Monday, April 20, 2020

Overcoming the fairy circle of antiphlogisticism with traitement moral

Anti-phlogistic physicians saw disease as fundamentally a problem of inflammation and fever. The 'original' principle of phlogiston was posited by Georg Stahl (Taylor, 2006). Substances were flammable because they contained phlogiston, believed to be an elemental fatty earth. William Cullen was at the forefront of chemistry as well as medicine (see eg. previous post). For Cullen, phlogiston was not a metaphysical ‘principle’ of inflammability, but firmly in the world of ordinary matter.

As Searle (1835) said, in his Lancet article (Volume 23, Issue 594, 587-90), antiphlogistic treatment was "considered to be corrective of a phlogistic condition". As he goes on, antiphlogistic treatment by some was "not confined to inflammatory complaints, but ... [was] adopted in almost all other cases, with the view of preventing inflammation and fever" [emphasis in original]. Purgatives and emetics seemed to demonstrate the truth of Stoll's theory that most illnesses resulted from gastric impurities, especially bile. Bleeding, purging and making use of emetics, were all designed to counteract and to deplete the over-active, over-heated body.

From Phillippe Pinel's point of view in A treatise on insanity,
physicians have ... allowed themselves to be confined within the fairy circle of antiphlogisticsm, and by that means to be diverted from the more important management of the mind (p.4)
Pinel's approach which was called traitement moral (translated as moral treatment) gave preference to "ways of gentleness" and minimised the use of restraint. Essentially it involved the use of contrived situations, artifice and pious fraud. A variety of strategies were used to control difficult patients, including stern warnings, the manipulative use of food and privileges, and physical restraints, as well as various theatrical gestures designed to shock patients out of their morbid ways of thinking.

There are ethical questions about such techniques, but they at least focused on emotional factors, and such moral treatment can be seen as arising out of Pinel's conceptual understanding of mental disorders as "lesions of the function of understanding". As far as he was concerned, insanity has a "moral" cause rooted in ideas and the passions.  This did not mean the body was not implicated, as he took an integrated mind/body understanding, in that le moral and le physique were seen as interrelated. Standing out against many other anatomists, he was aware from his own dissections that insanity does not have a discernible brain lesion.

No comments: