*
You see that this practice of the cure is, in a sense, absolutely homoge- neous with the classical conception of judgment and error; we are in line with, say, the Port Royal conception of the proposition and judgment.
You see that this practice of the cure is, in a sense, absolutely homoge- neous with the classical conception of judgment and error; we are in line with, say, the Port Royal conception of the proposition and judgment.
Foucault-Psychiatric-Power-1973-74
Semelaigne, Les Pioniers de la psychiatriefrancaise avant et apres Pinel (Paris: Bailliere, 1930) vol.
1, pp.
153-154.
28. F. Leuret, Du traitement moral de lafolie, p. 178.
29. Ibid. p. 179.
30. J. Fournet, "Le traitement moral de Palienation" Annales medico-psychologiques, p. 524. See
also, J. Parigot, Therapeutique naturelle de lafolie. L'air libre et la vie defamille dans la commune de Gheel(Brussels: J. B. Tircher, 1852) p. 13: "We think that the sick man needs the sympa
thy that family life gives birth to right from the start. "
31. J. Fournet, "Le traitement moral de Palienation" pp. 526-527. Joseph Daquin (1732 1815)
was born in Chambery where he was appointed in 1788 to the Incurables where he encountered the conditions imposed on the insane. See J. Daquin, La Philosophic de lajolie,
ou Essaiphilosophique sur le traitement des personnes altaquees defolie (Chambery: Gorin, 1791). A revised and expanded edition appeared in 1804 dedicated to Philippe Pinel: La Philosophic de lafolie, ou Von prouve que cclle maladic doit plutol etre traitee par les secours moraux que les secours physique (Chambery: Cleaz, 1804). See also, J. R. Nylleler, Joseph Daquin und seine "Philosophic de lajolie" (Zurich: Juris, 1961).
32. J. Fournet, "Le traitement moral de Palienation" p. 527. On Mettray, see above note 35 to the lecture of 28 November.
33. Charles Robert Darwin (1809-1882), On the Origins of the Species by means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life (London: J. Murray, 1859); French translation of the 6 l ' edition, De I'origine des especes au moyen de la selection naturell, ou la Lutte pour I'existence dans la nature, trans. E Barbier (Paris: Reinwald, 1876).
34. Jules Fournet (1811 1885), head of the clinic at the Hotel Dieu, author of, Doctrine organo-psychique de lafolie (Paris: Masson, 1867), and the discourse given at the Congres medico-psychologique in 1878, De I'hereditephysique ou morale (Paris: Imprimerie nationale, 1880).
35- Jean Pierre Casimir Pinel (1800 1866), nephew of Philippe Pinel, worked in 1829 at
76 rue de Chaillot, a clinic devoted to the treatment ol mental illnesses, before transferring
it in 1844 to Neuilly m 1844, in the old Saint-James folly. See his, Du traitement de Palienation mentale en general, et principalement par les bains tiedes prolonges et les arrosemenh continus d'eau
froide su la tete (Paris: J. B. Bailliere, 1853).
36. Alexandre Brierre de Boismont (1798 1881), after being employed in 1825 as doctor to the
Sainte-Colombe clinic, rue de Picpus, took over management of a clinic at 21 rue Neuvc Saint-Genevieve in 1838, which was transferred in 1859 to Saint Mande, where he died on
25 December 1881. See: "Maison de Sante du Docteur Brierre de Boismont, rue Neuve Sainte-Genevieve, no. 21, pres du Pantheon, Prospectus" Observations medico-legales sur la monomanie homicide (Pans: Mme. Auger Mequignon, 1826--taken from the Revue medicale, October and November 1826); and, Des hallucinations, ou Histoire raisonee des apparitions, des visions, des songes ( P a n s : J . B. Bailliere, 1845).
37. In 1821, Esprit Sylvestre Blanche (1796-1852) took over management of a clinic founded in 1806 in Montmartre by P. A. Prost, then rented, in 1846, the old town mansion ol Princess de Lamballe at Passy. He made himself known through his criticisms of Francois Leuret's application of moral treatment (see below, note 8 to the lecture of 19 December). See,
J. Le Breton, La Maison de sante du docteur Blanche, ses medecins, ses malades (Paris: Vigne, 1937);
? R. Vallery Radot, "La maison de sante du docteur Blanche" La Pres. se medicale,no. 10,
13 March 1943, pp. 131 132.
38. The lecture of 21 February 1973 of Foucault's College de France course "The punitive
society" was devoted to the organization of the world of delinquency. See also Surveillir et
Punir, pp. 254 260 and pp. 261 299; Discipline and Punish, pp. 252-256 and pp. 257-290.
39. In his clinic in the Saint Antoine suburb, which Doctor Pressat handed over to him
in 1847.
40. A. Brierre de Boismont, "De I'utilite de la vie de lamille dans le traitement de l'alienation
mentale" Annales medico-psychologiques, pp. 8-9.
5 December 1973 121
? SIX
12 DECEMBER 1973
Constitution of the child as target of psychiatric intervention. ^ A family-asylum Utopia: the Clermont-en-Oise asylum. ^ From psychiatry as "ambiguous master" of reality and truth in proto- psychiatric practices to psychiatry as "agent of intensification " of
reality. ^ Psychiatric power and discourse of truth. ^ The problem of simulation and the insurrection of the hysterics. ^ The question of the birth of psychoanalysis.
I WILL CONTINUE WITH last week's lecture for a while because last week I found a marvelous institution that I was vaguely aware of but did not realize how well it suited me. So I would like to say something about it because it seems to me to show very well this connection between asylum discipline and, let's say, the family model.
Contrary to a rather loose hypothesis, which I have myself maintained, that the asylum was constituted through the extension of the family model, I have tried to show you that the nineteenth century asylum functioned in fact on a model of micro power close to what we can call disciplinary power that functions in a way that is completely heterogeneous to the family. And then I tried to show that the insertion, the joining of the family model to the disciplinary system takes place relatively late in the nineteenth century--I think we can put it around the years i860 to 1880--and it was only then that the family could not
? 124 PSYCHIATRIC POWER
only become a model in the functioning of psychiatric discipline, but also, and especially, the horizon and object of psychiatric practice.
A time came, albeit late, when psychiatry really was concerned with the family. I have tried to show you that this occurred at the point of intersection of two processes which mutually supported each other: one was the constitution of what could be called the profits of abnormalities or irregularities, and the other was the internal disciplmanzation of the family. There is evidence for both of these processes.
On the one hand, of course, there is the growing extension through out the nineteenth century oi those profitable institutions whose aim is basically to make both abnormality and, at the same time, its correction, costly; let's say, roughly, clinics for children, adults, etcetera. On the other hand, there is the deployment of psychiatric techniques at the heart of the family, their use in family pedagogy. It seems to me that if we look at how this took place, at least in families which could yield a prolit from abnormality, that is to say bourgeois families, [by following] the evolution of the internal pedagogy of these families, we would see how the vigilant family eye, or, if you like, family sovereignty, gradually came to resemble the disciplinary form. The watchful family eye became a psychiatric gaze, or, at any rate, a psycho-pathological, a psychological gaze. Supervision of the child became supervision in the form oi decid ing on the normal and the abnormal; one began to keep an eye on the child's behavior, character, and sexuality, and it is here that we see the emergence of precisely all that psychologization ol the child within the family itself.
It seems to me that both the notions and apparatuses of psychiatric control were gradually imported into the family. With regard to the famous instruments of restraint found in asylums from around 1820 to 1830--binding hands, holding the head up, keeping in an upright position, etcetera--my impression is that, initially established as instru ments of and within asylum discipline, they gradually advance and take root in the family. The control of posture, of gestures, of the way to behave, the control of sexuality, with instruments for preventing masturbation, etcetera, all penetrate the family through a disciplmanzation which develops during the nineteenth century and the effect of which is that, through this disciplmanzation, the child's sexuality finally
? becomes an object of knowledge within the family itsell. And as a result of this the child will become the central target of psychiatric intervention. The child becomes the central target in two senses.
On the one hand, directly, since the institution of profit plugged into psychiatry will effectively ask the family to provide it with the material it needs in order to make its profit. Psychiatry says, more or less: "let your mad little children come to me," or, "you're never too young to be mad," or, "don't wait for the age of majority or adulthood to be mad. " And all of this is translated into the institutions of supervision, detection, training, and child therapy that you see developing at the end of the nineteenth century.
And then, in a second sense, childhood becomes the center, the target of psychiatric intervention indirectly, insofar as what one asks the mad adult about is, precisely, his childhood: let your childhood memories come, and through this you will be psychiatrized. This is more or less what I tried to set out last week.
All this brings me to this institution, which, around the 1860s, displays the asylum-family link up so well. I cannot say it is the first link up, but certainly its most perfect, best adjusted, almost Utopian form. I have found hardly any other examples, in France at least, which are so perlect as this establishment, which constitutes at this time, and early on therefore, a kind of family-asylum Utopia, the meeting point of family sovereignty and asylum discipline. This institution is the coupling ol the Clermont en Oise asylum with the Fitz-James clinic.
At the end ol the eighteenth century, in the neighborhood of Beuvais, there is a small house of confinement, in the classic sense of the term. It is run by Cordelier monks who, in return for an allowance, accept twenty residents either at the request of families or on the basis of lettres de cachet. The house is opened in 1790 and all its fine society is freed. However, obviously, some families are burdened with these dissolute, disorderly, mad people, and so they are then sent to someone at Clermont en Oise who has opened a kind of boarding house. At this time, just as Parisian restaurants were opening up on what was left of the great aristocratic houses broken up as a result of the Emigration, so, in the same way, many ol these boarding houses arose on the ruins of houses of confinement that had been thrown open. So there is a boarding house at Clermont-en-Oise
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in which, under the Revolution, during the Empire, and even at the beginning of the Restoration, there were twenty residents. Then, when the great institutionahzation of psychiatric practice takes place, this boarding house becomes increasingly important and the prefectural administration ol the Oise department and the founder of the boarding house come to an arrangement whereby the department's destitute insane will be sent to the Clermont boarding house m return for a payment by the department. What's more, the agreement is extended to the departments of Seine-et Oise, Seine et Marne, Somme, and l'Aisne, and in 1850 a total of five departments send more than a thousand people to this boarding house, which then simply resembles a multi departmental asylum. 1
At this point the asylum splits, or rather, puts out a sort of pseudopodium, in the form of what is called the "colony. "2 This "colony" is made up of a number ol the asylum's residents with the ability to
[work]. * On the pretext that they can be useful and, at the same time, that work is useful for their cure anyway, they are subjected to a very strict regime of agricultural work.
A second pseudopodium, linked to the farm, is established ior wealthy residents who do not come Irom the Clermont asylum, but who were sent directly by their lamihes and who pay a very high price for a completely different kind of boarding based on a different, lamily model. 5
In this way we have an institution with three levels: the Clermont asy lum with its thousand patients; the iarm with 100 150 men and women who are required to work;^ and then a boarding house for paying residents, who are lurther separated, the men living in the management quarters with the director of the institution himself, and the wealthy women liv ing in a dillerent building with the typical name of "petit chateau" where the general iorm of their existence follows the iamily model. 5 This was established in the decade 1850 to i860. In 1861,the director publishes a
balance sheet, which is at the same time a sort of prospectus, which is therefore highly eulogistic and slightly Utopian, but which gives an exact picture of the meticulous and subtle way the system operates.
In this kind ol establishment--the Clermont asylum, the farm, and the Fitz James petit chateau--there are a number of levels. On the one
* (Recording:) arc able to work
? hand, you have an easily identifiable economic circuit: first, a departmental grant for poor patients allocated by the general council according to their numbers; second, withdrawal from the poor patients ol the number of people necessary and sufficient for running a farm; and hnally, the creation and maintenance of a petit chateau with the profit Irom the farm, taking in a number of paying residents, their payment constituting the profit for those in charge of the general system. So, you have the system: community subsidy-work exploitation profit.
Second, you can see that there is a sort of perfect social microcosm, a sort of little Utopia of general social functioning. The asylum is the reserve army of the farm proletariat; it is all those who, potentially, could work, and who, if they cannot work, wait for the moment when they can, and, if they do not have the ability to work, remain in the asy lum vegetating. Then there is the place of productive work, which is represented by the farm. Then you have the institution in which those who benefit from the work and the profit are found. And to each of these levels corresponds a specific architecture: that of the asylum; that ol the larm, which in reality is a model practically bordering on slavery and colonization; and then the petit chateau with the management quarters.
You also have two types of power, the first of which is split. You have the traditional disciplinary power of the asylum, which is negative in a way, since its function is to keep people calm without getting anything positive from them. Then you have a second disciplinary type of power, but slightly modified, which is, roughly, the power of colonization: putting people to work, with the insane divided into squads and brigades, etcetera, under the authority and supervision of those who regularly put them to work. And then there is power on the family model for residents ol the petit chateau.
In short, you have three types of psychiatric intervention or manipu lation, corresponding to these three levels. One is, if you like, the degree zero of psychiatric intervention, that is to say, pure and simple penning within the asylum. Second, there is the psychiatric practice of putting patients to work on the pretext of curing them: ergotherapy. And then, third, for paying residents, you have individual, individualizing psychiatric practice on the family model.
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In the middle of all this, the most important and typical element is undoubtedly the way in which psychiatric knowledge and treatment are connected to the practice of putting those residents to work who are capable of working. Actually, very strangely, it is clear that the psychiatric categories developed by the psychiatry of the time, since Esquirol--and which I will try to show got absolutely no hold on therapy itself--are not in fact employed here at all as a classification of the curability of different people and the form of treatment that should be applied to them. Nosological classification is not linked to any therapeutic pre- scription but serves instead solely to define the possible utilization of individuals for the work they are offered.
Thus the directors of the Clermont asylum and the Fitz-James farm realized that if a patient was maniacal, monomaniacal, or demented, they were good for work in the fields and workshops looking after and manag- ing animals and plowing tools. 6 On the other hand, "imbeciles and idiots are responsible for cleaning the courtyards and stables and all the transport necessary for the service. "7 The use of women according to their sympto- matology is much more discriminating. Thus "those in the washhouse and laundry are almost always affected by a noisy delirium and would not be able to abide by the peace and quiet of workshop life. "8 In the washhouse and laundry, therefore, one can rave at the top of one's voice, talk loudly, and shout. Second, "those occupied with hanging out the washing are melancholies m whom this kind of work can restore the vital activity they so often lack. The imbeciles and idiots are responsible for taking laundry from the washhouse to the drying room. The workshops for sorting and folding the laundry are the remit of calm patients, monomaniacs, whose fixed ideas or hallucinations make possible a fairly sustained attention. "9
I have cited this establishment because it seemed to me to represent, around the 1860s, both the first form and most perfect realization of this family-discipline adjustment, and, at the same time, of the deployment of psychiatric knowledge as discipline.
*
This example leads us, moreover, to the problem that I would now like to consider, which is this: How and to what extent can one attribute a
? lherapeutic effect to this disciplinary, not yet familialized space, to this disciplinary system that we see being constituted between 1820 and 1830 and which will constitute the broad basis for the asylum institution? For, after all, it should not be forgotten that even if this disciplinary sys- tem is in many respects isomorphic with other disciplinary systems, like the school, the barracks, the workshop, and suchlike, it puts itself for- ward and justifies itself by its therapeutic function. What is it in this disciplinary space that is supposed to cure? What medical practice inhabits this space? This is the problem I would like to begin to address
today.
To do this I would like to start with a type of example about which
I have already spoken, which is what we can call the classical cure, mean- ing by classical the cure still current in the seventeenth and eighteenth centuries, and even at the beginning of the nineteenth century. I have given you a number of examples of this. There is the case of Pmel's patient who thought he was being pursued by revolutionaries, was waiting to be brought before the courts, and was consequently threatened with the death penalty. Pinel cured him by organizing a pseudo-trial around him, with pseudo-judges, in the course of which he was acquitted-- thanks to which he was cured. 10
In the same way, someone like Mason Cox, at the beginning of the nineteenth century gives the following example of a cure. It involves a man of forty years, who "had injured his health by too close attention to extensive mercantile concerns. "11 This passion for commerce had put into his head the idea that "his body was universally diseased. "12 And the main one of these, the one by which he felt most threatened, was what was called at the time "repelled itch," that is to say, an irruption of scabies which had not reached its term, which had spread throughout the organism, and manifested itself in a number of symptoms. The classical technique for curing it was to bring out this famous scabies and treat it as such.
For some time attempts were made to get the patient to understand that he did not have any of the illnesses in question: "no arguments could divert him . . . a formal consultation of medical men was therefore determined on, who, having previously agreed on the propriety of humouring the patient, professed to be unanimously of the opinion that
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his apprehension was just, a medical plan was laid down, some rebefacient application to different parts of the body occasioned crops of eruptions from time to time which were washed with some simple preparation. This farce continued a few weeks, and the patient at length was perfectly restored to health and reason. "13 His delirium had been satisfied, as it were.
What do these procedures of Pine! and Mason Cox presuppose and what do they bring into play? They presuppose--this is well known, I will not return to it--that the kernel of madness is a lalse belief, an illusion or an error. They also presuppose--which is already a bit different--that for the illness to disappear it is enough to dispel the error. The procedure of cure is therefore the reduction of the error; except the mad person's error is not just anyone's error.
The difference between the error of someone who is mad and some one who is not mad is not so much in the extravagance of the idea itself, because, after all, it is not very extravagant to believe one has "repelled itch. " And moreover, as Leuret will say later in his Fragments psychologiques sur lafolie, between Descartes who believed in vortices and a patient at Salpetriere who imagined that a council was being held in his lower abdomen/1 the extravagance is not especially on the patient's side. What makes a mad person's error the error of someone who is, precisely, mad? It is not then so much the extravagance, the final effect of the error, as the way in which the error can be overcome, dispelled. The mad person is someone whose error cannot be dispelled by a demonstration; he is someone for whom demonstration does not produce the truth. Consequently, one will have to find a different method of dispelling the error--since madness really is, in fact, the error--without using demonstration.
This means that, instead of attacking the erroneous judgment and showing that it has no correlation with reality, which is roughly the process of demonstration, one will let the lalse judgment be taken as true while transforming reality so that it is adapted to the mad, erroneous judgment. Now, when an erroneous judgment thus finds that it has a correlate in reality, which verifies it, from then on, the mental content coinciding with something in reality, there is no longer error and so no more madness.
? So it is not by treating the false judgment, by trying to correct it or dismiss it by demonstration, but rather by dressing up and manipulating reality that reality is placed on the same level, as it were, as the delirium. When the ialse judgment of the delirium is iound to have a real content in reality, it will as a result become a true judgment and the madness will cease being madness, since the error will have ceased being error. So one makes reality delirious so that the delirium is no longer delirium; one puts the delirium in the right so that it is no longer deceived. It is a matter, in short, of introducing reality into the delirium behind the mask of delirious figures, so that the delirium is satisfied by reality; through a game of transformations, of masks, one surreptitiously intro duces a reality beneath all the false propositions ol the delirium, or beneath the main false propositions of delirium, and in this way the delirium is verified.
*
You see that this practice of the cure is, in a sense, absolutely homoge- neous with the classical conception of judgment and error; we are in line with, say, the Port Royal conception of the proposition and judgment. b However, you see that there is a difference between the teacher or demon strator, the person who possesses the truth, and the psychiatrist. Whereas the master of truth, the teacher or scientist, manipulates judgment, the proposition, and thought, the doctor will manipulate reality in such a way that the error becomes true. In this kind of process the doctor is the inter mediary, the ambivalent person who [on the one hand] looks from the
side of reality and manipulates it, and, on the other, looks from the side of truth and error and arranges it that the (orm of reality comes up to the level of the error in order to transform it thereby into truth.
He manipulates reality by making it wear a mask; he makes this reality a little less real, or at any rate he deposits a film of unreality on it; he puts it between the brackets of the theater, of the "as if," of the pseudo-, and by making reality unreal in this way he carries out the transforma- tion of error into truth. Consequently he is the agent of reality--and in this he is not like the scientist or the teacher; he is however someone
A The manuscript clarilies: "Since it is as a comic, theatrical reality, as a pseudo reality that it is introduced into the delirium, and by according a second effectiveness to reality, since for the delirium to lail it is enough that the Ialse judgment become true through the masking ol reality. "
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who makes reality unreal in order to act on the erroneous judgment maintained by the patient. 16
I think we can say that the psychiatrist, as he will function in the space of asylum discipline, will no longer be the individual who consid- ers what the mad person says from the standpoint of truth, but will switch resolutely, definitively, to the standpoint of reality* He will no longer be the ambiguous master of reality and truth that he was still with Pinel and Mason Cox; he will be the master of reality. He will no longer have anything to do with somehow smuggling reality into the delirium; it is no longer a question of the psychiatrist being a smuggler ot reality as Pinel and Mason Cox were. The psychiatrist is someone who must give reality that constraining force by which it will be able to take over the madness, completely penetrate it, and make it disappear as madness. The psychiatrist is someone who--and this is what defines his task--must ensure that reality has the supplement of power necessary for it to impose itself on madness and, conversely, he is someone who must remove from madness its power to avoid reality.
From the nineteenth century, the psychiatrist is then a factor of the intensification of reality, and he is the agent of a surplus power of real- ity, whereas, in the classical period he was, in a way, the agent of a power of the 'derealization' of reality. You will say that if it is true that the nineteenth century psychiatrist crosses over completely to the side of reality, and if he becomes for madness the agent of the intensification of the power of reality, thanks precisely to the disciplinary power he gives himself, it is not true however that he does not pose the question of truth. I will say that, of course, the problem of truth is posed in nine- teenth century psychiatry, despite the nevertheless quite considerable negligence it manifests with regard to the theoretical elaboration of its practice. Psychiatry does not avoid the question of truth, but, instead of placing the question of the truth of madness at the very heart of the cure, at the heart of its relationship with the mad person, which was still the case for Pinel and Mason Cox, instead of bringing the problem of truth out into the open in the confrontation between doctor and
* The manuscript adds: "In asylum psychiatry, the psychiatrist plays the role oi master of reality in a completely different way. "
? patient, psychiatric power only poses the question of truth within itself. It gives itself the truth right from the start and once and for all by constituting itself as a medical and clinical science. This means that rather than the problem of the truth being at stake in the cure, it is resolved once and for all by psychiatric practice as soon as this practice assumes the status of a medical practice founded as the application of a psychiatric science.
So that if one had to define this power that I would like to talk to you about this year, I would suggest, provisionally, the following: Psychiatric power is that supplement of power by which the real is imposed on mad- ness in the name of a truth possessed once and for all by this power in the name of medical science, of psychiatry. On the basis of this definition, which I put forward in this provisional form, I think we can understand some general features of the history of psychiatry in the nineteenth century.
First there is the very strange relationship--I was going to say the absence of relationship--between psychiatric practice and, say, dis- courses of truth. On the one hand, it is true that with the psychiatrists of the beginning of the nineteenth century psychiatry very quickly shows great concern to constitute itself as a scientific discourse. But to what scientific discourses does psychiatric practice give rise? It gives rise to two types of discourse.
One of these we can call the clinical or classificatory, nosological dis course. Broadly speaking, this involves describing madness as an illness or, rather, as a series of mental illnesses, each with its own symptomatology, development, diagnostic and prognostic elements, etcetera. In this, the psychiatric discourse that takes shape takes normal clinical medical discourse as its model; it aims to constitute a sort of analogon of medical truth.
Then, and very soon too, even before Bayle's discovery of general paralysis, anyway from 1822 (the date of Bayle's discovery),17 you see the development of an anatomical pathological knowledge which poses the question of the substratum or organic correlatives of madness, the prob lem of the etiology of madness, of the relationship between madness and neurological lesions, etcetera. This is no longer a discourse analogous to medical discourse, but a real anatomical pathological or physiological- pathological discourse that is to serve as the materialist guarantee of psychiatric practice. 18
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Now, if you look at how psychiatric practice developed in the nineteenth century, how madness and mad people were actually handled in the asylum, you notice that, on the one hand, this practice was placed under the sign of and, so to speak, under the guarantee of these two discourses, one noso logical, of kinds of illnesses, and the other anatomical-pathological, of organic correlatives. Psychiatric practice developed in the shelter of these two discourses, but it never used them, or it only ever used them by ref- erence, by a system of cross references and, as it were, of pinning. Psychiatric practice, such as it was in the nineteenth century, never really put to work the knowledge, or quasi-knowledge, which was being built up in psychiatric nosology or in anatomical-pathological research. Basically, distributions in the asylum, the ways in which patients were classilied and divided up, the ways in which they were subjected to different regimes and given different tasks, and the ways in which they were declared cured or ill, curable or incurable, did not take these two discourses into account.
The two discourses were just sorts of guarantees of truth for a psy chiatnc practice that wanted to be given truth once and tor all and for it never to be called into question. The two big shadows of nosology and etiology, of medical nosography and pathological anatomy, were behind it to constitute, before any psychiatric practice, the definitive guarantee of a truth which this practice will never bring into operation in the practice of the cure. In crude terms, psychiatric power says: The question of truth will never be posed between madness and me for the very simple reason that I, psychiatry, am already a science. And if, as science, I have the right to question what I say, if it is true that I may make mistakes, it is in any case up to me, and to me alone, as science, to decide if what I say is true or to correct the mistake. I am the pos sessor, if not of truth in its content, at least of all the criteria ol truth. Furthermore, because, as scientific knowledge, I thereby possess the criteria of verification and truth, I can attach myself to reality and its power and impose on these demented and disturbed bodies the sur- plus-power that I give to reality. I am the surplus power of reality inas much as I possess, by myself and definitively, something that is the truth in relation madness.
? This is what a psychiatrist of the time called "the imprescriptible rights of reason over madness," which were for him the foundations of psychiatric intervention. 19
I think the reason for this absence of a connection between discourses of truth and psychiatric practice, for this gap, pertains to this function of the enhanced power of the real, which is the basic function of psychi- atric power and which must, as it were, slip behind its back a truth con sidered to be already acquired. This makes it possible to understand that the great problem of the history of psychiatry in the nineteenth century is not a problem of concepts, and not at all the problem of this or that illness: neither monomania nor even hysteria was the real problem, the cross psychiatry had to bear in the nineteenth century. If we accept that the question of truth is never posed in psychiatric power, then it is easy to understand that the cross nineteenth century psychiatry has to bear is quite simply the problem of simulation. 20
By simulation I do not mean the way in which someone who is not mad could pretend to be mad, because this does not really call psychiatric power into question. Pretending to be mad when one is sane is not some thing like an essential limit, boundary, or defect of psychiatric practice and psychiatric power, because, after all, this happens in other realms of knowledge, and in medicine in particular. We can always deceive a doctor by getting him to believe that we have this or that illness or symptom-- anyone who has done military service knows this--and medical practice is not thereby called into question. On the other hand, and this is the sim- ulation I want to talk to you about, the simulation that was the historical problem of psychiatry in the nineteenth century is simulation internal to madness, that is to say, that simulation that madness exercises with regard to itself, the way in which hysteria simulates hysteria, the way in which a true symptom is a certain way of lying and the way in which a false symptom is a way of being truly ill. All this constituted the insoluble problem, the limit and, ultimately, the failure of nineteenth century psychiatry that brought about a number of sudden developments.
If you like, psychiatry said more or less: I will not pose the problem of truth with you who are mad, because I possess the truth myself in terms of my knowledge, on the basis of my categories, and if I have a
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power in relation to you, the mad person, it is because I possess this truth. At this point madness replied: If you claim to possess the truth once and for all in terms of an already fully constituted knowledge, well, for my part, I will install falsehood in myself. And so, when you handle my symptoms, when you are dealing with what you call illness, you will find yourself caught in a trap, for at the heart of my symptoms there will be this small kernel of night, of falsehood, through which I will confront you with the question of truth. Consequently, I won't deceive you when your knowledge is limited--that would be pure and simple simulation-- but rather, if one day you want really to have a hold on me, you will have to accept the game of truth and falsehood that I ofier you.
Simulation: the whole history of psychiatry can be said to be perme- ated by this problem ol simulation, from the two simulators at Salpetriere in 1821, when it looms up before Georget, one of the leading psychiatrists of the period, until the 1880s and the important episode with Charcot. And when I say this problem, I am not talking about the theoretical problem of simulation, but the processes by which those who were mad actually responded with the question of falsehood to this psychiatric power that refused to pose the question of truth. The untruthfulness of simulation, madness simulating madness, was the anti-power of the mad confronted with psychiatric power.
I think the historical importance of this problem of both simulation and hysteria derives from this. It also enables us to understand the col- lective character of this phenomenon of simulation. We see it emerge around 1821 in the behavior of the two hysterics called "Petronille" and "Braguette. "21 I think these two patients founded an immense historical process in psychiatry; they were imitated in all the asylums in France because ultimately it was their weapon in the struggle with psychiatric power. And with the serious crisis of asylum psychiatry, which broke out at the end of the nineteenth century, around 1880, the problem of truth really was imposed by the mad on psychiatry when, in front of Charcot the great miracle worker, it became evident that all the symp toms he was studying were aroused by him on the basis of his patients' simulation.
I emphasize this history for a number of reasons. The first is that it is not a matter of symptoms. It is often said that hysteria has
? disappeared, or that it was the great illness of the nineteenth century. But it was not the great illness of the nineteenth century; it was, to use medical terminology, a typical asylum syndrome, or a syndrome correl- ative to asylum power or medical power. But I don't even like the word syndrome. It was actually the process by which patients tried to evade psychiatric power; it was a phenomenon of struggle, and not a patho- logical phenomenon. At any rate, that is how I think it should be viewed.
Second, we should not forget that if there was so much simulation within asylums after Braguette and Petronille, this was not only because it was made possible by the coexistence of patients withm the asylums, but also because of sometimes spontaneous and sometimes involuntary, sometimes explicit and sometimes implicit complicity with the patients on the part of the personnel, of warders, asylum doctors, and medical subordinates. We should not forget that Charcot practically never exam ined a single one of these hysterics, and that all his observations, falsi- lied by simulation, were actually given to him by the personnel surrounding the patients, and who, together with the patients, with greater or lesser degrees of complicity, constructed this world of simula- tion as resistance to psychiatric power that, m 1880 at Salpetnere, was incarnated in someone who, precisely, was not even a psychiatrist, but a neurologist, and so someone most able to base himself on the best constituted discourse ol truth.
The trap of falsehood, then, was set for the person who came armed with the highest medical knowledge. So the general phenomenon of simulation in the nineteenth century should be understood not only as a process of the patients' struggle against psychiatric power, but as a process of struggle at the heart of the psychiatric system, of the asylum system. And I think we arrive here at the episode that must be the aim of my course, which is the moment when, precisely, the question of truth, put aside after Pinel and Mason Cox by the disciplinary system ol the asylum and by the type of functioning of psychiatric power, was lorcibly reintroduced through all these processes. *
* The manuscript adds: "We can, then, call antipsychiatry any movement by which the question ol l ruth is put back in play within the relationship between the mad person and the psychiatrist. "
12 December 7 9 7 3 137
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We may say that psychoanalysis can be interpreted as psychiatry's first great retreat, as the moment when the question of the truth ol what is expressed in the symptoms, or, in any case, the game of truth and lie in the symptom, was forcibly imposed on psychiatric power; the prob- lem being whether psychoanalysis has not responded to this first defeat by setting up a first line of defense. At any rate, credit should not be given to Freud for the first depsychiatrization. We owe the first depsy chiatrization, the first moment that made psychiatric power totter on the question of truth, to this band of simulators. They are the ones who, with their falsehoods, trapped a psychiatric power which, in order to be the agent ol reality, claimed to be the possessor of truth and, within psychiatric practice and cure, refused to pose the question of the truth that madness might contain.
There was what could be called a great simulator's insurrection that spread through the whole of the asylum world in the nineteenth century, and the constant and endlessly rekindled source of which was Salpetnere, an asylum for women. This is why I don't think we can make hysteria, the question ol hysteria, the way in which psychiatrists got bogged down in hysteria in the nineteenth century, a kind of minor scientific error, a sort of epistemological blockage. It is clearly very reas suring to do this, because it makes it possible to write the history ol psychiatry and the birth of psychoanalysis in the same style as the expla nation of Copernicus, Kepler, or Einstein. That is to say, there is a sci entific blockage, an inability to get free from the excessive number oi spheres of the "Ptolemaic" world, or from Maxwell's equations, etcetera. We find secure footing in this scientific knowledge and, starting from this kind of dead-end, see an epistemological break and then the sudden appearance of Copernicus or Einstein. By posing the question in these terms, and by making the history of hysteria the analogon of these kinds of episodes, the history of psychoanalysis can be placed in the calm tradition ol the history of the sciences. However, if, as I would like to do, we make simulation--and so not hysteria--the militant underside ol psychiatric power rather than an epistemological problem of a dead end, if we accept that simulation was the insidious way lor the mad to pose the question of truth forcibly on a psychiatric power that only wanted to impose reality on them, then I think that we could write a
? history of psychiatry that would no longer revolve around psychiatry and its knowledge, but which finally would revolve around the mad.
And you can see that if we take up the history of psychiatry in this way, then it can be seen that what we can call the institutional perspec tive, which poses the problem of whether or not the institution is the site of violence, is in danger of suppressing something. It seems to me that it delineates the historical problem of psychiatry--that is to say, the problem of this power of reality that it was the psychiatrist's task to re-impose and which was trapped by the questioning falsehood of the simulators--in an extraordinarily narrow way.
This is the kind of general background I would like to give to the lollowing lectures. So, next week, I will try to resume this history, which I have suggested to you in a sketchy way, by taking up the problem of how psychiatric power functioned as a surplus-power of reality.
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1. In 1861 the asylum received 1227 insane persons, 561 men and 666 women, divided into 215 paying and 1212 destitute residents. See the work by the asylum's director, Guslave L a b i t t e , De la colonie de Fit^-James, succursale de I'asile prive de Clermont (Oise), considered au
point de vue de son organisation administrative el medicale (Paris: J. B. Bailliere, 1861) p. 15. On the history of the Clermont asylum, see E. J. Woillez, Essai hislorique, descriplif el slatislique sur la maison d'alienes de Clermont (Oise) (Clermont: V. Danicourt, 1839).
2. The Fitz James colony was created in 1847.
3. "In creating the Fitz James colony, first of all we wanted the patients to be in a completely
different environment than that ol Clermont" G. Labitte, De la colonie de Fit^-James, p. 13.
4. In 1861, the larm comprised "170 patients," ibid. p. 15.
5. According to G. Labilte's description: "1. The management section allocated to living
quarters for the director and male residents. 2. The Farm section, where the colonists stay. 3. The Petit Chateau section, inhabited by resident women. /|. The Bevrel section, occupied by women employed in laundering the linen" ibid. p. 6.
6. "On the larm . . . work in the fields and workshops, looking alter and managing animals and plowing tools, are the remit ol maniacs, monomaniacs and the demented" ibid. p. 15.
7. Ibid.
8. Ibid. p. V\. 9. Ibid.
10. P. Pinel, Traite medico-philosophique, section VI, ? iv: "Essai lente pour guerir une melancolie profonde produile par une cause morale" pp. 233 237; A Treatise on Insanity, "An attempt to cure a case ol melancholia produced by a moral cause" pp. 227i 227.
11. Joseph Mason Cox, Practical Observations on Insanity, Case II, p. 51; Observations sur la de? nence,(^06), p. 77.
12. Ibid. p. 51; ibid. p. 78.
13. Ibid. p. 52; ibid. pp. 78 79.
V\. F. Leuret, Fragments psychologiques sur la folie (Paris: Crochard, 1837|) ch. 2: "Delirium ol
intelligence": "The chair hirer of a Parisian parish, treated by Monsieur Esquirol,. . . said he had bishops in his belly who were holding a council. . . Descartes thought it an established tact that the pineal gland is a mirror which reflected the image ol external bodies . . . Is one of these assertions better proved than the other? " p. 7i3. Leuret is referring to Descartes' analysis of the role ol the pineal gland in the lormation of ideas ol objects which strike the senses: R. Descartes, Traite de VFlomme (Paris: Clerselier, 1667|) in Descartes, CEuvrcs el Lettres, ed. A. Bridoux, pp. 8 5 0 853; English translation, "Treatise on Man," trans. Robert Slootholl, in The Philosophical Writings oj Descartes, trans. John Cottingham, Robert Slootholl, Dugald Murdoch (Cambridge: Cambridge University Press, 1985) vol. 1, p. 106.
15. In this conception, "Judging is the action in which the mind, bringing together dillerent ideas, aflirms ol one that it is the other, or denies ol one that it is the other. This occurs when, for example, having the idea ol the earth and the idea ol round, I affirm or deny ol the earth that it is round" A. Arnauld and P. Nicole, La Logique, ou VArl depenser, contcnanl, outre les regies communes, plusieurs observations nouvelles propres a former le jugemenl ( 1 6 6 2 ) (Paris: Desprez, 1683, 51'1 edition) p. 36; English translation, Logic, or, The art of thinking, trans. J. V. Buroker (Cambridge: Cambridge University Press, 1996) p.
28. F. Leuret, Du traitement moral de lafolie, p. 178.
29. Ibid. p. 179.
30. J. Fournet, "Le traitement moral de Palienation" Annales medico-psychologiques, p. 524. See
also, J. Parigot, Therapeutique naturelle de lafolie. L'air libre et la vie defamille dans la commune de Gheel(Brussels: J. B. Tircher, 1852) p. 13: "We think that the sick man needs the sympa
thy that family life gives birth to right from the start. "
31. J. Fournet, "Le traitement moral de Palienation" pp. 526-527. Joseph Daquin (1732 1815)
was born in Chambery where he was appointed in 1788 to the Incurables where he encountered the conditions imposed on the insane. See J. Daquin, La Philosophic de lajolie,
ou Essaiphilosophique sur le traitement des personnes altaquees defolie (Chambery: Gorin, 1791). A revised and expanded edition appeared in 1804 dedicated to Philippe Pinel: La Philosophic de lafolie, ou Von prouve que cclle maladic doit plutol etre traitee par les secours moraux que les secours physique (Chambery: Cleaz, 1804). See also, J. R. Nylleler, Joseph Daquin und seine "Philosophic de lajolie" (Zurich: Juris, 1961).
32. J. Fournet, "Le traitement moral de Palienation" p. 527. On Mettray, see above note 35 to the lecture of 28 November.
33. Charles Robert Darwin (1809-1882), On the Origins of the Species by means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life (London: J. Murray, 1859); French translation of the 6 l ' edition, De I'origine des especes au moyen de la selection naturell, ou la Lutte pour I'existence dans la nature, trans. E Barbier (Paris: Reinwald, 1876).
34. Jules Fournet (1811 1885), head of the clinic at the Hotel Dieu, author of, Doctrine organo-psychique de lafolie (Paris: Masson, 1867), and the discourse given at the Congres medico-psychologique in 1878, De I'hereditephysique ou morale (Paris: Imprimerie nationale, 1880).
35- Jean Pierre Casimir Pinel (1800 1866), nephew of Philippe Pinel, worked in 1829 at
76 rue de Chaillot, a clinic devoted to the treatment ol mental illnesses, before transferring
it in 1844 to Neuilly m 1844, in the old Saint-James folly. See his, Du traitement de Palienation mentale en general, et principalement par les bains tiedes prolonges et les arrosemenh continus d'eau
froide su la tete (Paris: J. B. Bailliere, 1853).
36. Alexandre Brierre de Boismont (1798 1881), after being employed in 1825 as doctor to the
Sainte-Colombe clinic, rue de Picpus, took over management of a clinic at 21 rue Neuvc Saint-Genevieve in 1838, which was transferred in 1859 to Saint Mande, where he died on
25 December 1881. See: "Maison de Sante du Docteur Brierre de Boismont, rue Neuve Sainte-Genevieve, no. 21, pres du Pantheon, Prospectus" Observations medico-legales sur la monomanie homicide (Pans: Mme. Auger Mequignon, 1826--taken from the Revue medicale, October and November 1826); and, Des hallucinations, ou Histoire raisonee des apparitions, des visions, des songes ( P a n s : J . B. Bailliere, 1845).
37. In 1821, Esprit Sylvestre Blanche (1796-1852) took over management of a clinic founded in 1806 in Montmartre by P. A. Prost, then rented, in 1846, the old town mansion ol Princess de Lamballe at Passy. He made himself known through his criticisms of Francois Leuret's application of moral treatment (see below, note 8 to the lecture of 19 December). See,
J. Le Breton, La Maison de sante du docteur Blanche, ses medecins, ses malades (Paris: Vigne, 1937);
? R. Vallery Radot, "La maison de sante du docteur Blanche" La Pres. se medicale,no. 10,
13 March 1943, pp. 131 132.
38. The lecture of 21 February 1973 of Foucault's College de France course "The punitive
society" was devoted to the organization of the world of delinquency. See also Surveillir et
Punir, pp. 254 260 and pp. 261 299; Discipline and Punish, pp. 252-256 and pp. 257-290.
39. In his clinic in the Saint Antoine suburb, which Doctor Pressat handed over to him
in 1847.
40. A. Brierre de Boismont, "De I'utilite de la vie de lamille dans le traitement de l'alienation
mentale" Annales medico-psychologiques, pp. 8-9.
5 December 1973 121
? SIX
12 DECEMBER 1973
Constitution of the child as target of psychiatric intervention. ^ A family-asylum Utopia: the Clermont-en-Oise asylum. ^ From psychiatry as "ambiguous master" of reality and truth in proto- psychiatric practices to psychiatry as "agent of intensification " of
reality. ^ Psychiatric power and discourse of truth. ^ The problem of simulation and the insurrection of the hysterics. ^ The question of the birth of psychoanalysis.
I WILL CONTINUE WITH last week's lecture for a while because last week I found a marvelous institution that I was vaguely aware of but did not realize how well it suited me. So I would like to say something about it because it seems to me to show very well this connection between asylum discipline and, let's say, the family model.
Contrary to a rather loose hypothesis, which I have myself maintained, that the asylum was constituted through the extension of the family model, I have tried to show you that the nineteenth century asylum functioned in fact on a model of micro power close to what we can call disciplinary power that functions in a way that is completely heterogeneous to the family. And then I tried to show that the insertion, the joining of the family model to the disciplinary system takes place relatively late in the nineteenth century--I think we can put it around the years i860 to 1880--and it was only then that the family could not
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only become a model in the functioning of psychiatric discipline, but also, and especially, the horizon and object of psychiatric practice.
A time came, albeit late, when psychiatry really was concerned with the family. I have tried to show you that this occurred at the point of intersection of two processes which mutually supported each other: one was the constitution of what could be called the profits of abnormalities or irregularities, and the other was the internal disciplmanzation of the family. There is evidence for both of these processes.
On the one hand, of course, there is the growing extension through out the nineteenth century oi those profitable institutions whose aim is basically to make both abnormality and, at the same time, its correction, costly; let's say, roughly, clinics for children, adults, etcetera. On the other hand, there is the deployment of psychiatric techniques at the heart of the family, their use in family pedagogy. It seems to me that if we look at how this took place, at least in families which could yield a prolit from abnormality, that is to say bourgeois families, [by following] the evolution of the internal pedagogy of these families, we would see how the vigilant family eye, or, if you like, family sovereignty, gradually came to resemble the disciplinary form. The watchful family eye became a psychiatric gaze, or, at any rate, a psycho-pathological, a psychological gaze. Supervision of the child became supervision in the form oi decid ing on the normal and the abnormal; one began to keep an eye on the child's behavior, character, and sexuality, and it is here that we see the emergence of precisely all that psychologization ol the child within the family itself.
It seems to me that both the notions and apparatuses of psychiatric control were gradually imported into the family. With regard to the famous instruments of restraint found in asylums from around 1820 to 1830--binding hands, holding the head up, keeping in an upright position, etcetera--my impression is that, initially established as instru ments of and within asylum discipline, they gradually advance and take root in the family. The control of posture, of gestures, of the way to behave, the control of sexuality, with instruments for preventing masturbation, etcetera, all penetrate the family through a disciplmanzation which develops during the nineteenth century and the effect of which is that, through this disciplmanzation, the child's sexuality finally
? becomes an object of knowledge within the family itsell. And as a result of this the child will become the central target of psychiatric intervention. The child becomes the central target in two senses.
On the one hand, directly, since the institution of profit plugged into psychiatry will effectively ask the family to provide it with the material it needs in order to make its profit. Psychiatry says, more or less: "let your mad little children come to me," or, "you're never too young to be mad," or, "don't wait for the age of majority or adulthood to be mad. " And all of this is translated into the institutions of supervision, detection, training, and child therapy that you see developing at the end of the nineteenth century.
And then, in a second sense, childhood becomes the center, the target of psychiatric intervention indirectly, insofar as what one asks the mad adult about is, precisely, his childhood: let your childhood memories come, and through this you will be psychiatrized. This is more or less what I tried to set out last week.
All this brings me to this institution, which, around the 1860s, displays the asylum-family link up so well. I cannot say it is the first link up, but certainly its most perfect, best adjusted, almost Utopian form. I have found hardly any other examples, in France at least, which are so perlect as this establishment, which constitutes at this time, and early on therefore, a kind of family-asylum Utopia, the meeting point of family sovereignty and asylum discipline. This institution is the coupling ol the Clermont en Oise asylum with the Fitz-James clinic.
At the end ol the eighteenth century, in the neighborhood of Beuvais, there is a small house of confinement, in the classic sense of the term. It is run by Cordelier monks who, in return for an allowance, accept twenty residents either at the request of families or on the basis of lettres de cachet. The house is opened in 1790 and all its fine society is freed. However, obviously, some families are burdened with these dissolute, disorderly, mad people, and so they are then sent to someone at Clermont en Oise who has opened a kind of boarding house. At this time, just as Parisian restaurants were opening up on what was left of the great aristocratic houses broken up as a result of the Emigration, so, in the same way, many ol these boarding houses arose on the ruins of houses of confinement that had been thrown open. So there is a boarding house at Clermont-en-Oise
12 December 1973 125
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in which, under the Revolution, during the Empire, and even at the beginning of the Restoration, there were twenty residents. Then, when the great institutionahzation of psychiatric practice takes place, this boarding house becomes increasingly important and the prefectural administration ol the Oise department and the founder of the boarding house come to an arrangement whereby the department's destitute insane will be sent to the Clermont boarding house m return for a payment by the department. What's more, the agreement is extended to the departments of Seine-et Oise, Seine et Marne, Somme, and l'Aisne, and in 1850 a total of five departments send more than a thousand people to this boarding house, which then simply resembles a multi departmental asylum. 1
At this point the asylum splits, or rather, puts out a sort of pseudopodium, in the form of what is called the "colony. "2 This "colony" is made up of a number ol the asylum's residents with the ability to
[work]. * On the pretext that they can be useful and, at the same time, that work is useful for their cure anyway, they are subjected to a very strict regime of agricultural work.
A second pseudopodium, linked to the farm, is established ior wealthy residents who do not come Irom the Clermont asylum, but who were sent directly by their lamihes and who pay a very high price for a completely different kind of boarding based on a different, lamily model. 5
In this way we have an institution with three levels: the Clermont asy lum with its thousand patients; the iarm with 100 150 men and women who are required to work;^ and then a boarding house for paying residents, who are lurther separated, the men living in the management quarters with the director of the institution himself, and the wealthy women liv ing in a dillerent building with the typical name of "petit chateau" where the general iorm of their existence follows the iamily model. 5 This was established in the decade 1850 to i860. In 1861,the director publishes a
balance sheet, which is at the same time a sort of prospectus, which is therefore highly eulogistic and slightly Utopian, but which gives an exact picture of the meticulous and subtle way the system operates.
In this kind ol establishment--the Clermont asylum, the farm, and the Fitz James petit chateau--there are a number of levels. On the one
* (Recording:) arc able to work
? hand, you have an easily identifiable economic circuit: first, a departmental grant for poor patients allocated by the general council according to their numbers; second, withdrawal from the poor patients ol the number of people necessary and sufficient for running a farm; and hnally, the creation and maintenance of a petit chateau with the profit Irom the farm, taking in a number of paying residents, their payment constituting the profit for those in charge of the general system. So, you have the system: community subsidy-work exploitation profit.
Second, you can see that there is a sort of perfect social microcosm, a sort of little Utopia of general social functioning. The asylum is the reserve army of the farm proletariat; it is all those who, potentially, could work, and who, if they cannot work, wait for the moment when they can, and, if they do not have the ability to work, remain in the asy lum vegetating. Then there is the place of productive work, which is represented by the farm. Then you have the institution in which those who benefit from the work and the profit are found. And to each of these levels corresponds a specific architecture: that of the asylum; that ol the larm, which in reality is a model practically bordering on slavery and colonization; and then the petit chateau with the management quarters.
You also have two types of power, the first of which is split. You have the traditional disciplinary power of the asylum, which is negative in a way, since its function is to keep people calm without getting anything positive from them. Then you have a second disciplinary type of power, but slightly modified, which is, roughly, the power of colonization: putting people to work, with the insane divided into squads and brigades, etcetera, under the authority and supervision of those who regularly put them to work. And then there is power on the family model for residents ol the petit chateau.
In short, you have three types of psychiatric intervention or manipu lation, corresponding to these three levels. One is, if you like, the degree zero of psychiatric intervention, that is to say, pure and simple penning within the asylum. Second, there is the psychiatric practice of putting patients to work on the pretext of curing them: ergotherapy. And then, third, for paying residents, you have individual, individualizing psychiatric practice on the family model.
12 December 7973 127
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In the middle of all this, the most important and typical element is undoubtedly the way in which psychiatric knowledge and treatment are connected to the practice of putting those residents to work who are capable of working. Actually, very strangely, it is clear that the psychiatric categories developed by the psychiatry of the time, since Esquirol--and which I will try to show got absolutely no hold on therapy itself--are not in fact employed here at all as a classification of the curability of different people and the form of treatment that should be applied to them. Nosological classification is not linked to any therapeutic pre- scription but serves instead solely to define the possible utilization of individuals for the work they are offered.
Thus the directors of the Clermont asylum and the Fitz-James farm realized that if a patient was maniacal, monomaniacal, or demented, they were good for work in the fields and workshops looking after and manag- ing animals and plowing tools. 6 On the other hand, "imbeciles and idiots are responsible for cleaning the courtyards and stables and all the transport necessary for the service. "7 The use of women according to their sympto- matology is much more discriminating. Thus "those in the washhouse and laundry are almost always affected by a noisy delirium and would not be able to abide by the peace and quiet of workshop life. "8 In the washhouse and laundry, therefore, one can rave at the top of one's voice, talk loudly, and shout. Second, "those occupied with hanging out the washing are melancholies m whom this kind of work can restore the vital activity they so often lack. The imbeciles and idiots are responsible for taking laundry from the washhouse to the drying room. The workshops for sorting and folding the laundry are the remit of calm patients, monomaniacs, whose fixed ideas or hallucinations make possible a fairly sustained attention. "9
I have cited this establishment because it seemed to me to represent, around the 1860s, both the first form and most perfect realization of this family-discipline adjustment, and, at the same time, of the deployment of psychiatric knowledge as discipline.
*
This example leads us, moreover, to the problem that I would now like to consider, which is this: How and to what extent can one attribute a
? lherapeutic effect to this disciplinary, not yet familialized space, to this disciplinary system that we see being constituted between 1820 and 1830 and which will constitute the broad basis for the asylum institution? For, after all, it should not be forgotten that even if this disciplinary sys- tem is in many respects isomorphic with other disciplinary systems, like the school, the barracks, the workshop, and suchlike, it puts itself for- ward and justifies itself by its therapeutic function. What is it in this disciplinary space that is supposed to cure? What medical practice inhabits this space? This is the problem I would like to begin to address
today.
To do this I would like to start with a type of example about which
I have already spoken, which is what we can call the classical cure, mean- ing by classical the cure still current in the seventeenth and eighteenth centuries, and even at the beginning of the nineteenth century. I have given you a number of examples of this. There is the case of Pmel's patient who thought he was being pursued by revolutionaries, was waiting to be brought before the courts, and was consequently threatened with the death penalty. Pinel cured him by organizing a pseudo-trial around him, with pseudo-judges, in the course of which he was acquitted-- thanks to which he was cured. 10
In the same way, someone like Mason Cox, at the beginning of the nineteenth century gives the following example of a cure. It involves a man of forty years, who "had injured his health by too close attention to extensive mercantile concerns. "11 This passion for commerce had put into his head the idea that "his body was universally diseased. "12 And the main one of these, the one by which he felt most threatened, was what was called at the time "repelled itch," that is to say, an irruption of scabies which had not reached its term, which had spread throughout the organism, and manifested itself in a number of symptoms. The classical technique for curing it was to bring out this famous scabies and treat it as such.
For some time attempts were made to get the patient to understand that he did not have any of the illnesses in question: "no arguments could divert him . . . a formal consultation of medical men was therefore determined on, who, having previously agreed on the propriety of humouring the patient, professed to be unanimously of the opinion that
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his apprehension was just, a medical plan was laid down, some rebefacient application to different parts of the body occasioned crops of eruptions from time to time which were washed with some simple preparation. This farce continued a few weeks, and the patient at length was perfectly restored to health and reason. "13 His delirium had been satisfied, as it were.
What do these procedures of Pine! and Mason Cox presuppose and what do they bring into play? They presuppose--this is well known, I will not return to it--that the kernel of madness is a lalse belief, an illusion or an error. They also presuppose--which is already a bit different--that for the illness to disappear it is enough to dispel the error. The procedure of cure is therefore the reduction of the error; except the mad person's error is not just anyone's error.
The difference between the error of someone who is mad and some one who is not mad is not so much in the extravagance of the idea itself, because, after all, it is not very extravagant to believe one has "repelled itch. " And moreover, as Leuret will say later in his Fragments psychologiques sur lafolie, between Descartes who believed in vortices and a patient at Salpetriere who imagined that a council was being held in his lower abdomen/1 the extravagance is not especially on the patient's side. What makes a mad person's error the error of someone who is, precisely, mad? It is not then so much the extravagance, the final effect of the error, as the way in which the error can be overcome, dispelled. The mad person is someone whose error cannot be dispelled by a demonstration; he is someone for whom demonstration does not produce the truth. Consequently, one will have to find a different method of dispelling the error--since madness really is, in fact, the error--without using demonstration.
This means that, instead of attacking the erroneous judgment and showing that it has no correlation with reality, which is roughly the process of demonstration, one will let the lalse judgment be taken as true while transforming reality so that it is adapted to the mad, erroneous judgment. Now, when an erroneous judgment thus finds that it has a correlate in reality, which verifies it, from then on, the mental content coinciding with something in reality, there is no longer error and so no more madness.
? So it is not by treating the false judgment, by trying to correct it or dismiss it by demonstration, but rather by dressing up and manipulating reality that reality is placed on the same level, as it were, as the delirium. When the ialse judgment of the delirium is iound to have a real content in reality, it will as a result become a true judgment and the madness will cease being madness, since the error will have ceased being error. So one makes reality delirious so that the delirium is no longer delirium; one puts the delirium in the right so that it is no longer deceived. It is a matter, in short, of introducing reality into the delirium behind the mask of delirious figures, so that the delirium is satisfied by reality; through a game of transformations, of masks, one surreptitiously intro duces a reality beneath all the false propositions ol the delirium, or beneath the main false propositions of delirium, and in this way the delirium is verified.
*
You see that this practice of the cure is, in a sense, absolutely homoge- neous with the classical conception of judgment and error; we are in line with, say, the Port Royal conception of the proposition and judgment. b However, you see that there is a difference between the teacher or demon strator, the person who possesses the truth, and the psychiatrist. Whereas the master of truth, the teacher or scientist, manipulates judgment, the proposition, and thought, the doctor will manipulate reality in such a way that the error becomes true. In this kind of process the doctor is the inter mediary, the ambivalent person who [on the one hand] looks from the
side of reality and manipulates it, and, on the other, looks from the side of truth and error and arranges it that the (orm of reality comes up to the level of the error in order to transform it thereby into truth.
He manipulates reality by making it wear a mask; he makes this reality a little less real, or at any rate he deposits a film of unreality on it; he puts it between the brackets of the theater, of the "as if," of the pseudo-, and by making reality unreal in this way he carries out the transforma- tion of error into truth. Consequently he is the agent of reality--and in this he is not like the scientist or the teacher; he is however someone
A The manuscript clarilies: "Since it is as a comic, theatrical reality, as a pseudo reality that it is introduced into the delirium, and by according a second effectiveness to reality, since for the delirium to lail it is enough that the Ialse judgment become true through the masking ol reality. "
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who makes reality unreal in order to act on the erroneous judgment maintained by the patient. 16
I think we can say that the psychiatrist, as he will function in the space of asylum discipline, will no longer be the individual who consid- ers what the mad person says from the standpoint of truth, but will switch resolutely, definitively, to the standpoint of reality* He will no longer be the ambiguous master of reality and truth that he was still with Pinel and Mason Cox; he will be the master of reality. He will no longer have anything to do with somehow smuggling reality into the delirium; it is no longer a question of the psychiatrist being a smuggler ot reality as Pinel and Mason Cox were. The psychiatrist is someone who must give reality that constraining force by which it will be able to take over the madness, completely penetrate it, and make it disappear as madness. The psychiatrist is someone who--and this is what defines his task--must ensure that reality has the supplement of power necessary for it to impose itself on madness and, conversely, he is someone who must remove from madness its power to avoid reality.
From the nineteenth century, the psychiatrist is then a factor of the intensification of reality, and he is the agent of a surplus power of real- ity, whereas, in the classical period he was, in a way, the agent of a power of the 'derealization' of reality. You will say that if it is true that the nineteenth century psychiatrist crosses over completely to the side of reality, and if he becomes for madness the agent of the intensification of the power of reality, thanks precisely to the disciplinary power he gives himself, it is not true however that he does not pose the question of truth. I will say that, of course, the problem of truth is posed in nine- teenth century psychiatry, despite the nevertheless quite considerable negligence it manifests with regard to the theoretical elaboration of its practice. Psychiatry does not avoid the question of truth, but, instead of placing the question of the truth of madness at the very heart of the cure, at the heart of its relationship with the mad person, which was still the case for Pinel and Mason Cox, instead of bringing the problem of truth out into the open in the confrontation between doctor and
* The manuscript adds: "In asylum psychiatry, the psychiatrist plays the role oi master of reality in a completely different way. "
? patient, psychiatric power only poses the question of truth within itself. It gives itself the truth right from the start and once and for all by constituting itself as a medical and clinical science. This means that rather than the problem of the truth being at stake in the cure, it is resolved once and for all by psychiatric practice as soon as this practice assumes the status of a medical practice founded as the application of a psychiatric science.
So that if one had to define this power that I would like to talk to you about this year, I would suggest, provisionally, the following: Psychiatric power is that supplement of power by which the real is imposed on mad- ness in the name of a truth possessed once and for all by this power in the name of medical science, of psychiatry. On the basis of this definition, which I put forward in this provisional form, I think we can understand some general features of the history of psychiatry in the nineteenth century.
First there is the very strange relationship--I was going to say the absence of relationship--between psychiatric practice and, say, dis- courses of truth. On the one hand, it is true that with the psychiatrists of the beginning of the nineteenth century psychiatry very quickly shows great concern to constitute itself as a scientific discourse. But to what scientific discourses does psychiatric practice give rise? It gives rise to two types of discourse.
One of these we can call the clinical or classificatory, nosological dis course. Broadly speaking, this involves describing madness as an illness or, rather, as a series of mental illnesses, each with its own symptomatology, development, diagnostic and prognostic elements, etcetera. In this, the psychiatric discourse that takes shape takes normal clinical medical discourse as its model; it aims to constitute a sort of analogon of medical truth.
Then, and very soon too, even before Bayle's discovery of general paralysis, anyway from 1822 (the date of Bayle's discovery),17 you see the development of an anatomical pathological knowledge which poses the question of the substratum or organic correlatives of madness, the prob lem of the etiology of madness, of the relationship between madness and neurological lesions, etcetera. This is no longer a discourse analogous to medical discourse, but a real anatomical pathological or physiological- pathological discourse that is to serve as the materialist guarantee of psychiatric practice. 18
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Now, if you look at how psychiatric practice developed in the nineteenth century, how madness and mad people were actually handled in the asylum, you notice that, on the one hand, this practice was placed under the sign of and, so to speak, under the guarantee of these two discourses, one noso logical, of kinds of illnesses, and the other anatomical-pathological, of organic correlatives. Psychiatric practice developed in the shelter of these two discourses, but it never used them, or it only ever used them by ref- erence, by a system of cross references and, as it were, of pinning. Psychiatric practice, such as it was in the nineteenth century, never really put to work the knowledge, or quasi-knowledge, which was being built up in psychiatric nosology or in anatomical-pathological research. Basically, distributions in the asylum, the ways in which patients were classilied and divided up, the ways in which they were subjected to different regimes and given different tasks, and the ways in which they were declared cured or ill, curable or incurable, did not take these two discourses into account.
The two discourses were just sorts of guarantees of truth for a psy chiatnc practice that wanted to be given truth once and tor all and for it never to be called into question. The two big shadows of nosology and etiology, of medical nosography and pathological anatomy, were behind it to constitute, before any psychiatric practice, the definitive guarantee of a truth which this practice will never bring into operation in the practice of the cure. In crude terms, psychiatric power says: The question of truth will never be posed between madness and me for the very simple reason that I, psychiatry, am already a science. And if, as science, I have the right to question what I say, if it is true that I may make mistakes, it is in any case up to me, and to me alone, as science, to decide if what I say is true or to correct the mistake. I am the pos sessor, if not of truth in its content, at least of all the criteria ol truth. Furthermore, because, as scientific knowledge, I thereby possess the criteria of verification and truth, I can attach myself to reality and its power and impose on these demented and disturbed bodies the sur- plus-power that I give to reality. I am the surplus power of reality inas much as I possess, by myself and definitively, something that is the truth in relation madness.
? This is what a psychiatrist of the time called "the imprescriptible rights of reason over madness," which were for him the foundations of psychiatric intervention. 19
I think the reason for this absence of a connection between discourses of truth and psychiatric practice, for this gap, pertains to this function of the enhanced power of the real, which is the basic function of psychi- atric power and which must, as it were, slip behind its back a truth con sidered to be already acquired. This makes it possible to understand that the great problem of the history of psychiatry in the nineteenth century is not a problem of concepts, and not at all the problem of this or that illness: neither monomania nor even hysteria was the real problem, the cross psychiatry had to bear in the nineteenth century. If we accept that the question of truth is never posed in psychiatric power, then it is easy to understand that the cross nineteenth century psychiatry has to bear is quite simply the problem of simulation. 20
By simulation I do not mean the way in which someone who is not mad could pretend to be mad, because this does not really call psychiatric power into question. Pretending to be mad when one is sane is not some thing like an essential limit, boundary, or defect of psychiatric practice and psychiatric power, because, after all, this happens in other realms of knowledge, and in medicine in particular. We can always deceive a doctor by getting him to believe that we have this or that illness or symptom-- anyone who has done military service knows this--and medical practice is not thereby called into question. On the other hand, and this is the sim- ulation I want to talk to you about, the simulation that was the historical problem of psychiatry in the nineteenth century is simulation internal to madness, that is to say, that simulation that madness exercises with regard to itself, the way in which hysteria simulates hysteria, the way in which a true symptom is a certain way of lying and the way in which a false symptom is a way of being truly ill. All this constituted the insoluble problem, the limit and, ultimately, the failure of nineteenth century psychiatry that brought about a number of sudden developments.
If you like, psychiatry said more or less: I will not pose the problem of truth with you who are mad, because I possess the truth myself in terms of my knowledge, on the basis of my categories, and if I have a
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power in relation to you, the mad person, it is because I possess this truth. At this point madness replied: If you claim to possess the truth once and for all in terms of an already fully constituted knowledge, well, for my part, I will install falsehood in myself. And so, when you handle my symptoms, when you are dealing with what you call illness, you will find yourself caught in a trap, for at the heart of my symptoms there will be this small kernel of night, of falsehood, through which I will confront you with the question of truth. Consequently, I won't deceive you when your knowledge is limited--that would be pure and simple simulation-- but rather, if one day you want really to have a hold on me, you will have to accept the game of truth and falsehood that I ofier you.
Simulation: the whole history of psychiatry can be said to be perme- ated by this problem ol simulation, from the two simulators at Salpetriere in 1821, when it looms up before Georget, one of the leading psychiatrists of the period, until the 1880s and the important episode with Charcot. And when I say this problem, I am not talking about the theoretical problem of simulation, but the processes by which those who were mad actually responded with the question of falsehood to this psychiatric power that refused to pose the question of truth. The untruthfulness of simulation, madness simulating madness, was the anti-power of the mad confronted with psychiatric power.
I think the historical importance of this problem of both simulation and hysteria derives from this. It also enables us to understand the col- lective character of this phenomenon of simulation. We see it emerge around 1821 in the behavior of the two hysterics called "Petronille" and "Braguette. "21 I think these two patients founded an immense historical process in psychiatry; they were imitated in all the asylums in France because ultimately it was their weapon in the struggle with psychiatric power. And with the serious crisis of asylum psychiatry, which broke out at the end of the nineteenth century, around 1880, the problem of truth really was imposed by the mad on psychiatry when, in front of Charcot the great miracle worker, it became evident that all the symp toms he was studying were aroused by him on the basis of his patients' simulation.
I emphasize this history for a number of reasons. The first is that it is not a matter of symptoms. It is often said that hysteria has
? disappeared, or that it was the great illness of the nineteenth century. But it was not the great illness of the nineteenth century; it was, to use medical terminology, a typical asylum syndrome, or a syndrome correl- ative to asylum power or medical power. But I don't even like the word syndrome. It was actually the process by which patients tried to evade psychiatric power; it was a phenomenon of struggle, and not a patho- logical phenomenon. At any rate, that is how I think it should be viewed.
Second, we should not forget that if there was so much simulation within asylums after Braguette and Petronille, this was not only because it was made possible by the coexistence of patients withm the asylums, but also because of sometimes spontaneous and sometimes involuntary, sometimes explicit and sometimes implicit complicity with the patients on the part of the personnel, of warders, asylum doctors, and medical subordinates. We should not forget that Charcot practically never exam ined a single one of these hysterics, and that all his observations, falsi- lied by simulation, were actually given to him by the personnel surrounding the patients, and who, together with the patients, with greater or lesser degrees of complicity, constructed this world of simula- tion as resistance to psychiatric power that, m 1880 at Salpetnere, was incarnated in someone who, precisely, was not even a psychiatrist, but a neurologist, and so someone most able to base himself on the best constituted discourse ol truth.
The trap of falsehood, then, was set for the person who came armed with the highest medical knowledge. So the general phenomenon of simulation in the nineteenth century should be understood not only as a process of the patients' struggle against psychiatric power, but as a process of struggle at the heart of the psychiatric system, of the asylum system. And I think we arrive here at the episode that must be the aim of my course, which is the moment when, precisely, the question of truth, put aside after Pinel and Mason Cox by the disciplinary system ol the asylum and by the type of functioning of psychiatric power, was lorcibly reintroduced through all these processes. *
* The manuscript adds: "We can, then, call antipsychiatry any movement by which the question ol l ruth is put back in play within the relationship between the mad person and the psychiatrist. "
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We may say that psychoanalysis can be interpreted as psychiatry's first great retreat, as the moment when the question of the truth ol what is expressed in the symptoms, or, in any case, the game of truth and lie in the symptom, was forcibly imposed on psychiatric power; the prob- lem being whether psychoanalysis has not responded to this first defeat by setting up a first line of defense. At any rate, credit should not be given to Freud for the first depsychiatrization. We owe the first depsy chiatrization, the first moment that made psychiatric power totter on the question of truth, to this band of simulators. They are the ones who, with their falsehoods, trapped a psychiatric power which, in order to be the agent ol reality, claimed to be the possessor of truth and, within psychiatric practice and cure, refused to pose the question of the truth that madness might contain.
There was what could be called a great simulator's insurrection that spread through the whole of the asylum world in the nineteenth century, and the constant and endlessly rekindled source of which was Salpetnere, an asylum for women. This is why I don't think we can make hysteria, the question ol hysteria, the way in which psychiatrists got bogged down in hysteria in the nineteenth century, a kind of minor scientific error, a sort of epistemological blockage. It is clearly very reas suring to do this, because it makes it possible to write the history ol psychiatry and the birth of psychoanalysis in the same style as the expla nation of Copernicus, Kepler, or Einstein. That is to say, there is a sci entific blockage, an inability to get free from the excessive number oi spheres of the "Ptolemaic" world, or from Maxwell's equations, etcetera. We find secure footing in this scientific knowledge and, starting from this kind of dead-end, see an epistemological break and then the sudden appearance of Copernicus or Einstein. By posing the question in these terms, and by making the history of hysteria the analogon of these kinds of episodes, the history of psychoanalysis can be placed in the calm tradition ol the history of the sciences. However, if, as I would like to do, we make simulation--and so not hysteria--the militant underside ol psychiatric power rather than an epistemological problem of a dead end, if we accept that simulation was the insidious way lor the mad to pose the question of truth forcibly on a psychiatric power that only wanted to impose reality on them, then I think that we could write a
? history of psychiatry that would no longer revolve around psychiatry and its knowledge, but which finally would revolve around the mad.
And you can see that if we take up the history of psychiatry in this way, then it can be seen that what we can call the institutional perspec tive, which poses the problem of whether or not the institution is the site of violence, is in danger of suppressing something. It seems to me that it delineates the historical problem of psychiatry--that is to say, the problem of this power of reality that it was the psychiatrist's task to re-impose and which was trapped by the questioning falsehood of the simulators--in an extraordinarily narrow way.
This is the kind of general background I would like to give to the lollowing lectures. So, next week, I will try to resume this history, which I have suggested to you in a sketchy way, by taking up the problem of how psychiatric power functioned as a surplus-power of reality.
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1. In 1861 the asylum received 1227 insane persons, 561 men and 666 women, divided into 215 paying and 1212 destitute residents. See the work by the asylum's director, Guslave L a b i t t e , De la colonie de Fit^-James, succursale de I'asile prive de Clermont (Oise), considered au
point de vue de son organisation administrative el medicale (Paris: J. B. Bailliere, 1861) p. 15. On the history of the Clermont asylum, see E. J. Woillez, Essai hislorique, descriplif el slatislique sur la maison d'alienes de Clermont (Oise) (Clermont: V. Danicourt, 1839).
2. The Fitz James colony was created in 1847.
3. "In creating the Fitz James colony, first of all we wanted the patients to be in a completely
different environment than that ol Clermont" G. Labitte, De la colonie de Fit^-James, p. 13.
4. In 1861, the larm comprised "170 patients," ibid. p. 15.
5. According to G. Labilte's description: "1. The management section allocated to living
quarters for the director and male residents. 2. The Farm section, where the colonists stay. 3. The Petit Chateau section, inhabited by resident women. /|. The Bevrel section, occupied by women employed in laundering the linen" ibid. p. 6.
6. "On the larm . . . work in the fields and workshops, looking alter and managing animals and plowing tools, are the remit ol maniacs, monomaniacs and the demented" ibid. p. 15.
7. Ibid.
8. Ibid. p. V\. 9. Ibid.
10. P. Pinel, Traite medico-philosophique, section VI, ? iv: "Essai lente pour guerir une melancolie profonde produile par une cause morale" pp. 233 237; A Treatise on Insanity, "An attempt to cure a case ol melancholia produced by a moral cause" pp. 227i 227.
11. Joseph Mason Cox, Practical Observations on Insanity, Case II, p. 51; Observations sur la de? nence,(^06), p. 77.
12. Ibid. p. 51; ibid. p. 78.
13. Ibid. p. 52; ibid. pp. 78 79.
V\. F. Leuret, Fragments psychologiques sur la folie (Paris: Crochard, 1837|) ch. 2: "Delirium ol
intelligence": "The chair hirer of a Parisian parish, treated by Monsieur Esquirol,. . . said he had bishops in his belly who were holding a council. . . Descartes thought it an established tact that the pineal gland is a mirror which reflected the image ol external bodies . . . Is one of these assertions better proved than the other? " p. 7i3. Leuret is referring to Descartes' analysis of the role ol the pineal gland in the lormation of ideas ol objects which strike the senses: R. Descartes, Traite de VFlomme (Paris: Clerselier, 1667|) in Descartes, CEuvrcs el Lettres, ed. A. Bridoux, pp. 8 5 0 853; English translation, "Treatise on Man," trans. Robert Slootholl, in The Philosophical Writings oj Descartes, trans. John Cottingham, Robert Slootholl, Dugald Murdoch (Cambridge: Cambridge University Press, 1985) vol. 1, p. 106.
15. In this conception, "Judging is the action in which the mind, bringing together dillerent ideas, aflirms ol one that it is the other, or denies ol one that it is the other. This occurs when, for example, having the idea ol the earth and the idea ol round, I affirm or deny ol the earth that it is round" A. Arnauld and P. Nicole, La Logique, ou VArl depenser, contcnanl, outre les regies communes, plusieurs observations nouvelles propres a former le jugemenl ( 1 6 6 2 ) (Paris: Desprez, 1683, 51'1 edition) p. 36; English translation, Logic, or, The art of thinking, trans. J. V. Buroker (Cambridge: Cambridge University Press, 1996) p.
