À l’origine même de la psychiatrie comme nouvelle spécialité médicale : le partenariat Pinel-Pussin
Jean-François Pelletier
Ph. D., professeur adjoint sous octroi, Département de psychiatrie, Université de Montréal, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
Assistant Clinical Professor, Department of Psychiatry, Yale University
Larry Davidson
Ph.D., Professor, Department of Psychiatry, Yale University, New Haven
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
At the very roots of psychiatry as a new medical specialty: the Pinel-Pussin partnership
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
Auteurs : Jean-François Pelletier et Larry Davidson
Titre : À l’origine même de la psychiatrie comme nouvelle spécialité médicale : le partenariat Pinel-Pussin
Revue : Santé mentale au Québec, Volume 40, numéro 1, printemps 2015, p. 19-33
URI : http://id.erudit.org/iderudit/1032380ar
DOI : 10.7202/1032380ar
Tous droits réservés © Département de psychiatrie de l’Université de Montréal, 2015
