And the fact that he could never cure this woman is attributed precisely to her inability to own to this
biographical
schema that carries her identity.
Foucault-Psychiatric-Power-1973-74
"2* He is made to repeat them until he knows them: "He must learn my name, those of the students, supervisors, and nurses.
He must name all of us.
"
Leuret makes him read books, recite verse, and forces him to speak the Latin he learned at school; he forces him to speak in Italian, which he had learned when he was in the army; he makes him "tell a story. "24
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Finally, on another occasion, he puts him in the bath, puts him under the shower as usual and, having done this, contrary to the usual practice, orders him to empty the bath. Now Dupre is not accustomed to obey ing orders. He is forced to obey this order and, when Dupre is emptying the bath with his pails, as soon as his back is turned, Leuret refills the bath again so that he can repeat the order a number of times until the mechanism of order and obedience are completely locked together. 2S
In this series of operations, which basically locus on language, it seems to me to be, first ol all, a matter of correcting the delirium ol polymorphous naming and ol constraining the patient to restore to each person the name by which he gets his individuality within the discipli nary pyramid ol the asylum. In a way which is quite typical, Dupre is not required to learn the names of the patients but rather those ol the doctor, of the doctor's students, and of the supervisors and nurses: the apprenticeship of naming will be an apprenticeship in hierarchy at the same time. Naming and showing respect, the distribution ol names and the way in which individuals are placed in a hierarchy, amount to one and the same thing.
You see too that he is required to read and recite verse, etcetera. This is, of course, a matter of occupying the mind, of diverting the delirious use of language, but it is equally a matter of re teaching the subject to use the lorms ol language of learning and discipline, the forms he learned at school, that kind ol artificial language which is not really the one he uses, but the one by which the school's discipline and system ol order are imposed. Finally, in the episode ol the bath that is tilled and he is made to empty on an indefinitely repeated order, it really is this language of orders, but this time of precise orders that the patient must be taught.
In general, I think what is at stake for Leuret here is making the patient accessible to all the imperative uses ol language: the use ol proper names with which one greets, shows one's respect and pays attention to others; school recital and ol languages learned; language of command. You can see that it is not at all a sort of re-apprenticeship-- that one might call dialectical--of the truth. It is not a question of show ing Dupre, on the basis of language, that his judgments were false; there is no discussion about whether or not it is right to consider everyone
? "Halcyons," as Dupre believes in his delirium. 26 It is not a matter of t urning the false into truth in a dialectic peculiar to language or discus- sion. In this game of orders and commands, it is simply a matter of putting the subject back in contact with language inasmuch as it is the carrier of imperatives; it is the imperative use of language that refers back to and is organized by a whole system of power. This is the lan- guage peculiar to the asylum; it fixes the names that define the asylum hierarchy; it is the master's language. It is this whole web of power that must be visible as reality behind the language one teaches. The language one re teaches to the patient is not the language through which he will be able to rediscover the truth; the language he is forced to re learn is a language in which the reality of an order, of a discipline, of a power imposed on him, must appear. This is what Leuret says, moreover, at the end ol these language exercises: "Here is M. Dupre who has become attentive [attention being the laculty of reality of course; M. F. ], he has entered into a relationship with me; I bring an action to bear on him, he obeys me. "27 "Attention," that is to say, a relationship with the doctor-- that is to say, with the person who gives orders and holds the power--a relationship that consists precisely in the doctor, who holds the power, performing an action in the form of an order. It is a language, therefore, which is transparent to this reality of power.
Here again we see that, in a sense, Leuret is much more subtle, and more of a perfectionist, than the psychiatrists of his time. Even so, what was called "moral treatment" at this time really was something like this, although less directly focused on the uses of language, of course, on that kind of rigged dialogue that was really a game of order and obedience, because, unlike Leuret, most psychiatrists put their faith in the internal mechanisms of the asylum institution rather than in this direct action of the psychiatrist as holder of power. 28 However, in the end, if you look at what the functioning of the asylum institution itself was for the psychi- atrists of this period, and where they sought the therapeutic character of the asylum's action, you see that the asylum was thought to be thera- peutic because it obliged people to submit to regulation, to a use of time, it forced them to obey orders, to line up, to submit to the regularity of certain actions and habits, to submit to work. And for the psychiatrists of the time, this whole system of order, both as orders given and, equally,
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as institutional regularities and constraints, is ultimately one of the major factors of asylum therapy. As Falret said in 1854, in a rather late text, "a strictly observed positive regulation, which fixes the use ol every hour of the day, forces every patient to react against the irregularity of his ten- dencies by submitting to the general law. Instead of being left to himself to follow the impulse ol his whim or his disordered will, the insane per- son is constrained to bend before a rule which is all the more powerful for being established for everyone. He is obliged to place himself in the hands of a foreign will and to make a constant effort on himself so as not to incur the punishments attached to infringements ol the rule. "29
Esquirol too thought that this system of the order, of the order given and the order followed, of the order as command and the order as regu larity, was the major effective agent of asylum treatment: "In such a home there is a movement, an activity, a whirl into which every person gradually enters; the most stubborn, defiant lypemaniac is forced to live outside of himself and, without being aware of it, is carried away by the general movement and example of others (. . . ); the maniac himsell, restrained by the harmony, order and rule ol the home, defends himself better against his impulses and abandons himself less to his eccentric activities. "^0 In other words, order is reality in the form of discipline.
The third maneuver in the apparatus of asylum therapy is what could be called the management or organization of needs. Psychiatric power ensures the advance of reality, the hold of reality on madness, through the management of needs, and even through the emergence of new needs, through the creation, maintenance and renewal of needs.
Here again, as a starting point, I think we can take the very subtle, very curious version that Leuret gives of this principle.
His patient, M. Dupre, did not want to work on the grounds that he did not believe in the value of money: "Money has no value; there is nothing but counterfeit money" said Dupre,51 since I, Napoleon, am the only person who has the right to mint coins. Consequently, the money given to him is counterfeit money: It's pointless to work! Now, the problem is precisely that of getting Dupre to understand the need for this money. One day he is forced to work, but he hardly does any work. At the end of the day it is suggested that he take a salary corresponding to his day's work; he refuses, giving as his reason that "money has no
? value. "52 He is seized and money forced into his pocket, but he is con- lined "without food or drink" tor the night and following day as pun- ishment for having resisted. A nurse however, who has been duly prepared in advance, is sent to him, and says: "Ah! Monsieur Dupre, how I pity you not eating! II I was not afraid of Monsieur Leuret's authority and punishment I would bring you something to eat; I am prepared to take this risk if you give me a little reward. " So in order to eat M. Dupre is obliged to take from his pocket three of the eight sous he had been given.
No doubt the meaning or, at least, the usefulness of money is already beginning to emerge for him on the basis of this artificially created need. He is well fed and, here again, a "dozen grains of calomel" are mixed in with "the vegetables eaten by M. Dupre who, quickly feeling the need to go to the lavatory, calls the servant and begs her to give him a free hand. A new pecuniary arrangement. "^ The following day Dupre goes to work and "seeks the price for his day's work. " This is, says Leuret, "the first reason- able act, made voluntarily and with reflection, that I have got from him. "M
Of course, we might wonder about this astonishing relationship Leuret establishes between money and defecation, but, as you can see, in the form of an imperative intervention. You can see that it is not a sym- bolic relationship of two terms--money-excrement--but a tactical rela- tionship between four terms: food, defecation, work, and money, and in which the fifth term, which runs through the four points of the tactical rectangle, is medical power. I think we see the relationship between money and defecation, which, as you know, was to have a well known future, emerging here for the first time and it is established through this game of medical power passing between these four terms. 55
It seems to me that generally, and here again in a particularly subtle, clever form, Leuret provided the formula of something very important in the system of psychiatric treatment at this time. Basically it involves establishing the patient in a carefully maintained state of deprivation: the patient's existence must be kept just below a certain average level. Hence a number of tactics, less subtle than Leuret's, but which also had a long future in the asylum institution and in the history of madness.
The clothing tactic: Ferrus, in his treatise Des alienes, from 1837I, pro vides a whole theory of asylum clothing, in which he says: "The clothing
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of the insane calls for special attention: almost all the mad are vain and proud. Before the onset of their illness, most of them led a life full of adventures; they often had wealth which their mental disorder led them to squander. "56 They therefore had fine clothes and jewelry, and in the asylum they recreate these costumes which are, at the same time, the sign of their old splendor, of their current poverty, and of the way in which their delirium operates: the mad must be deprived of all this. However, says Ferrus, we must not go too lar, because in asylums the mad are often allowed only torn and shameful clothes, which humiliate them too much and may excite their delirium or their disgust, and then they walk about naked. Something must be found between the orna- ments of delirium and obscene nudity, and this will be "clothing of unrefined and sturdy materials, but cut in a single style and kept clean, so as to moderate the puerile vanities ol madness. "*7
There is also the tactic of food, which must be plain, uniform, and not given on demand but in rations that, as lar as possible, are slightly less than the average. Furthermore, in addition to this general rationing of food within the asylum is added a policy ol punishment by withholding food, especially after the policy of no restraint, that is to say, after the sup pression of some of the contraptions of constraint:38 the great asylum punishment was deprivation of courses, fasting, etcetera.
Then there is the tactic of setting to work. Work is highly over- determined in the asylum system since, on the one hand, it ensures the necessary order, discipline, regularity, and constant occupation. Thus, very quickly, around the 1830s, work becomes obligatory withm asylums. The Sainte-Anne farm was initially an extension of the Bicetre hospital before taking over from it. 39 As Girard de Cailleux said when he was the director of the Auxerre hospital: "peeling and preparing veg etables is frequently a highly beneficial occupation in treatment. ",0 The interesting thing about this is that this work is not just imposed because it is a lactor in order, discipline, and regularity, but because it enables one to slip in a system of reward. Asylum work is not tree; it is paid, and this payment is not a supplementary favor but at the very heart of the function of work, for the remuneration must be sufficient to satisfy certain needs created by the underlying asylum deprivation: insufficient food, the absence of any extras (tobacco, a dessert, etcetera, must be paid for).
? I or the system of remuneration imposed with work to function, one has to have wanted, to have needed, and to have been deprived. So, these remunerations must be sufficient to satisfy the needs created by the basic deprivation and, at the same time, sufficiently low to remain below, oi course, normal and general remunerations.
Finally, and above all, the great deprivation developed by asylum dis- upline is, perhaps, quite simply deprivation of freedom. And you see how, in the psychiatrists of the first half of the nineteenth century, the iheory ol isolation gradually changes or, if you like, is deepened and completed. The theory of isolation I was talking about last week was basically demanded by the obligation to create a break between the ther- apeutic framework and the patient's family, the milieu in which the illness developed. Subsequently you see the birth of the idea that isola- tion has a supplementary advantage: it not only protects the family but gives rise to a new need in the patient, the need for freedom, of which he was previously unaware. Treatment can be developed on the basis of this artificially created need.
In the asylum form of this period, psychiatric power is therefore the creator of needs and the management of the deprivations it establishes. There are a number of easily identifiable reasons for this administration of needs, this mstitutionalization of deprivation.
First, because the reality of the things one needs will be imposed through the game of needs; money, which previously had no value, will now acquire value when one is deprived and needs it to make up lor this deprivation. So, the reality of what one needs will be perceived through this game of deprivation. This is the first effect of the system.
The second effect is that the reality of an external world, which previously the omnipotence of madness was inclined to deny, takes shape through the asylum lack, and this reality beyond the asylum's walls is increasingly imposed as being inaccessible, but as inaccessible only during the time of madness. This external world will be real in basically two ways. On the one hand it will be the world of non lack m contrast to the asylum world, and so it will appear as a desirable reality. On the other hand, the external world will appear at the same time as
a world into which one is initiated by learning to react to one's own lack, to one's own needs: When you have learned that you must work to
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leed yourself, to earn money even to defecate, then you will be able to reach the outside world. The outside world is thus real as the world ol non lack in contrast to the asylum world of deprivations, and as the world to which the lack of the asylum will serve as a propaedeutic.
The third eflect of this policy of deprivation is that in this materially reduced status in comparison with the real world, with life outside the asylum, the patient will recognize his unsatisfied state, his reduced sta- tus, his lack of rights to anything, and the reason for his lack being that he is, quite simply, ill. It won't be the reality of the external world that he sees, but the reality of his own madness through the system ol depri- vations that have been established around him. In other words, he must learn that he must pay for his madness, because madness really exists as something by which he is affected; and madness will be paid lor by a general lack of existence, by this systematic deprivation.
Finally, the fourth eifect of the organization of asylum deprivation is that by learning deprivation, by learning that to make up lor this depri- vation he must work, concede certain things, submit to discipline, etcetera, the patient will learn that basically the care given him, the cure that one attempts to obtain for him, are not owed to him; he is obliged to get them through the efforts of obedience to work, discipline, and remunerated production; he will pay with his work lor the good that society does him. As Belloc said: ". . . ll society gives the insane the care they need, the latter must relieve it of the burden according the degree of their strength. "'1 In other words, the mad person learns the lourth aspect o( reality: as a patient he must provide for his own needs by his work so that society does not have to pay for them. So we arrive at the conclusion that, on the one hand, one pays for one's madness, but that, on the other hand, recovery is purchased. The asylum is precisely what makes one pay for one's madness with artificially created needs, and, at the same time, pay for one's treatment through a certain discipline, a certain output. The asylum, by establishing a deprivation, makes possi ble the creation of a currency with which one will pay for this cure. At bottom, what constitutes the asylum is the creation of the means of pay ment for the therapy on the basis of systematically created needs, the moral reward of madness. And you can see that the problem of money linked to the needs of madness, which has its price, and of the recovery,
? which must be purchased, is deeply inscribed in the psychiatric maneuver and the asylum apparatus.
Finally, the [fifth] apparatus is that of the statement of truth. This is lhe final phase, although in the therapy proposed by Leuret it is the penultimate episode: the patient must be got to tell the truth. You will say that if this is true, and if this episode is so important in the unfold- ing of the therapy, how could I say that the problem of truth was not posed in the practice of the classical treatment? 42 But you will see how this problem of truth is posed.
This is what Leuret did with Dupre. Dupre asserted that Paris was not Paris, that the king was not the king, that he himself was Napoleon, and that Paris was only the town of Langres that some people had disguised as Paris. '3 According to Leuret, there is only one thing to do, which is to take his patient to Paris, and, in fact, he organizes a walk through Paris under the direction of an intern. He shows him the differ- ent monuments of Paris, and says to him: "Do you not recognize Paris? -- No, no, Dupre replies, we are here in the town of Langres. Several of the things in Paris have been copied. "44 The intern pretends not to know his way and asks Dupre to guide him to Place Vendome. Dupre finds it eas- ily and the intern then says to him: "So we are in Paris since you can find Place Vendome so well! --No, I recognize Langres disguised as Paris. "0 Dupre is taken back to the hospital at Bicetre where he refuses to recog nize that he has visited Pans, and, "since he persists in his refusal, he is put in the bath and cold water is poured over his head. Then he agrees to anything one likes," and that Paris really is Paris. However, out of the bath "he returns to his mad ideas. He is made to undress again and the affusion is repeated: he gives way again," recognizes that Paris is Paris,
but, as soon as he is dressed again "he maintains he is Napoleon. A third affusion corrects him; he gives way and goes to bed. "'6
However, Leuret is not fooled and is fully aware that these kinds of exercises are not sufficient. He moves on to an exercise at a higher level, as it were: "The following day I have him brought to me, and after some words about his trip the day before, I ask him. Your name? --I have been using another; my real name is Louis-Napoleon Bonaparte. --Your profession? -- Lieutenant discharged from the 19th line; but I must explain. Lieutenant means army chief. --Where were you born? --Ajaccio, or, if you like,
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Paris. --I see from this certilicate that you were insane at Charenton. --I was not insane at Charenton. I was at my chateau of Samt-Maur for nine years. Displeased with his answers, I have him taken to the bath; under the shower I give him a newspaper and want him to read out aloud. He obeys. I question him and satisfy mysell that he has understood what he has read. Then, after asking out loud if the shower tank is quite full, I have a notebook given to Dupre on which I order him to give written answers to the questions I put to him. Your name? --Dupre. --Your profession? --Lieutenant. --Your place of birth? --Paris. --How long were you at Charenton? --Nine years. --And at Saint Yon? --Two years and two months. --How long have you been in the section for the treatment oi the insane at Bicetre? --Three months; lor three years I have been incurably insane. --Where did you go yesterday? --In the town ol Paris. --Do the bears talk? --No. "4/ Progress, you see, compared with the earlier episode. And now we reach the third stage in the exercise of the statement of the truth, which is a crucial moment as you will see. "From his answers we can see that Monsieur Dupre is in a sort ol uncertainty between madness and reason "^ He has been insane lor fifteen years! And, Leuret thinks, "now is the time to require him to make a decisive reso lution, that ol writing the story ol his life. "'19 He only carries it out after several showers and "devotes the rest ol the day and the lollowing day to writing his story, with many details. He knows and writes everything that a man can recall ol his childhood. He gives the names ol his lodg mgs and of the schools where he studied, of his teachers and fellow stu- dents in great numbers. In his whole account there is not a lalse thought or a word out of place. "so
The problem arises here, which I am quite unable to resolve at pre sent, of the way in which the autobiographical account was actually introduced into psychiatric practice, and criminological practice, around 1825 to 18^0, and how, in lact, the account of one's own life came to be an essential component, with several uses, in all those processes of taking charge ol individuals and disciplining them. Why did telling one's life story become an episode within the disciplinary enterprise? How was recounting one's past, how was the memory of childhood, able to find a place within this? I don't really know. Anyway,
? concerning this maneuver of the statement of the truth, I would like to say that it seems to me we can accept certain things.
First of all, you can see that the truth is not what is perceived. Basically, when M. Dupre was taken to see Pans, it was not so much in order that his perception revealed to him that Paris really was there, and that it was Pans. This is not what was asked of him; we know full well that so far as he will perceive anything, he will perceive Paris as the imitation of Paris. What is asked of him--and this is how the statement of the truth becomes effective--is that he avow it. It does not have to be perceived, it has to be said, even if it is said under the constraint of the shower. The fact alone of saying something that is the truth has a func- tion in itself; a confession, even when constrained, is more effective in the therapy than a correct idea, or an idea with exact perception, which remains silent. So, the statement of the truth has a performative charac ter in the game of the cure.
Second, I think we should note that the essential point of the truth, what Leuret is especially attached to, is in part, of course, that Paris is Paris, but what he wants above all is that his patient pin himself to his own history. What is required is that the patient recognizes himself in a kind of identity constituted by certain episodes in his life. In other words, it is in this recognition of certain biographical episodes that the patient must firstly state the truth; the most effective statement of the truth will not bear on things, but rather on the patient himself.
Finally, third, I think we should notice that this biographical truth which is asked of the patient, and the confession of which is so effective in the therapy, is not so much the truth that he could say about himself, at the level of his actual experience, but a truth imposed on him in a canon ical form: cross examination of identity, the recall of certain episodes already known to the doctor, acknowledgement that he really was at Charenton at a given moment, that he really was ill between certain dates, etcetera? 1 A biographical corpus is established from the outside through the system of family, employment, civil status, and medical observation. Ultimately the patient must own to this entire corpus of identity, and it has to be one of the most fruitful moments of the therapy when he does so; it is when this does not take place that we must despair of the illness.
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I will quote, just for the beauty of the dialogue, from another of Leuret's cases. It is the story of a woman whom he said he would never be able to cure.
And the fact that he could never cure this woman is attributed precisely to her inability to own to this biographical schema that carries her identity. Here is the dialogue that, according to Leuret, reveals her incurability: "How are you madam? --The person of myself is not a Mrs. (une dame), please call me Miss. --I do not know your name; would you like to tell me? --The person of myself does not have a name: she wishes that you do not write. --I would however really like to know what to call you, or rather what your name was formerly. --I understand what you mean. It was Catherine X, one must speak no more of what took place. The person of myself has lost her name, she gave it on enter ing Salpetriere. --How old are you? --The person of myself has no age. -- But this Catherine X you were talking about, how old is she? --I do not know (. . . )--II you are not the person about whom you speak, perhaps you are two people in one? --No, the person of myself does not know the one who was born in 1799- Maybe it is that lady whom you see there (. . . )--What have you done, and what has happened to you since you have been the person of yourself? --The person of myself has lived in the clinic for ( . . . ) . Physical and metaphysical experiments have been made on her and are still being made on her (. . . ) . There is an invisible who comes down, she wants to mix her voice with mine. The person of myself does not want this, she sends her away gently. --What are they like, these invisibles of which you speak? --They are small, impalpable, barely formed. --How are they dressed? --In a coat. --What language do they speak? --They speak French; if they spoke another language the person of myself would not understand them. --Are you certain that you see them? --Certainly, the person of myself sees them, but metaphysi- cally, in invisibility, never materially, because then they would no longer be invisible (. . . )--Do you sometimes feel the invisibles on your body? --The person of myself feels, and is very angry at it; they have done all sorts of indecent things to her (. . . )--How are you finding it at Salpetriere? --The person of myself finds it very well; she is treated very kindly by M. Pariset. She never asks anything from the maids (. . . )-- What do you think of the ladies with you here in this ward? --The person of myself thinks they have lost their reason. '02
? In a sense this is the most marvelous description of asylum existence lo be found. Once the name has been given on entering Salpetriere, once I his administrative, medical individuality has been constituted, all that remains is "the person of myself," who only speaks in the third person. In such a case, in which confession is not possible and with the endless statement in the third person of this someone who only expresses her self in the form of the person who is not anyone, Leuret clearly sees that lhe therapeutic processes organized around the statement of the truth were no longer possible. As soon as one has left one's name on entering Salpetriere and one is no more than "the person oi myself" in the asy lum, when, consequently, one can no longer recount one's childhood memories and recognize oneself in this statutory identity, then one is definitely good for the asylum.
We could say that at bottom the asylum machine owes its effectiveness to a number of things: uninterrupted disciplinary training; the dissym- metry of power inherent in this; the game of need, money, and work; statutory pinning to an administrative identity in which one must recognize oneself through a language of truth. However, you can see that this truth is not the truth of madness speaking in its own name but l he truth of a madness agreeing to first person recognition of itself in a particular administrative and medical reality constituted by asylum power. The operation of truth is accomplished when the patient has rec ognized himself in this identity. Consequently, the operation of truth lakes place in the form of charging discourse with the task oi this insti- tution of individual reality. The truth is never at issue between doctor and patient. What is given at the start, established once and for all, is the biographical reality with which the patient must identify if he wants to he cured.
There remains a final, supplementary episode in this Dupre affair. When Leuret has got this true account, but true precisely in terms of a biographical canon constituted in advance, he does something astonishing: he releases Dupre while telling him that he is still ill but no longer in need of the asylum at this time. What was Leuret doing in releasing his patient? In a way, certainly, it was a matter of continuing that kind of intensification of reality for which the asylum had been responsible.
That is to say, we will see Leuret again plotting exactly the same kind of
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maneuvers around his patient, now living in freedom, as those I have been talking about. He is trapped with problems of truth; when he claims to know Arabic he is placed in a situation in which he is iorced to confess that he does not know it. s* He is caught in the same con straints of language as those in which he was held in the asylum. The job Leuret found for his patient to lead him to the cure, that is to say, so that reality has a total grip on him, was as a printer's corrector,57' so that he is effectively inserted into that constraining order of language which, again, is not that of language as the bearer of truth, in its dialectical use, but of language in its imperative use. What he reads must actually con iorm to statutory and school orthography.
In the same way, Leuret explains that he created needs by taking him to the Opera so that he acquire the desire to go to performances. Hence the need for him to earn some money. It is still the same |enterprise] ol the renewal ol or identification with reality through a disciplinary game, now extended rather than concentrated and intense as in the asylum: "I increased his enjoyments so as to extend his needs and thus gain many means lor directing him. ,,vs
However, there is a much stronger, more subtle and interesting reason. This is that, in fact, Leuret identilied something in his patient that had three forms: the pleasure of the asylum,""6 the pleasure of being ill, and the pleasure of having symptoms. This triple pleasure is the underlying basis ol the omnipotence of madness.
When we go back over the whole development of the treatment, we see that from the start Leuret tried to attack this pleasure of the illness that he had detected in his patient. He uses the famous shower, the straitjacket, and deprivation of food right from the start, and these repressions have a double, physiological and moral, justification. The moral justification cor- responds to two objectives. On the one hand, it involves, of course, making the reality of the doctor's power felt against the omnipotence of madness. But it is also a matter of taking the pleasure out ot madness, that is to say, wiping out the pleasure of the symptom through the displeasure of the cure. Here again I think Leuret reproduces techniques that were employed by the psychiatrists of his time without being reflected or theorized.
However, what is particular about Leuret--and here he takes things further--is that in Dupre he found a special case. He had a patient who,
? when under the shower, and even when cauterized on the skin of his head,5' hardly protested and found that it was completely bearable so long as it was part of his treatment. ^8 Now it is here that Leuret no doubt goes further than most of the psychiatrists ol the time who--as sign, moreover, of their omnipotence lacing the patient--basically required the patient to accept treatment without a word. In this case he has a patient who accepts the treatment, and whose acceptance is, in a way, part of the illness.
Leuret identifies this acceptance as a bad sign lor his therapy; treatment is being incorporated within the delirium. When given a shower, Dupre says: "A woman is insulting me! "w Things must there- lore be arranged so that treatment and delirium are disconnected, so that treatment is confiscated from the delirium constantly invading it. It is thus necessary to give an especially painlul edge to the treatment, so that reality will establish its hold on the illness through the treatment.
We find some fundamental ideas in this technique: madness is linked to a pleasure; through pleasure, treatment may be integrated into the madness itself; the impact of reality may be neutralized by a mechanism ol pleasure intrinsic to the treatment; and, consequently, the cure must not only work at the level of reality, but also at the level of pleasure, and not only at the level of the pleasure the patient takes in his madness, but at the level of the pleasure the patient takes in his own treatment/
Hence, when Leuret realized that Dupre lound a whole series of pleasures in the asylum--in the asylum he could be delirious at ease, he could integrate his treatment in his delirium, and all the punishments inflicted on him were reinvested in his illness--then, at that point, Leuret concluded that he had to get his patient out ol the asylum and to deprive him of the pleasure of the illness, the hospital, and of the cure. As a result, he put him back into circulation, consequently taking the pleasure out ol the treatment and making it function in an absolutely non medical mode.
In this way Leuret is entirely resorbed as a medical personage. He has ceased playing his aggressive and imperious role, and in its place he brings a number of accomplices into play in order to construct the
* The manuscript adds: "There is both power and pleasure in every symptom. "
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following kind o( scenarios. Despite his job as a corrector at a printing house, M. Dupre continued to make systematic spelling mistakes, since in his delirium he wanted to simphiy the spelling system. A pseudo- letter of appointment was sent to him for a job that would have brought him a lot of money. M. Dupre drafts a letter oi acceptance of this new, well remunerated situation, but he lets by one or two spelling mistakes, so that Leuret's accomplice can send him a letter in which he says: "I would have employed you, if you had not made dreadful spelling mistakes. "60
So you see that all the mechanisms here, which are of the same type as those in the asylum, are now demedicalized. The medical personage, as Leuret says himself, must become instead a benign personage who tries to arrange things, who acts as an intermediary between harsh real ity and the patient. 61 However, as a result of this, the patient will no longer be able to take pleasure either in his illness, which causes so many unfortunate consequences, or in the asylum, since he is no longer there, or even in his doctor, since the doctor will have disappeared as such. M. Dupre's cure was wholly successful; it ended in the Spring of 1839 with a complete recovery. However, Leuret noted that at Paques in 1840 some unfortunate signs proved that a new illness was overcoming "the patient. "62
In summary, we can say that in the way that it functions through this kind of treatment, the asylum is a curing apparatus in which the doctor's action is part and parcel of the institution, the regulations, and the build ings. Basically, it is a question of a sort of great single body in which the walls, the wards, the instruments, the nurses, the supervisors, and the doctor are elements which have, of course, different functions to perform, but the essential function of which is to bring about a collective effect. And, according to different psychiatrists, the main accent, the most power, will sometimes be fixed on the general system of supervision, sometimes on the doctor, and sometimes on spatial isolation itself.
The second thing I would like to emphasize is that the asylum has been a site for the formation of several series of discourse. It was
? possible to construct a nosography, a classification of illnesses, on the basis of these observations. Also, on the basis of the free disposal of the corpses of the mad, it was possible to outline a pathological anatomy of mental illness. However, you can see that none of these discourses, nei- i her nosography nor pathological anatomy, served as a guide in the for ination of psychiatric practice. In actual fact, although we have had some protocols of this practice, we can say that it remained silent in that for years and years psychiatric practice did not produce an autonomous dis course other than the protocol of what was said and done. There have been no real theories of the cure, nor even attempts to explain it; the cure has been a corpus of maneuvers, tactics, and gestures to be made, actions and reactions to be activated, the tradition of which has been carried on through asylum life, in medical teaching, and with just some ol those cases, the longest of which I have quoted, as surfaces of emergence. All we can say about the way in which the mad were treated amounts to a body of tactics, a strategic ensemble.
Third, I think we should talk of an asylum tautology, in the sense that, through the asylum apparatus itself, the doctor is given a number of i instruments whose basic function is to impose reality, to intensify it, and add to it the supplement of power that will enable the doctor to get a grip on madness and reduce it, and therefore, to direct and govern it. These supplements of power added to reality by the asylum are discipli nary asymmetry, the imperative use of language, the management of lack and needs, the imposition of a statutory identity in which the patient must recognize himself, and the removal of pleasure from madness. These are the supplements oi power by which, thanks to the asylum and its processes, reality will be able to fix its grip on madness. But, you see-- and it is in this sense that there is a tautology--that all of this--the dis symmetry of power, the imperative use of language, etcetera--is not merely a supplement of power added to reality, but the real form of real- ity itself. To be adapted to the real, \. . . *] to want to leave the condition
of madness, is just precisely to accept a power that one recognizes is insurmountable and to relinquish the omnipotence of madness. To stop being mad is to agree to be obedient, to be able to earn one's living, to
' (Recording:) to relinquish the omnipotence ol madness,
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recognize onesell in the biographical identity that has been Iormed ol you, and to stop taking pleasure in madness. So as you can see, the instru- ment by which madness is reduced, the supplement of power added to reality so that it masters madness, is at the same time the criterion of the cure, or again, the criterion ol the cure is the instrument by which one cures. So, we can say that there is a great asylum tautology in that the asy lum is that which must give a supplementary intensity to reality and, at the same time, the asylum is reality in its naked power, it is reality med- ically intensified, it is medical action, medical power-knowledge, which has no other function than to be the agent of reality itseH.
The asylum tautology is this action of the supplement ol power accorded to reality, which consists in nothing other than the reproduc tion ol this reality itself within the asylum. And you can see why the doctors ol the time could say both that the asylum had to be something absolutely cut oil from the outside world, that the asylum world of mad ness had to be an absolutely specialized world entirely in the hands of a medical power delined by the pure competence of knowledge--confiscation, therelore, of the asylum space for the benefit of medical knowledge-- and, on the other hand, that the same doctors said that the general forms of the asylum had to recall everyday life as much as possible, that the asylums had to be similar to the colonies, workshops, colleges, and prisons, that is to say, that the specificity of the asylum is to be exactly homogeneous to that from which it is differentiated, by virtue of the line separating madness and non-madness.
Finally, the last point on which I will stop, and about which I will talk later, is that when we follow a cure like Leuret's in some detail-- with, of course, the qualification that this is the most sophisticated of all the cures for which we have an account--simply quoting the different episodes, without adding, I think, to what Leuret said, and by taking into account the fact that Leuret did not in any way theorize what he meant, you see a number of notions appearing: the doctor's power, language, money, need, identity, pleasure, reality, childhood memory. All of this is completely inscribed within the asylum strategy, but not yet constituting anything more than points of support for this asylum strat egy. Later, you know what their future will be; you will find them again m a completely extra-asylum discourse, or at any rate in a discourse that will
? present itself as extra-psychiatric. * However, before taking on this sta- tus of object or concept, in the kind of slow-motion which M. Dupre's cure offers us, we see them at work as tactical points of support, strate- gic elements, maneuvers, plans, and nodes in the relationships between I he patient and the asylum structure ltseli.
Later, we will see how they are detached from it in order to enter another type of discourse.
A The manuscript adds: "it is there that Freud will look lor them. "
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1. Opiates, preparations with an opium base, renowned lor suspending attacks ol lury and restoring order between ideas, were recommended, in preference to purgatives and bleedings, by Jean Baptiste Van Helmont (1577-1644) and Thomas Sydenham (1624 1689). Their use in treating "maniacal" or "furious" torms ol madness developed in the eighteenth century. See, Philippe Hecquet (1661 1737) Reflexions sur /'usage cle /'opium, des calmants el des narcoliques pour la guerison des maladies (Paris: G. Cavalier, 1726) p. 11;
J. Guislain, Traile sur Valienation meniale et sur les hospices des alienes, vol. I, book IV: "Moyens diriges sur le systeme nerveux central. Opium," pp. 345 353. See also the pages devoted to
this substance by M. Foucaull, in Hisloire de lajolie, pp. 516 319 (omitted Irom the English translation).
In the nineteenth century, Joseph Jacques Moreau de Tours ( 1804-1884) recommended
the use ol opiates in the treatment ol mania: "In the opiates (opium, datura, belladonna, henbane, aconite, etcetera) we can still find an excellent means ol calming the usual agita-
tion of maniacs and the passing Iits ol rage of monomaniacs. " "Lettres medicales sur la colome d'alienes de Gheel" Annales medko-psychologiques, vol. V, March 1845, p- 271. See,
C. Michea, De I'emploi des opiaces dans le trailement d'alienalion meniale (Pans: Malteste, 1849), and Rechcrches experimentales sur I'emploi des principaux agents de medication slupefianle dam le trailement de I'alienation meniale (Paris: Labe, 1857); H. Legrand du Saulle, "Recherches chnic|ues sur le mode d'administration de l'opium dans la manic" Annales medico-psychologiques, 3U series, vol. V, January 1857, pp. 1 27; H. Brochin, "Maladies nerveuses. ? Narcoliques" in Diclionnaire encyclopedique des sciences medicales, 2 series, vol. XII (Paris: Masson/Asselin, 1877), pp. 375 376; and, J. B. Fonssagrives, "Opium" ibid.
2,ul series, vol. XVI, 1881, pp. 146 240.
2. Laudanum, a preparation in which opium was combined with other ingredients, ol which
the most widely used was the liquid laudanum ol Sydenham, or "*>/>/ d'opium compose," was recommended lor digestive disorders, the treatment ol nervous illnesses and hysteria; see,
T. Sydenham, "Observaliones Medicae" (1680) in Opera Omnia (London: W. Greenhill, 1844) p. 113; English translation, "Medical Observations" in The Works of Thomas Sydenham, trans. R. G. Latham (London: The Sydenham Society, mdcccxlvm) vol. 1, p. 173. See Diclionnaire encyclopediaue des sciences medicales, 2 series, vol. II (Pans: Masson/Asselin, 1876) pp. 17 25.
3. Since Pinel, who asserted "the absolute necessity lor an invariable order ol work" (Traile medico-philosophique, section V: "Police generale et ordre journaher du service dans les hospices d'alienes" p. 212; A Treatise on Insanity, "General police and daily distribution ol services in lunatic asylums," p. 206) the alienists constantly stressed the importance ol regulations. Thus,J. P. Falret, "Du traitement generale des alienes" Des maladies menlales et des asiles d'alienes, p. 690: "What do we see in modern asylums? We see a strictly observed positive regulation, which fixes the use ol every hour ol the day and forces every patient to react against the irregularity of his tendencies by submitting to the general law. He is obliged to place himsell in the hands ol a loreign will and to make a constant ellort on himsell so as not to incur the punishments attached to inlnngemenls ol the rule. "
4.
Leuret makes him read books, recite verse, and forces him to speak the Latin he learned at school; he forces him to speak in Italian, which he had learned when he was in the army; he makes him "tell a story. "24
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Finally, on another occasion, he puts him in the bath, puts him under the shower as usual and, having done this, contrary to the usual practice, orders him to empty the bath. Now Dupre is not accustomed to obey ing orders. He is forced to obey this order and, when Dupre is emptying the bath with his pails, as soon as his back is turned, Leuret refills the bath again so that he can repeat the order a number of times until the mechanism of order and obedience are completely locked together. 2S
In this series of operations, which basically locus on language, it seems to me to be, first ol all, a matter of correcting the delirium ol polymorphous naming and ol constraining the patient to restore to each person the name by which he gets his individuality within the discipli nary pyramid ol the asylum. In a way which is quite typical, Dupre is not required to learn the names of the patients but rather those ol the doctor, of the doctor's students, and of the supervisors and nurses: the apprenticeship of naming will be an apprenticeship in hierarchy at the same time. Naming and showing respect, the distribution ol names and the way in which individuals are placed in a hierarchy, amount to one and the same thing.
You see too that he is required to read and recite verse, etcetera. This is, of course, a matter of occupying the mind, of diverting the delirious use of language, but it is equally a matter of re teaching the subject to use the lorms ol language of learning and discipline, the forms he learned at school, that kind ol artificial language which is not really the one he uses, but the one by which the school's discipline and system ol order are imposed. Finally, in the episode ol the bath that is tilled and he is made to empty on an indefinitely repeated order, it really is this language of orders, but this time of precise orders that the patient must be taught.
In general, I think what is at stake for Leuret here is making the patient accessible to all the imperative uses ol language: the use ol proper names with which one greets, shows one's respect and pays attention to others; school recital and ol languages learned; language of command. You can see that it is not at all a sort of re-apprenticeship-- that one might call dialectical--of the truth. It is not a question of show ing Dupre, on the basis of language, that his judgments were false; there is no discussion about whether or not it is right to consider everyone
? "Halcyons," as Dupre believes in his delirium. 26 It is not a matter of t urning the false into truth in a dialectic peculiar to language or discus- sion. In this game of orders and commands, it is simply a matter of putting the subject back in contact with language inasmuch as it is the carrier of imperatives; it is the imperative use of language that refers back to and is organized by a whole system of power. This is the lan- guage peculiar to the asylum; it fixes the names that define the asylum hierarchy; it is the master's language. It is this whole web of power that must be visible as reality behind the language one teaches. The language one re teaches to the patient is not the language through which he will be able to rediscover the truth; the language he is forced to re learn is a language in which the reality of an order, of a discipline, of a power imposed on him, must appear. This is what Leuret says, moreover, at the end ol these language exercises: "Here is M. Dupre who has become attentive [attention being the laculty of reality of course; M. F. ], he has entered into a relationship with me; I bring an action to bear on him, he obeys me. "27 "Attention," that is to say, a relationship with the doctor-- that is to say, with the person who gives orders and holds the power--a relationship that consists precisely in the doctor, who holds the power, performing an action in the form of an order. It is a language, therefore, which is transparent to this reality of power.
Here again we see that, in a sense, Leuret is much more subtle, and more of a perfectionist, than the psychiatrists of his time. Even so, what was called "moral treatment" at this time really was something like this, although less directly focused on the uses of language, of course, on that kind of rigged dialogue that was really a game of order and obedience, because, unlike Leuret, most psychiatrists put their faith in the internal mechanisms of the asylum institution rather than in this direct action of the psychiatrist as holder of power. 28 However, in the end, if you look at what the functioning of the asylum institution itself was for the psychi- atrists of this period, and where they sought the therapeutic character of the asylum's action, you see that the asylum was thought to be thera- peutic because it obliged people to submit to regulation, to a use of time, it forced them to obey orders, to line up, to submit to the regularity of certain actions and habits, to submit to work. And for the psychiatrists of the time, this whole system of order, both as orders given and, equally,
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as institutional regularities and constraints, is ultimately one of the major factors of asylum therapy. As Falret said in 1854, in a rather late text, "a strictly observed positive regulation, which fixes the use ol every hour of the day, forces every patient to react against the irregularity of his ten- dencies by submitting to the general law. Instead of being left to himself to follow the impulse ol his whim or his disordered will, the insane per- son is constrained to bend before a rule which is all the more powerful for being established for everyone. He is obliged to place himself in the hands of a foreign will and to make a constant effort on himself so as not to incur the punishments attached to infringements ol the rule. "29
Esquirol too thought that this system of the order, of the order given and the order followed, of the order as command and the order as regu larity, was the major effective agent of asylum treatment: "In such a home there is a movement, an activity, a whirl into which every person gradually enters; the most stubborn, defiant lypemaniac is forced to live outside of himself and, without being aware of it, is carried away by the general movement and example of others (. . . ); the maniac himsell, restrained by the harmony, order and rule ol the home, defends himself better against his impulses and abandons himself less to his eccentric activities. "^0 In other words, order is reality in the form of discipline.
The third maneuver in the apparatus of asylum therapy is what could be called the management or organization of needs. Psychiatric power ensures the advance of reality, the hold of reality on madness, through the management of needs, and even through the emergence of new needs, through the creation, maintenance and renewal of needs.
Here again, as a starting point, I think we can take the very subtle, very curious version that Leuret gives of this principle.
His patient, M. Dupre, did not want to work on the grounds that he did not believe in the value of money: "Money has no value; there is nothing but counterfeit money" said Dupre,51 since I, Napoleon, am the only person who has the right to mint coins. Consequently, the money given to him is counterfeit money: It's pointless to work! Now, the problem is precisely that of getting Dupre to understand the need for this money. One day he is forced to work, but he hardly does any work. At the end of the day it is suggested that he take a salary corresponding to his day's work; he refuses, giving as his reason that "money has no
? value. "52 He is seized and money forced into his pocket, but he is con- lined "without food or drink" tor the night and following day as pun- ishment for having resisted. A nurse however, who has been duly prepared in advance, is sent to him, and says: "Ah! Monsieur Dupre, how I pity you not eating! II I was not afraid of Monsieur Leuret's authority and punishment I would bring you something to eat; I am prepared to take this risk if you give me a little reward. " So in order to eat M. Dupre is obliged to take from his pocket three of the eight sous he had been given.
No doubt the meaning or, at least, the usefulness of money is already beginning to emerge for him on the basis of this artificially created need. He is well fed and, here again, a "dozen grains of calomel" are mixed in with "the vegetables eaten by M. Dupre who, quickly feeling the need to go to the lavatory, calls the servant and begs her to give him a free hand. A new pecuniary arrangement. "^ The following day Dupre goes to work and "seeks the price for his day's work. " This is, says Leuret, "the first reason- able act, made voluntarily and with reflection, that I have got from him. "M
Of course, we might wonder about this astonishing relationship Leuret establishes between money and defecation, but, as you can see, in the form of an imperative intervention. You can see that it is not a sym- bolic relationship of two terms--money-excrement--but a tactical rela- tionship between four terms: food, defecation, work, and money, and in which the fifth term, which runs through the four points of the tactical rectangle, is medical power. I think we see the relationship between money and defecation, which, as you know, was to have a well known future, emerging here for the first time and it is established through this game of medical power passing between these four terms. 55
It seems to me that generally, and here again in a particularly subtle, clever form, Leuret provided the formula of something very important in the system of psychiatric treatment at this time. Basically it involves establishing the patient in a carefully maintained state of deprivation: the patient's existence must be kept just below a certain average level. Hence a number of tactics, less subtle than Leuret's, but which also had a long future in the asylum institution and in the history of madness.
The clothing tactic: Ferrus, in his treatise Des alienes, from 1837I, pro vides a whole theory of asylum clothing, in which he says: "The clothing
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of the insane calls for special attention: almost all the mad are vain and proud. Before the onset of their illness, most of them led a life full of adventures; they often had wealth which their mental disorder led them to squander. "56 They therefore had fine clothes and jewelry, and in the asylum they recreate these costumes which are, at the same time, the sign of their old splendor, of their current poverty, and of the way in which their delirium operates: the mad must be deprived of all this. However, says Ferrus, we must not go too lar, because in asylums the mad are often allowed only torn and shameful clothes, which humiliate them too much and may excite their delirium or their disgust, and then they walk about naked. Something must be found between the orna- ments of delirium and obscene nudity, and this will be "clothing of unrefined and sturdy materials, but cut in a single style and kept clean, so as to moderate the puerile vanities ol madness. "*7
There is also the tactic of food, which must be plain, uniform, and not given on demand but in rations that, as lar as possible, are slightly less than the average. Furthermore, in addition to this general rationing of food within the asylum is added a policy ol punishment by withholding food, especially after the policy of no restraint, that is to say, after the sup pression of some of the contraptions of constraint:38 the great asylum punishment was deprivation of courses, fasting, etcetera.
Then there is the tactic of setting to work. Work is highly over- determined in the asylum system since, on the one hand, it ensures the necessary order, discipline, regularity, and constant occupation. Thus, very quickly, around the 1830s, work becomes obligatory withm asylums. The Sainte-Anne farm was initially an extension of the Bicetre hospital before taking over from it. 39 As Girard de Cailleux said when he was the director of the Auxerre hospital: "peeling and preparing veg etables is frequently a highly beneficial occupation in treatment. ",0 The interesting thing about this is that this work is not just imposed because it is a lactor in order, discipline, and regularity, but because it enables one to slip in a system of reward. Asylum work is not tree; it is paid, and this payment is not a supplementary favor but at the very heart of the function of work, for the remuneration must be sufficient to satisfy certain needs created by the underlying asylum deprivation: insufficient food, the absence of any extras (tobacco, a dessert, etcetera, must be paid for).
? I or the system of remuneration imposed with work to function, one has to have wanted, to have needed, and to have been deprived. So, these remunerations must be sufficient to satisfy the needs created by the basic deprivation and, at the same time, sufficiently low to remain below, oi course, normal and general remunerations.
Finally, and above all, the great deprivation developed by asylum dis- upline is, perhaps, quite simply deprivation of freedom. And you see how, in the psychiatrists of the first half of the nineteenth century, the iheory ol isolation gradually changes or, if you like, is deepened and completed. The theory of isolation I was talking about last week was basically demanded by the obligation to create a break between the ther- apeutic framework and the patient's family, the milieu in which the illness developed. Subsequently you see the birth of the idea that isola- tion has a supplementary advantage: it not only protects the family but gives rise to a new need in the patient, the need for freedom, of which he was previously unaware. Treatment can be developed on the basis of this artificially created need.
In the asylum form of this period, psychiatric power is therefore the creator of needs and the management of the deprivations it establishes. There are a number of easily identifiable reasons for this administration of needs, this mstitutionalization of deprivation.
First, because the reality of the things one needs will be imposed through the game of needs; money, which previously had no value, will now acquire value when one is deprived and needs it to make up lor this deprivation. So, the reality of what one needs will be perceived through this game of deprivation. This is the first effect of the system.
The second effect is that the reality of an external world, which previously the omnipotence of madness was inclined to deny, takes shape through the asylum lack, and this reality beyond the asylum's walls is increasingly imposed as being inaccessible, but as inaccessible only during the time of madness. This external world will be real in basically two ways. On the one hand it will be the world of non lack m contrast to the asylum world, and so it will appear as a desirable reality. On the other hand, the external world will appear at the same time as
a world into which one is initiated by learning to react to one's own lack, to one's own needs: When you have learned that you must work to
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leed yourself, to earn money even to defecate, then you will be able to reach the outside world. The outside world is thus real as the world ol non lack in contrast to the asylum world of deprivations, and as the world to which the lack of the asylum will serve as a propaedeutic.
The third eflect of this policy of deprivation is that in this materially reduced status in comparison with the real world, with life outside the asylum, the patient will recognize his unsatisfied state, his reduced sta- tus, his lack of rights to anything, and the reason for his lack being that he is, quite simply, ill. It won't be the reality of the external world that he sees, but the reality of his own madness through the system ol depri- vations that have been established around him. In other words, he must learn that he must pay for his madness, because madness really exists as something by which he is affected; and madness will be paid lor by a general lack of existence, by this systematic deprivation.
Finally, the fourth eifect of the organization of asylum deprivation is that by learning deprivation, by learning that to make up lor this depri- vation he must work, concede certain things, submit to discipline, etcetera, the patient will learn that basically the care given him, the cure that one attempts to obtain for him, are not owed to him; he is obliged to get them through the efforts of obedience to work, discipline, and remunerated production; he will pay with his work lor the good that society does him. As Belloc said: ". . . ll society gives the insane the care they need, the latter must relieve it of the burden according the degree of their strength. "'1 In other words, the mad person learns the lourth aspect o( reality: as a patient he must provide for his own needs by his work so that society does not have to pay for them. So we arrive at the conclusion that, on the one hand, one pays for one's madness, but that, on the other hand, recovery is purchased. The asylum is precisely what makes one pay for one's madness with artificially created needs, and, at the same time, pay for one's treatment through a certain discipline, a certain output. The asylum, by establishing a deprivation, makes possi ble the creation of a currency with which one will pay for this cure. At bottom, what constitutes the asylum is the creation of the means of pay ment for the therapy on the basis of systematically created needs, the moral reward of madness. And you can see that the problem of money linked to the needs of madness, which has its price, and of the recovery,
? which must be purchased, is deeply inscribed in the psychiatric maneuver and the asylum apparatus.
Finally, the [fifth] apparatus is that of the statement of truth. This is lhe final phase, although in the therapy proposed by Leuret it is the penultimate episode: the patient must be got to tell the truth. You will say that if this is true, and if this episode is so important in the unfold- ing of the therapy, how could I say that the problem of truth was not posed in the practice of the classical treatment? 42 But you will see how this problem of truth is posed.
This is what Leuret did with Dupre. Dupre asserted that Paris was not Paris, that the king was not the king, that he himself was Napoleon, and that Paris was only the town of Langres that some people had disguised as Paris. '3 According to Leuret, there is only one thing to do, which is to take his patient to Paris, and, in fact, he organizes a walk through Paris under the direction of an intern. He shows him the differ- ent monuments of Paris, and says to him: "Do you not recognize Paris? -- No, no, Dupre replies, we are here in the town of Langres. Several of the things in Paris have been copied. "44 The intern pretends not to know his way and asks Dupre to guide him to Place Vendome. Dupre finds it eas- ily and the intern then says to him: "So we are in Paris since you can find Place Vendome so well! --No, I recognize Langres disguised as Paris. "0 Dupre is taken back to the hospital at Bicetre where he refuses to recog nize that he has visited Pans, and, "since he persists in his refusal, he is put in the bath and cold water is poured over his head. Then he agrees to anything one likes," and that Paris really is Paris. However, out of the bath "he returns to his mad ideas. He is made to undress again and the affusion is repeated: he gives way again," recognizes that Paris is Paris,
but, as soon as he is dressed again "he maintains he is Napoleon. A third affusion corrects him; he gives way and goes to bed. "'6
However, Leuret is not fooled and is fully aware that these kinds of exercises are not sufficient. He moves on to an exercise at a higher level, as it were: "The following day I have him brought to me, and after some words about his trip the day before, I ask him. Your name? --I have been using another; my real name is Louis-Napoleon Bonaparte. --Your profession? -- Lieutenant discharged from the 19th line; but I must explain. Lieutenant means army chief. --Where were you born? --Ajaccio, or, if you like,
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Paris. --I see from this certilicate that you were insane at Charenton. --I was not insane at Charenton. I was at my chateau of Samt-Maur for nine years. Displeased with his answers, I have him taken to the bath; under the shower I give him a newspaper and want him to read out aloud. He obeys. I question him and satisfy mysell that he has understood what he has read. Then, after asking out loud if the shower tank is quite full, I have a notebook given to Dupre on which I order him to give written answers to the questions I put to him. Your name? --Dupre. --Your profession? --Lieutenant. --Your place of birth? --Paris. --How long were you at Charenton? --Nine years. --And at Saint Yon? --Two years and two months. --How long have you been in the section for the treatment oi the insane at Bicetre? --Three months; lor three years I have been incurably insane. --Where did you go yesterday? --In the town ol Paris. --Do the bears talk? --No. "4/ Progress, you see, compared with the earlier episode. And now we reach the third stage in the exercise of the statement of the truth, which is a crucial moment as you will see. "From his answers we can see that Monsieur Dupre is in a sort ol uncertainty between madness and reason "^ He has been insane lor fifteen years! And, Leuret thinks, "now is the time to require him to make a decisive reso lution, that ol writing the story ol his life. "'19 He only carries it out after several showers and "devotes the rest ol the day and the lollowing day to writing his story, with many details. He knows and writes everything that a man can recall ol his childhood. He gives the names ol his lodg mgs and of the schools where he studied, of his teachers and fellow stu- dents in great numbers. In his whole account there is not a lalse thought or a word out of place. "so
The problem arises here, which I am quite unable to resolve at pre sent, of the way in which the autobiographical account was actually introduced into psychiatric practice, and criminological practice, around 1825 to 18^0, and how, in lact, the account of one's own life came to be an essential component, with several uses, in all those processes of taking charge ol individuals and disciplining them. Why did telling one's life story become an episode within the disciplinary enterprise? How was recounting one's past, how was the memory of childhood, able to find a place within this? I don't really know. Anyway,
? concerning this maneuver of the statement of the truth, I would like to say that it seems to me we can accept certain things.
First of all, you can see that the truth is not what is perceived. Basically, when M. Dupre was taken to see Pans, it was not so much in order that his perception revealed to him that Paris really was there, and that it was Pans. This is not what was asked of him; we know full well that so far as he will perceive anything, he will perceive Paris as the imitation of Paris. What is asked of him--and this is how the statement of the truth becomes effective--is that he avow it. It does not have to be perceived, it has to be said, even if it is said under the constraint of the shower. The fact alone of saying something that is the truth has a func- tion in itself; a confession, even when constrained, is more effective in the therapy than a correct idea, or an idea with exact perception, which remains silent. So, the statement of the truth has a performative charac ter in the game of the cure.
Second, I think we should note that the essential point of the truth, what Leuret is especially attached to, is in part, of course, that Paris is Paris, but what he wants above all is that his patient pin himself to his own history. What is required is that the patient recognizes himself in a kind of identity constituted by certain episodes in his life. In other words, it is in this recognition of certain biographical episodes that the patient must firstly state the truth; the most effective statement of the truth will not bear on things, but rather on the patient himself.
Finally, third, I think we should notice that this biographical truth which is asked of the patient, and the confession of which is so effective in the therapy, is not so much the truth that he could say about himself, at the level of his actual experience, but a truth imposed on him in a canon ical form: cross examination of identity, the recall of certain episodes already known to the doctor, acknowledgement that he really was at Charenton at a given moment, that he really was ill between certain dates, etcetera? 1 A biographical corpus is established from the outside through the system of family, employment, civil status, and medical observation. Ultimately the patient must own to this entire corpus of identity, and it has to be one of the most fruitful moments of the therapy when he does so; it is when this does not take place that we must despair of the illness.
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I will quote, just for the beauty of the dialogue, from another of Leuret's cases. It is the story of a woman whom he said he would never be able to cure.
And the fact that he could never cure this woman is attributed precisely to her inability to own to this biographical schema that carries her identity. Here is the dialogue that, according to Leuret, reveals her incurability: "How are you madam? --The person of myself is not a Mrs. (une dame), please call me Miss. --I do not know your name; would you like to tell me? --The person of myself does not have a name: she wishes that you do not write. --I would however really like to know what to call you, or rather what your name was formerly. --I understand what you mean. It was Catherine X, one must speak no more of what took place. The person of myself has lost her name, she gave it on enter ing Salpetriere. --How old are you? --The person of myself has no age. -- But this Catherine X you were talking about, how old is she? --I do not know (. . . )--II you are not the person about whom you speak, perhaps you are two people in one? --No, the person of myself does not know the one who was born in 1799- Maybe it is that lady whom you see there (. . . )--What have you done, and what has happened to you since you have been the person of yourself? --The person of myself has lived in the clinic for ( . . . ) . Physical and metaphysical experiments have been made on her and are still being made on her (. . . ) . There is an invisible who comes down, she wants to mix her voice with mine. The person of myself does not want this, she sends her away gently. --What are they like, these invisibles of which you speak? --They are small, impalpable, barely formed. --How are they dressed? --In a coat. --What language do they speak? --They speak French; if they spoke another language the person of myself would not understand them. --Are you certain that you see them? --Certainly, the person of myself sees them, but metaphysi- cally, in invisibility, never materially, because then they would no longer be invisible (. . . )--Do you sometimes feel the invisibles on your body? --The person of myself feels, and is very angry at it; they have done all sorts of indecent things to her (. . . )--How are you finding it at Salpetriere? --The person of myself finds it very well; she is treated very kindly by M. Pariset. She never asks anything from the maids (. . . )-- What do you think of the ladies with you here in this ward? --The person of myself thinks they have lost their reason. '02
? In a sense this is the most marvelous description of asylum existence lo be found. Once the name has been given on entering Salpetriere, once I his administrative, medical individuality has been constituted, all that remains is "the person of myself," who only speaks in the third person. In such a case, in which confession is not possible and with the endless statement in the third person of this someone who only expresses her self in the form of the person who is not anyone, Leuret clearly sees that lhe therapeutic processes organized around the statement of the truth were no longer possible. As soon as one has left one's name on entering Salpetriere and one is no more than "the person oi myself" in the asy lum, when, consequently, one can no longer recount one's childhood memories and recognize oneself in this statutory identity, then one is definitely good for the asylum.
We could say that at bottom the asylum machine owes its effectiveness to a number of things: uninterrupted disciplinary training; the dissym- metry of power inherent in this; the game of need, money, and work; statutory pinning to an administrative identity in which one must recognize oneself through a language of truth. However, you can see that this truth is not the truth of madness speaking in its own name but l he truth of a madness agreeing to first person recognition of itself in a particular administrative and medical reality constituted by asylum power. The operation of truth is accomplished when the patient has rec ognized himself in this identity. Consequently, the operation of truth lakes place in the form of charging discourse with the task oi this insti- tution of individual reality. The truth is never at issue between doctor and patient. What is given at the start, established once and for all, is the biographical reality with which the patient must identify if he wants to he cured.
There remains a final, supplementary episode in this Dupre affair. When Leuret has got this true account, but true precisely in terms of a biographical canon constituted in advance, he does something astonishing: he releases Dupre while telling him that he is still ill but no longer in need of the asylum at this time. What was Leuret doing in releasing his patient? In a way, certainly, it was a matter of continuing that kind of intensification of reality for which the asylum had been responsible.
That is to say, we will see Leuret again plotting exactly the same kind of
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maneuvers around his patient, now living in freedom, as those I have been talking about. He is trapped with problems of truth; when he claims to know Arabic he is placed in a situation in which he is iorced to confess that he does not know it. s* He is caught in the same con straints of language as those in which he was held in the asylum. The job Leuret found for his patient to lead him to the cure, that is to say, so that reality has a total grip on him, was as a printer's corrector,57' so that he is effectively inserted into that constraining order of language which, again, is not that of language as the bearer of truth, in its dialectical use, but of language in its imperative use. What he reads must actually con iorm to statutory and school orthography.
In the same way, Leuret explains that he created needs by taking him to the Opera so that he acquire the desire to go to performances. Hence the need for him to earn some money. It is still the same |enterprise] ol the renewal ol or identification with reality through a disciplinary game, now extended rather than concentrated and intense as in the asylum: "I increased his enjoyments so as to extend his needs and thus gain many means lor directing him. ,,vs
However, there is a much stronger, more subtle and interesting reason. This is that, in fact, Leuret identilied something in his patient that had three forms: the pleasure of the asylum,""6 the pleasure of being ill, and the pleasure of having symptoms. This triple pleasure is the underlying basis ol the omnipotence of madness.
When we go back over the whole development of the treatment, we see that from the start Leuret tried to attack this pleasure of the illness that he had detected in his patient. He uses the famous shower, the straitjacket, and deprivation of food right from the start, and these repressions have a double, physiological and moral, justification. The moral justification cor- responds to two objectives. On the one hand, it involves, of course, making the reality of the doctor's power felt against the omnipotence of madness. But it is also a matter of taking the pleasure out ot madness, that is to say, wiping out the pleasure of the symptom through the displeasure of the cure. Here again I think Leuret reproduces techniques that were employed by the psychiatrists of his time without being reflected or theorized.
However, what is particular about Leuret--and here he takes things further--is that in Dupre he found a special case. He had a patient who,
? when under the shower, and even when cauterized on the skin of his head,5' hardly protested and found that it was completely bearable so long as it was part of his treatment. ^8 Now it is here that Leuret no doubt goes further than most of the psychiatrists ol the time who--as sign, moreover, of their omnipotence lacing the patient--basically required the patient to accept treatment without a word. In this case he has a patient who accepts the treatment, and whose acceptance is, in a way, part of the illness.
Leuret identifies this acceptance as a bad sign lor his therapy; treatment is being incorporated within the delirium. When given a shower, Dupre says: "A woman is insulting me! "w Things must there- lore be arranged so that treatment and delirium are disconnected, so that treatment is confiscated from the delirium constantly invading it. It is thus necessary to give an especially painlul edge to the treatment, so that reality will establish its hold on the illness through the treatment.
We find some fundamental ideas in this technique: madness is linked to a pleasure; through pleasure, treatment may be integrated into the madness itself; the impact of reality may be neutralized by a mechanism ol pleasure intrinsic to the treatment; and, consequently, the cure must not only work at the level of reality, but also at the level of pleasure, and not only at the level of the pleasure the patient takes in his madness, but at the level of the pleasure the patient takes in his own treatment/
Hence, when Leuret realized that Dupre lound a whole series of pleasures in the asylum--in the asylum he could be delirious at ease, he could integrate his treatment in his delirium, and all the punishments inflicted on him were reinvested in his illness--then, at that point, Leuret concluded that he had to get his patient out ol the asylum and to deprive him of the pleasure of the illness, the hospital, and of the cure. As a result, he put him back into circulation, consequently taking the pleasure out ol the treatment and making it function in an absolutely non medical mode.
In this way Leuret is entirely resorbed as a medical personage. He has ceased playing his aggressive and imperious role, and in its place he brings a number of accomplices into play in order to construct the
* The manuscript adds: "There is both power and pleasure in every symptom. "
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following kind o( scenarios. Despite his job as a corrector at a printing house, M. Dupre continued to make systematic spelling mistakes, since in his delirium he wanted to simphiy the spelling system. A pseudo- letter of appointment was sent to him for a job that would have brought him a lot of money. M. Dupre drafts a letter oi acceptance of this new, well remunerated situation, but he lets by one or two spelling mistakes, so that Leuret's accomplice can send him a letter in which he says: "I would have employed you, if you had not made dreadful spelling mistakes. "60
So you see that all the mechanisms here, which are of the same type as those in the asylum, are now demedicalized. The medical personage, as Leuret says himself, must become instead a benign personage who tries to arrange things, who acts as an intermediary between harsh real ity and the patient. 61 However, as a result of this, the patient will no longer be able to take pleasure either in his illness, which causes so many unfortunate consequences, or in the asylum, since he is no longer there, or even in his doctor, since the doctor will have disappeared as such. M. Dupre's cure was wholly successful; it ended in the Spring of 1839 with a complete recovery. However, Leuret noted that at Paques in 1840 some unfortunate signs proved that a new illness was overcoming "the patient. "62
In summary, we can say that in the way that it functions through this kind of treatment, the asylum is a curing apparatus in which the doctor's action is part and parcel of the institution, the regulations, and the build ings. Basically, it is a question of a sort of great single body in which the walls, the wards, the instruments, the nurses, the supervisors, and the doctor are elements which have, of course, different functions to perform, but the essential function of which is to bring about a collective effect. And, according to different psychiatrists, the main accent, the most power, will sometimes be fixed on the general system of supervision, sometimes on the doctor, and sometimes on spatial isolation itself.
The second thing I would like to emphasize is that the asylum has been a site for the formation of several series of discourse. It was
? possible to construct a nosography, a classification of illnesses, on the basis of these observations. Also, on the basis of the free disposal of the corpses of the mad, it was possible to outline a pathological anatomy of mental illness. However, you can see that none of these discourses, nei- i her nosography nor pathological anatomy, served as a guide in the for ination of psychiatric practice. In actual fact, although we have had some protocols of this practice, we can say that it remained silent in that for years and years psychiatric practice did not produce an autonomous dis course other than the protocol of what was said and done. There have been no real theories of the cure, nor even attempts to explain it; the cure has been a corpus of maneuvers, tactics, and gestures to be made, actions and reactions to be activated, the tradition of which has been carried on through asylum life, in medical teaching, and with just some ol those cases, the longest of which I have quoted, as surfaces of emergence. All we can say about the way in which the mad were treated amounts to a body of tactics, a strategic ensemble.
Third, I think we should talk of an asylum tautology, in the sense that, through the asylum apparatus itself, the doctor is given a number of i instruments whose basic function is to impose reality, to intensify it, and add to it the supplement of power that will enable the doctor to get a grip on madness and reduce it, and therefore, to direct and govern it. These supplements of power added to reality by the asylum are discipli nary asymmetry, the imperative use of language, the management of lack and needs, the imposition of a statutory identity in which the patient must recognize himself, and the removal of pleasure from madness. These are the supplements oi power by which, thanks to the asylum and its processes, reality will be able to fix its grip on madness. But, you see-- and it is in this sense that there is a tautology--that all of this--the dis symmetry of power, the imperative use of language, etcetera--is not merely a supplement of power added to reality, but the real form of real- ity itself. To be adapted to the real, \. . . *] to want to leave the condition
of madness, is just precisely to accept a power that one recognizes is insurmountable and to relinquish the omnipotence of madness. To stop being mad is to agree to be obedient, to be able to earn one's living, to
' (Recording:) to relinquish the omnipotence ol madness,
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recognize onesell in the biographical identity that has been Iormed ol you, and to stop taking pleasure in madness. So as you can see, the instru- ment by which madness is reduced, the supplement of power added to reality so that it masters madness, is at the same time the criterion of the cure, or again, the criterion ol the cure is the instrument by which one cures. So, we can say that there is a great asylum tautology in that the asy lum is that which must give a supplementary intensity to reality and, at the same time, the asylum is reality in its naked power, it is reality med- ically intensified, it is medical action, medical power-knowledge, which has no other function than to be the agent of reality itseH.
The asylum tautology is this action of the supplement ol power accorded to reality, which consists in nothing other than the reproduc tion ol this reality itself within the asylum. And you can see why the doctors ol the time could say both that the asylum had to be something absolutely cut oil from the outside world, that the asylum world of mad ness had to be an absolutely specialized world entirely in the hands of a medical power delined by the pure competence of knowledge--confiscation, therelore, of the asylum space for the benefit of medical knowledge-- and, on the other hand, that the same doctors said that the general forms of the asylum had to recall everyday life as much as possible, that the asylums had to be similar to the colonies, workshops, colleges, and prisons, that is to say, that the specificity of the asylum is to be exactly homogeneous to that from which it is differentiated, by virtue of the line separating madness and non-madness.
Finally, the last point on which I will stop, and about which I will talk later, is that when we follow a cure like Leuret's in some detail-- with, of course, the qualification that this is the most sophisticated of all the cures for which we have an account--simply quoting the different episodes, without adding, I think, to what Leuret said, and by taking into account the fact that Leuret did not in any way theorize what he meant, you see a number of notions appearing: the doctor's power, language, money, need, identity, pleasure, reality, childhood memory. All of this is completely inscribed within the asylum strategy, but not yet constituting anything more than points of support for this asylum strat egy. Later, you know what their future will be; you will find them again m a completely extra-asylum discourse, or at any rate in a discourse that will
? present itself as extra-psychiatric. * However, before taking on this sta- tus of object or concept, in the kind of slow-motion which M. Dupre's cure offers us, we see them at work as tactical points of support, strate- gic elements, maneuvers, plans, and nodes in the relationships between I he patient and the asylum structure ltseli.
Later, we will see how they are detached from it in order to enter another type of discourse.
A The manuscript adds: "it is there that Freud will look lor them. "
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1. Opiates, preparations with an opium base, renowned lor suspending attacks ol lury and restoring order between ideas, were recommended, in preference to purgatives and bleedings, by Jean Baptiste Van Helmont (1577-1644) and Thomas Sydenham (1624 1689). Their use in treating "maniacal" or "furious" torms ol madness developed in the eighteenth century. See, Philippe Hecquet (1661 1737) Reflexions sur /'usage cle /'opium, des calmants el des narcoliques pour la guerison des maladies (Paris: G. Cavalier, 1726) p. 11;
J. Guislain, Traile sur Valienation meniale et sur les hospices des alienes, vol. I, book IV: "Moyens diriges sur le systeme nerveux central. Opium," pp. 345 353. See also the pages devoted to
this substance by M. Foucaull, in Hisloire de lajolie, pp. 516 319 (omitted Irom the English translation).
In the nineteenth century, Joseph Jacques Moreau de Tours ( 1804-1884) recommended
the use ol opiates in the treatment ol mania: "In the opiates (opium, datura, belladonna, henbane, aconite, etcetera) we can still find an excellent means ol calming the usual agita-
tion of maniacs and the passing Iits ol rage of monomaniacs. " "Lettres medicales sur la colome d'alienes de Gheel" Annales medko-psychologiques, vol. V, March 1845, p- 271. See,
C. Michea, De I'emploi des opiaces dans le trailement d'alienalion meniale (Pans: Malteste, 1849), and Rechcrches experimentales sur I'emploi des principaux agents de medication slupefianle dam le trailement de I'alienation meniale (Paris: Labe, 1857); H. Legrand du Saulle, "Recherches chnic|ues sur le mode d'administration de l'opium dans la manic" Annales medico-psychologiques, 3U series, vol. V, January 1857, pp. 1 27; H. Brochin, "Maladies nerveuses. ? Narcoliques" in Diclionnaire encyclopedique des sciences medicales, 2 series, vol. XII (Paris: Masson/Asselin, 1877), pp. 375 376; and, J. B. Fonssagrives, "Opium" ibid.
2,ul series, vol. XVI, 1881, pp. 146 240.
2. Laudanum, a preparation in which opium was combined with other ingredients, ol which
the most widely used was the liquid laudanum ol Sydenham, or "*>/>/ d'opium compose," was recommended lor digestive disorders, the treatment ol nervous illnesses and hysteria; see,
T. Sydenham, "Observaliones Medicae" (1680) in Opera Omnia (London: W. Greenhill, 1844) p. 113; English translation, "Medical Observations" in The Works of Thomas Sydenham, trans. R. G. Latham (London: The Sydenham Society, mdcccxlvm) vol. 1, p. 173. See Diclionnaire encyclopediaue des sciences medicales, 2 series, vol. II (Pans: Masson/Asselin, 1876) pp. 17 25.
3. Since Pinel, who asserted "the absolute necessity lor an invariable order ol work" (Traile medico-philosophique, section V: "Police generale et ordre journaher du service dans les hospices d'alienes" p. 212; A Treatise on Insanity, "General police and daily distribution ol services in lunatic asylums," p. 206) the alienists constantly stressed the importance ol regulations. Thus,J. P. Falret, "Du traitement generale des alienes" Des maladies menlales et des asiles d'alienes, p. 690: "What do we see in modern asylums? We see a strictly observed positive regulation, which fixes the use ol every hour ol the day and forces every patient to react against the irregularity of his tendencies by submitting to the general law. He is obliged to place himsell in the hands ol a loreign will and to make a constant ellort on himsell so as not to incur the punishments attached to inlnngemenls ol the rule. "
4.
