Emmanuel Régis (1855–1918) was a French neuropsychiatrist and professor at the Faculty of Medicine in Bordeaux, where he was the first holder of the clinical chair of mental diseases. He was one of the French pioneers of forensic and military psychiatry, and his Précis de Psychiatrie (Manual of Psychiatry) was published internationally.
Biography Emmanuel Jean Baptiste Joseph Régis, aka Emmanuel Régis, was born on 29 April 1855 in Auterive (Haute-Garonne) and died in Bordeaux (Gironde) on 21 June 1918. He was the son of Louis Régis, a doctor of medicine, and Marie Joséphine Gabrielle Apollonie Fornier de Lachaux. His elder brother was an artillery colonel and military writer, and his younger brother was a graduate of the École Normale Supérieure and a mathematician. He married Raymonde Henriette Marie Fournié (1856–1940) in Pamiers (Ariège).
Medical training Emmanuel Régis prepared for his baccalaureate in Paris at a religious school run by the Priests of Saint Anthony on Rue Saint Antoine, where his uncle, the prelate Canon Régis, had also been educated. He studied medicine at the University of Toulouse, where he graduated with honours from the School of Medicine. He continued his medical training in Paris as a hospital intern. His calling to psychiatry may be attributed to a cousin, Doctor Linas, a former intern at the Charenton asylum in Paris and inspector of the asylums of the Seine. Régis became an intern at the Asylums of the Seine, initially at the Ville-Évrard asylum, then from 1879 at the clinic for mental pathology and brain diseases run by professor Benjamin Ball (1833–1893) at the Sainte Anne asylum in Paris. He then served as chef de clinique (assistant professor) from 1881 to 1882 in the same department. Benjamin Ball, the holder of France's first chair in mental diseases, was himself a student of Ernest-Charles Lasègue (1816–1883) and Jacques Joseph Moreau de Tours (1804–1884), who was known for his treatise On Hashish and Mental Alienation. Ball had a major influence on Régis, particularly regarding his medical approach to psychiatry, based upon the postulate that biological and hereditary factors play a key role in the etiology of mental illnesses.
During his internship, Régis was named Laureate of the Medical-Psychological Society and received the Esquirol Award (1879) and the Annales Médico-Psychologiques Prize (1880) for a study published in 1878 entitled Dynamics or functional exaltation at the onset of progressive general paresis. In 1880, he defended his medical thesis on La folie à deux ou folie simultanée, the title of which echoes the diagnostic term délire à deux, which was coined by the French psychiatrist in 1877. The thesis was awarded the Baillarger Prize.
Hospital and academic career After his internship, Emmanuel Régis was shortlisted in 1881 for the position of medical director at the women's asylum in Bailleul in Northern France, but his appointment was rejected due to an anonymous defamatory letter sent to the senator of the town. The ten-page letter called his legitimacy into question by accusing him of medical incompetence (he was alleged to have failed to diagnose a hydatid cyst of the liver during a faculty examination), and by claiming that his successive promotions had been obtained thanks to family connections. The real motive for this attack was ideological. The author of the anonymous letter claimed that Régis was not a republican, and denounced his family's links with the clerical party, within which his father had reportedly been very active, supporting Mac Mahon's attempted coup d’état of 16 May 1877. Régis's contemporaries attributed his dismissal to the conflictual relationship between Benjamin Ball, Régis' mentor, and Valentin Magnan, also a psychiatrist at Sainte-Anne Hospital. The rivalry between the alienists at psychiatric asylums and the neuropsychiatrists at general hospitals may also have been a factor. A similar episode was to occur later in Bordeaux during the agrégation examination, pitting Régis' student, the neuropsychiatrist Jean Abadie, against the asylum psychiatrist Charles Perrens.
In 1882, Emmanuel Régis accepted a post at the Castel d'Andorte clinic in Le Bouscat, a suburb of Bordeaux. This private psychiatric institution had been founded in 1845 by Doctor Desmaisons (1813–1894), a pupil of Jean-Étienne Esquirol. At the request of Albert Pitres, Dean of the Faculty of Medicine at Bordeaux, Emmanuel Régis began teaching psychiatry to medical students at in 1884. This open lecture series on mental illnesses, which received no official status for ten years, attracted a very wide audience thanks to Régis' teaching skills. The attendees included healthcare professionals as well as lawyers, magistrates and philosophers. Some of his students went on to achieve fame, such as Saint-John Perse (1887–1975), a law student, and Victor Segalen (1878–1919), a future doctor of the Navy. Segalen was a clinical trainee in Régis' department and defended his thesis in 1902 on the description of clinical psychiatric cases in literature. Régis also gave lectures in the faculties of law and arts, and foreign faculties sent specialists to him for training. Angelo Hesnard (1886–1969), a student of Régis, noted in his eulogy to him that "Régis’s academic work bestowed great honour on the University of Bordeaux".
In 1893, Emmanuel Régis was appointed associate professor, then full professor in 1905. On 28 September 1913, he was appointed to the chair of clinical mental health in Bordeaux, which was the first provincial chair dedicated exclusively to psychiatry. Régis was thus the first professor of psychiatry at the University of Bordeaux.
Régis initially had at his disposal for teaching purposes a few "cells" at in Bordeaux. These "cells" were described as "miserable" by his contemporaries. In 1902, Régis implemented the first open psychiatric ward in a general hospital in France. Comprising two rooms of six beds each (one for women and one for men), the ward was designed to hospitalise in dignified conditions the so-called "delusional patients at general hospitals" (délirants des hôpitaux). These patients presenting with acute and transient psychotic disorders could not be admitted to medical wards, where they "disturbed the peace of the wards". The creation of dedicated beds in the general hospital prevented them from being sent to an asylum, which Régis regarded as a “disgraceful measure”, and enabled medical students to be trained in appropriate conditions. Régis denounced the abusive isolation of the lunatics in asylums where they had no contact with the outside world, a policy that deprived “these patients of the nourishment they lack most, namely the emotional, moral and social bond with others, in other words, human intersubjectivity”.
In 1902, the prefect of Bordeaux appointed Régis as deputy inspector of lunatics in the Gironde, and entrusted him with organising the Psychiatric Observation Ward at the . The ward was comparable to the infirmerie spéciale du dépôt (special infirmary) at the prefecture of Paris. It was created to enforce the Mental Health Act of 30 June 1838 on the mentally ill, regulating compulsory psychiatric hospitalisation for individuals “disturbing public order and the safety of persons”. Individuals were observed for a maximum of three days in order to allow the medical team to decide whether they should be committed to an asylum following a forensic psychiatric assessment. The ward was relocated in the Jean Abadie Centre when this university neuropsychiatric centre was established in 1956 by Paul Delmas-Marsalet.
During World War I, Régis and Pitres co-directed the neuropsychiatry department of the 18th health region. They opened wards dedicated to soldiers presenting with psychiatric disorders at the Bordeaux asylum in August 1914. This was to be Régis final post. Deeply affected by the death in action on 20 October 1917 of his son Jean, an aviation sergeant, he died on 20 June 1918, a few months before the end of the war. His other son, Louis-Joseph-André Régis, defended his doctoral thesis in medicine on war amnesia at the Faculty of Medicine in Bordeaux in 1920, and subsequently became chief physician at the psychiatric hospital in Aix-en-Provence.
Emmanuel Régis was made a Knight of the Légion d'honneur in 1903. He was elected national correspondent of the French National Academy of Medicine for the anatomy and physiology division on 31 May 1910. He served as president of the Bordeaux Society of Medicine and Surgery (1909) and was a member of several international societies of neurology and psychiatry (United Kingdom, Moscow and the United States). He was also actively involved in organising numerous congresses, serving as secretary-general of the 3rd National Congress of Public Assistance and Private Charity (1903) and president of the 12th Congress of Psychiatrists and Neurologists of France and French-speaking Countries (Grenoble, 1902). He was a close friend of Egas Moniz (1874–1955), winner of the Nobel Prize in Medicine for the development of prefrontal lobotomy (1949), who often came to visit him in Bordeaux.
Work and research Emmanuel Régis' extensive and diverse body of work played a major role in the emergence of contemporary French psychiatry based on a medical and neurobiological approach, whilst remaining open to other schools of thought, particularly psychoanalytic ones. He was first and foremost a clinician whose research was based on the highly detailed observation of psychiatric symptoms and their natural course, and he was also a renowned teacher. In the tribute paid to him following his death, his contribution to psychiatry was highlighted in his eulogy: “Thanks to Régis, the general understanding of brain diseases was transformed by the theory he championed, demonstrating that the loss of reason can result, like all other morbid conditions, from accidental causes of intoxication or infection: he rehabilitated patients suffering from mental disorders.”
The Manual of Psychiatry
Emmanuel Régis' renown was primarily linked to his teaching skills. His Manuel pratique de maladie mentale (Practical Manual of Mental Illness) was first published in 1884 (reprinted in 1892). In 1906, it became the Précis de Psychiatrie (reprinted in 1909, 1914 and 1923). This work was translated into several languages and its second edition was honoured by the French Academy of Medicine. The manual served as the standard academic textbook on French psychiatry for decades. This voluminous book provides an exhaustive overview of the state of medical knowledge at the time regarding psychiatric disorders. In it, Régis detailed their symptoms and their course, as well as the etiological and pathophysiological hypotheses regarding their determinants and the neurobiological mechanisms involved in their onset.
The Précis de Psychiatrie also served as a vehicle for disseminating his medical vision of psychiatry, and the need not to limit clinical observations to the most severe cases of psychiatric disorders. He wrote in 1914: “One of the major shortcomings of psychiatric teaching and psychiatric manuals, as they have existed to date, is that they have focused almost exclusively on cases of severe madness in asylums, leaving symptomatic psychoses in the background—those I call, because of the setting in which they are most commonly observed, delusional disorders of general hospitals.”
The anatomical-clinical model of general paresis