medicine 14 (1959): 432.
8. Chiarugi, Della Pazzìa. Hereafter the title of Chiarugi's work will be given in this shortened form and cited passages identified directly in parentheses as DP for vol. I, DP II for vol. II, followed by the page(s), e.g. (DP II 16) Similarly Pinel's hook will be given as Traité, and citations from it in similar form, e.g. (TR 22-25).
9. Biological and psycho-social organizing constructs have been recognized throughout psychiatric history as ineluctably complementary. Yet they have had a long and uneasy co-existence. M. Dominic Beer gives a measured review of "this Body-Mind or 'Somatiker-Psychiker' debate" in two recent articles. "Psychosis: From Mental Disorder to Disease Concept," History of Psychiatry 6 (1995): 177-200; and "The Dichotomies: Psychosis/Neurosis and Functional/Organic: A Historical Perspective," History of Psychiatry 7 (1996): 231-255. Discussions of this subject tend to the polemical, as, for example, Andrew Scull, "Somatic Treatments and the Historiography of Psychiatry," History of Psychiatry 4 (1994) whose viewpoint is neatly caught by his quotation from Dickens apropos the psychiatry of his times: "coercion of the outward man, and rabid physicking for the inward man . . . nothing too monstrously cruel to be prescribed by mad doctors." Without special pleading for somatic treatments, Thomas Detre, in his article "The Future of Psychiatry," American Journal of Psychiatry 144 (1987): 621-625, expresses his view that "the mind and the brain are the same;" he adds that though psychological sensitivity is essential to diagnosis, clinical research and patient care, the future of psychiatry, and the comprehension and treatment of mental illness will be best served when mental illness is approached as a biological disorder, to be studied with criteria of 'hard science', not by "social pseudo scientists on semipermanent vacation from medicine."
10. Biological and psycho-social organizing constructs have been recognized throughout psychiatric history as ineluctably complementary. Yet they have had a long and uneasy co-existence. M. Dominic Beer gives a measured review of "this Body-Mind or 'Somatiker-Psychiker' debate" in two recent articles. "Psychosis: From Mental Disorder to Disease Concept," History of Psychiatry 6 (1995): 177-200; and "The Dichotomies: Psychosis/Neurosis and Functional/Organic: A Historical Perspective," History of Psychiatry 7 (1996): 231-255. Discussions of this subject tend to the polemical, as, for example, Andrew Scull, "Somatic Treatments and the Historiography of Psychiatry," History of Psychiatry 4 (1994) whose viewpoint is neatly caught by his quotation from Dickens apropos the psychiatry of his times: "coercion of the outward man, and rabid physicking for the inward man . . . nothing too monstrously cruel to be prescribed by mad doctors." Without special pleading for somatic treatments, Thomas Detre, in his article "The Future of Psychiatry," American Journal of Psychiatry 144 (1987): 621-625, expresses his view that "the mind and the brain are the same;" he adds that though psychological sensitivity is essential to diagnosis, clinical research and patient care, the future of psychiatry, and the comprehension and treatment of mental illness will be best served when mental illness is approached as a biological disorder, to be studied with criteria of 'hard science', not by "social pseudo scientists on semipermanent vacation from medicine."
11. Biological and psycho-social organizing constructs have been recognized throughout psychiatric history as ineluctably complementary. Yet they have had a long and uneasy co-existence. M. Dominic Beer gives a measured review of "this Body-Mind or 'Somatiker-Psychiker' debate" in two recent articles. "Psychosis: From Mental Disorder to Disease Concept," History of Psychiatry 6 (1995): 177-200; and "The Dichotomies: Psychosis/Neurosis and Functional/Organic: A Historical Perspective," History of Psychiatry 7 (1996): 231-255. Discussions of this subject tend to the polemical, as, for example, Andrew Scull, "Somatic Treatments and the Historiography of Psychiatry," History of Psychiatry 4 (1994) whose viewpoint is neatly caught by his quotation from Dickens apropos the psychiatry of his times: "coercion of the outward man, and rabid physicking for the inward man . . . nothing too monstrously cruel to be prescribed by mad doctors." Without special pleading for somatic treatments, Thomas Detre, in his article "The Future of Psychiatry," American Journal of Psychiatry 144 (1987): 621-625, expresses his view that "the mind and the brain are the same;" he adds that though psychological sensitivity is essential to diagnosis, clinical research and patient care, the future of psychiatry, and the comprehension and treatment of mental illness will be best served when mental illness is approached as a biological disorder, to be studied with criteria of 'hard science', not by "social pseudo scientists on semipermanent vacation from medicine."
12. Biological and psycho-social organizing constructs have been recognized throughout psychiatric history as ineluctably complementary. Yet they have had a long and uneasy co-existence. M. Dominic Beer gives a measured review of "this Body-Mind or 'Somatiker-Psychiker' debate" in two recent articles. "Psychosis: From Mental Disorder to Disease Concept," History of Psychiatry 6 (1995): 177-200; and "The Dichotomies: Psychosis/Neurosis and Functional/Organic: A Historical Perspective," History of Psychiatry 7 (1996): 231-255. Discussions of this subject tend to the polemical, as, for example, Andrew Scull, "Somatic Treatments and the Historiography of Psychiatry," History of Psychiatry 4 (1994) whose viewpoint is neatly caught by his quotation from Dickens apropos the psychiatry of his times: "coercion of the outward man, and rabid physicking for the inward man . . . nothing too monstrously cruel to be prescribed by mad doctors." Without special pleading for somatic treatments, Thomas Detre, in his article "The Future of Psychiatry," American Journal of Psychiatry 144 (1987): 621-625, expresses his view that "the mind and the brain are the same;" he adds that though psychological sensitivity is essential to diagnosis, clinical research and patient care, the future of psychiatry, and the comprehension and treatment of mental illness will be best served when mental illness is approached as a biological disorder, to be studied with criteria of 'hard science', not by "social pseudo scientists on semipermanent vacation from medicine."
13. Weiner, "La geste," 236, 239, and Malacrida and Panconesi, "Vincenzio Chiarugi," 23-27.
14. Weiner, "La geste," 236, 239, and Malacrida and Panconesi, "Vincenzio Chiarugi," 23-27.
15. Eric Cochrane, Florence in the Forgotten Centuries (Chicago: University of Chicago Press, 1978).
16. This and the subsequent translations from Della Pazzìa and Traité are mine. Passages in insert form are quotations, except when described as "from DP" (or "from TR"), in which case quoted and some paraphrased materials are mingled.
17. See Vincenzio Chiarugi, Insanity and its Classification, translated and with an introduction by George Mora (Nantucket: Scientific Press, 1989).
18. Chiarugi restricted the term "mind," il mente, almost exclusively to discussions of disorders, pathology, or out-of-the-ordinary experience, e.g. when the "eye of the mind is clouded by a veil" as in the transitory "delirium of sleep or intoxication." (DP 27-28) Where he wanted to discuss mental function or processes, instead of "mind," he referred to the soul, l'anima.
19. Chiarugi's Sensorio Comune, where all the senses commingle and interact with the soul, occupied a prominent position in Avicenna's "The Canon of Medicine," translated into Latin in the 12th century. The sensus communis was housed by Avicenna in the anterior ventricle, together with the imaginatio, which retained what the sensus communis received. See Angel Gonzalez De Pablo, "The medicine of the soul," History of Psychiatry 5 (1994): 498-199. Five centuries later, Thomas Willis offered his own brain/soul localizations: e.g. "understanding is seated in the corpus callosum and memory in the convolutions, which are its storehouse (a summary of Willis provided by Jiri Prochaska in his 1784 "dissertation on the functions of the nervous system") quoted in Solomon Diamond's introduction to a reprint of G. Pordage's 1684 translation from Latin into English of Thomas Willis, Two Discourses Concerning the Souls of Brutes. Chiarugi in his 1811 "La fisica dell'uomo, ossia corso completo di medicina etc. . . ." ceased to localize the 'common sensorium' and its functions, replacing this 'organ' with "an imperceptible and immaterial entity, providing the body with two faculties, those of intellect and volition." See: reference #18. Cabras, Campanini, and Lippi "Uno Psychiatra" p. 33.
20. Chiarugi's Sensorio Comune, where all the senses commingle and interact with the soul, occupied a prominent position in Avicenna's "The Canon of Medicine," translated into Latin in the 12th century. The sensus communis was housed by Avicenna in the anterior ventricle, together with the imaginatio, which retained what the sensus communis received. See Angel Gonzalez De Pablo, "The medicine of the soul," History of Psychiatry 5 (1994): 498-199. Five centuries later, Thomas Willis offered his own brain/soul localizations: e.g. "understanding is seated in the corpus callosum and memory in the convolutions, which are its storehouse (a summary of Willis provided by Jiri Prochaska in his 1784 "dissertation on the functions of the nervous system") quoted in Solomon Diamond's introduction to a reprint of G. Pordage's 1684 translation from Latin into English of Thomas Willis, Two Discourses Concerning the Souls of Brutes. Chiarugi in his 1811 "La fisica dell'uomo, ossia corso completo di medicina etc. . . ." ceased to localize the 'common sensorium' and its functions, replacing this 'organ' with "an imperceptible and immaterial entity, providing the body with two faculties, those of intellect and volition." See: reference #18. Cabras, Campanini, and Lippi "Uno Psychiatra" p. 33.
21. The cranial and spinal nerves visibly enter the brain below the cortex. Hence, in Chiarugi's neurology "the cortical substance is deprived etc. . . ." The concept of internal tracts which lead peripheral impulses from spinal and cranial nerves from the midbrain into complex organizing centers in the cortex, did not enter neurology until long after his time.
22. Though the peripheral nerves are visibly solid, Chiarugi hypothesized they contained channels through which neural fluids flowed. Apologizing for the lack of observational support, he stated: "the existence of this neural fluid appears to be a truth difficult to support, and it is essentially admissible in the service of explanation for certain phenomena." (DP 15)
23. That plethora of blood is a prime cause of inflammation, of many diseases, and susceptibility to disease was promulgated by Galen, influencing medical practice and lay endorsement of bloodletting from the late second to the middle of the nineteenth century. For a translation and discussion of this subject, see: Peter Brain, Galen on Bloodletting; a Study of the Origins, Development and Validity of his Opinions, with a Translation of the Three Works (New York: Cambridge University Press, 1986). Though bloodletting had been a widely employed therapeutic measure for insanity, Chiarugi and Pinel narrowed its indications to the treatment of those insane persons whose mental disorder was accompanied by 'plethora' as indicated by the fullness and rapidity of the pulse, swollen veins, a red face etc. For a recent historical-cultural study of plethora and bloodletting from Greek and Chinese antiquity through 1871, see: Shigehisa Kuriyama, "Interpreting the History of Bloodletting," Journal of the History of Medicine and Allied Sciences 50 (1995): 11-46; in which (12) the roots of the use of bloodletting in Enlightenment and subsequent psychiatric practice may be found in the medieval conviction that "letting blood . . . makes the mind sincere, it aids the memory, it purges the brain . . . builds up the sense . . . enriches sleep . . . removes anxiety." For bloodletting and plethora in American psychiatry see: Samuel B. Thielman, "Madness and Medicine: Trends in American Medical Therapeutics for Insanity, 1820-1860," Bulletin of the History of Medicine 61 (1987): 30-33.
24. That plethora of blood is a prime cause of inflammation, of many diseases, and susceptibility to disease was promulgated by Galen, influencing medical practice and lay endorsement of bloodletting from the late second to the middle of the nineteenth century. For a translation and discussion of this subject, see: Peter Brain, Galen on Bloodletting; a Study of the Origins, Development and Validity of his Opinions, with a Translation of the Three Works (New York: Cambridge University Press, 1986). Though bloodletting had been a widely employed therapeutic measure for insanity, Chiarugi and Pinel narrowed its indications to the treatment of those insane persons whose mental disorder was accompanied by 'plethora' as indicated by the fullness and rapidity of the pulse, swollen veins, a red face etc. For a recent historical-cultural study of plethora and bloodletting from Greek and Chinese antiquity through 1871, see: Shigehisa Kuriyama, "Interpreting the History of Bloodletting," Journal of the History of Medicine and Allied Sciences 50 (1995): 11-46; in which (12) the roots of the use of bloodletting in Enlightenment and subsequent psychiatric practice may be found in the medieval conviction that "letting blood . . . makes the mind sincere, it aids the memory, it purges the brain . . . builds up the sense . . . enriches sleep . . . removes anxiety." For bloodletting and plethora in American psychiatry see: Samuel B. Thielman, "Madness and Medicine: Trends in American Medical Therapeutics for Insanity, 1820-1860," Bulletin of the History of Medicine 61 (1987): 30-33.
25. That plethora of blood is a prime cause of inflammation, of many diseases, and susceptibility to disease was promulgated by Galen, influencing medical practice and lay endorsement of bloodletting from the late second to the middle of the nineteenth century. For a translation and discussion of this subject, see: Peter Brain, Galen on Bloodletting; a Study of the Origins, Development and Validity of his Opinions, with a Translation of the Three Works (New York: Cambridge University Press, 1986). Though bloodletting had been a widely employed therapeutic measure for insanity, Chiarugi and Pinel narrowed its indications to the treatment of those insane persons whose mental disorder was accompanied by 'plethora' as indicated by the fullness and rapidity of the pulse, swollen veins, a red face etc. For a recent historical-cultural study of plethora and bloodletting from Greek and Chinese antiquity through 1871, see: Shigehisa Kuriyama, "Interpreting the History of Bloodletting," Journal of the History of Medicine and Allied Sciences 50 (1995): 11-46; in which (12) the roots of the use of bloodletting in Enlightenment and subsequent psychiatric practice may be found in the medieval conviction that "letting blood . . . makes the mind sincere, it aids the memory, it purges the brain . . . builds up the sense . . . enriches sleep . . . removes anxiety." For bloodletting and plethora in American psychiatry see: Samuel B. Thielman, "Madness and Medicine: Trends in American Medical Therapeutics for Insanity, 1820-1860," Bulletin of the History of Medicine 61 (1987): 30-33.
26. P. L. Cabras, E. Campanini and D. Lippi, Uno Psychiatra Prima della Psychiatria: Vincenzio Chiarugi ed II Trattato "Della Pazzìa in Genere e in Specie" (1793-1794) (Firenze: Scientific Press, 1993), 67.
27. Ibid., 31-32.
28. He also submitted a group of 'mixed' passions; jealousy, shame, pity and desperation. He presented them as derivatives of the sedative and exciting passions; his argumentation was complex and lengthy and not essential here.
29. Malacrida and Panconesi, "Vincenzio Chiarugi" p. 23, note that Della Pazzìa "may be considered the first treatise on psychiatry in its modern sense," i.e. as an autonomous area in medicine.
30. Cabras, Campanini, Lippi, "Vincenzio Chiarugi," 22.
31. Malacrida and Panconesi, "Vincenzio Chiarugi,"
32. M. Covoni-Girolami (commissario), Regolamento dei Regi Spedali di Santa Maria e Bonifazio (Firenze: Gaetano Cambiagi Stampatore Granducale, 1789).
33. Mora, "Vincenzio Chiarugi," 43.
34. Pinel recurrently touched on this theme, e.g. [he entered the Bicêtre] "after the customary and unsuccessful treatment with baths, bloodletting, and inhumane means of repression at the Hotel Dieu." (TR 100).
35. Henri F. Ellenberger, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry (New York: Basic Books, 1970).
36. Both Chiarugi and Pinel used the three major diagnostic categories of Cullen's classificatory schema: Melancholia, mania, and dementia (Chiarugi's term amenza). The terms, familiar to us, were used quite differently in their times and are not interchangeable with today's current formal or informal usage. Furthermore, the clinical data they provided is insufficient for us to rediagnosis their patients in our terms. Parenthetically, they described these categories of mental illness as distinct, but regarded them as fluid. Chiarugi believed that melancholia could readily pass into mania and terminate in dementia. (DP 38) Pinel affirmed they had no necessary direction or order, e.g., "Some idiots, by some accidental cause, after falling back into mania, entirely regain the use of the faculty of reason." (TR 175)
37. Pinel presented this legendary fragment of medical history in greater detail: The man with the delusion that the tyrant cut off his head is cured by his physician, Philodotus, who had a lead bonnet constructed for his patient -its weight convinced him that his head was still on his shoulders. However, Pinel cited this story as an example of "the more or less ingenious expedients to treat such delusions" that should be regarded more as frivolous tales than clinical realities. (TR 23)
38. Weiner, "La Geste," 237.
39. Graziella Magherini and Vittorio Biotti, L'isola delle Stinche - e i percorsi della follia a Firenze nei secoli XIV-XVII (Firenze: Ponte Alle Grazie, 1992), 180.
40. Cabras, Campanini and Lippi, "Uno psychiatra," 59, extracted this bit of arcane lore from G. Orosi's three-volume Farmocopea Italiana 1856-1857.