In the 1830s we begin to see the
separation
of the insane from idiot children, in the lorm
ol both statements of principle and the beginning ol institutional realizations.
ol both statements of principle and the beginning ol institutional realizations.
Foucault-Psychiatric-Power-1973-74
Juchet and J.
Postel, "Le surveillan Jean Baptiste Pussin" Histoire
des sciences medicates, vol. 30, no. 2, 1996, pp. 189-198.
26. On the basis of the law of 30 June 1838 a debate began on the nature ol the powers in
charge in the asylums. Thus, the Prefect of the Seine, the Baron Haussmann, on the
27 December i860, set up a commission for "the improvement and relorms to be carried
out in the services lor the insane" which, Irom February to June 1861, discussed whether
an administrative director should be appointed alongside the asylum doctor or whether medical and administrative powers should both be in the hands ol a doctor director, as loreseen in article 13 of the order of application of the law of 18 December 1839. On
25 November 1861, the report concluded that "a single authority would be desirable, that
every administrative or medical element work under a single impulse towards the good that
is oflered" Rapport cle la Commission institute pour la reforme el I'amenagement clu service d'alienes du departement de la Seine (Paris: 1861).
27. P. Pinel, La Medecine clinique rendue plus precise el plus exacte par ^application de I'analyse, ou Recueil el resultats d'observations sur les maladies aigues,faites a la Salpetriere (Pans: Brosson et Gabon, 1804, 2nd edition) pp. 5 6.
28. Falret, for example, puts questioning in the forefront of clinical examination by laying down as principle that "il you wish to know the tendencies, the direction ol the mind, and the dispositions of leelings which are the source of every symptom, do not reduce your duty
as observer to the passive role ol secretary to the patients, ol stenographer ol their words
or narrator ol their actions . . . The lust principle to be lollowed . . . is therelore to change one's passive role ol the observer of the patient's words and actions into an active role, and frequently seek to provoke and call forth symptoms which would never arise sponta neously" J. P. Falret, "Discours d'ouverture: De la direction a impnmer a l'observation des alienes," in Lecons cliniques de medecine menlale Jaites a I'liospice de la Salpetriere (Paris:
J. B. Bailliere, 1854) pp. 19 20.
29. Ibid. 8th Lesson, pp. 221-222: "Sometimes one must artfully lead the conversation to cer
tain subjects one supposes are related to unhealthy ideas or sentiments; these calculated interviews act as touchstones for bringing to light morbid preoccupations. Considerable experience and much art is often necessary to observe certain insane people appropriately" See also, J. P. Falret, De Venseignement clinique des maladies mentales (Pans: Martinet, 1850) pp. 68 71.
30. Hence the numerous declarations that insist on the need to collect observations on the patients in "registers" which recapitulate the history of their illness. P. Pinel recommends "keeping exact journals ol the progress and diverse lorms taking by the insanity through- out its course, Irom its onset to its end" Traite medico-philosophique, section VI, ? xn, p. 256; A Treatise on Insanity, Section VI, p. 246. C. F. S. Giraudy stresses this in his Memoire sur la Maison nationale de Charenton, pp. 17-22. Moreau de Tours notes: "Information obtained about the patient are kept in the register, which must also contain the necessary details on
the progress of the illness ( . . . ) This register is a veritable notebook ol observations, a statistical study ol which is made at the end ol each year, which is a source ol precious documents" J. J. Moreau de Tours, "Lettres medicales sur la colonie d'alienes de Gheel" p. 267. On this form ol disciplinary writing, see M. Foucault, Surveiller et Punish, pp. 191 193; Discipline and Punish, pp. 191-192.
31. In 1817 Esquirol began a clinical class of mental illnesses at Salpetriere, which he contin- ued until his appointment as head doctor at Charenton in 1826. See, R. Semelaigne, Les Grands Alienistes francais (Pans: G. Steinheil, 1894) p. 128; and, C. Bouchet, Quelques mots sur Esquirol ( Nantes: C. Mellinet, 1841) p. 1.
32. At Bicetre Irom 1833 to 1839, Guillaume Ferrus, appointed head doctor at the beginning of 1826, gave "Clinical lessons on mental illnesses," which are reproduced in the Gazette medicalc de Paris, vol. I, no. 65,1833; vol. II, no. 39,1834, p. 48; vol. IV, no. 25,1836, pp. 28, 44 and 45; and in the Gazette des hopitaux, 1838, pp. 307, 314, 326, 345, 352, 369, 384, 399, 471, 536, 552, 576, 599 and 612; 1839, pp. 5,17, 33, 58, 69, 82, 434 and 441. In 1840, after the departure of Ferrus, Leuret organized clinical lessons which he continued until 1847, published in part in the Gazette des hopitaux, vol. II, 1840, pp. 233, 254, 269 and 295.
33. At Salpetriere,Jules Baillarger (1809 189O) took up clinical teaching in 1841. Jean-Pierre Falret, appointed doctor of a section for the insane, in turn began clinical teaching in 1843,
9 January 1974 197
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PSYCHIATRIC POWER
part ol which is published in the Ann ales medko-psychologiques, vol. IX, September 1847, pp. 232 264, and vol. XII, October 1849, pp. 524 579. These lessons are reprinted (with the same title) in: De I'cnseignement clinique des maladies mentale. See, M. Wiriot, L'Ensettlement clinique dans les hbpitaux de Paris entrc Z797/ and 1&48, Medical Thesis, Paris, 1970, no. 334 (Vincennes: Chaume, 1970).
34- J. P. Falret, De renseignemenl clinique, p. 126.
35.
36.
37-
38.
Ibid. p. 127: "The public narration ol their illness made by the insane is an even more precious help to the doctor . . . , the doctor must be powerlul in a very different way in the wholly new conditions ol the clinic, that is to say, when the prolessor makes all the phenomena ol his illness perceptible to the patient in the presence of more or less numerous auditors. "
Ibid. p. 119: "If the patients accept . . . he will give the history ol their illness with the fixed principle ol recounting only that which is completely known to them, and he will Irequently slop to ask them il he is trulhlully expressing the lacts that they themselves have told him earlier. "
Ibid. p. 125: "The account ol their illness, given in all its developments, often makes a strong impression on the insane, who themselves testily to its truth with visible satisfac- tion, and enjoy entering into the greatest detail in order to complete the account, as il they were astonished and proud that someone should take such an interest in them so as to know their entire history. "
Marie Francois Xavier Bichat (1771 1802), alter having been introduced to surgery in Lyon in the department ol Marc Antoine Petit (1762 1840 ) and, in June 1794, becoming the student ol Pierre Joseph Delsaut (1744 1795), surgeon at the Hotel Dieu, devoted himsell, after his appointment in 1800, to pathological anatomy, undertaking to establish the delinite relationships between alterations ol tissues and clinical symptoms. See, Trade des membranes en general et des diverse* membranes en particulier(Par\s: G a b o n , 1 8 ( ) 0 ) . H e set out his conceptions in Anatomie generate appliquee a la physiologic et a la medecine, in four volumes (Paris: Brosson et Gabon, 1801); English translation, General Anatomy, applied to Physiology and the Practice of Medicine, trans. C. Coffyn (London: 1824).
But it was above all Gaspard Llaurent Bayle (1774 1816) and Rene Theophile Laennec (1781 1826) who strove to lound clinical medicine and pathological anatomy in a single discipline. Bayle was one ol the first to formulate the methodology ol the young school ol clinical anatomy in his thesis defended 4 Venlose Year X/24 February 1802: Considerations sur la nosologic, la medecine d'observation et la medecine pratique, suiviies d'observations pour servir a rhistoire des pustules gangreneuses, Medical Thesis, Pans, no. 70 (Paris: Boiste [Gabon], 1802). He sets out the ideas that he will develop and clarify in, Recherches sur la phtisie pulmonaire (Pans: Gabon, 1810); English translation, Researches on Pulmonary Phthisis, trans. W. Barrow (London: Longman, 1815), and in "Considerations generales sur les secours que I'anatomie pathologique peut fournir a la medecine," in Dictionnaire des sciences medicates, vol. II (Pans: C. L. F. Panckoucke, 1812) pp. 61 78. R. T. Laennec renewed pulmonary pathology by endeavouring to "put the diagnosis ol internal organic lesions on the same level as the diagnosis of surgical illnesses," De Vauscultation mediate, ou Trade du diagnostic des malades des poumons et du coeur,fonde principalamenl sur ce nouveau moyen d'exploration, two volumes (Pans: Brosson and Chaude, 2lul revised and expanded edition, 1826) vol. 1, p. xxv; English translation, A Treatise on Mediate Auscultation, and on Diseases of the Lungs and Heart, translated by a Member of the College ol Physicians (London: J. B. Bailliere, 1846), and in his posthumous work, Trade inedit sur I'anatomie pathologique, ou Exposition des alterations visible qu'eprouve le corps humain dans I'etat de maladie (Pans: Alcan, 1884).
On Bichat, see the pages in chapter 8, "Ouvrez quelques cadavres" ol M. Foucault, Naissance de la clinique. Une archeologie du regard medical (Pans: P. U. F. , 1963) pp. 125 148; English translation, The Birth of the Clinic. An Archeology oj Medical Perception, trans. A. M. Sheridan Smith (London: Tavistock and New York: Pantheon, 1973), ch. 8, "Open Up a Few Corposes" pp. 124 148. More generally, see,J. E. Rochard, Histoire de la chirurgie francaise au X. 1X: siecle (Paris: J . B . Bailliere, 1875); O. Temkin, "The role ol surgery in the rise of modern medical thought" Bulletin oj the History of Medicine, Baltimore, Md: vol. 25, no. 3, 1951, pp. 248 259; E. H. Ackerknecht, (i) "Pariser chirgurgie von 1794-1850" Gesnerus, vol. 17, 1960, pp. 137 144, and (ii) Medicine at the Paris Hospitals, M9y\-^\S
? (Baltimore Md: The Johns Hopkins Press, 1967); French translation, La Medecine hospitaliere
a Paris, 179/\-l8/\&, trans. F. Blateau (Paris, Payol, 1986); P. Huard and M. Grmeck, eds. , Sciences, medecine, pharmacic, de la Revolution a rEmpire, 17&9-1&15 (Paris: Ed. Dacosta, 1970) pp. W Vl5; M. J. Imbault Huart, L'Ecole pratique de dissection de Paris de 1750 a
1822, ou I'injlucnce du concept de medecine pratique el de medecine d'observation dans I'enseignement medico-chirurgical an XVIH' siecle, These de doctoral cs lettres, University Paris I, 1973, reprinted University of Lille III, 1975; P. Huard, "Concepts et realites de Peducation et de
la profession medico-chirurgicales pendant la Revolution" Journal des savants, April June
1973, pp. 126 150.
On G. L. Bayle, see, M. J. Imbault Huart, "Bayle, Laennec et la melhode anatomo
clinique" Revue du Palais de la Decouverte, special number, 22 August 1981, pp. 179 89. Later, J. Dulfin, "Gaspard Laurent Bayle et son legs scientilique: au dela de l'anatomie pathologique" Canadian Bulletin of Medical History, Winnipeg, vol. 31,1986, pp. 167 184.
On Laennec, see, P. Huard, "Les chirurgiens et I'esprit chirurgical en France au XVIII1 siecle," Clio Medica, vol. 15, nos. 3 4,1981. Later, J. Duffin ( i ) "The medical philosophy ol R. T. Laennec (1781 1826)" History and Philosophy of (he Life Sciences, vol. 8,1986, pp. 195 219, and ( n ) "La medecine anatomo clinique: naissance et constitution d'une medecine moderne" Revue medicale de la Suisse Romande, no. 109, 1989, pp. 1005 1012.
$9.
In the 1830s we begin to see the separation of the insane from idiot children, in the lorm
ol both statements of principle and the beginning ol institutional realizations. Appointed
to Bicetre in 1826, in 1834 Guillaume Ferrus called lor the creation of "special establish ments in which every curative technique was brought together" Des alienes, p. 190. In 1839,
in a report ol the Medical Commission ol Paris Hospitals, Ferrus emphasized again "the usefulness of the creation ol a children's section at Bicetre" (quoted by D. M. Bourneville, Assistance, Traitement et Education des enfants idiots et degeneres. Rapportfait au congiis national d'Assistancepuhlique, Lyon,juin 189/I | Paris: Publications du Progres medical, 1895] p. 142). One of the first institutional realizations was that ol Jean Pierre Falret who, after his appointment to Salpetnere on 30 March 1831, decided to bring together 80 idiots and imbeciles in a common section. However, their slowness is such that, in 1835,
J. B. Parchappe can still write that the presence ol young idiots in "insane asylums, in the absence ol special quarters, oilers every kind ol drawback ( . . . ) I consider the creation ol
a quarter for children in insane asylums to be an indispensable necessity" Des principes a suivre dans la fondation el la construction des asiles d'alienes (Paris: Masson, 1853) p. 89. On this point, see the historical account of D. M. Bourneville, Assistance, Traitement et Education des en/ants idiots, ch. 1: "Aperc. ii historique de ('assistance et du traitement des enfants idiots et degeneres," pp. 1 7. See below, lecture ol 16 January 1974.
40. In the 1880s, when the nosology of neurological disorders reaches its completion, the held ol the neuroses jettisons the mass of organic symptoms (paralysis, anesthesia, sensonal disorders, algia, etcetera) which are supplanted by the new clinical neuropathology attached to the study of localized lesions of the nerves and marrow and specialized structures of the encephalon. What remains ol this field tends, around 1885 to 1890, to be organized around lour major clinical groups: ( a ) choreic neuroses (hysterical chorea, St. Vitus's dance); (b) neurasthenia; (c) hysteria; and (d) obsessions and phobias.
41. Foucault's analysis is inspired here by R. Castel, Le Psychanalysme (Paris: Maspero, 1973) about which he wrote in the manuscript for the lecture ol 7 November 1973: "This is a radical book because, for the lirst time, psychoanalysis is situated solely within psychiatric practice and power. "
9 January 1974 199
? nine
16 JANUARY 1974
The modes of generalisation of psychiatric power and the psychiatri^ation of childhood. ^ 1. The theoretical specification of
idiocy. The criterion of development. ^ Emergence of a psychopathology of idiocy and mental retardation. Edouard
Seguin: instinct and abnormality. ^ 2. The institutional annexation of idiocy by psychiatric power. ^ The umoral treatment" of idiots: Seguin. ^ The process of confinement and the
stigmati^ation of the dangerousness of idiots. ^ Recourse to the notion of degeneration.
I WOULD LIKE TO try to pick out the points and forms of the generalization of psychiatric power, which I have the impression took place fairly early on. I do not think, if you like, that the generalization of psychiatric power is contemporary with or an effect of psychoanalytic practice. It seems to me that there was a diffusion of psychiatric power very early on, a transmission that dates from a much earlier period and the effect of which is, of course, transmission of an archaic form of psychiatric power.
It seems to me that this diffusion of psychiatric power was carried out on the basis of childhood, that is to say, starting from the psychiatrization of childhood. Of course, you find sketches and forms of this generaliza- tion based on personages other than the child--we find them quite early on, for example, in connection with the criminal, with the development of psychiatric legal expertise and of the notion of monomania--but in
? 202 PSYCHIATRIC POWER
the end it seems to me that it was especially the child much more than the adult who provided the support for the diffusion of psychiatric power in the nineteenth century.
In other words--anyway, this is the hypothesis I would like to try out before you--I think that we should look for the principle of diffusion of psychiatric power in the direction of the coupling of the hospital and the school, of health institution and the system of learning (pedagogical insti- tution, model of health). And as an epigraph for what follows I would like to quote one of those short and dazzling sentences loved by Canguilhem. He wrote: " 'Normal' is the term used by the nineteenth century to des ignate the scholastic prototype and the state of organic health. "1 It seems to me that, in the end, the diffusion ot psychiatric power takes place by way of this development oi the concept of the "normal. "
It would be quite natural to expect the psychlatrization of childhood to take place by two routes apparently laid down in advance: by way of the discovery of the mad child on the one hand, and, on the other, by way of bringing childhood to light as the locus ol the foundation and origin of mental illness. *
Now, my impression is that things did not happen in this way exactly. In actual tact, it seems to me that the discovery of the mad child took place rather late and was much more the secondary effect of the psychiatrization of the child than its place of origin. I think the mad child appeared rather late in the nineteenth century;2 we see it emerging around Charcot, that is to say, around hysteria, around the 1880s, and it does not enter psychiatry by the royal road of the asylum, but by way of private consultation. The first children you see appearing in the file of the history of psychiatry are the children ot private clients; they are generally, with regard to Charcot, idiot grandsons of Russian grand dukes, or somewhat hysterical Latin American granddaughters. 3 It is these children, framed moreover by the parents, this trinity, who appeared in Charcot's offices around the 1880s. And it was not at all the tightening of family discipline, or the imposition of school discipline, which allowed the mad child to be picked out in the course of the nineteenth century.
* The manuscript clarities: "through the action ol anamnesis, the questioning of patients and their family, and the accounts ol their life. "
? On the other hand, neither was a fundamental, privileged, founding relationship between childhood and madness brought to light by the anamneses, the autobiographical accounts, to which psychiatric power constrained patients throughout the nineteenth century. When the mad were asked to recount their life, this was not at all an attempt to account for their madness on the basis of what happened in their childhood, but in order to grasp a madness already constituted, as it were, in this childhood, or at any rate, some forewarning signs of a predisposition to madness, which would already mark their childhood, or in order to find the signs of hereditary predisposition. And nor was the mad content of childhood experience questioned through anamnesis. So, the mad child, the child as object of psychiatry, appeared late, and a fundamental relationship between childhood and madness was not a question early on.
I would say then--this is the hypothesis I want to consider--that psychiatrization of the child, however paradoxical this may be, did not come about by way of the mad child or the madness of childhood, by way of the constitutive relationship between madness and childhood. It seems to me that psychiatrization of the child came about through a completely different figure: the imbecilic child, the idiot child, the child who will soon be called retarded, that is to say, a child about whom one was carelul to say, right from the start, in the first thirty years of the nineteenth century, that he was not mad/1 Psychiatrization of the child took place through the intermediary of the child who was not mad and this was the point from which psychiatric power was generalized.
I think we can pick out two apparently completely divergent processes. One is of a purely theoretical order. It can be analyzed on the basis of medical texts, observations, and nosographic treatises. This is the process of the theoretical elaboration of the notion of imbecility or idiocy as a phenomenon absolutely distinct from madness.
Summarizing things very schematically, we can say that until the end of the eighteenth century, what was called imbecility, stupidity and, already, idiocy, had no distinctive features in comparison with madness in general. It was nothing other than a species of madness, distin- guished, of course, from a series of other species, but which in any case belonged to the general category of madness. Sometimes, for example, you had a sort of major opposition between madness in the form of
16 January 1974 203
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"frenzy" ("fureur"),5 that is to say, of violence, of temporary agitation, if you like, a madness in the form of "more," and then a madness in the form of "less," which was instead a kind of dejection, inertia, on non- agitation,6 and which was in fact what was called "dementia,"7 "stupidity,"8 "imbecility," etcetera. Or again, imbecility or stupidity was defined as a particular form in a series in which one could find mania, melancholy, and dementia. 9 At the most we can [pick out]* some indications iden- tifying idiocy as an illness that it was easier to find in children; demen- tia, on the other hand, being an illness exactly similar in its content, but only occurring after a certain age. 10
The place occupied by imbecility or idiocy in the nosographic tables may seem surprising--it is either a broad notion, generally opposed to agitation and frenzy (fureur), or a precise notion--in any case, one is a little surprised to see imbecility appear within madness at a time when, precisely, madness was essentially characterized by delirium, that is to say, by error, false belief, licentious imagination, and assertion without any connection with reality. 11 Except, if it is true that madness is essen- tially defined by this core delirium, can idiocy or imbecility be seen as part of this large family of deliria? Actually, the nature of imbecility is assimilated--along with dementia, moreover--to a sort of delirium that either arrives late, as in the case of dementia, when it has reached its most acute point, that is to say, the stage when it is disappearing and where, pushed to its extreme point of exasperation, of violence, it falls in on itself, collapses and is nullified as delirium, or else it arrives much earlier, as in the case of idiocy. In this kind of eighteenth century nosog raphy, imbecility is the error of delirium, but so generalized, so total, that it can no longer conceive the least truth or form the least idea; it is, as it were, error that has become obnubilation, that is to say, delirium that has fallen into its own night. This is what Jacquelin Dubuisson, a psychiatrist who was a contemporary of Pinel, said about idiotism in 1816, and so fairly late: "Idiotism is a condition of stupor or of the abo- lition of the intellectual and affective functions, the result of which is a more or less complete obtuseness; in addition there are often alterations of the vital functions. These sort of insane individuals, deprived of the
* (Recording:) find
? sublime faculties that distinguish thinking and social man, are reduced to a purely mechanical existence that makes their condition abject and wretched. Causes. The causes are more or less the same as those of dementia, from which ldiotism only differs by a more intense and pro- lound alteration in the injured functions. "12
ldiotism, therefore, is not at all the kind of first, elementary ground on the basis of which other, more violent or intense pathological conditions could develop; it is instead the absolute, total form of madness. It is the vertigo of madness, turning on itself so quickly that none of the elements, the beliefs of the delirium can be detected; it is the non-color produced by colors whirling on themselves. It is this effect of the "obnubilation" of all thought, and even of all perception, which is defined in ldiotism, so that in this period it is nonetheless thought of as a category of delirium, despite the absence of symptoms. 15 This, more or less, is the, hastily recon structed, theoretical situation at the end of the eighteenth century.
How will the new notion of idiocy, of mental retardation, of imbecility be developed in the first forty years of the nineteenth century, that is to say, from Esquirol to Seguin in 1843? Here again, I refer just to texts, to theo- retical developments, and say nothing about institutions or real practices.
I think we can fix two important moments in the development of this notion of idiocy in the theoretical texts of psychiatry at the beginning of the nineteenth century* The moment typified by Esquirol and his texts of 1817, 1818, and 1820,V| and then Belhomme's book of 1824. 15 At this point you see a completely new notion of idiocy emerging, which you would not be able to find in the eighteenth century. Esquirol defines it in this way: "Idiocy is not a disease, but a condition in which the intel- lectual faculties are never manifested, or have never been sufficiently developed . . . "16 And, in 182^, Belhomme more or less textually sum- marizes the same definition; he says that "idiocy is . . . a constitutional condition in which the intellectual functions have never developed . . . "17
This definition is important because it introduces the notion of devel- opment; it makes development, or rather the absence of development the [distinctive] criterion for distinguishing between madness and idiocy.
* The manuscript says at this point: "The specification of idiocy in comparison with dementia-- that is to say the form or stage of mental illness to which it is closest--is carried out in two stages. "
16 January 7974 205
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Idiocy is not defined therefore with reference to truth or error, or with reference to the ability or inability to control oneself, or with reference to the intensity of the delirium, but with reference to development. Now, in these definitions, and in the descriptions following them, Esquirol and Belhomme make a sort of binary use of development. Development, for both Esquirol and Belhomme, is something one may or may not have, from which one has or has not benefited; one is developed in the same way as one has will or intelligence; one is not developed in the same way as one lacks intelligence or will. There is still a sort of very simplistic use of this notion of development.
However, despite this simplistic use of the notion, the criterion of a development one does or does not have, from which one does or does not benelit, allows a certain number of developments for covering this theoretical domain.
First, it allows a clear chronological distinction. If idiocy is an absence of development, then it is necessary, it is normal, that madness* is something that appears from the outset--and this in contradistinction to other forms of the weakening of thought, intellect, or perception, such as dementia, which, like the other mental illnesses of mania, monomania, lypemania, etcetera, appears at the earliest with puberty. 18 So, a chronological distinction is established at this time.
Second, there is a difference in the type of evolution involved. If idiocy is non-development, then it is stable and acquired once and for all: the idiot does not develop. Dementia, however, which is also an enfeeblement of thought, in contrast with idiocy, is a mental illness that evolves, which gets worse from year to year, which may stabilized for a time, and [whichJ may possibly be cured. 19
The third difference is that idiocy is always linked to organic defects of the constitution. 20 It is therefore a kind of disability,21 or is even included in the general table of monstrosities,22 whereas dementia may be accompanied by accidental lesions that occur at a particular moment. 25
Finally, there is a difference in the symptoms. Since dementia is a late illness which arises on the basis of certain processes and, possibly, organic lesions, it will always have a past, that is to say, in dementia we
* The argument here suggests that this should be 'idiocy'; G. B.
? will always find some remains, either of intelligence, or even of delirium, hut in any case something either positive or negative from the past of lhis condition will remain. The idiot, however, is someone without a past, someone for whom nothing remains, whose existence has not left, and will never leave, the least trace in his memory. And so you end up with Esquirol's canonical formulations that were repeated for more than a century: "The man suffering dementia is deprived of goods he previ ously enjoyed: he is a rich man who has become poor. The idiot has always been in a state of misfortune and wretchedness. "24
You can see that this notion of development, despite its crude, strictly binary use, nonetheless allows certain distinctions to be made and enables a dividing line to be drawn between two kinds of features: those of something that defines an illness, and those ol something belonging to disability or monstrosity, but not illness.
The second stage, some years later, around the 1840s, is Seguin, whom we will find throughout the process of the institutionalization and psychiatrization of childhood, and who, in his Traitement moral des idiots, provides the major concepts on the basis of which the psychology, the psychopathology, of mental retardation will be developed throughout the nineteenth century. 2^
Seguin makes a distinction between idiots strictly speaking and retarded children: "I was the first to point out the extreme difference separating them . . . Even the superficial idiot displays an arrested phys- iological and psychological development. "26 So, we do not have an absence of development, but arrested development. As for the retarded child, according to Seguin, what distinguishes him from the idiot is that he is not someone whose development has been halted. He is not some one whose development is arrested, but someone who "develops more slowly than children his age; he is behind their progress from start to finish, and this daily increasing backwardness ends up establishing an enormous difference, an insurmountable distance, between him and them. "27 This is the outcome of a continuous development.
I think the two related definitions, of the idiot as someone affected by arrested development, and of the retarded individual as someone
76 January 1974 207
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whose development, while continuous, is simply slower, are important theoretically. They bring in several notions that will be influential in the practice of the psychiatrization of the child.
First, the way in which Seguin conceives of development in his Traitement moral des idiots is no longer, as it was in Esquirol, something with which one is endowed or of which one is deprived, as with intelli- gence or will; development is a process which affects organic life and psychological life, a dimension along which neurological or psychologi- cal organizations, functions, behaviors, and acquisitions are spread out. It is a temporal dimension and no longer a kind of faculty or quality with which one is endowed.
Second, this temporal dimension is, in a sense, common to everyone. No one escapes it, but it is a dimension along which one may be halted. To that extent, development is common to everyone, but it is common more as a sort of optimum, as a rule of chronological succession with an ideal outcome. Development is therefore a kind of norm with reference to which one is situated, much more than a potentiality that is possessed in itself.
Third, you can see that this norm of development has two variables in the sense that, either one may be halted at this or that stage in this scale of development, along this dimension--and the idiot is precisely some- one who is halted very early on at a certain stage--[or], it is no longer the stage at which one is halted, but the speed with which one crosses this dimension--and someone who is retarded is precisely someone who, without being blocked at a certain stage, is checked at the level of his speed. Hence there are two pathologies, which complement one another moreover, one being the final effect of the other: a pathology of being blocked fat a] stage [which, as it happens, will be] terminal, and a pathology of slowness.
Hence, the fourth important thing is that we see a double normativ- ity taking shape. On the one hand, inasmuch as the idiot is someone halted at a certain stage, the scale of idiocy will be assessed by reference to the adult as the norm: the adult will appear as both the real and ideal end of development; so that the adult will function as the norm. On the other hand, the variable of slowness--Seguin's text says it very clearly-- is defined by other children: a retarded child is someone who develops
? more slowly than the others. A consequence of this is that some kind of childhood average, or a particular majority of children, will constitute t he other norm in relation to which the retarded child will be situated. So these two phenomena of mental deficiency--idiocy in the strict sense, and retardation--will be situated by reference to two normative levels: the adult, representing the final stage, and other children, defining the average speed of development.
The fifth point in this development is that idiocy and, with greater reason, mental retardation, can no longer be defined as illnesses. There was still ambiguity in Esquirol with regard to whether idiocy should be accorded the status of illness or non-illness. After all, in Esquirol, idiocy was the absence of something, and to that extent could be characterized as an illness. In Seguin, the idiot and the mentally retarded are not patients: they cannot be said to lack stages; they have either not reached
a stage or they have reached it too slowly. Seguing idiot or mentally retarded individual is someone who has not left the normal, or rather, he is situated at a lower degree within something that is the norm itself, that is to say, child development. The idiot is a particular sort of child, not someone who is ill; the idiot is someone more or less sunk within a childhood that is normal childhood itself. The idiot is a certain degree of childhood, or again, if you like, childhood is a certain way of passing more or less quickly through the degrees of idiocy, debility, or mental retardation. Consequently, you can see that idiocy or mental retardation cannot really be considered as pathological deviations, even if, in the end, it really is an illness, or something like a disability or organic lesion, which causes them. They are temporal varieties of stages within the normative development of the child. The idiot belongs to childhood, as previously he belonged to illness.
A number of consequences follow from this, the main one of which is obviously this: If it is true that the idiot or retarded child is someone stuck at a certain level, not within the field of illness, but within the temporality of childhood, then the treatment he is to be given will be no different in kind than that given to any child. That is to say, the only way to treat an idiot or retarded child is quite simply to impose education on them, obviously with possible variations and specifications concerning method, but there is nothing else to do but impose the educational
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schema itself. The therapy tor idiocy will be pedagogy itself, a more radical pedagogy which will search further, which will go back deeper into the archaic roots of all this, but a pedagogy all the same.
Finally, the sixth and final point I want to emphasize here is that, for Seguin, these halts and this delay or slowness in the developmental process do not belong to the order of illness. 28 But they quite evidently bring with them the sanctions of phenomena that fail to appear, of organizations that do not emerge, and of acquisitions of which the child is not capable: this is the negative side of mental retardation. However, there are also positive phenomena which are nothing other than the bringing to light, the emer- gence, the failure to integrate certain elements that normal development would have had to cover up, resist or integrate. This is what Seguin calls "instinct," which becomes blatant due to arrested or extremely slow devel- opment. Instinct, which belongs to childhood, is given from the start and it appears within idiocy or mental retardation m the wild state without being integrated. "Idiocy" says Seguin, "is an infirmity of the nervous sys tern the radical effect of which is to withdraw all or part of the child's organs and faculties from the regular action of his will, which hands him over to his instincts and removes him from the moral world. "29
So you can see that, all in all, what appears through this analysis of mental deficiency is the specification of organizations, conditions, or behaviors within childhood which are not strictly pathological, but which are deviant with respect to two norms: that of other children and that of the adult. What we see appearing here is precisely abnormality: the idiot or retarded child is not a child who is ill; he is an abnormal child.
What then, secondly, are the positive phenomena of this abnormality, or what is it, beyond divergence, deviation from the norm, that this abnormality frees? It is instinct. That is to say, these phenomena are not symptoms, they are kinds of both natural and anarchical elements. In short, instincts are to abnormality what symptoms are to illness. Abnormality does not have symptoms so much as instincts, which are, as it were, its natural element. * I think instinct as the real content of abnormality is what we see taking shape in Seguing analysis of retardation
* The manuscript says: "Whereas illness is characterized by symptoms and manifests itself in dysfunctions or deficiencies, instinct is more the nature of abnormality than its symptom. "
? jnd idiocy. This is what can be said at the simple level of discourse and theory about the establishment of this profoundly new category of abnormality as distinct from illness. And I think that the confiscation of (his new category of abnormality by medicine, its psychiatrization, was precisely the principle on which the diffusion of psychiatric power was based.
Actually, in the same period as the theoretical domain I have rapidly surveyed was being constituted, at the same time as this was taking place, not in the background, not as a consequence, but at the same time and, in truth, as a real condition of possibility of this development, a completely different and apparently contradictory process was taking place. Since if you go from Pinel or Dubuisson to Seguin, by way of Esquirol, you see the series of steps by which idiocy was specified in relation to madness, by which idiocy and mental illness were disconnected: theoretically, idiocy is no longer an illness at the level of its medical status. Now, at the same time, there is a contrary process, which is not theoretical, but a process of institutionalization, and this is the estab lishment of idiocy within the psychiatric space, a colonization of idiocy by psychiatry. And this is an extremely strange phenomenon.
In fact, if you go back to the situation at the end of the eighteenth century, to the time of Pinel, you still find people classified as "imbeciles" in the deepest depths of houses of confinement. Most of these people are adult, and one imagines that some at least of these were later described as "lunatics," but you also find twelve-year-old children. 50 Now, when the question of imbecility really began to be posed, and posed in medical terms, the lirst treatment was precisely to get rid of them, to deport them from that kind of confused space of confinement, and to annex them, basically, to institutions for the deaf and dumb, that is to say, to strictly pedagogical institutions where one had to compensate for certain defects, inadequacies, and disabilities, so that at the end of the eighteenth century you see the first practical approach to the treatment of idiots in homes for the deaf and dumb, and precisely with Itard, with whom, moreover, Seguin was initially trained. 31
And then you see them gradually brought back into the asylum space. In 1834, Voisin, one of the important psychiatrists of the time, opens an institute of "orthophrenia" at Issy, where what was involved
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was precisely having a place for the treatment of poor, mentally defective children; but this was still an institution half way, as it were, between the specialized pedagogy for the deaf and dumb and a psychiatric center in the strict sense. 52 Then, in the years immediately following this, from 1835 to 1845, i n the period when Seguin defines idiocy outside of mental illness, in the recently organized or reorganized big asylums, you see wings being opened, for the retarded, idiots, often hysterics and epileptics, and all of them children. In the years 1831 to 18^11,J. P. Falret organizes a wing at Salpetriere;5* in 1833, Ferrus opens a wing for idiot children at Bicetre,5'1 for which Seguin becomes responsible in 1842. 35
Throughout the second half of the nineteenth century you find the colonization of idiot children within the psychiatric space.
des sciences medicates, vol. 30, no. 2, 1996, pp. 189-198.
26. On the basis of the law of 30 June 1838 a debate began on the nature ol the powers in
charge in the asylums. Thus, the Prefect of the Seine, the Baron Haussmann, on the
27 December i860, set up a commission for "the improvement and relorms to be carried
out in the services lor the insane" which, Irom February to June 1861, discussed whether
an administrative director should be appointed alongside the asylum doctor or whether medical and administrative powers should both be in the hands ol a doctor director, as loreseen in article 13 of the order of application of the law of 18 December 1839. On
25 November 1861, the report concluded that "a single authority would be desirable, that
every administrative or medical element work under a single impulse towards the good that
is oflered" Rapport cle la Commission institute pour la reforme el I'amenagement clu service d'alienes du departement de la Seine (Paris: 1861).
27. P. Pinel, La Medecine clinique rendue plus precise el plus exacte par ^application de I'analyse, ou Recueil el resultats d'observations sur les maladies aigues,faites a la Salpetriere (Pans: Brosson et Gabon, 1804, 2nd edition) pp. 5 6.
28. Falret, for example, puts questioning in the forefront of clinical examination by laying down as principle that "il you wish to know the tendencies, the direction ol the mind, and the dispositions of leelings which are the source of every symptom, do not reduce your duty
as observer to the passive role ol secretary to the patients, ol stenographer ol their words
or narrator ol their actions . . . The lust principle to be lollowed . . . is therelore to change one's passive role ol the observer of the patient's words and actions into an active role, and frequently seek to provoke and call forth symptoms which would never arise sponta neously" J. P. Falret, "Discours d'ouverture: De la direction a impnmer a l'observation des alienes," in Lecons cliniques de medecine menlale Jaites a I'liospice de la Salpetriere (Paris:
J. B. Bailliere, 1854) pp. 19 20.
29. Ibid. 8th Lesson, pp. 221-222: "Sometimes one must artfully lead the conversation to cer
tain subjects one supposes are related to unhealthy ideas or sentiments; these calculated interviews act as touchstones for bringing to light morbid preoccupations. Considerable experience and much art is often necessary to observe certain insane people appropriately" See also, J. P. Falret, De Venseignement clinique des maladies mentales (Pans: Martinet, 1850) pp. 68 71.
30. Hence the numerous declarations that insist on the need to collect observations on the patients in "registers" which recapitulate the history of their illness. P. Pinel recommends "keeping exact journals ol the progress and diverse lorms taking by the insanity through- out its course, Irom its onset to its end" Traite medico-philosophique, section VI, ? xn, p. 256; A Treatise on Insanity, Section VI, p. 246. C. F. S. Giraudy stresses this in his Memoire sur la Maison nationale de Charenton, pp. 17-22. Moreau de Tours notes: "Information obtained about the patient are kept in the register, which must also contain the necessary details on
the progress of the illness ( . . . ) This register is a veritable notebook ol observations, a statistical study ol which is made at the end ol each year, which is a source ol precious documents" J. J. Moreau de Tours, "Lettres medicales sur la colonie d'alienes de Gheel" p. 267. On this form ol disciplinary writing, see M. Foucault, Surveiller et Punish, pp. 191 193; Discipline and Punish, pp. 191-192.
31. In 1817 Esquirol began a clinical class of mental illnesses at Salpetriere, which he contin- ued until his appointment as head doctor at Charenton in 1826. See, R. Semelaigne, Les Grands Alienistes francais (Pans: G. Steinheil, 1894) p. 128; and, C. Bouchet, Quelques mots sur Esquirol ( Nantes: C. Mellinet, 1841) p. 1.
32. At Bicetre Irom 1833 to 1839, Guillaume Ferrus, appointed head doctor at the beginning of 1826, gave "Clinical lessons on mental illnesses," which are reproduced in the Gazette medicalc de Paris, vol. I, no. 65,1833; vol. II, no. 39,1834, p. 48; vol. IV, no. 25,1836, pp. 28, 44 and 45; and in the Gazette des hopitaux, 1838, pp. 307, 314, 326, 345, 352, 369, 384, 399, 471, 536, 552, 576, 599 and 612; 1839, pp. 5,17, 33, 58, 69, 82, 434 and 441. In 1840, after the departure of Ferrus, Leuret organized clinical lessons which he continued until 1847, published in part in the Gazette des hopitaux, vol. II, 1840, pp. 233, 254, 269 and 295.
33. At Salpetriere,Jules Baillarger (1809 189O) took up clinical teaching in 1841. Jean-Pierre Falret, appointed doctor of a section for the insane, in turn began clinical teaching in 1843,
9 January 1974 197
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PSYCHIATRIC POWER
part ol which is published in the Ann ales medko-psychologiques, vol. IX, September 1847, pp. 232 264, and vol. XII, October 1849, pp. 524 579. These lessons are reprinted (with the same title) in: De I'cnseignement clinique des maladies mentale. See, M. Wiriot, L'Ensettlement clinique dans les hbpitaux de Paris entrc Z797/ and 1&48, Medical Thesis, Paris, 1970, no. 334 (Vincennes: Chaume, 1970).
34- J. P. Falret, De renseignemenl clinique, p. 126.
35.
36.
37-
38.
Ibid. p. 127: "The public narration ol their illness made by the insane is an even more precious help to the doctor . . . , the doctor must be powerlul in a very different way in the wholly new conditions ol the clinic, that is to say, when the prolessor makes all the phenomena ol his illness perceptible to the patient in the presence of more or less numerous auditors. "
Ibid. p. 119: "If the patients accept . . . he will give the history ol their illness with the fixed principle ol recounting only that which is completely known to them, and he will Irequently slop to ask them il he is trulhlully expressing the lacts that they themselves have told him earlier. "
Ibid. p. 125: "The account ol their illness, given in all its developments, often makes a strong impression on the insane, who themselves testily to its truth with visible satisfac- tion, and enjoy entering into the greatest detail in order to complete the account, as il they were astonished and proud that someone should take such an interest in them so as to know their entire history. "
Marie Francois Xavier Bichat (1771 1802), alter having been introduced to surgery in Lyon in the department ol Marc Antoine Petit (1762 1840 ) and, in June 1794, becoming the student ol Pierre Joseph Delsaut (1744 1795), surgeon at the Hotel Dieu, devoted himsell, after his appointment in 1800, to pathological anatomy, undertaking to establish the delinite relationships between alterations ol tissues and clinical symptoms. See, Trade des membranes en general et des diverse* membranes en particulier(Par\s: G a b o n , 1 8 ( ) 0 ) . H e set out his conceptions in Anatomie generate appliquee a la physiologic et a la medecine, in four volumes (Paris: Brosson et Gabon, 1801); English translation, General Anatomy, applied to Physiology and the Practice of Medicine, trans. C. Coffyn (London: 1824).
But it was above all Gaspard Llaurent Bayle (1774 1816) and Rene Theophile Laennec (1781 1826) who strove to lound clinical medicine and pathological anatomy in a single discipline. Bayle was one ol the first to formulate the methodology ol the young school ol clinical anatomy in his thesis defended 4 Venlose Year X/24 February 1802: Considerations sur la nosologic, la medecine d'observation et la medecine pratique, suiviies d'observations pour servir a rhistoire des pustules gangreneuses, Medical Thesis, Pans, no. 70 (Paris: Boiste [Gabon], 1802). He sets out the ideas that he will develop and clarify in, Recherches sur la phtisie pulmonaire (Pans: Gabon, 1810); English translation, Researches on Pulmonary Phthisis, trans. W. Barrow (London: Longman, 1815), and in "Considerations generales sur les secours que I'anatomie pathologique peut fournir a la medecine," in Dictionnaire des sciences medicates, vol. II (Pans: C. L. F. Panckoucke, 1812) pp. 61 78. R. T. Laennec renewed pulmonary pathology by endeavouring to "put the diagnosis ol internal organic lesions on the same level as the diagnosis of surgical illnesses," De Vauscultation mediate, ou Trade du diagnostic des malades des poumons et du coeur,fonde principalamenl sur ce nouveau moyen d'exploration, two volumes (Pans: Brosson and Chaude, 2lul revised and expanded edition, 1826) vol. 1, p. xxv; English translation, A Treatise on Mediate Auscultation, and on Diseases of the Lungs and Heart, translated by a Member of the College ol Physicians (London: J. B. Bailliere, 1846), and in his posthumous work, Trade inedit sur I'anatomie pathologique, ou Exposition des alterations visible qu'eprouve le corps humain dans I'etat de maladie (Pans: Alcan, 1884).
On Bichat, see the pages in chapter 8, "Ouvrez quelques cadavres" ol M. Foucault, Naissance de la clinique. Une archeologie du regard medical (Pans: P. U. F. , 1963) pp. 125 148; English translation, The Birth of the Clinic. An Archeology oj Medical Perception, trans. A. M. Sheridan Smith (London: Tavistock and New York: Pantheon, 1973), ch. 8, "Open Up a Few Corposes" pp. 124 148. More generally, see,J. E. Rochard, Histoire de la chirurgie francaise au X. 1X: siecle (Paris: J . B . Bailliere, 1875); O. Temkin, "The role ol surgery in the rise of modern medical thought" Bulletin oj the History of Medicine, Baltimore, Md: vol. 25, no. 3, 1951, pp. 248 259; E. H. Ackerknecht, (i) "Pariser chirgurgie von 1794-1850" Gesnerus, vol. 17, 1960, pp. 137 144, and (ii) Medicine at the Paris Hospitals, M9y\-^\S
? (Baltimore Md: The Johns Hopkins Press, 1967); French translation, La Medecine hospitaliere
a Paris, 179/\-l8/\&, trans. F. Blateau (Paris, Payol, 1986); P. Huard and M. Grmeck, eds. , Sciences, medecine, pharmacic, de la Revolution a rEmpire, 17&9-1&15 (Paris: Ed. Dacosta, 1970) pp. W Vl5; M. J. Imbault Huart, L'Ecole pratique de dissection de Paris de 1750 a
1822, ou I'injlucnce du concept de medecine pratique el de medecine d'observation dans I'enseignement medico-chirurgical an XVIH' siecle, These de doctoral cs lettres, University Paris I, 1973, reprinted University of Lille III, 1975; P. Huard, "Concepts et realites de Peducation et de
la profession medico-chirurgicales pendant la Revolution" Journal des savants, April June
1973, pp. 126 150.
On G. L. Bayle, see, M. J. Imbault Huart, "Bayle, Laennec et la melhode anatomo
clinique" Revue du Palais de la Decouverte, special number, 22 August 1981, pp. 179 89. Later, J. Dulfin, "Gaspard Laurent Bayle et son legs scientilique: au dela de l'anatomie pathologique" Canadian Bulletin of Medical History, Winnipeg, vol. 31,1986, pp. 167 184.
On Laennec, see, P. Huard, "Les chirurgiens et I'esprit chirurgical en France au XVIII1 siecle," Clio Medica, vol. 15, nos. 3 4,1981. Later, J. Duffin ( i ) "The medical philosophy ol R. T. Laennec (1781 1826)" History and Philosophy of (he Life Sciences, vol. 8,1986, pp. 195 219, and ( n ) "La medecine anatomo clinique: naissance et constitution d'une medecine moderne" Revue medicale de la Suisse Romande, no. 109, 1989, pp. 1005 1012.
$9.
In the 1830s we begin to see the separation of the insane from idiot children, in the lorm
ol both statements of principle and the beginning ol institutional realizations. Appointed
to Bicetre in 1826, in 1834 Guillaume Ferrus called lor the creation of "special establish ments in which every curative technique was brought together" Des alienes, p. 190. In 1839,
in a report ol the Medical Commission ol Paris Hospitals, Ferrus emphasized again "the usefulness of the creation ol a children's section at Bicetre" (quoted by D. M. Bourneville, Assistance, Traitement et Education des enfants idiots et degeneres. Rapportfait au congiis national d'Assistancepuhlique, Lyon,juin 189/I | Paris: Publications du Progres medical, 1895] p. 142). One of the first institutional realizations was that ol Jean Pierre Falret who, after his appointment to Salpetnere on 30 March 1831, decided to bring together 80 idiots and imbeciles in a common section. However, their slowness is such that, in 1835,
J. B. Parchappe can still write that the presence ol young idiots in "insane asylums, in the absence ol special quarters, oilers every kind ol drawback ( . . . ) I consider the creation ol
a quarter for children in insane asylums to be an indispensable necessity" Des principes a suivre dans la fondation el la construction des asiles d'alienes (Paris: Masson, 1853) p. 89. On this point, see the historical account of D. M. Bourneville, Assistance, Traitement et Education des en/ants idiots, ch. 1: "Aperc. ii historique de ('assistance et du traitement des enfants idiots et degeneres," pp. 1 7. See below, lecture ol 16 January 1974.
40. In the 1880s, when the nosology of neurological disorders reaches its completion, the held ol the neuroses jettisons the mass of organic symptoms (paralysis, anesthesia, sensonal disorders, algia, etcetera) which are supplanted by the new clinical neuropathology attached to the study of localized lesions of the nerves and marrow and specialized structures of the encephalon. What remains ol this field tends, around 1885 to 1890, to be organized around lour major clinical groups: ( a ) choreic neuroses (hysterical chorea, St. Vitus's dance); (b) neurasthenia; (c) hysteria; and (d) obsessions and phobias.
41. Foucault's analysis is inspired here by R. Castel, Le Psychanalysme (Paris: Maspero, 1973) about which he wrote in the manuscript for the lecture ol 7 November 1973: "This is a radical book because, for the lirst time, psychoanalysis is situated solely within psychiatric practice and power. "
9 January 1974 199
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16 JANUARY 1974
The modes of generalisation of psychiatric power and the psychiatri^ation of childhood. ^ 1. The theoretical specification of
idiocy. The criterion of development. ^ Emergence of a psychopathology of idiocy and mental retardation. Edouard
Seguin: instinct and abnormality. ^ 2. The institutional annexation of idiocy by psychiatric power. ^ The umoral treatment" of idiots: Seguin. ^ The process of confinement and the
stigmati^ation of the dangerousness of idiots. ^ Recourse to the notion of degeneration.
I WOULD LIKE TO try to pick out the points and forms of the generalization of psychiatric power, which I have the impression took place fairly early on. I do not think, if you like, that the generalization of psychiatric power is contemporary with or an effect of psychoanalytic practice. It seems to me that there was a diffusion of psychiatric power very early on, a transmission that dates from a much earlier period and the effect of which is, of course, transmission of an archaic form of psychiatric power.
It seems to me that this diffusion of psychiatric power was carried out on the basis of childhood, that is to say, starting from the psychiatrization of childhood. Of course, you find sketches and forms of this generaliza- tion based on personages other than the child--we find them quite early on, for example, in connection with the criminal, with the development of psychiatric legal expertise and of the notion of monomania--but in
? 202 PSYCHIATRIC POWER
the end it seems to me that it was especially the child much more than the adult who provided the support for the diffusion of psychiatric power in the nineteenth century.
In other words--anyway, this is the hypothesis I would like to try out before you--I think that we should look for the principle of diffusion of psychiatric power in the direction of the coupling of the hospital and the school, of health institution and the system of learning (pedagogical insti- tution, model of health). And as an epigraph for what follows I would like to quote one of those short and dazzling sentences loved by Canguilhem. He wrote: " 'Normal' is the term used by the nineteenth century to des ignate the scholastic prototype and the state of organic health. "1 It seems to me that, in the end, the diffusion ot psychiatric power takes place by way of this development oi the concept of the "normal. "
It would be quite natural to expect the psychlatrization of childhood to take place by two routes apparently laid down in advance: by way of the discovery of the mad child on the one hand, and, on the other, by way of bringing childhood to light as the locus ol the foundation and origin of mental illness. *
Now, my impression is that things did not happen in this way exactly. In actual tact, it seems to me that the discovery of the mad child took place rather late and was much more the secondary effect of the psychiatrization of the child than its place of origin. I think the mad child appeared rather late in the nineteenth century;2 we see it emerging around Charcot, that is to say, around hysteria, around the 1880s, and it does not enter psychiatry by the royal road of the asylum, but by way of private consultation. The first children you see appearing in the file of the history of psychiatry are the children ot private clients; they are generally, with regard to Charcot, idiot grandsons of Russian grand dukes, or somewhat hysterical Latin American granddaughters. 3 It is these children, framed moreover by the parents, this trinity, who appeared in Charcot's offices around the 1880s. And it was not at all the tightening of family discipline, or the imposition of school discipline, which allowed the mad child to be picked out in the course of the nineteenth century.
* The manuscript clarities: "through the action ol anamnesis, the questioning of patients and their family, and the accounts ol their life. "
? On the other hand, neither was a fundamental, privileged, founding relationship between childhood and madness brought to light by the anamneses, the autobiographical accounts, to which psychiatric power constrained patients throughout the nineteenth century. When the mad were asked to recount their life, this was not at all an attempt to account for their madness on the basis of what happened in their childhood, but in order to grasp a madness already constituted, as it were, in this childhood, or at any rate, some forewarning signs of a predisposition to madness, which would already mark their childhood, or in order to find the signs of hereditary predisposition. And nor was the mad content of childhood experience questioned through anamnesis. So, the mad child, the child as object of psychiatry, appeared late, and a fundamental relationship between childhood and madness was not a question early on.
I would say then--this is the hypothesis I want to consider--that psychiatrization of the child, however paradoxical this may be, did not come about by way of the mad child or the madness of childhood, by way of the constitutive relationship between madness and childhood. It seems to me that psychiatrization of the child came about through a completely different figure: the imbecilic child, the idiot child, the child who will soon be called retarded, that is to say, a child about whom one was carelul to say, right from the start, in the first thirty years of the nineteenth century, that he was not mad/1 Psychiatrization of the child took place through the intermediary of the child who was not mad and this was the point from which psychiatric power was generalized.
I think we can pick out two apparently completely divergent processes. One is of a purely theoretical order. It can be analyzed on the basis of medical texts, observations, and nosographic treatises. This is the process of the theoretical elaboration of the notion of imbecility or idiocy as a phenomenon absolutely distinct from madness.
Summarizing things very schematically, we can say that until the end of the eighteenth century, what was called imbecility, stupidity and, already, idiocy, had no distinctive features in comparison with madness in general. It was nothing other than a species of madness, distin- guished, of course, from a series of other species, but which in any case belonged to the general category of madness. Sometimes, for example, you had a sort of major opposition between madness in the form of
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"frenzy" ("fureur"),5 that is to say, of violence, of temporary agitation, if you like, a madness in the form of "more," and then a madness in the form of "less," which was instead a kind of dejection, inertia, on non- agitation,6 and which was in fact what was called "dementia,"7 "stupidity,"8 "imbecility," etcetera. Or again, imbecility or stupidity was defined as a particular form in a series in which one could find mania, melancholy, and dementia. 9 At the most we can [pick out]* some indications iden- tifying idiocy as an illness that it was easier to find in children; demen- tia, on the other hand, being an illness exactly similar in its content, but only occurring after a certain age. 10
The place occupied by imbecility or idiocy in the nosographic tables may seem surprising--it is either a broad notion, generally opposed to agitation and frenzy (fureur), or a precise notion--in any case, one is a little surprised to see imbecility appear within madness at a time when, precisely, madness was essentially characterized by delirium, that is to say, by error, false belief, licentious imagination, and assertion without any connection with reality. 11 Except, if it is true that madness is essen- tially defined by this core delirium, can idiocy or imbecility be seen as part of this large family of deliria? Actually, the nature of imbecility is assimilated--along with dementia, moreover--to a sort of delirium that either arrives late, as in the case of dementia, when it has reached its most acute point, that is to say, the stage when it is disappearing and where, pushed to its extreme point of exasperation, of violence, it falls in on itself, collapses and is nullified as delirium, or else it arrives much earlier, as in the case of idiocy. In this kind of eighteenth century nosog raphy, imbecility is the error of delirium, but so generalized, so total, that it can no longer conceive the least truth or form the least idea; it is, as it were, error that has become obnubilation, that is to say, delirium that has fallen into its own night. This is what Jacquelin Dubuisson, a psychiatrist who was a contemporary of Pinel, said about idiotism in 1816, and so fairly late: "Idiotism is a condition of stupor or of the abo- lition of the intellectual and affective functions, the result of which is a more or less complete obtuseness; in addition there are often alterations of the vital functions. These sort of insane individuals, deprived of the
* (Recording:) find
? sublime faculties that distinguish thinking and social man, are reduced to a purely mechanical existence that makes their condition abject and wretched. Causes. The causes are more or less the same as those of dementia, from which ldiotism only differs by a more intense and pro- lound alteration in the injured functions. "12
ldiotism, therefore, is not at all the kind of first, elementary ground on the basis of which other, more violent or intense pathological conditions could develop; it is instead the absolute, total form of madness. It is the vertigo of madness, turning on itself so quickly that none of the elements, the beliefs of the delirium can be detected; it is the non-color produced by colors whirling on themselves. It is this effect of the "obnubilation" of all thought, and even of all perception, which is defined in ldiotism, so that in this period it is nonetheless thought of as a category of delirium, despite the absence of symptoms. 15 This, more or less, is the, hastily recon structed, theoretical situation at the end of the eighteenth century.
How will the new notion of idiocy, of mental retardation, of imbecility be developed in the first forty years of the nineteenth century, that is to say, from Esquirol to Seguin in 1843? Here again, I refer just to texts, to theo- retical developments, and say nothing about institutions or real practices.
I think we can fix two important moments in the development of this notion of idiocy in the theoretical texts of psychiatry at the beginning of the nineteenth century* The moment typified by Esquirol and his texts of 1817, 1818, and 1820,V| and then Belhomme's book of 1824. 15 At this point you see a completely new notion of idiocy emerging, which you would not be able to find in the eighteenth century. Esquirol defines it in this way: "Idiocy is not a disease, but a condition in which the intel- lectual faculties are never manifested, or have never been sufficiently developed . . . "16 And, in 182^, Belhomme more or less textually sum- marizes the same definition; he says that "idiocy is . . . a constitutional condition in which the intellectual functions have never developed . . . "17
This definition is important because it introduces the notion of devel- opment; it makes development, or rather the absence of development the [distinctive] criterion for distinguishing between madness and idiocy.
* The manuscript says at this point: "The specification of idiocy in comparison with dementia-- that is to say the form or stage of mental illness to which it is closest--is carried out in two stages. "
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Idiocy is not defined therefore with reference to truth or error, or with reference to the ability or inability to control oneself, or with reference to the intensity of the delirium, but with reference to development. Now, in these definitions, and in the descriptions following them, Esquirol and Belhomme make a sort of binary use of development. Development, for both Esquirol and Belhomme, is something one may or may not have, from which one has or has not benefited; one is developed in the same way as one has will or intelligence; one is not developed in the same way as one lacks intelligence or will. There is still a sort of very simplistic use of this notion of development.
However, despite this simplistic use of the notion, the criterion of a development one does or does not have, from which one does or does not benelit, allows a certain number of developments for covering this theoretical domain.
First, it allows a clear chronological distinction. If idiocy is an absence of development, then it is necessary, it is normal, that madness* is something that appears from the outset--and this in contradistinction to other forms of the weakening of thought, intellect, or perception, such as dementia, which, like the other mental illnesses of mania, monomania, lypemania, etcetera, appears at the earliest with puberty. 18 So, a chronological distinction is established at this time.
Second, there is a difference in the type of evolution involved. If idiocy is non-development, then it is stable and acquired once and for all: the idiot does not develop. Dementia, however, which is also an enfeeblement of thought, in contrast with idiocy, is a mental illness that evolves, which gets worse from year to year, which may stabilized for a time, and [whichJ may possibly be cured. 19
The third difference is that idiocy is always linked to organic defects of the constitution. 20 It is therefore a kind of disability,21 or is even included in the general table of monstrosities,22 whereas dementia may be accompanied by accidental lesions that occur at a particular moment. 25
Finally, there is a difference in the symptoms. Since dementia is a late illness which arises on the basis of certain processes and, possibly, organic lesions, it will always have a past, that is to say, in dementia we
* The argument here suggests that this should be 'idiocy'; G. B.
? will always find some remains, either of intelligence, or even of delirium, hut in any case something either positive or negative from the past of lhis condition will remain. The idiot, however, is someone without a past, someone for whom nothing remains, whose existence has not left, and will never leave, the least trace in his memory. And so you end up with Esquirol's canonical formulations that were repeated for more than a century: "The man suffering dementia is deprived of goods he previ ously enjoyed: he is a rich man who has become poor. The idiot has always been in a state of misfortune and wretchedness. "24
You can see that this notion of development, despite its crude, strictly binary use, nonetheless allows certain distinctions to be made and enables a dividing line to be drawn between two kinds of features: those of something that defines an illness, and those ol something belonging to disability or monstrosity, but not illness.
The second stage, some years later, around the 1840s, is Seguin, whom we will find throughout the process of the institutionalization and psychiatrization of childhood, and who, in his Traitement moral des idiots, provides the major concepts on the basis of which the psychology, the psychopathology, of mental retardation will be developed throughout the nineteenth century. 2^
Seguin makes a distinction between idiots strictly speaking and retarded children: "I was the first to point out the extreme difference separating them . . . Even the superficial idiot displays an arrested phys- iological and psychological development. "26 So, we do not have an absence of development, but arrested development. As for the retarded child, according to Seguin, what distinguishes him from the idiot is that he is not someone whose development has been halted. He is not some one whose development is arrested, but someone who "develops more slowly than children his age; he is behind their progress from start to finish, and this daily increasing backwardness ends up establishing an enormous difference, an insurmountable distance, between him and them. "27 This is the outcome of a continuous development.
I think the two related definitions, of the idiot as someone affected by arrested development, and of the retarded individual as someone
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whose development, while continuous, is simply slower, are important theoretically. They bring in several notions that will be influential in the practice of the psychiatrization of the child.
First, the way in which Seguin conceives of development in his Traitement moral des idiots is no longer, as it was in Esquirol, something with which one is endowed or of which one is deprived, as with intelli- gence or will; development is a process which affects organic life and psychological life, a dimension along which neurological or psychologi- cal organizations, functions, behaviors, and acquisitions are spread out. It is a temporal dimension and no longer a kind of faculty or quality with which one is endowed.
Second, this temporal dimension is, in a sense, common to everyone. No one escapes it, but it is a dimension along which one may be halted. To that extent, development is common to everyone, but it is common more as a sort of optimum, as a rule of chronological succession with an ideal outcome. Development is therefore a kind of norm with reference to which one is situated, much more than a potentiality that is possessed in itself.
Third, you can see that this norm of development has two variables in the sense that, either one may be halted at this or that stage in this scale of development, along this dimension--and the idiot is precisely some- one who is halted very early on at a certain stage--[or], it is no longer the stage at which one is halted, but the speed with which one crosses this dimension--and someone who is retarded is precisely someone who, without being blocked at a certain stage, is checked at the level of his speed. Hence there are two pathologies, which complement one another moreover, one being the final effect of the other: a pathology of being blocked fat a] stage [which, as it happens, will be] terminal, and a pathology of slowness.
Hence, the fourth important thing is that we see a double normativ- ity taking shape. On the one hand, inasmuch as the idiot is someone halted at a certain stage, the scale of idiocy will be assessed by reference to the adult as the norm: the adult will appear as both the real and ideal end of development; so that the adult will function as the norm. On the other hand, the variable of slowness--Seguin's text says it very clearly-- is defined by other children: a retarded child is someone who develops
? more slowly than the others. A consequence of this is that some kind of childhood average, or a particular majority of children, will constitute t he other norm in relation to which the retarded child will be situated. So these two phenomena of mental deficiency--idiocy in the strict sense, and retardation--will be situated by reference to two normative levels: the adult, representing the final stage, and other children, defining the average speed of development.
The fifth point in this development is that idiocy and, with greater reason, mental retardation, can no longer be defined as illnesses. There was still ambiguity in Esquirol with regard to whether idiocy should be accorded the status of illness or non-illness. After all, in Esquirol, idiocy was the absence of something, and to that extent could be characterized as an illness. In Seguin, the idiot and the mentally retarded are not patients: they cannot be said to lack stages; they have either not reached
a stage or they have reached it too slowly. Seguing idiot or mentally retarded individual is someone who has not left the normal, or rather, he is situated at a lower degree within something that is the norm itself, that is to say, child development. The idiot is a particular sort of child, not someone who is ill; the idiot is someone more or less sunk within a childhood that is normal childhood itself. The idiot is a certain degree of childhood, or again, if you like, childhood is a certain way of passing more or less quickly through the degrees of idiocy, debility, or mental retardation. Consequently, you can see that idiocy or mental retardation cannot really be considered as pathological deviations, even if, in the end, it really is an illness, or something like a disability or organic lesion, which causes them. They are temporal varieties of stages within the normative development of the child. The idiot belongs to childhood, as previously he belonged to illness.
A number of consequences follow from this, the main one of which is obviously this: If it is true that the idiot or retarded child is someone stuck at a certain level, not within the field of illness, but within the temporality of childhood, then the treatment he is to be given will be no different in kind than that given to any child. That is to say, the only way to treat an idiot or retarded child is quite simply to impose education on them, obviously with possible variations and specifications concerning method, but there is nothing else to do but impose the educational
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schema itself. The therapy tor idiocy will be pedagogy itself, a more radical pedagogy which will search further, which will go back deeper into the archaic roots of all this, but a pedagogy all the same.
Finally, the sixth and final point I want to emphasize here is that, for Seguin, these halts and this delay or slowness in the developmental process do not belong to the order of illness. 28 But they quite evidently bring with them the sanctions of phenomena that fail to appear, of organizations that do not emerge, and of acquisitions of which the child is not capable: this is the negative side of mental retardation. However, there are also positive phenomena which are nothing other than the bringing to light, the emer- gence, the failure to integrate certain elements that normal development would have had to cover up, resist or integrate. This is what Seguin calls "instinct," which becomes blatant due to arrested or extremely slow devel- opment. Instinct, which belongs to childhood, is given from the start and it appears within idiocy or mental retardation m the wild state without being integrated. "Idiocy" says Seguin, "is an infirmity of the nervous sys tern the radical effect of which is to withdraw all or part of the child's organs and faculties from the regular action of his will, which hands him over to his instincts and removes him from the moral world. "29
So you can see that, all in all, what appears through this analysis of mental deficiency is the specification of organizations, conditions, or behaviors within childhood which are not strictly pathological, but which are deviant with respect to two norms: that of other children and that of the adult. What we see appearing here is precisely abnormality: the idiot or retarded child is not a child who is ill; he is an abnormal child.
What then, secondly, are the positive phenomena of this abnormality, or what is it, beyond divergence, deviation from the norm, that this abnormality frees? It is instinct. That is to say, these phenomena are not symptoms, they are kinds of both natural and anarchical elements. In short, instincts are to abnormality what symptoms are to illness. Abnormality does not have symptoms so much as instincts, which are, as it were, its natural element. * I think instinct as the real content of abnormality is what we see taking shape in Seguing analysis of retardation
* The manuscript says: "Whereas illness is characterized by symptoms and manifests itself in dysfunctions or deficiencies, instinct is more the nature of abnormality than its symptom. "
? jnd idiocy. This is what can be said at the simple level of discourse and theory about the establishment of this profoundly new category of abnormality as distinct from illness. And I think that the confiscation of (his new category of abnormality by medicine, its psychiatrization, was precisely the principle on which the diffusion of psychiatric power was based.
Actually, in the same period as the theoretical domain I have rapidly surveyed was being constituted, at the same time as this was taking place, not in the background, not as a consequence, but at the same time and, in truth, as a real condition of possibility of this development, a completely different and apparently contradictory process was taking place. Since if you go from Pinel or Dubuisson to Seguin, by way of Esquirol, you see the series of steps by which idiocy was specified in relation to madness, by which idiocy and mental illness were disconnected: theoretically, idiocy is no longer an illness at the level of its medical status. Now, at the same time, there is a contrary process, which is not theoretical, but a process of institutionalization, and this is the estab lishment of idiocy within the psychiatric space, a colonization of idiocy by psychiatry. And this is an extremely strange phenomenon.
In fact, if you go back to the situation at the end of the eighteenth century, to the time of Pinel, you still find people classified as "imbeciles" in the deepest depths of houses of confinement. Most of these people are adult, and one imagines that some at least of these were later described as "lunatics," but you also find twelve-year-old children. 50 Now, when the question of imbecility really began to be posed, and posed in medical terms, the lirst treatment was precisely to get rid of them, to deport them from that kind of confused space of confinement, and to annex them, basically, to institutions for the deaf and dumb, that is to say, to strictly pedagogical institutions where one had to compensate for certain defects, inadequacies, and disabilities, so that at the end of the eighteenth century you see the first practical approach to the treatment of idiots in homes for the deaf and dumb, and precisely with Itard, with whom, moreover, Seguin was initially trained. 31
And then you see them gradually brought back into the asylum space. In 1834, Voisin, one of the important psychiatrists of the time, opens an institute of "orthophrenia" at Issy, where what was involved
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was precisely having a place for the treatment of poor, mentally defective children; but this was still an institution half way, as it were, between the specialized pedagogy for the deaf and dumb and a psychiatric center in the strict sense. 52 Then, in the years immediately following this, from 1835 to 1845, i n the period when Seguin defines idiocy outside of mental illness, in the recently organized or reorganized big asylums, you see wings being opened, for the retarded, idiots, often hysterics and epileptics, and all of them children. In the years 1831 to 18^11,J. P. Falret organizes a wing at Salpetriere;5* in 1833, Ferrus opens a wing for idiot children at Bicetre,5'1 for which Seguin becomes responsible in 1842. 35
Throughout the second half of the nineteenth century you find the colonization of idiot children within the psychiatric space.
