Consequently, you see this notion of degeneration pick out the fam lly and ancestors, as a package without strict definition for the moment, and the child, and it makes the family the
collective
support of this dou ble phenomenon of abnormality and madness.
Foucault-Psychiatric-Power-1973-74
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. And even if an establishment is opened specifically for these children at Perray- Vaucluse in 1873,*6 it remains the case that at the end of the century, at Bicetre,37 Salpetriere,38 and Villejuif,39 there are still psychiatric wings for these mentally defective children. Moreover, not only is this colo- nization effectuated, de facto, by the opening of these sections within the psychiatric space, but a decision oi the Minister of the Interior in 18^0 states explicitly that the 1838 law on the confinement of the insane applies equally to idiots: this is no more than a matter of a sim pie ministerial decision that is based on the principle that idiots are still a category of the insane. ^0
So, at a moment when there is this clear theoretical division between insanity and idiocy, there are a whole series of institutions and adminis trative measures which lump together what was in the process of being distinguished. To what does this institutional annexation, contempo rary with the theoretical distinction, correspond?
It might be thought that this theoretical distinction is quite simply the effect of the organization of primary education at this lime: Guizot's law dates from 1833. '' It might be thought that with mental retardation or mental deficiency being filtered through the primary education then being developed, idiots identified as problems within these educational establishments will be gradually expelled into the asylums. This is in fact true, but not for the period I am considering. In actual fact it is at the end of the nineteenth century that generalized primary education will act as a filter, and the major inquiries which take place at the end
? o! the century on mental deficiency take place in an educational milieu, that is to say, the schools are asked for the facts for the inquiry/2 These inquiries are indeed conducted with primary school teachers, and the question will focus on the nature and possibilities of schooling. For example, in 1892-1893, when Rey conducts an inquiry into mental deficiency in the Bouches du-Rhone, he addresses himself to primary school teachers and, in order to identify the idiots, imbeciles, and mentally deficient, he asks which children do not follow school activi- ties in an appropriate way, which children make themselves noted by their unruliness, and which children cannot even attend school/'3 This is the basis on which the great patchwork will be established. Primary education acts in fact as the Hlter and reference for the phenomena of mental retardation.
However, this does not apply to the period I am considering, that is to say, around 1830 to ^ I O . In other words, it is not so as to provide chil- dren with schools, or because of a failure to provide them with schools, that the problem arises of where to put them. The problem of where to put them does not arise in terms of their schooling, of their ability or inability to be educated at school, but in terms of their parents* work. That is to say: what can be done so that the care needed by an idiot child does not make him an obstacle to working parents? What's more, this exactly corresponds to the government's concern at the time that the law on primary education was being made. You know that if "nursery schools" ("salles d'asi/e") were created in the 1830s, that is to say, creches and kindergartens, and if schooling was provided lor children in this period, it was not so much in order to equip them for future employ ment, as to free their parents lor work by no longer having to concern themselves with their children. 1^ The organization of these educational establishments at this time corresponded to the aim of releasing parents Irom taking care of their children so as to put them on the labor market.
The people who created the specialized establishments for idiots in this period had exactly the same concern. I remind you that Voisin opened his institute of "orthophrenia" on the rue de Sevres, not for the rich, who could pay, but for the poor. I will quote you a text by Fernald, which is a bit later but reflects this concern exactly, and which says: "Whereas care of an idiot child at home takes up the time and energy of
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one person, the proportion ol people employed in asylums is one person for five idiot children. The care at home of one idiot, especially if dis- abled, consumes the wages and abilities of the people of the household, so that an entire family falls into poverty. Humanity and good policy call for families to be relieved of responsibility for these unfortunates. "^5
In this way, and on the basis of this concern, it was decided to apply the law of confinement and assistance lor inmates to poor idiot children as well. The institutional assimilation of idiots and the mad takes place precisely on the basis of this concern to release parents for possible work. In 1853 Parchappe comes to this conclusion in his Principes a suivre dans la jondalion et la construction des asiles dfa/ienes: "Mental alienation includes not only all the lorms and degrees ol madness in the strict sense ( . . . ) but also idiocy which depends on a congenital delect, and imbecility produced by an illness after birth. Lunatic asylums must therelore be founded to receive all the insane, that is to say, the mad, the idiots, and the imbeciles. "'6
And now, some years after the clear distinction between madness and idiocy, you see the notion ol mental alienation move back a degree, as it were, and become the general category embracing all the forms ol madness and idiocy and imbecility as well. "Mental alienation" will become the practical concept on the basis of which one will be able to cover the need to confine the mentally ill and the mentally defective using the same mechanisms and in the same places of assistance. The practical nullification of the distinction between idiocy and mental ill- ness is sanctioned by the very strange and abstract notion of "mental alienation" as a general term covering the whole.
Now, once placed within the asylum space, the power exercised on idiot children is precisely psychiatric power in the pure state, and remains so with practically no elaboration. In the asylum for the mad a series ol processes take place which by which psychiatric power is con siderably elaborated, but when it is connected up with the conlinement of idiots this power is simply put to work and kept going lor years. At any rate, if you look at the way in which Seguin himself--who so clearly defined a difference between mental illness and idiocy in his Traitement moral des idiots--actually treated the idiots and mentally deficient at Bicetre, you see that he applied exactly the same schemas of psychiatric
? power, but with, as it were, a magnifying and purifying effect. And within this practice, which was absolutely canonical for defining the methods for educating idiots, we find exactly the same mechanisms of psychiatric power. The education of idiots and the abnormal is psychi- atric power in the pure state.
What in fact did Seguin do at Bicetre in 1842-1843? First, he con ceived of the education of idiots, which he called "moral treatment" moreover, using the same term as Leuret, to whom he refers, as first of all the confrontation of two wills: "The struggle of the two wills may be long or short, finish to the advantage of the teacher or of the pupil. "'7 You recall the way in which, in psychiatric "moral treatment," the con frontation of patient and doctor was indeed the confrontation of two wills in a struggle ior power. You find exactly the same formulation and the same practice in Seguin; except, one might wonder how Seguin can speak of the confrontation of two wills when it is a case of an adult and a retarded child or an idiot. We really must speak ol two wills and of a confrontation between teacher and idiot, Seguin says, because the idiot seems not to have any will, but in actual fact he has the will not to will, and this is precisely what characterizes instinct. What is "instinct"?
It is a certain anarchic form of will which consists in never wanting to submit to the will of others; it is a will which refuses to organize itself in the mode of the individual's monarchical will, which consequently refuses any order and any kind of integration within a system. Instinct is a will which "wills not to will"'1* and which stubbornly insists on not constituting itself as an adult will--the adult will being characterized, for Seguin, as a will that can obey. Instinct is an indefinite series of small refusals opposed to any will of the other person.
Again we find again a contrast with madness here. The idiot is some one who stubbornly says "no"; the mad person is someone who says a "yes," a presumptuous "yes" to all his crazy ideas, and the exasperation of the mad person's will consists precisely in saying "yes" even to things that are false. For Seguin, the idiot is someone who anarchically and stubbornly says "no" to everything, and so the teacher's role is absolutely similar to the psychiatrist's role facing the mad person: the psychiatrist must master this "yes" and transform it into a "no"; the teacher's role m his confrontation with the idiot consists in mastering this
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"no" and making it into a "yes" of acceptance/ The idioms "energetic no, no, no, repeated without respite, arms crossed or hanging down, or while biting his fist/'49 must be countered with a "power which tires him out and constantly says to him: On! On! It is up to the teacher to say it to him loudly enough, firmly enough, early enough and for long enough so that he can toe the line and show to what extent he is a man. "50
There is confrontation, then, which is of the same type as that found in psychiatric power, and which takes place in the form of a certain surplus-power, as in psychiatric power, constituted definitively on the teacher's side. And it is in relation to the teacher's body, as to the psychiatrist's body, that special education must be conducted. Seguin emphasizes and practices this omnipotence of the teacher in his visible body
First, the teacher must block all family power; the teacher becomes the absolute master of the child: "So long as the child is entrusted to the Master," Seguin says in an expression not lacking in style, "parents have the rights of grief, the Master has the rights of authority. Master of the application of his method, Master of the child, Master of the family's relationships with the child, Magister, he is thrice Master or not at all," says Seguin, who could not have had a very good grasp of Latin. 51 He is master at the level of his body and, like the psychiatrist, he must have an impeccable physique. "A clumsy, common bearing and gestures, poorly shaped, lackluster eyes set far apart, and a lifeless, expressionless gaze; or again, a fleshy mouth, thick, soft lips, incorrect pronunciation, drawling, guttural, nasal or poorly accented voice," are all absolutely proscribed for someone who wants to be Master of the idiot. 52 He must appear physically impeccable before the idiot, as a both powerful and unknown personage: "The Master must have a straightforward bearing, distinct speech and gestures, a clear-cut manner, to make him noted, listened to, seen, and recognized" straightaway by the idiot. 5*
The idiot's education must take place through its connection with this impeccable and omnipotent body. It is a physical connection, and it really is precisely through the master's body that the reality itself of the
* The manuscript adds: "Special education is the confrontation with this 'no'. "
? pedagogical content must pass. Seguin produces the theory and practice of this physical clinch of idiot child and omnipotent master. For example, he tells how he succeeded in subduing an unruly child: "A. H. was uncontrollably lively; climbing like a cat, slipping away like a mouse, one shouldn't have thought of getting him to stand upright and still for three seconds. I put him on a chair and sat down opposite him, holding his feet and knees between mine; one of my hands held his two on his knees, while the other constantly brought his mobile face back in front of me. Apart from eating and sleeping, we stayed like that for five weeks. "5' Consequently there is a total physical capture that serves to subject and master the body.
The same goes for looking. How do you teach an idiot to look? At any rate, you do not start by teaching him to look at things; you teach him to look at the master. His access to the reality of the world, the attention he will pay to differences between things, will begin with his perception of the master. When the idiot child's gaze wanders or gets lost, "you approach, the child struggles; your eyes seek his, he avoids your eyes; you pursue, he escapes again; you think you have got him, he closes his eyes; you are there, attentive, ready to surprise him, waiting for him to reopen his eyelids in order to penetrate his eyes with your gaze; and if, as reward for your efforts, the day he sees you for the first time, the child pushes you away, or if, in order to forget his primitive condition, his family pre-
sent to the world a distorted picture of the constant care you have given him, then you will begin again to expend your life anxiously in this way, no longer for the love of this or that, but for the triumph of the doctrine of which you alone still have the secret and the courage. This was how, for four months, I pursued the elusive gaze of a child in the void. The first time his eyes met mine, he broke away, letting out a loud cry (. . . ). ":>5 Here again we find the feature of psychiatric power that is so prominent; the organization of all power around and with the psychiatrist's body.
Third, in this moral treatment of idiot children you find again the organization of a disciplinary space like that of the asylum. We see, for example, learning the linear distribution of bodies, individual places, gymnastic exercises--the full use of time. As Bourneville will say later, "the children must be busy from getting up until going to bed. Their
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activities must be constantly varied ( . . . ) . From waking up, washing oneself, getting dressed, brushing one's clothes, cleaning one's shoes, mak- ing the bed, and, after that, keeping the attention constantly alert (school, workshop, gymnastics, singing, recreations, walks, games, etcetera) ( . . . ) until going to bed, when the children must be taught to lay out their clothes in an orderly way on their chair. '? 6 Full use of time, work.
In 1893, there were about two hundred children at Bicetre, some of whom worked from 8 . 0 0 a. m. until 11. 00 a. m. , and the others from 1. 00 p. m. until 5. 00 p. m. , as brush, shoe, and basket makers, etcetera. 57 This all went very well, since, even selling the product of their work at a very low, wholesale and not market, price, they succeeded in making "a profit of seven thousand francs";^8 after wages for the masters, run- ning costs, and repayment of loans for the construction of the buildings, there are seven thousand francs that Bourneville thinks will give the idiots a sense of being useful to society. 59
Finally, the last point, in which we also find again all the asylum mechanisms, is that like psychiatric power, the power over idiots is tau- tological in the sense I have tried to explain. That is to say, what is this psychiatric power entirely canalized through the master's body supposed to introduce, to convey within this asylum lor idiots? It must introduce nothing other than the outside, that is to say, ultimately, the school itself, the school to which the children could not adapt and in relation to which, precisely, it was possible to designate them as idiots. That is to say, the psychiatric power at work here makes school power lunction as a sort ol absolute reality in relation to which the idiot will be defined as an idiot, and, after making school power function as reality in this way, it will give it that supplement of power which will enable school power to get a hold as the general rule of treatment for idiots within the asylum. What does the psychiatric treatment of idiots do, if not precisely repeat the content of education itself in a multiplied and disciplinary form?
Consider, for example, the program of Perray Vaucluse at the end of the nineteenth century. In 1895, there were four sections within the division lor idiots. In the fourth section, the lowest, teaching was simply by sight with wooden objects: Bourneville says that this was exactly the level of infant classes. In the third section, a bit higher, there are "prac tical lessons, exercises in reading, reciting, sums and writing"; this is the
? level of preparatory classes. In the second section the children learn grammar, history, and slightly more difficult arithmetic; this is the level ol the linal year at primary school. In the first section the children are prepared for the school certificate. 60
You see the tautology ol psychiatric power with regard to schooling. On the one hand, school power functions as reality in relation to the psychiatric power that posits it as being that m relation to which it will be able to identify and specily those who are mentally retarded; and then, on the other hand, it will make it function within the asylum, given a supplement ol power.
4*
We have two processes therefore: the theoretical specihcation ol idiocy and the practical annexation by psychiatric power. How could these two processes, pulling in opposite directions, give rise to medicalization? *
For the coupling of these two processes ol opposing tendencies there was, I think, a simple economic reason, which, in its very humbleness, and certainly much more than the psychiatnzation of mental deficiency, was at the origin ol the generalization of psychiatric power. The famous 1838 law, then, which delined the modalities ol conlinement and the conditions of assistance to poor inmates, had to be applied to idiots. Now, m the terms ol this law, the cost ol board and lodgings lor someone conlined in the asylum was paid by the deparlemenlor the local commu nity from which he came; that is to say, the local community became linancially responsible for those who were confined. 61 The reason why the local authorities hesitated lor years to conline the mentally deficient, even alter the 1840 decision, was precisely the increased burden of their linancial obligations. 62 There are texts which are perlectly clear about
this. For the council of a departemenl, a prefecture, a town hall, to accept and support an idiot's conlinement, the doctor had to guarantee to the authority in question that the idiot was not only an idiot, that he was not only unable to provide for his own needs--it was not even enough to say that his family could not provide for his needs--but, and this was the
* The manuscript spccilies: "psychiatric. "
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only condition on which the local authorities agreed to support him, he had to say that he was dangerous, that is to say, that he could commit arson, murder, rape, etcetera. The doctors of the period from 187|0 to i 8 6 0 say this clearly. They say: In order to get care for him we have to write false reports, to make the situation look worse than it is and depict the idiot or mental defective as someone who is dangerous.
In other words, the notion of danger becomes necessary in order to transform an act of assistance into a phenomenon of protection and thus enable those responsible for assistance to accept that responsibility. Danger is the third element enabling the procedure of confinement and assistance to be set going, and the doctors actually give certificates in these terms. Now what is strange is that, on the basis of this kind of minor circumstance, which raises quite simply the problem of the cost of abnormality that we always come across in the history of psychiatry, the problem of the cost of abnormality will have a major effect, because, with the complaints ol these doctors who, lrom ^SZ\0 to 1850, complain about being forced to accuse idiots of being dangerous, you see the grad ual development ol a whole medical literature that increasingly takes itself seriously, which will, if you like, stigmatize the mentally deficient and actually make him into someone who is dangerous. 6^ Which means that lilty years later, when Bourneville writes his report, Assistance, Traitement et Education des enfants idiots et degeneres, idiot children have become dangerous. 6'1 Cases are regularly cited proving that idiots are dangerous: they are dangerous because they masturbate in public, com mit sexual offences, and are arsonists. And in 1895,* someone as serious as Bourneville tells this story in order to prove that idiots are dangerous: in the Eure departement, someone raped a young girl who was an idiot who had become a prostitute; so that the idiot proves the danger of idiots "at the very moment she was a victim. "65 We could find a number of similar statements; I am summarizing them. In 1895 Bourneville says: "Criminal anthropology has demonstrated that a high proportion of criminals, inveterate drunks, and prostitutes are, in reality, imbeciles at birth whom no one has ever sought to improve or discipline. "66
In this way you see the reconstitution ol the broad category of all those who may represent a danger for society, those moreover whom Voisin, in
* 1897J; 1895 is the dale of publication.
? 1830, was already wanting to confine when he said that one should also look after those who "are . . . noticeable for their difficult character, a pro- lound dissimulation, a wild self esteem, a boundless pride, burning pas- sions and terrible tendencies. "67 All of these will begin to be confined through this stigmatization of the idiot that is necessary for assistance to come into play. The outline emerges of that great reality of the both abnor mal and dangerous child, the pandemonium of whom Bourneville will recount in his 1895 text when he says that, ultimately, we are dealing with idiots and through them, alongside them and absolutely linked to idiocy, a whole series of perversions, which are perversions of the instincts. You see here how this notion of instinct serves as a peg for Segum's theory and for psychiatric practice. The children who must be confined are "children more or less defective from the intellectual point of view, but affected by perversions of the instincts: thieves, liars, masturbators, pederasts, arson- ists, destroyers, murderers, poisoners, etcetera. "
This whole family, thus reconstituted around the idiot, constitutes, pre- cisely, abnormal childhood. In the psychiatric order--I completely leave aside for the moment the problems of physiology and pathological anatomy--the category of abnormality did not apply to the adult at all in the nineteenth century; it was only applied to the child. In other words, I think we could summarize things by saying that in the nineteenth century, those who were mad were adults and, prior to the final years of the century, a mad child was not thought to be a real possibility; furthermore, the idea that the mad child had been discovered only arose through a retrospective projection of the adult onto the child; Charcot's mad children first, and then those of Freud soon after. However, in the nineteenth century, it is basi- cally the adult who is mad and, on the other hand, children who are abnor- mal. The child was the bearer of abnormalities, and around the idiot, around the problems raised by his exclusion, this entire family, this general field of abnormality, was constituted--from the liar to the poisoner, from the pederast to the murderer, from the onanist to the arsonist--at the center of which appears the retarded child, the mentally deficient child, the idiot. Through these practical problems raised by the idiot child you see psychiatry becoming something infinitely more general and dangerous than the power that controls and corrects madness; it is becoming power over the abnormal, the power to define, control, and correct what is abnormal.
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This double lunction of psychiatry, as power over madness and power over abnormality, corresponds to the gap between practices concerning the mad child and practices concerning the abnormal child. The disjunction between the mad child and the abnormal child seems to me to be an absolutely fundamental feature of the exercise ol psychiatric power m the nineteenth century. I think it is easy to draw the following main consequences from this.
The lirst consequence is that psychiatry will now be able to plug into a whole series ol disciplinary regimes existing around it, on the grounds of the principle that it alone is both the science and power of the abnormal. Psychiatry will be able to claim for itsell everything abnormal, all these deviations and abnormalities in relation to school, military, family and other forms of discipline. The generalization, diffusion, and dissemination ol psychiatric power took place in our society by way ol this carving out of the abnormal child.
The second consequence is a matter ol the internal rather than external consequences of dillusion. Psychiatry, as power over madness and power over abnormality, will find itself under a kind ol internal obligation to define possible relationships between the abnormal child and the mad adult. It is to this end that, basically in the second hall ol the nineteenth century, two concepts are developed that will enable the link to be made, that is to say, the notion ol instinct on the one hand, and the notion ol degeneration on the other.
Actually, instinct is precisely that element whose existence is natural, but which is abnormal in its anarchical functioning, which is abnormal whenever it is not mastered or repressed. So it is the fate ol this both nat ural and abnormal instinct, of instinct as element, as unity of nature and abnormality, which psychiatry will gradually try to reconstruct lrom child- hood to adulthood, lrom nature to abnormality, and from abnormality to illness. 69 Psychiatry will expect to find the link between the abnormal child and the mad adult in the fate ol instinct lrom childhood to adulthood.
On the other hand, "degeneration," the other great concept alongside that of "instinct," is an unlortunate concept; instinct had a career in which it remained valid as a concept for much longer. However, the notion of degeneration is also very interesting, because it is not, as is usually said, the projection of biological evolutionism onto psychiatry.
? Biological evolutionism will intervene in psychiatry, take up this notion and overload it with certain connotations, but it will do this later. 70
Degeneration, as Morel defines it, arises before Darwin and before evolutionism. 71 What is degeneration in Morel's time, and what will it basically remain until its abandonment at the beginning of the twentieth century? 72 A child who carries the traces of his parents' or ancestors' madness, as stigmata or signs, will be called "degenerate. " Degeneration is therefore, as it were, the effect of abnormality produced on the child by his parents. And, at the same time, the degenerate child is an abnormal child whose abnormality is such that, in certain determinate circumstances and following certain accidents, it may produce madness. Degeneration is therefore the predisposition of abnormality in the child that will make possible the adult's madness, and, in the form of abnormality, it is the sign on the child of his ancestors' madness.
Consequently, you see this notion of degeneration pick out the fam lly and ancestors, as a package without strict definition for the moment, and the child, and it makes the family the collective support of this dou ble phenomenon of abnormality and madness. If abnormality leads to madness and if madness produces abnormality, it is actually because we are already within this collective support that is the family. 7*
I come to the third and last consequence. Studying the point of depar- ture and functioning of the generalization of psychiatry, we now find our selves faced with these two notions: degeneration and instinct. That is to say, we are seeing the emergence of something that will become what we can call, very roughly as I quite realize, the field of psychoanalysis, that is to say, ol the familial destiny of instinct. What does instinct become m the family? What is the system of exchanges that take place between ancestors and descendants, children and parents, and which calls instinct into ques- tion? Take these two notions, make them function together, and it is right there that psychoanalysis will at any rate get going, will start talking.
So, the principle of the generalization of psychiatry is found on the child's side, not the adult's; it is not found in the generalized use of the notion of mental illness, but rather in the practical carving out of the field of abnormalities. It is precisely in this generalization, starting from the child and abnormality, and not from the adult and illness, that we see the emergence of the future object of psychoanalysis.
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1. G. Canguilhem, Le Normal et le Pathologique (Paris: P. U. F. , 1972, 2ml revised edition) p. 175; English translation, On the Normal and the Pathological, trans. Carolyn R. Fawcet (Dordrecht, Boston and London: D. Reidel, 1978) p. 145.
2. In 1856 C. S. Le Paulmier presented a study devoted specifically to the mad child: Des affections mentales chevies en/ants, et en partkulier de la manie, Pans Medical Thesis, no. 162 (Paris: Rignoux, 1856). Paul Moreau de Tours (1844-1908) published what may be con- sidered to be the first treatise of infant psychiatry: La Folie che\ les enfants (Paris:
J. B. Bailliere, 1888).
3. After his journey in Russia in 1881 to look after the daughter of an old mayor of Moscow
and that of a grand duke of Saint Petersburg, in his private practice on the Boulevard Saint Germain Charcot had to accept several children, from wealthy Russian circles, suffering from nervous ailments. As a Parisian journalist noted: "His Russian clientele in Paris is quite sizeable" (Le Temps, 18 March, 1881, p. 3). These cases, like those of the Latin American children, were not made the subjects of publications, apart from the case of a young "Russian Israelite" of 13 years referred to in a lecture: "De l'hystcne chez les jeunes ganjons," Progres medical, vol. X, no. 50, 16 23 December 1882, pp. 985 987, and no. 51, 24 31 December 1882, pp. 1003 1004; and those of Miss A. aged 15 years, and S. , 17 years, originally from Moscow, referred to in Lecons sur les maladies du systeme nerveux, vol. Ill, Lesson VI, pp. 92-96; Clinical Lectures on Diseases of the Nervous System, vol. 3, pp. 77 83. See, A. Lubimov, Le Professeur Charcot, trans. L. A. Roslopchine (Saint Petersburg: Souvorma, 1894).
4. Thus Esquirol, while treating idiocy in connection with mental illness, distanced himself Irom any assimilation of the idiot to the insane by suggesting that "idiocy cannot be confused with dementia and other mental alienations, to which it belongs moreover through the lesion of intellectual and moral faculties" ("Idiotisme" in Dictionnaire des sciences medicales, vol. XXIII, [Paris: C. L. F. Panckoucke, 1818| p. 509). Similarly, Jacques Etienne Belhomme (1800 1880), attached to the section for idiots in Esquirol's depart- ment at Salpetnere, suggested that "this ailment belongs exclusively to childhood, and any mental illness presenting similar phenomena to the latter alter puberty should be carefully distinguished from it" Dissertation inaugurate presentee et soutenue a lafaculte de Medecine de Paris, le V juillet 1824 (Paris: Germer Bailliere, 1843) p. 52.
5. "Frenzy (fureur) is an over-excitement of nervous and muscular lorces, excited by a false perception, a memory, or a ialse idea, characterized by an exasperation, a violent anger against present or absent individuals or objects, causes or witnesses of ihe event. Bouts of fureur are veritable paroxysms of delirium, which vary in their duration and the Irequency ol their recurrence" E. J. Georget, De lafolie. Considerations sur cctte maladie pp. 106-107.
6. Hence the opposition made by Joseph Daquin between the "extravagant" and the "stupid madman": "The extravagant madman comes and goes, and is continually physically agitated; he tears neither danger nor threats ( . . . ) In the imbecilic madman, the intellec- tual organs appear to be completely lacking; he conducts himsell on the impulse ol the other person, without any kind of discernment" La Philosophic de la Jolie, 1791 edition, p. 22, 1987 edition, p. 50.
7. William Cullen (1710 1790) speaks ol "innate dementia," which he defines as an "imbe- cility of the mind for judging, by which men do not perceive or recall the relationships b e t w e e n t h i n g s " Apparatus ad nosologiam methodicam, seu Synopsis nosologiae methodicae in usum studiosorum, Part IV, "Vesania" (Edinburgh: W. Creech, 1769). According to Desire Magloire Bourneville ( 1 8 4 0 - 1 9 0 9 ) , Recueilde memoires, notes el observations sur I'idiotie, vol. I: De I'idiotie (Paris: Lecroisner and Babe, 1891) p. 4,Jean Michel Sagar (1702 1778) devotes one and a hall pages to a form of imbecility he calls amentia in his work, Syslema morborum sympltomalicum secundum classes, ordines, genera et species (Vienna: Kraus, 1776). Francois Fodere stated that "innate dementia seems to be the same thing as idiocy," defining it as an "Entire or partial obliteration of the affective faculties, with no appearance ol either innate or acquired intellectual faculties," Traite du delire, vol. I, pp. 419420.
8. (a) Under the name of stupiditas sive morosis Thomas Willis isolates a class of mental illnesses in chapter XIII of his De Anima Brutorum, quae hominis vitalis ac sensiliva esl (London: R. Davis, 1672); English version, Two Discourses concerning the Soul of Brutes,
? Which Is That of the Vital and Sensitive of Man, ed. S. Pordage (London: Harper and Leigh, 1683)- From this, chapter III, "Of Stupidity or Foolishness," is reproduced in P. Cranefield, "A seventeenth century view of mental deficiency and schizophrenia: Thomas Willis on 'Stupidity or Foolishness'," Bulletin of the History of Medicine, vol. 35, no. 4, 1961, pp. 291 316. See p. 293: "Stupidity, or Morosis, or Foolishness, although it most chiefly belongs to the Rational Soul, and signifies a defect ol the Intellect and Judgment, yet it is not improperly reckoned among the Diseases of the Head or Brain; lorasmuch as this Eclipse of the superior soul, proceeds lrom the Imagination and the Memory being hurt, and the failing of these depends upon the faults oi the Animal Spirits, and the Brain itsell. " Foucault refers to this in Histoire de lafolie, pp. 270 271 and 278 280 (both passages omitted from the English translation). See,J. Vinchon and J. Vie, "Un maitre de la neuropsychiatrie au xviic siecle: Thomas Willis (1662- 1675)," Annales medko-psychologiques, 12th series, vol. II, July 1928, pp. 109-144.
( b ) Francois Boissier de Sauvages (1706 1767) Nosologia methodica sistens morborum classes, genera et species, Juxta Sydenhami mentem et bontanicorum ordinem, vol. II (Amsterdam: De Tournes, 1763); French translation, Nosologie methodique, ou Distribution des maladies en classes, en genres et en especes suivant Vesprit de Sydenham et Vordre des botanistes, trans. Gouvion (Lyon: Buyset, 1771) vol. II. The chapter devoted to amentia distinguishes an eighth species: amentia morosis, or Stupidity: "Imbecility, dullness, foolishness, stupid
Uy: this is a weakness, a slowness or abolition of the faculty ol imagination or judg- ment, without the accompaniment ol delirium" p. 340. See, L. S. King, "Boissier de Sauvages and eighteenth century nosology," Bulletin of the History of Medicine, vol. 40, no. 1,1966, pp. 43 51.
(c) Jean-Baptiste Theophile Jacquelin Dubuisson (1770 1836) deiines "idiotism" by "a condition ol stupor or of the abolition ol the intellectual and affective functions, the result of which is a more or less complete obtuseness" Des vesanies ou maladies mentales (Paris: Mequignon, 1816) p. 281.
(d) Gcorget adds to the genres of insanity defined by Pinel a "Fourth genre that we could designate as stupidity," characterized by "the accidental absence of the manifestation
of thought, either because the patient has no ideas, or because he cannot express them" De la jolie, p. 115- See, A. Ritti, "Stupeur Stupidite" in Dictionnaire encyclopedique des sciences medkales (Paris: Masson/Asselin, 1883) 3rJ series, vol. XII, pp. 454-469.
9. Thus Boissier de Sauvages inserts the ingenii imbecillitas in the 18 classification of his nosography devoted to amentia. See his Nosologie methodique, vol. II, pp. 334-342. For Joseph Daquin, "the words dementia and imbecility are roughly synonymous, with this difference however between them: the lormer is an absolute deprivation ol reason, while the latter is only an enfeeblement of it" La Philosophic de lafolie, p. 51.
10. J. E. Belhomme: "Idiocy is easily distinguished from dementia . . . One begins with life, or
in an age which precedes the lull development of intelligence; the other appears alter puberty; the former belongs exclusively to childhood, the latter is mainly an illness of old
age" ? 550/ sur Vidiotie. Propositions sur ^education des idiots mise en rapport avec leur degre d'intel- ligence (Paris: Didot Jeune, 1824) pp. 32 33- On the history of idiocy, see, E. Seguin, Traitement moral, hygiene et education des idiots et des autres enfants arrieres ou retardes dans leur developpement(Paris: J. -B. Bailliere, 1846) pp. 23-32; D. M. Bourneville, Assistance, Traitement et Education des enfants idiots et degeneres, ch. 1: "Aperc,u historique de I'assistance
et du traitement des enlants idiots et degeneres," pp. 1 7; L. Kanner, A History of the Care and Study of the Mentally Retarded (Springfield, 111: C. C. Thomas, 1964); G. Netchine, "Idiots, debiles et savants au xixL siecle" in R. Zazzo, Les Debilites mentales, pp. 70 107; and, R. Myrvold, L'Arrieration menlalc, de Pinel a Binet-Simon, Medical Thesis, Paris, 1973, no. 67-
11. See J. E. D. Esquirol, "Delire," in Dictionnaire des sciences medkales (Paris: C. L. F. Panckoucke, 1814) vol. VIII, p. 255: "Apyretic delirium [i. e. , without fever; J. L. ] is the pathognomic sign of vesania"; EJ. Georget, De lafolie, p. 75: "The essential symptom of this illness ( . . . ) consists in intellectual disorders to which the name delirium has been given; there is no madness without delirium. " Michel Foucault notes that for eighteenth century medicine an "implicit delirium exists in all the alterations of the mind. " Histoire de la folie, p. 254; Madness and Civilization, p. 99.
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12. J. -B. Jacquelin Dubuisson, Des vesanies, p. 281.
13. P. Pinel classifies "idiotism" among the "species" of mental alienation: Traitemedico-
philosophique, section IV, pp. 166 176; A Treatise on Insanity, "Mental Derangement Distributed into Different Species. Fifth species ol mental derangement: Idiotism, or obliteration of the intellectual and affective faculties," pp. 165 173-
14. J. E. D. Esquirol, "Hallucinations" in Dictionnairc des sciences medicales, vol. XX (Paris: C. L. F. Panckoucke, 1817) pp. 64-71; "Idiotisme," ibid. vol. XXIII, 1818, pp. 507-524; and "De l'idiotie" (1820) in Des maladies tnenta/es, vol. II, pp.
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. And even if an establishment is opened specifically for these children at Perray- Vaucluse in 1873,*6 it remains the case that at the end of the century, at Bicetre,37 Salpetriere,38 and Villejuif,39 there are still psychiatric wings for these mentally defective children. Moreover, not only is this colo- nization effectuated, de facto, by the opening of these sections within the psychiatric space, but a decision oi the Minister of the Interior in 18^0 states explicitly that the 1838 law on the confinement of the insane applies equally to idiots: this is no more than a matter of a sim pie ministerial decision that is based on the principle that idiots are still a category of the insane. ^0
So, at a moment when there is this clear theoretical division between insanity and idiocy, there are a whole series of institutions and adminis trative measures which lump together what was in the process of being distinguished. To what does this institutional annexation, contempo rary with the theoretical distinction, correspond?
It might be thought that this theoretical distinction is quite simply the effect of the organization of primary education at this lime: Guizot's law dates from 1833. '' It might be thought that with mental retardation or mental deficiency being filtered through the primary education then being developed, idiots identified as problems within these educational establishments will be gradually expelled into the asylums. This is in fact true, but not for the period I am considering. In actual fact it is at the end of the nineteenth century that generalized primary education will act as a filter, and the major inquiries which take place at the end
? o! the century on mental deficiency take place in an educational milieu, that is to say, the schools are asked for the facts for the inquiry/2 These inquiries are indeed conducted with primary school teachers, and the question will focus on the nature and possibilities of schooling. For example, in 1892-1893, when Rey conducts an inquiry into mental deficiency in the Bouches du-Rhone, he addresses himself to primary school teachers and, in order to identify the idiots, imbeciles, and mentally deficient, he asks which children do not follow school activi- ties in an appropriate way, which children make themselves noted by their unruliness, and which children cannot even attend school/'3 This is the basis on which the great patchwork will be established. Primary education acts in fact as the Hlter and reference for the phenomena of mental retardation.
However, this does not apply to the period I am considering, that is to say, around 1830 to ^ I O . In other words, it is not so as to provide chil- dren with schools, or because of a failure to provide them with schools, that the problem arises of where to put them. The problem of where to put them does not arise in terms of their schooling, of their ability or inability to be educated at school, but in terms of their parents* work. That is to say: what can be done so that the care needed by an idiot child does not make him an obstacle to working parents? What's more, this exactly corresponds to the government's concern at the time that the law on primary education was being made. You know that if "nursery schools" ("salles d'asi/e") were created in the 1830s, that is to say, creches and kindergartens, and if schooling was provided lor children in this period, it was not so much in order to equip them for future employ ment, as to free their parents lor work by no longer having to concern themselves with their children. 1^ The organization of these educational establishments at this time corresponded to the aim of releasing parents Irom taking care of their children so as to put them on the labor market.
The people who created the specialized establishments for idiots in this period had exactly the same concern. I remind you that Voisin opened his institute of "orthophrenia" on the rue de Sevres, not for the rich, who could pay, but for the poor. I will quote you a text by Fernald, which is a bit later but reflects this concern exactly, and which says: "Whereas care of an idiot child at home takes up the time and energy of
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one person, the proportion ol people employed in asylums is one person for five idiot children. The care at home of one idiot, especially if dis- abled, consumes the wages and abilities of the people of the household, so that an entire family falls into poverty. Humanity and good policy call for families to be relieved of responsibility for these unfortunates. "^5
In this way, and on the basis of this concern, it was decided to apply the law of confinement and assistance lor inmates to poor idiot children as well. The institutional assimilation of idiots and the mad takes place precisely on the basis of this concern to release parents for possible work. In 1853 Parchappe comes to this conclusion in his Principes a suivre dans la jondalion et la construction des asiles dfa/ienes: "Mental alienation includes not only all the lorms and degrees ol madness in the strict sense ( . . . ) but also idiocy which depends on a congenital delect, and imbecility produced by an illness after birth. Lunatic asylums must therelore be founded to receive all the insane, that is to say, the mad, the idiots, and the imbeciles. "'6
And now, some years after the clear distinction between madness and idiocy, you see the notion ol mental alienation move back a degree, as it were, and become the general category embracing all the forms ol madness and idiocy and imbecility as well. "Mental alienation" will become the practical concept on the basis of which one will be able to cover the need to confine the mentally ill and the mentally defective using the same mechanisms and in the same places of assistance. The practical nullification of the distinction between idiocy and mental ill- ness is sanctioned by the very strange and abstract notion of "mental alienation" as a general term covering the whole.
Now, once placed within the asylum space, the power exercised on idiot children is precisely psychiatric power in the pure state, and remains so with practically no elaboration. In the asylum for the mad a series ol processes take place which by which psychiatric power is con siderably elaborated, but when it is connected up with the conlinement of idiots this power is simply put to work and kept going lor years. At any rate, if you look at the way in which Seguin himself--who so clearly defined a difference between mental illness and idiocy in his Traitement moral des idiots--actually treated the idiots and mentally deficient at Bicetre, you see that he applied exactly the same schemas of psychiatric
? power, but with, as it were, a magnifying and purifying effect. And within this practice, which was absolutely canonical for defining the methods for educating idiots, we find exactly the same mechanisms of psychiatric power. The education of idiots and the abnormal is psychi- atric power in the pure state.
What in fact did Seguin do at Bicetre in 1842-1843? First, he con ceived of the education of idiots, which he called "moral treatment" moreover, using the same term as Leuret, to whom he refers, as first of all the confrontation of two wills: "The struggle of the two wills may be long or short, finish to the advantage of the teacher or of the pupil. "'7 You recall the way in which, in psychiatric "moral treatment," the con frontation of patient and doctor was indeed the confrontation of two wills in a struggle ior power. You find exactly the same formulation and the same practice in Seguin; except, one might wonder how Seguin can speak of the confrontation of two wills when it is a case of an adult and a retarded child or an idiot. We really must speak ol two wills and of a confrontation between teacher and idiot, Seguin says, because the idiot seems not to have any will, but in actual fact he has the will not to will, and this is precisely what characterizes instinct. What is "instinct"?
It is a certain anarchic form of will which consists in never wanting to submit to the will of others; it is a will which refuses to organize itself in the mode of the individual's monarchical will, which consequently refuses any order and any kind of integration within a system. Instinct is a will which "wills not to will"'1* and which stubbornly insists on not constituting itself as an adult will--the adult will being characterized, for Seguin, as a will that can obey. Instinct is an indefinite series of small refusals opposed to any will of the other person.
Again we find again a contrast with madness here. The idiot is some one who stubbornly says "no"; the mad person is someone who says a "yes," a presumptuous "yes" to all his crazy ideas, and the exasperation of the mad person's will consists precisely in saying "yes" even to things that are false. For Seguin, the idiot is someone who anarchically and stubbornly says "no" to everything, and so the teacher's role is absolutely similar to the psychiatrist's role facing the mad person: the psychiatrist must master this "yes" and transform it into a "no"; the teacher's role m his confrontation with the idiot consists in mastering this
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"no" and making it into a "yes" of acceptance/ The idioms "energetic no, no, no, repeated without respite, arms crossed or hanging down, or while biting his fist/'49 must be countered with a "power which tires him out and constantly says to him: On! On! It is up to the teacher to say it to him loudly enough, firmly enough, early enough and for long enough so that he can toe the line and show to what extent he is a man. "50
There is confrontation, then, which is of the same type as that found in psychiatric power, and which takes place in the form of a certain surplus-power, as in psychiatric power, constituted definitively on the teacher's side. And it is in relation to the teacher's body, as to the psychiatrist's body, that special education must be conducted. Seguin emphasizes and practices this omnipotence of the teacher in his visible body
First, the teacher must block all family power; the teacher becomes the absolute master of the child: "So long as the child is entrusted to the Master," Seguin says in an expression not lacking in style, "parents have the rights of grief, the Master has the rights of authority. Master of the application of his method, Master of the child, Master of the family's relationships with the child, Magister, he is thrice Master or not at all," says Seguin, who could not have had a very good grasp of Latin. 51 He is master at the level of his body and, like the psychiatrist, he must have an impeccable physique. "A clumsy, common bearing and gestures, poorly shaped, lackluster eyes set far apart, and a lifeless, expressionless gaze; or again, a fleshy mouth, thick, soft lips, incorrect pronunciation, drawling, guttural, nasal or poorly accented voice," are all absolutely proscribed for someone who wants to be Master of the idiot. 52 He must appear physically impeccable before the idiot, as a both powerful and unknown personage: "The Master must have a straightforward bearing, distinct speech and gestures, a clear-cut manner, to make him noted, listened to, seen, and recognized" straightaway by the idiot. 5*
The idiot's education must take place through its connection with this impeccable and omnipotent body. It is a physical connection, and it really is precisely through the master's body that the reality itself of the
* The manuscript adds: "Special education is the confrontation with this 'no'. "
? pedagogical content must pass. Seguin produces the theory and practice of this physical clinch of idiot child and omnipotent master. For example, he tells how he succeeded in subduing an unruly child: "A. H. was uncontrollably lively; climbing like a cat, slipping away like a mouse, one shouldn't have thought of getting him to stand upright and still for three seconds. I put him on a chair and sat down opposite him, holding his feet and knees between mine; one of my hands held his two on his knees, while the other constantly brought his mobile face back in front of me. Apart from eating and sleeping, we stayed like that for five weeks. "5' Consequently there is a total physical capture that serves to subject and master the body.
The same goes for looking. How do you teach an idiot to look? At any rate, you do not start by teaching him to look at things; you teach him to look at the master. His access to the reality of the world, the attention he will pay to differences between things, will begin with his perception of the master. When the idiot child's gaze wanders or gets lost, "you approach, the child struggles; your eyes seek his, he avoids your eyes; you pursue, he escapes again; you think you have got him, he closes his eyes; you are there, attentive, ready to surprise him, waiting for him to reopen his eyelids in order to penetrate his eyes with your gaze; and if, as reward for your efforts, the day he sees you for the first time, the child pushes you away, or if, in order to forget his primitive condition, his family pre-
sent to the world a distorted picture of the constant care you have given him, then you will begin again to expend your life anxiously in this way, no longer for the love of this or that, but for the triumph of the doctrine of which you alone still have the secret and the courage. This was how, for four months, I pursued the elusive gaze of a child in the void. The first time his eyes met mine, he broke away, letting out a loud cry (. . . ). ":>5 Here again we find the feature of psychiatric power that is so prominent; the organization of all power around and with the psychiatrist's body.
Third, in this moral treatment of idiot children you find again the organization of a disciplinary space like that of the asylum. We see, for example, learning the linear distribution of bodies, individual places, gymnastic exercises--the full use of time. As Bourneville will say later, "the children must be busy from getting up until going to bed. Their
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activities must be constantly varied ( . . . ) . From waking up, washing oneself, getting dressed, brushing one's clothes, cleaning one's shoes, mak- ing the bed, and, after that, keeping the attention constantly alert (school, workshop, gymnastics, singing, recreations, walks, games, etcetera) ( . . . ) until going to bed, when the children must be taught to lay out their clothes in an orderly way on their chair. '? 6 Full use of time, work.
In 1893, there were about two hundred children at Bicetre, some of whom worked from 8 . 0 0 a. m. until 11. 00 a. m. , and the others from 1. 00 p. m. until 5. 00 p. m. , as brush, shoe, and basket makers, etcetera. 57 This all went very well, since, even selling the product of their work at a very low, wholesale and not market, price, they succeeded in making "a profit of seven thousand francs";^8 after wages for the masters, run- ning costs, and repayment of loans for the construction of the buildings, there are seven thousand francs that Bourneville thinks will give the idiots a sense of being useful to society. 59
Finally, the last point, in which we also find again all the asylum mechanisms, is that like psychiatric power, the power over idiots is tau- tological in the sense I have tried to explain. That is to say, what is this psychiatric power entirely canalized through the master's body supposed to introduce, to convey within this asylum lor idiots? It must introduce nothing other than the outside, that is to say, ultimately, the school itself, the school to which the children could not adapt and in relation to which, precisely, it was possible to designate them as idiots. That is to say, the psychiatric power at work here makes school power lunction as a sort ol absolute reality in relation to which the idiot will be defined as an idiot, and, after making school power function as reality in this way, it will give it that supplement of power which will enable school power to get a hold as the general rule of treatment for idiots within the asylum. What does the psychiatric treatment of idiots do, if not precisely repeat the content of education itself in a multiplied and disciplinary form?
Consider, for example, the program of Perray Vaucluse at the end of the nineteenth century. In 1895, there were four sections within the division lor idiots. In the fourth section, the lowest, teaching was simply by sight with wooden objects: Bourneville says that this was exactly the level of infant classes. In the third section, a bit higher, there are "prac tical lessons, exercises in reading, reciting, sums and writing"; this is the
? level of preparatory classes. In the second section the children learn grammar, history, and slightly more difficult arithmetic; this is the level ol the linal year at primary school. In the first section the children are prepared for the school certificate. 60
You see the tautology ol psychiatric power with regard to schooling. On the one hand, school power functions as reality in relation to the psychiatric power that posits it as being that m relation to which it will be able to identify and specily those who are mentally retarded; and then, on the other hand, it will make it function within the asylum, given a supplement ol power.
4*
We have two processes therefore: the theoretical specihcation ol idiocy and the practical annexation by psychiatric power. How could these two processes, pulling in opposite directions, give rise to medicalization? *
For the coupling of these two processes ol opposing tendencies there was, I think, a simple economic reason, which, in its very humbleness, and certainly much more than the psychiatnzation of mental deficiency, was at the origin ol the generalization of psychiatric power. The famous 1838 law, then, which delined the modalities ol conlinement and the conditions of assistance to poor inmates, had to be applied to idiots. Now, m the terms ol this law, the cost ol board and lodgings lor someone conlined in the asylum was paid by the deparlemenlor the local commu nity from which he came; that is to say, the local community became linancially responsible for those who were confined. 61 The reason why the local authorities hesitated lor years to conline the mentally deficient, even alter the 1840 decision, was precisely the increased burden of their linancial obligations. 62 There are texts which are perlectly clear about
this. For the council of a departemenl, a prefecture, a town hall, to accept and support an idiot's conlinement, the doctor had to guarantee to the authority in question that the idiot was not only an idiot, that he was not only unable to provide for his own needs--it was not even enough to say that his family could not provide for his needs--but, and this was the
* The manuscript spccilies: "psychiatric. "
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only condition on which the local authorities agreed to support him, he had to say that he was dangerous, that is to say, that he could commit arson, murder, rape, etcetera. The doctors of the period from 187|0 to i 8 6 0 say this clearly. They say: In order to get care for him we have to write false reports, to make the situation look worse than it is and depict the idiot or mental defective as someone who is dangerous.
In other words, the notion of danger becomes necessary in order to transform an act of assistance into a phenomenon of protection and thus enable those responsible for assistance to accept that responsibility. Danger is the third element enabling the procedure of confinement and assistance to be set going, and the doctors actually give certificates in these terms. Now what is strange is that, on the basis of this kind of minor circumstance, which raises quite simply the problem of the cost of abnormality that we always come across in the history of psychiatry, the problem of the cost of abnormality will have a major effect, because, with the complaints ol these doctors who, lrom ^SZ\0 to 1850, complain about being forced to accuse idiots of being dangerous, you see the grad ual development ol a whole medical literature that increasingly takes itself seriously, which will, if you like, stigmatize the mentally deficient and actually make him into someone who is dangerous. 6^ Which means that lilty years later, when Bourneville writes his report, Assistance, Traitement et Education des enfants idiots et degeneres, idiot children have become dangerous. 6'1 Cases are regularly cited proving that idiots are dangerous: they are dangerous because they masturbate in public, com mit sexual offences, and are arsonists. And in 1895,* someone as serious as Bourneville tells this story in order to prove that idiots are dangerous: in the Eure departement, someone raped a young girl who was an idiot who had become a prostitute; so that the idiot proves the danger of idiots "at the very moment she was a victim. "65 We could find a number of similar statements; I am summarizing them. In 1895 Bourneville says: "Criminal anthropology has demonstrated that a high proportion of criminals, inveterate drunks, and prostitutes are, in reality, imbeciles at birth whom no one has ever sought to improve or discipline. "66
In this way you see the reconstitution ol the broad category of all those who may represent a danger for society, those moreover whom Voisin, in
* 1897J; 1895 is the dale of publication.
? 1830, was already wanting to confine when he said that one should also look after those who "are . . . noticeable for their difficult character, a pro- lound dissimulation, a wild self esteem, a boundless pride, burning pas- sions and terrible tendencies. "67 All of these will begin to be confined through this stigmatization of the idiot that is necessary for assistance to come into play. The outline emerges of that great reality of the both abnor mal and dangerous child, the pandemonium of whom Bourneville will recount in his 1895 text when he says that, ultimately, we are dealing with idiots and through them, alongside them and absolutely linked to idiocy, a whole series of perversions, which are perversions of the instincts. You see here how this notion of instinct serves as a peg for Segum's theory and for psychiatric practice. The children who must be confined are "children more or less defective from the intellectual point of view, but affected by perversions of the instincts: thieves, liars, masturbators, pederasts, arson- ists, destroyers, murderers, poisoners, etcetera. "
This whole family, thus reconstituted around the idiot, constitutes, pre- cisely, abnormal childhood. In the psychiatric order--I completely leave aside for the moment the problems of physiology and pathological anatomy--the category of abnormality did not apply to the adult at all in the nineteenth century; it was only applied to the child. In other words, I think we could summarize things by saying that in the nineteenth century, those who were mad were adults and, prior to the final years of the century, a mad child was not thought to be a real possibility; furthermore, the idea that the mad child had been discovered only arose through a retrospective projection of the adult onto the child; Charcot's mad children first, and then those of Freud soon after. However, in the nineteenth century, it is basi- cally the adult who is mad and, on the other hand, children who are abnor- mal. The child was the bearer of abnormalities, and around the idiot, around the problems raised by his exclusion, this entire family, this general field of abnormality, was constituted--from the liar to the poisoner, from the pederast to the murderer, from the onanist to the arsonist--at the center of which appears the retarded child, the mentally deficient child, the idiot. Through these practical problems raised by the idiot child you see psychiatry becoming something infinitely more general and dangerous than the power that controls and corrects madness; it is becoming power over the abnormal, the power to define, control, and correct what is abnormal.
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This double lunction of psychiatry, as power over madness and power over abnormality, corresponds to the gap between practices concerning the mad child and practices concerning the abnormal child. The disjunction between the mad child and the abnormal child seems to me to be an absolutely fundamental feature of the exercise ol psychiatric power m the nineteenth century. I think it is easy to draw the following main consequences from this.
The lirst consequence is that psychiatry will now be able to plug into a whole series ol disciplinary regimes existing around it, on the grounds of the principle that it alone is both the science and power of the abnormal. Psychiatry will be able to claim for itsell everything abnormal, all these deviations and abnormalities in relation to school, military, family and other forms of discipline. The generalization, diffusion, and dissemination ol psychiatric power took place in our society by way ol this carving out of the abnormal child.
The second consequence is a matter ol the internal rather than external consequences of dillusion. Psychiatry, as power over madness and power over abnormality, will find itself under a kind ol internal obligation to define possible relationships between the abnormal child and the mad adult. It is to this end that, basically in the second hall ol the nineteenth century, two concepts are developed that will enable the link to be made, that is to say, the notion ol instinct on the one hand, and the notion ol degeneration on the other.
Actually, instinct is precisely that element whose existence is natural, but which is abnormal in its anarchical functioning, which is abnormal whenever it is not mastered or repressed. So it is the fate ol this both nat ural and abnormal instinct, of instinct as element, as unity of nature and abnormality, which psychiatry will gradually try to reconstruct lrom child- hood to adulthood, lrom nature to abnormality, and from abnormality to illness. 69 Psychiatry will expect to find the link between the abnormal child and the mad adult in the fate ol instinct lrom childhood to adulthood.
On the other hand, "degeneration," the other great concept alongside that of "instinct," is an unlortunate concept; instinct had a career in which it remained valid as a concept for much longer. However, the notion of degeneration is also very interesting, because it is not, as is usually said, the projection of biological evolutionism onto psychiatry.
? Biological evolutionism will intervene in psychiatry, take up this notion and overload it with certain connotations, but it will do this later. 70
Degeneration, as Morel defines it, arises before Darwin and before evolutionism. 71 What is degeneration in Morel's time, and what will it basically remain until its abandonment at the beginning of the twentieth century? 72 A child who carries the traces of his parents' or ancestors' madness, as stigmata or signs, will be called "degenerate. " Degeneration is therefore, as it were, the effect of abnormality produced on the child by his parents. And, at the same time, the degenerate child is an abnormal child whose abnormality is such that, in certain determinate circumstances and following certain accidents, it may produce madness. Degeneration is therefore the predisposition of abnormality in the child that will make possible the adult's madness, and, in the form of abnormality, it is the sign on the child of his ancestors' madness.
Consequently, you see this notion of degeneration pick out the fam lly and ancestors, as a package without strict definition for the moment, and the child, and it makes the family the collective support of this dou ble phenomenon of abnormality and madness. If abnormality leads to madness and if madness produces abnormality, it is actually because we are already within this collective support that is the family. 7*
I come to the third and last consequence. Studying the point of depar- ture and functioning of the generalization of psychiatry, we now find our selves faced with these two notions: degeneration and instinct. That is to say, we are seeing the emergence of something that will become what we can call, very roughly as I quite realize, the field of psychoanalysis, that is to say, ol the familial destiny of instinct. What does instinct become m the family? What is the system of exchanges that take place between ancestors and descendants, children and parents, and which calls instinct into ques- tion? Take these two notions, make them function together, and it is right there that psychoanalysis will at any rate get going, will start talking.
So, the principle of the generalization of psychiatry is found on the child's side, not the adult's; it is not found in the generalized use of the notion of mental illness, but rather in the practical carving out of the field of abnormalities. It is precisely in this generalization, starting from the child and abnormality, and not from the adult and illness, that we see the emergence of the future object of psychoanalysis.
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1. G. Canguilhem, Le Normal et le Pathologique (Paris: P. U. F. , 1972, 2ml revised edition) p. 175; English translation, On the Normal and the Pathological, trans. Carolyn R. Fawcet (Dordrecht, Boston and London: D. Reidel, 1978) p. 145.
2. In 1856 C. S. Le Paulmier presented a study devoted specifically to the mad child: Des affections mentales chevies en/ants, et en partkulier de la manie, Pans Medical Thesis, no. 162 (Paris: Rignoux, 1856). Paul Moreau de Tours (1844-1908) published what may be con- sidered to be the first treatise of infant psychiatry: La Folie che\ les enfants (Paris:
J. B. Bailliere, 1888).
3. After his journey in Russia in 1881 to look after the daughter of an old mayor of Moscow
and that of a grand duke of Saint Petersburg, in his private practice on the Boulevard Saint Germain Charcot had to accept several children, from wealthy Russian circles, suffering from nervous ailments. As a Parisian journalist noted: "His Russian clientele in Paris is quite sizeable" (Le Temps, 18 March, 1881, p. 3). These cases, like those of the Latin American children, were not made the subjects of publications, apart from the case of a young "Russian Israelite" of 13 years referred to in a lecture: "De l'hystcne chez les jeunes ganjons," Progres medical, vol. X, no. 50, 16 23 December 1882, pp. 985 987, and no. 51, 24 31 December 1882, pp. 1003 1004; and those of Miss A. aged 15 years, and S. , 17 years, originally from Moscow, referred to in Lecons sur les maladies du systeme nerveux, vol. Ill, Lesson VI, pp. 92-96; Clinical Lectures on Diseases of the Nervous System, vol. 3, pp. 77 83. See, A. Lubimov, Le Professeur Charcot, trans. L. A. Roslopchine (Saint Petersburg: Souvorma, 1894).
4. Thus Esquirol, while treating idiocy in connection with mental illness, distanced himself Irom any assimilation of the idiot to the insane by suggesting that "idiocy cannot be confused with dementia and other mental alienations, to which it belongs moreover through the lesion of intellectual and moral faculties" ("Idiotisme" in Dictionnaire des sciences medicales, vol. XXIII, [Paris: C. L. F. Panckoucke, 1818| p. 509). Similarly, Jacques Etienne Belhomme (1800 1880), attached to the section for idiots in Esquirol's depart- ment at Salpetnere, suggested that "this ailment belongs exclusively to childhood, and any mental illness presenting similar phenomena to the latter alter puberty should be carefully distinguished from it" Dissertation inaugurate presentee et soutenue a lafaculte de Medecine de Paris, le V juillet 1824 (Paris: Germer Bailliere, 1843) p. 52.
5. "Frenzy (fureur) is an over-excitement of nervous and muscular lorces, excited by a false perception, a memory, or a ialse idea, characterized by an exasperation, a violent anger against present or absent individuals or objects, causes or witnesses of ihe event. Bouts of fureur are veritable paroxysms of delirium, which vary in their duration and the Irequency ol their recurrence" E. J. Georget, De lafolie. Considerations sur cctte maladie pp. 106-107.
6. Hence the opposition made by Joseph Daquin between the "extravagant" and the "stupid madman": "The extravagant madman comes and goes, and is continually physically agitated; he tears neither danger nor threats ( . . . ) In the imbecilic madman, the intellec- tual organs appear to be completely lacking; he conducts himsell on the impulse ol the other person, without any kind of discernment" La Philosophic de la Jolie, 1791 edition, p. 22, 1987 edition, p. 50.
7. William Cullen (1710 1790) speaks ol "innate dementia," which he defines as an "imbe- cility of the mind for judging, by which men do not perceive or recall the relationships b e t w e e n t h i n g s " Apparatus ad nosologiam methodicam, seu Synopsis nosologiae methodicae in usum studiosorum, Part IV, "Vesania" (Edinburgh: W. Creech, 1769). According to Desire Magloire Bourneville ( 1 8 4 0 - 1 9 0 9 ) , Recueilde memoires, notes el observations sur I'idiotie, vol. I: De I'idiotie (Paris: Lecroisner and Babe, 1891) p. 4,Jean Michel Sagar (1702 1778) devotes one and a hall pages to a form of imbecility he calls amentia in his work, Syslema morborum sympltomalicum secundum classes, ordines, genera et species (Vienna: Kraus, 1776). Francois Fodere stated that "innate dementia seems to be the same thing as idiocy," defining it as an "Entire or partial obliteration of the affective faculties, with no appearance ol either innate or acquired intellectual faculties," Traite du delire, vol. I, pp. 419420.
8. (a) Under the name of stupiditas sive morosis Thomas Willis isolates a class of mental illnesses in chapter XIII of his De Anima Brutorum, quae hominis vitalis ac sensiliva esl (London: R. Davis, 1672); English version, Two Discourses concerning the Soul of Brutes,
? Which Is That of the Vital and Sensitive of Man, ed. S. Pordage (London: Harper and Leigh, 1683)- From this, chapter III, "Of Stupidity or Foolishness," is reproduced in P. Cranefield, "A seventeenth century view of mental deficiency and schizophrenia: Thomas Willis on 'Stupidity or Foolishness'," Bulletin of the History of Medicine, vol. 35, no. 4, 1961, pp. 291 316. See p. 293: "Stupidity, or Morosis, or Foolishness, although it most chiefly belongs to the Rational Soul, and signifies a defect ol the Intellect and Judgment, yet it is not improperly reckoned among the Diseases of the Head or Brain; lorasmuch as this Eclipse of the superior soul, proceeds lrom the Imagination and the Memory being hurt, and the failing of these depends upon the faults oi the Animal Spirits, and the Brain itsell. " Foucault refers to this in Histoire de lafolie, pp. 270 271 and 278 280 (both passages omitted from the English translation). See,J. Vinchon and J. Vie, "Un maitre de la neuropsychiatrie au xviic siecle: Thomas Willis (1662- 1675)," Annales medko-psychologiques, 12th series, vol. II, July 1928, pp. 109-144.
( b ) Francois Boissier de Sauvages (1706 1767) Nosologia methodica sistens morborum classes, genera et species, Juxta Sydenhami mentem et bontanicorum ordinem, vol. II (Amsterdam: De Tournes, 1763); French translation, Nosologie methodique, ou Distribution des maladies en classes, en genres et en especes suivant Vesprit de Sydenham et Vordre des botanistes, trans. Gouvion (Lyon: Buyset, 1771) vol. II. The chapter devoted to amentia distinguishes an eighth species: amentia morosis, or Stupidity: "Imbecility, dullness, foolishness, stupid
Uy: this is a weakness, a slowness or abolition of the faculty ol imagination or judg- ment, without the accompaniment ol delirium" p. 340. See, L. S. King, "Boissier de Sauvages and eighteenth century nosology," Bulletin of the History of Medicine, vol. 40, no. 1,1966, pp. 43 51.
(c) Jean-Baptiste Theophile Jacquelin Dubuisson (1770 1836) deiines "idiotism" by "a condition ol stupor or of the abolition ol the intellectual and affective functions, the result of which is a more or less complete obtuseness" Des vesanies ou maladies mentales (Paris: Mequignon, 1816) p. 281.
(d) Gcorget adds to the genres of insanity defined by Pinel a "Fourth genre that we could designate as stupidity," characterized by "the accidental absence of the manifestation
of thought, either because the patient has no ideas, or because he cannot express them" De la jolie, p. 115- See, A. Ritti, "Stupeur Stupidite" in Dictionnaire encyclopedique des sciences medkales (Paris: Masson/Asselin, 1883) 3rJ series, vol. XII, pp. 454-469.
9. Thus Boissier de Sauvages inserts the ingenii imbecillitas in the 18 classification of his nosography devoted to amentia. See his Nosologie methodique, vol. II, pp. 334-342. For Joseph Daquin, "the words dementia and imbecility are roughly synonymous, with this difference however between them: the lormer is an absolute deprivation ol reason, while the latter is only an enfeeblement of it" La Philosophic de lafolie, p. 51.
10. J. E. Belhomme: "Idiocy is easily distinguished from dementia . . . One begins with life, or
in an age which precedes the lull development of intelligence; the other appears alter puberty; the former belongs exclusively to childhood, the latter is mainly an illness of old
age" ? 550/ sur Vidiotie. Propositions sur ^education des idiots mise en rapport avec leur degre d'intel- ligence (Paris: Didot Jeune, 1824) pp. 32 33- On the history of idiocy, see, E. Seguin, Traitement moral, hygiene et education des idiots et des autres enfants arrieres ou retardes dans leur developpement(Paris: J. -B. Bailliere, 1846) pp. 23-32; D. M. Bourneville, Assistance, Traitement et Education des enfants idiots et degeneres, ch. 1: "Aperc,u historique de I'assistance
et du traitement des enlants idiots et degeneres," pp. 1 7; L. Kanner, A History of the Care and Study of the Mentally Retarded (Springfield, 111: C. C. Thomas, 1964); G. Netchine, "Idiots, debiles et savants au xixL siecle" in R. Zazzo, Les Debilites mentales, pp. 70 107; and, R. Myrvold, L'Arrieration menlalc, de Pinel a Binet-Simon, Medical Thesis, Paris, 1973, no. 67-
11. See J. E. D. Esquirol, "Delire," in Dictionnaire des sciences medkales (Paris: C. L. F. Panckoucke, 1814) vol. VIII, p. 255: "Apyretic delirium [i. e. , without fever; J. L. ] is the pathognomic sign of vesania"; EJ. Georget, De lafolie, p. 75: "The essential symptom of this illness ( . . . ) consists in intellectual disorders to which the name delirium has been given; there is no madness without delirium. " Michel Foucault notes that for eighteenth century medicine an "implicit delirium exists in all the alterations of the mind. " Histoire de la folie, p. 254; Madness and Civilization, p. 99.
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12. J. -B. Jacquelin Dubuisson, Des vesanies, p. 281.
13. P. Pinel classifies "idiotism" among the "species" of mental alienation: Traitemedico-
philosophique, section IV, pp. 166 176; A Treatise on Insanity, "Mental Derangement Distributed into Different Species. Fifth species ol mental derangement: Idiotism, or obliteration of the intellectual and affective faculties," pp. 165 173-
14. J. E. D. Esquirol, "Hallucinations" in Dictionnairc des sciences medicales, vol. XX (Paris: C. L. F. Panckoucke, 1817) pp. 64-71; "Idiotisme," ibid. vol. XXIII, 1818, pp. 507-524; and "De l'idiotie" (1820) in Des maladies tnenta/es, vol. II, pp.
