Jean-Étienne Dominique Esquirol
Encyclopedia
Jean-Étienne Dominique Esquirol (1772–1840) was a French
psychiatrist
.
Born and raised in Toulouse
, Esquirol completed his education at Montpellier
. He came to Paris
in 1799 where he worked at the Salpêtrière Hospital
and became a favorite student of Philippe Pinel
.
To enable Esquirol to take up the intensive study of insanity
in an appropriate setting, Pinel reportedly put up the security for the house and garden on Rue de Buffon where Esquirol established a maison de santé or private asylum
in 1801 or 1802. Esquirol's maison was quite successful, being ranked, in 1810, as one of the three best such institutions in Paris.
In 1805 he published his thesis The passions considered as causes, symptoms and means of cure in cases of insanity. Esquirol, like Pinel, believed that the origin of mental illness
could be found in the passions of the soul and was convinced that madness does not fully and irremediably affect a patient's reason.
Esquirol was made médecin ordinaire at the Salpêtrière in 1811, following the death of Jean-Baptiste Pussin
, Pinel's trusted concierge. Pinel chose Esquirol because he was "a physician… devoted exclusively to the study of insanity," arguing that with his many years of maison de santé experience he was the only man suited for the job.
Esquirol saw the question of madness as institutional and national. This was especially true for the poor where he saw the state, with the help of doctors, playing an important role. He also saw an important role for doctors in caring for people accused of crimes who were declared not responsible by reason of insanity. In public controversies over this question he promoted the usefulness of the diagnosis of monomania
. By taking such an active role in these public matters, his fame eclipsed that of his teacher Pinel.
In 1817, under the restored Bourbon monarchy, Esquirol initiated a course in maladies mentales in the makeshift quarters of the Salpêtrière dining hall. This was perhaps the first formal teaching of psychiatry
in France. At this time he was neither a professor at the Paris faculty or the chief physician at a Paris hospital, but merely a médecin ordinaire. Nonetheless he was reported to have been one of the clinical instructors to whose hospital visits "students flock with a kind of frenzy". He had many very distinguished students.
In 1810, 1814 and 1817 Esquirol, at his own expense, had toured facilities for lunatics throughout France
. In 1818 following these trips he wrote a short memoir presented to the minister of the interior
and a more detailed description of his findings published in the Dictionnaire des sciences médicales. These articles described, in precise and frightening terms, the conditions in which the insane lived throughout France. They demonstrate that the reforms undertaken in Paris had not penetrated the provinces. Together these two articles constituted a program of reform directed both at the government and the medical profession.
This program consisted of four points:
At the behest of the minister of internal affairs, Esquirol next undertook a nationwide survey, visiting all the institutions throughout France where mental patients were confined. In 1822 he was appointed inspector general of medical faculties, and in 1825 director of Charenton Hospice. He became the main architect of the national law of 1838 that instituted departmental asylums for all needy French mental patients and that is still in force today. In 1834, he was elected a foreign member of the Royal Swedish Academy of Sciences
.
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
psychiatrist
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
.
Born and raised in Toulouse
Toulouse
Toulouse is a city in the Haute-Garonne department in southwestern FranceIt lies on the banks of the River Garonne, 590 km away from Paris and half-way between the Atlantic Ocean and the Mediterranean Sea...
, Esquirol completed his education at Montpellier
Montpellier
-Neighbourhoods:Since 2001, Montpellier has been divided into seven official neighbourhoods, themselves divided into sub-neighbourhoods. Each of them possesses a neighbourhood council....
. He came to Paris
Paris
Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...
in 1799 where he worked at the Salpêtrière Hospital
Pitié-Salpêtrière Hospital
The Pitié-Salpêtrière Hospital is a teaching hospital located in Paris, France. Part of the Assistance publique - Hôpitaux de Paris, it is one of Europe's largest hospitals...
and became a favorite student of Philippe Pinel
Philippe Pinel
Philippe Pinel was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy...
.
To enable Esquirol to take up the intensive study of insanity
Insanity
Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity...
in an appropriate setting, Pinel reportedly put up the security for the house and garden on Rue de Buffon where Esquirol established a maison de santé or private asylum
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
in 1801 or 1802. Esquirol's maison was quite successful, being ranked, in 1810, as one of the three best such institutions in Paris.
In 1805 he published his thesis The passions considered as causes, symptoms and means of cure in cases of insanity. Esquirol, like Pinel, believed that the origin of mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
could be found in the passions of the soul and was convinced that madness does not fully and irremediably affect a patient's reason.
Esquirol was made médecin ordinaire at the Salpêtrière in 1811, following the death of Jean-Baptiste Pussin
Jean-Baptiste Pussin
Jean-Baptiste Pussin was a hospital superintendent who, along with his wife and colleague Marguerite, is recognized as having established more humane treatment of patients with mental disorders...
, Pinel's trusted concierge. Pinel chose Esquirol because he was "a physician… devoted exclusively to the study of insanity," arguing that with his many years of maison de santé experience he was the only man suited for the job.
Esquirol saw the question of madness as institutional and national. This was especially true for the poor where he saw the state, with the help of doctors, playing an important role. He also saw an important role for doctors in caring for people accused of crimes who were declared not responsible by reason of insanity. In public controversies over this question he promoted the usefulness of the diagnosis of monomania
Monomania
In 19th century psychiatry, monomania is a single pathological preoccupation in an otherwise sound mind. Emotional monomania is that in which the patient is obsessed with only one emotion or several related to it; intellectual monomania is that which is related to only one kind of delirious idea...
. By taking such an active role in these public matters, his fame eclipsed that of his teacher Pinel.
In 1817, under the restored Bourbon monarchy, Esquirol initiated a course in maladies mentales in the makeshift quarters of the Salpêtrière dining hall. This was perhaps the first formal teaching of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
in France. At this time he was neither a professor at the Paris faculty or the chief physician at a Paris hospital, but merely a médecin ordinaire. Nonetheless he was reported to have been one of the clinical instructors to whose hospital visits "students flock with a kind of frenzy". He had many very distinguished students.
In 1810, 1814 and 1817 Esquirol, at his own expense, had toured facilities for lunatics throughout France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
. In 1818 following these trips he wrote a short memoir presented to the minister of the interior
Minister of the Interior (France)
The Minister of the Interior in France is one of the most important governmental cabinet positions, responsible for the following:* The general interior security of the country, with respect to criminal acts or natural catastrophes...
and a more detailed description of his findings published in the Dictionnaire des sciences médicales. These articles described, in precise and frightening terms, the conditions in which the insane lived throughout France. They demonstrate that the reforms undertaken in Paris had not penetrated the provinces. Together these two articles constituted a program of reform directed both at the government and the medical profession.
This program consisted of four points:
- First, that insanity should be treated in special hospitals by physicians with special training.
- Second, that reform involved exporting the advances made in Paris to the provinces.
- Third, that "a lunatic hospital is an instrument of cure". By this he meant that the physical structure of new psychiatric hospitals must be designed to support the practice of the new specialty.
- Fourth, Esquirol insisted on the definitive medicalizationMedicalizationMedicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...
of the care of the insane. "The physician must be the vital principal of a lunatic hospital. It is he who should set everything in motion… The physician should be invested with an authority from which no one is exempt."
At the behest of the minister of internal affairs, Esquirol next undertook a nationwide survey, visiting all the institutions throughout France where mental patients were confined. In 1822 he was appointed inspector general of medical faculties, and in 1825 director of Charenton Hospice. He became the main architect of the national law of 1838 that instituted departmental asylums for all needy French mental patients and that is still in force today. In 1834, he was elected a foreign member of the Royal Swedish Academy of Sciences
Royal Swedish Academy of Sciences
The Royal Swedish Academy of Sciences or Kungliga Vetenskapsakademien is one of the Royal Academies of Sweden. The Academy is an independent, non-governmental scientific organization which acts to promote the sciences, primarily the natural sciences and mathematics.The Academy was founded on 2...
.
External links and references
- Goldstein, Jan. Console and Classify: The French Psychiatric Profession in the Nineteenth Century, [Cambridge, Cambridge U.P., 1987].
- Weiner, Dora. ‘Le geste de Pinel: Psychiatric Myth,’ in Mark S. Micale and Roy Porter [eds.], Discovering the History of Psychiatry [Oxford, Oxford University Press, 1994] 232-247.
- Gauchet, Marcel & Swain, Gladys. [Translated by Catherine Porter], Madness and Democracy: the Modern Psychiatric Universe. [Princeton NJ, Princeton University Press, 1999].
- Rafael Huertas, "Between doctrine and clinical practice: nosography and semiology in the work of Jean-Etienne-Dominique Esquirol (1772—1840)," History of Psychiatry, 19,2 (2008), 123-140.