Madness and Glory (31): Therapeutic Encounters
The story of Phillipe Pinel, father of modern psychiatry
Posted Jun 01, 2019
This is a work of historical fiction
Pinel decided to meet in a generally regular manner with Lalladiere in the following weeks. He had not previously done this with other patients, visiting them usually for extended periods at long intervals or sometimes more frequently at Pussin’s request, but this man, whose stories were challengingly tangled, seemed now to want to talk with him. And, Pinel observed, Lalladiere’s symptoms seemed to be getting less and less severe, he behaved better in the asylum as the time went on.
He took to very careful watching of all of Lalladiere’s reactions as they spoke together. He never read or heard about doing this, either from his valued ancient sources or the work of current progressive mental hospital physicians in other countries. It was an extension of observation of symptoms, and Pinel noticed that the reactions seemed connected with particular passions or emotions. Things that might be joyful made Lalladiere’s hands fidget, sad things made him turn his head from side to side, and speaking about responsibility brought a look of terror to his eyes. He sometimes became silent when talking about accusations from the decreasingly recurrent voices. To help Lalladiere engage in discussion and, Pinel thought, to counter the passions, he commented on the reactions he saw regarding certain topics. It was effective, Lalladiere spoke more meaningfully and freely. To Pinel’s surprise, he frequently ended up talking about his parents.
His mother, Lalladiere related, behaved time and again in bizarre ways. Often, she would retreat to her bed for days at a time, or else go raging around the house screaming about something his father said. Or, she would sit at a table in the kitchen chopping at an onion over and over again. She was constantly accusatory, insisting to the young boy Lalladiere that his actions were painful and destructive to her. If he laughed about anything, he was making fun of her. Silent, he was resisting her. Playing, he was making too much noise; if he sat and did nothing, he was worthless and lazy. When he did well in school, he was trying to lord himself over her. She was sure that she could divine his thoughts, accusing him frequently of lewd or vicious intentions. At each of those times, she administered enemas to him in order to purge the intentions out of him. Throughout his childhood, he received at least one enema a day, sometimes three to four. In school, his pants were always soiled. He couldn’t remember how it was for his brother who died, but believed it was the same.
As active and intrusive as his mother was, his father was to the same degree inactive and avoidant of any contact. He never intervened when she hurled accusations at her son, nor did he respond when, as frequently happened, she instead stormed wildly at him. Sometimes after her outbursts, he disappeared for a day or two at a time, giving no account of where he had been. Seldom did he speak directly to his son, and when he did, he too was disapproving—not one bit of use around the house, did not take care of his mother when she took to her bed, and excelled in school surely by lying and cheating. A few times after one of his absences, he told Lalladiere that he would have stayed, not gone away, if he had been a better son. He never explained what he meant.
“Pussin, this man Lalladiere tells me terrible things about his parents, Pinel said one morning.”It is very troubling. I spent a good deal of time last night searching the literature—English, American, the ancients—and found no precedent for it. I believe it will be necessary to instruct him about his passions against them—anger, outrage, wishes for revenge. Parents must be honored and respected.”
“I met the mother when she came with her husband to visit. Never been here before and—pfft—they were demanding like a rabid Section Leader. But they weren’t too much worse than many of the families.”
“One thing I cannot be sure of is whether he makes it all up.”
“Yes, of course. But why?”
“We must listen and observe, Pussin. You heard me indicate to him my acceptance of his idea about a possible conspiracy. Perhaps, then, he tries to get me to believe things about his parents to shift blame for his insanity onto them.”
“It could be dangerous, Dr. Pinel, to accept his wild, possibly treasonous conspiracy talk.”
“Yes, and all of that could be delusion. His ideas about his parents could be, too.”
“Parents connected with insanity? This is not to be believed.”
“But we must consider, Pussin,” Pinel said, his face deeply thoughtful, “that the parents bring everyone into the world, eh? They care for us, train us. Only because of them do we become normal citizens, moral and responsible.”
“What are you saying, Dr. Pinel? Parents must be very strict to curb their children, is that not so? Surely that does not produce lunacy.”
Pinel nodded. “It can be so, Pussin. Best to be cautious here. Lalladiere must learn to respect, obey, and cherish his parents, just as sane people do.”
Leaving Pussin’s office, the parents of Gerard LeBlanc came into Pinel’s mind. They were not around when he watched Gerard first become eccentric, then raving and mad. Committing the young man to an asylum, to the Hotel Dieu, was all left to him. When the parents after short time came to the asylum, they insisted that Gerard be released to their care. They took him to their country house and after a few weeks he one day went into the nearby woods and shot himself in the head. Thinking about the events, Pinel felt sad and irritable. Killed himself while living in his parents’ home? Was there actually some clue in that? Beyond the betrayal was there a link between the parents and Gerard’s choice to die?
Lalladiere, in his cell, felt his mind becoming clearer. He touched the walls around him, assuring himself of their solidity and reality. Telling of his life, plunging into the forbidden world while someone important attended, helped him identify the beginnings of pain. The doctor’s lectures about passions, his suggestions for substitute involvements, were not so helpful but, to Lalladiere, they indicated caring, a wish to make his spirit well and bring him back to sanity. Most important, Dr. Pinel was interested in seeing and knowing everything about him. He received Lalladiere’s stories as information, not to find fault or justify abandonment as others had. Only for helping both to understand. Sometimes, he expressed welcome sympathy, even consolation.
Lalladiere brushed his hand across his forehead. The voices, much less frequent, remained a dimly vicious chorus. But now, he allowed himself to think about, even mull over, troublesome events in the past, especially his injury to Necker. The man prized him, trusted him. In return, he brought about his downfall and his ruin. Lies. False use of calculations, numbers Lalladiere used and cherished always as though they were friends. Distorted projections with mechanical attention to each minute detail so that the result, a fantastic construction, appeared substantial and correct. Did he know the misrepresented budget would damage the government? He remembered imagining, in his haze of disorientation and fear, Necker’s slumping shoulders, his shocked and furious face. Cheating and lying, he never did either in his life before. Rules never broken, no matter what. Be hungry rather than cheat, blood running from bitten lips rather than lie. His mother said his father lied. His father, one time when he actually addressed him, said his mother was once pure and good, but she had, with false words, infected the air they breathed. Lying caused disaster.
Many in the government, he knew, from lowest to high, lied and cheated regularly. Especially about money. His absolute honesty was one reason Necker trusted him so completely. “Isn’t that right, Dr. Pinel?” he asked aloud. In his own voice, in the empty cell, he asked loudly, “Isn’t that why I am suffering now?”
An attendant, apparently hearing his voice, came to the doorway of his cell. Trembling with fear, Lalladiere saw it was Ajacis. The man, fists doubled, began to move towards him lying on the cot. Before Lalladiere could cry out, as this time he felt able to do, the attendant Antoine appeared at the doorway bringing the midday meal. Ajacis saw him, mumbled something about Lalladiere being a pervert, and walked out. Grateful for the deliverance but still watchful, Lalladiere slowly ate the meal.
Genevieve came into his mind more frequently. She was pert and pretty during her visits, despite sometimes looking worried, in her satiny cream-white bonnet, green, red or lavender dresses. Her eyes were soft, as before, her voice clear and gentle. She spoke often of events outside the asylum, of the nation’s progress in helping both downtrodden and poor, a cause that one time mattered to him greatly. He remembered he used to tell her that he loved her. He tried to call up what that felt like. He shook inside.
“You seem to carry some heavy burden,” Pinel said one afternoon, noting that Lalladiere often sat before him with head bowed, shoulders slumped. “Can you tell me what weighs on you, is it something you believe you have done?”
“I betrayed the minister.”
“Yes, you have said that. What is this about? How did you betray him?”
“Falsified the national finances,” Lalladiere said, glaring belligerently to cope with his own self-revulsion. “The budget. I gave him overblown projections, fake accounting and estimates.”
“He submitted all of it officially to the Convention.”
“He resigned for good.”
“It was all completely false.”
“Well, then, did he do no checking himself? Submitted it to no one else for general assessment?”
“Yes, he did both,” Lalladiere said, softening. “But I was the expert at tallying collections and projecting expectations. I made them all think the figures were reliable and everyone trusted me.”
Pinel hesitated, hating what he heard. But, wanting to know more, he continued.
“And what was the result of this?”
“They mocked him. Torture.”
“I knew Minister Necker resigned some time ago. And he left the country. But I have heard nothing of torture. Where does that come in?”
“Torture,” Lalladiere repeated, lapsing into incoherence.
“What kind of torture?”
Still trying to follow despite his vexation, Pinel saw a tense look of anticipation on Lalladiere’s face.
“Do you expect,” he asked, struck by a flash of comprehension, “torture in here?”
“That we here shall now torture you because of what you have done?”
“I committed an unspeakable crime.”
“The man is not dead. He has surely recovered. The government still stands.”
Lalladiere paused. He thought of his defect, his failed manhood. Words burst from him:
“I did it intentionally.”
“What did you do intentionally, make false, overinflated estimates?”
“I hurt the minister intentionally.”
“You hurt the minister intentionally,” Pinel repeated, trying to overcome his contempt and understand.
“Yes, No...Yes, I think so.”
“I don’t know.”
“You must have some reason for saying so. What did you think when you falsified the budget?”
Lalladiere became silent. Pinel, feeling less contempt and some sympathy, sat and waited patiently.
“I hated him.”
“Hate? Why did you hate the man then?”
Face contorted, voice shaking, Lalladiere answered: “He ignored me while I suffered. Other things, too.”
Pinel, feeling strangely sad, stopped questioning and turned his head away. When he turned back, he saw Lalladiere’s lips moving in response to something unseen. Kill. Kill. You must not live. You must be torn limb from limb. Corrupt, despicable creature.
Watching the pained twisting of Lalladiere’s face, the strained, vigorous movements of his mouth, Pinel’s feelings turned fully into sympathy. These human beings, he thought, suffer so intensely. What tragic ideas, what unbearable sentiments, what wounds of the imagination! Lalladiere is both perpetrator and executioner. Could what he says be true, an intentional hurt to the man he seemed to idolize? Feeling the hatred I have wondered about? How does a man like Lalladiere come to believe such evil things about himself, have such terrible passions? And how can I find ways to help him?
He talked later with the Pussins about what he called the aching in Lalladiere’s soul, and in the weeks to follow, they all tried to devise ways of helping. The Pussins emphasized a need for rehabilitation. Because of Lalladiere’s now openly intense remorse over the injury he inflicted, they decided to encourage him to apply himself to religious devotion, whether or not he practiced it before. Marguerite Pussin brought in a people’s priest to hear Lalladiere’s confession, instruct him in penance, and prescribe rigid adherence to ritual and doctrine. Although there were no longer, on the orders of the Committee of Internal Affairs, symbols of worship in the chapel, governor Pussin brought Lalladiere a bible and extolled the practices of religious penitence and fastidiousness. Pinel spent time, in his regular meetings with Lalladiere, focusing on the circumstances surrounding the falsification of the budget. He heard about the love affair with Genevieve, its ending, about the duress and Lalladiere’s inability to work during the time before the budget was due. He learned in detail of Lalladiere’s previous devotion to Minister Necker, his years of ardent, conscientious work.
“I worked late into the night, Dr. Pinel. Usually when there were deadlines, I stayed in the office until two or three in the morning.”
“When did you eat?”
“I didn’t. Skipped meals.”
“I studied in detail every tax, every financial institution, every governmental collection procedure throughout the country.”
“You did all this for the minister?”
“He was the champion of the people.”
“Aha,” Pinel said, smiling, “the man was a pinnacle. He had no faults.”
Lalladiere hesitated. Was the doctor making fun of him? Yes—no, this doctor had joked with him, reducing pain, before.
“I was dazed. All the time. Didn’t know what was going on.”
“What are you talking about?” Pinel now had confidence he could get an answer to a direct question.
“He was not coming to the offices, always away at Versailles. I needed him. One day when I did see him he said he was planning to resign if the Assembly continued to use paper money to meet debts and deficits.”
“That upset you.”
“I thought he didn’t care, was going to leave.”
“So, the minister you extolled, idolized, for whom you worked so hard, was pulling back, possibly running out?”
“I saw them when I walked.”
“What do you mean? What, whom, did you see?”
Lalladiere turned his head away and did not speak.
“Was this something terrible to look at?” Pinel asked, seeing the movement.
“He was with her.”
“Her? Who was she?”
“Genevieve,” he blurted.
“What?” Pinel paused. “Oh, so you thought you were betrayed.”
“Both of them, two I loved, together.”
“Were you certain it was Genevieve?”
“Hatred for them both, I was racked with hatred,” Lalladiere said, ignoring Pinel’s question.
“One minute, hatred, then the next minute, love. Hate, then love. Love, then hate. I tried not to believe it. It all stopped, then I believed it again. Night after night, teeming with hatred, then intense tormenting love. Love the minister, love Genevieve, love both together. I couldn’t stand it. I hated them, the two of them.”
Listening, amazed at what he was hearing, Pinel began to wonder if, this time, Lalladiere had completely misperceived. The young devoted woman would not likely consort with the aging minister. He thought of another possible connection in Lalladiere’s head:
“Did you think they came together out of love for you? To take care of you?”
Lalladiere said nothing, but a tear came into his eye.
“I thought,” he said after a long pause, “that she was going after other men. But, with Necker, she also wanted him to help me.”
“Hate then love, eh? Love then hate. Which was worse?”
“Love, always the love.”
“Genevieve needed my protection.”
“She needed your protection? Why?”
“I didn’t know, I thought she was going out of her head.”
Lalladiere stopped and neither he nor Pinel spoke. Pinel watched alternating pain and relief cross Lalladiere’s previously expressionless face.
“What is it?” Pinel asked.
“It wasn’t Genevieve I saw.”
“Who was it?” asked Pinel, intrigued.
“Lying in my room later, fever-hot, my mind in chaos, a picture came to me of the woman as reddish-blond with very long straight hair. It wasn’t Genevieve.”
“No? Who, then?”
“I don’t know. It was not his wife.”
“What of that? Rage? More hatred?”
“Both. I was sure then he was running out, abandoning everything.”
At that moment, Pinel realized something new about hatred:
“And falsifying the budget would make the minister furious with you.”
Lalladiere grunted. Neither assent nor denial.
“Being furious, then hating you.”
“And his hatred would bind him to you.”
They went on with the matter over the next several days. Slowly, Lalladiere elaborated his fears of losing the minister, the turning to other interests when he needed him so much. He alluded also to some of Necker’s failings, the idol’s clay feet, such as his having actually overblown a previous budget, the famous Compte Rendu, to show a surplus. He was abandoning the nation, again ignoring important financial details while engaged in a clandestine affair.
Lalladiere was beginning to feel relief from the cobweb of guilt, hatred, and love. He was gaining some perspective, and the rehabilitation appeared to be working. His behavior in the asylum continued to improve. Pussin decided again to assign Lalladiere work in the institution. Advised by Pinel to avoid accounting tasks at that point, Pussin arranged for paid labor at the extensive Bicêtre farm behind the asylum buildings. In view of Lalladiere’s lightening of symptoms, Pussin thought it unlikely he would again try to run away. They would, in any case, be firm, expecting Lalladiere to carry out all work assigned and stay within specified areas.
“I would like, Pussin, to talk with some of the attendants who have had regular contact with Lalladiere,” Pinel said in their regular morning conference.
“But that is so very unusual. Do you believe I am doing something wrong?”
“Ah, surely no. I learn from your good work. But we must, as I say, observe. From the smallest to the largest thing. And for such information I now follow the practice of the wily old physician, Galen. A very astute student of insanity, Galen wrote that he routinely obtained important observations about such patients from the reports of closely associated persons—servants, relatives, and others.”
“Denis, Antoine, perhaps the new one, Simon. I will arrange the meeting.”