The first alienists

 1792

The first psychiatrists, called alienists, developed a new treatment for the mentally ill. Their method of moral management focused on a dependence relationship between doctor and patient. The psychiatrist used his authority to get a grip on the inmate. He tried to influence his reasoning and subdue his passions.

In the history of psychiatry, the first half of the 19th century is described as the period of moral management. This is immediately linked with the names of the pioneers of French psychiatry, Philippe Pinel and Etienne Esquirol. However, moral management actually started in Britain in the second half of the 18th century. As early as 1758, William Battie made a plea for moral management of the insane. The concept of moral management had even greater impact when, in 1792, the Quakers, a religious sect dedicated to charitable works, formerly known as the Religious Society of Friends, started to practise moral management in their institution, the York Retreat, under the leadership of William Tuke.

The most potent remedy that the psychiatrist had for his moral management was the institution itself.

However, Pinel was the first person to make a thorough study of moral management and to apply it. This was due to the changed political and philosophical climate in post-revolutionary France. Esquirol, one of his students, developed the ideas and contributed in large measure to the first French law for the treatment of the insane, which was introduced in 1830. Moral management aims to adopt a non-somatic approach.

It is a form of psychological manipulation in which passions, or emotions, play a key role. According to Pinel, the mentally deranged patient had to be subjugated by manoeuvring him into a close relationship of dependence on someone who was physically and morally superior. This person had to try to obtain an irresistible grip on the mentally ill patient, in order to influence his reasoning and subdue his passions. The physician-psychiatrist was the obvious choice for this position of authority.

The most potent remedy that the psychiatrist had for his moral management was the institution itself. The fabric of the asylum and, in particular, the house rules had to be organized in such a way that they strengthened the power exerted by the physician over the inmates.