In 18th-century France, physicians searched for the causes of mental illness and debated how best to treat it.
Looking Back to Look Forward
This MONTH in PSYCHIATRY
Revolutionary Paris was the center of things in more ways than one. Dr Phillipe Pinel, a child of the Enlightenment, laid down principles of psychiatry that many still follow today. Pinel, followed by his epigone Dr Jean-Étienne Dominique Esquirol, believed that the root cause of mental illness lay in the environment. Patients therefore required “moral treatment,” based on the belief that individuals exhibiting mental illness could be carefully re-educated in the humane and orderly regime of a reformed asylum.
Paris, a city associated with hedonism, indulgence, creativity and apostasy, was the home of a new psychiatric illness: generalised paresis of the insane (GPI). It was characterised by grandiose thinking, disorganized behaviour, emotional outbursts, and flights of wild fantasy culminating in collapse, rapid dementia, and paralysis. Patients were unable to care for themselves, dying mostly in lunatic asylums.
The Pinel school attributed GPI to environmental causes. But then one of the most original and unusual characters in the history of psychiatry arrived on the scene and challenged the environmental hypothesis. His name was Antoine Laurent Jessé Bayle. As a Royalist, he was swimming against the political currents of the day and a possible candidate for persecution. He had trained under Dr René Laennec, a proponent of the then-unfashionable anatomico-pathological view and inventor of the stethoscope.
Bayle went into psychiatry at the Royal Asylum for the Insane at Charenton in 1818. Up to one-third of the male patients had GPI, and it was clear that moral therapy was not going to provide a solution to their illness.
On November 21, 1822, Bayle presented his doctorate, describing 6 autopsy cases of GPI with gross thickening of the meninges and inflammation of the vasculature. GPI, he stated, was due to chronic meningo-vascular arachnoiditis. Its cause was anatomical, not environmental or moral. This extraordinary discovery was made by a young man at the level of what today would be regarded as internship. He was precociousness personified.
The significance of Bayle’s finding cannot be understated. It was the first description of “the visible and definable neuropathological cause of a psychiatric disease” and deserves to go down in history as the fons et origo of the scientific roots of the discipline.1
In 1825, Bayle pushed the envelope by claiming that all insanity was due to chronic meningeal inflammation. The response from his peers was critical, if not caustic. Dr Étienne-Jean Georget (making sure he did not leave anything out) condemned Bayle of being shallow, impertinent, showing exaggerated pretension, immature, reaching impossible conclusions, and having a rash nature.
Undeterred, Bayle went on to write up 100 autopsy findings in 1826, warning that the moral school “could lead one astray by making one neglect the organic cause of diseases, by focusing too exclusively on derangements of function.”
At the age of 27 Bayle walked away from psychiatry to become an archivist and sank into obscurity.
If the environmentalists won the battle, it was a short-lived victory; the war was eventually lost—decisively. Bayle had correctly anticipated a paradigm shift. Within decades, the anatomico-pathological model ruled supreme. The center of psychiatric gravity accordingly moved to the Germanic world, and French psychiatry was never the same.
Dr Kaplan wrote about syphilis in his book The Exceptional Brain and How it Changed the World. He is Clinical Associate Professor at the Graduate School of Medicine, Wollongong University and Research Fellow, History Department, Stellenbosch University, South Africa.
1. Kaplan RM. Syphilis, sex and psychiatry, 1789-1925: Part 1. Australas Psychiatry. 2010;18(1):17-21.