No More Learning

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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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.
40. JJ. Moreau de Tours, Du haschisch, Part III: "Therapeutique," p. 402: "One of the effects of hashish that I was most struck by ( . . . ) is that sort of maniacal excitation always
? accompanied by a sense ol cheerfulness and happiness ( . . . ) . I saw in this an ellective means for combating the fixed ideas o( melancholies (? ? ? ). Was I mistaken in my conjectures? I am led to think so. "
41. Ibid. p. 405: "Pinel, and with him all doctors ol the insane, saw mental alienation decided by bouts of agitation. " An allusion to the accounts of cures obtained following a "critical attack (acres critique)" that Pinel reports in his Traite mcdico-philosophique, section I, ? xiu: "Reasons which lead considering most bouts of mania as the healthy and favorable reaction to the cure" pp. 37-41; A Treatise on Insanity, pp. 3943. See also the article by Landre Beauvais (Pinel's assistant at Salpetriere) "Crisis" in Dictionnaire des sciences medicales, vol. VII (Paris: C. L. F. Panckoucke, 1813) pp. 370-392.
42. JJ. Moreau de Tours, Du haschisch: "A precise indication emerged that could be lormulated in this way: to preserve his primary acuity in the delirium tending to the chronic state, or to call back this acuity, to revive it when it threatens to become extinguished.
The extract ol Indian hemp was, of all the medicaments known, the most eminently suited lor lullilling this indication. "
43. See above, note 21 to lecture of 12 December 1973-
44. P. Foissac, Memoire sur le magnetisme animal, adresse a messieurs les membres de VAcademie roya/e
de medecine (Paris: Didot Jeune, 1825) p. 6: "When they have tallen into a deep sleep, the magnetized display the phenomena of a new lile (. . . ) . The sphere of consciousness grows, and already that faculty appears that is so precious that the first magnetizers will call 'intu
Hive' or 'lucidity' ( . . . ) . With it, the somnambulists ( . . . ) recognize the illness Irom which they suller, the near and distant causes ol these illnesses, their seat, their prognosis and their appropriate treatment (. . . ). By placing a hand successively on the head, chest, and abdomen ol someone unknown, the somnambulists also discover their illnesses, the pains and various alterations that they occasion; in addition they indicate whether cure is possi ble, easy or dilhcult, near at hand or lar oil, and what means must be used to achieve the result. "
45- See above, notes 28 and 33 the lecture ol 23 January 1974.
46. Thus the magnetic cure carried out on 4 May 1784 by Armand Marc Jacques de Chastenet,
marquis ol Puysegur (1751 1825), on Victor Race, a peasant attached to his property at Buzancy (Soissonnais): asleep, the latter answered questions, gave an opinion ol his state, indicated a course of therapy, and gave a prognosis with the date ol his return to health,
which will be confirmed. And on Charles Francois Ame, aged 14, who when put in a magnetic sleep announced the duration and intensity of his future crises. See,
A. M. J. Chastenet de Puysegur, (1) Memoires pour servir a I'histoire et a Vetablissement du magnetisme animal, vol. I, (Pans: 1784) pp. 199 211 and pp. 96 97; (2) Detail des cures operees
a Buzancy, pres de Soissons, par le magnetisme animal, a short anonymous work published by Puysegur (Soissons: 1784); (3) see also the account of the cure ol the young Hebert, pre
ceded by a plea in favor of magnetism: Appel aux savans observateurs du dix-neuvieme siecle de
la decision porlee par leurs predecesseurs contre le magnetisme animal, et fin du traitement du jeune Hebert (Paris: Dentu, 1813). On the history ot magnetic cures one can consult: S. Mialle,
Expose par ordre alphabelique des cures operees en France par le magtietisme animal depuis Mcsmer jusqu'a nos jours (1774-1&26) (Paris: Dentu, 1826). See also, H. F. Ellenberger, "Mesmer and
Puysegur: from magnetism to hypnotism," Psychoanalytic Review, vol. 52, no. 2 (1965).
47. This is taken from the eighth session conducted on 2 November 1820 by the Baron Jules Dupotet de Sennevoy in the service of Dr. Husson, head doctor at the Hotel Dieu, on
Catherine Samson, aged 18: see, Expose des experiences publiques sur le magnetisme animalfaites
a I'Hotel-Dieu de Paris, pendant le cours des mois d'octobre, novembre et decembre 1820 ( P a n s : Bechet Jeune, 3rd edition, 1826) p. 24.
48. In 1816, Etienne Jean Georget entered Esquirol's department at Salpetriere. On 8 February 1820 he defended his thesis, "Dissertation sur les causes de la folie," then published the work on which his reputation is based: De la folie. Considerations sur cette maladie. In 1821, with Leon Rostan, he turned two patients into experimental subjects, Petronille and Manoury, the widow Brouillard, called Braguette (see above, note 43).
49. "Petronille . . . asks Georget to throw her in the water while she is having her period" C. Burdin and F. Dubois (known as Dubois d'Amiens), Histoire academique du magnetisme animal (Paris: J. -B. Bailliere, 1841) p. 262.
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50. Ibid. pp. 262 263: "Petromlle's instructions had not been carried out meticulously; Pelronille had said that she had to be plunged in the Ourcq canal, since it was in this canal that she had (alien and contracted her illness: similia similibus; such had to be the end ol the story. "
51. James Braid (1795 i 8 6 0 ) , Scottish surgeon, converted to magnetism as a result ol demonstrations o( "mesmerism" at Manchester in November 1841 by Charles Lalontame,
a disciple ol the marquis de Puysegur, and popularized his practice under the term "hypnotism. " See,J. Braid, Neurhypnology, or the Rationale of Nervous Sleep Considered in rela-
tion with Animal Magnetism. Illustrated by Numerous Cases of its Successful Application in the
Relief and Cure of Diseases (London: John Churchill, 1843); French translation, with a
preface by E. Brown Sequard, Neurhypnologic, ou Traile du sommeil nerveux considere dans ses rapports avec le magnelisme animal, el relalanl de nombreux succes dans ses applications au iraitemenl des maladies, trans. G. Simon (Paris: A. Delahaye, 1883).
52. See below, note 55-
53. During the Restoration, the increasing potential ol magnetism was seen as a threat
by institutional medicine. The conlrontation corresponds to the setting up ol olbcial commissions: the lust, appointed on 28 February 1826, started work in January 1827 and delivered its conclusions on 28 June 1831, which, being deemed too lavorable, were not published by the Academie de medecine. A second, unlavorable, was voted on 5 September I837. The death warrant lor magnetism was signed on 15June 1842 with the decision ol the Academie to no longer concern itsell with the question. See, L. Peisse, "Des sciences occultes au xixc siecle. Le magnetisme animal," Revue des deux mondes, vol. 1, March 1842, pp. 695 723.
54. Whereas mesmerism proposed to "demonstrate that the heavenly bodies act on our earth and that our human bodies are equally subject to the same dynamic action" (A. Mesmer, Dissertalio physico-medica de planetarum influxu | Vienna: Chelem: 1766 | p. 32), and that the action ol the magnetizcr consists in canalizing this fluid on the patient, James Braid invoked a subjective action founded on the physiology ol the brain: see, The Power of the Mind over the Body: An Experimental Enquirey into the Nature and Cause of the Phenomena Attributed by Baron Reichenbach and Others to a New Imponderable (London: John Churchill, 1846), lor which he was hailed by, among others, the doctor Edgar Bei illon: "It is to Braid that honor is due lor having delmitively introduced the study ol induced sleep into the scientilic domain," and lor having rendered "a great service to science by giving to the whole ol his research the generic name ol hypnotism" Histoire de I'hypnotisme experimental ( Paris: Delahaye, 1902) p. 5.
55. Foucault refers here to the operation performed by E. F. Folhn and Paul Broca (to whom
the works ol Braid became known through a Bordeaux surgeon, Paul Azam) on a 40 year
old woman on 4 December 1859 at the Necker hospital. The operation was the subject ol
a report to the Academie des sciences presented by A. A. L. M. Velpeau on 7 December 1859: "Note sur une nouvelle methode anesthesique," Comptes rendus hebdomadaires desseances de I'Academie des sciences, vol. 49 (Paris: Mallet Buchelier, 1859) pp. 902 911.
56. Joseph Pierre Durand, known as Durand de Gros (1826 1900), was an exile in England where he discovered Braidism, and then in the United States. He returned to France where he published under the pseudonym ofJoseph Philips, Electrodynamisme vital, ou les Relations
physiologiques de Vesprit et de la matiere, demontrees par des experiences entieremenl nouvelles (Paris: J. B. Bailliere, 1855), and then, Cours theorique el pratique de braidisme, ou Hypnotisme nerveux
considere dans ses rapports avec la psychologiie, la physiologie et la pathologic, el dans ses applications a la medecine, a la chirurgie, a la physiologie experimenlale, a la medecine legale et a ^education (Paris:J. B. Bailliere, i860).
57. Durand de Gros defines "the hypotaxic state" as "a preparatory modification of vitality, a modification which usually remains latent and the whole effect of which is to incline the organization to undergo the determinant and specific action constituting the second stage" Cours theorique et pratique, p. 29.
58. Ibid. p. 112.
59. Ibid. Chorea is a nervous disorder characterized by sweeping and jerky involuntary
movements, with a gesticulatory appearance.
? 60. Ibid. p. 87: "Braidism is a process by which we seek to determine certain physiological changes in man with the aim ol lulfilling certain indications for medical or surgical treatment, or in order to facilitate the experimental studies of biology. "
61. Between 1850 and i 8 6 0 , under the impulse ol Guillaume Benjamin Amand Duchenne de Boulogne (1806 1875), the nosology of functional disorders ol motivity was redefined and enriched by two new groups of affections. On the one hand, "progressive muscular atrophy," studied from 18-19, and the "muscular atrophies with myopathic origin," in 1853: (1) La Paralyse atrophique de I'enjance (Pans: 1855). On the other hand, "progressive locomolor atrophy," known up until then as tabesdorsalis: (2) "De l'ataxie locomotrice progressive. Recherches sur unc maladie caractensee specialement par des troubles generaux de coordination des mouvemcnts," Archives generates de medecinc, 5th series, vol. 12, December 1858, pp. 6/|1 652; vol. 13, January 1859, pp. 5-23; February 1859, pp. 158 I64; April 1859, pp. -117 yi32. In i860 he described (3) the "paralysie glosso labio laryngee," ibid. 5th series, vol. 16, i860, pp. 283 296 and pp. /|31 Vi5. On Duchenne de Boulogne, see P. Guilly, Duchenne de Boulogne (Paris: Bailliere, 1936). On the constitution ol the neurological lield, see W. Riese, A History oj Neurology (New York: MD Publications, 1959), and F. H. Garrison, History of Neurology, edition revised and expanded by Laurence McHenry (Springfield, 111. : C. C. Thomas, 1969).
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6 FEBRUARY 1974
The emergence of the neurological body: Broca and Duchenne de Boulogne. ^ Illnesses of differential diagnosis and illnesses of absolute diagnosis. ^ The model of "generalparalysis" and the
neuroses. ^ The battle of hysteria: 1. The organisation of a "symptomatologLcal scenario. "nu 2. The maneuver of the "functional
mannequin" and hypnosis. The question of simulation. nu 3. Neurosis and trauma. The irruption of the sexual body.
LAST WEEK I SAID that one of the important events in the history of the consolidation of psychiatric power was, in my view, the appearance of what I called the "neurological body. "* What should we understand by "neurological body"? I would like to begin with this today.
Of course, the neurological body is still, always, the body of pathological-anatomical localization. There is no opposition between the neurological body and the body of pathological anatomy; the second is part of the first; it is, if you like, a derivative or expansion of it. And the best proof of this is that in one of his courses, in 1879, Charcot said that the constitution, progress, and, in his view, the culmination of neu- rology, was the triumph of the "spirit of localization. "1 Except that what I think is important is that the procedures for matching up anatomical localization and clinical observation in the case of neurology are not at all the same as in the case of ordinary general medicine. It seems to me
* The manuscript adds: "From 1850 to 1870, emergence of a new body. "
? 298 PSYCHIATRIC POWER
that neurology, clinical neurology, involves a quite different deployment of the body in the field of medical practice. My impression is that the encounter of the patient-body and the doctor body in neurology takes place in terms of a very different arrangement from that in general medicine. And it is the setting up of this new apparatus that seems to me to be the important episode, which is why I would like to try to identify the new apparatus set up by and through the constitution ol a neuropathology or neurological clinical medicine.
What is this apparatus, and in what does it consist? How is the sick body* captured in clinical neurology? Its capture takes place, I think, very differently trom the way the body was captured at the time ol the formation of pathological anatomy, more or less between Bichat2 and Laennec* I will give you an example straightaway by taking a text that is not by Charcot himself, but which is found in the Charcot archives at Salpetriere and was quite certainly written by one of his students-- clearly we don't know which one. It is an observation of a patient. This is how the patient is described: the patient's symptom was something very simple, the drooping of the left eyelid, called ptosis. So, the student takes the following notes for Charcot for him then to use for a lecture-- I am not giving you the description of the whole of the patient's lace, but just a quite small excerpt.
"If we tell him to open his eyelids, he raises the right one normally, the left one however, does not noticeably move, no more than the eye brow, so that the superciliary asymmetry becomes more marked. In this movement (. . . ) the skin ol the forehead wrinkles transversally on the right side, while it remains almost smooth on the left. At rest, the skin of the forehead is wrinkled neither on the right nor the left ( . . . ) . "
"Two more points should be noted: a small dimple, quite visible under a certain angle of light, eight millimeters above the left eyelid and about two centimeters to the left of the median line of the forehead; and a little projection within the dimple which seems due to the contraction of the eyelid muscle. These two points are very noticeable in comparison with the normal state of the right side. "1
* The manuscript clarifies: "body whose surlace is the bearer ol plastic values. "
? You have here a type of description which is, I think, really quite different from what is found in the anatomical-pathological procedure, m anatomical-pathological observation. ^ In a sense, this sort of descrip- tion takes us back to a sort of surlace, almost impressionistic gaze, such as could be found m eighteenth century medicine, when the patient's complexion, color, red cheeks and bloodshot eyes, etcetera, were impor tant elements for clinical diagnosis. 6 Pathological anatomy--Bichat, Laennec, if you like? infinttely reduced this impressionistic description of the surlace and codified what were ultimately a quite limited number of surlace signs intended to identify what was essential according to a well established clinical code, this being, precisely, the lesion, which then, thanks etther to a surgical operation or, especially, the autopsy, was described by the anatomical pathologist with almost as many details as, if not more than, the description I have just read to you. In other words, anatomical-pathology brought its minutely detailed description to bear on the deep and injured organ, the surface only being questioned through a grid of ultimately simple and limited signs.
Here, rather, as you can see, you have the striking reemergence of sur face values within medical discourse and knowledge. It is this surface that must be covered in all its hollows and bumps, and practically by looking only, by looking only that far. In fact, and no doubt even more than this clinical re validation of the almost impressionistic values of the surface, what is important and, I think, decisive, in this new clinical capture of the neurological patient, and in the correlative constitution of a neurological body before this gaze and apparatus of capture, is that the neurological examination is basically looking tor "responses. "
What I mean is that in the pathological anatomy of Bichat Laennec one can, of course, identify the signs straightaway, at the first glance; one can also obtain them from a stimulation: one taps, one listens, etcetera. That is to say, what is sought in classical pathological anatomy is essentially the system of stimulation-effect: one sounds the chest and listens to the noise;7 one asks the patient to cough and listens to its harshness; one palpates and sees if there is any heat. So: stimulation- effect.
In the case of the neurological examination being constituted in the mid-nineteenth century, the main part of the signs, in short what makes
6 February 197yi 299
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