The_Cambridge_Foucault_Lexicon

Psychiatry / 405

The human sciences in general are problematic for Foucault because they claim to give us knowledge about ourselves, about human beings, about human nature, thus denying our freedom to be other than what we are, and the psychological sciences are arguably the most pernicious subset of these sciences for a variety of reasons. For one, the psychological sciences – compared to other human sciences such as anthropology or sociology – are pervasive: we do not go to anthropologists or sociologists on a regular basis to learn about who we are, but many people go to psychiatrists and psychotherapists, and even those who do not (or cannot afford to) visit psychiatric experts will engage in a popularized form of psychologizing themselves and others. Whether actively psychiatrized or not, we are saturated by psychologizing discourses. The discourses of the psychological sciences, the most respected (because it is the most “scientiic”) of which is psychiatry, have become omnipresent, with psychologists and psychiatrists serving as experts on talk shows, writing columns in women’s magazines, talking on the news after every crisis or tragedy, writing books for laypeople, informing disciplines such as criminology and pedagogy, and serving as experts in courts of law. This last case particularly concerned Foucault, and he called it “Ubuesque” and “grotesque” (ECF-AB, 35) because it meant that psychiatrists had seized not just disciplinary power but the power of life and death, legal-juridical or sovereign power. Another reason that the psychological sciences are particularly pernicious, compared to other sciences, is that they set up institutions in which people can be incarcerated and dominated for the rest of their lives. Moreover, not only do the psychological sciences have their own institutions but they invade all other institutions, iniltrating the school, the hospital, the prison, the court of law, the family, and the workplace. To take just one example, many people now have to pass a personality test designed by psychiatrists in order to compete for a job.

In the late 1940s and early 1950s, Foucault pursued an education both in philosophy and in psychology, and the psychological sciences – psychiatry most prominently – remained a focus of his philosophical attention throughout his life. He received a licence de philosophie from the École Normale in 1948, a licence de psychologie in 1949, and in 1952 he earned not only the agrégation de philosophie but also a Diplôme de psycho-pathologie from the Institut de psychologie de Paris. Foucault’s irst teaching position was in psychology, not philosophy, at the University of Lille. Foucault’s critical engagements with psychiatry and the psychological sciences extend throughout his oeuvre, beginning with his earliest work, Maladie mentale et personnalité, reedited as Maladie mentale et psychologie (1954), and resurfacing as sustained themes in Foucault’s course lectures from 1973–1974 and 1974–1975, published as Psychiatric Power (2008) and Abnormal (2004). For the purpose of this article, I will focus on the History of Madness (2006 [1961]), Foucault’s most sustained and arguably most significant engagement with psychiatry.

History of Madness is described by Foucault not as a history of psychiatry but as an “archaeology of ... silence” (EHM, xxviii). For Foucault, an archaeology is a

406 / Chloë Taylor

study of what made a certain discourse – or, in this case, the absence or silencing of a discourse – possible. Thus, in writing an archaeology of silence rather than a history of psychiatry, Foucault is not so much concerned with what made psychiatric discourses possible as what made the silencing of madness possible. As it turns out, psychiatry was a key condition of this possibility. Positing, in this early work, something like an essential experience of madness, Foucault argues that what we hear about in psychiatric discourses and in the words of the mentally ill themselves is no longer madness but what has been allowed to be said once madness was silenced.

Foucault traces the experience of madness through the Renaissance, when madmen and women were perceived in at least three different ways: as tragic, eschatological igures (“Cosmic Madness”), as ironic jousting partners with reason (“Critical Madness”), and as igures of sin (gluttony, avarice, drunkenness, and sloth all being described as follies at this time). There is a self-recognition in the mad person during this period: as a igure of death and sin, the madman or woman reminds us that we will all die, that we are all sinners, and that all of our mortal projects are futile and vain. At the same time, madness gives access to fundamental truths of human existence that are not available to reason, and madmen are often igures who tell the (uncomfortable) truth. For instance, the fools in Shakespeare see and say what others cannot. As objects of uneasy identiication and reminders and speakers of undesired truths, Foucault claims that the Renaissance response to the mad was to send them into exile or to cast them off to sea. Consequently, the mad were associated with wandering, the amorphousness of water, and a geographical freedom. Drawing on art and literature from the period, Foucault illustrates this thesis with references to Shakespeare, Cervantes, and Bosch.

In contrast to the Renaissance, in the Age of Reason madness was no longer seen as a jousting partner with reason but as the very absence of reason. Far from giving humans access to truths not available to reason, madness was unreason, one form of immoral idleness among others (such as poverty, vagabondage, and libertinage). Madness was a chosen, moral failing, deserving of punishment. Since Enlightenment man was deined by his rationality, the mad were dehumanized, and consequently so thoroughly othered that an identiication with them – uneasy or otherwise – became impossible. As others, inhuman, the mad were seen as animals, but were also blamed for having chosen animality as other animals were not. The mad had irremediably foresaken their humanity. The Enlightenment response to madness was consequently punitive: coninement and forced labor. A key moment in this archaeology of silence is the creation of the Hôpital Général in 1657, at the beginning of the classical age, which marked the “Great Coninement” not only of the mad but of other unreasonable people – libertines, vagabonds, those who did not work, and criminals. Housed promiscuously together, the mad were nevertheless singled out from their fellow inmates by virtue of their bestialization. Their departure from reason alone was seen as incorrigible, and thus dehumanizing. As such, the mad alone could be

Psychiatry / 407

put on display and forced to perform tricks for the entertainment of spectators, and could live in the same conditions of material deprivation as domesticated animals, lacking adequate food, clothing, and shelter from the damp and cold.

The next great moment in Foucault’s archaeology of silence is Philippe Pinel’s “liberation” of the mad at Bicêtre in 1794 – at the beginning of the modern era. With this gesture, and the consequent birth of psychiatry, the understanding of madness changed again. Now madness was viewed by doctors and experienced by the mad themselves as a mental form of illness, in the realm of pathology rather than morality or sin. The relation of madness to truth was reformulated: no longer in dialogue with reason or revelatory of fundamental truths (as in the Renaissance), and no longer an absence of reason or the negation of truth (as in the classical age), modern madness was an object of medical reason and truthful scientiic discourse. This epistemic shift with respect to madness resulted in some basic material ameliorations in the living conditions of the mad, since their preferred treatment was no longer exile, coninement, or punishment but therapy and cure. Nevertheless, within asylums, all mad men and women continued to be conined (if not in chains then within walls), and continued to be corporally punished if they did not behave according to the dictates of doctors. If they were “liberated,” it was in the sense that those who behaved no longer dwelled in dungeons. Foucault contests that this was an even partial “liberation,” however, since he suggests that psychiatry could only afford to release the (well behaving) mad from their material chains because it had begun the successful shackling of their souls. The mad whose souls were not yet in chains, moreover – those who still outrageously misbehaved – were returned to material constraints: to straightjackets or mind-numbing regimes of drugs.

Just as Foucault contests that Pinel liberated the insane in 1794, so he rebuts the argument that Freud liberated the mad further a century later. If, after a hundred years, psychoanalysis appeared to “liberate” the mad beyond Pinel’s removal of their chains, allowing them to leave the asylum and to speak, it was only because four generations of psychiatry had fettered the souls of the mad so thoroughly that there was now little fear that they would speak anything but the discourses of medicine that the analysts wanted to hear. The “cosmic” truths of madness had by then been so deeply buried that the mad could safely be released not only from chains but from institutional walls and from silence. Broken, and having nothing left to say that did not parrot the psychiatrists – to whom they deferred, whose authority they had accepted, whose discourses they had internalized – the mad (and indeed the rest of us) could now be trusted to present themselves voluntarily for psychotherapy and to say nothing in that clinical space that challenged the medical view of the mind. Although the dominant view and experience of madness and mental experience more generally is thus now the medical one, Foucault argues that echoes of a “cosmic madness” continue to be heard in the works of writers and artists such as Nietzsche, Artaud, Goya, and Van Gogh.

408 / Chloë Taylor

Throughout the History of Madness, Foucault argues that the fact that the irst psychiatrists were doctors gave them the justiication, disguise, or authority to take control of people’s bodies, but that the work they did in the asylums was not medical. According to Foucault, psychiatrists simply represent and embody the norms, morality, or values of a particular society, and their job is to assimilate mental patients to these norms. Early psychiatrists such as Tuke and Pinel were aware that they were not using their medical expertise and scientiic knowledge in their work with the mad. They were self-consciously assimilating patients into the values of their society, including its sexual norms: the patients whom they considered “cured” were those who would marry and be ideal spouses, who would have children and be ideal parents, or who fulilled their assigned roles in the heterosexual family. In this early work, Foucault argues that just like the mad had to submit to a bourgeois work ethic within the asylum, they needed to submit to the values of the patriarchal bourgeois family. The mad had long had minority legal status, but they had not actually been treated like children. Now, however, they are theorized and treated as such. The psychiatrist, as the “adult,” represents to the mad “both domination and destination,” both the power to which one submits and the power that one is destined to become through assimilation. In the asylum, when unreason rebelled against reason, this was seen as a mere failure of a child to submit to the authority of the father. Foucault argues that madness was in this way reduced to a father-child drama, however madness was once about much bigger things. When psychoanalysis “discovers” Oedipal complexes at the root of all neuroses and psychopathologies, it is discovering something that was created recently in asylums: these petty parent-child squabbles are not what madness was about before the asylum reduced it to this. So reduced, however, it was safe to let the mad out of the asylums and to allow them to speak because one knew that they would talk about nothing more threatening than the mommy-daddy- baby discourses that Freud wanted to hear. Even today, psychiatry and psychoanalysis depoliticize and individualize madness, transforming what might have been social critique into family dramas of incest and genes.

Modern science claims to tell us something about madness, or mental illness, but before these sciences could even begin to work, the mad had to already be separated out from the sane. To be an object of scientiic knowledge to begin with, this division had to have already occurred. Yet this division was a constitutive act – it changed madness into something that is no longer in dialogue with reason; it subjugated madness so that what was studied was not the pure phenomenon of madness. Psychiatry thus studies an object of its own invention. Foucault wants to show that madness was not always divided from nonmadness, reason was not always divided from nonreason. In the Renaissance, reason and madness were in dialogue, madness threatened with a tragic truth. In contrast, mental illness is a “serene world,” and the language of psychiatry is a “monologue,” and what is being monologued about is not madness but mental illness, a much safer thing.

Psychiatry / 409

When Foucault wrote the History of Madness, he had not yet coined many of the terms for which he is now known, and in particular he had not yet theorized disciplinary power. It is nevertheless tempting and possible to read Foucault’s History through the lens of this later concept as it is contrasted with sovereign power – and indeed, Foucault does something like this in his 1973–1974 course lectures, “Psychiatric Power.” In Foucault’s later terminology, the classical age was an age of sovereign power. Power entailed the use of brute physical force; it was laborious and ineficient, depending on material weapons and chains and struggles between bodies. With Pinel, that power was supplemented and eventually all but replaced by a newer, cleaner, lighter, more elegant, and eficient form of power: discipline. Disciplinary power does not wield a sword or threaten death but controls people’s minds or souls, thereby getting them to control themselves so that physical force is not necessary. Disciplined individuals appear to be free and perceive themselves as free. Having internalized what is expected of them, they regulate themselves. As such, there is no need for physical constraints or physical punishments. The irony, for Foucault, is that the superluousness of shackles only shows how dominated we are by the disciplinary constitutions of our souls. Pinel’s “liberation” of the mad and placement of them in the irst psychiatric asylums, and Freud’s further “liberation” of these same individuals and placement of them on the analyst’s couch, like the shift from torture to prison, illustrates the replacement of sovereign power with disciplinary power. This is a power that functions not through laws but through norms, or is a normalizing form of power.

Foucault’s course lectures from 1973–1974, “Psychiatric Power,” revisit much of the ground covered by the History of Madness, once again providing a history of the emergence of psychiatric discourses and practices. This time, however, Foucault is equipped with the theory of disciplinary power that he was developing at the time in Discipline and Punish. The irst lectures in this series provide a detailed account of disciplinary power as it may be contrasted point by point with sovereign power, and describe psychiatric power as an example of discipline. In these same lectures, Foucault critiques some of his arguments as well as his methodology in History of Madness, claiming that the earlier work, in contrast to the current one, was a history of representations (its examples taken from art), essentialized madness, focused on institutions rather than power relations, and also committed the error of seeing psychiatric power as paternal – or patriarchal – power, reproducing the family within the asylum and assimilating patients into familial subjects. In fact, Foucault now argues, the family is an institution of sovereign power, in contrast to the asylum, which is a site of disciplinary power.

The following year, in his lecture series “Abnormal,” Foucault will change his mind again with respect to the psychiatry-family relation, arguing that the family has been thoroughly co-opted by disciplinary power and biopower, and thus the comparison between the family and doctors remains relevant, except that the order

412 / Adrian Switzer

to a single object” (Laplanche and Pontalis 1973, 26). Further, as Freud develops the notion of “ambivalence [Ambivalenz]” in “Mourning and Melancholia,” a subject is ambivalent toward a cathected object insofar as he or she differentiates the object from himor herself, investing it with love and signiicance; the subject also reverts to a primary narcissism by which she or he wants to make the object his or her own through incorporation.

These features of Freudian ambivalence might serve as broad contours of an “ambivalent” reading of Foucault’s engagement with psychoanalysis; they might also outline a reading of Foucault from a Freudian perspective. The following does not substantiate such a reading of Foucault and Freud. Rather, it merely sketches the possibility of such a reading from the details of Foucault’s writings on psychoanalysis.

Foucault’s irst two publications are critical studies of psychology: Mental Illness and Personality (1954), which was revised and retitled as Mental Illness and Psychology

(1962), and “Introduction: Dream, Imagination, Existence” in the French translation of Ludwig Binswanger’s Dream and Existence (1954).

The essay Dream and Existence that Foucault introduces in the French edition is an example of the Daseinsanalyse that Binswanger developed by combining the Heideggerian notion of Dasein, which “remove[s] [psychology] from its hoary metaphysical and religious rut,” concerning the question of the mind–body relation (EDE, 83) with Freud’s treatment of dreams as central to the psychic life of individuals. These two factors combine in the composition of what Binswanger calls a “personal life-history” (EDE, 86).

Foucault highlights Binswanger’s insistence that Daseinsanalyse draw on “myth, religion, and poetry” (EDE, 84). “The theme of [Binswanger’s] 1930 essay,” Foucault writes, “[is] existence in that mode of being of the dream in which it announces itself in a meaningful fashion.” What interests Foucault is the expressiveness of poetic and mythic language, and Binswanger’s attention to such expressiveness in crediting dreams their full, existential signiicance (EDE, 33).

All discursivity “implies a world of expression which precedes it, sustains it, and allows it to give body to what it means” (EDE, 35). Even with respect to the dream experience, which it purports to treat in its full signiicance, Freudian psychoanalysis “fail[s] to acknowledge this structure of language” and so “never gets a comprehensive grasp of meaning” (ibid.). Despite the direct link between Binswanger and Freud – and the successes of the former relative to the latter – Foucault concludes in unequivocal fashion: “Psychoanalysis has never succeeded in making images speak” (EDE, 38).

It is possible to read this conclusion as contradictory. As suggested earlier, it might also be possible to read Foucault’s conclusion ambivalently. A similar tone appears in Foucault’s other early engagement with psychology: Mental Illness and Personality (1954)/Mental Illness and Psychology (1962). In revising the work, Foucault replaces a Marxist approach to institutional discourse with a historical account of the

Psychoanalysis / 413

“constitution” of the modern experience of madness; such “historicization” of mental illness draws the second edition of the work close to psychoanalysis.

Foucault connects the discourse between mental illness and psychology to the “evolved” language in which the mentally ill patient experiences madness. On the discursive encounter between madness and psychology, consider Foucault’s rejection of organic explanations of mental illness: “[I]t is only by an artiice of language that the same meaning can be attributed to ‘illnesses of the body’ and ‘illnesses of the mind’” (EMIP, 10, emphasis added). Foucault situates madness in a linguistic register, both as experienced by the patient and as analyzed by the therapist. Psychoanalysis, aptly termed “the talking cure” by Freud’s patient Anna O., is by Foucault’s discursive standards the modern, scientiic form of psychology par excellence.

Second, consider Foucault’s “evolutionary” model of language. The madman’s struggles with the present are manifested in language: “Dialogue ... is replaced by a sort of monologue” (EMIP, 23–24). The monological breakdown of the mentally ill patient takes on a historical character once dialogue is seen in an evolutionary light: “A whole social evolution was required before dialogue became a mode of interhuman relation,” and the patient who loses his capacity for dialogical exchange “regresses through this whole social evolution” (EMIP, 23). It is at this point that Freud appears in Foucault’s discursive history of madness: “A whole side of Freud’s work consists of a commentary on the evolutive forms of neurosis” (EMIP, 19); Foucault even credits Freud with a “stroke of genius” in “go[ing] beyond the evolutionist horizon ... [and] reach[ing] the historical dimension of the human psyche” (EMIP, 31).

By drawing on mythopoetic “explanatory themes,” Freud transcends the “evolutionary horizon” preserved in language. He thus arrives at the discursive history of the mentally ill patient; such mythopoetic themes are “the raw material of evolution,” both “individual and social” (EMIP, 24). As vocally as he champions Freudian “regressive analysis” for using the expressive potential of myth and poetry (EMIP, 28), Foucault just as quickly criticizes Freud for “extrapolat[ing]” mythopoetic forms into the “biological reality” of the “death instinct.” The “evolutive” potential within language becomes instead a compulsion to repeat the past. Dismissively, Foucault concludes, “[t]his, no doubt, is to give to the facts a name,” but such “naming” is at the same time a “reject[ion] [of] any form of explanation” (EMIP, 34).

The History of Madness (1961) is a fuller realization of the discursive-historical approach that Foucault adopts in the revised edition of Mental Illness. Such methodological overlap with psychoanalysis, and Foucault’s interest in the issue of the constitution of madness and modern psychiatry, igure in the intensiication of his engagement with psychoanalysis. A Janus-faced igure appears at this theoretical juncture: the mad, modern subject à la Nietzsche and Artaud, and the medical persona as modern practitioner of the new science of psychiatry.

Psychoanalysis appears in the History of Madness along with the birth of the asylum and the modern, scientiic objectiication of madness. If “the psychiatry of