No More Learning

18 PSYCHIATRIC POWER
symptomes, la nature et la mode d'action de ses causes; sa marche et ses terminaisons; les differences qui la distinguent du delire aigu; les moyens du traitement qui lui conviennent; suivies de recherches cadaveriques (Paris: Crevot, 1820). Francois Leuret emphasizes the doctor-patient relation ship; see, Du traitement moral de lafolie (Paris: J. B. Bailliere, 1840). See the pages devoted to moral treatment in M. Foucault, Histoire de lafolie a Vage classique (Paris: Gallimard, 1972), Part 3, ch. 4: "Naissance de I'asile" pp. 484 487, 492 496, 501 511, 523 527; Abridged English translation, Madness and Civilisation. A History of Insanity in the Age of Reason,trans. R. Howard (New York: Random House, 1965 and London: Tavistock, 1967) pp. 243 255, 269-274 (pages 484 500 of the French edition are omitted from the English translation). See also, R. Castel, "Le traitement moral. Therapeutique mentale et controle sociale au XIXC siecle," Topique, no. 2, February 1970, pp. 109 129.
14. P. Pinel, Traile medico-philosophique, Section II, ? xxi: "Caractere des alienes les plus violents et dangereux, et expediens a prendre pour les reprimer" pp. 9 0 91; A Treatise on Insanity, "The most violent and dangerous maniacs described, with expedients for their repression" pp. 93-94.
15. Ibid. Section II, ? viii: "Avantage d'ebranler fortement I'imagination d'un aliene dans certains cas" pp. 6 0 61; English, ibid. "The advantages of restraint upon the imagination of maniacs illustrated" pp. 61 63.
16. M. Foucault, Folie et Deraison. Histoire de lafolie a Vage classique (Paris: Plon, 1961); Madness and Civilisation. [Apart from in this note, the French editor always relers to the 1972, Gallimard edition, Histoire de lafolie, as above in note 13; G. B. J
17. For example, Histoire de lafolie, Part 1, ch. 5, "Les insenses" p. 169 and p. 172; Part 2, ch. 1, "Le fou au jardin des especes" p. 223; and Part 3, ch. 2, "Le nouveau partage" p. 407 and p. 415; Madness and Civilisation, ch. 3, "The insane" p. 77 and pp. 80-81 (pages 223, 407, and 415 of French edition are omitted (rom the English translation). The point of depar lure for this criticism of the notion of "perception" or "experience" is L'Archeologie du savoir (Paris: Gallimard, 1969), ch. 3, "La formation des objets" and ch. 4, "La formation des modahtes enonciatives" pp. 55 74; English translation, The Archeology oj Knowledge, trans. A. Sheridan (London: Tavistock and New York: Pantheon, 1972), Part II, ch. 3, "The formation of objects" and ch. 4, "The formation of enunciative modalities" pp. 40 55.
18. The notion of violence underlies the analysis of the mode of treatment in Histoire de lafolie, Part 2, ch. 4, "Medecins et malades" pp. 327-328 and p. 358, and Part 3, ch. 4, "Naissance de I'asile" p. 497, pp. 502 503, p. 508, and p. 520; Madness and Civilisation, ch. 6, "Doctors and Patients" pp. 159-160 and p. 196, and ch. 9, "The Birth of the Asylum" pp. 243 245, p. 251, and p. 266 (page 497 of the French edition is omitted from the English translation). See below, "Course context" pp. 354-355-
19. The analyses devoted to the "Naissance de I'asile," ibid. pp. 483 530; "Birth of the asylum" ibid. pp. 241-278.
20. On the role of the family model in the reorganization of relations between madness and reason and the constitution of the asylum, see ibid. pp. 509 511; ibid. pp. 253 255.
21. Foucault is alluding here to the analyses of Louis Althusser who introduced the concept of "State apparatus" in his article "Ideologic et appareils ideologiques d'Etat. Notes pour une recherche," La Pensee. Revue du rationalisme moderne, no. 51, June 1970, pp. 3 3 8 ; reprinted in Positions (1964-1975) (Paris: Editions Sociales, 1976) pp. 65 125; English translation, "Ideology and Ideological State Apparatusses" in L. Althusser, Lenin and Philosophy, trans. (London: New Left Books, 1971).
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14 NOVEMBER 1973
Scene of a cure: George III. From the "macrophysics of sovereignty" to the "microphysics of disciplinary power. " ^ The newfigure of the
madman. r^ Little encyclopedia of scenes of cures. ^ The practice of hypnosis and hysteria. ^ The psychoanalytic scene; the antipsychiatric
scene. ^ Mary Barnes at Kingsley Hall. ^ Manipulation of madness and stratagem of truth: Mason Cox.
OBVIOUSLY YOU KNOW WHAT passes for the great founding scene of modern psychiatry, or of psychiatry period, which got under way at the beginning of the nineteenth century. It is the famous scene at Bicetre, which was not yet a hospital exactly, in which Pinel removes the chains binding the raving lunatics to the floor of their dungeon, and these lunatics, who were restrained out of fear that they would give vent to their frenzy if released, express their gratitude to Pinel as soon as they are freed from their bonds and thereby embark on the path of cure. This then is what passes for the initial, founding scene of psychiatry. 1
Now there is another scene that did not have the same destiny, although it had considerable repercussions in the same period, for rea- sons that are easy to understand. It is a scene which did not take place in France, but in England--and was reported in some detail by Pinel, moreover, in his Traite medico-philosophique of Year IX (1800)--and which, as you will see straightaway, was not without a kind of force, a malleable presence, inasmuch as in the period, not in which it took place, which was in 1788, but in which it became known in France, and
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finally in the whole of Europe, it had become, let's say, a certain custom for kings to lose their heads. It is an important scene because it stages precisely what psychiatric practice could be in that period as a regulated and concerted manipulation of relations of power.
Here is Pinel's text, which circulated in France and made the affair known:
"A monarch [George III of England; M. F. ] falls into a mania, and in order to make his cure more speedy and secure, no restrictions are placed on the prudence of the person who is to direct it [note the word: this is the doctor; M. F. ]; from then on, all trappings of royalty having disap- peared, the madman, separated from his family and his usual surround- ings, is consigned to an isolated palace, and he is confined alone in a room whose tiled floor and walls are covered with matting so that he cannot harm himself. The person directing the treatment tells him that he is no longer sovereign, but that he must henceforth be obedient and submissive. Two of his old pages, of Herculean stature, are charged with looking after his needs and providing him with all the services his con- dition requires, but also with convincing him that he is entirely subor dinate to them and must now obey them. They keep watch over him in calm silence, but take every opportunity to make him aware of how much stronger than him they are. One day, in fiery delirium, the mad- man harshly greets his old doctor who is making his visit, and daubs him with filth and excrement. One of the pages immediately enters the room without saying a word, grasps by his belt the delirious madman, who is himself in a disgustingly filthy state, forcibly throws him down on a pile of mattresses, strips him, washes him with a sponge, changes his clothes, and, looking at him haughtily, immediately leaves to take up his post again. Such lessons, repeated at intervals over some months and backed up by other means of treatment, have produced a sound cure without relapse. "2
I would like to analyze the elements of this scene. First of all, there is something quite striking in PinePs text, which he took from Willis, the king's doctor. 3 It seems to me that what appears first of all is, basically, a ceremony, a ceremony of deposition, a sort of reverse coronation in which it is quite clearly shown that it involves placing the king in a sit- uation of complete subordination; you remember the words: "all trappings
? of royalty having disappeared," and the doctor, who is, as it were, the effective agent of this dethronement, of this deconsecration, explicitly telling him that "he is no longer sovereign. "
A decree, consequently, of deposition: the king is reduced to impo- tence. And it seems to me that the "matting," which surrounds him and plays [such a big] role* both in the setting and the final scene, are important. The matting is both what isolates the king from the outside world, and, as well as preventing him from hearing and seeing the out- side world, prevents him from communicating his orders to it; that is to say, all the essential functions of the monarchy are, in the strict sense, bracketed off by the matting. In place of the scepter, crown, and sword, which should make the universal power of the king reigning over his kingdom visible and perceptible to all the spectators, in place of these signs, there is no more than the "matting" which confines him and reduces him, there where he is, to what he is, that is to say, to his body.
Deposition and therefore the king's fall; but my impression is that it is not the same type of fall as we find in, say, a Shakespearian drama: this is not Richard III4 threatened with falling under the power of another sovereign, nor King Lear5 stripped of his sovereignty and roaming the world in solitude, poverty, and madness. In fact, the king's [George III] madness, unlike that of King Lear, condemned to roam the world, fixes him at a precise point and, especially, brings him under, not another sovereign power, but a completely different type of power which differs term by term, I think, from the power of sovereignty. It is an anonymous, nameless and faceless power that is distributed between different per- sons. Above all, it is a power that is expressed through an implacable regulation that is not even formulated, since, basically, nothing is said, and the text actually says that all the agents of this power remain silent. The silence of regulation takes over, as it were, the empty place left by the king's dethronement.
So this is not a case of one sovereign power falling under another sovereign power, but the transition from a sovereign power--decapitated by the madness that has seized hold of the king's head, and dethroned by the ceremony that shows the king that he is no longer sovereign--to
* (Recording:) such an important role
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a different power. In place ol this beheaded and dethroned power, an anonymous, multiple, pale, colorless power is installed, which is basi- cally what I will call disciplinary power. One type of power, that of sov- ereignty, is replaced by what could be called disciplinary power, and the effect of which is not at all to consecrate someone's power, to concentrate power in a visible and named individual, but only to produce effects on its target, on the body and very person of the dethroned king, who must be rendered "docile and submissive"6 by this new power.
Whereas sovereign power is expressed through the symbols of the dazzling force of the individual who holds it, disciplinary power is a discreet, distributed power; it is a power which functions through net works and the visibility of which is only found in the obedience and submission of those on whom it is silently exercised. I think this is what is essential in this scene: the confrontation, the submission, and the con- necting up ol a sovereign power to a disciplinary power.
Who are the agents ol this disciplinary power? Curiously, the doctor, the person who organizes everything and really is m fact, up to a certain point, the focal element, the core of this disciplinary system, does not himself appear: Willis is never there. And when we have the scene ol the doctor, it is precisely an old doctor and not Willis himself. Who then are the agents ol this power? We are told that they are two old pages of Herculean stature.
I think we should stop here for a moment, for they too are very important in the scene. As a hypothesis, and subject to correction, I will say that this relationship of the Herculean pages to the mad king stripped bare should be compared with some iconographic themes. I think the plastic force of this history is due m part precisely to the fact that it contains elements [. . . *] of the traditional iconography for repre senting sovereigns. Now it seems to me that the king and his servants are traditionally represented in two forms.
There is the representation of the warrior king in breastplate and arms deploying and displaying his omnipotence--the Hercules king, if you like--and beside him, beneath him, subject to this kind of over- whelming power, are figures representing submission, weakness, defeat,
* (Recording:) which are part
? slavery, or possibly beauty. This, more or less, is one of the primary oppositions found in the iconography of royal power.
Then there is another possibility, but with a different play of opposi tions. This is not the Herculean king, but the king of human stature who is, rather, stripped of all the visible and immediate signs of physical force and clothed only in the symbols of his power; the king in his ermine, with his scepter, his globe, and then, beneath him, or accompa- nying him, the visible representation of a force subject to him: soldiers, pages, and servants who are the representation of a force, but of a force which is, as it were, silently commanded by the intermediary of these symbolic elements of power, by scepter, ermine, crown, and so forth. Broadly speaking, it seems to me that the relationship of king to ser vants is represented in this way in the iconography: always in terms of opposition, but in the form of these two kinds of opposition.
Now, here, in this scene taken from Willis that is recounted by Pinel, you find these same elements, but completely shifted and transformed. On the one hand, you have the wild force of the king who has become the human beast again and who is in exactly the same position as those submissive and enchained slaves we found in the Hrst of the icono graphic versions I spoke about. Opposite this, there is the restrained, disciplined, and serene force of the servants. In this opposition of the king who has become wild force and servants who are the visible repre- sentation of a force, but of a disciplined force, I think you have in fact the point at which a sovereignty that is disappearing is caught up in a disciplinary power that is being constituted and whose face, it seems to me, can be seen in these silent, muscular, and magnificent pages who are both obedient and all-powerful.
How do these Herculean servants exercise their functions? Here again I think we should examine the text in some detail. The text says that these Herculean servants are present in order to serve the king; it even says very precisely that their purpose is to serve his "needs" and his "condition. " Now it seems to me that in what could be called the power of sovereignty, in actual fact the servant really does serve the sovereign's needs and really must satisfy the requirements and needs of his condition: he is in fact the person who dresses and undresses the king, who ensures the provision of services for his body and his property, and so on.
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However, when the servant ministers to the sovereign's needs and con- dition, it is essentially because this is the sovereign's will. That is to say, the sovereign's will binds the servant, and it binds him individually, as this or that servant, to that function which consists in ensuring that he serves the sovereign's needs and condition. The king's will, his status as king, is what fixes the servant to his needs and condition.
Now, in the disciplinary relationship that we see appearing here, the servant is not at all in the service of the king's will, or it is not because it is the king's will that he serves the king's needs. He is in the service of the king's needs and condition without either the king's will or his status being involved. It is only the mechanical requirements of the body, as it were, which fix and determine what the servant's service must be. Consequently will and need, status and condition are disconnected. What's more, the servant will only act as a repressive force, he will leave off serving only in order to curb the king's will, when the latter is expressed over and above his needs and his condition.
This, more or less, is roughly the scene's setting. I would now like to move on to the important episode of this scene set in this context, that is to say the episode of the confrontation with the doctor: "One day, in fiery delirium, the madman harshly greets his old doctor who is making his visit, and daubs him with filth and excrement. One of the pages immediately enters the room without saying a word, grasps by his belt the delirious madman . . . "7
After the deposition scene, or dethronement if you like, there is the scene of rubbish, excrement, and filth. This is no longer just the king who is dethroned, this is not just dispossession of the attributes of sovereignty; it is the total inversion of sovereignty. The only force the king has left is his body reduced to its wild state, and the only weapons he has left are his bodily evacuations, which is precisely what he uses against his doctor. Now in doing this I think the king really inverts his sovereignty, not just because his waste matter has replaced his scepter and sword, but also because in this action he takes up, quite exactly, a gesture with a his- torical meaning. The act of throwing mud and refuse over someone is the centuries old gesture of insurrection against the powerful.
There is an entire tradition that would have it that we only speak of excrement and waste matter as the symbol of money. Still, a very serious
? political history could be done of excrement and waste matter, both a political and a medical history of the way in which excrement and waste matter could be a problem in themselves, and without any kind of symbohzation: they could be an economic problem, and a medical problem, of course, but they could also be the stake of a political struggle, which is very clear in the seventeenth century and especially the eighteenth century. And this profaning gesture of throwing mud, refuse, and excrement over the carriages, silk, and ermine of the great, well, King George III, having been its victim, knew full well what it meant.
So there is a total reversal of the sovereign function here, since the king takes up the insurrectional gesture not just of the poor, but even of the poorest of the poor. When the peasants revolted, they used the tools avail- able to them as weapons: scythes, staves, and suchlike. Artisans also made use of the tools of their trade. It was only the poorest, those who had noth- ing, who picked up stones and excrement in the street to throw at the pow- erful. This is the role that the king is taking up in his confrontation with the medical power entering the room in which he finds himself: sovereignty, both driven wild and inverted, against pale discipline.
It is at this point that the silent, muscular, invincible page enters, who seizes the king around the waist, throws him on the bed, strips him naked, washes him with a sponge, and withdraws, as the text says, "looking at him haughtily. "8 And once again you find here the displace- ment of the elements of a scene of power, which this time is no longer of the coronation, of the iconographic representation; it is, as you can see clearly, the scaffold, the scene of public torture. But here as well there is inversion and displacement: whereas the person who violates sover- eignty, who throws stones and excrement over the king, would have been killed, hung and quartered according to English law, here instead, discipline, making its entrance m the form of the page, will control, bring down, strip naked, scrub, and make the body clean and true.
That is what I wanted to say about this scene, which, much more than the scene of Pmel freeing the mad, appears to me typical of what is put to work m what I call proto-psychiatric practice, that is to say, roughly, the practice which develops in the last years of the eighteenth century and in the first twenty or thirty years of the nineteenth century, before the appearance of the great institutional edifice of the psychiatric asylum
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in the years between 1830 and 1840, say 1838 m France, with the law on conlinement and the organization of the major psychiatric hospitals. 9
This scene seems to me to be important. First of all because it means I can correct an error I made in Histoire de lafolie. You can see that there is no question here of the imposition of anything like a family model in psy- chiatric practice; it is not true that the father and mother, or the typical relationships of the family structure, are borrowed by psychiatric practice and pinned on madness and the direction of the insane. The relationship to the family will appear in the history of psychiatry, but this will be later, and, as far as I can see at present, we should identify hysteria as the point at which the family model is grafted on to psychiatric practice.
You can see also that the treatment, which, with an optimism subse- quently contradicted by the facts, Pinel said would produce "a sound cure without relapse,"10 takes place without anything like a valid description, analysis, diagnosis, or true knowledge of the king's illness. Here again, just as the family model only enters later, so too the moment of truth only enters psychiatric practice later.
Finally, I would like to emphasize that one can see very clearly here an interplay of elements, elements of power in a strict sense, which are put to work, shifted, turned around, and so on, outside of any institution. Here again, my impression is that the moment of the institution is not prior to these relationships of power. That is to say, the institution does not determine these relationships of power, any more than a discourse of truth prescribes them, or a family model suggests them. In actual fact, in this kind of scene you see these relationships of power functioning, I was going to say nakedly. In this it seems to me to pick out quite well the basis of relationships of power that constitute the core element of psychiatric practice, on the basis of which, in fact, we will later see the construction of institutional structures, the emergence of discourses of truth, and also the grafting or importation of a number of models.
However, for the moment, we are witnessing the emergence of a disciplinary power, the specific figure of which seems to me to appear here with remarkable clarity precisely to the extent that, in this case, disciplinary power is confronted by another form of political power that I will call the power of sovereignty. That is to say, if the first hypotheses now guiding me are correct, it will not be enough to say that right from
? the start we find something like political power in psychiatric practice; it seems to me that it is more complicated, and what's more will become increasingly complicated. For the moment I would like to schematize. We are not dealing with just any kind of political power; there are two absolutely distinct types of power corresponding to two systems, two different ways of functioning: the macrophysics of sovereignty, the power that could be put to work in a post-feudal, pre industrial government, and then the microphysics of disciplinary power, whose functioning we find in the different components I am presenting to you and which makes its appearance here leaning on, as it were, the disconnected, broken down, unmasked components of sovereign power.
There is a transformation, therefore, of the relationship of sovereignty into disciplinary power. And you see at the heart of all this, at bottom, a kind of general proposition which is: "You may well be the king, but if you are mad you will cease to be so," or again: "You may well be mad, but this won't make you king. " The king, George III in this case, could only be cured in Willis's scene, in Pinel's fable if you like, to the extent that he was not treated as king, and to the extent that he was subjected to a force that was not the force of royal power. "You are not king" seems to me to be the proposition at the heart of this kind of proto-psychiatry I am trying to analyze. If you refer then to the texts of Descartes, where it is a question of madmen who take themselves for kings, you notice that the two examples Descartes gives of madness are "taking oneself for a king" or believing one "has a body made of glass. "11 In truth, for Descartes and generally [. . . *] for all those who spoke about madness up until the end of the eighteenth century, "taking oneself for a king," or believing one has "a body made of glass," was exactly the same thing, that it to say they were two absolutely identical types of error, which immediately contradicted the most elementary facts of sensation. "Taking oneself for a king," "believing that one has a body of glass," was, quite simply, typical of madness as error.
Henceforth, it seems to me that in this proto psychiatric practice, and so for all the discourses of truth that get going on the basis of this practice, "believing oneself to be a king" is the true secret of madness.
* (Recording:) we can say
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If you look at how a delirium, an illusion, or a hallucination was analyzed in this period, you see that it doesn't much matter whether someone believes himself to be a king, that is to say, whether the content of his delirium is supposing that he exercises royal power, or, to the contrary, believes himself to be ruined, persecuted, and rejected by the whole of humanity. For the psychiatrists of this period, the fact of imposing this belief, of asserting it against every proof to the contrary, even putting it forward against medical knowledge, wanting to impose it on the doctor and, ultimately, on the whole asylum, thus asserting it against every other form of certainty or knowledge, constitutes a way of believing that one is a kmg. Whether you believe yourself to be a king or believe that you are wretched, wanting to impose this certainty as a kind of tyranny on all those around you basically amounts to "believing one is a king"; it is this that makes all madness a kind of belief rooted in the fact that one is king of the world. Psychiatrists at the start of the nineteenth century could have said that to be mad was to seize power in one's head. Moreover, for Georget, in a text from 1820, the treatise De lafolie, the major problem for the psychiatrist is basically "how to persuade otherwise" someone who believes that he is a king. 12
There are a number of reasons why I have stressed this scene of the king. First of all, it seems to me that it enables us to have a better under- standing of that other founding scene of psychiatry, the scene of Pinel I spoke about at the start, the scene of liberation. Pinel, at Bicetre in 1792, entering the dungeons, removing the chains from this or that patient who has been chained up for weeks or months, would seem to be the exact opposite of the history of the king who is dispossessed, the exact opposite of the history of the king who is confined, seized around the waist, and supervised by muscular pages. Actually, when we look closely, we can see the continuity between the two scenes.
When Pinel liberates the patients confined in the dungeons, the per- son who is liberated incurs a debt to his liberator that will and must be settled in two ways. First, the person liberated will settle his debt con tinually and voluntarily by obedience; the wild violence of a body, which was only restrained by the violence of chains, will be replaced by the constant submission of one will to another. In other words, removing the chains ensures something like subjection through grateful obedience.
? Then the patient will wipe out the debt in a second way, this time involuntarily. From the moment he is subjected in this way, where the continual and voluntary repayment of the debt of gratitude will have made him submit to the discipline of medical power, the working of this discipline and its own force will itself bring about the patient's cure. As a result, the cure will become involuntarily the second payment in kind for his liberation, the way in which the patient, or rather, the patient's illness, will pay the doctor for the gratitude he owes him.
You see that, in fact, this scene of liberation is not exactly a scene of humanism, and of course everyone knows this. But I think we can analyze it as a relationship of power, or as the transformation of a certain relation- ship of power that was one of violence--the prison, dungeon, chains, and here again, all this belongs to the old form of the power of sovereignty-- into a relationship of subjection that is a relationship of discipline.
This is the first reason for recounting the history of George III, since it seems to me to inaugurate a psychiatric practice for which Pinel is generally given credit.
The other reason for quoting this case is that it seems to me that the scene of George III is one in a whole series of other scenes. First of all, it is part of a series of scenes, which, in the first twenty-five or thirty years of the nineteenth century, constitute this proto-psychiatric practice. We could say that in the first quarter of the nineteenth century there was a kind of little encyclopedia of canonical cures constituted on the basis of the cases published by Haslam,13 Pinel,1/| Esquirol,15 Fodere,16 Georget,17 and Guislam. 18 And this little encyclopedia includes around fifty cases which circulate in all the psychiatric treatises of the time and all of which more or less conform to a similar model. Here, if you like, are one or two examples which show very clearly, I think, how all these scenes of cure resemble that major scene of the cure of George III.
Here, for example, is an example from PinePs Traite medico-philosophique: "A soldier, still in a state of insanity (. . . ) is suddenly dominated by the single idea of leaving for the army. " He refuses to return to his room in the evening when he is ordered to do so. When he is in his room, he sets about tearing everything apart and making a mess; then he is tied to the bed. "For eight days he is in this violent state, and he finally appears to realize that in continuing with his tantrums he is not the master. In the
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morning, during the head doctor's round, he adopts the most submis sive tone and, kissing his hand, says to him, 'You promised to give me my freedom within the home if I was peaceful. Well! I implore you to keep your word. ' Smiling, the other tells him of the pleasure he experiences at this happy return to himself; he speaks gently, and instantly removes all constraint. "19
Another example: a man was occupied with the single idea of "his omnipotence. " Only one consideration held him back, the "fear of destroying the Conde army (. . . ) which, according to him, was destined to lulfill the designs of the Eternal. " How to overcome this belief? The doctor watched out lor "a misdemeanor that would put him in the wrong and authorize severe treatment. " And then, by chance, when "one day the supervisor complained to him about the filth and excre ment he had left in his room, the lunatic flared up against him violently and threatened to destroy him. This was a favorable opportunity to punish him and convince him that his power was chimerical. "20
Yet another example: "A madman at the Bicetre asylum, who has no other delirium than that of believing himself to be a victim of the Revolution, repeating day and night that he was ready to suffer his fate. " Since he is to be guillotined, he thinks it no longer necessary to take care of himself; he "refuses to sleep in his bed," and lays stretched out on the floor. The supervisor is obliged to resort to constraint: "The madman is tied to his bed, but he seeks revenge by refusing any kind of food with the most invincible stubbornness. Exhortations, promises, and threats are all in vain. " However, after a time the patient is thirsty; he drinks some water but "firmly rejects even the broth, or any other kind of nourishment, liquid or solid, which is offered to him. " Towards the twelfth day, "the supervisor tells him that, since he is so disobedient, he will henceforth be deprived of his drink of cold water and will be given fatty broth instead. " Finally, thirst wins out and "he greedily takes the broth. " On the following days he takes some solid food and "thus gradually reacquires the qualities of a sound and robust health. "21*
* The manuscript also relers lo a case set out in paragraph IX: "Exemple propre a faire voir avec quelle attention le caractere de I'ahene doit etre etudie pour le ramener a la raison" pp. 196 197; "An instance illustrative of the advantage o( obtaining an intimate acquaintance with the character of the patient" pp. 191 193.
? I will come back to the detailed morphology of these scenes, but I would like to show you that at the beginning of nineteenth century psychiatry, even before and, I think, quite independently of any theoret- ical formulation and institutional organization, a tactic of the manipula tion of madness was defined which in a way sketched out the framework of power relationships needed for the mental orthopedics that had to lead to the cure. The scene of George III is basically one of these scenes, one of the first.
I think we could then trace the future development, and transformation of these scenes, and find again how, and under what conditions, these proto-psychiatric scenes are developed in a first phase, between 1840 and 1870, of what could be called moral treatment, of which Leuret was the hero. 22
Later, this same proto-psychiatric scene, transformed by moral treat- ment, is further greatly transformed by a fundamental episode in the history of psychiatry, by both the discovery and practice of hypnosis and the analysis of hysterical phenomena.
Then there is, of course, the psychoanalytic scene.
And finally, there is, if you like, the anti-psychiatric scene. Even so, it is strange to see how close this first scene of proto-psychiatry, the scene of George III, is to the scene described in the book by Mary Barnes and Berke. You are familiar with the story of Mary Barnes at Kingsley Hall, in which the elements are more or less the same as those found in the story of George III:
"One day Mary presented me with the ultimate test of my love for her. She covered herself in shit and waited to see what my reaction would be. Her account of this incident amuses her because of her blind confidence that her shit could not put me off. I can assure you the reverse was true. When I, unsuspectingly, walked into the games room and was accosted by foul smelling Mary Barnes looking far worse than the creature from the black lagoon, I was terrified and nauseated. My first reaction was to escape and I stalked away as fast as I could. Fortunately she didn't try to follow me. I would have belted her.
"I remember my first thoughts very well: T h i s is too much, too bloody much. She can damn well take care of herself from now on. I want nothing more to do with her\"
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Then Berke reflects and says to himself that, after all, if he does not do it, it will be all up for her, and he does not want this. This final argu- ment brooks no reply. He follows Mary Barnes, not without consider able reluctance on his part. "Mary was still in the games room, her head bowed, sobbing. I muttered something like, 'Now, now, it's all right. Let's go upstairs and get you a nice warm bath. ' It took at least an hour to get Mary cleaned up. She was a right mess. Shit was everywhere, in her hair, under her arms, in between her toes. I had visions of the principal character in an oldie terror movie, The Mummy's Ghost"2^
In reality he had failed to recognize the proto-scene of the history of psychiatry, that is to say the history of George III: it was precisely that. What I would like to do this year is basically a history of these psy-
chiatric scenes, taking into account what is for me perhaps a postulate, or at any rate a hypothesis, that this psychiatric scene and what is going on in this scene, the game of power which is sketched out in it, should be analyzed before any institutional organization, or discourse of truth, or importation of models. And I would like to study these scenes emphasizing one thing, which is that the scene involving George III that I have been talking about is not only the first in a long series of psychi- atric scenes, but is historically part of another, different series of scenes. In the proto-psychiatric scene you find again everything that could be called the ceremony of sovereignty: coronation, dispossession, submis- sion, allegiance, surrender, restoration, and so forth. But there is also the series of rituals of service imposed by some on others: giving orders, obeying, observing rules, punishing, rewarding, answering, remaining silent. There is the series of judicial procedures: proclaiming the law, watching out for infractions, obtaining a confession, establishing a fault, making a judgment, imposing a penalty. Finally, you find a whole series of medical practices, and crucially the major medical practice of the crisis: looking out for the moment at which the crisis intervenes, encouraging its unfolding and its completion, ensuring that the healthy forces prevail over the others.
It seems to me that if we want to produce a true history of psychiatry, at any rate of the psychiatric scene, it will be by situating it in this series of scenes--scenes of the ceremony of sovereignty, of rituals of service, of judicial procedures, and of medical practices--and not by making
? analysis of the institution the essential point and our point of departure. * Let's be really anti-institutionalist. What I propose to bring to light this year is, before analysis of the institution, the microphysics of power.
I would like now to look more closely at this proto-psychiatric scene of which I have given you a first idea. It seems to me that the scene of George III marks a very important break insofar as it clearly departs from a number of scenes that had been the regulated and canonical way of treating madness until then. It seems to me that until the end of the eighteenth century, and we still find some examples of this right at the start of the nineteenth century, the manipulation of madness by doctors was part of the stratagem of truth. It involved constituting around the illness, in the extension of the illness as it were, by letting it unfold and by following it, a sort of both fic- tional and real world in which madness will be caught in the trap of a real- ity that has been insidiously induced. I will give you an example of this; it is a case of Mason Cox, which was published in England in 1804 and in France m 1806, in his book Practical Observationson Insanity.
"Mr aged 36, of full habit, melancholic temperament, extremely attached to literary pursuits, and subject to depression of spirits without any obvious cause. His lucubrations were sometimes extended through whole days and nights in succession, and at these periods he was very abstemious, drank only water, and avoided animal food; his friends remonstrated with him on the hazard of such proceedings; and his house keeper being urgent for his adopting some plan that had his health for the immediate object, the idea struck him of her having some sinister design and that she intended to destroy him by means of a succession of poisoned shirts, under the baneful influence of which he believed himself then suf- fering. No arguments availed, and all reasoning was ineffectual, the hallu- cination therefore was humoured, a suspected shirt was exposed to some simple chemical experiments, continued, repeated, and varied with much ceremony, and the results so contrived as to prove the truth of the patient's suspicions; the house-keeper, notwithstanding all her protesta- tions of innocence was served with a pretended warrant, and in the pres- ence of the patient, hurried out of the house by the proper officers, and
* The manuscript clarities the notion of scene: "Understanding by scene, not a theatrical episode, but a ritual, a strategy, a battle. "
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secluded from his observation for a time, while he supposed she was in gaol expecting an ignominious death . . . After this preface, a formal con- sultation was held, certain antidotes prescribed, and after a few weeks he perfectly recovered; a new plan of life and regimen were adopted, and he has ever since continued to enjoy mens sana in corpore sano. "2/'
In a case history like this, you see finally how a psychiatric practice functioned. Basically, starting from the delirious idea, it involved developing a sort of labyrinth exactly patterned on the delirium itsell, homogeneous with the erroneous idea, through which the patient is taken. The patient believes, for example, that his servant gives him shirts poisoned with sulfur which irritate his skin. Okay, we pursue the delirium. His shirts are examined by an expert, which naturally produces a positive result. Since we have a positive result, the case is submitted to a court: the proofs are submitted and a judgment, a condemnation, is pronounced, and we pretend to send the servant to prison.
There is, then, the organization of a labyrinth homogeneous with the delirious idea, and a sort of forked outcome is placed at the end of this labyrinth, an outcome at two levels, which, precisely, will bring about the cure. On the one hand, there will be an event produced within the delirium. That is to say, at the level of the patient's delirium, the impris- onment of the guilty party confirms the truth of the delirium, but, at the same time, assures the patient that he has been freed from what, within his delirium, was the cause of his illness. There is then this first result, at the level of the delirium itself, authenticating the delirium and getting rid of what it is that functions as cause within the delirium.
Now, at a different level, that is to say at the level of the doctors, of those around the patient, something very different happens. By pre- tending to imprison the servant, she is put out of play, she is separated from the patient, and the patient thus finds himself sheltered from what, in reality, was the cause of his illness, that is to say his mistrust and hatred of her. So that which is the cause within, and the cause of, his delirium are short-circuited in one and the same operation.
This operation had to be one and the same; that is to say, it had to take place at the end of the labyrinth of the delirium, because for the doctors it was quite clear that if the servant was purely and simply dismissed, without being dismissed as the cause within the delirium,
? then the delirium could have begun again. The patient would imagine that she was still pursuing him, that she had found a way o( getting round them, or he would redirect mistrust ot his servant on to someone else. From the moment that one effectuates the delirium, that one accords it reality, authenticates it and, at the same time, suppresses the cause within it, one has the conditions for the liquidation ol the delirium itself. * And if the conditions for liquidating the delirium are at the same time the suppression of what caused the delirium itsell, then the cure is assured as a result. So, it you like, there is both suppression ol the cause of delirium, and suppression of the cause within the delirium. And it is this kind ol fork, arrived at through the labyrinth ol fictional venlication, that assures the very principle of the cure.
Now--and this is the third moment--when the patient really believes that his delirium was the truth, when the patient believes that what, within his delirium, was the cause of his illness has been suppressed, then he discovers as a result the possibility of accepting medical intervention. On the pretext ol curing him of the illness inflicted on him by the servant, one slips into this kind of opening a medication that is medication within the delirium, a medication that within the delirium will enable him to escape the illness caused by the servant, and which is a medication for the dehr mm since he is actually given medicine that, by calming his humors, by calming his blood, by discharging all the congestions of his blood system, etcetera, ensures the cure. And again you can see that an element of reality, the medicine, functions at two levels: as medication within the delirium and as therapy for the delirium. It is this kind of organized game around the fictional verification of the delirium that effectively ensures the cure.
Okay, this game of truth, within delirium and of delirium, will be completely suppressed in the psychiatric practice that commences at the start of the nineteenth century. It seems to me that the emergence of what we can call a disciplinary practice, this new microphysics of power, will sweep all this away and establish the core elements of all the psychiatric scenes that develop subsequently, and on the basis of which psychiatric theory and the psychiatric institution will be built.
* The manuscript adds: "One really suppresses that which functions as the cause within the delirium, but it is suppressed in a form that the delirium can accept. "
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1. "Philippe Pinel freeing the mad from their chains at Bicetre"--where, appointed on
6 August 1793, he took up his post as "infirmary doctor" on 11 September 1793--is the version given by his eldest son, Scipion Pinel (1795-1859), referring the event to 1792, in an apocryphal article attributed to his father: "Sur Pabolilion des chaines des alienes, par Philippe Pinel, membre d l'Institut. Note extraite de ses cahiers, communiques par M. Pinel fils" Archives de medicine, 1st year, vol. 2, May 1823, pp. 15 17; and communication to the Academy of Medicine: "Bicetre en 1792. De l'abolition des chaines" Memoires de I'Academie de medecine, no. 5, 1856, pp. 32-40. In 1849 the painter Charles Muller immor talized him in a painting entitled Pinel removes the chains from the mad of Bicetre. Foucault refers to this in Histoire de la folie, Part 3, ch. 4, pp. 483 484 and 496 501; Madness and Civilisation, ch. 9, pp. 241 243 (pages 484-501 of the French edition are omitted from the English translation).
2. P. Pinel, Traite medico-philosophique sur Valienation mentale, ou la Manie, section V: "Police interieure et surveillance a etablir dans les hospices d'alienation: ? vii, Les maniaques, durant leurs acces doivent ils etre condamnes a unc reclusion elroite? " pp. 192 193;
A Treatise on Insanity, "The importance of an enlightened system of police for the internal management ol lunatic asylums: Is close confinement requisite in all cases and throughout the whole term of acute mania? " pp. 187 188. George III (1738 1820), King of Great Britain and Ireland, had several episodes of mental disturbance in 1765, 1788 1789, lrom February to July 1810, and from October 1810 until his death on 29 January 1820. See
I. Macalpine and R. Hunter, George III and the Mad-Business (New York: Pantheon Books,
1969).
3. Sir Francis Willis (1718-1807), the proprietor ol an establishment in Lincolnshire for
people suffering irom mental disorders, was called to London on 5 December 1788 within the framework of a commission created by Parliament in order to pronounce on the King's condition. Willis looked alter George III until the remission of his disorder in March 1789. The episode referred to by Pinel is in "Observations sur le regime moral que est le plus propre a retablir, dans certains cas, la raison egaree des monarques" pp. 1} 15, reproduced
in J. Postel, Genese de la psychiatric Les premiers ecrits de Philippe Pinel (Le Plessis Robinson, Institut Synthelabo, 1998) pp. 194-197, and Traite medico-philosophique, pp. 192-193; A Treatise on Insanity, pp.