Philosophic
Anthologie etablie et presentee par Arnold I.
Foucault-Psychiatric-Power-1973-74
.
"6
Foucault approached his teaching as a researcher: explorations for a future book as well as the opening up of fields of problematization were formulated as an invitation to possible future researchers. This is why the courses at the College de France do not duplicate the published books. They are not sketches for the books even though both books and courses
? share certain themes. They have their own status. They arise from a specific discursive regime within the set of Foucault's "philosophical activities. " In particular they set out the programme for a genealogy of knowledge/power relations, which are the terms in which he thinks of his work from the beginning of the 1970s, as opposed to the programme of an archeology of discursive formations that previously orientated his work. 7
The courses also performed a role in contemporary reality. Those who followed his courses were not only held in thrall by the narrative that unfolded week by week and seduced by the rigorous exposition, they also found a perspective on contemporary reality. Michel Foucault's art con- sisted in using history to cut diagonally through contemporary reality. He could speak of Nietzsche or Aristotle, of expert psychiatric opinion or the Christian pastoral, but those who attended his lectures always took from what he said a perspective on the present and contemporary events. Foucault's specific strength in his courses was the subtle interplay between learned erudition, personal commitment, and work on the event.
*
With their development and refinement m the 1970s, Foucault's desk was quickly invaded by cassette recorders. The courses--and some seminars--have thus been preserved.
This edition is based on the words delivered in public by Foucault. It gives a transcription of these words that is as literal as possible. 8 We would have liked to present it as such. However, the transition from an oral to a written presentation calls for editorial intervention: At the very least it requires the introduction of punctuation and division into para- graphs. Our principle has been always to remain as close as possible to the course actually delivered.
Summaries and repetitions have been removed whenever it seemed to be absolutely necessary. Interrupted sentences have been restored and faulty constructions corrected. Suspension points indicate that the recording is inaudible. When a sentence is obscure there is a conjectural integration or an addition between square brackets. An asterisk directing the reader to the bottom of the page indicates a significant divergence between the notes used by Foucault and the words actually
Foreword xi
? xii FOREWORD
uttered. Quotations have been checked and references to the texts used are indicated. The critical apparatus is limited to the elucidation of obscure points, the explanation of some allusions and the clarification of critical points. To make the lectures easier to read, each lecture is pre ceded by a brief summary that indicates its principal articulations. 9
The text of the course is followed by the summary published by the Annuaire du College de France. Foucault usually wrote these in June, some time after the end of the course. It was an opportunity for him to pick out retrospectively the intention and objectives ol the course. It consti tutes the best introduction to the course.
Each volume ends with a "context" for which the course editors are responsible. It seeks to provide the reader with elements of the bio- graphical, ideological, and political context, situating the course within the published work and providing indications concerning its place within the corpus used in order to facilitate understanding and to avoid misinterpretations that might arise from a neglect of the circumstances in which each course was developed and delivered.
Psychiatric Power, the course delivered in 1973 and 1974, is edited by Jacques Lagrange.
*
A new aspect of Michel Foucault's "oeuvre" is published with this edition of the College de France courses.
Strictly speaking it is not a matter of unpublished work, since this edition reproduces words uttered publicly by Foucault, excluding the often highly developed written material he used to support his lectures. Daniel Defert possesses Michel Foucault's notes and he is to be warmly thanked for allowing the editors to consult them.
This edition of the College de France courses was authorized by Michel Foucault's heirs who wanted to be able to satisfy the strong demand for their publication, in France as elsewhere, and to do this under indisputably responsible conditions. The editors have tried to be equal to the degree ol conlidence placed in them.
FRANCOIS EWALD AND ALESSANDRO FONTANA
? 1. Michel Foucault concluded a short document drawn up in support of his candidacy with these words: "We should undertake the history ol systems of thought. " "Titres et travaux," in Dils et Ecrits, 195/l-19S8, four volumes, ed. Daniel Defert and Francois Ewald (Paris: Gallimard, 1994) vol. 1, p. 846; English translation, "Candidacy Presentation: College de France," in The Essential Works of Michel Foucault, 1954-1984, vol. 1: Ethics: Subjectivity and Truth, ed. Paul Rabinow, trans. Robert Hurley and others (New York: The New Press, 1997) p. 9.
2. It was published by Gallimard in May 1971 with the title VOrdre du discours (Paris). English translation: "The Order of Discourse," trans. Rupert Swyer, appendix to M. Foucault, The Archeology of Knowledge (New York: Pantheon, 1972).
3. This was Foucault's practice until the start of the 1980s.
4. Within the framework of the College de France.
5. In 1976, in the vain hope of reducing the size of the audience, Michel Foucault changed the
time of his course from 17/i5 to 9. 00. See the beginning of the lirst lecture (7 January 1976) ol "1/ Jaut defendre la societe". Cours au College de France, 1976 (Pans: Gallimard/Seuil, 1997); English translation, "Society Must be Defended". Lectures at the College de France 1975-1976, trans. David Macey (New York: Picador, 2003).
6. Gerard Petitjean, "Les Grands Pretres de I'universite Iranc. aise," Lc Nouvel Observateur, 1 April 1975-
7. See especially, "Nietzsche, la genealogie, I'histoire," in Dils et Ecrils, vol. 2, p. 137. English translation, "Nietzsche, Genealogy, History," trans. Donald F. Brouchard and Sherry Simon in, The Essential Works of Michel Foucault 1954-1984, vol. 2: Aesthetics, Method, and Epistemology, ed. James Faubion, trans. Robert Hurley and others (New York: The New Press, 1998), pp. 369 92.
8. We have made use ol the recordings made by Gilbert Burlet and Jacques Lagrange in particular. These are deposited in the College de France and the Institut Memoires de I'Edition Contemporaine.
9. At the end of the book, the criteria and solutions adopted by the editors ol this year's course are set out in the "Course context. "
Foreword xiii
? INTRODUCTION Arnold I. Davidson
MICHEL FOUCAULT'S CENTRAL CONTRIBUTION to political philosophy was his progressive development and refinement of a new conception of power, one that put into question the two reigning conceptions of power, the juridical conception found in classical liberal theories and the Marxist conception organized around the notions of State apparatus, dominant class, mechanisms of conservation, and juridical superstruc- ture. If the first volume of his history of sexuality, La Volonte de savoir (1976), is a culminating point of this dimension of Foucault's work, his courses throughout the 1970s return again and again to the problem of how to analyze power, continually adding historical and philosophical details that help us to see the full import and implications of his ana- lytics of power. At the beginning of the chapter "Methode" in La Volonte de savoir Foucault warns his readers against several misunderstandings that may be occasioned by the use of the word "power," misunder standings concerning the identity, the form, and the unity of power. Power should not be identified, according to Foucault, with the set of institutions and apparatuses in the State; it does not have the form of rules or law; finally, it does not have the global unity of a general system of domination whose effects would pass through the entire social body. Neither state institutions, nor law, nor general effects of domination constitute the basic elements of an adequate analysis of how power works in modern societies. 1 Without having yet developed all of the tools of his own analysis, Psychiatric Power already exhibits Foucault's aware ness of the shortcomings of available conceptions of power, and nowhere more clearly than in his own critique of notions implicit or explicit in
? his Histoire de lafolk. Foucault's dissatisfaction with his previous analy- sis of asylum power centers around two basic features ol the analysis in Histoire de lafolie: first, the privileged role he gave to the "perception of madness" instead of starting, as he does in Psychiatric Power, from an apparatus of power itself; second, the use of notions that now seem to him to be "rusty locks with which we cannot get very far" and that therefore compromise his analysis of power as it is articulated in Histoire de lafolie. 2
As regards this second point, Foucault's critique of his own use of the notions of violence, of institution, and of the family can be seen in ret- rospect to be an important part of his development of that alternative model of power that will be at the center of Surveiller et punir and La Volonte de savoir. In effect, Foucault's criticisms here take aim precisely at assumptions concerning the identity, the form, and the unity of power. Rather than thinking of power as the exercise of unbridled violence, one should think of it as the "physical exercise of an unbalanced force" (in the sense of an unequal, non symmetrical force), but a force that acts within "a rational, calculated, and controlled game of the exercise of power. '0 Instead of conceptualizing psychiatric power in terms of insti tutions, with their regularities and rules, one has to understand psychi- atric practice in terms of "imbalances of power" with the tactical uses of "networks, currents, relays, points of support, differences of potential" that characterize a form of power/1 Finally, in order to understand the functioning of asylum power, one cannot invoke the paradigm of the family, as if psychiatric power "does no more than reproduce the family to the advantage of, or on the demand of, a form of State control orga- nized by a State apparatus"; there is no foundational model that can be projected onto all levels of society, but rather different strategies that allow relations of power to take on a certain coherence. 3 In La Volonte de savoir, with more conceptual precision, Foucault explicitly understands power in terms of a multiplicity of relations of force, of incessant tacti cal struggles and confrontations that affect the distribution and arrangement of these relations of force, and of the strategies in which these relations of force take effect, with their more general lines of integration, their patterns and crystallizations. 6 And the nominalism
advocated in La Volonte de savoir is present in practice in Psychiatric
Introduction xv
? xvi INTRODUCTION
Power: power is "the name that one gives to a complex strategic situation in a given society. "7
The stakes of this nominalism are evident in one of the first theoretical claims about power that Foucault makes in Psychiatric Power, a claim that, despite its apparent simplicity, already requires an entire reelaboration of our conception of power:
. . . 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 dir ferences, which have to be analyzed, that power can begin to lunction. 8
This claim is the basis of Foucault's later insistence on "the strictly rela tional character of relationships of power" (and of relationships of resis tance), the fact that power "is produced at every moment, in every point, or rather in every relation Irom one point to another. "9 Foucault was never interested in providing a metaphysics of Power; his aim was an analysis of the techniques and technologies of power, where power is understood as relational, multiple, heterogeneous, and, of course, pro ductive. 10 Foucault went so far as once to proclaim, "power, it does not exist" so as to emphasize that, from his perspective, it is always bundles of relations, modifiable relations of force, never power in itself, that is to be studied--that is to say, to render the exercise of power intelligible, one should take up the point of view of "the moving base of relations of force that, by their inequality, continually lead to states of power, but always local and unstable. "" As late as 1987i, when the focus of his inter ests had already shifted, he stressed this point yet again: "I hardly employ the word power, and if I occasionally do, it is always as a short- hand with respect to the expression that I always use: relations of power.
I believe that it is precisely this relational conception ol power, with all ol its accompanying instruments of analysis, that allows Foucault to give his extraordinary historical reinterpretation ol the problem ol
? hysteria at the conclusion of Psychiatric Power. When in the final part of his lecture of 6 February Foucault takes up Charcot's treatment of hys terics and what he names "the great maneuvers of hysteria," he announces the angle of analysis he will adopt: "I will not try to analyze this in terms of the history of hysterics any more than in terms of psy chiatric knowledge of hysterics, but rather in terms ol battle, confronta- tion, reciprocal encirclement, of the laying of mirror traps |by which Foucault means traps that reflect one another], of investment and counter investment, of struggle for control between doctors and hysterics. "1* All of the terms in this description answer to his new analytics of power, with its "pseudo military vocabulary," that will provide the framework for his examination of a wide variety of historical phenomena during the 1970s. 1H And when he sets aside the idea of an epidemic of hysteria (a scientific-epistemological notion) in favor of an analysis focused on "the maelstrom of this battle" (le tourbillon de cette bataille) that sur rounds hysterical symptoms, one cannot help but hear an anticipation of the last line of Surveiller el punir where Foucault tells us that in those apparatuses of normalization that are intended "to provide relief, to cure, to help" one should hear "the rumbling of battle" (/e grondemenl de la balaille)P It is this rumbling, this maelstrom of battle that Foucault's perspective renders visible, a struggle that is effaced in a purely episte mological analysis and that is left out of sight within a theory of power built on a juridical and negative vocabulary. (Hence the way in which the "repressive hypothesis" renders imperceptible the multiplicity of possible points ol resistance. ) To take just one example, Foucault's ana lytics restores this relational dimension of battle to the great problem of simulation that was so crucial to the history of psychiatry; it enables him to treat simulation not as a theoretical problem, but as a process by which the mad actually responded to psychiatric power, a kind of "anti power," that is a modification ol the relations ol lorce, in the face ol the mechanisms ol psychiatric power--thus the appearance ol simulation not as a pathological phenomenon, but as a phenomenon of struggle. 16 As a result, lrom this point of view, hysterical simulation becomes "the militant underside |the militant reverse side] ol psychiatric power" and hysterics can be seen as "the true militants ol antipsychiatry. "1' Moreover, the elaboration of this microphysics of power does not require
Introduction X V l l
? xviii INTRODUCTION
Foucault to ignore the epistemological dimensions of the history of psychiatry, the discursive practices of psychiatric knowledge. On the contrary, it allows him to place these practices within a political history of truth, to reconnect these practices to the functioning of an apparatus of power, to link them to a level "that would allow discursive practice to be grasped at precisely the point where it is formed. "18 Psychiatric Power can be read as a kind of experiment in method, one that responds in his- torical detail to a set of questions that permeated the genealogical period of Foucault's work:
. . . to what extent can an apparatus of power produce statements, discourses and, consequently, all the forms of representation that may then [. . . ] derive from i t . . . How can this deployment of power, these tactics and strategies of power, give rise to assertions, negations, experiments (experiences^), and theories, in short to a game of truth? 19
At the very end of his course, when Foucault returns to the relations of power between hysteric and doctor, to hysterical resistance to medical power, the scene of sexuality is center stage. But the introduction of sex- uality into this scenario does not derive from the "power" of the doc tors, but rather from the hysterics themselves, as their putting into play of a point of resistance within the strategic field of existing relations of power. As a counter attack to the medical need to find an etiology for hysteria that will give its symptoms a pathological status, and more specifically (given the distributions of power-knowledge that surround the hysterical body) to find a trauma that will function as a "kind of invisible and pathological lesion which makes all of this a well and truly morbid whole," the hysteric will respond with the counter maneuver of a recounting of her sexual life, with all of its possible traumatism, thereby effecting a redistribution of force relations and a new configura tion of power.
. . . w h a t will the patients do with this injunction to find the trauma that persists in the symptoms? Into the breach opened by this injunction they will push their life, their real, everyday life,
? that is to say their sexual life. It is precisely this sexual life that they will recount, that they will connect up with the hospital and endlessly reactualize in the hospital. 20
And Foucault draws the following remarkable conclusion, which needs to be underlined and related, after the fact, to the context of his later history of sexuality:
It seems to me that this kind of bacchanal, this sexual pantomime, is not the as yet undeciphered residue of the hysterical syndrome. My impression is that this sexual bacchanal should be taken as the counter-maneuver by which the hysterics responded to the ascrip- tion of trauma: You want to find the cause of my symptoms, the cause that will enable you to pathologize them and enable you to function as a doctor; you want this trauma, well, you will get all my life, and you won't be able to avoid hearing me recount my life and, at the same time, seeing me mime my life anew and endlessly reactualize it in my attacks!
So this sexuality is not an indecipherable remainder but the hysteric's victory cry, the last maneuver by which they finally get the better of the neurologists and silence them: If you want symp- toms too, something functional; if you want to make your hypno- sis natural and each of your injunctions to cause the kind of symptoms you can take as natural; if you want to use me to denounce the simulators, well then, you really will have to hear what I want to say and see what I want to do! 21
This victory cry or the hysteric, although a genuine cry of victory, is not a definitive cry. Like all triumphs within the field of mobile and reversible power relations, one can be sure that it will be met by further tactical interventions, actions intended to modify the new disposition of force relations, rearranging yet again the existing relations of power. If it is the hysteric herself who, from within the field of power relations, imposes the sexual body on the neurologists and doctors, these latter, according to Foucault, could respond with one ol two possible attitudes. They could either make use of these sexual connotations to discredit
Introduction xix
? xx INTRODUCTION
hysteria as a genuine illness, as did Babinski, or they could attempt to circumvent this new hysterical maneuver by surrounding it once more medically--"this new investment will be the medical, psychiatric, and psychoanalytic take over of sexuality. "22 History has taught us that the second response would be the triumphant one. And the first volume of Foucault's history of sexuality picks up the battle where Psychiatric Power left off, with the codification of scientia sexualis and the solidification of the apparatus of sexuality, with a new medical victory cry in favor of sexuality. Indeed, the "hysterisation" of women's bodies is one of the four great strategic ensembles with respect to sex that Foucault singles out as having attained an historically noteworthy "efficacity" in the order of power and "productivity" in the order of knowledge. 23 The effects of an initially disruptive recounting of her sexual life by the hysteric will be reorganized by means of the constitution of a scientific modality of confession; the traumas of sexuality will become integrated into those procedures of individualization that produce our subjection. 27' If Charcot could not see or speak of this sexuality, the later history of psychiatry would find it everywhere, would insist on putting sex into discourse, would enjoin its patients to speak of their sexuality. When the science of the subject began to revolve around the question of sex, the hysteric's victory was effectively countered by new tactics and strategies of power, and the reactualization of one's sexual life was divested ol its potential ol resistance and became a practice now crucial to the functioning of psychiatric power. That is why Foucault's histonco-pohtical project will be "to define the strategies of power which are immanent to this will to know" that continues to encircle sexuality. 2S
It is in this light that we should read the last sentence ol Psychiatric Power, a phrase that might have seemed enigmatic when pronounced by Foucault on 6 February 1977i, but whose force is quite clear in the context ol La Volonte de savoir:
By breaking down the door ol the asylum, by ceasing to be mad so as
to become patients, by finally getting through to a true doctor, that
is to say the neurologist, and by providing him with genuine func- tional symptoms, the hysterics, to their greater pleasure, but doubtless to our greater misfortune, gave rise to a medicine of sexuality. 26
? This final diagnosis, namely that the great pleasure of the hysteric's vie tory became the great misfortune of our subjection to the apparatus of sexuality, focuses our attention on that moving stratum of force relations that underlies the instability, the transformability, of relations of power/resistance. If today the sexual body is no longer primarily the hysterical body, but rather, let us say, the perverse body, it remains up to us to learn to hear anew the rumbling of the current battle. Only in this way will we be able "to determine what is the principal danger" and "to render problematic everything that is habitual"--thus we will be able to put into movement the points of support for our counter attack against the apparatus of sexuality. 27
Introduction xxi
? XX11 INTRODUCTION
1. Michel Foucault, Histore de la sexualite, vol. 1, La Volonte de savoir (Paris: Gallimard, 1976), p. 121.
2. This volume, pp. 13 14.
3. This volume, p. 14.
4. This volume, p. 15-
5. This volume, p. 16.
6. Michel Foucault, La Volonte de savoir, pp. 121 122.
7. Ibid. , p. 123.
8. This volume, p. 4.
9. Michel Foucault, La Volonte de savoir, pp. 126,122. It is this relational conception ol power
that makes it possible for Foucault to argue that "where there is power, there is resistance. . . ", Ibid. , pp. 125-127. For a more detailed discussion, see my introduction to the second part of Michel Foucault.
Philosophic Anthologie etablie et presentee par Arnold I. Davidson et Frederic Gros. (Paris: Gallimard, 2004).
10. Michel Foucault, "Precisions sur le pouvoir. Reponses a certaines critiques" in Dits et ecrits II, 1976-1988 (Paris: Gallimard, 2001), p. 630 and "Les mailles du pouvoir" in Dits et ecrits II, pp. 1005 1008.
11. Michel Foucault, "Le jeu de Michel Foucault" in Dits et ecrits II, p. 302 and La Volonte de savoir, p. 122.
12. Michel Foucault, "L'ethique du souci de soi comme pratique de la liberte" in Dits et ecrits II, p. 1538.
13. This volume, p. 308.
14. This volume, p. 16.
15. This volume, p. 309 and Michel Foucault, Surveiller et punir. Naissance de la prison (Pans:
Gallimard, 1975), pp. 359360.
16. This volume, pp. 136-137.
17. This volume, p. 138 and p. 254.
18. This volume, p. 13.
19. This volume, p. 13.
20. This volume, p. 318.
21. This volume, pp. 322 323.
22. This volume, p. 323.
23. Michel Foucault, La Volonte de savoir, p. 137.
24. Ibid. , Part III.
25. Ibid. , p. 98.
26. This volume, p. 323, my emphasis.
27. Michel Foucault, "A propos de la genealogie de l'ethique: un aperc,u du travail en cours"
in Dits et ecrits II, p. 1205 and "A propos de la genealogie de l'ethique: un aperc,u du tra- vail en cours" in Dits et ecrits II, p. 1431. Not many English speaking readers are aware of the fact that there are two versions of this long conversation. The first version was published
in English as an appendix to the second edition of H. Dreytus and P. Rabinow, Michel Foucault: Beyond Structuralism and Hermeneutics; when that book was translated into French, Foucault made a number of modilications to this interview. Although the two versions overlap signilicantly, Foucault's reformulations are of great interest.
? TRANSLATOR'S NOTE
IN HIS DESCRIPTION OF the historical figure of "psychiatric power" Foucault frequently uses the term dispositif, referring to "disciplinary dispositif" and the "asylum dispositif" etcetera. There does not seem to be a satisfactory English equivalent for the particular way in which Foucault uses this term to designate a configuration or arrangement of elements and forces, practices and discourses, power and knowledge, that is both strategic and technical. On the one hand, in relation to "psychiatric power" the term picks out a sort of strategic game plan for the staging of real "battles" and "confrontations" that involve specific "tactics," "manipu- lations," "maneuvers," and the overall "tactical disposition" or "deploy ment" of elements and forces in an organized "battlefield" space. On the other hand, it also refers to a more or less stable "system" of "tech niques," "mechanisms," and "devices"; "a sort of apparatus or machinery. " I am not entirely happy with some of the existing translations-- "deployment," "set up," and even, in the case of Louis Althusser's use of the same term, "dispositive"--and have chosen to translate the word throughout as "apparatus. " This has its own drawbacks, the major one being that the same word translates "appareil" and perhaps risks confu sion with, for example, the notion of "State apparatuses" (apparei/s d'Etat), from which Foucault clearly wants to distinguish his own analy- sis. However, it should be said that on occasions Foucault himself uses appareil in a way that is difficult to distinguish from his use of dispositif. Wherever both words are used in close proximity to each other, or where it seems important to distinguish which word Foucault is using, the English is followed by the French word in brackets. Hopefully, the
? xxiv TRANSLATOR'S NOTE
analyses in which it is embedded will make Foucault's use of the term sufficiently clear.
I have not used existing English translations of authors quoted by Foucault in the lectures, but references to such translations can be found in the notes.
? o3*e
7 NOVEMBER 1973
The space of the asylum and disciplinary order. ^ Therapeutic process and "moral treatment. " ^ Scenes of curing. ^ Changes made by the coursefrom the approach o^Histoire de la folie:
1. From an analysis of "representations" to an "analytics of power"; 2. 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
7 November 1973 3
? 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.
7 November 1973 5
? 6 PSYCHIA TRIC POWER
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
7 November 1973 7
? 8 PSYCHIATRIC POWER
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.
Foucault approached his teaching as a researcher: explorations for a future book as well as the opening up of fields of problematization were formulated as an invitation to possible future researchers. This is why the courses at the College de France do not duplicate the published books. They are not sketches for the books even though both books and courses
? share certain themes. They have their own status. They arise from a specific discursive regime within the set of Foucault's "philosophical activities. " In particular they set out the programme for a genealogy of knowledge/power relations, which are the terms in which he thinks of his work from the beginning of the 1970s, as opposed to the programme of an archeology of discursive formations that previously orientated his work. 7
The courses also performed a role in contemporary reality. Those who followed his courses were not only held in thrall by the narrative that unfolded week by week and seduced by the rigorous exposition, they also found a perspective on contemporary reality. Michel Foucault's art con- sisted in using history to cut diagonally through contemporary reality. He could speak of Nietzsche or Aristotle, of expert psychiatric opinion or the Christian pastoral, but those who attended his lectures always took from what he said a perspective on the present and contemporary events. Foucault's specific strength in his courses was the subtle interplay between learned erudition, personal commitment, and work on the event.
*
With their development and refinement m the 1970s, Foucault's desk was quickly invaded by cassette recorders. The courses--and some seminars--have thus been preserved.
This edition is based on the words delivered in public by Foucault. It gives a transcription of these words that is as literal as possible. 8 We would have liked to present it as such. However, the transition from an oral to a written presentation calls for editorial intervention: At the very least it requires the introduction of punctuation and division into para- graphs. Our principle has been always to remain as close as possible to the course actually delivered.
Summaries and repetitions have been removed whenever it seemed to be absolutely necessary. Interrupted sentences have been restored and faulty constructions corrected. Suspension points indicate that the recording is inaudible. When a sentence is obscure there is a conjectural integration or an addition between square brackets. An asterisk directing the reader to the bottom of the page indicates a significant divergence between the notes used by Foucault and the words actually
Foreword xi
? xii FOREWORD
uttered. Quotations have been checked and references to the texts used are indicated. The critical apparatus is limited to the elucidation of obscure points, the explanation of some allusions and the clarification of critical points. To make the lectures easier to read, each lecture is pre ceded by a brief summary that indicates its principal articulations. 9
The text of the course is followed by the summary published by the Annuaire du College de France. Foucault usually wrote these in June, some time after the end of the course. It was an opportunity for him to pick out retrospectively the intention and objectives ol the course. It consti tutes the best introduction to the course.
Each volume ends with a "context" for which the course editors are responsible. It seeks to provide the reader with elements of the bio- graphical, ideological, and political context, situating the course within the published work and providing indications concerning its place within the corpus used in order to facilitate understanding and to avoid misinterpretations that might arise from a neglect of the circumstances in which each course was developed and delivered.
Psychiatric Power, the course delivered in 1973 and 1974, is edited by Jacques Lagrange.
*
A new aspect of Michel Foucault's "oeuvre" is published with this edition of the College de France courses.
Strictly speaking it is not a matter of unpublished work, since this edition reproduces words uttered publicly by Foucault, excluding the often highly developed written material he used to support his lectures. Daniel Defert possesses Michel Foucault's notes and he is to be warmly thanked for allowing the editors to consult them.
This edition of the College de France courses was authorized by Michel Foucault's heirs who wanted to be able to satisfy the strong demand for their publication, in France as elsewhere, and to do this under indisputably responsible conditions. The editors have tried to be equal to the degree ol conlidence placed in them.
FRANCOIS EWALD AND ALESSANDRO FONTANA
? 1. Michel Foucault concluded a short document drawn up in support of his candidacy with these words: "We should undertake the history ol systems of thought. " "Titres et travaux," in Dils et Ecrits, 195/l-19S8, four volumes, ed. Daniel Defert and Francois Ewald (Paris: Gallimard, 1994) vol. 1, p. 846; English translation, "Candidacy Presentation: College de France," in The Essential Works of Michel Foucault, 1954-1984, vol. 1: Ethics: Subjectivity and Truth, ed. Paul Rabinow, trans. Robert Hurley and others (New York: The New Press, 1997) p. 9.
2. It was published by Gallimard in May 1971 with the title VOrdre du discours (Paris). English translation: "The Order of Discourse," trans. Rupert Swyer, appendix to M. Foucault, The Archeology of Knowledge (New York: Pantheon, 1972).
3. This was Foucault's practice until the start of the 1980s.
4. Within the framework of the College de France.
5. In 1976, in the vain hope of reducing the size of the audience, Michel Foucault changed the
time of his course from 17/i5 to 9. 00. See the beginning of the lirst lecture (7 January 1976) ol "1/ Jaut defendre la societe". Cours au College de France, 1976 (Pans: Gallimard/Seuil, 1997); English translation, "Society Must be Defended". Lectures at the College de France 1975-1976, trans. David Macey (New York: Picador, 2003).
6. Gerard Petitjean, "Les Grands Pretres de I'universite Iranc. aise," Lc Nouvel Observateur, 1 April 1975-
7. See especially, "Nietzsche, la genealogie, I'histoire," in Dils et Ecrils, vol. 2, p. 137. English translation, "Nietzsche, Genealogy, History," trans. Donald F. Brouchard and Sherry Simon in, The Essential Works of Michel Foucault 1954-1984, vol. 2: Aesthetics, Method, and Epistemology, ed. James Faubion, trans. Robert Hurley and others (New York: The New Press, 1998), pp. 369 92.
8. We have made use ol the recordings made by Gilbert Burlet and Jacques Lagrange in particular. These are deposited in the College de France and the Institut Memoires de I'Edition Contemporaine.
9. At the end of the book, the criteria and solutions adopted by the editors ol this year's course are set out in the "Course context. "
Foreword xiii
? INTRODUCTION Arnold I. Davidson
MICHEL FOUCAULT'S CENTRAL CONTRIBUTION to political philosophy was his progressive development and refinement of a new conception of power, one that put into question the two reigning conceptions of power, the juridical conception found in classical liberal theories and the Marxist conception organized around the notions of State apparatus, dominant class, mechanisms of conservation, and juridical superstruc- ture. If the first volume of his history of sexuality, La Volonte de savoir (1976), is a culminating point of this dimension of Foucault's work, his courses throughout the 1970s return again and again to the problem of how to analyze power, continually adding historical and philosophical details that help us to see the full import and implications of his ana- lytics of power. At the beginning of the chapter "Methode" in La Volonte de savoir Foucault warns his readers against several misunderstandings that may be occasioned by the use of the word "power," misunder standings concerning the identity, the form, and the unity of power. Power should not be identified, according to Foucault, with the set of institutions and apparatuses in the State; it does not have the form of rules or law; finally, it does not have the global unity of a general system of domination whose effects would pass through the entire social body. Neither state institutions, nor law, nor general effects of domination constitute the basic elements of an adequate analysis of how power works in modern societies. 1 Without having yet developed all of the tools of his own analysis, Psychiatric Power already exhibits Foucault's aware ness of the shortcomings of available conceptions of power, and nowhere more clearly than in his own critique of notions implicit or explicit in
? his Histoire de lafolk. Foucault's dissatisfaction with his previous analy- sis of asylum power centers around two basic features ol the analysis in Histoire de lafolie: first, the privileged role he gave to the "perception of madness" instead of starting, as he does in Psychiatric Power, from an apparatus of power itself; second, the use of notions that now seem to him to be "rusty locks with which we cannot get very far" and that therefore compromise his analysis of power as it is articulated in Histoire de lafolie. 2
As regards this second point, Foucault's critique of his own use of the notions of violence, of institution, and of the family can be seen in ret- rospect to be an important part of his development of that alternative model of power that will be at the center of Surveiller et punir and La Volonte de savoir. In effect, Foucault's criticisms here take aim precisely at assumptions concerning the identity, the form, and the unity of power. Rather than thinking of power as the exercise of unbridled violence, one should think of it as the "physical exercise of an unbalanced force" (in the sense of an unequal, non symmetrical force), but a force that acts within "a rational, calculated, and controlled game of the exercise of power. '0 Instead of conceptualizing psychiatric power in terms of insti tutions, with their regularities and rules, one has to understand psychi- atric practice in terms of "imbalances of power" with the tactical uses of "networks, currents, relays, points of support, differences of potential" that characterize a form of power/1 Finally, in order to understand the functioning of asylum power, one cannot invoke the paradigm of the family, as if psychiatric power "does no more than reproduce the family to the advantage of, or on the demand of, a form of State control orga- nized by a State apparatus"; there is no foundational model that can be projected onto all levels of society, but rather different strategies that allow relations of power to take on a certain coherence. 3 In La Volonte de savoir, with more conceptual precision, Foucault explicitly understands power in terms of a multiplicity of relations of force, of incessant tacti cal struggles and confrontations that affect the distribution and arrangement of these relations of force, and of the strategies in which these relations of force take effect, with their more general lines of integration, their patterns and crystallizations. 6 And the nominalism
advocated in La Volonte de savoir is present in practice in Psychiatric
Introduction xv
? xvi INTRODUCTION
Power: power is "the name that one gives to a complex strategic situation in a given society. "7
The stakes of this nominalism are evident in one of the first theoretical claims about power that Foucault makes in Psychiatric Power, a claim that, despite its apparent simplicity, already requires an entire reelaboration of our conception of power:
. . . 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 dir ferences, which have to be analyzed, that power can begin to lunction. 8
This claim is the basis of Foucault's later insistence on "the strictly rela tional character of relationships of power" (and of relationships of resis tance), the fact that power "is produced at every moment, in every point, or rather in every relation Irom one point to another. "9 Foucault was never interested in providing a metaphysics of Power; his aim was an analysis of the techniques and technologies of power, where power is understood as relational, multiple, heterogeneous, and, of course, pro ductive. 10 Foucault went so far as once to proclaim, "power, it does not exist" so as to emphasize that, from his perspective, it is always bundles of relations, modifiable relations of force, never power in itself, that is to be studied--that is to say, to render the exercise of power intelligible, one should take up the point of view of "the moving base of relations of force that, by their inequality, continually lead to states of power, but always local and unstable. "" As late as 1987i, when the focus of his inter ests had already shifted, he stressed this point yet again: "I hardly employ the word power, and if I occasionally do, it is always as a short- hand with respect to the expression that I always use: relations of power.
I believe that it is precisely this relational conception ol power, with all ol its accompanying instruments of analysis, that allows Foucault to give his extraordinary historical reinterpretation ol the problem ol
? hysteria at the conclusion of Psychiatric Power. When in the final part of his lecture of 6 February Foucault takes up Charcot's treatment of hys terics and what he names "the great maneuvers of hysteria," he announces the angle of analysis he will adopt: "I will not try to analyze this in terms of the history of hysterics any more than in terms of psy chiatric knowledge of hysterics, but rather in terms ol battle, confronta- tion, reciprocal encirclement, of the laying of mirror traps |by which Foucault means traps that reflect one another], of investment and counter investment, of struggle for control between doctors and hysterics. "1* All of the terms in this description answer to his new analytics of power, with its "pseudo military vocabulary," that will provide the framework for his examination of a wide variety of historical phenomena during the 1970s. 1H And when he sets aside the idea of an epidemic of hysteria (a scientific-epistemological notion) in favor of an analysis focused on "the maelstrom of this battle" (le tourbillon de cette bataille) that sur rounds hysterical symptoms, one cannot help but hear an anticipation of the last line of Surveiller el punir where Foucault tells us that in those apparatuses of normalization that are intended "to provide relief, to cure, to help" one should hear "the rumbling of battle" (/e grondemenl de la balaille)P It is this rumbling, this maelstrom of battle that Foucault's perspective renders visible, a struggle that is effaced in a purely episte mological analysis and that is left out of sight within a theory of power built on a juridical and negative vocabulary. (Hence the way in which the "repressive hypothesis" renders imperceptible the multiplicity of possible points ol resistance. ) To take just one example, Foucault's ana lytics restores this relational dimension of battle to the great problem of simulation that was so crucial to the history of psychiatry; it enables him to treat simulation not as a theoretical problem, but as a process by which the mad actually responded to psychiatric power, a kind of "anti power," that is a modification ol the relations ol lorce, in the face ol the mechanisms ol psychiatric power--thus the appearance ol simulation not as a pathological phenomenon, but as a phenomenon of struggle. 16 As a result, lrom this point of view, hysterical simulation becomes "the militant underside |the militant reverse side] ol psychiatric power" and hysterics can be seen as "the true militants ol antipsychiatry. "1' Moreover, the elaboration of this microphysics of power does not require
Introduction X V l l
? xviii INTRODUCTION
Foucault to ignore the epistemological dimensions of the history of psychiatry, the discursive practices of psychiatric knowledge. On the contrary, it allows him to place these practices within a political history of truth, to reconnect these practices to the functioning of an apparatus of power, to link them to a level "that would allow discursive practice to be grasped at precisely the point where it is formed. "18 Psychiatric Power can be read as a kind of experiment in method, one that responds in his- torical detail to a set of questions that permeated the genealogical period of Foucault's work:
. . . to what extent can an apparatus of power produce statements, discourses and, consequently, all the forms of representation that may then [. . . ] derive from i t . . . How can this deployment of power, these tactics and strategies of power, give rise to assertions, negations, experiments (experiences^), and theories, in short to a game of truth? 19
At the very end of his course, when Foucault returns to the relations of power between hysteric and doctor, to hysterical resistance to medical power, the scene of sexuality is center stage. But the introduction of sex- uality into this scenario does not derive from the "power" of the doc tors, but rather from the hysterics themselves, as their putting into play of a point of resistance within the strategic field of existing relations of power. As a counter attack to the medical need to find an etiology for hysteria that will give its symptoms a pathological status, and more specifically (given the distributions of power-knowledge that surround the hysterical body) to find a trauma that will function as a "kind of invisible and pathological lesion which makes all of this a well and truly morbid whole," the hysteric will respond with the counter maneuver of a recounting of her sexual life, with all of its possible traumatism, thereby effecting a redistribution of force relations and a new configura tion of power.
. . . w h a t will the patients do with this injunction to find the trauma that persists in the symptoms? Into the breach opened by this injunction they will push their life, their real, everyday life,
? that is to say their sexual life. It is precisely this sexual life that they will recount, that they will connect up with the hospital and endlessly reactualize in the hospital. 20
And Foucault draws the following remarkable conclusion, which needs to be underlined and related, after the fact, to the context of his later history of sexuality:
It seems to me that this kind of bacchanal, this sexual pantomime, is not the as yet undeciphered residue of the hysterical syndrome. My impression is that this sexual bacchanal should be taken as the counter-maneuver by which the hysterics responded to the ascrip- tion of trauma: You want to find the cause of my symptoms, the cause that will enable you to pathologize them and enable you to function as a doctor; you want this trauma, well, you will get all my life, and you won't be able to avoid hearing me recount my life and, at the same time, seeing me mime my life anew and endlessly reactualize it in my attacks!
So this sexuality is not an indecipherable remainder but the hysteric's victory cry, the last maneuver by which they finally get the better of the neurologists and silence them: If you want symp- toms too, something functional; if you want to make your hypno- sis natural and each of your injunctions to cause the kind of symptoms you can take as natural; if you want to use me to denounce the simulators, well then, you really will have to hear what I want to say and see what I want to do! 21
This victory cry or the hysteric, although a genuine cry of victory, is not a definitive cry. Like all triumphs within the field of mobile and reversible power relations, one can be sure that it will be met by further tactical interventions, actions intended to modify the new disposition of force relations, rearranging yet again the existing relations of power. If it is the hysteric herself who, from within the field of power relations, imposes the sexual body on the neurologists and doctors, these latter, according to Foucault, could respond with one ol two possible attitudes. They could either make use of these sexual connotations to discredit
Introduction xix
? xx INTRODUCTION
hysteria as a genuine illness, as did Babinski, or they could attempt to circumvent this new hysterical maneuver by surrounding it once more medically--"this new investment will be the medical, psychiatric, and psychoanalytic take over of sexuality. "22 History has taught us that the second response would be the triumphant one. And the first volume of Foucault's history of sexuality picks up the battle where Psychiatric Power left off, with the codification of scientia sexualis and the solidification of the apparatus of sexuality, with a new medical victory cry in favor of sexuality. Indeed, the "hysterisation" of women's bodies is one of the four great strategic ensembles with respect to sex that Foucault singles out as having attained an historically noteworthy "efficacity" in the order of power and "productivity" in the order of knowledge. 23 The effects of an initially disruptive recounting of her sexual life by the hysteric will be reorganized by means of the constitution of a scientific modality of confession; the traumas of sexuality will become integrated into those procedures of individualization that produce our subjection. 27' If Charcot could not see or speak of this sexuality, the later history of psychiatry would find it everywhere, would insist on putting sex into discourse, would enjoin its patients to speak of their sexuality. When the science of the subject began to revolve around the question of sex, the hysteric's victory was effectively countered by new tactics and strategies of power, and the reactualization of one's sexual life was divested ol its potential ol resistance and became a practice now crucial to the functioning of psychiatric power. That is why Foucault's histonco-pohtical project will be "to define the strategies of power which are immanent to this will to know" that continues to encircle sexuality. 2S
It is in this light that we should read the last sentence ol Psychiatric Power, a phrase that might have seemed enigmatic when pronounced by Foucault on 6 February 1977i, but whose force is quite clear in the context ol La Volonte de savoir:
By breaking down the door ol the asylum, by ceasing to be mad so as
to become patients, by finally getting through to a true doctor, that
is to say the neurologist, and by providing him with genuine func- tional symptoms, the hysterics, to their greater pleasure, but doubtless to our greater misfortune, gave rise to a medicine of sexuality. 26
? This final diagnosis, namely that the great pleasure of the hysteric's vie tory became the great misfortune of our subjection to the apparatus of sexuality, focuses our attention on that moving stratum of force relations that underlies the instability, the transformability, of relations of power/resistance. If today the sexual body is no longer primarily the hysterical body, but rather, let us say, the perverse body, it remains up to us to learn to hear anew the rumbling of the current battle. Only in this way will we be able "to determine what is the principal danger" and "to render problematic everything that is habitual"--thus we will be able to put into movement the points of support for our counter attack against the apparatus of sexuality. 27
Introduction xxi
? XX11 INTRODUCTION
1. Michel Foucault, Histore de la sexualite, vol. 1, La Volonte de savoir (Paris: Gallimard, 1976), p. 121.
2. This volume, pp. 13 14.
3. This volume, p. 14.
4. This volume, p. 15-
5. This volume, p. 16.
6. Michel Foucault, La Volonte de savoir, pp. 121 122.
7. Ibid. , p. 123.
8. This volume, p. 4.
9. Michel Foucault, La Volonte de savoir, pp. 126,122. It is this relational conception ol power
that makes it possible for Foucault to argue that "where there is power, there is resistance. . . ", Ibid. , pp. 125-127. For a more detailed discussion, see my introduction to the second part of Michel Foucault.
Philosophic Anthologie etablie et presentee par Arnold I. Davidson et Frederic Gros. (Paris: Gallimard, 2004).
10. Michel Foucault, "Precisions sur le pouvoir. Reponses a certaines critiques" in Dits et ecrits II, 1976-1988 (Paris: Gallimard, 2001), p. 630 and "Les mailles du pouvoir" in Dits et ecrits II, pp. 1005 1008.
11. Michel Foucault, "Le jeu de Michel Foucault" in Dits et ecrits II, p. 302 and La Volonte de savoir, p. 122.
12. Michel Foucault, "L'ethique du souci de soi comme pratique de la liberte" in Dits et ecrits II, p. 1538.
13. This volume, p. 308.
14. This volume, p. 16.
15. This volume, p. 309 and Michel Foucault, Surveiller et punir. Naissance de la prison (Pans:
Gallimard, 1975), pp. 359360.
16. This volume, pp. 136-137.
17. This volume, p. 138 and p. 254.
18. This volume, p. 13.
19. This volume, p. 13.
20. This volume, p. 318.
21. This volume, pp. 322 323.
22. This volume, p. 323.
23. Michel Foucault, La Volonte de savoir, p. 137.
24. Ibid. , Part III.
25. Ibid. , p. 98.
26. This volume, p. 323, my emphasis.
27. Michel Foucault, "A propos de la genealogie de l'ethique: un aperc,u du travail en cours"
in Dits et ecrits II, p. 1205 and "A propos de la genealogie de l'ethique: un aperc,u du tra- vail en cours" in Dits et ecrits II, p. 1431. Not many English speaking readers are aware of the fact that there are two versions of this long conversation. The first version was published
in English as an appendix to the second edition of H. Dreytus and P. Rabinow, Michel Foucault: Beyond Structuralism and Hermeneutics; when that book was translated into French, Foucault made a number of modilications to this interview. Although the two versions overlap signilicantly, Foucault's reformulations are of great interest.
? TRANSLATOR'S NOTE
IN HIS DESCRIPTION OF the historical figure of "psychiatric power" Foucault frequently uses the term dispositif, referring to "disciplinary dispositif" and the "asylum dispositif" etcetera. There does not seem to be a satisfactory English equivalent for the particular way in which Foucault uses this term to designate a configuration or arrangement of elements and forces, practices and discourses, power and knowledge, that is both strategic and technical. On the one hand, in relation to "psychiatric power" the term picks out a sort of strategic game plan for the staging of real "battles" and "confrontations" that involve specific "tactics," "manipu- lations," "maneuvers," and the overall "tactical disposition" or "deploy ment" of elements and forces in an organized "battlefield" space. On the other hand, it also refers to a more or less stable "system" of "tech niques," "mechanisms," and "devices"; "a sort of apparatus or machinery. " I am not entirely happy with some of the existing translations-- "deployment," "set up," and even, in the case of Louis Althusser's use of the same term, "dispositive"--and have chosen to translate the word throughout as "apparatus. " This has its own drawbacks, the major one being that the same word translates "appareil" and perhaps risks confu sion with, for example, the notion of "State apparatuses" (apparei/s d'Etat), from which Foucault clearly wants to distinguish his own analy- sis. However, it should be said that on occasions Foucault himself uses appareil in a way that is difficult to distinguish from his use of dispositif. Wherever both words are used in close proximity to each other, or where it seems important to distinguish which word Foucault is using, the English is followed by the French word in brackets. Hopefully, the
? xxiv TRANSLATOR'S NOTE
analyses in which it is embedded will make Foucault's use of the term sufficiently clear.
I have not used existing English translations of authors quoted by Foucault in the lectures, but references to such translations can be found in the notes.
? o3*e
7 NOVEMBER 1973
The space of the asylum and disciplinary order. ^ Therapeutic process and "moral treatment. " ^ Scenes of curing. ^ Changes made by the coursefrom the approach o^Histoire de la folie:
1. From an analysis of "representations" to an "analytics of power"; 2. 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
7 November 1973 3
? 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.
7 November 1973 5
? 6 PSYCHIA TRIC POWER
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
7 November 1973 7
? 8 PSYCHIATRIC POWER
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.
