"If I have
succeeded
in putting the works relating to the morbid anatomy ol the nervous centers in their true light, you will not have (ailed to recognize the main tendency which becomes more pronounced in all these works.
Foucault-Psychiatric-Power-1973-74
It is olten said that this consisted in getting a hysteric and saying to his students: "See what illness she is afiected by," and, effectively, dictating symptoms to the patient.
This is true, it corresponds to the first maneuver I was telling you about, but I think the major and most subtle and perverse of Charcot's maneuvers, was precisely displaying these two hgures together.
When traumatized people from outside the hospital appeared at his private oflice--the vic- tims o) different kinds ol accidents with no visible traces of lesions and sulfering from paralysis, coxalgia, anesthesia--Charcot called for a hysteric, hypnotized him and said: "You can no longer walk," and looked to see whether the hysteric's paralysis really was similar to that of the person traumatized.
A famous case of this kind was one ol post-traumatic coxalgia in a railroad employee.
Charcot was almost sure that the coxalgia was not caused by a lesion; he had a feeling however that it was not a pure and simple simulation.
He called for two hysterics, hypnotized them, and gave them instructions through which he managed to reconstitute the employee's coxalgia on the kind ol lunctional mannequin that the hysteric had become, and so the coxalgia had to be considered hysterical?
'
Everyone benefits. In the first place, the insurance companies, of course, and the people who had to pay, and, also the patient to a certain extent, since, if he is not a simulator, a malingerer, Charcot said, we can not deny him something, albeit, obviously, not of the same order as ll he had a real injury. So the cake was cut in two. However, clearly this is not the important problem: the doctor also benelits since, thanks to the use of the hysteric as a lunctional mannequin, the doctor could make a dif lerential diagnosis that will now be brought to bear on the simulator. One will now be able to master the iamous panic dread of the simulator that so obsessed doctors in the first half of the nineteenth century, since one will have these hysterics who, traitors to their own lie, as it were, will make it possible to denounce the lie of others, and, as a result, the doctor will hnally have the upper hand over simulation. '8
Finally, ol course, the hysterics beneht, since il they serve as functional mannequins in this way, authenticating the functional or, as
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it was said at this time, "dynamic" illness without lesion, if the hysteric is there to authenticate this illness, then she inevitably escapes all suspicion of simulation, since she is the basis on which the simulation of others can be denounced. As a result, it is once again thanks to the hysteric that the doctor will be able to ensure his power; if he escapes the simulator's trap it is because he has the hysteric who makes possible the double, organic/dynamic/simulation, differential diagnosis. And con- sequently, the hysteric has the upper hand over the doctor a second time, since by obeying the instructions he gives her under hypnosis, she gets to be the authority of verification, as it were, the authority adjudicating truth between illness and lie. The second triumph of the hysteric. You understand that here too the hysterics do not hesitate to reconstitute, on demand, the coxalgia and anesthesia, etcetera that they are asked for under hypnosis.
Hence the third maneuver of redistribution around the trauma. At the end of the second maneuver, the doctor is therefore once again newly dependent on the hysteric, because if the disorders reproduced on order by the hysteric, and so generously, so profusely, with such obedience and, at the same time, with such a thirst for power, will not this be proof after all that it is all fabricated, as Bernheim was already beginning to say? H9 In the end, is not the appearance of this great hysterical symp- tomatology at la Salpetriere all due to the set of medical powers being exercised within the hospital?
If the doctor is not to be entirely dependent on this hysterical behav- ior which could well be said to be fabricated, if he is to renew his power over all this phenomena and take it back under his control, he will have to include within a strict pathological schema both the fact that some one can be hypnotized and the fact that he reproduces pathological types of phenomena under hypnosis, and, at the same time, that those well known lunctional disorders, which Charcot had shown were so close to hysterical phenomena, can be placed in this pathological frame- work. A pathological framework is needed which simultaneously envelops hypnosis, the hysterical symptoms produced under hypnosis, and the event which brings about the functional disorders oi patients who are not hypnotized. Since the body cannot speak because there is no lesion, this search for a pathological framework leads Charcot to look for
? an assignable cause. One will have to look at the etiological level for something on which to pin all these phenomena and thereby attach them to a rigorous pathology, that is to say, what one will have to discover is an event.
This was how Charcot developed the concept ol trauma. 50
What is a trauma for Charcot? It is something--a violent event, a blow, a (all, a (ear, a spectacle, etcetera--which provokes a sort of dis- crete, localized hypnotic state, but which sometimes lasts for a long time, so that, following the trauma, a certain idea enters the individual's head, inscribes itself in his cortex, and acts like a sort of permanent injunction.
An example of a trauma: a child is knocked down by a vehicle; he faints. In the moment before fainting he has the feeling that the wheels ol the vehicle run over his body. He comes to and, after a time, realizes that he is paralyzed; and if he is paralyzed it is because he thinks the wheels ran over his body. 51 Now this belief is inscribed and continues to (unction within a set ol micro hypnotic states, within a localized hyp- notic state concerning this beliel. What provokes paralysis o( the legs is, as it were, this idea that has become a hypnotic injunction? 2 We see here how the notion of trauma, which will be so important in the iuture, is established and, at the same time, the link between this notion and the old conception of delirium. Since if he is paralyzed, it is because he believes that the wheels of the van ran over him--you can see how this is linked with the old conception of madness always concealing a delirium. 5* So, a trauma is something that provokes a localized and permanent hypnotic state on just this point.
As for hypnotism, what is it? Well, it will also be a trauma, but in the form ol a complete, brief, transitory shock, which will be suspended solely by the doctor's will, but which will envelop the individual's general behavior, so that within this state of hypnosis, which is a sort oi generalized and provisional trauma, the doctor's will, his words, will be able to implant ideas and images in the subject which thus have the same role, the same Iunction, and the same eilect of injunction as the injunction I was talking about with regard to natural, non-hypnotic traumas. Thus, between hysterical phenomena produced under hypno- sis and hysterical phenomena following an event, there is a convergence
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which points towards this fundamental notion of trauma. Trauma is what provokes hypnosis, and hypnosis is a sort of general reactivation o( the trauma through the doctor's will.
Hence the need in Charcot's practice to go in search of the trauma itself.
That is to say, to be sure that the hysteric really is a hysteric and that all her symptoms, whether under hypnosis or outside ol hypnosis, really are pathological, one will have to discover the etiology, to find the trauma, the kind of invisible and pathological lesion which makes all of this a well and truly morbid whole. * Hence the necessity for hysterics, whether or not they are under hypnosis, to recount their childhood, their life, so as to lind again that kind of fundamental and essential event that will persist and is always present in the hysterical syndrome, and of which the latter is in some way the permanent actual izati on. Vl'
However--and here we find the hysteric again and her counter- maneuver--what will the patients do with this injunction to find the trauma that persists in the symptom? Into the breach opened by this injunction they will push their lile, their real, everyday life, that is to say, their sexual hie. It is precisely this sexual life that they will recount, that they will connect up with the hospital and endlessly reactualize in the hospital. Unfortunately, we cannot trust Charcot's text for prool of this counter-investment of the search for the trauma by the story of sexual life, because Charcot does not talk about it. However, when we look at his students' observations, we see what is involved throughout these anamneses, what was at stake, what was talked about, and also what was really involved m the famous attacks with a pseudo-epileptic lorm. I will take just one example, a case recorded by Bourneville.
This is how the patient recounted her life. From age six to thirteen she was a boarder in a religious convent "at La Ferte sous Jouarre where she enjoyed a degree ol lreedom, wandered in the countryside, willingly let herself be kissed for sweets. " This is the protocol produced by one ol Charcot's students on the basis of the patient's own accounts. "She often
* The manuscript clarifies: "Hence the double search: (a) lor the nervous diathesis which causes susceptibility to trauma; search for heredity. And then (b) for the trauma itsell. "
t The manuscript adds: "Hence the violence ol the opposition to Bernheim: if everyone could be hypnotized the edifice would collapse. "
? visited the wife ol a workman, Jules, a painter. The latter was in the habit of getting drunk, and when this happened there were violent arguments in the household; he beat his wife, dragged her or tied her up by the hair. Louise [the patient; M. F. ] sometimes witnessed these scenes. One day,Jules would have tried to kiss her, even rape her, which gave her a great fright. During the holidays [she was aged between six and thirteen years; M. F. |, she came to Paris and spent the days with her brother, Antonio, one year younger than her, who seems to have been very precocious and taught her many things she should not have known. He mocked her naivety, which led her to accept the explanation he gave to her of, amongst other things, how children are made. During the hoi idays, in the house where her parents were in service, she had the opportunity to see a Mr. C [the master of the house; M. F. ], who was her mother's lover. Her mother obliged Louise to kiss this man and wanted her to call him her father. On her permanent return to Pans, Louise was placed [after her period of boarding, so she was 13; M. F. ] in C's home on the pretext of learning to sing and sew, etcetera. She slept in a little isolated room. C, whose relationship with his wife was a bit strained, took advantage of her absences to try to have relations with Louise, aged thirteen and a half. The first time, he failed; he wanted her to go to bed in front of him. A second attempt ended in some incomplete approaches, due to her resistance. A third time, C, after dangling all sorts of promises before her eyes, hne gowns, etcetera, seeing that she did not want to give in, threatened her with a razor; taking advantage of her fear, he got her to drink a liqueur, undressed her, threw her down on his bed, and had full sexual intercourse with her. The following day Louise was suffering, etcetera. "^
The lives of hysterics recounted by Charcot's patients are in fact often of this order and level. And, if we look at the observations taken for Charcot by his students, what really happened in those famous attacks that Charcot said were strangely similar to epileptic fits and very diffi- cult to distinguish from epileptic fits if you were not a good neurologist?
At the level of the discourse, this is what Louise said: "Tell me! . . . You must tell me! Peasant! You must be vile. So you believe this boy more than me. . . I swear to you that this boy has never laid a hand on me. . . I did not respond to his caresses, we were in a held . . . I assure you that I did not
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want it. . . Call them (Commanding physiognomy). Well? (She suddenly looks to her right) . . . But that is not what you said to him! . . . Antonio, you must repeat what he told you . . . that he touched me . . . But I did not want. Antonio, you are lying! . . . It is true, he had a snake in his pants, he wanted to put it in my belly, but he did not even find m e . . . let's finish with it. . . We were on a bench . . . You kissed me more than once, I did not kiss you; I am a lunatic . . . Antonio, you are laughing. . ,"56
Discourses like this take place in the period called delirious, the last period of Charcot's analysis. And if we go back to the "plastic" phase of "passionate poses," this is the form they take in another patient: "Celina M is attentive, sees someone, motions with her head for him to come to her, opens her arms, brings them together as if she was embracing the imaginary being. Her physiognomy expresses discontent to start with, disappointment, then, in a sudden change, happiness. At this point we see some movements of the stomach; her legs bend, M falls back on her bed and makes new clonic movements. With a rapid movement she moves her body to the right side of the bed, her head resting on the pillow; her face is flushed, her body partly rolls over on itself, her right cheek lying on the pillow, her face looking to the right, the patient presents her buttocks, which are raised, the lower limbs being bent. Alter some moments, while maintaining this lubricious position, M makes some movements with her pelvis. She then stands up and has some major clonic movements. Finally, she grimaces, cries, seems deeply frustrated. She sits down again, looks to the left, signals with her head and right hand. She witnesses varied scenes, seeming, by the play ol her physiog- nomy, to experience pleasant and painful sensations alternately Suddenly, she puts her body back in the middle of the bed, raises it slightly and, with her right hand, makes the gestures of the mea culpa, followed by contortions and grimaces. Then she lets out some sharp cries: 'Oh! la! laP smiles, looks around with a lubricious air, sits down, seems to see Ernest and says: 'Well come on then! Come on! ' "57
So, at the level of the daily observations of patients by Charcot's students, this is the real content of these attacks.
Now I think this is where the hysterics, for the third time, take back power over the psychiatrist, lor these discourses, scenes, and postures, which Charcot codiiied under the term "pseudo-epilepsy" or "major
? hysterical attack," analogous to but different from epilepsy, all of this real content that we see in everyday observations, could not in fact be admitted by Charcot. Not for reasons of morality or prudishness, if you like, but he quite simply could not accept it. If you recall, I spoke to you about neurosis as it existed and was discredited around the 1840s, as it was again in Charcot's time by Jules Falret. Why was it discredited? 58 It was discredited both because it was simulation--and Charcot tried to get round this objection--and because it was sexual, because it included a number of lubricious elements. If one really wanted to succeed in demonstrating that hysteria was a genuine illness, if one absolutely wanted to make it work within the system of differential diagnosis, if one did not want its status as illness to be challenged, then it had to be entirely shorn of that disqualifying element which was as harmful as simulation, namely lubricity or sexuality/ Therefore it really was necessary that it did not arise, or was not said.
Now, he could not prevent it from occurring, since it was he, Charcot, who was calling for symptoms, for attacks. And, in fact, the patients pro- vided many attacks, the surface symptomatology and general scenario of which conformed to the rules laid down by Charcot. But under the cover of this scenario, as it were, they crammed in all their individual life, sexuality, and memories; they reactualized their sexuality, and at the very heart of the hospital, with the interns or doctors. Consequently, since Charcot could not prevent this from happening, there was only one thing he could do, which was not to say it, or rather, to say the opposite. In fact, you can read this in Charcot, which is paradoxical when you know the observations on which it is based. He said: "For my own part, I am far from thinking that lubricity is always at work in hysteria; I am even convinced of the contrary. "59
And you recall the episode that takes place one evening in the winter of 1885-1886, while Freud was training with Charcot and, invited to Charcot's house, was amazed to hear Charcot say in an aside to someone: "Oh! hysteria, everyone knows full well that it is a matter of sexuality. " And Freud comments saying: "When I heard this I was really surprised
* The manuscript adds: "If it was let back in, then the whole edifice of pathologization con- structed in competition with the hysterics was going to collapse. "
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and said to myself: 'But if he knows, why doesn't he say so? ' "60 If he did not say so, it was, I think, for these reasons. Only, one might wonder how Freud, who spent six months at la Salpetriere, and who therefore was present every day at the scenes of which I have given you [two] examples, did not speak of it either with regard to his stay at la Salpetriere, and one might wonder how the discovery of sexuality in hysteria only emerged for him some years later. 61 Charcot's only possi bility was quite precisely not to see and not to speak.
For amusement, I will quote this little episode I lound in the Charcot archives; it is a student's note, that what's more is without irony: "M. Charcot sends for Genevieve, suffering lrom hysterical spasms. She is on a stretcher; the interns, the senior doctors have previously hypno- tized her. She undergoes her major hysterical attack. Charcot, following his usual technique, shows how hypnosis can not only provoke, induce hysterical phenomena, but can also stop them; he takes his baton, rest- ing it on the patient's belly, precisely on the ovaries, and the attack is in fact suspended. Charcot removes his baton; the attack begins again; tonic period, clonic period, delirium and, at the moment of delirium, Genevieve cries out: 'Camille! Camille! Kiss me! Give me your cock. ' Professor Charcot has Genevieve taken away; her delirium continues. "62
It seems to me that this kind of bacchanal, this sexual pantomime, is not the as yet undeciphered residue of the hysterical syndrome. My impression is that this sexual bacchanal should be taken as the counter- maneuver by which the hysterics responded to the ascription of trauma: You want to find the cause of my symptoms, the cause that will enable you to pathologize them and enable you to function as a doctor; you want this trauma, well, you will get all my life, and you won't be able to avoid hearing me recount my life and, at the same time, seeing me mime my life anew and endlessly reactualize it in my attacks!
So this sexuality is not an indecipherable remainder but the hysteric's victory cry, the last maneuver by which they finally get the better of the neurologists and silence them: If you want symptoms too, something functional; if you want to make your hypnosis natural and each of your injunctions to cause the kind of symptoms you can take as natural; if you want to use me to denounce the simulators, well then, you really will have to hear what I want to say and see what I want to
? do! And Charcot, who saw everything, who, in the low slanting daylight, saw even the smallest dimples and the smallest humps on a paralytic's face,63 was indeed obliged to turn his admirable eyes away when the patient was saying all that she had to say.
At the end of this kind of great battle between the neurologist and the hysteric, around the clinical apparatus of n euro pathology, a new body appears beneath the apparently captured neurological body,* beneath the body that the neurologist hoped and believed he had really captured in truth. This new body is no longer the neurological body; it is the sexual body. It is the hysteric who imposes this new personage on neurologists and doctors, which is no longer the pathological-anatomical body of Laennec and Bichat, the disciplinary body of psychiatry, or the neurological body of Duchenne de Boulogne or Charcot, but the sexual body, confronted with which henceforth only two attitudes were possible.
Either there is the attitude of Charcot's successor, Babinski, which consists in a retrospective devaluation of hysteria, which, since it has these connotations, will no longer be an illness. 67' Or there is a new attempt to circumvent the maneuver of hysterical encirclement, so as to give a medical meaning to this new course that loomed up on all sides around the neurological body fabricated by the doctors. This new investment will be the medical, psychiatric, and psychoanalytic take over of sexuality.
By breaking down the door of the asylum, by ceasing to be mad so as to become patients, by finally getting through to a true doctor, that is to say, the neurologist, and by providing him with genuine functional symptoms, the hysterics, to their greater pleasure, but doubtless to our greater misfortune, gave rise to a medicine of sexuality.
* Manuscript variant: "and by which one wanted to judge madness, to question it in truth . . . "
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1.
"If I have succeeded in putting the works relating to the morbid anatomy ol the nervous centers in their true light, you will not have (ailed to recognize the main tendency which becomes more pronounced in all these works. All seem, in some way, dominated by what we could call the spirit of localization, which is in fact only an ollshoot of the spirit of analysis" J. -M. Charcot, "Faculte de Medecine dc Paris: Anatomo-pathologie du systeme nerveux," Progres medical, 71'1 year, no. 14, 5 April 1879, p. 161.
2. On Bichat, see above note }8 to the lecture ol 9 January 1974.
3. On Laennec, see ibid. From 1803, Laennec gave a private course ol pathological
anatomy, which he wanted to make into a separate discipline. He put lorward an anatomical-pathological classification ol organic affections derived from, but more com plete than that ol Bichat; see, "Anatomie palhologicjue," in Didionnaire des sciences medicates, vol. II (Paris: C. L. F. Panckoucke, 1812) pp. 46-61. See the chapter Foucatilt devotes to pathological anatomy, "[. 'invisible visible" in Naissance de la clinique, pp. 151-176; The Birth oj the Clinic, ch. 9, "The Visible Invisible" pp. 149-173.
4. This is the observation ol I. N. , eighteen years old, suffering from ptosis of the lelt eyelid, presented at the consultation of 18 February 1891. See J. M. Charcot, Clinique des maladies du systeme nerveux (7##9-7#9/), Lectures edited by C. Guinon, Lecture of 24 February 1891 (recorded by A. Souques), vol. I (Paris: Aux bureaux du Progres medical/Vw Babe, 1892) p. 332.
5. On the "anatomical clinical gaze" see Naissance de la clinique, ch. 8, "Ouvrez quelques cadavres," pp. 136-142, and ch. 9, "L'invisible visible," pp. 164-172; The Birth of the Clinic, ch. 8, "Open Up a Few Corpses," pp. 124-148, and ch. 9, "The Visible Invisible," pp. 149-173.
6. Ibid. , ch. 6, "Des signes et des cas"; ibid. , ch. 6, "Signs and Cases. "
7. Foucault is relernng to the clinical mode of examination by "percussion" lor which Jean Nicolas Corvisart (1755-1821) became the advocate after translating and annotating the work of the Viennese Leopold Auenbrugger (1722-1809): Invenlum novum ex percussione thoracis humani ul signo abstrusos inlerni pecloris morhos delegendi ( Vindobonae: Typis Joannis Thomas Trattner, 1761; French translation, Nouvelle melhode pour reconnaitre les maladies internes de la poitrine par la percussion de cette cavite, trans, and commentary J. N. Corvisart
(Paris: Migneret, 1 8 0 8 ) ) . In September 1816 Laennec perfected the stethoscope at the Necker hospital; see R. T. H. Laennec, De I'auscultation mediate; A Treatise on Mediate
Auscultation.
8. As a result of numerous works, including those of the physiologist Francois Magendie (1783-1855) in 1826, which resorted to electrical stimulation in order to study the mech anisms of nervous excitation and muscular contraction, G. B. A. Duchenne de Boulogne used "Faradization" to explore the excitability of muscles and nerves and to establish the diagnosis and treatment of their affections. He set out the results m a first paper presented in 1847 to the Academie des sciences: (1) "De l'art de limiter l'action electrique dans les organes, nouvelle methode d'electrisation appelee 'electrisation localisee,' " republished in Archives generates de medecine,)u\y and August 1850, and February and March 1851. In 1850 he set out in a second report a method of "galvanization" using continuous currents with the aim of studying muscular functions and providing the means for "a differential diag nosis of paralyses": ( 2 ) Application de la galvanisation localisee a /'elude desJondions muscu/aires (Paris: J. B. Baillierc, 1851). All these works were brought together in one work: ( 3 ) De /'electrisation localisee el de son application a la physiologie, a la pathologie et a la therapeulique (Paris: J. B. Bailliere, 1855). See also above, note 61 to lecture of 30 January 1974, and R. A. Adams, "A. Duchenne" in W. Haymaker and F. Schiller, eds. The Founders of Neurology, vol. 2 (Springfield, 111. :C. C. Thomas, 1970) pp. 430-435.
9. Pierre Paul Broca (1824-1880), surgeon at Bicetre, presented a note to the Paris Societe d'Anthropologie on 18 April 1861: (1) "Remarques sur le siege de la faculte du langage articule, suivies d'une observation d'aphemie (perte de la parole)" concerning a patient, Leborgne, hospitalized at Bicetre for twenty one years, who had recently lost the use of speech and could now only pronounce the syllabic "tan" repeated twice. Transferred into Broca's department on 11 April 1861, where he died on 17 April, his autopsy revealed a center of softening of the foot of the third left frontal convolution, to which Broca
? 10.
11. 12.
13. 14-
15. 16.
17.
18.
attributed the loss of articulated speech; see Bulletin de la Societe d'Anthropologie de Paris, 1M series, vol. II, August 1861, pp. 330-357, republished in H. Hccaen and J. Dubois, La Naissance de la neurophysiologie du langage, 1826-1&65 (Paris: Flammanon, 1969) pp. 61-91. Between 1861 and 1865, further observations confirmed to Broca the role of the third lett convolution: see ( 2 ) "Localisation des lonctions cerebralcs. Siege du lanage articule," Bulletin de la Societe d'Anthropologie de Paris, Tx series, vol. IV, 186}, pp. 200-204, and (3) "Sur le siege de la laculte du langage articule," ibid. 1M series, vol. VI, 1865, pp. 577-393, republished in H. Hecaen and J. Dubois, La Naissance de la neurophysiologie du langage, pp. 108-123.
To Duchenne de Boulogne we owe the description of "progressive locomotor ataxia" or tabes dorsalis, of syphilitic origin, characterized by lack ol motor coordination and usually accompanied by abolition of the reflexes and deep sensibility: see, "De I'ataxie locomolrice progressive," republished in De I'ataxie locomotrice progressive (Paris: Rignoux, 1859).
G. B. A. Duchenne, Diagnostic differentiel des ajjeclions cerebelleuses el de I'ataxie locomotrice progressive (extract Irom La Gazelle hehdomadairc de medecine el de chirurgie, 1864) (Paris: Martinet, 1864).
Ibid. p. 5: "When the man begins to feel the eHects of alcoholic intoxication, his body, in the upright position, sways in every direction (. . . ). In subjects struck by locomotor ataxia, the body's oscillations, in an upright position, have a very dillerent character; they are abrupt, shorter and more rapid, whereas those ol drunkenness resemble a sort ol swaying.
I have already compared the upright ataxic to a dancer who wants to keep his balance on a taut wire. " See G. B. A. Duchenne, De I'ataxie locomotrice progressive, p. 78: "To a certain extent the patient can be compared to an individual who is trying with difficulty to keep his balance on a stretched wire without a balancing pole. "
G. B. A. Duchenne, Diagnostic difjerenliel des affections cerebelleuses, pp. 5-6.
Ibid. p. 6: "The man who is drunk (. . . ) walks making alternative curves to the lelt and right, or zigzags, and cannot go straight ahead ( . . . ) . The ataxic ( . . . ) usually walks straight ahead unsteadily, but without making curves or zigzags like the drunken man. " Ibid. p. 7: "I asked them if, standing upright or walking ( . . . ) they did not (eel the head heavy or turn, as when one has drunk too much wine or spirits. They answered that their head was completely Iree, and that they only lacked balance in the legs" (author's emphasis). Foucault is relerring to the analyses put lorward by Broca in his 1861 article: "Remarques sur le siege de la laculte du langage articule," in which he proposed the term "aphemie" (see above, note 9) to designate this loss of the "faculty of articulating words" in H. Hccaen and J. Dubois, La Naissance de la neurophysiologie du langage, p. 63-
Anarthria is a motor aphasia linked to an affection of the Broca area, situated on the external lace of the dominant cerebral hemisphere, at the lower part of the third frontal convolution. Characterized by disorders ol the articulation of speech, without lesions ol the phonatory organs, it was described by Pierre Marie (1853-1940) in "De l'aphasie (cecite verbale, surdite verbale, aphasie motrice, agraphie)," Revue du medecine, vol. Ill, 1883, pp. 693-702.
As testifies the use of the term "hystero epilepsy" to designate a hybrid form (composed ol hysteria and epilepsy) marked by convulsive crises, as states J. B. Lodois Bnffaut: "We see the hysteric becoming epileptic, remaining both the one and the other, which constitutes hystero-epilepsy, or epilepsy increasingly dominating, and suppressing, as it were, the original hysteria" Rapports de I'hysterie et de I'epilepsie, Medical Thesis, Paris, no. 146 (Paris: 1851) p. 24. See E. J. Georget--according to whom hysteria is a convulsive nervous disorder that forms a continuum with epilepsy--the article "Hystene," in Dictionnaire de medecine, vol. 11 (Paris: Bechet Jeune, 1824) pp. 526-551- On the confusion of epilepsy with other "convulsive disorders," see O. Temkin, The Falling Sickness: A Story of Epilepsy from the Greeks to the Beginnings of Modern Neurology (Baltimore, Md. : The Johns Hopkins Press, 119451 1971, 2na revised edition) pp. 351-359.
Foucault takes two dates as reference points:
(1) 1820, the year in which the debate on the causes of madness begins on the occasion of Etienne Georget's defence of his thesis, 8 February 1820: "Dissertation sur les causes de la folie" (see above, note 18 to lecture of 12 December 1973). Published in January 1843 by J. Baillarger, L. Cense and F. Longet, the Annales medico-psychologiques. Journal de
19.
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/'anatomic, de la physiologic ct tie la pathologic du sysleme nerveux, specifically intended to gather all the documents concerning the relationships between the physical and the moral, mental pathology, legal medicine of the insane, and clinical neuroses (Paris, Fort in and Masson), was the site for an almost permanent debate on the organic and moral causes ol madness, with a significant moment in the 1840s which saw conflict with the supporters of organicism, such as (a) L. Rostan, author oi Exposition des principes de Vor- gancisme, precedee de reflexions sur Vincredulitc en matiere de medecine (Paris: Asselin, 1846); ( b ) A. |de( Foville, author, with J. B. Delaye, of a paper lor the Prix Escjuirol in 1821, "Sur les causes de la fohe et leur mode d'action, suivies de recherches sur la nature et le siege special de cette maladie," Nouveau Journal de medecine, vol. XII, October 1821, pp. 110 sq. \ as well as G. Ferrus, and L. Calmed; | c | J J . Moreau de Tours, who on 9 June 1830, delended a thesis entitled: De Vinjluencc du physique, relativement an desordre des facultes inlel- lecluclles, el en parliculier dans cette variete de delire designee par M. Esquirol sous le nom de Monomanic, Paris Medical Thesis, no. 127 (Paris: Didot, 1830) taking up the terms "organicism," and "organicist" as a banner--and the partisans of the pscyhological school, who preferred to be called "dualists": P. N. Gerdy, Frederic Dubois d'Amiens (1799-1873), C. Michea, Louis Francois Emile Renaudin (1808-1865). As well as ( d ) J . B. Parchappe de Vinay, author ol an article entitled precisely "De la predominance des causes morales dans la generation de la fohe," Annales medico-psychologiques, vol. II, November 1843, pp. 358-371. And |e| L. F.
Everyone benefits. In the first place, the insurance companies, of course, and the people who had to pay, and, also the patient to a certain extent, since, if he is not a simulator, a malingerer, Charcot said, we can not deny him something, albeit, obviously, not of the same order as ll he had a real injury. So the cake was cut in two. However, clearly this is not the important problem: the doctor also benelits since, thanks to the use of the hysteric as a lunctional mannequin, the doctor could make a dif lerential diagnosis that will now be brought to bear on the simulator. One will now be able to master the iamous panic dread of the simulator that so obsessed doctors in the first half of the nineteenth century, since one will have these hysterics who, traitors to their own lie, as it were, will make it possible to denounce the lie of others, and, as a result, the doctor will hnally have the upper hand over simulation. '8
Finally, ol course, the hysterics beneht, since il they serve as functional mannequins in this way, authenticating the functional or, as
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it was said at this time, "dynamic" illness without lesion, if the hysteric is there to authenticate this illness, then she inevitably escapes all suspicion of simulation, since she is the basis on which the simulation of others can be denounced. As a result, it is once again thanks to the hysteric that the doctor will be able to ensure his power; if he escapes the simulator's trap it is because he has the hysteric who makes possible the double, organic/dynamic/simulation, differential diagnosis. And con- sequently, the hysteric has the upper hand over the doctor a second time, since by obeying the instructions he gives her under hypnosis, she gets to be the authority of verification, as it were, the authority adjudicating truth between illness and lie. The second triumph of the hysteric. You understand that here too the hysterics do not hesitate to reconstitute, on demand, the coxalgia and anesthesia, etcetera that they are asked for under hypnosis.
Hence the third maneuver of redistribution around the trauma. At the end of the second maneuver, the doctor is therefore once again newly dependent on the hysteric, because if the disorders reproduced on order by the hysteric, and so generously, so profusely, with such obedience and, at the same time, with such a thirst for power, will not this be proof after all that it is all fabricated, as Bernheim was already beginning to say? H9 In the end, is not the appearance of this great hysterical symp- tomatology at la Salpetriere all due to the set of medical powers being exercised within the hospital?
If the doctor is not to be entirely dependent on this hysterical behav- ior which could well be said to be fabricated, if he is to renew his power over all this phenomena and take it back under his control, he will have to include within a strict pathological schema both the fact that some one can be hypnotized and the fact that he reproduces pathological types of phenomena under hypnosis, and, at the same time, that those well known lunctional disorders, which Charcot had shown were so close to hysterical phenomena, can be placed in this pathological frame- work. A pathological framework is needed which simultaneously envelops hypnosis, the hysterical symptoms produced under hypnosis, and the event which brings about the functional disorders oi patients who are not hypnotized. Since the body cannot speak because there is no lesion, this search for a pathological framework leads Charcot to look for
? an assignable cause. One will have to look at the etiological level for something on which to pin all these phenomena and thereby attach them to a rigorous pathology, that is to say, what one will have to discover is an event.
This was how Charcot developed the concept ol trauma. 50
What is a trauma for Charcot? It is something--a violent event, a blow, a (all, a (ear, a spectacle, etcetera--which provokes a sort of dis- crete, localized hypnotic state, but which sometimes lasts for a long time, so that, following the trauma, a certain idea enters the individual's head, inscribes itself in his cortex, and acts like a sort of permanent injunction.
An example of a trauma: a child is knocked down by a vehicle; he faints. In the moment before fainting he has the feeling that the wheels ol the vehicle run over his body. He comes to and, after a time, realizes that he is paralyzed; and if he is paralyzed it is because he thinks the wheels ran over his body. 51 Now this belief is inscribed and continues to (unction within a set ol micro hypnotic states, within a localized hyp- notic state concerning this beliel. What provokes paralysis o( the legs is, as it were, this idea that has become a hypnotic injunction? 2 We see here how the notion of trauma, which will be so important in the iuture, is established and, at the same time, the link between this notion and the old conception of delirium. Since if he is paralyzed, it is because he believes that the wheels of the van ran over him--you can see how this is linked with the old conception of madness always concealing a delirium. 5* So, a trauma is something that provokes a localized and permanent hypnotic state on just this point.
As for hypnotism, what is it? Well, it will also be a trauma, but in the form ol a complete, brief, transitory shock, which will be suspended solely by the doctor's will, but which will envelop the individual's general behavior, so that within this state of hypnosis, which is a sort oi generalized and provisional trauma, the doctor's will, his words, will be able to implant ideas and images in the subject which thus have the same role, the same Iunction, and the same eilect of injunction as the injunction I was talking about with regard to natural, non-hypnotic traumas. Thus, between hysterical phenomena produced under hypno- sis and hysterical phenomena following an event, there is a convergence
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which points towards this fundamental notion of trauma. Trauma is what provokes hypnosis, and hypnosis is a sort of general reactivation o( the trauma through the doctor's will.
Hence the need in Charcot's practice to go in search of the trauma itself.
That is to say, to be sure that the hysteric really is a hysteric and that all her symptoms, whether under hypnosis or outside ol hypnosis, really are pathological, one will have to discover the etiology, to find the trauma, the kind of invisible and pathological lesion which makes all of this a well and truly morbid whole. * Hence the necessity for hysterics, whether or not they are under hypnosis, to recount their childhood, their life, so as to lind again that kind of fundamental and essential event that will persist and is always present in the hysterical syndrome, and of which the latter is in some way the permanent actual izati on. Vl'
However--and here we find the hysteric again and her counter- maneuver--what will the patients do with this injunction to find the trauma that persists in the symptom? Into the breach opened by this injunction they will push their lile, their real, everyday life, that is to say, their sexual hie. It is precisely this sexual life that they will recount, that they will connect up with the hospital and endlessly reactualize in the hospital. Unfortunately, we cannot trust Charcot's text for prool of this counter-investment of the search for the trauma by the story of sexual life, because Charcot does not talk about it. However, when we look at his students' observations, we see what is involved throughout these anamneses, what was at stake, what was talked about, and also what was really involved m the famous attacks with a pseudo-epileptic lorm. I will take just one example, a case recorded by Bourneville.
This is how the patient recounted her life. From age six to thirteen she was a boarder in a religious convent "at La Ferte sous Jouarre where she enjoyed a degree ol lreedom, wandered in the countryside, willingly let herself be kissed for sweets. " This is the protocol produced by one ol Charcot's students on the basis of the patient's own accounts. "She often
* The manuscript clarifies: "Hence the double search: (a) lor the nervous diathesis which causes susceptibility to trauma; search for heredity. And then (b) for the trauma itsell. "
t The manuscript adds: "Hence the violence ol the opposition to Bernheim: if everyone could be hypnotized the edifice would collapse. "
? visited the wife ol a workman, Jules, a painter. The latter was in the habit of getting drunk, and when this happened there were violent arguments in the household; he beat his wife, dragged her or tied her up by the hair. Louise [the patient; M. F. ] sometimes witnessed these scenes. One day,Jules would have tried to kiss her, even rape her, which gave her a great fright. During the holidays [she was aged between six and thirteen years; M. F. |, she came to Paris and spent the days with her brother, Antonio, one year younger than her, who seems to have been very precocious and taught her many things she should not have known. He mocked her naivety, which led her to accept the explanation he gave to her of, amongst other things, how children are made. During the hoi idays, in the house where her parents were in service, she had the opportunity to see a Mr. C [the master of the house; M. F. ], who was her mother's lover. Her mother obliged Louise to kiss this man and wanted her to call him her father. On her permanent return to Pans, Louise was placed [after her period of boarding, so she was 13; M. F. ] in C's home on the pretext of learning to sing and sew, etcetera. She slept in a little isolated room. C, whose relationship with his wife was a bit strained, took advantage of her absences to try to have relations with Louise, aged thirteen and a half. The first time, he failed; he wanted her to go to bed in front of him. A second attempt ended in some incomplete approaches, due to her resistance. A third time, C, after dangling all sorts of promises before her eyes, hne gowns, etcetera, seeing that she did not want to give in, threatened her with a razor; taking advantage of her fear, he got her to drink a liqueur, undressed her, threw her down on his bed, and had full sexual intercourse with her. The following day Louise was suffering, etcetera. "^
The lives of hysterics recounted by Charcot's patients are in fact often of this order and level. And, if we look at the observations taken for Charcot by his students, what really happened in those famous attacks that Charcot said were strangely similar to epileptic fits and very diffi- cult to distinguish from epileptic fits if you were not a good neurologist?
At the level of the discourse, this is what Louise said: "Tell me! . . . You must tell me! Peasant! You must be vile. So you believe this boy more than me. . . I swear to you that this boy has never laid a hand on me. . . I did not respond to his caresses, we were in a held . . . I assure you that I did not
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want it. . . Call them (Commanding physiognomy). Well? (She suddenly looks to her right) . . . But that is not what you said to him! . . . Antonio, you must repeat what he told you . . . that he touched me . . . But I did not want. Antonio, you are lying! . . . It is true, he had a snake in his pants, he wanted to put it in my belly, but he did not even find m e . . . let's finish with it. . . We were on a bench . . . You kissed me more than once, I did not kiss you; I am a lunatic . . . Antonio, you are laughing. . ,"56
Discourses like this take place in the period called delirious, the last period of Charcot's analysis. And if we go back to the "plastic" phase of "passionate poses," this is the form they take in another patient: "Celina M is attentive, sees someone, motions with her head for him to come to her, opens her arms, brings them together as if she was embracing the imaginary being. Her physiognomy expresses discontent to start with, disappointment, then, in a sudden change, happiness. At this point we see some movements of the stomach; her legs bend, M falls back on her bed and makes new clonic movements. With a rapid movement she moves her body to the right side of the bed, her head resting on the pillow; her face is flushed, her body partly rolls over on itself, her right cheek lying on the pillow, her face looking to the right, the patient presents her buttocks, which are raised, the lower limbs being bent. Alter some moments, while maintaining this lubricious position, M makes some movements with her pelvis. She then stands up and has some major clonic movements. Finally, she grimaces, cries, seems deeply frustrated. She sits down again, looks to the left, signals with her head and right hand. She witnesses varied scenes, seeming, by the play ol her physiog- nomy, to experience pleasant and painful sensations alternately Suddenly, she puts her body back in the middle of the bed, raises it slightly and, with her right hand, makes the gestures of the mea culpa, followed by contortions and grimaces. Then she lets out some sharp cries: 'Oh! la! laP smiles, looks around with a lubricious air, sits down, seems to see Ernest and says: 'Well come on then! Come on! ' "57
So, at the level of the daily observations of patients by Charcot's students, this is the real content of these attacks.
Now I think this is where the hysterics, for the third time, take back power over the psychiatrist, lor these discourses, scenes, and postures, which Charcot codiiied under the term "pseudo-epilepsy" or "major
? hysterical attack," analogous to but different from epilepsy, all of this real content that we see in everyday observations, could not in fact be admitted by Charcot. Not for reasons of morality or prudishness, if you like, but he quite simply could not accept it. If you recall, I spoke to you about neurosis as it existed and was discredited around the 1840s, as it was again in Charcot's time by Jules Falret. Why was it discredited? 58 It was discredited both because it was simulation--and Charcot tried to get round this objection--and because it was sexual, because it included a number of lubricious elements. If one really wanted to succeed in demonstrating that hysteria was a genuine illness, if one absolutely wanted to make it work within the system of differential diagnosis, if one did not want its status as illness to be challenged, then it had to be entirely shorn of that disqualifying element which was as harmful as simulation, namely lubricity or sexuality/ Therefore it really was necessary that it did not arise, or was not said.
Now, he could not prevent it from occurring, since it was he, Charcot, who was calling for symptoms, for attacks. And, in fact, the patients pro- vided many attacks, the surface symptomatology and general scenario of which conformed to the rules laid down by Charcot. But under the cover of this scenario, as it were, they crammed in all their individual life, sexuality, and memories; they reactualized their sexuality, and at the very heart of the hospital, with the interns or doctors. Consequently, since Charcot could not prevent this from happening, there was only one thing he could do, which was not to say it, or rather, to say the opposite. In fact, you can read this in Charcot, which is paradoxical when you know the observations on which it is based. He said: "For my own part, I am far from thinking that lubricity is always at work in hysteria; I am even convinced of the contrary. "59
And you recall the episode that takes place one evening in the winter of 1885-1886, while Freud was training with Charcot and, invited to Charcot's house, was amazed to hear Charcot say in an aside to someone: "Oh! hysteria, everyone knows full well that it is a matter of sexuality. " And Freud comments saying: "When I heard this I was really surprised
* The manuscript adds: "If it was let back in, then the whole edifice of pathologization con- structed in competition with the hysterics was going to collapse. "
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and said to myself: 'But if he knows, why doesn't he say so? ' "60 If he did not say so, it was, I think, for these reasons. Only, one might wonder how Freud, who spent six months at la Salpetriere, and who therefore was present every day at the scenes of which I have given you [two] examples, did not speak of it either with regard to his stay at la Salpetriere, and one might wonder how the discovery of sexuality in hysteria only emerged for him some years later. 61 Charcot's only possi bility was quite precisely not to see and not to speak.
For amusement, I will quote this little episode I lound in the Charcot archives; it is a student's note, that what's more is without irony: "M. Charcot sends for Genevieve, suffering lrom hysterical spasms. She is on a stretcher; the interns, the senior doctors have previously hypno- tized her. She undergoes her major hysterical attack. Charcot, following his usual technique, shows how hypnosis can not only provoke, induce hysterical phenomena, but can also stop them; he takes his baton, rest- ing it on the patient's belly, precisely on the ovaries, and the attack is in fact suspended. Charcot removes his baton; the attack begins again; tonic period, clonic period, delirium and, at the moment of delirium, Genevieve cries out: 'Camille! Camille! Kiss me! Give me your cock. ' Professor Charcot has Genevieve taken away; her delirium continues. "62
It seems to me that this kind of bacchanal, this sexual pantomime, is not the as yet undeciphered residue of the hysterical syndrome. My impression is that this sexual bacchanal should be taken as the counter- maneuver by which the hysterics responded to the ascription of trauma: You want to find the cause of my symptoms, the cause that will enable you to pathologize them and enable you to function as a doctor; you want this trauma, well, you will get all my life, and you won't be able to avoid hearing me recount my life and, at the same time, seeing me mime my life anew and endlessly reactualize it in my attacks!
So this sexuality is not an indecipherable remainder but the hysteric's victory cry, the last maneuver by which they finally get the better of the neurologists and silence them: If you want symptoms too, something functional; if you want to make your hypnosis natural and each of your injunctions to cause the kind of symptoms you can take as natural; if you want to use me to denounce the simulators, well then, you really will have to hear what I want to say and see what I want to
? do! And Charcot, who saw everything, who, in the low slanting daylight, saw even the smallest dimples and the smallest humps on a paralytic's face,63 was indeed obliged to turn his admirable eyes away when the patient was saying all that she had to say.
At the end of this kind of great battle between the neurologist and the hysteric, around the clinical apparatus of n euro pathology, a new body appears beneath the apparently captured neurological body,* beneath the body that the neurologist hoped and believed he had really captured in truth. This new body is no longer the neurological body; it is the sexual body. It is the hysteric who imposes this new personage on neurologists and doctors, which is no longer the pathological-anatomical body of Laennec and Bichat, the disciplinary body of psychiatry, or the neurological body of Duchenne de Boulogne or Charcot, but the sexual body, confronted with which henceforth only two attitudes were possible.
Either there is the attitude of Charcot's successor, Babinski, which consists in a retrospective devaluation of hysteria, which, since it has these connotations, will no longer be an illness. 67' Or there is a new attempt to circumvent the maneuver of hysterical encirclement, so as to give a medical meaning to this new course that loomed up on all sides around the neurological body fabricated by the doctors. This new investment will be the medical, psychiatric, and psychoanalytic take over of sexuality.
By breaking down the door of the asylum, by ceasing to be mad so as to become patients, by finally getting through to a true doctor, that is to say, the neurologist, and by providing him with genuine functional symptoms, the hysterics, to their greater pleasure, but doubtless to our greater misfortune, gave rise to a medicine of sexuality.
* Manuscript variant: "and by which one wanted to judge madness, to question it in truth . . . "
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1.
"If I have succeeded in putting the works relating to the morbid anatomy ol the nervous centers in their true light, you will not have (ailed to recognize the main tendency which becomes more pronounced in all these works. All seem, in some way, dominated by what we could call the spirit of localization, which is in fact only an ollshoot of the spirit of analysis" J. -M. Charcot, "Faculte de Medecine dc Paris: Anatomo-pathologie du systeme nerveux," Progres medical, 71'1 year, no. 14, 5 April 1879, p. 161.
2. On Bichat, see above note }8 to the lecture ol 9 January 1974.
3. On Laennec, see ibid. From 1803, Laennec gave a private course ol pathological
anatomy, which he wanted to make into a separate discipline. He put lorward an anatomical-pathological classification ol organic affections derived from, but more com plete than that ol Bichat; see, "Anatomie palhologicjue," in Didionnaire des sciences medicates, vol. II (Paris: C. L. F. Panckoucke, 1812) pp. 46-61. See the chapter Foucatilt devotes to pathological anatomy, "[. 'invisible visible" in Naissance de la clinique, pp. 151-176; The Birth oj the Clinic, ch. 9, "The Visible Invisible" pp. 149-173.
4. This is the observation ol I. N. , eighteen years old, suffering from ptosis of the lelt eyelid, presented at the consultation of 18 February 1891. See J. M. Charcot, Clinique des maladies du systeme nerveux (7##9-7#9/), Lectures edited by C. Guinon, Lecture of 24 February 1891 (recorded by A. Souques), vol. I (Paris: Aux bureaux du Progres medical/Vw Babe, 1892) p. 332.
5. On the "anatomical clinical gaze" see Naissance de la clinique, ch. 8, "Ouvrez quelques cadavres," pp. 136-142, and ch. 9, "L'invisible visible," pp. 164-172; The Birth of the Clinic, ch. 8, "Open Up a Few Corpses," pp. 124-148, and ch. 9, "The Visible Invisible," pp. 149-173.
6. Ibid. , ch. 6, "Des signes et des cas"; ibid. , ch. 6, "Signs and Cases. "
7. Foucault is relernng to the clinical mode of examination by "percussion" lor which Jean Nicolas Corvisart (1755-1821) became the advocate after translating and annotating the work of the Viennese Leopold Auenbrugger (1722-1809): Invenlum novum ex percussione thoracis humani ul signo abstrusos inlerni pecloris morhos delegendi ( Vindobonae: Typis Joannis Thomas Trattner, 1761; French translation, Nouvelle melhode pour reconnaitre les maladies internes de la poitrine par la percussion de cette cavite, trans, and commentary J. N. Corvisart
(Paris: Migneret, 1 8 0 8 ) ) . In September 1816 Laennec perfected the stethoscope at the Necker hospital; see R. T. H. Laennec, De I'auscultation mediate; A Treatise on Mediate
Auscultation.
8. As a result of numerous works, including those of the physiologist Francois Magendie (1783-1855) in 1826, which resorted to electrical stimulation in order to study the mech anisms of nervous excitation and muscular contraction, G. B. A. Duchenne de Boulogne used "Faradization" to explore the excitability of muscles and nerves and to establish the diagnosis and treatment of their affections. He set out the results m a first paper presented in 1847 to the Academie des sciences: (1) "De l'art de limiter l'action electrique dans les organes, nouvelle methode d'electrisation appelee 'electrisation localisee,' " republished in Archives generates de medecine,)u\y and August 1850, and February and March 1851. In 1850 he set out in a second report a method of "galvanization" using continuous currents with the aim of studying muscular functions and providing the means for "a differential diag nosis of paralyses": ( 2 ) Application de la galvanisation localisee a /'elude desJondions muscu/aires (Paris: J. B. Baillierc, 1851). All these works were brought together in one work: ( 3 ) De /'electrisation localisee el de son application a la physiologie, a la pathologie et a la therapeulique (Paris: J. B. Bailliere, 1855). See also above, note 61 to lecture of 30 January 1974, and R. A. Adams, "A. Duchenne" in W. Haymaker and F. Schiller, eds. The Founders of Neurology, vol. 2 (Springfield, 111. :C. C. Thomas, 1970) pp. 430-435.
9. Pierre Paul Broca (1824-1880), surgeon at Bicetre, presented a note to the Paris Societe d'Anthropologie on 18 April 1861: (1) "Remarques sur le siege de la faculte du langage articule, suivies d'une observation d'aphemie (perte de la parole)" concerning a patient, Leborgne, hospitalized at Bicetre for twenty one years, who had recently lost the use of speech and could now only pronounce the syllabic "tan" repeated twice. Transferred into Broca's department on 11 April 1861, where he died on 17 April, his autopsy revealed a center of softening of the foot of the third left frontal convolution, to which Broca
? 10.
11. 12.
13. 14-
15. 16.
17.
18.
attributed the loss of articulated speech; see Bulletin de la Societe d'Anthropologie de Paris, 1M series, vol. II, August 1861, pp. 330-357, republished in H. Hccaen and J. Dubois, La Naissance de la neurophysiologie du langage, 1826-1&65 (Paris: Flammanon, 1969) pp. 61-91. Between 1861 and 1865, further observations confirmed to Broca the role of the third lett convolution: see ( 2 ) "Localisation des lonctions cerebralcs. Siege du lanage articule," Bulletin de la Societe d'Anthropologie de Paris, Tx series, vol. IV, 186}, pp. 200-204, and (3) "Sur le siege de la laculte du langage articule," ibid. 1M series, vol. VI, 1865, pp. 577-393, republished in H. Hecaen and J. Dubois, La Naissance de la neurophysiologie du langage, pp. 108-123.
To Duchenne de Boulogne we owe the description of "progressive locomotor ataxia" or tabes dorsalis, of syphilitic origin, characterized by lack ol motor coordination and usually accompanied by abolition of the reflexes and deep sensibility: see, "De I'ataxie locomolrice progressive," republished in De I'ataxie locomotrice progressive (Paris: Rignoux, 1859).
G. B. A. Duchenne, Diagnostic differentiel des ajjeclions cerebelleuses el de I'ataxie locomotrice progressive (extract Irom La Gazelle hehdomadairc de medecine el de chirurgie, 1864) (Paris: Martinet, 1864).
Ibid. p. 5: "When the man begins to feel the eHects of alcoholic intoxication, his body, in the upright position, sways in every direction (. . . ). In subjects struck by locomotor ataxia, the body's oscillations, in an upright position, have a very dillerent character; they are abrupt, shorter and more rapid, whereas those ol drunkenness resemble a sort ol swaying.
I have already compared the upright ataxic to a dancer who wants to keep his balance on a taut wire. " See G. B. A. Duchenne, De I'ataxie locomotrice progressive, p. 78: "To a certain extent the patient can be compared to an individual who is trying with difficulty to keep his balance on a stretched wire without a balancing pole. "
G. B. A. Duchenne, Diagnostic difjerenliel des affections cerebelleuses, pp. 5-6.
Ibid. p. 6: "The man who is drunk (. . . ) walks making alternative curves to the lelt and right, or zigzags, and cannot go straight ahead ( . . . ) . The ataxic ( . . . ) usually walks straight ahead unsteadily, but without making curves or zigzags like the drunken man. " Ibid. p. 7: "I asked them if, standing upright or walking ( . . . ) they did not (eel the head heavy or turn, as when one has drunk too much wine or spirits. They answered that their head was completely Iree, and that they only lacked balance in the legs" (author's emphasis). Foucault is relerring to the analyses put lorward by Broca in his 1861 article: "Remarques sur le siege de la laculte du langage articule," in which he proposed the term "aphemie" (see above, note 9) to designate this loss of the "faculty of articulating words" in H. Hccaen and J. Dubois, La Naissance de la neurophysiologie du langage, p. 63-
Anarthria is a motor aphasia linked to an affection of the Broca area, situated on the external lace of the dominant cerebral hemisphere, at the lower part of the third frontal convolution. Characterized by disorders ol the articulation of speech, without lesions ol the phonatory organs, it was described by Pierre Marie (1853-1940) in "De l'aphasie (cecite verbale, surdite verbale, aphasie motrice, agraphie)," Revue du medecine, vol. Ill, 1883, pp. 693-702.
As testifies the use of the term "hystero epilepsy" to designate a hybrid form (composed ol hysteria and epilepsy) marked by convulsive crises, as states J. B. Lodois Bnffaut: "We see the hysteric becoming epileptic, remaining both the one and the other, which constitutes hystero-epilepsy, or epilepsy increasingly dominating, and suppressing, as it were, the original hysteria" Rapports de I'hysterie et de I'epilepsie, Medical Thesis, Paris, no. 146 (Paris: 1851) p. 24. See E. J. Georget--according to whom hysteria is a convulsive nervous disorder that forms a continuum with epilepsy--the article "Hystene," in Dictionnaire de medecine, vol. 11 (Paris: Bechet Jeune, 1824) pp. 526-551- On the confusion of epilepsy with other "convulsive disorders," see O. Temkin, The Falling Sickness: A Story of Epilepsy from the Greeks to the Beginnings of Modern Neurology (Baltimore, Md. : The Johns Hopkins Press, 119451 1971, 2na revised edition) pp. 351-359.
Foucault takes two dates as reference points:
(1) 1820, the year in which the debate on the causes of madness begins on the occasion of Etienne Georget's defence of his thesis, 8 February 1820: "Dissertation sur les causes de la folie" (see above, note 18 to lecture of 12 December 1973). Published in January 1843 by J. Baillarger, L. Cense and F. Longet, the Annales medico-psychologiques. Journal de
19.
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/'anatomic, de la physiologic ct tie la pathologic du sysleme nerveux, specifically intended to gather all the documents concerning the relationships between the physical and the moral, mental pathology, legal medicine of the insane, and clinical neuroses (Paris, Fort in and Masson), was the site for an almost permanent debate on the organic and moral causes ol madness, with a significant moment in the 1840s which saw conflict with the supporters of organicism, such as (a) L. Rostan, author oi Exposition des principes de Vor- gancisme, precedee de reflexions sur Vincredulitc en matiere de medecine (Paris: Asselin, 1846); ( b ) A. |de( Foville, author, with J. B. Delaye, of a paper lor the Prix Escjuirol in 1821, "Sur les causes de la fohe et leur mode d'action, suivies de recherches sur la nature et le siege special de cette maladie," Nouveau Journal de medecine, vol. XII, October 1821, pp. 110 sq. \ as well as G. Ferrus, and L. Calmed; | c | J J . Moreau de Tours, who on 9 June 1830, delended a thesis entitled: De Vinjluencc du physique, relativement an desordre des facultes inlel- lecluclles, el en parliculier dans cette variete de delire designee par M. Esquirol sous le nom de Monomanic, Paris Medical Thesis, no. 127 (Paris: Didot, 1830) taking up the terms "organicism," and "organicist" as a banner--and the partisans of the pscyhological school, who preferred to be called "dualists": P. N. Gerdy, Frederic Dubois d'Amiens (1799-1873), C. Michea, Louis Francois Emile Renaudin (1808-1865). As well as ( d ) J . B. Parchappe de Vinay, author ol an article entitled precisely "De la predominance des causes morales dans la generation de la fohe," Annales medico-psychologiques, vol. II, November 1843, pp. 358-371. And |e| L. F.
