The sensation of heaviness or even absence of the limb struck, and, again, the paralysis which is never wanting, in some degree at any rate, will give rise quite naturally, as it were, to the idea of motor
weakness
of the limb.
Foucault-Psychiatric-Power-1973-74
.
.
) could be reproduced artificially in certain circumstances, which is the wonderful thing about it and ideal in pathological physiology.
To be able to reproduce a pathological state is perfection, because it seems that we hold the theory when we have in our hands the means to repro duce the morbid phenomena.
" See, ibid.
Policlinique of Tuesday 1st May 1888: "Production artificielle de parlaysie dans Fetal hypnotique: procedes de guerison de ces paralysies expcnmentales" (in a hypnotisable hystero epileptic) pp.
373-385.
41. In 1870, owing to renovations to the Sainte-Laure building, in which the insane, epileptics and hysterics in Louis Delasiauve's department were hospitalized, the administration put the insane and reputedly insane epileptics in Baillarger's department, and opened a department lor the other epileptics and hysterics: the "section of simple epileptics," which was entrusted to Charcot in 1872. See the "Le^on d'ouverture" of the chair of the clinic of illnesses of the nervous system, in Lecons, vol. Ill, pp. 2-3; Clinical Lectures, vol. 3, "Introductory" pp. 2-3.
42. J. -M. Charcot, "Metallotherapie et hypnotisme. Electrotherapie," in CEuvres completes, vol. IX (Paris: Lecrosnier & Babe, 1890) p. 297: "The research undertaken at the hospital
of la Salpetriere by M. Charcot and, under his direction, by several of his students, date from 1878. " Charcot set out his first results in "Lemons sur le grand hypnotisme chez les hysteriques. " At the Academie des sciences on 13 February 1882 he gave a paper that proposed a description in neurological terms and sought to give hypnosis a scientific status: "Physiologie pathologique. Sur les divers etats nerveux determines par Fhypnotisation chez
les hysteriques," Comptes rendus hebdomadaires des seances de VAcademie des sciences, vol. 94, no. \, 13 February 1882 (Paris: Gauthier Villars, 1882) pp. 403-405. See, A. R. Owen, Hysteria, Hypnosis and Healing: the Work ofJ. -M. Charcot (London: D. Dobson, 1971).
43. In the 1860s problems arose linked to series of industrial and railway accidents: problems
o( expertise, indemnities, and the determination of employment disability. With regard to industrial accidents, La Securite Generate, supported by the Credit Industriel et Commercial, was created by decree on 14 November 1865- The law of 11 July 1868 recom mended the creation of two national funds for insurance in cases of death and accidents arising from industrial and agricultural work; it was spelled out by the decree of 10 August 1868. In May 1880, a draft bill on "responsibility lor the accidents suffered by workers in their work" was put forward by Martin Nadaud; it was not until 9 April 1898 that the law on accidents at work was passed. See (a) G. Hamon, Histoire generale de I'assurance en France et a Vetranger (Paris: A. Giard and F. Briere, 1897); (b) V. Senes, Les Origines des compagnies d'assurance (Paris: L. Dulac, 1900); (c) J. -P. Richard, Histoire des institutions d*assurance en France (Paris: Ed. de FArgus, 1956); ( d ) H. Hatzfeld, Du pauperisme a la Securite sociale, 1850-1940 (Paris: 1971). Foucault returns to the question in October 1974: see, "Crise de la medecine ou crise de Fantimedecine," Dits et Ecrits, vol. 3, p. 54.
44. In January and February 1867, Henri Legrand du Saulle (1830-1886) devoted a series of lectures to the question published in his Etude medico-legale sur les assurances sur la vie (Paris: Savy, 1868).
45- Thus, Cl. Guillemaud deals with the question of screening for simulation in his work, Des accidents de chemin defer et de leurs consequences medico-judiciaires (Paris: 1851) pp. 40-41. A. Souques devotes his thesis to the question of simulation: Contribution a I'etude des syndromes hysteriques "simulateurs" des maladies organiques de la moelle epiniere, Medical Thesis, Pans,
6 February 1974 329
? 330 PSYCHIATRIC POWER
no. 158 (Paris: Lecrosnier & Babe, 1891). See also above, note 20 to lecture of 12 December
1973, and note 20 to lecture of 30 January 1974.
46. See above p. 184 sq and p. 234 sq. In the second half of the nineteenth century there is a
growing literature on the results of these accidents: [A] Anglo Saxon, which attributes
them to an inflammation either of the spine ("Railway Spine") or the brain ("Railway
Brain"). See (a) J. E. Erichsen, On Railway and Other Injuries of the Nervous System (Philadelphia: H. C. Lea, 1867), and On Concussion of the Spine, Nervous Shock, and Other ObscureInjuriesoftheNervousSystem(New York:Wood,1875);(b) H. W. Page,Injuriesofthe
Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in their Surgical
and Medico-legal Aspects (London: J. Churchill, 1883), and his book, a dedicated copy ol
which he sent to Charcot, Railway Injuries with Special Reference to those oj the Back and Nervous System in their Medico-legal and Clinical Aspects (London: Griffin and Co. ,
1891). | B | German, which considers the results to be a specific "traumatic neurosis. " See,
(a) H. Oppenhcim and R. Thomsen, "Uber das Vorkommen und die Bedeutung der sensorishcen Aniisthesie bei Erkrankungen des zentralen Nerven-systems" Archiv fur Psychiatrie (Berlin, 1884) vol. 15, pp. 559-583 and pp. 663-680; (b) H. Oppenhcim, Die traumatischen Neurosen (. . . ^(Berlin: Hirschwald, 1889). Charcot devotes an 1877 lecture to
the question: "De Pinfluence des lesions traumatiques sur le developpement des phenomenes d'hyserie locale" (lecture given at la Salpetriere, December 1877), Progres medical, 6th year, no. 18, 4 May 1878, pp. 335-338. Not accepting the existence of a specific
clinical entity and arguing for the possibility of reproducing paralyses under hypnosis sim
ilar to traumatic paralyses, Charcot defined a variety of hysteria: "traumatic hysteria. "
Between 1878 and 1893 he published twenty cases oi paralysis due to accidents at work or
railway accidents: (1) Lecons, vol. Ill, Lecture 18 (in which he criticizes the German con ception) p. 258; Lecture 22: "Sur deux cas de monoplegie brachiale hystenque chez l'homme," pp. 354-356; Lecture 23: "Sur deux cas de coxalgie hysterique chez Phomme,"
pp. 370-385; Lecture 24 (pp. 386-398 in which draws an analogy between the English "nervous shock" and the hypnotic state produced by suggestion), and Appendix 1,
pp. 458-462; English translation, Clinical Lectures, vol. 3: Lecture 18, "Concerning six cases
of hysteria in the male," pp. 224-225; Lecture 22, "On two cases ol hysterical brachial monoplegia in the male (continuedy'; Lecture 24, "On a case of hysterical hip disease in a
man resulting from injury"; and Appendix 1, "Two additional cases of hystero-traumatic paralysis in men"; (2) Lecons du mardi, vol. II, Policlinique of Tuesday 4 December 1888,
Lecture 7, pp. 131-139, Appendix 1: "Hysterie et nevrose traumatique. Collision des trains
et hysterie consecutive," pp. 527-535; (3) Clinique des maladies du systemenerveux, vol. 1,
Lecture 3, 13 November 1889, pp. 61-64; (4) J. M. Charcot and P. Marie, "Hysteria,
mainly hystero epilepsy"--which opposes the German conception ol a specific "traumatic neurosis"--in, D. Hack Tuke, Dictionary of Psychological Medicine, vol. 1 (London: J. &
A. Churchill, 1892) pp. 639-640. See also, (a) Ch. Vibert, La Nevrose traumatique. Etude medico-legale sur les blessures produites par les accidents de chemin defer et les traumatismes analogues (Paris: J. B. Bailliere, 1893); ( b ) E. Fischer-Homberger, "Railway Spine und traumatische Neurose. Seele und Ruckenmark," Gesnerus, vol. 27, 1970, pp. 96-111, and since then we
have his book Die Traumatische Neurose. Vom somatischen %um so^ialen Leiden (Berne: Hans Huber, 1975).
47. Lecons, vol. Ill, Lecture 24, "Sur un cas de coxalgie hystenque de cause traumatique chez l'homme" (from Dr. P. Mane) pp. 391-392; Clinical Lectures, vol. 3, Lecture 24: "On a case of hysterical hip disease in a man, resulting from injury" pp. 333-334- To demonstrate that Ch. , a sawyer, the victim of an accident at work, was suffering from hysterical coxalgia, without organic lesion, Charcot reproduced the coxalgia in two patients placed in a "hypnotic state. "
48. On simulation, see above, note 45. There are references to this literature in: ( a ) A. Laurent, Etude medico-legale sur la simulation de lafolie; ( b ) E. Boisseau, article, "Maladies simulees," in Dictionnaire encydopedique des sciences medicales, 2nd series, vol. IV (Paris: Masson/Asselin, 1876) pp. 266-281; (c) G. Tourdes, article, "Simulation. " Charcot takes up the question
on several occasions: (1) Lecons du mardi, vol. I, Policlinique of Tuesday 20 March 1888: "Ataxie locomotnce. Forme anormale," pp. 281-284; (2) Lecons, vol. I, Lecture 9, "De l'ischurie hysterique" ? "Simulation" pp. 281-283, Clinical lectures, vol. 1,
? Lecture 9: "Hysterical ischuria" pp. 230-232; vol. Ill, "Lecon d'ouverture de la chaire de la clinique des maladies du systeme nerveux" ? VII, "Simulation" pp. 17-22; vol. 3, Lecture 1: "Introductory--? Simulation," and Lecture 26, "Cas de mutisme hysterique chez l'homme. Lcs simulations" p. 422; "A case ol hysterical mutism in a man--? Malingerers. "
49. From the 1880s, Hippolyte Bernheim (1840-1919), professor of the Faculty and president of the Nancy Societe medicale, criticized Charcot's experiments: De la suggestion dans I'etat hypnotique et dans I'etat de veille (Paris: Doin, 1884). He makes the criticism clearer in Hypnotisme, Suggestion, Psychotherapie. Etudes nouvelles (Pans: Doin, 1891) p. 172: "One would not believe how many neuropaths and hysterics we are liable to produce by unconscious suggestion: we create neuralgia, hysterogenic zones (? ? ? ); we externalize our conceptions on the patient; we fabricate an observation with the preconceived ideas we have in our mind. " Already, in an article that appeared in Le Temps, 29 January 1891, he declared: "I believe that the attack of grand hysteria that la Salpetnere gives us as classical, unfolding in clear and precise phases (. . . ) is an hysteria of culture. " Refusing moreover to confine hypnotism in the pathological register, he asserts that "what we call hypnotism is nothing other than the activation ol a normal property of the brain, suggestibility, that is to say the capacity to be influenced by an accepted idea and to seek its realization. " On the Charcot Bernheim debate, see Hillman, "A scientific study of hystery" Bulletin of the History of Medicine, vol. 29, no. 2, 1955, pp. 163-182.
50. The notion o( "trauma," understood first of all as a "mechanical action" liable to trigger hysterical accidents, was established from 1877. See, Lecons, vol. I, Appendix VII, "De l'influence des lesions traumatique sur lc development des phenomenes d'hystene locale" (December 1877) pp. 446-457 |the Appendix does not appear in the English translation, Clinical Lectures]. From 1885 the notion is deepened in the sense o( taking a mechanism of "traumatic suggestion" into account; see, ibid. vol. Ill, Lectures, 20, 21 and 22, "Sur deux cas de monoplegie brachiale hysterique, de cause traumatique chez l'homme" (with a sec- tion devoted to "Hypnotism and nervous shock"); Clinical Lectures, vol. Ill, Lectures 20, 21 and 22, "On a case of hysterical hip disease in a man, resulting from injury. "
51. This is the case of Le Logeais, a messenger of 29 years, knocked down on 21 October 1885 by a horse-drawn van. After being hospitalized twice, at Beaujon and the Hotel Dieu, he was admitted into Charcot's department on 21 March 1886, with paralysis and anesthesia of the limbs; see, Lecons, vol. Ill, Appendix I, "Cas de paralysie hystero traumatique survenue a la suite d'un accident de voiture" (Observation recorded by M. Berbez) pp. 541-559; Clinical Lectures, vol. 3, Appendix 1: "A case of hystero traumatic paraplegia supervening on a street accident. " The accident "gave rise to the conviction in Le Log 's mind that the wheels of the van which knocked him over 'passed over the body,' as he puts it. Nevertheless, this conviction, which has even appeared to him in his dreams, is completely erroneous" p. 386.
52. Ibid. pp. 553-554; ibid. p. 385: "in the very fact of local shock, and particularly in the sensory and motor phenomena attached thereto, must be sought the point of departure ol the suggestion.
The sensation of heaviness or even absence of the limb struck, and, again, the paralysis which is never wanting, in some degree at any rate, will give rise quite naturally, as it were, to the idea of motor weakness of the limb. And this idea, by reason of the som nambulic mental condition, comes to acquire, after a period of incubation, a considerable development, and is finally able to become realised objectively in the form of a complete paralysis" p. 385.
53. A conception illustrated by the remarks of Esquirol's article "Manie," in Dictionnaire des sciences medicales, vol. XXX (Paris: C. L. F. Panckoucke, 1818) p. 454: "The actions to which the insane abandon themselves are always the result of the delirium"; or of E. J. Georget, De lafolie. Considerations sur cette maladie, p. 75: "There is no madness without delirium"; or again of F. E. Fodere, Traite de medecine legate et d'hygienepublique, vol. I (Paris: Mame, 1813) p. 184.
54. On the story of childhood, see the case of Augustine, in Iconographie photographique de la Salpetnere, published by D. M. Bourneville, Delahaye and Regnard, vol. II (Paris: Delahaye, 1878) p. 167.
55- The case is that ol Louise Augustine, who entered Charcot's department at the age of fifteen and a half. See, Lecons, vol. I, Part Two: "Hystero epilepsie," Observation 2,
6 February 1974 331
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PSYCHIATRIC POWER
pp. 125-126 ["Observation 2," and the case history quoted at length by Foucault to which this refers, cannot be found in the English translation, Clinical Lectures. The same is true lor the cases cited in the following notes 56 and 57. See Foucauk's comments on the publica tion of Charcot's lectures in M. Foucault, The History of Sexuality. Volume 1: An Introduction, p. 56 and note; G. B. |.
56. This concerns the scene during which she calls on a friend, Emile, to exonerate her, before her brother, ol the latter's charges. See ibid. p. 149 [See previous note; G. B. J.
57. The case ol Celina, who entered Charcot's department in 1870: ibid. p. 132 {see note 55; G. B. |.
58. See above, note 26. See also, Jules Falret, "Responsabilitie legale des alienes," ? "Hystene" (1876) in Les Alienes et les Asiles d'alienes, p. 189: "These patients often present disorders of a more or pronounced character which give them a particular style and which has been designated under the generic term of hysterical character. They are fantasists, inclined to lies and invention; they are romancers, loving domination and capricious. "
59. Lecons, vol. 1, Lecture 10, "De I'hemianesthesie hystenque," p. 301; Clinical Lectures, vol. 1, Lecture 10, "Hysterical hemianaethesia," p. 2^7. Charcot makes the remark with reference to Paul Briquet's Traite clinique et therapeutique de Vhysterie (Paris: H. B. Bailliere, 1859).
60. It was at "one ol Charcot's evening receptions" that Freud overheard a discussion between Charcot and Paul Brouardel, professor of legal medicine. With relerence to a patient, Charcot said " 'Mais, dans ces parcils e'est toujours la chose genitale, toujours . . . toujours . . . toujours' |'But in this sort of case it's always a genital thing--always, always, always': words left in French in the English Standard Edition | ( . . . ) . I know that for a moment I was almost paralysed with amazement and said to myself: 'Well, but if he knows that, why does he never say so? ' " "On the History of the Psycho Analytic Movement," Standard Edition, vol. 14 (1957) p. 14; Z. ur Geschichte der psychoanalytischen Bewegung (1914) in GW, vol. X (1946) p. 51.
61. Freud's stay in Charcot's department Irom 30 October 1885 to 28 February 1886 was thanks to a bursary. See S. Freud, "Bencht iiber meine mit Universitats Jubiliiums Reisestipendium unternommene Studenreise nach Paris und Berlin" (1886), in
J. and R. Gicklhorn, Sigmund Freuds akademische Laujhahn, im Lichte der Dokumenle von J. and JR. Gicklhorn (Vienna: Urban & Schwarzenberg, 1960) pp. 82-89; English transla
tion, "Report on my Studies in Paris and Berlin," Standard Edition, vol. 1 (1966). The lirst texts in which Freud envisaged a sexual etiology of the neuroses concerned neurasthenia and anxiety neuroses: see La Naissance de la psychanalyse, Manuscript A, 1892, pp. 59-60, and Manuscript B, 8 February 1893, pp. 61-65; English translation, "Extracts from the Fliess Papers" Drafts A and B, Standard Edition, vol. 1 (1966) pp. 177-178 and pp. 179-184. He extends this hypothesis to the psychoneuroses in 1894: see, Die Ahwehr-Neuropsychosen, in GW, vol. I; "The Neuro Psychoses of Defence" Standard Edition, vol. 3 (1962). See also the article which recapitulates the problem: "Die Sexualitiit in der Atiologie der Neurosen" (1898), in GW, vol. I, pp. 489-516; "Sexuality in the Aetiology of the Neuroses" Standard Edition, vol. 3 (1962).
62. The case concerns the "period of erotic delirium" of Genevieve, who was born at Loudon
on 2 January 1843 and entered Charcot's department in 1872 as a "simple epileptic. " See Iconographie pholographique de la Salpetriere, vol. I, p. 70: "The observer, still not accustomed to these scenes, was quite astounded seeing the hideous contortions of her face, that expression of extreme lubricity . . . speaking to one of the assistants, she suddenly leaned towards him, saying: 'Kiss me! (. . . ). Give me (. . . ). ' " The observation is quoted
by Foucault in La Volonte de savoir, p. 75, n. 1; The History of Sexuality. 1. An Introduction,
p. 56, n. 1.
63- See above, note 4.
64. Joseph Francois Felix Babinski (1857-1932), after having been senior doctor in Charcot's
department lrom 1885 to 1887, and following the latter's death, in a communication to the Paris Societe de Neurologie on 7 November 1901, distanced himself from his conceptions by proposing to replace the term "hysteria" with that of "pithiatism" (from neiGeiv, to persuade), in order to designate a class of morbid phenomena resulting from suggestion and curable by suggestion, thus dissociating hysteria from hypnotism: "the greek words peitho [iTeiSo)] and iatos | id-ros] signify, the first 'persuasion' and the second 'curable,' the
? neologism 'pithiatism' could very well designate the psychical state displayed by disorders curable by persuasion and replace advantageously the word 'hysteria'. " "Definition de I'hysterie," Revue neurologique, 1901, no. 9, p. 1090; reprinted in (Euvres scientifique, Part 9: "Hystene-Pithiatisme" (Paris: Masson, 1934) p. 464. Babinski developed his conception between 1906 and 1909: (1) "Ma conception de I'hysterie et de l'hypnotisme (Pithiatisme)" lecture at the Societe de l'Internat of Paris hospitals, 28June 1906, in ibid. pp. /|65-/|85; (2) "Demembrement de I'hysterie traditionnelle. Pithiatisme" La Semaine medicaky 6 January 1909, pp. 66-67, where he states: "We no longer see those major attacks with the four famous periods, those great hypnotic states characterized by lethargy, catalepsy, and somnambulism. Students and young doctors who read the description of these disorders in the books of the period get the impression that it is a matter of paleo pathology" (republished in (Euvresscientifiques, p. 500).
6 February 7974 333
? COURSE SUMMARY*
FOR A LONG TIME, medicine, psychiatry, penal justice, and criminology remained, and to a large extent remain still today, on the borders of a manifestation of truth in accordance with the norms of knowledge and of a production of truth in the form of the test, the latter always tending to hide behind and get its justification from the former. The current crisis of these "disciplines" does not merely call into question their limits or uncertainties within the field of knowledge, it calls into question knowledge itself, the form of knowledge, the "subject-object" norm; it puts in question the relationships between our society's economic and political structures and knowledge (not in its true or false contents, but in its power-knowledge functions). It is, then, a histonco-political crisis.
Take, first of all, the example of medicine, along with the space connected to it, the hospital. Even quite late the hospital was still an ambiguous place, both a place for finding a hidden truth through observation and a place of testing for a truth to be produced.
In the hospital there is a direct action on the disease: the hospital does not only enable disease to reveal its truth to the doctor's gaze, it produces that truth. The hospital is a birthplace of the true disease. It was assumed, in fact, that left at liberty--in his "milieu," his family and his social circle, with his regimen, habits, prejudices, and illusions--the sick person would be affected by a complex, confused, and tangled disease, a sort of unnatural disease that was both the mixture of several diseases and the obstacle preventing the true disease from appearing in its authentic nature. In removing that parasitic vegetation, those aberrant
* Published in the Annuaire du College de France, U annee. Histoire des syslemes de pensee, annee 1973-1974, (1974), pp. 293 300, and in Dits et ecrits, 1954-1988, vol. 2 (Paris: Gallimard, 1994), pp. 674 685. An earlier translation of this summary appears in M. Foucault, The Essential Works of Michel Foucault, 1954-1984, Vol. 1: Ethics: subjectivity and truth, ed. Paul Rabinow, trans. Robert Hurley and others (New York: New Press, 1997) pp. 39 50.
? 336 PSYCHIATRIC POWER
forms, the role of the hospital, therefore, was not only to make the disease visible just as it is, but also finally to produce it in its hitherto enclosed and fettered truth. Its distinctive nature, its essential characteristics, and its specific development would finally be able to become reality through the effect of hospitalization.
The eighteenth century hospital was supposed to create the conditions for the truth of the disease to manifest itself. It was therefore a place of observation and demonstration, but also of purification and testing. It was a sort of complex equipment for both revealing and really producing the disease: both a botanical site for the contemplation of species, and a still alchemical site for the elaboration of pathological substances.
This dual function continued to be taken on for a long time by the great hospital structures established in the nineteenth century. For a century (1760-1860), the theory and practice of hospitalization, and, in a general way, the conception of disease, were dominated by this ambiguity: as a reception structure for the disease, should the hospital be a space of knowledge or a place of testing?
Hence a series of problems pervaded the thought and practice of doctors. Here are a few:
1. Therapy consists in suppressing the illness, in reducing it to nonexistence; however, for therapy to be rational and grounded in truth, should it not allow the disease to develop? When should one intervene, and in what way? Should one intervene at all? Should one act so that the disease develops or so that it stops, so as to alleviate it or so as to lead it to its term?
2. There are diseases and modifications of diseases, pure and impure, simple and complex diseases. In the end, is there not just one disease, of which all the others are more or less distantly derived forms, or should we assume the exis- tence of irreducible categories? (The debate between Broussais and his oppo- nents concerning the notion of irritation. The problem of essential fevers. )
3. What is a normal disease? What is a disease that follows its course? Is it a disease that leads to death, or a disease that is cured spontaneously after completing its evolution? It was in these terms that Bichat wondered about the position of disease between life and death.
We know that Pasteur tan biology brought a prodigious simplification to all these problems. By determining the agent of the sickness and identifying it as a specific organism, it enabled the hospital to become a
? place of observation, diagnosis, and clinical and experimental identifica- tion, but also one of immediate intervention and counter-attack against the microbial invasion.
As for the testing function, we see that it may disappear. The place where the disease will be produced is the laboratory, in the test tube; however, the disease is not realized in a crisis there; its process is reduced to a magnified mechanism; it is reduced to a verifiable and con trollable phenomenon. For the disease, the hospital milieu no longer has to be the site that favors a decisive event; it simply makes possible a reduction, a transfer, a magnification, an observation; the test (epreuve) is transformed into proof (^preuve) within the technical structure of the laboratory and in the doctor's description.
It we wanted to produce an "ethno epistemology" of the medical personality, we would have to say that the Pasteunan revolution deprived him of his doubtless age-old role in the ritual production and testing of the disease. The disappearance of this role was no doubt dra matized by the fact that Pasteur did not merely show that the doctor did not have to be the producer of the disease "in its truth," but that, due to his ignorance of the truth, he had on thousands ot occasions made himseH the propagator and reproducer of disease: the hospital doctor going from bed to bed was one of the major agents of contagion. Pasteur inflicted a formidable narcissistic wound on doctors, for which they took a long time to forgive him: the hands that the doctor had to run over the patient's body, palpate it, and examine it, those hands that had to dis cover the disease, bring it to light and display it, Pasteur designated as carriers of disease. Until then, the role of the hospital space and of the doctor's knowledge was to produce the "critical" truth of the disease; and now the doctor's body and the crowded hospital appeared as the producers of the disease's reality.
Disinlection of the doctor and the hospital gave them a new inno- cence lrom which they have drawn new powers and a new status in men's imagination. But that is another story.
These few remarks may help us to understand the position ot the madman and the psychiatrist in the asylum space.
41. In 1870, owing to renovations to the Sainte-Laure building, in which the insane, epileptics and hysterics in Louis Delasiauve's department were hospitalized, the administration put the insane and reputedly insane epileptics in Baillarger's department, and opened a department lor the other epileptics and hysterics: the "section of simple epileptics," which was entrusted to Charcot in 1872. See the "Le^on d'ouverture" of the chair of the clinic of illnesses of the nervous system, in Lecons, vol. Ill, pp. 2-3; Clinical Lectures, vol. 3, "Introductory" pp. 2-3.
42. J. -M. Charcot, "Metallotherapie et hypnotisme. Electrotherapie," in CEuvres completes, vol. IX (Paris: Lecrosnier & Babe, 1890) p. 297: "The research undertaken at the hospital
of la Salpetriere by M. Charcot and, under his direction, by several of his students, date from 1878. " Charcot set out his first results in "Lemons sur le grand hypnotisme chez les hysteriques. " At the Academie des sciences on 13 February 1882 he gave a paper that proposed a description in neurological terms and sought to give hypnosis a scientific status: "Physiologie pathologique. Sur les divers etats nerveux determines par Fhypnotisation chez
les hysteriques," Comptes rendus hebdomadaires des seances de VAcademie des sciences, vol. 94, no. \, 13 February 1882 (Paris: Gauthier Villars, 1882) pp. 403-405. See, A. R. Owen, Hysteria, Hypnosis and Healing: the Work ofJ. -M. Charcot (London: D. Dobson, 1971).
43. In the 1860s problems arose linked to series of industrial and railway accidents: problems
o( expertise, indemnities, and the determination of employment disability. With regard to industrial accidents, La Securite Generate, supported by the Credit Industriel et Commercial, was created by decree on 14 November 1865- The law of 11 July 1868 recom mended the creation of two national funds for insurance in cases of death and accidents arising from industrial and agricultural work; it was spelled out by the decree of 10 August 1868. In May 1880, a draft bill on "responsibility lor the accidents suffered by workers in their work" was put forward by Martin Nadaud; it was not until 9 April 1898 that the law on accidents at work was passed. See (a) G. Hamon, Histoire generale de I'assurance en France et a Vetranger (Paris: A. Giard and F. Briere, 1897); (b) V. Senes, Les Origines des compagnies d'assurance (Paris: L. Dulac, 1900); (c) J. -P. Richard, Histoire des institutions d*assurance en France (Paris: Ed. de FArgus, 1956); ( d ) H. Hatzfeld, Du pauperisme a la Securite sociale, 1850-1940 (Paris: 1971). Foucault returns to the question in October 1974: see, "Crise de la medecine ou crise de Fantimedecine," Dits et Ecrits, vol. 3, p. 54.
44. In January and February 1867, Henri Legrand du Saulle (1830-1886) devoted a series of lectures to the question published in his Etude medico-legale sur les assurances sur la vie (Paris: Savy, 1868).
45- Thus, Cl. Guillemaud deals with the question of screening for simulation in his work, Des accidents de chemin defer et de leurs consequences medico-judiciaires (Paris: 1851) pp. 40-41. A. Souques devotes his thesis to the question of simulation: Contribution a I'etude des syndromes hysteriques "simulateurs" des maladies organiques de la moelle epiniere, Medical Thesis, Pans,
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no. 158 (Paris: Lecrosnier & Babe, 1891). See also above, note 20 to lecture of 12 December
1973, and note 20 to lecture of 30 January 1974.
46. See above p. 184 sq and p. 234 sq. In the second half of the nineteenth century there is a
growing literature on the results of these accidents: [A] Anglo Saxon, which attributes
them to an inflammation either of the spine ("Railway Spine") or the brain ("Railway
Brain"). See (a) J. E. Erichsen, On Railway and Other Injuries of the Nervous System (Philadelphia: H. C. Lea, 1867), and On Concussion of the Spine, Nervous Shock, and Other ObscureInjuriesoftheNervousSystem(New York:Wood,1875);(b) H. W. Page,Injuriesofthe
Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in their Surgical
and Medico-legal Aspects (London: J. Churchill, 1883), and his book, a dedicated copy ol
which he sent to Charcot, Railway Injuries with Special Reference to those oj the Back and Nervous System in their Medico-legal and Clinical Aspects (London: Griffin and Co. ,
1891). | B | German, which considers the results to be a specific "traumatic neurosis. " See,
(a) H. Oppenhcim and R. Thomsen, "Uber das Vorkommen und die Bedeutung der sensorishcen Aniisthesie bei Erkrankungen des zentralen Nerven-systems" Archiv fur Psychiatrie (Berlin, 1884) vol. 15, pp. 559-583 and pp. 663-680; (b) H. Oppenhcim, Die traumatischen Neurosen (. . . ^(Berlin: Hirschwald, 1889). Charcot devotes an 1877 lecture to
the question: "De Pinfluence des lesions traumatiques sur le developpement des phenomenes d'hyserie locale" (lecture given at la Salpetriere, December 1877), Progres medical, 6th year, no. 18, 4 May 1878, pp. 335-338. Not accepting the existence of a specific
clinical entity and arguing for the possibility of reproducing paralyses under hypnosis sim
ilar to traumatic paralyses, Charcot defined a variety of hysteria: "traumatic hysteria. "
Between 1878 and 1893 he published twenty cases oi paralysis due to accidents at work or
railway accidents: (1) Lecons, vol. Ill, Lecture 18 (in which he criticizes the German con ception) p. 258; Lecture 22: "Sur deux cas de monoplegie brachiale hystenque chez l'homme," pp. 354-356; Lecture 23: "Sur deux cas de coxalgie hysterique chez Phomme,"
pp. 370-385; Lecture 24 (pp. 386-398 in which draws an analogy between the English "nervous shock" and the hypnotic state produced by suggestion), and Appendix 1,
pp. 458-462; English translation, Clinical Lectures, vol. 3: Lecture 18, "Concerning six cases
of hysteria in the male," pp. 224-225; Lecture 22, "On two cases ol hysterical brachial monoplegia in the male (continuedy'; Lecture 24, "On a case of hysterical hip disease in a
man resulting from injury"; and Appendix 1, "Two additional cases of hystero-traumatic paralysis in men"; (2) Lecons du mardi, vol. II, Policlinique of Tuesday 4 December 1888,
Lecture 7, pp. 131-139, Appendix 1: "Hysterie et nevrose traumatique. Collision des trains
et hysterie consecutive," pp. 527-535; (3) Clinique des maladies du systemenerveux, vol. 1,
Lecture 3, 13 November 1889, pp. 61-64; (4) J. M. Charcot and P. Marie, "Hysteria,
mainly hystero epilepsy"--which opposes the German conception ol a specific "traumatic neurosis"--in, D. Hack Tuke, Dictionary of Psychological Medicine, vol. 1 (London: J. &
A. Churchill, 1892) pp. 639-640. See also, (a) Ch. Vibert, La Nevrose traumatique. Etude medico-legale sur les blessures produites par les accidents de chemin defer et les traumatismes analogues (Paris: J. B. Bailliere, 1893); ( b ) E. Fischer-Homberger, "Railway Spine und traumatische Neurose. Seele und Ruckenmark," Gesnerus, vol. 27, 1970, pp. 96-111, and since then we
have his book Die Traumatische Neurose. Vom somatischen %um so^ialen Leiden (Berne: Hans Huber, 1975).
47. Lecons, vol. Ill, Lecture 24, "Sur un cas de coxalgie hystenque de cause traumatique chez l'homme" (from Dr. P. Mane) pp. 391-392; Clinical Lectures, vol. 3, Lecture 24: "On a case of hysterical hip disease in a man, resulting from injury" pp. 333-334- To demonstrate that Ch. , a sawyer, the victim of an accident at work, was suffering from hysterical coxalgia, without organic lesion, Charcot reproduced the coxalgia in two patients placed in a "hypnotic state. "
48. On simulation, see above, note 45. There are references to this literature in: ( a ) A. Laurent, Etude medico-legale sur la simulation de lafolie; ( b ) E. Boisseau, article, "Maladies simulees," in Dictionnaire encydopedique des sciences medicales, 2nd series, vol. IV (Paris: Masson/Asselin, 1876) pp. 266-281; (c) G. Tourdes, article, "Simulation. " Charcot takes up the question
on several occasions: (1) Lecons du mardi, vol. I, Policlinique of Tuesday 20 March 1888: "Ataxie locomotnce. Forme anormale," pp. 281-284; (2) Lecons, vol. I, Lecture 9, "De l'ischurie hysterique" ? "Simulation" pp. 281-283, Clinical lectures, vol. 1,
? Lecture 9: "Hysterical ischuria" pp. 230-232; vol. Ill, "Lecon d'ouverture de la chaire de la clinique des maladies du systeme nerveux" ? VII, "Simulation" pp. 17-22; vol. 3, Lecture 1: "Introductory--? Simulation," and Lecture 26, "Cas de mutisme hysterique chez l'homme. Lcs simulations" p. 422; "A case ol hysterical mutism in a man--? Malingerers. "
49. From the 1880s, Hippolyte Bernheim (1840-1919), professor of the Faculty and president of the Nancy Societe medicale, criticized Charcot's experiments: De la suggestion dans I'etat hypnotique et dans I'etat de veille (Paris: Doin, 1884). He makes the criticism clearer in Hypnotisme, Suggestion, Psychotherapie. Etudes nouvelles (Pans: Doin, 1891) p. 172: "One would not believe how many neuropaths and hysterics we are liable to produce by unconscious suggestion: we create neuralgia, hysterogenic zones (? ? ? ); we externalize our conceptions on the patient; we fabricate an observation with the preconceived ideas we have in our mind. " Already, in an article that appeared in Le Temps, 29 January 1891, he declared: "I believe that the attack of grand hysteria that la Salpetnere gives us as classical, unfolding in clear and precise phases (. . . ) is an hysteria of culture. " Refusing moreover to confine hypnotism in the pathological register, he asserts that "what we call hypnotism is nothing other than the activation ol a normal property of the brain, suggestibility, that is to say the capacity to be influenced by an accepted idea and to seek its realization. " On the Charcot Bernheim debate, see Hillman, "A scientific study of hystery" Bulletin of the History of Medicine, vol. 29, no. 2, 1955, pp. 163-182.
50. The notion o( "trauma," understood first of all as a "mechanical action" liable to trigger hysterical accidents, was established from 1877. See, Lecons, vol. I, Appendix VII, "De l'influence des lesions traumatique sur lc development des phenomenes d'hystene locale" (December 1877) pp. 446-457 |the Appendix does not appear in the English translation, Clinical Lectures]. From 1885 the notion is deepened in the sense o( taking a mechanism of "traumatic suggestion" into account; see, ibid. vol. Ill, Lectures, 20, 21 and 22, "Sur deux cas de monoplegie brachiale hysterique, de cause traumatique chez l'homme" (with a sec- tion devoted to "Hypnotism and nervous shock"); Clinical Lectures, vol. Ill, Lectures 20, 21 and 22, "On a case of hysterical hip disease in a man, resulting from injury. "
51. This is the case of Le Logeais, a messenger of 29 years, knocked down on 21 October 1885 by a horse-drawn van. After being hospitalized twice, at Beaujon and the Hotel Dieu, he was admitted into Charcot's department on 21 March 1886, with paralysis and anesthesia of the limbs; see, Lecons, vol. Ill, Appendix I, "Cas de paralysie hystero traumatique survenue a la suite d'un accident de voiture" (Observation recorded by M. Berbez) pp. 541-559; Clinical Lectures, vol. 3, Appendix 1: "A case of hystero traumatic paraplegia supervening on a street accident. " The accident "gave rise to the conviction in Le Log 's mind that the wheels of the van which knocked him over 'passed over the body,' as he puts it. Nevertheless, this conviction, which has even appeared to him in his dreams, is completely erroneous" p. 386.
52. Ibid. pp. 553-554; ibid. p. 385: "in the very fact of local shock, and particularly in the sensory and motor phenomena attached thereto, must be sought the point of departure ol the suggestion.
The sensation of heaviness or even absence of the limb struck, and, again, the paralysis which is never wanting, in some degree at any rate, will give rise quite naturally, as it were, to the idea of motor weakness of the limb. And this idea, by reason of the som nambulic mental condition, comes to acquire, after a period of incubation, a considerable development, and is finally able to become realised objectively in the form of a complete paralysis" p. 385.
53. A conception illustrated by the remarks of Esquirol's article "Manie," in Dictionnaire des sciences medicales, vol. XXX (Paris: C. L. F. Panckoucke, 1818) p. 454: "The actions to which the insane abandon themselves are always the result of the delirium"; or of E. J. Georget, De lafolie. Considerations sur cette maladie, p. 75: "There is no madness without delirium"; or again of F. E. Fodere, Traite de medecine legate et d'hygienepublique, vol. I (Paris: Mame, 1813) p. 184.
54. On the story of childhood, see the case of Augustine, in Iconographie photographique de la Salpetnere, published by D. M. Bourneville, Delahaye and Regnard, vol. II (Paris: Delahaye, 1878) p. 167.
55- The case is that ol Louise Augustine, who entered Charcot's department at the age of fifteen and a half. See, Lecons, vol. I, Part Two: "Hystero epilepsie," Observation 2,
6 February 1974 331
? 332
PSYCHIATRIC POWER
pp. 125-126 ["Observation 2," and the case history quoted at length by Foucault to which this refers, cannot be found in the English translation, Clinical Lectures. The same is true lor the cases cited in the following notes 56 and 57. See Foucauk's comments on the publica tion of Charcot's lectures in M. Foucault, The History of Sexuality. Volume 1: An Introduction, p. 56 and note; G. B. |.
56. This concerns the scene during which she calls on a friend, Emile, to exonerate her, before her brother, ol the latter's charges. See ibid. p. 149 [See previous note; G. B. J.
57. The case ol Celina, who entered Charcot's department in 1870: ibid. p. 132 {see note 55; G. B. |.
58. See above, note 26. See also, Jules Falret, "Responsabilitie legale des alienes," ? "Hystene" (1876) in Les Alienes et les Asiles d'alienes, p. 189: "These patients often present disorders of a more or pronounced character which give them a particular style and which has been designated under the generic term of hysterical character. They are fantasists, inclined to lies and invention; they are romancers, loving domination and capricious. "
59. Lecons, vol. 1, Lecture 10, "De I'hemianesthesie hystenque," p. 301; Clinical Lectures, vol. 1, Lecture 10, "Hysterical hemianaethesia," p. 2^7. Charcot makes the remark with reference to Paul Briquet's Traite clinique et therapeutique de Vhysterie (Paris: H. B. Bailliere, 1859).
60. It was at "one ol Charcot's evening receptions" that Freud overheard a discussion between Charcot and Paul Brouardel, professor of legal medicine. With relerence to a patient, Charcot said " 'Mais, dans ces parcils e'est toujours la chose genitale, toujours . . . toujours . . . toujours' |'But in this sort of case it's always a genital thing--always, always, always': words left in French in the English Standard Edition | ( . . . ) . I know that for a moment I was almost paralysed with amazement and said to myself: 'Well, but if he knows that, why does he never say so? ' " "On the History of the Psycho Analytic Movement," Standard Edition, vol. 14 (1957) p. 14; Z. ur Geschichte der psychoanalytischen Bewegung (1914) in GW, vol. X (1946) p. 51.
61. Freud's stay in Charcot's department Irom 30 October 1885 to 28 February 1886 was thanks to a bursary. See S. Freud, "Bencht iiber meine mit Universitats Jubiliiums Reisestipendium unternommene Studenreise nach Paris und Berlin" (1886), in
J. and R. Gicklhorn, Sigmund Freuds akademische Laujhahn, im Lichte der Dokumenle von J. and JR. Gicklhorn (Vienna: Urban & Schwarzenberg, 1960) pp. 82-89; English transla
tion, "Report on my Studies in Paris and Berlin," Standard Edition, vol. 1 (1966). The lirst texts in which Freud envisaged a sexual etiology of the neuroses concerned neurasthenia and anxiety neuroses: see La Naissance de la psychanalyse, Manuscript A, 1892, pp. 59-60, and Manuscript B, 8 February 1893, pp. 61-65; English translation, "Extracts from the Fliess Papers" Drafts A and B, Standard Edition, vol. 1 (1966) pp. 177-178 and pp. 179-184. He extends this hypothesis to the psychoneuroses in 1894: see, Die Ahwehr-Neuropsychosen, in GW, vol. I; "The Neuro Psychoses of Defence" Standard Edition, vol. 3 (1962). See also the article which recapitulates the problem: "Die Sexualitiit in der Atiologie der Neurosen" (1898), in GW, vol. I, pp. 489-516; "Sexuality in the Aetiology of the Neuroses" Standard Edition, vol. 3 (1962).
62. The case concerns the "period of erotic delirium" of Genevieve, who was born at Loudon
on 2 January 1843 and entered Charcot's department in 1872 as a "simple epileptic. " See Iconographie pholographique de la Salpetriere, vol. I, p. 70: "The observer, still not accustomed to these scenes, was quite astounded seeing the hideous contortions of her face, that expression of extreme lubricity . . . speaking to one of the assistants, she suddenly leaned towards him, saying: 'Kiss me! (. . . ). Give me (. . . ). ' " The observation is quoted
by Foucault in La Volonte de savoir, p. 75, n. 1; The History of Sexuality. 1. An Introduction,
p. 56, n. 1.
63- See above, note 4.
64. Joseph Francois Felix Babinski (1857-1932), after having been senior doctor in Charcot's
department lrom 1885 to 1887, and following the latter's death, in a communication to the Paris Societe de Neurologie on 7 November 1901, distanced himself from his conceptions by proposing to replace the term "hysteria" with that of "pithiatism" (from neiGeiv, to persuade), in order to designate a class of morbid phenomena resulting from suggestion and curable by suggestion, thus dissociating hysteria from hypnotism: "the greek words peitho [iTeiSo)] and iatos | id-ros] signify, the first 'persuasion' and the second 'curable,' the
? neologism 'pithiatism' could very well designate the psychical state displayed by disorders curable by persuasion and replace advantageously the word 'hysteria'. " "Definition de I'hysterie," Revue neurologique, 1901, no. 9, p. 1090; reprinted in (Euvres scientifique, Part 9: "Hystene-Pithiatisme" (Paris: Masson, 1934) p. 464. Babinski developed his conception between 1906 and 1909: (1) "Ma conception de I'hysterie et de l'hypnotisme (Pithiatisme)" lecture at the Societe de l'Internat of Paris hospitals, 28June 1906, in ibid. pp. /|65-/|85; (2) "Demembrement de I'hysterie traditionnelle. Pithiatisme" La Semaine medicaky 6 January 1909, pp. 66-67, where he states: "We no longer see those major attacks with the four famous periods, those great hypnotic states characterized by lethargy, catalepsy, and somnambulism. Students and young doctors who read the description of these disorders in the books of the period get the impression that it is a matter of paleo pathology" (republished in (Euvresscientifiques, p. 500).
6 February 7974 333
? COURSE SUMMARY*
FOR A LONG TIME, medicine, psychiatry, penal justice, and criminology remained, and to a large extent remain still today, on the borders of a manifestation of truth in accordance with the norms of knowledge and of a production of truth in the form of the test, the latter always tending to hide behind and get its justification from the former. The current crisis of these "disciplines" does not merely call into question their limits or uncertainties within the field of knowledge, it calls into question knowledge itself, the form of knowledge, the "subject-object" norm; it puts in question the relationships between our society's economic and political structures and knowledge (not in its true or false contents, but in its power-knowledge functions). It is, then, a histonco-political crisis.
Take, first of all, the example of medicine, along with the space connected to it, the hospital. Even quite late the hospital was still an ambiguous place, both a place for finding a hidden truth through observation and a place of testing for a truth to be produced.
In the hospital there is a direct action on the disease: the hospital does not only enable disease to reveal its truth to the doctor's gaze, it produces that truth. The hospital is a birthplace of the true disease. It was assumed, in fact, that left at liberty--in his "milieu," his family and his social circle, with his regimen, habits, prejudices, and illusions--the sick person would be affected by a complex, confused, and tangled disease, a sort of unnatural disease that was both the mixture of several diseases and the obstacle preventing the true disease from appearing in its authentic nature. In removing that parasitic vegetation, those aberrant
* Published in the Annuaire du College de France, U annee. Histoire des syslemes de pensee, annee 1973-1974, (1974), pp. 293 300, and in Dits et ecrits, 1954-1988, vol. 2 (Paris: Gallimard, 1994), pp. 674 685. An earlier translation of this summary appears in M. Foucault, The Essential Works of Michel Foucault, 1954-1984, Vol. 1: Ethics: subjectivity and truth, ed. Paul Rabinow, trans. Robert Hurley and others (New York: New Press, 1997) pp. 39 50.
? 336 PSYCHIATRIC POWER
forms, the role of the hospital, therefore, was not only to make the disease visible just as it is, but also finally to produce it in its hitherto enclosed and fettered truth. Its distinctive nature, its essential characteristics, and its specific development would finally be able to become reality through the effect of hospitalization.
The eighteenth century hospital was supposed to create the conditions for the truth of the disease to manifest itself. It was therefore a place of observation and demonstration, but also of purification and testing. It was a sort of complex equipment for both revealing and really producing the disease: both a botanical site for the contemplation of species, and a still alchemical site for the elaboration of pathological substances.
This dual function continued to be taken on for a long time by the great hospital structures established in the nineteenth century. For a century (1760-1860), the theory and practice of hospitalization, and, in a general way, the conception of disease, were dominated by this ambiguity: as a reception structure for the disease, should the hospital be a space of knowledge or a place of testing?
Hence a series of problems pervaded the thought and practice of doctors. Here are a few:
1. Therapy consists in suppressing the illness, in reducing it to nonexistence; however, for therapy to be rational and grounded in truth, should it not allow the disease to develop? When should one intervene, and in what way? Should one intervene at all? Should one act so that the disease develops or so that it stops, so as to alleviate it or so as to lead it to its term?
2. There are diseases and modifications of diseases, pure and impure, simple and complex diseases. In the end, is there not just one disease, of which all the others are more or less distantly derived forms, or should we assume the exis- tence of irreducible categories? (The debate between Broussais and his oppo- nents concerning the notion of irritation. The problem of essential fevers. )
3. What is a normal disease? What is a disease that follows its course? Is it a disease that leads to death, or a disease that is cured spontaneously after completing its evolution? It was in these terms that Bichat wondered about the position of disease between life and death.
We know that Pasteur tan biology brought a prodigious simplification to all these problems. By determining the agent of the sickness and identifying it as a specific organism, it enabled the hospital to become a
? place of observation, diagnosis, and clinical and experimental identifica- tion, but also one of immediate intervention and counter-attack against the microbial invasion.
As for the testing function, we see that it may disappear. The place where the disease will be produced is the laboratory, in the test tube; however, the disease is not realized in a crisis there; its process is reduced to a magnified mechanism; it is reduced to a verifiable and con trollable phenomenon. For the disease, the hospital milieu no longer has to be the site that favors a decisive event; it simply makes possible a reduction, a transfer, a magnification, an observation; the test (epreuve) is transformed into proof (^preuve) within the technical structure of the laboratory and in the doctor's description.
It we wanted to produce an "ethno epistemology" of the medical personality, we would have to say that the Pasteunan revolution deprived him of his doubtless age-old role in the ritual production and testing of the disease. The disappearance of this role was no doubt dra matized by the fact that Pasteur did not merely show that the doctor did not have to be the producer of the disease "in its truth," but that, due to his ignorance of the truth, he had on thousands ot occasions made himseH the propagator and reproducer of disease: the hospital doctor going from bed to bed was one of the major agents of contagion. Pasteur inflicted a formidable narcissistic wound on doctors, for which they took a long time to forgive him: the hands that the doctor had to run over the patient's body, palpate it, and examine it, those hands that had to dis cover the disease, bring it to light and display it, Pasteur designated as carriers of disease. Until then, the role of the hospital space and of the doctor's knowledge was to produce the "critical" truth of the disease; and now the doctor's body and the crowded hospital appeared as the producers of the disease's reality.
Disinlection of the doctor and the hospital gave them a new inno- cence lrom which they have drawn new powers and a new status in men's imagination. But that is another story.
These few remarks may help us to understand the position ot the madman and the psychiatrist in the asylum space.
