Résumés
Résumé
Le partenariat patient en santé mentale et psychiatrie est considéré de nos jours comme une innovation et comme une composante essentielle à des soins de santé mentale personnalisés. Un retour sur le paradigme humaniste inscrit au coeur des travaux précurseurs de Philippe Pinel et Jean-Baptiste Pussin permet cependant de constater que le « traitement moral » qu’ils préconisaient, il y a déjà 200 ans, reposait en bonne partie sur cette mise à profit de l’expérience vécue, particulièrement en contexte de soutien entre pairs. Le mouvement contemporain centré sur le plein exercice de la citoyenneté pour tous et celui plus ancien du traitement moral ont en commun qu’ils insistent tous les deux pour que les personnes atteintes de maladies mentales soient traitées avec dignité et respect. Toutefois, alors que le traitement moral se prodiguait à l’intérieur de l’enceinte asilaire, l’objectif des soins axés sur le plein exercice de la citoyenneté est pour sa part celui d’une vie et d’un soutien dans la communauté et pour tout le monde. Nous suggérons tout de même que Pussin et Pinel ont formulé des idées probablement si avant-gardistes que nous commençons tout juste à les comprendre et à vouloir les appliquer à nos pratiques postasilaires.
Mots-clés :
- Pinel et Pussin,
- naissance de la psychiatrie,
- traitement moral,
- psychiatrie citoyenne,
- rétablissement
Abstract
Objectives: Moral treatment is a psychological approach that contrasted sharply with a treatment of constraint, beatings, immersion in cold water, diet, or repeated heavy bleeding. In response to the violent treatment that was common in asylums of late 18th century, Philippe Pinel conceived a ‘medical moral treatment’. This paper considers the roots of the recovery paradigm in the pioneering work of Philippe Pinel and Jean-Baptiste Pussin. The aim is to discuss the early 19th century moral treatment to identify some key principles that can also inspire citizenship-oriented mental health care, but we also suggest that a simple equating of citizenship-oriented practice with moral treatment overlooks some of the central aspects of the recovery paradigm.
Methods: One of the main sources for this discussion is Pinel’s “Memoir on madness” (Pinel, 1794), offered for the first time to the English-speaking reader by Dora Weiner. This analysis also draws on the “Observations of Citizen Pussin” that Pinel asked him to write for both of them to articulate fully several of the key principles of their humanistic approach.
Results: Looking back on the humanistic principles that were at the core of the pioneering work of Philippe Pinel and Jean-Baptiste Pussin, we suggest that the “moral treatment” they were advocating, more than 200 years ago, was in some ways based on a genuine patient partnership, especially on peer support. The contemporary recovery movement, that might also be centered on the full exercise of citizenship, and the older “moral treatment” have in common that they both insist that people with mental illness be treated with dignity and respect. However, while the “moral treatment” was taking place within the asylum, the goal of citizenship-oriented mental health care is one of a life in the community for everyone. We suggest, nevertheless, that Pinel and Pussin have formulated ideas probably so forward thinking that we are just beginning to understand and try to apply them to our post-asylum practices.
Conclusion: Pinel’s philosophy of psychiatry both undergirded moral treatment and can be useful in shaping contemporary patient-centered and citizenship-oriented practice. The insights and lessons offered by Pinel and Pussin are far from being limited to the place and time of their creation. Recent advances in mental health care have been based on insights identical to those of Pinel and Pussin regarding the episodic nature of the illness, the rarity of the illness becoming all-encompassing, the reality of recovery, and the valuable roles that employment and peer mentoring can play in promoting it. We have now seen in the two hundred years that followed the publication of Pinel’s Treatise the failures of asylums to provide moral treatment to persons with mental illnesse. In contrast, citizenship-oriented care stresses the importance of self-determination and the active role of the person in recovering a sense of efficacy and agency as a foundation for full citizenship for all.
Keywords:
- Pinel-Pussin,
- roots of psychiatry,
- moral treatment,
- citizenship-oriented mental health care,
- recovery
Parties annexes
Bibliographie
- Berrios, G. (2006). Introduction to : ‘Mind in general’ by Sir Alexander Crichton, (Classic Text No. 68 :). History of Psychiatry, 17(4), 469-497.
- Burti, L. (2001). Italian psychiatric reform 20 plus years after. Acta Psychiatrica Scandinavia 104 (Suppl. 410) : 41-46.
- Charland, L. (2007). Benevolent theory : moral treatment at the York Retreat. History of Psychiatry, 18, 61-80.
- Charland, L. (2010). Science and morals in the affective psychopathology of Philippe Pinel. History of Psychiatry 21 : 38-53.
- Davidson, L., Rakfeldt, J., et Strauss, J.S. (2010). The roots of recovery in psychiatry : Lessons learned. Chichester : Wiley Blackwell.
- Foucault, M. (1972). Histoire de la folie à l’âge classique. Paris : Gallimard.
- Gauchet, M. et Swain, G. (1980). La Pratique de l’esprit humain, Paris : Éditions Gallimard.
- Juchet, J. et Postel, J. (1996). Le « surveillant » Jean-Baptiste Pussin à la Salpêtrière. Histoire des sciences médicales, 33(2), 189-198.
- Pelletier, J.-F., Corbière, M, Lecomte, T, Briand, C, Corrigan, P, Davidson, L, Rowe, M. (2015) Citizenship and Recovery : Two Intertwined Concepts for Civic-Recovery, BMC Psychiatry, 15(37).
- Pinel, P. (1794). Observation sur la manie pour servir l’histoire naturelle de l’homme, Société d’histoire naturelle. Reproduit dans Postel, J. (1981). Genèse de la psychiatrie. Les premiers écrits psychiatriques de Pinel. Paris : Le Sycomore.
- Pinel, P. (1798). Nosographie Philosophique : ou la méthode de l’analyse appliquée à la médecine (1re éd.). Paris : Marandan.
- Pinel, P. (1801). Traité médico-philosophique sur l’aliénation mentale ou la manie (1re éd.). Paris : Richard, Caille et Ravier.
- Pinel, P. (1809). Traité médico-philosophique sur l’aliénation mentale ou la manie (2e éd.). Paris : J.A. Brosson Éditeur.
- Pinel, P. (1807). Nosographie philosophique, ou, La Méthode de l’analyse appliquée a la médecine (3e éd.). Paris : J.A. Brosson Éditeur.
- Pussin, J.-B. (1797). Observations faites par le Citoyen Pussin sur les fous (250-253), reproduit dans Weiner, D. (1980). Philippe-Pinel et l’abolition des chaînes : un document retrouvé. L’Information psychiatrique, 56(2), 245-253.
- Richards, T, Montori VM, Godlee F, Lapsley P, et Paul D. (2013). Let the patient revolution begin. British Medical Journal, 346 :f2614. doi : 10.1136/bmj.f2614.
- Salkeld, R., Wagstaff, C. et Tew, J. (2013) Toward a new way of relating : An evaluation of recovery training delivered jointly to service users and staff. Journal of Mental Health, 22(2), 165-173.
- Sueur, L. et Beer, D. (1997). The psychological treatment of insanity in France in the first part of the nineteenth century, History of Psychiatry,8, 37-53.
- Weiner, D. (1979). The apprenticeship of Philippe Pinel : A new document, ‘Observations of Citizen Pussin on the Insane.’ American Journal of Psychiatry, 36(9) : 1128-1134.
- Weiner, D. (1999). Comprendre et soigner : Philippe Pinel (1745-1826). La Médecine de l’esprit. Paris : Fayard.
- Weiner, D. (1980). Philippe-Pinel et l’abolition des chaînes : un document retrouvé. L’Information psychiatrique, 56(2), 245-253.
- Weiner, D. (1992). Pinel’s ‘Memoir on Madness’ of December 11, 1794 : A fundamental text of modern psychiatry. American Journal of Psychiatry, 149(6), 725-732.
- Woods, E. et Carlson, E. (1961). The psychiatry of Philippe Pinel. Bulletin of the History of Medicines, 35, 14-25.