Delcourt, Les Grands
Sanctuaires
de la Grece (Paris: Presses universitaires de France, 1947) pp.
Foucault-Psychiatric-Power-1973-74
30 On the one hand, the doctor must first foresee the crisis, identify when it will occur,31 wait for the exact day on which it will take place, and then, at that point, engage in battle to defeat the disease,32 in short, so that nature triumphs over the disease.
That is to say, in a sense the doctor's role is to reinforce the energy of nature.
But we must be careful when reinforcing nature's energy, because what happens if we reinforce it too much when struggling against the disease?
The result is that being, as it were, exhausted, and lacking strength, the disease will not join in the combat and the crisis will not take place, and if the crisis does not take place, then the harmful condition will persist.
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So a proper balance must be maintained. Similarly, if we reinforce nature too much, if nature becomes too vigorous and too strong, then the movement by which it tries to expel the disease will be too violent, and there will be the danger of the patient dying from the violence of nature's efforts against the disease. So we must neither weaken the ill ness too much, which risks avoiding the crisis, as it were, nor reinforce nature too much, because then there is the danger of the crisis being too violent. So you can see that in this technology of the crisis the doctor is much more the manager and arbitrator of the crisis than the agent of a therapeutic intervention. * The doctor must foresee the crisis, know the opposing forces, imagine its outcome, and arrange things so that it occurs at the right time; he must see how and with what force it approaches, and he must introduce only those necessary adjustments to each side of the balance so that the crisis takes its proper course.
And you can see that in its general form the technique of the crisis in Greek medicine is no different from the technique of a judge or arbitra- tor in a judicial dispute. In this technique of the test you have a sort of model, a jundico political matrix, which is applied both to the con- tentious battle in a case of penal law and to medical practice. Moreover, in medical practice there is a sort of supplementary complexity that is found again in judicial practice. This is that, as you can see, the doctor does not cure, and it cannot even be said that he directly confronts the disease, since it is nature that confronts the disease; he foresees the crisis, he gauges the contending forces, and he succeeds if he manages nature's success. And, to come back to this word crisis, which after all means "to judge,"B just as the disease comes up for judgment on the day of the crisis, so the doctor, in this role as a kind of arbitrator, is judged in turn by how he presides over the combat, and he may come out as victor or vanquished in relation to the disease.
In relation to the combat of nature and the disease, the doctor's is a second order combat, from which he will come out victor or vanquished in relation to these internal laws, but equally in relation to other doctors. And here again we come back to the juridical model. You know
* The manuscript adds: "more the role of observance of rules than of the observation ol phenomena. "
? that judges could be disqualified when they judged badly, in turn having to undergo a trial from which they will come out either victors or vanquished. And this kind of joust between the adversaries and between the laws of combat and then the judge had a sort of public character. This double combat always had public features. Now medical consultation, as you see it at work from Hippocrates up to Moliere's famous doctors--on the meaning and status of which we should nonetheless reflect a little--always involved several people. ^ That is to say, it involved at once a joust of nature against the disease, of the doctor with regard to this struggle of nature against the disease, and of the doctor with other doctors.
They were all present, each confronting the others, each making his own prediction about when the crisis must occur, what its nature would be, and what would be the outcome. However self-justifymg it may be, it seems to me that the famous scene Galen describes to explain how he made his lortune in Rome is an entirely typical scene of this kind of enthronement of the doctor. The story recounts how the young Galen, an unknown doctor coming to Rome from Asia Minor, participates in a kind of medical joust around a patient. When the doctors were predict mg this or that, Galen says, looking at the ill young man: There will be a crisis shortly; this crisis will be a nosebleed, and he will bleed from the right nostril. This is in fact what happens, and, Galen says, one by one all the doctors around me were quietly overshadowed. 35 The joust was also a joust between the doctors.
The doctor's appropriation of a patient, the recognition of the family doctor, the doctor patient discourse, are all the effect of a whole series oi economic, sociological and epistemological transformations of medi cine. However, in this medicine of the test, in which the crisis was the main component, the joust between doctors was as essential as the joust between nature and the disease. So you can see, this technology of truth test, of truth-event, persists for a long time in medicine, m medical practice, which, once again, like alchemy, was not utterly foreign to the developments of the scientific knowledge which adjoined, cut across, and were tangled up with it.
A word more on this subject. With the example ol medicine you can see, of course, that the extension of the other series, of the demonstrative
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technology of truth, was not brought about at a stroke, like a kind ol overall reversal, and it certainly does not take place in the same way in astronomy as in medicine, or in judicial practice the same way as m botany. However, broadly speaking, I think we can say that two processes have supported this transformation in the technology of truth, at least in what concerns empirical knowledge.
I think the transition from a technology of truth-event to truth demonstration is linked, on the one hand, to the extension of political procedures of the inquiry. The inquiry, the report, the evidence ol several people, the cross checking of information, the circulation of knowledge from the center of power to the points where it ends up and back again, as well as all the agencies ol parallel verification, progres sively, over a long history, gradually constituted the instrument of the political and economic power of industrial society; hence the refine- ment, the increasingly fine grid of these techniques of inquiry within the elements where they were usually applied. Broadly speaking, the refinement by which we passed from a basically fiscal kind of inquiry in the Middle Ages--knowing who collects what, who possesses what, so that the necessary deductions are made--to a police kind of investiga tion into peopled behavior, into how they live, think, make love, etcetera, this transition from fiscal inquiry to police investigation, the constitution of a police individuality starting from fiscal individuality, which was the only individuality known by power in the Middle Ages, reveals the tightening of the technique of inquiry in our kind of society. 36
Moreover, there was not only a local tightening, but also a planetary extension to the entire surface of the globe. There is a double movement of colonization: colonization in depth, which fed on the actions, bodies, and thoughts of individuals, and then colonization at the level of territories and surfaces. We can say that from the end of the Middle Ages we have seen the entire surface of the Earth, down to the finest grain of things, bodies, and actions, subjected to generalized investigation: a sort of grand inquisitorial parasitism. That is to say, at any time, at any place, and with regard to anything in the world, the question of truth can and must be posed. Truth is everywhere and awaits us everywhere, at any place and at any time. This, very schematically, is the great process that led to this move from a technology of the truth-event to a technology of truth findings.
? The other process was a sort of opposite process, f. . . *] establishing the rarity of this truth of anywhere and anytime. This rarefaction is not brought to bear on the emergence or production of truth however, but precisely on who can discover it. In one sense, this universal truth of anywhere and anytime, which any inquiry can and must track down and discover with regard to no matter what, is accessible to anyone; anyone can have access to it, since it is there, everywhere and all the time. However, the necessary circumstances are still required, and we must acquire the forms of thought and techniques that will give us access to this truth that is everywhere, but always deep down, buried, and diffi cult to reach.
So we will have, of course, a universal subject of this universal truth, but it will be an abstract subject because, concretely, the universal sub- ject able to grasp this truth is rare, since it must be a subject qualified by procedures of pedagogy and selection. Universities, learned societies, canonical teaching, schools, laboratories, the interplay of specialization and professional qualification, are all ways of organizing the rarity of those who can have access to a truth that science posits as universal. It will be the abstract right of every individual to be a universal subject, if you like, but to be one in fact, concretely, will necessarily entail rare individuals being qualified to perform the function of universal subject. In the history of the West since the eighteenth century, the appearance of philosophers, men of science, intellectuals, professors, laboratories, etcetera, is directly correlated with this extension of the standpoint of scientilic truth and corresponds precisely to the rarelaction of those who can know a truth that is now present everywhere and at every moment. Fine. That's the little history I wanted to present. What is its relation- ship to madness? We're just coming to it.
In the medicine in general that I have been talking about, the notion of crisis disappears at the end of the eighteenth century. It not only
* (Recording:) we could call it
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disappears as a notion, after Hoffmann*7 say, but also as an organizing principle of medical technique. Why did it disappear? Well, I think it disappeared for the reasons I have just given in a general schema, that is to say, with regard to disease, as with regard to everything henceforth, there is the organization of a sort of inquisitorial space or grid. 38 The construction of what we can broadly call hospital and medical facilities in Europe in the eighteenth century basically ensures the general sur- veillance of populations, making it possible, in principle, to investigate the health of every individual. 39 The hospital also makes possible the integration of the living individual's body, and especially his dead body, into the disease. ^0 That is to say, at the end of the eighteenth century we will have both a general surveillance of populations and the concrete possibility of establishing a relationship between a disease and a body on which an autopsy has been carried out. The birth of pathological anatomy and, at the same time, the appearance of a statistical medicine, of a medicine of large numbersH1--both the ascription of precise causal- ity by the projection of the illness on a dead body and the possibility of inspecting a set of populations--provide the two major epistemological tools of nineteenth century medicine. And it is quite clear that hence forth a technology of observation and demonstration will progressively make the technique of crisis unnecessary.
What happens in psychiatry then? Well, I think something very strange takes place. On the one hand, it is clear that the psychiatric hospital, like the hospital of general medicine, cannot but tend to make the crisis disappear. The psychiatric hospital, like any other hospital, is a space of inquiry and inspection, a sort of inquisitorial site, and there is no need at all for that test of truth. I have also tried to show you that not only is there no need for the test of truth, but there is no need for truth at all, whether arrived at by the technique of the test or by that of demonstration. Furthermore, not only is there no need for it, but to tell the truth the crisis as an event in the madman's madness and behavior is ruled out. Why is it ruled out? Essentially for three reasons I think.
First, it is ruled out precisely by the fact that the hospital functions as a disciplinary system, that is to say, as a system subject to rules, expecting a certain order, imposing a certain regime that excludes any thing like the raging and raving outburst of the crisis ol madness.
? Moreover, the main instruction, the main technique of this asylum discipline, is: Don't think about it. Don't think about it; think about something else; read, work, go into the fields, but anyway, don't think about your madness/'2 Cultivate, not your own garden, but the director's. Do woodwork, earn your keep, but don't think about your illness. The disciplinary space of the asylum cannot permit the crisis of madness.
Second, constant recourse to pathological anatomy in asylum practice, from about around 1825, played the role of theoretical rejection of the crisis/3 Actually, nothing, apart from what took place with general paral- ysis, permitted the assumption, or anyway the ascription, of a physical cause to mental illness. Now, the practice of autopsy was, at least in a great many hospitals, a sort of regular practice the basic meaning of which was, I think, the following: if there is a truth of madness, it is cer- tainly not in what the mad say; it can only reside in their nerves and their brain. To that extent, the crisis as the moment of truth, as the moment at which the truth of madness burst forth, was ruled out epistemologically by recourse to pathological anatomy, or rather, I think that pathological anatomy was the epistemological cover behind which the existence of the crisis could always be rejected, denied, or suppressed: We can strap you to your armchair, we can refuse to listen to what you say, since we will seek the truth of madness from pathological anatomy, when you are dead.
Finally, the third reason for rejecting the crisis was a process I have not considered until now: the relationship between madness and crime. In fact, from around 1820-1825 we see a very strange process in the courts in which doctors--who were not called on by the prosecutor or by the president of the court, and often not even by lawyers--gave their opinion on a crime and, as it were, tried to claim the crime for mental illness itself. v' Faced with any crime, the doctors raised the question: Could not this be a sign of illness? And it was in this way that they con- structed the very curious notion of monomania which, schematically, means this: when someone commits a crime which has no raison d'etre, no justification at the level of his interest, wouldn't the fact alone of committing the crime be the symptom of an illness, the essence of which would basically be the crime itself? Monomania was a sort of single symptom illness with just one symptom occurring only once in the individual's life, but a symptom that was, precisely, the crime? ''5
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One wonders why psychiatrists take this interest in crime, and why they insist so strongly and, in a way, so violently on the potential identity of crime and mental illness. There are, of course, a number of reasons, but I think one of them is the attempt to demonstrate not so much that every criminal may be mad, but to demonstrate something that is much more serious, and also much more important for psychi- atric power, namely, that every mad person is a possible criminal. The determination to pin madness on a crime, even on every crime, was a way of founding psychiatric power, not in terms of truth, since precisely it is not a question of truth, but in terms of danger: Mve are here to protect society, since at the heart of every madness there is the possibil ity of crime. In my view, pinning something like a madness on a crime is, for social reasons of course, a way of getting the individual out of trouble, but, as a general rule, at the level of the general operation of this ascription of madness to crime, there is the psychiatrists' wish to base their practice on something like social defense, since they cannot base it in truth. So, we can say that the effect of the disciplinary system of psychiatry is basically to get rid of the crisis. Not only is it not needed, it is not wanted, since the crisis could be dangerous, since the madman's crisis could well be another person's death. There is no need for it, pathological anatomy dispenses with it, and the regime of order and discipline means that the crisis is not desirable.
However, at the same time as this is taking place, there is a movement in the opposite direction, for the explanation and justification of which there are two reasons. On the one hand, the crisis is needed because, in the end, neither the disciplinary regime, nor the obligatory calm imposed on the mad, nor pathological anatomy, enabled psychiatric knowledge to be founded as truth. So that this knowledge, which I have tried to show you operated as a supplement of power, was for a long time running on empty, and obviously it could not rail to seek to pro- vide itself with a content of truth according to the same norms of the medical technology of the time, that is to say, the technology of reported findings. But since this was not possible, the crisis was resorted to for another, positive reason.
The real point at which psychiatric knowledge is exercised is not ini- tially or essentially what enables the illness to be specified, described,
? and explained. In other words, whereas the doctor, given his position, is basically obliged to respond to the patient's symptoms and complaints with an activity of specification and characterization--hence the bet that differential diagnosis has been the major medical activity since the nineteenth century--the psychiatrist is not required, or called in at the patient's request, to give the latter's symptoms a status, character, and speciiication. The psychiatrist is needed at an earlier stage, at a lower level, where it has to be decided whether or not there is an illness. For the psychiatrist it is a matter of answering the question: Is this individ- ual mad or not? The question is put to him by the Iamily in cases ol voluntary admission, or by the administration in cases ol compulsory admission--although the administration only puts the question on the quiet, since it reserves the right to disregard what the psychiatrist says--
but, in any case, the psychiatrist is situated at this level.
Whereas (general] medical knowledge functions at the point ol the specification ol the illness, at the point of differential diagnosis, medical knowledge in psychiatry functions at the point of the decision between madness or non madness, the point, if you like, ol reality or non reality, reality or fiction, whether this be liction on the part of the patient who, for one reason or another, would like to pretend to be mad, or the fiction of the Iamily circle, which imagines, wishes, desires, or imposes the image of madness. This is the point at which the psychiatrist's
knowledge, and also his power, functions. '6
Now what tools does the psychiatrist possess that enable him to
function at this level and decide on the reality ol madness? It is precisely here that we encounter the paradox of nineteenth century psychiatric knowledge once again. On the one hand, psychiatric knowledge really tried to construct itsell on the model ol medicine observation, of inquiry and demonstration; it really tried to constitute a symptomato- logical type of knowledge for itself; a description of different illnesses was actually constituted, etcetera, but, to tell the truth, this was only the cover and justification for an activity situated elsewhere, and this activity was precisely that of deciding between reality or lie, reality or simulation. The activity of psychiatric knowledge is really situated at the point of simulation, at the point of fiction, not at the point of characterization.
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There are, I think, a number of consequences of this. The first is that in order to resolve this problem the psychiatric hospital literally invented a new medical crisis. This was no longer that old crisis of truth played out between the forces of the disease and the forces of nature that was typical of the medical crisis put to work in the eighteenth century, but a crisis that I will call a crisis of reality, which is played out between the mad person and the power that confines him, the doctor's power knowledge. The doctor must be able to arbitrate on the question of the reality or non-reality of the madness.
So, as you can see, unlike the hospital of general medicine, the psychiatric hospital's function is not to be the place where an "illness" exhibits its specific and differential characteristics in comparison with other illnesses. The psychiatric hospital has a much simpler, more elementary, more lundamental function. Its function is, precisely, to give madness reality, to open up a space of realization for madness. The psychiatric hospital exists so that madness becomes real, whereas the hospital's function tout court is both knowing what the illness is and eliminating it. The psychiatric hospital's function, following the psychi atric decision concerning the reality of the madness, is to make it exist as reality.
Here we encounter an institutional type of criticism of the psychi atric hospital, which charges it, precisely, with fabricating the mad out of the people it claims to cure. This institutional type of criticism thus poses the question: What kind oi institution could work in such a way that the mad could be cured and not pushed deeper into illness? How could the [asylum] institution work like any hospital? " However, in the end I think this criticism is quite inadequate because it lacks the essential. That is to say, it lacks an analysis of the distribution of psychiatric power that makes it possible to show that the fact that the psychiatric hospital is a place for the realization of madness is not an accident or due to a deviation of the institution, but that the very func tion of psychiatric power is to have before it, and for the patient, a space of realization for the illness (that, when it comes to it, may or may not be in the hospital). We can say then that the function of psychiatric power is to realize madness in an institution where the function of dis- cipline is precisely to get rid of all the violence, crises, and, if necessary,
? all the symptoms of madness. The real function and effect of the asylum institution in itself, of this institution of discipline--and it is in this respect that my analysis differs from institutional analyses--is to sup- press, I do not say madness, but the symptoms of madness, at the same time as the function of psychiatric power, which is exercised within and lixes individuals to the asylum, is to realize madness.
All in all, there is an ideal for this double lunctioning of psychiatric power, which realizes madness, and of the disciplinary institution, which refuses to listen to madness, which flattens out its symptoms and planes down all its manifestations: this is dementia. What is a demented person? He is someone who is nothing other than the reality of his madness; he is the person in whom the multiplicity of symptoms or, rather, their flattening out, is such that it is no longer possible to ascribe to him a specific symptomatology by which he could be characterized. The demented person is therefore someone who corresponds exactly to the working of the asylum institution, since, by means of discipline, all the symptoms in their specificity have been smoothed out: there are no longer any outward signs, externalizations, or crises. And, at the same time, someone who is demented answers to what psychiatric power wants, since he actually realizes madness as an individual reality within the asylum.
The famous development of dementia, which nineteenth century psy- chiatrists could observe as a natural phenomenon in madness, is noth- ing other than the series of intertwined effects of an asylum discipline that smoothes away outward signs and symptoms, and medical power's appeal to the patient to be a madman, to realize madness. The demented person is actually what was fabricated by this double game of power and discipline.
As for the hysterics, those famous, dear hysterics, I would say that they were precisely the front of resistance to this gradient of dementia that involved the double game of psychiatric power and asylum discipline. They were the front of resistance, because, what is a hysteric? A hysteric is someone who is so seduced by the best and most clearly specified symptoms--those, precisely, offered by the organically ill--that he or she adopts them. The hysteric constitutes herself as the blazon of genuine illnesses; she models herself as a body and site bearing genuine
2^ January 1974 253
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symptoms. To the ascription ol and propensity towards the subsidence ol symptoms in dementia, the hysteric responds with the exacerbation of the most precise and well determined symptoms; and while doing this, she pursues a game such that when one wants to lix her illness in reality, one can never manage to do so, since, when her symptom should refer to an organic substratum, she shows that there is no substratum, so that she cannot be fixed at the level of the reality of her illness at the very moment she displays the most spectacular symptoms. Hysteria was the effective way ol defending onesell Irom dementia; the only way not to be demented in a nineteenth century hospital was to be a hysteric, that is to say, to counter the pressure that annihilated symptoms, that obliterated them, by building up the visible, plastic edifice of a whole panoply of symptoms, and, by means of simulation, resisting madness being fixed in reality. The hysteric has magnificent symptoms, but at the same time she sidesteps the reality of her illness; she goes against the current of the asylum game and, to that extent, we salute the hysterics as the true militants ol antipsychiatry. ^
? 1. Discovered in the sixteenth century, the use oi ether spread in the nineteenth century in the treatment ol neuroses and for screening simulated illnesses, on account of its "stupefying" property. See above, note 18 to lecture of 9'11 January 1974.
2. Discovered simultaneously in 1831 by Justus Liebig in Germany and by Soubeiran in France, the use of chloroform as an anesthetic began in 1847. See, E. Soubeiran, "Recherches sur quelques combinaisons de chlore" Annales de chimie et de physique, vol. XLIII, October 1831, pp. 113-157; H. Bayard, "L'utihsation de l'ether et le diagnostic des maladies men tales"; H. Brochin, "Maladies nerveuses", ? "Anesthesiques: ether et chloroforme"; and, Lailler (pharmacist of the Quatre Mares asylum) "Les nouveaux hypnotiques et leur emploi en medecine mentale" Annales medico-psychologiques, 7lh series, vol. IV,July 1886, pp. 64-90.
}. See above, note 1 to lecture ol 19 December 1973.
4. See above, note 2 to lecture of 19 December 1973.
5. J. J. Moreau de Tours discovered the effects ol hashish on his journey in the East from 1837
6.
to 1840 and he subsequently devoted his research to it, loreseeing possibilities of experi ment to clanly the relations between its ellects and dreams and delirium. See, Du haschkh
et d'alienation mentale. Etudes psychologiques (Paris: Fortin, 1845).
Experiments in "animal magnetism" took place in hospitals under the Restoration. Thus,
at the Hotel Dieu, on 20 October 1820, the head doctor, Henri Marie Husson (1772 1853) invited the baron Dupotet de Sennevoy to make some demonstrations; under
the supervision of Joseph Recamier and Alexandre Bertrand, a young woman of 18, Catherine Samson, was given magnetic treatment. See J. Dupotet de Sennevoy (1790 1866),ExposedesexperiencessurlemagnelismeanimalfaitesaVHotelDieudePan'spen- dant le cours des mois d'octobre, novembre et decembre 1820 (Paris: Bechet Jeune, 1821). At Salpetnere, Etienne Georget and Leon Rostan used some ol their patients as experimental subjects. Without giving their names, Georget records these experiments in De la physiolo-
gie du systeme nerveux, et specialment du cerveux, vol. I, p. 404. See, L. Rostan, Du magnetisme animal (Paris: Rignoux, 1825). See also, A. Gauthier, Histoire du somnambulismc, vol. II, p. 324. See below, note 48 to lecture of 30 January 1974-
Foucault is alluding to the debate between Socrates and Parmemdes on the problem of the things ol which there are Ideas. See, Plato, Parmenides, 130c d.
From the middle ol the eighth century B. C. until the end of the fourth century A. D. , Delphi, a town ol Phocis at the foot ol Parnassus, was a favorite site for Apollo to deliver his oracles through the mouth of the Pythia. See, M.
Delcourt, Les Grands Sanctuaires de la Grece (Paris: Presses universitaires de France, 1947) pp. 76 92; M. Delcourt, VOracle de Delphes (Paris: Payot, 1955); R. Flaceliere, Devins et Oracles grecs (Paris: Presses universitaires de France, 1972) pp. 49 83; and, G. Roux, Delphes, son oracle et ses dieux (Paris: Les Belles Lettres, 1976).
Epidaurus, a town of Argolis on the east Peloponnese, was the site ol the sanctuary Apollo's son, Asclepius, where divination through dreams was practiced. See, M. Delcourt, Les Grands Sanctuaires, pp. 93 113; R. Flaceliere, Devins et Oracles grecs, pp. 36 37; and, G. Vlastos, "Religion and medicine in the cult of Asclepius: a review article" Review oj Religion, vol. 13,1948 1949, pp. 269 290.
The notion of Kaipo^ {kairos) defines the occasion, the opportunity to be seized, and con- sequently the time of possible action. Hippocrates ( 4 6 0 377 B. C. ) devotes a chapter of his Des Maladies, I, to this notion, in (Euvres completes, ed. Littre (Paris, J. -B. Bailliere, 1849) vol. VI, ch. 5, "Ol the opportune and inopportune" pp. 148 151; English translation, "Diseases 1" in Hippocrates, vol. V, trans. Paul Potter (Cambridge, Mass. : Harvard University Press, The Loeb Classical Library, 1988). See, P. Joos, "Zufall. Kunst und Natur
bei dem Hippokratitkern" Janus, no. 46, 1957, pp. 238 252; P. Kucharski, "Sur la notion pythagoncienne de kairos11 Revue philosophique de la France et de Vetranger, vol. CLII, no. 2, 1963, pp. 141-169; and P Chantraine, "KoupoS" in Dictionnaire etymologique de la langue grecque. Histoire des mots (Pans: Klincksieck, 1970) vol. II, p. 480.
7. 8.
9.
10.
11. Foucault is alluding here to the Heideggerian problematic that, in a discussion with G. Preti, he then associated with that of Husserl in the same reproach of calling into "question all our knowledge and its loundations ( . . . ) on the basis of that which is
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PSYCHIATRIC POWER
12.
original (. . . ) at the expense of all articulated historical content," M. Foucault, "Les prob- lemes de la culture. Un debat Foucault Preti" (September 1972) Dits et Ecrits, vol. 2, p. 372. So it is the Heideggerian conception of history that is intended here. See especially, M. Heidegger, (1) Sein und Zeit (Halle: Nemeyer, 1927); English translation, Being and Time, trans. J. Macquarrie and E. Robinson (Oxlord: Blackwells, 1967); (2) Vom Wesen des Grundes (Halle: Nemeyer, 1929); English translation, The Essence of Reasons, trans. Terrence Malick (Evanstan: Northwestern University Press, 1969); (3) Vom Wesen der Wahreit (Frankfurt: Klostermann, 19/l3); English translation, The Essence of Truth, on Plato's parable of the cave allegory and Theaetetus, trans. T. Sadler (London: Continuum, 2002); (4) Hol^wege (Frankfurt: Klostermann; 1952); English translation, Off the Beaten Track, trans. J. Young and K. Haynes (Cambridge: Cambridge University Press, 2002); (5) Vortrage und Aufsat^e (Pfullingen: Neske, 1954); ( 6 ) Nietzsche, vol. 2 (Pfullingen: Neske, 1961); English translation, Nietzsche, vol. 2: The Eternal Recurrence of the Same, trans. David Farrell Krell (San Francisco: Harper & Row, 1984). On the relations between Foucault and Heidegger, see M. Foucault, (1) Les Mots et les choses, ch. 9, "L'Homme et ses doubles" ? IV and vi; The Order of Things, ch. 9, "Man and his doubles" sections 4 and 6; (2) "L'Homme est-il mort? " (interview with C. Bonnefoy, June 1966) Dits et Ecrits, vol. 1, p. 542; (3) "Ariane s'est pendue" (April 1969) Dits et Ecrits, vol. 1, p. 768 and p. 770; (4) "Foucault, le philosophe, est en train de parler. Pensez" (29 May 1973) Dits et Ecrits, vol. 2, p. 424; (5) "Prisons et asiles dans le m^canisme du pouvoir" (interview with M. D'Eramo, March 1974), Dits et Ecrits, vol. 2, p. 521; ( 6 ) "Structuralisme et poststructuralisme" (interview with G. Raulet, Spring 1983) Dits et tents, vol. 4, p. 455; English translation, "Structuralism and Post-Structuralism," trans. Jeremy Harding, Essential Works of Foucault, 2, p. 456; (7) "Politique et ethique: une interview," Dits et Ecrits,vol. 4, p. 585; "Politics and Ethics: An Interview" trans. P. Rabinow, The Foucault Reader, pp. 373-374; ( 8 ) "Le retour de la morale" (interview with G. Barbedette and A. Scala, 29 May 1984) Dits et Ecrits, vol. 4, p. 703; English translation, "The Return of Morality" trans. Thomas Levin and Isabelle Lorenz, in Michel Foucault, Politics, Philosophy, Culture. Interviews and Other Writings, 1977-19&4, ed. Lawrence D. Kritzman (New York and London: Routledge, 1988);
( 9 ) "Verite, pouvoir et soi" (interview with R. Martin, 25 October 1982) Dits et Ecrits, vol. 4, p. 780.
In the third lecture of the 1970 1971 course, "The Will to Knowledge (savoir')" Foucault proposed the "opposite view" of a history of the "will to knowledge (connaitre)," in which truth has "the immediate, universal and bare form of observation, external to the proce dure of judgment," proposing the need to "write a history ol the relationships between truth and torture (supplice)," in which "truth is not observed but decided in the form of the oath and the invocation prescribed by the ritual of the ordeal. " A regime, consequently, in which "truth is not linked to the possible light and gaze brought to bear on things by a subject, but to the obscurity of the future and disturbing event. " Other fragments oi such a history are put lorward in the ninth lecture of the 1971-1972 course, "Penal Theories and Institutions," which deals with the system of proof in procedures of the oath, ordeals, and judicial duel from the tenth to the thirteenth century. Foucault was inspired by M. Detienne, Les Maitres de verite dans la Grece archaique (Paris: Maspero, 1967); English translation, The Masters of Truth in Archaic Greece, trans. Janet Lloyd (New York: Zone Books, 1999).
The thirteenth lecture of the course "Penal Theories and Institutions" dedicated to "the confession, the test" explains the meaning ol the detour through what Foucault calls "juridico-political matrices" such as the test, the inquiry, etcetera, and distinguishes three levels of analysis: (a) an "historical description of the sciences," in which "the history of the sciences" consists; (b) an "archeology of knowledge" which takes the relationships ol knowledge and power into account; and (c) a "dynastic of knowledge" which, thanks to the freeing of the juridico political matrices which authorize the archeology, is situated "at the level which combines the most prolit, knowledge and power" (course manuscript con suited thanks to the kindness of Daniel Defert). Foucault takes up this distinction between the "archeological" and "dynastic" in an interview with S. Hasumi, September 1972 "De l'archeologie a la dynastique," Dits et Ecrits, vol. 2, p. 406. On "archeology," see the many definitions given by Foucault: (1) in Dits et Merits, vol. 1: "Michel Foucault, Les Mots et les
13.
? Choses" pp. 498-499; "Sur les fa^ons d'ecrire l'histoire" p. 595; "Reponse a une question" p. 681, and "Michel Foucault explique son dernier livre" pp. 771 772; (2) in Dits et Ecrits, vol. 2: "La volonte de savoir" p. 2-12; "La verite et les formes juridiques" pp. 643-644; English translation, "Truth and Juridical Forms," trans. Robert Hurley, Essential Works of Foucault, 3; ( 3 ) m Dits et Ecrits, vol. 3: "Cours du 7 janvier 1976" p. 167; English translation, lecture of 7 January 1976, "Society Must Be Defended" ch. 1, pp. 10 11; "Dialogue sur le pou- voir", pp. 468-469; (4) in Dits et Ecrits, vol. 4: "Entretien avec Michel Foucault" p. 57; "Structuralisme et poststructuralisme" p. 443; English translation, "Structuralism and Post Structuralism," trans. Jeremy Harding, Essential Works of Foucault, 2, pp. 444 445-
14. In fact Foucault will not keep to this program apart from some comments on the role of childhood in the generalization ol psychiatric knowledge and power in the 1974-1975 College de France lectures of 5,12, and 19 March: Les Anormaux, pp. 217 301; Abnormal, pp. 231 321.
15- From the Old English, ordal, judgment, the "judgment of God" or "ordeal," means to settle contentious questions with the idea that God intervenes in the case to judge during tests likes those of "fire," the "branding iron," "cold or boiling water," and the "cross," etcetera. See L. Tanon, Histoire des tribunaux de /'Inquisition en France (Pans: L. Larose and Forcel, 1893) on the penalties of "lire" (pp. 464-479) and the "cross" (pp. 490-498). As J. -P. Levy emphasizes in his, La Hierarchie des preuves dans le droit savant du Moyen Age, depuis la renaissance du droit romain jusqu'a la fin du xivc siecle (Paris: Sirey, 1939), in this procedure "the trial is not an investigation with the aim of finding out the truth ( . . . ) . It is originally
a struggle, and later, an appeal to God; the concern with making the truth come out is left up to Him, but the judge does not seek it himselt" (p. 163).
Foucault referred to the question of the ordeal in the third lecture of the 1970-1971 College de France lectures, "The Will to Knowledge," in which he noted that in "the treat
ments to which madness was subjected, we find something like this ordeal test of the truth. " The ninth lecture of the 1971 1972 lectures, devoted to accusatory procedure and
the system of proof, refers to it (see above note 12). See also, M. Foucault, "La verite et les
iormes juridiques"; "Truth and Juridical Forms. " See, A. Esmein, Histoire de la procedure criminelle en France, et specialement de la procedure inquisitoire depuis le xiii' siecle jusqu'a nos jours (Paris: Larose et Forcel, 1882) pp. 260 283; E. Vacandard, "L'Eglise et les ordalies" in
filudes de critique et d'histoire religieuse, vol. I (Paris: V. Lecoffre, 1905) pp. 189 214; G. Glotz, Etudes sociales et juridiques sur I'antiquite grecque, ch. 2, "L'ordalie" (Paris: Hachette, 1 9 0 6 ) pp. 69 97; A. Michel, "Ordalies" in, A. Vacant, ed. , Dictionnaire de theologie catholique, vol. XI (Paris: Letouzey et Ane, 1930) col. 1139-1152; Y. Bongert, Recherches sur les cours la'iques du xe au xiif siecles (Paris: A et J. Picard, 1949) pp. 215-228; H. Nottarp, Gottehurteilstudien (Munich: Kosel Verlag, 1956); and J. Gaudemet, "Les ordalies au Moyen Age: doctrine, legislation et pratique canonique" in Recueil de la Societe Jean Bodin (Brussels: 1965) vol. XVII, Part 2, La Preuve.
16. In the basically accusatory procedures that involved taking God as witness so that he pro- duces the accuracy or retraction oi the accusation, confession was not enough to pronounce sentence. See, H. C. Lea, A History of the Inquisition of the Middle Ages, vol. 1, pp. 407-408;
A. Esmein, Histoire de la procedure criminelle, p. 273; andj. P. Levy, La Hierarchie des preuves, pp. 19 83. On confession, see Surveiller et Punir, pp.
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So a proper balance must be maintained. Similarly, if we reinforce nature too much, if nature becomes too vigorous and too strong, then the movement by which it tries to expel the disease will be too violent, and there will be the danger of the patient dying from the violence of nature's efforts against the disease. So we must neither weaken the ill ness too much, which risks avoiding the crisis, as it were, nor reinforce nature too much, because then there is the danger of the crisis being too violent. So you can see that in this technology of the crisis the doctor is much more the manager and arbitrator of the crisis than the agent of a therapeutic intervention. * The doctor must foresee the crisis, know the opposing forces, imagine its outcome, and arrange things so that it occurs at the right time; he must see how and with what force it approaches, and he must introduce only those necessary adjustments to each side of the balance so that the crisis takes its proper course.
And you can see that in its general form the technique of the crisis in Greek medicine is no different from the technique of a judge or arbitra- tor in a judicial dispute. In this technique of the test you have a sort of model, a jundico political matrix, which is applied both to the con- tentious battle in a case of penal law and to medical practice. Moreover, in medical practice there is a sort of supplementary complexity that is found again in judicial practice. This is that, as you can see, the doctor does not cure, and it cannot even be said that he directly confronts the disease, since it is nature that confronts the disease; he foresees the crisis, he gauges the contending forces, and he succeeds if he manages nature's success. And, to come back to this word crisis, which after all means "to judge,"B just as the disease comes up for judgment on the day of the crisis, so the doctor, in this role as a kind of arbitrator, is judged in turn by how he presides over the combat, and he may come out as victor or vanquished in relation to the disease.
In relation to the combat of nature and the disease, the doctor's is a second order combat, from which he will come out victor or vanquished in relation to these internal laws, but equally in relation to other doctors. And here again we come back to the juridical model. You know
* The manuscript adds: "more the role of observance of rules than of the observation ol phenomena. "
? that judges could be disqualified when they judged badly, in turn having to undergo a trial from which they will come out either victors or vanquished. And this kind of joust between the adversaries and between the laws of combat and then the judge had a sort of public character. This double combat always had public features. Now medical consultation, as you see it at work from Hippocrates up to Moliere's famous doctors--on the meaning and status of which we should nonetheless reflect a little--always involved several people. ^ That is to say, it involved at once a joust of nature against the disease, of the doctor with regard to this struggle of nature against the disease, and of the doctor with other doctors.
They were all present, each confronting the others, each making his own prediction about when the crisis must occur, what its nature would be, and what would be the outcome. However self-justifymg it may be, it seems to me that the famous scene Galen describes to explain how he made his lortune in Rome is an entirely typical scene of this kind of enthronement of the doctor. The story recounts how the young Galen, an unknown doctor coming to Rome from Asia Minor, participates in a kind of medical joust around a patient. When the doctors were predict mg this or that, Galen says, looking at the ill young man: There will be a crisis shortly; this crisis will be a nosebleed, and he will bleed from the right nostril. This is in fact what happens, and, Galen says, one by one all the doctors around me were quietly overshadowed. 35 The joust was also a joust between the doctors.
The doctor's appropriation of a patient, the recognition of the family doctor, the doctor patient discourse, are all the effect of a whole series oi economic, sociological and epistemological transformations of medi cine. However, in this medicine of the test, in which the crisis was the main component, the joust between doctors was as essential as the joust between nature and the disease. So you can see, this technology of truth test, of truth-event, persists for a long time in medicine, m medical practice, which, once again, like alchemy, was not utterly foreign to the developments of the scientific knowledge which adjoined, cut across, and were tangled up with it.
A word more on this subject. With the example ol medicine you can see, of course, that the extension of the other series, of the demonstrative
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technology of truth, was not brought about at a stroke, like a kind ol overall reversal, and it certainly does not take place in the same way in astronomy as in medicine, or in judicial practice the same way as m botany. However, broadly speaking, I think we can say that two processes have supported this transformation in the technology of truth, at least in what concerns empirical knowledge.
I think the transition from a technology of truth-event to truth demonstration is linked, on the one hand, to the extension of political procedures of the inquiry. The inquiry, the report, the evidence ol several people, the cross checking of information, the circulation of knowledge from the center of power to the points where it ends up and back again, as well as all the agencies ol parallel verification, progres sively, over a long history, gradually constituted the instrument of the political and economic power of industrial society; hence the refine- ment, the increasingly fine grid of these techniques of inquiry within the elements where they were usually applied. Broadly speaking, the refinement by which we passed from a basically fiscal kind of inquiry in the Middle Ages--knowing who collects what, who possesses what, so that the necessary deductions are made--to a police kind of investiga tion into peopled behavior, into how they live, think, make love, etcetera, this transition from fiscal inquiry to police investigation, the constitution of a police individuality starting from fiscal individuality, which was the only individuality known by power in the Middle Ages, reveals the tightening of the technique of inquiry in our kind of society. 36
Moreover, there was not only a local tightening, but also a planetary extension to the entire surface of the globe. There is a double movement of colonization: colonization in depth, which fed on the actions, bodies, and thoughts of individuals, and then colonization at the level of territories and surfaces. We can say that from the end of the Middle Ages we have seen the entire surface of the Earth, down to the finest grain of things, bodies, and actions, subjected to generalized investigation: a sort of grand inquisitorial parasitism. That is to say, at any time, at any place, and with regard to anything in the world, the question of truth can and must be posed. Truth is everywhere and awaits us everywhere, at any place and at any time. This, very schematically, is the great process that led to this move from a technology of the truth-event to a technology of truth findings.
? The other process was a sort of opposite process, f. . . *] establishing the rarity of this truth of anywhere and anytime. This rarefaction is not brought to bear on the emergence or production of truth however, but precisely on who can discover it. In one sense, this universal truth of anywhere and anytime, which any inquiry can and must track down and discover with regard to no matter what, is accessible to anyone; anyone can have access to it, since it is there, everywhere and all the time. However, the necessary circumstances are still required, and we must acquire the forms of thought and techniques that will give us access to this truth that is everywhere, but always deep down, buried, and diffi cult to reach.
So we will have, of course, a universal subject of this universal truth, but it will be an abstract subject because, concretely, the universal sub- ject able to grasp this truth is rare, since it must be a subject qualified by procedures of pedagogy and selection. Universities, learned societies, canonical teaching, schools, laboratories, the interplay of specialization and professional qualification, are all ways of organizing the rarity of those who can have access to a truth that science posits as universal. It will be the abstract right of every individual to be a universal subject, if you like, but to be one in fact, concretely, will necessarily entail rare individuals being qualified to perform the function of universal subject. In the history of the West since the eighteenth century, the appearance of philosophers, men of science, intellectuals, professors, laboratories, etcetera, is directly correlated with this extension of the standpoint of scientilic truth and corresponds precisely to the rarelaction of those who can know a truth that is now present everywhere and at every moment. Fine. That's the little history I wanted to present. What is its relation- ship to madness? We're just coming to it.
In the medicine in general that I have been talking about, the notion of crisis disappears at the end of the eighteenth century. It not only
* (Recording:) we could call it
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disappears as a notion, after Hoffmann*7 say, but also as an organizing principle of medical technique. Why did it disappear? Well, I think it disappeared for the reasons I have just given in a general schema, that is to say, with regard to disease, as with regard to everything henceforth, there is the organization of a sort of inquisitorial space or grid. 38 The construction of what we can broadly call hospital and medical facilities in Europe in the eighteenth century basically ensures the general sur- veillance of populations, making it possible, in principle, to investigate the health of every individual. 39 The hospital also makes possible the integration of the living individual's body, and especially his dead body, into the disease. ^0 That is to say, at the end of the eighteenth century we will have both a general surveillance of populations and the concrete possibility of establishing a relationship between a disease and a body on which an autopsy has been carried out. The birth of pathological anatomy and, at the same time, the appearance of a statistical medicine, of a medicine of large numbersH1--both the ascription of precise causal- ity by the projection of the illness on a dead body and the possibility of inspecting a set of populations--provide the two major epistemological tools of nineteenth century medicine. And it is quite clear that hence forth a technology of observation and demonstration will progressively make the technique of crisis unnecessary.
What happens in psychiatry then? Well, I think something very strange takes place. On the one hand, it is clear that the psychiatric hospital, like the hospital of general medicine, cannot but tend to make the crisis disappear. The psychiatric hospital, like any other hospital, is a space of inquiry and inspection, a sort of inquisitorial site, and there is no need at all for that test of truth. I have also tried to show you that not only is there no need for the test of truth, but there is no need for truth at all, whether arrived at by the technique of the test or by that of demonstration. Furthermore, not only is there no need for it, but to tell the truth the crisis as an event in the madman's madness and behavior is ruled out. Why is it ruled out? Essentially for three reasons I think.
First, it is ruled out precisely by the fact that the hospital functions as a disciplinary system, that is to say, as a system subject to rules, expecting a certain order, imposing a certain regime that excludes any thing like the raging and raving outburst of the crisis ol madness.
? Moreover, the main instruction, the main technique of this asylum discipline, is: Don't think about it. Don't think about it; think about something else; read, work, go into the fields, but anyway, don't think about your madness/'2 Cultivate, not your own garden, but the director's. Do woodwork, earn your keep, but don't think about your illness. The disciplinary space of the asylum cannot permit the crisis of madness.
Second, constant recourse to pathological anatomy in asylum practice, from about around 1825, played the role of theoretical rejection of the crisis/3 Actually, nothing, apart from what took place with general paral- ysis, permitted the assumption, or anyway the ascription, of a physical cause to mental illness. Now, the practice of autopsy was, at least in a great many hospitals, a sort of regular practice the basic meaning of which was, I think, the following: if there is a truth of madness, it is cer- tainly not in what the mad say; it can only reside in their nerves and their brain. To that extent, the crisis as the moment of truth, as the moment at which the truth of madness burst forth, was ruled out epistemologically by recourse to pathological anatomy, or rather, I think that pathological anatomy was the epistemological cover behind which the existence of the crisis could always be rejected, denied, or suppressed: We can strap you to your armchair, we can refuse to listen to what you say, since we will seek the truth of madness from pathological anatomy, when you are dead.
Finally, the third reason for rejecting the crisis was a process I have not considered until now: the relationship between madness and crime. In fact, from around 1820-1825 we see a very strange process in the courts in which doctors--who were not called on by the prosecutor or by the president of the court, and often not even by lawyers--gave their opinion on a crime and, as it were, tried to claim the crime for mental illness itself. v' Faced with any crime, the doctors raised the question: Could not this be a sign of illness? And it was in this way that they con- structed the very curious notion of monomania which, schematically, means this: when someone commits a crime which has no raison d'etre, no justification at the level of his interest, wouldn't the fact alone of committing the crime be the symptom of an illness, the essence of which would basically be the crime itself? Monomania was a sort of single symptom illness with just one symptom occurring only once in the individual's life, but a symptom that was, precisely, the crime? ''5
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One wonders why psychiatrists take this interest in crime, and why they insist so strongly and, in a way, so violently on the potential identity of crime and mental illness. There are, of course, a number of reasons, but I think one of them is the attempt to demonstrate not so much that every criminal may be mad, but to demonstrate something that is much more serious, and also much more important for psychi- atric power, namely, that every mad person is a possible criminal. The determination to pin madness on a crime, even on every crime, was a way of founding psychiatric power, not in terms of truth, since precisely it is not a question of truth, but in terms of danger: Mve are here to protect society, since at the heart of every madness there is the possibil ity of crime. In my view, pinning something like a madness on a crime is, for social reasons of course, a way of getting the individual out of trouble, but, as a general rule, at the level of the general operation of this ascription of madness to crime, there is the psychiatrists' wish to base their practice on something like social defense, since they cannot base it in truth. So, we can say that the effect of the disciplinary system of psychiatry is basically to get rid of the crisis. Not only is it not needed, it is not wanted, since the crisis could be dangerous, since the madman's crisis could well be another person's death. There is no need for it, pathological anatomy dispenses with it, and the regime of order and discipline means that the crisis is not desirable.
However, at the same time as this is taking place, there is a movement in the opposite direction, for the explanation and justification of which there are two reasons. On the one hand, the crisis is needed because, in the end, neither the disciplinary regime, nor the obligatory calm imposed on the mad, nor pathological anatomy, enabled psychiatric knowledge to be founded as truth. So that this knowledge, which I have tried to show you operated as a supplement of power, was for a long time running on empty, and obviously it could not rail to seek to pro- vide itself with a content of truth according to the same norms of the medical technology of the time, that is to say, the technology of reported findings. But since this was not possible, the crisis was resorted to for another, positive reason.
The real point at which psychiatric knowledge is exercised is not ini- tially or essentially what enables the illness to be specified, described,
? and explained. In other words, whereas the doctor, given his position, is basically obliged to respond to the patient's symptoms and complaints with an activity of specification and characterization--hence the bet that differential diagnosis has been the major medical activity since the nineteenth century--the psychiatrist is not required, or called in at the patient's request, to give the latter's symptoms a status, character, and speciiication. The psychiatrist is needed at an earlier stage, at a lower level, where it has to be decided whether or not there is an illness. For the psychiatrist it is a matter of answering the question: Is this individ- ual mad or not? The question is put to him by the Iamily in cases ol voluntary admission, or by the administration in cases ol compulsory admission--although the administration only puts the question on the quiet, since it reserves the right to disregard what the psychiatrist says--
but, in any case, the psychiatrist is situated at this level.
Whereas (general] medical knowledge functions at the point ol the specification ol the illness, at the point of differential diagnosis, medical knowledge in psychiatry functions at the point of the decision between madness or non madness, the point, if you like, ol reality or non reality, reality or fiction, whether this be liction on the part of the patient who, for one reason or another, would like to pretend to be mad, or the fiction of the Iamily circle, which imagines, wishes, desires, or imposes the image of madness. This is the point at which the psychiatrist's
knowledge, and also his power, functions. '6
Now what tools does the psychiatrist possess that enable him to
function at this level and decide on the reality ol madness? It is precisely here that we encounter the paradox of nineteenth century psychiatric knowledge once again. On the one hand, psychiatric knowledge really tried to construct itsell on the model ol medicine observation, of inquiry and demonstration; it really tried to constitute a symptomato- logical type of knowledge for itself; a description of different illnesses was actually constituted, etcetera, but, to tell the truth, this was only the cover and justification for an activity situated elsewhere, and this activity was precisely that of deciding between reality or lie, reality or simulation. The activity of psychiatric knowledge is really situated at the point of simulation, at the point of fiction, not at the point of characterization.
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There are, I think, a number of consequences of this. The first is that in order to resolve this problem the psychiatric hospital literally invented a new medical crisis. This was no longer that old crisis of truth played out between the forces of the disease and the forces of nature that was typical of the medical crisis put to work in the eighteenth century, but a crisis that I will call a crisis of reality, which is played out between the mad person and the power that confines him, the doctor's power knowledge. The doctor must be able to arbitrate on the question of the reality or non-reality of the madness.
So, as you can see, unlike the hospital of general medicine, the psychiatric hospital's function is not to be the place where an "illness" exhibits its specific and differential characteristics in comparison with other illnesses. The psychiatric hospital has a much simpler, more elementary, more lundamental function. Its function is, precisely, to give madness reality, to open up a space of realization for madness. The psychiatric hospital exists so that madness becomes real, whereas the hospital's function tout court is both knowing what the illness is and eliminating it. The psychiatric hospital's function, following the psychi atric decision concerning the reality of the madness, is to make it exist as reality.
Here we encounter an institutional type of criticism of the psychi atric hospital, which charges it, precisely, with fabricating the mad out of the people it claims to cure. This institutional type of criticism thus poses the question: What kind oi institution could work in such a way that the mad could be cured and not pushed deeper into illness? How could the [asylum] institution work like any hospital? " However, in the end I think this criticism is quite inadequate because it lacks the essential. That is to say, it lacks an analysis of the distribution of psychiatric power that makes it possible to show that the fact that the psychiatric hospital is a place for the realization of madness is not an accident or due to a deviation of the institution, but that the very func tion of psychiatric power is to have before it, and for the patient, a space of realization for the illness (that, when it comes to it, may or may not be in the hospital). We can say then that the function of psychiatric power is to realize madness in an institution where the function of dis- cipline is precisely to get rid of all the violence, crises, and, if necessary,
? all the symptoms of madness. The real function and effect of the asylum institution in itself, of this institution of discipline--and it is in this respect that my analysis differs from institutional analyses--is to sup- press, I do not say madness, but the symptoms of madness, at the same time as the function of psychiatric power, which is exercised within and lixes individuals to the asylum, is to realize madness.
All in all, there is an ideal for this double lunctioning of psychiatric power, which realizes madness, and of the disciplinary institution, which refuses to listen to madness, which flattens out its symptoms and planes down all its manifestations: this is dementia. What is a demented person? He is someone who is nothing other than the reality of his madness; he is the person in whom the multiplicity of symptoms or, rather, their flattening out, is such that it is no longer possible to ascribe to him a specific symptomatology by which he could be characterized. The demented person is therefore someone who corresponds exactly to the working of the asylum institution, since, by means of discipline, all the symptoms in their specificity have been smoothed out: there are no longer any outward signs, externalizations, or crises. And, at the same time, someone who is demented answers to what psychiatric power wants, since he actually realizes madness as an individual reality within the asylum.
The famous development of dementia, which nineteenth century psy- chiatrists could observe as a natural phenomenon in madness, is noth- ing other than the series of intertwined effects of an asylum discipline that smoothes away outward signs and symptoms, and medical power's appeal to the patient to be a madman, to realize madness. The demented person is actually what was fabricated by this double game of power and discipline.
As for the hysterics, those famous, dear hysterics, I would say that they were precisely the front of resistance to this gradient of dementia that involved the double game of psychiatric power and asylum discipline. They were the front of resistance, because, what is a hysteric? A hysteric is someone who is so seduced by the best and most clearly specified symptoms--those, precisely, offered by the organically ill--that he or she adopts them. The hysteric constitutes herself as the blazon of genuine illnesses; she models herself as a body and site bearing genuine
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symptoms. To the ascription ol and propensity towards the subsidence ol symptoms in dementia, the hysteric responds with the exacerbation of the most precise and well determined symptoms; and while doing this, she pursues a game such that when one wants to lix her illness in reality, one can never manage to do so, since, when her symptom should refer to an organic substratum, she shows that there is no substratum, so that she cannot be fixed at the level of the reality of her illness at the very moment she displays the most spectacular symptoms. Hysteria was the effective way ol defending onesell Irom dementia; the only way not to be demented in a nineteenth century hospital was to be a hysteric, that is to say, to counter the pressure that annihilated symptoms, that obliterated them, by building up the visible, plastic edifice of a whole panoply of symptoms, and, by means of simulation, resisting madness being fixed in reality. The hysteric has magnificent symptoms, but at the same time she sidesteps the reality of her illness; she goes against the current of the asylum game and, to that extent, we salute the hysterics as the true militants ol antipsychiatry. ^
? 1. Discovered in the sixteenth century, the use oi ether spread in the nineteenth century in the treatment ol neuroses and for screening simulated illnesses, on account of its "stupefying" property. See above, note 18 to lecture of 9'11 January 1974.
2. Discovered simultaneously in 1831 by Justus Liebig in Germany and by Soubeiran in France, the use of chloroform as an anesthetic began in 1847. See, E. Soubeiran, "Recherches sur quelques combinaisons de chlore" Annales de chimie et de physique, vol. XLIII, October 1831, pp. 113-157; H. Bayard, "L'utihsation de l'ether et le diagnostic des maladies men tales"; H. Brochin, "Maladies nerveuses", ? "Anesthesiques: ether et chloroforme"; and, Lailler (pharmacist of the Quatre Mares asylum) "Les nouveaux hypnotiques et leur emploi en medecine mentale" Annales medico-psychologiques, 7lh series, vol. IV,July 1886, pp. 64-90.
}. See above, note 1 to lecture ol 19 December 1973.
4. See above, note 2 to lecture of 19 December 1973.
5. J. J. Moreau de Tours discovered the effects ol hashish on his journey in the East from 1837
6.
to 1840 and he subsequently devoted his research to it, loreseeing possibilities of experi ment to clanly the relations between its ellects and dreams and delirium. See, Du haschkh
et d'alienation mentale. Etudes psychologiques (Paris: Fortin, 1845).
Experiments in "animal magnetism" took place in hospitals under the Restoration. Thus,
at the Hotel Dieu, on 20 October 1820, the head doctor, Henri Marie Husson (1772 1853) invited the baron Dupotet de Sennevoy to make some demonstrations; under
the supervision of Joseph Recamier and Alexandre Bertrand, a young woman of 18, Catherine Samson, was given magnetic treatment. See J. Dupotet de Sennevoy (1790 1866),ExposedesexperiencessurlemagnelismeanimalfaitesaVHotelDieudePan'spen- dant le cours des mois d'octobre, novembre et decembre 1820 (Paris: Bechet Jeune, 1821). At Salpetnere, Etienne Georget and Leon Rostan used some ol their patients as experimental subjects. Without giving their names, Georget records these experiments in De la physiolo-
gie du systeme nerveux, et specialment du cerveux, vol. I, p. 404. See, L. Rostan, Du magnetisme animal (Paris: Rignoux, 1825). See also, A. Gauthier, Histoire du somnambulismc, vol. II, p. 324. See below, note 48 to lecture of 30 January 1974-
Foucault is alluding to the debate between Socrates and Parmemdes on the problem of the things ol which there are Ideas. See, Plato, Parmenides, 130c d.
From the middle ol the eighth century B. C. until the end of the fourth century A. D. , Delphi, a town ol Phocis at the foot ol Parnassus, was a favorite site for Apollo to deliver his oracles through the mouth of the Pythia. See, M.
Delcourt, Les Grands Sanctuaires de la Grece (Paris: Presses universitaires de France, 1947) pp. 76 92; M. Delcourt, VOracle de Delphes (Paris: Payot, 1955); R. Flaceliere, Devins et Oracles grecs (Paris: Presses universitaires de France, 1972) pp. 49 83; and, G. Roux, Delphes, son oracle et ses dieux (Paris: Les Belles Lettres, 1976).
Epidaurus, a town of Argolis on the east Peloponnese, was the site ol the sanctuary Apollo's son, Asclepius, where divination through dreams was practiced. See, M. Delcourt, Les Grands Sanctuaires, pp. 93 113; R. Flaceliere, Devins et Oracles grecs, pp. 36 37; and, G. Vlastos, "Religion and medicine in the cult of Asclepius: a review article" Review oj Religion, vol. 13,1948 1949, pp. 269 290.
The notion of Kaipo^ {kairos) defines the occasion, the opportunity to be seized, and con- sequently the time of possible action. Hippocrates ( 4 6 0 377 B. C. ) devotes a chapter of his Des Maladies, I, to this notion, in (Euvres completes, ed. Littre (Paris, J. -B. Bailliere, 1849) vol. VI, ch. 5, "Ol the opportune and inopportune" pp. 148 151; English translation, "Diseases 1" in Hippocrates, vol. V, trans. Paul Potter (Cambridge, Mass. : Harvard University Press, The Loeb Classical Library, 1988). See, P. Joos, "Zufall. Kunst und Natur
bei dem Hippokratitkern" Janus, no. 46, 1957, pp. 238 252; P. Kucharski, "Sur la notion pythagoncienne de kairos11 Revue philosophique de la France et de Vetranger, vol. CLII, no. 2, 1963, pp. 141-169; and P Chantraine, "KoupoS" in Dictionnaire etymologique de la langue grecque. Histoire des mots (Pans: Klincksieck, 1970) vol. II, p. 480.
7. 8.
9.
10.
11. Foucault is alluding here to the Heideggerian problematic that, in a discussion with G. Preti, he then associated with that of Husserl in the same reproach of calling into "question all our knowledge and its loundations ( . . . ) on the basis of that which is
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12.
original (. . . ) at the expense of all articulated historical content," M. Foucault, "Les prob- lemes de la culture. Un debat Foucault Preti" (September 1972) Dits et Ecrits, vol. 2, p. 372. So it is the Heideggerian conception of history that is intended here. See especially, M. Heidegger, (1) Sein und Zeit (Halle: Nemeyer, 1927); English translation, Being and Time, trans. J. Macquarrie and E. Robinson (Oxlord: Blackwells, 1967); (2) Vom Wesen des Grundes (Halle: Nemeyer, 1929); English translation, The Essence of Reasons, trans. Terrence Malick (Evanstan: Northwestern University Press, 1969); (3) Vom Wesen der Wahreit (Frankfurt: Klostermann, 19/l3); English translation, The Essence of Truth, on Plato's parable of the cave allegory and Theaetetus, trans. T. Sadler (London: Continuum, 2002); (4) Hol^wege (Frankfurt: Klostermann; 1952); English translation, Off the Beaten Track, trans. J. Young and K. Haynes (Cambridge: Cambridge University Press, 2002); (5) Vortrage und Aufsat^e (Pfullingen: Neske, 1954); ( 6 ) Nietzsche, vol. 2 (Pfullingen: Neske, 1961); English translation, Nietzsche, vol. 2: The Eternal Recurrence of the Same, trans. David Farrell Krell (San Francisco: Harper & Row, 1984). On the relations between Foucault and Heidegger, see M. Foucault, (1) Les Mots et les choses, ch. 9, "L'Homme et ses doubles" ? IV and vi; The Order of Things, ch. 9, "Man and his doubles" sections 4 and 6; (2) "L'Homme est-il mort? " (interview with C. Bonnefoy, June 1966) Dits et Ecrits, vol. 1, p. 542; (3) "Ariane s'est pendue" (April 1969) Dits et Ecrits, vol. 1, p. 768 and p. 770; (4) "Foucault, le philosophe, est en train de parler. Pensez" (29 May 1973) Dits et Ecrits, vol. 2, p. 424; (5) "Prisons et asiles dans le m^canisme du pouvoir" (interview with M. D'Eramo, March 1974), Dits et Ecrits, vol. 2, p. 521; ( 6 ) "Structuralisme et poststructuralisme" (interview with G. Raulet, Spring 1983) Dits et tents, vol. 4, p. 455; English translation, "Structuralism and Post-Structuralism," trans. Jeremy Harding, Essential Works of Foucault, 2, p. 456; (7) "Politique et ethique: une interview," Dits et Ecrits,vol. 4, p. 585; "Politics and Ethics: An Interview" trans. P. Rabinow, The Foucault Reader, pp. 373-374; ( 8 ) "Le retour de la morale" (interview with G. Barbedette and A. Scala, 29 May 1984) Dits et Ecrits, vol. 4, p. 703; English translation, "The Return of Morality" trans. Thomas Levin and Isabelle Lorenz, in Michel Foucault, Politics, Philosophy, Culture. Interviews and Other Writings, 1977-19&4, ed. Lawrence D. Kritzman (New York and London: Routledge, 1988);
( 9 ) "Verite, pouvoir et soi" (interview with R. Martin, 25 October 1982) Dits et Ecrits, vol. 4, p. 780.
In the third lecture of the 1970 1971 course, "The Will to Knowledge (savoir')" Foucault proposed the "opposite view" of a history of the "will to knowledge (connaitre)," in which truth has "the immediate, universal and bare form of observation, external to the proce dure of judgment," proposing the need to "write a history ol the relationships between truth and torture (supplice)," in which "truth is not observed but decided in the form of the oath and the invocation prescribed by the ritual of the ordeal. " A regime, consequently, in which "truth is not linked to the possible light and gaze brought to bear on things by a subject, but to the obscurity of the future and disturbing event. " Other fragments oi such a history are put lorward in the ninth lecture of the 1971-1972 course, "Penal Theories and Institutions," which deals with the system of proof in procedures of the oath, ordeals, and judicial duel from the tenth to the thirteenth century. Foucault was inspired by M. Detienne, Les Maitres de verite dans la Grece archaique (Paris: Maspero, 1967); English translation, The Masters of Truth in Archaic Greece, trans. Janet Lloyd (New York: Zone Books, 1999).
The thirteenth lecture of the course "Penal Theories and Institutions" dedicated to "the confession, the test" explains the meaning ol the detour through what Foucault calls "juridico-political matrices" such as the test, the inquiry, etcetera, and distinguishes three levels of analysis: (a) an "historical description of the sciences," in which "the history of the sciences" consists; (b) an "archeology of knowledge" which takes the relationships ol knowledge and power into account; and (c) a "dynastic of knowledge" which, thanks to the freeing of the juridico political matrices which authorize the archeology, is situated "at the level which combines the most prolit, knowledge and power" (course manuscript con suited thanks to the kindness of Daniel Defert). Foucault takes up this distinction between the "archeological" and "dynastic" in an interview with S. Hasumi, September 1972 "De l'archeologie a la dynastique," Dits et Ecrits, vol. 2, p. 406. On "archeology," see the many definitions given by Foucault: (1) in Dits et Merits, vol. 1: "Michel Foucault, Les Mots et les
13.
? Choses" pp. 498-499; "Sur les fa^ons d'ecrire l'histoire" p. 595; "Reponse a une question" p. 681, and "Michel Foucault explique son dernier livre" pp. 771 772; (2) in Dits et Ecrits, vol. 2: "La volonte de savoir" p. 2-12; "La verite et les formes juridiques" pp. 643-644; English translation, "Truth and Juridical Forms," trans. Robert Hurley, Essential Works of Foucault, 3; ( 3 ) m Dits et Ecrits, vol. 3: "Cours du 7 janvier 1976" p. 167; English translation, lecture of 7 January 1976, "Society Must Be Defended" ch. 1, pp. 10 11; "Dialogue sur le pou- voir", pp. 468-469; (4) in Dits et Ecrits, vol. 4: "Entretien avec Michel Foucault" p. 57; "Structuralisme et poststructuralisme" p. 443; English translation, "Structuralism and Post Structuralism," trans. Jeremy Harding, Essential Works of Foucault, 2, pp. 444 445-
14. In fact Foucault will not keep to this program apart from some comments on the role of childhood in the generalization ol psychiatric knowledge and power in the 1974-1975 College de France lectures of 5,12, and 19 March: Les Anormaux, pp. 217 301; Abnormal, pp. 231 321.
15- From the Old English, ordal, judgment, the "judgment of God" or "ordeal," means to settle contentious questions with the idea that God intervenes in the case to judge during tests likes those of "fire," the "branding iron," "cold or boiling water," and the "cross," etcetera. See L. Tanon, Histoire des tribunaux de /'Inquisition en France (Pans: L. Larose and Forcel, 1893) on the penalties of "lire" (pp. 464-479) and the "cross" (pp. 490-498). As J. -P. Levy emphasizes in his, La Hierarchie des preuves dans le droit savant du Moyen Age, depuis la renaissance du droit romain jusqu'a la fin du xivc siecle (Paris: Sirey, 1939), in this procedure "the trial is not an investigation with the aim of finding out the truth ( . . . ) . It is originally
a struggle, and later, an appeal to God; the concern with making the truth come out is left up to Him, but the judge does not seek it himselt" (p. 163).
Foucault referred to the question of the ordeal in the third lecture of the 1970-1971 College de France lectures, "The Will to Knowledge," in which he noted that in "the treat
ments to which madness was subjected, we find something like this ordeal test of the truth. " The ninth lecture of the 1971 1972 lectures, devoted to accusatory procedure and
the system of proof, refers to it (see above note 12). See also, M. Foucault, "La verite et les
iormes juridiques"; "Truth and Juridical Forms. " See, A. Esmein, Histoire de la procedure criminelle en France, et specialement de la procedure inquisitoire depuis le xiii' siecle jusqu'a nos jours (Paris: Larose et Forcel, 1882) pp. 260 283; E. Vacandard, "L'Eglise et les ordalies" in
filudes de critique et d'histoire religieuse, vol. I (Paris: V. Lecoffre, 1905) pp. 189 214; G. Glotz, Etudes sociales et juridiques sur I'antiquite grecque, ch. 2, "L'ordalie" (Paris: Hachette, 1 9 0 6 ) pp. 69 97; A. Michel, "Ordalies" in, A. Vacant, ed. , Dictionnaire de theologie catholique, vol. XI (Paris: Letouzey et Ane, 1930) col. 1139-1152; Y. Bongert, Recherches sur les cours la'iques du xe au xiif siecles (Paris: A et J. Picard, 1949) pp. 215-228; H. Nottarp, Gottehurteilstudien (Munich: Kosel Verlag, 1956); and J. Gaudemet, "Les ordalies au Moyen Age: doctrine, legislation et pratique canonique" in Recueil de la Societe Jean Bodin (Brussels: 1965) vol. XVII, Part 2, La Preuve.
16. In the basically accusatory procedures that involved taking God as witness so that he pro- duces the accuracy or retraction oi the accusation, confession was not enough to pronounce sentence. See, H. C. Lea, A History of the Inquisition of the Middle Ages, vol. 1, pp. 407-408;
A. Esmein, Histoire de la procedure criminelle, p. 273; andj. P. Levy, La Hierarchie des preuves, pp. 19 83. On confession, see Surveiller et Punir, pp.
