To enable Esquirol to take up the intensive study of insanity in an appropriate setting, Pinel reportedly put up the security for the house and garden on Rue de Buffon where Esquirol established a maison santé[?] or private asylum in 1801 or 1802. Esquirol's maison was quite successful, being ranked, in 1810, as one of the three best such institutions in Paris.
In 1805 he published his thesis The passions considered as causes, symptoms and means of cure in cases of insanity. Esquirol, like Pinel, believed that the origin of mental illness lies in the passions of the soul and was convinced that madness does not fully and irremediably affect a patient’s reason.
Esquirol was made médecin ordinaire at the Salpêtrière in 1811, following the death of Jean-Baptiste Pussin[?] 1745-1811, Pinel's trusted concierge. Pinel chose Esquirol because he was "a physician…devoted exclusively to the study of insanity," arguing that with his many years of maison de santé experience he was the only man suited for the job.
Esquirol saw the question of madness as institutional and national. This was especially true for the poor where he saw the state, with the help of doctors, playing an important role . He also saw an important role for doctors in caring for people accused of crimes who were declared not responsible by reason of insanity. In public controversies over this question he promoted the usefulness of the diagnosis of monomania. By taking such an active role in these public matters, his fame eclipsed that of his teacher Pinel.
In 1817, under the restored Bourbon monarchy[?], Esquirol initiated a course in maladies mentale in the makeshift quarters of the Salpêtrière dining hall. This was perhaps the first formal teaching of psychiatry in France. At this time he was neither a professor at the Paris faculty or the chief physician at a Paris hospital, but merely a médecin ordinaire. Nonetheless he was reported to have been one of the clinical instructors to whose hospital visits "students flock with a kind of frenzy". He had many very distinguished students.
In 1810, 1814 and 1817 Esquirol, at his own expense, had toured facilities for lunatics throughout France. In 1818 following these trips he wrote a short memoir presented to the minister of the interior and a more detailed description of his findings published in the Dictionnaire des sciences médicales. These articles described, in precise and frightening terms, the conditions in which the insane lived throughout France. They demonstrate that the reforms undertaken in Paris had not penetrated the provinces. Together these two articles consitituted a program of reform directed both at the government and the medical profession.
This program consisted of four points:
At the behest of the minister of internal affairs, Esquirol next undertook a nationwide survey, visiting all the institutions throughout France where mental patients were confined. In 1822 he was appointed inspector general of medical faculties, and in 1825 director of Charenton Hospice[?]. He became the main architect of the national law of 1838 that instituted departmental asylums for all needy French mental patients and that is still in force today.