The notion of violence underlies the analysis of the mode of
treatment
in Histoire de lafolie, Part 2, ch.
Foucault-Psychiatric-Power-1973-74
.
]* derive from it.
The apparatus of power as a productive instance of discursive practice. In this respect, in comparison with what I call archeology, the discursive analysis of power would operate at a level--I am not very happy with the word "fundamental"--let's say at a level that would enable discursive practice to be grasped at precisely the point where it is formed. To what should we refer this formation of discursive practice, where should we look for it?
If we look for the relationship between discursive practice and, let's say, economic structures, relations of production, I do not think we can avoid recourse to something like representation, the subject, and so on, appealing to a ready made psychology and philosophy. The problem for me is this: Basically, are not apparatuses of power, with all that remains enigmatic and still to be explored in this word "power," precisely the point from which it should be possible to locate the formation of dis- cursive practices. How can this deployment of power, these tactics and strategies of power, give rise to assertions, negations, experiments, and theories, in short to a game of truth? Apparatus of power and game of truth, apparatus of power and discourse of truth: This is what I would like to examine a little this year, starting from the point I have referred to, that is to say, psychiatry and madness.
The second criticism I have of that final chapter is that I appealed-- but, after all, I cannot say I did so very consciously, because I was very ignorant of antipsychiatry and especially of the psycho-sociology of the
* (Recording:) be formed from it and
7 November 1973 13
? 14 PSYCHIATRIC POWER
time--I appealed, implicitly or explicitly, to three notions that seem to me to be rusty locks with which we cannot get very far.
First, the notion of violence. 18 What actually struck me when I was reading Pinel, Esquirol, and others, is that contrary to what the hagiographies say, Pinel, Esquirol, and the others appealed strongly to physical force, and consequently it seemed to me that one could not ascribe PinePs relorm to a humanism, because his entire practice was still permeated by something like violence.
Now, if it is true that we cannot in fact ascribe Pinel's reform to humanism, I do not think this is because he resorted to violence. When in fact we speak of violence, and this is what bothers me about the notion, we always have in mind a kind of connotation ol physical power, of an unregulated, passionate power, an unbridled power, il I can put it like that. This notion seems to me to be dangerous because, on the one hand, picking out a power that is physical, unregulated, etcetera, allows one to think that good power, or just simply power, power not perme ated by violence, is not physical power. It seems to me rather that what is essential in all power is that ultimately its point of application is always the body. All power is physical, and there is a direct connection between the body and political power.
Then again, violence does not seem to me to be a very satisfactory notion, because it allows one to think that the physical exercise of an unbalanced force is not part of a rational, calculated, and controlled game of the exercise of power. Now the examples I have just given clearly prove that power as it is exercised in the asylum is a meticulous, calculated power, the tactics and strategies of which are absolutely definite; and, at the very heart of these strategies, we see quite precisely the place and role of violence, if we call violence the physical exercise of a com pletely unbalanced force. Taken in its final ramifications, at its capillary level, where it affects the individual himself, this power is physical and, thereby, it is violent, in the sense that it is absolutely irregular, not in the sense that it is unbridled, but in the sense, rather, that it is commanded by all the dispositions of a kind of microphysics of bodies.
The second notion to which I referred, and, I think, not very satisfacto- rily, is that of the institution. 19 It seemed to me that we could say that from the beginning of the nineteenth century psychiatric knowledge took
? the forms and dimensions we know in close connection with what could be called the institutionalization of psychiatry; even more precisely, it took these forms and dimensions in connection with a number of institutions of which the asylum was the most important. Now I no longer think that the institution is very satisfactory notion. It seems to me that it harbors a number of dangers, because as soon as we talk about institutions we are basically talking about both individuals and the group, we take the indi- vidual, the group, and the rules which govern them as given, and as a result we can throw in all the psychological or sociological discourses. *
In actual fact, we should show, rather, that what is essential is not the institution with its regularity, with its rules, but precisely the imbalances of power that I have tried to show both distort the asylum's regularity and, at the same time, make it function. What is important therefore is not institutional regularities, but much more the practical dispositions of power, the characteristic networks, currents, relays, points of support, and differences of potential that characterize a form of power, which are, I think, constitutive of, precisely, both the individual and the group.
It seems to me that that insofar as power is a procedure of individu- alization, the individual is only the effect of power. And it is on the basis of this network of power, functioning in its differences of potential, in its discrepancies, that something like the individual, the group, the community, and the institution appear. In other words, before tackling institutions, we have to deal with the relations of force in these tactical arrangements that permeate institutions.
Finally, the third notion I referred to in order to explain the functioning of the asylum at the start of nineteenth century is the family, and I tried to show roughly how the violence of Pinel [or] Esquirol was their introduction of the family model into the asylum institution. 20 Now I do not think that "violence" is the right word, or that we should situate our analysis at the level of the "institution," and I do not think that we should talk of the family. At any rate, re-reading Pinel, Esquirol, Fodere, and others, in the end I found very little use of this family model. It is not true that the doctor tries to reactivate the image or
* The manuscript adds: "The institution neutralizes relations of force, or it only makes them function within the space it defines. "
7 November 1973 15
? 16 PSYCHIA TRIC POWER
figure of the father within the space of the asylum; I think this takes place much later, even at the end of what could be called the psychiatric episode in the history of medicine, that is to say only m the twentieth century.
It is not the family, neither is it the State apparatus, and I think it would be equally false to say, as it often is, that asylum practice, psychiatric power, does no more than reproduce the family to the advantage of, or on the demand of, a form of State control organized by a State apparatus. 21 The State apparatus cannot serve as the basis,* and the family cannot serve as the model, [. . . '] for the relations of power that we can identify within psychiatric practice.
In doing without these notions and these models, that is to say, the family model, the norm, if you like, of the State apparatus, the notion of the institution, and the notion of violence, I think the problem that arises is that of analyzing these relations of power peculiar to psychiatric practice insofar as--and this will be the object of the course--they pro- duce statements that are given as valid, justified statements. Rather, therefore, than speak of violence, I would prefer to speak of a micro- physics of power; rather than speak of the institution, I would much prefer to try to see what tactics are put to work in these forces which confront each other; rather than speak of the family model or "State apparatus," I would like to try to see the strategy of these relations of power and confrontations which unfold within psychiatric practice.
You will say that it is all very well to have substituted a microphysics of power for violence, tactics for institution, strategy for the model of the family, but have I really made an advance? I have avoided terms that would allow the introduction of a psycho-sociological vocabulary into all these analyses, and now I am faced with a pseudo-military vocabu- lary which is not much better. Nevertheless, we will try to see what we can do with it. *
* The manuscript specifies: "We cannot use the notion of State apparatus because it is much too broad, much too abstract to designate these immediate, tiny, capillary powers that are exerted on the body, behavior, actions, and time of individuals. The State apparatus does not take this microphysics of power into account. "
1 (Recording:) for what takes place
f The manuscript (pages 11-23) continues on the question of defining the current problem of psychiatry and puts forward an analysis ol antipsychiatry.
? 1. Francois Emmanuel Fodere (1764-1835), Traite du delire, applique a la medecine, a la morale et a la legislation (Paris: Croullebois, 1817), Vol. 2, section VI, ch. 2: "Plan et distribution d'un hospice pour la guerison des alienes," p. 215.
2. Donatien Alphonse Francois de Sade (1740 1814), Les Cent vingt Journees de Sodome, ou I'Ecole du libertinage (1785), in (Euvres completes (Paris: Jean Jacques Pauvert, 1967), vol. 26; English translation in Marquis de Sade, The 120 days of Sodom and other writings, trans. Austryn Wainhouse and Richard Seaver (New York: Grove Press, 1966).
3. Joseph Michel Antoine Servan (1737-1807), Discours sur Vadministration de la justice criminelle, delivered by Monsieur Servan (Geneva: 1767), p. 35: "The unshakeable basis of the most solid empires is founded on the soft fibers of the brain. " (Republished in C. Beccana, Traite des delits et des peines, trans. P. J. Dufey [Paris: Dulibon, 1821]).
4. Philippe Pinel (1745 1826), Traite medico-philosophique sur Valienalion mentale, ou la Manie (Paris: Richard, Caille and Ravier, Year 9/1801), section II, "Traitement moral des alienes," ? xxiii: "Necessite d'entretenir un ordre constant dans les hospices des alienes," pp. 95 96; abridged English translation of original, 1801 edition [omitting Pinel's intro- duction and material added in longer French 1809 edition; G. B. ], A Treatise on Insanity, trans. B. B. Davis (New York: Hafner, 1962), section II: "The Moral Treatment of Insanity"; "The necessity of maintaining constant order in lunatic asylums, and of studying the varieties of character exhibited by the patients," p. 99-
5. Jean Etienne Dominique Esquirol (1772 1807), Des maladies mentales considerees sous les rapports medical, hygienique et medico-legal, 2 volumes (Paris: J. B. Bailliere, 1838). Abridged English translation and with additions by the translator, Menial Maladies. A Treatise on Insanity, trans. E. K. Hunt (Philadelphia: Lea and Blanchard, 1845) |Hunt says, p. vi: "All that portion of this Treatise, relating properly to insanity, has been published entire; the remainder, referring, for the most part, to the statistics and hygiene ol establishments for
the insane, together with the medico-legal relations of the subject, have been omitted";
G. B. ].
6. John Haslam (1764 1844), Observations on Insanity, with Practical Remarks on the Disease, and
an Account oj the Morbid Appearances of Dissection (London: Rivington, 1798), republished in an expanded edition under the title, Madness and Melancholy (London:J. Callow, 1809); and, Considerations on the Moral Management of Insane Persons (London: R. Hunter, 1817).
7. J. E. D. Esquirol, Des etablissements consacres aux alienes en France, et des moyens d'ameliorer le sort de ces infortunes (Report to the Minister of the Interior, September 1818), printed by Mme. Huzard, 1819. Reprinted in Des maladies mentales, vol. 2, pp. 399 431.
8. F. E. Fodere, Traite du delire, vol. 2, section 6, ch. 3, "Du choix des administrateurs, des medians, des employes et des servants," pp. 230-231.
9. Ibid. p. 237.
10. Ibid. pp. 241 242.
11. Ibid. p. 230.
12. P. Pmel, Traite medico-philosophique, section II, ? vi: "Avantages de l'art de dinger les alienes
pour seconder les effets des medicaments," p. 58; A Treatise on Insanity, pp. 59 60.
13. "Moral treatment," which develops at the end of the eighteenth century, brings together all the means of acting on the patient's psyche, as opposed to "physical treatment," which acts on the body through remedies and means of constraint. Following the death in 1791 of the wife of a Quaker, in suspicious circumstances at the York asylum, William Tiike (1732 1822) proposed the creation of an establishment for members of the Society of
Friends affected by mental disorders. The Retreat opened on 11 May 1796 (see below, lee ture of 5 December 1973, note 18). John Haslam, the apothecary at Bethlehem hospital, before becoming a medical doctor in 1816, developed principles of moral treatment in his works (see above, this lecture, note 6). In France, Pinel took up the principle in his "Observations sur le regime moral que est le plus propre a retablir, dans certains cas, la raison egaree des maniaques," Gazette de sante, no. 4, 1789, pp. 13-15, and in his report, "Recherches et observations sur le traitement moral des alienes," Memoires de la Societe medicale d'emulation. Section Medicine, no. 2,1798, pp. 215-255, republished with some changes in Traite medico-philosophique, section II, pp. 46-105. Etienne Jean Georget (1795 1828) systematized the principles in De la folie. Considerations sur cette maladie: son siege et ses
7 November 1973 17
? 18 PSYCHIATRIC POWER
symptomes, la nature et la mode d'action de ses causes; sa marche et ses terminaisons; les differences qui la distinguent du delire aigu; les moyens du traitement qui lui conviennent; suivies de recherches cadaveriques (Paris: Crevot, 1820). Francois Leuret emphasizes the doctor-patient relation ship; see, Du traitement moral de lafolie (Paris: J. B. Bailliere, 1840). See the pages devoted to moral treatment in M. Foucault, Histoire de lafolie a Vage classique (Paris: Gallimard, 1972), Part 3, ch. 4: "Naissance de I'asile" pp. 484 487, 492 496, 501 511, 523 527; Abridged English translation, Madness and Civilisation. A History of Insanity in the Age of Reason,trans. R. Howard (New York: Random House, 1965 and London: Tavistock, 1967) pp. 243 255, 269-274 (pages 484 500 of the French edition are omitted from the English translation). See also, R. Castel, "Le traitement moral. Therapeutique mentale et controle sociale au XIXC siecle," Topique, no. 2, February 1970, pp. 109 129.
14. P. Pinel, Traile medico-philosophique, Section II, ? xxi: "Caractere des alienes les plus violents et dangereux, et expediens a prendre pour les reprimer" pp. 9 0 91; A Treatise on Insanity, "The most violent and dangerous maniacs described, with expedients for their repression" pp. 93-94.
15. Ibid. Section II, ? viii: "Avantage d'ebranler fortement I'imagination d'un aliene dans certains cas" pp. 6 0 61; English, ibid. "The advantages of restraint upon the imagination of maniacs illustrated" pp. 61 63.
16. M. Foucault, Folie et Deraison. Histoire de lafolie a Vage classique (Paris: Plon, 1961); Madness and Civilisation. [Apart from in this note, the French editor always relers to the 1972, Gallimard edition, Histoire de lafolie, as above in note 13; G. B. J
17. For example, Histoire de lafolie, Part 1, ch. 5, "Les insenses" p. 169 and p. 172; Part 2, ch. 1, "Le fou au jardin des especes" p. 223; and Part 3, ch. 2, "Le nouveau partage" p. 407 and p. 415; Madness and Civilisation, ch. 3, "The insane" p. 77 and pp. 80-81 (pages 223, 407, and 415 of French edition are omitted (rom the English translation). The point of depar lure for this criticism of the notion of "perception" or "experience" is L'Archeologie du savoir (Paris: Gallimard, 1969), ch. 3, "La formation des objets" and ch. 4, "La formation des modahtes enonciatives" pp. 55 74; English translation, The Archeology oj Knowledge, trans. A. Sheridan (London: Tavistock and New York: Pantheon, 1972), Part II, ch. 3, "The formation of objects" and ch. 4, "The formation of enunciative modalities" pp. 40 55.
18.
The notion of violence underlies the analysis of the mode of treatment in Histoire de lafolie, Part 2, ch. 4, "Medecins et malades" pp. 327-328 and p. 358, and Part 3, ch. 4, "Naissance de I'asile" p. 497, pp. 502 503, p. 508, and p. 520; Madness and Civilisation, ch. 6, "Doctors and Patients" pp. 159-160 and p. 196, and ch. 9, "The Birth of the Asylum" pp. 243 245, p. 251, and p. 266 (page 497 of the French edition is omitted from the English translation). See below, "Course context" pp. 354-355-
19. The analyses devoted to the "Naissance de I'asile," ibid. pp. 483 530; "Birth of the asylum" ibid. pp. 241-278.
20. On the role of the family model in the reorganization of relations between madness and reason and the constitution of the asylum, see ibid. pp. 509 511; ibid. pp. 253 255.
21. Foucault is alluding here to the analyses of Louis Althusser who introduced the concept of "State apparatus" in his article "Ideologic et appareils ideologiques d'Etat. Notes pour une recherche," La Pensee. Revue du rationalisme moderne, no. 51, June 1970, pp. 3 3 8 ; reprinted in Positions (1964-1975) (Paris: Editions Sociales, 1976) pp. 65 125; English translation, "Ideology and Ideological State Apparatusses" in L. Althusser, Lenin and Philosophy, trans. (London: New Left Books, 1971).
? two
14 NOVEMBER 1973
Scene of a cure: George III. From the "macrophysics of sovereignty" to the "microphysics of disciplinary power. " ^ The newfigure of the
madman. r^ Little encyclopedia of scenes of cures. ^ The practice of hypnosis and hysteria. ^ The psychoanalytic scene; the antipsychiatric
scene. ^ Mary Barnes at Kingsley Hall. ^ Manipulation of madness and stratagem of truth: Mason Cox.
OBVIOUSLY YOU KNOW WHAT passes for the great founding scene of modern psychiatry, or of psychiatry period, which got under way at the beginning of the nineteenth century. It is the famous scene at Bicetre, which was not yet a hospital exactly, in which Pinel removes the chains binding the raving lunatics to the floor of their dungeon, and these lunatics, who were restrained out of fear that they would give vent to their frenzy if released, express their gratitude to Pinel as soon as they are freed from their bonds and thereby embark on the path of cure. This then is what passes for the initial, founding scene of psychiatry. 1
Now there is another scene that did not have the same destiny, although it had considerable repercussions in the same period, for rea- sons that are easy to understand. It is a scene which did not take place in France, but in England--and was reported in some detail by Pinel, moreover, in his Traite medico-philosophique of Year IX (1800)--and which, as you will see straightaway, was not without a kind of force, a malleable presence, inasmuch as in the period, not in which it took place, which was in 1788, but in which it became known in France, and
? 20 PSYCHIA TRIC POWER
finally in the whole of Europe, it had become, let's say, a certain custom for kings to lose their heads. It is an important scene because it stages precisely what psychiatric practice could be in that period as a regulated and concerted manipulation of relations of power.
Here is Pinel's text, which circulated in France and made the affair known:
"A monarch [George III of England; M. F. ] falls into a mania, and in order to make his cure more speedy and secure, no restrictions are placed on the prudence of the person who is to direct it [note the word: this is the doctor; M. F. ]; from then on, all trappings of royalty having disap- peared, the madman, separated from his family and his usual surround- ings, is consigned to an isolated palace, and he is confined alone in a room whose tiled floor and walls are covered with matting so that he cannot harm himself. The person directing the treatment tells him that he is no longer sovereign, but that he must henceforth be obedient and submissive. Two of his old pages, of Herculean stature, are charged with looking after his needs and providing him with all the services his con- dition requires, but also with convincing him that he is entirely subor dinate to them and must now obey them. They keep watch over him in calm silence, but take every opportunity to make him aware of how much stronger than him they are. One day, in fiery delirium, the mad- man harshly greets his old doctor who is making his visit, and daubs him with filth and excrement. One of the pages immediately enters the room without saying a word, grasps by his belt the delirious madman, who is himself in a disgustingly filthy state, forcibly throws him down on a pile of mattresses, strips him, washes him with a sponge, changes his clothes, and, looking at him haughtily, immediately leaves to take up his post again. Such lessons, repeated at intervals over some months and backed up by other means of treatment, have produced a sound cure without relapse. "2
I would like to analyze the elements of this scene. First of all, there is something quite striking in PinePs text, which he took from Willis, the king's doctor. 3 It seems to me that what appears first of all is, basically, a ceremony, a ceremony of deposition, a sort of reverse coronation in which it is quite clearly shown that it involves placing the king in a sit- uation of complete subordination; you remember the words: "all trappings
? of royalty having disappeared," and the doctor, who is, as it were, the effective agent of this dethronement, of this deconsecration, explicitly telling him that "he is no longer sovereign. "
A decree, consequently, of deposition: the king is reduced to impo- tence. And it seems to me that the "matting," which surrounds him and plays [such a big] role* both in the setting and the final scene, are important. The matting is both what isolates the king from the outside world, and, as well as preventing him from hearing and seeing the out- side world, prevents him from communicating his orders to it; that is to say, all the essential functions of the monarchy are, in the strict sense, bracketed off by the matting. In place of the scepter, crown, and sword, which should make the universal power of the king reigning over his kingdom visible and perceptible to all the spectators, in place of these signs, there is no more than the "matting" which confines him and reduces him, there where he is, to what he is, that is to say, to his body.
Deposition and therefore the king's fall; but my impression is that it is not the same type of fall as we find in, say, a Shakespearian drama: this is not Richard III4 threatened with falling under the power of another sovereign, nor King Lear5 stripped of his sovereignty and roaming the world in solitude, poverty, and madness. In fact, the king's [George III] madness, unlike that of King Lear, condemned to roam the world, fixes him at a precise point and, especially, brings him under, not another sovereign power, but a completely different type of power which differs term by term, I think, from the power of sovereignty. It is an anonymous, nameless and faceless power that is distributed between different per- sons. Above all, it is a power that is expressed through an implacable regulation that is not even formulated, since, basically, nothing is said, and the text actually says that all the agents of this power remain silent. The silence of regulation takes over, as it were, the empty place left by the king's dethronement.
So this is not a case of one sovereign power falling under another sovereign power, but the transition from a sovereign power--decapitated by the madness that has seized hold of the king's head, and dethroned by the ceremony that shows the king that he is no longer sovereign--to
* (Recording:) such an important role
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a different power. In place ol this beheaded and dethroned power, an anonymous, multiple, pale, colorless power is installed, which is basi- cally what I will call disciplinary power. One type of power, that of sov- ereignty, is replaced by what could be called disciplinary power, and the effect of which is not at all to consecrate someone's power, to concentrate power in a visible and named individual, but only to produce effects on its target, on the body and very person of the dethroned king, who must be rendered "docile and submissive"6 by this new power.
Whereas sovereign power is expressed through the symbols of the dazzling force of the individual who holds it, disciplinary power is a discreet, distributed power; it is a power which functions through net works and the visibility of which is only found in the obedience and submission of those on whom it is silently exercised. I think this is what is essential in this scene: the confrontation, the submission, and the con- necting up ol a sovereign power to a disciplinary power.
Who are the agents ol this disciplinary power? Curiously, the doctor, the person who organizes everything and really is m fact, up to a certain point, the focal element, the core of this disciplinary system, does not himself appear: Willis is never there. And when we have the scene ol the doctor, it is precisely an old doctor and not Willis himself. Who then are the agents ol this power? We are told that they are two old pages of Herculean stature.
I think we should stop here for a moment, for they too are very important in the scene. As a hypothesis, and subject to correction, I will say that this relationship of the Herculean pages to the mad king stripped bare should be compared with some iconographic themes. I think the plastic force of this history is due m part precisely to the fact that it contains elements [. . . *] of the traditional iconography for repre senting sovereigns. Now it seems to me that the king and his servants are traditionally represented in two forms.
There is the representation of the warrior king in breastplate and arms deploying and displaying his omnipotence--the Hercules king, if you like--and beside him, beneath him, subject to this kind of over- whelming power, are figures representing submission, weakness, defeat,
* (Recording:) which are part
? slavery, or possibly beauty. This, more or less, is one of the primary oppositions found in the iconography of royal power.
Then there is another possibility, but with a different play of opposi tions. This is not the Herculean king, but the king of human stature who is, rather, stripped of all the visible and immediate signs of physical force and clothed only in the symbols of his power; the king in his ermine, with his scepter, his globe, and then, beneath him, or accompa- nying him, the visible representation of a force subject to him: soldiers, pages, and servants who are the representation of a force, but of a force which is, as it were, silently commanded by the intermediary of these symbolic elements of power, by scepter, ermine, crown, and so forth. Broadly speaking, it seems to me that the relationship of king to ser vants is represented in this way in the iconography: always in terms of opposition, but in the form of these two kinds of opposition.
Now, here, in this scene taken from Willis that is recounted by Pinel, you find these same elements, but completely shifted and transformed. On the one hand, you have the wild force of the king who has become the human beast again and who is in exactly the same position as those submissive and enchained slaves we found in the Hrst of the icono graphic versions I spoke about. Opposite this, there is the restrained, disciplined, and serene force of the servants. In this opposition of the king who has become wild force and servants who are the visible repre- sentation of a force, but of a disciplined force, I think you have in fact the point at which a sovereignty that is disappearing is caught up in a disciplinary power that is being constituted and whose face, it seems to me, can be seen in these silent, muscular, and magnificent pages who are both obedient and all-powerful.
How do these Herculean servants exercise their functions? Here again I think we should examine the text in some detail. The text says that these Herculean servants are present in order to serve the king; it even says very precisely that their purpose is to serve his "needs" and his "condition. " Now it seems to me that in what could be called the power of sovereignty, in actual fact the servant really does serve the sovereign's needs and really must satisfy the requirements and needs of his condition: he is in fact the person who dresses and undresses the king, who ensures the provision of services for his body and his property, and so on.
74 November 7973 23
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However, when the servant ministers to the sovereign's needs and con- dition, it is essentially because this is the sovereign's will. That is to say, the sovereign's will binds the servant, and it binds him individually, as this or that servant, to that function which consists in ensuring that he serves the sovereign's needs and condition. The king's will, his status as king, is what fixes the servant to his needs and condition.
Now, in the disciplinary relationship that we see appearing here, the servant is not at all in the service of the king's will, or it is not because it is the king's will that he serves the king's needs. He is in the service of the king's needs and condition without either the king's will or his status being involved. It is only the mechanical requirements of the body, as it were, which fix and determine what the servant's service must be. Consequently will and need, status and condition are disconnected. What's more, the servant will only act as a repressive force, he will leave off serving only in order to curb the king's will, when the latter is expressed over and above his needs and his condition.
This, more or less, is roughly the scene's setting. I would now like to move on to the important episode of this scene set in this context, that is to say the episode of the confrontation with the doctor: "One day, in fiery delirium, the madman harshly greets his old doctor who is making his visit, and daubs him with filth and excrement. One of the pages immediately enters the room without saying a word, grasps by his belt the delirious madman . . . "7
After the deposition scene, or dethronement if you like, there is the scene of rubbish, excrement, and filth. This is no longer just the king who is dethroned, this is not just dispossession of the attributes of sovereignty; it is the total inversion of sovereignty. The only force the king has left is his body reduced to its wild state, and the only weapons he has left are his bodily evacuations, which is precisely what he uses against his doctor. Now in doing this I think the king really inverts his sovereignty, not just because his waste matter has replaced his scepter and sword, but also because in this action he takes up, quite exactly, a gesture with a his- torical meaning. The act of throwing mud and refuse over someone is the centuries old gesture of insurrection against the powerful.
There is an entire tradition that would have it that we only speak of excrement and waste matter as the symbol of money. Still, a very serious
? political history could be done of excrement and waste matter, both a political and a medical history of the way in which excrement and waste matter could be a problem in themselves, and without any kind of symbohzation: they could be an economic problem, and a medical problem, of course, but they could also be the stake of a political struggle, which is very clear in the seventeenth century and especially the eighteenth century. And this profaning gesture of throwing mud, refuse, and excrement over the carriages, silk, and ermine of the great, well, King George III, having been its victim, knew full well what it meant.
So there is a total reversal of the sovereign function here, since the king takes up the insurrectional gesture not just of the poor, but even of the poorest of the poor. When the peasants revolted, they used the tools avail- able to them as weapons: scythes, staves, and suchlike. Artisans also made use of the tools of their trade. It was only the poorest, those who had noth- ing, who picked up stones and excrement in the street to throw at the pow- erful. This is the role that the king is taking up in his confrontation with the medical power entering the room in which he finds himself: sovereignty, both driven wild and inverted, against pale discipline.
It is at this point that the silent, muscular, invincible page enters, who seizes the king around the waist, throws him on the bed, strips him naked, washes him with a sponge, and withdraws, as the text says, "looking at him haughtily. "8 And once again you find here the displace- ment of the elements of a scene of power, which this time is no longer of the coronation, of the iconographic representation; it is, as you can see clearly, the scaffold, the scene of public torture. But here as well there is inversion and displacement: whereas the person who violates sover- eignty, who throws stones and excrement over the king, would have been killed, hung and quartered according to English law, here instead, discipline, making its entrance m the form of the page, will control, bring down, strip naked, scrub, and make the body clean and true.
That is what I wanted to say about this scene, which, much more than the scene of Pmel freeing the mad, appears to me typical of what is put to work m what I call proto-psychiatric practice, that is to say, roughly, the practice which develops in the last years of the eighteenth century and in the first twenty or thirty years of the nineteenth century, before the appearance of the great institutional edifice of the psychiatric asylum
74 November 7973 25
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in the years between 1830 and 1840, say 1838 m France, with the law on conlinement and the organization of the major psychiatric hospitals. 9
This scene seems to me to be important. First of all because it means I can correct an error I made in Histoire de lafolie. You can see that there is no question here of the imposition of anything like a family model in psy- chiatric practice; it is not true that the father and mother, or the typical relationships of the family structure, are borrowed by psychiatric practice and pinned on madness and the direction of the insane. The relationship to the family will appear in the history of psychiatry, but this will be later, and, as far as I can see at present, we should identify hysteria as the point at which the family model is grafted on to psychiatric practice.
You can see also that the treatment, which, with an optimism subse- quently contradicted by the facts, Pinel said would produce "a sound cure without relapse,"10 takes place without anything like a valid description, analysis, diagnosis, or true knowledge of the king's illness. Here again, just as the family model only enters later, so too the moment of truth only enters psychiatric practice later.
Finally, I would like to emphasize that one can see very clearly here an interplay of elements, elements of power in a strict sense, which are put to work, shifted, turned around, and so on, outside of any institution. Here again, my impression is that the moment of the institution is not prior to these relationships of power. That is to say, the institution does not determine these relationships of power, any more than a discourse of truth prescribes them, or a family model suggests them. In actual fact, in this kind of scene you see these relationships of power functioning, I was going to say nakedly. In this it seems to me to pick out quite well the basis of relationships of power that constitute the core element of psychiatric practice, on the basis of which, in fact, we will later see the construction of institutional structures, the emergence of discourses of truth, and also the grafting or importation of a number of models.
However, for the moment, we are witnessing the emergence of a disciplinary power, the specific figure of which seems to me to appear here with remarkable clarity precisely to the extent that, in this case, disciplinary power is confronted by another form of political power that I will call the power of sovereignty. That is to say, if the first hypotheses now guiding me are correct, it will not be enough to say that right from
? the start we find something like political power in psychiatric practice; it seems to me that it is more complicated, and what's more will become increasingly complicated. For the moment I would like to schematize. We are not dealing with just any kind of political power; there are two absolutely distinct types of power corresponding to two systems, two different ways of functioning: the macrophysics of sovereignty, the power that could be put to work in a post-feudal, pre industrial government, and then the microphysics of disciplinary power, whose functioning we find in the different components I am presenting to you and which makes its appearance here leaning on, as it were, the disconnected, broken down, unmasked components of sovereign power.
There is a transformation, therefore, of the relationship of sovereignty into disciplinary power. And you see at the heart of all this, at bottom, a kind of general proposition which is: "You may well be the king, but if you are mad you will cease to be so," or again: "You may well be mad, but this won't make you king. " The king, George III in this case, could only be cured in Willis's scene, in Pinel's fable if you like, to the extent that he was not treated as king, and to the extent that he was subjected to a force that was not the force of royal power. "You are not king" seems to me to be the proposition at the heart of this kind of proto-psychiatry I am trying to analyze. If you refer then to the texts of Descartes, where it is a question of madmen who take themselves for kings, you notice that the two examples Descartes gives of madness are "taking oneself for a king" or believing one "has a body made of glass. "11 In truth, for Descartes and generally [. . . *] for all those who spoke about madness up until the end of the eighteenth century, "taking oneself for a king," or believing one has "a body made of glass," was exactly the same thing, that it to say they were two absolutely identical types of error, which immediately contradicted the most elementary facts of sensation. "Taking oneself for a king," "believing that one has a body of glass," was, quite simply, typical of madness as error.
Henceforth, it seems to me that in this proto psychiatric practice, and so for all the discourses of truth that get going on the basis of this practice, "believing oneself to be a king" is the true secret of madness.
* (Recording:) we can say
74 November 7973 27
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If you look at how a delirium, an illusion, or a hallucination was analyzed in this period, you see that it doesn't much matter whether someone believes himself to be a king, that is to say, whether the content of his delirium is supposing that he exercises royal power, or, to the contrary, believes himself to be ruined, persecuted, and rejected by the whole of humanity. For the psychiatrists of this period, the fact of imposing this belief, of asserting it against every proof to the contrary, even putting it forward against medical knowledge, wanting to impose it on the doctor and, ultimately, on the whole asylum, thus asserting it against every other form of certainty or knowledge, constitutes a way of believing that one is a kmg. Whether you believe yourself to be a king or believe that you are wretched, wanting to impose this certainty as a kind of tyranny on all those around you basically amounts to "believing one is a king"; it is this that makes all madness a kind of belief rooted in the fact that one is king of the world. Psychiatrists at the start of the nineteenth century could have said that to be mad was to seize power in one's head. Moreover, for Georget, in a text from 1820, the treatise De lafolie, the major problem for the psychiatrist is basically "how to persuade otherwise" someone who believes that he is a king. 12
There are a number of reasons why I have stressed this scene of the king. First of all, it seems to me that it enables us to have a better under- standing of that other founding scene of psychiatry, the scene of Pinel I spoke about at the start, the scene of liberation. Pinel, at Bicetre in 1792, entering the dungeons, removing the chains from this or that patient who has been chained up for weeks or months, would seem to be the exact opposite of the history of the king who is dispossessed, the exact opposite of the history of the king who is confined, seized around the waist, and supervised by muscular pages. Actually, when we look closely, we can see the continuity between the two scenes.
When Pinel liberates the patients confined in the dungeons, the per- son who is liberated incurs a debt to his liberator that will and must be settled in two ways. First, the person liberated will settle his debt con tinually and voluntarily by obedience; the wild violence of a body, which was only restrained by the violence of chains, will be replaced by the constant submission of one will to another. In other words, removing the chains ensures something like subjection through grateful obedience.
? Then the patient will wipe out the debt in a second way, this time involuntarily. From the moment he is subjected in this way, where the continual and voluntary repayment of the debt of gratitude will have made him submit to the discipline of medical power, the working of this discipline and its own force will itself bring about the patient's cure. As a result, the cure will become involuntarily the second payment in kind for his liberation, the way in which the patient, or rather, the patient's illness, will pay the doctor for the gratitude he owes him.
You see that, in fact, this scene of liberation is not exactly a scene of humanism, and of course everyone knows this. But I think we can analyze it as a relationship of power, or as the transformation of a certain relation- ship of power that was one of violence--the prison, dungeon, chains, and here again, all this belongs to the old form of the power of sovereignty-- into a relationship of subjection that is a relationship of discipline.
This is the first reason for recounting the history of George III, since it seems to me to inaugurate a psychiatric practice for which Pinel is generally given credit.
The other reason for quoting this case is that it seems to me that the scene of George III is one in a whole series of other scenes. First of all, it is part of a series of scenes, which, in the first twenty-five or thirty years of the nineteenth century, constitute this proto-psychiatric practice. We could say that in the first quarter of the nineteenth century there was a kind of little encyclopedia of canonical cures constituted on the basis of the cases published by Haslam,13 Pinel,1/| Esquirol,15 Fodere,16 Georget,17 and Guislam. 18 And this little encyclopedia includes around fifty cases which circulate in all the psychiatric treatises of the time and all of which more or less conform to a similar model. Here, if you like, are one or two examples which show very clearly, I think, how all these scenes of cure resemble that major scene of the cure of George III.
Here, for example, is an example from PinePs Traite medico-philosophique: "A soldier, still in a state of insanity (. . . ) is suddenly dominated by the single idea of leaving for the army. " He refuses to return to his room in the evening when he is ordered to do so. When he is in his room, he sets about tearing everything apart and making a mess; then he is tied to the bed.
The apparatus of power as a productive instance of discursive practice. In this respect, in comparison with what I call archeology, the discursive analysis of power would operate at a level--I am not very happy with the word "fundamental"--let's say at a level that would enable discursive practice to be grasped at precisely the point where it is formed. To what should we refer this formation of discursive practice, where should we look for it?
If we look for the relationship between discursive practice and, let's say, economic structures, relations of production, I do not think we can avoid recourse to something like representation, the subject, and so on, appealing to a ready made psychology and philosophy. The problem for me is this: Basically, are not apparatuses of power, with all that remains enigmatic and still to be explored in this word "power," precisely the point from which it should be possible to locate the formation of dis- cursive practices. How can this deployment of power, these tactics and strategies of power, give rise to assertions, negations, experiments, and theories, in short to a game of truth? Apparatus of power and game of truth, apparatus of power and discourse of truth: This is what I would like to examine a little this year, starting from the point I have referred to, that is to say, psychiatry and madness.
The second criticism I have of that final chapter is that I appealed-- but, after all, I cannot say I did so very consciously, because I was very ignorant of antipsychiatry and especially of the psycho-sociology of the
* (Recording:) be formed from it and
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? 14 PSYCHIATRIC POWER
time--I appealed, implicitly or explicitly, to three notions that seem to me to be rusty locks with which we cannot get very far.
First, the notion of violence. 18 What actually struck me when I was reading Pinel, Esquirol, and others, is that contrary to what the hagiographies say, Pinel, Esquirol, and the others appealed strongly to physical force, and consequently it seemed to me that one could not ascribe PinePs relorm to a humanism, because his entire practice was still permeated by something like violence.
Now, if it is true that we cannot in fact ascribe Pinel's reform to humanism, I do not think this is because he resorted to violence. When in fact we speak of violence, and this is what bothers me about the notion, we always have in mind a kind of connotation ol physical power, of an unregulated, passionate power, an unbridled power, il I can put it like that. This notion seems to me to be dangerous because, on the one hand, picking out a power that is physical, unregulated, etcetera, allows one to think that good power, or just simply power, power not perme ated by violence, is not physical power. It seems to me rather that what is essential in all power is that ultimately its point of application is always the body. All power is physical, and there is a direct connection between the body and political power.
Then again, violence does not seem to me to be a very satisfactory notion, because it allows one to think that the physical exercise of an unbalanced force is not part of a rational, calculated, and controlled game of the exercise of power. Now the examples I have just given clearly prove that power as it is exercised in the asylum is a meticulous, calculated power, the tactics and strategies of which are absolutely definite; and, at the very heart of these strategies, we see quite precisely the place and role of violence, if we call violence the physical exercise of a com pletely unbalanced force. Taken in its final ramifications, at its capillary level, where it affects the individual himself, this power is physical and, thereby, it is violent, in the sense that it is absolutely irregular, not in the sense that it is unbridled, but in the sense, rather, that it is commanded by all the dispositions of a kind of microphysics of bodies.
The second notion to which I referred, and, I think, not very satisfacto- rily, is that of the institution. 19 It seemed to me that we could say that from the beginning of the nineteenth century psychiatric knowledge took
? the forms and dimensions we know in close connection with what could be called the institutionalization of psychiatry; even more precisely, it took these forms and dimensions in connection with a number of institutions of which the asylum was the most important. Now I no longer think that the institution is very satisfactory notion. It seems to me that it harbors a number of dangers, because as soon as we talk about institutions we are basically talking about both individuals and the group, we take the indi- vidual, the group, and the rules which govern them as given, and as a result we can throw in all the psychological or sociological discourses. *
In actual fact, we should show, rather, that what is essential is not the institution with its regularity, with its rules, but precisely the imbalances of power that I have tried to show both distort the asylum's regularity and, at the same time, make it function. What is important therefore is not institutional regularities, but much more the practical dispositions of power, the characteristic networks, currents, relays, points of support, and differences of potential that characterize a form of power, which are, I think, constitutive of, precisely, both the individual and the group.
It seems to me that that insofar as power is a procedure of individu- alization, the individual is only the effect of power. And it is on the basis of this network of power, functioning in its differences of potential, in its discrepancies, that something like the individual, the group, the community, and the institution appear. In other words, before tackling institutions, we have to deal with the relations of force in these tactical arrangements that permeate institutions.
Finally, the third notion I referred to in order to explain the functioning of the asylum at the start of nineteenth century is the family, and I tried to show roughly how the violence of Pinel [or] Esquirol was their introduction of the family model into the asylum institution. 20 Now I do not think that "violence" is the right word, or that we should situate our analysis at the level of the "institution," and I do not think that we should talk of the family. At any rate, re-reading Pinel, Esquirol, Fodere, and others, in the end I found very little use of this family model. It is not true that the doctor tries to reactivate the image or
* The manuscript adds: "The institution neutralizes relations of force, or it only makes them function within the space it defines. "
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figure of the father within the space of the asylum; I think this takes place much later, even at the end of what could be called the psychiatric episode in the history of medicine, that is to say only m the twentieth century.
It is not the family, neither is it the State apparatus, and I think it would be equally false to say, as it often is, that asylum practice, psychiatric power, does no more than reproduce the family to the advantage of, or on the demand of, a form of State control organized by a State apparatus. 21 The State apparatus cannot serve as the basis,* and the family cannot serve as the model, [. . . '] for the relations of power that we can identify within psychiatric practice.
In doing without these notions and these models, that is to say, the family model, the norm, if you like, of the State apparatus, the notion of the institution, and the notion of violence, I think the problem that arises is that of analyzing these relations of power peculiar to psychiatric practice insofar as--and this will be the object of the course--they pro- duce statements that are given as valid, justified statements. Rather, therefore, than speak of violence, I would prefer to speak of a micro- physics of power; rather than speak of the institution, I would much prefer to try to see what tactics are put to work in these forces which confront each other; rather than speak of the family model or "State apparatus," I would like to try to see the strategy of these relations of power and confrontations which unfold within psychiatric practice.
You will say that it is all very well to have substituted a microphysics of power for violence, tactics for institution, strategy for the model of the family, but have I really made an advance? I have avoided terms that would allow the introduction of a psycho-sociological vocabulary into all these analyses, and now I am faced with a pseudo-military vocabu- lary which is not much better. Nevertheless, we will try to see what we can do with it. *
* The manuscript specifies: "We cannot use the notion of State apparatus because it is much too broad, much too abstract to designate these immediate, tiny, capillary powers that are exerted on the body, behavior, actions, and time of individuals. The State apparatus does not take this microphysics of power into account. "
1 (Recording:) for what takes place
f The manuscript (pages 11-23) continues on the question of defining the current problem of psychiatry and puts forward an analysis ol antipsychiatry.
? 1. Francois Emmanuel Fodere (1764-1835), Traite du delire, applique a la medecine, a la morale et a la legislation (Paris: Croullebois, 1817), Vol. 2, section VI, ch. 2: "Plan et distribution d'un hospice pour la guerison des alienes," p. 215.
2. Donatien Alphonse Francois de Sade (1740 1814), Les Cent vingt Journees de Sodome, ou I'Ecole du libertinage (1785), in (Euvres completes (Paris: Jean Jacques Pauvert, 1967), vol. 26; English translation in Marquis de Sade, The 120 days of Sodom and other writings, trans. Austryn Wainhouse and Richard Seaver (New York: Grove Press, 1966).
3. Joseph Michel Antoine Servan (1737-1807), Discours sur Vadministration de la justice criminelle, delivered by Monsieur Servan (Geneva: 1767), p. 35: "The unshakeable basis of the most solid empires is founded on the soft fibers of the brain. " (Republished in C. Beccana, Traite des delits et des peines, trans. P. J. Dufey [Paris: Dulibon, 1821]).
4. Philippe Pinel (1745 1826), Traite medico-philosophique sur Valienalion mentale, ou la Manie (Paris: Richard, Caille and Ravier, Year 9/1801), section II, "Traitement moral des alienes," ? xxiii: "Necessite d'entretenir un ordre constant dans les hospices des alienes," pp. 95 96; abridged English translation of original, 1801 edition [omitting Pinel's intro- duction and material added in longer French 1809 edition; G. B. ], A Treatise on Insanity, trans. B. B. Davis (New York: Hafner, 1962), section II: "The Moral Treatment of Insanity"; "The necessity of maintaining constant order in lunatic asylums, and of studying the varieties of character exhibited by the patients," p. 99-
5. Jean Etienne Dominique Esquirol (1772 1807), Des maladies mentales considerees sous les rapports medical, hygienique et medico-legal, 2 volumes (Paris: J. B. Bailliere, 1838). Abridged English translation and with additions by the translator, Menial Maladies. A Treatise on Insanity, trans. E. K. Hunt (Philadelphia: Lea and Blanchard, 1845) |Hunt says, p. vi: "All that portion of this Treatise, relating properly to insanity, has been published entire; the remainder, referring, for the most part, to the statistics and hygiene ol establishments for
the insane, together with the medico-legal relations of the subject, have been omitted";
G. B. ].
6. John Haslam (1764 1844), Observations on Insanity, with Practical Remarks on the Disease, and
an Account oj the Morbid Appearances of Dissection (London: Rivington, 1798), republished in an expanded edition under the title, Madness and Melancholy (London:J. Callow, 1809); and, Considerations on the Moral Management of Insane Persons (London: R. Hunter, 1817).
7. J. E. D. Esquirol, Des etablissements consacres aux alienes en France, et des moyens d'ameliorer le sort de ces infortunes (Report to the Minister of the Interior, September 1818), printed by Mme. Huzard, 1819. Reprinted in Des maladies mentales, vol. 2, pp. 399 431.
8. F. E. Fodere, Traite du delire, vol. 2, section 6, ch. 3, "Du choix des administrateurs, des medians, des employes et des servants," pp. 230-231.
9. Ibid. p. 237.
10. Ibid. pp. 241 242.
11. Ibid. p. 230.
12. P. Pmel, Traite medico-philosophique, section II, ? vi: "Avantages de l'art de dinger les alienes
pour seconder les effets des medicaments," p. 58; A Treatise on Insanity, pp. 59 60.
13. "Moral treatment," which develops at the end of the eighteenth century, brings together all the means of acting on the patient's psyche, as opposed to "physical treatment," which acts on the body through remedies and means of constraint. Following the death in 1791 of the wife of a Quaker, in suspicious circumstances at the York asylum, William Tiike (1732 1822) proposed the creation of an establishment for members of the Society of
Friends affected by mental disorders. The Retreat opened on 11 May 1796 (see below, lee ture of 5 December 1973, note 18). John Haslam, the apothecary at Bethlehem hospital, before becoming a medical doctor in 1816, developed principles of moral treatment in his works (see above, this lecture, note 6). In France, Pinel took up the principle in his "Observations sur le regime moral que est le plus propre a retablir, dans certains cas, la raison egaree des maniaques," Gazette de sante, no. 4, 1789, pp. 13-15, and in his report, "Recherches et observations sur le traitement moral des alienes," Memoires de la Societe medicale d'emulation. Section Medicine, no. 2,1798, pp. 215-255, republished with some changes in Traite medico-philosophique, section II, pp. 46-105. Etienne Jean Georget (1795 1828) systematized the principles in De la folie. Considerations sur cette maladie: son siege et ses
7 November 1973 17
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symptomes, la nature et la mode d'action de ses causes; sa marche et ses terminaisons; les differences qui la distinguent du delire aigu; les moyens du traitement qui lui conviennent; suivies de recherches cadaveriques (Paris: Crevot, 1820). Francois Leuret emphasizes the doctor-patient relation ship; see, Du traitement moral de lafolie (Paris: J. B. Bailliere, 1840). See the pages devoted to moral treatment in M. Foucault, Histoire de lafolie a Vage classique (Paris: Gallimard, 1972), Part 3, ch. 4: "Naissance de I'asile" pp. 484 487, 492 496, 501 511, 523 527; Abridged English translation, Madness and Civilisation. A History of Insanity in the Age of Reason,trans. R. Howard (New York: Random House, 1965 and London: Tavistock, 1967) pp. 243 255, 269-274 (pages 484 500 of the French edition are omitted from the English translation). See also, R. Castel, "Le traitement moral. Therapeutique mentale et controle sociale au XIXC siecle," Topique, no. 2, February 1970, pp. 109 129.
14. P. Pinel, Traile medico-philosophique, Section II, ? xxi: "Caractere des alienes les plus violents et dangereux, et expediens a prendre pour les reprimer" pp. 9 0 91; A Treatise on Insanity, "The most violent and dangerous maniacs described, with expedients for their repression" pp. 93-94.
15. Ibid. Section II, ? viii: "Avantage d'ebranler fortement I'imagination d'un aliene dans certains cas" pp. 6 0 61; English, ibid. "The advantages of restraint upon the imagination of maniacs illustrated" pp. 61 63.
16. M. Foucault, Folie et Deraison. Histoire de lafolie a Vage classique (Paris: Plon, 1961); Madness and Civilisation. [Apart from in this note, the French editor always relers to the 1972, Gallimard edition, Histoire de lafolie, as above in note 13; G. B. J
17. For example, Histoire de lafolie, Part 1, ch. 5, "Les insenses" p. 169 and p. 172; Part 2, ch. 1, "Le fou au jardin des especes" p. 223; and Part 3, ch. 2, "Le nouveau partage" p. 407 and p. 415; Madness and Civilisation, ch. 3, "The insane" p. 77 and pp. 80-81 (pages 223, 407, and 415 of French edition are omitted (rom the English translation). The point of depar lure for this criticism of the notion of "perception" or "experience" is L'Archeologie du savoir (Paris: Gallimard, 1969), ch. 3, "La formation des objets" and ch. 4, "La formation des modahtes enonciatives" pp. 55 74; English translation, The Archeology oj Knowledge, trans. A. Sheridan (London: Tavistock and New York: Pantheon, 1972), Part II, ch. 3, "The formation of objects" and ch. 4, "The formation of enunciative modalities" pp. 40 55.
18.
The notion of violence underlies the analysis of the mode of treatment in Histoire de lafolie, Part 2, ch. 4, "Medecins et malades" pp. 327-328 and p. 358, and Part 3, ch. 4, "Naissance de I'asile" p. 497, pp. 502 503, p. 508, and p. 520; Madness and Civilisation, ch. 6, "Doctors and Patients" pp. 159-160 and p. 196, and ch. 9, "The Birth of the Asylum" pp. 243 245, p. 251, and p. 266 (page 497 of the French edition is omitted from the English translation). See below, "Course context" pp. 354-355-
19. The analyses devoted to the "Naissance de I'asile," ibid. pp. 483 530; "Birth of the asylum" ibid. pp. 241-278.
20. On the role of the family model in the reorganization of relations between madness and reason and the constitution of the asylum, see ibid. pp. 509 511; ibid. pp. 253 255.
21. Foucault is alluding here to the analyses of Louis Althusser who introduced the concept of "State apparatus" in his article "Ideologic et appareils ideologiques d'Etat. Notes pour une recherche," La Pensee. Revue du rationalisme moderne, no. 51, June 1970, pp. 3 3 8 ; reprinted in Positions (1964-1975) (Paris: Editions Sociales, 1976) pp. 65 125; English translation, "Ideology and Ideological State Apparatusses" in L. Althusser, Lenin and Philosophy, trans. (London: New Left Books, 1971).
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14 NOVEMBER 1973
Scene of a cure: George III. From the "macrophysics of sovereignty" to the "microphysics of disciplinary power. " ^ The newfigure of the
madman. r^ Little encyclopedia of scenes of cures. ^ The practice of hypnosis and hysteria. ^ The psychoanalytic scene; the antipsychiatric
scene. ^ Mary Barnes at Kingsley Hall. ^ Manipulation of madness and stratagem of truth: Mason Cox.
OBVIOUSLY YOU KNOW WHAT passes for the great founding scene of modern psychiatry, or of psychiatry period, which got under way at the beginning of the nineteenth century. It is the famous scene at Bicetre, which was not yet a hospital exactly, in which Pinel removes the chains binding the raving lunatics to the floor of their dungeon, and these lunatics, who were restrained out of fear that they would give vent to their frenzy if released, express their gratitude to Pinel as soon as they are freed from their bonds and thereby embark on the path of cure. This then is what passes for the initial, founding scene of psychiatry. 1
Now there is another scene that did not have the same destiny, although it had considerable repercussions in the same period, for rea- sons that are easy to understand. It is a scene which did not take place in France, but in England--and was reported in some detail by Pinel, moreover, in his Traite medico-philosophique of Year IX (1800)--and which, as you will see straightaway, was not without a kind of force, a malleable presence, inasmuch as in the period, not in which it took place, which was in 1788, but in which it became known in France, and
? 20 PSYCHIA TRIC POWER
finally in the whole of Europe, it had become, let's say, a certain custom for kings to lose their heads. It is an important scene because it stages precisely what psychiatric practice could be in that period as a regulated and concerted manipulation of relations of power.
Here is Pinel's text, which circulated in France and made the affair known:
"A monarch [George III of England; M. F. ] falls into a mania, and in order to make his cure more speedy and secure, no restrictions are placed on the prudence of the person who is to direct it [note the word: this is the doctor; M. F. ]; from then on, all trappings of royalty having disap- peared, the madman, separated from his family and his usual surround- ings, is consigned to an isolated palace, and he is confined alone in a room whose tiled floor and walls are covered with matting so that he cannot harm himself. The person directing the treatment tells him that he is no longer sovereign, but that he must henceforth be obedient and submissive. Two of his old pages, of Herculean stature, are charged with looking after his needs and providing him with all the services his con- dition requires, but also with convincing him that he is entirely subor dinate to them and must now obey them. They keep watch over him in calm silence, but take every opportunity to make him aware of how much stronger than him they are. One day, in fiery delirium, the mad- man harshly greets his old doctor who is making his visit, and daubs him with filth and excrement. One of the pages immediately enters the room without saying a word, grasps by his belt the delirious madman, who is himself in a disgustingly filthy state, forcibly throws him down on a pile of mattresses, strips him, washes him with a sponge, changes his clothes, and, looking at him haughtily, immediately leaves to take up his post again. Such lessons, repeated at intervals over some months and backed up by other means of treatment, have produced a sound cure without relapse. "2
I would like to analyze the elements of this scene. First of all, there is something quite striking in PinePs text, which he took from Willis, the king's doctor. 3 It seems to me that what appears first of all is, basically, a ceremony, a ceremony of deposition, a sort of reverse coronation in which it is quite clearly shown that it involves placing the king in a sit- uation of complete subordination; you remember the words: "all trappings
? of royalty having disappeared," and the doctor, who is, as it were, the effective agent of this dethronement, of this deconsecration, explicitly telling him that "he is no longer sovereign. "
A decree, consequently, of deposition: the king is reduced to impo- tence. And it seems to me that the "matting," which surrounds him and plays [such a big] role* both in the setting and the final scene, are important. The matting is both what isolates the king from the outside world, and, as well as preventing him from hearing and seeing the out- side world, prevents him from communicating his orders to it; that is to say, all the essential functions of the monarchy are, in the strict sense, bracketed off by the matting. In place of the scepter, crown, and sword, which should make the universal power of the king reigning over his kingdom visible and perceptible to all the spectators, in place of these signs, there is no more than the "matting" which confines him and reduces him, there where he is, to what he is, that is to say, to his body.
Deposition and therefore the king's fall; but my impression is that it is not the same type of fall as we find in, say, a Shakespearian drama: this is not Richard III4 threatened with falling under the power of another sovereign, nor King Lear5 stripped of his sovereignty and roaming the world in solitude, poverty, and madness. In fact, the king's [George III] madness, unlike that of King Lear, condemned to roam the world, fixes him at a precise point and, especially, brings him under, not another sovereign power, but a completely different type of power which differs term by term, I think, from the power of sovereignty. It is an anonymous, nameless and faceless power that is distributed between different per- sons. Above all, it is a power that is expressed through an implacable regulation that is not even formulated, since, basically, nothing is said, and the text actually says that all the agents of this power remain silent. The silence of regulation takes over, as it were, the empty place left by the king's dethronement.
So this is not a case of one sovereign power falling under another sovereign power, but the transition from a sovereign power--decapitated by the madness that has seized hold of the king's head, and dethroned by the ceremony that shows the king that he is no longer sovereign--to
* (Recording:) such an important role
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a different power. In place ol this beheaded and dethroned power, an anonymous, multiple, pale, colorless power is installed, which is basi- cally what I will call disciplinary power. One type of power, that of sov- ereignty, is replaced by what could be called disciplinary power, and the effect of which is not at all to consecrate someone's power, to concentrate power in a visible and named individual, but only to produce effects on its target, on the body and very person of the dethroned king, who must be rendered "docile and submissive"6 by this new power.
Whereas sovereign power is expressed through the symbols of the dazzling force of the individual who holds it, disciplinary power is a discreet, distributed power; it is a power which functions through net works and the visibility of which is only found in the obedience and submission of those on whom it is silently exercised. I think this is what is essential in this scene: the confrontation, the submission, and the con- necting up ol a sovereign power to a disciplinary power.
Who are the agents ol this disciplinary power? Curiously, the doctor, the person who organizes everything and really is m fact, up to a certain point, the focal element, the core of this disciplinary system, does not himself appear: Willis is never there. And when we have the scene ol the doctor, it is precisely an old doctor and not Willis himself. Who then are the agents ol this power? We are told that they are two old pages of Herculean stature.
I think we should stop here for a moment, for they too are very important in the scene. As a hypothesis, and subject to correction, I will say that this relationship of the Herculean pages to the mad king stripped bare should be compared with some iconographic themes. I think the plastic force of this history is due m part precisely to the fact that it contains elements [. . . *] of the traditional iconography for repre senting sovereigns. Now it seems to me that the king and his servants are traditionally represented in two forms.
There is the representation of the warrior king in breastplate and arms deploying and displaying his omnipotence--the Hercules king, if you like--and beside him, beneath him, subject to this kind of over- whelming power, are figures representing submission, weakness, defeat,
* (Recording:) which are part
? slavery, or possibly beauty. This, more or less, is one of the primary oppositions found in the iconography of royal power.
Then there is another possibility, but with a different play of opposi tions. This is not the Herculean king, but the king of human stature who is, rather, stripped of all the visible and immediate signs of physical force and clothed only in the symbols of his power; the king in his ermine, with his scepter, his globe, and then, beneath him, or accompa- nying him, the visible representation of a force subject to him: soldiers, pages, and servants who are the representation of a force, but of a force which is, as it were, silently commanded by the intermediary of these symbolic elements of power, by scepter, ermine, crown, and so forth. Broadly speaking, it seems to me that the relationship of king to ser vants is represented in this way in the iconography: always in terms of opposition, but in the form of these two kinds of opposition.
Now, here, in this scene taken from Willis that is recounted by Pinel, you find these same elements, but completely shifted and transformed. On the one hand, you have the wild force of the king who has become the human beast again and who is in exactly the same position as those submissive and enchained slaves we found in the Hrst of the icono graphic versions I spoke about. Opposite this, there is the restrained, disciplined, and serene force of the servants. In this opposition of the king who has become wild force and servants who are the visible repre- sentation of a force, but of a disciplined force, I think you have in fact the point at which a sovereignty that is disappearing is caught up in a disciplinary power that is being constituted and whose face, it seems to me, can be seen in these silent, muscular, and magnificent pages who are both obedient and all-powerful.
How do these Herculean servants exercise their functions? Here again I think we should examine the text in some detail. The text says that these Herculean servants are present in order to serve the king; it even says very precisely that their purpose is to serve his "needs" and his "condition. " Now it seems to me that in what could be called the power of sovereignty, in actual fact the servant really does serve the sovereign's needs and really must satisfy the requirements and needs of his condition: he is in fact the person who dresses and undresses the king, who ensures the provision of services for his body and his property, and so on.
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However, when the servant ministers to the sovereign's needs and con- dition, it is essentially because this is the sovereign's will. That is to say, the sovereign's will binds the servant, and it binds him individually, as this or that servant, to that function which consists in ensuring that he serves the sovereign's needs and condition. The king's will, his status as king, is what fixes the servant to his needs and condition.
Now, in the disciplinary relationship that we see appearing here, the servant is not at all in the service of the king's will, or it is not because it is the king's will that he serves the king's needs. He is in the service of the king's needs and condition without either the king's will or his status being involved. It is only the mechanical requirements of the body, as it were, which fix and determine what the servant's service must be. Consequently will and need, status and condition are disconnected. What's more, the servant will only act as a repressive force, he will leave off serving only in order to curb the king's will, when the latter is expressed over and above his needs and his condition.
This, more or less, is roughly the scene's setting. I would now like to move on to the important episode of this scene set in this context, that is to say the episode of the confrontation with the doctor: "One day, in fiery delirium, the madman harshly greets his old doctor who is making his visit, and daubs him with filth and excrement. One of the pages immediately enters the room without saying a word, grasps by his belt the delirious madman . . . "7
After the deposition scene, or dethronement if you like, there is the scene of rubbish, excrement, and filth. This is no longer just the king who is dethroned, this is not just dispossession of the attributes of sovereignty; it is the total inversion of sovereignty. The only force the king has left is his body reduced to its wild state, and the only weapons he has left are his bodily evacuations, which is precisely what he uses against his doctor. Now in doing this I think the king really inverts his sovereignty, not just because his waste matter has replaced his scepter and sword, but also because in this action he takes up, quite exactly, a gesture with a his- torical meaning. The act of throwing mud and refuse over someone is the centuries old gesture of insurrection against the powerful.
There is an entire tradition that would have it that we only speak of excrement and waste matter as the symbol of money. Still, a very serious
? political history could be done of excrement and waste matter, both a political and a medical history of the way in which excrement and waste matter could be a problem in themselves, and without any kind of symbohzation: they could be an economic problem, and a medical problem, of course, but they could also be the stake of a political struggle, which is very clear in the seventeenth century and especially the eighteenth century. And this profaning gesture of throwing mud, refuse, and excrement over the carriages, silk, and ermine of the great, well, King George III, having been its victim, knew full well what it meant.
So there is a total reversal of the sovereign function here, since the king takes up the insurrectional gesture not just of the poor, but even of the poorest of the poor. When the peasants revolted, they used the tools avail- able to them as weapons: scythes, staves, and suchlike. Artisans also made use of the tools of their trade. It was only the poorest, those who had noth- ing, who picked up stones and excrement in the street to throw at the pow- erful. This is the role that the king is taking up in his confrontation with the medical power entering the room in which he finds himself: sovereignty, both driven wild and inverted, against pale discipline.
It is at this point that the silent, muscular, invincible page enters, who seizes the king around the waist, throws him on the bed, strips him naked, washes him with a sponge, and withdraws, as the text says, "looking at him haughtily. "8 And once again you find here the displace- ment of the elements of a scene of power, which this time is no longer of the coronation, of the iconographic representation; it is, as you can see clearly, the scaffold, the scene of public torture. But here as well there is inversion and displacement: whereas the person who violates sover- eignty, who throws stones and excrement over the king, would have been killed, hung and quartered according to English law, here instead, discipline, making its entrance m the form of the page, will control, bring down, strip naked, scrub, and make the body clean and true.
That is what I wanted to say about this scene, which, much more than the scene of Pmel freeing the mad, appears to me typical of what is put to work m what I call proto-psychiatric practice, that is to say, roughly, the practice which develops in the last years of the eighteenth century and in the first twenty or thirty years of the nineteenth century, before the appearance of the great institutional edifice of the psychiatric asylum
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in the years between 1830 and 1840, say 1838 m France, with the law on conlinement and the organization of the major psychiatric hospitals. 9
This scene seems to me to be important. First of all because it means I can correct an error I made in Histoire de lafolie. You can see that there is no question here of the imposition of anything like a family model in psy- chiatric practice; it is not true that the father and mother, or the typical relationships of the family structure, are borrowed by psychiatric practice and pinned on madness and the direction of the insane. The relationship to the family will appear in the history of psychiatry, but this will be later, and, as far as I can see at present, we should identify hysteria as the point at which the family model is grafted on to psychiatric practice.
You can see also that the treatment, which, with an optimism subse- quently contradicted by the facts, Pinel said would produce "a sound cure without relapse,"10 takes place without anything like a valid description, analysis, diagnosis, or true knowledge of the king's illness. Here again, just as the family model only enters later, so too the moment of truth only enters psychiatric practice later.
Finally, I would like to emphasize that one can see very clearly here an interplay of elements, elements of power in a strict sense, which are put to work, shifted, turned around, and so on, outside of any institution. Here again, my impression is that the moment of the institution is not prior to these relationships of power. That is to say, the institution does not determine these relationships of power, any more than a discourse of truth prescribes them, or a family model suggests them. In actual fact, in this kind of scene you see these relationships of power functioning, I was going to say nakedly. In this it seems to me to pick out quite well the basis of relationships of power that constitute the core element of psychiatric practice, on the basis of which, in fact, we will later see the construction of institutional structures, the emergence of discourses of truth, and also the grafting or importation of a number of models.
However, for the moment, we are witnessing the emergence of a disciplinary power, the specific figure of which seems to me to appear here with remarkable clarity precisely to the extent that, in this case, disciplinary power is confronted by another form of political power that I will call the power of sovereignty. That is to say, if the first hypotheses now guiding me are correct, it will not be enough to say that right from
? the start we find something like political power in psychiatric practice; it seems to me that it is more complicated, and what's more will become increasingly complicated. For the moment I would like to schematize. We are not dealing with just any kind of political power; there are two absolutely distinct types of power corresponding to two systems, two different ways of functioning: the macrophysics of sovereignty, the power that could be put to work in a post-feudal, pre industrial government, and then the microphysics of disciplinary power, whose functioning we find in the different components I am presenting to you and which makes its appearance here leaning on, as it were, the disconnected, broken down, unmasked components of sovereign power.
There is a transformation, therefore, of the relationship of sovereignty into disciplinary power. And you see at the heart of all this, at bottom, a kind of general proposition which is: "You may well be the king, but if you are mad you will cease to be so," or again: "You may well be mad, but this won't make you king. " The king, George III in this case, could only be cured in Willis's scene, in Pinel's fable if you like, to the extent that he was not treated as king, and to the extent that he was subjected to a force that was not the force of royal power. "You are not king" seems to me to be the proposition at the heart of this kind of proto-psychiatry I am trying to analyze. If you refer then to the texts of Descartes, where it is a question of madmen who take themselves for kings, you notice that the two examples Descartes gives of madness are "taking oneself for a king" or believing one "has a body made of glass. "11 In truth, for Descartes and generally [. . . *] for all those who spoke about madness up until the end of the eighteenth century, "taking oneself for a king," or believing one has "a body made of glass," was exactly the same thing, that it to say they were two absolutely identical types of error, which immediately contradicted the most elementary facts of sensation. "Taking oneself for a king," "believing that one has a body of glass," was, quite simply, typical of madness as error.
Henceforth, it seems to me that in this proto psychiatric practice, and so for all the discourses of truth that get going on the basis of this practice, "believing oneself to be a king" is the true secret of madness.
* (Recording:) we can say
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If you look at how a delirium, an illusion, or a hallucination was analyzed in this period, you see that it doesn't much matter whether someone believes himself to be a king, that is to say, whether the content of his delirium is supposing that he exercises royal power, or, to the contrary, believes himself to be ruined, persecuted, and rejected by the whole of humanity. For the psychiatrists of this period, the fact of imposing this belief, of asserting it against every proof to the contrary, even putting it forward against medical knowledge, wanting to impose it on the doctor and, ultimately, on the whole asylum, thus asserting it against every other form of certainty or knowledge, constitutes a way of believing that one is a kmg. Whether you believe yourself to be a king or believe that you are wretched, wanting to impose this certainty as a kind of tyranny on all those around you basically amounts to "believing one is a king"; it is this that makes all madness a kind of belief rooted in the fact that one is king of the world. Psychiatrists at the start of the nineteenth century could have said that to be mad was to seize power in one's head. Moreover, for Georget, in a text from 1820, the treatise De lafolie, the major problem for the psychiatrist is basically "how to persuade otherwise" someone who believes that he is a king. 12
There are a number of reasons why I have stressed this scene of the king. First of all, it seems to me that it enables us to have a better under- standing of that other founding scene of psychiatry, the scene of Pinel I spoke about at the start, the scene of liberation. Pinel, at Bicetre in 1792, entering the dungeons, removing the chains from this or that patient who has been chained up for weeks or months, would seem to be the exact opposite of the history of the king who is dispossessed, the exact opposite of the history of the king who is confined, seized around the waist, and supervised by muscular pages. Actually, when we look closely, we can see the continuity between the two scenes.
When Pinel liberates the patients confined in the dungeons, the per- son who is liberated incurs a debt to his liberator that will and must be settled in two ways. First, the person liberated will settle his debt con tinually and voluntarily by obedience; the wild violence of a body, which was only restrained by the violence of chains, will be replaced by the constant submission of one will to another. In other words, removing the chains ensures something like subjection through grateful obedience.
? Then the patient will wipe out the debt in a second way, this time involuntarily. From the moment he is subjected in this way, where the continual and voluntary repayment of the debt of gratitude will have made him submit to the discipline of medical power, the working of this discipline and its own force will itself bring about the patient's cure. As a result, the cure will become involuntarily the second payment in kind for his liberation, the way in which the patient, or rather, the patient's illness, will pay the doctor for the gratitude he owes him.
You see that, in fact, this scene of liberation is not exactly a scene of humanism, and of course everyone knows this. But I think we can analyze it as a relationship of power, or as the transformation of a certain relation- ship of power that was one of violence--the prison, dungeon, chains, and here again, all this belongs to the old form of the power of sovereignty-- into a relationship of subjection that is a relationship of discipline.
This is the first reason for recounting the history of George III, since it seems to me to inaugurate a psychiatric practice for which Pinel is generally given credit.
The other reason for quoting this case is that it seems to me that the scene of George III is one in a whole series of other scenes. First of all, it is part of a series of scenes, which, in the first twenty-five or thirty years of the nineteenth century, constitute this proto-psychiatric practice. We could say that in the first quarter of the nineteenth century there was a kind of little encyclopedia of canonical cures constituted on the basis of the cases published by Haslam,13 Pinel,1/| Esquirol,15 Fodere,16 Georget,17 and Guislam. 18 And this little encyclopedia includes around fifty cases which circulate in all the psychiatric treatises of the time and all of which more or less conform to a similar model. Here, if you like, are one or two examples which show very clearly, I think, how all these scenes of cure resemble that major scene of the cure of George III.
Here, for example, is an example from PinePs Traite medico-philosophique: "A soldier, still in a state of insanity (. . . ) is suddenly dominated by the single idea of leaving for the army. " He refuses to return to his room in the evening when he is ordered to do so. When he is in his room, he sets about tearing everything apart and making a mess; then he is tied to the bed.
