" "Folie soupc,onee d'etre feinte, observee par le
professeur
Monteggia" Irans.
Foucault-Psychiatric-Power-1973-74
intellectual and moral orthopedics which one day will surely be intro duced into educational and penitentiary establishments.
"58 So, hypnosis makes it possible to fashion, to train behavior.
It also makes possible a nullification of symptoms. With hypnosis one must be able to prevent the appearance of a symptom; Durand de Gros claims that the shaking of chorea can be completely quashed by giving an order to the patient. 59
Finally, third, the hypnotist can get a hold on the patient's body at the level of the analysis and modification of functions: he can produce a muscular contraction or paralysis; he can excite or nullify sensibility on the body's surface; he can weaken or arouse the intellectual or moral faculties; he can even modify automatic functions like circulation and breathing. 60
So, in the hypnosis that is now accepted, you see the patient's famous body, previously absent from psychiatric practice, being defined, or appearing rather. Hypnosis will enable action on the body, not just at the disciplinary level ol manifest behavior, but also at the level of mus- cles, nerves, and basic functions. Hypnosis is consequently a new, much more sophisticated and intensive way than questioning lor the psychia trist to obtain a real hold on the patient's body; or rather, it is the first time that the patient's body is finally available to the psychiatrist in, as it were, its functional detail. Psychiatric power will finally get a hold on the body that had eluded it since it became known that pathological anatomy could never account lor the functioning and mechanisms of madness. *
So, with these different instruments, these different techniques for realizing the illness, I think we have the elements from which the great central episode in the history of nineteenth century psychiatry and madness will develop. There are, then, three instruments: questioning, hypnosis, and drugs. Questioning, hypnosis and drugs are really three
* The manuscript adds: "With hypnosis wc have then a type of test of the illness--which draws close to drugs through the effect of discipline and through the elfect ol the reproduction of the pathological reality.
hut it is distinct Irom and, in a sense, privileged with regard to drugs,
because it is entirely suited to the doctor's will: doing what one wants with the patient.
- because it allows, or at least one expects from it, nullification of the symptoms, one by one,
and because it makes possible a direct hold on the body. "
30 January 1974 287
? 288 PSYCHIA TRIC POWER
ways of actually realizing the illness, but, of course, in questioning, this realization only takes place in language and has above all the double defect of, firstly, not putting the psychiatrist in internal communication with the mechanisms of madness other than through the game of questions and answers, and, secondly, not giving a hold on the detail of the patient's body.
With drugs, rather, there is the possibility of this internal hold, this kind of supplement of power given to the psychiatrist by the fact that he thinks he can understand the phenomena of madness; an internal hold therefore. And hypnosis will be the instrument by which the psychia- trist will get a hold on the very functioning of the patient's body.
You see that we have here the elements from which it will be possi- ble to constitute, or rather, the elements which are in place and which, quite suddenly, around i860 to 1880, will assume extreme importance and intensity when, precisely within classical organic medicine, a new definition, or rather, a new reality of the body will appear, that is to say, when a body is discovered which is not just a body with organs and tis- sues, but a body with functions, performances, and behavior--in short, when, around Duchenne de Boulogne, between 1850 and i 8 6 0 , the neurological body is discovered. 61
At this point, by connecting up through the techniques of hypnosis and drugs with this new body discovered by medicine, it will finally be possible to try to inscribe the mechanisms of madness in a system of dif- ferential knowledge, in a medicine basically founded on pathological anatomy or pathological physiology; the major phenomenon will now be this inscription, this attempt to inscribe madness withm a general medical symptomatology, which the absence of the body and of differ- ential diagnosis had always marginalized. The failure of this attempt by Charcot, the fact that the neurological body, like the body of pathologi- cal anatomy, will elude the psychiatrist, will leave psychiatric power with the three instruments of power established in the first half of the nineteenth century. That is to say, after the disappearance of the great neurological hope, we will find again only the three elements: questioning--language--hypnosis, and drugs, that is to say, the three elements with which psychiatric power, within or outside the asylum space, still operates today.
? 1. In fact, it was not until 1879 that the works of Alfred Fournier (1832-1914) revealed general paralysis as a frequent complication of tertiary syphilis: see his Syphilis du cerveau (Paris: Masson, 1879). Before being accepted, this relationship gave rise to many debates at the Societe medico-psychologique, from April to June 1879 and from February to November 1898. On 27 March 1893, Le Filliatre, in a communication, "Des antecedents syphilitiques chez quelques paralytiques generaux," presented syphilis as "a major predis- posing cause," and met with hardly any opposition; see, Annales medico-psychologiques, 7th series, vol. XVII, July 1893, p. 436. As the general secretary oi the Societe medico- psychologiques later recalled, "in 1893, the exclusive partisans of the specific origin of general praralysis were still rare among us" A. Ritti, "Histoire des travaux de la Societe medico-psychologiques (1852 1902)" Annales medico-psychologiques, 8th series, vol. XVI, July 1902, p. 58. Its specific etiology will only become imperative in 1913 with the discov ery by Noguchi and Moore of pale treponema in the brains ol general paralytics.
2. A. LJ. Bayle, Traite des maladies du cerveau et de ses membranes, pp. 536 537: "Among the many symptoms with which this ailment is accompanied, we can reduce to two those which basically serve to characterize it ( . . . ) : 1. derangement of the intellectual laculties, or delir- ium; 2. incomplete paralysis. 1. Delirium: Mental alienation ( . . . ) , partial to start with and consisting in a sort of monomania with enfeeblement of the laculties, then becomes general and maniacal with over excitement (. . . ); it then degenerates into a condition oi dementia (. . . ); 2. Paralysis: The paralysis which, together with delirium, establishes the diagnosis of chronic meningitis, is a diminution and an enleeblement which, very slightly
at first, and conlined to a single organ, increases progressively and gradually extends to a greater number of parts, and ends by invading the entire locomotive system, in such a way that the name which seems the most suitable to us ( . . . ) is that oi general and incomplete paralysis. " See above, note 17 to the lecture of 12 December 1973, and see also J. Christian and A. Ritti, "Paralysie generale," in Dictionnaire encyclopedique des sciences medicales, 2nd series, vol. XX (Paris: Masson/Asselin, 1884).
3. Jules Baillarger (1809 1890) states that "it is impossible to go along with Bayle in considering madness as a constant and essential symptom of general paralysis. There are therefore no grounds for accepting the two orders ol symptoms essential for the character ization ol general paralysis: the symptoms of dementia and paralysis" in the Appendix to Doumic's French translation of the 2nd, revised and expanded edition of Wilhelm Gnesinger's Die Pathologie und Therapie depsychischen Krakheiten (Traite des maladies mentales. Pathologie et therapeutique), preceded by a work on general paralysis by Dr. Baillarger: Des symptomes de la paralysie generale et des rapports de cette maladie avec lafolie (Paris: A. Delahaye, 1865) p. 612. Baillarger returns to this problem on several occasions: (1) "Des rapports de
la paralysie generale e dal lolie" Annales medico-psychologiques, 2nd series, vol. V, January 1853, pp. 158-166; (2) "De la folie avec predominance du delire des grandeurs dans ses rapports avec la paralysie generale," ibid. 4th series, vol. VIII, July 1866, pp. 1-20. In his article on the theory of general paralysis, (3) "De la lolie paralytique et de la demence paralytique considerees comme deux maladies distinctes," he reasserts that 'general paralysis' must be completely separatedfrom madness and considered as a special independent disease" ibid. 6th series, vol. IX, January 1883, p. 28, author's emphasis.
4. See above, Lecture of 19 December 1973, pp. 158-162.
5. Actually, heredity was already invoked as one of the causes of madness. P. Pmel, in the 2nd
edition of his Traite asserted that it would be difficult "to deny any hereditary transmission
of mania when we note everywhere and in several successive generations some members of certain families affected by this illness" Traite medico-philosophique, 1809 edition. Esquirol states that "heredity is the most common predisposing cause ol madness" Des maladies men- tales, vol. I, p. 64; Mental Maladies, p. 49. However, heredity is not treated separately as a distinct subject until the work of C. Michea, De Vinfluence de Vheredite dans la production des maladies nerveuses (a work awarded a prize by the Academie de medecine on 20 December 1843) and the article by J. Baillarger, "Recherches statistique sur l'heredite de la folie" (note read to the Academie de medecine, 2 April 1844) in which he was able to state (ab initio) that: "Everyone agrees about the influence of heredity in the production of madness" Annales medico-psychologiques, vol. Ill, May 1844, p. 328. The notion of "pathological
30 January 1974 289
? 290 PSYCHIATRIC POWER
heredity" is specified between 1850 and 1850 by the works of Jacques Moreau de Tours,
who introduced the idea ol a transmission ol the pathological in different forms, or "dis
similar heredity," thereby opening up the possibility lor most forms ol insanity to enter the hereditary Iramework. See his (1) "De la predisposition hereditaire aux affections cerebrales. Existe-t il des signes particulars auxquels on puisse reconnaitre cette predis position? " report to the Academie des sciences, 15 December 1851, Annales medico- psychologiques, 2nd series, vol. IV, January 1852, pp. 119 129; July 1852, pp. 447 455; and
( 2 ) La Psychologie morbide dans ses rapports avec la philosophic' de I'histoire, ou De Vinfluence des nevropathies sur le dynamisme intellectuel {Paris: Masson, 1859). The high point ol hereditar ianism is reached in 1885 and 1886 with the last debates of the Societe medico psychologique on the signs ol hereditary madness (see below, note 7). See J. Dejerine, L'Heredi/e dans les maladies du sysleme nerveux; A. Voisin, "Heredite" in Nouveau Dictionnaire
de medecine et de chirurgie pratiques, vol. XVII (Paris: J. -B. Bailliere, 1873). Foucault returns to the question on 19 March 1975, is his lectures Les Anormaux, pp. 296 300; Abnormal, pp. 313 318.
6. See above, note 71 to lecture of 16 January 1974, and Les Anormaux, lectures ol 5 February, p. 110, and 19 March 1975, pp. 297-300; Abnormal, p. 119 and pp. 314 318.
7. See the report ol Moreau de Tours on the question ol prognostic signs ol madness: "De la predisposition hereditaire aux affections cerebrales," and his "Memoire sur les prodromes de la folie" (read to the Academie de medecine, 22 April 1851). In 1868, Morel's intern, Georges Doutrebente, received the Prix Esquirol lor his "Etude genealogique sur les alienes hereditaires" devoted to "moral, physical and intellectual signs which enable the immedi
ate diagnosis ol a morbid hereditary inlluence in individuals predisposed to or affected by mental alienation" Annales medico-psychologiques, 5th series, vol. II, September 1869, p. 197- From 30 March 1885 to 26 July 1886, the Societe medico psychologique devoted ten sessions, spread over more than a year, to the question ol the "intellectual and moral signs of hereditary madness. "
8. On the lormation ol the notion ol abnormality, see the lectures of 22 January 1975 and 19 March 1975 in Les anormaux, pp. 53 56 and pp. 29$ 298; Abnormal, pp. 57 60 and pp. 310 315-
9. Moi, Pierre Riviere; I, Pierre Riviere.
10. On the notion ol "homicidal monomania" see above, the lecture ol 23 January 1974,
note 45, pp. 263 264.
11. "Particulars and explanation ol the occurrence on June 3 in Aunay at the village ol la
Faucterie written by the author ol this deed" Moi, Pierre Riviere, p. 124 and p. 127; /, Pierre
Riviere, p. 101 and p. 104.
12. This refers to the questioning ol A. , 42 years old, admitted to Bicetre on 18 June 1839
suffering from auditory and visual hallucinations, and for erotic and ambitious ideas. See,
F. Leuret, Du traitement moral de lafolie, "Hallucines," Observation 1, pp. 199 200.
13. Reference to the cure of M. Dupre. See ibid. pp. 441 442 and above, lecture of 9 January
1974.
14. See above, lecture 19 December 1973, pp. 161 162.
15. On the visit, seeJ. -P. Falret, De Venseignement clinique desmaladies mentales, pp. 105-109.
16. See above, lecture of 9 January 1974, pp. 186 188.
17. To illustrate the interview by silence, the manuscript refers to Example XLV ol
Griesinger's Traite, p. 392; Mental Pathology and Therapeutics, pp. 334 335: "I would have
said that she was listening ( . . . ) I walked a hundred paces without saying a word, and without appearing to fix my attention on her (. . . ). I stopped again, and regarded her attentively, without seeming to be the least curious (. . . ). We continued looking at each other in this way for nearly hall an hour, when she murmured some words which I did not comprehend. I gave her my notebook, on which she wrote (. . . ). " See also, J. P. Falret, Lecons cliniques de medecine menlale, p. 22: "Instead ol sharpening the madman's cunning in eluding an authority that bothers him, show ( . . . ) neglect; remove Irom his mind any idea
( . . . ) ol a desire to penetrate his thoughts, and then you may be sure, seeing that you are not concerned to control everything in him, he will be without deliance, he will show himself as he is, and you will be able to study him more easily and with greater success. "
18. See above, lecture of 19 December 1973, note 2.
? 19. See above, lecture ol 19 December 1975, note 1.
20. This was Monteggia, the surgeon lor the Milan prisons, who, suspecting a criminal ol
leigning madness, administered lepeated strong doses ol opium, so that he felt so tired "by the action ol the opium, that fearing death, he considered continued pretence pointless.
" "Folie soupc,onee d'etre feinte, observee par le professeur Monteggia" Irans. C. C. H. Marc in "Materiaux pour 1'histoire medico legale de I'alienation mentale," Annaks d'hygiene publique et de medecine legate, vol. II, Part 2, 1829, p. 375- See also, C. C. H. Marc, De la folie consideree dans ses rapports avec les questions medico-judkiaires, vol. I, p. 7i98, and A. Laurent, Elude medico-legale sur la simulation de la folie, p . 2 3 9 -
21. Discovered in 18-Vi by Antoine Jerome Balard (1802-1876) (or the treatment of angina chest pains, amyl nitrate lound material lor therapeutic experimentation in epilepsy and hysteria. See A. Dechambre, "Nitrite d'amyle" in Dictionnaire encyclopedique des sciences medicales, 2nd series, vol. XIII (Paris: Masson/Asselin, 1879) pp. 262 269.
22. See above, note 2 to lecture ol 23 January 1977i.
25. See above, note 18 to lecture of 9 January 1977|.
2/\. B. A. Morel recommended the use of etherisation as "the most innocent and speedy way to
reach knowledge ol the truth" "De l'ethensation dans la lohe du point du vue du
diagnosticjue et de la medecine legale," p. 135-
25. J. J. Moreau du Tours, Du haschisch et de Valienation mentale.
26. The rubrics given correspond to the titles ol sections 2 to 8 ol chapter 1, "Phenomenes
psychologiques," ibid. pp. 51-181.
27. Foucault is relerring to the work of Claude Bernard (1813 1878) which, begun in 18-13, led
him to the liver's glycogenic function, the object of his doctoral thesis in natural science, defended 17 March 1855: Recherches sur une nouvelle fonction du foie, considere comme organe producteur de maliere sucree che^Vhomme et les animaux (Paris: J. B. Bailliere, 1855). The his lory of the stages ol his discovery appears in his Introduction a /'etude de la medecine experi- mental (Paris: J. B. Bailliere, 1865) pp. 286 289 and pp. 518 520; English translation, Claude Bernard, Experimental Medicine, trans. Henry Copley Greene (New Brunswick and London: Transaction Publishers, 1999) pp. 165 167 and pp. 181 185.
28. See above, note 12 to lecture of 5 December 1975.
29. J. J. Moreau de Tours, Du haschisch, p. }6.
50. J. J. Moreau de Tours, Trade pratique de la folie nevropalhique (vulgo hysterique) (Pans:
J. B. Bailliere, 1869) pages iv, xiv, xvn, and xix. 51. J. J. Moreau de Tours, Du haschisch, pp. 55 56.
52. Ibid. p. 56.
55. Ibid. pp. /|1 /|2, and, by the same author, "De l'identite de I'etat de reve et de la lolie," Annales medico-psychologiques, 3rd series, vol. I, July 1855, pp. 361 /|08.
V\. As Foucault recalls in Histoire de lajolie, the idea of an analogy between the mechanisms which produce dreams and madness develops Irom the seventeenth century; see Histoire de lajolie, Part II, ch. 2, "La transcendance du delire," pp. 256 261; Madness and Civilisation, ch. /\, "Passion and Delirium," pp. 101 107. To the texts to which he relers there we can add a letter Irom Spinoza to Pierre Balling in which he evokes a type of dream which, depending on the body and the movement ol its humors, is analogous to what we see in those suffering from delirium, (Letter to Pierre Balling, 20 July 1664, in CEuvres, vol. IV, trans, and notes by C. Appuhn [Paris: Gamier Flammanon, 19661 p. 172), as well as Kant's lamous expression: "The madman is also a waking dreamer/Der Verriickte ist also ein Traumer im Wachen" in Essai sur les maladies de la tele, trans. J. P. Lefevre, in Evolution
psychiatrique (Toulouse: Privat, 1971) p. 222. See also I. Kant, Anthropologie in pragmaiischer Hinsicht afegcfasst von Immanuel Kant (Konigsberg: Friedrich Nicolovius, 1798); French translation, Anthropologie du point de vue pragmatique, trans. Michel Foucault (Paris: Vnn, 196/|); English translation, Anthropology from a Pragmatic Point oj View, trans. Mary J. Gregor (The Hague: Martinus Nijhoff, W'l) Part I, ? 53, p. 89: "The man who (. . . ) is abandoned to a play of thought in which he sees, conducts and judges himself, [is] not in a world in common with others, but in his own world (as in dreaming). "
35. J. E. D. Esquirol, (1) "Delire" in Dictionnaire des sciences medicales, vol. VIII (1814) p. 252: "Delirium like dreams only works on objects which appear to our senses in a healthy state and while we are awake ( . . . ) . Then we could distance ourselves Irom them or draw near
}0 January 1974 291
? 292
PSYCHIATRIC POWER
36.
to them; in sleep and delirium we do not enjoy that faculty"; reprinted in Des maladies mentales, vol. I; (2) "Hallucinations" in Dictionnaire des sciences medicales, vol. XX (Pans: C. L. F. Panckoucke, 1817) p. 67: "The person who is delirious, the person who dreams (. . . )
is abandoned to his hallucinations, to his dreams ( . . . ) ; he dreams completely awake"; reprinted in Des maladies mentales, vol. I, p. 292; and (3) in his "Des illusions chez les alienes (Erreurs des sens)," reprinted in Des maladies mentales, vol. I; "Illusions ol the insane" in Mental Maladies, Esquirol writes that those "hallucinating are dreamers wide awake. "
On this psychiatric tradition we can reler to the following: A. Maury, (l) "Nouvelles observations sur les analogies des phenomenes du reve et de I'alienation mentale," paper given to the Societe medico psychologique, 25 October 1852, Annales medico-psychologiques, 2nd series, vol. V, July 1853, pp. /|0/|-421; (2) "De certains faits observes dans le reves et dans 1'etat intermediare entre le sommeil et la veille," in which Maury, placing himself in this tradition, proposes that "the man who falls under the sway ol a dream truly represents man affected by mental alienation" Annales medico-psychologiques, 3rd series, vol. Ill, April 1857, pp. 157-176, passage quoted p. 168; and (3) Le Sommeil et les Reves. Etudes psychologiques sur ces phenomenes et les divers etats qui s'y attachent (Paris: Didier, 1861), especially ch. 5, "Des analogies de I'hallucination et du reve," pp. 80 100, and ch. 6, "Des analogies du reve et de I'alienation mentale" pp. 101 148; S. Freud, Die Traumdeutung (1901) chs. 1and 8, in GW, vols. II III (Frankfurt: S. Fischer Verlag, 1942) pp. 199 and pp. 627-6/12; French translation, [. 'Interpretation des reves, trans. D. Berger (Pans: Presses universitaires de France, 1967) pp. 11 89 and pp. 529 551; English translation, "The Interpretation ol Dreams" in Standard Edition, translation under general editorship ol
James Strachey (1953 1974) vol. 4, pp. 1 95 and vol. 5, pp. 626 628; H. Ey, (1) "Breves remarques histonques sur les rapports des etats psychopathiques avec le reve et les etats intermediaires au sommeil et a la veille," Annales medico-psychologiques, 14th series, vol. II,
June 1934; (2) Etudes psychiatriques, vol. I: His/orique, Melhodologie, Psychopathologie generate, Part 2: "Le 'reve, fait primordial' de la psychopathologie. Historique et position du prob leme" et "Bibliographic" (Paris: Desclee de Brouwer, 1962, 2nd revised and expanded
ed. ), pp. 218 228 and p. 282; (3) "La dissolution de la conscience dans le sommeil et le
reve et ses rapports avec la psychopathologie," Evolution psychiatrique, vol. XXXV, no. 1, 1970, pp. 1 37. See also the pages Foucault devotes to the question in Histoire de lafolie, pp. 256 261; Madness and Civilisation, pp. 101 107.
37. Which is what J. Baillarger finds in the discussion ol the summary ol the work of JJ. Moreau de Tours by Dr. Bousquet: "Du delire au point de vue pathologique et anatomo pathologique," paper read to the Academie imperiale de medecine, 8 May 1855,
Annales medico-psychologiques, 3rd series, vol. I, July 1855, pp. 448 455. Replying to criticisms ol Bousquet, he notes that "what is important to get accepted is not the identity
of the organic state in the two cases, but only the extreme analogy, Irom the psychological point ol view, presented by the sleeping state and the mad state, and the precious things we can learn lrom this comparative study" ibid. p. 465. Moreau de Tours, for his part, refer ring to the "organic conditions" ol sleep, and the "lundamental phenomena of delirium," proposes that "to grasp, study, and understand well a set of phenomena as complex as that
of intellectual disorders, we must. . . group these phenomena according to the analogies,
the more or less numerous aflinities that they present" Du hashish, p. 44.
38. Moreau de Tours, ibid. Part II, ? 1: "Generalites physiologiques," pp. 32 47.
39. An allusion to the privilege that, according to J. Derrida, Descartes accords to the dream
over madness in the "First meditation: Some things that one can put in doubt," Meditations touchant la premiere philosophic (1641), in CEuvres et Lettres, pp. 268-269; English translation, "Meditations on First Philosophy" trans. John Cottingham, in The Philosophical Writings of Descartes, vol. II, pp. 13 14; See Foucault's commentaries in Histoire de lafolie, Part I, ch. 2,
pp. 56-59 (omitted Irom the English translation of Madness and Civilisation except for
one short paragraph, p. 38) and "Mon corps, ce papier, ce feu" in, Dits et Ecrits, vol. 2,
pp. 245 268; English translation, "My Body, This Paper, This Fire" trans. Geoff Bennington, in Essential Works of Foucault, 2, pp. 393 417.
It also makes possible a nullification of symptoms. With hypnosis one must be able to prevent the appearance of a symptom; Durand de Gros claims that the shaking of chorea can be completely quashed by giving an order to the patient. 59
Finally, third, the hypnotist can get a hold on the patient's body at the level of the analysis and modification of functions: he can produce a muscular contraction or paralysis; he can excite or nullify sensibility on the body's surface; he can weaken or arouse the intellectual or moral faculties; he can even modify automatic functions like circulation and breathing. 60
So, in the hypnosis that is now accepted, you see the patient's famous body, previously absent from psychiatric practice, being defined, or appearing rather. Hypnosis will enable action on the body, not just at the disciplinary level ol manifest behavior, but also at the level of mus- cles, nerves, and basic functions. Hypnosis is consequently a new, much more sophisticated and intensive way than questioning lor the psychia trist to obtain a real hold on the patient's body; or rather, it is the first time that the patient's body is finally available to the psychiatrist in, as it were, its functional detail. Psychiatric power will finally get a hold on the body that had eluded it since it became known that pathological anatomy could never account lor the functioning and mechanisms of madness. *
So, with these different instruments, these different techniques for realizing the illness, I think we have the elements from which the great central episode in the history of nineteenth century psychiatry and madness will develop. There are, then, three instruments: questioning, hypnosis, and drugs. Questioning, hypnosis and drugs are really three
* The manuscript adds: "With hypnosis wc have then a type of test of the illness--which draws close to drugs through the effect of discipline and through the elfect ol the reproduction of the pathological reality.
hut it is distinct Irom and, in a sense, privileged with regard to drugs,
because it is entirely suited to the doctor's will: doing what one wants with the patient.
- because it allows, or at least one expects from it, nullification of the symptoms, one by one,
and because it makes possible a direct hold on the body. "
30 January 1974 287
? 288 PSYCHIA TRIC POWER
ways of actually realizing the illness, but, of course, in questioning, this realization only takes place in language and has above all the double defect of, firstly, not putting the psychiatrist in internal communication with the mechanisms of madness other than through the game of questions and answers, and, secondly, not giving a hold on the detail of the patient's body.
With drugs, rather, there is the possibility of this internal hold, this kind of supplement of power given to the psychiatrist by the fact that he thinks he can understand the phenomena of madness; an internal hold therefore. And hypnosis will be the instrument by which the psychia- trist will get a hold on the very functioning of the patient's body.
You see that we have here the elements from which it will be possi- ble to constitute, or rather, the elements which are in place and which, quite suddenly, around i860 to 1880, will assume extreme importance and intensity when, precisely within classical organic medicine, a new definition, or rather, a new reality of the body will appear, that is to say, when a body is discovered which is not just a body with organs and tis- sues, but a body with functions, performances, and behavior--in short, when, around Duchenne de Boulogne, between 1850 and i 8 6 0 , the neurological body is discovered. 61
At this point, by connecting up through the techniques of hypnosis and drugs with this new body discovered by medicine, it will finally be possible to try to inscribe the mechanisms of madness in a system of dif- ferential knowledge, in a medicine basically founded on pathological anatomy or pathological physiology; the major phenomenon will now be this inscription, this attempt to inscribe madness withm a general medical symptomatology, which the absence of the body and of differ- ential diagnosis had always marginalized. The failure of this attempt by Charcot, the fact that the neurological body, like the body of pathologi- cal anatomy, will elude the psychiatrist, will leave psychiatric power with the three instruments of power established in the first half of the nineteenth century. That is to say, after the disappearance of the great neurological hope, we will find again only the three elements: questioning--language--hypnosis, and drugs, that is to say, the three elements with which psychiatric power, within or outside the asylum space, still operates today.
? 1. In fact, it was not until 1879 that the works of Alfred Fournier (1832-1914) revealed general paralysis as a frequent complication of tertiary syphilis: see his Syphilis du cerveau (Paris: Masson, 1879). Before being accepted, this relationship gave rise to many debates at the Societe medico-psychologique, from April to June 1879 and from February to November 1898. On 27 March 1893, Le Filliatre, in a communication, "Des antecedents syphilitiques chez quelques paralytiques generaux," presented syphilis as "a major predis- posing cause," and met with hardly any opposition; see, Annales medico-psychologiques, 7th series, vol. XVII, July 1893, p. 436. As the general secretary oi the Societe medico- psychologiques later recalled, "in 1893, the exclusive partisans of the specific origin of general praralysis were still rare among us" A. Ritti, "Histoire des travaux de la Societe medico-psychologiques (1852 1902)" Annales medico-psychologiques, 8th series, vol. XVI, July 1902, p. 58. Its specific etiology will only become imperative in 1913 with the discov ery by Noguchi and Moore of pale treponema in the brains ol general paralytics.
2. A. LJ. Bayle, Traite des maladies du cerveau et de ses membranes, pp. 536 537: "Among the many symptoms with which this ailment is accompanied, we can reduce to two those which basically serve to characterize it ( . . . ) : 1. derangement of the intellectual laculties, or delir- ium; 2. incomplete paralysis. 1. Delirium: Mental alienation ( . . . ) , partial to start with and consisting in a sort of monomania with enfeeblement of the laculties, then becomes general and maniacal with over excitement (. . . ); it then degenerates into a condition oi dementia (. . . ); 2. Paralysis: The paralysis which, together with delirium, establishes the diagnosis of chronic meningitis, is a diminution and an enleeblement which, very slightly
at first, and conlined to a single organ, increases progressively and gradually extends to a greater number of parts, and ends by invading the entire locomotive system, in such a way that the name which seems the most suitable to us ( . . . ) is that oi general and incomplete paralysis. " See above, note 17 to the lecture of 12 December 1973, and see also J. Christian and A. Ritti, "Paralysie generale," in Dictionnaire encyclopedique des sciences medicales, 2nd series, vol. XX (Paris: Masson/Asselin, 1884).
3. Jules Baillarger (1809 1890) states that "it is impossible to go along with Bayle in considering madness as a constant and essential symptom of general paralysis. There are therefore no grounds for accepting the two orders ol symptoms essential for the character ization ol general paralysis: the symptoms of dementia and paralysis" in the Appendix to Doumic's French translation of the 2nd, revised and expanded edition of Wilhelm Gnesinger's Die Pathologie und Therapie depsychischen Krakheiten (Traite des maladies mentales. Pathologie et therapeutique), preceded by a work on general paralysis by Dr. Baillarger: Des symptomes de la paralysie generale et des rapports de cette maladie avec lafolie (Paris: A. Delahaye, 1865) p. 612. Baillarger returns to this problem on several occasions: (1) "Des rapports de
la paralysie generale e dal lolie" Annales medico-psychologiques, 2nd series, vol. V, January 1853, pp. 158-166; (2) "De la folie avec predominance du delire des grandeurs dans ses rapports avec la paralysie generale," ibid. 4th series, vol. VIII, July 1866, pp. 1-20. In his article on the theory of general paralysis, (3) "De la lolie paralytique et de la demence paralytique considerees comme deux maladies distinctes," he reasserts that 'general paralysis' must be completely separatedfrom madness and considered as a special independent disease" ibid. 6th series, vol. IX, January 1883, p. 28, author's emphasis.
4. See above, Lecture of 19 December 1973, pp. 158-162.
5. Actually, heredity was already invoked as one of the causes of madness. P. Pmel, in the 2nd
edition of his Traite asserted that it would be difficult "to deny any hereditary transmission
of mania when we note everywhere and in several successive generations some members of certain families affected by this illness" Traite medico-philosophique, 1809 edition. Esquirol states that "heredity is the most common predisposing cause ol madness" Des maladies men- tales, vol. I, p. 64; Mental Maladies, p. 49. However, heredity is not treated separately as a distinct subject until the work of C. Michea, De Vinfluence de Vheredite dans la production des maladies nerveuses (a work awarded a prize by the Academie de medecine on 20 December 1843) and the article by J. Baillarger, "Recherches statistique sur l'heredite de la folie" (note read to the Academie de medecine, 2 April 1844) in which he was able to state (ab initio) that: "Everyone agrees about the influence of heredity in the production of madness" Annales medico-psychologiques, vol. Ill, May 1844, p. 328. The notion of "pathological
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heredity" is specified between 1850 and 1850 by the works of Jacques Moreau de Tours,
who introduced the idea ol a transmission ol the pathological in different forms, or "dis
similar heredity," thereby opening up the possibility lor most forms ol insanity to enter the hereditary Iramework. See his (1) "De la predisposition hereditaire aux affections cerebrales. Existe-t il des signes particulars auxquels on puisse reconnaitre cette predis position? " report to the Academie des sciences, 15 December 1851, Annales medico- psychologiques, 2nd series, vol. IV, January 1852, pp. 119 129; July 1852, pp. 447 455; and
( 2 ) La Psychologie morbide dans ses rapports avec la philosophic' de I'histoire, ou De Vinfluence des nevropathies sur le dynamisme intellectuel {Paris: Masson, 1859). The high point ol hereditar ianism is reached in 1885 and 1886 with the last debates of the Societe medico psychologique on the signs ol hereditary madness (see below, note 7). See J. Dejerine, L'Heredi/e dans les maladies du sysleme nerveux; A. Voisin, "Heredite" in Nouveau Dictionnaire
de medecine et de chirurgie pratiques, vol. XVII (Paris: J. -B. Bailliere, 1873). Foucault returns to the question on 19 March 1975, is his lectures Les Anormaux, pp. 296 300; Abnormal, pp. 313 318.
6. See above, note 71 to lecture of 16 January 1974, and Les Anormaux, lectures ol 5 February, p. 110, and 19 March 1975, pp. 297-300; Abnormal, p. 119 and pp. 314 318.
7. See the report ol Moreau de Tours on the question ol prognostic signs ol madness: "De la predisposition hereditaire aux affections cerebrales," and his "Memoire sur les prodromes de la folie" (read to the Academie de medecine, 22 April 1851). In 1868, Morel's intern, Georges Doutrebente, received the Prix Esquirol lor his "Etude genealogique sur les alienes hereditaires" devoted to "moral, physical and intellectual signs which enable the immedi
ate diagnosis ol a morbid hereditary inlluence in individuals predisposed to or affected by mental alienation" Annales medico-psychologiques, 5th series, vol. II, September 1869, p. 197- From 30 March 1885 to 26 July 1886, the Societe medico psychologique devoted ten sessions, spread over more than a year, to the question ol the "intellectual and moral signs of hereditary madness. "
8. On the lormation ol the notion ol abnormality, see the lectures of 22 January 1975 and 19 March 1975 in Les anormaux, pp. 53 56 and pp. 29$ 298; Abnormal, pp. 57 60 and pp. 310 315-
9. Moi, Pierre Riviere; I, Pierre Riviere.
10. On the notion ol "homicidal monomania" see above, the lecture ol 23 January 1974,
note 45, pp. 263 264.
11. "Particulars and explanation ol the occurrence on June 3 in Aunay at the village ol la
Faucterie written by the author ol this deed" Moi, Pierre Riviere, p. 124 and p. 127; /, Pierre
Riviere, p. 101 and p. 104.
12. This refers to the questioning ol A. , 42 years old, admitted to Bicetre on 18 June 1839
suffering from auditory and visual hallucinations, and for erotic and ambitious ideas. See,
F. Leuret, Du traitement moral de lafolie, "Hallucines," Observation 1, pp. 199 200.
13. Reference to the cure of M. Dupre. See ibid. pp. 441 442 and above, lecture of 9 January
1974.
14. See above, lecture 19 December 1973, pp. 161 162.
15. On the visit, seeJ. -P. Falret, De Venseignement clinique desmaladies mentales, pp. 105-109.
16. See above, lecture of 9 January 1974, pp. 186 188.
17. To illustrate the interview by silence, the manuscript refers to Example XLV ol
Griesinger's Traite, p. 392; Mental Pathology and Therapeutics, pp. 334 335: "I would have
said that she was listening ( . . . ) I walked a hundred paces without saying a word, and without appearing to fix my attention on her (. . . ). I stopped again, and regarded her attentively, without seeming to be the least curious (. . . ). We continued looking at each other in this way for nearly hall an hour, when she murmured some words which I did not comprehend. I gave her my notebook, on which she wrote (. . . ). " See also, J. P. Falret, Lecons cliniques de medecine menlale, p. 22: "Instead ol sharpening the madman's cunning in eluding an authority that bothers him, show ( . . . ) neglect; remove Irom his mind any idea
( . . . ) ol a desire to penetrate his thoughts, and then you may be sure, seeing that you are not concerned to control everything in him, he will be without deliance, he will show himself as he is, and you will be able to study him more easily and with greater success. "
18. See above, lecture of 19 December 1973, note 2.
? 19. See above, lecture ol 19 December 1975, note 1.
20. This was Monteggia, the surgeon lor the Milan prisons, who, suspecting a criminal ol
leigning madness, administered lepeated strong doses ol opium, so that he felt so tired "by the action ol the opium, that fearing death, he considered continued pretence pointless.
" "Folie soupc,onee d'etre feinte, observee par le professeur Monteggia" Irans. C. C. H. Marc in "Materiaux pour 1'histoire medico legale de I'alienation mentale," Annaks d'hygiene publique et de medecine legate, vol. II, Part 2, 1829, p. 375- See also, C. C. H. Marc, De la folie consideree dans ses rapports avec les questions medico-judkiaires, vol. I, p. 7i98, and A. Laurent, Elude medico-legale sur la simulation de la folie, p . 2 3 9 -
21. Discovered in 18-Vi by Antoine Jerome Balard (1802-1876) (or the treatment of angina chest pains, amyl nitrate lound material lor therapeutic experimentation in epilepsy and hysteria. See A. Dechambre, "Nitrite d'amyle" in Dictionnaire encyclopedique des sciences medicales, 2nd series, vol. XIII (Paris: Masson/Asselin, 1879) pp. 262 269.
22. See above, note 2 to lecture ol 23 January 1977i.
25. See above, note 18 to lecture of 9 January 1977|.
2/\. B. A. Morel recommended the use of etherisation as "the most innocent and speedy way to
reach knowledge ol the truth" "De l'ethensation dans la lohe du point du vue du
diagnosticjue et de la medecine legale," p. 135-
25. J. J. Moreau du Tours, Du haschisch et de Valienation mentale.
26. The rubrics given correspond to the titles ol sections 2 to 8 ol chapter 1, "Phenomenes
psychologiques," ibid. pp. 51-181.
27. Foucault is relerring to the work of Claude Bernard (1813 1878) which, begun in 18-13, led
him to the liver's glycogenic function, the object of his doctoral thesis in natural science, defended 17 March 1855: Recherches sur une nouvelle fonction du foie, considere comme organe producteur de maliere sucree che^Vhomme et les animaux (Paris: J. B. Bailliere, 1855). The his lory of the stages ol his discovery appears in his Introduction a /'etude de la medecine experi- mental (Paris: J. B. Bailliere, 1865) pp. 286 289 and pp. 518 520; English translation, Claude Bernard, Experimental Medicine, trans. Henry Copley Greene (New Brunswick and London: Transaction Publishers, 1999) pp. 165 167 and pp. 181 185.
28. See above, note 12 to lecture of 5 December 1975.
29. J. J. Moreau de Tours, Du haschisch, p. }6.
50. J. J. Moreau de Tours, Trade pratique de la folie nevropalhique (vulgo hysterique) (Pans:
J. B. Bailliere, 1869) pages iv, xiv, xvn, and xix. 51. J. J. Moreau de Tours, Du haschisch, pp. 55 56.
52. Ibid. p. 56.
55. Ibid. pp. /|1 /|2, and, by the same author, "De l'identite de I'etat de reve et de la lolie," Annales medico-psychologiques, 3rd series, vol. I, July 1855, pp. 361 /|08.
V\. As Foucault recalls in Histoire de lajolie, the idea of an analogy between the mechanisms which produce dreams and madness develops Irom the seventeenth century; see Histoire de lajolie, Part II, ch. 2, "La transcendance du delire," pp. 256 261; Madness and Civilisation, ch. /\, "Passion and Delirium," pp. 101 107. To the texts to which he relers there we can add a letter Irom Spinoza to Pierre Balling in which he evokes a type of dream which, depending on the body and the movement ol its humors, is analogous to what we see in those suffering from delirium, (Letter to Pierre Balling, 20 July 1664, in CEuvres, vol. IV, trans, and notes by C. Appuhn [Paris: Gamier Flammanon, 19661 p. 172), as well as Kant's lamous expression: "The madman is also a waking dreamer/Der Verriickte ist also ein Traumer im Wachen" in Essai sur les maladies de la tele, trans. J. P. Lefevre, in Evolution
psychiatrique (Toulouse: Privat, 1971) p. 222. See also I. Kant, Anthropologie in pragmaiischer Hinsicht afegcfasst von Immanuel Kant (Konigsberg: Friedrich Nicolovius, 1798); French translation, Anthropologie du point de vue pragmatique, trans. Michel Foucault (Paris: Vnn, 196/|); English translation, Anthropology from a Pragmatic Point oj View, trans. Mary J. Gregor (The Hague: Martinus Nijhoff, W'l) Part I, ? 53, p. 89: "The man who (. . . ) is abandoned to a play of thought in which he sees, conducts and judges himself, [is] not in a world in common with others, but in his own world (as in dreaming). "
35. J. E. D. Esquirol, (1) "Delire" in Dictionnaire des sciences medicales, vol. VIII (1814) p. 252: "Delirium like dreams only works on objects which appear to our senses in a healthy state and while we are awake ( . . . ) . Then we could distance ourselves Irom them or draw near
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PSYCHIATRIC POWER
36.
to them; in sleep and delirium we do not enjoy that faculty"; reprinted in Des maladies mentales, vol. I; (2) "Hallucinations" in Dictionnaire des sciences medicales, vol. XX (Pans: C. L. F. Panckoucke, 1817) p. 67: "The person who is delirious, the person who dreams (. . . )
is abandoned to his hallucinations, to his dreams ( . . . ) ; he dreams completely awake"; reprinted in Des maladies mentales, vol. I, p. 292; and (3) in his "Des illusions chez les alienes (Erreurs des sens)," reprinted in Des maladies mentales, vol. I; "Illusions ol the insane" in Mental Maladies, Esquirol writes that those "hallucinating are dreamers wide awake. "
On this psychiatric tradition we can reler to the following: A. Maury, (l) "Nouvelles observations sur les analogies des phenomenes du reve et de I'alienation mentale," paper given to the Societe medico psychologique, 25 October 1852, Annales medico-psychologiques, 2nd series, vol. V, July 1853, pp. /|0/|-421; (2) "De certains faits observes dans le reves et dans 1'etat intermediare entre le sommeil et la veille," in which Maury, placing himself in this tradition, proposes that "the man who falls under the sway ol a dream truly represents man affected by mental alienation" Annales medico-psychologiques, 3rd series, vol. Ill, April 1857, pp. 157-176, passage quoted p. 168; and (3) Le Sommeil et les Reves. Etudes psychologiques sur ces phenomenes et les divers etats qui s'y attachent (Paris: Didier, 1861), especially ch. 5, "Des analogies de I'hallucination et du reve," pp. 80 100, and ch. 6, "Des analogies du reve et de I'alienation mentale" pp. 101 148; S. Freud, Die Traumdeutung (1901) chs. 1and 8, in GW, vols. II III (Frankfurt: S. Fischer Verlag, 1942) pp. 199 and pp. 627-6/12; French translation, [. 'Interpretation des reves, trans. D. Berger (Pans: Presses universitaires de France, 1967) pp. 11 89 and pp. 529 551; English translation, "The Interpretation ol Dreams" in Standard Edition, translation under general editorship ol
James Strachey (1953 1974) vol. 4, pp. 1 95 and vol. 5, pp. 626 628; H. Ey, (1) "Breves remarques histonques sur les rapports des etats psychopathiques avec le reve et les etats intermediaires au sommeil et a la veille," Annales medico-psychologiques, 14th series, vol. II,
June 1934; (2) Etudes psychiatriques, vol. I: His/orique, Melhodologie, Psychopathologie generate, Part 2: "Le 'reve, fait primordial' de la psychopathologie. Historique et position du prob leme" et "Bibliographic" (Paris: Desclee de Brouwer, 1962, 2nd revised and expanded
ed. ), pp. 218 228 and p. 282; (3) "La dissolution de la conscience dans le sommeil et le
reve et ses rapports avec la psychopathologie," Evolution psychiatrique, vol. XXXV, no. 1, 1970, pp. 1 37. See also the pages Foucault devotes to the question in Histoire de lafolie, pp. 256 261; Madness and Civilisation, pp. 101 107.
37. Which is what J. Baillarger finds in the discussion ol the summary ol the work of JJ. Moreau de Tours by Dr. Bousquet: "Du delire au point de vue pathologique et anatomo pathologique," paper read to the Academie imperiale de medecine, 8 May 1855,
Annales medico-psychologiques, 3rd series, vol. I, July 1855, pp. 448 455. Replying to criticisms ol Bousquet, he notes that "what is important to get accepted is not the identity
of the organic state in the two cases, but only the extreme analogy, Irom the psychological point ol view, presented by the sleeping state and the mad state, and the precious things we can learn lrom this comparative study" ibid. p. 465. Moreau de Tours, for his part, refer ring to the "organic conditions" ol sleep, and the "lundamental phenomena of delirium," proposes that "to grasp, study, and understand well a set of phenomena as complex as that
of intellectual disorders, we must. . . group these phenomena according to the analogies,
the more or less numerous aflinities that they present" Du hashish, p. 44.
38. Moreau de Tours, ibid. Part II, ? 1: "Generalites physiologiques," pp. 32 47.
39. An allusion to the privilege that, according to J. Derrida, Descartes accords to the dream
over madness in the "First meditation: Some things that one can put in doubt," Meditations touchant la premiere philosophic (1641), in CEuvres et Lettres, pp. 268-269; English translation, "Meditations on First Philosophy" trans. John Cottingham, in The Philosophical Writings of Descartes, vol. II, pp. 13 14; See Foucault's commentaries in Histoire de lafolie, Part I, ch. 2,
pp. 56-59 (omitted Irom the English translation of Madness and Civilisation except for
one short paragraph, p. 38) and "Mon corps, ce papier, ce feu" in, Dits et Ecrits, vol. 2,
pp. 245 268; English translation, "My Body, This Paper, This Fire" trans. Geoff Bennington, in Essential Works of Foucault, 2, pp. 393 417.
