<P> The right psychical treatment therefore keeps in view the truth that insanity is not an abstract loss of reason (neither in the point of intelligence nor of will and its responsibility), but only derangement, only a contradiction in a still subsisting reason; − just as physical disease is not an abstract, i.e. mere and total, loss of health (if it were that, it would be death), but a contradiction in it . This humane treatment, no less benevolent than reasonable (the services of Pinel towards which deserve the highest acknowledgement), presupposes the patient's rationality, and in that assumption has the sound basis for dealing with him on this side − just as in the case of bodily disease the physician bases his treatment on the vitality which as such still contains health . </P> <P> Pinel also started a trend for diagnosing forms of insanity that seemed to occur' without delerium' (confusion, delusions or hallucinations). Pinel called this Manie sans délire, folie raisonnante or folie lucide raisonnante . He described cases who seemed to be overwhelmed by instinctive furious passions but still seemed sane . This was influential in leading to the concept of moral insanity, which became an accepted diagnosis through the second half of the 19th century . Pinel's main psychiatric heir, Esquirol, built on Pinel's work and popularised various concepts of monomania . </P> <P> However, Pinel was also criticised and rejected in some quarters . A new generation favoured pathological anatomy, seeking to locate mental disorders in brain lesions . Pinel undertook comparisons of skull sizes, and considered possible physiological substrates, but he was criticized for his emphasis on psychology and the social environment . Opponents were bolstered by the discovery of tertiary syphilis as the cause of some mental disorder . Pinel's humanitarian achievements were emphasized and mythologised instead . </P> <P> With increasing industrialization, asylums generally became overcrowded, misused, isolated and run - down . The moral treatment principles were often neglected along with the patients . There was recurrent debate over the use of psychological - social oppression even if some physical forces were removed . By the mid-19th century in England, the Alleged Lunatics' Friend Society was proclaiming the moral treatment approach was achieved "by mildness and coaxing, and by solitary confinement", treating people like children without rights to make their own decisions . </P>

Mental health reform came about through the efforts of philippe pinel and