Falret, Des
maladies
mentales et des asiles d'alienes, p.
Foucault-Psychiatric-Power-1973-74
95 97; and, J.
Guislain, Traile sur I'alienation meniale, vol.
II, book 16: "Regime alimentaire a observer dans I'alienation mentale" pp.
139 152.
5. Work, an essential component ol moral treatment, was conceived ol in the double perspec live of therapy (isolation) and discipline (order). See, P. Pinel, Traile medico-philosophique, section V, ? xxi: "L01 fondamentale de tout hospice d'alienes, celle d'un travail mecanique": "Constant work changes the vicious circle ol ideas, clanhes the laculties ol understanding by exercising them, alone keeps order wherever the insane are assembled, and dispenses with a host ol detailed and often pointless rules in order to maintain inter
nal police" p. 225; A Treatise on Insanity, "Mechanical employment essential to the success
ful management of lunatic hospitals" p. 217. Cf. , C. Bouchct, "Du travail applique aux alienes" Annales medico-psychologiques, vol. XII, November 1848, pp. 301-302. In Hisloire de
? lajolie, pp. 505 506; Madness and Civilisation, pp. 247 249, Foucault refers to a study by Jean Calvet, from 1952, on the historical origins ol the work ol patients in insane asylums. 6. P. Pinel lends his authority to the shower by making it an instrument of both treatment and conditioning. See the second, revised and expanded edition of his Traitemedico-
philosophique sur {'alienation mentale (Paris: Caille et Ravier, 1809) pp. 205-206. See also, H. Girard de Cailleux, "Considerations sur le traitement des maladies mentales" Annales medico-psychologiques, vol. IV, November, 1844, pp. 330-331; H. Rech (de Montpellier), "De la douche et des affusions d'eau Iroide sur la tete dans le traitement des alienations men- tales" ibid. vol. IX, January 1847, pp. 124 125. It is Francois Leuret especially who makes use of it in Traitement moral de lafolie, ch. 3, ? "Douches et affusions froides" pp. 158-162. See Foucault's discussion of M. Dupre's cure in this and the following lecture (above, French p. 143 sq. and below, French p. 173 sq). Foucault devotes several pages to this cure in: Maladie mentale et Psychologic (Paris: P. U. F. , 1962) pp. 85-86; English translation, Mental Illness and Psychology, trans. Alan Sheridan (Now York: Harper and Row, 1976) p. 72; Histoire de lajolie, p. 338 and pp. 520-521; Madness and Civilisation, p. 172 and pp. 266 267; and "L'eau et la iolie" Dils et Ecrits, vol. 1, pp. 268-272. He returns to it in "Sexuality and Solitude" London Review of Books, 21 May 5 June 1981, p. 3 and pp. 5 6, reprinted in The Essential Works oj Foucault, 1954-19$/l, vol. 1: Ethics: subjectivity and truth, ed. Paul Rabinow, trans. Robert Hurley and others (New York: The New Press, 1997) pp. 175 176; French translation, "Sexualite et solitude," trans. F. Durand Bogaert, Dits el Ecrits, vol. 4. , pp. 168 169.
7. The rotary swing was perfected by the English doctor Erasmus Darwin (1731-1802) and used to treat madness by Mason Cox, who praised its eilectiveness: "I think it can be put
to both a moral and a physical use, and be employed with success both as a means of rebel
and as a means oi discipline, in order to make the patient more adaptable and docile" Observations sur la demence, p. 58. | It has not been possible to consult the first, 1804, edi tion of Practical Observations on Insanity, on which the French translation is based, and the passage quoted here does not appear in the second, 1806, edition. However, reierence is made to the rotary swing elsewhere in the 1806 edition, e. g. , p. 137; G. B. ] See, L. Amard, Traite analytique de la folie et des moyens de la guerir (Lyon: printed by Ballanche, 1807)
pp. 80 93; J. Guislain, Traite sur Valienation mentale, vol. I, book IV, and, Moyens diriges sur le systeme nerveux cerebral. De la rotation (Amsterdam: Van der Hey, 1826) p. 374 and p. 404; C. Buvat Pochon, Les Traitemenls de choc d'autrejois en psychiatric Leurs liens avec les therapeu- tiques modernes, Medical thesis, Paris, no. 1262 (Paris: Le Francois, 1939). See Histoire de la
Jolie, pp. 341 342; Madness and Civilisation, pp. 176-177.
8. While he was alive, Leuret had to defend himself from critics who condemned his practice
as, in his own words, "retrograde and dangerous" (DM traitement moral de lafolie, p. 68). His main opponent was E. S. Blanche, in his paper to the royal Academy of medicine, Du dan-
ger des rigueurs corporelles dans le traitement de lajolie (Paris: Gardembas, 1839), as well as in his short work, De Fetal actuel du traitement de lajolie en France (Paris: Gardembas, 1840). These polemics were echoed in Leuret's obituary notices: U. Trelat, "Notice sur Leuret" Annales d'hygiene publique et de medecine legale, vol. 45, 1851, pp. 241-262; and A. Brierre de Boismont, "Notice biographique sur M. F. Leuret" Annales medico-psychologiques, 2nd series, vol. III,July 1851, pp. 512 527.
9. It is Observation XXII: "Bearers ol imaginary titles and ranks" Du traitement moral de la folie, pp. 418-462.
10. 11. 12.
Ibid. pp. 421-424.
Ibid. p. 429.
P. Pinel, Traile medico-philosophique, op. cit. , section II, ? ix: "Intimider Pahene, mais ne point se permettre aucun acte de violence" p. 61; A Treatise on Insanity, "Intimidation too often associated with violence" pp. 64-65.
13. J. E. D. Esquirol, "De la folie" (1816) in Des maladies mentales vol. 1, p. 126; Mental Maladies, "Insanity," p. 76.
14. See above note 3. Already, for J. Guislain, this was one ol the advantages of "isolation in the treatment oi insanity": "Based on a leeling of dependence that he makes the insane person feel ( . . . ) lorced to conform to a loreign will" Traile sur I'alienation mentale, vol. I, p. 409.
19 December 1973 169
? 170 PSYCHIATRIC POWER
15- F. Leuret, Du irailemenl moral de lajolie, p. 422: "Dupre is a name oi convenience, a name oi disguise; his true name, as we well know, is Napoleon. "
16. Ibid. p. 423: "The distinctive sign of his Halcyon status is his constant ability to enjoy the pleasures of love. "
17. Ibid. p. 423: "Only he in the home is a man; all the others are women. "
18. EJ. Georgct, De lafolie. Considerations sur cette maladie, p. 284.
19. F. Leuret, Du traitement moral de lafolie, p. 429.
20. Ibid. p. 430. 21. Ibid. p. 430. 22. Ibid. p. 422. 23. Ibid. p. 431.
24. Ibid. p. 431. 25. Ibid. p. 432. 26. Ibid. p. 422.
27. Ibid. , p. 432.
28. Leuret defined his treatment thus: "I understand by moral treatment oi madness the reasoned use o( all means that act directly on the intelligence and passions of the insane" ibid. p. 156.
29. J. P.
Falret, Des maladies mentales et des asiles d'alienes, p. 690.
30.
31.
32. 33. 34. 35-
J. E. D. Esquirol, "De la folie" (1816) in Des maladies mentales, vol. I, p. 126; Mental Maladies, "Insanity," p. 76.
F. Leuret, Du traitement moral de lajolie, p. 424.
Ibid. p. 434.
Ibid. p. 435.
Ibid.
Michel Foucault is alluding here to the "money-excrement" relationship, which had a great
iuture in psychoanalytic literature. Mentioned by Freud in a letter to Fliess of 22 December
1897 (French translation in La Naissance de la psychanalyse. Lettres a Wilhelm Fliess, 1887-1902, trans. A Berman [Paris: P. U. F. , 19561 p. 212; English translation, The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887-190/I, trans. J. M. Masson [Cambridge, Mass. : The Belknap Press of Harvard University Press, 1985] p. 288), this symbolic relationship
is developed in the theory of anal eroticism. See, S. Freud, "Charakter und Analerotik"
( 1 9 0 8 ) in Gesammelle Werke | hereafter, GW] (Frankfurt: S. Fischer Verlag, 1941) vol. VII,
pp. 201 209; English translation "Character and Anal Eroticism" in The Standard Edition
oj the Complete Psychological Works of Sigmund Freud | hereaiter Standard Edition], trans, under General Editorship of James Strachey (London: The Hogarth Press, 1953 1974) vol. 9; "Uber Triebumsetzung insbesondere der Analerotik" (1917) in GW (1946) vol. X,
pp. 401 410; "On Transformations of Instinct as Exemplified in Anal Eroticism," Standard Edition, vol. 17. See also, E. Borneman, Psychoanalyse des Geldes. Eine kritische Untersuchungpsy- choanalytisher Geldtheorien (Frankiurt: Suhrkamp Verlag, 1973); French translation, Psychanalyse de Vargent. Une recherche critique sur les theories psychanalytiques de I'argent, trans. D. Guerineau (Paris: P. U. F. , 1978); English translation, The Psychoanalysis of Money
(New York: Urizen Books, 1976).
G. Ferrus, Des alienes. Considerations sur I'etat des maisons qui leur sont destinees, lanl en France qu'en Anglelerre; sur le regime hygienique et moral auquel ces malades doivent etre soumis; sur quelques questions de medecine legale el de legislation relatives a leur elat civil (Pains: printed by Mme. Huzard, 1834) p. 234.
36.
37. Ibid.
38. See above, lecture of 5 December 1973, note 18.
39. The "Sainte Anne iarm" derived irom the donation made by Anne of Austria in 1651 for
the construction of an establishment for taking in the sick during epidemics. Partially con structed, the land remained under cultivation. In 1833, Guillaume Ferrus (1784-1861), head doctor at Bicetre, decided to use it to put to work convalescents and able bodied incurables irom the three sections of the asylum. A decision oi the commission set up on 27 December i860 by the prefect Haussmann to "study the improvements and reforms to be carried out in the service for the insane of the Seine department" marked the end oi the iarm. The construction of an asylum, begun in 1863 according to the plans established
? under the directive oi Girard de Cailleux, was inaugurated on 1 May 1867. See, C. Guesstel,
AsHe d'alienes de Saintc-Anne a Paris (Versailles: Aubert, 1880).
'lO. Henri Girard de Cailleux (1814 1884) iilled the posts of head doctor and director ol the
Auxerre insane asylum lrom 20 June 1840 until his appointment in i860 as Inspector General for the Seine service for the insane. The quotation comes from his article: "De la construction et de la direction des asiles d'alienes" Annales d'hygiene publique et de medecine legate, vol. 40, 1st Part, July 1848, p. 30.
11. H. Belloc, Les Asiles d'alienes transformed en centres d'exploitation rurale, moyen d'exonerer en tout ou en partie les departements des depenses c/u'ils font pour leurs alienes en augmentant le bien-etre de ces maladcs, et en les rapprochant des conditions d'existence de Vhomme en societe (Pans: Bechet, 1862) p. 15.
|2. Foucault is alluding here to several earlier propositions: (a) In the lecture of 7 November 1973 he argues that the doctor's therapeutic process does not require "any discourse ol truth" (above, p. 10); ( b ) in that of 14 November Foucault claims that the "game ol truth, within delirium and of delirium, will be completely suppressed in the psychiatric practice that commences at the start oi the nineteenth century" (above, p. 35); and (c) in the lec- ture of 12 December 1973 he concludes that in psychiatric power the question of truth is never posed (above, p. 134).
15. F. Leu ret, Du traitement moral de lajolie, p. 423 and pp. 435 436.
14. Ibid.
15. Ibid. 16. Ibid. 17. Ibid. 18. Ibid. 19. Ibid.
50. Ibid.
51. Ibid,
p. 438.
p. 439.
p. 440.
pp. 440 442. p. 444.
pp. 444 445.
pp. 441 442.
52. F. Leuret, Fragments psychologiques sur lajolie, pp. 121-124.
53. T. Leuret, Du traitement moral de la /olie, pp. 449450.
54. Ibid. p. 449.
55. Ibid. p. 451.
56. Ibid. p. 425: "He does not dream of leaving the hospital and no longer fears the treatments with which he is threatened or that he has been made to undergo. "
57. Ibid. p. 426: "A red hot iron was applied once to the top of his head, and twice to the nape of his neck. "
58. Ibid. p. 429: "He then asks me ii it is a question oi his treatment; in which case he will resign himself to whatever I would like to do. "
59. Ibid. p. 430.
6 0 . Ibid. p. 453: "In a very short letter he let pass a dozen spelling mistakes, and it would have
been better if he had not aspired for a job of this kind. "
61. Ibid. p. 454: "I let the struggle get under way; M. Dupre detended himseli the best
he could, then, when he was too greatly pressed, I came to his aid, taking the role oi
conciliator. "
62. Ibid. p. 461.
19 December 1973 171
? eight
9 JANUARY 1974
Psychiatric power and the practice of "direction ". ^ The game of "reality" in the asylum. ^ The asylum, a medically demarcated
space and the question of its medical or administrative direction. ^ The tokens of psychiatric knowledge: (a) the technique of questioning; (b) the interplay of medication and punishment; (c) the clinical presentation. ^ Asylum "microphysics ofpower. " ^ Emergence of the Psyfunction and of neuropathology. ^ The triple destiny of psychiatric power.
I HAVE SHOWN THAT psychiatric power in its both archaic and elementary form, as it functioned in the proto-psychiatry of the first thirty or forty years of the nineteenth century, essentially operated as a supplement of power given to reality.
This means, first of all, that psychiatric power is above all a certain way of managing, of administering, before being a cure or therapeutic intervention: it is a regime. Or rather, it is because and to the extent that it is a regime of isolation, regularity, the use of time, a system of measured deprivations, and the obligation to work, etcetera, that certain therapeutic effects are expected from it.
Psychiatric power is a regime, but at the same time--and I have stressed this aspect--it seems to me that in the nineteenth century it is a struggle against madness conceived as a will in revolt, as an unbounded will, whatever nosographic analysis or description may ultimately be given of its phenomena. Even in a case of delirium, it is the will to
? 17xl PSYCHIATRIC POWER
believe in that delirium, the will to assert that delirium, the will at the heart of that assertion of the delirium, which is the target ol the strug gle that runs through and drives the psychiatric regime throughout its development.
Psychiatric power is therefore mastery, an endeavor to subjugate, and my impression is that the word that best corresponds to this function ing of psychiatric power, and which is found in all the texts Irom Pinel to Leuret,1 the term that recurs most frequently and appears to me to be entirely typical of this enterprise of both regime and mastery, of regu- larity and struggle, is the notion of "direction" (direction)* The history of this notion should be studied, because it did not originate in psychiatry--lar lrom it. In the nineteenth century this notion still carries a whole set of connotations arising lrom religious practice. For three or four centuries before the nineteenth century, "spiritual direction" (direction de conscience) defined a general field of techniques and objects. 2 At a certain point, some of these techniques and objects, along with this practice of direction, were imported into the psychiatric iield. It would be a history worth doing. Anyway, there's a track here: the psychiatrist is someone who directs the operations of the hospital and who directs individuals.
Just to indicate not only its existence, but also the clear awareness of this practice on the part of psychiatrists themselves, I will quote a text from 1861 which comes from the director of the Saint-Yon asylum: "In the asylum I direct, I praise, reward, reprimand, command, constrain, threaten, and punish every day; and for why? Am I not then a madman myself? And everything I do, my colleagues all do likewise; all, without exception, because it derives from the nature of things. "3
What is the aim of this "direction"? This is the point I got to last week. I think it is basically to give reality a constraining power. This means two things.
First of all it means making this reality inevitable and, as it were, commanding, making it function like power, giving it that supplement
* Nineteenth century English psychiatrists, and English translations of French psychiatrists, such as Pinel, generally use "management," or "moral treatment" etcetera, where the French use "direction," although the latter is occasionally used as well. Since Foucault explicitly draws attention to the term and its history I have left it as direction in English.
? oi vigor which will enable it to match up to madness, or to give it that extra reach which will enable it to get through to those individuals who are mad who flee it or turn away from it. So it is a supplement given to reality.
But at the same time, and this is the other aspect of psychiatric power, its aim is to validate the power exercised within the asylum as being quite simply the power of reality itself. What does this intra-asylum power claim to bring about by the way it functions within this planned space, and in the name of what does it justify itself as power?
5. Work, an essential component ol moral treatment, was conceived ol in the double perspec live of therapy (isolation) and discipline (order). See, P. Pinel, Traile medico-philosophique, section V, ? xxi: "L01 fondamentale de tout hospice d'alienes, celle d'un travail mecanique": "Constant work changes the vicious circle ol ideas, clanhes the laculties ol understanding by exercising them, alone keeps order wherever the insane are assembled, and dispenses with a host ol detailed and often pointless rules in order to maintain inter
nal police" p. 225; A Treatise on Insanity, "Mechanical employment essential to the success
ful management of lunatic hospitals" p. 217. Cf. , C. Bouchct, "Du travail applique aux alienes" Annales medico-psychologiques, vol. XII, November 1848, pp. 301-302. In Hisloire de
? lajolie, pp. 505 506; Madness and Civilisation, pp. 247 249, Foucault refers to a study by Jean Calvet, from 1952, on the historical origins ol the work ol patients in insane asylums. 6. P. Pinel lends his authority to the shower by making it an instrument of both treatment and conditioning. See the second, revised and expanded edition of his Traitemedico-
philosophique sur {'alienation mentale (Paris: Caille et Ravier, 1809) pp. 205-206. See also, H. Girard de Cailleux, "Considerations sur le traitement des maladies mentales" Annales medico-psychologiques, vol. IV, November, 1844, pp. 330-331; H. Rech (de Montpellier), "De la douche et des affusions d'eau Iroide sur la tete dans le traitement des alienations men- tales" ibid. vol. IX, January 1847, pp. 124 125. It is Francois Leuret especially who makes use of it in Traitement moral de lafolie, ch. 3, ? "Douches et affusions froides" pp. 158-162. See Foucault's discussion of M. Dupre's cure in this and the following lecture (above, French p. 143 sq. and below, French p. 173 sq). Foucault devotes several pages to this cure in: Maladie mentale et Psychologic (Paris: P. U. F. , 1962) pp. 85-86; English translation, Mental Illness and Psychology, trans. Alan Sheridan (Now York: Harper and Row, 1976) p. 72; Histoire de lajolie, p. 338 and pp. 520-521; Madness and Civilisation, p. 172 and pp. 266 267; and "L'eau et la iolie" Dils et Ecrits, vol. 1, pp. 268-272. He returns to it in "Sexuality and Solitude" London Review of Books, 21 May 5 June 1981, p. 3 and pp. 5 6, reprinted in The Essential Works oj Foucault, 1954-19$/l, vol. 1: Ethics: subjectivity and truth, ed. Paul Rabinow, trans. Robert Hurley and others (New York: The New Press, 1997) pp. 175 176; French translation, "Sexualite et solitude," trans. F. Durand Bogaert, Dits el Ecrits, vol. 4. , pp. 168 169.
7. The rotary swing was perfected by the English doctor Erasmus Darwin (1731-1802) and used to treat madness by Mason Cox, who praised its eilectiveness: "I think it can be put
to both a moral and a physical use, and be employed with success both as a means of rebel
and as a means oi discipline, in order to make the patient more adaptable and docile" Observations sur la demence, p. 58. | It has not been possible to consult the first, 1804, edi tion of Practical Observations on Insanity, on which the French translation is based, and the passage quoted here does not appear in the second, 1806, edition. However, reierence is made to the rotary swing elsewhere in the 1806 edition, e. g. , p. 137; G. B. ] See, L. Amard, Traite analytique de la folie et des moyens de la guerir (Lyon: printed by Ballanche, 1807)
pp. 80 93; J. Guislain, Traite sur Valienation mentale, vol. I, book IV, and, Moyens diriges sur le systeme nerveux cerebral. De la rotation (Amsterdam: Van der Hey, 1826) p. 374 and p. 404; C. Buvat Pochon, Les Traitemenls de choc d'autrejois en psychiatric Leurs liens avec les therapeu- tiques modernes, Medical thesis, Paris, no. 1262 (Paris: Le Francois, 1939). See Histoire de la
Jolie, pp. 341 342; Madness and Civilisation, pp. 176-177.
8. While he was alive, Leuret had to defend himself from critics who condemned his practice
as, in his own words, "retrograde and dangerous" (DM traitement moral de lafolie, p. 68). His main opponent was E. S. Blanche, in his paper to the royal Academy of medicine, Du dan-
ger des rigueurs corporelles dans le traitement de lajolie (Paris: Gardembas, 1839), as well as in his short work, De Fetal actuel du traitement de lajolie en France (Paris: Gardembas, 1840). These polemics were echoed in Leuret's obituary notices: U. Trelat, "Notice sur Leuret" Annales d'hygiene publique et de medecine legale, vol. 45, 1851, pp. 241-262; and A. Brierre de Boismont, "Notice biographique sur M. F. Leuret" Annales medico-psychologiques, 2nd series, vol. III,July 1851, pp. 512 527.
9. It is Observation XXII: "Bearers ol imaginary titles and ranks" Du traitement moral de la folie, pp. 418-462.
10. 11. 12.
Ibid. pp. 421-424.
Ibid. p. 429.
P. Pinel, Traile medico-philosophique, op. cit. , section II, ? ix: "Intimider Pahene, mais ne point se permettre aucun acte de violence" p. 61; A Treatise on Insanity, "Intimidation too often associated with violence" pp. 64-65.
13. J. E. D. Esquirol, "De la folie" (1816) in Des maladies mentales vol. 1, p. 126; Mental Maladies, "Insanity," p. 76.
14. See above note 3. Already, for J. Guislain, this was one ol the advantages of "isolation in the treatment oi insanity": "Based on a leeling of dependence that he makes the insane person feel ( . . . ) lorced to conform to a loreign will" Traile sur I'alienation mentale, vol. I, p. 409.
19 December 1973 169
? 170 PSYCHIATRIC POWER
15- F. Leuret, Du irailemenl moral de lajolie, p. 422: "Dupre is a name oi convenience, a name oi disguise; his true name, as we well know, is Napoleon. "
16. Ibid. p. 423: "The distinctive sign of his Halcyon status is his constant ability to enjoy the pleasures of love. "
17. Ibid. p. 423: "Only he in the home is a man; all the others are women. "
18. EJ. Georgct, De lafolie. Considerations sur cette maladie, p. 284.
19. F. Leuret, Du traitement moral de lafolie, p. 429.
20. Ibid. p. 430. 21. Ibid. p. 430. 22. Ibid. p. 422. 23. Ibid. p. 431.
24. Ibid. p. 431. 25. Ibid. p. 432. 26. Ibid. p. 422.
27. Ibid. , p. 432.
28. Leuret defined his treatment thus: "I understand by moral treatment oi madness the reasoned use o( all means that act directly on the intelligence and passions of the insane" ibid. p. 156.
29. J. P.
Falret, Des maladies mentales et des asiles d'alienes, p. 690.
30.
31.
32. 33. 34. 35-
J. E. D. Esquirol, "De la folie" (1816) in Des maladies mentales, vol. I, p. 126; Mental Maladies, "Insanity," p. 76.
F. Leuret, Du traitement moral de lajolie, p. 424.
Ibid. p. 434.
Ibid. p. 435.
Ibid.
Michel Foucault is alluding here to the "money-excrement" relationship, which had a great
iuture in psychoanalytic literature. Mentioned by Freud in a letter to Fliess of 22 December
1897 (French translation in La Naissance de la psychanalyse. Lettres a Wilhelm Fliess, 1887-1902, trans. A Berman [Paris: P. U. F. , 19561 p. 212; English translation, The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887-190/I, trans. J. M. Masson [Cambridge, Mass. : The Belknap Press of Harvard University Press, 1985] p. 288), this symbolic relationship
is developed in the theory of anal eroticism. See, S. Freud, "Charakter und Analerotik"
( 1 9 0 8 ) in Gesammelle Werke | hereafter, GW] (Frankfurt: S. Fischer Verlag, 1941) vol. VII,
pp. 201 209; English translation "Character and Anal Eroticism" in The Standard Edition
oj the Complete Psychological Works of Sigmund Freud | hereaiter Standard Edition], trans, under General Editorship of James Strachey (London: The Hogarth Press, 1953 1974) vol. 9; "Uber Triebumsetzung insbesondere der Analerotik" (1917) in GW (1946) vol. X,
pp. 401 410; "On Transformations of Instinct as Exemplified in Anal Eroticism," Standard Edition, vol. 17. See also, E. Borneman, Psychoanalyse des Geldes. Eine kritische Untersuchungpsy- choanalytisher Geldtheorien (Frankiurt: Suhrkamp Verlag, 1973); French translation, Psychanalyse de Vargent. Une recherche critique sur les theories psychanalytiques de I'argent, trans. D. Guerineau (Paris: P. U. F. , 1978); English translation, The Psychoanalysis of Money
(New York: Urizen Books, 1976).
G. Ferrus, Des alienes. Considerations sur I'etat des maisons qui leur sont destinees, lanl en France qu'en Anglelerre; sur le regime hygienique et moral auquel ces malades doivent etre soumis; sur quelques questions de medecine legale el de legislation relatives a leur elat civil (Pains: printed by Mme. Huzard, 1834) p. 234.
36.
37. Ibid.
38. See above, lecture of 5 December 1973, note 18.
39. The "Sainte Anne iarm" derived irom the donation made by Anne of Austria in 1651 for
the construction of an establishment for taking in the sick during epidemics. Partially con structed, the land remained under cultivation. In 1833, Guillaume Ferrus (1784-1861), head doctor at Bicetre, decided to use it to put to work convalescents and able bodied incurables irom the three sections of the asylum. A decision oi the commission set up on 27 December i860 by the prefect Haussmann to "study the improvements and reforms to be carried out in the service for the insane of the Seine department" marked the end oi the iarm. The construction of an asylum, begun in 1863 according to the plans established
? under the directive oi Girard de Cailleux, was inaugurated on 1 May 1867. See, C. Guesstel,
AsHe d'alienes de Saintc-Anne a Paris (Versailles: Aubert, 1880).
'lO. Henri Girard de Cailleux (1814 1884) iilled the posts of head doctor and director ol the
Auxerre insane asylum lrom 20 June 1840 until his appointment in i860 as Inspector General for the Seine service for the insane. The quotation comes from his article: "De la construction et de la direction des asiles d'alienes" Annales d'hygiene publique et de medecine legate, vol. 40, 1st Part, July 1848, p. 30.
11. H. Belloc, Les Asiles d'alienes transformed en centres d'exploitation rurale, moyen d'exonerer en tout ou en partie les departements des depenses c/u'ils font pour leurs alienes en augmentant le bien-etre de ces maladcs, et en les rapprochant des conditions d'existence de Vhomme en societe (Pans: Bechet, 1862) p. 15.
|2. Foucault is alluding here to several earlier propositions: (a) In the lecture of 7 November 1973 he argues that the doctor's therapeutic process does not require "any discourse ol truth" (above, p. 10); ( b ) in that of 14 November Foucault claims that the "game ol truth, within delirium and of delirium, will be completely suppressed in the psychiatric practice that commences at the start oi the nineteenth century" (above, p. 35); and (c) in the lec- ture of 12 December 1973 he concludes that in psychiatric power the question of truth is never posed (above, p. 134).
15. F. Leu ret, Du traitement moral de lajolie, p. 423 and pp. 435 436.
14. Ibid.
15. Ibid. 16. Ibid. 17. Ibid. 18. Ibid. 19. Ibid.
50. Ibid.
51. Ibid,
p. 438.
p. 439.
p. 440.
pp. 440 442. p. 444.
pp. 444 445.
pp. 441 442.
52. F. Leuret, Fragments psychologiques sur lajolie, pp. 121-124.
53. T. Leuret, Du traitement moral de la /olie, pp. 449450.
54. Ibid. p. 449.
55. Ibid. p. 451.
56. Ibid. p. 425: "He does not dream of leaving the hospital and no longer fears the treatments with which he is threatened or that he has been made to undergo. "
57. Ibid. p. 426: "A red hot iron was applied once to the top of his head, and twice to the nape of his neck. "
58. Ibid. p. 429: "He then asks me ii it is a question oi his treatment; in which case he will resign himself to whatever I would like to do. "
59. Ibid. p. 430.
6 0 . Ibid. p. 453: "In a very short letter he let pass a dozen spelling mistakes, and it would have
been better if he had not aspired for a job of this kind. "
61. Ibid. p. 454: "I let the struggle get under way; M. Dupre detended himseli the best
he could, then, when he was too greatly pressed, I came to his aid, taking the role oi
conciliator. "
62. Ibid. p. 461.
19 December 1973 171
? eight
9 JANUARY 1974
Psychiatric power and the practice of "direction ". ^ The game of "reality" in the asylum. ^ The asylum, a medically demarcated
space and the question of its medical or administrative direction. ^ The tokens of psychiatric knowledge: (a) the technique of questioning; (b) the interplay of medication and punishment; (c) the clinical presentation. ^ Asylum "microphysics ofpower. " ^ Emergence of the Psyfunction and of neuropathology. ^ The triple destiny of psychiatric power.
I HAVE SHOWN THAT psychiatric power in its both archaic and elementary form, as it functioned in the proto-psychiatry of the first thirty or forty years of the nineteenth century, essentially operated as a supplement of power given to reality.
This means, first of all, that psychiatric power is above all a certain way of managing, of administering, before being a cure or therapeutic intervention: it is a regime. Or rather, it is because and to the extent that it is a regime of isolation, regularity, the use of time, a system of measured deprivations, and the obligation to work, etcetera, that certain therapeutic effects are expected from it.
Psychiatric power is a regime, but at the same time--and I have stressed this aspect--it seems to me that in the nineteenth century it is a struggle against madness conceived as a will in revolt, as an unbounded will, whatever nosographic analysis or description may ultimately be given of its phenomena. Even in a case of delirium, it is the will to
? 17xl PSYCHIATRIC POWER
believe in that delirium, the will to assert that delirium, the will at the heart of that assertion of the delirium, which is the target ol the strug gle that runs through and drives the psychiatric regime throughout its development.
Psychiatric power is therefore mastery, an endeavor to subjugate, and my impression is that the word that best corresponds to this function ing of psychiatric power, and which is found in all the texts Irom Pinel to Leuret,1 the term that recurs most frequently and appears to me to be entirely typical of this enterprise of both regime and mastery, of regu- larity and struggle, is the notion of "direction" (direction)* The history of this notion should be studied, because it did not originate in psychiatry--lar lrom it. In the nineteenth century this notion still carries a whole set of connotations arising lrom religious practice. For three or four centuries before the nineteenth century, "spiritual direction" (direction de conscience) defined a general field of techniques and objects. 2 At a certain point, some of these techniques and objects, along with this practice of direction, were imported into the psychiatric iield. It would be a history worth doing. Anyway, there's a track here: the psychiatrist is someone who directs the operations of the hospital and who directs individuals.
Just to indicate not only its existence, but also the clear awareness of this practice on the part of psychiatrists themselves, I will quote a text from 1861 which comes from the director of the Saint-Yon asylum: "In the asylum I direct, I praise, reward, reprimand, command, constrain, threaten, and punish every day; and for why? Am I not then a madman myself? And everything I do, my colleagues all do likewise; all, without exception, because it derives from the nature of things. "3
What is the aim of this "direction"? This is the point I got to last week. I think it is basically to give reality a constraining power. This means two things.
First of all it means making this reality inevitable and, as it were, commanding, making it function like power, giving it that supplement
* Nineteenth century English psychiatrists, and English translations of French psychiatrists, such as Pinel, generally use "management," or "moral treatment" etcetera, where the French use "direction," although the latter is occasionally used as well. Since Foucault explicitly draws attention to the term and its history I have left it as direction in English.
? oi vigor which will enable it to match up to madness, or to give it that extra reach which will enable it to get through to those individuals who are mad who flee it or turn away from it. So it is a supplement given to reality.
But at the same time, and this is the other aspect of psychiatric power, its aim is to validate the power exercised within the asylum as being quite simply the power of reality itself. What does this intra-asylum power claim to bring about by the way it functions within this planned space, and in the name of what does it justify itself as power?
