Falret, "Du
traitement
general des alienes" (lecture at Salpetriere, 1854) in Des maladies mentales el des asiles d'alienes (Paris: J.
Foucault-Psychiatric-Power-1973-74
This is a start of methodical, regular, reasonable action, and this action leads to others.
"28 With regard to one patient he says: "If I succeed in getting him to accept promotion, putting him in the place of commander, and if he acquits himself well, from that moment I would consider his cure almost certain.
I never employ a supervisor to command the marching and maneuvers, only patients.
"
"With the help of this somewhat military organization [and so we pass from orthopedic exercise to the very constitution of medical knowl- edge; M. F. J, inspection of the patients is facilitated, whether in the wards or courtyards, and every day I can give at least a glance to the incurably insane, keeping most of my time for the insane subject to active treat ment. "29 So, with these methods of review, inspection, lining up in the courtyard, and the doctor's observation, we are effectively in the military world. This is how the asylum functioned until around the 1850s, at which point, it seems to me, we see something that indicates a shift. *
A The manuscript continues this analysis, noting: "All in all, a disciplinary apparatus which is in principle supposed to have therapeutic ellectiveness. We see that under these conditions the correlate of this therapy, the object in its sights, is the will. Madness, no longer defined as blind iiess, but as affection ol the will, and the insertion ol the madman in a disciplinary therapeutic held, are two correlative phenomena which mutually support and reinforce each other. "
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Around 1850-1860 we begin to see the idea expressed that, first of all, the madman is like a child; second, that the madman must be placed m a milieu analogous to the family, although it is not a family; and finally, third, that these quasi lamilial elements have a therapeutic value in themselves.
You find the idea that the madman is like a child in, for example, a text by Fournet, to which I will return because it is important, "The moral treatment of insanity," which appeared in the Annales medico-
psychologique in 1854- The madman must be treated like a child, and it is the family, "the true family in which the spirit of peace, intelligence and love reigns," that, "from the earliest time and the first human aberra- tions," must ensure "the moral treatment, the model treatment of the aberrations of heart and mind. "30
This text from 1854 is all the more curious in that we see it taking a direction that is, I think, quite new at this time. Fournet says that the family has a therapeutic value, that the family is effectively the model on the basis of which one can construct a moral and psychological orthope dies, of which, he says, we have examples outside the psychiatric hospital: "The missionaries of civilization [and by this I think he means the soldiers then colonizing Algeria as well as missionaries in the strict sense; M. F. ] who take from the family its spirit of peace, benevolence, devotion, and even the name of father, and who seek to cure the preju dices, false traditions, and errors of savage nations, are Pmels and Daqums in comparison with the conquering armies who claim to bring civilization through the brutal force of arms and who act on nations in the way that chains and prisons act on the unfortunate insane. "*1
In plain words this means that there were two ages of psychiatry; one in which chains were employed and the other where, let's say, humane feelings were employed. Well, in the same way, there are two methods and maybe two ages in colonization: one is the age of the pure and sim- ple conquest by arms, and the other is the period of establishment and colonization in depth. And this in depth colonization is carried out by the organization of the family model; it is by introducing the family into the traditions and errors of savage peoples that one begins the work of colonization. Fournet continues, saying that exactly the same thing is found with delinquents. He cites Mettray, founded in 1840, where, in
? what is basically a purely military schema, the names father, elder brother, and so on, were used in a pseudo-family organization. Fournet refers to this in order to say: You see that here as well the family model is used to try to "reconstitute . . . the elements and regime of the family around these unfortunates, orphaned through the deeds or vices of their parents. " And he concludes: "It is not, gentlemen, that I wish from today to include insanity (alienation mentale) in the same category as the moral alienation of peoples or individuals subject to the judgment of history or the law . . . "32 This is another work, which he promises for the luture, but never produced.
But you see that if he did not do it, many others did subsequently. You see delinquents as the residues of society, colonized peoples as the residues of history, and the mad as the residues of humanity in general, all included together in the same category, all the individuals-- delinquents, peoples to be colonized, or the mad--who can only be reconverted, civilized and subjected to orthopedic treatment if they are ottered a family model.
I think we have here an important point of inflexion. It is important because it takes place quite early, 1854, that is to say, before Darwinism, belore On the Origins of the Species. ^ Certainly, the principle of ontogenesis- phylogenesis was already known, at least in its general form, but you see the strange use of it here and, especially--even more than the interesting bracketing together of the mad, the primitive, and the delinquent--the
appearance of the family as the common remedy for being savage, delinquent, or mad. I am not in any way claiming that this text is the first, but it seems to me to be one of the most revealing and I have hardly found any earlier text that is so clear. So, we can say that the phenomenon I would like to talk about takes place roughly around thel850s.
So, why did it take place then? What happened in this period? What is the basis of all this? For a long time I have looked for an answer to these questions, and it seemed that we could be put on the track by sim ply asking the Nietzschean question: "Who is speaking? " Who actually lormulates this idea? Where do we find it?
You find it in people like Fournet,3' in Casimir Pinel, a descendant of Pinel,*5 in Brierre de Boismont,36 and you also begin to find it in
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Blanche,*7 that is to say, in a series of individuals whose common characteristic is simply that ol having at some time managed a public service, but especially private clinics, alongside and very different from hospitals and public institutions. Furthermore, all the examples they give of familialization as therapeutic milieu are based on the example of clinics. A fine discovery, you will say. Everyone knows that, from the nineteenth century, there were hospitals barracks for the exploited and comfortable clinics for the rich. Actually, in relation to this I would like to bring out a phenomenon which goes a bit beyond this opposition, or, if you like, which is lodged in it but is much more precise.
I wonder if there was not a quite important phenomenon in the nineteenth century, of which this would be one of the innumerable eflects. This important phenomenon, the elfect of which arises here, would be the integration, organization, and exploitation ol what I would call the profits of abnormalities, of illegalities or irregularities. I would say that the disciplinary systems had a primary, massive, overall function which appears clearly in the eighteenth century: to adjust the multiplicity of individuals to the apparatuses of production, or to the State apparatuses (appareils) which control them, or again, to adjust the combination of men to the accumulation of capital. Insofar as these dis- ciplinary systems were normalizing, they necessarily produced, on their borders and through exclusion, residual abnormalities, illegalities, and irregularities. The tighter the disciplinary system, the more numerous the abnormalities and irregularities. Now, from these irregularities, ille galities, and abnormalities that the disciplinary system was designed to reduce, but that at the same time it created precisely to the extent that it functioned, the economic and political system of the bourgeoisie of the nineteenth century [drew]* a source of profit on the one hand, and of the reinforcement of power on the other.
I will take the example of prostitution, which is quite close to that of the psychiatric hospitals I will talk about after. Clearly, we don't have to wait until the nineteenth century for the existence of that famous triangle of prostitutes, clients and procurers, for the existence of broth- els and established networks, etcetera. We don't have to wait until the
* (Recording:) found
? nineteenth century for the employment of prostitutes and procurers as mlormers and for the circulation of large sums of money for sexual pleasure in general. However, in the nineteenth century I think we see t he organization in European countries of a tight network resting first of all on a system of property, of hotels and brothels, etcetera, and which uses procurers as intermediaries and agents, who are at the same time informers recruited from a group about whose constitution I tried to say some things last year, that is, delinquents. *8
II there was this kind of need for delinquents, and if, in the end, so much care was taken to form them into an "underworld," it is precisely because they were the reserve army ol these important agents of which procurers-informers are only examples. Procurers, enframed by and coupled with the police, are the basic intermediaries ol the system of prostitution. So what was the purpose of this system with its rigorous organization and its supports and relays? Its function is to bring back to capital itself, to the normal circuits of capitalist profit, all the profits that can be extracted from sexual pleasure, on the triple condition, of course, that, first, this sexual pleasure is marginalized, deprecated, and prohibited, and so then becomes costly solely by virtue of being prohibited. Second, il one wants to make a profit from sexual pleasure, then it must not only be prohibited, but it must actually be tolerated. And, finally, it must be supervised by a particular power, which is ensured by the coupling of criminals and police, through the procurer- informer. Brought back into the normal circuits of capitalism in this way, the profit from sexual pleasure will bring about the secondary effect of the reinforcement of all the procedures of surveillance and, consequently, the constitution of what could be called an infra-power, which is finally brought to bear on men's everyday, individual, and corporal behavior:
the disciplinary system of prostitution. Because this is what is involved; alongside the army, school, and psychiatric hospital, prostitution, as it was organized in the nineteenth century, is again a disciplinary system, the economic and political impact of which can be seen straightaway.
First, sexual pleasure is made profitable, that is to say, it is made into a source of profit due to both its prohibition and its tolerance. Second, the profits from sexual pleasure flow back into the general circuits of capitalism. Third, leaning on this so as to fix even more firmly the
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extreme effects, the synaptic relays of State power, which end up reaching into men's everyday pleasure.
But prostitution is, of course, only one example of this kind of general mechanism which can be found in the disciplinary systems set up in the eighteenth century for a particular overall function, and which are then refined in the nineteenth century on the basis of this discipline which was essentially demanded by the formation of a new apparatus of production. Finer disciplines are adapted to these disciplines, or, if you like, the old disciplines are refined and thus find new possibilities for the constitution of profit and the reinforcement of power.
Let us now turn to the clinics of Brierre de Boismont, Blanche, and others. What basically is involved is the extraction of profit, and maximum profit, from the marginalization carried out by psychiatric discipline. For if it is clear that the basic aim of psychiatric discipline in its overall form is to take out of circulation individuals who cannot be employed in the apparatus of production, at another level, on a more restricted scale and with a very different social localization, they can be turned into a new source of profit. *
In fact, when a number of individuals from the wealthy classes are themselves marginalized, in the name of the same knowledge that deter- mines confinement, then it will be possible to profit from them. That is to say, it will be possible to ask families who have the means to "pay to be cured. " So you can see that the first step in the process will consist in demanding a profit from the family of the individual who is declared ill--on certain conditions.
Obviously it must not be possible to cure the patient at home. So the principle of isolation will continue to be emphasized for the patient who is a source of profit: "We will not cure you in your family. But if we ask your family to pay for you to be confined elsewhere, we must of course guarantee to restore to it something in its image. " That is to say,
* In the manuscript Foucault adds: "It is the profit from irregularity which serves as a vector for importing the family model into psychiatric practice. "
? it is necessary to give back a certain benefit to the family proportionate to the profit demanded from it; a certain profit for the medical body is requested for confining an individual in this way, to pay a pension, etcetera, but the family must benefit from this. This benefit will be the renewal of the system of power within the family. The psychiatrists say to the family: "We will give back to you someone who will really conform and be adjusted and adapted to your system of power. " Therefore, re-familialized individuals will be produced, inasmuch as it is the family that, by designating the mad person, provided the possibility of a profit to those who constitute the profit from marginalization. From this derives the need for clinics to be very closely adapted to the family model.
Thus in Brierre de Boismont's clinic, in the Samt-Antoine suburb, there was an organization completely modeled on the family, that is to say, with a father and mother. What's more, the model was not new: Blanche provided a first example of it during the Restoration. 39 The father is Brierre de Boismont himself, and the mother is his wife. Everyone lives in the family home, all are brothers, everyone takes their meals together, and all must have family feelings for each other. The reactivation of family feelings, the investment of every family function in the clinic, will be the effective agency of the cure.
There are some very clear accounts of this in Brierre de Boismont, in his quotation of the correspondence between his patients, after their cure, and himself or his wife. He quotes the letter of an old patient who wrote to Madame Brierre de Boismont: "Far from you, madame, I will often seek the memory so deeply engraved on my heart, in order to enjoy once more that calm filled with affection that you communicate to those who have the good fortune to be received into your home. I will often cast my mind back to your family milieu, so united in all its parts, so affectionate in each of its members, the eldest of whom is as gracious as she is intelligent. If, as is my wish, I return from my own family, you shall be my first visit, for it is a heartfelt debt" (20 May 1847)/'?
I think this letter is interesting. You see that the criterion, the form of the cure itself, is the activation of canonical types of family feelings: grat- itude towards the mother and father. You also see at work here, or rising to the surface at least, the theme of a love which is both validated and
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quasi-incestuous, since the patient is supposed to be Brierre de Boismont's son, and so the brother of the eldest daughter for whom he experiences some feelings. What will be the effect of this reactivation of family feelings, what will he do when he returns to Paris? First of all he will see his family, the true family--that is to say, the family that will get the benefit of the medical process--and, only secondly, he will see Brierre de Boismont's family, this quasi-family, which therefore plays a role of both super- and sub family. It is a super-family inasmuch as it is the ideal family, which functions in the pure state, the family as it should be always; and it is inasmuch as it is the true family that it is attributed an orthopedic function. Second, it is a sub-family inasmuch as its role is to efface itself before the real family, to activate family feelings by means of its internal mechanism only so that the real family benefits from this, and, at that point, it is no more than the kind of schematic support which, discreetly, constantly sustains the functioning of the real family. This super family and sub-family is constructed in these clinics, the social and economic location of which is, as you can see, very different from that of the asylum.
However, if the bourgeois, paying clinic is thus famihalized--functioning on the family model--then the family, in turn, outside the clinic, must play its role. It is not just a question of saying to the family, if you pay me, I will make your madman able to function in the family; the family still has to play its role, that is to say, actually designate those who are mad. It must play a disciplinary role for itself, as it were, that is to say, it must say: Here is our mad, abnormal member, who is a matter for medicine. That is to say, you have familiahzation of the therapeutic milieu for the clinics on one side, and, on the other, disciplinarization of the family, which at that point becomes the agency of the abnormahzation of individuals.
Whereas the question of the abnormal individual did not arise for the sovereign family--which was concerned rather with the hierarchical order of births, the order of inheritance, relationships of allegiance, obedience, and preeminence between them, with the name and all the sub-functions of the name--the disciplinarized family will begin to sub- stitute for this sovereign function of the name the psychological function of the designation of abnormal individuals, of the abnormahzation of individuals.
? What I am saying about the clinics is also valid for the school, and to a certain extent for health in general, and for military service, and so on. What I have wanted to show you is that, however much the family con tinued to conform to a model of sovereignty in the nineteenth century, it may be that, from the middle ol the nineteenth century perhaps, there was a sort ol internal disciplinanzation of the family, that is to say, a kind of transfer of disciplinary forms and schemas, of those techniques of power given by the disciplines, into the very heart of the game of lamily sovereignty.
Just as the family model is transferred into disciplinary systems, dis ciplinary techniques are transplanted into the family. And at that point the family, while retaining the specific heterogeneity of sovereign power, begins to function like a little school: the strange category ol student parents appears, home duties begin to appear, the control of school dis cipline by the lamily; the lamily becomes a micro-clinic which controls the normality or abnormality of the body, of the soul; it becomes a small scale barracks, and maybe it becomes, we will come back to this, the place where sexuality circulates.
I think we can say that, on the basis of disciplinary systems, family sovereignty will be placed under the following obligation: "You must hnd for us the mad, feeble minded, diflicult, and perverse, and you must lind them yourself, through the exercise of disciplinary kinds ol control within lamily sovereignty. And when, through the operation ol this dis- ciplinanzed sovereignty, you have lound your mad, abnormal, feeble minded, and difficult members in your home, we, say the disciplines, will put them through the filter of normalizing apparatuses and restore them to you, the lamily, for your greater functional benefit. We will make them conform to your needs, even if, obviously, we have made our profit on this. "
This is how disciplinary power lives off family sovereignty, requiring the family to play the role of the agency that decides between normal and abnormal, regular and irregular, asking the family to hand over its abnormal, irregular individuals, etcetera, and making a profit from this, which enters into the general system of profit and can be called, if you like, the economic benefit of irregularity. After which, what's more, the lamily is supposed to find again, at the end ol the process, an individual
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who has been disciplined in such a way that he can be effectively subjected to the family's specific schema of sovereignty. Being a good son, a good husband, and so on, is really the outcome offered by all these disciplinary establishments, by schools, hospitals, reformatories, and the rest. This means that they are machines thanks to which it is thought that disciplinary apparatuses will constitute characters who can take their place within the specific morphology of the family's power of sovereignty.
? 1. "Lesjurieux must be placed in a place of salely, but they can only be detained by virtue of
a judgment which must be prompted by the family ( . . . ) . It is to the Tribunals alone that
it [the Civil Code; J. L. | entrusts the care ol establishing iheir condition. " Circular of Portalis, 30 Fructidor Year 12 (17 September 1804) cited in G. Bollotte, "Les malades men- taux de 1789 a 1838 dans I'ceuvre de P. Serieux" Information psychiatrique, vol. 44, no. 10, 1968, p. 916. The Civil Code of 1804 reformulated the old jurisdiction in article 489 (Title XI, ch. 2): "The person who has reached the age of majority and is in a habitual state
of imbecility, dementia, or trenzy, must be interdicted, even when this state has intervals of lucidity. " See, "Interdit" in CJ. de Ferriere, ed. , Dictionnaire de droil el de pratique (Paris: Brunei, 1769) vol. 2, pp. 48-50; H. Legrand du Saulle, Etude medico-legale sur ('interdiction des alienes et sur le conseil judiciaire (Paris: Delahaye el Lecrosnier, 1881); P. Serieux and L. Libert, La Regime des alienes en France au XVIIT siecle (Paris: Masson, 1914); P. Serieux and M. Trenel, "L'inlerdiction des alienes par voie judiciaire (sentence d'interdiction) sous I'Ancien Regime" Revue historique de droit francais el etranger, 4'1' series, 10th year, July September 1931, pp. 450 486; A. Laingui, La Responsabilite penale dans I'ancien droil (XVT- XVIII' siecles) (Paris: Librairie generale de droit et de jurisprudence, 1970) vol. 2, pp. 173 204. Foucault relers to interdiction in Hisloire de la folie, pp. 141-143 (omitted from Madness and Civilisation). He returns to the topic in the lecture of 12 January 1975 ol his course al the College de France, 1974 1975, Les Anormaux, eds. V. Marchetti and
A. Salomoni (Paris: Gallimard/Seuil, 1999) pp. 131-136; English translation, Michel Foucault, Abnormal. Lectures at the College de France 7974-7975, English ed. Arnold I. Davidson, trans. Graham Burchell (New York: Picador, 2O03) pp. 141-145.
2. The law ol 16 24 August 1790 made conhnement a police measure by entrusting "to the vigilance and authority ol municipal bodies . . . the responsibility lor avoiding or remedy
ing unlortunate events which could be occasioned by the insane or thefurieux left in lib erty" (Title XI, article 3) in Legislation sur les alienes et les enjants assisles. Recueil des his, decrels et circulaires (1790-1879)(Paris: Ministere de I'Interieur et des Cukes, 1880 ) vol. 1, p. 3. See, M. Foucault, Hisloire de lajolie, p. 443; Madness and Civilisation, pp. 238 239-
3. F. E. Fodere, Traite du delire, vol. 2, p. 252.
4. P. Berthier, Medecine mentale, vol. 1; De I'isolement (Paris: J. B. Bailliere, 1857) p. 10.
5. The principle is stated by Esquirol in his "Memoire sur I'isolement des alienes" (read at
the Institut on 1 October 1852): "The isolation of the insane (sequestration, confinement) consists in withdrawing him Irom all his habits, in separating him from his lamily, his friends, and his servants; in surrounding him with strangers; in changing his whole way of
life" Des maladies mentales considerees sous les rapports medical, hygienique el medico-legal, vol. 2, p. 745-J. P.
Falret, "Du traitement general des alienes" (lecture at Salpetriere, 1854) in Des maladies mentales el des asiles d'alienes (Paris: J. B. Bailliere, 1864) pp. 677-699, see p. 685 sq. ;J. Guislain, Traitesur les phrenopathies, p. 409;J-M. Dupuy, Qulquesconsiderations surla
Jolie. Visite au Castel d'Andorle, etablissemcnl destine aux alienes de la classe riche (Pengueux: Dupont, 1848) pp. 7-8.
6. Francois Leuret states that "whenever one can, one should impose silence on the patient on the subject ol his delirium and occupy him with something else" Du traitement moral de la
Jolie, op. cit. , p. 120. See also his "Memoire sur la revulsion morale dans le traitement de la folie" in Memoires de I'Academic royale de medecine, 1841, p. 658. However, it is J. P. Falret who, in a faithful summary ol Esquirol's conceptions, states the principle most explicitly in an unpublished manuscript: "Isolation is obviously of prime importance . . . But, once the patient has been withdrawn from external influences, should he be left to himself without seeking to destroy the lixity of his unhealthy preoccupations? Obviously not. Not content with having removed the causes which may foment it, one must combat the delir- ium itself, and to this end experience recognizes no more ellective means than, for some, fixing their attention on objects most likely to fascinate them, and, lor others, diverting them from their hxed ideas, distracting them from their preoccupations by constantly pre senting them with objects loreign to their delirium, and by completely directing their attention on every kind ol occupation, so that it is impossible lor them to think of the subject ol their illness. " Quoted by G. Daumezon and P. Koechlin, "La psychotherapie institutionelle
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7.
Iranc. aise contemporaine" AnnaisPortugueses de psiquialria, vol. 4, no. 4, 1952, p. 27/l. See also, J. P. Falret, Des maladies menlales el des asiles d'alienes, p. 687.
"The moral cause of insanity often exists in the bosom of the lamily, and gets its source from sorrows, domestic disputes, setbacks, etcetera (. . . ) the lirst shock to the intellectual
and moral faculties olten takes place in the insane person's own home, amongst his acquaintances, his relatives, and his friends. " J. E. D. Esquirol, Des passions, considerees comme causes, symplomes el moyens curatifs de /'alienation mentale, Paris Medical Thesis no. 574 (Paris: Didot Jeune. 1805), p. 43. SeeJ. Fournet, "Le traitement moral de l'alienation mentale, soit morale, a son principe et son modele dans la famille" (Report read to the Societe medicale d'emulation, 4 March 1854): "A good number ol the insane find in what we call the family
not only the conditions which irritate, aggravate and precipitate these kinds ol alfections, but in virtue ol this, the conditions which give birth to them" Annales medico-psychologiques, 2,KI series, vol. 6, October 1854, pp. 523 524; and A. Brierre de Boismont, "De l'utilite de
la vie de lamille dans le traitement de l'alienation mentale, et plus speciaiement de ses lormes tristes" (Report read to the Academic des sciences, 21 August 1865) Annales medico- psychologiques, 4th series, vol. 7, 1866 (Paris: Martinet, 1866), pp. 40 68.
8. J. E. D. Esquirol, "De la lolie" in Des maladies mentales, vol. 1, p. 120; English translation, J. E. D. Esquirol, Mental Maladies. A Treatise on Insanity, trans. E. K. Hunt (New York and London: Hafner, 1965) p. 74: "The insane man becomes timid and suspicious. He fears
every one that he approaches; and his suspicions extend to those who were most dear to him. The conviction that every one is endeavouring to torment and slander him, to render him miserable, and to ruin him, in body and estate, puts the finishing stroke to this moral perversion. Hence that symptomatic suspicion, which olten grows up without motive. "
9. In 1849, Pierre Berthier (1830 1877) became intern under his uncle, Henri Girard de Cailleux, head doctor and director ol the Auxerre mental asylum. Alter the defense ol his thesis, "De la nature de l'alienation mentale d'apres ses causes el son traitement," at Montpellier in 1857, Berthier returned to Auxerre lor two years belore his appointment as head doctor at Bourg (Ain), before becoming resident doctor at Bicetre in 1865.
10. P. Berthier, Medecine mentale, vol. 1, Observation C, p. 25.
11. Ibid. Observation D, p. 25.
12. Ibid. Obscn'ation B: "M. G. , sullering lrom acute melancholy ( . . . ) arrives in the most unlortunate state (. . . ). After some months of treatment, and not without many ellorls, improvement arrives ( . . . ) . In spile ol the express prohibition of the doctor director, the patient sees his son; he breaks a glass window pane and throws himsell through the opening he has made, with the intention ol joining him. From that moment (. . . ) the hal lucinations reappear with greater intensity, sleep vanishes, the delirium increases; and the patient's situation constantly gets worse" pp. 24-25.
13. In Hisloirc de la folie, pp. 517 519, this principle was considered under the heading "Mirror Recognition"; Madness and Cwili^ation, pp. 262 265.
14. "In a ground floor building, at any moment and without a sound he can arrive close to the patients and servants. " J. E. D. Esquirol, Des elablissements consacres aux alienes en France, p. 36; reprinted in Des maladies mentales, vol. 2, p. 426.
15. P. Pinel, Traile medico-philosophique sur l'alienation mentale, on la Manic, section II, ? xxn: "Habilite dans l'art de diriger les alienes, en paraissant se preter a leurs idees imaginaires," pp. 9 3 9 4 ; A Treatise on Insanity, Section II, "The propriety of appearing to assent to the absurd propositions and fanciful ideas of maniacs" pp. 9 6 97. In lact, Pinel says: "Three insane persons, each ol whom believed himsell to be a king, and each ol whom took the title Louis XVI, quarreled one day over the prerogatives ol royalty, and defended them somewhat too energetically. The keeper approached one ol them, and drawing him aside, asked: 'Why do you argue with these men who are evidently mad? Doesn't everyone know that you should be recognized as Louis XVI? ' Flattered by this homage, the madman immediately with drew, glancing at the others with a disdainlul hauteur. The same trick succeeded with a second, and thus it was that in an instant t here remained no trace ol the dispute. " This pas sage is quoted, with a somewhat dillerent commentary, in Histoire de lajolie, pp. 517 518; Madness and Civilisation, pp. 262 263.
16. J. E. D. Esquirol, "De la folie" in Des maladies mentales, vol. 1, p. 124; Mental Maladies. A Treatise on Insanity, pp. 75 76. Evoking the "strongest objection that can be urged against
? establishments devoted to this kind of treatment," Esquirol counters that "the frightful effects that may result from mingling with companions in misfortune" are compensated for by a cohabitation that "does not injure them,--that it is not an obstacle to a cure--that it is a valuable means of treatment, because it obliges the insane to reflect upon their condition ( . . . ) to occupy their thoughts with what is going on around them,--to forget themselves, as it were, which is, in itself, a means ol cure. " Falret also claims that the asylum makes it possible "to prompt reflection on oneself through the contrast between everything around the patient and his only family circle. " J. P. Falret, "Du traitement general des alienes" (1854) <<n Des maladies mentales el des asiles d'alienes, p. 687.
17. Histoire de la folie evokes the "almost arithmetical obviousness of punishment" p. 521; Madness and Civilisation, p. 267.
18. The roots of the principle of no restraintare found in the reforms undertaken by the Englishmen W Tuke, J. Haslam, and E. Charlesworth, and the Irishman J. Conolly. Following the death at York asylum ol a woman belonging to the Quakers, William Tuke founded on 11 May 1796 an establishment lor the insane lor members of the Society of Friends: the Retreat. Samuel Hike (1784 1857), William's grandson, published Description of the Retreat, an Institution near York jor Insane Persons oj the Society of Friends (York: W Alexander, 1813). See, R. Semalaigne, Alienistes et Philanthropes: les Pinel et les Tuke (Paris: Steinheil, 1912); M. Foucault, Histoire de la folie, pp. 484 487, 492 496, 501-511, Madness and Civilisation, pp. 243 255 (pages 484 501 ol the French edition are omitted Irom the English translation); John Haslam, apothecary at the Bethlehem hospital in London, devoted a work to him: Considerations on the Moral Management of Insane Persons (see also above notes 6 and 13 to the lecture ol 7 November 1973); in 1820, Edward Charlesworth (1783 1853), consultant doctor at the Lincoln Asylum, attacked the coercive methods then much in evidence: Remarks on the Treatment oj the Insane and the Management of Lunatics Asylums (London: Rivington, l825);John Conolly (1794-1866), promoter of no restraint, applied it from 1 June 1839 after his arrival at the Middlesex asylum at Hanwell, near London. He set out his conceptions in, The Construction and GovernmentojLunatics Asylums and Hospitals for the Insane (London: J. Churchill, 1847), and in The Treatment oj the Insane without Mechanical Restraint (London: Smith and Elder, 1856). See also, H. Labatt, An Essay on Use and Abuse of Restraint in the Management of the Insane (London: Hodges and Smith, 1847).
19. Letter ol the Mother Superior of the asylum lor women at Lille to the Mother Superior of the nuns ol Saint Joseph ol Cluny who ministered to the asylum of Saint Yon (Lower Seine)--of which Benedict Augustin Morel (1807-1873) was the head doctor from 23 May 1856--in which she set out the way in she controlled agitated patients: "We set to work . . . taking an agitated woman so as to put her under the supervision of a nun who knew how to impress. " Quoted in B. A. Morel's report, Le Non-Restraint, ou De Vabolition des moyens coercitifs dans le traitement de lajolie (Paris: Masson, i 8 6 0 ) p. 77.
20. An armchair resting on bellows so that "at the slightest movement the insane person is bounced about in every direction, and the unpleasant sensation caused by this movement lorces him to be keep calm. " J. Guislain, Traite sur les phrenopathies, p. 414.
21. Iron handcuffs covered with leather arc recommended by Esquirol as one ol the "many means more gentle than chains," J. E. D. Esquirol, "Des Maisons d'alienes" in Des maladies mentales, vol. 2, p. 533. See also, J. Guislain, Traite sur Valienation mentale et sur les hospices des alienes, vol. 2, book 12, "Institutions for the insane. Means of repression," pp. 271 272.
22.
"With the help of this somewhat military organization [and so we pass from orthopedic exercise to the very constitution of medical knowl- edge; M. F. J, inspection of the patients is facilitated, whether in the wards or courtyards, and every day I can give at least a glance to the incurably insane, keeping most of my time for the insane subject to active treat ment. "29 So, with these methods of review, inspection, lining up in the courtyard, and the doctor's observation, we are effectively in the military world. This is how the asylum functioned until around the 1850s, at which point, it seems to me, we see something that indicates a shift. *
A The manuscript continues this analysis, noting: "All in all, a disciplinary apparatus which is in principle supposed to have therapeutic ellectiveness. We see that under these conditions the correlate of this therapy, the object in its sights, is the will. Madness, no longer defined as blind iiess, but as affection ol the will, and the insertion ol the madman in a disciplinary therapeutic held, are two correlative phenomena which mutually support and reinforce each other. "
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Around 1850-1860 we begin to see the idea expressed that, first of all, the madman is like a child; second, that the madman must be placed m a milieu analogous to the family, although it is not a family; and finally, third, that these quasi lamilial elements have a therapeutic value in themselves.
You find the idea that the madman is like a child in, for example, a text by Fournet, to which I will return because it is important, "The moral treatment of insanity," which appeared in the Annales medico-
psychologique in 1854- The madman must be treated like a child, and it is the family, "the true family in which the spirit of peace, intelligence and love reigns," that, "from the earliest time and the first human aberra- tions," must ensure "the moral treatment, the model treatment of the aberrations of heart and mind. "30
This text from 1854 is all the more curious in that we see it taking a direction that is, I think, quite new at this time. Fournet says that the family has a therapeutic value, that the family is effectively the model on the basis of which one can construct a moral and psychological orthope dies, of which, he says, we have examples outside the psychiatric hospital: "The missionaries of civilization [and by this I think he means the soldiers then colonizing Algeria as well as missionaries in the strict sense; M. F. ] who take from the family its spirit of peace, benevolence, devotion, and even the name of father, and who seek to cure the preju dices, false traditions, and errors of savage nations, are Pmels and Daqums in comparison with the conquering armies who claim to bring civilization through the brutal force of arms and who act on nations in the way that chains and prisons act on the unfortunate insane. "*1
In plain words this means that there were two ages of psychiatry; one in which chains were employed and the other where, let's say, humane feelings were employed. Well, in the same way, there are two methods and maybe two ages in colonization: one is the age of the pure and sim- ple conquest by arms, and the other is the period of establishment and colonization in depth. And this in depth colonization is carried out by the organization of the family model; it is by introducing the family into the traditions and errors of savage peoples that one begins the work of colonization. Fournet continues, saying that exactly the same thing is found with delinquents. He cites Mettray, founded in 1840, where, in
? what is basically a purely military schema, the names father, elder brother, and so on, were used in a pseudo-family organization. Fournet refers to this in order to say: You see that here as well the family model is used to try to "reconstitute . . . the elements and regime of the family around these unfortunates, orphaned through the deeds or vices of their parents. " And he concludes: "It is not, gentlemen, that I wish from today to include insanity (alienation mentale) in the same category as the moral alienation of peoples or individuals subject to the judgment of history or the law . . . "32 This is another work, which he promises for the luture, but never produced.
But you see that if he did not do it, many others did subsequently. You see delinquents as the residues of society, colonized peoples as the residues of history, and the mad as the residues of humanity in general, all included together in the same category, all the individuals-- delinquents, peoples to be colonized, or the mad--who can only be reconverted, civilized and subjected to orthopedic treatment if they are ottered a family model.
I think we have here an important point of inflexion. It is important because it takes place quite early, 1854, that is to say, before Darwinism, belore On the Origins of the Species. ^ Certainly, the principle of ontogenesis- phylogenesis was already known, at least in its general form, but you see the strange use of it here and, especially--even more than the interesting bracketing together of the mad, the primitive, and the delinquent--the
appearance of the family as the common remedy for being savage, delinquent, or mad. I am not in any way claiming that this text is the first, but it seems to me to be one of the most revealing and I have hardly found any earlier text that is so clear. So, we can say that the phenomenon I would like to talk about takes place roughly around thel850s.
So, why did it take place then? What happened in this period? What is the basis of all this? For a long time I have looked for an answer to these questions, and it seemed that we could be put on the track by sim ply asking the Nietzschean question: "Who is speaking? " Who actually lormulates this idea? Where do we find it?
You find it in people like Fournet,3' in Casimir Pinel, a descendant of Pinel,*5 in Brierre de Boismont,36 and you also begin to find it in
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Blanche,*7 that is to say, in a series of individuals whose common characteristic is simply that ol having at some time managed a public service, but especially private clinics, alongside and very different from hospitals and public institutions. Furthermore, all the examples they give of familialization as therapeutic milieu are based on the example of clinics. A fine discovery, you will say. Everyone knows that, from the nineteenth century, there were hospitals barracks for the exploited and comfortable clinics for the rich. Actually, in relation to this I would like to bring out a phenomenon which goes a bit beyond this opposition, or, if you like, which is lodged in it but is much more precise.
I wonder if there was not a quite important phenomenon in the nineteenth century, of which this would be one of the innumerable eflects. This important phenomenon, the elfect of which arises here, would be the integration, organization, and exploitation ol what I would call the profits of abnormalities, of illegalities or irregularities. I would say that the disciplinary systems had a primary, massive, overall function which appears clearly in the eighteenth century: to adjust the multiplicity of individuals to the apparatuses of production, or to the State apparatuses (appareils) which control them, or again, to adjust the combination of men to the accumulation of capital. Insofar as these dis- ciplinary systems were normalizing, they necessarily produced, on their borders and through exclusion, residual abnormalities, illegalities, and irregularities. The tighter the disciplinary system, the more numerous the abnormalities and irregularities. Now, from these irregularities, ille galities, and abnormalities that the disciplinary system was designed to reduce, but that at the same time it created precisely to the extent that it functioned, the economic and political system of the bourgeoisie of the nineteenth century [drew]* a source of profit on the one hand, and of the reinforcement of power on the other.
I will take the example of prostitution, which is quite close to that of the psychiatric hospitals I will talk about after. Clearly, we don't have to wait until the nineteenth century for the existence of that famous triangle of prostitutes, clients and procurers, for the existence of broth- els and established networks, etcetera. We don't have to wait until the
* (Recording:) found
? nineteenth century for the employment of prostitutes and procurers as mlormers and for the circulation of large sums of money for sexual pleasure in general. However, in the nineteenth century I think we see t he organization in European countries of a tight network resting first of all on a system of property, of hotels and brothels, etcetera, and which uses procurers as intermediaries and agents, who are at the same time informers recruited from a group about whose constitution I tried to say some things last year, that is, delinquents. *8
II there was this kind of need for delinquents, and if, in the end, so much care was taken to form them into an "underworld," it is precisely because they were the reserve army ol these important agents of which procurers-informers are only examples. Procurers, enframed by and coupled with the police, are the basic intermediaries ol the system of prostitution. So what was the purpose of this system with its rigorous organization and its supports and relays? Its function is to bring back to capital itself, to the normal circuits of capitalist profit, all the profits that can be extracted from sexual pleasure, on the triple condition, of course, that, first, this sexual pleasure is marginalized, deprecated, and prohibited, and so then becomes costly solely by virtue of being prohibited. Second, il one wants to make a profit from sexual pleasure, then it must not only be prohibited, but it must actually be tolerated. And, finally, it must be supervised by a particular power, which is ensured by the coupling of criminals and police, through the procurer- informer. Brought back into the normal circuits of capitalism in this way, the profit from sexual pleasure will bring about the secondary effect of the reinforcement of all the procedures of surveillance and, consequently, the constitution of what could be called an infra-power, which is finally brought to bear on men's everyday, individual, and corporal behavior:
the disciplinary system of prostitution. Because this is what is involved; alongside the army, school, and psychiatric hospital, prostitution, as it was organized in the nineteenth century, is again a disciplinary system, the economic and political impact of which can be seen straightaway.
First, sexual pleasure is made profitable, that is to say, it is made into a source of profit due to both its prohibition and its tolerance. Second, the profits from sexual pleasure flow back into the general circuits of capitalism. Third, leaning on this so as to fix even more firmly the
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extreme effects, the synaptic relays of State power, which end up reaching into men's everyday pleasure.
But prostitution is, of course, only one example of this kind of general mechanism which can be found in the disciplinary systems set up in the eighteenth century for a particular overall function, and which are then refined in the nineteenth century on the basis of this discipline which was essentially demanded by the formation of a new apparatus of production. Finer disciplines are adapted to these disciplines, or, if you like, the old disciplines are refined and thus find new possibilities for the constitution of profit and the reinforcement of power.
Let us now turn to the clinics of Brierre de Boismont, Blanche, and others. What basically is involved is the extraction of profit, and maximum profit, from the marginalization carried out by psychiatric discipline. For if it is clear that the basic aim of psychiatric discipline in its overall form is to take out of circulation individuals who cannot be employed in the apparatus of production, at another level, on a more restricted scale and with a very different social localization, they can be turned into a new source of profit. *
In fact, when a number of individuals from the wealthy classes are themselves marginalized, in the name of the same knowledge that deter- mines confinement, then it will be possible to profit from them. That is to say, it will be possible to ask families who have the means to "pay to be cured. " So you can see that the first step in the process will consist in demanding a profit from the family of the individual who is declared ill--on certain conditions.
Obviously it must not be possible to cure the patient at home. So the principle of isolation will continue to be emphasized for the patient who is a source of profit: "We will not cure you in your family. But if we ask your family to pay for you to be confined elsewhere, we must of course guarantee to restore to it something in its image. " That is to say,
* In the manuscript Foucault adds: "It is the profit from irregularity which serves as a vector for importing the family model into psychiatric practice. "
? it is necessary to give back a certain benefit to the family proportionate to the profit demanded from it; a certain profit for the medical body is requested for confining an individual in this way, to pay a pension, etcetera, but the family must benefit from this. This benefit will be the renewal of the system of power within the family. The psychiatrists say to the family: "We will give back to you someone who will really conform and be adjusted and adapted to your system of power. " Therefore, re-familialized individuals will be produced, inasmuch as it is the family that, by designating the mad person, provided the possibility of a profit to those who constitute the profit from marginalization. From this derives the need for clinics to be very closely adapted to the family model.
Thus in Brierre de Boismont's clinic, in the Samt-Antoine suburb, there was an organization completely modeled on the family, that is to say, with a father and mother. What's more, the model was not new: Blanche provided a first example of it during the Restoration. 39 The father is Brierre de Boismont himself, and the mother is his wife. Everyone lives in the family home, all are brothers, everyone takes their meals together, and all must have family feelings for each other. The reactivation of family feelings, the investment of every family function in the clinic, will be the effective agency of the cure.
There are some very clear accounts of this in Brierre de Boismont, in his quotation of the correspondence between his patients, after their cure, and himself or his wife. He quotes the letter of an old patient who wrote to Madame Brierre de Boismont: "Far from you, madame, I will often seek the memory so deeply engraved on my heart, in order to enjoy once more that calm filled with affection that you communicate to those who have the good fortune to be received into your home. I will often cast my mind back to your family milieu, so united in all its parts, so affectionate in each of its members, the eldest of whom is as gracious as she is intelligent. If, as is my wish, I return from my own family, you shall be my first visit, for it is a heartfelt debt" (20 May 1847)/'?
I think this letter is interesting. You see that the criterion, the form of the cure itself, is the activation of canonical types of family feelings: grat- itude towards the mother and father. You also see at work here, or rising to the surface at least, the theme of a love which is both validated and
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quasi-incestuous, since the patient is supposed to be Brierre de Boismont's son, and so the brother of the eldest daughter for whom he experiences some feelings. What will be the effect of this reactivation of family feelings, what will he do when he returns to Paris? First of all he will see his family, the true family--that is to say, the family that will get the benefit of the medical process--and, only secondly, he will see Brierre de Boismont's family, this quasi-family, which therefore plays a role of both super- and sub family. It is a super-family inasmuch as it is the ideal family, which functions in the pure state, the family as it should be always; and it is inasmuch as it is the true family that it is attributed an orthopedic function. Second, it is a sub-family inasmuch as its role is to efface itself before the real family, to activate family feelings by means of its internal mechanism only so that the real family benefits from this, and, at that point, it is no more than the kind of schematic support which, discreetly, constantly sustains the functioning of the real family. This super family and sub-family is constructed in these clinics, the social and economic location of which is, as you can see, very different from that of the asylum.
However, if the bourgeois, paying clinic is thus famihalized--functioning on the family model--then the family, in turn, outside the clinic, must play its role. It is not just a question of saying to the family, if you pay me, I will make your madman able to function in the family; the family still has to play its role, that is to say, actually designate those who are mad. It must play a disciplinary role for itself, as it were, that is to say, it must say: Here is our mad, abnormal member, who is a matter for medicine. That is to say, you have familiahzation of the therapeutic milieu for the clinics on one side, and, on the other, disciplinarization of the family, which at that point becomes the agency of the abnormahzation of individuals.
Whereas the question of the abnormal individual did not arise for the sovereign family--which was concerned rather with the hierarchical order of births, the order of inheritance, relationships of allegiance, obedience, and preeminence between them, with the name and all the sub-functions of the name--the disciplinarized family will begin to sub- stitute for this sovereign function of the name the psychological function of the designation of abnormal individuals, of the abnormahzation of individuals.
? What I am saying about the clinics is also valid for the school, and to a certain extent for health in general, and for military service, and so on. What I have wanted to show you is that, however much the family con tinued to conform to a model of sovereignty in the nineteenth century, it may be that, from the middle ol the nineteenth century perhaps, there was a sort ol internal disciplinanzation of the family, that is to say, a kind of transfer of disciplinary forms and schemas, of those techniques of power given by the disciplines, into the very heart of the game of lamily sovereignty.
Just as the family model is transferred into disciplinary systems, dis ciplinary techniques are transplanted into the family. And at that point the family, while retaining the specific heterogeneity of sovereign power, begins to function like a little school: the strange category ol student parents appears, home duties begin to appear, the control of school dis cipline by the lamily; the lamily becomes a micro-clinic which controls the normality or abnormality of the body, of the soul; it becomes a small scale barracks, and maybe it becomes, we will come back to this, the place where sexuality circulates.
I think we can say that, on the basis of disciplinary systems, family sovereignty will be placed under the following obligation: "You must hnd for us the mad, feeble minded, diflicult, and perverse, and you must lind them yourself, through the exercise of disciplinary kinds ol control within lamily sovereignty. And when, through the operation ol this dis- ciplinanzed sovereignty, you have lound your mad, abnormal, feeble minded, and difficult members in your home, we, say the disciplines, will put them through the filter of normalizing apparatuses and restore them to you, the lamily, for your greater functional benefit. We will make them conform to your needs, even if, obviously, we have made our profit on this. "
This is how disciplinary power lives off family sovereignty, requiring the family to play the role of the agency that decides between normal and abnormal, regular and irregular, asking the family to hand over its abnormal, irregular individuals, etcetera, and making a profit from this, which enters into the general system of profit and can be called, if you like, the economic benefit of irregularity. After which, what's more, the lamily is supposed to find again, at the end ol the process, an individual
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who has been disciplined in such a way that he can be effectively subjected to the family's specific schema of sovereignty. Being a good son, a good husband, and so on, is really the outcome offered by all these disciplinary establishments, by schools, hospitals, reformatories, and the rest. This means that they are machines thanks to which it is thought that disciplinary apparatuses will constitute characters who can take their place within the specific morphology of the family's power of sovereignty.
? 1. "Lesjurieux must be placed in a place of salely, but they can only be detained by virtue of
a judgment which must be prompted by the family ( . . . ) . It is to the Tribunals alone that
it [the Civil Code; J. L. | entrusts the care ol establishing iheir condition. " Circular of Portalis, 30 Fructidor Year 12 (17 September 1804) cited in G. Bollotte, "Les malades men- taux de 1789 a 1838 dans I'ceuvre de P. Serieux" Information psychiatrique, vol. 44, no. 10, 1968, p. 916. The Civil Code of 1804 reformulated the old jurisdiction in article 489 (Title XI, ch. 2): "The person who has reached the age of majority and is in a habitual state
of imbecility, dementia, or trenzy, must be interdicted, even when this state has intervals of lucidity. " See, "Interdit" in CJ. de Ferriere, ed. , Dictionnaire de droil el de pratique (Paris: Brunei, 1769) vol. 2, pp. 48-50; H. Legrand du Saulle, Etude medico-legale sur ('interdiction des alienes et sur le conseil judiciaire (Paris: Delahaye el Lecrosnier, 1881); P. Serieux and L. Libert, La Regime des alienes en France au XVIIT siecle (Paris: Masson, 1914); P. Serieux and M. Trenel, "L'inlerdiction des alienes par voie judiciaire (sentence d'interdiction) sous I'Ancien Regime" Revue historique de droit francais el etranger, 4'1' series, 10th year, July September 1931, pp. 450 486; A. Laingui, La Responsabilite penale dans I'ancien droil (XVT- XVIII' siecles) (Paris: Librairie generale de droit et de jurisprudence, 1970) vol. 2, pp. 173 204. Foucault relers to interdiction in Hisloire de la folie, pp. 141-143 (omitted from Madness and Civilisation). He returns to the topic in the lecture of 12 January 1975 ol his course al the College de France, 1974 1975, Les Anormaux, eds. V. Marchetti and
A. Salomoni (Paris: Gallimard/Seuil, 1999) pp. 131-136; English translation, Michel Foucault, Abnormal. Lectures at the College de France 7974-7975, English ed. Arnold I. Davidson, trans. Graham Burchell (New York: Picador, 2O03) pp. 141-145.
2. The law ol 16 24 August 1790 made conhnement a police measure by entrusting "to the vigilance and authority ol municipal bodies . . . the responsibility lor avoiding or remedy
ing unlortunate events which could be occasioned by the insane or thefurieux left in lib erty" (Title XI, article 3) in Legislation sur les alienes et les enjants assisles. Recueil des his, decrels et circulaires (1790-1879)(Paris: Ministere de I'Interieur et des Cukes, 1880 ) vol. 1, p. 3. See, M. Foucault, Hisloire de lajolie, p. 443; Madness and Civilisation, pp. 238 239-
3. F. E. Fodere, Traite du delire, vol. 2, p. 252.
4. P. Berthier, Medecine mentale, vol. 1; De I'isolement (Paris: J. B. Bailliere, 1857) p. 10.
5. The principle is stated by Esquirol in his "Memoire sur I'isolement des alienes" (read at
the Institut on 1 October 1852): "The isolation of the insane (sequestration, confinement) consists in withdrawing him Irom all his habits, in separating him from his lamily, his friends, and his servants; in surrounding him with strangers; in changing his whole way of
life" Des maladies mentales considerees sous les rapports medical, hygienique el medico-legal, vol. 2, p. 745-J. P.
Falret, "Du traitement general des alienes" (lecture at Salpetriere, 1854) in Des maladies mentales el des asiles d'alienes (Paris: J. B. Bailliere, 1864) pp. 677-699, see p. 685 sq. ;J. Guislain, Traitesur les phrenopathies, p. 409;J-M. Dupuy, Qulquesconsiderations surla
Jolie. Visite au Castel d'Andorle, etablissemcnl destine aux alienes de la classe riche (Pengueux: Dupont, 1848) pp. 7-8.
6. Francois Leuret states that "whenever one can, one should impose silence on the patient on the subject ol his delirium and occupy him with something else" Du traitement moral de la
Jolie, op. cit. , p. 120. See also his "Memoire sur la revulsion morale dans le traitement de la folie" in Memoires de I'Academic royale de medecine, 1841, p. 658. However, it is J. P. Falret who, in a faithful summary ol Esquirol's conceptions, states the principle most explicitly in an unpublished manuscript: "Isolation is obviously of prime importance . . . But, once the patient has been withdrawn from external influences, should he be left to himself without seeking to destroy the lixity of his unhealthy preoccupations? Obviously not. Not content with having removed the causes which may foment it, one must combat the delir- ium itself, and to this end experience recognizes no more ellective means than, for some, fixing their attention on objects most likely to fascinate them, and, lor others, diverting them from their hxed ideas, distracting them from their preoccupations by constantly pre senting them with objects loreign to their delirium, and by completely directing their attention on every kind ol occupation, so that it is impossible lor them to think of the subject ol their illness. " Quoted by G. Daumezon and P. Koechlin, "La psychotherapie institutionelle
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7.
Iranc. aise contemporaine" AnnaisPortugueses de psiquialria, vol. 4, no. 4, 1952, p. 27/l. See also, J. P. Falret, Des maladies menlales el des asiles d'alienes, p. 687.
"The moral cause of insanity often exists in the bosom of the lamily, and gets its source from sorrows, domestic disputes, setbacks, etcetera (. . . ) the lirst shock to the intellectual
and moral faculties olten takes place in the insane person's own home, amongst his acquaintances, his relatives, and his friends. " J. E. D. Esquirol, Des passions, considerees comme causes, symplomes el moyens curatifs de /'alienation mentale, Paris Medical Thesis no. 574 (Paris: Didot Jeune. 1805), p. 43. SeeJ. Fournet, "Le traitement moral de l'alienation mentale, soit morale, a son principe et son modele dans la famille" (Report read to the Societe medicale d'emulation, 4 March 1854): "A good number ol the insane find in what we call the family
not only the conditions which irritate, aggravate and precipitate these kinds ol alfections, but in virtue ol this, the conditions which give birth to them" Annales medico-psychologiques, 2,KI series, vol. 6, October 1854, pp. 523 524; and A. Brierre de Boismont, "De l'utilite de
la vie de lamille dans le traitement de l'alienation mentale, et plus speciaiement de ses lormes tristes" (Report read to the Academic des sciences, 21 August 1865) Annales medico- psychologiques, 4th series, vol. 7, 1866 (Paris: Martinet, 1866), pp. 40 68.
8. J. E. D. Esquirol, "De la lolie" in Des maladies mentales, vol. 1, p. 120; English translation, J. E. D. Esquirol, Mental Maladies. A Treatise on Insanity, trans. E. K. Hunt (New York and London: Hafner, 1965) p. 74: "The insane man becomes timid and suspicious. He fears
every one that he approaches; and his suspicions extend to those who were most dear to him. The conviction that every one is endeavouring to torment and slander him, to render him miserable, and to ruin him, in body and estate, puts the finishing stroke to this moral perversion. Hence that symptomatic suspicion, which olten grows up without motive. "
9. In 1849, Pierre Berthier (1830 1877) became intern under his uncle, Henri Girard de Cailleux, head doctor and director ol the Auxerre mental asylum. Alter the defense ol his thesis, "De la nature de l'alienation mentale d'apres ses causes el son traitement," at Montpellier in 1857, Berthier returned to Auxerre lor two years belore his appointment as head doctor at Bourg (Ain), before becoming resident doctor at Bicetre in 1865.
10. P. Berthier, Medecine mentale, vol. 1, Observation C, p. 25.
11. Ibid. Observation D, p. 25.
12. Ibid. Obscn'ation B: "M. G. , sullering lrom acute melancholy ( . . . ) arrives in the most unlortunate state (. . . ). After some months of treatment, and not without many ellorls, improvement arrives ( . . . ) . In spile ol the express prohibition of the doctor director, the patient sees his son; he breaks a glass window pane and throws himsell through the opening he has made, with the intention ol joining him. From that moment (. . . ) the hal lucinations reappear with greater intensity, sleep vanishes, the delirium increases; and the patient's situation constantly gets worse" pp. 24-25.
13. In Hisloirc de la folie, pp. 517 519, this principle was considered under the heading "Mirror Recognition"; Madness and Cwili^ation, pp. 262 265.
14. "In a ground floor building, at any moment and without a sound he can arrive close to the patients and servants. " J. E. D. Esquirol, Des elablissements consacres aux alienes en France, p. 36; reprinted in Des maladies mentales, vol. 2, p. 426.
15. P. Pinel, Traile medico-philosophique sur l'alienation mentale, on la Manic, section II, ? xxn: "Habilite dans l'art de diriger les alienes, en paraissant se preter a leurs idees imaginaires," pp. 9 3 9 4 ; A Treatise on Insanity, Section II, "The propriety of appearing to assent to the absurd propositions and fanciful ideas of maniacs" pp. 9 6 97. In lact, Pinel says: "Three insane persons, each ol whom believed himsell to be a king, and each ol whom took the title Louis XVI, quarreled one day over the prerogatives ol royalty, and defended them somewhat too energetically. The keeper approached one ol them, and drawing him aside, asked: 'Why do you argue with these men who are evidently mad? Doesn't everyone know that you should be recognized as Louis XVI? ' Flattered by this homage, the madman immediately with drew, glancing at the others with a disdainlul hauteur. The same trick succeeded with a second, and thus it was that in an instant t here remained no trace ol the dispute. " This pas sage is quoted, with a somewhat dillerent commentary, in Histoire de lajolie, pp. 517 518; Madness and Civilisation, pp. 262 263.
16. J. E. D. Esquirol, "De la folie" in Des maladies mentales, vol. 1, p. 124; Mental Maladies. A Treatise on Insanity, pp. 75 76. Evoking the "strongest objection that can be urged against
? establishments devoted to this kind of treatment," Esquirol counters that "the frightful effects that may result from mingling with companions in misfortune" are compensated for by a cohabitation that "does not injure them,--that it is not an obstacle to a cure--that it is a valuable means of treatment, because it obliges the insane to reflect upon their condition ( . . . ) to occupy their thoughts with what is going on around them,--to forget themselves, as it were, which is, in itself, a means ol cure. " Falret also claims that the asylum makes it possible "to prompt reflection on oneself through the contrast between everything around the patient and his only family circle. " J. P. Falret, "Du traitement general des alienes" (1854) <<n Des maladies mentales el des asiles d'alienes, p. 687.
17. Histoire de la folie evokes the "almost arithmetical obviousness of punishment" p. 521; Madness and Civilisation, p. 267.
18. The roots of the principle of no restraintare found in the reforms undertaken by the Englishmen W Tuke, J. Haslam, and E. Charlesworth, and the Irishman J. Conolly. Following the death at York asylum ol a woman belonging to the Quakers, William Tuke founded on 11 May 1796 an establishment lor the insane lor members of the Society of Friends: the Retreat. Samuel Hike (1784 1857), William's grandson, published Description of the Retreat, an Institution near York jor Insane Persons oj the Society of Friends (York: W Alexander, 1813). See, R. Semalaigne, Alienistes et Philanthropes: les Pinel et les Tuke (Paris: Steinheil, 1912); M. Foucault, Histoire de la folie, pp. 484 487, 492 496, 501-511, Madness and Civilisation, pp. 243 255 (pages 484 501 ol the French edition are omitted Irom the English translation); John Haslam, apothecary at the Bethlehem hospital in London, devoted a work to him: Considerations on the Moral Management of Insane Persons (see also above notes 6 and 13 to the lecture ol 7 November 1973); in 1820, Edward Charlesworth (1783 1853), consultant doctor at the Lincoln Asylum, attacked the coercive methods then much in evidence: Remarks on the Treatment oj the Insane and the Management of Lunatics Asylums (London: Rivington, l825);John Conolly (1794-1866), promoter of no restraint, applied it from 1 June 1839 after his arrival at the Middlesex asylum at Hanwell, near London. He set out his conceptions in, The Construction and GovernmentojLunatics Asylums and Hospitals for the Insane (London: J. Churchill, 1847), and in The Treatment oj the Insane without Mechanical Restraint (London: Smith and Elder, 1856). See also, H. Labatt, An Essay on Use and Abuse of Restraint in the Management of the Insane (London: Hodges and Smith, 1847).
19. Letter ol the Mother Superior of the asylum lor women at Lille to the Mother Superior of the nuns ol Saint Joseph ol Cluny who ministered to the asylum of Saint Yon (Lower Seine)--of which Benedict Augustin Morel (1807-1873) was the head doctor from 23 May 1856--in which she set out the way in she controlled agitated patients: "We set to work . . . taking an agitated woman so as to put her under the supervision of a nun who knew how to impress. " Quoted in B. A. Morel's report, Le Non-Restraint, ou De Vabolition des moyens coercitifs dans le traitement de lajolie (Paris: Masson, i 8 6 0 ) p. 77.
20. An armchair resting on bellows so that "at the slightest movement the insane person is bounced about in every direction, and the unpleasant sensation caused by this movement lorces him to be keep calm. " J. Guislain, Traite sur les phrenopathies, p. 414.
21. Iron handcuffs covered with leather arc recommended by Esquirol as one ol the "many means more gentle than chains," J. E. D. Esquirol, "Des Maisons d'alienes" in Des maladies mentales, vol. 2, p. 533. See also, J. Guislain, Traite sur Valienation mentale et sur les hospices des alienes, vol. 2, book 12, "Institutions for the insane. Means of repression," pp. 271 272.
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