You find it in people like Fournet,3' in Casimir Pinel, a
descendant
of Pinel,*5 in Brierre de Boismont,36 and you also begin to find it in
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We find hundreds of formulations of this principle throughout the nineteenth century. I will give you just one as a reference and example, because it is an old and, as it were, founding formulation. It is a text by Fodere, from 1817, in which he says that someone admitted into an asy- lum "enters a new world in which he must be completely separated from his relatives, friends and acquaintances. "3 And I will quote a later text, from 1857, because it will serve us as a reference point and marks an important cleavage: "At the first glimmer of madness, separate the patient from his lamily, his Iriends, and his home. Immediately place him under the protection of the art. "7' So, a lunatic can never be cured in his family.
What's more, throughout the therapy, that is to say, the medical process that should lead to the cure, contact with the family is disrup tive, dangerous, and as far as possible should be avoided. This is the principle, if you like, of isolation, or rather the principle ol the foreign world, since the word 'isolation' is dangerous, appearing to suggest that the patient must be alone, whereas this is not how he is treated in the asylum. The family space and the space marked out by the disciplinary power of the asylum must be absolutely foreign to each other. 5 Why? I will just indicate the reasons here as points of reference. Some are extra ordinarily banal, and others are quite interesting and, through successive transformations, will have a future in the history of psychiatric power.
The first reason is the principle of distraction, which is important despite its apparent banality. To be cured, a lunatic must never think ol his madness. 6 One must act so that his madness is never present in his mind, is removed from his speech as far as possible, and cannot be seen by witnesses. Hiding his madness, not expressing it, putting it from his mmd, thinking of something else: this is, if you like, a principle of non-association, of dissociation.
This is one of the great schemas of psychiatric practice in this period, up until the time when the principle of association triumphs in its place. And when I say, principle of association, I am not thinking of Freud, but of Charcot, that is to say, of the sudden emergence of hyste na, since hysteria will be the great dividing point in this history. So, if the family must be absent, if one must place the mad individual in an absolutely foreign world, it is because of the principle of distraction.
? The second principle--again very banal, but interesting for its history--is that the family is immediately identified and indicated as, ll not exactly the cause of insanity, at least its occasion. That is to say, what precipitates episodes of madness are vexations, financial worries, jeal ousy in love, griel, separations, ruin, and poverty, etcetera. All ol this can set ofl madness and constantly feed it/ It is therefore with reference to the family as the permanent support ol madness, and in order to short circuit it, that patient and family must be separated.
The third, very interesting reason given, is the very strange notion introduced by Esquirol of "symptomatic suspicion," which will later break up and disappear, although it is still iound lor quite a while without EstjuiroPs term itself being used. Esquirol says that the mental patient, and particularly the maniac, is struck by a "symptomatic suspicion. "
This means that insanity is a process during which the individual's mood changes: his sensations are altered, he experiences new impressions, he no longer sees things correctly, he does not see (aces or understand words in the same way, and he may even hear voices with no real foun- dation, or see images, which are not exactly perceptual images but hal lucmations. There are two reasons why the lunatic does not understand the causes ol all these changes at the level ol his body: on the one hand, he does not know that he is mad, and, on the other, he does not know the mechanisms of the madness.
Not understanding the cause of all these transformations, he looks lor their origin elsewhere than in himself, than in his body, and elsewhere than in his madness. That is to say, he looks for their origin in his fam ily circle. In this way he connects the cause of these impressions, rather than their strangeness, to everything around him. As a result, he thinks that the cause ol this feeling of discomfort is nothing other than the malevolence of those around him, and he feels persecuted. Persecution, what Esquirol called "symptomatic suspicion," is a kind of ground on which the patient's relationships with his family circle develops. Obviously, if we want to break this symptomatic suspicion, if we want to make the patient aware that he is ill and that the strangeness of his sensations only comes from his illness, we must disconnect his existence Irom all those who have been around him, and who, since the onset of his illness, are now marked by this symptomatic suspicion.
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Finally, the fourth reason advanced by psychiatrists to explain the need to break with the family is that in every family there are power relationships--which I would call the power of sovereignty, but it's not important--which are incompatible with the cure of madness for two reasons. The first is that, in themselves, these power relationships fuel the madness: a lather's tyrannical exercise of his will over his children and family circle is part of the family's specific system of power, and will obviously reinforce the father's delusion of grandeur; a wife's legitimate pursuit of her whims, and her imposition of these whims on her husband, is based on the specific type of power relationships in the fam lly space, but it can only fuel the wife's madness. Consequently, indi- viduals must be deprived of the situation of power, of the points of support for their power in the family. A further reason, of course, is that medical power is, in itself, a different type of power from that of the family, and if we want the doctor's power to be exercised effectively, to get a real hold on the patient, we must of course suspend all the config urations, points of support, and relays specific to family power.
These, roughly, are the four reasons found m the psychiatry of the period for explaining the necessary therapeutic break between asylum and family And there are endless highly edifying case histories in which you are told that just as a therapeutic procedure was about to be successful, everything was immediately upset by the slightest contact with the family.
Thus, in his treatise Medecine mentale, Berthier--who had been the student of Girard de Cailleux and had worked at the Auxerre hospital9--recounts a series of dreadful case histories of people who were on the way to being cured until contact with the family produced catastrophic effects. "M. B. , a most respectable ecclesiastic who had always practiced an austere way of life, was affected, without noticeable cause, by monomania. As a suitable and precautionary measure, every one he knew was banned from entering the asylum. Despite this enlightened advice, his father managed to get to him. The patient, who was getting better, immediately gets worse: his delirium takes on differ- ent forms. He has hallucinations, puts aside his breviary, swears, blasphemes, and becomes prey to an erotico-arrogant delirium. "10
Another, even more beautiful case history: "Miss S. arrives in a deplorable state from a clinic of the Rhone department, suffering from
? melancholy, with maniacal excitement caused by sorrow and reversals of fortune. After two years of assiduous care we bring about a real improvement: convalescence approaches. Her son, delighted with the change, expresses the desire to see her. The head doctor agrees, but rec- ommends a brief visit. The young man, having no idea of the importance of this recommendation, exceeds the limits. At the end of two hours the agitation is reborn. "11
Ah! that's not the case history I wanted to tell you. It was the case history of a father at the Auxerre hospital who was on the way to recov ery when he sees his son through a window. Seized by a frenetic desire to see his son, he smashes the window pane. The catastrophe occurred after he breaks the glass separating the asylum from the outside world, and so separating him from his son: he relapsed into his delirium. The process was immediately precipitated by contact with the family. 12
So, entering the asylum, asylum life, necessarily involves breaking with the family.
If we now consider what takes place once entry has occurred, once the rite of purification and the break has been carried out, if we consider how the asylum is supposed to cure, how the asylum cure is supposed to take place, we see that we are still very far from the possibility of the family being the effective agent of cure. It must never be a question of the family. What's more, to bring about the cure one must never lean on elements, arrangements, or structures that might in any way evoke the family.
We will take Esquirol, and most of those who followed him up until the 1860s, as our basis. In this first episode of the history of psychiatric power, what is it in the hospital that cures? There are two things . . . no, actually there is basically one thing: in the hospital it is the hospital itself that cures. That is to say, the architectural arrangement itself, the organization of space, the way individuals are distributed in this space, the way they move around it, the way one looks or is looked at within it, all has therapeutic value in itself. In the psychiatry of this period the hospital is the curing machine. When I said there were two things, I was going to say that there is truth, but I will try to show you how the dis- course of truth, or the emergence of truth as a psychiatric operation, are ultimately only effects of this spatial arrangement.
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The hospital then is the curing machine. How does the hospital cure? It is absolutely not by reproducing the family that the hospital cures; the hospital is not in any way an ideal family. If the hospital cures it is because it puts to work those elements that I tried to show you were iormalized in Bentham; it cures because the hospital is a panoptic machine, and it is as a panoptic apparatus that the hospital cures. The hospital is in (act a machine for exercising power, lor inducing, distrib uting, and applying power according to BenthanVs schema, even il, obviously, the specific architectural arrangements ol BenthanVs design are modified. Let's say, broadly speaking, that we can find four or five operational elements ol the same order as BenthanVs Panopticon, and which are supposed to play an effective role in the cure.
First, permanent visibility. 1* The madman must not only be someone who is watched; the fact of knowing that one is always being watched, better still, the fact of knowing that one can always be watched, that one is always under the potential power of a permanent gaze, has therapeu tic value in itself, since it is precisely when one knows one is being looked at, and looked at as mad, that one will not display one's madness and the principle ol distraction, of dissociation, will function to the full.
The madman then must be in the position of someone who can always be seen, from which you get the principle for the asylum's architectural organization. A different system than the circular Panopticon was pre ferred, but one that ensured just as much visibility. This was the princi pie of pavilion architecture, that is to say of small pavilions, which Esquirol explained should be laid out on three sides, the fourth opening onto the countryside. As far as possible, the pavilions thus arranged should only have a ground floor, because the doctor needed to be able to arrive stealthily and take in everything at a glance, without anyone, patients, warders, or supervisors, hearing him. 1'1 Moreover, in this trans formed pavilion architecture, the model employed until the end of the nineteenth century, the cell--since, for Esquirol, the cell was at that time, if not preferable to the dormitory, at least the alternative to it--had to open on two sides in such a way that when the madman was looking out of one side, he could be watched through the other window to see how he was looking out the other side. What Esquirol says about asylum architecture is a strict transposition of the principle of panopticism.
? Second, the principle of central supervision by means of a tower from where an anonymous power was constantly exercised is also modified. But it is found again, up to a point, first in the form of the director's building, which must be at the center and watch over all the pavilions set out around it. But, more particularly, central supervision is ensured in a different way than in Bentham's Panopticon, but in such a way as to produce the same effect. It is ensured by what we could call the pyrami dal organization of supervisory observation.
That is to say, the relationships within the hierarchy of warders, nurses, supervisors, and doctors are formed in terms of a hierarchical channel culminating in the head doctor, the single person in charge of the asylum, because, and every psychiatrist of the period emphasizes this, administrative power and medical power must not be separated, and all these relays of supervision must finally converge on this kind of unitary and absolute knowledge-power constituted by the head doctor.
Third, the principle of isolation, which must also have a therapeutic value. Isolation and mdividualization are ensured by Esquirol's cell, which almost exactly reproduces the cell of Bentham's Panopticon, with its double opening and backlighting. In the standard practice of the period, which is the system of what could be called the triangular per ception of madness, we also find this very curious principle of isolation, that is to say, of dissociation from all effects of the group, and of the assignation of the individual to himself as such.
That is to say, the asylum frequently met with the following objection: Is it really a good idea, medically, to put all the mad people together in the same space? First of all, won't the madness be contagious? And secondly, won't seeing others who are mad induce melancholy, sadness, etcetera, in those placed amongst them?
To which the doctors reply: Not at all. Quite the reverse, it is very good to see the madness of others, provided that each patient perceives the other madmen around him in the same way that the doctor sees them. In other words, we cannot ask a madman straightaway to adopt the same point of view on himself as the doctor, because he is too attached to his own madness. However, he is not attached to the madness of others. Consequently, if the doctor shows each patient how all the others around him are really ill and mad, as a result of this, perceiving the
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madness of others in a triangular fashion, the patient in question will end up understanding what it is to be mad, suffer delirium, be maniacal or melancholic, and suffer monomania. When someone who believes he is Louis XVI is confronted with someone who also thinks he is Louis XVI, and when he sees how the doctor judges this other person, he will then be able to arrive, indirectly, at a consciousness of himself that is analogous to medical consciousness. 15
You have here an isolation of the madman in his own madness through this game of triangulation, which in itself has a curative effect,16 or at any rate, which is the guarantee that there will be none of those corrosive phenomena of contagion in the asylum, those group phenom- ena, which it is precisely the function of the Panopticon to avoid in the hospital, school, or other institutions. The non-contagion, the non existence of the group, is to be ensured by this kind of medical consciousness of others that each patient must have of those around him.
Finally, and here again you lind the themes of the Panopticon, the asy lum acts through the play ol ceaseless punishment, which is ensured either by the personnel, of course, who must be present the whole time and close to each individual, or by a set of instruments. 17 Towards the 1840s in England, which was somewhat backward relative to Western psychiatric practice, a number of English and especially Irish doctors set out the principle of no restraint* that is to say, of the abolition of mstru ments of physical restraint. 18 The demand created a considerable stir at the time and there was a sort of campaign for no restraint in all the hos- pitals of Europe and a quite important modification, in fact, in the way the mad were treated. However I do not think that the alternative, physical restraint or no restraint, was ultimately very serious.
As evidence for this I will take a letter sent by the reverend Mother Superior, in charge of the nuns at Lille, to her colleague, the Superior at Rouen, in which she said: You know, it's not that serious. You too can do what we do at Lille. You can easily remove these instruments on condition that you place "an imposing nun" beside all the lunatics you have set free. 19
Ultimately, the choice between the intervention of personnel and the use ot an instrument is superficial with regard to the deep mechanism of
* In English in original; G. B.
? ceaseless punishment. Even so, I think that the system of restraint, of physical restraint, is in a sense more eloquent and more evident than the other. In the hospitals of this period--and so after Pinel's famous unchaining of the insane at Bicetre--throughout the years from 1820 to 1845--the date oi no restraint--there was a whole set of marvelous mstru- ments: the fixed chair, that is to say, fixed to the wall and to which the patient was attached; the moving chair, which moved about according to the patient's restlessness;20 handcuffs;21 muffs;22 straitjacket;23 the finger- glove garment, which fit the individual tightly from his neck down so that his hands were pressed against his thighs; wicker caskets27' in which individuals were enclosed; and dog collars with spikes under the chin. They make up an entire, highly interesting technology of the body, the history of which should perhaps be written, setting it in the general history of these physical apparatuses.
It seems to me that we can say that before the nineteenth century there were a fairly considerable number of these corporal apparatuses. I think we can identify three types. First, security and testing appara- tuses, that is to say, apparatuses which prohibit a certain type of action, block a certain type of desire, the problem being the extent to which it is bearable and whether or not the prohibition materialized in the apparatus will be infringed. The classic example of these instruments is the chastity belt.
There is another type of corporal apparatuses used for extracting the truth and which coniorm to a law of gradual intensification, of quanti- tative increase--the water torture, the strappado,25 for example--which were usually employed in the test of truth in judicial practice.
Finally, third, there are the corporal apparatuses with the basic function of both displaying and marking the force of power: branding the shoulder or forehead with a letter. Torturing regicides with pincers and burning them was both an apparatus of public torture and of branding; it was the demonstration of the power unleashed on the tortured and subjected body itself. 26
We have here three major types of corporal apparatuses, and there is a fourth type of instrument that I think--but this is an hypothesis, for, again, the history of all this should be studied--appears precisely in the nineteenth century and in asylums. These are what we can call orthopedic
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instruments. By this I mean instruments whose function is not proof, branding by power, or extraction of truth, but correction, training, and taming of the body.
I think these apparatuses can be described in the following way. First, they are apparatuses of continuous action. Second, the progressive effect of these apparatuses must be to make themselves redundant, that is to say, ultimately one should be able to remove the apparatus and its effect will be definitively inscribed in the body. So, they are apparatuses with a self-nullifying effect. And finally, as much as possible they should be homeostatic apparatuses. That is to say, they are apparatuses such that the less one resists them the less one feels them, and the more one tries to escape them, the more one suffers. This is the system of the collar with iron spikes: if you do not lower your head you do not feel it, but the more you lower your head, the more you suffer; it is the system of the straitjacket: the more you struggle, the tighter it gets; it is the system of the chair which gives you vertigo: as long as you do not move you are comfortably seated, but if you are restless the chair's vibration makes you seasick.
This is the principle of the orthopedic instrument, which in the mechanics of the asylum is, I think, the equivalent of what Bentham dreamed of in the form of absolute visibility.
All of this directs us towards a psychiatric system in which the fam lly has absolutely no role. Not only has the family been sterilized, excluded right from the start, but also, in what is supposed to be the therapeutic process of the asylum apparatus, there is nothing that recalls anything like the family. The model one thinks of, the model which operates, is clearly more that of the workshop, of big colonial kinds ol agricultural exploitation, or of life in the barracks, with its parades and inspections.
And hospitals in this period really functioned in terms of this schematism. The Panopticon as a general system, as a system of perma- nent inspection, of uninterrupted observation, was obviously realized in the spatial organization of individuals set alongside each other, perma nently under the eyes of the person responsible for supervising them. This is how a director of the Lille asylum puts it:27 when he took over responsibility for the asylum, a bit before the no restraint campaign, he
? was surprised to hear dreadful cries everywhere, but was both reassured and, we should say, disturbed, when he saw that the patients were really very calm, because he had them all in view, pinned to the wall, each of them attached to a chair fixed to the wall--a system, as you can see, which reproduced the Panopticon mechanism.
We have then an entirely extra familial type ol restraint. I do not think that anything in the asylum brings to mind the organization of the family system; we think rather of the workshop, school, and barracks. Moreover, it is explicitly the military deployment of individuals that we see appearing [inj the work in the workshop, in agricultural work, and in work at school.
For example, in his book of 1840 on Traitement moral, Leuret said that "whenever the weather permits, patients who are in a condition to march, and who cannot or do not wish to work, are brought together in the hospital courtyard and drilled like soldiers. Imitation is such a pow erful lever, even on the laziest and most obstinate men, that I have seen several of the latter, who, resisting everything to start with, nonetheless agree to march. This is a start of methodical, regular, reasonable action, and this action leads to others. "28 With regard to one patient he says: "If I succeed in getting him to accept promotion, putting him in the place of commander, and if he acquits himself well, from that moment I would consider his cure almost certain. I never employ a supervisor to command the marching and maneuvers, only patients. "
"With the help of this somewhat military organization [and so we pass from orthopedic exercise to the very constitution of medical knowl- edge; M. F. J, inspection of the patients is facilitated, whether in the wards or courtyards, and every day I can give at least a glance to the incurably insane, keeping most of my time for the insane subject to active treat ment. "29 So, with these methods of review, inspection, lining up in the courtyard, and the doctor's observation, we are effectively in the military world. This is how the asylum functioned until around the 1850s, at which point, it seems to me, we see something that indicates a shift. *
A The manuscript continues this analysis, noting: "All in all, a disciplinary apparatus which is in principle supposed to have therapeutic ellectiveness. We see that under these conditions the correlate of this therapy, the object in its sights, is the will. Madness, no longer defined as blind iiess, but as affection ol the will, and the insertion ol the madman in a disciplinary therapeutic held, are two correlative phenomena which mutually support and reinforce each other. "
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Around 1850-1860 we begin to see the idea expressed that, first of all, the madman is like a child; second, that the madman must be placed m a milieu analogous to the family, although it is not a family; and finally, third, that these quasi lamilial elements have a therapeutic value in themselves.
You find the idea that the madman is like a child in, for example, a text by Fournet, to which I will return because it is important, "The moral treatment of insanity," which appeared in the Annales medico-
psychologique in 1854- The madman must be treated like a child, and it is the family, "the true family in which the spirit of peace, intelligence and love reigns," that, "from the earliest time and the first human aberra- tions," must ensure "the moral treatment, the model treatment of the aberrations of heart and mind. "30
This text from 1854 is all the more curious in that we see it taking a direction that is, I think, quite new at this time. Fournet says that the family has a therapeutic value, that the family is effectively the model on the basis of which one can construct a moral and psychological orthope dies, of which, he says, we have examples outside the psychiatric hospital: "The missionaries of civilization [and by this I think he means the soldiers then colonizing Algeria as well as missionaries in the strict sense; M. F. ] who take from the family its spirit of peace, benevolence, devotion, and even the name of father, and who seek to cure the preju dices, false traditions, and errors of savage nations, are Pmels and Daqums in comparison with the conquering armies who claim to bring civilization through the brutal force of arms and who act on nations in the way that chains and prisons act on the unfortunate insane. "*1
In plain words this means that there were two ages of psychiatry; one in which chains were employed and the other where, let's say, humane feelings were employed. Well, in the same way, there are two methods and maybe two ages in colonization: one is the age of the pure and sim- ple conquest by arms, and the other is the period of establishment and colonization in depth. And this in depth colonization is carried out by the organization of the family model; it is by introducing the family into the traditions and errors of savage peoples that one begins the work of colonization. Fournet continues, saying that exactly the same thing is found with delinquents. He cites Mettray, founded in 1840, where, in
? what is basically a purely military schema, the names father, elder brother, and so on, were used in a pseudo-family organization. Fournet refers to this in order to say: You see that here as well the family model is used to try to "reconstitute . . . the elements and regime of the family around these unfortunates, orphaned through the deeds or vices of their parents. " And he concludes: "It is not, gentlemen, that I wish from today to include insanity (alienation mentale) in the same category as the moral alienation of peoples or individuals subject to the judgment of history or the law . . . "32 This is another work, which he promises for the luture, but never produced.
But you see that if he did not do it, many others did subsequently. You see delinquents as the residues of society, colonized peoples as the residues of history, and the mad as the residues of humanity in general, all included together in the same category, all the individuals-- delinquents, peoples to be colonized, or the mad--who can only be reconverted, civilized and subjected to orthopedic treatment if they are ottered a family model.
I think we have here an important point of inflexion. It is important because it takes place quite early, 1854, that is to say, before Darwinism, belore On the Origins of the Species. ^ Certainly, the principle of ontogenesis- phylogenesis was already known, at least in its general form, but you see the strange use of it here and, especially--even more than the interesting bracketing together of the mad, the primitive, and the delinquent--the
appearance of the family as the common remedy for being savage, delinquent, or mad. I am not in any way claiming that this text is the first, but it seems to me to be one of the most revealing and I have hardly found any earlier text that is so clear. So, we can say that the phenomenon I would like to talk about takes place roughly around thel850s.
So, why did it take place then? What happened in this period? What is the basis of all this? For a long time I have looked for an answer to these questions, and it seemed that we could be put on the track by sim ply asking the Nietzschean question: "Who is speaking? " Who actually lormulates this idea? Where do we find it?
You find it in people like Fournet,3' in Casimir Pinel, a descendant of Pinel,*5 in Brierre de Boismont,36 and you also begin to find it in
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Blanche,*7 that is to say, in a series of individuals whose common characteristic is simply that ol having at some time managed a public service, but especially private clinics, alongside and very different from hospitals and public institutions. Furthermore, all the examples they give of familialization as therapeutic milieu are based on the example of clinics. A fine discovery, you will say. Everyone knows that, from the nineteenth century, there were hospitals barracks for the exploited and comfortable clinics for the rich. Actually, in relation to this I would like to bring out a phenomenon which goes a bit beyond this opposition, or, if you like, which is lodged in it but is much more precise.
I wonder if there was not a quite important phenomenon in the nineteenth century, of which this would be one of the innumerable eflects. This important phenomenon, the elfect of which arises here, would be the integration, organization, and exploitation ol what I would call the profits of abnormalities, of illegalities or irregularities. I would say that the disciplinary systems had a primary, massive, overall function which appears clearly in the eighteenth century: to adjust the multiplicity of individuals to the apparatuses of production, or to the State apparatuses (appareils) which control them, or again, to adjust the combination of men to the accumulation of capital. Insofar as these dis- ciplinary systems were normalizing, they necessarily produced, on their borders and through exclusion, residual abnormalities, illegalities, and irregularities. The tighter the disciplinary system, the more numerous the abnormalities and irregularities. Now, from these irregularities, ille galities, and abnormalities that the disciplinary system was designed to reduce, but that at the same time it created precisely to the extent that it functioned, the economic and political system of the bourgeoisie of the nineteenth century [drew]* a source of profit on the one hand, and of the reinforcement of power on the other.
I will take the example of prostitution, which is quite close to that of the psychiatric hospitals I will talk about after. Clearly, we don't have to wait until the nineteenth century for the existence of that famous triangle of prostitutes, clients and procurers, for the existence of broth- els and established networks, etcetera. We don't have to wait until the
* (Recording:) found
? nineteenth century for the employment of prostitutes and procurers as mlormers and for the circulation of large sums of money for sexual pleasure in general. However, in the nineteenth century I think we see t he organization in European countries of a tight network resting first of all on a system of property, of hotels and brothels, etcetera, and which uses procurers as intermediaries and agents, who are at the same time informers recruited from a group about whose constitution I tried to say some things last year, that is, delinquents. *8
II there was this kind of need for delinquents, and if, in the end, so much care was taken to form them into an "underworld," it is precisely because they were the reserve army ol these important agents of which procurers-informers are only examples. Procurers, enframed by and coupled with the police, are the basic intermediaries ol the system of prostitution. So what was the purpose of this system with its rigorous organization and its supports and relays? Its function is to bring back to capital itself, to the normal circuits of capitalist profit, all the profits that can be extracted from sexual pleasure, on the triple condition, of course, that, first, this sexual pleasure is marginalized, deprecated, and prohibited, and so then becomes costly solely by virtue of being prohibited. Second, il one wants to make a profit from sexual pleasure, then it must not only be prohibited, but it must actually be tolerated. And, finally, it must be supervised by a particular power, which is ensured by the coupling of criminals and police, through the procurer- informer. Brought back into the normal circuits of capitalism in this way, the profit from sexual pleasure will bring about the secondary effect of the reinforcement of all the procedures of surveillance and, consequently, the constitution of what could be called an infra-power, which is finally brought to bear on men's everyday, individual, and corporal behavior:
the disciplinary system of prostitution. Because this is what is involved; alongside the army, school, and psychiatric hospital, prostitution, as it was organized in the nineteenth century, is again a disciplinary system, the economic and political impact of which can be seen straightaway.
First, sexual pleasure is made profitable, that is to say, it is made into a source of profit due to both its prohibition and its tolerance. Second, the profits from sexual pleasure flow back into the general circuits of capitalism. Third, leaning on this so as to fix even more firmly the
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extreme effects, the synaptic relays of State power, which end up reaching into men's everyday pleasure.
But prostitution is, of course, only one example of this kind of general mechanism which can be found in the disciplinary systems set up in the eighteenth century for a particular overall function, and which are then refined in the nineteenth century on the basis of this discipline which was essentially demanded by the formation of a new apparatus of production. Finer disciplines are adapted to these disciplines, or, if you like, the old disciplines are refined and thus find new possibilities for the constitution of profit and the reinforcement of power.
Let us now turn to the clinics of Brierre de Boismont, Blanche, and others. What basically is involved is the extraction of profit, and maximum profit, from the marginalization carried out by psychiatric discipline. For if it is clear that the basic aim of psychiatric discipline in its overall form is to take out of circulation individuals who cannot be employed in the apparatus of production, at another level, on a more restricted scale and with a very different social localization, they can be turned into a new source of profit. *
In fact, when a number of individuals from the wealthy classes are themselves marginalized, in the name of the same knowledge that deter- mines confinement, then it will be possible to profit from them. That is to say, it will be possible to ask families who have the means to "pay to be cured. " So you can see that the first step in the process will consist in demanding a profit from the family of the individual who is declared ill--on certain conditions.
Obviously it must not be possible to cure the patient at home. So the principle of isolation will continue to be emphasized for the patient who is a source of profit: "We will not cure you in your family. But if we ask your family to pay for you to be confined elsewhere, we must of course guarantee to restore to it something in its image. " That is to say,
* In the manuscript Foucault adds: "It is the profit from irregularity which serves as a vector for importing the family model into psychiatric practice. "
? it is necessary to give back a certain benefit to the family proportionate to the profit demanded from it; a certain profit for the medical body is requested for confining an individual in this way, to pay a pension, etcetera, but the family must benefit from this. This benefit will be the renewal of the system of power within the family. The psychiatrists say to the family: "We will give back to you someone who will really conform and be adjusted and adapted to your system of power. " Therefore, re-familialized individuals will be produced, inasmuch as it is the family that, by designating the mad person, provided the possibility of a profit to those who constitute the profit from marginalization. From this derives the need for clinics to be very closely adapted to the family model.
Thus in Brierre de Boismont's clinic, in the Samt-Antoine suburb, there was an organization completely modeled on the family, that is to say, with a father and mother. What's more, the model was not new: Blanche provided a first example of it during the Restoration. 39 The father is Brierre de Boismont himself, and the mother is his wife. Everyone lives in the family home, all are brothers, everyone takes their meals together, and all must have family feelings for each other. The reactivation of family feelings, the investment of every family function in the clinic, will be the effective agency of the cure.
There are some very clear accounts of this in Brierre de Boismont, in his quotation of the correspondence between his patients, after their cure, and himself or his wife. He quotes the letter of an old patient who wrote to Madame Brierre de Boismont: "Far from you, madame, I will often seek the memory so deeply engraved on my heart, in order to enjoy once more that calm filled with affection that you communicate to those who have the good fortune to be received into your home. I will often cast my mind back to your family milieu, so united in all its parts, so affectionate in each of its members, the eldest of whom is as gracious as she is intelligent. If, as is my wish, I return from my own family, you shall be my first visit, for it is a heartfelt debt" (20 May 1847)/'?
I think this letter is interesting. You see that the criterion, the form of the cure itself, is the activation of canonical types of family feelings: grat- itude towards the mother and father. You also see at work here, or rising to the surface at least, the theme of a love which is both validated and
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quasi-incestuous, since the patient is supposed to be Brierre de Boismont's son, and so the brother of the eldest daughter for whom he experiences some feelings. What will be the effect of this reactivation of family feelings, what will he do when he returns to Paris? First of all he will see his family, the true family--that is to say, the family that will get the benefit of the medical process--and, only secondly, he will see Brierre de Boismont's family, this quasi-family, which therefore plays a role of both super- and sub family. It is a super-family inasmuch as it is the ideal family, which functions in the pure state, the family as it should be always; and it is inasmuch as it is the true family that it is attributed an orthopedic function. Second, it is a sub-family inasmuch as its role is to efface itself before the real family, to activate family feelings by means of its internal mechanism only so that the real family benefits from this, and, at that point, it is no more than the kind of schematic support which, discreetly, constantly sustains the functioning of the real family. This super family and sub-family is constructed in these clinics, the social and economic location of which is, as you can see, very different from that of the asylum.
However, if the bourgeois, paying clinic is thus famihalized--functioning on the family model--then the family, in turn, outside the clinic, must play its role. It is not just a question of saying to the family, if you pay me, I will make your madman able to function in the family; the family still has to play its role, that is to say, actually designate those who are mad. It must play a disciplinary role for itself, as it were, that is to say, it must say: Here is our mad, abnormal member, who is a matter for medicine. That is to say, you have familiahzation of the therapeutic milieu for the clinics on one side, and, on the other, disciplinarization of the family, which at that point becomes the agency of the abnormahzation of individuals.
Whereas the question of the abnormal individual did not arise for the sovereign family--which was concerned rather with the hierarchical order of births, the order of inheritance, relationships of allegiance, obedience, and preeminence between them, with the name and all the sub-functions of the name--the disciplinarized family will begin to sub- stitute for this sovereign function of the name the psychological function of the designation of abnormal individuals, of the abnormahzation of individuals.
? What I am saying about the clinics is also valid for the school, and to a certain extent for health in general, and for military service, and so on. What I have wanted to show you is that, however much the family con tinued to conform to a model of sovereignty in the nineteenth century, it may be that, from the middle ol the nineteenth century perhaps, there was a sort ol internal disciplinanzation of the family, that is to say, a kind of transfer of disciplinary forms and schemas, of those techniques of power given by the disciplines, into the very heart of the game of lamily sovereignty.
Just as the family model is transferred into disciplinary systems, dis ciplinary techniques are transplanted into the family. And at that point the family, while retaining the specific heterogeneity of sovereign power, begins to function like a little school: the strange category ol student parents appears, home duties begin to appear, the control of school dis cipline by the lamily; the lamily becomes a micro-clinic which controls the normality or abnormality of the body, of the soul; it becomes a small scale barracks, and maybe it becomes, we will come back to this, the place where sexuality circulates.
I think we can say that, on the basis of disciplinary systems, family sovereignty will be placed under the following obligation: "You must hnd for us the mad, feeble minded, diflicult, and perverse, and you must lind them yourself, through the exercise of disciplinary kinds ol control within lamily sovereignty. And when, through the operation ol this dis- ciplinanzed sovereignty, you have lound your mad, abnormal, feeble minded, and difficult members in your home, we, say the disciplines, will put them through the filter of normalizing apparatuses and restore them to you, the lamily, for your greater functional benefit. We will make them conform to your needs, even if, obviously, we have made our profit on this. "
This is how disciplinary power lives off family sovereignty, requiring the family to play the role of the agency that decides between normal and abnormal, regular and irregular, asking the family to hand over its abnormal, irregular individuals, etcetera, and making a profit from this, which enters into the general system of profit and can be called, if you like, the economic benefit of irregularity. After which, what's more, the lamily is supposed to find again, at the end ol the process, an individual
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who has been disciplined in such a way that he can be effectively subjected to the family's specific schema of sovereignty. Being a good son, a good husband, and so on, is really the outcome offered by all these disciplinary establishments, by schools, hospitals, reformatories, and the rest. This means that they are machines thanks to which it is thought that disciplinary apparatuses will constitute characters who can take their place within the specific morphology of the family's power of sovereignty.
? 1. "Lesjurieux must be placed in a place of salely, but they can only be detained by virtue of
a judgment which must be prompted by the family ( . . . ) . It is to the Tribunals alone that
it [the Civil Code; J. L. | entrusts the care ol establishing iheir condition. " Circular of Portalis, 30 Fructidor Year 12 (17 September 1804) cited in G. Bollotte, "Les malades men- taux de 1789 a 1838 dans I'ceuvre de P. Serieux" Information psychiatrique, vol. 44, no. 10, 1968, p. 916. The Civil Code of 1804 reformulated the old jurisdiction in article 489 (Title XI, ch. 2): "The person who has reached the age of majority and is in a habitual state
of imbecility, dementia, or trenzy, must be interdicted, even when this state has intervals of lucidity. " See, "Interdit" in CJ. de Ferriere, ed. , Dictionnaire de droil el de pratique (Paris: Brunei, 1769) vol. 2, pp. 48-50; H. Legrand du Saulle, Etude medico-legale sur ('interdiction des alienes et sur le conseil judiciaire (Paris: Delahaye el Lecrosnier, 1881); P. Serieux and L. Libert, La Regime des alienes en France au XVIIT siecle (Paris: Masson, 1914); P. Serieux and M. Trenel, "L'inlerdiction des alienes par voie judiciaire (sentence d'interdiction) sous I'Ancien Regime" Revue historique de droit francais el etranger, 4'1' series, 10th year, July September 1931, pp. 450 486; A. Laingui, La Responsabilite penale dans I'ancien droil (XVT- XVIII' siecles) (Paris: Librairie generale de droit et de jurisprudence, 1970) vol. 2, pp. 173 204. Foucault relers to interdiction in Hisloire de la folie, pp. 141-143 (omitted from Madness and Civilisation). He returns to the topic in the lecture of 12 January 1975 ol his course al the College de France, 1974 1975, Les Anormaux, eds. V. Marchetti and
A. Salomoni (Paris: Gallimard/Seuil, 1999) pp. 131-136; English translation, Michel Foucault, Abnormal. Lectures at the College de France 7974-7975, English ed. Arnold I. Davidson, trans. Graham Burchell (New York: Picador, 2O03) pp. 141-145.
2. The law ol 16 24 August 1790 made conhnement a police measure by entrusting "to the vigilance and authority ol municipal bodies . . . the responsibility lor avoiding or remedy
ing unlortunate events which could be occasioned by the insane or thefurieux left in lib erty" (Title XI, article 3) in Legislation sur les alienes et les enjants assisles. Recueil des his, decrels et circulaires (1790-1879)(Paris: Ministere de I'Interieur et des Cukes, 1880 ) vol. 1, p. 3. See, M. Foucault, Hisloire de lajolie, p. 443; Madness and Civilisation, pp. 238 239-
3. F. E. Fodere, Traite du delire, vol. 2, p. 252.
4. P. Berthier, Medecine mentale, vol. 1; De I'isolement (Paris: J. B. Bailliere, 1857) p. 10.
5. The principle is stated by Esquirol in his "Memoire sur I'isolement des alienes" (read at
the Institut on 1 October 1852): "The isolation of the insane (sequestration, confinement) consists in withdrawing him Irom all his habits, in separating him from his lamily, his friends, and his servants; in surrounding him with strangers; in changing his whole way of
life" Des maladies mentales considerees sous les rapports medical, hygienique el medico-legal, vol. 2, p. 745-J. P. Falret, "Du traitement general des alienes" (lecture at Salpetriere, 1854) in Des maladies mentales el des asiles d'alienes (Paris: J. B. Bailliere, 1864) pp. 677-699, see p. 685 sq. ;J. Guislain, Traitesur les phrenopathies, p. 409;J-M. Dupuy, Qulquesconsiderations surla
Jolie. Visite au Castel d'Andorle, etablissemcnl destine aux alienes de la classe riche (Pengueux: Dupont, 1848) pp. 7-8.
6. Francois Leuret states that "whenever one can, one should impose silence on the patient on the subject ol his delirium and occupy him with something else" Du traitement moral de la
Jolie, op. cit. , p. 120. See also his "Memoire sur la revulsion morale dans le traitement de la folie" in Memoires de I'Academic royale de medecine, 1841, p. 658. However, it is J. P. Falret who, in a faithful summary ol Esquirol's conceptions, states the principle most explicitly in an unpublished manuscript: "Isolation is obviously of prime importance . . . But, once the patient has been withdrawn from external influences, should he be left to himself without seeking to destroy the lixity of his unhealthy preoccupations? Obviously not. Not content with having removed the causes which may foment it, one must combat the delir- ium itself, and to this end experience recognizes no more ellective means than, for some, fixing their attention on objects most likely to fascinate them, and, lor others, diverting them from their hxed ideas, distracting them from their preoccupations by constantly pre senting them with objects loreign to their delirium, and by completely directing their attention on every kind ol occupation, so that it is impossible lor them to think of the subject ol their illness. " Quoted by G. Daumezon and P. Koechlin, "La psychotherapie institutionelle
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7.
Iranc. aise contemporaine" AnnaisPortugueses de psiquialria, vol. 4, no. 4, 1952, p. 27/l. See also, J. P. Falret, Des maladies menlales el des asiles d'alienes, p. 687.
"The moral cause of insanity often exists in the bosom of the lamily, and gets its source from sorrows, domestic disputes, setbacks, etcetera (. . . ) the lirst shock to the intellectual
and moral faculties olten takes place in the insane person's own home, amongst his acquaintances, his relatives, and his friends. " J. E. D.
We find hundreds of formulations of this principle throughout the nineteenth century. I will give you just one as a reference and example, because it is an old and, as it were, founding formulation. It is a text by Fodere, from 1817, in which he says that someone admitted into an asy- lum "enters a new world in which he must be completely separated from his relatives, friends and acquaintances. "3 And I will quote a later text, from 1857, because it will serve us as a reference point and marks an important cleavage: "At the first glimmer of madness, separate the patient from his lamily, his Iriends, and his home. Immediately place him under the protection of the art. "7' So, a lunatic can never be cured in his family.
What's more, throughout the therapy, that is to say, the medical process that should lead to the cure, contact with the family is disrup tive, dangerous, and as far as possible should be avoided. This is the principle, if you like, of isolation, or rather the principle ol the foreign world, since the word 'isolation' is dangerous, appearing to suggest that the patient must be alone, whereas this is not how he is treated in the asylum. The family space and the space marked out by the disciplinary power of the asylum must be absolutely foreign to each other. 5 Why? I will just indicate the reasons here as points of reference. Some are extra ordinarily banal, and others are quite interesting and, through successive transformations, will have a future in the history of psychiatric power.
The first reason is the principle of distraction, which is important despite its apparent banality. To be cured, a lunatic must never think ol his madness. 6 One must act so that his madness is never present in his mind, is removed from his speech as far as possible, and cannot be seen by witnesses. Hiding his madness, not expressing it, putting it from his mmd, thinking of something else: this is, if you like, a principle of non-association, of dissociation.
This is one of the great schemas of psychiatric practice in this period, up until the time when the principle of association triumphs in its place. And when I say, principle of association, I am not thinking of Freud, but of Charcot, that is to say, of the sudden emergence of hyste na, since hysteria will be the great dividing point in this history. So, if the family must be absent, if one must place the mad individual in an absolutely foreign world, it is because of the principle of distraction.
? The second principle--again very banal, but interesting for its history--is that the family is immediately identified and indicated as, ll not exactly the cause of insanity, at least its occasion. That is to say, what precipitates episodes of madness are vexations, financial worries, jeal ousy in love, griel, separations, ruin, and poverty, etcetera. All ol this can set ofl madness and constantly feed it/ It is therefore with reference to the family as the permanent support ol madness, and in order to short circuit it, that patient and family must be separated.
The third, very interesting reason given, is the very strange notion introduced by Esquirol of "symptomatic suspicion," which will later break up and disappear, although it is still iound lor quite a while without EstjuiroPs term itself being used. Esquirol says that the mental patient, and particularly the maniac, is struck by a "symptomatic suspicion. "
This means that insanity is a process during which the individual's mood changes: his sensations are altered, he experiences new impressions, he no longer sees things correctly, he does not see (aces or understand words in the same way, and he may even hear voices with no real foun- dation, or see images, which are not exactly perceptual images but hal lucmations. There are two reasons why the lunatic does not understand the causes ol all these changes at the level ol his body: on the one hand, he does not know that he is mad, and, on the other, he does not know the mechanisms of the madness.
Not understanding the cause of all these transformations, he looks lor their origin elsewhere than in himself, than in his body, and elsewhere than in his madness. That is to say, he looks for their origin in his fam ily circle. In this way he connects the cause of these impressions, rather than their strangeness, to everything around him. As a result, he thinks that the cause ol this feeling of discomfort is nothing other than the malevolence of those around him, and he feels persecuted. Persecution, what Esquirol called "symptomatic suspicion," is a kind of ground on which the patient's relationships with his family circle develops. Obviously, if we want to break this symptomatic suspicion, if we want to make the patient aware that he is ill and that the strangeness of his sensations only comes from his illness, we must disconnect his existence Irom all those who have been around him, and who, since the onset of his illness, are now marked by this symptomatic suspicion.
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Finally, the fourth reason advanced by psychiatrists to explain the need to break with the family is that in every family there are power relationships--which I would call the power of sovereignty, but it's not important--which are incompatible with the cure of madness for two reasons. The first is that, in themselves, these power relationships fuel the madness: a lather's tyrannical exercise of his will over his children and family circle is part of the family's specific system of power, and will obviously reinforce the father's delusion of grandeur; a wife's legitimate pursuit of her whims, and her imposition of these whims on her husband, is based on the specific type of power relationships in the fam lly space, but it can only fuel the wife's madness. Consequently, indi- viduals must be deprived of the situation of power, of the points of support for their power in the family. A further reason, of course, is that medical power is, in itself, a different type of power from that of the family, and if we want the doctor's power to be exercised effectively, to get a real hold on the patient, we must of course suspend all the config urations, points of support, and relays specific to family power.
These, roughly, are the four reasons found m the psychiatry of the period for explaining the necessary therapeutic break between asylum and family And there are endless highly edifying case histories in which you are told that just as a therapeutic procedure was about to be successful, everything was immediately upset by the slightest contact with the family.
Thus, in his treatise Medecine mentale, Berthier--who had been the student of Girard de Cailleux and had worked at the Auxerre hospital9--recounts a series of dreadful case histories of people who were on the way to being cured until contact with the family produced catastrophic effects. "M. B. , a most respectable ecclesiastic who had always practiced an austere way of life, was affected, without noticeable cause, by monomania. As a suitable and precautionary measure, every one he knew was banned from entering the asylum. Despite this enlightened advice, his father managed to get to him. The patient, who was getting better, immediately gets worse: his delirium takes on differ- ent forms. He has hallucinations, puts aside his breviary, swears, blasphemes, and becomes prey to an erotico-arrogant delirium. "10
Another, even more beautiful case history: "Miss S. arrives in a deplorable state from a clinic of the Rhone department, suffering from
? melancholy, with maniacal excitement caused by sorrow and reversals of fortune. After two years of assiduous care we bring about a real improvement: convalescence approaches. Her son, delighted with the change, expresses the desire to see her. The head doctor agrees, but rec- ommends a brief visit. The young man, having no idea of the importance of this recommendation, exceeds the limits. At the end of two hours the agitation is reborn. "11
Ah! that's not the case history I wanted to tell you. It was the case history of a father at the Auxerre hospital who was on the way to recov ery when he sees his son through a window. Seized by a frenetic desire to see his son, he smashes the window pane. The catastrophe occurred after he breaks the glass separating the asylum from the outside world, and so separating him from his son: he relapsed into his delirium. The process was immediately precipitated by contact with the family. 12
So, entering the asylum, asylum life, necessarily involves breaking with the family.
If we now consider what takes place once entry has occurred, once the rite of purification and the break has been carried out, if we consider how the asylum is supposed to cure, how the asylum cure is supposed to take place, we see that we are still very far from the possibility of the family being the effective agent of cure. It must never be a question of the family. What's more, to bring about the cure one must never lean on elements, arrangements, or structures that might in any way evoke the family.
We will take Esquirol, and most of those who followed him up until the 1860s, as our basis. In this first episode of the history of psychiatric power, what is it in the hospital that cures? There are two things . . . no, actually there is basically one thing: in the hospital it is the hospital itself that cures. That is to say, the architectural arrangement itself, the organization of space, the way individuals are distributed in this space, the way they move around it, the way one looks or is looked at within it, all has therapeutic value in itself. In the psychiatry of this period the hospital is the curing machine. When I said there were two things, I was going to say that there is truth, but I will try to show you how the dis- course of truth, or the emergence of truth as a psychiatric operation, are ultimately only effects of this spatial arrangement.
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The hospital then is the curing machine. How does the hospital cure? It is absolutely not by reproducing the family that the hospital cures; the hospital is not in any way an ideal family. If the hospital cures it is because it puts to work those elements that I tried to show you were iormalized in Bentham; it cures because the hospital is a panoptic machine, and it is as a panoptic apparatus that the hospital cures. The hospital is in (act a machine for exercising power, lor inducing, distrib uting, and applying power according to BenthanVs schema, even il, obviously, the specific architectural arrangements ol BenthanVs design are modified. Let's say, broadly speaking, that we can find four or five operational elements ol the same order as BenthanVs Panopticon, and which are supposed to play an effective role in the cure.
First, permanent visibility. 1* The madman must not only be someone who is watched; the fact of knowing that one is always being watched, better still, the fact of knowing that one can always be watched, that one is always under the potential power of a permanent gaze, has therapeu tic value in itself, since it is precisely when one knows one is being looked at, and looked at as mad, that one will not display one's madness and the principle ol distraction, of dissociation, will function to the full.
The madman then must be in the position of someone who can always be seen, from which you get the principle for the asylum's architectural organization. A different system than the circular Panopticon was pre ferred, but one that ensured just as much visibility. This was the princi pie of pavilion architecture, that is to say of small pavilions, which Esquirol explained should be laid out on three sides, the fourth opening onto the countryside. As far as possible, the pavilions thus arranged should only have a ground floor, because the doctor needed to be able to arrive stealthily and take in everything at a glance, without anyone, patients, warders, or supervisors, hearing him. 1'1 Moreover, in this trans formed pavilion architecture, the model employed until the end of the nineteenth century, the cell--since, for Esquirol, the cell was at that time, if not preferable to the dormitory, at least the alternative to it--had to open on two sides in such a way that when the madman was looking out of one side, he could be watched through the other window to see how he was looking out the other side. What Esquirol says about asylum architecture is a strict transposition of the principle of panopticism.
? Second, the principle of central supervision by means of a tower from where an anonymous power was constantly exercised is also modified. But it is found again, up to a point, first in the form of the director's building, which must be at the center and watch over all the pavilions set out around it. But, more particularly, central supervision is ensured in a different way than in Bentham's Panopticon, but in such a way as to produce the same effect. It is ensured by what we could call the pyrami dal organization of supervisory observation.
That is to say, the relationships within the hierarchy of warders, nurses, supervisors, and doctors are formed in terms of a hierarchical channel culminating in the head doctor, the single person in charge of the asylum, because, and every psychiatrist of the period emphasizes this, administrative power and medical power must not be separated, and all these relays of supervision must finally converge on this kind of unitary and absolute knowledge-power constituted by the head doctor.
Third, the principle of isolation, which must also have a therapeutic value. Isolation and mdividualization are ensured by Esquirol's cell, which almost exactly reproduces the cell of Bentham's Panopticon, with its double opening and backlighting. In the standard practice of the period, which is the system of what could be called the triangular per ception of madness, we also find this very curious principle of isolation, that is to say, of dissociation from all effects of the group, and of the assignation of the individual to himself as such.
That is to say, the asylum frequently met with the following objection: Is it really a good idea, medically, to put all the mad people together in the same space? First of all, won't the madness be contagious? And secondly, won't seeing others who are mad induce melancholy, sadness, etcetera, in those placed amongst them?
To which the doctors reply: Not at all. Quite the reverse, it is very good to see the madness of others, provided that each patient perceives the other madmen around him in the same way that the doctor sees them. In other words, we cannot ask a madman straightaway to adopt the same point of view on himself as the doctor, because he is too attached to his own madness. However, he is not attached to the madness of others. Consequently, if the doctor shows each patient how all the others around him are really ill and mad, as a result of this, perceiving the
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madness of others in a triangular fashion, the patient in question will end up understanding what it is to be mad, suffer delirium, be maniacal or melancholic, and suffer monomania. When someone who believes he is Louis XVI is confronted with someone who also thinks he is Louis XVI, and when he sees how the doctor judges this other person, he will then be able to arrive, indirectly, at a consciousness of himself that is analogous to medical consciousness. 15
You have here an isolation of the madman in his own madness through this game of triangulation, which in itself has a curative effect,16 or at any rate, which is the guarantee that there will be none of those corrosive phenomena of contagion in the asylum, those group phenom- ena, which it is precisely the function of the Panopticon to avoid in the hospital, school, or other institutions. The non-contagion, the non existence of the group, is to be ensured by this kind of medical consciousness of others that each patient must have of those around him.
Finally, and here again you lind the themes of the Panopticon, the asy lum acts through the play ol ceaseless punishment, which is ensured either by the personnel, of course, who must be present the whole time and close to each individual, or by a set of instruments. 17 Towards the 1840s in England, which was somewhat backward relative to Western psychiatric practice, a number of English and especially Irish doctors set out the principle of no restraint* that is to say, of the abolition of mstru ments of physical restraint. 18 The demand created a considerable stir at the time and there was a sort of campaign for no restraint in all the hos- pitals of Europe and a quite important modification, in fact, in the way the mad were treated. However I do not think that the alternative, physical restraint or no restraint, was ultimately very serious.
As evidence for this I will take a letter sent by the reverend Mother Superior, in charge of the nuns at Lille, to her colleague, the Superior at Rouen, in which she said: You know, it's not that serious. You too can do what we do at Lille. You can easily remove these instruments on condition that you place "an imposing nun" beside all the lunatics you have set free. 19
Ultimately, the choice between the intervention of personnel and the use ot an instrument is superficial with regard to the deep mechanism of
* In English in original; G. B.
? ceaseless punishment. Even so, I think that the system of restraint, of physical restraint, is in a sense more eloquent and more evident than the other. In the hospitals of this period--and so after Pinel's famous unchaining of the insane at Bicetre--throughout the years from 1820 to 1845--the date oi no restraint--there was a whole set of marvelous mstru- ments: the fixed chair, that is to say, fixed to the wall and to which the patient was attached; the moving chair, which moved about according to the patient's restlessness;20 handcuffs;21 muffs;22 straitjacket;23 the finger- glove garment, which fit the individual tightly from his neck down so that his hands were pressed against his thighs; wicker caskets27' in which individuals were enclosed; and dog collars with spikes under the chin. They make up an entire, highly interesting technology of the body, the history of which should perhaps be written, setting it in the general history of these physical apparatuses.
It seems to me that we can say that before the nineteenth century there were a fairly considerable number of these corporal apparatuses. I think we can identify three types. First, security and testing appara- tuses, that is to say, apparatuses which prohibit a certain type of action, block a certain type of desire, the problem being the extent to which it is bearable and whether or not the prohibition materialized in the apparatus will be infringed. The classic example of these instruments is the chastity belt.
There is another type of corporal apparatuses used for extracting the truth and which coniorm to a law of gradual intensification, of quanti- tative increase--the water torture, the strappado,25 for example--which were usually employed in the test of truth in judicial practice.
Finally, third, there are the corporal apparatuses with the basic function of both displaying and marking the force of power: branding the shoulder or forehead with a letter. Torturing regicides with pincers and burning them was both an apparatus of public torture and of branding; it was the demonstration of the power unleashed on the tortured and subjected body itself. 26
We have here three major types of corporal apparatuses, and there is a fourth type of instrument that I think--but this is an hypothesis, for, again, the history of all this should be studied--appears precisely in the nineteenth century and in asylums. These are what we can call orthopedic
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instruments. By this I mean instruments whose function is not proof, branding by power, or extraction of truth, but correction, training, and taming of the body.
I think these apparatuses can be described in the following way. First, they are apparatuses of continuous action. Second, the progressive effect of these apparatuses must be to make themselves redundant, that is to say, ultimately one should be able to remove the apparatus and its effect will be definitively inscribed in the body. So, they are apparatuses with a self-nullifying effect. And finally, as much as possible they should be homeostatic apparatuses. That is to say, they are apparatuses such that the less one resists them the less one feels them, and the more one tries to escape them, the more one suffers. This is the system of the collar with iron spikes: if you do not lower your head you do not feel it, but the more you lower your head, the more you suffer; it is the system of the straitjacket: the more you struggle, the tighter it gets; it is the system of the chair which gives you vertigo: as long as you do not move you are comfortably seated, but if you are restless the chair's vibration makes you seasick.
This is the principle of the orthopedic instrument, which in the mechanics of the asylum is, I think, the equivalent of what Bentham dreamed of in the form of absolute visibility.
All of this directs us towards a psychiatric system in which the fam lly has absolutely no role. Not only has the family been sterilized, excluded right from the start, but also, in what is supposed to be the therapeutic process of the asylum apparatus, there is nothing that recalls anything like the family. The model one thinks of, the model which operates, is clearly more that of the workshop, of big colonial kinds ol agricultural exploitation, or of life in the barracks, with its parades and inspections.
And hospitals in this period really functioned in terms of this schematism. The Panopticon as a general system, as a system of perma- nent inspection, of uninterrupted observation, was obviously realized in the spatial organization of individuals set alongside each other, perma nently under the eyes of the person responsible for supervising them. This is how a director of the Lille asylum puts it:27 when he took over responsibility for the asylum, a bit before the no restraint campaign, he
? was surprised to hear dreadful cries everywhere, but was both reassured and, we should say, disturbed, when he saw that the patients were really very calm, because he had them all in view, pinned to the wall, each of them attached to a chair fixed to the wall--a system, as you can see, which reproduced the Panopticon mechanism.
We have then an entirely extra familial type ol restraint. I do not think that anything in the asylum brings to mind the organization of the family system; we think rather of the workshop, school, and barracks. Moreover, it is explicitly the military deployment of individuals that we see appearing [inj the work in the workshop, in agricultural work, and in work at school.
For example, in his book of 1840 on Traitement moral, Leuret said that "whenever the weather permits, patients who are in a condition to march, and who cannot or do not wish to work, are brought together in the hospital courtyard and drilled like soldiers. Imitation is such a pow erful lever, even on the laziest and most obstinate men, that I have seen several of the latter, who, resisting everything to start with, nonetheless agree to march. This is a start of methodical, regular, reasonable action, and this action leads to others. "28 With regard to one patient he says: "If I succeed in getting him to accept promotion, putting him in the place of commander, and if he acquits himself well, from that moment I would consider his cure almost certain. I never employ a supervisor to command the marching and maneuvers, only patients. "
"With the help of this somewhat military organization [and so we pass from orthopedic exercise to the very constitution of medical knowl- edge; M. F. J, inspection of the patients is facilitated, whether in the wards or courtyards, and every day I can give at least a glance to the incurably insane, keeping most of my time for the insane subject to active treat ment. "29 So, with these methods of review, inspection, lining up in the courtyard, and the doctor's observation, we are effectively in the military world. This is how the asylum functioned until around the 1850s, at which point, it seems to me, we see something that indicates a shift. *
A The manuscript continues this analysis, noting: "All in all, a disciplinary apparatus which is in principle supposed to have therapeutic ellectiveness. We see that under these conditions the correlate of this therapy, the object in its sights, is the will. Madness, no longer defined as blind iiess, but as affection ol the will, and the insertion ol the madman in a disciplinary therapeutic held, are two correlative phenomena which mutually support and reinforce each other. "
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Around 1850-1860 we begin to see the idea expressed that, first of all, the madman is like a child; second, that the madman must be placed m a milieu analogous to the family, although it is not a family; and finally, third, that these quasi lamilial elements have a therapeutic value in themselves.
You find the idea that the madman is like a child in, for example, a text by Fournet, to which I will return because it is important, "The moral treatment of insanity," which appeared in the Annales medico-
psychologique in 1854- The madman must be treated like a child, and it is the family, "the true family in which the spirit of peace, intelligence and love reigns," that, "from the earliest time and the first human aberra- tions," must ensure "the moral treatment, the model treatment of the aberrations of heart and mind. "30
This text from 1854 is all the more curious in that we see it taking a direction that is, I think, quite new at this time. Fournet says that the family has a therapeutic value, that the family is effectively the model on the basis of which one can construct a moral and psychological orthope dies, of which, he says, we have examples outside the psychiatric hospital: "The missionaries of civilization [and by this I think he means the soldiers then colonizing Algeria as well as missionaries in the strict sense; M. F. ] who take from the family its spirit of peace, benevolence, devotion, and even the name of father, and who seek to cure the preju dices, false traditions, and errors of savage nations, are Pmels and Daqums in comparison with the conquering armies who claim to bring civilization through the brutal force of arms and who act on nations in the way that chains and prisons act on the unfortunate insane. "*1
In plain words this means that there were two ages of psychiatry; one in which chains were employed and the other where, let's say, humane feelings were employed. Well, in the same way, there are two methods and maybe two ages in colonization: one is the age of the pure and sim- ple conquest by arms, and the other is the period of establishment and colonization in depth. And this in depth colonization is carried out by the organization of the family model; it is by introducing the family into the traditions and errors of savage peoples that one begins the work of colonization. Fournet continues, saying that exactly the same thing is found with delinquents. He cites Mettray, founded in 1840, where, in
? what is basically a purely military schema, the names father, elder brother, and so on, were used in a pseudo-family organization. Fournet refers to this in order to say: You see that here as well the family model is used to try to "reconstitute . . . the elements and regime of the family around these unfortunates, orphaned through the deeds or vices of their parents. " And he concludes: "It is not, gentlemen, that I wish from today to include insanity (alienation mentale) in the same category as the moral alienation of peoples or individuals subject to the judgment of history or the law . . . "32 This is another work, which he promises for the luture, but never produced.
But you see that if he did not do it, many others did subsequently. You see delinquents as the residues of society, colonized peoples as the residues of history, and the mad as the residues of humanity in general, all included together in the same category, all the individuals-- delinquents, peoples to be colonized, or the mad--who can only be reconverted, civilized and subjected to orthopedic treatment if they are ottered a family model.
I think we have here an important point of inflexion. It is important because it takes place quite early, 1854, that is to say, before Darwinism, belore On the Origins of the Species. ^ Certainly, the principle of ontogenesis- phylogenesis was already known, at least in its general form, but you see the strange use of it here and, especially--even more than the interesting bracketing together of the mad, the primitive, and the delinquent--the
appearance of the family as the common remedy for being savage, delinquent, or mad. I am not in any way claiming that this text is the first, but it seems to me to be one of the most revealing and I have hardly found any earlier text that is so clear. So, we can say that the phenomenon I would like to talk about takes place roughly around thel850s.
So, why did it take place then? What happened in this period? What is the basis of all this? For a long time I have looked for an answer to these questions, and it seemed that we could be put on the track by sim ply asking the Nietzschean question: "Who is speaking? " Who actually lormulates this idea? Where do we find it?
You find it in people like Fournet,3' in Casimir Pinel, a descendant of Pinel,*5 in Brierre de Boismont,36 and you also begin to find it in
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Blanche,*7 that is to say, in a series of individuals whose common characteristic is simply that ol having at some time managed a public service, but especially private clinics, alongside and very different from hospitals and public institutions. Furthermore, all the examples they give of familialization as therapeutic milieu are based on the example of clinics. A fine discovery, you will say. Everyone knows that, from the nineteenth century, there were hospitals barracks for the exploited and comfortable clinics for the rich. Actually, in relation to this I would like to bring out a phenomenon which goes a bit beyond this opposition, or, if you like, which is lodged in it but is much more precise.
I wonder if there was not a quite important phenomenon in the nineteenth century, of which this would be one of the innumerable eflects. This important phenomenon, the elfect of which arises here, would be the integration, organization, and exploitation ol what I would call the profits of abnormalities, of illegalities or irregularities. I would say that the disciplinary systems had a primary, massive, overall function which appears clearly in the eighteenth century: to adjust the multiplicity of individuals to the apparatuses of production, or to the State apparatuses (appareils) which control them, or again, to adjust the combination of men to the accumulation of capital. Insofar as these dis- ciplinary systems were normalizing, they necessarily produced, on their borders and through exclusion, residual abnormalities, illegalities, and irregularities. The tighter the disciplinary system, the more numerous the abnormalities and irregularities. Now, from these irregularities, ille galities, and abnormalities that the disciplinary system was designed to reduce, but that at the same time it created precisely to the extent that it functioned, the economic and political system of the bourgeoisie of the nineteenth century [drew]* a source of profit on the one hand, and of the reinforcement of power on the other.
I will take the example of prostitution, which is quite close to that of the psychiatric hospitals I will talk about after. Clearly, we don't have to wait until the nineteenth century for the existence of that famous triangle of prostitutes, clients and procurers, for the existence of broth- els and established networks, etcetera. We don't have to wait until the
* (Recording:) found
? nineteenth century for the employment of prostitutes and procurers as mlormers and for the circulation of large sums of money for sexual pleasure in general. However, in the nineteenth century I think we see t he organization in European countries of a tight network resting first of all on a system of property, of hotels and brothels, etcetera, and which uses procurers as intermediaries and agents, who are at the same time informers recruited from a group about whose constitution I tried to say some things last year, that is, delinquents. *8
II there was this kind of need for delinquents, and if, in the end, so much care was taken to form them into an "underworld," it is precisely because they were the reserve army ol these important agents of which procurers-informers are only examples. Procurers, enframed by and coupled with the police, are the basic intermediaries ol the system of prostitution. So what was the purpose of this system with its rigorous organization and its supports and relays? Its function is to bring back to capital itself, to the normal circuits of capitalist profit, all the profits that can be extracted from sexual pleasure, on the triple condition, of course, that, first, this sexual pleasure is marginalized, deprecated, and prohibited, and so then becomes costly solely by virtue of being prohibited. Second, il one wants to make a profit from sexual pleasure, then it must not only be prohibited, but it must actually be tolerated. And, finally, it must be supervised by a particular power, which is ensured by the coupling of criminals and police, through the procurer- informer. Brought back into the normal circuits of capitalism in this way, the profit from sexual pleasure will bring about the secondary effect of the reinforcement of all the procedures of surveillance and, consequently, the constitution of what could be called an infra-power, which is finally brought to bear on men's everyday, individual, and corporal behavior:
the disciplinary system of prostitution. Because this is what is involved; alongside the army, school, and psychiatric hospital, prostitution, as it was organized in the nineteenth century, is again a disciplinary system, the economic and political impact of which can be seen straightaway.
First, sexual pleasure is made profitable, that is to say, it is made into a source of profit due to both its prohibition and its tolerance. Second, the profits from sexual pleasure flow back into the general circuits of capitalism. Third, leaning on this so as to fix even more firmly the
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extreme effects, the synaptic relays of State power, which end up reaching into men's everyday pleasure.
But prostitution is, of course, only one example of this kind of general mechanism which can be found in the disciplinary systems set up in the eighteenth century for a particular overall function, and which are then refined in the nineteenth century on the basis of this discipline which was essentially demanded by the formation of a new apparatus of production. Finer disciplines are adapted to these disciplines, or, if you like, the old disciplines are refined and thus find new possibilities for the constitution of profit and the reinforcement of power.
Let us now turn to the clinics of Brierre de Boismont, Blanche, and others. What basically is involved is the extraction of profit, and maximum profit, from the marginalization carried out by psychiatric discipline. For if it is clear that the basic aim of psychiatric discipline in its overall form is to take out of circulation individuals who cannot be employed in the apparatus of production, at another level, on a more restricted scale and with a very different social localization, they can be turned into a new source of profit. *
In fact, when a number of individuals from the wealthy classes are themselves marginalized, in the name of the same knowledge that deter- mines confinement, then it will be possible to profit from them. That is to say, it will be possible to ask families who have the means to "pay to be cured. " So you can see that the first step in the process will consist in demanding a profit from the family of the individual who is declared ill--on certain conditions.
Obviously it must not be possible to cure the patient at home. So the principle of isolation will continue to be emphasized for the patient who is a source of profit: "We will not cure you in your family. But if we ask your family to pay for you to be confined elsewhere, we must of course guarantee to restore to it something in its image. " That is to say,
* In the manuscript Foucault adds: "It is the profit from irregularity which serves as a vector for importing the family model into psychiatric practice. "
? it is necessary to give back a certain benefit to the family proportionate to the profit demanded from it; a certain profit for the medical body is requested for confining an individual in this way, to pay a pension, etcetera, but the family must benefit from this. This benefit will be the renewal of the system of power within the family. The psychiatrists say to the family: "We will give back to you someone who will really conform and be adjusted and adapted to your system of power. " Therefore, re-familialized individuals will be produced, inasmuch as it is the family that, by designating the mad person, provided the possibility of a profit to those who constitute the profit from marginalization. From this derives the need for clinics to be very closely adapted to the family model.
Thus in Brierre de Boismont's clinic, in the Samt-Antoine suburb, there was an organization completely modeled on the family, that is to say, with a father and mother. What's more, the model was not new: Blanche provided a first example of it during the Restoration. 39 The father is Brierre de Boismont himself, and the mother is his wife. Everyone lives in the family home, all are brothers, everyone takes their meals together, and all must have family feelings for each other. The reactivation of family feelings, the investment of every family function in the clinic, will be the effective agency of the cure.
There are some very clear accounts of this in Brierre de Boismont, in his quotation of the correspondence between his patients, after their cure, and himself or his wife. He quotes the letter of an old patient who wrote to Madame Brierre de Boismont: "Far from you, madame, I will often seek the memory so deeply engraved on my heart, in order to enjoy once more that calm filled with affection that you communicate to those who have the good fortune to be received into your home. I will often cast my mind back to your family milieu, so united in all its parts, so affectionate in each of its members, the eldest of whom is as gracious as she is intelligent. If, as is my wish, I return from my own family, you shall be my first visit, for it is a heartfelt debt" (20 May 1847)/'?
I think this letter is interesting. You see that the criterion, the form of the cure itself, is the activation of canonical types of family feelings: grat- itude towards the mother and father. You also see at work here, or rising to the surface at least, the theme of a love which is both validated and
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quasi-incestuous, since the patient is supposed to be Brierre de Boismont's son, and so the brother of the eldest daughter for whom he experiences some feelings. What will be the effect of this reactivation of family feelings, what will he do when he returns to Paris? First of all he will see his family, the true family--that is to say, the family that will get the benefit of the medical process--and, only secondly, he will see Brierre de Boismont's family, this quasi-family, which therefore plays a role of both super- and sub family. It is a super-family inasmuch as it is the ideal family, which functions in the pure state, the family as it should be always; and it is inasmuch as it is the true family that it is attributed an orthopedic function. Second, it is a sub-family inasmuch as its role is to efface itself before the real family, to activate family feelings by means of its internal mechanism only so that the real family benefits from this, and, at that point, it is no more than the kind of schematic support which, discreetly, constantly sustains the functioning of the real family. This super family and sub-family is constructed in these clinics, the social and economic location of which is, as you can see, very different from that of the asylum.
However, if the bourgeois, paying clinic is thus famihalized--functioning on the family model--then the family, in turn, outside the clinic, must play its role. It is not just a question of saying to the family, if you pay me, I will make your madman able to function in the family; the family still has to play its role, that is to say, actually designate those who are mad. It must play a disciplinary role for itself, as it were, that is to say, it must say: Here is our mad, abnormal member, who is a matter for medicine. That is to say, you have familiahzation of the therapeutic milieu for the clinics on one side, and, on the other, disciplinarization of the family, which at that point becomes the agency of the abnormahzation of individuals.
Whereas the question of the abnormal individual did not arise for the sovereign family--which was concerned rather with the hierarchical order of births, the order of inheritance, relationships of allegiance, obedience, and preeminence between them, with the name and all the sub-functions of the name--the disciplinarized family will begin to sub- stitute for this sovereign function of the name the psychological function of the designation of abnormal individuals, of the abnormahzation of individuals.
? What I am saying about the clinics is also valid for the school, and to a certain extent for health in general, and for military service, and so on. What I have wanted to show you is that, however much the family con tinued to conform to a model of sovereignty in the nineteenth century, it may be that, from the middle ol the nineteenth century perhaps, there was a sort ol internal disciplinanzation of the family, that is to say, a kind of transfer of disciplinary forms and schemas, of those techniques of power given by the disciplines, into the very heart of the game of lamily sovereignty.
Just as the family model is transferred into disciplinary systems, dis ciplinary techniques are transplanted into the family. And at that point the family, while retaining the specific heterogeneity of sovereign power, begins to function like a little school: the strange category ol student parents appears, home duties begin to appear, the control of school dis cipline by the lamily; the lamily becomes a micro-clinic which controls the normality or abnormality of the body, of the soul; it becomes a small scale barracks, and maybe it becomes, we will come back to this, the place where sexuality circulates.
I think we can say that, on the basis of disciplinary systems, family sovereignty will be placed under the following obligation: "You must hnd for us the mad, feeble minded, diflicult, and perverse, and you must lind them yourself, through the exercise of disciplinary kinds ol control within lamily sovereignty. And when, through the operation ol this dis- ciplinanzed sovereignty, you have lound your mad, abnormal, feeble minded, and difficult members in your home, we, say the disciplines, will put them through the filter of normalizing apparatuses and restore them to you, the lamily, for your greater functional benefit. We will make them conform to your needs, even if, obviously, we have made our profit on this. "
This is how disciplinary power lives off family sovereignty, requiring the family to play the role of the agency that decides between normal and abnormal, regular and irregular, asking the family to hand over its abnormal, irregular individuals, etcetera, and making a profit from this, which enters into the general system of profit and can be called, if you like, the economic benefit of irregularity. After which, what's more, the lamily is supposed to find again, at the end ol the process, an individual
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who has been disciplined in such a way that he can be effectively subjected to the family's specific schema of sovereignty. Being a good son, a good husband, and so on, is really the outcome offered by all these disciplinary establishments, by schools, hospitals, reformatories, and the rest. This means that they are machines thanks to which it is thought that disciplinary apparatuses will constitute characters who can take their place within the specific morphology of the family's power of sovereignty.
? 1. "Lesjurieux must be placed in a place of salely, but they can only be detained by virtue of
a judgment which must be prompted by the family ( . . . ) . It is to the Tribunals alone that
it [the Civil Code; J. L. | entrusts the care ol establishing iheir condition. " Circular of Portalis, 30 Fructidor Year 12 (17 September 1804) cited in G. Bollotte, "Les malades men- taux de 1789 a 1838 dans I'ceuvre de P. Serieux" Information psychiatrique, vol. 44, no. 10, 1968, p. 916. The Civil Code of 1804 reformulated the old jurisdiction in article 489 (Title XI, ch. 2): "The person who has reached the age of majority and is in a habitual state
of imbecility, dementia, or trenzy, must be interdicted, even when this state has intervals of lucidity. " See, "Interdit" in CJ. de Ferriere, ed. , Dictionnaire de droil el de pratique (Paris: Brunei, 1769) vol. 2, pp. 48-50; H. Legrand du Saulle, Etude medico-legale sur ('interdiction des alienes et sur le conseil judiciaire (Paris: Delahaye el Lecrosnier, 1881); P. Serieux and L. Libert, La Regime des alienes en France au XVIIT siecle (Paris: Masson, 1914); P. Serieux and M. Trenel, "L'inlerdiction des alienes par voie judiciaire (sentence d'interdiction) sous I'Ancien Regime" Revue historique de droit francais el etranger, 4'1' series, 10th year, July September 1931, pp. 450 486; A. Laingui, La Responsabilite penale dans I'ancien droil (XVT- XVIII' siecles) (Paris: Librairie generale de droit et de jurisprudence, 1970) vol. 2, pp. 173 204. Foucault relers to interdiction in Hisloire de la folie, pp. 141-143 (omitted from Madness and Civilisation). He returns to the topic in the lecture of 12 January 1975 ol his course al the College de France, 1974 1975, Les Anormaux, eds. V. Marchetti and
A. Salomoni (Paris: Gallimard/Seuil, 1999) pp. 131-136; English translation, Michel Foucault, Abnormal. Lectures at the College de France 7974-7975, English ed. Arnold I. Davidson, trans. Graham Burchell (New York: Picador, 2O03) pp. 141-145.
2. The law ol 16 24 August 1790 made conhnement a police measure by entrusting "to the vigilance and authority ol municipal bodies . . . the responsibility lor avoiding or remedy
ing unlortunate events which could be occasioned by the insane or thefurieux left in lib erty" (Title XI, article 3) in Legislation sur les alienes et les enjants assisles. Recueil des his, decrels et circulaires (1790-1879)(Paris: Ministere de I'Interieur et des Cukes, 1880 ) vol. 1, p. 3. See, M. Foucault, Hisloire de lajolie, p. 443; Madness and Civilisation, pp. 238 239-
3. F. E. Fodere, Traite du delire, vol. 2, p. 252.
4. P. Berthier, Medecine mentale, vol. 1; De I'isolement (Paris: J. B. Bailliere, 1857) p. 10.
5. The principle is stated by Esquirol in his "Memoire sur I'isolement des alienes" (read at
the Institut on 1 October 1852): "The isolation of the insane (sequestration, confinement) consists in withdrawing him Irom all his habits, in separating him from his lamily, his friends, and his servants; in surrounding him with strangers; in changing his whole way of
life" Des maladies mentales considerees sous les rapports medical, hygienique el medico-legal, vol. 2, p. 745-J. P. Falret, "Du traitement general des alienes" (lecture at Salpetriere, 1854) in Des maladies mentales el des asiles d'alienes (Paris: J. B. Bailliere, 1864) pp. 677-699, see p. 685 sq. ;J. Guislain, Traitesur les phrenopathies, p. 409;J-M. Dupuy, Qulquesconsiderations surla
Jolie. Visite au Castel d'Andorle, etablissemcnl destine aux alienes de la classe riche (Pengueux: Dupont, 1848) pp. 7-8.
6. Francois Leuret states that "whenever one can, one should impose silence on the patient on the subject ol his delirium and occupy him with something else" Du traitement moral de la
Jolie, op. cit. , p. 120. See also his "Memoire sur la revulsion morale dans le traitement de la folie" in Memoires de I'Academic royale de medecine, 1841, p. 658. However, it is J. P. Falret who, in a faithful summary ol Esquirol's conceptions, states the principle most explicitly in an unpublished manuscript: "Isolation is obviously of prime importance . . . But, once the patient has been withdrawn from external influences, should he be left to himself without seeking to destroy the lixity of his unhealthy preoccupations? Obviously not. Not content with having removed the causes which may foment it, one must combat the delir- ium itself, and to this end experience recognizes no more ellective means than, for some, fixing their attention on objects most likely to fascinate them, and, lor others, diverting them from their hxed ideas, distracting them from their preoccupations by constantly pre senting them with objects loreign to their delirium, and by completely directing their attention on every kind ol occupation, so that it is impossible lor them to think of the subject ol their illness. " Quoted by G. Daumezon and P. Koechlin, "La psychotherapie institutionelle
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7.
Iranc. aise contemporaine" AnnaisPortugueses de psiquialria, vol. 4, no. 4, 1952, p. 27/l. See also, J. P. Falret, Des maladies menlales el des asiles d'alienes, p. 687.
"The moral cause of insanity often exists in the bosom of the lamily, and gets its source from sorrows, domestic disputes, setbacks, etcetera (. . . ) the lirst shock to the intellectual
and moral faculties olten takes place in the insane person's own home, amongst his acquaintances, his relatives, and his friends. " J. E. D.
