*
In actual fact, we should show, rather, that what is essential is not the institution with its regularity, with its rules, but precisely the imbalances of power that I have tried to show both distort the asylum's regularity and, at the same time, make it function.
In actual fact, we should show, rather, that what is essential is not the institution with its regularity, with its rules, but precisely the imbalances of power that I have tried to show both distort the asylum's regularity and, at the same time, make it function.
Foucault-Psychiatric-Power-1973-74
From "violence" to the "microphysics of power"; 3.
From "institutional regularities" to the "arrangements" of power.
THE TOPIC I PROPOSE to present this year, psychiatric power, is slightly, but not completely, different from the topics I have spoken to you about over the last two years.
I will begin by trying to describe a kind of fictional scene in the following familiar, recognizable setting:
"I would like these homes to be built in sacred forests, in steep and isolated spots, in the midst of great disorder, like at the Grande- Chartreuse, etcetera. Also, before the newcomer arrives at his destina- tion, it would be a good idea if he were to be brought down by machines, be taken through ever new and more amazing places, and if the officials of these places were to wear distinctive costumes. The romantic is suit- able here, and I have often said to mysell that we could make use of those old castles built over caverns that pass through a hill and open out onto a pleasant little valley. . . Phantasmagoria and other resources of physics, music, water, flashes of lightning, thunder, etcetera would be
? 2 PSYCHIA TRIC POWER
used in turn and, very likely, not without some success on the common man. "1
This is not the castle of Cent vingtJournees. 1 It is a castle in which many more, an almost infinite number of days will be passed; it is Fodere's description, in 1817, of an ideal asylum. What will take place in this set ting? Well, of course, order reigns, the law, and power reigns. Here, in this castle protected by this romantic, alpine setting, which is only accessible by means of complicated machines, and whose very appear- ance must amaze the common man, an order reigns in the simple sense of a never ending, permanent regulation of time, activities, and actions; an order which surrounds, penetrates, and works on bodies, applies itself to their surfaces, but which equally imprints itself on the nerves and what someone called "the soft fibers of the brain. "3 An order, there- fore, for which bodies are only surfaces to be penetrated and volumes to be worked on, an order which is like a great nervure of prescriptions, such that bodies are invaded and run through by order.
"One should not be greatly surprised," Pinel writes, "at the great importance I attach to maintaining calm and order in a home for the insane, and to the physical and moral qualities that such supervision requires, since this is one of the fundamental bases of the treatment of mania, and without it we will obtain neither exact observations nor a per manent cure, however we insist on the most highly praised medicaments. "7'
That is to say, you can see that a certain degree of order, a degree discipline, and regularity, reaching inside the body, are necessary for two things.
On the one hand, they are necessary for the very constitution of medical knowledge, since exact observation is not possible without this discipline, without this order, without this prescriptive schema of regularities. The condition of the medical gaze (regard medkale), of its neutrality, and the possibility of it gaining access to the object, in short, the effective condition of possibility of the relationship of objectivity, which is constitutive ol medical knowledge and the criterion of its validity, is a relationship of order, a distribution of time, space, and
? individuals. In actual fact, and I will come back to this elsewhere, we cannot even say of "individuals"; let's just say a certain distribution of bodies, actions, behavior, and of discourses. It is in this well-ordered dispersion that we find the field on the basis of which something like the relationship of the medical gaze to its object, the relationship of objectivity, is possible--a relationship which appears as the effect of the first dispersion constituted by the disciplinary order. Secondly, this discipli- nary order, which appears in PinePs text as the condition for exact obser- vation, is at the same time the condition for permanent cure. That is to say, the therapeutic process itself, the transformation on the basis of which someone who is considered to be ill ceases to be so, can only be produced within this regulated distribution of power. The condition, therefore, of the relationship to the object and of the objectivity of medical knowledge, and the condition of the therapeutic process, are the same: disciplinary order. But this kind of immanent order, which covers the entire space of the asylum, is in reality thoroughly permeated and entirely sustained by a dissymmetry that attaches it imperiously to a single authority which is both internal to the asylum and the point from which the disciplinary distribution and dispersion of time, bodies, actions, and behavior, is determined. This authority within the asylum is, at the same time, endowed with unlimited power, which nothing must or can resist. This inaccessible authority without symmetry or reciprocity, which thus func- tions as the source of power, as the factor of the order's essential dissym- metry, and which determines that this order always derives from a non reciprocal relationship of power, is obviously medical authority, which, as you will see, functions as power well before it functions as knowledge.
Because, what is the doctor? Well, there he is, the one who appears when the patient has been brought to the asylum by these surprising machines I was just talking about. I know that this is all a fictional description, in the sense that I have not constructed it on the basis of texts coming from a single psychiatrist; if I had used only the texts of a single psychiatrist, the demonstration would not be valid. I have used Fodere's Traite du delire, PinePs Traite medico-philosophique on mania, EsquiroPs collected articles in Des maladies mentales? and Haslam. 6
So, how then does this authority without symmetry or limit, which permeates and drives the universal order of the asylum, appear? This is
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how it appears in Fodere's text, Traite du delire from 1817, that is at that great, prolific moment in the protohistory of eighteenth century psychiatry--EsquiroPs great text appears in 18187--the moment when psychiatric knowledge is both inserted within the medical field and assumes its autonomy as a specialty. "Generally speaking, perhaps one of the first conditions of success in our profession is a fine, that is to say noble and manly physique; it is especially indispensable for impressing the mad. Dark hair, or hair whitened by age, lively eyes, a proud bearing, limbs and chest announcing strength and health, prominent features, and a strong and expressive voice are the forms that generally have a great effect on individuals who think they are superior to everyone else. The mind undoubtedly regulates the body, but this is not apparent to begin with and external forms are needed to lead the multitude. "8
So, as you can see, the figure himself must function at first sight. But, in this first sight, which is the basis on which the psychiatric relation ship is built, the doctor is essentially a body, and more exactly he is a quite particular physique, a characterization, a morphology, in which there are the full muscles, the broad chest, the color of the hair, and so on. And this physical presence, with these qualities, which functions as the clause of absolute dissymmetry in the regular order of the asylum, is what determines that the asylum is not, as the psycho-sociologists would say, a rule governed institution; in reality it is a field polarized in terms of an essential dissymmetry of power, which thus assumes its form, its figure, and its physical inscription in the doctor's body itself.
But, of course, the doctor's power is not the only power exercised, for in the asylum, as everywhere else, power is never something that someone possesses, any more than it is something that emanates from someone. Power does not belong to anyone or even to a group; there is only power because there is dispersion, relays, networks, reciprocal supports, differ- ences of potential, discrepancies, etcetera. It is in this system of differences, which have to be analyzed, that power can start to function.
There is, then, a whole series of relays around the doctor, the main ones being the following. First of all there are the supervisors, to whom Fodere reserves the task of informing on the patients, of being the unarmed, inexpert gaze, the kind of optical canal through which the learned gaze, that is to say the objective gaze of the psychiatrist himself,
? will be exercised. This relayed gaze, ensured by the supervisors, must also take in the servants, that is to say those who hold the last link in the chain of authority. The supervisor, therefore, is both the master of the last masters and the one whose discourse, gaze, observations and reports must make possible the constitution of medical knowledge. What are supervisors? What must they be? "In a supervisor of the insane it is necessary to look for a well proportioned physical stature, strong and vigorous muscles, a proud and intrepid bearing for certain occasions, a voice with a striking tone when needed. In addition, he must have the strictest integrity, pure moral standards, and a firmness compatible with gentle and persuasive forms ( . . . ) and he must be absolutely obedient to the doctor's orders. "9
The final stage--I skip some of the relays--is constituted by the servants, who hold a very odd power. Actually, the servant is the last relay of the net- work, of this difference in potential that permeates the asylum on the basis of the doctor's power; he is therefore the power below. But he is not just below because he is at the bottom of the hierarchy; he is also below because he must be below the patient. It is not so much the supervisors above him that he must serve, but the patients themselves; but m this position he must really only pretend to serve them. The servants apparently obey the patients' orders and give them material assistance, but they do so m such a way that, on the one hand, the patients' behavior can be observed from behind, underhand, at the level of the orders they may give, instead of being observed from above, as by the supervisors and the doctor. In a way, the ser- vants will thus set up the patients, and observe them at the level of their daily life and from the side of their exercise of will and their desires; and they will report anything worth noting to the supervisor, who will report it to the doctor. At the same time, when the patient gives orders that must not be carried out, the servant's task--while feigning to be at the patient's ser- vice, to obey him and so seeming not to have an autonomous will--must be to not do what the patient requests, and to appeal to the great anonymous authority of the rules or to the doctor's particular will. As a result, the patient who is set up by the servant's observation will find himself out flanked by the doctor's will that he rediscovers when he gives the servant orders, and the patient's encirclement by the doctor's will or by the general regulation of the asylum will be ensured through this pretence of service.
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Here is the description of the servants in this scenario:
u ? 398. The servants or warders selected must be big, strong, honest, intelligent, and clean, both personally and in their habits. In order to handle the extreme sensitivity of some of the insane, especially on points of honor, it would almost always be better for the servants to seem to them to be their domestic servants rather than their warders (. . . )? However, since they must not obey the mad, and often are even forced to suppress them, to reconcile the idea of being a servant with a refusal to obey, and to avoid any discord, the supervisor's task will be to insinuate cleverly to the patients that those serving them have been given certain instructions and orders by the doctor, which they cannot exceed without being given direct permission. "10
So, you have this system of power functioning within the asylum and distorting the general regulative system, a system of power which is secured by a multiplicity, a dispersion, a system of differences and hier- archies, but even more precisely by what could be called a tactical arrangement in which different individuals occupy a definite place and ensure a number of precise functions. You have therefore a tactical func- tioning of power or, rather, it is this tactical arrangement that enables power to be exercised.
If you go back to what Pinel himself said about the possibility of observation in an asylum, you can see that this observation, which ensures the objectivity and truth of psychiatric discourse, is only possi- ble through a relatively complex tactical arrangement; I say "relatively complex," because what I have just said is still very schematic. But, in fact, if there really is this tactical deployment and so many precautions have to be taken to arrive at something that is, after all, as simple as observation, it is probably because within the asylums field of regula tions there is something, a force, that is dangerous. For power to be deployed with all this cunning, or rather, for the asylum's regulated uni- verse to be so obsessed with these kind of relays of power, which falsify and distort this universe, then it is highly likely that at the very heart of this space there is a threatening power to be mastered or defeated.
In other words, if we end up with this kind of tactical arrangement, it is because before the problem being one of knowledge, or rather, for the problem to be able to be one of knowledge, of the truth of the
? illness, and of its cure, it must first of all be one of victory. So what is organized in the asylum is actually a battlefield.
Obviously it is the mad person who is to be brought under control. I have just quoted the odd definition of the mad person given by Fodere, who said that he is someone who thinks he is "superior to everyone else. "11 In actual fact, this really is how the madman makes his appearance in psychiatric discourse and practice at the start of the nineteenth century, and it is there that we find the great turning point, the great division that I have already spoken about, which is the disappearance of the criterion of error in the definition of madness or in the ascription of madness.
Broadly speaking, until the end of the eighteenth century--and even m police reports, lettres de cachet, interrogations, etcetera, concerning individu- als in places like Bicetre and Charenton--to say that someone was mad, to ascribe madness to him, was always to say that he was mistaken, and to say in what respect, on what point, in what way, and within what limits he was mistaken; madness was basically characterized by its system of belief. Now, very suddenly, at the beginning of the nineteenth century, a criterion appears for recognizing and ascribing madness which is absolutely differ- ent and which is--I was going to say, the will, but that is not exactly right-- in fact, at the start of the nineteenth century, we can say that what characterizes the madman, that by which one ascribes madness to him, is the insurrection of a force, of a furiously raging, uncontrolled and possibly uncontrollable force within him, which takes four major forms according to the domain it affects and the field in which it wreaks its devastation.
There is the pure force of the individual who traditionally is said to be "raving" (furieux).
There is the force inasmuch as it affects the instincts and passions, the force of unbridled instincts and unlimited passions. This will character- ize a madness that, precisely, is not one of error, which does not include illusion of the senses, false belief, or hallucination, and which is called mania without delirium.
Third, there is a sort of madness that affects ideas themselves, dis- rupts them, makes them incoherent, and brings them into conflict with each other. This is called mania.
Finally, there is the force ol madness that no longer affects the general domain of ideas, disrupting them all and bringing them into conflict
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with each other, but which affects one particular idea that is thus indef initely strengthened and stubbornly lodged in the patient's behavior, discourse, and mind. This is called either melancholy or monomania.
And the first major distribution of this asylum practice at the beginning of the nineteenth century exactly retranscribes what is taking place within the asylum itself, that is to say, the fact that it is no longer a ques- tion of recognizing the madman's error, but of situating very precisely the point where the wild force of the madness unleashes its insurrection: What is the point, what is the domain, with regard to which the force will explode and make its appearance, completely disrupting the individual's behavior?
Consequently, the tactic of the asylum in general and, more partial larly, the individual tactic applied by the doctor to this or that patient within the general framework of this system of power, will and must be adjusted to the characterization, to the localization, to the domain of application of this explosion and raging outburst of force. So that if the great, unbridled force of madness really is the target of the asylum tactics, if it really is the adversary of these tactics, what else can cure be but the submission of this force? And so we find in Pinel this very sim- ple but, I think, fundamental definition of psychiatric therapeutics, a definition that, notwithstanding its crudity and barbaric character, is not found prior to this period. The therapeutics of madness is uthe art of, as it were, subjugating and taming the lunatic by making him strictly dependent on a man who, by his physical and moral qualities, is able to exercise an irresistible influence on him and alter the vicious chain of his ideas. "12
I have the impression that this definition given by Pinel of the therapeutic process cuts across all that I have been saying to you. First of all, with regard to the principle of the patient's strict dependence in relation to a certain power: This power can be embodied in one and only one man who exercises it not so much in terms of and on the basis of a knowledge, as in terms of the physical and moral qualities that enable him to exercise an influence that can have no limit, an irresistible influence. And it is starting from this that it becomes possible to change the vicious chain of ideas; it is on the basis of this moral orthopedics, if you like, that cure is possible. And finally, that is why, in this proto-psychiatric
? practice, the basic therapeutic action takes the form of scenes and a battle.
Two types of intervention are very clearly distinguished in the psychiatry of this period. During the first third of the nineteenth century, one of these is regularly and continually discredited: specifically medical, or medicinal, practice. The other, first defined by the English, by Haslam in particular, and then very quickly taken up in France, is the development of the practice called "moral treatment. "13
This moral treatment is not at all, as one might think, a sort of long- term process whose first and last function would be to bring to light the truth of the madness, to be able to observe it, describe it, diagnose it, and, on that basis, to define the therapy. The therapeutic process formu lated between 1810 and 1830 is a scene, a scene of confrontation. This scene of confrontation may present two aspects. The first is, if you like, incomplete, and is like a process of wearing down, of testing, which is not carried out by the doctor--for the doctor himself must obviously be sovereign--but by the supervisor.
Here is an example of this first outline of the great scene, given by Pinel in his Traite medico-philosophique.
Faced with a raving lunatic, the supervisor "advances towards the lunatic with an intrepid air, but slowly and gradually, and to avoid exasperating him he does not carry any kind of weapon. As he advances he speaks to him in the firmest, most threatening tone and, with calm warnings, continues to fix the lunatic's attention on himself so as to hide what is going on around him. He gives precise and imperious orders to obey and to surrender. Somewhat disconcerted by the super- visor's overbearing manner, the lunatic loses every other object from view and, at a signal, is suddenly surrounded by assistants, whom he had not noticed slowly advancing on him. Each grabs hold of one of the lunatic's limbs, one an arm, the other a thigh or a leg. "14
Pinel gives further advice on the use of certain instruments, like the "semicircular piece of iron" fixed to the end of a pole, for example. When the lunatic's attention is captured by the supervisor's haughty demeanor and is fixed on him so that he is unaware of anyone else approaching him, this kind of lance with a semicircular end is used to pin him to the wall and overpower him. This is, if you like, the
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imperfect scene, the one reserved for the supervisor, and which consists in breaking the wild force of the lunatic with this kind of cunning and sudden violence.
However, it is obvious that this is not the major scene of the cure. The cure scene is complex. Here is a famous example from PinePs Traite medico-philosophique. It involves a young man "dominated by religious prejudices" who thought that for his salvation he had "to imitate the abstinence and mortifications of the old anchorites," that is to say, to refuse not only all the pleasures of the flesh, of course, but also all food. And then one day, with more than his usual firmness, he refuses a soup he is served. "In the evening, citizen Pussin appears at the door of his chamber in a frightening get up [in the sense of classical theater, of course; M. F. J, with fiery eyes and a striking voice, and accompanied by a group of assistants close by who are armed with strong chains that they shake noisily. The soup is placed by the lunatic who is given the most precise instruction to take it during the night if he does not wish to incur the most cruel treatment. They withdraw and leave him in the most painful state, wavering between the idea of the threatened punish- ment and the terrifying perspective of the other life. After an inner struggle of several hours, the first idea wins out and he decides to take his food. He is then subjected to a suitable diet for his recovery; sleep and strength return by degrees, as also the use of reason, and in this way he avoids a certain death. During his convalescence he often confessed to me the cruel agitation and confusion he suffered during the night of his ordeal. "15 We have here, I think, a scene that is very important in its general morphology.
First, you can see that the therapeutic operation does not take place by way of the doctors recognition of the causes of the illness. The doctor does not require any work of diagnosis or nosography, any discourse of truth, for the success of his operation.
Second, it is an important operation because in this and similar cases, as you see, there is no application of a technical medical formula to something seen as a pathological process of behavior. What is involved is the confrontation of two wills, that of the doctor and those who represent him on the one hand, and then that of the patient. What is established, therefore, is a battle, a relationship of force.
? Third, the primary elfect of this relationship ot force is to provoke a second relationship of force, within the patient as it were, since it involves provoking a conflict between the fixed idea to which the patient is attached and the lear of punishment: one struggle provokes another. And, when the scene succeeds, there must be a victory in both struggles, the victory of one idea over another, which must be at the same time the victory ol the doctor's will over the patient's will.
Fourth, what is important in this scene is that there is indeed a moment when the truth comes out. This is when the patient recognizes that his belief in the necessity of fasting to ensure his salvation was erro- neous and delirious, when he recognizes what has taken place, when he confesses his experience of wavering, hesitations, and torments, etcetera. In short, in this scene in which, hitherto, the truth was not involved, it is the patient's own account that constitutes the moment when the truth blazes lorth.
Finally, the process of the cure is effectuated, accomplished, and sealed when truth has been acquired through confession in this way, in the effective moment of confession, and not by piecing together a med- ical knowledge.
So there is a distribution of force, power, the event, and truth here, which is unlike anything in what could be called the medical model being constructed in clinical medicine in the same period. We can say that the clinical medicine of this time put together an epistemological model of medical truth, observation, and objectivity that will make possible the real insertion of medicine within a domain of scientific discourse where, with its own modalities, it will join physiology and biology, etcetera. In the period 1800 to 1830 I think something takes place that is quite different from what is usually thought to have occurred. It seems to me that what happened in these thirty years is usually interpreted as the moment when psychiatry was finally inserted within a medical practice and knowledge to which previously it had been relatively foreign. It is usually thought that at that moment psychi- atry appeared for the first time as a specialty within the medical domain.
Leaving aside for the moment the problem of why in fact such a prac lice could be seen as a medical practice, and why the people who carried
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out these operations had to be doctors, it seems to me that, in its morphology, in its general deployment, the medical operation of the cure performed by those whom we think of as the founders of psychia try has practically nothing to do with what was then becoming the experience, observation, diagnostic activity, and therapeutic process of medicine. At this level of the cure, of this event, the psychiatric scene and procedure are, I believe, from that moment, absolutely irreducible to what was taking place in medicine in the same period.
It is this heterogeneity then that will mark the history of psychiatry at the very moment at which it is founded within a system of institu- tions that nevertheless connect it to medicine. For all of this, this stag ing, the organization of the asylum space, the activating and unfolding of these scenes, are only possible, accepted and institutionalized within establishments that are being given a medical status at this time, and by people who are medically qualified.
We have here, if you like, a first set of problems. This is the point of departure for what I would like to study a little this year. Actually, it is roughly the point reached by my earlier work, Histoire de lafolk, or, at any rate, the point where it broke off. 16 I would like to take things up again at this point, except with some differences. It seems to me that in that work, which I take as a reference point because it is a kind of "background"* for me, for the work I am doing now, there were a num- ber of things that were entirely open to criticism, especially in the final chapter in which I ended up precisely at asylum power.
First of all, I think it was still an analysis of representations. It seems to me that, above all, I was trying to study the image of madness pro- duced in the seventeenth and eighteenth centuries, the fear it aroused, and the knowledge formed with reference to it, either traditionally, or according to botanical, naturalistic, and medical models, etcetera. It was this core of representations, of both traditional and non-traditional images, fantasies, and knowledge, this kind of core of representations
* English in original; G. B.
? that I situated as the point of departure, as the site of origin of the prac- tices concerning madness that managed to establish themselves in the seventeenth and eighteenth centuries. In short, I accorded a privileged role to what could be called the perception of madness. 17
Here, in this second volume, I would like to see if it is possible to make a radically different analysis and if, instead of starting from the analysis of this kind of representational core, which inevitably refers to a history of mentalities, of thought, we could start from an apparatus (^dispositij^)of power. That is to say, to what extent can an apparatus of power produce statements, discourses and, consequently, all the forms of representation that may then \. . . ]* derive from it.
The apparatus of power as a productive instance of discursive practice. In this respect, in comparison with what I call archeology, the discursive analysis of power would operate at a level--I am not very happy with the word "fundamental"--let's say at a level that would enable discursive practice to be grasped at precisely the point where it is formed. To what should we refer this formation of discursive practice, where should we look for it?
If we look for the relationship between discursive practice and, let's say, economic structures, relations of production, I do not think we can avoid recourse to something like representation, the subject, and so on, appealing to a ready made psychology and philosophy. The problem for me is this: Basically, are not apparatuses of power, with all that remains enigmatic and still to be explored in this word "power," precisely the point from which it should be possible to locate the formation of dis- cursive practices. How can this deployment of power, these tactics and strategies of power, give rise to assertions, negations, experiments, and theories, in short to a game of truth? Apparatus of power and game of truth, apparatus of power and discourse of truth: This is what I would like to examine a little this year, starting from the point I have referred to, that is to say, psychiatry and madness.
The second criticism I have of that final chapter is that I appealed-- but, after all, I cannot say I did so very consciously, because I was very ignorant of antipsychiatry and especially of the psycho-sociology of the
* (Recording:) be formed from it and
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time--I appealed, implicitly or explicitly, to three notions that seem to me to be rusty locks with which we cannot get very far.
First, the notion of violence. 18 What actually struck me when I was reading Pinel, Esquirol, and others, is that contrary to what the hagiographies say, Pinel, Esquirol, and the others appealed strongly to physical force, and consequently it seemed to me that one could not ascribe PinePs relorm to a humanism, because his entire practice was still permeated by something like violence.
Now, if it is true that we cannot in fact ascribe Pinel's reform to humanism, I do not think this is because he resorted to violence. When in fact we speak of violence, and this is what bothers me about the notion, we always have in mind a kind of connotation ol physical power, of an unregulated, passionate power, an unbridled power, il I can put it like that. This notion seems to me to be dangerous because, on the one hand, picking out a power that is physical, unregulated, etcetera, allows one to think that good power, or just simply power, power not perme ated by violence, is not physical power. It seems to me rather that what is essential in all power is that ultimately its point of application is always the body. All power is physical, and there is a direct connection between the body and political power.
Then again, violence does not seem to me to be a very satisfactory notion, because it allows one to think that the physical exercise of an unbalanced force is not part of a rational, calculated, and controlled game of the exercise of power. Now the examples I have just given clearly prove that power as it is exercised in the asylum is a meticulous, calculated power, the tactics and strategies of which are absolutely definite; and, at the very heart of these strategies, we see quite precisely the place and role of violence, if we call violence the physical exercise of a com pletely unbalanced force. Taken in its final ramifications, at its capillary level, where it affects the individual himself, this power is physical and, thereby, it is violent, in the sense that it is absolutely irregular, not in the sense that it is unbridled, but in the sense, rather, that it is commanded by all the dispositions of a kind of microphysics of bodies.
The second notion to which I referred, and, I think, not very satisfacto- rily, is that of the institution. 19 It seemed to me that we could say that from the beginning of the nineteenth century psychiatric knowledge took
? the forms and dimensions we know in close connection with what could be called the institutionalization of psychiatry; even more precisely, it took these forms and dimensions in connection with a number of institutions of which the asylum was the most important. Now I no longer think that the institution is very satisfactory notion. It seems to me that it harbors a number of dangers, because as soon as we talk about institutions we are basically talking about both individuals and the group, we take the indi- vidual, the group, and the rules which govern them as given, and as a result we can throw in all the psychological or sociological discourses.
*
In actual fact, we should show, rather, that what is essential is not the institution with its regularity, with its rules, but precisely the imbalances of power that I have tried to show both distort the asylum's regularity and, at the same time, make it function. What is important therefore is not institutional regularities, but much more the practical dispositions of power, the characteristic networks, currents, relays, points of support, and differences of potential that characterize a form of power, which are, I think, constitutive of, precisely, both the individual and the group.
It seems to me that that insofar as power is a procedure of individu- alization, the individual is only the effect of power. And it is on the basis of this network of power, functioning in its differences of potential, in its discrepancies, that something like the individual, the group, the community, and the institution appear. In other words, before tackling institutions, we have to deal with the relations of force in these tactical arrangements that permeate institutions.
Finally, the third notion I referred to in order to explain the functioning of the asylum at the start of nineteenth century is the family, and I tried to show roughly how the violence of Pinel [or] Esquirol was their introduction of the family model into the asylum institution. 20 Now I do not think that "violence" is the right word, or that we should situate our analysis at the level of the "institution," and I do not think that we should talk of the family. At any rate, re-reading Pinel, Esquirol, Fodere, and others, in the end I found very little use of this family model. It is not true that the doctor tries to reactivate the image or
* The manuscript adds: "The institution neutralizes relations of force, or it only makes them function within the space it defines. "
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figure of the father within the space of the asylum; I think this takes place much later, even at the end of what could be called the psychiatric episode in the history of medicine, that is to say only m the twentieth century.
It is not the family, neither is it the State apparatus, and I think it would be equally false to say, as it often is, that asylum practice, psychiatric power, does no more than reproduce the family to the advantage of, or on the demand of, a form of State control organized by a State apparatus. 21 The State apparatus cannot serve as the basis,* and the family cannot serve as the model, [. . . '] for the relations of power that we can identify within psychiatric practice.
In doing without these notions and these models, that is to say, the family model, the norm, if you like, of the State apparatus, the notion of the institution, and the notion of violence, I think the problem that arises is that of analyzing these relations of power peculiar to psychiatric practice insofar as--and this will be the object of the course--they pro- duce statements that are given as valid, justified statements. Rather, therefore, than speak of violence, I would prefer to speak of a micro- physics of power; rather than speak of the institution, I would much prefer to try to see what tactics are put to work in these forces which confront each other; rather than speak of the family model or "State apparatus," I would like to try to see the strategy of these relations of power and confrontations which unfold within psychiatric practice.
You will say that it is all very well to have substituted a microphysics of power for violence, tactics for institution, strategy for the model of the family, but have I really made an advance? I have avoided terms that would allow the introduction of a psycho-sociological vocabulary into all these analyses, and now I am faced with a pseudo-military vocabu- lary which is not much better. Nevertheless, we will try to see what we can do with it. *
* The manuscript specifies: "We cannot use the notion of State apparatus because it is much too broad, much too abstract to designate these immediate, tiny, capillary powers that are exerted on the body, behavior, actions, and time of individuals. The State apparatus does not take this microphysics of power into account. "
1 (Recording:) for what takes place
f The manuscript (pages 11-23) continues on the question of defining the current problem of psychiatry and puts forward an analysis ol antipsychiatry.
? 1. Francois Emmanuel Fodere (1764-1835), Traite du delire, applique a la medecine, a la morale et a la legislation (Paris: Croullebois, 1817), Vol. 2, section VI, ch. 2: "Plan et distribution d'un hospice pour la guerison des alienes," p. 215.
2. Donatien Alphonse Francois de Sade (1740 1814), Les Cent vingt Journees de Sodome, ou I'Ecole du libertinage (1785), in (Euvres completes (Paris: Jean Jacques Pauvert, 1967), vol. 26; English translation in Marquis de Sade, The 120 days of Sodom and other writings, trans. Austryn Wainhouse and Richard Seaver (New York: Grove Press, 1966).
3. Joseph Michel Antoine Servan (1737-1807), Discours sur Vadministration de la justice criminelle, delivered by Monsieur Servan (Geneva: 1767), p. 35: "The unshakeable basis of the most solid empires is founded on the soft fibers of the brain. " (Republished in C. Beccana, Traite des delits et des peines, trans. P. J. Dufey [Paris: Dulibon, 1821]).
4. Philippe Pinel (1745 1826), Traite medico-philosophique sur Valienalion mentale, ou la Manie (Paris: Richard, Caille and Ravier, Year 9/1801), section II, "Traitement moral des alienes," ? xxiii: "Necessite d'entretenir un ordre constant dans les hospices des alienes," pp. 95 96; abridged English translation of original, 1801 edition [omitting Pinel's intro- duction and material added in longer French 1809 edition; G. B. ], A Treatise on Insanity, trans. B. B. Davis (New York: Hafner, 1962), section II: "The Moral Treatment of Insanity"; "The necessity of maintaining constant order in lunatic asylums, and of studying the varieties of character exhibited by the patients," p. 99-
5. Jean Etienne Dominique Esquirol (1772 1807), Des maladies mentales considerees sous les rapports medical, hygienique et medico-legal, 2 volumes (Paris: J. B. Bailliere, 1838). Abridged English translation and with additions by the translator, Menial Maladies. A Treatise on Insanity, trans. E. K. Hunt (Philadelphia: Lea and Blanchard, 1845) |Hunt says, p. vi: "All that portion of this Treatise, relating properly to insanity, has been published entire; the remainder, referring, for the most part, to the statistics and hygiene ol establishments for
the insane, together with the medico-legal relations of the subject, have been omitted";
G. B. ].
6. John Haslam (1764 1844), Observations on Insanity, with Practical Remarks on the Disease, and
an Account oj the Morbid Appearances of Dissection (London: Rivington, 1798), republished in an expanded edition under the title, Madness and Melancholy (London:J. Callow, 1809); and, Considerations on the Moral Management of Insane Persons (London: R. Hunter, 1817).
7. J. E. D. Esquirol, Des etablissements consacres aux alienes en France, et des moyens d'ameliorer le sort de ces infortunes (Report to the Minister of the Interior, September 1818), printed by Mme. Huzard, 1819. Reprinted in Des maladies mentales, vol. 2, pp. 399 431.
8. F. E. Fodere, Traite du delire, vol. 2, section 6, ch. 3, "Du choix des administrateurs, des medians, des employes et des servants," pp. 230-231.
9. Ibid. p. 237.
10. Ibid. pp. 241 242.
11. Ibid. p. 230.
12. P. Pmel, Traite medico-philosophique, section II, ? vi: "Avantages de l'art de dinger les alienes
pour seconder les effets des medicaments," p. 58; A Treatise on Insanity, pp. 59 60.
13. "Moral treatment," which develops at the end of the eighteenth century, brings together all the means of acting on the patient's psyche, as opposed to "physical treatment," which acts on the body through remedies and means of constraint. Following the death in 1791 of the wife of a Quaker, in suspicious circumstances at the York asylum, William Tiike (1732 1822) proposed the creation of an establishment for members of the Society of
Friends affected by mental disorders. The Retreat opened on 11 May 1796 (see below, lee ture of 5 December 1973, note 18). John Haslam, the apothecary at Bethlehem hospital, before becoming a medical doctor in 1816, developed principles of moral treatment in his works (see above, this lecture, note 6). In France, Pinel took up the principle in his "Observations sur le regime moral que est le plus propre a retablir, dans certains cas, la raison egaree des maniaques," Gazette de sante, no. 4, 1789, pp. 13-15, and in his report, "Recherches et observations sur le traitement moral des alienes," Memoires de la Societe medicale d'emulation. Section Medicine, no. 2,1798, pp. 215-255, republished with some changes in Traite medico-philosophique, section II, pp. 46-105. Etienne Jean Georget (1795 1828) systematized the principles in De la folie. Considerations sur cette maladie: son siege et ses
7 November 1973 17
? 18 PSYCHIATRIC POWER
symptomes, la nature et la mode d'action de ses causes; sa marche et ses terminaisons; les differences qui la distinguent du delire aigu; les moyens du traitement qui lui conviennent; suivies de recherches cadaveriques (Paris: Crevot, 1820). Francois Leuret emphasizes the doctor-patient relation ship; see, Du traitement moral de lafolie (Paris: J. B. Bailliere, 1840). See the pages devoted to moral treatment in M. Foucault, Histoire de lafolie a Vage classique (Paris: Gallimard, 1972), Part 3, ch. 4: "Naissance de I'asile" pp. 484 487, 492 496, 501 511, 523 527; Abridged English translation, Madness and Civilisation. A History of Insanity in the Age of Reason,trans. R. Howard (New York: Random House, 1965 and London: Tavistock, 1967) pp. 243 255, 269-274 (pages 484 500 of the French edition are omitted from the English translation). See also, R. Castel, "Le traitement moral. Therapeutique mentale et controle sociale au XIXC siecle," Topique, no. 2, February 1970, pp. 109 129.
14. P. Pinel, Traile medico-philosophique, Section II, ? xxi: "Caractere des alienes les plus violents et dangereux, et expediens a prendre pour les reprimer" pp. 9 0 91; A Treatise on Insanity, "The most violent and dangerous maniacs described, with expedients for their repression" pp. 93-94.
15. Ibid. Section II, ? viii: "Avantage d'ebranler fortement I'imagination d'un aliene dans certains cas" pp. 6 0 61; English, ibid. "The advantages of restraint upon the imagination of maniacs illustrated" pp. 61 63.
16. M. Foucault, Folie et Deraison. Histoire de lafolie a Vage classique (Paris: Plon, 1961); Madness and Civilisation. [Apart from in this note, the French editor always relers to the 1972, Gallimard edition, Histoire de lafolie, as above in note 13; G. B. J
17. For example, Histoire de lafolie, Part 1, ch. 5, "Les insenses" p. 169 and p. 172; Part 2, ch. 1, "Le fou au jardin des especes" p. 223; and Part 3, ch. 2, "Le nouveau partage" p. 407 and p. 415; Madness and Civilisation, ch. 3, "The insane" p. 77 and pp. 80-81 (pages 223, 407, and 415 of French edition are omitted (rom the English translation). The point of depar lure for this criticism of the notion of "perception" or "experience" is L'Archeologie du savoir (Paris: Gallimard, 1969), ch. 3, "La formation des objets" and ch. 4, "La formation des modahtes enonciatives" pp. 55 74; English translation, The Archeology oj Knowledge, trans. A. Sheridan (London: Tavistock and New York: Pantheon, 1972), Part II, ch. 3, "The formation of objects" and ch. 4, "The formation of enunciative modalities" pp. 40 55.
18. The notion of violence underlies the analysis of the mode of treatment in Histoire de lafolie, Part 2, ch. 4, "Medecins et malades" pp. 327-328 and p. 358, and Part 3, ch. 4, "Naissance de I'asile" p. 497, pp. 502 503, p. 508, and p. 520; Madness and Civilisation, ch. 6, "Doctors and Patients" pp. 159-160 and p. 196, and ch. 9, "The Birth of the Asylum" pp. 243 245, p. 251, and p. 266 (page 497 of the French edition is omitted from the English translation). See below, "Course context" pp. 354-355-
19. The analyses devoted to the "Naissance de I'asile," ibid. pp. 483 530; "Birth of the asylum" ibid. pp. 241-278.
20. On the role of the family model in the reorganization of relations between madness and reason and the constitution of the asylum, see ibid. pp. 509 511; ibid.
THE TOPIC I PROPOSE to present this year, psychiatric power, is slightly, but not completely, different from the topics I have spoken to you about over the last two years.
I will begin by trying to describe a kind of fictional scene in the following familiar, recognizable setting:
"I would like these homes to be built in sacred forests, in steep and isolated spots, in the midst of great disorder, like at the Grande- Chartreuse, etcetera. Also, before the newcomer arrives at his destina- tion, it would be a good idea if he were to be brought down by machines, be taken through ever new and more amazing places, and if the officials of these places were to wear distinctive costumes. The romantic is suit- able here, and I have often said to mysell that we could make use of those old castles built over caverns that pass through a hill and open out onto a pleasant little valley. . . Phantasmagoria and other resources of physics, music, water, flashes of lightning, thunder, etcetera would be
? 2 PSYCHIA TRIC POWER
used in turn and, very likely, not without some success on the common man. "1
This is not the castle of Cent vingtJournees. 1 It is a castle in which many more, an almost infinite number of days will be passed; it is Fodere's description, in 1817, of an ideal asylum. What will take place in this set ting? Well, of course, order reigns, the law, and power reigns. Here, in this castle protected by this romantic, alpine setting, which is only accessible by means of complicated machines, and whose very appear- ance must amaze the common man, an order reigns in the simple sense of a never ending, permanent regulation of time, activities, and actions; an order which surrounds, penetrates, and works on bodies, applies itself to their surfaces, but which equally imprints itself on the nerves and what someone called "the soft fibers of the brain. "3 An order, there- fore, for which bodies are only surfaces to be penetrated and volumes to be worked on, an order which is like a great nervure of prescriptions, such that bodies are invaded and run through by order.
"One should not be greatly surprised," Pinel writes, "at the great importance I attach to maintaining calm and order in a home for the insane, and to the physical and moral qualities that such supervision requires, since this is one of the fundamental bases of the treatment of mania, and without it we will obtain neither exact observations nor a per manent cure, however we insist on the most highly praised medicaments. "7'
That is to say, you can see that a certain degree of order, a degree discipline, and regularity, reaching inside the body, are necessary for two things.
On the one hand, they are necessary for the very constitution of medical knowledge, since exact observation is not possible without this discipline, without this order, without this prescriptive schema of regularities. The condition of the medical gaze (regard medkale), of its neutrality, and the possibility of it gaining access to the object, in short, the effective condition of possibility of the relationship of objectivity, which is constitutive ol medical knowledge and the criterion of its validity, is a relationship of order, a distribution of time, space, and
? individuals. In actual fact, and I will come back to this elsewhere, we cannot even say of "individuals"; let's just say a certain distribution of bodies, actions, behavior, and of discourses. It is in this well-ordered dispersion that we find the field on the basis of which something like the relationship of the medical gaze to its object, the relationship of objectivity, is possible--a relationship which appears as the effect of the first dispersion constituted by the disciplinary order. Secondly, this discipli- nary order, which appears in PinePs text as the condition for exact obser- vation, is at the same time the condition for permanent cure. That is to say, the therapeutic process itself, the transformation on the basis of which someone who is considered to be ill ceases to be so, can only be produced within this regulated distribution of power. The condition, therefore, of the relationship to the object and of the objectivity of medical knowledge, and the condition of the therapeutic process, are the same: disciplinary order. But this kind of immanent order, which covers the entire space of the asylum, is in reality thoroughly permeated and entirely sustained by a dissymmetry that attaches it imperiously to a single authority which is both internal to the asylum and the point from which the disciplinary distribution and dispersion of time, bodies, actions, and behavior, is determined. This authority within the asylum is, at the same time, endowed with unlimited power, which nothing must or can resist. This inaccessible authority without symmetry or reciprocity, which thus func- tions as the source of power, as the factor of the order's essential dissym- metry, and which determines that this order always derives from a non reciprocal relationship of power, is obviously medical authority, which, as you will see, functions as power well before it functions as knowledge.
Because, what is the doctor? Well, there he is, the one who appears when the patient has been brought to the asylum by these surprising machines I was just talking about. I know that this is all a fictional description, in the sense that I have not constructed it on the basis of texts coming from a single psychiatrist; if I had used only the texts of a single psychiatrist, the demonstration would not be valid. I have used Fodere's Traite du delire, PinePs Traite medico-philosophique on mania, EsquiroPs collected articles in Des maladies mentales? and Haslam. 6
So, how then does this authority without symmetry or limit, which permeates and drives the universal order of the asylum, appear? This is
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? 4 PSYCHIA TRIC POWER
how it appears in Fodere's text, Traite du delire from 1817, that is at that great, prolific moment in the protohistory of eighteenth century psychiatry--EsquiroPs great text appears in 18187--the moment when psychiatric knowledge is both inserted within the medical field and assumes its autonomy as a specialty. "Generally speaking, perhaps one of the first conditions of success in our profession is a fine, that is to say noble and manly physique; it is especially indispensable for impressing the mad. Dark hair, or hair whitened by age, lively eyes, a proud bearing, limbs and chest announcing strength and health, prominent features, and a strong and expressive voice are the forms that generally have a great effect on individuals who think they are superior to everyone else. The mind undoubtedly regulates the body, but this is not apparent to begin with and external forms are needed to lead the multitude. "8
So, as you can see, the figure himself must function at first sight. But, in this first sight, which is the basis on which the psychiatric relation ship is built, the doctor is essentially a body, and more exactly he is a quite particular physique, a characterization, a morphology, in which there are the full muscles, the broad chest, the color of the hair, and so on. And this physical presence, with these qualities, which functions as the clause of absolute dissymmetry in the regular order of the asylum, is what determines that the asylum is not, as the psycho-sociologists would say, a rule governed institution; in reality it is a field polarized in terms of an essential dissymmetry of power, which thus assumes its form, its figure, and its physical inscription in the doctor's body itself.
But, of course, the doctor's power is not the only power exercised, for in the asylum, as everywhere else, power is never something that someone possesses, any more than it is something that emanates from someone. Power does not belong to anyone or even to a group; there is only power because there is dispersion, relays, networks, reciprocal supports, differ- ences of potential, discrepancies, etcetera. It is in this system of differences, which have to be analyzed, that power can start to function.
There is, then, a whole series of relays around the doctor, the main ones being the following. First of all there are the supervisors, to whom Fodere reserves the task of informing on the patients, of being the unarmed, inexpert gaze, the kind of optical canal through which the learned gaze, that is to say the objective gaze of the psychiatrist himself,
? will be exercised. This relayed gaze, ensured by the supervisors, must also take in the servants, that is to say those who hold the last link in the chain of authority. The supervisor, therefore, is both the master of the last masters and the one whose discourse, gaze, observations and reports must make possible the constitution of medical knowledge. What are supervisors? What must they be? "In a supervisor of the insane it is necessary to look for a well proportioned physical stature, strong and vigorous muscles, a proud and intrepid bearing for certain occasions, a voice with a striking tone when needed. In addition, he must have the strictest integrity, pure moral standards, and a firmness compatible with gentle and persuasive forms ( . . . ) and he must be absolutely obedient to the doctor's orders. "9
The final stage--I skip some of the relays--is constituted by the servants, who hold a very odd power. Actually, the servant is the last relay of the net- work, of this difference in potential that permeates the asylum on the basis of the doctor's power; he is therefore the power below. But he is not just below because he is at the bottom of the hierarchy; he is also below because he must be below the patient. It is not so much the supervisors above him that he must serve, but the patients themselves; but m this position he must really only pretend to serve them. The servants apparently obey the patients' orders and give them material assistance, but they do so m such a way that, on the one hand, the patients' behavior can be observed from behind, underhand, at the level of the orders they may give, instead of being observed from above, as by the supervisors and the doctor. In a way, the ser- vants will thus set up the patients, and observe them at the level of their daily life and from the side of their exercise of will and their desires; and they will report anything worth noting to the supervisor, who will report it to the doctor. At the same time, when the patient gives orders that must not be carried out, the servant's task--while feigning to be at the patient's ser- vice, to obey him and so seeming not to have an autonomous will--must be to not do what the patient requests, and to appeal to the great anonymous authority of the rules or to the doctor's particular will. As a result, the patient who is set up by the servant's observation will find himself out flanked by the doctor's will that he rediscovers when he gives the servant orders, and the patient's encirclement by the doctor's will or by the general regulation of the asylum will be ensured through this pretence of service.
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Here is the description of the servants in this scenario:
u ? 398. The servants or warders selected must be big, strong, honest, intelligent, and clean, both personally and in their habits. In order to handle the extreme sensitivity of some of the insane, especially on points of honor, it would almost always be better for the servants to seem to them to be their domestic servants rather than their warders (. . . )? However, since they must not obey the mad, and often are even forced to suppress them, to reconcile the idea of being a servant with a refusal to obey, and to avoid any discord, the supervisor's task will be to insinuate cleverly to the patients that those serving them have been given certain instructions and orders by the doctor, which they cannot exceed without being given direct permission. "10
So, you have this system of power functioning within the asylum and distorting the general regulative system, a system of power which is secured by a multiplicity, a dispersion, a system of differences and hier- archies, but even more precisely by what could be called a tactical arrangement in which different individuals occupy a definite place and ensure a number of precise functions. You have therefore a tactical func- tioning of power or, rather, it is this tactical arrangement that enables power to be exercised.
If you go back to what Pinel himself said about the possibility of observation in an asylum, you can see that this observation, which ensures the objectivity and truth of psychiatric discourse, is only possi- ble through a relatively complex tactical arrangement; I say "relatively complex," because what I have just said is still very schematic. But, in fact, if there really is this tactical deployment and so many precautions have to be taken to arrive at something that is, after all, as simple as observation, it is probably because within the asylums field of regula tions there is something, a force, that is dangerous. For power to be deployed with all this cunning, or rather, for the asylum's regulated uni- verse to be so obsessed with these kind of relays of power, which falsify and distort this universe, then it is highly likely that at the very heart of this space there is a threatening power to be mastered or defeated.
In other words, if we end up with this kind of tactical arrangement, it is because before the problem being one of knowledge, or rather, for the problem to be able to be one of knowledge, of the truth of the
? illness, and of its cure, it must first of all be one of victory. So what is organized in the asylum is actually a battlefield.
Obviously it is the mad person who is to be brought under control. I have just quoted the odd definition of the mad person given by Fodere, who said that he is someone who thinks he is "superior to everyone else. "11 In actual fact, this really is how the madman makes his appearance in psychiatric discourse and practice at the start of the nineteenth century, and it is there that we find the great turning point, the great division that I have already spoken about, which is the disappearance of the criterion of error in the definition of madness or in the ascription of madness.
Broadly speaking, until the end of the eighteenth century--and even m police reports, lettres de cachet, interrogations, etcetera, concerning individu- als in places like Bicetre and Charenton--to say that someone was mad, to ascribe madness to him, was always to say that he was mistaken, and to say in what respect, on what point, in what way, and within what limits he was mistaken; madness was basically characterized by its system of belief. Now, very suddenly, at the beginning of the nineteenth century, a criterion appears for recognizing and ascribing madness which is absolutely differ- ent and which is--I was going to say, the will, but that is not exactly right-- in fact, at the start of the nineteenth century, we can say that what characterizes the madman, that by which one ascribes madness to him, is the insurrection of a force, of a furiously raging, uncontrolled and possibly uncontrollable force within him, which takes four major forms according to the domain it affects and the field in which it wreaks its devastation.
There is the pure force of the individual who traditionally is said to be "raving" (furieux).
There is the force inasmuch as it affects the instincts and passions, the force of unbridled instincts and unlimited passions. This will character- ize a madness that, precisely, is not one of error, which does not include illusion of the senses, false belief, or hallucination, and which is called mania without delirium.
Third, there is a sort of madness that affects ideas themselves, dis- rupts them, makes them incoherent, and brings them into conflict with each other. This is called mania.
Finally, there is the force ol madness that no longer affects the general domain of ideas, disrupting them all and bringing them into conflict
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with each other, but which affects one particular idea that is thus indef initely strengthened and stubbornly lodged in the patient's behavior, discourse, and mind. This is called either melancholy or monomania.
And the first major distribution of this asylum practice at the beginning of the nineteenth century exactly retranscribes what is taking place within the asylum itself, that is to say, the fact that it is no longer a ques- tion of recognizing the madman's error, but of situating very precisely the point where the wild force of the madness unleashes its insurrection: What is the point, what is the domain, with regard to which the force will explode and make its appearance, completely disrupting the individual's behavior?
Consequently, the tactic of the asylum in general and, more partial larly, the individual tactic applied by the doctor to this or that patient within the general framework of this system of power, will and must be adjusted to the characterization, to the localization, to the domain of application of this explosion and raging outburst of force. So that if the great, unbridled force of madness really is the target of the asylum tactics, if it really is the adversary of these tactics, what else can cure be but the submission of this force? And so we find in Pinel this very sim- ple but, I think, fundamental definition of psychiatric therapeutics, a definition that, notwithstanding its crudity and barbaric character, is not found prior to this period. The therapeutics of madness is uthe art of, as it were, subjugating and taming the lunatic by making him strictly dependent on a man who, by his physical and moral qualities, is able to exercise an irresistible influence on him and alter the vicious chain of his ideas. "12
I have the impression that this definition given by Pinel of the therapeutic process cuts across all that I have been saying to you. First of all, with regard to the principle of the patient's strict dependence in relation to a certain power: This power can be embodied in one and only one man who exercises it not so much in terms of and on the basis of a knowledge, as in terms of the physical and moral qualities that enable him to exercise an influence that can have no limit, an irresistible influence. And it is starting from this that it becomes possible to change the vicious chain of ideas; it is on the basis of this moral orthopedics, if you like, that cure is possible. And finally, that is why, in this proto-psychiatric
? practice, the basic therapeutic action takes the form of scenes and a battle.
Two types of intervention are very clearly distinguished in the psychiatry of this period. During the first third of the nineteenth century, one of these is regularly and continually discredited: specifically medical, or medicinal, practice. The other, first defined by the English, by Haslam in particular, and then very quickly taken up in France, is the development of the practice called "moral treatment. "13
This moral treatment is not at all, as one might think, a sort of long- term process whose first and last function would be to bring to light the truth of the madness, to be able to observe it, describe it, diagnose it, and, on that basis, to define the therapy. The therapeutic process formu lated between 1810 and 1830 is a scene, a scene of confrontation. This scene of confrontation may present two aspects. The first is, if you like, incomplete, and is like a process of wearing down, of testing, which is not carried out by the doctor--for the doctor himself must obviously be sovereign--but by the supervisor.
Here is an example of this first outline of the great scene, given by Pinel in his Traite medico-philosophique.
Faced with a raving lunatic, the supervisor "advances towards the lunatic with an intrepid air, but slowly and gradually, and to avoid exasperating him he does not carry any kind of weapon. As he advances he speaks to him in the firmest, most threatening tone and, with calm warnings, continues to fix the lunatic's attention on himself so as to hide what is going on around him. He gives precise and imperious orders to obey and to surrender. Somewhat disconcerted by the super- visor's overbearing manner, the lunatic loses every other object from view and, at a signal, is suddenly surrounded by assistants, whom he had not noticed slowly advancing on him. Each grabs hold of one of the lunatic's limbs, one an arm, the other a thigh or a leg. "14
Pinel gives further advice on the use of certain instruments, like the "semicircular piece of iron" fixed to the end of a pole, for example. When the lunatic's attention is captured by the supervisor's haughty demeanor and is fixed on him so that he is unaware of anyone else approaching him, this kind of lance with a semicircular end is used to pin him to the wall and overpower him. This is, if you like, the
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imperfect scene, the one reserved for the supervisor, and which consists in breaking the wild force of the lunatic with this kind of cunning and sudden violence.
However, it is obvious that this is not the major scene of the cure. The cure scene is complex. Here is a famous example from PinePs Traite medico-philosophique. It involves a young man "dominated by religious prejudices" who thought that for his salvation he had "to imitate the abstinence and mortifications of the old anchorites," that is to say, to refuse not only all the pleasures of the flesh, of course, but also all food. And then one day, with more than his usual firmness, he refuses a soup he is served. "In the evening, citizen Pussin appears at the door of his chamber in a frightening get up [in the sense of classical theater, of course; M. F. J, with fiery eyes and a striking voice, and accompanied by a group of assistants close by who are armed with strong chains that they shake noisily. The soup is placed by the lunatic who is given the most precise instruction to take it during the night if he does not wish to incur the most cruel treatment. They withdraw and leave him in the most painful state, wavering between the idea of the threatened punish- ment and the terrifying perspective of the other life. After an inner struggle of several hours, the first idea wins out and he decides to take his food. He is then subjected to a suitable diet for his recovery; sleep and strength return by degrees, as also the use of reason, and in this way he avoids a certain death. During his convalescence he often confessed to me the cruel agitation and confusion he suffered during the night of his ordeal. "15 We have here, I think, a scene that is very important in its general morphology.
First, you can see that the therapeutic operation does not take place by way of the doctors recognition of the causes of the illness. The doctor does not require any work of diagnosis or nosography, any discourse of truth, for the success of his operation.
Second, it is an important operation because in this and similar cases, as you see, there is no application of a technical medical formula to something seen as a pathological process of behavior. What is involved is the confrontation of two wills, that of the doctor and those who represent him on the one hand, and then that of the patient. What is established, therefore, is a battle, a relationship of force.
? Third, the primary elfect of this relationship ot force is to provoke a second relationship of force, within the patient as it were, since it involves provoking a conflict between the fixed idea to which the patient is attached and the lear of punishment: one struggle provokes another. And, when the scene succeeds, there must be a victory in both struggles, the victory of one idea over another, which must be at the same time the victory ol the doctor's will over the patient's will.
Fourth, what is important in this scene is that there is indeed a moment when the truth comes out. This is when the patient recognizes that his belief in the necessity of fasting to ensure his salvation was erro- neous and delirious, when he recognizes what has taken place, when he confesses his experience of wavering, hesitations, and torments, etcetera. In short, in this scene in which, hitherto, the truth was not involved, it is the patient's own account that constitutes the moment when the truth blazes lorth.
Finally, the process of the cure is effectuated, accomplished, and sealed when truth has been acquired through confession in this way, in the effective moment of confession, and not by piecing together a med- ical knowledge.
So there is a distribution of force, power, the event, and truth here, which is unlike anything in what could be called the medical model being constructed in clinical medicine in the same period. We can say that the clinical medicine of this time put together an epistemological model of medical truth, observation, and objectivity that will make possible the real insertion of medicine within a domain of scientific discourse where, with its own modalities, it will join physiology and biology, etcetera. In the period 1800 to 1830 I think something takes place that is quite different from what is usually thought to have occurred. It seems to me that what happened in these thirty years is usually interpreted as the moment when psychiatry was finally inserted within a medical practice and knowledge to which previously it had been relatively foreign. It is usually thought that at that moment psychi- atry appeared for the first time as a specialty within the medical domain.
Leaving aside for the moment the problem of why in fact such a prac lice could be seen as a medical practice, and why the people who carried
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out these operations had to be doctors, it seems to me that, in its morphology, in its general deployment, the medical operation of the cure performed by those whom we think of as the founders of psychia try has practically nothing to do with what was then becoming the experience, observation, diagnostic activity, and therapeutic process of medicine. At this level of the cure, of this event, the psychiatric scene and procedure are, I believe, from that moment, absolutely irreducible to what was taking place in medicine in the same period.
It is this heterogeneity then that will mark the history of psychiatry at the very moment at which it is founded within a system of institu- tions that nevertheless connect it to medicine. For all of this, this stag ing, the organization of the asylum space, the activating and unfolding of these scenes, are only possible, accepted and institutionalized within establishments that are being given a medical status at this time, and by people who are medically qualified.
We have here, if you like, a first set of problems. This is the point of departure for what I would like to study a little this year. Actually, it is roughly the point reached by my earlier work, Histoire de lafolk, or, at any rate, the point where it broke off. 16 I would like to take things up again at this point, except with some differences. It seems to me that in that work, which I take as a reference point because it is a kind of "background"* for me, for the work I am doing now, there were a num- ber of things that were entirely open to criticism, especially in the final chapter in which I ended up precisely at asylum power.
First of all, I think it was still an analysis of representations. It seems to me that, above all, I was trying to study the image of madness pro- duced in the seventeenth and eighteenth centuries, the fear it aroused, and the knowledge formed with reference to it, either traditionally, or according to botanical, naturalistic, and medical models, etcetera. It was this core of representations, of both traditional and non-traditional images, fantasies, and knowledge, this kind of core of representations
* English in original; G. B.
? that I situated as the point of departure, as the site of origin of the prac- tices concerning madness that managed to establish themselves in the seventeenth and eighteenth centuries. In short, I accorded a privileged role to what could be called the perception of madness. 17
Here, in this second volume, I would like to see if it is possible to make a radically different analysis and if, instead of starting from the analysis of this kind of representational core, which inevitably refers to a history of mentalities, of thought, we could start from an apparatus (^dispositij^)of power. That is to say, to what extent can an apparatus of power produce statements, discourses and, consequently, all the forms of representation that may then \. . . ]* derive from it.
The apparatus of power as a productive instance of discursive practice. In this respect, in comparison with what I call archeology, the discursive analysis of power would operate at a level--I am not very happy with the word "fundamental"--let's say at a level that would enable discursive practice to be grasped at precisely the point where it is formed. To what should we refer this formation of discursive practice, where should we look for it?
If we look for the relationship between discursive practice and, let's say, economic structures, relations of production, I do not think we can avoid recourse to something like representation, the subject, and so on, appealing to a ready made psychology and philosophy. The problem for me is this: Basically, are not apparatuses of power, with all that remains enigmatic and still to be explored in this word "power," precisely the point from which it should be possible to locate the formation of dis- cursive practices. How can this deployment of power, these tactics and strategies of power, give rise to assertions, negations, experiments, and theories, in short to a game of truth? Apparatus of power and game of truth, apparatus of power and discourse of truth: This is what I would like to examine a little this year, starting from the point I have referred to, that is to say, psychiatry and madness.
The second criticism I have of that final chapter is that I appealed-- but, after all, I cannot say I did so very consciously, because I was very ignorant of antipsychiatry and especially of the psycho-sociology of the
* (Recording:) be formed from it and
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time--I appealed, implicitly or explicitly, to three notions that seem to me to be rusty locks with which we cannot get very far.
First, the notion of violence. 18 What actually struck me when I was reading Pinel, Esquirol, and others, is that contrary to what the hagiographies say, Pinel, Esquirol, and the others appealed strongly to physical force, and consequently it seemed to me that one could not ascribe PinePs relorm to a humanism, because his entire practice was still permeated by something like violence.
Now, if it is true that we cannot in fact ascribe Pinel's reform to humanism, I do not think this is because he resorted to violence. When in fact we speak of violence, and this is what bothers me about the notion, we always have in mind a kind of connotation ol physical power, of an unregulated, passionate power, an unbridled power, il I can put it like that. This notion seems to me to be dangerous because, on the one hand, picking out a power that is physical, unregulated, etcetera, allows one to think that good power, or just simply power, power not perme ated by violence, is not physical power. It seems to me rather that what is essential in all power is that ultimately its point of application is always the body. All power is physical, and there is a direct connection between the body and political power.
Then again, violence does not seem to me to be a very satisfactory notion, because it allows one to think that the physical exercise of an unbalanced force is not part of a rational, calculated, and controlled game of the exercise of power. Now the examples I have just given clearly prove that power as it is exercised in the asylum is a meticulous, calculated power, the tactics and strategies of which are absolutely definite; and, at the very heart of these strategies, we see quite precisely the place and role of violence, if we call violence the physical exercise of a com pletely unbalanced force. Taken in its final ramifications, at its capillary level, where it affects the individual himself, this power is physical and, thereby, it is violent, in the sense that it is absolutely irregular, not in the sense that it is unbridled, but in the sense, rather, that it is commanded by all the dispositions of a kind of microphysics of bodies.
The second notion to which I referred, and, I think, not very satisfacto- rily, is that of the institution. 19 It seemed to me that we could say that from the beginning of the nineteenth century psychiatric knowledge took
? the forms and dimensions we know in close connection with what could be called the institutionalization of psychiatry; even more precisely, it took these forms and dimensions in connection with a number of institutions of which the asylum was the most important. Now I no longer think that the institution is very satisfactory notion. It seems to me that it harbors a number of dangers, because as soon as we talk about institutions we are basically talking about both individuals and the group, we take the indi- vidual, the group, and the rules which govern them as given, and as a result we can throw in all the psychological or sociological discourses.
*
In actual fact, we should show, rather, that what is essential is not the institution with its regularity, with its rules, but precisely the imbalances of power that I have tried to show both distort the asylum's regularity and, at the same time, make it function. What is important therefore is not institutional regularities, but much more the practical dispositions of power, the characteristic networks, currents, relays, points of support, and differences of potential that characterize a form of power, which are, I think, constitutive of, precisely, both the individual and the group.
It seems to me that that insofar as power is a procedure of individu- alization, the individual is only the effect of power. And it is on the basis of this network of power, functioning in its differences of potential, in its discrepancies, that something like the individual, the group, the community, and the institution appear. In other words, before tackling institutions, we have to deal with the relations of force in these tactical arrangements that permeate institutions.
Finally, the third notion I referred to in order to explain the functioning of the asylum at the start of nineteenth century is the family, and I tried to show roughly how the violence of Pinel [or] Esquirol was their introduction of the family model into the asylum institution. 20 Now I do not think that "violence" is the right word, or that we should situate our analysis at the level of the "institution," and I do not think that we should talk of the family. At any rate, re-reading Pinel, Esquirol, Fodere, and others, in the end I found very little use of this family model. It is not true that the doctor tries to reactivate the image or
* The manuscript adds: "The institution neutralizes relations of force, or it only makes them function within the space it defines. "
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figure of the father within the space of the asylum; I think this takes place much later, even at the end of what could be called the psychiatric episode in the history of medicine, that is to say only m the twentieth century.
It is not the family, neither is it the State apparatus, and I think it would be equally false to say, as it often is, that asylum practice, psychiatric power, does no more than reproduce the family to the advantage of, or on the demand of, a form of State control organized by a State apparatus. 21 The State apparatus cannot serve as the basis,* and the family cannot serve as the model, [. . . '] for the relations of power that we can identify within psychiatric practice.
In doing without these notions and these models, that is to say, the family model, the norm, if you like, of the State apparatus, the notion of the institution, and the notion of violence, I think the problem that arises is that of analyzing these relations of power peculiar to psychiatric practice insofar as--and this will be the object of the course--they pro- duce statements that are given as valid, justified statements. Rather, therefore, than speak of violence, I would prefer to speak of a micro- physics of power; rather than speak of the institution, I would much prefer to try to see what tactics are put to work in these forces which confront each other; rather than speak of the family model or "State apparatus," I would like to try to see the strategy of these relations of power and confrontations which unfold within psychiatric practice.
You will say that it is all very well to have substituted a microphysics of power for violence, tactics for institution, strategy for the model of the family, but have I really made an advance? I have avoided terms that would allow the introduction of a psycho-sociological vocabulary into all these analyses, and now I am faced with a pseudo-military vocabu- lary which is not much better. Nevertheless, we will try to see what we can do with it. *
* The manuscript specifies: "We cannot use the notion of State apparatus because it is much too broad, much too abstract to designate these immediate, tiny, capillary powers that are exerted on the body, behavior, actions, and time of individuals. The State apparatus does not take this microphysics of power into account. "
1 (Recording:) for what takes place
f The manuscript (pages 11-23) continues on the question of defining the current problem of psychiatry and puts forward an analysis ol antipsychiatry.
? 1. Francois Emmanuel Fodere (1764-1835), Traite du delire, applique a la medecine, a la morale et a la legislation (Paris: Croullebois, 1817), Vol. 2, section VI, ch. 2: "Plan et distribution d'un hospice pour la guerison des alienes," p. 215.
2. Donatien Alphonse Francois de Sade (1740 1814), Les Cent vingt Journees de Sodome, ou I'Ecole du libertinage (1785), in (Euvres completes (Paris: Jean Jacques Pauvert, 1967), vol. 26; English translation in Marquis de Sade, The 120 days of Sodom and other writings, trans. Austryn Wainhouse and Richard Seaver (New York: Grove Press, 1966).
3. Joseph Michel Antoine Servan (1737-1807), Discours sur Vadministration de la justice criminelle, delivered by Monsieur Servan (Geneva: 1767), p. 35: "The unshakeable basis of the most solid empires is founded on the soft fibers of the brain. " (Republished in C. Beccana, Traite des delits et des peines, trans. P. J. Dufey [Paris: Dulibon, 1821]).
4. Philippe Pinel (1745 1826), Traite medico-philosophique sur Valienalion mentale, ou la Manie (Paris: Richard, Caille and Ravier, Year 9/1801), section II, "Traitement moral des alienes," ? xxiii: "Necessite d'entretenir un ordre constant dans les hospices des alienes," pp. 95 96; abridged English translation of original, 1801 edition [omitting Pinel's intro- duction and material added in longer French 1809 edition; G. B. ], A Treatise on Insanity, trans. B. B. Davis (New York: Hafner, 1962), section II: "The Moral Treatment of Insanity"; "The necessity of maintaining constant order in lunatic asylums, and of studying the varieties of character exhibited by the patients," p. 99-
5. Jean Etienne Dominique Esquirol (1772 1807), Des maladies mentales considerees sous les rapports medical, hygienique et medico-legal, 2 volumes (Paris: J. B. Bailliere, 1838). Abridged English translation and with additions by the translator, Menial Maladies. A Treatise on Insanity, trans. E. K. Hunt (Philadelphia: Lea and Blanchard, 1845) |Hunt says, p. vi: "All that portion of this Treatise, relating properly to insanity, has been published entire; the remainder, referring, for the most part, to the statistics and hygiene ol establishments for
the insane, together with the medico-legal relations of the subject, have been omitted";
G. B. ].
6. John Haslam (1764 1844), Observations on Insanity, with Practical Remarks on the Disease, and
an Account oj the Morbid Appearances of Dissection (London: Rivington, 1798), republished in an expanded edition under the title, Madness and Melancholy (London:J. Callow, 1809); and, Considerations on the Moral Management of Insane Persons (London: R. Hunter, 1817).
7. J. E. D. Esquirol, Des etablissements consacres aux alienes en France, et des moyens d'ameliorer le sort de ces infortunes (Report to the Minister of the Interior, September 1818), printed by Mme. Huzard, 1819. Reprinted in Des maladies mentales, vol. 2, pp. 399 431.
8. F. E. Fodere, Traite du delire, vol. 2, section 6, ch. 3, "Du choix des administrateurs, des medians, des employes et des servants," pp. 230-231.
9. Ibid. p. 237.
10. Ibid. pp. 241 242.
11. Ibid. p. 230.
12. P. Pmel, Traite medico-philosophique, section II, ? vi: "Avantages de l'art de dinger les alienes
pour seconder les effets des medicaments," p. 58; A Treatise on Insanity, pp. 59 60.
13. "Moral treatment," which develops at the end of the eighteenth century, brings together all the means of acting on the patient's psyche, as opposed to "physical treatment," which acts on the body through remedies and means of constraint. Following the death in 1791 of the wife of a Quaker, in suspicious circumstances at the York asylum, William Tiike (1732 1822) proposed the creation of an establishment for members of the Society of
Friends affected by mental disorders. The Retreat opened on 11 May 1796 (see below, lee ture of 5 December 1973, note 18). John Haslam, the apothecary at Bethlehem hospital, before becoming a medical doctor in 1816, developed principles of moral treatment in his works (see above, this lecture, note 6). In France, Pinel took up the principle in his "Observations sur le regime moral que est le plus propre a retablir, dans certains cas, la raison egaree des maniaques," Gazette de sante, no. 4, 1789, pp. 13-15, and in his report, "Recherches et observations sur le traitement moral des alienes," Memoires de la Societe medicale d'emulation. Section Medicine, no. 2,1798, pp. 215-255, republished with some changes in Traite medico-philosophique, section II, pp. 46-105. Etienne Jean Georget (1795 1828) systematized the principles in De la folie. Considerations sur cette maladie: son siege et ses
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symptomes, la nature et la mode d'action de ses causes; sa marche et ses terminaisons; les differences qui la distinguent du delire aigu; les moyens du traitement qui lui conviennent; suivies de recherches cadaveriques (Paris: Crevot, 1820). Francois Leuret emphasizes the doctor-patient relation ship; see, Du traitement moral de lafolie (Paris: J. B. Bailliere, 1840). See the pages devoted to moral treatment in M. Foucault, Histoire de lafolie a Vage classique (Paris: Gallimard, 1972), Part 3, ch. 4: "Naissance de I'asile" pp. 484 487, 492 496, 501 511, 523 527; Abridged English translation, Madness and Civilisation. A History of Insanity in the Age of Reason,trans. R. Howard (New York: Random House, 1965 and London: Tavistock, 1967) pp. 243 255, 269-274 (pages 484 500 of the French edition are omitted from the English translation). See also, R. Castel, "Le traitement moral. Therapeutique mentale et controle sociale au XIXC siecle," Topique, no. 2, February 1970, pp. 109 129.
14. P. Pinel, Traile medico-philosophique, Section II, ? xxi: "Caractere des alienes les plus violents et dangereux, et expediens a prendre pour les reprimer" pp. 9 0 91; A Treatise on Insanity, "The most violent and dangerous maniacs described, with expedients for their repression" pp. 93-94.
15. Ibid. Section II, ? viii: "Avantage d'ebranler fortement I'imagination d'un aliene dans certains cas" pp. 6 0 61; English, ibid. "The advantages of restraint upon the imagination of maniacs illustrated" pp. 61 63.
16. M. Foucault, Folie et Deraison. Histoire de lafolie a Vage classique (Paris: Plon, 1961); Madness and Civilisation. [Apart from in this note, the French editor always relers to the 1972, Gallimard edition, Histoire de lafolie, as above in note 13; G. B. J
17. For example, Histoire de lafolie, Part 1, ch. 5, "Les insenses" p. 169 and p. 172; Part 2, ch. 1, "Le fou au jardin des especes" p. 223; and Part 3, ch. 2, "Le nouveau partage" p. 407 and p. 415; Madness and Civilisation, ch. 3, "The insane" p. 77 and pp. 80-81 (pages 223, 407, and 415 of French edition are omitted (rom the English translation). The point of depar lure for this criticism of the notion of "perception" or "experience" is L'Archeologie du savoir (Paris: Gallimard, 1969), ch. 3, "La formation des objets" and ch. 4, "La formation des modahtes enonciatives" pp. 55 74; English translation, The Archeology oj Knowledge, trans. A. Sheridan (London: Tavistock and New York: Pantheon, 1972), Part II, ch. 3, "The formation of objects" and ch. 4, "The formation of enunciative modalities" pp. 40 55.
18. The notion of violence underlies the analysis of the mode of treatment in Histoire de lafolie, Part 2, ch. 4, "Medecins et malades" pp. 327-328 and p. 358, and Part 3, ch. 4, "Naissance de I'asile" p. 497, pp. 502 503, p. 508, and p. 520; Madness and Civilisation, ch. 6, "Doctors and Patients" pp. 159-160 and p. 196, and ch. 9, "The Birth of the Asylum" pp. 243 245, p. 251, and p. 266 (page 497 of the French edition is omitted from the English translation). See below, "Course context" pp. 354-355-
19. The analyses devoted to the "Naissance de I'asile," ibid. pp. 483 530; "Birth of the asylum" ibid. pp. 241-278.
20. On the role of the family model in the reorganization of relations between madness and reason and the constitution of the asylum, see ibid. pp. 509 511; ibid.
