Here again it was
necessary
to protect
?
?
Foucault-Psychiatric-Power-1973-74
Broussard, and M.
Hamoniaux, "L'evolution histonque de la Petite Roquette" Revue "Reeducation" no.
191, May 1967; H.
Gaillac, Les Maisons de correction (18}0-19/I5) (Paris: Ed.
Cujas, 1971) pp.
61-66; and, J.
Gillet, Recherche sur la Petite Roquette (Paris: 1975).
19. J. Bentham, The Panopticon, Letter 21, Schools, p. 93, emphasis in original; La Panoplique, p. 166.
20. Bentham writes that it gives "such herculean and ineludible strength to the grip ol power" ibid. p. 88; ibid. p. 160.
21. Ibid. Preface, p. 31; ibid. p. 95-
22. Ibid. Letter, 21, Schools: "That species of Iraud at Westminster called cribbing, a vice thought
hitherto congenial to schools, will never creep in here" p. 86 (emphasis in original);
ibid. p. 158.
23. Ibid. Letter 18, Manufactories, pp. 8 0 81; ibid. p. 150.
24. Ibid. Letter 7, Penitentiary houses--safe custody, p. 48; ibid. p. 115-
25. Ibid. Letter 19, Mad-houses, pp. 81-82; ibid. p. 152.
? 26. Ibid. Letter 2, Plan for a Penitentiary Inspection house, pp. 35 36; ibid. pp. 7 8.
27. Ibid. Letter 21, Schools, p. 92; ibid. p. 16M.
2S. Foucault is alluding to Condillac's project ol deducing the order ol knowledge starting Irom sensation as the raw material of every development ol the human mind. See, Fitienne Bonnot de Condillac (1715 1780), Essai sur I'origine dcs connaissances humaine, ouvrage ou I'on riduil a un sail principc lout ce c/ui concemc I'enlcndemenl humain (Pans: P. Mortier, 17/|6); English translation, Essay on the origin of human know/edge, trans. H. Aarslelf (Cambridge: Cambridge University Press, 2001); Traite dcs sensations (Paris: De Bure, 175M | reprinted, Paris: Fayard, 198M |); English translation "A Treatise on the Sensations" in Philosophical Writings of Fjienne Bonnot, Abbe de Condi/lac, trans. Franklin Philip in collaboration with Harlan Lane (Hillsdale and London: Lawrence Erlbaum, 1982). Foucault refers to this in an interview with C. Bonneloy in June 1966: "L'homme est il mort? " Dits el Ecrits, vol. 1, p. 57|2, and in Les Mots el le Choses, pp. 7M 77; The Order of Things, pp. 6 0 63.
29. This remark, which Bentham attributes to Helvetius, actually corresponds to the title ol a chapter "Education can do everything"--ol the posthumous work ol Claude Adrien Helvetius, De l'homme, de ses /aculles intellectuellcs el de son education, published by Prince Gelitzin (Amsterdam: 177M) vol. 3; English translation, A Treatise on Man; his intellectual faculties and his education, trans. W. Hooper ( London: Mil).
30. Pierre Carlet de Chamblam de Manvaux ( 1688 1763), La Dispute, comedie en un acle el en prose, oit pour savoir qui de l'homme ou de la /emme donne naissance a I'inconstance, le Prince et Hetmiane vont epier la rencontre de deux garcons et deux fillies eleves depuis leur en/ance dans I'isolement d'une Joret (Pans: J. Clousier, 17M7).
31. Allusion to Ernst Kantorowiez, The King's Two Bodies.
32. See A. Penot, Les Cites ouvrieres de Mulhouse et des deparlements du Haut-Rhin (Mulhouse:
L. Bader, 1867). Foucault returns to this topic in his interview with J. P. Barou and
M. Perot, "L'ceil du pouvoir"; "The Eye ol Power. "
33. See. J. B. Monlalcon and J. F. Terme, Hisloire des en/ants trouves (Pai is: J. B. Bailliere, 1837);
E. Parent de C u r z o n , Etudes sur les en/ants trouves au point de me de legislation, de la morale et de {'economic politique (Poitiers: H. Oudm, I8M7); HJ. B. Davenne, De I'organisation et du regime des secours publics en Trance (Paris: P. Dupont, 1865) vol. 1; L. Lallemand, Hisloire des en/ants abandonnes et delaisses. Eludes sur la protection de I'en/ancc (Pans: Picard et Guillaumin, 1885);J. Bouzon, Cent Ans de luttc sociale. La legislation de I'en/ance de 17$9 a /cS94 (Paris: Guillaumin, 189M); C. Rollet, En/ance uhandonnec: vicicux, insoumis, vagabonds. Colonies agiicoles, ccolcs de re/orme et de preservation (Clermont Ferrand: G. Mont Louis, 1899); and H. Gaillac, Les Maisons de cotrecliont. Michel Foucault returns to the topic in Surveiller el Punir, pp. 30M 305; Discipline and Punish pp. 297 298.
3M. The law ol 10January 18M9 organized public Assistance in Paris under the Prelecture ol the Seine and the Minister ol the Interior. It appointed the director ol this administration as guardian ol foundlings, orphans, and abandoned children. See, A. de Watterwille, Legislation charitable, ou Recucil des lois arretes, decrels qui rcgissenl les etablisscments dc bien/aisance (1790 187M) in 3 volumes (Paris: A. Hcvis, 1863 187M); C. J. Viala, Assistance de I'en/ance pauvre el abandonnee (Nimes: Chastanier, 1892); F. Drevlus, L'Assistance sous la Seconde Republique (18M8 1851) (Paris: E. Comely, 1907); and,J. Dehaussy, VAssistance publique a I'en/ance. Les en/ants abandonnes (Pans: Libra me du Recueil, 1951).
35. Founded on 22January 18MO by the magistrate Frederic Auguste Demetz (1796 1873), the Mettray colony, near Tours, was devoted to children accjuitted on the grounds ol absence of responsibility and to children detained lor paternal correction. See F. A. Demetz, Fondation d'une colonie agricole de fames detenus a Mettray (Paris: Duprat, 1839); A. Cochin, Notice sur Mettray (Paris: Clave et Tailleler, 18M7); E. Ducpetiaux, ( i ) Colonies agricoles, ccolcs rurales et ecoles de re/orme pour les indigents, les meridiants et les vagabonds, et specialemenl pour les enjants dcs deux sexes, en Suisse, en Allemagne, en France, en Angleterre, dans les Pays Bus et en Bclgique, Report lor the Minister ol Justice (Brussels: printed by T. Lesigne, 1851), pp. 50 65; (11) La Colonie dc Mettray (Batignolles: De Hennuyer, 1856); (iii) Notice sur la colonie agricole de Mettray (Tours: Ladeveze, 1861); H. Gaillac, Les Maisons dc correction, pp. 8 0 85. Foucault refers to Mettray in Surveiller et Punir, pp. 300 303; Discipline and Punish, pp. 293 296.
28 November 1973 91
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5 DECEMBER 1973
The asylum and thefamily. From interdiction to confinement. The break between the asylum and thefamily. rsJ The asylum; a curing machine. ^ Typology of "corporal apparatuses (appareils
corporels)". ^ The madman and the child. ^ Clinics (maisons de sante). ^ Disciplinary apparatuses andfamily power.
I HAVE TRIED TO bring out at least some of the underlying disciplinary basis of the asylum, to show you how, from the eighteenth century, a sort of disciplinary network begins to cover society in which a number of specific disciplinary schemas appear, like the army, the school, the workshop, etcetera, and of which Bentham's Panopticonappears to me to be the formalization, or anyway the systematic and purified outline.
I would like now to examine more specifically how the asylum works, because it seems to me that the asylum has its particular features. On the one hand, it has a privileged and, what's more, difficult, problematic relationship with the family. On the other hand, as a disciplinary system, the asylum is also a site for the formation of a certain type of discourse of truth. I do not mean that the other disciplinary systems do not give rise to discourses of truth and have no relationship to the family, but in the case of the institution and discipline of the asylum I think the relationship to the family is very specific and surcharged. Moreover, it developed over a very long time and was constantly transformed throughout the nineteenth century. In addition to this, its discourse of truth is also a specific discourse.
? 94 PSYCHIATRIC POWI-R
Finally, the third characteristic feature is that, in all likelihood--this is my hypothesis and the line I would like to pursue--the discourse of truth developed in the asylum and the relationship to the family mutu- ally support each other, lean on each other and will hnally give rise to a psychiatric discourse which will present itsell as a discourse of truth in which the family--lamily figures and family processes--is its lundamen tal object, target, and field of reference. The problem is how psychiatric discourse, the discourse arising from the exercise ol psychiatric power, will be able to become the discourse ol the family, the true discourse oi the family, the true discourse about the family.
So, today: the problem ol the asylum and the lamily.
I think we should start with the asylum without the lamily, with the asylum both violently and explicitly breaking with the lamily. This is the situation at the start that we find in the proto-psychiatry ol which Pinel, but even more Fodere and especially Esquirol, were the representatives and founders.
For the asylum breaking with the lamily I will take three accounts. The first is the actual juridical lorm of psychiatric confinement, with partial lar reference to the 1838 law, from which we have not yet escaped, since this law, with some modifications, more or less still governs confinement in an asylum. Given the period in which it is situated, it seems to me that this law should be interpreted as a break with the lamily and as the dis possession of the family's rights with regard to its mad members. In (act, before the 1838 law, the basic procedure, the fundamental juridical ele ment that permitted taking charge of the madman, characterizing him and designating his status as insane, was essentially interdiction.
What was interdiction? First, it was a juridical procedure that was and had to be requested by the family. Second, interdiction was a judicial measure, that is to say, it was a judge who actually made the decision, but on the request of the family and after obligatory consultation ol family members. Finally, third, the legal effect of this procedure of inter diction was the transfer ol the interdicted individual's civil rights to a family council and his placement under a regime of guardianship. So, interdiction was, il you like, an episode of family law validated by judi- cial procedures. 1 This was the procedure ol interdiction, and it was the basic procedure: the madman was essentially someone interdicted, and
? dissipate, spendthrift, mad, and similar individuals were recognized by their designated status as interdicted.
As for confinement, I was going to say that throughout the classical age it took place according to this legal procedure, but actually it did not take place in this way, but rather in an irregular manner. That is to say, confinement could occur either after the procedure of interdiction or independently of it, in which case it was always a de facto confinement obtained by the family who requested the intervention of the lieutenant of police, or of the intendant, etcetera, or even a confinement decided on by royal power, or by parliament, when someone had committed an irregularity, an infraction, or a crime, and it was thought better to con- fine him rather than go through the system of justice. The procedure of confinement, therefore, did not have a formal legal origin; it surrounded interdiction and could be substituted for it, but did not have a homoge- neous or fundamental judicial status in this kind of taking charge of those who were mad.
Taking charge of those who were mad took place, then, by interdiction, and interdiction was an episode of family law validated by judicial procedure. I will skip a number of episodes that already foreshadow the 1838 law: the law of August 1790, lor example, which gave certain rights to the municipal authority. 2
I think the 1838 law consists in two fundamental things. The hrst is that confinement overrides interdiction. That is to say, in taking charge of the mad, the essential component is now confinement, interdiction only being added afterwards, if necessary, as a possible judicial supplement, when there is danger of the individual's legal situation, his civil rights, being jeopardized, or, alternatively, when the individual may jeopardize his family's situation by exercising his rights. But interdiction is no more than a component accompanying what is now the basic procedure of confinement.
One takes hold of the madman through confinement, that is to say, by seizing the body itself. The fundamental juridical component is no longer that of depriving the individual of his civil and family rights, but a real arrest. Who ensures this arrest, and how? Of course, most of the time, it takes place at the family's request, but not necessarily. In the 1838 law confinement may well be decided on prefectural authority,
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without having been requested by the family In any case, whether or not it has been requested by the family, it is always prefectural authority, doubled by medical authority, which in the end must decide on some one's confinement. Someone arrives in a public hospital, or in a private clinic, with the diagnosis or presumption of madness: he will only be really, officially, designated and characterized as mad when someone qualified by the civil authorities has made an assessment, and when the civil authorities, that is to say, the prefectural authority, have thus made a decision on this assessment. That is to say, the madman is no longer dis- tinguished and assigned a status in relation to the family field, but now appears within what we can call a technical-administrative field, or, if you like, a State-medical field, constituted by the coupling of psychiatric knowledge and power with administrative investigation and power. It is this coupling that will designate the mad individual as mad, and the family's power with regard to the mad individual will henceforth be relatively limited.
The mad individual now emerges as a social adversary, as a danger for society, and no longer as someone who may jeopardize the rights, wealth, and privileges of a family The mechanism of the 1838 law designates a social enemy, and we can say that one consequence of this is that the family is dispossessed. I would say that when we read the justifications put forward for the 1838 law when it was being voted on, or the com mentanes on it afterwards, it is always said that it really was necessary to give this preeminence to confinement over interdiction, to scientific- State power over family power, in order to protect both the life and rights of the family circle. Actually, as long as the lengthy, cumbersome, and difficult procedure of interdiction was the basic component, it was relatively difficult to gain control over someone who was mad, and meanwhile he could continue to wreak havoc in his family circle. He was a danger to those around him and his immediate family was exposed to his outbursts. It was necessary therefore to protect the family circle: hence the need for the procedure of speedy confinement before the lengthy procedure of interdiction.
On the other hand, it was stressed that giving too much importance to interdiction, making it the major component, opened the way to fam lly plots and conflicts of interest.
Here again it was necessary to protect
? the restricted, close family--ascendants and descendants--against the covetousness of the extended family.
This is true and, in a sense, the 1838 law really did function in this way, dispossessing the extended family to the advantage of, and in the interest of, the close family. But precisely this is quite typical of a whole series of processes that are found again throughout the nineteenth century, and which are not only valid for the insane, but also for pedagogy, delinquency, and so forth. *
The power of the State, or, let's say, a certain technical-State power, enters like a wedge, as it were, in the broad system ot the family; it takes over a number of the extended family's powers in its own name, and, in order to exercise the power it has appropriated, rests on an entity, the small family cell, which I do not say is absolutely new, but which is carved out in a new way, strengthened, and intensified.
The small family cell of ascendants and descendants is a sort of zone ot intensification within the larger lamily that is dispossessed and short-circuited. It is the power of the State, or, in this case, technical- State power, which will isolate and lean on this narrow, cellular, intense lamily that is the effect of the incidence of a technical-State power on the large, dispossessed family. This is what I think we can say about the mechanism ot the 1838 law. You can see that, inasmuch as all the big asy- lums have functioned for 150 years now on the basis of this juridical lorm, it is important to note that it does not favor the family's powers. On the contrary, it divests the family of its traditional powers. In juridi cal terms, therefore, there is a break between the asylum and the family.
What do we see when we look at the medical tactic, that is to say, the way in which things unfold in the asylum?
The first principle, which is now consolidated, and which you will hnd practically throughout the life, I was going to say, the serene life of psychiatric discipline, that is to say, until the twentieth century, the principle, or precept rather, a rule of know-how, is that one can never cure a lunatic in his family. The family milieu is absolutely incompatible with the management of any therapeutic action.
A The manuscript adds: "In fact, we grasp here a process that will be found again throughout I lie history of psychiatric power. "
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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 . .
19. J. Bentham, The Panopticon, Letter 21, Schools, p. 93, emphasis in original; La Panoplique, p. 166.
20. Bentham writes that it gives "such herculean and ineludible strength to the grip ol power" ibid. p. 88; ibid. p. 160.
21. Ibid. Preface, p. 31; ibid. p. 95-
22. Ibid. Letter, 21, Schools: "That species of Iraud at Westminster called cribbing, a vice thought
hitherto congenial to schools, will never creep in here" p. 86 (emphasis in original);
ibid. p. 158.
23. Ibid. Letter 18, Manufactories, pp. 8 0 81; ibid. p. 150.
24. Ibid. Letter 7, Penitentiary houses--safe custody, p. 48; ibid. p. 115-
25. Ibid. Letter 19, Mad-houses, pp. 81-82; ibid. p. 152.
? 26. Ibid. Letter 2, Plan for a Penitentiary Inspection house, pp. 35 36; ibid. pp. 7 8.
27. Ibid. Letter 21, Schools, p. 92; ibid. p. 16M.
2S. Foucault is alluding to Condillac's project ol deducing the order ol knowledge starting Irom sensation as the raw material of every development ol the human mind. See, Fitienne Bonnot de Condillac (1715 1780), Essai sur I'origine dcs connaissances humaine, ouvrage ou I'on riduil a un sail principc lout ce c/ui concemc I'enlcndemenl humain (Pans: P. Mortier, 17/|6); English translation, Essay on the origin of human know/edge, trans. H. Aarslelf (Cambridge: Cambridge University Press, 2001); Traite dcs sensations (Paris: De Bure, 175M | reprinted, Paris: Fayard, 198M |); English translation "A Treatise on the Sensations" in Philosophical Writings of Fjienne Bonnot, Abbe de Condi/lac, trans. Franklin Philip in collaboration with Harlan Lane (Hillsdale and London: Lawrence Erlbaum, 1982). Foucault refers to this in an interview with C. Bonneloy in June 1966: "L'homme est il mort? " Dits el Ecrits, vol. 1, p. 57|2, and in Les Mots el le Choses, pp. 7M 77; The Order of Things, pp. 6 0 63.
29. This remark, which Bentham attributes to Helvetius, actually corresponds to the title ol a chapter "Education can do everything"--ol the posthumous work ol Claude Adrien Helvetius, De l'homme, de ses /aculles intellectuellcs el de son education, published by Prince Gelitzin (Amsterdam: 177M) vol. 3; English translation, A Treatise on Man; his intellectual faculties and his education, trans. W. Hooper ( London: Mil).
30. Pierre Carlet de Chamblam de Manvaux ( 1688 1763), La Dispute, comedie en un acle el en prose, oit pour savoir qui de l'homme ou de la /emme donne naissance a I'inconstance, le Prince et Hetmiane vont epier la rencontre de deux garcons et deux fillies eleves depuis leur en/ance dans I'isolement d'une Joret (Pans: J. Clousier, 17M7).
31. Allusion to Ernst Kantorowiez, The King's Two Bodies.
32. See A. Penot, Les Cites ouvrieres de Mulhouse et des deparlements du Haut-Rhin (Mulhouse:
L. Bader, 1867). Foucault returns to this topic in his interview with J. P. Barou and
M. Perot, "L'ceil du pouvoir"; "The Eye ol Power. "
33. See. J. B. Monlalcon and J. F. Terme, Hisloire des en/ants trouves (Pai is: J. B. Bailliere, 1837);
E. Parent de C u r z o n , Etudes sur les en/ants trouves au point de me de legislation, de la morale et de {'economic politique (Poitiers: H. Oudm, I8M7); HJ. B. Davenne, De I'organisation et du regime des secours publics en Trance (Paris: P. Dupont, 1865) vol. 1; L. Lallemand, Hisloire des en/ants abandonnes et delaisses. Eludes sur la protection de I'en/ancc (Pans: Picard et Guillaumin, 1885);J. Bouzon, Cent Ans de luttc sociale. La legislation de I'en/ance de 17$9 a /cS94 (Paris: Guillaumin, 189M); C. Rollet, En/ance uhandonnec: vicicux, insoumis, vagabonds. Colonies agiicoles, ccolcs de re/orme et de preservation (Clermont Ferrand: G. Mont Louis, 1899); and H. Gaillac, Les Maisons de cotrecliont. Michel Foucault returns to the topic in Surveiller el Punir, pp. 30M 305; Discipline and Punish pp. 297 298.
3M. The law ol 10January 18M9 organized public Assistance in Paris under the Prelecture ol the Seine and the Minister ol the Interior. It appointed the director ol this administration as guardian ol foundlings, orphans, and abandoned children. See, A. de Watterwille, Legislation charitable, ou Recucil des lois arretes, decrels qui rcgissenl les etablisscments dc bien/aisance (1790 187M) in 3 volumes (Paris: A. Hcvis, 1863 187M); C. J. Viala, Assistance de I'en/ance pauvre el abandonnee (Nimes: Chastanier, 1892); F. Drevlus, L'Assistance sous la Seconde Republique (18M8 1851) (Paris: E. Comely, 1907); and,J. Dehaussy, VAssistance publique a I'en/ance. Les en/ants abandonnes (Pans: Libra me du Recueil, 1951).
35. Founded on 22January 18MO by the magistrate Frederic Auguste Demetz (1796 1873), the Mettray colony, near Tours, was devoted to children accjuitted on the grounds ol absence of responsibility and to children detained lor paternal correction. See F. A. Demetz, Fondation d'une colonie agricole de fames detenus a Mettray (Paris: Duprat, 1839); A. Cochin, Notice sur Mettray (Paris: Clave et Tailleler, 18M7); E. Ducpetiaux, ( i ) Colonies agricoles, ccolcs rurales et ecoles de re/orme pour les indigents, les meridiants et les vagabonds, et specialemenl pour les enjants dcs deux sexes, en Suisse, en Allemagne, en France, en Angleterre, dans les Pays Bus et en Bclgique, Report lor the Minister ol Justice (Brussels: printed by T. Lesigne, 1851), pp. 50 65; (11) La Colonie dc Mettray (Batignolles: De Hennuyer, 1856); (iii) Notice sur la colonie agricole de Mettray (Tours: Ladeveze, 1861); H. Gaillac, Les Maisons dc correction, pp. 8 0 85. Foucault refers to Mettray in Surveiller et Punir, pp. 300 303; Discipline and Punish, pp. 293 296.
28 November 1973 91
? five
5 DECEMBER 1973
The asylum and thefamily. From interdiction to confinement. The break between the asylum and thefamily. rsJ The asylum; a curing machine. ^ Typology of "corporal apparatuses (appareils
corporels)". ^ The madman and the child. ^ Clinics (maisons de sante). ^ Disciplinary apparatuses andfamily power.
I HAVE TRIED TO bring out at least some of the underlying disciplinary basis of the asylum, to show you how, from the eighteenth century, a sort of disciplinary network begins to cover society in which a number of specific disciplinary schemas appear, like the army, the school, the workshop, etcetera, and of which Bentham's Panopticonappears to me to be the formalization, or anyway the systematic and purified outline.
I would like now to examine more specifically how the asylum works, because it seems to me that the asylum has its particular features. On the one hand, it has a privileged and, what's more, difficult, problematic relationship with the family. On the other hand, as a disciplinary system, the asylum is also a site for the formation of a certain type of discourse of truth. I do not mean that the other disciplinary systems do not give rise to discourses of truth and have no relationship to the family, but in the case of the institution and discipline of the asylum I think the relationship to the family is very specific and surcharged. Moreover, it developed over a very long time and was constantly transformed throughout the nineteenth century. In addition to this, its discourse of truth is also a specific discourse.
? 94 PSYCHIATRIC POWI-R
Finally, the third characteristic feature is that, in all likelihood--this is my hypothesis and the line I would like to pursue--the discourse of truth developed in the asylum and the relationship to the family mutu- ally support each other, lean on each other and will hnally give rise to a psychiatric discourse which will present itsell as a discourse of truth in which the family--lamily figures and family processes--is its lundamen tal object, target, and field of reference. The problem is how psychiatric discourse, the discourse arising from the exercise ol psychiatric power, will be able to become the discourse ol the family, the true discourse oi the family, the true discourse about the family.
So, today: the problem ol the asylum and the lamily.
I think we should start with the asylum without the lamily, with the asylum both violently and explicitly breaking with the lamily. This is the situation at the start that we find in the proto-psychiatry ol which Pinel, but even more Fodere and especially Esquirol, were the representatives and founders.
For the asylum breaking with the lamily I will take three accounts. The first is the actual juridical lorm of psychiatric confinement, with partial lar reference to the 1838 law, from which we have not yet escaped, since this law, with some modifications, more or less still governs confinement in an asylum. Given the period in which it is situated, it seems to me that this law should be interpreted as a break with the lamily and as the dis possession of the family's rights with regard to its mad members. In (act, before the 1838 law, the basic procedure, the fundamental juridical ele ment that permitted taking charge of the madman, characterizing him and designating his status as insane, was essentially interdiction.
What was interdiction? First, it was a juridical procedure that was and had to be requested by the family. Second, interdiction was a judicial measure, that is to say, it was a judge who actually made the decision, but on the request of the family and after obligatory consultation ol family members. Finally, third, the legal effect of this procedure of inter diction was the transfer ol the interdicted individual's civil rights to a family council and his placement under a regime of guardianship. So, interdiction was, il you like, an episode of family law validated by judi- cial procedures. 1 This was the procedure ol interdiction, and it was the basic procedure: the madman was essentially someone interdicted, and
? dissipate, spendthrift, mad, and similar individuals were recognized by their designated status as interdicted.
As for confinement, I was going to say that throughout the classical age it took place according to this legal procedure, but actually it did not take place in this way, but rather in an irregular manner. That is to say, confinement could occur either after the procedure of interdiction or independently of it, in which case it was always a de facto confinement obtained by the family who requested the intervention of the lieutenant of police, or of the intendant, etcetera, or even a confinement decided on by royal power, or by parliament, when someone had committed an irregularity, an infraction, or a crime, and it was thought better to con- fine him rather than go through the system of justice. The procedure of confinement, therefore, did not have a formal legal origin; it surrounded interdiction and could be substituted for it, but did not have a homoge- neous or fundamental judicial status in this kind of taking charge of those who were mad.
Taking charge of those who were mad took place, then, by interdiction, and interdiction was an episode of family law validated by judicial procedure. I will skip a number of episodes that already foreshadow the 1838 law: the law of August 1790, lor example, which gave certain rights to the municipal authority. 2
I think the 1838 law consists in two fundamental things. The hrst is that confinement overrides interdiction. That is to say, in taking charge of the mad, the essential component is now confinement, interdiction only being added afterwards, if necessary, as a possible judicial supplement, when there is danger of the individual's legal situation, his civil rights, being jeopardized, or, alternatively, when the individual may jeopardize his family's situation by exercising his rights. But interdiction is no more than a component accompanying what is now the basic procedure of confinement.
One takes hold of the madman through confinement, that is to say, by seizing the body itself. The fundamental juridical component is no longer that of depriving the individual of his civil and family rights, but a real arrest. Who ensures this arrest, and how? Of course, most of the time, it takes place at the family's request, but not necessarily. In the 1838 law confinement may well be decided on prefectural authority,
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without having been requested by the family In any case, whether or not it has been requested by the family, it is always prefectural authority, doubled by medical authority, which in the end must decide on some one's confinement. Someone arrives in a public hospital, or in a private clinic, with the diagnosis or presumption of madness: he will only be really, officially, designated and characterized as mad when someone qualified by the civil authorities has made an assessment, and when the civil authorities, that is to say, the prefectural authority, have thus made a decision on this assessment. That is to say, the madman is no longer dis- tinguished and assigned a status in relation to the family field, but now appears within what we can call a technical-administrative field, or, if you like, a State-medical field, constituted by the coupling of psychiatric knowledge and power with administrative investigation and power. It is this coupling that will designate the mad individual as mad, and the family's power with regard to the mad individual will henceforth be relatively limited.
The mad individual now emerges as a social adversary, as a danger for society, and no longer as someone who may jeopardize the rights, wealth, and privileges of a family The mechanism of the 1838 law designates a social enemy, and we can say that one consequence of this is that the family is dispossessed. I would say that when we read the justifications put forward for the 1838 law when it was being voted on, or the com mentanes on it afterwards, it is always said that it really was necessary to give this preeminence to confinement over interdiction, to scientific- State power over family power, in order to protect both the life and rights of the family circle. Actually, as long as the lengthy, cumbersome, and difficult procedure of interdiction was the basic component, it was relatively difficult to gain control over someone who was mad, and meanwhile he could continue to wreak havoc in his family circle. He was a danger to those around him and his immediate family was exposed to his outbursts. It was necessary therefore to protect the family circle: hence the need for the procedure of speedy confinement before the lengthy procedure of interdiction.
On the other hand, it was stressed that giving too much importance to interdiction, making it the major component, opened the way to fam lly plots and conflicts of interest.
Here again it was necessary to protect
? the restricted, close family--ascendants and descendants--against the covetousness of the extended family.
This is true and, in a sense, the 1838 law really did function in this way, dispossessing the extended family to the advantage of, and in the interest of, the close family. But precisely this is quite typical of a whole series of processes that are found again throughout the nineteenth century, and which are not only valid for the insane, but also for pedagogy, delinquency, and so forth. *
The power of the State, or, let's say, a certain technical-State power, enters like a wedge, as it were, in the broad system ot the family; it takes over a number of the extended family's powers in its own name, and, in order to exercise the power it has appropriated, rests on an entity, the small family cell, which I do not say is absolutely new, but which is carved out in a new way, strengthened, and intensified.
The small family cell of ascendants and descendants is a sort of zone ot intensification within the larger lamily that is dispossessed and short-circuited. It is the power of the State, or, in this case, technical- State power, which will isolate and lean on this narrow, cellular, intense lamily that is the effect of the incidence of a technical-State power on the large, dispossessed family. This is what I think we can say about the mechanism ot the 1838 law. You can see that, inasmuch as all the big asy- lums have functioned for 150 years now on the basis of this juridical lorm, it is important to note that it does not favor the family's powers. On the contrary, it divests the family of its traditional powers. In juridi cal terms, therefore, there is a break between the asylum and the family.
What do we see when we look at the medical tactic, that is to say, the way in which things unfold in the asylum?
The first principle, which is now consolidated, and which you will hnd practically throughout the life, I was going to say, the serene life of psychiatric discipline, that is to say, until the twentieth century, the principle, or precept rather, a rule of know-how, is that one can never cure a lunatic in his family. The family milieu is absolutely incompatible with the management of any therapeutic action.
A The manuscript adds: "In fact, we grasp here a process that will be found again throughout I lie history of psychiatric power. "
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? 98 PSYCHIATRIC POWER
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 . .
