Madness and Glory: (6): Back to the Asylum
The story of Philippe Pinel, father of modern psychiatry. Part 6.
Posted May 08, 2019
This is historical fiction. Lalladiere, some hospital personnel, and members of the government are fictitious but Phillipe Pinel and his actions were real.
It took more than two hours. Théo went to the gendarmerie, was sent to Bicêtre to report the immobile man on the floor in his house, and waited until the attendants, Denis and Ajacis, were dispatched. Before that, Théo, Suzette, and a fascinated Jean-Luc exerted great effort attempting to lift Lalladiere up, rouse him, stir him in some way. And each time his head, arms, or legs remained compliantly where they were put. Théo, believing that Lalladiere was faking and putting on an elaborate act, grabbed several of his wife’s milliner’s pins and stuck them into various portions of the immobile body. No reaction, not even a grimace. Baffled, he realized, faking or not, this must be the escaped lunatic. They needed to get him out, taken back to the Bicêtre.
When the two attendants arrived at the house, they went immediately to the room to see the familiar, for them, recumbent wax statue. After a quick glance at Lalladiere’s crooked arm motionless in space, Denis and Ajacis together set about the difficult task of lifting the dead-weighted body onto a wood-slatted litter. In the past, they would have immediately set into a lunatic in that condition with beatings and whippings, but things had markedly changed. Later, outside the house people who heard about the madman at the house of the Rochereaus felt no such constraint. When the attendants drove the litter back to Bicêtre, bystanders spit at the cart and hit at it with pikes.
Jean-Luc watched his new friend carried by Denis and Ajacis and followed them cheerlessly to the cart. His parents told him that lunatics were exposed to the evil eye and possessed by the Devil, but Jean-Luc knew something else about this man he found hiding in the enclosure by the side of the street. He had correctly recognized Lalladiere’s fear, his paralyzing helplessness. He hoped this man, the lunatic, wouldn’t be hurt when he got back to the Bicêtre. Hurt? The word reverberated in his mind. His father, he was sure, would now punish him badly for having brought Lalladiere home.
Theo determined first to go to the house of the local municipal Section Leader, a sans-culotte revolutionary, and complain about the Bicêtre escape.
“They’ve unchained the madmen. They are running all over Paris,” he blurted as Section Leader Henri Barchon came to the door.
“What? The devil, the living devil.”
“Yes. One of them just came to my house. By God, he bewitched my son. Attendants from the asylum, I called them, they had to pull and pull on him, almost had to use a crane to get him out. Got him away, finally, in a large litter.”
“Was he dangerous?”
“You have to know he was. Couldn’t rouse him, but I was sure the whole time he would come at me the minute I turned my back.”
“Who is responsible for this?”
“It’s the new head of the Bicêtre, I was told. He’s having all those lunatics unchained. And so they escape, move around the streets, come right to our houses. No one is safe.”
“Is this new head an aristocrat?”
“Name’s Pinel, doctor Pinel.”
“It must be an aristocrat plot,” Barchon said, spitting through his teeth. “They release the madmen into the streets. Cause holy mayhem. Distract us from hunger and the work to overthrow them.”
“What can we do?”
“I will report this to the leaders at the Commune.”
Denis also was thinking about punishment, the strict new rules against beating and chaining, and Lalladiere’s escape. He was relieved that the inmate was finally rounded up and soon back where he belonged. But Denis could never stand the taking on of that kind of paralysis. The strange condition which, experienced as he was, also appeared always like make-believe. He had come to agree with the new rules, but right then felt like beating Lalladiere into responding. This man was a real person, not a mass of wax, or clay, or tar that could be shaped into any form you put it. Lying there in one place without moving, or resisting, or acting like a human being, he was infuriating. Denis felt sure it was done on purpose. If not, he couldn’t understand what the lunacy was, what made Lalladiere crazy that way. He couldn’t quite believe in ideas about lunatics being possessed. But if the ideas were right, if Lalladiere was possessed, Denis wanted to beat the damned burrowing spirit out of him. Ajacis, though quiet, had no doubts at all about causes, but he vowed to himself that he would find a way to do just that.
In the cart, Lalladiere’s lashed-down body lurched from side to side as the hard wheels bounced over the cobbled street. Clear thoughts and even voices came rarely. He dimly knew that enemies were on every side carrying him away to tear him apart and kill him. He knew he had to continue motionless, lying tightly against the boards of the cart as though tied against them. Then, outside the cart, he heard a faint chorus of beautiful voices beckoning to him.
Come, Guillaume. Come to us. Stately, stately, soft and caring. Sweet serenity, the well of all compassion. Oh come to us, we are near to you, so near. Come.
These were sounds and voices he had never heard before. Lovely, ethereal sounding, and melodious. He thought to move toward them, but his body constrained him. His arms and legs were still bound by deeper convictions inside. The chorus also was out to trap him, bring him close, then tear him apart and kill him. As the cart moved onward, they did not leave, their harmonies grew more beautiful, their calls and offers became more persistent, wafting through the boards.
At Bicêtre, he was taken directly to a cell for solitary confinement. He stayed there into the night, motionless, still hearing the beckoning voices through the walls. They promised to love him, take care of him forever, if he would only stir himself, move, and come to them. Finally he fell asleep, awakening a short time later to raucous, more familiar voices. They told him what a low, unworthy, shiteating person he was, and cautioned him never to respond to any commands but theirs. To them, he mumbled quietly over and over: “I know, I know.”
The door of his cell opened and the attendant Ajacis entered. Without a word, the tall, burly, red-headed figure walked to where Lalladiere was lying, and with a long flat handle board in hand, began to beat the inert legs stretched out on the floor. Seeing that Lalladiere’s legs did not move, even to avoid the blows, he deftly shifted the board to his other hand and pummeled his upper body.
“I know you, you faking runaway. Devil, goddamned freak. You were the one at the Bastille who went through the garden of the arsenal, climbed up onto those roofs and got inside,” Ajacis said as he continued to strike at arms, shoulders, and ribs.
“You were a great hero, eh? Ain’t it so, freak?”
No moan, no sound from Lalladiere.
“Nobody even noticed what I did there.” Still no sound despite the blows, only involuntary twitching.
“Who do you think grabbed the bastard governor de Launey outside the fortress and, in the middle of that muddled crowd, slit his throat?”
Quite skillful with the heavy board, as well as with any kind of beating, Ajacis smashed the flat face of it against Lalladiere’s arm, moving his hand closer to his body.
“Well, now you know, hero-freak,” Ajacis hissed as he took the board into both hands and hit at the groin, upper legs, and other portions of the ribs and arms, “I will get you to move again but not so you can ever run and escape. This will teach you not to do your climbing up on roofs and make attendants search for you again.”
Lalladiere’s silence, although at times his body shifted slightly in painful recoil from the blows, seemed to deprive Ajacis of full enjoyment of his punishment. He noticed, in the minimal light, that he had already raised great welts on the body and bleeding had begun in several places, providing a tell-tale account of the flogging. Warnings from both governor Pussin and Dr.Pinel were strong and persistent. Although this beating would not likely be traced to him—the freak says nothing or, if he lives, only crazy things—he had to be careful.
Despite excruciating pain, Lalladiere did not stir when Ajacis left the cell, nor did he change the stilted position he was left in.
Urine that passed out of him during the night stayed wet in his clothes.
Food quickly left at his door the next morning by an indifferent attendant Georges was not approached or touched. When Georges at midday brought food to the cell, he noticed the bread and full cup on the floor and entered to see the welts and oozing blood on Lalladiere’s body. Not quite so indifferent but mostly afraid he would be blamed, Georges washed off much of the blood and covered some of the bruises and welts.
Late that afternoon, hospital governor Pussin came with attendant Antoine into Lalladiere’s cell. For a moment, he stood in silence by Lalladiere’s immobile body with arms extended bizarrely over the edges of the straw-matted cot. Despite his experience with this man and others, the sight also made him wonder momentarily whether the man was faking. He was immediately troubled, though, by the sight of the dressings, welts, and oozing blood. Pointing at them, he looked sternly at Antoine.
“Who did this?”
“I am sorry, governor Pussin, I don’t know”
“Whoever did this will be sorry. We do not tolerate beatings at Bicêtre any more. The man will be fired. Clean him up, I will wait.”
Pussin watched while Antoine tried to clean the remaining blood on the awkwardly placed limbs. Lalladiere did not shift or move. He would not, Pussin thought, speak about the beating. He went outside, brought in a stool, and sat down.
“This is governor Pussin, Lalladiere, I have come to see you.”
“You ran away from us, Lalladiere. We have taken away your chains, allowed you to walk freely in the yard. And now you run away. Do we shackle you again?”
Lalladiere, immobile and silent, heard again the beautiful voices. Pussin, also silent, watched his unrevealing face. Then:
“You will stay here in solitary now, you understand. You must not run away again.” His words mixed with the singing.
Come, oh come to us. Sweet, oh sweet serenity.
Thinking about the need to inflict a strong noncorporal deterrent, Pussin waited. But first he needed to get Lalladiere to respond. He recognized the man was suffering, not simply from the beating. Often, in the past, he was able to elicit some reaction by getting himself on the inmate’s side, consoling him in some way.
“I do not know who beat you, but we will not let it ever happen again. We do not want to hurt you, humiliate or torment you, Lalladiere. You are safe here. We will keep you safe.”
No evidence of any effect, or even that the words were heard. Pussin, with a distinctly sincere tone, repeated his reassurance of safety. Was there now a slight movement, a shifting, in his left hand?
“You are not hopeless.”
Although there was little change at first, Pussin, over and over at measured intervals and in a steady voice, repeated his assertions first of security and then of hope. Slowly, gradually, Lalladiere’s body loosened. No limb movements yet or alterations of position, but governor Pussin knew he had touched a chord. They were few words, meager offers of care and promise, but they were conveyed by him, the caretaker, with steady conviction. That, together with the protection and assured restraint of the hospital cell’s surrounding walls, might help Lalladiere to move again. Pussin did not know but vaguely guessed that close walls and care served to protect an inmate from his own fears of discharging his destructive impulses. He got up to leave the cell, walked to the door, and looking back, saw Lalladiere’s arm bend a little in preparation for turning in the cot.
The next day, in his daily report to Dr.Pinel, governor Pussin brought up Lalladiere and his condition. He spoke concisely, descriptively, confident of the doctor’s understanding. Pinel had, in the short time since assuming leadership of the asylum, become Pussin’s hero. The cessation of inmate beatings and removal of chains, a policy which the governor had been attempting to introduce at Bicêtre for several years, was enthusiastically taken up by Pinel soon after he arrived. He recognized it was a breakthrough for medical treatment and a liberation from malfeasance and pain. It was, of course, a big change, a radically new one that had already had stirred up difficulties with the leaders in the Paris Commune. Pinel had recently received an official letter from them demanding he stop all runaways. But the doctor was determined to continue; he decided to keep records and address himself to the medical community. He began to document both the early successes and the failures in writing.
“Dr. Pinel,” Pussin said, “the man has shown this negative state before and come out of it, slowly.”
“A state of waxy flexibility, you mean.”
“Yes, exactly. It was of course pointless, because of the lack of movement, to use a straightjacket with him. But Lalladiere has run away, and it is necessary still to show firmness.” Pussin decided to handle the beating himself and not for the moment to tell Pinel about it.
“You do that well, Pussin. Consolation, reassurance, which you always temper with firmness. Has this patient been treated elsewhere?”
“Transferred here a few months ago from the Hospice d’Humanité. The usual treatment. Cathartics, bloodletting, and baths. Before Lalladiere suddenly became insane, Dr. Pinel, he was a man of intelligence and influence, assistant to Minister Necker.”
“Tell me what you have observed.”
Pussin described Lalladiere’s escape, the reports of his scaling stone walls, running over the roofs of buildings, impressive feats of vigor and agility. He went on then to recount Lalladiere’s behavior since coming to the Bicêtre asylum. There were periods of extreme agitation, violent resistance when being restrained, vile and abusive language. These were often followed by long stretches of docility, only rarely by descent into the waxy flexibility. Sometimes, he even was quite collaborative, helping attendants and other inmates.
The man surely heard non-existent things. He frequently moved his lips in a repetitive way with an undertone of conversation and other sounds. Both his agitation and immobile states responded better, Pussin noticed, to comments about his probable state of mind than to force. Not always, however. He was a difficult patient.
Observation. Pinel listened intently to the details of Pussin’s account. Up to then, he knew little about Lalladiere. There were far too many inmates at Bicêtre for him to know or follow each. But beyond that, careful observation was, he believed, absolutely vital and he relied strongly on the reports of this canny, resourceful governor.
Pinel had been trained at the Montpelier medical school of southwestern France to derive all theory and practice from observation, and had gone eagerly beyond his teachers. Fascinated from an early age by the classics, he avidly studied Greek and Latin works pertaining to illness, both literary and historical, and devoured the writings of the early physicians Galen and Hippocrates. He found all of these contained important knowledge derived from observations about disease and treatment. When he later undertook the care of lunatics, he discovered careful documentations by the early physicians about such patients that were particularly useful. They were keener observers of the insane than the long procession of physicians who came after them, including some of his teachers. His father, a humble and devoted rural barber-surgeon, also read widely and encouraged him to learn as much as he could about the care of people. Reading classical medical works as well as philosophy in a grassy field near the school, he thought someday he might make an important contribution to medical knowledge and treatment.
At the Bicêtre, both Jean-Jacques Pussin and his collaborator wife Marguerite showed him sick inmates who had at one time been beaten in response to agitated ramblings and attacks and were chained as punishment or containment. These inmates, they reported, became even more vicious and resentful. At the smallest opportunity they had attacked attendants whose attention lapsed when they came to feed them, maiming and sometimes murdering them. Other shackled inmates, as Pinel continually saw, remained in complete lassitude and torpor, lacking even any concern with their own filth. These he ordered freed and cleaned up immediately.
“Yes, Pussin, I agree with keeping him in solitary confinement. Without the chains, as we have seen, we must still be firm”.
“It is important that he knows, when he comes to move freely, as he surely will, that he cannot run away again.”
“Important for his sake, Pussin. But unfortunately we must also insure against those who are already attacking us for allowing such a man to be free.”
Pussin, narrow-eyed in a deeply creased face slitted his eyes further and nodded. “Then, when eventually he collaborates, as he has before, I shall try—I hope I can arrange it—to give him work to do in the institution. I have not been able to find something suitable up to now.”
“Fine, fine. We can then observe whether work is effective for him.”
“We have already had many improve as a result.”
“No other hospitals I know of do it, but the idea has a sound basis.”
“An antidote to insanity.”
“Indeed, but it comes from ancient wisdom.”
“What do you mean?”
“Observation, Pussin. Observation.” Pinel pointed with his index fingers to the edges of his eyes. “What we can clearly divine from the sequences, documented by the wisely observant ancients, about such a type as the great Greek hero, Herakles. First, he went mad and killed his children. Then, he was given a series of tasks to perform—far, far more difficult at any rate than any you could put forward here—but tasks that healed. As it is reported, he gradually regained his senses fully.” [a1]
“Hercule, the great strongman?” Pussin asked, frowning and giving the famous hero’s name a French rather than Greek rendering. He was not accustomed to thinking in such grand analogies.
“I see you are troubled,” Pinel said, smiling and with the flat of his hand tapping the air in front of him. “Did you not know that the great Herakles—Hercule, that is—went mad with fervor and violence?”
Then, as Pussin refrained from answering, Pinel added, his blue eyes twinkling, “So, it is not that, then. It is the Herakles. You are distressed that the great strongman was not a Frenchman, is it not so?”
As Pussin looked away and sputtered, Pinel said laughing, “Do not fret, Pussin, you have helped me greatly. I shall go to see Lalladiere this afternoon”.