From Paris we move about 60 km north, to the region of Picardie, to visit Clermont, where we meet
Constance Pascal
Costance Pascal
At the Asylum for the mentally ill, the place she called “the Penal Colony for Psychiatrists”, Constance Pascal had plans to reform institutional medicine, to create outpatient services and to establish asylum schools for children.
She was the first female psychiatrist in France.
Her huge contribution to psychiatry is largely forgotten: she prohibited corporal punishment and straitjackets for the mentally ill, she ensured clean dormitories, she was interested in educating children with severe learning difficulties, and in creating familial colonies for the less severely affected:
“Tous les fous, tous les maniaques, tous les épileptiques, ne sont pas des ‘sujet d’asile’” (1913)
[Not all mad, not all lunatics, not all epileptics should be in asylums]
Through interviews in the press, Pascal brought attention to the suffering of mentally ill people, aiming at reducing stigma and discrimination.
In the course of her professional life, Pascal worked in six psychiatric hospitals. Her interests shifted from descriptive nosological categorization of the external manifestations of mental illness, to experimental treatments with shock therapy, and ultimately to a psychoanalytical approach to affective suffering. Her research is well-documented by numerous publications.
Pascal was a Romanian immigrant, a professional woman, a psychiatrist and a reformer of patients’ care, a researcher in mental illness as well as a single mother of her daughter.
Achieving her professional goals required exceptional inner strength and courage.
In a letter from 1912/13 to her brother Trajan she wrote:
“Mon grand tort a été d’avoir fait des études. Dans ma famille arriérée, mon instruction a été une parure inutile qui a coûté cher. Si j’étais restée auprès de ma mère et si je m’étais mariée avec un officier de cavalerie, on aurait dépensé le triple et jamais tu ne me l’aurais reproché.”
[My great crime was to study. In my backward family, my education was considered a useless and costly ornament. If I had stayed with my mother and married a cavalry officer, the family would have spent three times the sum and you would never have blamed me for it. Translated by Gordon, 2013]
Update Dec 2017 – The European Psychiatric Association has established the EPA Constance Pascal – Helen Boyle Prize for Outstanding Achievement by a Woman in Working to Improve Mental Health Care in Europe. (site)
“Women have long been discriminated against, including in the fields of mental health care and psychiatry. The aim of this prestigious Prize is to publicly acknowledge and increase awareness of the outstanding achievements by women in working to improve mental health care in Europe”.
Pascal at Châlon sur Marne
Constance Pascal passed the examination to become an asylum intern in 1903. During her internship, she was a student of Paul Sérieux who introduced the work of Emil Kraepelin in France. Her 1905 dissertation, Formes atypiques de la paralysie générale, supervised by Sérieux, gained the highest mark, a bronze medal from the medical faculty and, in 1906, the prestigious Moreau de Tours prize. The thesis was reported in the press as a feminist success. In 1908 she published an article on Robert Schumann, contributing to the debate about his mental illness. With all the caution due to the fact that – as she wrote – “to do really scientific work in mental pathology, one needs direct observation”, she distinguished two mental disorders occurring in the life of the composer. Even more relevant was her assertion that Schumann’s musical genius was the result of perfect mental functioning. Affirming that
“His genius emerges not because of a mental disability but in spite of it”,
she opposed the Cesare Lombroso‘s theory of the mad genius.
“We know that musical genius is not only a celestial gift; heaven’s grace is no longer enough to create a good artist. Music is a science whose laws oblige the composer to construct a perfect architecture in which ideas, feelings and the passions combine and co-ordinate in a vigorous logic. Artists no longer write under the dictation of the gods, they compose”.
Frontispice of the book on dementia praecox
A series of clinical studies on dementia praecox were collected in the monograph La démence précoce: étude clinique et médico-légale published by Pascal in 1911. This volume was an analytical summation of previously published research and clinical reports on a condition that the same year was embraced in the term schizophrenia, introduced by the Swiss psychiatrist Eugen Bleuler. In 1918 the American Medico-Psychological Association approved the definitive shift from ‘dementia praecox’ to ‘schizophrenia‘. Elmer Southard was one of the proponents of this shift and in his report acknowledged Pascal in the historical information concerning the evolution of the term. As pointed out by Noll (2007), Southard found it unlikely that dementia praecox was caused by a toxic process, as suggested by Pascal which followed Kraepelin’s interpretation.
Au point de vue anatomique, on peut considérer la démence précoce comme une cérébropathie toxique parenchymateuse.
[From an anatomical point of view, early dementia can be considered as toxic parenchymal cerebropathy.]
Intelligence, memory and language were preserved, at least in the less severe cases of this disease. Pascal distinguished dementia praecox, a form of affective dementia, from degenerative amnestic dementia.
La paralysie générale, la démence sénile, etc., sont des démences amnésiques; la démence précoce, una démence affective.
[General paralysis, senile dementia, and so on, are amnestic dementias; dementia praecox, an affective dementia.]
Pascal outlined the importance of an interdisciplinary approach to the disease.
La démence précoce intéresse non seulement les aliénistes, mais encore les psychologues, les éducateurs, les magistrats et les médecins.
[Dementia praecox is of interest not only to alienists, but also to psychologists, educators, judges and doctors.]
Pascal and the staff at Châlon sur Marne
She was a pioneer in promoting manual work as an effective therapeutic intervention:
Dans notre service (colonies de Fitz-James et de Villers), nous avons constaté que les déments précoces qui s’occupent régulièrement dans les fermes et dans les champs paraissent moins déments que ceux qui ne travaillent pas. Le travail constitue donc le meilleur traitment thérapeutique contre l’inertie mentale.
[In our department (Fitz-James and Villers settlements), we have found that individuals affected by dementia praecox who regularly work on farms and in fields seem less insane than those who do not work. Labour is therefore the best therapeutic treatment against mental inertia.]
Pascal was in contact with Kraepelin, who even offered her a collaboration
“If at any time you wish to work with us, you will always be welcome. With collegial esteem I remain your devoted, Kraepelin” (May 26, 1909).
Pascal at the Vauchuse Asylum
Biography. Constanza Pascal was born on August 22, 1877 in Pitesti, province of Walachia, Romania. Her father Ion Pascal was a landowner. She attended secondary school in Bucharest. Her brother Trajan was encouraged to pursue a military career but Constanza was not allowed to continue her studies. After the death of her father in 1891 she obtained the permission, from her family, to pursue a professional qualification. In 1897 she moved to Paris to start her medical training with minimal financial support.
In 1902, the feminist activist Madeleine Pelletier, after being barred from the examination to become a psychiatric intern, organized a successful campaign to allow women to sit for public examination for the post. In 1903, Constanza Pascal and Madeleine Pelletier were the first two women to be accepted as asylum interns. During her internship, Pascal was first at Perray Vauchuse and then at Ville Evrard under Paul Sérieux.
After a ten year period of residence with good behavior, in 1907, she gained the French citizenship and changed her name to Constance. She was then eligible to take the examination for a permanent psychiatric post, which she passed in 1908 – the first time for a woman. Pascal was assigned as junior doctor to the Asylum of Clermont de l’Oise, where she remained until 1920, apart from a two-year period at the Saint Maurice asylum. In 1913 she sent a report to the Ministry of Justice advocating the establishment of ‘school hospitals’ for children with mental disability to prevent institutionalization. However, her reform plans were blocked by the outbreak of World War I. Clermont was occupied by the Germans in 1914. Patients were not evacuated and lived under terrible conditions of food deprivation and hygiene, the asylum admitted also shell-shocked soldiers. These difficult years, were troubled by quarrels with her brother Trajan over the family inheritance. In 1915, Constance Pascal met General Justin Mengin, Commander of the 6th Army Brigade, who had been quartered at Clermont. His wife, Marie Gabrielle Nicolas Mengin, was suffering mental health problems and four years later was interned in the asylum of Evreux.
Jeanne, Pascal’s daughter
By the end of the year Constance discovered she was pregnant by Mengin and this posed a great risk for her career. She did not reveal her condition and obtained a leave on April 1, 1916 for health problems. On July 17, 1916 she gave birth to her daughter, Jeanne, who was recorded with no surname, as ‘daughter of unnamed father and mother’. She was officially an orphan, and received her mother’s surname when formally adopted in 1924. After one month Pascal returned to Clermont, but she soon arranged a temporary transfer to the Maison Nationale de Santé at Saint Maurice, a section of the Charenton Asylum in the outskirts of Paris. Here she fostered her daughter with the help of her friend Jeanne Streicher and General Mengin. In January 1920 she was the first woman to be appointed médecin-chef at Prémontré. In this isolated Asylum, with a staff resistant to improvements in care pratices, Pascal remained less than two years, until her successful application to a position in Châlon sur Marne. Here, in 1923, she established one of the first Instituts Médico-Pédagogiques to give education and medical assistance to children under 16 years of age. The institute ceased its activities soon after her departure in 1926, when Pascal moved to the Paris region, after succeeding the second examination in 1925. She was in Moisselles from 1926 to 1927, and then she was appointed chief physician in Maison Blanche. General Mengin continued to visit her and their child, providing some financial support. In 1928 Constance Pascal was diagnosed with breast cancer and she underwent a mastectomy but she was not free from recurrence from then on. She supervised the education of her daughter to give her the best intellectual opportunities.
She died of cancer on December 21, 1937, at Maison Blanche, with medical attendants and her daughter being present. She had asked for no commemoration in the psychiatric press. In all her life she maintained a strong separation between professional and private worlds.
Awards
- 1905 Bronze medal from the medical faculty
- 1906 Moreau de Tours prize
Acknowledgments
We are grateful to Felicia Gordon for her kind support and for introducing our project to Margeret Rees, Pascal’s granddaughter, who gave us the original photographs of the Pascal Rees family.
Credit
To cite this profile, please use the following format:
Metitieri, T., Mele, S. and Favero, M. (2017). Profile of Constance Pascal. In WiNEu, European Women in Neuroscience, Untold stories: the Women Pioneers of Neuroscience in Europe. Retrieved from https://wineurope.eu/pascal-2/
Selected work
For a complete list, see Barbier J-M., Serra G., Loas G. (1999): Constance Pascal: pioneer of French psychiatry. History of Psychiatry 10: 425–37
- Pascal C. (1908): Les maladies mentales de Robert Schumann (génie et démence). Journal de Psychologie Normale et Pathologique 5: 98–130.
- Pascal C. (1911). La Démence précoce: étude psychologique, médicale et médico-légale. Paris, Alcan.
- Pascal C. (1913-14): L’Enfance anormale dans les maisons de correction. Revue Philanthropique, Paris XXXIV: 260-71.
- Pascal C. (1914): Le Signe de la main et le signe de la poigné de main dans la démence précoce. Archives Internationales de Neurologie: 152-60.
- Pascal C. (1920): Demi-fous? La Presse Médicale: 1489-90.
- Pascal C. (1932): Chagrins d’amour et psychoses. Le Progrès Médical 36: 1513-24.
- Pascal C. (1936): La Pathologie des refuges. Paris Médical: 221-5.
- Pascal C., Davesne J. (1925): La thérapeutique sanguine dans les psychoses. La Presse Médicale: 1126-8.
- Pascal C., Davesne J. (1926): Chocs émotionnels pathogènes et thérapeutiques. Journal de Psychologie Normale et Pathologique: 456-87.
- Pascal C., Davesne J. (1926): Traitement des maladies mentales par les chocs. Paris: Masson.
References
- Barbier J-M., Serra G., Loas G. (1999): Constance Pascal: pioneer of French psychiatry. History of Psychiatry 10: 425–37.
- Bourgeois M.L. (2015): Constance Pascal (1877–1937). First female psychiatrist and chief-doctor of France’s psychiatry hospitals. Annales Medico-Psychologiques 173: 815–816.
- Chazaud J. (2001): Constance Pascal, première femme aliéniste en France. Histoire des Sciences Médicales 35 (1): 85–90.
- Gordon F. (2013): Constance Pascal (1877–1937): Authority, Femininity and Feminism in French Psychiatry. London, IGRS Books.
- Gordon F. (2006): French psychiatry and the new woman: the case of Dr Constance Pascal, 1877–1937. History of Psychiatry 17 (2): 159-182.
- Gordon F. (2015): Robert Schumann’s mental illnesses. (Genius and madness), by Mlle Dr Pascal (1908a): Introduction and translation by Felicia Gordon. History of Psychiatry 26(3): 359-71.
- Noll R. (2007): Classic Text No. 72 – Non–dementia non–praecox: Note on the advantages to mental hygiene of extirpating a term, by E.E. Southard [1919]. History of Psychiatry 18(4): 483–502.
