The_Cambridge_Foucault_Lexicon

564 / Patrick Singy

Before Bichat, a disease had been conceptualized as an essence, a pathological species, “inserting itself in the body, where it is possible” (EBC, 136). For instance, in the eighteenth century, “the same spasmodic disease can move from the lower abdomen ... , toward the chest ... , and inally toward the head.... The organs are the concrete supports of the disease, they never constitute its indispensible conditions” (EBC, 10). Even an eighteenth-century pathological anatomist like Morgagni, who is traditionally considered to be a precursor of modern medicine, belonged to this early modern coniguration of medicine. Morgagni opened up corpses of people who had been sick and found lesions in their bodies. For him those lesions were the seats or causes of diseases – De Sedibus et Causis Morborum (1761) was the title of his most inluential work – but, unlike what they were to become in the nineteenth century, they were not the diseases themselves (EBC, 140).

What were the epistemological transformations that made possible Bichat’s new form of medical knowledge? Instead of focusing on organs, like most earlier pathological anatomists, Bichat focused on tissues, of which he described twentyone. According to this system, each organ can be divided into its constitutive tissues. Most importantly, the divisions between tissues are revealed by the ways morbid processes are occurring. For instance, a morbid process often takes place in only one of the tissues of an organ, and in this way effectuates a “real division” between the different tissues of this organ (EBC, 131, 150). Additionally, the morbid process affecting the tissue of an organ might spread to other organs, if the latter are constituted of the same tissue, because “a pathological phenomenon follows in the organism the privileged path prescribed by tissue identity” (EBC, 149). If Bichat created modern pathological anatomy, it is therefore “only insofar as the pathological spontaneously anatomizes” (EBC, 131).

Foucault described other Bichatian principles governing tissues and their relations (EBC, 149, 152). What is crucial is that “these principles deine the rules of the pathological cursus and describe in advance the possible paths that it must follow” (EBC, 152). A disease is no longer something that comes from the outside and attacks the body; it is now a modiication of life itself. As Bichat declared, a pathological phenomenon is the augmentation, diminution, or alteration of a physiological phenomenon (ibid.). More profoundly, disease is the “silent work” of death, which is present in the unavoidable wear of organs as soon as they are being used (EBC, 158). Hence we see the following historical reversal that marks the modern period: “It is not because he falls sick that man dies; it is fundamentally because he is mortal that he may fall sick” (EBC, 155).

But death is not only something that is present within the living body. With Bichat, it became a “technical instrument” (EBC, 144). For the irst time in the history of medicine, there is a “conceptual mastery of death” (EBC, 141). Before Bichat, a common criticism made against pathological anatomy was that death has effects on the body that cannot be distinguished from the pathological phenomena themselves.

Xavier Bichat (1771–1802) / 565

For instance, it was dificult to separate in a corpse morbid decomposition from the gangrene that had aflicted the person when she was living (EBC, 134). Thanks to the new organization of clinics that followed the French Revolution, it became possible to open up corpses very soon after death and thus lessen this dificulty (EBC, 141). In a most important conceptual innovation, Bichat also showed that death is a process: not all the organs die at once. For instance, he demonstrated by means of experiments on animals that the death of the brain causes the death of the heart only indirectly, through the intermediary death of the lungs. In living beings, the relations between these organs were invisible; it is only by using death instrumentally that Bichat managed “to illuminate organic phenomena and their disturbances” (EBC, 143). Death became “the great analyst, which shows the connections by unfolding them, and which bursts open the wonders of genesis in the rigor of decomposition: and one should let the word decomposition stumble under the weight of its meaning”

(EBC, 144, Foucault’s italics).

Bichat’s revolution is as radical as it is simple: it is now “the body itself that has become ill” (EBC, 136). Today we take for granted the rules of the game that Bichat and his contemporaries established only in the early nineteenth century: “For us, the human deines, by natural right, the space of origin and of distribution of disease: a space whose lines, volumes, surfaces and routes are laid down, in accordance with a now familiar geometry, by the anatomical atlas” (EBC, 3). This is not to say that Foucault had any illusion as to the scientiic validity of most of Bichat’s ideas. What mattered to him was that Bichat had triggered an epistemological transformation, which “can take place even in a system of afirmations that would be scientiically false” (FDE2, 29). Doctors today might not ind in Bichat’s work much that is scientiically true, yet at the epistemological level they still follow the rules of his game.

In Foucault’s work, Bichat is explicitly mentioned only in the narrow context of the history of clinical medicine. Yet there are indications that point to the larger role he played in Foucault’s overall interpretation of the history of modernity. Because of the intimate connection between death and life – death working its way through life, death as an instrument for understanding life – Foucault drew a parallel between Bichat and the nineteenth-century obsession with death in the works of many artists and writers, such as Goya, Géricault, or Baudelaire (EBC, 171). For the same reason, he also noted the signiicance of the chronological overlap between Bichat and the Marquis de Sade (1740–1814): “Is not Bichat, after all, the contemporary of the man who introduced suddenly, in the most discursive of languages, eroticism and its inevitable point, death?” (EBC, 171; see also 195). Although Foucault did not make the following rapprochement as explicitly as one would have expected, Bichat is even more directly linked to the comparative anatomist Georges Cuvier (1769–1832), who plays in The Order of Things a role very similar to Bichat’s in Birth of the Clinic.

Cuvier transformed animal taxonomies whereas Bichat revolutionized pathological anatomy, but both have been crucial actors in the emergence of the modern concept

566 / Patrick Singy

of life, which is one of the key concepts of the modern episteme. Foucault in fact described Cuvier’s and Bichat’s accomplishments in somewhat similar terms: “From Cuvier onward, it is life in its non-perceptible, purely functional aspect that provides the basis for the exterior possibility of a classiication” (EOT, 268); and “From Bichat onward, the pathological phenomenon was perceived against the background of life”

(EBC, 153, Foucault’s italics). From an archaeological point of view, Cuvier and Bichat had an equivalent historical function: they brought about the same epistemological transformation, the magnitude of which we are still feeling today. However, since according to Foucault modern medicine has been more deeply ingrained within the modern episteme than any other discipline (EBC, 197), and since Bichat personiies this type of medicine, it is perhaps he, more than Sade, Cuvier, or anyone else, who best represents our historical moment.

Patrick Singy

See Also

Body

Death

Life

Georges Canguilhem

Suggested Reading

Huneman, Philippe. 1998. Bichat, la vie et la mort. Paris: Presses Universitaires de France.

568 / Paolo Savoia

generation’s – philosophical formation, it is not a surprise to see him engaged in an enterprise of explanation, divulgation, and development of Binswanger’s work.

In Foucault’s 1954 little book on mental illness and psychology (EMIP, 1954, 1961), reedited in 1961 with huge changes after the publication of History of Madness, the chapter dedicated to existential psychology is the place where he mentions, with clear but not unconditioned sympathy, Binswanger, alongside Jaspers, Minkowski, and Roland Kuhn. The context is a discussion of the particular existential structures of the pathological world, as individuated by phenomenological analysis (spatiality, temporality, the dimension of one’s own body, etc.). Foucault remarked here that Binswanger brilliantly studied mental pathologies as disturbances of the existential dimension of temporality. In his Über Ideenlucht (Binswanger 1933), he showed how the temporal experience of the maniac is fragmented, and how that of the schizophrenic is constituted by an alternation of a fragmented time and a suspension of temporality in a sort of eternity (EMIP, 51). A few pages later, Foucault mentions probably the most famous of the clinical cases reported by Binswanger, that of Ellen West (Binswanger 1957a), as a case of a disorder of sense of her own body and its place in space, according to the existential dimension of the rise and the fall. But if the contexts of these cursory remarks remained those of a historical and theoretical introduction to contemporary psychology, the essay on Binswanger’s article on dream is where Foucault actively, and uniquely, endorsed the method of Daseinsanalyse.

The introduction to Dream and Existence is a text that largely goes beyond the task of explaining and commenting on another text, and it is a very complex work in which a lot of threads are intertwined. The effect of estrangement is increased by the fact that Foucault speaks in a phenomenological and Heideggerian jargon about themes like fundamental human freedom, the dialectic between images and imagination, and the authenticity of existence. We can individuate at least four main topics in this text that are impossible to summarize: a criticism of Freud’s naturalism about dreams and the unconscious; the individuation of the phenomenological problem of understanding the act of expression; the importance of the existential dimension of spatiality; and the relation between imagination and images.

In order to focus on the speciic fascination the young Foucault felt for Binswanger, we have to look at the irst paragraph of the introduction, where the problem is that of the possibility of building an anthropology in its relations to a Heideggerian ontology. Binswanger’s particular form of analysis is interesting because it doesn’t aim to build a new form of psychology or a new kind of autonomous philosophical speculation but at the same time conceives itself as fundamental to objective and experimental knowledge of man. This is because its method is fully determined by its object, namely man, or better, the being of man, Menschsein (FDE1a, 94). Anthropology – that is the proper name of this effort – is opposed to every form of positivism, to every naturalistic form of psychology that takes man as homo natura; on the contrary, it is placed from the beginning in the domain of an

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ontological relection on the Dasein.This anthropology focuses on the concrete content of what in Heideggerian terms can be described as the transcendental structure of the Dasein. But if anthropology is opposed to positivism, it is not, on the other hand, a form of a priori philosophical speculation. Neither science nor philosophical abstraction, it is the study of the real and concrete content of human existence as it experiences itself. Binswanger’s work blurs the boundary – which Heidegger himself seems to have drawn too neatly – between anthropology and ontology, and places itself in a zone of exchange between these two domains (FDE1a, 95). That is precisely the function of Binswanger’s insistence on the dimension of spatiality in dreams, and particularly on the direction that goes from the rise to the fall and vice versa (perfectly illustrated by the case of Ellen West). To this vertical dimension of spatiality both the temporality and the authenticity of existence are linked. This means that with a spatial analysis of dreams we are able to leave the domain of anthropology and enter that of ontology, namely the domain that concerns the mode of being of existence as being-in-the-world. This passage from anthropology to ontology, Foucault argues, is not abstract, not a priori, but rather comes from a concrete relection on man: it is existence itself that shows its ontological basis (FDE1a, 137).

Foucault tells us that the theme of Binswanger’s article is not so much dream and existence, but dream as a modality of existence, as one of the ways in which existence shows itself. Dream is a mode of expression of existence considered as a global structure. This is one of the sources of Foucault’s comparison between Freud’s Traumdeutung and Binswanger’s work on dreams. Freud – Foucault says – brilliantly individuated the semantics of dreams, but he stopped there: “The Language of the dream is analyzed only in its semantic function. Freudian analysis leaves its morphological and syntactic structure in the dark.... The peculiarly imaginative dimension of the meaningful expression is completely omitted.... Psychoanalysis has never succeeded in making images speak” (EDE, 35, 38). For the young Foucault, this is precisely the problem that the existential and phenomenological method of Binswanger is able to resolve. The logic of dream is not given by censorship, Foucault argues, but it is a compromise between the authentic movement of imagination and its adulteration in the crystallized form of the image. In fact, it is not correct to say that dreams are made of images, because oneiric images are nothing but a single frozen moment in the original lux of the imagination of the dreamer: “to have an image is to leave off imagining” (EDE, 71). Discussing Sartre and Bachelard, among others, Foucault is here interested in theorizing about the perennial movement of imagination, which relects a fundamental freedom, in opposition to the ixity and instantaneousness of images. Dreams are the original place of the movement of imagination, and this is also why, from a more practical point of view, the physician has to keep in mind that his patient’s illness is not an entity, a state, but a cut in the lux of temporal and spatial existence (EDE, 66).

570 / Paolo Savoia

How can we make sense of this theoretical interest in phenomenological psychiatry, and how can we place it in the context of Foucault’s works that followed? An answer to the irst question might be found in his intellectual biography. Between the end of the 1940s and the beginning of the 1950s – to put the facts in line – Foucault met Daniel Lagache, followed Georges Gusdorf’s lectures on psychopathology at the École Normale Supérieure, followed Merleau-Ponty’s courses on psychology at the Sorbonne (where he encountered an important reference shared by MerleauPonty, his maître Canguilhem, and Binswanger: Kurt Goldstein and Gestalttheorie), as well as Henry Ey’s lectures at the Saint-Anne hospital. In 1952, he took a diplôme in psychopathology and worked in the laboratory where H. Labory experimented on the irst neuroleptic, and he started to teach thought psychology at the École Normale Supérieure and the University of Lille, which he continued to do until 1955. During 1952 and 1954, he and Jaqueline Verdeaux, with whom he worked in a laboratory of experimental psychology at the Saint-Anne hospital, traveled a few times to Switzerland. There he met Roland Kuhn and Binswanger himself, and discussed with Binswanger his introduction, Heidegger, and phenomenology.

To answer the second question is more complicated. In addition to his work on Binswanger’s anthropology, in the late 1950s Foucault translated and introduced Kant’s Anthropology; we might say that what was at irst a philosophical interest in anthropology became later a historical theme, in the last part of The Order of Things. All of his work on anthropology surely was very useful when he attempted to historicize all this knowledge about man. But on a methodological level, and even if he spent his career constantly criticizing the transcendental subject of phenomenology, Foucault gave, at least on two occasions, some interesting genetic self-explanations that are worth reporting. In 1980, Foucault answered an explicit question about his early work on Binswanger in this way:

My reading of what was called “existential analysis”... was important for me during the time I was working in psychiatric hospitals and while I was looking for something different from the traditional schemas of psychiatric observation, a counterweight to them.... And I believe that Roland Laing was impressed by all that as well.... But we moved on to other things.... [E]xistential analysis helped us delimit and get a better grasp on what was heavy and oppressive in the gaze and the knowledge apparatus of academic psychiatry. (EEW3, 257–258)

And in a 1984 text, he added:

To study forms of experience ... in their history is an idea that originated with an earlier project, in which I made use of the methods of existential analysis in the ield of psychiatry and in the domain of “mental illness.” For two reasons ... this project left me unsatisied: its theoretical weakness in elaborating the notion of

Ludwig Binswanger (1881–1966) / 571

experience, and its ambiguous link with a psychiatric practice which it simultaneously ignored and took for granted. One could deal with the irst problem by referring to a general theory of the human being, and treat the second altogether differently by turning, as is so often done, to the “economic and social context”; one could choose, by doing so, to accept the resulting dilemma of a philosophical anthropology and a social history. But I wondered whether, rather than playing on this alternative, it would not be possible to consider the very historicity of forms of experience (EFR, 334).

Paolo Savoia

See Also

Phenomenology

Psychiatry

Martin Heidegger

Suggested Reading

Basso, Elisabetta. 2007. Michel Foucault e la Daseinsanalyse. Un’indagine metodologica. Milan: Mimesis.

Binswanger, Ludwig. 1933. Über Ideenlucht. Zurich: Art. Institut Orell Füssli. 1957. “Ellen West,” in Schizophrenie. Pfullingen: G. Neske.

Herzog, Max. 1994. Weltentwürfe: Ludwig Binswangers phänomenologische Psychologie. Berlin: Walter de Gruyter.

Kuhn, Roland, and Henri Maldiney. 1971. “Préface,” in Ludwig Binswanger, Introduction à l’analyse existentielle. Paris: Les Éditions de Minuit.

Lanzoni, Susan. 2003. “An Epistemology of the Clinic: Ludwig Binswanger’s Phenomenology of the Other,” Critical Inquiry 30:160–186.

2005. “The Enigma of Subjectivity: Ludwig Binswanger’s Existential Anthropology of Mania,” History of the Human Sciences 18:23–41

Spiegelberg, Herbert. 1972. Phenomenology in Psychology and Psychiatry: A Historical Introduction. Evanston, IL: Northwestern University Press.

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the extremes of unreason. So when in the “Preface” to the original edition of Folie et déraison (written in 1960 and published in1961) Foucault writes that madness is nothing else than “absence of work [l’absence d’œuvre],” he may have been drawing inspiration from the notion of work [l’œuvre] in Blanchot (EPHM, xxxi). (After 1972, this preface did not appear in the later editions of the text.) Between the publication of Folie et déraison and its expansion as Histoire de la folie à l’âge classique (1972), Foucault published an article entitled “La folie, l’absence d’œuvre” (appearing as an appendix to Histoire de la folie until 1972) in which the inluence of Blanchot’s work on his thinking of madness is readily apparent.

In this 1964 article, Foucault writes about the relationship of Western culture to its limits, to what is excluded from it and is considered to be the forbidden, the intolerable, and the transgressive. Madness, the quintessential limit-experience, can only be welcomed by literature and art. Noting the “strange proximity” between madness and literature (EAW, 548), Foucault deines madness as “a reserve of meaning,” this reserve to be understood as “a igure that retains and suspends meaning” (EAW, 547). Madness as such a “reserve” does not manifest or narrate the birth of a “work [œuvre ]” but rather it “refers to the empty form [la forme vide] from where the work comes,” the site where the work never ceases to be absent, even though “it will never be found” there (EAW, 548). The work, turned toward the elemental depth, is said to be and not be there and by deinition escapes comprehension. There, in this “pale region,” the “twin incompatibility” of the work and madness becomes apparent (ibid.). This is also “the place that the language of literature approaches” (ibid.). This language, Foucault writes, should not be deined by what it says or by its structures but by its “being.” This being, which needs to be interrogated, is related to “the double” and “the void” that hollows it out. It thus belongs to the region where “the experience of madness has been enacted” (ibid.). Madness would then be this absence of work (l’absence d’œuvre), this unworking or worklessness. (Blanchot seems to have adopted Foucault’s notion of “the absence of work” in his own writings [Blanchot 1992, 424].)

Foucault’s major essay devoted to Blanchot, Maurice Blanchot: The Thought of the Outside, begins by invoking the saying attributed to Epimenides, the sixth-century BCE Cretan philosopher-poet. Foucault distinguishes the Epimenidean “I lie,” which he claims shakes the foundations of Greek truth, from “I speak,” which inaugurates any discussion of modern literature. Contrary to widely held belief, modern literature is not characterized by self-reference or a doubling back (EEW2, 148). The event that we understand as “literature” is only, on the surface, of the order of an interiorization; rather it is a matter of “a passage to the ‘outside’” (ibid.). Literature, Foucault writes, is language distancing itself from itself, not a folding back [repli] but a gap [écart], a dispersion rather than a return of signs to themselves (EEW2, 149). The “subject” of literature – what speaks – is thus “less language than the void” (ibid.). For Foucault, “I speak” functions counter to “I think,” the indubitable certainty of the “I” and its