Vincenzo Chiarugi
Encyclopedia
Vincenzo Chiarugi was an Italian
physician
who introduced humanitarian reforms to the psychiatric hospital care
of people with mental disorders. His early part in a movement towards moral treatment
was relatively overlooked until a gradual reassessment through the 20th century left his work described as a landmark in the history of psychiatry. He also specialized in dermatology
and wrote on other subjects.
, near Florence
. He graduated from the medical school
of Pisa
in 1780, then moved to Florence to work at the Santa Maria Novella hospital.
From 1785 to 1788, Chiarugi was director of the Santa Dorotea hospital in Florence, where he outlawed chains as a means of restraint for psychiatric patients. A prior attempt had been made there in the 1750’s, but chains softened with canvas strips had been reintroduced.
In 1788, Chiarugi was appointed physician director ("primo infermiere") of the new Bonifacio Hospital, a building he had helped plan. The hospital took in the mentally ill as well as invalids (who were typically poor, homeless and unemployed) and patients with skin conditions. Chiarugi was the chief author of new humanitarian regulations for the hospital that were introduced in 1789.
In 1793-1794 Chiarugi's main published psychiatric work, his three volume On Insanity and Its Classification (Della Pazzìa in Genere e in Specie), was published in Florence. He also published works on dermatology
and agriculture
, and a book about his home town.
In 1802 Chiarugi became professor
of dermatology
and mental diseases, and later professor of physiology
, pathology
, and "materia medica" at the medical school of Florence. He continued his work of reform and of teaching until his death in 1820.
, who introduced social and economic reforms across Florence, including an institution for the rehabilitation of juvenile delinquents and the abolition of torture
and the death penalty. Leopoldo also directed his attention to the mistreatment and neglect of the mentally ill, which was continuing despite progress in other areas of medicine and science. In 1774, the "legge sui pazzi" (law on the insane) was introduced, the first of its kind in Europe, which allowed steps to be taken to hospitalize individuals regarded as insane. A public hospital, the Bonifacio, was rebuilt for the purpose, and the young physician Chiarugi was put in charge.
that was in common use at the time: melancholia
, mania
, and dementia
(terms used differently from today). He saw these categories as distinct but fluid.
At the Bonifacio Hospital, he was the chief compiler of a new set of rules ("Regolamento") covering the approach to custody and care, the conduct of all staff, and procedures for admissions and record-keeping. A detailed history was required for each patient admitted to the hospital. Men were separated from women. The rules have been described as bureaucratic and paternalistic in tone but expressing a novel concern for the welfare of the mentally ill, as represented by:
"The patient is to be treated with respect; not put to work (with the exception that those accustomed to such work may be expected to help in cleaning); no physical pain to be inflicted under any circumstance—and the director shall be vigilantly observant of this; the application of restraints, often necessary in the treatment of mania, must be applied in accord with humanitarian and hygienic practices; patients are to have access to the grounds to walk, play, or exercise; they are to be bathed regularly, even if they must be tied down while this is being done; they will be fed in their closed rooms while observed through a small grated window; visiting by friends or family is extremely unwise—when it occurs, it must be closely supervised" (From Regolamento 294–376).
Chiarugi recommended cloth and leather restraints, partly strengthened with iron, applied in a way that prevented sores or lacerations. Ties and handcuffs
that permitted mobility were preferred to straitjackets. In "On Insanity", he advised that patients with mania should be confined to a secure room without furniture or anything that could be dangerous, and with nothing too stimulating such as pictures, noise, light or items reminiscent of home. Although it was severely prohibited at the Bonifacio to beat patients, he advised that whipping around the waist could sometimes work for "arrogant" manic patients thought to be rational enough to be sedated by fear of it. Brief submersion in cold water was sometimes used, but not the usual practice of submersion to the point of near-drowning. He did not employ the practice of controlling patients by withdrawal of food to the point of near-starvation, but described different diets for different conditions.
Chiarugi used a diverse mixture of remedies and drugs in his treatments, principally opium
. Some were intended to be sedatives and some mild stimulants, the latter including irritants and blistering agents applied to the skin. He also employed hydrotherapy
and, to a lesser extent, bloodletting
. Psychological techniques were used and were also intended to be either sedative (e.g. dark rooms away from noise or heat, tender and sad music) or mildly stimulating (e.g. physical or mental exercise, cheerful companionship, joyful music). Chiarugi argued that a therapist must become:
"patron of their hearts, capture their confidence and trust. [In order to] drive away their false impressions and cause diverse passions to be born, and even if possible contrary passions. The therapist must conduct himself in a philosophical manner, displaying sensitivity and delicacy and prudence beyond the ordinary. He should refrain from opposing the mad ideas, as the ordinary person might do, with unconcealed animosity, menace or blows. Such tactics disturb these unfortunates and enhance their stubborn adherence to their delusions. To the contrary, one must guide them to the understanding of what is true by kindness (dolcezza), by indirect means, instilling reason drop by
drop. The therapist must provide them with the material most appropriate to raise the mask from erroneous beliefs, to show them the truth almost by a process of inductive logic" (from Della Pazzia, II 67–68).
He also advised: "Keep that melancholic who is single mindedly concerned with his hatred for a particular person isolated from the sight and the memory of that person. Have him go on voyages where he will have the opportunity to converse with wise and genial companions, which will distract him from his preoccupations and allow new ideas and concerns to enter his mind. Should the preoccupation be with loss of or the unavailability of a love object, that [desired] person should be put in the most unfavorable light, by emphasizing the defects of the loved one, as Ovid advised. Or prudently find a new love for him, not precipitously, but gradually so as to not turn his melancholia into mania. Turn his constricting sadness and timidity into the livelier emotion, into the intense affect of fear. This can be done by taking him by surprise with the manforte [literally, a support; a crook or crutch-like implement] and with it drag him to a seclusion room" (from Della Pazzia II, p74).
For suicidal patients, Chiarugi advised the use of religious arguments for the value of life. For delusions, he advised using the delusion against itself, for example: "Should he have the delusion that “he must vomit to rid his stomach of frogs, give him an emetic and have one of the assistants artfully place frogs in the basin into which the patient vomits. By such and similar means the melancholic’s errors may be combated with their own weapons!" (from Della Pazzia II, p 68–69). For delusions of grandeur, patients "swollen with pride, with fancies of great wealth and power", Chiarugi recommended disparagement and humiliation, showing the patient evidence of their fallibility. For mania, he focused on ensuring the safety of patients and staff, and seeking to contain and calm the patient.
The most prominent theoretical perspective in Chiarugi's published writing is neurological, merged with philosophical perspectives on brain, mind and soul consistent with Catholic theory. He argued that moral (i.e. psychological) or physical forces disrupted the internal workings of the nervous system. He wrote of an interplay between passions (which could be too extreme or prolonged), reasoning (which could become faulty) and the brain. He conceived of neural functioning as involving force
and, in a hydrodynamic sense, fluids. Blood flow to the brain was thought to add to neural fluid pressure. He conceived of disorder as either involving over-excitement or under-excitement of the brain and nervous system. Signs of the former, such as heightened altertness, pulse and appetite, indicated the need for sedation; signs of the latter indicated the need for stimulation. He argued that the soul of a person was perfect even if the mind was led astray due to its close integration with the brain. He examined post-mortem brains of patients and claimed to observe some pathological abnormalities, arguing that others might not be visible to the naked eye.
Chiarugi did not enjoy the renown bestowed on Pinel
, a French psychiatrist who introduced similar reforms several years after Chiarugi. It has been suggested this was partly because late 18th century revolutionary France received greater attention. In addition, the support Chiarugi had enjoyed from the state of Florence faded, and he had no natural successor to continue to develop and publicise his work, by contrast to Pinel in France and William Tuke
in England
. It has also been noted that while Pinel expressed empathy and admiration for his patients and enlived his work with individual case material, Chiarugi's writing, while never disdaining the mentally ill, did not highlight his humanitarian reforms and was characterized by a benign impersonality.
Through the 20th century there was a slow reevaluation of Chiarugi's contributions. Further translations were made of his psychiatric work. Original language versions were republished in Italy. He became recognised as an early contributor to a movement that became known as moral treatment
and his work said to "constitute a major landmark in the history of psychiatry".
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
who introduced humanitarian reforms to the psychiatric hospital care
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...
of people with mental disorders. His early part in a movement towards moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
was relatively overlooked until a gradual reassessment through the 20th century left his work described as a landmark in the history of psychiatry. He also specialized in dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
and wrote on other subjects.
Career
Vincenzo Chiarugi was born in EmpoliEmpoli
Empoli is a town and comune in Tuscany, Italy, about 20 km southwest of Florence, to the south of the Arno in a plain formed by the latter river. The plain has been usable for agriculture since Roman times. The commune's territory becomes a hilly one as it departs from the river...
, near Florence
Florence
Florence is the capital city of the Italian region of Tuscany and of the province of Florence. It is the most populous city in Tuscany, with approximately 370,000 inhabitants, expanding to over 1.5 million in the metropolitan area....
. He graduated from the medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
of Pisa
Pisa
Pisa is a city in Tuscany, Central Italy, on the right bank of the mouth of the River Arno on the Tyrrhenian Sea. It is the capital city of the Province of Pisa...
in 1780, then moved to Florence to work at the Santa Maria Novella hospital.
From 1785 to 1788, Chiarugi was director of the Santa Dorotea hospital in Florence, where he outlawed chains as a means of restraint for psychiatric patients. A prior attempt had been made there in the 1750’s, but chains softened with canvas strips had been reintroduced.
In 1788, Chiarugi was appointed physician director ("primo infermiere") of the new Bonifacio Hospital, a building he had helped plan. The hospital took in the mentally ill as well as invalids (who were typically poor, homeless and unemployed) and patients with skin conditions. Chiarugi was the chief author of new humanitarian regulations for the hospital that were introduced in 1789.
In 1793-1794 Chiarugi's main published psychiatric work, his three volume On Insanity and Its Classification (Della Pazzìa in Genere e in Specie), was published in Florence. He also published works on dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
and agriculture
Agriculture
Agriculture is the cultivation of animals, plants, fungi and other life forms for food, fiber, and other products used to sustain life. Agriculture was the key implement in the rise of sedentary human civilization, whereby farming of domesticated species created food surpluses that nurtured the...
, and a book about his home town.
In 1802 Chiarugi became professor
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...
of dermatology
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
and mental diseases, and later professor of physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, and "materia medica" at the medical school of Florence. He continued his work of reform and of teaching until his death in 1820.
Enlightenment context
In Chiarugi's early career, the Italian state of Florence was ruled by Grand Duke Pietro Leopoldo (1747–1792). Leopold was a man of the EnlightenmentAge of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
, who introduced social and economic reforms across Florence, including an institution for the rehabilitation of juvenile delinquents and the abolition of torture
Torture
Torture is the act of inflicting severe pain as a means of punishment, revenge, forcing information or a confession, or simply as an act of cruelty. Throughout history, torture has often been used as a method of political re-education, interrogation, punishment, and coercion...
and the death penalty. Leopoldo also directed his attention to the mistreatment and neglect of the mentally ill, which was continuing despite progress in other areas of medicine and science. In 1774, the "legge sui pazzi" (law on the insane) was introduced, the first of its kind in Europe, which allowed steps to be taken to hospitalize individuals regarded as insane. A public hospital, the Bonifacio, was rebuilt for the purpose, and the young physician Chiarugi was put in charge.
Psychiatric practice and theory
Chiarugi employed three major diagnostic categories from a classification scheme by William CullenWilliam Cullen
William Cullen FRS FRSE FRCPE FPSG was a Scottish physician, chemist and agriculturalist, and one of the most important professors at the Edinburgh Medical School, during its heyday as the leading center of medical education in the English-speaking world.Cullen was also a central figure in the...
that was in common use at the time: melancholia
Melancholia
Melancholia , also lugubriousness, from the Latin lugere, to mourn; moroseness, from the Latin morosus, self-willed, fastidious habit; wistfulness, from old English wist: intent, or saturnine, , in contemporary usage, is a mood disorder of non-specific depression,...
, mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
, and dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
(terms used differently from today). He saw these categories as distinct but fluid.
At the Bonifacio Hospital, he was the chief compiler of a new set of rules ("Regolamento") covering the approach to custody and care, the conduct of all staff, and procedures for admissions and record-keeping. A detailed history was required for each patient admitted to the hospital. Men were separated from women. The rules have been described as bureaucratic and paternalistic in tone but expressing a novel concern for the welfare of the mentally ill, as represented by:
"The patient is to be treated with respect; not put to work (with the exception that those accustomed to such work may be expected to help in cleaning); no physical pain to be inflicted under any circumstance—and the director shall be vigilantly observant of this; the application of restraints, often necessary in the treatment of mania, must be applied in accord with humanitarian and hygienic practices; patients are to have access to the grounds to walk, play, or exercise; they are to be bathed regularly, even if they must be tied down while this is being done; they will be fed in their closed rooms while observed through a small grated window; visiting by friends or family is extremely unwise—when it occurs, it must be closely supervised" (From Regolamento 294–376).
Chiarugi recommended cloth and leather restraints, partly strengthened with iron, applied in a way that prevented sores or lacerations. Ties and handcuffs
Handcuffs
Handcuffs are restraint devices designed to secure an individual's wrists close together. They comprise two parts, linked together by a chain, a hinge, or rigid bar. Each half has a rotating arm which engages with a ratchet that prevents it from being opened once closed around a person's wrist...
that permitted mobility were preferred to straitjackets. In "On Insanity", he advised that patients with mania should be confined to a secure room without furniture or anything that could be dangerous, and with nothing too stimulating such as pictures, noise, light or items reminiscent of home. Although it was severely prohibited at the Bonifacio to beat patients, he advised that whipping around the waist could sometimes work for "arrogant" manic patients thought to be rational enough to be sedated by fear of it. Brief submersion in cold water was sometimes used, but not the usual practice of submersion to the point of near-drowning. He did not employ the practice of controlling patients by withdrawal of food to the point of near-starvation, but described different diets for different conditions.
Chiarugi used a diverse mixture of remedies and drugs in his treatments, principally opium
Opium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...
. Some were intended to be sedatives and some mild stimulants, the latter including irritants and blistering agents applied to the skin. He also employed hydrotherapy
Hydrotherapy
Hydrotherapy, formerly called hydropathy, involves the use of water for pain-relief and treating illness. The term hydrotherapy itself is synonymous with the term water cure as it was originally marketed by practitioners and promoters in the 19th century...
and, to a lesser extent, bloodletting
Bloodletting
Bloodletting is the withdrawal of often little quantities of blood from a patient to cure or prevent illness and disease. Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" the proper balance of which maintained health...
. Psychological techniques were used and were also intended to be either sedative (e.g. dark rooms away from noise or heat, tender and sad music) or mildly stimulating (e.g. physical or mental exercise, cheerful companionship, joyful music). Chiarugi argued that a therapist must become:
"patron of their hearts, capture their confidence and trust. [In order to] drive away their false impressions and cause diverse passions to be born, and even if possible contrary passions. The therapist must conduct himself in a philosophical manner, displaying sensitivity and delicacy and prudence beyond the ordinary. He should refrain from opposing the mad ideas, as the ordinary person might do, with unconcealed animosity, menace or blows. Such tactics disturb these unfortunates and enhance their stubborn adherence to their delusions. To the contrary, one must guide them to the understanding of what is true by kindness (dolcezza), by indirect means, instilling reason drop by
drop. The therapist must provide them with the material most appropriate to raise the mask from erroneous beliefs, to show them the truth almost by a process of inductive logic" (from Della Pazzia, II 67–68).
He also advised: "Keep that melancholic who is single mindedly concerned with his hatred for a particular person isolated from the sight and the memory of that person. Have him go on voyages where he will have the opportunity to converse with wise and genial companions, which will distract him from his preoccupations and allow new ideas and concerns to enter his mind. Should the preoccupation be with loss of or the unavailability of a love object, that [desired] person should be put in the most unfavorable light, by emphasizing the defects of the loved one, as Ovid advised. Or prudently find a new love for him, not precipitously, but gradually so as to not turn his melancholia into mania. Turn his constricting sadness and timidity into the livelier emotion, into the intense affect of fear. This can be done by taking him by surprise with the manforte [literally, a support; a crook or crutch-like implement] and with it drag him to a seclusion room" (from Della Pazzia II, p74).
For suicidal patients, Chiarugi advised the use of religious arguments for the value of life. For delusions, he advised using the delusion against itself, for example: "Should he have the delusion that “he must vomit to rid his stomach of frogs, give him an emetic and have one of the assistants artfully place frogs in the basin into which the patient vomits. By such and similar means the melancholic’s errors may be combated with their own weapons!" (from Della Pazzia II, p 68–69). For delusions of grandeur, patients "swollen with pride, with fancies of great wealth and power", Chiarugi recommended disparagement and humiliation, showing the patient evidence of their fallibility. For mania, he focused on ensuring the safety of patients and staff, and seeking to contain and calm the patient.
The most prominent theoretical perspective in Chiarugi's published writing is neurological, merged with philosophical perspectives on brain, mind and soul consistent with Catholic theory. He argued that moral (i.e. psychological) or physical forces disrupted the internal workings of the nervous system. He wrote of an interplay between passions (which could be too extreme or prolonged), reasoning (which could become faulty) and the brain. He conceived of neural functioning as involving force
Force
In physics, a force is any influence that causes an object to undergo a change in speed, a change in direction, or a change in shape. In other words, a force is that which can cause an object with mass to change its velocity , i.e., to accelerate, or which can cause a flexible object to deform...
and, in a hydrodynamic sense, fluids. Blood flow to the brain was thought to add to neural fluid pressure. He conceived of disorder as either involving over-excitement or under-excitement of the brain and nervous system. Signs of the former, such as heightened altertness, pulse and appetite, indicated the need for sedation; signs of the latter indicated the need for stimulation. He argued that the soul of a person was perfect even if the mind was led astray due to its close integration with the brain. He examined post-mortem brains of patients and claimed to observe some pathological abnormalities, arguing that others might not be visible to the naked eye.
Recognition
Chiarugi was known in Italy for his psychiatric theories and teaching more than for his humanitarian approach. His publications on mental illness were not widely translated or disseminated elsewhere, although the first volume of "On Insanity" was translated in to German.Chiarugi did not enjoy the renown bestowed on Pinel
Pinel
Pinel is the surname of:* Raquel Pinel, Spanish football forward currently playing for Valencia CF in the Spanish league* Marcel Pinel , French footballer* Suzanne Pinel, CM is a Canadian children's entertainer and citizenship judge...
, a French psychiatrist who introduced similar reforms several years after Chiarugi. It has been suggested this was partly because late 18th century revolutionary France received greater attention. In addition, the support Chiarugi had enjoyed from the state of Florence faded, and he had no natural successor to continue to develop and publicise his work, by contrast to Pinel in France and William Tuke
William Tuke
William Tuke was an English businessman, philanthropist and Quaker. He was instrumental in the development of more humane methods in the custody and care of people with mental disorders, an approach that came to be known as moral treatment.-Career:Tuke was born in York to a leading Quaker family...
in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
. It has also been noted that while Pinel expressed empathy and admiration for his patients and enlived his work with individual case material, Chiarugi's writing, while never disdaining the mentally ill, did not highlight his humanitarian reforms and was characterized by a benign impersonality.
Through the 20th century there was a slow reevaluation of Chiarugi's contributions. Further translations were made of his psychiatric work. Original language versions were republished in Italy. He became recognised as an early contributor to a movement that became known as moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
and his work said to "constitute a major landmark in the history of psychiatry".
External links
- An image of Vincenzo Chiarugi from the American Journal of Psychiatry.