Joseph Daquin (1732 1815)
was born in Chambery where he was appointed in 1788 to the Incurables where he encountered the conditions imposed on the insane.
was born in Chambery where he was appointed in 1788 to the Incurables where he encountered the conditions imposed on the insane.
Foucault-Psychiatric-Power-1973-74
E.
D.
Esquirol, Mental Maladies.
A Treatise on Insanity, trans.
E.
K.
Hunt (New York and London: Hafner, 1965) p.
74: "The insane man becomes timid and suspicious.
He fears
every one that he approaches; and his suspicions extend to those who were most dear to him. The conviction that every one is endeavouring to torment and slander him, to render him miserable, and to ruin him, in body and estate, puts the finishing stroke to this moral perversion. Hence that symptomatic suspicion, which olten grows up without motive. "
9. In 1849, Pierre Berthier (1830 1877) became intern under his uncle, Henri Girard de Cailleux, head doctor and director ol the Auxerre mental asylum. Alter the defense ol his thesis, "De la nature de l'alienation mentale d'apres ses causes el son traitement," at Montpellier in 1857, Berthier returned to Auxerre lor two years belore his appointment as head doctor at Bourg (Ain), before becoming resident doctor at Bicetre in 1865.
10. P. Berthier, Medecine mentale, vol. 1, Observation C, p. 25.
11. Ibid. Observation D, p. 25.
12. Ibid. Obscn'ation B: "M. G. , sullering lrom acute melancholy ( . . . ) arrives in the most unlortunate state (. . . ). After some months of treatment, and not without many ellorls, improvement arrives ( . . . ) . In spile ol the express prohibition of the doctor director, the patient sees his son; he breaks a glass window pane and throws himsell through the opening he has made, with the intention ol joining him. From that moment (. . . ) the hal lucinations reappear with greater intensity, sleep vanishes, the delirium increases; and the patient's situation constantly gets worse" pp. 24-25.
13. In Hisloirc de la folie, pp. 517 519, this principle was considered under the heading "Mirror Recognition"; Madness and Cwili^ation, pp. 262 265.
14. "In a ground floor building, at any moment and without a sound he can arrive close to the patients and servants. " J. E. D. Esquirol, Des elablissements consacres aux alienes en France, p. 36; reprinted in Des maladies mentales, vol. 2, p. 426.
15. P. Pinel, Traile medico-philosophique sur l'alienation mentale, on la Manic, section II, ? xxn: "Habilite dans l'art de diriger les alienes, en paraissant se preter a leurs idees imaginaires," pp. 9 3 9 4 ; A Treatise on Insanity, Section II, "The propriety of appearing to assent to the absurd propositions and fanciful ideas of maniacs" pp. 9 6 97. In lact, Pinel says: "Three insane persons, each ol whom believed himsell to be a king, and each ol whom took the title Louis XVI, quarreled one day over the prerogatives ol royalty, and defended them somewhat too energetically. The keeper approached one ol them, and drawing him aside, asked: 'Why do you argue with these men who are evidently mad? Doesn't everyone know that you should be recognized as Louis XVI? ' Flattered by this homage, the madman immediately with drew, glancing at the others with a disdainlul hauteur. The same trick succeeded with a second, and thus it was that in an instant t here remained no trace ol the dispute. " This pas sage is quoted, with a somewhat dillerent commentary, in Histoire de lajolie, pp. 517 518; Madness and Civilisation, pp. 262 263.
16. J. E. D. Esquirol, "De la folie" in Des maladies mentales, vol. 1, p. 124; Mental Maladies. A Treatise on Insanity, pp. 75 76. Evoking the "strongest objection that can be urged against
? establishments devoted to this kind of treatment," Esquirol counters that "the frightful effects that may result from mingling with companions in misfortune" are compensated for by a cohabitation that "does not injure them,--that it is not an obstacle to a cure--that it is a valuable means of treatment, because it obliges the insane to reflect upon their condition ( . . . ) to occupy their thoughts with what is going on around them,--to forget themselves, as it were, which is, in itself, a means ol cure. " Falret also claims that the asylum makes it possible "to prompt reflection on oneself through the contrast between everything around the patient and his only family circle. " J. P. Falret, "Du traitement general des alienes" (1854) <<n Des maladies mentales el des asiles d'alienes, p. 687.
17. Histoire de la folie evokes the "almost arithmetical obviousness of punishment" p. 521; Madness and Civilisation, p. 267.
18. The roots of the principle of no restraintare found in the reforms undertaken by the Englishmen W Tuke, J. Haslam, and E. Charlesworth, and the Irishman J. Conolly. Following the death at York asylum ol a woman belonging to the Quakers, William Tuke founded on 11 May 1796 an establishment lor the insane lor members of the Society of Friends: the Retreat. Samuel Hike (1784 1857), William's grandson, published Description of the Retreat, an Institution near York jor Insane Persons oj the Society of Friends (York: W Alexander, 1813). See, R. Semalaigne, Alienistes et Philanthropes: les Pinel et les Tuke (Paris: Steinheil, 1912); M. Foucault, Histoire de la folie, pp. 484 487, 492 496, 501-511, Madness and Civilisation, pp. 243 255 (pages 484 501 ol the French edition are omitted Irom the English translation); John Haslam, apothecary at the Bethlehem hospital in London, devoted a work to him: Considerations on the Moral Management of Insane Persons (see also above notes 6 and 13 to the lecture ol 7 November 1973); in 1820, Edward Charlesworth (1783 1853), consultant doctor at the Lincoln Asylum, attacked the coercive methods then much in evidence: Remarks on the Treatment oj the Insane and the Management of Lunatics Asylums (London: Rivington, l825);John Conolly (1794-1866), promoter of no restraint, applied it from 1 June 1839 after his arrival at the Middlesex asylum at Hanwell, near London. He set out his conceptions in, The Construction and GovernmentojLunatics Asylums and Hospitals for the Insane (London: J. Churchill, 1847), and in The Treatment oj the Insane without Mechanical Restraint (London: Smith and Elder, 1856). See also, H. Labatt, An Essay on Use and Abuse of Restraint in the Management of the Insane (London: Hodges and Smith, 1847).
19. Letter ol the Mother Superior of the asylum lor women at Lille to the Mother Superior of the nuns ol Saint Joseph ol Cluny who ministered to the asylum of Saint Yon (Lower Seine)--of which Benedict Augustin Morel (1807-1873) was the head doctor from 23 May 1856--in which she set out the way in she controlled agitated patients: "We set to work . . . taking an agitated woman so as to put her under the supervision of a nun who knew how to impress. " Quoted in B. A. Morel's report, Le Non-Restraint, ou De Vabolition des moyens coercitifs dans le traitement de lajolie (Paris: Masson, i 8 6 0 ) p. 77.
20. An armchair resting on bellows so that "at the slightest movement the insane person is bounced about in every direction, and the unpleasant sensation caused by this movement lorces him to be keep calm. " J. Guislain, Traite sur les phrenopathies, p. 414.
21. Iron handcuffs covered with leather arc recommended by Esquirol as one ol the "many means more gentle than chains," J. E. D. Esquirol, "Des Maisons d'alienes" in Des maladies mentales, vol. 2, p. 533. See also, J. Guislain, Traite sur Valienation mentale et sur les hospices des alienes, vol. 2, book 12, "Institutions for the insane. Means of repression," pp. 271 272.
22. The "strong muffs" are a piece of cloth holding the hands together in front of the body.
23. The straitjacket was invented in 1790 by Guilleret, an upholsterer of Bicetre, and consists of a shirt made of strong cloth or canvas, open at the back, with long sleeves crossing over in Iront and fastened at the back, immobilizing the arms. See, J. Guislain, Traite sur
I'alienation mentale, vol. 2, pp. 269-271; E. Rouhier, De la camisole ou gilet de force (Paris: Pillet, 1871); A. Voisin, "D l'utilite de la camisole de force et des moyens de contention dans
le traitement de la folie" (Communication to the Societe medico psychologiques, 26 July i860) Annales medico-psychologiques, 3rtl series, vol. 6, November i860, pp. 427431; V. Magnan, "Camisole," in Dictionnaire encyclopedique des sciences medicales (Paris: Masson/Asselin, 1880) 1st series, vol. 11, pp. 780 784. Foucault analyses the meaning of its use in Histoire de lafolie, p. 460 (omitted from the English translation).
5 December 1973 119
? 120 PSYCHIATRIC POWER
24. An instrument of restraint, the wicker casket is a cage, a man's length, in which the patient is laid out on a mattress. It has a lid and is cut oft at the neckline. See, J. Guislain, Traite sur Valienalion mentale, vol. 2, p. 263.
25. The strappado (I'estrapade) hoisted the guilty person, attached by a rope and tied hands and feet, to the top of a bracket, and then let him fall towards the ground several times. On the test of truth in judicial procedure, see Foucault's course at the College de France for 1971-1972, "Penal Theories and Institutions," sixth lecture, and Surveilkr et Punire, pp. 43 46, Discipline and Punish, pp. 39-42.
26. On the public torture and execution of Damien, see Surveilkr et Punir, pp. 9-11 and 36-72; DisciplineandPunish,pp. 3-6and32 69.
27- This is Doctor Gosseret, recounting his having discovered "patients of both sexes fixed to wall by iron chains," quoted by B. A. Morel, Le Non-Restraint, p. 14. Guillaume Ferrus also says that "in some places the unfortunates are fixed to the wall, to which they are attached in an upright position by means of a strap," quoted in R. Semelaigne, Les Pioniers de la psychiatriefrancaise avant et apres Pinel (Paris: Bailliere, 1930) vol. 1, pp. 153-154.
28. F. Leuret, Du traitement moral de lafolie, p. 178.
29. Ibid. p. 179.
30. J. Fournet, "Le traitement moral de Palienation" Annales medico-psychologiques, p. 524. See
also, J. Parigot, Therapeutique naturelle de lafolie. L'air libre et la vie defamille dans la commune de Gheel(Brussels: J. B. Tircher, 1852) p. 13: "We think that the sick man needs the sympa
thy that family life gives birth to right from the start. "
31. J. Fournet, "Le traitement moral de Palienation" pp. 526-527.
Joseph Daquin (1732 1815)
was born in Chambery where he was appointed in 1788 to the Incurables where he encountered the conditions imposed on the insane. See J. Daquin, La Philosophic de lajolie,
ou Essaiphilosophique sur le traitement des personnes altaquees defolie (Chambery: Gorin, 1791). A revised and expanded edition appeared in 1804 dedicated to Philippe Pinel: La Philosophic de lafolie, ou Von prouve que cclle maladic doit plutol etre traitee par les secours moraux que les secours physique (Chambery: Cleaz, 1804). See also, J. R. Nylleler, Joseph Daquin und seine "Philosophic de lajolie" (Zurich: Juris, 1961).
32. J. Fournet, "Le traitement moral de Palienation" p. 527. On Mettray, see above note 35 to the lecture of 28 November.
33. Charles Robert Darwin (1809-1882), On the Origins of the Species by means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life (London: J. Murray, 1859); French translation of the 6 l ' edition, De I'origine des especes au moyen de la selection naturell, ou la Lutte pour I'existence dans la nature, trans. E Barbier (Paris: Reinwald, 1876).
34. Jules Fournet (1811 1885), head of the clinic at the Hotel Dieu, author of, Doctrine organo-psychique de lafolie (Paris: Masson, 1867), and the discourse given at the Congres medico-psychologique in 1878, De I'hereditephysique ou morale (Paris: Imprimerie nationale, 1880).
35- Jean Pierre Casimir Pinel (1800 1866), nephew of Philippe Pinel, worked in 1829 at
76 rue de Chaillot, a clinic devoted to the treatment ol mental illnesses, before transferring
it in 1844 to Neuilly m 1844, in the old Saint-James folly. See his, Du traitement de Palienation mentale en general, et principalement par les bains tiedes prolonges et les arrosemenh continus d'eau
froide su la tete (Paris: J. B. Bailliere, 1853).
36. Alexandre Brierre de Boismont (1798 1881), after being employed in 1825 as doctor to the
Sainte-Colombe clinic, rue de Picpus, took over management of a clinic at 21 rue Neuvc Saint-Genevieve in 1838, which was transferred in 1859 to Saint Mande, where he died on
25 December 1881. See: "Maison de Sante du Docteur Brierre de Boismont, rue Neuve Sainte-Genevieve, no. 21, pres du Pantheon, Prospectus" Observations medico-legales sur la monomanie homicide (Pans: Mme. Auger Mequignon, 1826--taken from the Revue medicale, October and November 1826); and, Des hallucinations, ou Histoire raisonee des apparitions, des visions, des songes ( P a n s : J . B. Bailliere, 1845).
37. In 1821, Esprit Sylvestre Blanche (1796-1852) took over management of a clinic founded in 1806 in Montmartre by P. A. Prost, then rented, in 1846, the old town mansion ol Princess de Lamballe at Passy. He made himself known through his criticisms of Francois Leuret's application of moral treatment (see below, note 8 to the lecture of 19 December). See,
J. Le Breton, La Maison de sante du docteur Blanche, ses medecins, ses malades (Paris: Vigne, 1937);
? R. Vallery Radot, "La maison de sante du docteur Blanche" La Pres. se medicale,no. 10,
13 March 1943, pp. 131 132.
38. The lecture of 21 February 1973 of Foucault's College de France course "The punitive
society" was devoted to the organization of the world of delinquency. See also Surveillir et
Punir, pp. 254 260 and pp. 261 299; Discipline and Punish, pp. 252-256 and pp. 257-290.
39. In his clinic in the Saint Antoine suburb, which Doctor Pressat handed over to him
in 1847.
40. A. Brierre de Boismont, "De I'utilite de la vie de lamille dans le traitement de l'alienation
mentale" Annales medico-psychologiques, pp. 8-9.
5 December 1973 121
? SIX
12 DECEMBER 1973
Constitution of the child as target of psychiatric intervention. ^ A family-asylum Utopia: the Clermont-en-Oise asylum. ^ From psychiatry as "ambiguous master" of reality and truth in proto- psychiatric practices to psychiatry as "agent of intensification " of
reality. ^ Psychiatric power and discourse of truth. ^ The problem of simulation and the insurrection of the hysterics. ^ The question of the birth of psychoanalysis.
I WILL CONTINUE WITH last week's lecture for a while because last week I found a marvelous institution that I was vaguely aware of but did not realize how well it suited me. So I would like to say something about it because it seems to me to show very well this connection between asylum discipline and, let's say, the family model.
Contrary to a rather loose hypothesis, which I have myself maintained, that the asylum was constituted through the extension of the family model, I have tried to show you that the nineteenth century asylum functioned in fact on a model of micro power close to what we can call disciplinary power that functions in a way that is completely heterogeneous to the family. And then I tried to show that the insertion, the joining of the family model to the disciplinary system takes place relatively late in the nineteenth century--I think we can put it around the years i860 to 1880--and it was only then that the family could not
? 124 PSYCHIATRIC POWER
only become a model in the functioning of psychiatric discipline, but also, and especially, the horizon and object of psychiatric practice.
A time came, albeit late, when psychiatry really was concerned with the family. I have tried to show you that this occurred at the point of intersection of two processes which mutually supported each other: one was the constitution of what could be called the profits of abnormalities or irregularities, and the other was the internal disciplmanzation of the family. There is evidence for both of these processes.
On the one hand, of course, there is the growing extension through out the nineteenth century oi those profitable institutions whose aim is basically to make both abnormality and, at the same time, its correction, costly; let's say, roughly, clinics for children, adults, etcetera. On the other hand, there is the deployment of psychiatric techniques at the heart of the family, their use in family pedagogy. It seems to me that if we look at how this took place, at least in families which could yield a prolit from abnormality, that is to say bourgeois families, [by following] the evolution of the internal pedagogy of these families, we would see how the vigilant family eye, or, if you like, family sovereignty, gradually came to resemble the disciplinary form. The watchful family eye became a psychiatric gaze, or, at any rate, a psycho-pathological, a psychological gaze. Supervision of the child became supervision in the form oi decid ing on the normal and the abnormal; one began to keep an eye on the child's behavior, character, and sexuality, and it is here that we see the emergence of precisely all that psychologization ol the child within the family itself.
It seems to me that both the notions and apparatuses of psychiatric control were gradually imported into the family. With regard to the famous instruments of restraint found in asylums from around 1820 to 1830--binding hands, holding the head up, keeping in an upright position, etcetera--my impression is that, initially established as instru ments of and within asylum discipline, they gradually advance and take root in the family. The control of posture, of gestures, of the way to behave, the control of sexuality, with instruments for preventing masturbation, etcetera, all penetrate the family through a disciplmanzation which develops during the nineteenth century and the effect of which is that, through this disciplmanzation, the child's sexuality finally
? becomes an object of knowledge within the family itsell. And as a result of this the child will become the central target of psychiatric intervention. The child becomes the central target in two senses.
On the one hand, directly, since the institution of profit plugged into psychiatry will effectively ask the family to provide it with the material it needs in order to make its profit. Psychiatry says, more or less: "let your mad little children come to me," or, "you're never too young to be mad," or, "don't wait for the age of majority or adulthood to be mad. " And all of this is translated into the institutions of supervision, detection, training, and child therapy that you see developing at the end of the nineteenth century.
And then, in a second sense, childhood becomes the center, the target of psychiatric intervention indirectly, insofar as what one asks the mad adult about is, precisely, his childhood: let your childhood memories come, and through this you will be psychiatrized. This is more or less what I tried to set out last week.
All this brings me to this institution, which, around the 1860s, displays the asylum-family link up so well. I cannot say it is the first link up, but certainly its most perfect, best adjusted, almost Utopian form. I have found hardly any other examples, in France at least, which are so perlect as this establishment, which constitutes at this time, and early on therefore, a kind of family-asylum Utopia, the meeting point of family sovereignty and asylum discipline. This institution is the coupling ol the Clermont en Oise asylum with the Fitz-James clinic.
At the end ol the eighteenth century, in the neighborhood of Beuvais, there is a small house of confinement, in the classic sense of the term. It is run by Cordelier monks who, in return for an allowance, accept twenty residents either at the request of families or on the basis of lettres de cachet. The house is opened in 1790 and all its fine society is freed. However, obviously, some families are burdened with these dissolute, disorderly, mad people, and so they are then sent to someone at Clermont en Oise who has opened a kind of boarding house. At this time, just as Parisian restaurants were opening up on what was left of the great aristocratic houses broken up as a result of the Emigration, so, in the same way, many ol these boarding houses arose on the ruins of houses of confinement that had been thrown open. So there is a boarding house at Clermont-en-Oise
12 December 1973 125
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in which, under the Revolution, during the Empire, and even at the beginning of the Restoration, there were twenty residents. Then, when the great institutionahzation of psychiatric practice takes place, this boarding house becomes increasingly important and the prefectural administration ol the Oise department and the founder of the boarding house come to an arrangement whereby the department's destitute insane will be sent to the Clermont boarding house m return for a payment by the department. What's more, the agreement is extended to the departments of Seine-et Oise, Seine et Marne, Somme, and l'Aisne, and in 1850 a total of five departments send more than a thousand people to this boarding house, which then simply resembles a multi departmental asylum. 1
At this point the asylum splits, or rather, puts out a sort of pseudopodium, in the form of what is called the "colony. "2 This "colony" is made up of a number ol the asylum's residents with the ability to
[work]. * On the pretext that they can be useful and, at the same time, that work is useful for their cure anyway, they are subjected to a very strict regime of agricultural work.
A second pseudopodium, linked to the farm, is established ior wealthy residents who do not come Irom the Clermont asylum, but who were sent directly by their lamihes and who pay a very high price for a completely different kind of boarding based on a different, lamily model. 5
In this way we have an institution with three levels: the Clermont asy lum with its thousand patients; the iarm with 100 150 men and women who are required to work;^ and then a boarding house for paying residents, who are lurther separated, the men living in the management quarters with the director of the institution himself, and the wealthy women liv ing in a dillerent building with the typical name of "petit chateau" where the general iorm of their existence follows the iamily model. 5 This was established in the decade 1850 to i860. In 1861,the director publishes a
balance sheet, which is at the same time a sort of prospectus, which is therefore highly eulogistic and slightly Utopian, but which gives an exact picture of the meticulous and subtle way the system operates.
In this kind ol establishment--the Clermont asylum, the farm, and the Fitz James petit chateau--there are a number of levels. On the one
* (Recording:) arc able to work
? hand, you have an easily identifiable economic circuit: first, a departmental grant for poor patients allocated by the general council according to their numbers; second, withdrawal from the poor patients ol the number of people necessary and sufficient for running a farm; and hnally, the creation and maintenance of a petit chateau with the profit Irom the farm, taking in a number of paying residents, their payment constituting the profit for those in charge of the general system. So, you have the system: community subsidy-work exploitation profit.
Second, you can see that there is a sort of perfect social microcosm, a sort of little Utopia of general social functioning. The asylum is the reserve army of the farm proletariat; it is all those who, potentially, could work, and who, if they cannot work, wait for the moment when they can, and, if they do not have the ability to work, remain in the asy lum vegetating. Then there is the place of productive work, which is represented by the farm. Then you have the institution in which those who benefit from the work and the profit are found. And to each of these levels corresponds a specific architecture: that of the asylum; that ol the larm, which in reality is a model practically bordering on slavery and colonization; and then the petit chateau with the management quarters.
You also have two types of power, the first of which is split. You have the traditional disciplinary power of the asylum, which is negative in a way, since its function is to keep people calm without getting anything positive from them. Then you have a second disciplinary type of power, but slightly modified, which is, roughly, the power of colonization: putting people to work, with the insane divided into squads and brigades, etcetera, under the authority and supervision of those who regularly put them to work. And then there is power on the family model for residents ol the petit chateau.
In short, you have three types of psychiatric intervention or manipu lation, corresponding to these three levels. One is, if you like, the degree zero of psychiatric intervention, that is to say, pure and simple penning within the asylum. Second, there is the psychiatric practice of putting patients to work on the pretext of curing them: ergotherapy. And then, third, for paying residents, you have individual, individualizing psychiatric practice on the family model.
12 December 7973 127
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In the middle of all this, the most important and typical element is undoubtedly the way in which psychiatric knowledge and treatment are connected to the practice of putting those residents to work who are capable of working. Actually, very strangely, it is clear that the psychiatric categories developed by the psychiatry of the time, since Esquirol--and which I will try to show got absolutely no hold on therapy itself--are not in fact employed here at all as a classification of the curability of different people and the form of treatment that should be applied to them. Nosological classification is not linked to any therapeutic pre- scription but serves instead solely to define the possible utilization of individuals for the work they are offered.
Thus the directors of the Clermont asylum and the Fitz-James farm realized that if a patient was maniacal, monomaniacal, or demented, they were good for work in the fields and workshops looking after and manag- ing animals and plowing tools. 6 On the other hand, "imbeciles and idiots are responsible for cleaning the courtyards and stables and all the transport necessary for the service. "7 The use of women according to their sympto- matology is much more discriminating. Thus "those in the washhouse and laundry are almost always affected by a noisy delirium and would not be able to abide by the peace and quiet of workshop life. "8 In the washhouse and laundry, therefore, one can rave at the top of one's voice, talk loudly, and shout. Second, "those occupied with hanging out the washing are melancholies m whom this kind of work can restore the vital activity they so often lack. The imbeciles and idiots are responsible for taking laundry from the washhouse to the drying room. The workshops for sorting and folding the laundry are the remit of calm patients, monomaniacs, whose fixed ideas or hallucinations make possible a fairly sustained attention. "9
I have cited this establishment because it seemed to me to represent, around the 1860s, both the first form and most perfect realization of this family-discipline adjustment, and, at the same time, of the deployment of psychiatric knowledge as discipline.
*
This example leads us, moreover, to the problem that I would now like to consider, which is this: How and to what extent can one attribute a
? lherapeutic effect to this disciplinary, not yet familialized space, to this disciplinary system that we see being constituted between 1820 and 1830 and which will constitute the broad basis for the asylum institution? For, after all, it should not be forgotten that even if this disciplinary sys- tem is in many respects isomorphic with other disciplinary systems, like the school, the barracks, the workshop, and suchlike, it puts itself for- ward and justifies itself by its therapeutic function. What is it in this disciplinary space that is supposed to cure? What medical practice inhabits this space? This is the problem I would like to begin to address
today.
To do this I would like to start with a type of example about which
I have already spoken, which is what we can call the classical cure, mean- ing by classical the cure still current in the seventeenth and eighteenth centuries, and even at the beginning of the nineteenth century. I have given you a number of examples of this. There is the case of Pmel's patient who thought he was being pursued by revolutionaries, was waiting to be brought before the courts, and was consequently threatened with the death penalty. Pinel cured him by organizing a pseudo-trial around him, with pseudo-judges, in the course of which he was acquitted-- thanks to which he was cured. 10
In the same way, someone like Mason Cox, at the beginning of the nineteenth century gives the following example of a cure. It involves a man of forty years, who "had injured his health by too close attention to extensive mercantile concerns. "11 This passion for commerce had put into his head the idea that "his body was universally diseased. "12 And the main one of these, the one by which he felt most threatened, was what was called at the time "repelled itch," that is to say, an irruption of scabies which had not reached its term, which had spread throughout the organism, and manifested itself in a number of symptoms. The classical technique for curing it was to bring out this famous scabies and treat it as such.
For some time attempts were made to get the patient to understand that he did not have any of the illnesses in question: "no arguments could divert him . . . a formal consultation of medical men was therefore determined on, who, having previously agreed on the propriety of humouring the patient, professed to be unanimously of the opinion that
12 December 7973 129
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his apprehension was just, a medical plan was laid down, some rebefacient application to different parts of the body occasioned crops of eruptions from time to time which were washed with some simple preparation. This farce continued a few weeks, and the patient at length was perfectly restored to health and reason. "13 His delirium had been satisfied, as it were.
What do these procedures of Pine! and Mason Cox presuppose and what do they bring into play? They presuppose--this is well known, I will not return to it--that the kernel of madness is a lalse belief, an illusion or an error. They also presuppose--which is already a bit different--that for the illness to disappear it is enough to dispel the error. The procedure of cure is therefore the reduction of the error; except the mad person's error is not just anyone's error.
The difference between the error of someone who is mad and some one who is not mad is not so much in the extravagance of the idea itself, because, after all, it is not very extravagant to believe one has "repelled itch. " And moreover, as Leuret will say later in his Fragments psychologiques sur lafolie, between Descartes who believed in vortices and a patient at Salpetriere who imagined that a council was being held in his lower abdomen/1 the extravagance is not especially on the patient's side. What makes a mad person's error the error of someone who is, precisely, mad? It is not then so much the extravagance, the final effect of the error, as the way in which the error can be overcome, dispelled. The mad person is someone whose error cannot be dispelled by a demonstration; he is someone for whom demonstration does not produce the truth. Consequently, one will have to find a different method of dispelling the error--since madness really is, in fact, the error--without using demonstration.
This means that, instead of attacking the erroneous judgment and showing that it has no correlation with reality, which is roughly the process of demonstration, one will let the lalse judgment be taken as true while transforming reality so that it is adapted to the mad, erroneous judgment. Now, when an erroneous judgment thus finds that it has a correlate in reality, which verifies it, from then on, the mental content coinciding with something in reality, there is no longer error and so no more madness.
? So it is not by treating the false judgment, by trying to correct it or dismiss it by demonstration, but rather by dressing up and manipulating reality that reality is placed on the same level, as it were, as the delirium. When the ialse judgment of the delirium is iound to have a real content in reality, it will as a result become a true judgment and the madness will cease being madness, since the error will have ceased being error. So one makes reality delirious so that the delirium is no longer delirium; one puts the delirium in the right so that it is no longer deceived. It is a matter, in short, of introducing reality into the delirium behind the mask of delirious figures, so that the delirium is satisfied by reality; through a game of transformations, of masks, one surreptitiously intro duces a reality beneath all the false propositions ol the delirium, or beneath the main false propositions of delirium, and in this way the delirium is verified. *
You see that this practice of the cure is, in a sense, absolutely homoge- neous with the classical conception of judgment and error; we are in line with, say, the Port Royal conception of the proposition and judgment. b However, you see that there is a difference between the teacher or demon strator, the person who possesses the truth, and the psychiatrist. Whereas the master of truth, the teacher or scientist, manipulates judgment, the proposition, and thought, the doctor will manipulate reality in such a way that the error becomes true. In this kind of process the doctor is the inter mediary, the ambivalent person who [on the one hand] looks from the
side of reality and manipulates it, and, on the other, looks from the side of truth and error and arranges it that the (orm of reality comes up to the level of the error in order to transform it thereby into truth.
He manipulates reality by making it wear a mask; he makes this reality a little less real, or at any rate he deposits a film of unreality on it; he puts it between the brackets of the theater, of the "as if," of the pseudo-, and by making reality unreal in this way he carries out the transforma- tion of error into truth. Consequently he is the agent of reality--and in this he is not like the scientist or the teacher; he is however someone
A The manuscript clarilies: "Since it is as a comic, theatrical reality, as a pseudo reality that it is introduced into the delirium, and by according a second effectiveness to reality, since for the delirium to lail it is enough that the Ialse judgment become true through the masking ol reality. "
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who makes reality unreal in order to act on the erroneous judgment maintained by the patient. 16
I think we can say that the psychiatrist, as he will function in the space of asylum discipline, will no longer be the individual who consid- ers what the mad person says from the standpoint of truth, but will switch resolutely, definitively, to the standpoint of reality* He will no longer be the ambiguous master of reality and truth that he was still with Pinel and Mason Cox; he will be the master of reality. He will no longer have anything to do with somehow smuggling reality into the delirium; it is no longer a question of the psychiatrist being a smuggler ot reality as Pinel and Mason Cox were. The psychiatrist is someone who must give reality that constraining force by which it will be able to take over the madness, completely penetrate it, and make it disappear as madness. The psychiatrist is someone who--and this is what defines his task--must ensure that reality has the supplement of power necessary for it to impose itself on madness and, conversely, he is someone who must remove from madness its power to avoid reality.
From the nineteenth century, the psychiatrist is then a factor of the intensification of reality, and he is the agent of a surplus power of real- ity, whereas, in the classical period he was, in a way, the agent of a power of the 'derealization' of reality. You will say that if it is true that the nineteenth century psychiatrist crosses over completely to the side of reality, and if he becomes for madness the agent of the intensification of the power of reality, thanks precisely to the disciplinary power he gives himself, it is not true however that he does not pose the question of truth. I will say that, of course, the problem of truth is posed in nine- teenth century psychiatry, despite the nevertheless quite considerable negligence it manifests with regard to the theoretical elaboration of its practice. Psychiatry does not avoid the question of truth, but, instead of placing the question of the truth of madness at the very heart of the cure, at the heart of its relationship with the mad person, which was still the case for Pinel and Mason Cox, instead of bringing the problem of truth out into the open in the confrontation between doctor and
* The manuscript adds: "In asylum psychiatry, the psychiatrist plays the role oi master of reality in a completely different way. "
? patient, psychiatric power only poses the question of truth within itself. It gives itself the truth right from the start and once and for all by constituting itself as a medical and clinical science. This means that rather than the problem of the truth being at stake in the cure, it is resolved once and for all by psychiatric practice as soon as this practice assumes the status of a medical practice founded as the application of a psychiatric science.
So that if one had to define this power that I would like to talk to you about this year, I would suggest, provisionally, the following: Psychiatric power is that supplement of power by which the real is imposed on mad- ness in the name of a truth possessed once and for all by this power in the name of medical science, of psychiatry. On the basis of this definition, which I put forward in this provisional form, I think we can understand some general features of the history of psychiatry in the nineteenth century.
First there is the very strange relationship--I was going to say the absence of relationship--between psychiatric practice and, say, dis- courses of truth. On the one hand, it is true that with the psychiatrists of the beginning of the nineteenth century psychiatry very quickly shows great concern to constitute itself as a scientific discourse. But to what scientific discourses does psychiatric practice give rise? It gives rise to two types of discourse.
every one that he approaches; and his suspicions extend to those who were most dear to him. The conviction that every one is endeavouring to torment and slander him, to render him miserable, and to ruin him, in body and estate, puts the finishing stroke to this moral perversion. Hence that symptomatic suspicion, which olten grows up without motive. "
9. In 1849, Pierre Berthier (1830 1877) became intern under his uncle, Henri Girard de Cailleux, head doctor and director ol the Auxerre mental asylum. Alter the defense ol his thesis, "De la nature de l'alienation mentale d'apres ses causes el son traitement," at Montpellier in 1857, Berthier returned to Auxerre lor two years belore his appointment as head doctor at Bourg (Ain), before becoming resident doctor at Bicetre in 1865.
10. P. Berthier, Medecine mentale, vol. 1, Observation C, p. 25.
11. Ibid. Observation D, p. 25.
12. Ibid. Obscn'ation B: "M. G. , sullering lrom acute melancholy ( . . . ) arrives in the most unlortunate state (. . . ). After some months of treatment, and not without many ellorls, improvement arrives ( . . . ) . In spile ol the express prohibition of the doctor director, the patient sees his son; he breaks a glass window pane and throws himsell through the opening he has made, with the intention ol joining him. From that moment (. . . ) the hal lucinations reappear with greater intensity, sleep vanishes, the delirium increases; and the patient's situation constantly gets worse" pp. 24-25.
13. In Hisloirc de la folie, pp. 517 519, this principle was considered under the heading "Mirror Recognition"; Madness and Cwili^ation, pp. 262 265.
14. "In a ground floor building, at any moment and without a sound he can arrive close to the patients and servants. " J. E. D. Esquirol, Des elablissements consacres aux alienes en France, p. 36; reprinted in Des maladies mentales, vol. 2, p. 426.
15. P. Pinel, Traile medico-philosophique sur l'alienation mentale, on la Manic, section II, ? xxn: "Habilite dans l'art de diriger les alienes, en paraissant se preter a leurs idees imaginaires," pp. 9 3 9 4 ; A Treatise on Insanity, Section II, "The propriety of appearing to assent to the absurd propositions and fanciful ideas of maniacs" pp. 9 6 97. In lact, Pinel says: "Three insane persons, each ol whom believed himsell to be a king, and each ol whom took the title Louis XVI, quarreled one day over the prerogatives ol royalty, and defended them somewhat too energetically. The keeper approached one ol them, and drawing him aside, asked: 'Why do you argue with these men who are evidently mad? Doesn't everyone know that you should be recognized as Louis XVI? ' Flattered by this homage, the madman immediately with drew, glancing at the others with a disdainlul hauteur. The same trick succeeded with a second, and thus it was that in an instant t here remained no trace ol the dispute. " This pas sage is quoted, with a somewhat dillerent commentary, in Histoire de lajolie, pp. 517 518; Madness and Civilisation, pp. 262 263.
16. J. E. D. Esquirol, "De la folie" in Des maladies mentales, vol. 1, p. 124; Mental Maladies. A Treatise on Insanity, pp. 75 76. Evoking the "strongest objection that can be urged against
? establishments devoted to this kind of treatment," Esquirol counters that "the frightful effects that may result from mingling with companions in misfortune" are compensated for by a cohabitation that "does not injure them,--that it is not an obstacle to a cure--that it is a valuable means of treatment, because it obliges the insane to reflect upon their condition ( . . . ) to occupy their thoughts with what is going on around them,--to forget themselves, as it were, which is, in itself, a means ol cure. " Falret also claims that the asylum makes it possible "to prompt reflection on oneself through the contrast between everything around the patient and his only family circle. " J. P. Falret, "Du traitement general des alienes" (1854) <<n Des maladies mentales el des asiles d'alienes, p. 687.
17. Histoire de la folie evokes the "almost arithmetical obviousness of punishment" p. 521; Madness and Civilisation, p. 267.
18. The roots of the principle of no restraintare found in the reforms undertaken by the Englishmen W Tuke, J. Haslam, and E. Charlesworth, and the Irishman J. Conolly. Following the death at York asylum ol a woman belonging to the Quakers, William Tuke founded on 11 May 1796 an establishment lor the insane lor members of the Society of Friends: the Retreat. Samuel Hike (1784 1857), William's grandson, published Description of the Retreat, an Institution near York jor Insane Persons oj the Society of Friends (York: W Alexander, 1813). See, R. Semalaigne, Alienistes et Philanthropes: les Pinel et les Tuke (Paris: Steinheil, 1912); M. Foucault, Histoire de la folie, pp. 484 487, 492 496, 501-511, Madness and Civilisation, pp. 243 255 (pages 484 501 ol the French edition are omitted Irom the English translation); John Haslam, apothecary at the Bethlehem hospital in London, devoted a work to him: Considerations on the Moral Management of Insane Persons (see also above notes 6 and 13 to the lecture ol 7 November 1973); in 1820, Edward Charlesworth (1783 1853), consultant doctor at the Lincoln Asylum, attacked the coercive methods then much in evidence: Remarks on the Treatment oj the Insane and the Management of Lunatics Asylums (London: Rivington, l825);John Conolly (1794-1866), promoter of no restraint, applied it from 1 June 1839 after his arrival at the Middlesex asylum at Hanwell, near London. He set out his conceptions in, The Construction and GovernmentojLunatics Asylums and Hospitals for the Insane (London: J. Churchill, 1847), and in The Treatment oj the Insane without Mechanical Restraint (London: Smith and Elder, 1856). See also, H. Labatt, An Essay on Use and Abuse of Restraint in the Management of the Insane (London: Hodges and Smith, 1847).
19. Letter ol the Mother Superior of the asylum lor women at Lille to the Mother Superior of the nuns ol Saint Joseph ol Cluny who ministered to the asylum of Saint Yon (Lower Seine)--of which Benedict Augustin Morel (1807-1873) was the head doctor from 23 May 1856--in which she set out the way in she controlled agitated patients: "We set to work . . . taking an agitated woman so as to put her under the supervision of a nun who knew how to impress. " Quoted in B. A. Morel's report, Le Non-Restraint, ou De Vabolition des moyens coercitifs dans le traitement de lajolie (Paris: Masson, i 8 6 0 ) p. 77.
20. An armchair resting on bellows so that "at the slightest movement the insane person is bounced about in every direction, and the unpleasant sensation caused by this movement lorces him to be keep calm. " J. Guislain, Traite sur les phrenopathies, p. 414.
21. Iron handcuffs covered with leather arc recommended by Esquirol as one ol the "many means more gentle than chains," J. E. D. Esquirol, "Des Maisons d'alienes" in Des maladies mentales, vol. 2, p. 533. See also, J. Guislain, Traite sur Valienation mentale et sur les hospices des alienes, vol. 2, book 12, "Institutions for the insane. Means of repression," pp. 271 272.
22. The "strong muffs" are a piece of cloth holding the hands together in front of the body.
23. The straitjacket was invented in 1790 by Guilleret, an upholsterer of Bicetre, and consists of a shirt made of strong cloth or canvas, open at the back, with long sleeves crossing over in Iront and fastened at the back, immobilizing the arms. See, J. Guislain, Traite sur
I'alienation mentale, vol. 2, pp. 269-271; E. Rouhier, De la camisole ou gilet de force (Paris: Pillet, 1871); A. Voisin, "D l'utilite de la camisole de force et des moyens de contention dans
le traitement de la folie" (Communication to the Societe medico psychologiques, 26 July i860) Annales medico-psychologiques, 3rtl series, vol. 6, November i860, pp. 427431; V. Magnan, "Camisole," in Dictionnaire encyclopedique des sciences medicales (Paris: Masson/Asselin, 1880) 1st series, vol. 11, pp. 780 784. Foucault analyses the meaning of its use in Histoire de lafolie, p. 460 (omitted from the English translation).
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24. An instrument of restraint, the wicker casket is a cage, a man's length, in which the patient is laid out on a mattress. It has a lid and is cut oft at the neckline. See, J. Guislain, Traite sur Valienalion mentale, vol. 2, p. 263.
25. The strappado (I'estrapade) hoisted the guilty person, attached by a rope and tied hands and feet, to the top of a bracket, and then let him fall towards the ground several times. On the test of truth in judicial procedure, see Foucault's course at the College de France for 1971-1972, "Penal Theories and Institutions," sixth lecture, and Surveilkr et Punire, pp. 43 46, Discipline and Punish, pp. 39-42.
26. On the public torture and execution of Damien, see Surveilkr et Punir, pp. 9-11 and 36-72; DisciplineandPunish,pp. 3-6and32 69.
27- This is Doctor Gosseret, recounting his having discovered "patients of both sexes fixed to wall by iron chains," quoted by B. A. Morel, Le Non-Restraint, p. 14. Guillaume Ferrus also says that "in some places the unfortunates are fixed to the wall, to which they are attached in an upright position by means of a strap," quoted in R. Semelaigne, Les Pioniers de la psychiatriefrancaise avant et apres Pinel (Paris: Bailliere, 1930) vol. 1, pp. 153-154.
28. F. Leuret, Du traitement moral de lafolie, p. 178.
29. Ibid. p. 179.
30. J. Fournet, "Le traitement moral de Palienation" Annales medico-psychologiques, p. 524. See
also, J. Parigot, Therapeutique naturelle de lafolie. L'air libre et la vie defamille dans la commune de Gheel(Brussels: J. B. Tircher, 1852) p. 13: "We think that the sick man needs the sympa
thy that family life gives birth to right from the start. "
31. J. Fournet, "Le traitement moral de Palienation" pp. 526-527.
Joseph Daquin (1732 1815)
was born in Chambery where he was appointed in 1788 to the Incurables where he encountered the conditions imposed on the insane. See J. Daquin, La Philosophic de lajolie,
ou Essaiphilosophique sur le traitement des personnes altaquees defolie (Chambery: Gorin, 1791). A revised and expanded edition appeared in 1804 dedicated to Philippe Pinel: La Philosophic de lafolie, ou Von prouve que cclle maladic doit plutol etre traitee par les secours moraux que les secours physique (Chambery: Cleaz, 1804). See also, J. R. Nylleler, Joseph Daquin und seine "Philosophic de lajolie" (Zurich: Juris, 1961).
32. J. Fournet, "Le traitement moral de Palienation" p. 527. On Mettray, see above note 35 to the lecture of 28 November.
33. Charles Robert Darwin (1809-1882), On the Origins of the Species by means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life (London: J. Murray, 1859); French translation of the 6 l ' edition, De I'origine des especes au moyen de la selection naturell, ou la Lutte pour I'existence dans la nature, trans. E Barbier (Paris: Reinwald, 1876).
34. Jules Fournet (1811 1885), head of the clinic at the Hotel Dieu, author of, Doctrine organo-psychique de lafolie (Paris: Masson, 1867), and the discourse given at the Congres medico-psychologique in 1878, De I'hereditephysique ou morale (Paris: Imprimerie nationale, 1880).
35- Jean Pierre Casimir Pinel (1800 1866), nephew of Philippe Pinel, worked in 1829 at
76 rue de Chaillot, a clinic devoted to the treatment ol mental illnesses, before transferring
it in 1844 to Neuilly m 1844, in the old Saint-James folly. See his, Du traitement de Palienation mentale en general, et principalement par les bains tiedes prolonges et les arrosemenh continus d'eau
froide su la tete (Paris: J. B. Bailliere, 1853).
36. Alexandre Brierre de Boismont (1798 1881), after being employed in 1825 as doctor to the
Sainte-Colombe clinic, rue de Picpus, took over management of a clinic at 21 rue Neuvc Saint-Genevieve in 1838, which was transferred in 1859 to Saint Mande, where he died on
25 December 1881. See: "Maison de Sante du Docteur Brierre de Boismont, rue Neuve Sainte-Genevieve, no. 21, pres du Pantheon, Prospectus" Observations medico-legales sur la monomanie homicide (Pans: Mme. Auger Mequignon, 1826--taken from the Revue medicale, October and November 1826); and, Des hallucinations, ou Histoire raisonee des apparitions, des visions, des songes ( P a n s : J . B. Bailliere, 1845).
37. In 1821, Esprit Sylvestre Blanche (1796-1852) took over management of a clinic founded in 1806 in Montmartre by P. A. Prost, then rented, in 1846, the old town mansion ol Princess de Lamballe at Passy. He made himself known through his criticisms of Francois Leuret's application of moral treatment (see below, note 8 to the lecture of 19 December). See,
J. Le Breton, La Maison de sante du docteur Blanche, ses medecins, ses malades (Paris: Vigne, 1937);
? R. Vallery Radot, "La maison de sante du docteur Blanche" La Pres. se medicale,no. 10,
13 March 1943, pp. 131 132.
38. The lecture of 21 February 1973 of Foucault's College de France course "The punitive
society" was devoted to the organization of the world of delinquency. See also Surveillir et
Punir, pp. 254 260 and pp. 261 299; Discipline and Punish, pp. 252-256 and pp. 257-290.
39. In his clinic in the Saint Antoine suburb, which Doctor Pressat handed over to him
in 1847.
40. A. Brierre de Boismont, "De I'utilite de la vie de lamille dans le traitement de l'alienation
mentale" Annales medico-psychologiques, pp. 8-9.
5 December 1973 121
? SIX
12 DECEMBER 1973
Constitution of the child as target of psychiatric intervention. ^ A family-asylum Utopia: the Clermont-en-Oise asylum. ^ From psychiatry as "ambiguous master" of reality and truth in proto- psychiatric practices to psychiatry as "agent of intensification " of
reality. ^ Psychiatric power and discourse of truth. ^ The problem of simulation and the insurrection of the hysterics. ^ The question of the birth of psychoanalysis.
I WILL CONTINUE WITH last week's lecture for a while because last week I found a marvelous institution that I was vaguely aware of but did not realize how well it suited me. So I would like to say something about it because it seems to me to show very well this connection between asylum discipline and, let's say, the family model.
Contrary to a rather loose hypothesis, which I have myself maintained, that the asylum was constituted through the extension of the family model, I have tried to show you that the nineteenth century asylum functioned in fact on a model of micro power close to what we can call disciplinary power that functions in a way that is completely heterogeneous to the family. And then I tried to show that the insertion, the joining of the family model to the disciplinary system takes place relatively late in the nineteenth century--I think we can put it around the years i860 to 1880--and it was only then that the family could not
? 124 PSYCHIATRIC POWER
only become a model in the functioning of psychiatric discipline, but also, and especially, the horizon and object of psychiatric practice.
A time came, albeit late, when psychiatry really was concerned with the family. I have tried to show you that this occurred at the point of intersection of two processes which mutually supported each other: one was the constitution of what could be called the profits of abnormalities or irregularities, and the other was the internal disciplmanzation of the family. There is evidence for both of these processes.
On the one hand, of course, there is the growing extension through out the nineteenth century oi those profitable institutions whose aim is basically to make both abnormality and, at the same time, its correction, costly; let's say, roughly, clinics for children, adults, etcetera. On the other hand, there is the deployment of psychiatric techniques at the heart of the family, their use in family pedagogy. It seems to me that if we look at how this took place, at least in families which could yield a prolit from abnormality, that is to say bourgeois families, [by following] the evolution of the internal pedagogy of these families, we would see how the vigilant family eye, or, if you like, family sovereignty, gradually came to resemble the disciplinary form. The watchful family eye became a psychiatric gaze, or, at any rate, a psycho-pathological, a psychological gaze. Supervision of the child became supervision in the form oi decid ing on the normal and the abnormal; one began to keep an eye on the child's behavior, character, and sexuality, and it is here that we see the emergence of precisely all that psychologization ol the child within the family itself.
It seems to me that both the notions and apparatuses of psychiatric control were gradually imported into the family. With regard to the famous instruments of restraint found in asylums from around 1820 to 1830--binding hands, holding the head up, keeping in an upright position, etcetera--my impression is that, initially established as instru ments of and within asylum discipline, they gradually advance and take root in the family. The control of posture, of gestures, of the way to behave, the control of sexuality, with instruments for preventing masturbation, etcetera, all penetrate the family through a disciplmanzation which develops during the nineteenth century and the effect of which is that, through this disciplmanzation, the child's sexuality finally
? becomes an object of knowledge within the family itsell. And as a result of this the child will become the central target of psychiatric intervention. The child becomes the central target in two senses.
On the one hand, directly, since the institution of profit plugged into psychiatry will effectively ask the family to provide it with the material it needs in order to make its profit. Psychiatry says, more or less: "let your mad little children come to me," or, "you're never too young to be mad," or, "don't wait for the age of majority or adulthood to be mad. " And all of this is translated into the institutions of supervision, detection, training, and child therapy that you see developing at the end of the nineteenth century.
And then, in a second sense, childhood becomes the center, the target of psychiatric intervention indirectly, insofar as what one asks the mad adult about is, precisely, his childhood: let your childhood memories come, and through this you will be psychiatrized. This is more or less what I tried to set out last week.
All this brings me to this institution, which, around the 1860s, displays the asylum-family link up so well. I cannot say it is the first link up, but certainly its most perfect, best adjusted, almost Utopian form. I have found hardly any other examples, in France at least, which are so perlect as this establishment, which constitutes at this time, and early on therefore, a kind of family-asylum Utopia, the meeting point of family sovereignty and asylum discipline. This institution is the coupling ol the Clermont en Oise asylum with the Fitz-James clinic.
At the end ol the eighteenth century, in the neighborhood of Beuvais, there is a small house of confinement, in the classic sense of the term. It is run by Cordelier monks who, in return for an allowance, accept twenty residents either at the request of families or on the basis of lettres de cachet. The house is opened in 1790 and all its fine society is freed. However, obviously, some families are burdened with these dissolute, disorderly, mad people, and so they are then sent to someone at Clermont en Oise who has opened a kind of boarding house. At this time, just as Parisian restaurants were opening up on what was left of the great aristocratic houses broken up as a result of the Emigration, so, in the same way, many ol these boarding houses arose on the ruins of houses of confinement that had been thrown open. So there is a boarding house at Clermont-en-Oise
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in which, under the Revolution, during the Empire, and even at the beginning of the Restoration, there were twenty residents. Then, when the great institutionahzation of psychiatric practice takes place, this boarding house becomes increasingly important and the prefectural administration ol the Oise department and the founder of the boarding house come to an arrangement whereby the department's destitute insane will be sent to the Clermont boarding house m return for a payment by the department. What's more, the agreement is extended to the departments of Seine-et Oise, Seine et Marne, Somme, and l'Aisne, and in 1850 a total of five departments send more than a thousand people to this boarding house, which then simply resembles a multi departmental asylum. 1
At this point the asylum splits, or rather, puts out a sort of pseudopodium, in the form of what is called the "colony. "2 This "colony" is made up of a number ol the asylum's residents with the ability to
[work]. * On the pretext that they can be useful and, at the same time, that work is useful for their cure anyway, they are subjected to a very strict regime of agricultural work.
A second pseudopodium, linked to the farm, is established ior wealthy residents who do not come Irom the Clermont asylum, but who were sent directly by their lamihes and who pay a very high price for a completely different kind of boarding based on a different, lamily model. 5
In this way we have an institution with three levels: the Clermont asy lum with its thousand patients; the iarm with 100 150 men and women who are required to work;^ and then a boarding house for paying residents, who are lurther separated, the men living in the management quarters with the director of the institution himself, and the wealthy women liv ing in a dillerent building with the typical name of "petit chateau" where the general iorm of their existence follows the iamily model. 5 This was established in the decade 1850 to i860. In 1861,the director publishes a
balance sheet, which is at the same time a sort of prospectus, which is therefore highly eulogistic and slightly Utopian, but which gives an exact picture of the meticulous and subtle way the system operates.
In this kind ol establishment--the Clermont asylum, the farm, and the Fitz James petit chateau--there are a number of levels. On the one
* (Recording:) arc able to work
? hand, you have an easily identifiable economic circuit: first, a departmental grant for poor patients allocated by the general council according to their numbers; second, withdrawal from the poor patients ol the number of people necessary and sufficient for running a farm; and hnally, the creation and maintenance of a petit chateau with the profit Irom the farm, taking in a number of paying residents, their payment constituting the profit for those in charge of the general system. So, you have the system: community subsidy-work exploitation profit.
Second, you can see that there is a sort of perfect social microcosm, a sort of little Utopia of general social functioning. The asylum is the reserve army of the farm proletariat; it is all those who, potentially, could work, and who, if they cannot work, wait for the moment when they can, and, if they do not have the ability to work, remain in the asy lum vegetating. Then there is the place of productive work, which is represented by the farm. Then you have the institution in which those who benefit from the work and the profit are found. And to each of these levels corresponds a specific architecture: that of the asylum; that ol the larm, which in reality is a model practically bordering on slavery and colonization; and then the petit chateau with the management quarters.
You also have two types of power, the first of which is split. You have the traditional disciplinary power of the asylum, which is negative in a way, since its function is to keep people calm without getting anything positive from them. Then you have a second disciplinary type of power, but slightly modified, which is, roughly, the power of colonization: putting people to work, with the insane divided into squads and brigades, etcetera, under the authority and supervision of those who regularly put them to work. And then there is power on the family model for residents ol the petit chateau.
In short, you have three types of psychiatric intervention or manipu lation, corresponding to these three levels. One is, if you like, the degree zero of psychiatric intervention, that is to say, pure and simple penning within the asylum. Second, there is the psychiatric practice of putting patients to work on the pretext of curing them: ergotherapy. And then, third, for paying residents, you have individual, individualizing psychiatric practice on the family model.
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In the middle of all this, the most important and typical element is undoubtedly the way in which psychiatric knowledge and treatment are connected to the practice of putting those residents to work who are capable of working. Actually, very strangely, it is clear that the psychiatric categories developed by the psychiatry of the time, since Esquirol--and which I will try to show got absolutely no hold on therapy itself--are not in fact employed here at all as a classification of the curability of different people and the form of treatment that should be applied to them. Nosological classification is not linked to any therapeutic pre- scription but serves instead solely to define the possible utilization of individuals for the work they are offered.
Thus the directors of the Clermont asylum and the Fitz-James farm realized that if a patient was maniacal, monomaniacal, or demented, they were good for work in the fields and workshops looking after and manag- ing animals and plowing tools. 6 On the other hand, "imbeciles and idiots are responsible for cleaning the courtyards and stables and all the transport necessary for the service. "7 The use of women according to their sympto- matology is much more discriminating. Thus "those in the washhouse and laundry are almost always affected by a noisy delirium and would not be able to abide by the peace and quiet of workshop life. "8 In the washhouse and laundry, therefore, one can rave at the top of one's voice, talk loudly, and shout. Second, "those occupied with hanging out the washing are melancholies m whom this kind of work can restore the vital activity they so often lack. The imbeciles and idiots are responsible for taking laundry from the washhouse to the drying room. The workshops for sorting and folding the laundry are the remit of calm patients, monomaniacs, whose fixed ideas or hallucinations make possible a fairly sustained attention. "9
I have cited this establishment because it seemed to me to represent, around the 1860s, both the first form and most perfect realization of this family-discipline adjustment, and, at the same time, of the deployment of psychiatric knowledge as discipline.
*
This example leads us, moreover, to the problem that I would now like to consider, which is this: How and to what extent can one attribute a
? lherapeutic effect to this disciplinary, not yet familialized space, to this disciplinary system that we see being constituted between 1820 and 1830 and which will constitute the broad basis for the asylum institution? For, after all, it should not be forgotten that even if this disciplinary sys- tem is in many respects isomorphic with other disciplinary systems, like the school, the barracks, the workshop, and suchlike, it puts itself for- ward and justifies itself by its therapeutic function. What is it in this disciplinary space that is supposed to cure? What medical practice inhabits this space? This is the problem I would like to begin to address
today.
To do this I would like to start with a type of example about which
I have already spoken, which is what we can call the classical cure, mean- ing by classical the cure still current in the seventeenth and eighteenth centuries, and even at the beginning of the nineteenth century. I have given you a number of examples of this. There is the case of Pmel's patient who thought he was being pursued by revolutionaries, was waiting to be brought before the courts, and was consequently threatened with the death penalty. Pinel cured him by organizing a pseudo-trial around him, with pseudo-judges, in the course of which he was acquitted-- thanks to which he was cured. 10
In the same way, someone like Mason Cox, at the beginning of the nineteenth century gives the following example of a cure. It involves a man of forty years, who "had injured his health by too close attention to extensive mercantile concerns. "11 This passion for commerce had put into his head the idea that "his body was universally diseased. "12 And the main one of these, the one by which he felt most threatened, was what was called at the time "repelled itch," that is to say, an irruption of scabies which had not reached its term, which had spread throughout the organism, and manifested itself in a number of symptoms. The classical technique for curing it was to bring out this famous scabies and treat it as such.
For some time attempts were made to get the patient to understand that he did not have any of the illnesses in question: "no arguments could divert him . . . a formal consultation of medical men was therefore determined on, who, having previously agreed on the propriety of humouring the patient, professed to be unanimously of the opinion that
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his apprehension was just, a medical plan was laid down, some rebefacient application to different parts of the body occasioned crops of eruptions from time to time which were washed with some simple preparation. This farce continued a few weeks, and the patient at length was perfectly restored to health and reason. "13 His delirium had been satisfied, as it were.
What do these procedures of Pine! and Mason Cox presuppose and what do they bring into play? They presuppose--this is well known, I will not return to it--that the kernel of madness is a lalse belief, an illusion or an error. They also presuppose--which is already a bit different--that for the illness to disappear it is enough to dispel the error. The procedure of cure is therefore the reduction of the error; except the mad person's error is not just anyone's error.
The difference between the error of someone who is mad and some one who is not mad is not so much in the extravagance of the idea itself, because, after all, it is not very extravagant to believe one has "repelled itch. " And moreover, as Leuret will say later in his Fragments psychologiques sur lafolie, between Descartes who believed in vortices and a patient at Salpetriere who imagined that a council was being held in his lower abdomen/1 the extravagance is not especially on the patient's side. What makes a mad person's error the error of someone who is, precisely, mad? It is not then so much the extravagance, the final effect of the error, as the way in which the error can be overcome, dispelled. The mad person is someone whose error cannot be dispelled by a demonstration; he is someone for whom demonstration does not produce the truth. Consequently, one will have to find a different method of dispelling the error--since madness really is, in fact, the error--without using demonstration.
This means that, instead of attacking the erroneous judgment and showing that it has no correlation with reality, which is roughly the process of demonstration, one will let the lalse judgment be taken as true while transforming reality so that it is adapted to the mad, erroneous judgment. Now, when an erroneous judgment thus finds that it has a correlate in reality, which verifies it, from then on, the mental content coinciding with something in reality, there is no longer error and so no more madness.
? So it is not by treating the false judgment, by trying to correct it or dismiss it by demonstration, but rather by dressing up and manipulating reality that reality is placed on the same level, as it were, as the delirium. When the ialse judgment of the delirium is iound to have a real content in reality, it will as a result become a true judgment and the madness will cease being madness, since the error will have ceased being error. So one makes reality delirious so that the delirium is no longer delirium; one puts the delirium in the right so that it is no longer deceived. It is a matter, in short, of introducing reality into the delirium behind the mask of delirious figures, so that the delirium is satisfied by reality; through a game of transformations, of masks, one surreptitiously intro duces a reality beneath all the false propositions ol the delirium, or beneath the main false propositions of delirium, and in this way the delirium is verified. *
You see that this practice of the cure is, in a sense, absolutely homoge- neous with the classical conception of judgment and error; we are in line with, say, the Port Royal conception of the proposition and judgment. b However, you see that there is a difference between the teacher or demon strator, the person who possesses the truth, and the psychiatrist. Whereas the master of truth, the teacher or scientist, manipulates judgment, the proposition, and thought, the doctor will manipulate reality in such a way that the error becomes true. In this kind of process the doctor is the inter mediary, the ambivalent person who [on the one hand] looks from the
side of reality and manipulates it, and, on the other, looks from the side of truth and error and arranges it that the (orm of reality comes up to the level of the error in order to transform it thereby into truth.
He manipulates reality by making it wear a mask; he makes this reality a little less real, or at any rate he deposits a film of unreality on it; he puts it between the brackets of the theater, of the "as if," of the pseudo-, and by making reality unreal in this way he carries out the transforma- tion of error into truth. Consequently he is the agent of reality--and in this he is not like the scientist or the teacher; he is however someone
A The manuscript clarilies: "Since it is as a comic, theatrical reality, as a pseudo reality that it is introduced into the delirium, and by according a second effectiveness to reality, since for the delirium to lail it is enough that the Ialse judgment become true through the masking ol reality. "
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who makes reality unreal in order to act on the erroneous judgment maintained by the patient. 16
I think we can say that the psychiatrist, as he will function in the space of asylum discipline, will no longer be the individual who consid- ers what the mad person says from the standpoint of truth, but will switch resolutely, definitively, to the standpoint of reality* He will no longer be the ambiguous master of reality and truth that he was still with Pinel and Mason Cox; he will be the master of reality. He will no longer have anything to do with somehow smuggling reality into the delirium; it is no longer a question of the psychiatrist being a smuggler ot reality as Pinel and Mason Cox were. The psychiatrist is someone who must give reality that constraining force by which it will be able to take over the madness, completely penetrate it, and make it disappear as madness. The psychiatrist is someone who--and this is what defines his task--must ensure that reality has the supplement of power necessary for it to impose itself on madness and, conversely, he is someone who must remove from madness its power to avoid reality.
From the nineteenth century, the psychiatrist is then a factor of the intensification of reality, and he is the agent of a surplus power of real- ity, whereas, in the classical period he was, in a way, the agent of a power of the 'derealization' of reality. You will say that if it is true that the nineteenth century psychiatrist crosses over completely to the side of reality, and if he becomes for madness the agent of the intensification of the power of reality, thanks precisely to the disciplinary power he gives himself, it is not true however that he does not pose the question of truth. I will say that, of course, the problem of truth is posed in nine- teenth century psychiatry, despite the nevertheless quite considerable negligence it manifests with regard to the theoretical elaboration of its practice. Psychiatry does not avoid the question of truth, but, instead of placing the question of the truth of madness at the very heart of the cure, at the heart of its relationship with the mad person, which was still the case for Pinel and Mason Cox, instead of bringing the problem of truth out into the open in the confrontation between doctor and
* The manuscript adds: "In asylum psychiatry, the psychiatrist plays the role oi master of reality in a completely different way. "
? patient, psychiatric power only poses the question of truth within itself. It gives itself the truth right from the start and once and for all by constituting itself as a medical and clinical science. This means that rather than the problem of the truth being at stake in the cure, it is resolved once and for all by psychiatric practice as soon as this practice assumes the status of a medical practice founded as the application of a psychiatric science.
So that if one had to define this power that I would like to talk to you about this year, I would suggest, provisionally, the following: Psychiatric power is that supplement of power by which the real is imposed on mad- ness in the name of a truth possessed once and for all by this power in the name of medical science, of psychiatry. On the basis of this definition, which I put forward in this provisional form, I think we can understand some general features of the history of psychiatry in the nineteenth century.
First there is the very strange relationship--I was going to say the absence of relationship--between psychiatric practice and, say, dis- courses of truth. On the one hand, it is true that with the psychiatrists of the beginning of the nineteenth century psychiatry very quickly shows great concern to constitute itself as a scientific discourse. But to what scientific discourses does psychiatric practice give rise? It gives rise to two types of discourse.
