166 176; A Treatise on Insanity, "Mental
Derangement
Distributed into Different Species.
Foucault-Psychiatric-Power-1973-74
Psychiatry, as power over madness and power over abnormality, will find itself under a kind ol internal obligation to define possible relationships between the abnormal child and the mad adult.
It is to this end that, basically in the second hall ol the nineteenth century, two concepts are developed that will enable the link to be made, that is to say, the notion ol instinct on the one hand, and the notion ol degeneration on the other.
Actually, instinct is precisely that element whose existence is natural, but which is abnormal in its anarchical functioning, which is abnormal whenever it is not mastered or repressed. So it is the fate ol this both nat ural and abnormal instinct, of instinct as element, as unity of nature and abnormality, which psychiatry will gradually try to reconstruct lrom child- hood to adulthood, lrom nature to abnormality, and from abnormality to illness. 69 Psychiatry will expect to find the link between the abnormal child and the mad adult in the fate ol instinct lrom childhood to adulthood.
On the other hand, "degeneration," the other great concept alongside that of "instinct," is an unlortunate concept; instinct had a career in which it remained valid as a concept for much longer. However, the notion of degeneration is also very interesting, because it is not, as is usually said, the projection of biological evolutionism onto psychiatry.
? Biological evolutionism will intervene in psychiatry, take up this notion and overload it with certain connotations, but it will do this later. 70
Degeneration, as Morel defines it, arises before Darwin and before evolutionism. 71 What is degeneration in Morel's time, and what will it basically remain until its abandonment at the beginning of the twentieth century? 72 A child who carries the traces of his parents' or ancestors' madness, as stigmata or signs, will be called "degenerate. " Degeneration is therefore, as it were, the effect of abnormality produced on the child by his parents. And, at the same time, the degenerate child is an abnormal child whose abnormality is such that, in certain determinate circumstances and following certain accidents, it may produce madness. Degeneration is therefore the predisposition of abnormality in the child that will make possible the adult's madness, and, in the form of abnormality, it is the sign on the child of his ancestors' madness.
Consequently, you see this notion of degeneration pick out the fam lly and ancestors, as a package without strict definition for the moment, and the child, and it makes the family the collective support of this dou ble phenomenon of abnormality and madness. If abnormality leads to madness and if madness produces abnormality, it is actually because we are already within this collective support that is the family. 7*
I come to the third and last consequence. Studying the point of depar- ture and functioning of the generalization of psychiatry, we now find our selves faced with these two notions: degeneration and instinct. That is to say, we are seeing the emergence of something that will become what we can call, very roughly as I quite realize, the field of psychoanalysis, that is to say, ol the familial destiny of instinct. What does instinct become m the family? What is the system of exchanges that take place between ancestors and descendants, children and parents, and which calls instinct into ques- tion? Take these two notions, make them function together, and it is right there that psychoanalysis will at any rate get going, will start talking.
So, the principle of the generalization of psychiatry is found on the child's side, not the adult's; it is not found in the generalized use of the notion of mental illness, but rather in the practical carving out of the field of abnormalities. It is precisely in this generalization, starting from the child and abnormality, and not from the adult and illness, that we see the emergence of the future object of psychoanalysis.
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1. G. Canguilhem, Le Normal et le Pathologique (Paris: P. U. F. , 1972, 2ml revised edition) p. 175; English translation, On the Normal and the Pathological, trans. Carolyn R. Fawcet (Dordrecht, Boston and London: D. Reidel, 1978) p. 145.
2. In 1856 C. S. Le Paulmier presented a study devoted specifically to the mad child: Des affections mentales chevies en/ants, et en partkulier de la manie, Pans Medical Thesis, no. 162 (Paris: Rignoux, 1856). Paul Moreau de Tours (1844-1908) published what may be con- sidered to be the first treatise of infant psychiatry: La Folie che\ les enfants (Paris:
J. B. Bailliere, 1888).
3. After his journey in Russia in 1881 to look after the daughter of an old mayor of Moscow
and that of a grand duke of Saint Petersburg, in his private practice on the Boulevard Saint Germain Charcot had to accept several children, from wealthy Russian circles, suffering from nervous ailments. As a Parisian journalist noted: "His Russian clientele in Paris is quite sizeable" (Le Temps, 18 March, 1881, p. 3). These cases, like those of the Latin American children, were not made the subjects of publications, apart from the case of a young "Russian Israelite" of 13 years referred to in a lecture: "De l'hystcne chez les jeunes ganjons," Progres medical, vol. X, no. 50, 16 23 December 1882, pp. 985 987, and no. 51, 24 31 December 1882, pp. 1003 1004; and those of Miss A. aged 15 years, and S. , 17 years, originally from Moscow, referred to in Lecons sur les maladies du systeme nerveux, vol. Ill, Lesson VI, pp. 92-96; Clinical Lectures on Diseases of the Nervous System, vol. 3, pp. 77 83. See, A. Lubimov, Le Professeur Charcot, trans. L. A. Roslopchine (Saint Petersburg: Souvorma, 1894).
4. Thus Esquirol, while treating idiocy in connection with mental illness, distanced himself Irom any assimilation of the idiot to the insane by suggesting that "idiocy cannot be confused with dementia and other mental alienations, to which it belongs moreover through the lesion of intellectual and moral faculties" ("Idiotisme" in Dictionnaire des sciences medicales, vol. XXIII, [Paris: C. L. F. Panckoucke, 1818| p. 509). Similarly, Jacques Etienne Belhomme (1800 1880), attached to the section for idiots in Esquirol's depart- ment at Salpetnere, suggested that "this ailment belongs exclusively to childhood, and any mental illness presenting similar phenomena to the latter alter puberty should be carefully distinguished from it" Dissertation inaugurate presentee et soutenue a lafaculte de Medecine de Paris, le V juillet 1824 (Paris: Germer Bailliere, 1843) p. 52.
5. "Frenzy (fureur) is an over-excitement of nervous and muscular lorces, excited by a false perception, a memory, or a ialse idea, characterized by an exasperation, a violent anger against present or absent individuals or objects, causes or witnesses of ihe event. Bouts of fureur are veritable paroxysms of delirium, which vary in their duration and the Irequency ol their recurrence" E. J. Georget, De lafolie. Considerations sur cctte maladie pp. 106-107.
6. Hence the opposition made by Joseph Daquin between the "extravagant" and the "stupid madman": "The extravagant madman comes and goes, and is continually physically agitated; he tears neither danger nor threats ( . . . ) In the imbecilic madman, the intellec- tual organs appear to be completely lacking; he conducts himsell on the impulse ol the other person, without any kind of discernment" La Philosophic de la Jolie, 1791 edition, p. 22, 1987 edition, p. 50.
7. William Cullen (1710 1790) speaks ol "innate dementia," which he defines as an "imbe- cility of the mind for judging, by which men do not perceive or recall the relationships b e t w e e n t h i n g s " Apparatus ad nosologiam methodicam, seu Synopsis nosologiae methodicae in usum studiosorum, Part IV, "Vesania" (Edinburgh: W. Creech, 1769). According to Desire Magloire Bourneville ( 1 8 4 0 - 1 9 0 9 ) , Recueilde memoires, notes el observations sur I'idiotie, vol. I: De I'idiotie (Paris: Lecroisner and Babe, 1891) p. 4,Jean Michel Sagar (1702 1778) devotes one and a hall pages to a form of imbecility he calls amentia in his work, Syslema morborum sympltomalicum secundum classes, ordines, genera et species (Vienna: Kraus, 1776). Francois Fodere stated that "innate dementia seems to be the same thing as idiocy," defining it as an "Entire or partial obliteration of the affective faculties, with no appearance ol either innate or acquired intellectual faculties," Traite du delire, vol. I, pp. 419420.
8. (a) Under the name of stupiditas sive morosis Thomas Willis isolates a class of mental illnesses in chapter XIII of his De Anima Brutorum, quae hominis vitalis ac sensiliva esl (London: R. Davis, 1672); English version, Two Discourses concerning the Soul of Brutes,
? Which Is That of the Vital and Sensitive of Man, ed. S. Pordage (London: Harper and Leigh, 1683)- From this, chapter III, "Of Stupidity or Foolishness," is reproduced in P. Cranefield, "A seventeenth century view of mental deficiency and schizophrenia: Thomas Willis on 'Stupidity or Foolishness'," Bulletin of the History of Medicine, vol. 35, no. 4, 1961, pp. 291 316. See p. 293: "Stupidity, or Morosis, or Foolishness, although it most chiefly belongs to the Rational Soul, and signifies a defect ol the Intellect and Judgment, yet it is not improperly reckoned among the Diseases of the Head or Brain; lorasmuch as this Eclipse of the superior soul, proceeds lrom the Imagination and the Memory being hurt, and the failing of these depends upon the faults oi the Animal Spirits, and the Brain itsell. " Foucault refers to this in Histoire de lafolie, pp. 270 271 and 278 280 (both passages omitted from the English translation). See,J. Vinchon and J. Vie, "Un maitre de la neuropsychiatrie au xviic siecle: Thomas Willis (1662- 1675)," Annales medko-psychologiques, 12th series, vol. II, July 1928, pp. 109-144.
( b ) Francois Boissier de Sauvages (1706 1767) Nosologia methodica sistens morborum classes, genera et species, Juxta Sydenhami mentem et bontanicorum ordinem, vol. II (Amsterdam: De Tournes, 1763); French translation, Nosologie methodique, ou Distribution des maladies en classes, en genres et en especes suivant Vesprit de Sydenham et Vordre des botanistes, trans. Gouvion (Lyon: Buyset, 1771) vol. II. The chapter devoted to amentia distinguishes an eighth species: amentia morosis, or Stupidity: "Imbecility, dullness, foolishness, stupid
Uy: this is a weakness, a slowness or abolition of the faculty ol imagination or judg- ment, without the accompaniment ol delirium" p. 340. See, L. S. King, "Boissier de Sauvages and eighteenth century nosology," Bulletin of the History of Medicine, vol. 40, no. 1,1966, pp. 43 51.
(c) Jean-Baptiste Theophile Jacquelin Dubuisson (1770 1836) deiines "idiotism" by "a condition ol stupor or of the abolition ol the intellectual and affective functions, the result of which is a more or less complete obtuseness" Des vesanies ou maladies mentales (Paris: Mequignon, 1816) p. 281.
(d) Gcorget adds to the genres of insanity defined by Pinel a "Fourth genre that we could designate as stupidity," characterized by "the accidental absence of the manifestation
of thought, either because the patient has no ideas, or because he cannot express them" De la jolie, p. 115- See, A. Ritti, "Stupeur Stupidite" in Dictionnaire encyclopedique des sciences medkales (Paris: Masson/Asselin, 1883) 3rJ series, vol. XII, pp. 454-469.
9. Thus Boissier de Sauvages inserts the ingenii imbecillitas in the 18 classification of his nosography devoted to amentia. See his Nosologie methodique, vol. II, pp. 334-342. For Joseph Daquin, "the words dementia and imbecility are roughly synonymous, with this difference however between them: the lormer is an absolute deprivation ol reason, while the latter is only an enfeeblement of it" La Philosophic de lafolie, p. 51.
10. J. E. Belhomme: "Idiocy is easily distinguished from dementia . . . One begins with life, or
in an age which precedes the lull development of intelligence; the other appears alter puberty; the former belongs exclusively to childhood, the latter is mainly an illness of old
age" ? 550/ sur Vidiotie. Propositions sur ^education des idiots mise en rapport avec leur degre d'intel- ligence (Paris: Didot Jeune, 1824) pp. 32 33- On the history of idiocy, see, E. Seguin, Traitement moral, hygiene et education des idiots et des autres enfants arrieres ou retardes dans leur developpement(Paris: J. -B. Bailliere, 1846) pp. 23-32; D. M. Bourneville, Assistance, Traitement et Education des enfants idiots et degeneres, ch. 1: "Aperc,u historique de I'assistance
et du traitement des enlants idiots et degeneres," pp. 1 7; L. Kanner, A History of the Care and Study of the Mentally Retarded (Springfield, 111: C. C. Thomas, 1964); G. Netchine, "Idiots, debiles et savants au xixL siecle" in R. Zazzo, Les Debilites mentales, pp. 70 107; and, R. Myrvold, L'Arrieration menlalc, de Pinel a Binet-Simon, Medical Thesis, Paris, 1973, no. 67-
11. See J. E. D. Esquirol, "Delire," in Dictionnaire des sciences medkales (Paris: C. L. F. Panckoucke, 1814) vol. VIII, p. 255: "Apyretic delirium [i. e. , without fever; J. L. ] is the pathognomic sign of vesania"; EJ. Georget, De lafolie, p. 75: "The essential symptom of this illness ( . . . ) consists in intellectual disorders to which the name delirium has been given; there is no madness without delirium. " Michel Foucault notes that for eighteenth century medicine an "implicit delirium exists in all the alterations of the mind. " Histoire de la folie, p. 254; Madness and Civilization, p. 99.
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12. J. -B. Jacquelin Dubuisson, Des vesanies, p. 281.
13. P. Pinel classifies "idiotism" among the "species" of mental alienation: Traitemedico-
philosophique, section IV, pp.
166 176; A Treatise on Insanity, "Mental Derangement Distributed into Different Species. Fifth species ol mental derangement: Idiotism, or obliteration of the intellectual and affective faculties," pp. 165 173-
14. J. E. D. Esquirol, "Hallucinations" in Dictionnairc des sciences medicales, vol. XX (Paris: C. L. F. Panckoucke, 1817) pp. 64-71; "Idiotisme," ibid. vol. XXIII, 1818, pp. 507-524; and "De l'idiotie" (1820) in Des maladies tnenta/es, vol. II, pp. 286 397; Mental Maladies, "Idiocy," pp. 445 496.
15- This is the medical thesis defended by Jacques Elienne Belhomme on 1 July 1824: Essai sur l'idiotie. Propositions sur {'education des idiots mise en rapport avec leur degre d'intelligence, Medical Thesis, Paris, no. 125 (Paris: Didot Jeune, 1824), reprinted with some corrections: Paris: Germer Bailliere, 1843-
16. J. E. D. Esquirol, "De l'idiotie" in Des Maladies mentales, p. 284; Mental Maladies, "Idiocy," p. 446.
17. J. E. Belhomme, Essai sur l'idiotie, 1843 ed. , p. 51.
18. J. E. D. Esquirol, "De l'idiotie," p. 284: "Idiocy begins with life or in the age which precedes
the full development ol the intellectual and affective laculties . . . Dementia, like mania and monomania, only begins with puberty"; "Idiocy" p. 446. See also,J. E. Belhomme, (note 10 above).
19. J. E. D. Esquirol, "De l'idiotie,"pp. 284 285: "Idiots are what they must be throughout their life . . . We do not imagine the possibility ol changing this condition," whereas "dementia (. . . ) has a period of more or less rapid growth. Chronic, senile dementia gets worse from year to year ( . . . ) . We can cure dementia, we conceive ol the possibility of suspending its accidents"; "Idiocy,"pp. 446 447. It is precisely because alienists like Louis Florentin Calmeil, Achille | de] Foville, Elienne Georget, Louis Francois Lelut (1804 1877), and Francois Leurel consider idiots incurable that they recommend their isolation in asylums.
20. J. E. D. Esquirol, ibid. p. 284: "Everyone detects an imperfect organization or halted devel opment in them. On opening the cranium we almost always lind defects of conformation"; ibid. p. 446; J. E. Belhomme, 1824 edition, p. 33: "The idiot presents traces ol an incomplete organization . . . The autopsy of idiots reveal delects ol conformation, of organization"; EJ. Georget, De la folie, p. 105: "Idiots and imbeciles not only have a badly lormed intel lectual organ (see, the opening of bodies), but their whole system usually shares this unhealthy condition. In general, they are little developed ( . . . ) many are rachitic, scrolu lous, paralytics, or epileptics, and sometimes combine several of these illnesses (. . . ). The organization ol the brain in these case is no better than those ol all the other organs. "
21. On 1 November 1852, Henri Jean Baptiste Davenne, general director of Public Assistance, sending the Seine Prelect a report, the fourth chapter ol which concerned the education of idiot and imbecile children, stated: "The idiot is nothing other than a poor cripple to whom the doctor will never give what nature has denied him. " Rapport du Direcleur de I'adminstration de VAssistance Publique a M. Ic Prejel de la Seine sur le service des alienes du department de la Seine (Paris: Imprimerie de I'adminstration de PAssistance Publique, 1852).
22. For Etienne Georget, since idiots are characterized by "an original defect of development, they must be ranked among the monsters; this is truly the case in the intellectual respect"
De la folie, p. 102, n. 1. On the connotations of the term at this time, see C. Davaine, "Monstres," in Dictionnaire encyclopedique des sciences medicales, vol. LXI (Paris: Asselin, 1874) pp. 201 264.
23. J. E. D. Esquirol, "De l'idiotie," p. 285: "On opening the body we sometimes lind organic lesions, but these are accidental, for the thickening of the bones of the cranium, and the separation ol their tables, coinciding only with dementia, do not characterize any delects of conformation"; "Idiocy" p. 447.
24. Ibid.
25. In 1831, Edouard Seguin (1812-1880), assistant teacher to Jean Itard, doctor of the National Institution lor deal mutes, was entrusted by the latter, and by Esquirol, with the education of an idiot child. He reports this experience in Essai sur I'education d'un enfant
? (Pans: Porlhman, 1839). In 187JO, he put his method into practice in the Hospice des Incurables in the Saint Martin district, and published, Theone pratique dc /'education des enjants arrieres el idiots. Lecons aux jeunes idiots de VHospice des Incurables ( P a r i s : G e r m e r Bailliere, 187|2). In October 1842, the Conseil general des Hospices decided to transfer the children from Bicetre into Doctor Felix Voisin's department, which Segum leaves in 187|3 alter disagreements. Before emigrating to the United States in 1850, he drew up a balance sheet of his experiences in Trailcment moral, hygiene et education des idiots, in which he delines his principles of "physiological education. " No publication in France dealt with Segum between the thesis ot I. Saint Yves, Apercus historiques sur les travaux concernanl ^education medico-pedagogique: hard, Bourneville, Medical Thesis, Lyon, no. 103, 1913-191-1 (Paris: P. Lethielleux, I917i) and the article by H. Beauchesne, "Segum, instituteur d'idiots a Bicetre, ou la premiere equip medico pedagogique," Perspectives psychiatriques, vol. 30, 1970, pp. 11 V\. See, since then, Y. Pelicier and G. Thuillier, (i) "Pour une hisloire de l'education des enlants idiots en France, 1830 1 9 1 V Revue historique, vol. 261, no. 1, January 1979, pp. 99 130, and (ii) Edouard Seguin (1812-1880). Vinstiluleur des idiots (Paris: Ed. Economica, 1980); A. Brauner, ed. Acles du colloque international: Cent ans apres Edouard Seguin (Saint Mande: Groupement du recherches pratiques pour I'enfance, 1981);
J. G. G. Martin, "Une biographie franchise d'Onesime Edouard Seguin ( 2 0 January 1812-- 28 October 1880), premier therapeute des enfants arrieres, d'apres ses ecrits et les documents historiques," Medical Thesis, Paris Saint Anloine, 1981, no. 137l.
26. E. Seguin, Traitemenl moral, hygiene et education des idiots, p. 72: "It has been said that I conlused idiot children with merely backward or retarded children; and it has been said precisely because I was the first to point out the extreme dillerence separating them. "
27. Ibid. : "The retarded child is not halted in himself, except he develops more slowly than children his age . . . "
28. Ibid. p. 26: "No, idiocy is not an illness. "
29. Ibid. p. 107.
30. At the beginning ol the nineteenth century asylums took in, and sometimes mixed
together, both adults and a child population ol "idiots," "imbeciles," and "epileptics," who were poorly distinguished medically until I87|0 and even alter. Thus in 1852, at Bicetre, the third section ol the quarters housing the insane included epileptic adults and children, and some idiots. See D. M. Bourneville, Assistance, Traitemenl et Education des enfants idiots et degeneres, p. 7j. For an inventory ol the places, see, H. J. B. Davenne, Rapport. . . sur le service des alienes du department de la Seine.
31. Jean Marc Gaspard Itard (1771 1838), was trained as a surgeon and was appointed on 31 December 1800 as resident doctor ol the National Institution lor the deal and dumb, directed by the abbot Sicard. There, with the help of the governess Madame Guerm, lor more than lour years he undertook the "moral treatment" ol a twelve year-old child, cap tured in 1799 in the forests ol Lacaume ( Aveyron). See,J. M. G. Itard, (i ) De ^education d'un homme sauvage, ou des premiers developpemenh physiques et moraux du jeunc sauvage de I'Aveyron (Paris: Goujon, 1801); (ii) Rapport fait a S. E. le Minis/re de Vlnterieur sur les nombreux developpemenls el Petal actuel du sauvage de /'Aveyron (Paris: Imprimene impenale, 1807); republished by D. M. Bourneville under the title: Rapports el memoires sur le sauvage de IAveyron, Vidiolie et la surdi-mulite, vol. II (Paris: Alcan, 1817|); reprinted in L. Malson, Les Enjants sauvage, mylhe el realite, followed by, J. Itard, Memoire et Rapport sur Victor d'Aveyron (Paris: Union generale d'edition, 1967i); English translation in Lucien Malson and Jean Itard, Wolf Children, trans. L. Malson, and The Wild Boy of Aveyron (London: NLB, 1972).
32. In 1822, with Jean Pierre Falret, Felix Voisin (1797I 1872), a student of Esquirol attracted by the problems ol treating idiot children, founded a clinic at Vanves (see, Etablissement pour le traitemenl des alienes des deux sexes,Jonde en juillet 1822 a Vanves |Pans: A. Belin, 1828J). In 1833, the Conseil generale des Hospices entrusted him with the organization of a ser vice for idiots and epileptics at the Hospice des Incurables on the rue de Sevres. In 1837I he created an "orlhophrenic establishment" at V\ avenue de Vaugirard at Issy les Moulineaux, lor idiot children. In 1836, the residents ol this establishment, along with those of the Hospice, were translerred to Bicetre, where Voisin arrived in 187|0. The only document on this establishment comes from Charles Chretien Marc (1771-1840), "Rapport a M. le Conseiller d'Etat, Prefet de police, sur 1'etablissement orthophrenique de M. Felix
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PSYCHIATRIC POWER
Voisin," Le Motu'teur, 24 October 1834, and reprinted as an appendix to F. Voisin, De l'idiotie checks enfants, et les aulres particularities d'intelligence ou de caractere qui necessitenl pour eux une instruction et une education speciales de leur responsabilite moral (Paris: J. B. Bailliere, 1843) pp.
Actually, instinct is precisely that element whose existence is natural, but which is abnormal in its anarchical functioning, which is abnormal whenever it is not mastered or repressed. So it is the fate ol this both nat ural and abnormal instinct, of instinct as element, as unity of nature and abnormality, which psychiatry will gradually try to reconstruct lrom child- hood to adulthood, lrom nature to abnormality, and from abnormality to illness. 69 Psychiatry will expect to find the link between the abnormal child and the mad adult in the fate ol instinct lrom childhood to adulthood.
On the other hand, "degeneration," the other great concept alongside that of "instinct," is an unlortunate concept; instinct had a career in which it remained valid as a concept for much longer. However, the notion of degeneration is also very interesting, because it is not, as is usually said, the projection of biological evolutionism onto psychiatry.
? Biological evolutionism will intervene in psychiatry, take up this notion and overload it with certain connotations, but it will do this later. 70
Degeneration, as Morel defines it, arises before Darwin and before evolutionism. 71 What is degeneration in Morel's time, and what will it basically remain until its abandonment at the beginning of the twentieth century? 72 A child who carries the traces of his parents' or ancestors' madness, as stigmata or signs, will be called "degenerate. " Degeneration is therefore, as it were, the effect of abnormality produced on the child by his parents. And, at the same time, the degenerate child is an abnormal child whose abnormality is such that, in certain determinate circumstances and following certain accidents, it may produce madness. Degeneration is therefore the predisposition of abnormality in the child that will make possible the adult's madness, and, in the form of abnormality, it is the sign on the child of his ancestors' madness.
Consequently, you see this notion of degeneration pick out the fam lly and ancestors, as a package without strict definition for the moment, and the child, and it makes the family the collective support of this dou ble phenomenon of abnormality and madness. If abnormality leads to madness and if madness produces abnormality, it is actually because we are already within this collective support that is the family. 7*
I come to the third and last consequence. Studying the point of depar- ture and functioning of the generalization of psychiatry, we now find our selves faced with these two notions: degeneration and instinct. That is to say, we are seeing the emergence of something that will become what we can call, very roughly as I quite realize, the field of psychoanalysis, that is to say, ol the familial destiny of instinct. What does instinct become m the family? What is the system of exchanges that take place between ancestors and descendants, children and parents, and which calls instinct into ques- tion? Take these two notions, make them function together, and it is right there that psychoanalysis will at any rate get going, will start talking.
So, the principle of the generalization of psychiatry is found on the child's side, not the adult's; it is not found in the generalized use of the notion of mental illness, but rather in the practical carving out of the field of abnormalities. It is precisely in this generalization, starting from the child and abnormality, and not from the adult and illness, that we see the emergence of the future object of psychoanalysis.
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1. G. Canguilhem, Le Normal et le Pathologique (Paris: P. U. F. , 1972, 2ml revised edition) p. 175; English translation, On the Normal and the Pathological, trans. Carolyn R. Fawcet (Dordrecht, Boston and London: D. Reidel, 1978) p. 145.
2. In 1856 C. S. Le Paulmier presented a study devoted specifically to the mad child: Des affections mentales chevies en/ants, et en partkulier de la manie, Pans Medical Thesis, no. 162 (Paris: Rignoux, 1856). Paul Moreau de Tours (1844-1908) published what may be con- sidered to be the first treatise of infant psychiatry: La Folie che\ les enfants (Paris:
J. B. Bailliere, 1888).
3. After his journey in Russia in 1881 to look after the daughter of an old mayor of Moscow
and that of a grand duke of Saint Petersburg, in his private practice on the Boulevard Saint Germain Charcot had to accept several children, from wealthy Russian circles, suffering from nervous ailments. As a Parisian journalist noted: "His Russian clientele in Paris is quite sizeable" (Le Temps, 18 March, 1881, p. 3). These cases, like those of the Latin American children, were not made the subjects of publications, apart from the case of a young "Russian Israelite" of 13 years referred to in a lecture: "De l'hystcne chez les jeunes ganjons," Progres medical, vol. X, no. 50, 16 23 December 1882, pp. 985 987, and no. 51, 24 31 December 1882, pp. 1003 1004; and those of Miss A. aged 15 years, and S. , 17 years, originally from Moscow, referred to in Lecons sur les maladies du systeme nerveux, vol. Ill, Lesson VI, pp. 92-96; Clinical Lectures on Diseases of the Nervous System, vol. 3, pp. 77 83. See, A. Lubimov, Le Professeur Charcot, trans. L. A. Roslopchine (Saint Petersburg: Souvorma, 1894).
4. Thus Esquirol, while treating idiocy in connection with mental illness, distanced himself Irom any assimilation of the idiot to the insane by suggesting that "idiocy cannot be confused with dementia and other mental alienations, to which it belongs moreover through the lesion of intellectual and moral faculties" ("Idiotisme" in Dictionnaire des sciences medicales, vol. XXIII, [Paris: C. L. F. Panckoucke, 1818| p. 509). Similarly, Jacques Etienne Belhomme (1800 1880), attached to the section for idiots in Esquirol's depart- ment at Salpetnere, suggested that "this ailment belongs exclusively to childhood, and any mental illness presenting similar phenomena to the latter alter puberty should be carefully distinguished from it" Dissertation inaugurate presentee et soutenue a lafaculte de Medecine de Paris, le V juillet 1824 (Paris: Germer Bailliere, 1843) p. 52.
5. "Frenzy (fureur) is an over-excitement of nervous and muscular lorces, excited by a false perception, a memory, or a ialse idea, characterized by an exasperation, a violent anger against present or absent individuals or objects, causes or witnesses of ihe event. Bouts of fureur are veritable paroxysms of delirium, which vary in their duration and the Irequency ol their recurrence" E. J. Georget, De lafolie. Considerations sur cctte maladie pp. 106-107.
6. Hence the opposition made by Joseph Daquin between the "extravagant" and the "stupid madman": "The extravagant madman comes and goes, and is continually physically agitated; he tears neither danger nor threats ( . . . ) In the imbecilic madman, the intellec- tual organs appear to be completely lacking; he conducts himsell on the impulse ol the other person, without any kind of discernment" La Philosophic de la Jolie, 1791 edition, p. 22, 1987 edition, p. 50.
7. William Cullen (1710 1790) speaks ol "innate dementia," which he defines as an "imbe- cility of the mind for judging, by which men do not perceive or recall the relationships b e t w e e n t h i n g s " Apparatus ad nosologiam methodicam, seu Synopsis nosologiae methodicae in usum studiosorum, Part IV, "Vesania" (Edinburgh: W. Creech, 1769). According to Desire Magloire Bourneville ( 1 8 4 0 - 1 9 0 9 ) , Recueilde memoires, notes el observations sur I'idiotie, vol. I: De I'idiotie (Paris: Lecroisner and Babe, 1891) p. 4,Jean Michel Sagar (1702 1778) devotes one and a hall pages to a form of imbecility he calls amentia in his work, Syslema morborum sympltomalicum secundum classes, ordines, genera et species (Vienna: Kraus, 1776). Francois Fodere stated that "innate dementia seems to be the same thing as idiocy," defining it as an "Entire or partial obliteration of the affective faculties, with no appearance ol either innate or acquired intellectual faculties," Traite du delire, vol. I, pp. 419420.
8. (a) Under the name of stupiditas sive morosis Thomas Willis isolates a class of mental illnesses in chapter XIII of his De Anima Brutorum, quae hominis vitalis ac sensiliva esl (London: R. Davis, 1672); English version, Two Discourses concerning the Soul of Brutes,
? Which Is That of the Vital and Sensitive of Man, ed. S. Pordage (London: Harper and Leigh, 1683)- From this, chapter III, "Of Stupidity or Foolishness," is reproduced in P. Cranefield, "A seventeenth century view of mental deficiency and schizophrenia: Thomas Willis on 'Stupidity or Foolishness'," Bulletin of the History of Medicine, vol. 35, no. 4, 1961, pp. 291 316. See p. 293: "Stupidity, or Morosis, or Foolishness, although it most chiefly belongs to the Rational Soul, and signifies a defect ol the Intellect and Judgment, yet it is not improperly reckoned among the Diseases of the Head or Brain; lorasmuch as this Eclipse of the superior soul, proceeds lrom the Imagination and the Memory being hurt, and the failing of these depends upon the faults oi the Animal Spirits, and the Brain itsell. " Foucault refers to this in Histoire de lafolie, pp. 270 271 and 278 280 (both passages omitted from the English translation). See,J. Vinchon and J. Vie, "Un maitre de la neuropsychiatrie au xviic siecle: Thomas Willis (1662- 1675)," Annales medko-psychologiques, 12th series, vol. II, July 1928, pp. 109-144.
( b ) Francois Boissier de Sauvages (1706 1767) Nosologia methodica sistens morborum classes, genera et species, Juxta Sydenhami mentem et bontanicorum ordinem, vol. II (Amsterdam: De Tournes, 1763); French translation, Nosologie methodique, ou Distribution des maladies en classes, en genres et en especes suivant Vesprit de Sydenham et Vordre des botanistes, trans. Gouvion (Lyon: Buyset, 1771) vol. II. The chapter devoted to amentia distinguishes an eighth species: amentia morosis, or Stupidity: "Imbecility, dullness, foolishness, stupid
Uy: this is a weakness, a slowness or abolition of the faculty ol imagination or judg- ment, without the accompaniment ol delirium" p. 340. See, L. S. King, "Boissier de Sauvages and eighteenth century nosology," Bulletin of the History of Medicine, vol. 40, no. 1,1966, pp. 43 51.
(c) Jean-Baptiste Theophile Jacquelin Dubuisson (1770 1836) deiines "idiotism" by "a condition ol stupor or of the abolition ol the intellectual and affective functions, the result of which is a more or less complete obtuseness" Des vesanies ou maladies mentales (Paris: Mequignon, 1816) p. 281.
(d) Gcorget adds to the genres of insanity defined by Pinel a "Fourth genre that we could designate as stupidity," characterized by "the accidental absence of the manifestation
of thought, either because the patient has no ideas, or because he cannot express them" De la jolie, p. 115- See, A. Ritti, "Stupeur Stupidite" in Dictionnaire encyclopedique des sciences medkales (Paris: Masson/Asselin, 1883) 3rJ series, vol. XII, pp. 454-469.
9. Thus Boissier de Sauvages inserts the ingenii imbecillitas in the 18 classification of his nosography devoted to amentia. See his Nosologie methodique, vol. II, pp. 334-342. For Joseph Daquin, "the words dementia and imbecility are roughly synonymous, with this difference however between them: the lormer is an absolute deprivation ol reason, while the latter is only an enfeeblement of it" La Philosophic de lafolie, p. 51.
10. J. E. Belhomme: "Idiocy is easily distinguished from dementia . . . One begins with life, or
in an age which precedes the lull development of intelligence; the other appears alter puberty; the former belongs exclusively to childhood, the latter is mainly an illness of old
age" ? 550/ sur Vidiotie. Propositions sur ^education des idiots mise en rapport avec leur degre d'intel- ligence (Paris: Didot Jeune, 1824) pp. 32 33- On the history of idiocy, see, E. Seguin, Traitement moral, hygiene et education des idiots et des autres enfants arrieres ou retardes dans leur developpement(Paris: J. -B. Bailliere, 1846) pp. 23-32; D. M. Bourneville, Assistance, Traitement et Education des enfants idiots et degeneres, ch. 1: "Aperc,u historique de I'assistance
et du traitement des enlants idiots et degeneres," pp. 1 7; L. Kanner, A History of the Care and Study of the Mentally Retarded (Springfield, 111: C. C. Thomas, 1964); G. Netchine, "Idiots, debiles et savants au xixL siecle" in R. Zazzo, Les Debilites mentales, pp. 70 107; and, R. Myrvold, L'Arrieration menlalc, de Pinel a Binet-Simon, Medical Thesis, Paris, 1973, no. 67-
11. See J. E. D. Esquirol, "Delire," in Dictionnaire des sciences medkales (Paris: C. L. F. Panckoucke, 1814) vol. VIII, p. 255: "Apyretic delirium [i. e. , without fever; J. L. ] is the pathognomic sign of vesania"; EJ. Georget, De lafolie, p. 75: "The essential symptom of this illness ( . . . ) consists in intellectual disorders to which the name delirium has been given; there is no madness without delirium. " Michel Foucault notes that for eighteenth century medicine an "implicit delirium exists in all the alterations of the mind. " Histoire de la folie, p. 254; Madness and Civilization, p. 99.
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12. J. -B. Jacquelin Dubuisson, Des vesanies, p. 281.
13. P. Pinel classifies "idiotism" among the "species" of mental alienation: Traitemedico-
philosophique, section IV, pp.
166 176; A Treatise on Insanity, "Mental Derangement Distributed into Different Species. Fifth species ol mental derangement: Idiotism, or obliteration of the intellectual and affective faculties," pp. 165 173-
14. J. E. D. Esquirol, "Hallucinations" in Dictionnairc des sciences medicales, vol. XX (Paris: C. L. F. Panckoucke, 1817) pp. 64-71; "Idiotisme," ibid. vol. XXIII, 1818, pp. 507-524; and "De l'idiotie" (1820) in Des maladies tnenta/es, vol. II, pp. 286 397; Mental Maladies, "Idiocy," pp. 445 496.
15- This is the medical thesis defended by Jacques Elienne Belhomme on 1 July 1824: Essai sur l'idiotie. Propositions sur {'education des idiots mise en rapport avec leur degre d'intelligence, Medical Thesis, Paris, no. 125 (Paris: Didot Jeune, 1824), reprinted with some corrections: Paris: Germer Bailliere, 1843-
16. J. E. D. Esquirol, "De l'idiotie" in Des Maladies mentales, p. 284; Mental Maladies, "Idiocy," p. 446.
17. J. E. Belhomme, Essai sur l'idiotie, 1843 ed. , p. 51.
18. J. E. D. Esquirol, "De l'idiotie," p. 284: "Idiocy begins with life or in the age which precedes
the full development ol the intellectual and affective laculties . . . Dementia, like mania and monomania, only begins with puberty"; "Idiocy" p. 446. See also,J. E. Belhomme, (note 10 above).
19. J. E. D. Esquirol, "De l'idiotie,"pp. 284 285: "Idiots are what they must be throughout their life . . . We do not imagine the possibility ol changing this condition," whereas "dementia (. . . ) has a period of more or less rapid growth. Chronic, senile dementia gets worse from year to year ( . . . ) . We can cure dementia, we conceive ol the possibility of suspending its accidents"; "Idiocy,"pp. 446 447. It is precisely because alienists like Louis Florentin Calmeil, Achille | de] Foville, Elienne Georget, Louis Francois Lelut (1804 1877), and Francois Leurel consider idiots incurable that they recommend their isolation in asylums.
20. J. E. D. Esquirol, ibid. p. 284: "Everyone detects an imperfect organization or halted devel opment in them. On opening the cranium we almost always lind defects of conformation"; ibid. p. 446; J. E. Belhomme, 1824 edition, p. 33: "The idiot presents traces ol an incomplete organization . . . The autopsy of idiots reveal delects ol conformation, of organization"; EJ. Georget, De la folie, p. 105: "Idiots and imbeciles not only have a badly lormed intel lectual organ (see, the opening of bodies), but their whole system usually shares this unhealthy condition. In general, they are little developed ( . . . ) many are rachitic, scrolu lous, paralytics, or epileptics, and sometimes combine several of these illnesses (. . . ). The organization ol the brain in these case is no better than those ol all the other organs. "
21. On 1 November 1852, Henri Jean Baptiste Davenne, general director of Public Assistance, sending the Seine Prelect a report, the fourth chapter ol which concerned the education of idiot and imbecile children, stated: "The idiot is nothing other than a poor cripple to whom the doctor will never give what nature has denied him. " Rapport du Direcleur de I'adminstration de VAssistance Publique a M. Ic Prejel de la Seine sur le service des alienes du department de la Seine (Paris: Imprimerie de I'adminstration de PAssistance Publique, 1852).
22. For Etienne Georget, since idiots are characterized by "an original defect of development, they must be ranked among the monsters; this is truly the case in the intellectual respect"
De la folie, p. 102, n. 1. On the connotations of the term at this time, see C. Davaine, "Monstres," in Dictionnaire encyclopedique des sciences medicales, vol. LXI (Paris: Asselin, 1874) pp. 201 264.
23. J. E. D. Esquirol, "De l'idiotie," p. 285: "On opening the body we sometimes lind organic lesions, but these are accidental, for the thickening of the bones of the cranium, and the separation ol their tables, coinciding only with dementia, do not characterize any delects of conformation"; "Idiocy" p. 447.
24. Ibid.
25. In 1831, Edouard Seguin (1812-1880), assistant teacher to Jean Itard, doctor of the National Institution lor deal mutes, was entrusted by the latter, and by Esquirol, with the education of an idiot child. He reports this experience in Essai sur I'education d'un enfant
? (Pans: Porlhman, 1839). In 187JO, he put his method into practice in the Hospice des Incurables in the Saint Martin district, and published, Theone pratique dc /'education des enjants arrieres el idiots. Lecons aux jeunes idiots de VHospice des Incurables ( P a r i s : G e r m e r Bailliere, 187|2). In October 1842, the Conseil general des Hospices decided to transfer the children from Bicetre into Doctor Felix Voisin's department, which Segum leaves in 187|3 alter disagreements. Before emigrating to the United States in 1850, he drew up a balance sheet of his experiences in Trailcment moral, hygiene et education des idiots, in which he delines his principles of "physiological education. " No publication in France dealt with Segum between the thesis ot I. Saint Yves, Apercus historiques sur les travaux concernanl ^education medico-pedagogique: hard, Bourneville, Medical Thesis, Lyon, no. 103, 1913-191-1 (Paris: P. Lethielleux, I917i) and the article by H. Beauchesne, "Segum, instituteur d'idiots a Bicetre, ou la premiere equip medico pedagogique," Perspectives psychiatriques, vol. 30, 1970, pp. 11 V\. See, since then, Y. Pelicier and G. Thuillier, (i) "Pour une hisloire de l'education des enlants idiots en France, 1830 1 9 1 V Revue historique, vol. 261, no. 1, January 1979, pp. 99 130, and (ii) Edouard Seguin (1812-1880). Vinstiluleur des idiots (Paris: Ed. Economica, 1980); A. Brauner, ed. Acles du colloque international: Cent ans apres Edouard Seguin (Saint Mande: Groupement du recherches pratiques pour I'enfance, 1981);
J. G. G. Martin, "Une biographie franchise d'Onesime Edouard Seguin ( 2 0 January 1812-- 28 October 1880), premier therapeute des enfants arrieres, d'apres ses ecrits et les documents historiques," Medical Thesis, Paris Saint Anloine, 1981, no. 137l.
26. E. Seguin, Traitemenl moral, hygiene et education des idiots, p. 72: "It has been said that I conlused idiot children with merely backward or retarded children; and it has been said precisely because I was the first to point out the extreme dillerence separating them. "
27. Ibid. : "The retarded child is not halted in himself, except he develops more slowly than children his age . . . "
28. Ibid. p. 26: "No, idiocy is not an illness. "
29. Ibid. p. 107.
30. At the beginning ol the nineteenth century asylums took in, and sometimes mixed
together, both adults and a child population ol "idiots," "imbeciles," and "epileptics," who were poorly distinguished medically until I87|0 and even alter. Thus in 1852, at Bicetre, the third section ol the quarters housing the insane included epileptic adults and children, and some idiots. See D. M. Bourneville, Assistance, Traitemenl et Education des enfants idiots et degeneres, p. 7j. For an inventory ol the places, see, H. J. B. Davenne, Rapport. . . sur le service des alienes du department de la Seine.
31. Jean Marc Gaspard Itard (1771 1838), was trained as a surgeon and was appointed on 31 December 1800 as resident doctor ol the National Institution lor the deal and dumb, directed by the abbot Sicard. There, with the help of the governess Madame Guerm, lor more than lour years he undertook the "moral treatment" ol a twelve year-old child, cap tured in 1799 in the forests ol Lacaume ( Aveyron). See,J. M. G. Itard, (i ) De ^education d'un homme sauvage, ou des premiers developpemenh physiques et moraux du jeunc sauvage de I'Aveyron (Paris: Goujon, 1801); (ii) Rapport fait a S. E. le Minis/re de Vlnterieur sur les nombreux developpemenls el Petal actuel du sauvage de /'Aveyron (Paris: Imprimene impenale, 1807); republished by D. M. Bourneville under the title: Rapports el memoires sur le sauvage de IAveyron, Vidiolie et la surdi-mulite, vol. II (Paris: Alcan, 1817|); reprinted in L. Malson, Les Enjants sauvage, mylhe el realite, followed by, J. Itard, Memoire et Rapport sur Victor d'Aveyron (Paris: Union generale d'edition, 1967i); English translation in Lucien Malson and Jean Itard, Wolf Children, trans. L. Malson, and The Wild Boy of Aveyron (London: NLB, 1972).
32. In 1822, with Jean Pierre Falret, Felix Voisin (1797I 1872), a student of Esquirol attracted by the problems ol treating idiot children, founded a clinic at Vanves (see, Etablissement pour le traitemenl des alienes des deux sexes,Jonde en juillet 1822 a Vanves |Pans: A. Belin, 1828J). In 1833, the Conseil generale des Hospices entrusted him with the organization of a ser vice for idiots and epileptics at the Hospice des Incurables on the rue de Sevres. In 1837I he created an "orlhophrenic establishment" at V\ avenue de Vaugirard at Issy les Moulineaux, lor idiot children. In 1836, the residents ol this establishment, along with those of the Hospice, were translerred to Bicetre, where Voisin arrived in 187|0. The only document on this establishment comes from Charles Chretien Marc (1771-1840), "Rapport a M. le Conseiller d'Etat, Prefet de police, sur 1'etablissement orthophrenique de M. Felix
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Voisin," Le Motu'teur, 24 October 1834, and reprinted as an appendix to F. Voisin, De l'idiotie checks enfants, et les aulres particularities d'intelligence ou de caractere qui necessitenl pour eux une instruction et une education speciales de leur responsabilite moral (Paris: J. B. Bailliere, 1843) pp.
