Mesmer,
Dissertalio
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is abandoned to his hallucinations, to his dreams ( . . . ) ; he dreams completely awake"; reprinted in Des maladies mentales, vol. I, p. 292; and (3) in his "Des illusions chez les alienes (Erreurs des sens)," reprinted in Des maladies mentales, vol. I; "Illusions ol the insane" in Mental Maladies, Esquirol writes that those "hallucinating are dreamers wide awake. "
On this psychiatric tradition we can reler to the following: A. Maury, (l) "Nouvelles observations sur les analogies des phenomenes du reve et de I'alienation mentale," paper given to the Societe medico psychologique, 25 October 1852, Annales medico-psychologiques, 2nd series, vol. V, July 1853, pp. /|0/|-421; (2) "De certains faits observes dans le reves et dans 1'etat intermediare entre le sommeil et la veille," in which Maury, placing himself in this tradition, proposes that "the man who falls under the sway ol a dream truly represents man affected by mental alienation" Annales medico-psychologiques, 3rd series, vol. Ill, April 1857, pp. 157-176, passage quoted p. 168; and (3) Le Sommeil et les Reves. Etudes psychologiques sur ces phenomenes et les divers etats qui s'y attachent (Paris: Didier, 1861), especially ch. 5, "Des analogies de I'hallucination et du reve," pp. 80 100, and ch. 6, "Des analogies du reve et de I'alienation mentale" pp. 101 148; S. Freud, Die Traumdeutung (1901) chs. 1and 8, in GW, vols. II III (Frankfurt: S. Fischer Verlag, 1942) pp. 199 and pp. 627-6/12; French translation, [. 'Interpretation des reves, trans. D. Berger (Pans: Presses universitaires de France, 1967) pp. 11 89 and pp. 529 551; English translation, "The Interpretation ol Dreams" in Standard Edition, translation under general editorship ol
James Strachey (1953 1974) vol. 4, pp. 1 95 and vol. 5, pp. 626 628; H. Ey, (1) "Breves remarques histonques sur les rapports des etats psychopathiques avec le reve et les etats intermediaires au sommeil et a la veille," Annales medico-psychologiques, 14th series, vol. II,
June 1934; (2) Etudes psychiatriques, vol. I: His/orique, Melhodologie, Psychopathologie generate, Part 2: "Le 'reve, fait primordial' de la psychopathologie. Historique et position du prob leme" et "Bibliographic" (Paris: Desclee de Brouwer, 1962, 2nd revised and expanded
ed. ), pp. 218 228 and p. 282; (3) "La dissolution de la conscience dans le sommeil et le
reve et ses rapports avec la psychopathologie," Evolution psychiatrique, vol. XXXV, no. 1, 1970, pp. 1 37. See also the pages Foucault devotes to the question in Histoire de lafolie, pp. 256 261; Madness and Civilisation, pp. 101 107.
37. Which is what J. Baillarger finds in the discussion ol the summary ol the work of JJ. Moreau de Tours by Dr. Bousquet: "Du delire au point de vue pathologique et anatomo pathologique," paper read to the Academie imperiale de medecine, 8 May 1855,
Annales medico-psychologiques, 3rd series, vol. I, July 1855, pp. 448 455. Replying to criticisms ol Bousquet, he notes that "what is important to get accepted is not the identity
of the organic state in the two cases, but only the extreme analogy, Irom the psychological point ol view, presented by the sleeping state and the mad state, and the precious things we can learn lrom this comparative study" ibid. p. 465. Moreau de Tours, for his part, refer ring to the "organic conditions" ol sleep, and the "lundamental phenomena of delirium," proposes that "to grasp, study, and understand well a set of phenomena as complex as that
of intellectual disorders, we must. . . group these phenomena according to the analogies,
the more or less numerous aflinities that they present" Du hashish, p. 44.
38. Moreau de Tours, ibid. Part II, ? 1: "Generalites physiologiques," pp. 32 47.
39. An allusion to the privilege that, according to J. Derrida, Descartes accords to the dream
over madness in the "First meditation: Some things that one can put in doubt," Meditations touchant la premiere philosophic (1641), in CEuvres et Lettres, pp. 268-269; English translation, "Meditations on First Philosophy" trans. John Cottingham, in The Philosophical Writings of Descartes, vol. II, pp. 13 14; See Foucault's commentaries in Histoire de lafolie, Part I, ch. 2,
pp. 56-59 (omitted Irom the English translation of Madness and Civilisation except for
one short paragraph, p. 38) and "Mon corps, ce papier, ce feu" in, Dits et Ecrits, vol. 2,
pp. 245 268; English translation, "My Body, This Paper, This Fire" trans. Geoff Bennington, in Essential Works of Foucault, 2, pp. 393 417.
40. JJ. Moreau de Tours, Du haschisch, Part III: "Therapeutique," p. 402: "One of the effects of hashish that I was most struck by ( . . . ) is that sort of maniacal excitation always
? accompanied by a sense ol cheerfulness and happiness ( . . . ) . I saw in this an ellective means for combating the fixed ideas o( melancholies (? ? ? ). Was I mistaken in my conjectures? I am led to think so. "
41. Ibid. p. 405: "Pinel, and with him all doctors ol the insane, saw mental alienation decided by bouts of agitation. " An allusion to the accounts of cures obtained following a "critical attack (acres critique)" that Pinel reports in his Traite mcdico-philosophique, section I, ? xiu: "Reasons which lead considering most bouts of mania as the healthy and favorable reaction to the cure" pp. 37-41; A Treatise on Insanity, pp. 3943. See also the article by Landre Beauvais (Pinel's assistant at Salpetriere) "Crisis" in Dictionnaire des sciences medicales, vol. VII (Paris: C. L. F. Panckoucke, 1813) pp. 370-392.
42. JJ. Moreau de Tours, Du haschisch: "A precise indication emerged that could be lormulated in this way: to preserve his primary acuity in the delirium tending to the chronic state, or to call back this acuity, to revive it when it threatens to become extinguished. The extract ol Indian hemp was, of all the medicaments known, the most eminently suited lor lullilling this indication. "
43. See above, note 21 to lecture of 12 December 1973-
44. P. Foissac, Memoire sur le magnetisme animal, adresse a messieurs les membres de VAcademie roya/e
de medecine (Paris: Didot Jeune, 1825) p. 6: "When they have tallen into a deep sleep, the magnetized display the phenomena of a new lile (. . . ) . The sphere of consciousness grows, and already that faculty appears that is so precious that the first magnetizers will call 'intu
Hive' or 'lucidity' ( . . . ) . With it, the somnambulists ( . . . ) recognize the illness Irom which they suller, the near and distant causes ol these illnesses, their seat, their prognosis and their appropriate treatment (. . . ). By placing a hand successively on the head, chest, and abdomen ol someone unknown, the somnambulists also discover their illnesses, the pains and various alterations that they occasion; in addition they indicate whether cure is possi ble, easy or dilhcult, near at hand or lar oil, and what means must be used to achieve the result. "
45- See above, notes 28 and 33 the lecture ol 23 January 1974.
46. Thus the magnetic cure carried out on 4 May 1784 by Armand Marc Jacques de Chastenet,
marquis ol Puysegur (1751 1825), on Victor Race, a peasant attached to his property at Buzancy (Soissonnais): asleep, the latter answered questions, gave an opinion ol his state, indicated a course of therapy, and gave a prognosis with the date ol his return to health,
which will be confirmed. And on Charles Francois Ame, aged 14, who when put in a magnetic sleep announced the duration and intensity of his future crises. See,
A. M. J. Chastenet de Puysegur, (1) Memoires pour servir a I'histoire et a Vetablissement du magnetisme animal, vol. I, (Pans: 1784) pp. 199 211 and pp. 96 97; (2) Detail des cures operees
a Buzancy, pres de Soissons, par le magnetisme animal, a short anonymous work published by Puysegur (Soissons: 1784); (3) see also the account of the cure ol the young Hebert, pre
ceded by a plea in favor of magnetism: Appel aux savans observateurs du dix-neuvieme siecle de
la decision porlee par leurs predecesseurs contre le magnetisme animal, et fin du traitement du jeune Hebert (Paris: Dentu, 1813). On the history ot magnetic cures one can consult: S. Mialle,
Expose par ordre alphabelique des cures operees en France par le magtietisme animal depuis Mcsmer jusqu'a nos jours (1774-1&26) (Paris: Dentu, 1826). See also, H. F. Ellenberger, "Mesmer and
Puysegur: from magnetism to hypnotism," Psychoanalytic Review, vol. 52, no. 2 (1965).
47. This is taken from the eighth session conducted on 2 November 1820 by the Baron Jules Dupotet de Sennevoy in the service of Dr. Husson, head doctor at the Hotel Dieu, on
Catherine Samson, aged 18: see, Expose des experiences publiques sur le magnetisme animalfaites
a I'Hotel-Dieu de Paris, pendant le cours des mois d'octobre, novembre et decembre 1820 ( P a n s : Bechet Jeune, 3rd edition, 1826) p. 24.
48. In 1816, Etienne Jean Georget entered Esquirol's department at Salpetriere. On 8 February 1820 he defended his thesis, "Dissertation sur les causes de la folie," then published the work on which his reputation is based: De la folie. Considerations sur cette maladie. In 1821, with Leon Rostan, he turned two patients into experimental subjects, Petronille and Manoury, the widow Brouillard, called Braguette (see above, note 43).
49. "Petronille . . . asks Georget to throw her in the water while she is having her period" C. Burdin and F. Dubois (known as Dubois d'Amiens), Histoire academique du magnetisme animal (Paris: J. -B. Bailliere, 1841) p. 262.
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50. Ibid. pp. 262 263: "Petromlle's instructions had not been carried out meticulously; Pelronille had said that she had to be plunged in the Ourcq canal, since it was in this canal that she had (alien and contracted her illness: similia similibus; such had to be the end ol the story. "
51. James Braid (1795 i 8 6 0 ) , Scottish surgeon, converted to magnetism as a result ol demonstrations o( "mesmerism" at Manchester in November 1841 by Charles Lalontame,
a disciple ol the marquis de Puysegur, and popularized his practice under the term "hypnotism. " See,J. Braid, Neurhypnology, or the Rationale of Nervous Sleep Considered in rela-
tion with Animal Magnetism. Illustrated by Numerous Cases of its Successful Application in the
Relief and Cure of Diseases (London: John Churchill, 1843); French translation, with a
preface by E. Brown Sequard, Neurhypnologic, ou Traile du sommeil nerveux considere dans ses rapports avec le magnelisme animal, el relalanl de nombreux succes dans ses applications au iraitemenl des maladies, trans. G. Simon (Paris: A. Delahaye, 1883).
52. See below, note 55-
53. During the Restoration, the increasing potential ol magnetism was seen as a threat
by institutional medicine. The conlrontation corresponds to the setting up ol olbcial commissions: the lust, appointed on 28 February 1826, started work in January 1827 and delivered its conclusions on 28 June 1831, which, being deemed too lavorable, were not published by the Academie de medecine. A second, unlavorable, was voted on 5 September I837. The death warrant lor magnetism was signed on 15June 1842 with the decision ol the Academie to no longer concern itsell with the question. See, L. Peisse, "Des sciences occultes au xixc siecle. Le magnetisme animal," Revue des deux mondes, vol. 1, March 1842, pp. 695 723.
54. Whereas mesmerism proposed to "demonstrate that the heavenly bodies act on our earth and that our human bodies are equally subject to the same dynamic action" (A.
Mesmer, Dissertalio physico-medica de planetarum influxu | Vienna: Chelem: 1766 | p. 32), and that the action ol the magnetizcr consists in canalizing this fluid on the patient, James Braid invoked a subjective action founded on the physiology ol the brain: see, The Power of the Mind over the Body: An Experimental Enquirey into the Nature and Cause of the Phenomena Attributed by Baron Reichenbach and Others to a New Imponderable (London: John Churchill, 1846), lor which he was hailed by, among others, the doctor Edgar Bei illon: "It is to Braid that honor is due lor having delmitively introduced the study ol induced sleep into the scientilic domain," and lor having rendered "a great service to science by giving to the whole ol his research the generic name ol hypnotism" Histoire de I'hypnotisme experimental ( Paris: Delahaye, 1902) p. 5.
55. Foucault refers here to the operation performed by E. F. Folhn and Paul Broca (to whom
the works ol Braid became known through a Bordeaux surgeon, Paul Azam) on a 40 year
old woman on 4 December 1859 at the Necker hospital. The operation was the subject ol
a report to the Academie des sciences presented by A. A. L. M. Velpeau on 7 December 1859: "Note sur une nouvelle methode anesthesique," Comptes rendus hebdomadaires desseances de I'Academie des sciences, vol. 49 (Paris: Mallet Buchelier, 1859) pp. 902 911.
56. Joseph Pierre Durand, known as Durand de Gros (1826 1900), was an exile in England where he discovered Braidism, and then in the United States. He returned to France where he published under the pseudonym ofJoseph Philips, Electrodynamisme vital, ou les Relations
physiologiques de Vesprit et de la matiere, demontrees par des experiences entieremenl nouvelles (Paris: J. B. Bailliere, 1855), and then, Cours theorique el pratique de braidisme, ou Hypnotisme nerveux
considere dans ses rapports avec la psychologiie, la physiologie et la pathologic, el dans ses applications a la medecine, a la chirurgie, a la physiologie experimenlale, a la medecine legale et a ^education (Paris:J. B. Bailliere, i860).
57. Durand de Gros defines "the hypotaxic state" as "a preparatory modification of vitality, a modification which usually remains latent and the whole effect of which is to incline the organization to undergo the determinant and specific action constituting the second stage" Cours theorique et pratique, p. 29.
58. Ibid. p. 112.
59. Ibid. Chorea is a nervous disorder characterized by sweeping and jerky involuntary
movements, with a gesticulatory appearance.
? 60. Ibid. p. 87: "Braidism is a process by which we seek to determine certain physiological changes in man with the aim ol lulfilling certain indications for medical or surgical treatment, or in order to facilitate the experimental studies of biology. "
61. Between 1850 and i 8 6 0 , under the impulse ol Guillaume Benjamin Amand Duchenne de Boulogne (1806 1875), the nosology of functional disorders ol motivity was redefined and enriched by two new groups of affections. On the one hand, "progressive muscular atrophy," studied from 18-19, and the "muscular atrophies with myopathic origin," in 1853: (1) La Paralyse atrophique de I'enjance (Pans: 1855). On the other hand, "progressive locomolor atrophy," known up until then as tabesdorsalis: (2) "De l'ataxie locomotrice progressive. Recherches sur unc maladie caractensee specialement par des troubles generaux de coordination des mouvemcnts," Archives generates de medecinc, 5th series, vol. 12, December 1858, pp. 6/|1 652; vol. 13, January 1859, pp. 5-23; February 1859, pp. 158 I64; April 1859, pp. -117 yi32. In i860 he described (3) the "paralysie glosso labio laryngee," ibid. 5th series, vol. 16, i860, pp. 283 296 and pp. /|31 Vi5. On Duchenne de Boulogne, see P. Guilly, Duchenne de Boulogne (Paris: Bailliere, 1936). On the constitution ol the neurological lield, see W. Riese, A History oj Neurology (New York: MD Publications, 1959), and F. H. Garrison, History of Neurology, edition revised and expanded by Laurence McHenry (Springfield, 111. : C. C. Thomas, 1969).
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The emergence of the neurological body: Broca and Duchenne de Boulogne. ^ Illnesses of differential diagnosis and illnesses of absolute diagnosis. ^ The model of "generalparalysis" and the
neuroses. ^ The battle of hysteria: 1. The organisation of a "symptomatologLcal scenario. "nu 2. The maneuver of the "functional
mannequin" and hypnosis. The question of simulation. nu 3. Neurosis and trauma. The irruption of the sexual body.
LAST WEEK I SAID that one of the important events in the history of the consolidation of psychiatric power was, in my view, the appearance of what I called the "neurological body. "* What should we understand by "neurological body"? I would like to begin with this today.
Of course, the neurological body is still, always, the body of pathological-anatomical localization. There is no opposition between the neurological body and the body of pathological anatomy; the second is part of the first; it is, if you like, a derivative or expansion of it. And the best proof of this is that in one of his courses, in 1879, Charcot said that the constitution, progress, and, in his view, the culmination of neu- rology, was the triumph of the "spirit of localization. "1 Except that what I think is important is that the procedures for matching up anatomical localization and clinical observation in the case of neurology are not at all the same as in the case of ordinary general medicine. It seems to me
* The manuscript adds: "From 1850 to 1870, emergence of a new body. "
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that neurology, clinical neurology, involves a quite different deployment of the body in the field of medical practice. My impression is that the encounter of the patient-body and the doctor body in neurology takes place in terms of a very different arrangement from that in general medicine. And it is the setting up of this new apparatus that seems to me to be the important episode, which is why I would like to try to identify the new apparatus set up by and through the constitution ol a neuropathology or neurological clinical medicine.
What is this apparatus, and in what does it consist? How is the sick body* captured in clinical neurology? Its capture takes place, I think, very differently trom the way the body was captured at the time ol the formation of pathological anatomy, more or less between Bichat2 and Laennec* I will give you an example straightaway by taking a text that is not by Charcot himself, but which is found in the Charcot archives at Salpetriere and was quite certainly written by one of his students-- clearly we don't know which one. It is an observation of a patient. This is how the patient is described: the patient's symptom was something very simple, the drooping of the left eyelid, called ptosis. So, the student takes the following notes for Charcot for him then to use for a lecture-- I am not giving you the description of the whole of the patient's lace, but just a quite small excerpt.
"If we tell him to open his eyelids, he raises the right one normally, the left one however, does not noticeably move, no more than the eye brow, so that the superciliary asymmetry becomes more marked. In this movement (. . . ) the skin ol the forehead wrinkles transversally on the right side, while it remains almost smooth on the left. At rest, the skin of the forehead is wrinkled neither on the right nor the left ( . . . ) . "
"Two more points should be noted: a small dimple, quite visible under a certain angle of light, eight millimeters above the left eyelid and about two centimeters to the left of the median line of the forehead; and a little projection within the dimple which seems due to the contraction of the eyelid muscle. These two points are very noticeable in comparison with the normal state of the right side. "1
* The manuscript clarifies: "body whose surlace is the bearer ol plastic values. "
? You have here a type of description which is, I think, really quite different from what is found in the anatomical-pathological procedure, m anatomical-pathological observation. ^ In a sense, this sort of descrip- tion takes us back to a sort of surlace, almost impressionistic gaze, such as could be found m eighteenth century medicine, when the patient's complexion, color, red cheeks and bloodshot eyes, etcetera, were impor tant elements for clinical diagnosis. 6 Pathological anatomy--Bichat, Laennec, if you like? infinttely reduced this impressionistic description of the surlace and codified what were ultimately a quite limited number of surlace signs intended to identify what was essential according to a well established clinical code, this being, precisely, the lesion, which then, thanks etther to a surgical operation or, especially, the autopsy, was described by the anatomical pathologist with almost as many details as, if not more than, the description I have just read to you. In other words, anatomical-pathology brought its minutely detailed description to bear on the deep and injured organ, the surface only being questioned through a grid of ultimately simple and limited signs.
Here, rather, as you can see, you have the striking reemergence of sur face values within medical discourse and knowledge. It is this surface that must be covered in all its hollows and bumps, and practically by looking only, by looking only that far. In fact, and no doubt even more than this clinical re validation of the almost impressionistic values of the surface, what is important and, I think, decisive, in this new clinical capture of the neurological patient, and in the correlative constitution of a neurological body before this gaze and apparatus of capture, is that the neurological examination is basically looking tor "responses. "
What I mean is that in the pathological anatomy of Bichat Laennec one can, of course, identify the signs straightaway, at the first glance; one can also obtain them from a stimulation: one taps, one listens, etcetera. That is to say, what is sought in classical pathological anatomy is essentially the system of stimulation-effect: one sounds the chest and listens to the noise;7 one asks the patient to cough and listens to its harshness; one palpates and sees if there is any heat. So: stimulation- effect.
In the case of the neurological examination being constituted in the mid-nineteenth century, the main part of the signs, in short what makes
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a sign a sign, is not so much that it is [deciphered asj a more or less mechanical effect, like the noise following percussion in classical patho logical anatomy, but that a sign is [deciphered) as a response. I think the substitution of the schema of stimulus-response for the schema of stimulus effect, and the organization of a whole battery of stimuli- responses, is crucial.
We have a number of examples of this staging of a battery of stimuli- responses. At the strictly elementary level, there was the founding discovery oi neuropathology in Duchenne de Boulogne's research into what he called "localized Faradization," when, by moistening two electrodes, he succeeded in getting a single muscular response, or, rather, the response of a single muscle to electrification of the surface of the skin; by moistening the surface of the skin he succeeded in limiting the effect of the charge and obtained a single response of a single muscle: this was the founding discovery of everything here. 8 Then, starting from this, there were the studies of reflexes and then, especially, the study of complex behavior involving either a gearing of diverse automatisms or a prior learning, and it is there that we find, more or less, the two great domains in which the capture, the apparatuses of neurological capture, were completely established. This was Broca's study of aphasia,9 the study of walking, and notably Duchenne de Boulogne's study of tabetics. 10
Taking the second example, Duchenne produced a description of the walking of tabetics that is presented precisely in terms of stimulus response or, rather, in terms of behavior and the sequence of episodes of behavior that constitute the action of walking. Duchenne's problem was to distinguish the disorder of balance found in tabetics, that is to say, at a certain stage and in a certain form of general paralysis, from the vertigo of alcoholic intoxication or even of certain cerebellar disorders. In 1864, in a fundamental article, Duchenne managed to give a differential description of the gait of tabetics and the rocking of vertigo. " In the case of vertigo, the subject gives way to wide swaying, whereas in the subject suffering from tabes the rocking movements are "short," "they are abrupt"--Duchenne de Boulogne says that the subject has the bearing of a tightrope walker without his balancing pole, cautiously advancing one step at a time while trying to restore his balance. 12 In the case of vertigo, there is no muscular contraction, but a general weakening of the
? musculature and tone instead, whereas [-. . *] the tabetic is always holding himself back, and if we observe what happens at the level of his calves and legs, we see, even before he loses his balance, even before he is aware of losing his balance, some small, brief spasms which flicker across the musculature ot his legs, and then, gradually, these contrac- tions become more significant, until they become voluntary when the subject becomes aware that he is losing his balance. 13 This is completely different, therefore, from the collapse in vertigo. In vertigo, the subject zigzags; that it to say, going from one point to another, he cannot keep to a straight line. The tabetic however, goes completely straight ahead; it is just his body that wobbles around this straight line. 17' And finally, in drunkenness, there is the internal sensation of vertigo, whereas the tabetic has the impression that it is not his body that lacks balance at all, but only his legs, locally as it were. 15 These are the principal themes, more or less, of Duchenne de Boulogne's analysis of the tabetic's gait.
Now, in this kind of analysis--and the same would be true for Broca's analyses of aphasia roughly at the same time, between 1859 and 1865-- what is achieved by seeking to obtain a system of signs of responses that show dysfunctions, rather than a system of signs of effects that would reveal the presence of lesions at a given point? What we obtain, of course, is the possibility of distinguishing and analyzing what neurolo- gists called, and still call today, synergies, that is to say, the different cor- relations existing between this or that muscle: What are the different muscles that must be used in order to get such and such a response? What happens when it is precisely just one of them that is put out of play? So, we get a study of synergies.
Secondly, and I think this is the important thing, it becomes possible to set out the phenomena analyzed in different levels according to an axis of the voluntary and the automatic. That is to say, on the basis of this analysis of behavior, of responses to different stimuli, we can see the functional difference, the difference of neurological and muscular imple mentation, between simple reflex behavior, automatic behavior, sponta- neous voluntary behavior, and, finally, spontaneous behavior produced
* (On the recording, repetition of:) rather
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by an order coming from outside. All of this hierarchy in the bodily implementation of the voluntary and the involuntary, of the automatic and the spontaneous, of what is required by an order or what is sponta- neously linked together within behavior, will make possible--and this is the essential point--a clinical analysis, an analysis in terms of physical ascription, of the mdividuaPs intentional attitude.
Consequently, a capture of the subject's attitude, of the subject's consciousness, of the will itself within his body, becomes possible. Neuropathology showed the will invested in the body, the effects of the will or the degrees of will legible in the organization of responses to stimuli. You are familiar with all the analyses Broca initiated on the different levels ol the performance of aphasics, according to whether it is a matter ol simple mumblings, of swear words uttered automatically, of phrases triggered spontaneously in a certain situation, or of phrases which must be repeated in a certain order and on a certain injunction. 16 All of these clinical deferences of performance between different levels of behavior make possible the clinical analysis of the individual at the level of his intention, at the very level of that much vaunted will that I have tried to show you was the great correlate of discipline. It was the will, in fact, on which and to which disciplinary power had to be applied; it really was the vis avis of disciplinary power, but then it was only acces sible through the system of reward and punishment. Neuropathology now provides the clinical instrument by which it is thought the individual can be captured at the level of this will itself.
Let's consider things a bit differently and bit more precisely. We could say that, in one respect, with the neurological examination medicine will lose power m comparison with classical anatomical-pathology. That is to say, in the anatomical pathology constituted by Laennec, Bichat, and others, ultimately very little was demanded from the individual: he was asked to lie down, bend his leg, cough, breathe deeply, and so on. Consequently there was a minimum of injunctions on the doctor's part, and minimum dependence on the patient's will. On the other hand, with neuropathology, the doctor's understanding of his patient will have to pass through the latter's will, or at any rate through his cooperation. He will not just say: "Lie down! Cough! ", but will have to say to him: "Walk! Put out your leg! Hold out your hand! Speak! Read this
? sentence! Try to write this! " and so on. In short, we now have a technique of examination reliant on instruction and injunction. Consequently, since instruction and injunction necessarily have to pass through the patients will, the latter will be at the very heart of the examination and, to that extent, the doctor's authority will be at the very heart of this neurological apparatus. The doctor will give orders, he will try to impose his will, and the patient, after all, may always feign inability or unwillingness. That is to say, one really will depend on the patient's will. However, the clinical possibility of identifying voluntary and involuntary, automatic and spontaneous behavior, the possibility of clinically deciphering the levels of will in behavior that I was just telling you about, will enable one to see whether the patient really responds as he is told to, the quality and nature of his responses, and the extent to which his responses have or have not been faked by the will which comes into play; and here the doctor will recapture the power he lost by giving instructions. For example, after Broca, neurologists could easily distinguish voluntary mutism from an aphasia like anarthna: in the case of anarthna, the impossibility of speaking is always accompanied by a series of background sounds, of automatisms which accompany the attempt to speak; it is also always accompanied by correlative motor disorders, and it is also accompanied by expressive deficiencies in gestures and written expression, etcetera. 17 Someone who refuses to speak, and furthermore a hysteric who does not speak, is someone who has gestures, can write, understands, and has none of the accompanying supplementary disorders typical of anarthna.
So you can see that the individual's will can be captured at the level of his real behavior, at the level, rather, of the clinical observation of his behavior. Consequently, if it is true that, on the one hand, the game of instruction typical of the neurological examination makes the possibility of examination depend on the patient's will to a certain extent, on the other hand, with clinical observation, with the clinical decipherment now available, the patient can be circumvented and short-circuited.
To summarize this in a few words, let's say that a new clinical medical apparatus is put in place that is different in its nature, equipment, and effects from what we can call the Bichat-Laennec clinical apparatus, as well as from the psychiatric apparatus. In organic medicine, the patient
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was given a minimum of injunctions like "Lie down! Cough! " and the rest was given over entirely to the doctors examination carried out through the interplay of stimuli and effects. I have tried to show you that the essential component of capture in psychiatry was questioning, which is the substitute for the examination techniques of organic medi- cine. Questioning depends, of course, on the subjects will, and for the psychiatrist the answers are not a test of truth or the possibility of a dif- ferential decipherment of the disease, but merely a test of reality; ques- tioning simply corresponds to the question: "Is he mad? "
So, neurology is neither an examination in the sense of pathological- anatomy, nor questioning; it is a new apparatus which replaces question- ing with injunctions, and which through these injunctions seeks to get responses, but responses which are not the subjects verbal responses, as in questioning, but the responses of the subject's body; responses which can be clinically deciphered at the level of the body and which one can consequently submit to a differential examination without fear of being duped by the subject who responds. We can now differentiate between someone who does not want to speak and someone suffering from apha- sia, that is to say, we can now establish a differential diagnosis within forms of behavior for which this was hitherto not possible and which were previously questioned in terms of an absolute diagnosis. The test of reality is no longer necessary: clinical neurology, m a certain domain at least, will enable differential diagnosis to get a hold, like organic medicine, but on the basis of a completely different apparatus. Broadly speaking, the neu- rologist says: Obey my orders, but keep quiet, and your body will answer for you by giving responses that, because I am a doctor, I alone will be able to decipher and analyze in terms of truth.
"Obey my orders, keep quiet, and your body will respond": you see that it is precisely here that the hysterical crisis will quite naturally rush in. Hysteria will enter into this apparatus. I am not talking about the appearance of hysteria: in my view the question of the historical exis- tence of hysteria is a futile question. I mean that the emergence of hyste ria within the medical field, the possibility of making it an illness, and its medical manipulation are only possible when this new clinical appa- ratus, the origin of which is neurological and not psychiatric, was estab- lished; or when this new trap was set.
? "Obey, keep quiet, your body will speak. " So, you want my body to speak! My body will speak, and I really promise you that there will be much more truth than you can imagine in the answers it will give you. Not, certainly, that my body knows more about it than you, but because there is something in your injunctions that you do not formulate but which I can clearly hear; a certain silent injunction to which my body will respond. * And it is this, the effect of your silent injunctions, that you will call "hysteria in its nature. " This, more or less, is the hysteric's discourse rushing in to the trap I have just described.
Fine. So, what takes place once this trap, this new apparatus of cap ture has been set?
Broadly speaking, I think we could say that until then, in medicine, until the existence of neurology and the clinical apparatus specific to neurology, there were two great domains of illnesses: mental illnesses and the others, the true illnesses. I do not think it is enough to say that mental illnesses and all the others are opposed to each other as illnesses of the mind on the one hand, and illness of the body on the other. This would not be correct, first of all because for many psychiatrists, from 1820 to 1870-1880, illnesses of the mind are just illnesses of the body with the characteristic of having psychical symptoms or syndromes. Then, it was absolutely accepted in this period that the so-called con- vulsive illnesses--medically, clinically, no effective difference was made between epilepsy and the others18--were illnesses of the mind.
is abandoned to his hallucinations, to his dreams ( . . . ) ; he dreams completely awake"; reprinted in Des maladies mentales, vol. I, p. 292; and (3) in his "Des illusions chez les alienes (Erreurs des sens)," reprinted in Des maladies mentales, vol. I; "Illusions ol the insane" in Mental Maladies, Esquirol writes that those "hallucinating are dreamers wide awake. "
On this psychiatric tradition we can reler to the following: A. Maury, (l) "Nouvelles observations sur les analogies des phenomenes du reve et de I'alienation mentale," paper given to the Societe medico psychologique, 25 October 1852, Annales medico-psychologiques, 2nd series, vol. V, July 1853, pp. /|0/|-421; (2) "De certains faits observes dans le reves et dans 1'etat intermediare entre le sommeil et la veille," in which Maury, placing himself in this tradition, proposes that "the man who falls under the sway ol a dream truly represents man affected by mental alienation" Annales medico-psychologiques, 3rd series, vol. Ill, April 1857, pp. 157-176, passage quoted p. 168; and (3) Le Sommeil et les Reves. Etudes psychologiques sur ces phenomenes et les divers etats qui s'y attachent (Paris: Didier, 1861), especially ch. 5, "Des analogies de I'hallucination et du reve," pp. 80 100, and ch. 6, "Des analogies du reve et de I'alienation mentale" pp. 101 148; S. Freud, Die Traumdeutung (1901) chs. 1and 8, in GW, vols. II III (Frankfurt: S. Fischer Verlag, 1942) pp. 199 and pp. 627-6/12; French translation, [. 'Interpretation des reves, trans. D. Berger (Pans: Presses universitaires de France, 1967) pp. 11 89 and pp. 529 551; English translation, "The Interpretation ol Dreams" in Standard Edition, translation under general editorship ol
James Strachey (1953 1974) vol. 4, pp. 1 95 and vol. 5, pp. 626 628; H. Ey, (1) "Breves remarques histonques sur les rapports des etats psychopathiques avec le reve et les etats intermediaires au sommeil et a la veille," Annales medico-psychologiques, 14th series, vol. II,
June 1934; (2) Etudes psychiatriques, vol. I: His/orique, Melhodologie, Psychopathologie generate, Part 2: "Le 'reve, fait primordial' de la psychopathologie. Historique et position du prob leme" et "Bibliographic" (Paris: Desclee de Brouwer, 1962, 2nd revised and expanded
ed. ), pp. 218 228 and p. 282; (3) "La dissolution de la conscience dans le sommeil et le
reve et ses rapports avec la psychopathologie," Evolution psychiatrique, vol. XXXV, no. 1, 1970, pp. 1 37. See also the pages Foucault devotes to the question in Histoire de lafolie, pp. 256 261; Madness and Civilisation, pp. 101 107.
37. Which is what J. Baillarger finds in the discussion ol the summary ol the work of JJ. Moreau de Tours by Dr. Bousquet: "Du delire au point de vue pathologique et anatomo pathologique," paper read to the Academie imperiale de medecine, 8 May 1855,
Annales medico-psychologiques, 3rd series, vol. I, July 1855, pp. 448 455. Replying to criticisms ol Bousquet, he notes that "what is important to get accepted is not the identity
of the organic state in the two cases, but only the extreme analogy, Irom the psychological point ol view, presented by the sleeping state and the mad state, and the precious things we can learn lrom this comparative study" ibid. p. 465. Moreau de Tours, for his part, refer ring to the "organic conditions" ol sleep, and the "lundamental phenomena of delirium," proposes that "to grasp, study, and understand well a set of phenomena as complex as that
of intellectual disorders, we must. . . group these phenomena according to the analogies,
the more or less numerous aflinities that they present" Du hashish, p. 44.
38. Moreau de Tours, ibid. Part II, ? 1: "Generalites physiologiques," pp. 32 47.
39. An allusion to the privilege that, according to J. Derrida, Descartes accords to the dream
over madness in the "First meditation: Some things that one can put in doubt," Meditations touchant la premiere philosophic (1641), in CEuvres et Lettres, pp. 268-269; English translation, "Meditations on First Philosophy" trans. John Cottingham, in The Philosophical Writings of Descartes, vol. II, pp. 13 14; See Foucault's commentaries in Histoire de lafolie, Part I, ch. 2,
pp. 56-59 (omitted Irom the English translation of Madness and Civilisation except for
one short paragraph, p. 38) and "Mon corps, ce papier, ce feu" in, Dits et Ecrits, vol. 2,
pp. 245 268; English translation, "My Body, This Paper, This Fire" trans. Geoff Bennington, in Essential Works of Foucault, 2, pp. 393 417.
40. JJ. Moreau de Tours, Du haschisch, Part III: "Therapeutique," p. 402: "One of the effects of hashish that I was most struck by ( . . . ) is that sort of maniacal excitation always
? accompanied by a sense ol cheerfulness and happiness ( . . . ) . I saw in this an ellective means for combating the fixed ideas o( melancholies (? ? ? ). Was I mistaken in my conjectures? I am led to think so. "
41. Ibid. p. 405: "Pinel, and with him all doctors ol the insane, saw mental alienation decided by bouts of agitation. " An allusion to the accounts of cures obtained following a "critical attack (acres critique)" that Pinel reports in his Traite mcdico-philosophique, section I, ? xiu: "Reasons which lead considering most bouts of mania as the healthy and favorable reaction to the cure" pp. 37-41; A Treatise on Insanity, pp. 3943. See also the article by Landre Beauvais (Pinel's assistant at Salpetriere) "Crisis" in Dictionnaire des sciences medicales, vol. VII (Paris: C. L. F. Panckoucke, 1813) pp. 370-392.
42. JJ. Moreau de Tours, Du haschisch: "A precise indication emerged that could be lormulated in this way: to preserve his primary acuity in the delirium tending to the chronic state, or to call back this acuity, to revive it when it threatens to become extinguished. The extract ol Indian hemp was, of all the medicaments known, the most eminently suited lor lullilling this indication. "
43. See above, note 21 to lecture of 12 December 1973-
44. P. Foissac, Memoire sur le magnetisme animal, adresse a messieurs les membres de VAcademie roya/e
de medecine (Paris: Didot Jeune, 1825) p. 6: "When they have tallen into a deep sleep, the magnetized display the phenomena of a new lile (. . . ) . The sphere of consciousness grows, and already that faculty appears that is so precious that the first magnetizers will call 'intu
Hive' or 'lucidity' ( . . . ) . With it, the somnambulists ( . . . ) recognize the illness Irom which they suller, the near and distant causes ol these illnesses, their seat, their prognosis and their appropriate treatment (. . . ). By placing a hand successively on the head, chest, and abdomen ol someone unknown, the somnambulists also discover their illnesses, the pains and various alterations that they occasion; in addition they indicate whether cure is possi ble, easy or dilhcult, near at hand or lar oil, and what means must be used to achieve the result. "
45- See above, notes 28 and 33 the lecture ol 23 January 1974.
46. Thus the magnetic cure carried out on 4 May 1784 by Armand Marc Jacques de Chastenet,
marquis ol Puysegur (1751 1825), on Victor Race, a peasant attached to his property at Buzancy (Soissonnais): asleep, the latter answered questions, gave an opinion ol his state, indicated a course of therapy, and gave a prognosis with the date ol his return to health,
which will be confirmed. And on Charles Francois Ame, aged 14, who when put in a magnetic sleep announced the duration and intensity of his future crises. See,
A. M. J. Chastenet de Puysegur, (1) Memoires pour servir a I'histoire et a Vetablissement du magnetisme animal, vol. I, (Pans: 1784) pp. 199 211 and pp. 96 97; (2) Detail des cures operees
a Buzancy, pres de Soissons, par le magnetisme animal, a short anonymous work published by Puysegur (Soissons: 1784); (3) see also the account of the cure ol the young Hebert, pre
ceded by a plea in favor of magnetism: Appel aux savans observateurs du dix-neuvieme siecle de
la decision porlee par leurs predecesseurs contre le magnetisme animal, et fin du traitement du jeune Hebert (Paris: Dentu, 1813). On the history ot magnetic cures one can consult: S. Mialle,
Expose par ordre alphabelique des cures operees en France par le magtietisme animal depuis Mcsmer jusqu'a nos jours (1774-1&26) (Paris: Dentu, 1826). See also, H. F. Ellenberger, "Mesmer and
Puysegur: from magnetism to hypnotism," Psychoanalytic Review, vol. 52, no. 2 (1965).
47. This is taken from the eighth session conducted on 2 November 1820 by the Baron Jules Dupotet de Sennevoy in the service of Dr. Husson, head doctor at the Hotel Dieu, on
Catherine Samson, aged 18: see, Expose des experiences publiques sur le magnetisme animalfaites
a I'Hotel-Dieu de Paris, pendant le cours des mois d'octobre, novembre et decembre 1820 ( P a n s : Bechet Jeune, 3rd edition, 1826) p. 24.
48. In 1816, Etienne Jean Georget entered Esquirol's department at Salpetriere. On 8 February 1820 he defended his thesis, "Dissertation sur les causes de la folie," then published the work on which his reputation is based: De la folie. Considerations sur cette maladie. In 1821, with Leon Rostan, he turned two patients into experimental subjects, Petronille and Manoury, the widow Brouillard, called Braguette (see above, note 43).
49. "Petronille . . . asks Georget to throw her in the water while she is having her period" C. Burdin and F. Dubois (known as Dubois d'Amiens), Histoire academique du magnetisme animal (Paris: J. -B. Bailliere, 1841) p. 262.
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50. Ibid. pp. 262 263: "Petromlle's instructions had not been carried out meticulously; Pelronille had said that she had to be plunged in the Ourcq canal, since it was in this canal that she had (alien and contracted her illness: similia similibus; such had to be the end ol the story. "
51. James Braid (1795 i 8 6 0 ) , Scottish surgeon, converted to magnetism as a result ol demonstrations o( "mesmerism" at Manchester in November 1841 by Charles Lalontame,
a disciple ol the marquis de Puysegur, and popularized his practice under the term "hypnotism. " See,J. Braid, Neurhypnology, or the Rationale of Nervous Sleep Considered in rela-
tion with Animal Magnetism. Illustrated by Numerous Cases of its Successful Application in the
Relief and Cure of Diseases (London: John Churchill, 1843); French translation, with a
preface by E. Brown Sequard, Neurhypnologic, ou Traile du sommeil nerveux considere dans ses rapports avec le magnelisme animal, el relalanl de nombreux succes dans ses applications au iraitemenl des maladies, trans. G. Simon (Paris: A. Delahaye, 1883).
52. See below, note 55-
53. During the Restoration, the increasing potential ol magnetism was seen as a threat
by institutional medicine. The conlrontation corresponds to the setting up ol olbcial commissions: the lust, appointed on 28 February 1826, started work in January 1827 and delivered its conclusions on 28 June 1831, which, being deemed too lavorable, were not published by the Academie de medecine. A second, unlavorable, was voted on 5 September I837. The death warrant lor magnetism was signed on 15June 1842 with the decision ol the Academie to no longer concern itsell with the question. See, L. Peisse, "Des sciences occultes au xixc siecle. Le magnetisme animal," Revue des deux mondes, vol. 1, March 1842, pp. 695 723.
54. Whereas mesmerism proposed to "demonstrate that the heavenly bodies act on our earth and that our human bodies are equally subject to the same dynamic action" (A.
Mesmer, Dissertalio physico-medica de planetarum influxu | Vienna: Chelem: 1766 | p. 32), and that the action ol the magnetizcr consists in canalizing this fluid on the patient, James Braid invoked a subjective action founded on the physiology ol the brain: see, The Power of the Mind over the Body: An Experimental Enquirey into the Nature and Cause of the Phenomena Attributed by Baron Reichenbach and Others to a New Imponderable (London: John Churchill, 1846), lor which he was hailed by, among others, the doctor Edgar Bei illon: "It is to Braid that honor is due lor having delmitively introduced the study ol induced sleep into the scientilic domain," and lor having rendered "a great service to science by giving to the whole ol his research the generic name ol hypnotism" Histoire de I'hypnotisme experimental ( Paris: Delahaye, 1902) p. 5.
55. Foucault refers here to the operation performed by E. F. Folhn and Paul Broca (to whom
the works ol Braid became known through a Bordeaux surgeon, Paul Azam) on a 40 year
old woman on 4 December 1859 at the Necker hospital. The operation was the subject ol
a report to the Academie des sciences presented by A. A. L. M. Velpeau on 7 December 1859: "Note sur une nouvelle methode anesthesique," Comptes rendus hebdomadaires desseances de I'Academie des sciences, vol. 49 (Paris: Mallet Buchelier, 1859) pp. 902 911.
56. Joseph Pierre Durand, known as Durand de Gros (1826 1900), was an exile in England where he discovered Braidism, and then in the United States. He returned to France where he published under the pseudonym ofJoseph Philips, Electrodynamisme vital, ou les Relations
physiologiques de Vesprit et de la matiere, demontrees par des experiences entieremenl nouvelles (Paris: J. B. Bailliere, 1855), and then, Cours theorique el pratique de braidisme, ou Hypnotisme nerveux
considere dans ses rapports avec la psychologiie, la physiologie et la pathologic, el dans ses applications a la medecine, a la chirurgie, a la physiologie experimenlale, a la medecine legale et a ^education (Paris:J. B. Bailliere, i860).
57. Durand de Gros defines "the hypotaxic state" as "a preparatory modification of vitality, a modification which usually remains latent and the whole effect of which is to incline the organization to undergo the determinant and specific action constituting the second stage" Cours theorique et pratique, p. 29.
58. Ibid. p. 112.
59. Ibid. Chorea is a nervous disorder characterized by sweeping and jerky involuntary
movements, with a gesticulatory appearance.
? 60. Ibid. p. 87: "Braidism is a process by which we seek to determine certain physiological changes in man with the aim ol lulfilling certain indications for medical or surgical treatment, or in order to facilitate the experimental studies of biology. "
61. Between 1850 and i 8 6 0 , under the impulse ol Guillaume Benjamin Amand Duchenne de Boulogne (1806 1875), the nosology of functional disorders ol motivity was redefined and enriched by two new groups of affections. On the one hand, "progressive muscular atrophy," studied from 18-19, and the "muscular atrophies with myopathic origin," in 1853: (1) La Paralyse atrophique de I'enjance (Pans: 1855). On the other hand, "progressive locomolor atrophy," known up until then as tabesdorsalis: (2) "De l'ataxie locomotrice progressive. Recherches sur unc maladie caractensee specialement par des troubles generaux de coordination des mouvemcnts," Archives generates de medecinc, 5th series, vol. 12, December 1858, pp. 6/|1 652; vol. 13, January 1859, pp. 5-23; February 1859, pp. 158 I64; April 1859, pp. -117 yi32. In i860 he described (3) the "paralysie glosso labio laryngee," ibid. 5th series, vol. 16, i860, pp. 283 296 and pp. /|31 Vi5. On Duchenne de Boulogne, see P. Guilly, Duchenne de Boulogne (Paris: Bailliere, 1936). On the constitution ol the neurological lield, see W. Riese, A History oj Neurology (New York: MD Publications, 1959), and F. H. Garrison, History of Neurology, edition revised and expanded by Laurence McHenry (Springfield, 111. : C. C. Thomas, 1969).
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The emergence of the neurological body: Broca and Duchenne de Boulogne. ^ Illnesses of differential diagnosis and illnesses of absolute diagnosis. ^ The model of "generalparalysis" and the
neuroses. ^ The battle of hysteria: 1. The organisation of a "symptomatologLcal scenario. "nu 2. The maneuver of the "functional
mannequin" and hypnosis. The question of simulation. nu 3. Neurosis and trauma. The irruption of the sexual body.
LAST WEEK I SAID that one of the important events in the history of the consolidation of psychiatric power was, in my view, the appearance of what I called the "neurological body. "* What should we understand by "neurological body"? I would like to begin with this today.
Of course, the neurological body is still, always, the body of pathological-anatomical localization. There is no opposition between the neurological body and the body of pathological anatomy; the second is part of the first; it is, if you like, a derivative or expansion of it. And the best proof of this is that in one of his courses, in 1879, Charcot said that the constitution, progress, and, in his view, the culmination of neu- rology, was the triumph of the "spirit of localization. "1 Except that what I think is important is that the procedures for matching up anatomical localization and clinical observation in the case of neurology are not at all the same as in the case of ordinary general medicine. It seems to me
* The manuscript adds: "From 1850 to 1870, emergence of a new body. "
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that neurology, clinical neurology, involves a quite different deployment of the body in the field of medical practice. My impression is that the encounter of the patient-body and the doctor body in neurology takes place in terms of a very different arrangement from that in general medicine. And it is the setting up of this new apparatus that seems to me to be the important episode, which is why I would like to try to identify the new apparatus set up by and through the constitution ol a neuropathology or neurological clinical medicine.
What is this apparatus, and in what does it consist? How is the sick body* captured in clinical neurology? Its capture takes place, I think, very differently trom the way the body was captured at the time ol the formation of pathological anatomy, more or less between Bichat2 and Laennec* I will give you an example straightaway by taking a text that is not by Charcot himself, but which is found in the Charcot archives at Salpetriere and was quite certainly written by one of his students-- clearly we don't know which one. It is an observation of a patient. This is how the patient is described: the patient's symptom was something very simple, the drooping of the left eyelid, called ptosis. So, the student takes the following notes for Charcot for him then to use for a lecture-- I am not giving you the description of the whole of the patient's lace, but just a quite small excerpt.
"If we tell him to open his eyelids, he raises the right one normally, the left one however, does not noticeably move, no more than the eye brow, so that the superciliary asymmetry becomes more marked. In this movement (. . . ) the skin ol the forehead wrinkles transversally on the right side, while it remains almost smooth on the left. At rest, the skin of the forehead is wrinkled neither on the right nor the left ( . . . ) . "
"Two more points should be noted: a small dimple, quite visible under a certain angle of light, eight millimeters above the left eyelid and about two centimeters to the left of the median line of the forehead; and a little projection within the dimple which seems due to the contraction of the eyelid muscle. These two points are very noticeable in comparison with the normal state of the right side. "1
* The manuscript clarifies: "body whose surlace is the bearer ol plastic values. "
? You have here a type of description which is, I think, really quite different from what is found in the anatomical-pathological procedure, m anatomical-pathological observation. ^ In a sense, this sort of descrip- tion takes us back to a sort of surlace, almost impressionistic gaze, such as could be found m eighteenth century medicine, when the patient's complexion, color, red cheeks and bloodshot eyes, etcetera, were impor tant elements for clinical diagnosis. 6 Pathological anatomy--Bichat, Laennec, if you like? infinttely reduced this impressionistic description of the surlace and codified what were ultimately a quite limited number of surlace signs intended to identify what was essential according to a well established clinical code, this being, precisely, the lesion, which then, thanks etther to a surgical operation or, especially, the autopsy, was described by the anatomical pathologist with almost as many details as, if not more than, the description I have just read to you. In other words, anatomical-pathology brought its minutely detailed description to bear on the deep and injured organ, the surface only being questioned through a grid of ultimately simple and limited signs.
Here, rather, as you can see, you have the striking reemergence of sur face values within medical discourse and knowledge. It is this surface that must be covered in all its hollows and bumps, and practically by looking only, by looking only that far. In fact, and no doubt even more than this clinical re validation of the almost impressionistic values of the surface, what is important and, I think, decisive, in this new clinical capture of the neurological patient, and in the correlative constitution of a neurological body before this gaze and apparatus of capture, is that the neurological examination is basically looking tor "responses. "
What I mean is that in the pathological anatomy of Bichat Laennec one can, of course, identify the signs straightaway, at the first glance; one can also obtain them from a stimulation: one taps, one listens, etcetera. That is to say, what is sought in classical pathological anatomy is essentially the system of stimulation-effect: one sounds the chest and listens to the noise;7 one asks the patient to cough and listens to its harshness; one palpates and sees if there is any heat. So: stimulation- effect.
In the case of the neurological examination being constituted in the mid-nineteenth century, the main part of the signs, in short what makes
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a sign a sign, is not so much that it is [deciphered asj a more or less mechanical effect, like the noise following percussion in classical patho logical anatomy, but that a sign is [deciphered) as a response. I think the substitution of the schema of stimulus-response for the schema of stimulus effect, and the organization of a whole battery of stimuli- responses, is crucial.
We have a number of examples of this staging of a battery of stimuli- responses. At the strictly elementary level, there was the founding discovery oi neuropathology in Duchenne de Boulogne's research into what he called "localized Faradization," when, by moistening two electrodes, he succeeded in getting a single muscular response, or, rather, the response of a single muscle to electrification of the surface of the skin; by moistening the surface of the skin he succeeded in limiting the effect of the charge and obtained a single response of a single muscle: this was the founding discovery of everything here. 8 Then, starting from this, there were the studies of reflexes and then, especially, the study of complex behavior involving either a gearing of diverse automatisms or a prior learning, and it is there that we find, more or less, the two great domains in which the capture, the apparatuses of neurological capture, were completely established. This was Broca's study of aphasia,9 the study of walking, and notably Duchenne de Boulogne's study of tabetics. 10
Taking the second example, Duchenne produced a description of the walking of tabetics that is presented precisely in terms of stimulus response or, rather, in terms of behavior and the sequence of episodes of behavior that constitute the action of walking. Duchenne's problem was to distinguish the disorder of balance found in tabetics, that is to say, at a certain stage and in a certain form of general paralysis, from the vertigo of alcoholic intoxication or even of certain cerebellar disorders. In 1864, in a fundamental article, Duchenne managed to give a differential description of the gait of tabetics and the rocking of vertigo. " In the case of vertigo, the subject gives way to wide swaying, whereas in the subject suffering from tabes the rocking movements are "short," "they are abrupt"--Duchenne de Boulogne says that the subject has the bearing of a tightrope walker without his balancing pole, cautiously advancing one step at a time while trying to restore his balance. 12 In the case of vertigo, there is no muscular contraction, but a general weakening of the
? musculature and tone instead, whereas [-. . *] the tabetic is always holding himself back, and if we observe what happens at the level of his calves and legs, we see, even before he loses his balance, even before he is aware of losing his balance, some small, brief spasms which flicker across the musculature ot his legs, and then, gradually, these contrac- tions become more significant, until they become voluntary when the subject becomes aware that he is losing his balance. 13 This is completely different, therefore, from the collapse in vertigo. In vertigo, the subject zigzags; that it to say, going from one point to another, he cannot keep to a straight line. The tabetic however, goes completely straight ahead; it is just his body that wobbles around this straight line. 17' And finally, in drunkenness, there is the internal sensation of vertigo, whereas the tabetic has the impression that it is not his body that lacks balance at all, but only his legs, locally as it were. 15 These are the principal themes, more or less, of Duchenne de Boulogne's analysis of the tabetic's gait.
Now, in this kind of analysis--and the same would be true for Broca's analyses of aphasia roughly at the same time, between 1859 and 1865-- what is achieved by seeking to obtain a system of signs of responses that show dysfunctions, rather than a system of signs of effects that would reveal the presence of lesions at a given point? What we obtain, of course, is the possibility of distinguishing and analyzing what neurolo- gists called, and still call today, synergies, that is to say, the different cor- relations existing between this or that muscle: What are the different muscles that must be used in order to get such and such a response? What happens when it is precisely just one of them that is put out of play? So, we get a study of synergies.
Secondly, and I think this is the important thing, it becomes possible to set out the phenomena analyzed in different levels according to an axis of the voluntary and the automatic. That is to say, on the basis of this analysis of behavior, of responses to different stimuli, we can see the functional difference, the difference of neurological and muscular imple mentation, between simple reflex behavior, automatic behavior, sponta- neous voluntary behavior, and, finally, spontaneous behavior produced
* (On the recording, repetition of:) rather
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by an order coming from outside. All of this hierarchy in the bodily implementation of the voluntary and the involuntary, of the automatic and the spontaneous, of what is required by an order or what is sponta- neously linked together within behavior, will make possible--and this is the essential point--a clinical analysis, an analysis in terms of physical ascription, of the mdividuaPs intentional attitude.
Consequently, a capture of the subject's attitude, of the subject's consciousness, of the will itself within his body, becomes possible. Neuropathology showed the will invested in the body, the effects of the will or the degrees of will legible in the organization of responses to stimuli. You are familiar with all the analyses Broca initiated on the different levels ol the performance of aphasics, according to whether it is a matter ol simple mumblings, of swear words uttered automatically, of phrases triggered spontaneously in a certain situation, or of phrases which must be repeated in a certain order and on a certain injunction. 16 All of these clinical deferences of performance between different levels of behavior make possible the clinical analysis of the individual at the level of his intention, at the very level of that much vaunted will that I have tried to show you was the great correlate of discipline. It was the will, in fact, on which and to which disciplinary power had to be applied; it really was the vis avis of disciplinary power, but then it was only acces sible through the system of reward and punishment. Neuropathology now provides the clinical instrument by which it is thought the individual can be captured at the level of this will itself.
Let's consider things a bit differently and bit more precisely. We could say that, in one respect, with the neurological examination medicine will lose power m comparison with classical anatomical-pathology. That is to say, in the anatomical pathology constituted by Laennec, Bichat, and others, ultimately very little was demanded from the individual: he was asked to lie down, bend his leg, cough, breathe deeply, and so on. Consequently there was a minimum of injunctions on the doctor's part, and minimum dependence on the patient's will. On the other hand, with neuropathology, the doctor's understanding of his patient will have to pass through the latter's will, or at any rate through his cooperation. He will not just say: "Lie down! Cough! ", but will have to say to him: "Walk! Put out your leg! Hold out your hand! Speak! Read this
? sentence! Try to write this! " and so on. In short, we now have a technique of examination reliant on instruction and injunction. Consequently, since instruction and injunction necessarily have to pass through the patients will, the latter will be at the very heart of the examination and, to that extent, the doctor's authority will be at the very heart of this neurological apparatus. The doctor will give orders, he will try to impose his will, and the patient, after all, may always feign inability or unwillingness. That is to say, one really will depend on the patient's will. However, the clinical possibility of identifying voluntary and involuntary, automatic and spontaneous behavior, the possibility of clinically deciphering the levels of will in behavior that I was just telling you about, will enable one to see whether the patient really responds as he is told to, the quality and nature of his responses, and the extent to which his responses have or have not been faked by the will which comes into play; and here the doctor will recapture the power he lost by giving instructions. For example, after Broca, neurologists could easily distinguish voluntary mutism from an aphasia like anarthna: in the case of anarthna, the impossibility of speaking is always accompanied by a series of background sounds, of automatisms which accompany the attempt to speak; it is also always accompanied by correlative motor disorders, and it is also accompanied by expressive deficiencies in gestures and written expression, etcetera. 17 Someone who refuses to speak, and furthermore a hysteric who does not speak, is someone who has gestures, can write, understands, and has none of the accompanying supplementary disorders typical of anarthna.
So you can see that the individual's will can be captured at the level of his real behavior, at the level, rather, of the clinical observation of his behavior. Consequently, if it is true that, on the one hand, the game of instruction typical of the neurological examination makes the possibility of examination depend on the patient's will to a certain extent, on the other hand, with clinical observation, with the clinical decipherment now available, the patient can be circumvented and short-circuited.
To summarize this in a few words, let's say that a new clinical medical apparatus is put in place that is different in its nature, equipment, and effects from what we can call the Bichat-Laennec clinical apparatus, as well as from the psychiatric apparatus. In organic medicine, the patient
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was given a minimum of injunctions like "Lie down! Cough! " and the rest was given over entirely to the doctors examination carried out through the interplay of stimuli and effects. I have tried to show you that the essential component of capture in psychiatry was questioning, which is the substitute for the examination techniques of organic medi- cine. Questioning depends, of course, on the subjects will, and for the psychiatrist the answers are not a test of truth or the possibility of a dif- ferential decipherment of the disease, but merely a test of reality; ques- tioning simply corresponds to the question: "Is he mad? "
So, neurology is neither an examination in the sense of pathological- anatomy, nor questioning; it is a new apparatus which replaces question- ing with injunctions, and which through these injunctions seeks to get responses, but responses which are not the subjects verbal responses, as in questioning, but the responses of the subject's body; responses which can be clinically deciphered at the level of the body and which one can consequently submit to a differential examination without fear of being duped by the subject who responds. We can now differentiate between someone who does not want to speak and someone suffering from apha- sia, that is to say, we can now establish a differential diagnosis within forms of behavior for which this was hitherto not possible and which were previously questioned in terms of an absolute diagnosis. The test of reality is no longer necessary: clinical neurology, m a certain domain at least, will enable differential diagnosis to get a hold, like organic medicine, but on the basis of a completely different apparatus. Broadly speaking, the neu- rologist says: Obey my orders, but keep quiet, and your body will answer for you by giving responses that, because I am a doctor, I alone will be able to decipher and analyze in terms of truth.
"Obey my orders, keep quiet, and your body will respond": you see that it is precisely here that the hysterical crisis will quite naturally rush in. Hysteria will enter into this apparatus. I am not talking about the appearance of hysteria: in my view the question of the historical exis- tence of hysteria is a futile question. I mean that the emergence of hyste ria within the medical field, the possibility of making it an illness, and its medical manipulation are only possible when this new clinical appa- ratus, the origin of which is neurological and not psychiatric, was estab- lished; or when this new trap was set.
? "Obey, keep quiet, your body will speak. " So, you want my body to speak! My body will speak, and I really promise you that there will be much more truth than you can imagine in the answers it will give you. Not, certainly, that my body knows more about it than you, but because there is something in your injunctions that you do not formulate but which I can clearly hear; a certain silent injunction to which my body will respond. * And it is this, the effect of your silent injunctions, that you will call "hysteria in its nature. " This, more or less, is the hysteric's discourse rushing in to the trap I have just described.
Fine. So, what takes place once this trap, this new apparatus of cap ture has been set?
Broadly speaking, I think we could say that until then, in medicine, until the existence of neurology and the clinical apparatus specific to neurology, there were two great domains of illnesses: mental illnesses and the others, the true illnesses. I do not think it is enough to say that mental illnesses and all the others are opposed to each other as illnesses of the mind on the one hand, and illness of the body on the other. This would not be correct, first of all because for many psychiatrists, from 1820 to 1870-1880, illnesses of the mind are just illnesses of the body with the characteristic of having psychical symptoms or syndromes. Then, it was absolutely accepted in this period that the so-called con- vulsive illnesses--medically, clinically, no effective difference was made between epilepsy and the others18--were illnesses of the mind.
