The historiography of mental medicine in 19th century France focuses on the relationship between nosographic knowledge and the treatment of insanity in the asylum. Indeed, describing the symptoms of understanding is the epistemic principle of "moral treatment." In the meantime, the organic seat of understanding is the brain. Nevertheless, Philippe Pinel and Etienne Esquirol categorically rejected the cerebral etiology of madness. How can this clinical judgment be explained? Therefore, the chapter aims to analyze the forms and functions of the objections to the cerebral localization of madness. The epistemological challenge is to explain the status of the brain at the intersection of the pathology of moral causes, the physiology of the viscera and the nervous system, and the anatomical-clinical autopsy of the insane. Based on this result, it is no longer possible to deduce from the "moral approach" to mental illness that psychopathology and psychotherapy have Pinel and Esquirol as their precursors.