The Petit Chateau section,
inhabited
by resident women.
Foucault-Psychiatric-Power-1973-74
* 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.
One of these we can call the clinical or classificatory, nosological dis course. Broadly speaking, this involves describing madness as an illness or, rather, as a series of mental illnesses, each with its own symptomatology, development, diagnostic and prognostic elements, etcetera. In this, the psychiatric discourse that takes shape takes normal clinical medical discourse as its model; it aims to constitute a sort of analogon of medical truth.
Then, and very soon too, even before Bayle's discovery of general paralysis, anyway from 1822 (the date of Bayle's discovery),17 you see the development of an anatomical pathological knowledge which poses the question of the substratum or organic correlatives of madness, the prob lem of the etiology of madness, of the relationship between madness and neurological lesions, etcetera. This is no longer a discourse analogous to medical discourse, but a real anatomical pathological or physiological- pathological discourse that is to serve as the materialist guarantee of psychiatric practice. 18
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Now, if you look at how psychiatric practice developed in the nineteenth century, how madness and mad people were actually handled in the asylum, you notice that, on the one hand, this practice was placed under the sign of and, so to speak, under the guarantee of these two discourses, one noso logical, of kinds of illnesses, and the other anatomical-pathological, of organic correlatives. Psychiatric practice developed in the shelter of these two discourses, but it never used them, or it only ever used them by ref- erence, by a system of cross references and, as it were, of pinning. Psychiatric practice, such as it was in the nineteenth century, never really put to work the knowledge, or quasi-knowledge, which was being built up in psychiatric nosology or in anatomical-pathological research. Basically, distributions in the asylum, the ways in which patients were classilied and divided up, the ways in which they were subjected to different regimes and given different tasks, and the ways in which they were declared cured or ill, curable or incurable, did not take these two discourses into account.
The two discourses were just sorts of guarantees of truth for a psy chiatnc practice that wanted to be given truth once and tor all and for it never to be called into question. The two big shadows of nosology and etiology, of medical nosography and pathological anatomy, were behind it to constitute, before any psychiatric practice, the definitive guarantee of a truth which this practice will never bring into operation in the practice of the cure. In crude terms, psychiatric power says: The question of truth will never be posed between madness and me for the very simple reason that I, psychiatry, am already a science. And if, as science, I have the right to question what I say, if it is true that I may make mistakes, it is in any case up to me, and to me alone, as science, to decide if what I say is true or to correct the mistake. I am the pos sessor, if not of truth in its content, at least of all the criteria ol truth. Furthermore, because, as scientific knowledge, I thereby possess the criteria of verification and truth, I can attach myself to reality and its power and impose on these demented and disturbed bodies the sur- plus-power that I give to reality. I am the surplus power of reality inas much as I possess, by myself and definitively, something that is the truth in relation madness.
? This is what a psychiatrist of the time called "the imprescriptible rights of reason over madness," which were for him the foundations of psychiatric intervention. 19
I think the reason for this absence of a connection between discourses of truth and psychiatric practice, for this gap, pertains to this function of the enhanced power of the real, which is the basic function of psychi- atric power and which must, as it were, slip behind its back a truth con sidered to be already acquired. This makes it possible to understand that the great problem of the history of psychiatry in the nineteenth century is not a problem of concepts, and not at all the problem of this or that illness: neither monomania nor even hysteria was the real problem, the cross psychiatry had to bear in the nineteenth century. If we accept that the question of truth is never posed in psychiatric power, then it is easy to understand that the cross nineteenth century psychiatry has to bear is quite simply the problem of simulation. 20
By simulation I do not mean the way in which someone who is not mad could pretend to be mad, because this does not really call psychiatric power into question. Pretending to be mad when one is sane is not some thing like an essential limit, boundary, or defect of psychiatric practice and psychiatric power, because, after all, this happens in other realms of knowledge, and in medicine in particular. We can always deceive a doctor by getting him to believe that we have this or that illness or symptom-- anyone who has done military service knows this--and medical practice is not thereby called into question. On the other hand, and this is the sim- ulation I want to talk to you about, the simulation that was the historical problem of psychiatry in the nineteenth century is simulation internal to madness, that is to say, that simulation that madness exercises with regard to itself, the way in which hysteria simulates hysteria, the way in which a true symptom is a certain way of lying and the way in which a false symptom is a way of being truly ill. All this constituted the insoluble problem, the limit and, ultimately, the failure of nineteenth century psychiatry that brought about a number of sudden developments.
If you like, psychiatry said more or less: I will not pose the problem of truth with you who are mad, because I possess the truth myself in terms of my knowledge, on the basis of my categories, and if I have a
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power in relation to you, the mad person, it is because I possess this truth. At this point madness replied: If you claim to possess the truth once and for all in terms of an already fully constituted knowledge, well, for my part, I will install falsehood in myself. And so, when you handle my symptoms, when you are dealing with what you call illness, you will find yourself caught in a trap, for at the heart of my symptoms there will be this small kernel of night, of falsehood, through which I will confront you with the question of truth. Consequently, I won't deceive you when your knowledge is limited--that would be pure and simple simulation-- but rather, if one day you want really to have a hold on me, you will have to accept the game of truth and falsehood that I ofier you.
Simulation: the whole history of psychiatry can be said to be perme- ated by this problem ol simulation, from the two simulators at Salpetriere in 1821, when it looms up before Georget, one of the leading psychiatrists of the period, until the 1880s and the important episode with Charcot. And when I say this problem, I am not talking about the theoretical problem of simulation, but the processes by which those who were mad actually responded with the question of falsehood to this psychiatric power that refused to pose the question of truth. The untruthfulness of simulation, madness simulating madness, was the anti-power of the mad confronted with psychiatric power.
I think the historical importance of this problem of both simulation and hysteria derives from this. It also enables us to understand the col- lective character of this phenomenon of simulation. We see it emerge around 1821 in the behavior of the two hysterics called "Petronille" and "Braguette. "21 I think these two patients founded an immense historical process in psychiatry; they were imitated in all the asylums in France because ultimately it was their weapon in the struggle with psychiatric power. And with the serious crisis of asylum psychiatry, which broke out at the end of the nineteenth century, around 1880, the problem of truth really was imposed by the mad on psychiatry when, in front of Charcot the great miracle worker, it became evident that all the symp toms he was studying were aroused by him on the basis of his patients' simulation.
I emphasize this history for a number of reasons. The first is that it is not a matter of symptoms. It is often said that hysteria has
? disappeared, or that it was the great illness of the nineteenth century. But it was not the great illness of the nineteenth century; it was, to use medical terminology, a typical asylum syndrome, or a syndrome correl- ative to asylum power or medical power. But I don't even like the word syndrome. It was actually the process by which patients tried to evade psychiatric power; it was a phenomenon of struggle, and not a patho- logical phenomenon. At any rate, that is how I think it should be viewed.
Second, we should not forget that if there was so much simulation within asylums after Braguette and Petronille, this was not only because it was made possible by the coexistence of patients withm the asylums, but also because of sometimes spontaneous and sometimes involuntary, sometimes explicit and sometimes implicit complicity with the patients on the part of the personnel, of warders, asylum doctors, and medical subordinates. We should not forget that Charcot practically never exam ined a single one of these hysterics, and that all his observations, falsi- lied by simulation, were actually given to him by the personnel surrounding the patients, and who, together with the patients, with greater or lesser degrees of complicity, constructed this world of simula- tion as resistance to psychiatric power that, m 1880 at Salpetnere, was incarnated in someone who, precisely, was not even a psychiatrist, but a neurologist, and so someone most able to base himself on the best constituted discourse ol truth.
The trap of falsehood, then, was set for the person who came armed with the highest medical knowledge. So the general phenomenon of simulation in the nineteenth century should be understood not only as a process of the patients' struggle against psychiatric power, but as a process of struggle at the heart of the psychiatric system, of the asylum system. And I think we arrive here at the episode that must be the aim of my course, which is the moment when, precisely, the question of truth, put aside after Pinel and Mason Cox by the disciplinary system ol the asylum and by the type of functioning of psychiatric power, was lorcibly reintroduced through all these processes. *
* The manuscript adds: "We can, then, call antipsychiatry any movement by which the question ol l ruth is put back in play within the relationship between the mad person and the psychiatrist. "
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We may say that psychoanalysis can be interpreted as psychiatry's first great retreat, as the moment when the question of the truth ol what is expressed in the symptoms, or, in any case, the game of truth and lie in the symptom, was forcibly imposed on psychiatric power; the prob- lem being whether psychoanalysis has not responded to this first defeat by setting up a first line of defense. At any rate, credit should not be given to Freud for the first depsychiatrization. We owe the first depsy chiatrization, the first moment that made psychiatric power totter on the question of truth, to this band of simulators. They are the ones who, with their falsehoods, trapped a psychiatric power which, in order to be the agent ol reality, claimed to be the possessor of truth and, within psychiatric practice and cure, refused to pose the question of the truth that madness might contain.
There was what could be called a great simulator's insurrection that spread through the whole of the asylum world in the nineteenth century, and the constant and endlessly rekindled source of which was Salpetnere, an asylum for women. This is why I don't think we can make hysteria, the question ol hysteria, the way in which psychiatrists got bogged down in hysteria in the nineteenth century, a kind of minor scientific error, a sort of epistemological blockage. It is clearly very reas suring to do this, because it makes it possible to write the history ol psychiatry and the birth of psychoanalysis in the same style as the expla nation of Copernicus, Kepler, or Einstein. That is to say, there is a sci entific blockage, an inability to get free from the excessive number oi spheres of the "Ptolemaic" world, or from Maxwell's equations, etcetera. We find secure footing in this scientific knowledge and, starting from this kind of dead-end, see an epistemological break and then the sudden appearance of Copernicus or Einstein. By posing the question in these terms, and by making the history of hysteria the analogon of these kinds of episodes, the history of psychoanalysis can be placed in the calm tradition ol the history of the sciences. However, if, as I would like to do, we make simulation--and so not hysteria--the militant underside ol psychiatric power rather than an epistemological problem of a dead end, if we accept that simulation was the insidious way lor the mad to pose the question of truth forcibly on a psychiatric power that only wanted to impose reality on them, then I think that we could write a
? history of psychiatry that would no longer revolve around psychiatry and its knowledge, but which finally would revolve around the mad.
And you can see that if we take up the history of psychiatry in this way, then it can be seen that what we can call the institutional perspec tive, which poses the problem of whether or not the institution is the site of violence, is in danger of suppressing something. It seems to me that it delineates the historical problem of psychiatry--that is to say, the problem of this power of reality that it was the psychiatrist's task to re-impose and which was trapped by the questioning falsehood of the simulators--in an extraordinarily narrow way.
This is the kind of general background I would like to give to the lollowing lectures. So, next week, I will try to resume this history, which I have suggested to you in a sketchy way, by taking up the problem of how psychiatric power functioned as a surplus-power of reality.
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1. In 1861 the asylum received 1227 insane persons, 561 men and 666 women, divided into 215 paying and 1212 destitute residents. See the work by the asylum's director, Guslave L a b i t t e , De la colonie de Fit^-James, succursale de I'asile prive de Clermont (Oise), considered au
point de vue de son organisation administrative el medicale (Paris: J. B. Bailliere, 1861) p. 15. On the history of the Clermont asylum, see E. J. Woillez, Essai hislorique, descriplif el slatislique sur la maison d'alienes de Clermont (Oise) (Clermont: V. Danicourt, 1839).
2. The Fitz James colony was created in 1847.
3. "In creating the Fitz James colony, first of all we wanted the patients to be in a completely
different environment than that ol Clermont" G. Labitte, De la colonie de Fit^-James, p. 13.
4. In 1861, the larm comprised "170 patients," ibid. p. 15.
5. According to G. Labilte's description: "1. The management section allocated to living
quarters for the director and male residents. 2. The Farm section, where the colonists stay. 3.
The Petit Chateau section, inhabited by resident women. /|. The Bevrel section, occupied by women employed in laundering the linen" ibid. p. 6.
6. "On the larm . . . work in the fields and workshops, looking alter and managing animals and plowing tools, are the remit ol maniacs, monomaniacs and the demented" ibid. p. 15.
7. Ibid.
8. Ibid. p. V\. 9. Ibid.
10. P. Pinel, Traite medico-philosophique, section VI, ? iv: "Essai lente pour guerir une melancolie profonde produile par une cause morale" pp. 233 237; A Treatise on Insanity, "An attempt to cure a case ol melancholia produced by a moral cause" pp. 227i 227.
11. Joseph Mason Cox, Practical Observations on Insanity, Case II, p. 51; Observations sur la de? nence,(^06), p. 77.
12. Ibid. p. 51; ibid. p. 78.
13. Ibid. p. 52; ibid. pp. 78 79.
V\. F. Leuret, Fragments psychologiques sur la folie (Paris: Crochard, 1837|) ch. 2: "Delirium ol
intelligence": "The chair hirer of a Parisian parish, treated by Monsieur Esquirol,. . . said he had bishops in his belly who were holding a council. . . Descartes thought it an established tact that the pineal gland is a mirror which reflected the image ol external bodies . . . Is one of these assertions better proved than the other? " p. 7i3. Leuret is referring to Descartes' analysis of the role ol the pineal gland in the lormation of ideas ol objects which strike the senses: R. Descartes, Traite de VFlomme (Paris: Clerselier, 1667|) in Descartes, CEuvrcs el Lettres, ed. A. Bridoux, pp. 8 5 0 853; English translation, "Treatise on Man," trans. Robert Slootholl, in The Philosophical Writings oj Descartes, trans. John Cottingham, Robert Slootholl, Dugald Murdoch (Cambridge: Cambridge University Press, 1985) vol. 1, p. 106.
15. In this conception, "Judging is the action in which the mind, bringing together dillerent ideas, aflirms ol one that it is the other, or denies ol one that it is the other. This occurs when, for example, having the idea ol the earth and the idea ol round, I affirm or deny ol the earth that it is round" A. Arnauld and P. Nicole, La Logique, ou VArl depenser, contcnanl, outre les regies communes, plusieurs observations nouvelles propres a former le jugemenl ( 1 6 6 2 ) (Paris: Desprez, 1683, 51'1 edition) p. 36; English translation, Logic, or, The art of thinking, trans. J. V. Buroker (Cambridge: Cambridge University Press, 1996) p. 23. See, L. Mann, La Critique du discours. Sur la "Logique de Port-Royal" et les "Pensees de Pascal" ( P a r i s : E d . d e Minuit, 1975) pp. 275 299; and Foucault's comments in Les Mots et let Choses, Part One, "Representer," pp. 72 81; The Order oj Things, pp. 58 67; and, "Introduction" to A. Arnauld and C. Lancelot, Grammaire generale et raisonnee conlenanl lesJondements de Part de
parler expliques d'une maniere claire et nalurelle (Paris: Republications Paulet, 1969),
reprinted in Dits el Ecrits, vol. 1, pp. 732 752.
16. On this theatrical production, see Michel Foucault, Histoirc de lafolie, pp. 350 354; Madness
and Civilisation, pp. 187 191. The second lecture ol the College de France course of 1970 1971, "The Will to Knowledge," speaks of this "theatricalization" of madness as an "ordeal test" which involves "seeing which oi the two, patient or doctor, would keep up the game of truth the longest, all this theater of madness by which the doctor objectively real- ized as it were the patient's delirium and, on the basis ol this feigned truth, reached the patient's truth" (personal notes;J. L. ).
? 17. Whereas paralytic disorders were considered to be intercurrent affections ol the develop ment of dementia or, as Esquirol said, a "complication" of the illness (sec the article " D e m e n c e " in Dictiotmairc des sciences medicates, par unc sociele de medecins et de chirurgiens | Paris: C. L. F. Panckoucke, 1814] vol. VIII, p. 283, and the article "Folie" vol. XVI, 1816), in 1822, Antoine Laurent Jesse Bayle (1799-1858), on the basis of six observations lol lowed by anatomical checks, gathered in the department ol Royer Collard at Salpetnere, identified a morbid entity which, following the anatomical cause to which he attributed it, he called "chronic arachnitis," using the tact that "in all the periods ol the illness, there is a constant relationship between the paralysis and the delirium . . . we therelore could not reluse to accept that these two orders ol phenomena are the symptoms ol a single illness, that is to say of a chronic arachnitis," to which he devotes a first part ol his thesis defended on 21 November 1822 (Recherches sur les maladies mentales, Medical Thesis, Paris, no. 1/|7 [Paris: Didot Jean, 1822j): Recherches sur /'arachnitis chronique, la gastrile, la gaslro-enterite, et la goutle, considerees comme causes de {'alienation menlale (Pans: Gabon, 1822; centenary repub licalion Paris: Masson, 1922) vol. 1, p. 32. Bayle later extended his conception to most men tal tllnesses: "Most mental illnesses are the symptoms of an original chronic phlegmasia ol the 'membranes of the brain' " Traitc des maladies et de scs membranes (Paris: Gabon, 1826) p. xxiv. See also his text, "De la cause orgamque de l'alienation mentale accompagnee de paralysie generale" (read at the Imperial Academy ol Medicine) Annales medico-
psychologiques, 3rJ series, vol. 1,July 1855, pp. 409 425.
18. In the 1820s, a group ol young doctors turned to pathological anatomy on which it tried to graft clinical psychiatry. Felix Voisin set out the programme: "Given the symptoms, how can the seat ol the disease be determined. This is the problem that medicine illuminated by physiology can address today" Des causes morales et physiques des maladies mentales, et de quelcjues aulres afjeclions telles que I'hyslerie, la nymphomanie el le salyriasis ( Paris: J. B. Bailliere, 1826) p. 329. In 1821, two students of Leon Rostan (1791 1866), Achille |de| Foville (1799 1878) and Jean Baptiste Delaye (1789 1879), presented a paper for the Prix Esquirol: "Considerations sur les causes de la folie et de leur mode d'action, suivies de recherches sur la nature et le siege special de cette maladie" (Paris: 1821). On 31 December
1819, Jean Pierre Falret (1794-1870) defended his thesis: Observations et propositions medico-chirurgicales, Medical Thesis, Paris, no. 296 (Paris: Didot, 1919) belore publishing his, De rhypocondrie el du suicide. Considerations sur les causes, sur le siege el le traitemenl du ces maladies, sur les moyens d'en arrctcr les progres et d'en prevoir les developpements ( P a n s : Croullebois, 1822). On 6 December 1823, Falret gave a lecture to the Athenee de Medecine: "Inductions ttrees de Pouverture des corps des alienes pour servir an diagnostic et an traitemenl des maladies mentales" (Paris: Bibliotheque Medicale, 182/|).
In 1830 a debate on the organic causes ol madness was started on the occasion ol the thesis ol one ol Esquirol's students, Etienne Georget (who entered Salpetriere in 1816 and in 1819 won the Prix Esquirol with his paper: "Des ouvertures du corps des alienes") which was defended on 8 February 1820, Dissertation sur les causes de la folie, Medical Thesis, Paris, no. 31 (Pans: Didot Jeune, 1820), and in which he criticizes Pinel and Esquirol lor being satisfied with observation of the phenomena of madness without seeking to connect them to a productive cause. In his work, De lafolie, p. 72, Georget declares: "I must not tear linding mysell in opposition to my teachers . . . by demonstrating that madness is a cerebral
idiopathic allection. "
19. It was Jean Pierre Falret who asserted that, thanks to isolation, "the lamily, in the silence
ol a positive law, overcoming the fear of committing an arbitrary act, and making use of the imprescriptible right of reason over delirium, subscribes to the teachings ol science in order to obtain the benefit of the cure of the insane. " J. -P. Falret, Observations sur le projel de loi relalij aux alienes, presented le 6 Janvier 1837 a la Chambrc des deputes par le ministre de Vlnterieur (Paris: Everal, 1837) p. 6.
20. The problem of simulation was raised in 1800 by P. Pinel who devoted a chapter to it in his Traile medico-philosophique section VI, ? xxii: "Mania simulee; moyens de la reconnoitre" pp. 297 302; A Treatise on Insanity, "Feigned mania: the method of ascertaining it," pp. 282 287. See also, A. Laurent, Etude medico-Iegalc sur la simulation de lafolie. Considerations cliniques et
pratiques a I'usage des medecins experts, des magistrals el desjurisconsulles (Paris: Masson, 1866); H. Bayard, "Memoire sur les maladies simulees," Annales d'hygiene publique et de medecine
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21.
legate, lsl series, vol. XXXVIII, 1867, p. 277; E. Boisseau, "Maladies simulees" in A. Dechambre and others, eds. Diclionnaire encyclopedic/ue des sciences medicates, 2,H series, vol. 2 (Paris: Masson/Asselin, 1876) pp. 266-281; G. Tourcles, "Simulation" ibid. pp. 681 715. Charcot dealt with the question on several occasions: ( l ) "Ataxie locomotnce, forme anormale" (20 March 1888) in Lecons du mardi a la Salpelriere. Policlinique 1887-1888, notes of the course of M. Blin,J. Charcot, and H. Colin (Paris: Lecrosnier & Babe, 1889) vol. 1, pp. 281-284; (2) Lecture IX: "De 1'ischurie hyslerique," (1873) in Lecons sur les maladies du systeme nervcux, vol. 1, collected and published by D. M. Bourneville (Pans: Delahaye et Lecroisner, 1884, 5th edition) pp. 281 283; English translation, J. M. Charcot, Clinical Lectures on Diseases of the Nervous System, vol. 1, trans. George Sigerson (London: New Sydcnham Society, 1877) Lecture 10, "Hysterical ischuria" pp. 230-232; (}) Lecture 1: "Lec,on d'ouverture de la chaire de clinique des maladies du systeme nerveux" (23 April 1882), and Lecture XXVI: "Cas du mutisme hystenque chez l'homme," both in Lecons sur les maladies du systeme nerveux, vol. 3, collected and published by Babinski, Bernard, Fere, Guinon, Marie and Gilles de La Tourcttc (1887) (Paris: Lecroisner & Babe, 1890), pp. 17 22 and 452-433; English translation, J. M. Charcot, Clinical Lectures on Diseases of the Nervous System, trans. Thomas Savill (London and New York: Tavistock/Routledge, 1991) vol. 3, Lecture I, "Introductory," pp. 14 19, and Lecture 26, "A Case ot Hysterical Mutism in a man," pp. 368 570.
In 1821, at Salpetnere, Etienne Georget, attracted by the experiments conducted by the Baron Jules Dupotet de Sennevoy in October 1820 at the Hotel Dieu in the department ol Hussun, with the help of Leon Rostan, converted two patients into somnambulistic experimental subjects: Petronille and Manoury, the widow Brouillard, called "Braguette. " See A. Dechambre, "Nouvelles experiences sur le magnetisme animal" Gazette medicale de Paris, 12 September 1835, p. 585- Georget reports these experiments, without revealing the identity ol the patients, in De la physiologie du systeme nerveux, et specialement du ccrveau, vol. 1, ch. 3: "Somnambulisme magnetique" (Paris:J. B. Bailliere, 1821) p. 404. See also, A. Gauthier, Histoire du somnambulisme: che^ tous les peuples, sous les noms divers d'extases, songes, oracles, visions, etc. (Paris: F. Maltese, 1842) vol. 2, p. 324; A.
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.
One of these we can call the clinical or classificatory, nosological dis course. Broadly speaking, this involves describing madness as an illness or, rather, as a series of mental illnesses, each with its own symptomatology, development, diagnostic and prognostic elements, etcetera. In this, the psychiatric discourse that takes shape takes normal clinical medical discourse as its model; it aims to constitute a sort of analogon of medical truth.
Then, and very soon too, even before Bayle's discovery of general paralysis, anyway from 1822 (the date of Bayle's discovery),17 you see the development of an anatomical pathological knowledge which poses the question of the substratum or organic correlatives of madness, the prob lem of the etiology of madness, of the relationship between madness and neurological lesions, etcetera. This is no longer a discourse analogous to medical discourse, but a real anatomical pathological or physiological- pathological discourse that is to serve as the materialist guarantee of psychiatric practice. 18
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Now, if you look at how psychiatric practice developed in the nineteenth century, how madness and mad people were actually handled in the asylum, you notice that, on the one hand, this practice was placed under the sign of and, so to speak, under the guarantee of these two discourses, one noso logical, of kinds of illnesses, and the other anatomical-pathological, of organic correlatives. Psychiatric practice developed in the shelter of these two discourses, but it never used them, or it only ever used them by ref- erence, by a system of cross references and, as it were, of pinning. Psychiatric practice, such as it was in the nineteenth century, never really put to work the knowledge, or quasi-knowledge, which was being built up in psychiatric nosology or in anatomical-pathological research. Basically, distributions in the asylum, the ways in which patients were classilied and divided up, the ways in which they were subjected to different regimes and given different tasks, and the ways in which they were declared cured or ill, curable or incurable, did not take these two discourses into account.
The two discourses were just sorts of guarantees of truth for a psy chiatnc practice that wanted to be given truth once and tor all and for it never to be called into question. The two big shadows of nosology and etiology, of medical nosography and pathological anatomy, were behind it to constitute, before any psychiatric practice, the definitive guarantee of a truth which this practice will never bring into operation in the practice of the cure. In crude terms, psychiatric power says: The question of truth will never be posed between madness and me for the very simple reason that I, psychiatry, am already a science. And if, as science, I have the right to question what I say, if it is true that I may make mistakes, it is in any case up to me, and to me alone, as science, to decide if what I say is true or to correct the mistake. I am the pos sessor, if not of truth in its content, at least of all the criteria ol truth. Furthermore, because, as scientific knowledge, I thereby possess the criteria of verification and truth, I can attach myself to reality and its power and impose on these demented and disturbed bodies the sur- plus-power that I give to reality. I am the surplus power of reality inas much as I possess, by myself and definitively, something that is the truth in relation madness.
? This is what a psychiatrist of the time called "the imprescriptible rights of reason over madness," which were for him the foundations of psychiatric intervention. 19
I think the reason for this absence of a connection between discourses of truth and psychiatric practice, for this gap, pertains to this function of the enhanced power of the real, which is the basic function of psychi- atric power and which must, as it were, slip behind its back a truth con sidered to be already acquired. This makes it possible to understand that the great problem of the history of psychiatry in the nineteenth century is not a problem of concepts, and not at all the problem of this or that illness: neither monomania nor even hysteria was the real problem, the cross psychiatry had to bear in the nineteenth century. If we accept that the question of truth is never posed in psychiatric power, then it is easy to understand that the cross nineteenth century psychiatry has to bear is quite simply the problem of simulation. 20
By simulation I do not mean the way in which someone who is not mad could pretend to be mad, because this does not really call psychiatric power into question. Pretending to be mad when one is sane is not some thing like an essential limit, boundary, or defect of psychiatric practice and psychiatric power, because, after all, this happens in other realms of knowledge, and in medicine in particular. We can always deceive a doctor by getting him to believe that we have this or that illness or symptom-- anyone who has done military service knows this--and medical practice is not thereby called into question. On the other hand, and this is the sim- ulation I want to talk to you about, the simulation that was the historical problem of psychiatry in the nineteenth century is simulation internal to madness, that is to say, that simulation that madness exercises with regard to itself, the way in which hysteria simulates hysteria, the way in which a true symptom is a certain way of lying and the way in which a false symptom is a way of being truly ill. All this constituted the insoluble problem, the limit and, ultimately, the failure of nineteenth century psychiatry that brought about a number of sudden developments.
If you like, psychiatry said more or less: I will not pose the problem of truth with you who are mad, because I possess the truth myself in terms of my knowledge, on the basis of my categories, and if I have a
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power in relation to you, the mad person, it is because I possess this truth. At this point madness replied: If you claim to possess the truth once and for all in terms of an already fully constituted knowledge, well, for my part, I will install falsehood in myself. And so, when you handle my symptoms, when you are dealing with what you call illness, you will find yourself caught in a trap, for at the heart of my symptoms there will be this small kernel of night, of falsehood, through which I will confront you with the question of truth. Consequently, I won't deceive you when your knowledge is limited--that would be pure and simple simulation-- but rather, if one day you want really to have a hold on me, you will have to accept the game of truth and falsehood that I ofier you.
Simulation: the whole history of psychiatry can be said to be perme- ated by this problem ol simulation, from the two simulators at Salpetriere in 1821, when it looms up before Georget, one of the leading psychiatrists of the period, until the 1880s and the important episode with Charcot. And when I say this problem, I am not talking about the theoretical problem of simulation, but the processes by which those who were mad actually responded with the question of falsehood to this psychiatric power that refused to pose the question of truth. The untruthfulness of simulation, madness simulating madness, was the anti-power of the mad confronted with psychiatric power.
I think the historical importance of this problem of both simulation and hysteria derives from this. It also enables us to understand the col- lective character of this phenomenon of simulation. We see it emerge around 1821 in the behavior of the two hysterics called "Petronille" and "Braguette. "21 I think these two patients founded an immense historical process in psychiatry; they were imitated in all the asylums in France because ultimately it was their weapon in the struggle with psychiatric power. And with the serious crisis of asylum psychiatry, which broke out at the end of the nineteenth century, around 1880, the problem of truth really was imposed by the mad on psychiatry when, in front of Charcot the great miracle worker, it became evident that all the symp toms he was studying were aroused by him on the basis of his patients' simulation.
I emphasize this history for a number of reasons. The first is that it is not a matter of symptoms. It is often said that hysteria has
? disappeared, or that it was the great illness of the nineteenth century. But it was not the great illness of the nineteenth century; it was, to use medical terminology, a typical asylum syndrome, or a syndrome correl- ative to asylum power or medical power. But I don't even like the word syndrome. It was actually the process by which patients tried to evade psychiatric power; it was a phenomenon of struggle, and not a patho- logical phenomenon. At any rate, that is how I think it should be viewed.
Second, we should not forget that if there was so much simulation within asylums after Braguette and Petronille, this was not only because it was made possible by the coexistence of patients withm the asylums, but also because of sometimes spontaneous and sometimes involuntary, sometimes explicit and sometimes implicit complicity with the patients on the part of the personnel, of warders, asylum doctors, and medical subordinates. We should not forget that Charcot practically never exam ined a single one of these hysterics, and that all his observations, falsi- lied by simulation, were actually given to him by the personnel surrounding the patients, and who, together with the patients, with greater or lesser degrees of complicity, constructed this world of simula- tion as resistance to psychiatric power that, m 1880 at Salpetnere, was incarnated in someone who, precisely, was not even a psychiatrist, but a neurologist, and so someone most able to base himself on the best constituted discourse ol truth.
The trap of falsehood, then, was set for the person who came armed with the highest medical knowledge. So the general phenomenon of simulation in the nineteenth century should be understood not only as a process of the patients' struggle against psychiatric power, but as a process of struggle at the heart of the psychiatric system, of the asylum system. And I think we arrive here at the episode that must be the aim of my course, which is the moment when, precisely, the question of truth, put aside after Pinel and Mason Cox by the disciplinary system ol the asylum and by the type of functioning of psychiatric power, was lorcibly reintroduced through all these processes. *
* The manuscript adds: "We can, then, call antipsychiatry any movement by which the question ol l ruth is put back in play within the relationship between the mad person and the psychiatrist. "
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We may say that psychoanalysis can be interpreted as psychiatry's first great retreat, as the moment when the question of the truth ol what is expressed in the symptoms, or, in any case, the game of truth and lie in the symptom, was forcibly imposed on psychiatric power; the prob- lem being whether psychoanalysis has not responded to this first defeat by setting up a first line of defense. At any rate, credit should not be given to Freud for the first depsychiatrization. We owe the first depsy chiatrization, the first moment that made psychiatric power totter on the question of truth, to this band of simulators. They are the ones who, with their falsehoods, trapped a psychiatric power which, in order to be the agent ol reality, claimed to be the possessor of truth and, within psychiatric practice and cure, refused to pose the question of the truth that madness might contain.
There was what could be called a great simulator's insurrection that spread through the whole of the asylum world in the nineteenth century, and the constant and endlessly rekindled source of which was Salpetnere, an asylum for women. This is why I don't think we can make hysteria, the question ol hysteria, the way in which psychiatrists got bogged down in hysteria in the nineteenth century, a kind of minor scientific error, a sort of epistemological blockage. It is clearly very reas suring to do this, because it makes it possible to write the history ol psychiatry and the birth of psychoanalysis in the same style as the expla nation of Copernicus, Kepler, or Einstein. That is to say, there is a sci entific blockage, an inability to get free from the excessive number oi spheres of the "Ptolemaic" world, or from Maxwell's equations, etcetera. We find secure footing in this scientific knowledge and, starting from this kind of dead-end, see an epistemological break and then the sudden appearance of Copernicus or Einstein. By posing the question in these terms, and by making the history of hysteria the analogon of these kinds of episodes, the history of psychoanalysis can be placed in the calm tradition ol the history of the sciences. However, if, as I would like to do, we make simulation--and so not hysteria--the militant underside ol psychiatric power rather than an epistemological problem of a dead end, if we accept that simulation was the insidious way lor the mad to pose the question of truth forcibly on a psychiatric power that only wanted to impose reality on them, then I think that we could write a
? history of psychiatry that would no longer revolve around psychiatry and its knowledge, but which finally would revolve around the mad.
And you can see that if we take up the history of psychiatry in this way, then it can be seen that what we can call the institutional perspec tive, which poses the problem of whether or not the institution is the site of violence, is in danger of suppressing something. It seems to me that it delineates the historical problem of psychiatry--that is to say, the problem of this power of reality that it was the psychiatrist's task to re-impose and which was trapped by the questioning falsehood of the simulators--in an extraordinarily narrow way.
This is the kind of general background I would like to give to the lollowing lectures. So, next week, I will try to resume this history, which I have suggested to you in a sketchy way, by taking up the problem of how psychiatric power functioned as a surplus-power of reality.
72 December 7973 139
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1. In 1861 the asylum received 1227 insane persons, 561 men and 666 women, divided into 215 paying and 1212 destitute residents. See the work by the asylum's director, Guslave L a b i t t e , De la colonie de Fit^-James, succursale de I'asile prive de Clermont (Oise), considered au
point de vue de son organisation administrative el medicale (Paris: J. B. Bailliere, 1861) p. 15. On the history of the Clermont asylum, see E. J. Woillez, Essai hislorique, descriplif el slatislique sur la maison d'alienes de Clermont (Oise) (Clermont: V. Danicourt, 1839).
2. The Fitz James colony was created in 1847.
3. "In creating the Fitz James colony, first of all we wanted the patients to be in a completely
different environment than that ol Clermont" G. Labitte, De la colonie de Fit^-James, p. 13.
4. In 1861, the larm comprised "170 patients," ibid. p. 15.
5. According to G. Labilte's description: "1. The management section allocated to living
quarters for the director and male residents. 2. The Farm section, where the colonists stay. 3.
The Petit Chateau section, inhabited by resident women. /|. The Bevrel section, occupied by women employed in laundering the linen" ibid. p. 6.
6. "On the larm . . . work in the fields and workshops, looking alter and managing animals and plowing tools, are the remit ol maniacs, monomaniacs and the demented" ibid. p. 15.
7. Ibid.
8. Ibid. p. V\. 9. Ibid.
10. P. Pinel, Traite medico-philosophique, section VI, ? iv: "Essai lente pour guerir une melancolie profonde produile par une cause morale" pp. 233 237; A Treatise on Insanity, "An attempt to cure a case ol melancholia produced by a moral cause" pp. 227i 227.
11. Joseph Mason Cox, Practical Observations on Insanity, Case II, p. 51; Observations sur la de? nence,(^06), p. 77.
12. Ibid. p. 51; ibid. p. 78.
13. Ibid. p. 52; ibid. pp. 78 79.
V\. F. Leuret, Fragments psychologiques sur la folie (Paris: Crochard, 1837|) ch. 2: "Delirium ol
intelligence": "The chair hirer of a Parisian parish, treated by Monsieur Esquirol,. . . said he had bishops in his belly who were holding a council. . . Descartes thought it an established tact that the pineal gland is a mirror which reflected the image ol external bodies . . . Is one of these assertions better proved than the other? " p. 7i3. Leuret is referring to Descartes' analysis of the role ol the pineal gland in the lormation of ideas ol objects which strike the senses: R. Descartes, Traite de VFlomme (Paris: Clerselier, 1667|) in Descartes, CEuvrcs el Lettres, ed. A. Bridoux, pp. 8 5 0 853; English translation, "Treatise on Man," trans. Robert Slootholl, in The Philosophical Writings oj Descartes, trans. John Cottingham, Robert Slootholl, Dugald Murdoch (Cambridge: Cambridge University Press, 1985) vol. 1, p. 106.
15. In this conception, "Judging is the action in which the mind, bringing together dillerent ideas, aflirms ol one that it is the other, or denies ol one that it is the other. This occurs when, for example, having the idea ol the earth and the idea ol round, I affirm or deny ol the earth that it is round" A. Arnauld and P. Nicole, La Logique, ou VArl depenser, contcnanl, outre les regies communes, plusieurs observations nouvelles propres a former le jugemenl ( 1 6 6 2 ) (Paris: Desprez, 1683, 51'1 edition) p. 36; English translation, Logic, or, The art of thinking, trans. J. V. Buroker (Cambridge: Cambridge University Press, 1996) p. 23. See, L. Mann, La Critique du discours. Sur la "Logique de Port-Royal" et les "Pensees de Pascal" ( P a r i s : E d . d e Minuit, 1975) pp. 275 299; and Foucault's comments in Les Mots et let Choses, Part One, "Representer," pp. 72 81; The Order oj Things, pp. 58 67; and, "Introduction" to A. Arnauld and C. Lancelot, Grammaire generale et raisonnee conlenanl lesJondements de Part de
parler expliques d'une maniere claire et nalurelle (Paris: Republications Paulet, 1969),
reprinted in Dits el Ecrits, vol. 1, pp. 732 752.
16. On this theatrical production, see Michel Foucault, Histoirc de lafolie, pp. 350 354; Madness
and Civilisation, pp. 187 191. The second lecture ol the College de France course of 1970 1971, "The Will to Knowledge," speaks of this "theatricalization" of madness as an "ordeal test" which involves "seeing which oi the two, patient or doctor, would keep up the game of truth the longest, all this theater of madness by which the doctor objectively real- ized as it were the patient's delirium and, on the basis ol this feigned truth, reached the patient's truth" (personal notes;J. L. ).
? 17. Whereas paralytic disorders were considered to be intercurrent affections ol the develop ment of dementia or, as Esquirol said, a "complication" of the illness (sec the article " D e m e n c e " in Dictiotmairc des sciences medicates, par unc sociele de medecins et de chirurgiens | Paris: C. L. F. Panckoucke, 1814] vol. VIII, p. 283, and the article "Folie" vol. XVI, 1816), in 1822, Antoine Laurent Jesse Bayle (1799-1858), on the basis of six observations lol lowed by anatomical checks, gathered in the department ol Royer Collard at Salpetnere, identified a morbid entity which, following the anatomical cause to which he attributed it, he called "chronic arachnitis," using the tact that "in all the periods ol the illness, there is a constant relationship between the paralysis and the delirium . . . we therelore could not reluse to accept that these two orders ol phenomena are the symptoms ol a single illness, that is to say of a chronic arachnitis," to which he devotes a first part ol his thesis defended on 21 November 1822 (Recherches sur les maladies mentales, Medical Thesis, Paris, no. 1/|7 [Paris: Didot Jean, 1822j): Recherches sur /'arachnitis chronique, la gastrile, la gaslro-enterite, et la goutle, considerees comme causes de {'alienation menlale (Pans: Gabon, 1822; centenary repub licalion Paris: Masson, 1922) vol. 1, p. 32. Bayle later extended his conception to most men tal tllnesses: "Most mental illnesses are the symptoms of an original chronic phlegmasia ol the 'membranes of the brain' " Traitc des maladies et de scs membranes (Paris: Gabon, 1826) p. xxiv. See also his text, "De la cause orgamque de l'alienation mentale accompagnee de paralysie generale" (read at the Imperial Academy ol Medicine) Annales medico-
psychologiques, 3rJ series, vol. 1,July 1855, pp. 409 425.
18. In the 1820s, a group ol young doctors turned to pathological anatomy on which it tried to graft clinical psychiatry. Felix Voisin set out the programme: "Given the symptoms, how can the seat ol the disease be determined. This is the problem that medicine illuminated by physiology can address today" Des causes morales et physiques des maladies mentales, et de quelcjues aulres afjeclions telles que I'hyslerie, la nymphomanie el le salyriasis ( Paris: J. B. Bailliere, 1826) p. 329. In 1821, two students of Leon Rostan (1791 1866), Achille |de| Foville (1799 1878) and Jean Baptiste Delaye (1789 1879), presented a paper for the Prix Esquirol: "Considerations sur les causes de la folie et de leur mode d'action, suivies de recherches sur la nature et le siege special de cette maladie" (Paris: 1821). On 31 December
1819, Jean Pierre Falret (1794-1870) defended his thesis: Observations et propositions medico-chirurgicales, Medical Thesis, Paris, no. 296 (Paris: Didot, 1919) belore publishing his, De rhypocondrie el du suicide. Considerations sur les causes, sur le siege el le traitemenl du ces maladies, sur les moyens d'en arrctcr les progres et d'en prevoir les developpements ( P a n s : Croullebois, 1822). On 6 December 1823, Falret gave a lecture to the Athenee de Medecine: "Inductions ttrees de Pouverture des corps des alienes pour servir an diagnostic et an traitemenl des maladies mentales" (Paris: Bibliotheque Medicale, 182/|).
In 1830 a debate on the organic causes ol madness was started on the occasion ol the thesis ol one ol Esquirol's students, Etienne Georget (who entered Salpetriere in 1816 and in 1819 won the Prix Esquirol with his paper: "Des ouvertures du corps des alienes") which was defended on 8 February 1820, Dissertation sur les causes de la folie, Medical Thesis, Paris, no. 31 (Pans: Didot Jeune, 1820), and in which he criticizes Pinel and Esquirol lor being satisfied with observation of the phenomena of madness without seeking to connect them to a productive cause. In his work, De lafolie, p. 72, Georget declares: "I must not tear linding mysell in opposition to my teachers . . . by demonstrating that madness is a cerebral
idiopathic allection. "
19. It was Jean Pierre Falret who asserted that, thanks to isolation, "the lamily, in the silence
ol a positive law, overcoming the fear of committing an arbitrary act, and making use of the imprescriptible right of reason over delirium, subscribes to the teachings ol science in order to obtain the benefit of the cure of the insane. " J. -P. Falret, Observations sur le projel de loi relalij aux alienes, presented le 6 Janvier 1837 a la Chambrc des deputes par le ministre de Vlnterieur (Paris: Everal, 1837) p. 6.
20. The problem of simulation was raised in 1800 by P. Pinel who devoted a chapter to it in his Traile medico-philosophique section VI, ? xxii: "Mania simulee; moyens de la reconnoitre" pp. 297 302; A Treatise on Insanity, "Feigned mania: the method of ascertaining it," pp. 282 287. See also, A. Laurent, Etude medico-Iegalc sur la simulation de lafolie. Considerations cliniques et
pratiques a I'usage des medecins experts, des magistrals el desjurisconsulles (Paris: Masson, 1866); H. Bayard, "Memoire sur les maladies simulees," Annales d'hygiene publique et de medecine
72 December 7973 141
? 142
PSYCHIATRIC POWER
21.
legate, lsl series, vol. XXXVIII, 1867, p. 277; E. Boisseau, "Maladies simulees" in A. Dechambre and others, eds. Diclionnaire encyclopedic/ue des sciences medicates, 2,H series, vol. 2 (Paris: Masson/Asselin, 1876) pp. 266-281; G. Tourcles, "Simulation" ibid. pp. 681 715. Charcot dealt with the question on several occasions: ( l ) "Ataxie locomotnce, forme anormale" (20 March 1888) in Lecons du mardi a la Salpelriere. Policlinique 1887-1888, notes of the course of M. Blin,J. Charcot, and H. Colin (Paris: Lecrosnier & Babe, 1889) vol. 1, pp. 281-284; (2) Lecture IX: "De 1'ischurie hyslerique," (1873) in Lecons sur les maladies du systeme nervcux, vol. 1, collected and published by D. M. Bourneville (Pans: Delahaye et Lecroisner, 1884, 5th edition) pp. 281 283; English translation, J. M. Charcot, Clinical Lectures on Diseases of the Nervous System, vol. 1, trans. George Sigerson (London: New Sydcnham Society, 1877) Lecture 10, "Hysterical ischuria" pp. 230-232; (}) Lecture 1: "Lec,on d'ouverture de la chaire de clinique des maladies du systeme nerveux" (23 April 1882), and Lecture XXVI: "Cas du mutisme hystenque chez l'homme," both in Lecons sur les maladies du systeme nerveux, vol. 3, collected and published by Babinski, Bernard, Fere, Guinon, Marie and Gilles de La Tourcttc (1887) (Paris: Lecroisner & Babe, 1890), pp. 17 22 and 452-433; English translation, J. M. Charcot, Clinical Lectures on Diseases of the Nervous System, trans. Thomas Savill (London and New York: Tavistock/Routledge, 1991) vol. 3, Lecture I, "Introductory," pp. 14 19, and Lecture 26, "A Case ot Hysterical Mutism in a man," pp. 368 570.
In 1821, at Salpetnere, Etienne Georget, attracted by the experiments conducted by the Baron Jules Dupotet de Sennevoy in October 1820 at the Hotel Dieu in the department ol Hussun, with the help of Leon Rostan, converted two patients into somnambulistic experimental subjects: Petronille and Manoury, the widow Brouillard, called "Braguette. " See A. Dechambre, "Nouvelles experiences sur le magnetisme animal" Gazette medicale de Paris, 12 September 1835, p. 585- Georget reports these experiments, without revealing the identity ol the patients, in De la physiologie du systeme nerveux, et specialement du ccrveau, vol. 1, ch. 3: "Somnambulisme magnetique" (Paris:J. B. Bailliere, 1821) p. 404. See also, A. Gauthier, Histoire du somnambulisme: che^ tous les peuples, sous les noms divers d'extases, songes, oracles, visions, etc. (Paris: F. Maltese, 1842) vol. 2, p. 324; A.
