Foucault's Lectures on 'Psychiatric Power' at the College de France (1973-74)

Francis Willis

 "The government of maniacs is an art, not to be acquired without long experience, and frequent and attentive observation. As maniacs are extremely subdolous [cunning], the physician's first visit should be by surprize. He must employ every moment of his time by mildness or menaces, as circumstances direct, to gain an ascendancy over them, and to obtain their favour and prepossession. If this opportunity be lost, it will be difficult, if not impossible to effect it afterwards; and more especially, if he should betray any signs of timidity. He may be obliged at one moment, according to the exigency of the case, to be placid and accommodating in his manners, and the next, angry and absolute."
"The maniac was locked in a room, raving and exceedingly turbulent. I took two men with me, and learning that he had no offensive weapons, I planted them at the door, with directions to be silent, and to keep out of sight, unless I should want their assistance. I then suddenly unlocked the door- rushed into the room and caught his eye in an instant. The business was then done- he became peacable in a moment- trembled with fear, and was as governable as it was possible for a furious madman to be."

William Pargeter, Observations on Manical Disorders, 1792.

"Of the celebrated Willis [who treated George III] it has been said, that the utmost sweetness and affability is the usual expression of his countenance. But, when he looks a maniac in the face for the first time, he appears instantly to change character. His features present a new aspect, such as commands the respect and attention, even of lunatics. His looks appear to penetrate into their hearts, and to read their thoughts as soon as they are formed. Thus does he obtain an authority over his patients, which afterwards co-operating with other means, contribute to restore them to themselves and to their friends."Philippe Pinel, 'A Treatise on Insanity', 1800.

"For therapeutic purposes Willis fostered a sense of fear in his patients, ‘because', he was quoted as saying, 'fear provides the only grip that one can obtain on the mind of a maniac.' Willis acquired a reputation for gaining control over patients by catching their eye. One writer noted that he had an eye like Mars, to threaten or command... his numerous patients stood as much in awe of this formidable weapon, as of bars, chains or straight-waistcoats."

Francis Willis (Junior), A Treatise on Mental Derangement, 1824.

A selection from Foucault's lectures at the College de France between 1973-4, translated by Graham Burchell, and published by Macmillan in 2006 with the title 'Psychiatric Power.'

Note: for a selection from the chapter titled 'The Birth of the Asylum' of Madness and Civilization: A History of Insanity in the Age of Reason see here.

14 November 1973
Pinel removing the chains from the female patients at La Salpetriere in Paris (the painting is on a wall inside the hospital).
Obviously you know what passes for the great founding scene of modern psychiatry... 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... 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. Now there is another scene... . 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 (1800). 
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; from then on, all trappings of royalty having disappeared, the madman, separated from his family and his usual surroundings, 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 condition requires, but also with convincing him that he is entirely subordinate 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 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, 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 the other means of treatment, have produced a sound cure without relapse.
I would like to analyze the elements of this scene. First of all, there is something quite striking in Pinel's text, which he took from Willis, the king's doctor. 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 situation 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."

...the king is reduced to impotence.

Scene of the confrontation between King George III and
Dr. Francis Willis from The Madness of King George (1984)

...this is not a case of one sovereign power falling under another sovereign power, but the transition from a sovereign power... to a different power. In place of this beheaded and dethroned power, an anonymous, multiple, pale, colourless power is installed, which... I will call disciplinary power. One type of power, that of sovereignty, is replaced by what could be called disciplinary power,...[and] the body and very person of the dethroned king [is] rendered "docile and submissive" to this new power.

The text says that [the] Herculean servants are present in order to serve the king;... to serve his "needs" and his "condition." [...] However, when the servant ministers to the sovereign's needs and condition, it is essentially because this is the sovereign's will. Now, in the disciplinary relationship that we see appearing here, the servant is not at all in the service of the king's will... .

After the deposition scene, or dethronement if you like, there is the scene of... excrement and filth. [...] The only force the king has left in 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... the king really inverts his sovereignty,... because in this action he takes up... a gesture with a historical meaning. The act of throwing mud and refuse over someone is the centuries old gesture of insurrection against the powerful.

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 victem, 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. [...] It was only the poorest, those who had nothing, who picked up stones and excrement in the street to throw at the powerful. 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 [imprisoned]: sovereignity, 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."

...this scene... much more than the scene of Pinel freeing the mad, appears to me typical of what is put to work in 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... .
...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.
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." [...] "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. 

Henceforth, it seems to me that in this proto-psychiatric practice,... "believing oneself to be a king" is the true secret of madness. 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 psychiatrist of this period, the fact of imposing this belief, of asserting it against every proof to the contrary,... wanting to impose it on the doctor and, ultimately, on the whole asylum,... constitutes a way of believing that one is a king. 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 la folie, the major problem for the psychiatrist is basically "how to persuade otherwise" someone who believes that he is a king.  [editors note: In the chapter The Birth of the Asylum of his History of Madness, Foucault reproduces an antidote related by Pinel in his A Treatise on Insanity (Traité médico-philosophique sur l'aliénation mentale; ou la manie)
Three insane persons, each of whom believed himself to be a kng, and each of whom took the title Louis XVI, quarreled one day over the prerogatives of royalty, and defended them somwhat too energetically. The keeper approached one of them, and drawing him aside, asked: 'Why do you argue with these men who are evidently mad? Doesn't everyone know that you should be recognized as Louis XVI?' Flattered by this homage, the madman immediately withdrew, glancing at the others with a disdainful hauteur. The same trick worked with the second patient. And thus in an instant there no longer remained any trace of an argument.]

[This scene] enables us to have a better understanding 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... , would seem to be the exact opposite of the history of the king who is dispossessed,... confined, seized around the waist, and supervised by muscular pages. Aactually, when we look closely, we can see the continuity between the two scenes. 
When Pinel liberates the patients confined in the dungeons, the person who is liberated incurs a debt to his liberator that will and must be settled... . ...the person liberated will settle his debt continually 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. 

You see that, in fact, this scene of liberation is not exactly a scene of humanism... . But I think we can analyze it as a relationship of power, or as the transformation of a certain relationship 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. ...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 encylopedia of canonical cures constituted on the basis of the cases published by Haslam, Pinel, Esquirol, Fodere, Georget, and Guislain. And this little encylopedia includes around fifty cases which circulate in all the psychiatric treatise of the time and all of which more or less conform to a similiar model. 

Here... is an example from Pinel's Traite medico-philosophique: [...] a man was occupied with the single idea of "his omnipotence." [...] How to overcome this belief? The doctor watched out for "a misdemeanor that would put him in the wrong and authorize severe treatment." And then, by chance, when "one day the supervisor complained to him about the filth and excrement he had left in his room, the lunatic flared up against thim violently and threatened to destroy him. This was a farourable opportunity to punish him and convince him that his power was chimerical." 

21 November 1973

I started... with this scene of George III confronted by his servants who were, at the same time, agents of medical power, because it seemed to me a fine example of the confrontation between a power, which, in the person of the king himself, is sovereign power embodied in this mad king, and another type of power, which is instead anonymous and silent, and which, paradoxically, gets support from the servants' strength, from a muscular, obedient force.... . So, on the one hand, there is the king's furious outburst and, facing this, the controlled force of the servants. And the therapeutic process presupposed by Willis and, after him, Pinel, consisted in getting madness to migrate from a sovereignty it drove wild and within which it exploded, to a discipline supposed to subjugate it. What appears in this capture of madness,... was therefore a power that I call "disciplinary power."

...disciplinary power, in its specificity, has a history... . If we take only the history going from the Middle Ages until our own time, I think we can say that the formation of this power, in its specific characteristics, was not completely marginal to medieval society, but it was certainly not central either. It was formed within religoius communities from where, being transformed in the process, it was taken into the lay communities that developed and multiplied in the pre-Reformation period, let's say in the fourteenth and fifteenth centuries. We can see this transfer to communities like the famous "Brothers of the Common Life," which are not exactly monastic but which, on the basis of techniques taken from monastic life, as well as ascetic exercises taken from a whole tradition of religoius exercises, defined disciplinary methods for daily life and pedagogy. This is just one example of the spread of monastic or ascetic disciplines before the Reformation. We then see these techniques gradually spreaking far afield, penetrating sixteenth, and especially seventeenth and eighteenth century society, and, in the nineteenth century, becoming the major general form of this synaptic contact: political power-individual body.To take a somewhat symbolic reference point, I think this evolution, which goes from the Brethren of the Common Life, that is to say from the fourteenth century, to this point of explosion, that is to say, when disciplinary power became an absolutely generalized social form, ends up, in 1791, with Bentham's Panopticon, which provides the most general political and technical formula of disciplinary power. I think the confrontation between George III and his servants- which is more or less contemporaneous with the Panopticon- this confrontation of the king's madness and medical discipline is one of the historical and symbolic points of the emergence and definitive installation of disciplinary power in society.

Until the beginning of the seventeenth century, roughly until the Thirty Years War, military discipline did not exist; what existed was a never-ending transition from vagabondage to the army. That is to say, the army was always constituted by a group of people recruited for a finite time for the needs of the cause... .

From the middle of the seventeenth century you see something like the disciplinary system appearing in the army; that is to say an army lodged in barracks and in which the soldiers are engaged.

In the disciplinary system... one is perpetually under someone's gaze, or, at any rate, in the situation of being observed. [...] Disciplinary power refers... to a final or optimum state. It looks forward to the future, towards the moment when it will keep going by itself and only a virtual supervision will be required, when discipline, consequently, will have become habit. [...] What is it, then, that ensures this permanent functioning of discipline, this kind of genetic continuity typical of disciplinary power? It is... exercise; progressive, graduated exercise will mark out the growth and improvement of discipline on a temporal scale. 

28 November 1973

What I described [last week] as a sort of apparatus (appareil) or machinery, the major forms of which are clearly apparent in the seventeenth century, let's say especially in the eighteenth century. Actually, the disciplinary apparatuses (dispositifs) were not formed in the seventeenth and eighteenth centuries,... and they certainly did not replace overnight those apparatuses of sovereignty with which I tried to compare them. Disciplinary apparatuses come from far back; for a long time they were anchored and functioned in the midst of apparatuses of sovereignty; they were formed like islands where a type of power was exercised which was very different from what could be called the periods general morphology of sovereignty.
Where did these disciplinary apparatus exist? It is not difficult to find them and follow their history. They are found basically in religious communities... .

These disciplinary apparatuses were, of course, integrated within the general schema of feudal and monarchical sovereignty, and it is true that they functioned... within this more general apparatus that enframed them, supported them, and at any rate absolutely tolerated them. But they also played a critical role of opposition and innovation.

The kind of reform, or rather series of reforms, that took place within the Benedictine order in the eleventh and twelfth centuries, basically represents an attempt to extract religious practice, or to extract the entire order, from the system of feudal sovereignty within which it was held and embedded.
In the Middle Ages, and much more on the eve of the Reformation, we see the constitution of relatively egalitarian communal groups which are not governed by the apparatus of sovereignty but by the apparatus of discipline: a single rule imposed on everyone in the same way... . Thus, very early on you see the appearance of phenomena like the mendicant monks, who already represent a kind of social opposition through a new disciplinary schema [The "mendicant orders" were organized in the thirteenth century with a view to regenerating religious life; professing to live only by public charity and practicing poverty, they devoted themselves to preaching and teaching. The four first mendicant orders are the Dominicans, the Franciscans, the Carmelites, and the Augustinians. Constituted in 1209 by Francis of Assisi, the "Brotherhood of Penitents," devoted to the preaching of penitence, was transformed into a religious order in 1210 with the name "Friars Minor" (minores: humble) and intending to lead an itinerant life of poverty.]. You also see religious communities constituted by the lality, like the Brethren of the Common Life, who appear in Holland in the fourteenth century... .

...for a long time disciplinary apparatuses existed like islands in the general plasma of relations of sovereignty. Throughout the Middle Ages, in the sixteenth century, and still in the eighteenth century, these disciplinary systems remained marginal, whatever the uses to whcih they may have been put or the general effects they may have entailed. They remained on the side, but nevertheless it was through them that a series of innovations were sketched out which will gradually spread over the whole of society. And it is precisely in the seventeenth and eighteenth centuries, through a sort of progressive extension... that we see the constitution of what we could call, but very roughly and schematically, a "disicplinary society" replacing a society of sovereignty.
How did this extension of disciplinary apparatuses take place?

First, there was a parasitic invasion of young students who, until the end of the fifteenth and beginning of the sixteenth centuries, had maintained their autonomy, their rules of movement and vagabondage... . The disciplinarization of this student youth, this colonization of youth, was one of the first points of application and extension of the disciplinary system.

Anyway, there is this very interesting schema, both monastic and military, which will be an instrument of the colonization of youth within pedagogical forms.
I think we can see all this as one of the first moments of the colonization of an entire society by means of disciplinary apparatuses.

We find another application of these disciplinary apparatuses in a different type of colonization; no longer that of youth, but quite simply of colonized peoples. And there is quite a strange history here. [...] It seems that disciplinarization took place..., interestingly, as a counterpoint to slavery.
In fact, it was the Jesuits in South America who opposed slavery for theological and religious reasons... . [...] The famous, so called "communist" Guarani republics in Paraguay were really disciplinary microcosms in which there was a hierarchical system to which the Jesuits held the keys... .

In short, it was a kind of permanent penal system.

The third type of colonization you see taking shape, after that of student youth and colonized peoples, was the internal colonization and confinement of vagrants, beggars, nomads, delinquents, prostitutes, etcetera, in the classical age. [...] Disciplinary apparatuses are installed in more or less all of these cases, and we can see quite clearly that they derive directly from religious institutions.

As for the system of confinement and the methods for colonizing vagrants and nomads, etcetera, the forms were again very close to those of religion, since in most cases it was the religious orders who had, if not the initiative for creating, at least the responsibility for managing these establishments. It is therefore the external version of religious disciplines that we see being progressively applied in ever less marginal and ever more central sectors of the social system.
Then, at the end of the seventeenth century, and during the eighteenth century, disciplinary apparatus appear and are established which no longer have a religious basis, which are the transformation of this but out in the open as it were, without any regular support from the religious side. You see the appearance of disciplinary systems.

After the army, it was quite simply the working class that began to receive disciplinary apparatuses. With the appearance of the big work-shops in the eighteenth century, of the mining towns or big centres of metallurgy... . see the appearance of disciplinary forms imposed on works, with the first workers' cities, like that of Creusot. Then, in the same period, the great instrument of worker discipline, the employment document, the livret, is imposed on every worker [in 1781 in France]. is the token, as it were, of all the disciplinary systems that bear down on him.
So, once again very schematically, these isolated, local, marginal disciplinary systems, which took shape in the Middle Ages, begin to cover all society through a sort of process that we could call external and internal colonization... .

We come here to the point at which I would like to go back to..., to the problem of asylum discipline as constitutive of the general form of psychiatric power. ...what appeared openly, as it were, in the naked state, in the psychiatric practice of the start of the nineteenth century, was a power with the general form of what I have called discipline.

In fact, there was an extremely clear and quite remarkable formalization of this microphysics of disciplinary power. It is found quite simply in Bentham's Panopticon. What is the Panopticon?

It is usually said that in 1787 Bentham invented the model of a prison, and that this was reproduced, with a number of modifications, in some European prisons... . In fact, Bentham's Panopticon is not a model of a prison, or it is not only a model of a prison; it is a model, and Bentham is quite clear about this, for a prison, but also for a hospital, for a school, workshop, orphanage, and so on. [...] And again, when I say it is a schema for a series of possible institutions, I think I am still not exactly right.
In fact, Bentham does not even say that it is a schema for institutions, he says that it is a mechanism, a schema which gives strength to any institution, a sort of mechanism by which the power which functions, or which should function in an institution will be able to gain maximum force. [...] "Its great excellence consists, in the great strength it is capable of giving to any institution it may be thought proper to apply it to." [...] Bentham also says that what is marvelous about the Panopticon is that it constitutes a "new mode of obtaining power, of mind over mind."

There is a circular building, the periphery of the Panopticon, within which cells are set, opening both onto the inner side of the ring through an iron grate door and onto the outside through a window. Around the inner circumference of this ring is a gallary, allowing one to walk around the building, passing each cell. Then there is an empty space and, at its centre, a tower, a kind of cylindrical construction of several levels at the top of which is a sort of lantern, that is to say, a large open room, whcih is such that from this central site one can observe everything happening in each cell, just by turning around. This is the schema.



It seems to me that the panoptic mechanism provides the common thread... . So that Panopticism could, I think, appear and function within our society as a general form; we could speak equally of a disciplinary society or of a panoptic society. We live within a generalize panopticism by virtue of the fact that we live within a disciplinary system.

You will say that this is all very well, but can we really say that disciplinary apparatuses have extended over the whole of society, and that the... powers of sovereignty have been eliminated by disciplinary mechanisms?
Just as the disciplinary type of power existed in medieval societies, in which schemas of sovereignty were nevertheless prevalent, so too, I think, forms of the power of sovereignty can still be found in contemporary society. Where do we find them? [...] seems to me that the family is a sort of cell within which the power exercised is not, as one usually says, disciplinary, but rather of the same type as the power of sovereignty.

When an individual escaped from the sovereignty of the family, he was put in a psychiatric hospital where it was a matter of training him in the apprenticeship of pure and simple discipline... . Psychiatry gradually puts itself forward as the institutional enterprise of discipline that will make possible the individual's refamilialization.

5 December 1973

Around 1850-1860 we begin to see the idea expressed that, first and foremost, the madman is like a child; second, that the madman must be placed in a milieu analogous to the family... ; and finally, third, that these quasi familial elements have a therapeutic value in themselves.

You find the idea that the madman is like a child in, for example, a text by Fournet, to which I will return because it is important, "The moral treatment of insanity," which appeared in the Annales medicopsychologique in 1854. The madman must be treated like a child, and it is the family, "the true family in which the spirit of peace, intelligence and love reigns," that, "from the earliest time and the first human aberrations," must ensure "the moral treatment, the model treatment of the aberrations of heart and mind."

Fournet says that the family has a therapetuic value, that the family is effectively the model on the basis of which one can construct a moral and psychological orthopedics, of which, he says, we have examples outside the psychiatric hospital:
The missionaries [and by this I think he means the soldiers then colonizing Algeria as well as missionaries in the strict sense; M.F.] who take from the family its spirit of peace, benevolence, devotion, and even the name of the father, and who seek to cure the prejudices, false traditions, and errors of savage nations, are Pinels and Daquins in comparison with the conquering armies who claim to bring civilization through the brutal force of arms and who act on nations in the way that chains and prisons act on the unfortunate insane.

In plain words this means that there were two ages of psychiatry; one in which chains were employed [i.e., the dungeons of the 'ancient regime'] and the other where, let's say, humane feelings were employed [the 'moral treatment' of Pinel and Tuke]. Well, in the same way, there are two methods and maybe two ages in colonization: one is the age of pure and simple conquest by arms, and the other is the period of establishment and colonization in depth [i.e., as indicated, in the case of South America, in the transition from the papal Bull Dum Diversus, under the auspices of which the Conquistadors conquered the 'Indians', to Sublimus Dei, under the auspices of which the priests evangelized]. And this in-depth colonization is carried out by the organization of the family model; it is by introducing the family into the traditions and errors of savage peoples that one begins the work of colonization [in the case of South America, ascribing to them a christian soul i.e., see La Cases]. Fournet continues, saying that exactly the same thing is found with delinquents. He cites Mettray [see Discipline and Punish], founded in 1840, where, in what is basically a purely military schema, the names father, elder brother, and so on, were used in a pseudo-family organization. Fournet refers to this is order to say: You see that here as well the family model is used to try to "reconstitute... the elements and regime of the family around these unfortunates, orphaned through the deeds or vices of their parents." And he concludes: "It is not, gentlemen, that I wish from today to include insanity (alienation mentale) in the same category as the moral alienation of peoples or individuals subject to the judgement of history or the law... ." This is another work, which he promises for the future, but never produced.


But you see that if he did not do it, many others did subsequently. You see delinquents as the residues of society, colonized peoples as the residues of history, and the mad as the residues of humanity in general, all included together in the same category, all the individuals- delinquents, peoples to be colonized, or the mad- who can only be reconverted, civilized and subjected to orthopedic treatment if they are offered a family model.
I think we have here an important point of inflexion. It is important because it takes place quite early, 1854, that is to say, before Darwinism, before On the Origin of the Species. Certainly, the principle of ontogenesis-phylogenesis was already known, at least in its general form, but you see the strange use of it here and, especially- even more than the interesting bracketing together of the mad, the primitive, and the delinquent- the appearance of the family as the common remedy for being savage, delinquent, or mad.
.... the disciplinary system had a primary, massive, overall function which appears clearly in the eighteenth century... . Insofar as these disciplinary systems were normalizing, they necessarily produced, on their borders and through exclusion, residual abnormalities, illegalities, and irregularities. ...these irregularities, illegalities, and abnormalities that the disciplinary system was designed to reduce,... it created pricisely to the extent that it functioned... .
...the disciplinary system set up in the eighteenth century for a particular overall function,... then refined in the nineteenth century... .

Just as the family model is transferred into disciplinary systems, disciplinary techniques are transplanted into the family.

12 December 1973

The psychiatrist is someone who must give reality that constraining force by which it will be able to take over the madness, completely penetrate it, and make it disappear as madness. The psychiatrist is someone who-- and this is what defines his task-- must ensure that reality has the supplement of power necessary for it to impose itself on madness and, conversely, he is someone who must remove from madness its power to avoid reality.

So that if one had to define this power that I would like to talk to you about this year, I would suggest, provisionally, the following: Psychiatric power is that supplement of power by which the real is imposed on madness in the name of a truth possessed once and for all by this power in the name of medical science, of psychiatry.

This is what a psychiatrist of the time called "the imprescriptible rights of reason over madness," which were for him the foundations of psychiatric intervention. 

19 December 1973

First, there is the maneuver of creating an imbalance of power... .

I think this first meeting [between doctor and patient] fully reveals what we could call the general ritual of the asylum. Basically,... in all of the asylums of this period, the first episode of contact between the doctor and his patient is indeed this ceremony, this initial show of force
; that is to say, the demonstration that the field of forces in which the patient finds himself in the asylum is unbalanced... . Right from the start one must be in a different world in which there is a break, an imbalance, between doctor and patient.... . It is on the basis of this absolutely statutory difference of level, of potential, which will never disappear in asylum life, that the process of treatment can unfold. It is a commonplace in the advice given by alienists concerning different treatments that one should always begin by marking power in this way. Power is all on one side, Pinel said when he recommended approaching the patient with "a sort of ceremony of fear, an imposing air, which can act strongly on the imagination [of the maniac] and convince him that all resistance is pointless." Esquirol said the same: "In a home for the insane there must be one and only one chief to whom everything is subordinate."
Clearly, it is the "principle of a foreign will"... , which we can call Falret's principle, which is the substitution of a "foreign will" for the patient's [i.e., insane] will.
The patient must feel himself immediately confronted by something in which all the reality he will face in the asylum is summed up and concentrated in the doctor's foreign and omnipotent will.

...establishing an absolute difference of power involves above all breaking down the fundamental assertion of omnipotence in madness. In every madness, whatever its content, there is always an assertion of omnipotence, and this [obstinancy] is the target of the first ritual of the assertion of a foreign and absolutely superior will.

...when there is no delusion of grandeur, there is still an assertion of omnipotence, not in the way the delirium is expressed, but in the way it is exercised.
Whatever the content of the delirium, even when one thinks one is persecuted, the fact of asserting one's delirium, that is to say refusing all discussion, reasoning, and proof, is in itself an assertion of omnipotence, and this is absolutely coextensive with all madness, whereas expressing omnipotence within the delirium is only the fact of having delusions of grandeur.
Asserting one's omnipotence in the delirium simply by the fact of being delirious is typical of all madness.
Consequently, you can see how and why this first move, this first maneuver of the psychiatric operation is justified: it is a matter of breaking down the omnipotence of madness, of reducing it by demonstrating a different, more vigorous will endowed with greater power. Georget advises doctors: "Instead of... refusing to accord a lunatic the status of king that he claims, prove to him that he is powerless and that you, who are anything but powerless, can do anything to him; perhaps he will reflect that actually, it may well be that he was in error."
So, this first contact... is inserted in the general context of asylum practice of this time... in the form of the delirium's omnipotence countered by the doctor's reality and omnipotence, which is accorded him by, precisely, the statutory imbalance of the asylum.

...if you look at what the functioning of the asylum institution itself was for the psychiatrists of this period, and where they sought the therapeutic character of the asylum's action, you see that the asylum was thought to be therapeutic because it obliged people to submit to regulation, to a use of time, it forced them to obey orders, to line up, to submit to the regularity of certain actions and habits, to submit to work. [...] As Falret said in 1854, "a strictly observed positive regulation, which fixes the use of every hour of the day, forces every patient to react against the irregularity of his tendencies by submitting to the general law. Instead of being left to himself to follow the impulse of his whim or his disordered will, the insane person is constrained to bend before a rule which is all the more powerful for being established for everyone. He is obliged to place himself in the hands of a foreign will and to make a constant effort on himself so as not to incur the punishments attached to infringements of the rule."
Esquirol too thought that this system of the order... was the major effective agent of asylum treatment: "In such a home there is a movement, an activity, a whirl into which every person gradually enters; the most stubborn, defiant lypemaniac is forced to live outside of himself and, without being aware of it, is carried away by the general movement and example of others (...); the maniac himself, restrained by the harmony, order and rule of the home, defends himself better against his impulses and abandons himself less to his eccentric activities." In other words, order is reality in the form of discipline.
The third maneuver in the apparatus of asylum therapy is what could be called the management or organization of needs.

Basically it involves establishing the patient in a carefully maintained state of deprivation: the patient's existence must be kept just below a certain average level.

Asylum work is not free; it is paid, and this payment is not a supplementary favor but at the very heart of the function of work, for the remuneration must be sufficient to satisfy certain needs created by the underlying asylum deprivation: insufficient food, the absence of any extras (tobacco, a dessert, etcetera, must be paid for).

...above all,
the great deprivation developed by asylum discipline is, perhaps, quite simply deprivation of freedom. And you see how, in the psychiatrists of the first half of the nineteenth century, the theory of isolation gradually changes or, if you like, is deepened and completed. [...] ... isolation... not only protects the family but gives rise to a new need in the patient, the need for freedom, of which he was previously unaware. Treatment can be developed on the basis of this artificially created need. 

In the asylum form of this period, psychiatric power is therefore the creator of needs and the management of the deprivations it establishes. 

The... effect of this policy of deprivation is that in this materially reduced status in comparison... with life outside the asylum, the patient will recognize his unsatisfied state, his reduced status, his lack of rights to anything, and the reason for his lack being that he is, quite simply, ill. [...] In other words, he must learn that he must pay for his madness, because madness really exists as something by which he is affected; and madness will be paid for by... this systematic deprivation.

Finally,... the [last] phase, although in the therapy proposed by Leuret it is the penultimate episode: the patient must be got to tell the truth. [editors note: here Foucault relates the treatment practiced by Leuret of subjecting his patients to cold showers in order to get from them a confession of their own madness. For a description of this treatment, see the introduction to
'About the Beginning of the Hermeneutics of the Self: Two Lectures at Dartmouth' here]

We could say that at bottom the asylum machine owes its effectiveness to a number of things: uninterrupted disciplinary training; the dissymmetry of power inherent in this; the game of need, money, and work; statutory pinning to an administrative identity in which one must recognize oneself through a language of truth.

The medical personage, as Leuret says himself, must become... a benign personage who tries to arrange things, who acts as an intermediary between harsh reality and the patient. 

9 January 1974

Psychiatric power is a regime, but at the same time... in the nineteenth century it is a struggle against madness conceived as a will in revolt, as an unbounded will, whatever nosographic analysis or description may ultimately be given of its phenomena. Even in a case of delirium, it is the will to believe in that delirium, the will to assert that delirium, the will at the heart of that assertion of the delirium, which is the target of the struggle that runs through and drives the psychiatric regime throughout its development.

[The aim of] psychiatric power... is to validate the power exercised within the asylum as being quite simply the power of reality itself. [...] It justifies itself as power in the name of reality itself.

The reality the patient must confront, the reality to which his attention-- distracted by his will-- must submit and by which he must be subjugated, is first of all the other as a center of will, as a source of power... . This is the first yoke of reality to which the mad person must be subjected.

The asylum is the psychiatrists body, stretched and distended to the dimensions of an establishment, extended to the point that his power is exerted as if every part of the asylum is a part of his own body.

You recall those scenes I talked about to start with: every therapy begins with the sudden appearance of the psychiatrist in person, in flesh and blood, looming up in front of his patient, either on the day of his arrival or when his treatment begins, and with the prestige of this body of which it was indeed said that it must be without defect, that it must impose itself through its own stature and weight. This body must impress itself on the patient as reality, or as that through which the reality of every other reality will have to pass; this is the body to which the patient must be subjected.

In conclusion, I would like to say that, as you can see, we arrive at this paradox of the completely specific constitution of a space of discipline... which differs from all the others because it has a medical stamp.

...around 1840 to 1860, there was a sort of diffusion, a migration of this psychiatric power, which spread into other institutions, into other disciplinary regimes... it doubled, as it were.

Now, how did this kind of dissemination come about? How was it that this psychiatric power, which seemed to be so firmly tied up with the specific space of the asylum, began to drift? [...] I think the intermediary is easily found and is basically the psychiatrization of abnormal children, and more precisely the psychiatrization of idiots.

16th January

...this is the hypothesis I would like to try out before you-- I think that we should look for the principle of diffusion of psychiatric power in the direction of the coupling of the hospital and the school, of health institutions and the system of learning... . [...] It seems to me that, in the end, the diffusion of psychiatric power takes place by way of this development of the concept "normal."

...[the] psychiatrization of the child came about through... [the figure of] the imbecile child, the idiot child, the child who will soon be called retarded, that is to say, a child about whom one was careful to say, right from the start, in the first thirty years of the nineteenth century, that he was not mad. Psychiatrization of the child took place through the intermediary of the child who was not mad and this was the point from which psychiatric power was generalized. see a completely new notion of idiocy emerging, which you would not be able to find in the eighteenth century. Esquirol defines it in this way: "Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested, or have never been sufficiently developed... ." And, in 1824, Belhomme more or less textually summarizes the same definition; he say that "idiocy is... a constitutional condition in which the intellectual functions have never developed... ."
This definition is important because it introduces the notion of development; it makes development, or rather the absence of development the criterion for distinquishing between madness and idiocy. [...] Development, for both Esquirol and Belhomme, is something one may or may not have, from which one has or has not benefited... .

...the way in which Seguin conceives of development in his Traitement moral des idiots is no longer, as it was in Esquirol, something with which one is endowed or of which one is deprived, as with intelligence or will; development is a process which affects organic life and psychological life, a dimension along which neurological or psychological organizations, functions, behaviors, and acquisitions are spread out. It is a temporal dimension and no longer a kind of faculty or quality with which one is endowed.
...this temporal dimension is, in a sense, common to everyone. No one escapes it, but it is a dimension along which one may be halted. To that extend, development is common to everyone, but it is common more as a sort of optimum, as a rule of chronological succession with an ideal outcome. Development is therefore a kind of norm with reference to which one is situated... .

...the adult will appear as both the real and ideal end of development; so that the adult will function as the norm. [...] So [that the] phenomena of mental deficiency-- idiocy in the strict sense, and retardation-- will be situated by reference to two normative levels: the adult, representing the final stage, and other children, defining the average speed of development.

Seguin's idiot or mentally retarded individual is someone who has not left the normal, or rather, he is situated at a lower degree within something that is the norm itself, that is to say, child development. The idiot is... someone more or less sunk within a childhood that is normal childhood itself. The idiot is a certain degree of childhood, or again, if you like, childhood is a certain way of passing more or less quickly through the degrees of idiocy, debility, or mental retardation.

A number of consequences follow from this, the main one of which is obviously this: if it is true that the idiot or retarded child is someone stuck at a certain level, not within the field of illness, but within the temporality of childhood, then the treatment he is to be given will be no different in kind than that given to any child. That is to say, the only way to treat an idiot or retarded child is quite simply to impose education on them... , impose the educational scheme itself. The therapy for idiocy will be pedagogy itself... .

...the establishment of this profoundly new category of abnormality as distinct from from illness. And I think that the confiscation of this new category of abnormality by medicine, its psychiatrization, was precisely the principle on which the diffusion of psychiatric power was based.

...Seguin was initially trained [by Itard, who wrote
An historical account of the Discovery and Education of a Savage Man, or of the First Developments, Physical and Moral, of the Young Savage caught in the Woods Near Aveyron in 1898]. the period when Sequin defines idiocy outside of mental illness, in the recently organized or reorganized big asylums, you see wings being opened, for the retarded, idiots,... and all of them children.

Throughout the second half of the nineteenth century you find the colonization of idiot children within the psychiatric space.

So, at a moment when there is this clear theoretical division between insanity and idiocy, there are a whole series of institutions and administrative measures which lump together what was in the process of being distinguished.

It might be thought that with mental retardation or mental deficiency being filtered through the primary education then being developed ['Guizot's law dates from 1833'], idiots identified as problems within these educational establishments will be gradually expelled into the asylum. [...] In actual fact it is at the end of the nineteenth century that generalized primary education will act as a filter... and reference for the phenomena of mental retardation.
However, this does not apply to the period I am considering, that is to say, around 1830 to 1840. [...] You know that if "nursery schools" ("salles d'asile") were created in the 1830's, that is to say, creches and kindergartens, and if schooling was provided for children in this period, it was not so much in order to equip them for future employment, as to free their parents for work by no longer having to concern themselves with their children. The organization of these educational establishments at this time corresponded to the aim of releasing parents from taking care of their children so as to put them on the labor market [In the case of England, a review of the Inquery set up by the Parliment into the 'need for public education' in the 1830's, reveals that an agreement was found in seeing the duty of public education as the 'inculcation of the principles of Christian morality', that is, abstracted from, and independent of, any particular 'sect'].
The people who created the specialized establishments for idiots in this period had exactly the same concern.

...if you look at the way in which Seguin himself... actually treated the idiots and mentally deficient at Bicetre, you see that he applied exactly the same schemas of psychiatric power, but with, as it were, a magnifying and purifying effect. [...] The education of idiots and the abnormal is psychiatric power in the pure state.

First, he conceived of the education of idiots, which he called "moral treament" moreover, using the same term as Leuret, to whom he refers, as first of all the confrontation of two wills: "The struggle of the two wills may be long or short, finish to the advantage of the teacher or of the pupil." You recall the way in which, in psychiatric "moral treatment," the confrontation of patient and doctor was indeed the confrontation of two wills in a struggle for power. You find exactly the same formulation and the same practice in Seguin; except, one might wonder how Seguin can speak of the confrontation of two wills when it is a case of an adult and a retarded child or an idiot. We really must speak of two wills and of a confrontation between teacher and idiot, Seguin says, because the idiot seems not to have any will, but in actual fact he has the will not to will, and this is precisely what characterizes instinct. What is "instinct"?
It is a certain anarchic form of will which consists in never wanting to submit to the will of others; it is a will which refuses to organize itself in the mode of the individual's monarchical will... . Instinct is a will which "wills not to will," and which stubbornly insists on not constituting itself as an adult will-- the adult will being characterized, for Seguin, as a will that can obey [i.e, the dictates of reason, the
precepts of morality, etc.].

The idiot's "energetic no, no, no, repeated without respite, arms crossed or hanging down, or while biting his fist," must be countered with a "power which tires him out and constantly says to him: On! On! It is up to the teacher to say it to him loudly enough, firmly enough, early enough and for long enough so that he can toe the line and show to what extent he is a man."

Seguin emphasizes and practices this omnipotence of the teacher in his visible body.

He is master at the level of his body and, like the psychiatrist, he must have an impeccable physique. "A clumsy, common bearing and gestures, poorly shaped, lackluster eyes set apart, and a lifeless, expressionless gaze; or again, a fleshy mouth, thick, soft lips, incorrect pronunciation, drawling, guttural, nasal or poorly accented voice," are all absolutely proscribed [prohibitted] for someone who wants to be Master of the idiot [for that whould make him an idiot, as much as playing, entertaining the role of, the duped fool, would make Descartes himself a fool]. He must appear physically impeccable before the idiot, as both powerful and unknown personage: "The Master must have a straightforward bearing, distinct speech and gestures, a clear-cut manner, to make him noted, listened to, seen, and recognized" straight away by the idiot.
The idiot's education must take place through its connection with this impeccable and omnipotent body.

His access to the reality of the world, the attention he will pay to differences between things, will begin with his perception of the master. When the idiot child's gaze wanders or lets lost, "you approach, the child struggles; your eyes seek his, he avoids your eyes; you pursue, he escapes again; you think you have got him, he closes his eyes; you are there, attentive, ready to surprise him, waiting for him to reopen his eyelids in order to penetrate his eyes with your gaze; and if, as reward for your efforts, the day he sees you for the first time, the child pushes you away, or if, in order to forget his primitive condition, his family present to the world a distorted picture of the constant care you have given him [i.e., call into question the teacher and his methods], then you will begin again to expend your life anxiously in this way [i.e., resume your task with firm resolve], no longer for the love of this or that, but for the triumph of the doctrine [i.e., elaborated here] of which you alone still have the secret and the courage. This was how, for four months, I pursued the elusive gaze of a child in the void. The first time his eyes met mine, he broke away, letting out a loud cry (...)."

[Note: for a selection from the section titled Moral Treatment of Seguin's Idiocy and its Treatment (1866) see here] this moral treament of idiot children you find again the organization of a disciplinary space like that of the asylum. [...] As Bourneville will say later, "the children must be busy from getting up until going to bed. Their activities must be constantly varied. ...keeeping the attention constantly alert... ." Full use of time, work.

What does the psychiatric treatment of idiots do, if not precisely repeat the content of education itself in a multiplied and disciplinary form?

We have two processes therefore: the theoretical specification of idiocy and the practical annexation by psychiatric power.

Degeneration, as Morel defines it, arises before Darwin and before evolutionism. What is degeneration in Morel's time, and what will it basically remain until... the beginning of the twentieth century? A child who carries the traces of his parents' or ancestors' madness, as stigmata or sign, will be called "degenerate." Degeneration is therefore, as it were, the effect of abnormality produced on the child by his parents. And, at the same time, the degenerate child is an abnormal child whose abormality is such that, in certain determinate circumstances and following certain accidents, it may produce madness. Degeneration is therefore the predisposition of abnormality in the child that will make possible the adult's madness, and, in the form of abnormality, it is the sign on the child of his ancestors' madness.