Thus, in the
Policlinique
of 21 February 1888, "Hysteria in young boys," Charcot acknowl- edged: "It is very strange that in particularly mental forms the stigmata do not appear.
Foucault-Psychiatric-Power-1973-74
) they did not (eel the head heavy or turn, as when one has drunk too much wine or spirits.
They answered that their head was completely Iree, and that they only lacked balance in the legs" (author's emphasis).
Foucault is relerring to the analyses put lorward by Broca in his 1861 article: "Remarques sur le siege de la laculte du langage articule," in which he proposed the term "aphemie" (see above, note 9) to designate this loss of the "faculty of articulating words" in H.
Hccaen and J.
Dubois, La Naissance de la neurophysiologie du langage, p.
63-
Anarthria is a motor aphasia linked to an affection of the Broca area, situated on the external lace of the dominant cerebral hemisphere, at the lower part of the third frontal convolution. Characterized by disorders ol the articulation of speech, without lesions ol the phonatory organs, it was described by Pierre Marie (1853-1940) in "De l'aphasie (cecite verbale, surdite verbale, aphasie motrice, agraphie)," Revue du medecine, vol. Ill, 1883, pp. 693-702.
As testifies the use of the term "hystero epilepsy" to designate a hybrid form (composed ol hysteria and epilepsy) marked by convulsive crises, as states J. B. Lodois Bnffaut: "We see the hysteric becoming epileptic, remaining both the one and the other, which constitutes hystero-epilepsy, or epilepsy increasingly dominating, and suppressing, as it were, the original hysteria" Rapports de I'hysterie et de I'epilepsie, Medical Thesis, Paris, no. 146 (Paris: 1851) p. 24. See E. J. Georget--according to whom hysteria is a convulsive nervous disorder that forms a continuum with epilepsy--the article "Hystene," in Dictionnaire de medecine, vol. 11 (Paris: Bechet Jeune, 1824) pp. 526-551- On the confusion of epilepsy with other "convulsive disorders," see O. Temkin, The Falling Sickness: A Story of Epilepsy from the Greeks to the Beginnings of Modern Neurology (Baltimore, Md. : The Johns Hopkins Press, 119451 1971, 2na revised edition) pp. 351-359.
Foucault takes two dates as reference points:
(1) 1820, the year in which the debate on the causes of madness begins on the occasion of Etienne Georget's defence of his thesis, 8 February 1820: "Dissertation sur les causes de la folie" (see above, note 18 to lecture of 12 December 1973). Published in January 1843 by J. Baillarger, L. Cense and F. Longet, the Annales medico-psychologiques. Journal de
19.
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PSYCHIATRIC POWER
/'anatomic, de la physiologic ct tie la pathologic du sysleme nerveux, specifically intended to gather all the documents concerning the relationships between the physical and the moral, mental pathology, legal medicine of the insane, and clinical neuroses (Paris, Fort in and Masson), was the site for an almost permanent debate on the organic and moral causes ol madness, with a significant moment in the 1840s which saw conflict with the supporters of organicism, such as (a) L. Rostan, author oi Exposition des principes de Vor- gancisme, precedee de reflexions sur Vincredulitc en matiere de medecine (Paris: Asselin, 1846); ( b ) A. |de( Foville, author, with J. B. Delaye, of a paper lor the Prix Escjuirol in 1821, "Sur les causes de la fohe et leur mode d'action, suivies de recherches sur la nature et le siege special de cette maladie," Nouveau Journal de medecine, vol. XII, October 1821, pp. 110 sq. \ as well as G. Ferrus, and L. Calmed; | c | J J . Moreau de Tours, who on 9 June 1830, delended a thesis entitled: De Vinjluencc du physique, relativement an desordre des facultes inlel- lecluclles, el en parliculier dans cette variete de delire designee par M. Esquirol sous le nom de Monomanic, Paris Medical Thesis, no. 127 (Paris: Didot, 1830) taking up the terms "organicism," and "organicist" as a banner--and the partisans of the pscyhological school, who preferred to be called "dualists": P. N. Gerdy, Frederic Dubois d'Amiens (1799-1873), C. Michea, Louis Francois Emile Renaudin (1808-1865). As well as ( d ) J . B. Parchappe de Vinay, author ol an article entitled precisely "De la predominance des causes morales dans la generation de la fohe," Annales medico-psychologiques, vol. II, November 1843, pp. 358-371. And |e| L. F. Lelut, who criticizes the use of pathological anatomy in mental medicine in his Inductions sur la valcur des alterations de Vencephale dans le delire aigu el dans la folie (Paris: Trinquart, 1836).
(n) 1880, when a third organicist wave spreads out with the works ol Magnan and Charcot, who, thinking they have mastered the physiopathology ol the brain, think the time has arrived lor definitive conclusions.
20. On Bayle's conception, see above, note 17 to the lecture ol 12 December 1973, and note 2 to the lecture ol 9january 1974.
21. Against Bayle, who admitted "three orders of essential symptoms belonging to madness, dementia and paralysis," Baillarger maintained that "the essential symptoms ol this illness, those without which it never exists, are ol two orders: those constituted by phenomena of paralysis and the others by phenomena ol dementia," and delirium, when it exists, only "constitutes a completely accessory symptom. " J. Baillarger, "Des symptomes de la paralysie generate et des rapports de cette maladie avec la folie," Appendix to the transla lions of W. Griesinger's Traile, p. 614 and p. 612.
22. "Good illness" or, as Foucault said, " 'good form'. The major structure which governs all perception of madness is exactly represented in the analysis of the psychiatric symp loms of nervous syphilis" Histoire de lajolie, p. 542 (omitted from the English transla tion). Already, in 1955, Henri Ey saw a "prototype" in it having exercised "an invincible power of attraction on psychiatrists" ("Histoire de la psychiatrie" in Encyclopedic medico- chirurgicalc. Psychiatrie, vol. I, 1955, p. 7). This stems from the fact that, just as clinical anatomy is constituted, A. L. J. Bayle isolates an entity in psychiatry corresponding to the medical model (see above, note 17 to the lecture of 12 December 1973): it has a defin- able cause lrom the angle of pathological anatomy, it presents a specific symptomatol ogy, and it has an evolution defined by three periods leading to motor impotence and dementia. On the history of the problem, see J. Baillarger, "De la decouverte de la paralysie generale et des doctrines emises par les premiers auteurs," Annales medico-psy- chologiques, 3rd series, vol. V, October 1859, 1S| part, pp. 509-526, and 3KI series, vol. VI,
January i 8 6 0 , 2,ul part, pp. 1-14.
23. See above, note 1 to the lecture of 30 January 1974.
24. In the 1840s, the basic definition of the neuroses had hardly changed from when the
Scottish doctor William Cullen introduced the term in his Apparatus ad nosologium methodicam, seu Synopsis nosologiae melhodicae, belore it being laid down with the appearance of First Lines of the Practice of Physic, in 4 volumes (Edinburgh: Elliot, 1777) vol. 3, p. 122: "In this place I propose to comprehend, under the title NEUROSES, all those preternatural aflections of the sense or motion which are without pyrexia [lever; J. L. J, as a part of the primary disease; and all those which do not depend upon a topical affection of the organs, but upon a more general affection of the nervous system, and of those powers of the system
? upon which the sense and motion more especially depend"; French translation Elements de medecine pratique, trans, with notes from the 4lh edition, M. Bosquillon (Paris: Barois et Meqiugnon, 1785) vol. II, p. 185. Thus, in 1843, under the rubric "Neuroses," the Introduction to the Anna/es medico-psychologiques, vol. I, January 1843, pp. xxm xxiv, states: "NEUROSES: We see disturbance of the Junctions ol relational life predominating here, as
in the dillerent lorms ol mental alienation. This disorder appears in a thousand ways in hypochondria, hysteria, catalepsy, epilepsy, somnambulism, neuralgia, hyslencism, etcetera (. . . ). Intermediary in some way between disorders ol nutritional liie and mental illnesses, they seem to share two natures. Here a lunctional disorder of organic life com
mands the attack, there an intellectual disorder dominates the paroxysms. " See, ( a ) A. [de] Foville, entry lor "Neuroses" in Dictionnaire de medecine el de chirnrgie pratiques, vol. XII (Paris: Gabon, 1834), pp. 55-57; (b) E. Monneret and L. Fleury, entry for "Neuroses" in Compendiumde medecine pratique, vol. VI (Paris: Bechel, 1845) p. 209; (c) E. Littre and
C. Robin, Dictionnaire de medecine, de chirnrgie, de pkarmacie, des sciences accessoires et de /'art velerinaire (Paris: 1855): "NEUROSIS: generic name tor illnesses whose seat one assumes
is in the nervous system and which consist in a lunctional disorder without perceptible lesion in the structure ol the parts or material agent able to produce it"; and
( d ) J. M. Bruttin, DiJJercnls Theories sur Vhystcric dans la premiere moilie du XIX siecle (Zurich: Juris, 1969).
25. "Introduction" to the Annales medico-psychologiques, vol. I, January 1843, p. xxv.
26. Jules Falret, "La folie raisonnante ou lolie morale" read at the Societe medico
psychologique on 8 January 1866, Annales medico-pschologiques, 4,h series, vol. VII, May 1866: "Another principal lad, basically typical ol hysterics, is the spirit ol duplicity and
lies. These patients ( . . . ) have no greater pleasure than deceiving and leading the people with whom they have relations into error. Hysterics, who exaggerate their convulsive movements (which are often partly simulated), equally misrepresent and exaggerate all the movements ol their soul (. . . ). In short, the life ol hysterics is just a constant lie (. . . )"; reprinted in Etudes cliniqaes sur les maladies mentales el nerveuses (Paris: J. B. Bailliere, 1889), Study II, p. 502.
27. It wasjules Dcjenne who expressed himself in this way in his "Lec. on inaugurale a la clin- ique des maladies du systcme nerveux" on 31 March 1911, La Presse medicale, V1 April, 1911, pp. 253-258: "Through his studies on hysteria, Charcot rescued a domain from the psychi- atrists that the latter vainly tried to regain. Certainly his doctrine of hysteria has not remained wholly intact. But even if Charcot had only the merit of making doctors under- stand that, beyond material lesions, the problems posed by certain psychical disorders oflered their activity a considerable field, for this we would owe him all our gratitude. " Quoted in G. Guillain, J. -M. Charcot (1825-189)): sa vie, son cruvre (Paris: Masson, 1955) p. 143. An illustration ol this will be the transfer of paternity rights over hysteria to neurologists in medical encyclopedias and dictionaries.
28. Foucault is relerring here to the obituary notice Freud wrote in August 1893 and published in the Wiener medt\inische Wochenschrift, vol. 43, no. 37, 1893, pp. 1513-1520: "In the hall in which he gave his lectures there hung a picture which showed 'citizen' Pinel having the chains taken oil the poor madmen in the Salpetnere. " S. Freud, "Charcot" GW, vol. 1,1952, p. 28; English translation, "Charcot" in Standard Edition, vol. 3, p. 18; French translation, "Charcot" trans. J. Altounian and others in S. Freud, Resultats, Idees, Problemes, vol. I, 1890-1920 (Paris: Presses universitaires de France, 1984) p. 68.
29. J. M. Charcot, Lecons sur les maladies du sysleme nerveux, vol. 1, Lecture 11: "De l'hyperesthesie ovanenne," pp. 320-345; English translation, Clinical Lectures on Diseases of the Nervous System, trans. George Sigerson (London: New Sydenham Society, 1877) vol. 1, Lecture 11: "Ovarian hyperaesthesia" pp. 262-282: "most ol the accidents which persist, in
a more or less permanent manner, in the intervals between the convulsive (its ol hysterical patients, and which almost always enable us, on account ol the characteristics they present, to recognise the great neurosis lor what it really is, even in the absence of convulsions" p. 262. Thus "Hemianaeslhesia, paralysis, contracture, fixed painful points occupying dillerent parts of the body," p. 262.
30. J. -M. Charcot, Lecons, vol. 1, Appendice V: "Des troubles de la vision chez les hystenques," pp. 427-434- (This appendix is omitted Irom the English translation. )
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31. Lemons, vol. 1, Lecture 10: "De l'heminesthesie hysterique" pp. 300-319; Clinical Lectures, vol. 1, "Hysterical hemianaesthesia" pp. 246-261.
32. Ibid. Lecture 12: "De la contracture hysterique" pp. 347-366; "Hysterical contracture" pp. 283-299; Lecons sur les maladies, vol. 3, Lecture 7: "Deux cas de contracture hysterique d'origine traumatique" pp. 97-107, and Lecture 8, (continued), pp. 109-123; Clinical Lectures, vol. 3, Lectures 7 and 8, "Two cases of hysterical contracture of traumatic origin" pp. 84-106.
33.
Thus, in the Policlinique of 21 February 1888, "Hysteria in young boys," Charcot acknowl- edged: "It is very strange that in particularly mental forms the stigmata do not appear. " Lecons du mardi a la Salpetriere. Policlinique 1887-1S88, vol. 1, p. 208: "All these stigmata (. . . ) are constants in hysteria, but despite their constancy, I have to acknowledge that it quite often happens that we do not find them all, or even, when it comes to it, any. "
34- Sketched out Irom 1872 in the Lecons (vol. 1, Lecture 13: "De Phystero-epilepsie" pp. 373-374, and Appendice 6: "Description de la grande attaque hysterique" pp. 435-448; Clinical lectures, vol. 1, Lecture 13, "Hystero epilepsy" pp. 302-307, [the appendix is omitted from the English translation]), it was codified in 1878 when Charcot reduced it to a "a very simple formula": "All these apparently disordered and variable phenomena . . . follow a rule of development. The complete attack is made up ol four periods: 1. Epileptoid period. It may and usually does resemble the genuine epileptic attack (. . . ). There are grounds for dividing this epileptic period into three phases: a) tonic phase (. . . ); b) clonic phase. Limbs and the whole body are shaken by brief and rapid oscillations ( . . . ) which end in big generalized jolts ( . . . ) ; c) phase of resolution ( . . . ) . 2. Period of contortions and large movements (. . . ). 3. Period of passionate poses. Hallucination clearly governs this third period. The patient herself comes on the stage and through the expressive and ani- mated gesticulations to which she abandons herseli ( . . . ) it is easy to lollow all the episodes of the drama at which she thinks she is present and in which she olten plays the leading role (. . . ). 4. Terminal period. Finally the patient returns to the real world. " P. Richer's record of "Description de la grande attaque hysterique. Hospice de la Salpetriere," Progres medical, 7th year, no. 2, 11 January 1879, pp. 17-18.
35. While the term "hystero-epilepsy" (see above, note 19) covered, as Charcot recalls, "a com- bination of the two neuroses, varying in proportions in different cases," constituting "a mixed form, a kind of hybrid composed half oi hysteria and hall ol epilepsy," Charcot means to distinguish between epilepsy and hystero-epilepsy as pathologically distinct entities, which could not come together to iorm "a hybrid" illness. He also distinguishes a "hystero-epilepsy with distinct crises," in which epilepsy is the primary disease on which hysteria becomes grafted, and a "hysteria, with mixed attacks," in which the epileptic Iorm of convulsion only appears as "an accessory element": "in these cases, hysteria is solely and always present, taking on it the semblance of epilepsy" Lecons, vol. 1, Lecture 13: "De 1' hystero epilepsie" pp. 368-369; Clinical Lectures, vol. 1, Lecture 13: "Hystero epilepsy" pp. 301-302. So the term "hystero-epilepsy" designates no more than the final degree oi hysteria taken to its extreme development, or major hysteria. He will later reject the term itself: "My respect lor tradition previously led me to retain this denomination hystero epilepsy; but I confess to you that it bothers me a great deal, lor it is absurd. There is not the least relationship between epilepsy and hystero epilepsy, even with mixed attacks" Lecons du mardi, Lesson XVIII, 19 March 1889, pp. 424-425. Foucault returns to the question in Les Anormaux, lecture of 26 February 1975, p. 167; Abnormal, p. 224. See also, C. Fere, "Notes pour servir a I'histoire de Phystero-epilepsie," Archives de neurologic, vol. Ill, 1882, pp. 160-175 and pp. 281-309.
36. On this differential picture, see the lecture, "Caracteres differentiels entre I'epilepsie et I'hystero epilepsie," summarized in Progres medical, 2,K' year, no. 2, 10 January 1874, pp. 18-19, and, Lecons, vol. 1, Lecture 13; Clinical Lectures, vol. 1, Lecture 13.
37. Lecons, vol. 3, Lecture 18: "A propos de six cas d'hysterie chez l'homme" pp. 260-261; Clinical Lectures, vol. 3, Lecture 18: "Concerning six cases of hysteria in the male,": "a
woman named Aurel -, now 62 years of age ( . . . ) left hemianaesthesia, complete ( . . . ) which ( . . . ) still exists to day, that is to say, after the long period of thirty-four years! This patient has been under our observation for fifteen years and the hemianaesthesia has never ceased (. . . ) to be present" pp. 226-227.
? 38. The case was thai of Habill, who, "had two series of attacks in December 1885: the first, which lasted 13 days in which 4506 attacks were counted, and the other, which lasted 14 days, in which 17,083 attacks were counted" Lemons du mardi, vol. II, Le^on IV, Policlinique du mardi 13 November 1888: Attaque de sommeil hystenque, p. 68.
39- Reference to the artificial reproduction of hysterical manifestations under hypnosis, with regard to which Charcot stated: "Then it is truly that we see before us the human machine in all its simplicity, dreamt of by De la Mettrie" Lecons, vol. Ill, p. 337; Clinical Lectures, vol. 3, Lecture 21: "On two cases of hysterical brachial monoplegia in the male of traumatic origin. --Hystero traumatic monoplegia (continuation)" p. 290. See Julien Offray de La Mettrie (1709-1751), L'Homme machine (Paris: 1747); English translation, Machine Man and Other Writings, trans. Ann Thomson (Cambridge: Cambridge University Press, 1996).
4(). Charcot, Lecons du mardi, vol. I, Polichnique du mardi 24 January 1888: "Paralysies hystero- traumatiques developpees par suggestion," pp. 135-136: "This paralysis ( . . . ) could be reproduced artificially in certain circumstances, which is the wonderful thing about it and ideal in pathological physiology. To be able to reproduce a pathological state is perfection, because it seems that we hold the theory when we have in our hands the means to repro duce the morbid phenomena. " See, ibid. Policlinique of Tuesday 1st May 1888: "Production artificielle de parlaysie dans Fetal hypnotique: procedes de guerison de ces paralysies expcnmentales" (in a hypnotisable hystero epileptic) pp. 373-385.
41. In 1870, owing to renovations to the Sainte-Laure building, in which the insane, epileptics and hysterics in Louis Delasiauve's department were hospitalized, the administration put the insane and reputedly insane epileptics in Baillarger's department, and opened a department lor the other epileptics and hysterics: the "section of simple epileptics," which was entrusted to Charcot in 1872. See the "Le^on d'ouverture" of the chair of the clinic of illnesses of the nervous system, in Lecons, vol. Ill, pp. 2-3; Clinical Lectures, vol. 3, "Introductory" pp. 2-3.
42. J. -M. Charcot, "Metallotherapie et hypnotisme. Electrotherapie," in CEuvres completes, vol. IX (Paris: Lecrosnier & Babe, 1890) p. 297: "The research undertaken at the hospital
of la Salpetriere by M. Charcot and, under his direction, by several of his students, date from 1878. " Charcot set out his first results in "Lemons sur le grand hypnotisme chez les hysteriques. " At the Academie des sciences on 13 February 1882 he gave a paper that proposed a description in neurological terms and sought to give hypnosis a scientific status: "Physiologie pathologique. Sur les divers etats nerveux determines par Fhypnotisation chez
les hysteriques," Comptes rendus hebdomadaires des seances de VAcademie des sciences, vol. 94, no. \, 13 February 1882 (Paris: Gauthier Villars, 1882) pp. 403-405. See, A. R. Owen, Hysteria, Hypnosis and Healing: the Work ofJ. -M. Charcot (London: D. Dobson, 1971).
43. In the 1860s problems arose linked to series of industrial and railway accidents: problems
o( expertise, indemnities, and the determination of employment disability. With regard to industrial accidents, La Securite Generate, supported by the Credit Industriel et Commercial, was created by decree on 14 November 1865- The law of 11 July 1868 recom mended the creation of two national funds for insurance in cases of death and accidents arising from industrial and agricultural work; it was spelled out by the decree of 10 August 1868. In May 1880, a draft bill on "responsibility lor the accidents suffered by workers in their work" was put forward by Martin Nadaud; it was not until 9 April 1898 that the law on accidents at work was passed. See (a) G. Hamon, Histoire generale de I'assurance en France et a Vetranger (Paris: A. Giard and F. Briere, 1897); (b) V. Senes, Les Origines des compagnies d'assurance (Paris: L. Dulac, 1900); (c) J. -P. Richard, Histoire des institutions d*assurance en France (Paris: Ed. de FArgus, 1956); ( d ) H. Hatzfeld, Du pauperisme a la Securite sociale, 1850-1940 (Paris: 1971). Foucault returns to the question in October 1974: see, "Crise de la medecine ou crise de Fantimedecine," Dits et Ecrits, vol. 3, p. 54.
44. In January and February 1867, Henri Legrand du Saulle (1830-1886) devoted a series of lectures to the question published in his Etude medico-legale sur les assurances sur la vie (Paris: Savy, 1868).
45- Thus, Cl. Guillemaud deals with the question of screening for simulation in his work, Des accidents de chemin defer et de leurs consequences medico-judiciaires (Paris: 1851) pp. 40-41. A. Souques devotes his thesis to the question of simulation: Contribution a I'etude des syndromes hysteriques "simulateurs" des maladies organiques de la moelle epiniere, Medical Thesis, Pans,
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no. 158 (Paris: Lecrosnier & Babe, 1891). See also above, note 20 to lecture of 12 December
1973, and note 20 to lecture of 30 January 1974.
46. See above p. 184 sq and p. 234 sq. In the second half of the nineteenth century there is a
growing literature on the results of these accidents: [A] Anglo Saxon, which attributes
them to an inflammation either of the spine ("Railway Spine") or the brain ("Railway
Brain"). See (a) J. E. Erichsen, On Railway and Other Injuries of the Nervous System (Philadelphia: H. C. Lea, 1867), and On Concussion of the Spine, Nervous Shock, and Other ObscureInjuriesoftheNervousSystem(New York:Wood,1875);(b) H. W. Page,Injuriesofthe
Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in their Surgical
and Medico-legal Aspects (London: J. Churchill, 1883), and his book, a dedicated copy ol
which he sent to Charcot, Railway Injuries with Special Reference to those oj the Back and Nervous System in their Medico-legal and Clinical Aspects (London: Griffin and Co. ,
1891). | B | German, which considers the results to be a specific "traumatic neurosis. " See,
(a) H. Oppenhcim and R. Thomsen, "Uber das Vorkommen und die Bedeutung der sensorishcen Aniisthesie bei Erkrankungen des zentralen Nerven-systems" Archiv fur Psychiatrie (Berlin, 1884) vol. 15, pp.
Anarthria is a motor aphasia linked to an affection of the Broca area, situated on the external lace of the dominant cerebral hemisphere, at the lower part of the third frontal convolution. Characterized by disorders ol the articulation of speech, without lesions ol the phonatory organs, it was described by Pierre Marie (1853-1940) in "De l'aphasie (cecite verbale, surdite verbale, aphasie motrice, agraphie)," Revue du medecine, vol. Ill, 1883, pp. 693-702.
As testifies the use of the term "hystero epilepsy" to designate a hybrid form (composed ol hysteria and epilepsy) marked by convulsive crises, as states J. B. Lodois Bnffaut: "We see the hysteric becoming epileptic, remaining both the one and the other, which constitutes hystero-epilepsy, or epilepsy increasingly dominating, and suppressing, as it were, the original hysteria" Rapports de I'hysterie et de I'epilepsie, Medical Thesis, Paris, no. 146 (Paris: 1851) p. 24. See E. J. Georget--according to whom hysteria is a convulsive nervous disorder that forms a continuum with epilepsy--the article "Hystene," in Dictionnaire de medecine, vol. 11 (Paris: Bechet Jeune, 1824) pp. 526-551- On the confusion of epilepsy with other "convulsive disorders," see O. Temkin, The Falling Sickness: A Story of Epilepsy from the Greeks to the Beginnings of Modern Neurology (Baltimore, Md. : The Johns Hopkins Press, 119451 1971, 2na revised edition) pp. 351-359.
Foucault takes two dates as reference points:
(1) 1820, the year in which the debate on the causes of madness begins on the occasion of Etienne Georget's defence of his thesis, 8 February 1820: "Dissertation sur les causes de la folie" (see above, note 18 to lecture of 12 December 1973). Published in January 1843 by J. Baillarger, L. Cense and F. Longet, the Annales medico-psychologiques. Journal de
19.
6 February 1974 325
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PSYCHIATRIC POWER
/'anatomic, de la physiologic ct tie la pathologic du sysleme nerveux, specifically intended to gather all the documents concerning the relationships between the physical and the moral, mental pathology, legal medicine of the insane, and clinical neuroses (Paris, Fort in and Masson), was the site for an almost permanent debate on the organic and moral causes ol madness, with a significant moment in the 1840s which saw conflict with the supporters of organicism, such as (a) L. Rostan, author oi Exposition des principes de Vor- gancisme, precedee de reflexions sur Vincredulitc en matiere de medecine (Paris: Asselin, 1846); ( b ) A. |de( Foville, author, with J. B. Delaye, of a paper lor the Prix Escjuirol in 1821, "Sur les causes de la fohe et leur mode d'action, suivies de recherches sur la nature et le siege special de cette maladie," Nouveau Journal de medecine, vol. XII, October 1821, pp. 110 sq. \ as well as G. Ferrus, and L. Calmed; | c | J J . Moreau de Tours, who on 9 June 1830, delended a thesis entitled: De Vinjluencc du physique, relativement an desordre des facultes inlel- lecluclles, el en parliculier dans cette variete de delire designee par M. Esquirol sous le nom de Monomanic, Paris Medical Thesis, no. 127 (Paris: Didot, 1830) taking up the terms "organicism," and "organicist" as a banner--and the partisans of the pscyhological school, who preferred to be called "dualists": P. N. Gerdy, Frederic Dubois d'Amiens (1799-1873), C. Michea, Louis Francois Emile Renaudin (1808-1865). As well as ( d ) J . B. Parchappe de Vinay, author ol an article entitled precisely "De la predominance des causes morales dans la generation de la fohe," Annales medico-psychologiques, vol. II, November 1843, pp. 358-371. And |e| L. F. Lelut, who criticizes the use of pathological anatomy in mental medicine in his Inductions sur la valcur des alterations de Vencephale dans le delire aigu el dans la folie (Paris: Trinquart, 1836).
(n) 1880, when a third organicist wave spreads out with the works ol Magnan and Charcot, who, thinking they have mastered the physiopathology ol the brain, think the time has arrived lor definitive conclusions.
20. On Bayle's conception, see above, note 17 to the lecture ol 12 December 1973, and note 2 to the lecture ol 9january 1974.
21. Against Bayle, who admitted "three orders of essential symptoms belonging to madness, dementia and paralysis," Baillarger maintained that "the essential symptoms ol this illness, those without which it never exists, are ol two orders: those constituted by phenomena of paralysis and the others by phenomena ol dementia," and delirium, when it exists, only "constitutes a completely accessory symptom. " J. Baillarger, "Des symptomes de la paralysie generate et des rapports de cette maladie avec la folie," Appendix to the transla lions of W. Griesinger's Traile, p. 614 and p. 612.
22. "Good illness" or, as Foucault said, " 'good form'. The major structure which governs all perception of madness is exactly represented in the analysis of the psychiatric symp loms of nervous syphilis" Histoire de lajolie, p. 542 (omitted from the English transla tion). Already, in 1955, Henri Ey saw a "prototype" in it having exercised "an invincible power of attraction on psychiatrists" ("Histoire de la psychiatrie" in Encyclopedic medico- chirurgicalc. Psychiatrie, vol. I, 1955, p. 7). This stems from the fact that, just as clinical anatomy is constituted, A. L. J. Bayle isolates an entity in psychiatry corresponding to the medical model (see above, note 17 to the lecture of 12 December 1973): it has a defin- able cause lrom the angle of pathological anatomy, it presents a specific symptomatol ogy, and it has an evolution defined by three periods leading to motor impotence and dementia. On the history of the problem, see J. Baillarger, "De la decouverte de la paralysie generale et des doctrines emises par les premiers auteurs," Annales medico-psy- chologiques, 3rd series, vol. V, October 1859, 1S| part, pp. 509-526, and 3KI series, vol. VI,
January i 8 6 0 , 2,ul part, pp. 1-14.
23. See above, note 1 to the lecture of 30 January 1974.
24. In the 1840s, the basic definition of the neuroses had hardly changed from when the
Scottish doctor William Cullen introduced the term in his Apparatus ad nosologium methodicam, seu Synopsis nosologiae melhodicae, belore it being laid down with the appearance of First Lines of the Practice of Physic, in 4 volumes (Edinburgh: Elliot, 1777) vol. 3, p. 122: "In this place I propose to comprehend, under the title NEUROSES, all those preternatural aflections of the sense or motion which are without pyrexia [lever; J. L. J, as a part of the primary disease; and all those which do not depend upon a topical affection of the organs, but upon a more general affection of the nervous system, and of those powers of the system
? upon which the sense and motion more especially depend"; French translation Elements de medecine pratique, trans, with notes from the 4lh edition, M. Bosquillon (Paris: Barois et Meqiugnon, 1785) vol. II, p. 185. Thus, in 1843, under the rubric "Neuroses," the Introduction to the Anna/es medico-psychologiques, vol. I, January 1843, pp. xxm xxiv, states: "NEUROSES: We see disturbance of the Junctions ol relational life predominating here, as
in the dillerent lorms ol mental alienation. This disorder appears in a thousand ways in hypochondria, hysteria, catalepsy, epilepsy, somnambulism, neuralgia, hyslencism, etcetera (. . . ). Intermediary in some way between disorders ol nutritional liie and mental illnesses, they seem to share two natures. Here a lunctional disorder of organic life com
mands the attack, there an intellectual disorder dominates the paroxysms. " See, ( a ) A. [de] Foville, entry lor "Neuroses" in Dictionnaire de medecine el de chirnrgie pratiques, vol. XII (Paris: Gabon, 1834), pp. 55-57; (b) E. Monneret and L. Fleury, entry for "Neuroses" in Compendiumde medecine pratique, vol. VI (Paris: Bechel, 1845) p. 209; (c) E. Littre and
C. Robin, Dictionnaire de medecine, de chirnrgie, de pkarmacie, des sciences accessoires et de /'art velerinaire (Paris: 1855): "NEUROSIS: generic name tor illnesses whose seat one assumes
is in the nervous system and which consist in a lunctional disorder without perceptible lesion in the structure ol the parts or material agent able to produce it"; and
( d ) J. M. Bruttin, DiJJercnls Theories sur Vhystcric dans la premiere moilie du XIX siecle (Zurich: Juris, 1969).
25. "Introduction" to the Annales medico-psychologiques, vol. I, January 1843, p. xxv.
26. Jules Falret, "La folie raisonnante ou lolie morale" read at the Societe medico
psychologique on 8 January 1866, Annales medico-pschologiques, 4,h series, vol. VII, May 1866: "Another principal lad, basically typical ol hysterics, is the spirit ol duplicity and
lies. These patients ( . . . ) have no greater pleasure than deceiving and leading the people with whom they have relations into error. Hysterics, who exaggerate their convulsive movements (which are often partly simulated), equally misrepresent and exaggerate all the movements ol their soul (. . . ). In short, the life ol hysterics is just a constant lie (. . . )"; reprinted in Etudes cliniqaes sur les maladies mentales el nerveuses (Paris: J. B. Bailliere, 1889), Study II, p. 502.
27. It wasjules Dcjenne who expressed himself in this way in his "Lec. on inaugurale a la clin- ique des maladies du systcme nerveux" on 31 March 1911, La Presse medicale, V1 April, 1911, pp. 253-258: "Through his studies on hysteria, Charcot rescued a domain from the psychi- atrists that the latter vainly tried to regain. Certainly his doctrine of hysteria has not remained wholly intact. But even if Charcot had only the merit of making doctors under- stand that, beyond material lesions, the problems posed by certain psychical disorders oflered their activity a considerable field, for this we would owe him all our gratitude. " Quoted in G. Guillain, J. -M. Charcot (1825-189)): sa vie, son cruvre (Paris: Masson, 1955) p. 143. An illustration ol this will be the transfer of paternity rights over hysteria to neurologists in medical encyclopedias and dictionaries.
28. Foucault is relerring here to the obituary notice Freud wrote in August 1893 and published in the Wiener medt\inische Wochenschrift, vol. 43, no. 37, 1893, pp. 1513-1520: "In the hall in which he gave his lectures there hung a picture which showed 'citizen' Pinel having the chains taken oil the poor madmen in the Salpetnere. " S. Freud, "Charcot" GW, vol. 1,1952, p. 28; English translation, "Charcot" in Standard Edition, vol. 3, p. 18; French translation, "Charcot" trans. J. Altounian and others in S. Freud, Resultats, Idees, Problemes, vol. I, 1890-1920 (Paris: Presses universitaires de France, 1984) p. 68.
29. J. M. Charcot, Lecons sur les maladies du sysleme nerveux, vol. 1, Lecture 11: "De l'hyperesthesie ovanenne," pp. 320-345; English translation, Clinical Lectures on Diseases of the Nervous System, trans. George Sigerson (London: New Sydenham Society, 1877) vol. 1, Lecture 11: "Ovarian hyperaesthesia" pp. 262-282: "most ol the accidents which persist, in
a more or less permanent manner, in the intervals between the convulsive (its ol hysterical patients, and which almost always enable us, on account ol the characteristics they present, to recognise the great neurosis lor what it really is, even in the absence of convulsions" p. 262. Thus "Hemianaeslhesia, paralysis, contracture, fixed painful points occupying dillerent parts of the body," p. 262.
30. J. -M. Charcot, Lecons, vol. 1, Appendice V: "Des troubles de la vision chez les hystenques," pp. 427-434- (This appendix is omitted Irom the English translation. )
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31. Lemons, vol. 1, Lecture 10: "De l'heminesthesie hysterique" pp. 300-319; Clinical Lectures, vol. 1, "Hysterical hemianaesthesia" pp. 246-261.
32. Ibid. Lecture 12: "De la contracture hysterique" pp. 347-366; "Hysterical contracture" pp. 283-299; Lecons sur les maladies, vol. 3, Lecture 7: "Deux cas de contracture hysterique d'origine traumatique" pp. 97-107, and Lecture 8, (continued), pp. 109-123; Clinical Lectures, vol. 3, Lectures 7 and 8, "Two cases of hysterical contracture of traumatic origin" pp. 84-106.
33.
Thus, in the Policlinique of 21 February 1888, "Hysteria in young boys," Charcot acknowl- edged: "It is very strange that in particularly mental forms the stigmata do not appear. " Lecons du mardi a la Salpetriere. Policlinique 1887-1S88, vol. 1, p. 208: "All these stigmata (. . . ) are constants in hysteria, but despite their constancy, I have to acknowledge that it quite often happens that we do not find them all, or even, when it comes to it, any. "
34- Sketched out Irom 1872 in the Lecons (vol. 1, Lecture 13: "De Phystero-epilepsie" pp. 373-374, and Appendice 6: "Description de la grande attaque hysterique" pp. 435-448; Clinical lectures, vol. 1, Lecture 13, "Hystero epilepsy" pp. 302-307, [the appendix is omitted from the English translation]), it was codified in 1878 when Charcot reduced it to a "a very simple formula": "All these apparently disordered and variable phenomena . . . follow a rule of development. The complete attack is made up ol four periods: 1. Epileptoid period. It may and usually does resemble the genuine epileptic attack (. . . ). There are grounds for dividing this epileptic period into three phases: a) tonic phase (. . . ); b) clonic phase. Limbs and the whole body are shaken by brief and rapid oscillations ( . . . ) which end in big generalized jolts ( . . . ) ; c) phase of resolution ( . . . ) . 2. Period of contortions and large movements (. . . ). 3. Period of passionate poses. Hallucination clearly governs this third period. The patient herself comes on the stage and through the expressive and ani- mated gesticulations to which she abandons herseli ( . . . ) it is easy to lollow all the episodes of the drama at which she thinks she is present and in which she olten plays the leading role (. . . ). 4. Terminal period. Finally the patient returns to the real world. " P. Richer's record of "Description de la grande attaque hysterique. Hospice de la Salpetriere," Progres medical, 7th year, no. 2, 11 January 1879, pp. 17-18.
35. While the term "hystero-epilepsy" (see above, note 19) covered, as Charcot recalls, "a com- bination of the two neuroses, varying in proportions in different cases," constituting "a mixed form, a kind of hybrid composed half oi hysteria and hall ol epilepsy," Charcot means to distinguish between epilepsy and hystero-epilepsy as pathologically distinct entities, which could not come together to iorm "a hybrid" illness. He also distinguishes a "hystero-epilepsy with distinct crises," in which epilepsy is the primary disease on which hysteria becomes grafted, and a "hysteria, with mixed attacks," in which the epileptic Iorm of convulsion only appears as "an accessory element": "in these cases, hysteria is solely and always present, taking on it the semblance of epilepsy" Lecons, vol. 1, Lecture 13: "De 1' hystero epilepsie" pp. 368-369; Clinical Lectures, vol. 1, Lecture 13: "Hystero epilepsy" pp. 301-302. So the term "hystero-epilepsy" designates no more than the final degree oi hysteria taken to its extreme development, or major hysteria. He will later reject the term itself: "My respect lor tradition previously led me to retain this denomination hystero epilepsy; but I confess to you that it bothers me a great deal, lor it is absurd. There is not the least relationship between epilepsy and hystero epilepsy, even with mixed attacks" Lecons du mardi, Lesson XVIII, 19 March 1889, pp. 424-425. Foucault returns to the question in Les Anormaux, lecture of 26 February 1975, p. 167; Abnormal, p. 224. See also, C. Fere, "Notes pour servir a I'histoire de Phystero-epilepsie," Archives de neurologic, vol. Ill, 1882, pp. 160-175 and pp. 281-309.
36. On this differential picture, see the lecture, "Caracteres differentiels entre I'epilepsie et I'hystero epilepsie," summarized in Progres medical, 2,K' year, no. 2, 10 January 1874, pp. 18-19, and, Lecons, vol. 1, Lecture 13; Clinical Lectures, vol. 1, Lecture 13.
37. Lecons, vol. 3, Lecture 18: "A propos de six cas d'hysterie chez l'homme" pp. 260-261; Clinical Lectures, vol. 3, Lecture 18: "Concerning six cases of hysteria in the male,": "a
woman named Aurel -, now 62 years of age ( . . . ) left hemianaesthesia, complete ( . . . ) which ( . . . ) still exists to day, that is to say, after the long period of thirty-four years! This patient has been under our observation for fifteen years and the hemianaesthesia has never ceased (. . . ) to be present" pp. 226-227.
? 38. The case was thai of Habill, who, "had two series of attacks in December 1885: the first, which lasted 13 days in which 4506 attacks were counted, and the other, which lasted 14 days, in which 17,083 attacks were counted" Lemons du mardi, vol. II, Le^on IV, Policlinique du mardi 13 November 1888: Attaque de sommeil hystenque, p. 68.
39- Reference to the artificial reproduction of hysterical manifestations under hypnosis, with regard to which Charcot stated: "Then it is truly that we see before us the human machine in all its simplicity, dreamt of by De la Mettrie" Lecons, vol. Ill, p. 337; Clinical Lectures, vol. 3, Lecture 21: "On two cases of hysterical brachial monoplegia in the male of traumatic origin. --Hystero traumatic monoplegia (continuation)" p. 290. See Julien Offray de La Mettrie (1709-1751), L'Homme machine (Paris: 1747); English translation, Machine Man and Other Writings, trans. Ann Thomson (Cambridge: Cambridge University Press, 1996).
4(). Charcot, Lecons du mardi, vol. I, Polichnique du mardi 24 January 1888: "Paralysies hystero- traumatiques developpees par suggestion," pp. 135-136: "This paralysis ( . . . ) could be reproduced artificially in certain circumstances, which is the wonderful thing about it and ideal in pathological physiology. To be able to reproduce a pathological state is perfection, because it seems that we hold the theory when we have in our hands the means to repro duce the morbid phenomena. " See, ibid. Policlinique of Tuesday 1st May 1888: "Production artificielle de parlaysie dans Fetal hypnotique: procedes de guerison de ces paralysies expcnmentales" (in a hypnotisable hystero epileptic) pp. 373-385.
41. In 1870, owing to renovations to the Sainte-Laure building, in which the insane, epileptics and hysterics in Louis Delasiauve's department were hospitalized, the administration put the insane and reputedly insane epileptics in Baillarger's department, and opened a department lor the other epileptics and hysterics: the "section of simple epileptics," which was entrusted to Charcot in 1872. See the "Le^on d'ouverture" of the chair of the clinic of illnesses of the nervous system, in Lecons, vol. Ill, pp. 2-3; Clinical Lectures, vol. 3, "Introductory" pp. 2-3.
42. J. -M. Charcot, "Metallotherapie et hypnotisme. Electrotherapie," in CEuvres completes, vol. IX (Paris: Lecrosnier & Babe, 1890) p. 297: "The research undertaken at the hospital
of la Salpetriere by M. Charcot and, under his direction, by several of his students, date from 1878. " Charcot set out his first results in "Lemons sur le grand hypnotisme chez les hysteriques. " At the Academie des sciences on 13 February 1882 he gave a paper that proposed a description in neurological terms and sought to give hypnosis a scientific status: "Physiologie pathologique. Sur les divers etats nerveux determines par Fhypnotisation chez
les hysteriques," Comptes rendus hebdomadaires des seances de VAcademie des sciences, vol. 94, no. \, 13 February 1882 (Paris: Gauthier Villars, 1882) pp. 403-405. See, A. R. Owen, Hysteria, Hypnosis and Healing: the Work ofJ. -M. Charcot (London: D. Dobson, 1971).
43. In the 1860s problems arose linked to series of industrial and railway accidents: problems
o( expertise, indemnities, and the determination of employment disability. With regard to industrial accidents, La Securite Generate, supported by the Credit Industriel et Commercial, was created by decree on 14 November 1865- The law of 11 July 1868 recom mended the creation of two national funds for insurance in cases of death and accidents arising from industrial and agricultural work; it was spelled out by the decree of 10 August 1868. In May 1880, a draft bill on "responsibility lor the accidents suffered by workers in their work" was put forward by Martin Nadaud; it was not until 9 April 1898 that the law on accidents at work was passed. See (a) G. Hamon, Histoire generale de I'assurance en France et a Vetranger (Paris: A. Giard and F. Briere, 1897); (b) V. Senes, Les Origines des compagnies d'assurance (Paris: L. Dulac, 1900); (c) J. -P. Richard, Histoire des institutions d*assurance en France (Paris: Ed. de FArgus, 1956); ( d ) H. Hatzfeld, Du pauperisme a la Securite sociale, 1850-1940 (Paris: 1971). Foucault returns to the question in October 1974: see, "Crise de la medecine ou crise de Fantimedecine," Dits et Ecrits, vol. 3, p. 54.
44. In January and February 1867, Henri Legrand du Saulle (1830-1886) devoted a series of lectures to the question published in his Etude medico-legale sur les assurances sur la vie (Paris: Savy, 1868).
45- Thus, Cl. Guillemaud deals with the question of screening for simulation in his work, Des accidents de chemin defer et de leurs consequences medico-judiciaires (Paris: 1851) pp. 40-41. A. Souques devotes his thesis to the question of simulation: Contribution a I'etude des syndromes hysteriques "simulateurs" des maladies organiques de la moelle epiniere, Medical Thesis, Pans,
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no. 158 (Paris: Lecrosnier & Babe, 1891). See also above, note 20 to lecture of 12 December
1973, and note 20 to lecture of 30 January 1974.
46. See above p. 184 sq and p. 234 sq. In the second half of the nineteenth century there is a
growing literature on the results of these accidents: [A] Anglo Saxon, which attributes
them to an inflammation either of the spine ("Railway Spine") or the brain ("Railway
Brain"). See (a) J. E. Erichsen, On Railway and Other Injuries of the Nervous System (Philadelphia: H. C. Lea, 1867), and On Concussion of the Spine, Nervous Shock, and Other ObscureInjuriesoftheNervousSystem(New York:Wood,1875);(b) H. W. Page,Injuriesofthe
Spine and Spinal Cord without Apparent Mechanical Lesion and Nervous Shock in their Surgical
and Medico-legal Aspects (London: J. Churchill, 1883), and his book, a dedicated copy ol
which he sent to Charcot, Railway Injuries with Special Reference to those oj the Back and Nervous System in their Medico-legal and Clinical Aspects (London: Griffin and Co. ,
1891). | B | German, which considers the results to be a specific "traumatic neurosis. " See,
(a) H. Oppenhcim and R. Thomsen, "Uber das Vorkommen und die Bedeutung der sensorishcen Aniisthesie bei Erkrankungen des zentralen Nerven-systems" Archiv fur Psychiatrie (Berlin, 1884) vol. 15, pp.
