MADNESS AND CIVILIZATION A History of Insanity in the Age of Reason | Michel Foucault

| quinta-feira, 22 de outubro de 2009
Descartes closes his eyes and plugs up his
ears the better to see the true brightness of essential daylight; thus he
is secured against the dazzlement of the madman who, opening his
eyes, sees only night, and not seeing at all, believes he sees when he
imagines. In the uniform lucidity of his closed senses, Descartes has
broken with all possible fascination, and if he sees, he is certain of
seeing that which he sees.





This translation is of the edition abridged by the author and published in the
Plon 10/18 series. However, the author has added some additional material
from the original edition, including the chapter "Passion and Delirium."
Library of Congress Cataloging in Publication Data
Foucault, Michel. Madness and
civilization.
Translation of Folie et deraison; histoire de la folie.
Includes bibliographical references. 1. Psychiatry—
History. 2. Mental illness. I. Title.
Manufactured in the United States of America
13579C8642
INTRODUCTION
MICHEL FOUCAULT has achieved something truly creative in this
book on the history of madness during the so-called classical
age: the end of the sixteenth and the seventeenth and eighteenth
centuries. Rather than to review historically the concept of
madness, the author has chosen to recreate, mostly from
original documents, mental illness, folly, and unreason as they
must have existed in their time, place, and proper social
perspective. In a sense, he has tried to re-create the negative
part of the concept, that which has disappeared under the
retroactive influence of present-day ideas and the passage of
time. Too many historical books about psychic disorders look
at the past in the light of the present; they single out only what
has positive and direct relevance to present-day psychiatry.
This book belongs to the few which demonstrate how skillful,
sensitive scholarship uses history to enrich, deepen, and reveal
new avenues for thought and investigation.
No oversimplifications, no black-and-white statements, no
sweeping generalizations are ever allowed in this book; folly is
brought back to life as a complex social phenomenon, part and
parcel of the human condition. Most of the time, for the sake of
clarity, we examine madness through one of its facets; as M.
Foucault animates one facet of the problem after the other, he
always keeps them related to each other. The end of the Middle
Ages emphasized the comic, but just as often the tragic aspect
of madness, as in Tristan and Iseult, for example. The
Renaissance, with
(v)
Erasmus's Praise of Folly, demonstrated how fascinating imagination
and some of its vagaries were to the thinkers of that day. The French
Revolution, Pinel, and Tuke emphasized political, legal, medical, or
religious aspects of madness; and today, our so-called objective
medical approach, in spite of the benefits that it has brought to the
mentally ill, continues to look at only one side of the picture. Folly is
so human that it has common roots with poetry and tragedy; it is
revealed as much in the insane asylum as in the writings of a
Cervantes or a Shakespeare, or in the deep psychological insights
and cries of revolt of a Nietzsche. Correctly or incorrectly, the
author feels that Freud's death instinct also stems from the tragic
elements which led men of all epochs to worship, laugh at, and dread
folly simultaneously. Fascinating as Renaissance men found it—
they painted it, praised it, sang about it—it also heralded for them
death of the body by picturing death of the mind.
Nothing is more illuminating than to follow with M. Foucault the
many threads which are woven in this complex book, whether it
speaks of changing symptoms, commitment procedures, or
treatment. For example: he sees a definite connection between some
of the attitudes toward madness and the disappearance, between
1200 and 1400, of leprosy. In the middle of the twelfth century,
France had more than 2,000 leprosariums, and England and Scotland
220 for a population of a million and a half people. As leprosy
vanished, in part because of segregation, a void was created and the
moral values attached to the leper had to find another scapegoat.
Mental illness and unreason attracted that stigma to themselves, but
even this was neither complete, simple, nor immediate.
Renaissance men developed a delightful, yet horrible way of
dealing with their mad denizens: they were put on a ship and
entrusted to mariners because folly, water, and sea, as everyone then
"knew," had an affinity for each
(vi)
other. Thus, "Ships of Fools" crisscrossed the seas and canals of
Europe with their comic and pathetic cargo of souls. Some of them
found pleasure and even a cure in the changing surroundings, in the
isolation of being cast off, while others withdrew further, became
worse, or died alone and away from their families. The cities and
villages which had thus rid themselves of their crazed and crazy,
could now take pleasure in watching the exciting sideshow when a
ship full of foreign lunatics would dock at their harbors. The
seventeenth and eighteenth centuries saw much social unrest and
economic depression, which they tried to solve by imprisoning the
indigents with the criminals and forcing them to work. The demented
fitted quite naturally between those two extremes of social
maladjustment and iniquity.
A nice and hallowed tradition has labeled Tuke and Pinel as the
saviors of the mentally ill, but the truth of the matter is not so simple.
Many others had treated them with kindness, pleading that they
belonged first and foremost with their families, and for at least two
hundred years before the i78os, legislation had been considered or
passed to segregate criminals and indigents from fools. But this
legislation was prompted, as often as not, by a desire to protect the
poor, the criminal, the man imprisoned for debts, and the juvenile
delinquent from the frightening bestiality of the madman. As the
madman had replaced the leper, the mentally ill person was now a
subhuman and beastly scapegoat; hence the need to protect others.
While the Quaker Tuke applied his religious principles, first to
demented "friends" and later to foes also, partly to convert them, the
great Pinel was not sure at times that he was dealing with sick
people; he often marveled at their unbelievable endurance of
physical hardship, and often cited the ability of schizophrenic
women to sleep naked in subfreezing temperatures without suffering
any ill effects. Were not these
(vii)
people more healthy, more resistant than ordinary human beings?
Didn't they have too much animal spirit in them?
Naturally, it is impossible to discuss a book as complex as
Madness and Civilization without oversimplifying and doing it an
injustice. It is a tale of nuances, relative values, and delicate
shadings. Yet, it is an impressive monument: in a dispassionate
manner it marshals overwhelming evidence to dispel more
effectively than many previous attempts the myth of mental illness,
and re-establishes folly and unreason in their rightful place as
complex, human—too hu man—phenomena. The roots and
symptoms of folly are being looked for today in psychology,
medicine, and sociology, but they were and still are as present and
important in art,* religion, ethics, and epistemology. Madness is
really a manifestation of the "soul," a variable concept which from
antiquity to the twentieth century covered approximately what came
to be known, after Freud, as the unconscious part of the human
mind. + Only time will tell how much better students of the psyche
can look at the future, after reading this sobering re-creation of
yesteryear's madness and the ineffective attempts of humanity to
treat it by amputation, projections, prejudices, and segregation.
JOSE BARCHILON, M.D.
* My only quarrel with the book is the lack of emphasis on the humoristic elements
in psychoses and neuroses: i.e., the patient laughs at himself, or laughs at the world
through his illness.
+ The fear and dread of madness is as real a factor in social and medical attitudes
or measures as anxiety, symptoms, and resistance in coping with impulses from the
individual unconscious; even though the author does not explicitly compare madness
with the unconscious, he equates madness and dream activity so that the inference is
clear enough.
(viii)
PREFACE
PASCAL: "Men are so necessarily mad, that not to be mad would
amount to another form of madness." And Dostoievsky, in his DIARY
OF A WRITER: "It is not by confining one's neighbor that one is
convinced of one's own sanity."
We have yet to write the history of that other form of
madness, by which men, in an act of sovereign reason, confine
their neighbors, and communicate and recognize each
other through the merciless language of non-madness; to
define the moment of this conspiracy before it was permanently
established in the realm of truth, before it was revived
by the lyricism of protest. We must try to return, in history, to
that zero point in the course of madness at which madness is
an undifferentiated experience, a not yet divided experience
of division itself. We must describe, from the start of its
trajectory, that "other form" which relegates Reason and
Madness to one side or the other of its action as things
henceforth external, deaf to all exchange, and as though
dead to one another.
This is doubtless an uncomfortable region. To explore it we
must renounce the convenience of terminal truths, and never
let ourselves be guided by what we may know of madness.
None of the concepts of psychopathology, even and
especially in the implicit process of retrospections, can play
an organizing role. What is constitutive is the action that
divides madness, and not the science elaborated once this
division is made and calm restored. What is originative is the
caesura that establishes the distance between reason and
non-reason; reason's subjugation of non-reason, wrest-
(ix)
ing from it its truth as madness, crime, or disease, derives
explicitly from this point. Hence we must speak of that initial
dispute without assuming a victory, or the right to a victory;
we must speak of those actions re-examined in history,
leaving in abeyance all that may figure as a conclusion, as a
refuge in truth; we shall have to speak of this act of scission,
of this distance set, of this void instituted between reason and
what is not reason, without ever relying upon the fulfillment of
what it claims to be.
Then, and then only, can we determine the realm in which
the man of madness and the man of reason, moving apart,
are not yet disjunct; and in an incipient and very crude
language, antedating that of science, begin the dialogue of
their breach, testifying in a fugitive way that they still speak to
each other. Here madness and non-madness, reason and
non-reason are inextricably involved: inseparable at the
moment when they do not yet exist, and existing for each
other, in relation to each other, in the exchange which
separates them.
In the serene world of mental illness, modem man no
longer communicates with the madman: on one hand, the
man of reason delegates the physician to madness, thereby
authorizing a relation only through the abstract universality of
disease; on the other, the man of madness communicates
with society only by the intermediary of an equally abstract
reason which is order, physical and moral constraint, the
anonymous pressure of the group, the requirements of
conformity. As for a common language, there is no such thing;
or rather, there is no such thing any longer;
the constitution of madness as a mental illness, at the end of
the eighteenth century, affords the evidence of a broken
dialogue, posits the separation as already effected, and
thrusts into oblivion all those stammered, imperfect words
without fixed syntax in which the exchange between madness
and reason was made. The language of psychiatry,
(x)
which is a monologue of reason about madness, has been
established only on the basis of such a silence.
I have not tried to write the history of that language, but
rather the archaeology of that silence.
The Greeks had a relation to something that they called
******;. This relation was not merely one of condemnation; the
existence of Thrasymachus or of Collides suffices to prove it,
even if their language has reached us already enveloped in
the reassuring dialectic of Socrates. But the Greek Logos had
no contrary.
European man, since the beginning of the Middle Ages, has
had a relation to something he calls, indiscriminately,
Madness, Dementia, Insanity. Perhaps it is to this obscure
presence that Western reason owes something of its depth,
as the ******| of the Socratic reasoners owes something to the
threat of ******. In any case, the Reason-Madness nexus
constitutes for Western culture one of the dimensions of its
originality; it already accompanied that culture long before
Hieronymus Bosch, and will follow it long after Nietzsche and
Artaud.
What, then, is this confrontation beneath the language of
reason? Where can an interrogation lead us which does not
follow reason in its horizontal course, but seeks to retrace in
time that constant vertically which confronts European culture
with what it is not, establishes its range by its own
derangement? What realm do we enter which is neither the
history of knowledge, nor history itself; which is controlled by
neither the teleology of truth nor the rational sequence of
causes, since causes have value and meaning only beyond
the division? A realm, no doubt, where what is in question is
the limits rather than the identity of a culture.
The classical period—from Willis to Pinel, from the frenzies
of Racine's Oreste to Sade's Juliette and the Quinta
(xi)
del Sordo of Goya—covers precisely that epoch in
which the exchange between madness and reason
modifies its language, and in a radical manner. In the
history of madness, two events indicate this change
with a singular clarity: 1657, the creation of the Hopital
General and the "great confinement" of the poor; 1794,
the liberation of the chained inmates of Bicetre.
Between these two unique and symmetrical events,
something happens whose ambiguity has left the
historians of medicine at a loss: blind repression in an
absolutist regime, according to some; but according to
others, the gradual discovery by science and
philanthropy of madness in its positive truth. As a
matter of fact, beneath these reversible meanings, a
structure is forming which does not resolve the
ambiguity but determines it. It is this structure which
accounts for the transition from the medieval and
humanist experience of madness to our own experience,
which confines insanity within mental illness.
In the Middle Ages and until the Renaissance, man's
dispute with madness was a dramatic debate in which
he confronted the secret powers of the world; the
experience of madness was clouded by images of the
Fall and the Will of God, of the Beast and the
Metamorphosis, and of all the marvelous secrets of
Knowledge. In our era, the experience of madness
remains silent in the composure of a knowledge which,
knowing too much about madness, forgets it. But from
one of these experiences to the other, the shift has
been made by a world without images, without positive
character, in a kind of silent transparency which
reveals— as mute institution, act without commentary,
immediate knowledge—a great motionless structure;
this structure is one of neither drama nor knowledge; it
is the point where history is immobilized in the tragic
category which both establishes and impugns it.
(xii)
CONTENTS
I "Stultifera Navis" 3
II The Great Confinement 38
III The Insane 65
IV Passion and Delirium 85
V Aspects of Madness 117
VI Doctors and Patients 159
VII The Great Fear 199
VIII The New Division 221
IX The Birth of the Asylum 241
Conclusion 219
Notes 201
MADNESS AND
CIVILIZATION
A History of Insanity in
the Age of Reason
I "Stultifera Navis"
AT the end of the Middle Ages, leprosy disappeared from the
Western world. In the margins of the community, at the gates of
cities, there stretched wastelands which sickness had ceased to haunt
but had left sterile and long uninhabitable. For centuries, these
reaches would belong to the non-human. From the fourteenth to the
seventeenth century, they would wait, soliciting with strange
incantations a new incarnation of disease, another grimace of terror,
renewed rites of purification and exclusion.
From the High Middle Ages to the end of the Crusades,
leprosariums had multiplied their cities of the damned over the
entire face of Europe. According to Mathieu Paris, there were as
many as 19,000 of them throughout Christendom. In any case,
around 1226, when Louis VIII established the lazar-house law for
France, more than 2,000 appeared on the official registers. There
were 43 in the
(3)
diocese of Paris alone: these included Bourg-le-Reine, Cor-beil,
Saint-Valere, and the sinister Champ-Pourri (Rotten Field); included
also was Charenton. The two largest were in the immediate vicinity
of Paris: Saint-Germain and Saint-Lazare:1 we shall hear their names
again in the history of another sickness. This is because from the
fifteenth century on, all were emptied; in the next century Saint-
Germain became a reformatory for young criminals; and before the
time of Saint Vincent there was only one leper left at Saint-Lazare,
"Sieur Langlois, practitioner in the civil court." The lazar house of
Nancy, which was among the largest in Europe, had only four
inmates during the regency of Marie de Medicis. According to
Catel'sM emoires, there were 29 hospitals in Toulouse at the end of
the medieval period:
seven were leprosariums; but at the beginning of the seventeenth
century we find only three mentioned: Saint-Cyprian, Amaud-
Bernard, and Saint-Michael. It was a pleasure to celebrate the
disappearance of leprosy: in 1635 the inhabitants of Reims formed a
solemn procession to thank God for having delivered their city from
this scourge.
For a century already, royal authority had undertaken the control
and reorganization of the immense fortune represented by the
endowments of the lazar houses; in a decree of December 19, 1543,
Francois I had a census and inventory taken "to remedy the great
disorder that exists at present in the lazar houses"; in his turn, Henri
IV in an edict of 1606 prescribed a revision of their accounts and
allotted "the sums obtained from this investigation to the sustenance
of poor noblemen and crippled soldiers." The same request for
regulation is recorded on October 24, 1612, but the excess revenues
were now to be used for feeding the poor.
In fact, the question of the leprosariums was not seeded in France
before the end of the seventeenth century; and the problem's
economic importance provoked more than one conflict. Were there
not still, in the year 1677, 44 lazar-
(4)
houses in the province of Dauphin alone? On February 20, 1672,
Louis XIV assigned to the Orders of Saint-Lazare and Mont-Camel
the effects of all the military and hospital orders; they were entrusted
with the administration of the lazar houses of the kingdom. Some
twenty years later, the edict of 1672 was revoked, and by a series of
staggered measures from March 1693 to July 1695 the goods of the
lazar houses were thenceforth assigned to other hospitals and
welfare establishments. The few lepers scattered in the 1,200 stillexisting
houses were collected at Saint-Mesmin near Orleans. These
decrees were first applied in Paris, where the Parlement transferred
the revenue in question to the establishments of the Hopital General;
this example was imitated by the provincial authorities; Toulouse
transferred the effects of its lazar houses to the Hopital des
Incurables (1696); those of Beaulieu in Normandy went to the
Hotel-Dieu in Caen; those of Voley were assigned to the Hopital de
Sainte-Foy. Only Saint-Mesmin and the wards of Ganets, near
Bordeaux, remained as a reminder.
England and Scotland alone had opened 220 lazar houses for a
million and a half inhabitants in the twelfth century. But as early as
the fourteenth century they began to empty out; by the time Edward
III ordered an inquiry into the hospital of Ripon—in 1 342— there
were no more lepers; he assigned the institution's effects to the poor.
At the end of the twelfth century, Archbishop Puisel had founded a
hospital in which by 1434 only two beds were reserved for lepers,
should any be found. In 1348, the great leprosarium of Saint Albans
contained only three patients; the hospital of Romenal in Kent was
abandoned twenty-four years later, for lack of lepers. At Chatham,
the lazar house of Saint Bartholomew, established in 1078, had been
one of the most important in England; under Elizabeth, it cared for
only two patients; it was finally closed in 1627.
The same regression of leprosy occurred in Germany, perhaps a
little more slowly; and the same conversion of
(5)
the lazar houses, hastened by the Reformation, which left municipal
administrations in charge of welfare and hospital establishments; this
was the case in Leipzig, in Munich, in Hamburg. In 1542, the effects
of the lazar houses of Schleswig-Holstein were transferred to the
hospitals. In Stuttgart a magistrate's report o f1589 indicates that for
fifty years already there had been no lepers in the house provided for
them. At Lipplingen, the lazar house was soon peopled with
incurables and madmen.
A strange disappearance, which was doubtless not the long-sought
effect of obscure medical practices, but the spontaneous result of
segregation and also the consequence, after the Crusades, of the
break with the Eastern sources of infection. Leprosy withdrew,
leaving derelict these low places and these rites which were
intended, not to suppress it, but to keep it at a sacred distance, to fix
it in an inverse exaltation. What doubtless remained longer than
leprosy, and would persist when the lazar houses had been empty for
years, were the values and images attached to the figure of the leper
as well as the meaning of his exclusion, the social importance of that
insistent and fearful figure which was not driven off without first
being inscribed within a sacred circle.
If the leper was removed from the world, and from the
community of the Church visible, his existence was yet a constant
manifestation of God, since it was a sign both of His anger and of
His grace: "My friend," says the ritual of the Church of Vienne, "it
pleaseth Our Lord that thou shouldst be infected with this malady,
and thou hast great grace at the hands of Our Lord that he desireth to
punish thee for thy iniquities in this world." And at the very moment
when the priest and his assistants drag him out of the church with
backward step, the leper is assured that he still bears witness for
God: "And howsoever thou mayest be apart from the Church and the
company of the Sound, yet art thou not apart from the grace of God."
Brueghel's
(6)
lepers attend at a distance, but forever, that climb to Calvary on
which the entire people accompanies Christ. Hieratic witnesses of
evil, they accomplish their salvation in and by their very exclusion:
in a strange reversibility that is the opposite of good works and
prayer, they are saved by the hand that is not stretched out. The
sinner who abandons the leper at his door opens his way to heaven.
"For which have patience in thy malady; for Our Lord hateth thee
not because of it, keepeth thee not from his company; but if thou
hast patience thou wilt be saved, as was the leper who died before
the gate of the rich man and was carried straight to paradise."
Abandonment is his salvation; his exclusion offers him another form
of communion.
Leprosy disappeared, the leper vanished, or almost, from memory;
these structures remained. Often, in these same places, the formulas
of exclusion would be repeated, strangely similar two or three
centuries later. Poor vagabonds, criminals, and "deranged minds"
would take the part played by the leper, and we shall see what
salvation was expected from this exclusion, for them and for those
who excluded them as well. With an altogether new meaning and in
a very different culture, the forms would remain—essentially that
major form of a rigorous division which is social exclusion but
spiritual reintegration.
Something new appears in the imaginary landscape of the
Renaissance; soon it will occupy a privileged place there: the Ship of
Fools, a strange "drunken boat" that glides along the calm rivers of
the Rhineland and the Flemish canals.
The Narrenschiff, of course, is a literary composition, probably
borrowed from the old Argonaut cycle, one of the great mythic
themes recently revived and rejuvenated, acquiring an institutional
aspect in the Burgundy Estates. Fashion favored the composition of
these Ships, whose
(7)
crew of imaginary heroes, ethical models, or social types embarked
on a great symbolic voyage which would bring them, if not fortune,
then at least the figure of their destiny or their truth. Thus
Symphorien Champier composes a Ship of Princes and Battles of
Nobility in 1502, then a Ship of Virtuous Ladies in 1503; there is also
a Ship of Health, alongside the Blauive Schute of Jacob van
Oestvoren in 1413, Sebastian Brant's Narrenschiff (1494), and the
work of Josse Bade-Stultiferae naviculae scaphae fatuarum
mulierum (1498). Bosch's painting, of course, belongs to this dream
fleet.
But of all these romantic or satiric vessels, the Narrenschiff is the
only one that had a real existence—for they did exist, these boats
that conveyed their insane cargo from town to town. Madmen then
led an easy wandering existence. The towns drove them outside their
limits; they were allowed to wander in the open countryside, when
not entrusted to a group of merchants and pilgrims. The custom was
especially frequent in Germany; in Nuremberg, in the first half of the
fifteenth century, the presence of 63 madmen had been registered; 31
were driven away; in the fifty years that followed, there are records
of 21 more obligatory departures; and these are only the madmen
arrested by the municipal authorities. Frequently they were handed
over to boatmen: in Frankfort, in 1399, seamen were instructed to rid
the city of a madman who walked about the streets naked; in the first
years of the fifteenth century, a criminal madman was expelled in
the same manner from Mainz. Sometimes the sailors disembarked
these bothersome passengers sooner than they had promised; witness
a blacksmith of Frankfort twice expelled and twice returning before
being taken to Kreuznach for good. Often the cities of Europe must
have seen these "ships of fools" approaching their harbors.
It is not easy to discover the exact meaning of this cus-
(8)
tom. One might suppose it was a general means of extradition by
which municipalities sent wandering madmen out of their own
jurisdiction; a hypothesis which will not in itself account for the
facts, since certain madmen, even before special houses were built
for them, were admitted to hospitals and cared for as such; at the
Hotel-Dieu in Paris, their cots were set up in the dormitories.
Moreover, in the majority of the cities of Europe there existed
throughout the Middle Ages and the Renaissance a place of
detention reserved for the insane; there was for example the Chatelet
of Melun or the famous Tour aux Fous in Caen; there were the
numberless Narrtunner of Germany, like the gates of Lubeck or the
Jungpfer of Hamburg. Madmen were thus not invariably expelled.
One might then speculate that among them only foreigners were
driven away, each city agreeing to care for those madmen among its
own citizens. Do we not in fact find among the account books of
certain medieval cities subsidies for madmen or donations made for
the care of the insane? However, the problem is not so simple, for
there existed gathering places where the madmen, more numerous
than elsewhere, were not autoch-thonous. First come the shrines:
Saint-Mathurin de Larchant, Saint-Hildevert de Gournay, Besancon,
Gheel; pilgrimages to these places were organized, often supported,
by cities or hospitals. It is possible that these ships of fools, which
haunted the imagination of the entire early Renaissance, were
pilgrimage boats, highly symbolic cargoes of madmen in search of
their reason: some went down the Rhineland rivers toward Belgium
and Gheel; others sailed up the Rhine toward the Jura and Besancon.
But other cities, like Nuremberg, were certainly not shrines and
yet contained great numbers of madmen-many more, in any case,
than could have been furnished by the city itself. These madmen
were housed and provided for in the city budget, and yet they were
not given treat-
(9)
ment; they were simply thrown into prison. We may suppose that in
certain important cities— centers of travel and markets—madmen
had been brought in considerable numbers by merchants and
mariners and "lost" there, thus ridding their native cities of their
presence. It may have happened that these places of
"counrerpilgrimage" have become confused with the places where,
on the contrary, the insane were taken as pilgrims. Interest in cure
and in exclusion coincide: madmen were confined in the holy locus
of a miracle. It is possible that the village of Gheel developed in this
manner—a shrine that became a ward, a holy land where madness
hoped for deliverance, but where man enacted, according to old
themes, a sort of ritual division.
What matters is that the vagabond madmen, the act of driving
them away, their departure and embarkation do not assume their
entire significance on the plane of social utility or security. Other
meanings much closer to rite are certainly present; and we can still
discern some traces of them. Thus access to churches was denied to
madmen, although ecclesiastical law did not deny them the use of
the sacraments. The Church takes no action against a priest who
goes mad; but in Nuremberg in 1421 a mad priest was expelled with
particular solemnity, as if the impurity was multiplied by the sacred
nature of his person, and the city put on its budget the money given
him as a viaticum. It happened that certain madmen were publicly
whipped, and in the course of a kind of a game they were chased in
a mock race and driven out of the city with quarterstaff blows. So
many signs that the expulsion of madmen had become one of a
number of ritual exiles.
Thus we better understand the curious implication assigned to the
navigation of madmen and the prestige attending it. On the one
hand, we must not minimize its incontestable practical
effectiveness: to hand a madman over to sailors was to be
permanently sure he would not be prowl-
(10)
ing beneath the city walls; it made sure that he would go far away; it
made him a prisoner of his own departure. But water adds to this the
dark mass of its own values; it carries off, but it does more: it
purifies. Navigation delivers man to the uncertainty of fate; on
water, each of us is in the hands of his own destiny; every
embarkation is, potentially, the last. It is for the other world that the
madman sets sail in his fools' boat; it is from the other world that he
comes when he disembarks. The madman's voyage is at once a
rigorous division and an absolute Passage. In one sense, it simply
develops, across a half-real, half-imaginary geography, the
madman'sl iminal position on the horizon of medieval concern—a
position symbolized and made real at the same time by the
madman's privilege of being confined within the city gates: his
exclusion must enclose him; if he cannot and must not have another
prison than the threshold itself, he is kept at the point of passage. He
is put in the interior of the exterior, and inversely. A highly
symbolic position, which will doubtless remain his until our own
day, if we are willing to admit that what was formerly a visible
fortress of order has now become the castle of our conscience.
Water and navigation certainly play this role. Confined on the
ship, from which there is no escape, the madman is delivered to the
river with its thousand arms, the sea with its thousand roads, to that
great uncertainty external to everything. He is a prisoner in the
midst of what is the freest, the openest of routes: bound fast at the
infinite crossroads. He is the Passenger par excellence: that is, the
prisoner of the passage. And the land he will come to is unknown—
as is, once he disembarks, the land from which he comes. He has his
truth and his homeland only in that fruitless expanse between two
countries that cannot belong to him. Is it this ritual and these values
which are at the origin of the long imaginary relationship that can be
traced
(11)
through the whole of Western culture? Or is it, conversely, this
relationship that, from time immemorial, has called into being and
established the rite of embarkation? One thing at least is certain:
water and madness have long been linked in the dreams of European
man.
Already, disguised as a madman, Tristan had ordered boatmen to
land him on the coast of Cornwall. And when he arrived at the castle
of King Mark, no one recognized him, no one knew whence he had
come. But he made too many strange remarks, both familiar and
distant; he knew too well the secrets of the commonplace not to
have been from another, yet nearby, world. He did not come from
the solid land, with its solid cities; but indeed from the ceaseless
unrest of the sea, from those unknown highways which conceal so
much strange knowledge, from that fantastic plain, the underside of
the world. Iseut, first of all, realized that this madman was a son of
the sea, and that insolent sailors had cast him here, a sign of
misfortune: "Accursed be the sailors that brought this madman!
Why did they not throw him into the sea!"2 And more than once in
the course of time, the same theme reappears: among the mystics of
the fifteenth century, it has become the motif of the soul as a skiff,
abandoned on the infinite sea of desires, in the sterile field of cares
and ignorance, among the mirages of knowledge, amid the unreason
of the world—a craft at the mercy of the sea's great madness, unless
it throws out a solid anchor, faith, or raises its spiritual sails so that
the breath of God may bring it to port. At the end of the sixteenth
century, De Lancre sees in the sea the origin of the demoniacal
leanings of an entire people: the hazardous labor of ships,
dependence on the stars, hereditary secrets, estrangement from
women—the very image of the great, turbulent plain itself makes
man lose faith in God and all his attachment to his home; he is then
in the hands of the Devil, in the sea of Satan's ruses8 .In the classical
period,
(12)
the melancholy of the English was easily explained by the influence
of a maritime climate, cold, humidity, the instability of the weather;
all those fine droplets of water that penetrated the channels and
fibers of the human body and made it lose its firmness, predisposed
it to madness. Finally, neglecting an immense literature that
stretches from Ophelia to the Lorelei, let us note only the great halfanthropological,
half-cosmological analyses of Heinroth, which interpret
madness as the manifestation in man of an obscure and
aquatic element, a dark disorder, a moving chaos, the seed and death
of all things, which opposes the mind's luminous and adult stability.
But if the navigation of madmen is linked in the Western mind
with so many immemorial motifs, why, so abruptly, in the fifteenth
century, is the theme suddenly formulated in literature and
iconography? Why does the figure of the Ship of Fools and its
insane crew all at once invade the most familiar landscapes? Why,
from the old union of water and madness, was this ship born one
day, and on just that day?
Because it symbolized a great disquiet, suddenly dawning on the
horizon of European culture at the end of the Middle Ages. Madness
and the madman become major figures, in their ambiguity: menace
and mockery, the dizzying unreason of the world, and the feeble
ridicule of men.
First a whole literature of tales and moral fables, in origin,
doubtless, quite remote. But by the end of the Middle Ages, it bulks
large: a long series of "follies" which, stigmatizing vices and faults
as in the past, no longer attribute them all to pride, to lack of charity,
to neglect of Christian virtues, but to a sort of great unreason for
which nothing, in fact, is exactly responsible, but which involves
everyone in a kind of secret complicity. The denunciation of
madness (la folie) becomes the general form of criticism.
(13)
In farces and soties, the character of the Madman, the Fool, or the
Simpleton assumes more and more importance. He is no longer
simply a ridiculous and familiar silhouette in the wings: he stands
center stage as the guardian of truth-playing here a role which is the
complement and converse of that taken by madness in the tales and
the satires. If folly leads each man into a blindness where he is lost,
the madman, on the contrary, reminds each man of his truth; in a
comedy where each man deceives the other and dupes himself, the
madman is comedy to the second degree: the deception of deception;
he utters, in his simpleton's language which makes no show of
reason, the words of reason that release, in the comic, the comedy:
he speaks love to lovers, the truth of life to the young, the middling
reality of things to the proud, to the insolent, and to liars. Even the
old feasts of fools, so popular in Flanders and northern Europe, were
theatrical events, and organized into social and moral criticism,
whatever they may have contained of spontaneous religious parody.
In learned literature, too. Madness or Folly was at work, at the
very heart of reason and truth. It is Folly which embarks all men
without distinction on its insane ship and binds them to the vocation
of a common odyssey (Van Oestvoren's Blauwe Schute, Brant's
Narrenschiff); it is Folly whose baleful reign Thomas Mumer
conjures up in his Narrenbeschwonmg; it is Folly which gets the best
of Love in Corroz's satireC entre fol amour, or argues with Love as
to which of the two comes first, which of the two makes the other
possible, and triumphs in Louise Labe's dialogue,D ebat de folie et
d'amour. Folly also has its academic pastimes; it is the object of
argument, it contends against itself; it is denounced, and defends
itself by claiming that it is closer to happiness and truth than reason,
that it is closer to reason than reason itself; Jakob Wimpfeling edits
the Monopolium philosophorum, and Judocus Gallus the
(14)
Monopolium et societas, vulgo des lichtschiffs. Finally, at the center
of all these serious games, the great humanist texts: the Moria
rediviva of Flayder and Erasmus'sP raise of Folly. And confronting
all these discussions, with their tireless dialectic, confronting these
discourses constantly reworded and reworked, a long dynasty of
images, from Hieronymus Bosch with The Cure of Madness and
The Ship of Fools, down to Brueghel and his Dulle Griet, woodcuts
and engravings transcribe what the theater, what literature and art
have already taken up: the intermingled themes of the Feast and of
the Dance of Fools. Indeed, from the fifteenth century on, the face of
madness has haunted the imagination of Western man.
A sequence of dates speaks for itself: the Dance of Death in the
Cimetiere des Innocents doubtless dates from the first years of the
fifteenth century, the one in the Chaise-Dieu was probably
composed around 1460; and it was in 1485 that Guyot Marchant
published his Danse macabre. These sixty years, certainly, were
dominated by all this grinning imagery of Death. And it was in 1494
that Brant wrote the Narrenschiff; in 1497 it was translated into
Latin. In the very last years of the century Hieronymus Bosch
painted his Ship of Fools. The Praise of Folly dates from 1509. The
order of succession is clear.
Up to the second half of the fifteenth century, or even a little
beyond, the theme of death reigns alone. The end of man, the end of
time bear the face of pestilence and war. What overhangs human
existence is this conclusion and this order from which nothing
escapes. The presence that threatens even within this world is a
fleshless one. Then in the last years of the century this enormous
uneasiness turns on itself; the mockery of madness replaces death
and its solemnity. From the discovery of that necessity which inevitably
reduces man to nothing, we have shifted to the scornful
contemplation of that nothing which is existence
(15)
itself. Fear in the face of the absolute limit of death turns inward in a
continuous irony; man disarms it in advance, making it an object of
derision by giving it an everyday, tamed form, by constantly
renewing it in the spectacle of life, by scattering it throughout the
vices, the difficulties, and the absurdities of all men. Death's
annihilation is no longer anything because it was already everything,
because life itself was only futility, vain words, a squabble of cap
and bells. The head that will become a skull is already empty.
Madness is the deja-la of death.4 But it is also its vanquished
presence, evaded in those everyday signs which, announcing that
death reigns already, indicate that its prey will be a sorry prize
indeed. What death unmasks was never more than a mask; to
discover the grin of the skeleton, one need only lift off something
that was neither beauty nor truth, but only a plaster and tinsel face.
From the vain mask to the corpse, the same smile persists. But when
the madman laughs, he already laughs with the laugh of death; the
lunatic, anticipating the macabre, has disarmed it. The cries of Dulle
Griet triumph, in the high Renaissance, over that Triumph of Death
sung at the end of the Middle Ages on the walls of the Campo Santo.
The substitution of the theme of madness for that of death does not
mark a break, but rather a torsion within the same anxiety. What is in
question is still the nothingness of existence, but this nothingness is
no longer considered an external, final term, both threat and
conclusion; it is experienced from within as the continuous and
constant form of existence. And where once man's madness had been
not to see that death's term was approaching, so that it was necessary
to recall him to wisdom with the spectacle of death, now wisdom
consisted of denouncing madness everywhere, teaching men that
they were no more than dead men already, and that if the end was
near, it was to the degree that madness, become universal, would be
one
(16)
and the same with death itself. This is what Eustache Desbchamps
prophesies:
We are cowardly and weak, Covetous, old,
evil-tongued. Fools are all I see, in truth.
The end is near, All goes ill . . .
The elements are now reversed. It is no longer the end of time and
of the world which will show retrospectively that men were mad not
to have been prepared for them; it is the tide of madness, its secret
invasion, that shows that the world is near its final catastrophe; it is
man's insanity that invokes and makes necessary the world's end.
In its various forms—plastic or literary—this experience of
madness seems extremely coherent. Painting and text constantly
refer to one another—commentary here and il lustration there. We
find the same theme of the Narrentanz over and over in popular
festivals, in theatrical performances, in engravings and woodcuts,
and the entire last part of the Praise of Folly is constructed on the
model of a long dance of madmen in which each profession and each
estate parades in turn to form the great round of unreason. It is likely
that in Bosch'sT emptation of Saint Anthony in Lisbon, many figures
of the fantastic fauna which invade the canvas are borrowed from
traditional masks; some perhaps are transferred from the Malleus
maleficarum. As for the famous Ship of Fools, is it not a direct
translation of Brant'sN arrenschiff, whose tide it bears, and of which
it seems to illustrate quite precisely canto XXVII, also consecrated to
stigmatizing "drunkards and gluttons"? It has even been suggested
that Bosch's painting was part of a series of pictures illustrating the
principal cantos of Brant's poem.
(17)
As a matter of fact, we must not be misled by what appears to be
a strict continuity in these themes, nor imagine more than is revealed
by history itself. It is unlikely that an analysis like the one Emile
Male worked out for the preceding epochs, especially apropos of the
theme of death, could be repeated. Between word and image,
between what is depicted by language and what is uttered by plastic
form, the unity begins to dissolve; a single and identical meaning is
not immediately common to them. And if it is true that the image
still has the function of speaking, of transmitting something
consubstanrial with language, we must recognize that it already no
longer says the same thing; and that by its own plastic values
painting engages in an experiment that will take it farther and farther
from language, whatever the superficial identity of the theme. Figure
and speech still illustrate the same fable of folly in the same moral
world, but already they take two different directions, indicating, in a
still barely perceptible scission, what will be the great line of
cleavage in the Western experience of madness.
The dawn of madness on the horizon of the Renaissance is first
perceptible in the decay of Gothic symbolism; as if that world,
whose network of spiritual meanings was so close-knit, had begun to
unravel, showing faces whose meaning was no longer clear except in
the forms of madness. The Gothic forms persist for a time, but little
by little they grow silent, cease to speak, to remind, to teach anything
but their own fantastic presence, transcending all possible
language (though still familiar to the eye). Freed from wisdom and
from the teaching that organized it, the image begins to gravitate
about its own madness.
Paradoxically, this liberation derives from a proliferation of
meaning, from a self-multiplication of significance, weaving
relationships so numerous, so intertwined, so rich, that they can no
longer be deciphered except in the esoterism of knowledge. Things
themselves become so burdened
(18)
with attributes, signs, allusions that they finally lose their own form.
Meaning is no longer read in an immediate perception, the figure no
longer speaks for itself; between the knowledge which animates it
and the form into which it is transposed, a gap widens. It is free for
the dream. One book bears witness to meaning's proliferation at the
end of the Gothic world, the Speculum huwanae salvationis, which,
beyond all the correspondences established by the patristic tradition,
elaborates, between the Old and the New Testament, a symbolism
not on the order of Prophecy, but deriving from an equivalence of
imagery. The Passion of Christ is not prefigured only by the sacrifice
of Abraham; it is surrounded by all the glories of torture and its
innumerable dreams; Tubal the blacksmith and Isaiah's wheel take
their places around the Cross, forming beyond all the lessons of the
sacrifice the fantastic tableau of savagery, of tormented bodies, and
of suffering. Thus the image is burdened with supplementary
meanings, and forced to express them. And dreams, madness, the
unreasonable can also slip into this excess of meaning. The symbolic
figures easily become nightmare silhouettes. Witness that old image
of wisdom so often translated, in German engravings, by a longnecked
bird whose thoughts, rising slowly from heart to head, have
time to be weighed and reflected on; a symbol whose values are
blunted by being overemphasized: the long path of reflection
becomes in the image the alembic of a subtle learning, an instrument
which distills quintessences. The neck of the Gutemensch is
endlessly elongated, the better to illustrate, beyond wisdom, all the
real mediations of knowledge; and the symbolic man becomes a
fantastic bird whose disproportionate neck folds a thousand times
upon itself—an insane being, halfway between animal and thing,
closer to the charms of an image than to the rigor of a meaning. This
symbolic wisdom is a prisoner of the madness of dreams.
(19)
A fundamental conversion of the world of images: the constraint
of a multiplied meaning liberates that world from the control of
form. So many diverse meanings are established beneath the surface
of the image that it presents only an enigmatic face. And its power is
no longer to teach but to fascinate. Characteristic is the evolution of
the famous gryllos already familiar to the Middle Ages in the
English psalters, and at Chartres and Bourges. It taught, then, how
the soul of desiring man had become a prisoner of the beast; these
grotesque faces set in the bellies of monsters belonged to the world
of the great Platonic metaphor and denounced the spirit's corruption
in the folly of sin. But in the fifteenth century the gryllos, image of
human madness, becomes one of the preferred figures in the countless
Temptations. What assails the hermit's tranquillity is not objects
of desire, but these hermetic, demented forms which have risen from
a dream, and remain silent and furtive on the surface of a world. In
the Lisbon Temptation, facing Saint Anthony sits one of these
figures born of madness, of its solitude, of its penitence, of its
privations; a wan smile lights this bodiless face, the pure presence of
anxiety in the form of an agile grimace. Now it is exactly this
nightmare silhouette that is at once the subject and object of the
temptation; it is this figure which fascinates the gaze of the ascetic—
both are prisoners of a kind of mirror interrogation, which remains
unanswered in a silence inhabited only by the monstrous swarm that
surrounds them. The gryllos no longer recalls man, by its satiric
form, to his spiritual vocation forgotten in the folly of desire. It is
madness become Temptation; all it embodies of the impossible, the
fantastic, the inhuman, all that suggests the unnatural, the writhing of
an insane presence on the earth's surface-all this is precisely what
gives the gryllos its strange power. The freedom, however
frightening, of his dreams, the hallucinations of his madness, have
more power of attraction
(20)
for fifteenth-century man than the desirable reality of the flesh.
What then is this fascination which now operates through the
images of madness?
First, man finds in these fantastic figures one of the secrets and
one of the vocations of his nature. In the thought of the Middle Ages,
the legions of animals, named once and for all by Adam,
symbolically bear the values of humanity. But at the beginning of
the Renaissance, the relations with animality are reversed; the beast
is set free; it escapes the world of legend and moral illustration to
acquire a fantastic nature of its own. And by an astonishing reversal,
it is now the animal that will stalk man, capture him, and reveal him
to his own truth. Impossible animals, issuing from a demented
imagination, become the secret nature of man; and when on the Last
Day sinful man appears in his hideous nakedness, we see that he has
the monstrous shape of a delirious animal; these are the screech owls
whose toad bodies combine, in Thierry Bouts's Hell, with the
nakedness of the damned; these are Stephan Lochner's winged
insects with cats' heads, sphinxes with beetles' wing cases, birds
whose wings are as disturbing and as avid as hands; this is the great
beast of prey with knotty fingers that figures in Matthias
Grunewald's Temptation. Animality has escaped domestication by
human symbols and values; and it is animality that reveals the dark
rage, the sterile madness that lie in men's hearts.
At the opposite pole to this nature of shadows, madness fascinates
because it is knowledge. It is knowledge, first, because all these
absurd figures are in reality elements of a difficult, hermetic, esoteric
learning. These strange forms are situated, from the first, in the
space of the Great Secret, and the Saint Anthony who is tempted by
them is not a victim of the violence of desire but of the much more
insidious lure of curiosity; he is tempted by that distant and
(21)
intimate knowledge which is offered, and at the same time evaded,
by the smile of the gryllos; his backward movement is nothing but
that step by which he keeps from crossing the forbidden limits of
knowledge; he knows already— and that is his temptation—what
Jerome Cardan will say later: "Wisdom, like other precious
substances, must be torn from the bowels of the earth." This
knowledge, so inaccessible, so formidable, the Fool, in his innocent
idiocy, already possesses. While the man of reason and wisdom
perceives only fragmentary and all the more unnerving images of it,
the Fool bears it intact as an unbroken sphere: that crystal ball which
for all others is empty is in his eyes filled with the density of an
invisible knowledge. Brueghel mocks the sick man who tries to
penetrate this crystal sphere, but it is this iridescent bubble of
knowledge—an absurd but infinitely precious lantern—that sways at
the end of the stick Dulle Griet bears on her shoulder. And it is this
sphere which figures on the reverse of the Garden of Delights.
Another symbol of knowledge, the tree (the forbidden tree, the tree
of promised immortality and of sin), once planted in the heart of the
earthly paradise, has been uprooted and now forms the mast of the
Ship of Fools, as seen in the engraving that illustrates Josse Bade's
Stultiferae naviculae; it is this tree, without a doubt, that sways over
Bosch's Ship of Fools.
What does it presage, this wisdom of fools? Doubtless, since it is
a forbidden wisdom, it presages both the reign of Satan and the end
of the world; ultimate bliss and supreme punishment; omnipotence
on earth and the infernal fall. The Ship of Fools sails through a
landscape of delights, where all is offered to desire, a sort of
renewed paradise, since here man no longer knows either suffering
or need; and yet he has not recovered his innocence. This false happiness
is the diabolical triumph of the Antichrist; it is the
(22)
End, already at hand. Apocalyptic dreams are not new, it is true, in
the fifteenth century; they are, however, very different in nature
from what they had been earlier. The delicately fantastic
iconography of the fourteenth century, where castles are toppled like
dice, where the Beast is always the traditional dragon held at bay by
the Virgin, in short where the order of God and its imminent victory
are always apparent, gives way to a vision of the world where all
wisdom is annihilated. This is the great witches' Sabbath of nature:
mountains melt and become plains, the earth vomits up the dead and
bones tumble out of tombs; the stars fall, the earth catches fire, all
life withers and comes to death. The end has no value as passage and
promise; it is the advent of a night in which the world's old reason is
engulfed. It is enough to look at Durer's Horsemen of the
Apocalypse, sent by God Himself: these are no angels of triumph
and reconciliation; these are no heralds of serene justice, but the
disheveled warriors of a mad vengeance. The world sinks into
universal Fury. Victory is neither God's nor the Devil's: it belongs to
Madness.
On all sides, madness fascinates man. The fantastic images it
generates are not fleeting appearances that quickly disappear from
the surface of things. By a strange paradox, what is born from the
strangest delirium was already hidden, like a secret, like an
inaccessible truth, in the bowels of the earth. When man deploys the
arbitrary nature of his madness, he confronts the dark necessity of
the world; the animal that haunts his nightmares and his nights of
privation is his own nature, which will lay bare hell's pitiless truth;
the vain images of blind idiocy—such are the world's Magna
Scientia; and already, in this disorder, in this mad universe, is
prefigured what will be the cruelty of the finale. In such images—
and this is doubtless what gives them their weight, what imposes
such great coherence on their
(23)
fantasy—the Renaissance has expressed what it appre hended of the
threats and secrets of the world.
During the same period, the literary, philosophical, and moral
themes of madness are in an altogether different vein.
The Middle Ages had given madness, or folly, a place in the
hierarchy of vices. Beginning with the thirteenth century, it is
customarily ranked among the wicked soldiers of the psychomachy.
It figures, at Paris as at Amiens, among the evil soldiery, and is
among the twelve dualities that dispute the sovereignty of the human
soul: Faith and Idolatry, Hope and Despair, Charity and Avarice,
Chastity and Lust, Prudence and Folly, Patience and Anger,
Gentleness and Harshness, Concord and Discord, Obedience and
Rebellion, Perseverance and Inconstancy, Fortitude and Cowardice,
Humility and Pride. In the Renaissance, Folly leaves this modest
place and comes to the fore. Whereas according to Hugues de Saint-
Victor the genealogical tree of the Vices, that of the Old Adam, had
pride as its root. Folly now leads the joyous throng of all human
weaknesses. Uncontested coryphaeus, she guides them, sweeps them
on, and names them: "Recognize them here, in the group of my
companions.... She whose brows are drawn is Philautia (Self-Love).
She whom you see laugh with her eyes and applaud with her hands is
Colacia (Flattery). She who seems half asleep is Lethe
(Forgetfulness). She who leans upon her elbows and folds her hands
is Misoponia (Sloth). She who is crowned with roses and anointed
with perfume is Hedonia (Sensuality). She whose eyes wander
without seeing is Anoia (Stupidity). She whose abundant flesh has
the hue of flowers is Tryphe (Indolence). And here among these
young women are two gods: the god of Good Cheer and the god of
Deep Sleep."5 The absolute privilege of Folly is to reign over
whatever is bad in man. But does she not also reign indirectly over
all the good he can do: over ambition, that makes wise politicians;
over avarice, that
(24)
makes wealth grow; over indiscreet curiosity, that inspires
philosophers and men of learning? Louise Labe merely follows
Erasmus when she has Mercury implore the gods:
"Do not let that beautiful Lady perish who has given you so much
pleasure."
But this new royalty has little in common with the dark reign of
which we were just speaking and which communicated with the
great tragic powers of this world.
True, madness attracts, but it does not fascinate. It rules all that is
easy, joyous, frivolous in the world. It is madness, folly, which
makes men "sport and rejoice," as it has given the gods "Genius,
Beauty, Bacchus, Silenus, and the gentle guardian of gardens."6 All
within it is brilliant surface: no enigma is concealed.
No doubt, madness has something to do with the strange paths of
knowledge. The first canto of Brant's poem is devoted to books and
scholars; and in the engraving which illustrates this passage in the
Latin edition of 1497, we see enthroned upon his bristling cathedra
of books the Magister who wears behind his doctoral cap a fool's cap
sewn with bells. Erasmus, in his dance of fools, reserves a large
place for scholars: after the Grammarians, the Poets, Rhetoricians,
and Writers, come the Jurists; after them, the "Philosophers
respectable in beard and mantle"; finally the numberless troop of the
Theologians. But if knowledge is so important in madness, it is not
because the latter can control the secrets of knowledge; en the
contrary, madness is the punishment of a disorderly and useless
science. If madness is the truth of knowledge, it is because
knowledge is absurd, and instead of addressing itself to the great
book of experience, loses its way in the dust of books and in idle
debate; learning becomes madness through the very excess of false
learning.
O vos doctores, qui grandia nomina. fertis
Respicite antiquos patris, jurisque peritos.
(25)
Non in
candidulis
pensebant
dogmata
libris,
Arte sed
ingenua
sitibundum
pectus
alebant.7
(O ye learned
men, who bear
great names,
Look back at the
ancient fathers,
learned in the law.
They did not
weigh dogmas in
shining white
books,
But fed their
thirsty hearts with
natural skill.)
According to the theme long familiar to popular satire, madness
appears here as the comic punishment of knowledge and its ignorant
presumption.
In a general way, then, madness is not linked to the world and its
subterranean forms, but rather to man, to his weaknesses, dreams,
and illusions. Whatever obscure cosmic manifestation there was in
madness as seen by Bosch is wiped out in Erasmus; madness no
longer lies in wait for mankind at the four comers of the earth; it
insinuates itself within man, or rather it is a subtle rapport that man
maintains with himself. The mythological personification of
madness in Erasmus is only a literary device. In fact, only "follies"
exist—human forms of madness: "I count as many images as there
are men"; one need only glance at states, even the wisest and best
governed: "So many forms of madness abound there, and each day
sees so many new ones born, that a thousand Democrituses would
not suffice to mock them." There is no madness but that which is in
every man, since it is man who constitutes madness in the
attachment he bears for himself and by the illusions he entertains.
Philautia is the first figure Folly leads out in her dance, but that is
because they are linked by a privileged relation: self-attachment is
the first sign of madness, but it is because man is attached to himself
that he accepts error as truth, lies as reality, violence and ugliness as
beauty and justice. "This man, uglier than a monkey, imagines
himself handsome as Nereus; that one thinks he is Euclid because he
has traced three lines with a compass; that other
(26)
one thinks he can sing like Hermogenes, whereas he is the ass before
the lyre, and his voice sounds as false as that of the rooster pecking
his hen." In this delusive attachment to himself, man generates his
madness like a mirage. The symbol of madness will henceforth be
that mirror which, without reflecting anything real, will secretly
offer the man who observes himself in it the dream of his own
presumption. Madness deals not so much with truth and the world,
as with man and whatever truth about himself he is able to perceive.
It thus gives access to a completely moral universe. Evil is not
punishment or the end of time, but only fault and flaw. A hundred
and sixteen cantos of Brant's poem are de voted to portraits of the
insane passengers on the Ship:
there are misers, slanderers, drunkards; there are those who indulge
in disorder and debauchery; those who interpret the Scriptures
falsely; those who practice adultery. Locher, Brant's translator, notes
in his Latin preface the purpose and meaning of the work; it is
concerned to teach "what evil there may be, what good; what vices;
whither virtue, whither error may lead"; and this while castigating,
according to the wickedness each man is guilty of, "the unholy, the
proud, the greedy, the extravagant, the debauched, the voluptuous,
the quick-tempered, the gluttonous, the voracious, the envious, the
poisoners, the faith-breakers" . . . in short, all that man has been able
to invent in the way of irregularities in his conduct.
In the domain of literary and philosophic expression, the
experience of madness in the fifteenth century generally takes the
form of moral satire. Nothing suggests those great threats of
invasion that haunted the imagination of the painters. On the
contrary, great pains are taken to ward it off; one does not speak of
such things. Erasmus turns our gaze from that insanity "which the
Furies let slip from hell, each time they release their serpents"; it is
not these insane
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forms that he has chosen to praise, but the "sweet illusion" that frees
the soul from "its painful cares and returns it to the various forms of
sensuality." This calm world is easily mastered; it readily yields its
naive mysteries to the eyes of the wise man, and the latter, by
laughter, always keeps his distance. Whereas Bosch, Brueghel, and
Diirer were terribly earth-bound spectators, implicated in that
madness they saw surging around them, Erasmus observes it from
far enough away to be out of danger; he observes it from the heights
of his Olympus, and if he sings its praises, it is because he can laugh
at it with the inextinguishable laughter of the Gods. For the madness
of men is a divine spectacle: "In fact, could one make observations
from the Moon, as did Menippus, considering the numberless agitations
of the Earth, one would think one saw a swarm of flies or gnats
fighting among themselves, struggling and laying traps, stealing
from one another, playing, gamboling, falling, and dying, and one
would not believe the troubles, the tragedies that were produced by
such a minute animalcule destined to perish so shortly." Madness is
no longer the familiar foreignness of the world; it is merely a commonplace
spectacle for the foreign spectator; no longer a figure of
the cosmos, but a characteristic of the aevum.
But a new enterprise was being undertaken that would abolish the
tragic experience of madness in a critical consciousness. Let us
ignore this phenomenon for the moment and consider
indiscriminately those figures to be found in Don Quixote as well as
in Scudery's novels, inK ing Lear as well as in the theater of Jean de
Rotrou or Tristan 1'Hermite.
Let us begin with the most important, and the most durable—
since the eighteenth century will still recognize its only just erased
forms: madness by romantic identification. Its features have been
fixed once and for all by Cervantes. But the theme is tirelessly
repeated: direct adaptations (the
(28)
Don Quichotte of Guerin de Bouscal was performed in 1639; two
years later, he staged Le Gouvernement de Sancho Panca),
reinterpretations of a particular episode (Pichou's Les Folies de
Cardenio is a variation on the theme of the "Ragged Knight" of the
Sierra Morena), or, in a more indirect fashion, satire on novels of
fantasy (as in Subligny's La Fausse Clelie, and within the story
itself, as in the episode of Julie d'Arviane). The chimeras are transmitted
from author to reader, but what was fantasy on one side
becomes hallucination on the other; the writer's strata gem is quite
naively accepted as an image of reality. In appearance, this is
nothing but the simple-minded critique of novels of fantasy, but just
under the surface lies an enormous anxiety concerning the
relationships, in a work of art, between the real and the imaginary,
and perhaps also concerning the confused communication between
fantastic invention and the fascinations of delirium. "We owe the
invention of the arts to deranged imaginations; the Caprice of
Painters, Poets, and Musicians is only a name moderated in civility
to express their Madness."8 Madness, in which the values of another
age, another art, another morality are called into question, but which
also reflects—blurred and disturbed, strangely compromised by one
another in a common chimera—all the forms, even the most remote,
of the human imagination.
Immediately following this first form: the madness of vain
presumption. But it is not with a literary model that the madman
identifies; it is with himself, and by means of a delusive attachment
that enables him to grant himself all the qualities, all the virtues or
powers he lacks. He inherits the old Philautia of Erasmus. Poor, he
is rich; ugly, he admires himself; with chains still on his feet, he
takes himself for God. Such a one was Osuma's master of arts who
believed he was Neptune.9 Such is the ridiculous fate of the seven
characters of Desmarets de Saint-Sorlin'sL es Vision-
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naires, of Chateaufort in Cyrano de Bergerac'sL e Pedant joue, of M.
de Richesource in Sir Politik. Measureless madness, which has as
many faces as the world has characters, ambitions, and necessary
illusions. Even in its extremities, this is the least extreme of
madnesses; it is, in the heart of every man, the imaginary relation he
maintains with himself. It engenders the commonest of his faults. To
denounce it is the first and last element of all moral criticism.
To the moral world, also, belongs the madness of just punishment,
which chastises, along with the disorders of the mind, those of the
heart. But it has still other powers: the punishment it inflicts
multiplies by nature insofar as, by punishing itself, it unveils the
truth. The justification of this madness is that it is truthful. Truthful
since the sufferer already experiences, in the vain whirlwind of his
hallucinations, what will for all eternity be the pain of his
punishment: Eraste, in Corneille's Melite, sees himself already
pursued by the Eumenides and condemned by Minos. Truthful, too,
because the crime hidden from all eyes dawns like day in the night of
this strange punishment;
madness, in its wild, untamable words, proclaims its own meaning;
in its chimeras, it utters its secret truth; its cries speak for its
conscience. Thus Lady Macbeth's delirium reveals to those who
"have known what they should not" words long uttered only to "dead
pillows."
Then the last type of madness: that of desperate passion. Love
disappointed in its excess, and especially love deceived by the
fatality of death, has no other recourse but madness. As long as there
was an object, mad love was more love than madness; left to itself, it
pursues itself in the void of delirium. Punishment of a passion too
abjectly abandoned to its violence? No doubt; but this punishment is
also a relief; it spreads, over the irreparable absence, the mercy of
imaginary presences; it recovers, in the paradox of innocent joy or in
the heroism of senseless pursuits, the vanished
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form. If it leads to death, it is a death in which the lovers will never
be separated again. This is Ophelia's last song, this is the delirium of
Ariste in La Folie du sage. But above all, this is the bitter and sweet
madness of King Lear.
In Shakespeare, madness is allied to death and murder; in
Cervantes, images are controlled by the presumption and the
complacencies of the imaginary. These are supreme models whose
imitators deflect and disarm them. Doubtless, both testify more to a
tragic experience of madness appearing in the fifteenth century, than
to a critical and moral experience of Unreason developing in their
own epoch. Outside of time, they establish a link with a meaning
about to be lost, and whose continuity will no longer survive except
in darkness. But it is by comparing their work, and what it maintains,
with the meanings that develop among their contemporaries or
imitators, that we may decipher what is happening, at the beginning
of the seventeenth century, in the literary experience of madness.
In Shakespeare or Cervantes, madness still occupies an extreme
place, in that it is beyond appeal. Nothing ever restores it either to
truth or to reason. It leads only to laceration and thence to death.
Madness, in its vain words, is not vanity; the void that fills it is a
"disease beyond my practice," as the doctor says about Lady
Macbeth; it is already the plenitude of death; a madness that has no
need of a physician, but only of divine mercy. The sweet joy Ophelia
finally regains reconciles her with no happiness;
her mad song is as close to the essential as the "cry of women" that
announces through the corridors of Macbeth's castle that "the Queen
is dead." Certainly Don Quixote's death occurs in a peaceful
landscape, which at the last moment has rejoined reason and truth.
Suddenly the Knight's madness has grown conscious of itself, and in
his own eyes trickles out in nonsense. But is this sudden wisdom of
his folly anything but "a new madness that had
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just come into his head"? The equivocation is endlessly reversible
and cannot be resolved, ultimately, except by death itself. Madness
dissipated can be only the same thing as the imminence of the end;
"and even one of the signs by which they realized that the sick man
was dying, was that he had returned so easily from madness to
reason." But death itself does not bring peace; madness will still
triumph —a truth mockingly eternal, beyond the end of a life which
yet had been delivered from madness by this very end. Ironically,
Don Quixote's insane life pursues and immortalizes him only by his
insanity; madness is still the imperishable life of death: "Here lies the
famous hidalgo who carried valor to such lengths that it was said
death could not triumph over life by his demise."
But very soon, madness leaves these ultimate regions where
Cervantes and Shakespeare had situated it; and in the literature of the
early seventeenth century it occupies, by preference, a median place;
it thus constitutes the knot more than the denouement, the peripity
rather than the final release. Displaced in the economy of narrative
and dramatic structures, it authorizes the manifestation of truth and
the return of reason.
Thus madness is no longer considered in its tragic reality, in the
absolute laceration that gives it access to the other world; but only in
the irony of its illusions. It is not a real punishment, but only the
image of punishment, thus a pretense; it can be linked only to the
appearance of a crime or to the illusion of a death. Though Ariste, in
Tristan 1'Hermite'Lsa Folie du sage, goes mad at the news of his
daughter's death, the fact is that she is not really dead; when Eraste,
in Melite, sees himself pursued by the Eumenides and dragged before
Minos, it is for a double crime which he might have committed,
which he might have wanted to commit, but which in fact has not
occasioned any real death. Madness is deprived of its dramatic
seriousness; it is
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punishment or despair only in the dimension of error. Its dramatic
function exists only insofar as we are concerned with a false drama;
a chimerical form in which only supposed faults, illusory murders,
ephemeral disappearances are involved.
Yet this absence of seriousness does not keep madness from being
essential—even more essential than it had been, for if it brings
illusion to its climax, it is from this point that illusion is undone. In
the madness in which his error has enveloped him, the character
involuntarily begins to unravel the web. Accusing himself, he speaks
the truth in spite of himself. In Melite, for example, all the stratagems
the hero has accumulated to deceive others are turned against
himself, and he becomes their first victim, believing that he is guilty
of the deaths of his rival and his mistress. But in his delirium, he
blames himself for having invented a whole series of love letters; the
truth comes to light, in and through madness, which, provoked by the
illusion of a denouement, actually resolves the real imbroglio of
which it is both cause and effect. To put it another way, madness is
the false punishment of a false solution, but by its own virtue it
brings to light the real problem, which can then be truly resolved. It
conceals beneath error the secret enterprise of truth. It is this function
of madness, both ambiguous and central, that the author of L'Ospital
des fous employs when he portrays a pair of lovers who, to escape
their pursuers, pretend to be mad and hide among madmen;
in a fit of simulated dementia, the girl, who is dressed as a boy,
pretends to believe she is a girl—which she really is— thus uttering,
by the reciprocal neutralization of these two pretenses, the truth
which in the end will triumph.
Madness is the purest, most total form of qui pro quo; it takes the
false for the true, death for life, man for woman, the beloved for the
Erinnys and the victim for Minos. But it is also the most rigorously
necessary form of the qui pro
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quo in the dramatic economy, for it needs no external element to
reach a true resolution. It has merely to carry its illusion to the point
of truth. Thus it is, at the very heart of the structure, in its
mechanical center, both a feigned conclusion, pregnant with a secret
"starting over," and the first step toward what will turn out to be the
reconciliation with reason and truth. It marks the point toward which
converge, apparently, the tragic destinies of the characters, and from
which, in reality, emerge the lines leading to happiness regained. In
madness equilibrium is established, but it masks that equilibrium
beneath the cloud of illusion, beneath feigned disorder; the rigor of
the architecture is concealed beneath the cunning arrangement of
these disordered violences. The sudden bursts of life, the random
gestures and words, the 'wind of madness that suddenly breaks lines,
shatters attitudes, rumples draperies—while the strings are merely
being pulled tighter—this is the very type of ba roque trompe-l'oeil.
Madness is the great trompe-l'oeil in the tragicomic structures of
preclassical literature.
This was understood by Georges de Scudery, who made his
Comedie des comediens a theater of theater, situating his play, from
the start, in the interacting illusions of madness. One group of actors
takes the part of spectators, another that of actors. The former must
pretend to take the decor for reality, the play for life, while in reality
these actors are performing in a real decor; on the other hand, the
latter must pretend to play the part of actors, while in fact, quite
simply, they are actors acting. A double impersonation in which
each element is doubled, thus forming that renewed exchange of the
real and the illusory which is itself the dramatic meaning of
madness. "I do not know," Mondory says in the prologue to
Scudery's play, "what extravagance has today come over my
companions, but it is so great that I am forced to believe that some
spell has robbed them of their reason, and the worst of it is that they
(34)
are trying to make me lose mine, and you yours as well. They wish
to persuade me that I am not on a stage, that this is the city of Lyons,
that over there is an inn, and there an innyard where actors who are
not ourselves, yet who are, are performing a Pastoral." In this
extravaganza, the theater develops its truth, which is illusion. Which
is, in the strict sense, madness.
The classical experience of madness is born. The great threat that
dawned on the horizon of the fifteenth century subsides, the
disturbing powers that inhabit Bosch's painint g have lost their
violence. Forms remain, now transparent and docile, forming a
cortege, the inevitable procession of reason. Madness has ceased to
be—at the limits of the world, of man and death—an eschatological
figure; the darkness has dispersed on which the eyes of madness
were fixed and out of which the forms of the impossible were bom.
Oblivion falls upon the world navigated by the free slaves of the
Ship of Fools. Madness will no longer proceed from a point within
the world to a point beyond, on its strange voyage; it will never
again be that fugitive and absolute limit. Behold it moored now,
made fast among things and men. Retained and maintained. No
longer a ship but a hospital.
Scarcely a century after the career of the mad ships, we note the
appearance of the theme of the "Hospital of Madmen," the
"Madhouse." Here every empty head, fixed and classified according
to the true reason of men, utters contradiction and irony, the double
language of Wisdom:
". . . the Hospital of incurable Madmen, where are recited from end
to end all the follies and fevers of the mind, by men as well as
women, a task no less useful than enjoyable, and necessary for the
acquisition of true wisdom." 10 Here each form of madness finds its
proper place, its distinguishing mark, and its tutelary divinity:
frenzied and ranting
(35)
madness, symbolized by a fool astride a chair, straggles beneath
Minerva's gaze; the somber melancholies that roam the countryside,
solitary and avid wolves, have as their god Jupiter, patron of animal
metamorphoses; then come the "mad drunkards," the "madmen
deprived of memory and understanding," the "madmen benumbed
and half-dead," the "madmen of giddy and empty heads" ... All this
world of disorder, in perfect order, pronounces, each in his turn, the
Praise of Reason. Already, in this "Hospital," confinement has
succeeded embarkation.
Tamed, madness preserves all the appearances of its reign. It now
takes part in the measures of reason and in the labor of truth. It plays
on the surface of things and in the glitter of daylight, over all the
workings of appearances, over the ambiguity of reality and illusion,
over all that indeterminate web, ever rewoven and broken, which
both unites and separates truth and appearance. It hides and
manifests, it utters truth and falsehood, it is light and shadow. It
shimmers, a central and indulgent figure, already precarious in this
baroque age.
Let us not be surprised to come upon it so often in the fictions of
the novel and the theater. Let us not be surprised to find it actually
prowling through the streets. Thousands of times, Francois Colletet
has met it there:
I see, in this thoroughfare,
A natural, followed by children.
. . . Consider this unhappy wretch;
Poor mad fool, what will he do
With so many rags and tatters? . . .
I have seen such wild lunatics
Shouting insults in the streets . . .
Madness traces a very familiar silhouette in the social landscape.
A new and lively pleasure is taken in the old confraternities of
madmen, in their festivals, their gather-
(36)
ings, their speeches. Men argue passionately for or against Nicolas
Joubert, better known by the name of Angoulevent, who declares
himself Prince of Fools, a tide disputed by Valenti le Comte and
Jacques Resneau: there follow pamphlets, a trial, arguments; his
lawyer declares and certifies him to be "an empty head, a gutted
gourd, lacking in common sense; a cane, a broken brain, that has
neither spring nor whole wheel in his head." Bluet d' Arberes, who
calls himself Comte de Permission, is a protege of the Crequis, the
Lesdiguieres, the Bouillons, the Nemours; in 1602 he publishes—or
someone publishes for him—his works, in which he warns the
reader that "he does not know how to read or write, and has never
learned," but that he is animated "by the inspiration of God and the
Angels." Pierre Dupuis, whom Regnier mentions in his sixth satire,
is, according to Brascambille, "an archfool in a long robe"; he
himself in his "Remontrance sur le reveil de Mattre Guillaume"
states that he has "a mind elevated as far as the antechamber of the
third degree of the moon." And many other characters present in
Regnier's fourteenth satire.
This world of the early seventeenth century is strangely
hospitable, in all senses, to madness. Madness is here, at the heart of
things and of men, an ironic sign that misplaces the guideposts
between the real and the chimerical, barely retaining the memory of
the great tragic threats—a life more disturbed than disturbing, an
absurd agitation in society, the mobility of reason.
But new requirements are being generated:
A hundred and a hundred times have I taken up my lantern,
Seeking, at high noon . . ,11
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II
THE GREAT CONFINEMENT
Compelle intrare.
BY a strange act of force, the classical age was to reduce to silence
the madness whose voices the Renaissance had just liberated, but
whose violence it had already tamed.
It is common knowledge that the seventeenth century created
enormous houses of confinement; it is less commonly known that
more than one out of every hundred inhabitants of the city of Paris
found themselves confined there, within several months. It is
common knowledge that absolute power made use of lettres de
cachet and arbitrary measures of imprisonment; what is less familiar
is the judicial conscience that could inspire such practices. Since
Pinel, Tuke, Wagnitz, we know that madmen were subjected to the
regime of this confinement for a century and a half, and that they
would one day be discovered in the
wards of the Hopital General, in the cells of prisons; they would
be found mingled with the population of the workhouses or
Zuchthausern. But it has rarely been made clear what their status
was there, what the meaning was of this proximity which seemed to
assign the same homeland to the poor, to the unemployed, to
prisoners, and to the insane. It is within the walls of confinement
that Pinel and nineteenth-century psychiatry would come upon
madmen; it is there —let us remember—that they would leave them,
not without boasting of having "delivered" them. From the middle
of the seventeenth century, madness was linked with this country of
confinement, and with the act which designated confinement as its
natural abode.
A date can serve as a landmark: 1656, the decree that founded, in
Paris, the Hopital General. At first glance, this is merely a reform—
little more than an administrative reorganization. Several already
existing establishments are grouped under a single administration:
the Salpetriere, rebuilt under the preceding reign to house an
arsenal; Bicetre, which Louis XIII had wanted to give to the
Commandery of Saint Louis as a rest home for military invalids;
"the House and the Hospital of La Pitie, the larger as well as the
smaller, those of Le Refuge, situated in the Faubourg Saint-Victor,
the House and Hospital of Scipion, the House of La Savonnerie,
with all the lands, places, gardens, houses, and buildings thereto
appertaining."1 All were now assigned to the poor of Paris "of both
sexes, of all ages and from all localities, of whatever breeding and
birth, in whatever state they may be, able-bodied or invalid, sick or
convalescent, curable or incurable." These establishments had to
accept, lodge, and feed those who presented themselves or those
sent by royal or judicial authority; it was also necessary to assure the
subsistence, the appearance, and the general order of those who
could not find room, but who might or who deserved to be there.
This responsibility was
entrusted to directors appointed for life, who exercised their
powers, not only in the buildings of the Hopital but throughout the
city of Paris, over all those who came under their jurisdiction: "They
have all power of authority, of direction, of administration, of
commerce, of police, of jurisdiction, of correction and punishment
over all the poor of Paris, both within and without the Hopital
General." The directors also appointed a doctor at a salary of one
thousand livres a year; he was to reside at La Pitie, but had to visit
each of the houses of the Hopital twice a week.
From the very start, one thing is clear: the Hopital General is not
a medical establishment. It is rather a sort of semijudicial structure,
an administrative entity which, along with the already constituted
powers, and outside of the courts, decides, judges, and executes.
"The directors having for these purposes stakes, irons, prisons, and
dungeons in the said Hopital General and the places thereto
appertaining so much as they deem necessary, no appeal will be
accepted from the regulations they establish within the said hospital;
and as for such regulations as intervene from without, they will be
executed according to their form and tenor, notwithstanding
opposition or whatsoever appeal made or to be made, and without
prejudice to these, and for which, notwithstanding all defense or
suits for justice, no distinction will be made."2 A quasi-absolute
sovereignty, jurisdiction without appeal, a writ of execution against
which nothing can prevail—the Hopital General is a strange power
that the King establishes between the police and the courts, at the
limits of the law: a third order of repression. The insane whom Pinel
would find at Bicetre and at La Salpetriere belonged to this world.
In its functioning, or in its purpose, the Hopital General had
nothing to do with any medical concept. It was an instance of order,
of the monarchical and bourgeois order being organized in France
during this period. It was di-
(40)
rectly linked with the royal power which placed it under the
authority of the civil government alone; the Grand Almonry of the
Realm, which previously formed an ecclesiastical and spiritual
mediation in the politics of assistance, was abruptly elided. The King
decreed: "We choose to be guardian and protector of the said Hopital
General as being of our royal founding and especially as it does not
depend in any manner whatsoever upon our Grand Almonry, nor
upon any of our high officers, but is to be totally exempt from the
direction, visitation, and jurisdiction of the officers of the General
Reform and others of the Grand Almonry, and from all others to
whom we forbid all knowledge and jurisdiction in any fashion or
manner whatsoever." The origin of the project had been
parliamentary, and the first two administrative heads appointed were
the first President of the Parlement and the Procurator General. But
they were soon supplemented by the Archbishop of Paris, the
President of the Court of Assistance, the President of the Court of
Exchequer, the Chief of Police, and the Provost of Merchants.
Henceforth the "Grand Bureau" had no more than a deliberative role.
The actual administration and the real responsibilities were entrusted
to agents recruited by co-optation. These were the true governors,
the delegates of royal power and bourgeois fortune to the world of
poverty. The Revolution was able to give them this testimony:
"Chosen from the best families of the bourgeoisie, . . . they brought
to their administration disinterested views and pure intentions."3
This structure proper to the monarchical and bourgeois order of
France, contemporary with its organization in absolutist forms, soon
extended its network over the whole of France. An edict of the King,
dated June 16, 1676, prescribed the establishment of an "hopital
general in each city of his kingdom." Occasionally the measure had
been anticipated by the local authorities; the bourgeoisie of Lyons
(41)
had already organized in 1612 a charity establishment that
functioned in an analogous manner. The Archbishop of Tours was
proud to declare on July 10, 1676, that his "archepiscopal city has
happily foreseen the pious intentions of the King and erected an
hopital general called La Charite even before the one in Paris,
whose order has served as a model for all those subsequently
established, within or outside the kingdom." The Charite of Tours, in
fact, had been founded in 1656, and the King had endowed it with
an income of four thousand livres. Over the entire face of France,
hopitaux generaux were opened; on the eve of the Revolution, they
were to be found in thirty-two provincial cities.
Even if it had been deliberately excluded from the organization of
the hopitaux generaux—by complicity, doubtless, between royal
power and bourgeoisie—the Church nonetheless did not remain a
stranger to the movement. It reformed its own hospital institutions,
redistributed the wealth of its foundations, even created congregations
whose purposes were rather analogous to those of the Hopital
General. Vincent de Paul reorganized Saint-Lazare, the most
important of the former lazar houses of Paris; on January 7, 1632, he
signed a contract in the name of the Congregationists of the Mission
with the "Priory" of Saint-Lazare, which was now to receive
"persons detained by order of His Majesty." The Order of Good
Sons opened hospitals of this nature in the north of France. The
Brothers of Saint John of God, called into France in 1602, founded
first the Charite of Paris in the Faubourg Saint-Germain, then
Charenton, into which they moved on May 10, 1645. Not far from
Paris, they also operated the Charite of Senlis, which opened on
October 27, 1670. Some years before, the Duchess of Bouillon had
donated them the buildings and benefices of La Maladrerie, founded
in the fourteenth century by Thibaut de Champagne, at Chateau-
(42)
Thierry. They administered also the Charites of Saint-Yon,
Pontorson, Cadillac, and Romans. In 1699, the Lazarists founded in
Marseilles the establishment that was to become the Hopital Saint-
Pierre. Then, in the eighteenth century, came Armentieres (1712),
Mareville (1714), the Good Savior of Caen (1735); Saint-Meins of
Rennes opened shortly before the Revolution (1780).
The phenomenon has European dimensions. The constitution of
an absolute monarchy and the intense Catholic renaissance during
the Counter-Reformation produced in France a very particular
character of simultaneous competition and complicity between the
government and the Church. Elsewhere it assumed quite different
forms; but its localization in time was just as precise. The great
hospitals, houses of confinement, establishments of religion and
public order, of assistance and punishment, of governmental charity
and welfare measures, are a phenomenon of the classical period: as
universal as itself and almost contemporary with its birth. In
German-speaking countries, it was marked by the creation of houses
of correction, the Zucht-hausern; the first antedates the French
houses of confinement (except for the Charite of Lyons); it opened
in Hamburg around 1620. The others were founded in the second
half of the century: Basel (1667), Breslau (1668), Frankfort (1684),
Spandau (1684), Konigsberg (1691). They continued to multiply in
the eighteenth century; Leipzig first in 1701, then Halle and Cassel
in 1717 and 1720, later Brieg and Osnabruck (1756), and finally
Torgau in 1771.
In England the origins of confinement are more remote. An act of
1575 covering both "the punishment of vagabonds and the relief of
the poor" prescribed the construction of houses of correction, to
number at least one per county. Their upkeep was to be assured by a
tax, but the public was encouraged to make voluntary donations. It
ap-
(43)
pears, however, that in this form the measure was scarcely ever
applied, since, some years later, it was decided to authorize private
enterprise: it was no longer necessary to obtain an official permit to
open a hospital or a house of correction; anyone who pleased might
do so. At the beginning of the seventeenth century, a general
reorganization: a fine of five pounds was imposed on any justice of
the peace who had not established one in the area of his jurisdiction;
the houses were to install trades, workshops, and factories (milling,
spinning, weaving) to aid in their upkeep and assure their inmates of
work; a judge was to decide who was qualified to be sent there. The
development of these "bridewells" was not too considerable; often
they were gradually absorbed by the prisons to which they were
attached; the practice never spread as far as Scotland. On the other
hand, the workhouses were destined to greater success. They date
from the second half of the seventeenth century. An act of 1670
defined their status, appointed officers of justice to oversee the
collection of taxes and the administration of sums that would permit
their functioning, and entrusted the supreme control of their
administration to a justice of the peace. In 1697 several parishes of
Bristol united to form the first workhouse in England, and to
designate the corporation that would administer it. Another was
established at Worcester in 1703, a third the same year at Dublin;
then at Plymouth, Norwich, Hull, and Exeter. By the end of the
eighteenth century, there were 126 of them. The Gilbert Act of 1792
gives the parishes facilities to create new ones;
at the same time, the control and authority of the justice of the
peace is reinforced; to keep the workhouses from becoming
hospitals, it is recommended that all contagious invalids be turned
away.
In several years, an entire network had spread across Europe.
John Howard, at the end of the eighteenth century, undertook to
investigate it; in England, Holland, Germany,
(44)
France, Italy, Spain, he made pilgrimages to all the chief centers
of confinement—"hospitals, prisons, jails"—and his philanthropy
was outraged by the fact that the same walls could contain those
condemned by common law, young men who disturbed their
families' peace or who squandered their goods, people without
profession, and the insane. Proof that even at this period, a certain
meaning had been lost: that which had so hastily, so spontaneously
summoned into being all over Europe the category of classical order
we call confinement. In a hundred and fifty years, confinement had
become the abusive amalgam of heterogeneous elements. Yet at its
origin, there must have existed a unity which justified its urgency;
between these diverse forms and the classical period that called
them into being, there must have been a principle of cohesion we
cannot evade under the scandal of pre-Revolutionary sensibility.
What, then, was the reality represented by this entire population
which almost overnight found itself shut up, excluded more severely
than the lepers? We must not forget that a few years after its
foundation, the Hopital General of Paris alone contained six
thousand persons, or around one per cent of the population. There
must have formed, silently and doubtless over the course of many
years, a social sensibility, common to European culture, that
suddenly began to manifest itself in the second half of the
seventeenth century; it was this sensibility that suddenly isolated the
category destined to populate the places of confinement. To inhabit
the reaches long since abandoned by the lepers, they chose a group
that to our eyes is strangely mixed and confused. But what is for us
merely an undifferentiated sensibility must have been, for those
living in the classical age, a clearly articulated perception. It is this
mode of perception which we must investigate in order to discover
the form of sensibility to madness in an epoch we are accustomed to
define by the privileges of Reason. The act
(45)
which, by tracing the locus of confinement, conferred upon it its
power of segregation and provided a new homeland for madness,
though it may be coherent and concerted, is not simple. It organizes
into a complex unity a new sensibility to poverty and to the duties of
assistance, new forms of reaction to the economic problems of
unemployment and idleness, a new ethic of work, and also the dream
of a city where moral obligation was joined to civil law, within the
authoritarian forms of constraint. Obscurely, these themes are
present during the construction of the cities of confinement and their
organization. They give a meaning to this ritual, and explain in part
the mode in which madness was perceived, and experienced, by the
classical age.
Confinement, that massive phenomenon, the signs of which are
found all across eighteenth-century Europe, is a "police" matter.
Police, in the precise sense that the classical epoch gave to it—that
is, the totality of measures which make work possible and necessary
for all those who could not live without it; the question Voltaire
would soon formulate, Colbert's contemporaries had already asked:
"Since you have established yourselves as a people, have you not
yet discovered the secret of forcing all the rich to make all the poor
work? Are you still ignorant of the first principles of the police?"
Before having the medical meaning we give it, or that at least we
like to suppose it has, confinement was required by something quite
different from any concern with curing the sick. What made it
necessary was an imperative of labor. Our philanthropy prefers to
recognize the signs of a benevolence toward sickness where there is
only a condemnation of idleness.
Let us return to the first moments of the "Confinement," and to
that royal edict of April 27, 1656, that led to the
(46)
creation of the Hopital General. From the beginning, the
institution set itself the task of preventing "mendicancy and idleness
as the source of all disorders." In fact, this was the last of the great
measures that had been taken since the Renaissance to put an end to
unemployment or at least to begging.4 In 1532, the Parlement of
Paris decided to arrest beggars and force them to work in the sewers
of the city, chained in pairs. The situation soon reached critical proportions:
on March 23, 1534, the order was given "to poor scholars
and indigenes" to leave the city, while it was forbidden "henceforth
to sing hymns before images in the streets." The wars of religion
multiplied this suspect crowd, which included peasants driven from
their farms, disbanded soldiers or deserters, unemployed workers,
impoverished students, and the sick. When Henri IV began the siege
of Paris, the city, which had less than 100,000 inhabitants, contained
more than 30,000 beggars. An economic revival began early in the
seventeenth century; it was decided to reabsorb by force the
unemployed who had not regained a place in society; a decree of the
Parlement dated 1606 ordered the beggars of Paris to be whipped in
the public square, branded on the shoulder, shorn, and then driven
from the city; to keep them from returning, an ordinance of 1607
established companies of archers at all the city gates to forbid entry
to indigents. When the effects of the economic renaissance
disappeared with the Thirty Years' War, the problems of mendicancy
and idleness reappeared; until the middle of the century, the regular
increase of taxes hindered manufactures and augmented
unemployment. This was the period of uprisings in Paris (1621), in
Lyons (1652), in Rouen (1639). At the same time, the world of labor
was disorganized by the appearance of new economic structures; as
the large manufactories developed, the guilds lost their powers and
their rights, the "General Regulations" prohibited all as-
(47)
semblies of workers, all leagues, all "associations." In many
professions, however, the guilds were reconstituted. They were
prosecuted, but it seems that the Parlements showed a certain apathy;
the Parlement of Normandy disclaimed all competence to judge the
rioters of Rouen. This is doubtless why the Church intervened and
accused the workers' secret gatherings of sorcery. A decree of the
Sorbonne, in 1655, proclaimed "guilty of sacrilege and mortal sin"
all those who were found in such bad company.
In this silent conflict that opposed the severity of the Church to
the indulgence of the Parlements, the creation of the Hopital was
certainly, at least in the beginning, a victory for the Parlement. It
was, in any case, a new solution. For the first time, purely negative
measures of exclusion were replaced by a measure of confinement;
the unemployed person was no longer driven away or punished; he
was taken in charge, at the expense of the nation but at the cost of
his individual liberty. Between him and society, an implicit system
of obligation was established: he had the right to be fed, but he must
accept the physical and moral constraint of confinement.
It is this entire, rather undifferentiated mass at which the edict of
1657 is aimed: a population without resources, without social
moorings, a class rejected or rendered mobile by new economic
developments. Less than two weeks after it was signed, the edict was
read and proclaimed in the streets. Paragraph 9: "We expressly
prohibit and forbid all persons of either sex, of any locality and of
any age, of whatever breeding and birth, and in whatever condition
they may be, able-bodied or invalid, sick or convalescent, curable or
incurable, to beg in the city and suburbs of Paris, neither in the
churches, nor at the doors of such, nor at the doors of houses nor in
the streets, nor anywhere else in public, nor in secret, by day or
night... under pain of being whipped for the first offense, and for the
second
(48)
condemned to the galleys if men and boys, banished if women
and girls." The year after—Sunday, May 13, 1657 —a high mass in
honor of the Holy Ghost was sung at the Church of Saint-Louis de la
Pitie, and on the morning of Monday the fourteenth, the militia,
which was to become, in the mythology of popular terror, "the
archers of the Hopital," began to hunt down beggars and herd them
into the different buildings of the Hopital. Four years later. La
Salpetriere housed 1,460 women and small children; at La Pitie there
were 98 boys, 897 girls between seven and seventeen, and 95
women; at Bicetre, 1,615 adult men; at La Savonnerie, 305 boys
between eight and thirteen; finally, Scipion lodged 530 pregnant
women, nursing women, and very young children. Initially, married
people, even in need, were not admitted; the administration was
instructed to feed them at home; but soon, thanks to a grant from
Mazarin, it was possible to lodge them at La Salpetriere. In all,
between five and six thousand persons.
Throughout Europe, confinement had the same meaning, at least
if we consider its origin. It constituted one of the answers the
seventeenth century gave to an economic crisis that affected the
entire Western world: reduction of wages, unemployment, scarcity
of coin—the coincidence of these phenomena probably being due to
a crisis in the Spanish economy. Even England, of all the countries
of Western Europe the least dependent on the system, had to solve
the same problems. Despite all the measures taken to avoid
unemployment and the reduction of wages, poverty continued to
spread in the nation. In 1622 appeared a pamphlet, Grievous Groan
for the Poor, attributed to Thomas Dekker, which, emphasizing the
danger, condemns the general negligence: "Though the number of
the poor do daily increase, all things yet worketh for the worst in
their behalf; . . . many of these parishes turneth forth their poor, yea,
and their lusty labourers that will not
(49)
work ... to beg, filch, and steal for their maintenance, so that the
country is pitifully pestered with them." It was feared that they
would overrun the country, and since they could not, as on the
Continent, cross the border into another nation, it was proposed that
they be "banished and conveyed to the New-found Land, the East
and West Indies." In 1630, the King established a commission to
assure the rigorous observance of the Poor Laws. That same year, it
published a series of "orders and directions"; it recommended
prosecuting beggars and vagabonds, as well as "all those who live in
idleness and will not work for reasonable wages or who spend what
they have in taverns." They must be punished according to law and
placed in houses of correction; as for those with wives and children,
investigation must be made as to whether they were married and
their children baptized, "for these people live like savages without
being married, nor buried, nor baptized; and it is this licentious
liberty which causes so many to rejoice in vagabondage." Despite
the recovery that began in England in the middle of the century, the
problem was still unsolved in Cromwell's time, for the Lord Mayor
complains of "this vermin that troops about the city, disturbing
public order, assaulting carriages, demanding alms with loud cries at
the doors of churches and private houses."
For a long time, the house of correction or the premises of the
Hopital General would serve to contain the unemployed, the idle,
and vagabonds. Each time a crisis occurred and the number of the
poor sharply increased, the houses of confinement regained, at least
for a time, their initial economic significance. In the middle of the
eighteenth century, there was another great crisis: 12,000 begging
workers at Rouen and as many at Tours; at Lyons the manufactories
closed. The Count d'Argenson, "who commands the department of
Paris and the marshalseas," gave orders "to arrest all the beggars of
the kingdom; the marshalseas will
(50)
perform this task in the countryside, while the same thing is done
in Paris, whither they are sure not to return, being entrapped on all
sides."
But outside of the periods of crisis, confinement acquired another
meaning. Its repressive function was combined with a new use. It
was no longer merely a question of confining those out of work, but
of giving work to those who had been confined and thus making
them contribute to the prosperity of all. The alternation is clear:
cheap manpower in the periods of full employment and high
salaries; and in periods of unemployment, reabsorption of the idle
and social protection against agitation and uprisings. Let us not
forget that the first houses of confinement appear in England in the
most industrialized parts of the country: Worcester, Norwich,
Bristol; that the first hopital general was opened in Lyons, forty
years before that of Paris; that Hamburg was the first German city to
have its Zuchthaus, in 1620. Its regulations, published in 1622, were
quite precise. The internees must all work. Exact record was kept of
the value of their work, and they were paid a fourth of it. For work
was not only an occupation; it must be productive. The eight
directors of the house established a general plan. The Werkmeister
assigned a task to each, and ascertained at the end of the week that it
had been accomplished. The rule of work would remain in effect
until the end of the eighteenth century, since John Howard could
still attest that they were "knitting and spinning; weaving stockings,
linen, hair, and wool—and rasping logwood and hartshorn. The
quota of a robust man who shreds such wood is forty-five pounds a
day. Some men and horses labour at a fulling-mill. A blacksmith
works there without cease." Each house of confinement in Germany
had its specialty: spinning was paramount in Bremen, Brunswick,
Munich, Breslau, Berlin; weaving in Hanover. The men shredded
wood in Bremen and Hamburg. In Nuremberg
(51)
they polished optical glass; at Mainz the principal labor was the
milling of flour.
The first houses of correction were opened in England during a
full economic recession. The act of 1610 recommended only joining
certain mills and weaving and carding shops to all houses of
correction in order to occupy the pensioners. But what had been a
moral requirement became an economic tactic when commerce and
industry recovered after 1651, the economic situation having been
re-established by the Navigation Act and the lowering of the discount
rate. All able-bodied manpower was to be used to the best
advantage, that is, as cheaply as possible. When John Carey
established his workhouse project in Bristol, he ranked the need for
work first: "The poor of both sexes . . . may be employed in beating
hemp, dressing and spinning flax, or in carding wool and cotton." At
Worcester, they manufactured clothes and stuffs; a workshop for
children was established. All of which did not always proceed
without difficulties. It was suggested that the workhouses might
enter the local industries and markets, on the principle perhaps that
such cheap production would have a regulatory effect on the sale
price. But the manufactories protested. Daniel Defoe noticed that by
the effect of the too easy competition of the workhouses, poverty
was created in one area on the pretext of suppressing it in another;
"it is giving to one what you take away from another; putting a
vagabond in an honest man's employment, and putting diligence on
the tenters to find out some other work to maintain his family."
Faced with this danger of competition, the authorities let the work
gradually disappear. The pensioners could no longer earn even
enough to pay for their upkeep; at times it was necessary to put them
in prison so that they might at least have free bread. As for the
bridewells, as Howard attested, there were few "in which any work
is done, or can be done. The prisoners
(52)
have neither tools, nor materials of any kind: but spend their time
in sloth, profaneness and debauchery."
When the Hopital General was created in Paris, it was intended
above all to suppress beggary, rather than to provide an occupation
for the internees. It seems, however, that Colbert, like his English
contemporaries, regarded assistance through work as both a remedy
to unemployment and a stimulus to the development of
manufactories. In any case, in the provinces the directors were to see
that the houses of charity had a certain economic significance. "All
the poor who are capable of working must, upon work days, do what
is necessary to avoid idleness, which is the mother of all evils, as
well as to accustom them to honest toil and also to earning some part
of their sustenance."
Sometimes there were even arrangements which permitted private
entrepreneurs to utilize the manpower of the asylums for their own
profit. It was stipulated, for example, according to an agreement
made in 1708, that an entrepreneur should furnish the Charite of
Tulle with wool, soap, and coal, and in return the establishment
would re-deliver the wool carded and spun. The profit was divided
between the entrepreneur and the hospital. Even in Paris, several
attempts were made to transform the buildings of the Hopital
General into factories. If we can believe the author of an anonymous
memoire that appeared in 1790, at La Pitie "all the varieties of
manufacture that could be offered to the capital" were attempted;
finally, "in a kind of despair, a manufacture was undertaken of a sort
of lacing found to be the least costly." Elsewhere, such efforts were
scarcely more fruitful. Numerous efforts were made at Bicetre:
manufacture of thread and rope, mirror polishing, and especially the
famous "great well." An attempt was even made, in 1781, to
substitute teams of prisoners for the horses that brought up the
water, in relay from five in the morning to eight at night: "What
reason could have
(53)
determined this strange occupation? Was it that of economy or
simply the necessity of busying the prisoners? If the latter, would it
not have been better to occupy them with work more useful both for
them and for the hospital? If for reasons of economy, we are a long
way from finding any."6 During the entire eighteenth century, the
economic significance Colbert wanted to give the Hopital General
continued to recede; that center of forced labor would become a
place of privileged idleness. "What is the source of the disorders at
Bicetre?" the men of the Revolution were again to ask. And they
would supply the answer that had already been given in the
seventeenth century: "It is idleness. What is the means of remedying
it? Work."
The classical age used confinement in an equivocal manner,
making it play a double role: to reabsorb unemployment, or at least
eliminate its most visible social effects, and to control costs when
they seemed likely to become too high; to act alternately on the
manpower market and on the cost of production. As it turned out, it
does not seem that the houses of confinement were able to play
effectively the double role that was expected of them. If they
absorbed the unemployed, it was mostly to mask their poverty, and
to avoid the social or political disadvantages of agitation; but at the
very moment the unemployed were herded into forced-labor shops,
unemployment increased in neighboring regions or in similar areas.
As for the effect on production costs, it could only be artificial, the
market price of such products being disproportionate to the cost of
manufacture, calculated according to the expenses occasioned by
confinement itself.
Measured by their functional value alone, the creation of the
houses of confinement can be regarded as a failure. Their
disappearance throughout Europe, at the beginning of the nineteenth
century, as receiving centers for the in-
(54)
digent and prisons of poverty, was to sanction their ultimate
failure: a transitory and ineffectual remedy, a social precaution
clumsily formulated by a nascent industrialization. And yet, in this
very failure, the classical period conducted an irreducible
experiment. What appears to us today as a clumsy dialectic of
production and prices then possessed its real meaning as a certain
ethical consciousness of labor, in which the difficulties of the
economic mechanisms lost their urgency in favor of an affirmation
of value.
In this first phase of the industrial world, labor did not seem
linked to the problems it was to provoke; it was regarded, on the
contrary, as a general solution, an infallible panacea, a remedy to all
forms of poverty. Labor and poverty were located in a simple
opposition, in inverse proportion to each other. As for that power, its
special characteristic, of abolishing poverty, labor—according to the
classical interpretation—possessed it not so much by its produc tive
capacity as by a certain force of moral enchantment. Labor's
effectiveness was acknowledged because it was based on an ethical
transcendence. Since the Fall, man had accepted labor as a penance
and for its power to work redemption. It was not a law of nature
which forced man to work, but the effect of a curse. The earth was
innocent of that sterility in which it would slumber if man remained
idle: "The land had not sinned, and if it is accursed, it is by the labor
of the fallen man who cultivates it; from it no fruit is won,
particularly the most necessary fruit, save by force and continual
labor."6
The obligation to work was not linked to any confidence in
nature; and it was not even through an obscure loyalty that the land
would reward man's labor. The theme was constant among Catholic
thinkers, as among the Protestants, that labor does not bear its own
fruits. Produce and wealth were not found at the term of a dialectic
of labor and nature. Here is Calvin's admonition: "Nor do we be-
(55)
lieve, according as men will be vigilant and skillful, according as
they will have done their duty well, that they can make their land
fertile; it is the benediction of God which governs all things." And
this danger of a labor which would remain sterile if God did not
intervene in His infinite mercy is acknowledged in turn by Bossuet:
"At each moment, the hope of the harvest and the unique fruit of all
our labors may escape us; we are at the mercy of the inconstant
heavens that bring down rain upon the tender ears." This precarious
labor to which nature is never obliged to respond—save by the
special will of' God—is nonetheless obligatory in all strictness: not
on the level of natural syntheses, but on the level of moral syntheses.
The poor man who, without consenting to "torment" the land, waits
until God comes to his aid, since He has promised to feed the birds
of the sky, would be disobeying the great law of Scripture: "Thou
shalt not tempt the Lord thy God." Does not reluctance to work mean
"trying beyond measure the power of God," as Calvin says? It is
seeking to constrain the miracle,7 whereas the miracle is granted
daily to man as the gratuitous reward of his labor. If it is true that
labor is not inscribed among the laws of nature, it is enveloped in the
order of the fallen world. This is why idleness is rebellion—the
worst form of all, in a sense: it waits for nature to be generous as in
the innocence of Eden, and seeks to constrain a Goodness to which
man cannot lay claim since Adam. Pride was the sin of man before
the Fall; but the sin of idleness is the supreme pride of man once he
has fallen, the absurd pride of poverty. In our world, where the land
is no longer fertile except in thistles and weeds, idleness is the fault
par excellence. In the Middle Ages, the great sin, radix malorum
omnium, was pride, Superbla. According to Johan Huizinga, there
was a time, at the dawn of the Renaissance, when the supreme sin
assumed the aspect of Avarice, Dante'sc icca cupidigia. All
(56)
the seventeenth-century texts, on the contrary, announced the
infernal triumph of Sloth: it was sloth which led the round of the
vices and swept them on. Let us not forget that according to the edict
of its creation, the Hopital General must prevent "mendicancy and
idleness as sources of all disorder." Louis Bourdaloue echoes these
condemnations of sloth, the wretched pride of fallen man: "What,
then, is the disorder of an idle life? It is, replies Saint Ambrose, in its
true meaning a second rebellion of the creature against God." Labor
in the houses of confinement thus assumed its ethical meaning: since
sloth had become the absolute form of rebellion, the idle would be
forced to work, in the endless leisure of a labor without utility or
profit.
It was in a certain experience of labor that the indissociably
economic and moral demand for confinement was formulated.
Between labor and idleness in the classical world ran a line of
demarcation that replaced the exclusion of leprosy. The asylum was
substituted for the lazar house, in the geography of haunted places as
in the landscape of the moral universe. The old rites of
excommunication were revived, but in the world of production and
commerce. It was in these places of doomed and despised idleness,
in this space invented by a society which had derived an ethical
transcendence from the law of work, that madness would appear and
soon expand until it had annexed them. A day was to come when it
could possess these sterile reaches of idleness by a sort of very old
and very dim right of inheritance. The nineteenth century would
consent, would even insist that to the mad and to them alone be
transferred these lands on which, a hundred and fifty years before,
men had sought to pen the poor, the vagabond, the unemployed.
It is not immaterial that madmen were included in the proscription
of idleness. From its origin, they would have
(57)
their place beside the poor, deserving or not, and the idle,
voluntary or not. Like them, they would be subject to the rules of
forced labor. More than once, in fact, they figured in their singular
fashion within this uniform constraint. In the workshops in which
they were interned, they distinguished themselves by their inability
to work and to follow the rhythms of collective life. The necessity,
discovered in the eighteenth century, to provide a special regime for
the insane, and the great crisis of confinement that shortly preceded
the Revolution, are linked to the experience of madness available in
the universal necessity of labor. Men did not wait until the
seventeenth century to "shut up" the mad, but it was in this period
that they began to "confine" or "intern" them, along with an entire
population with whom their kinship was recognized. Until the
Renaissance, the sensibility to madness was linked to the presence
of imaginary transcendences. In the classical age, for the first time,
madness was perceived through a condemnation of idleness and in a
social immanence guaranteed by the community of labor. This
community acquired an ethical power of segregation, which
permitted it to eject, as into another world, all forms of social
uselessness. It was in this other world, encircled by the sacred
powers of labor, that madness would assume the status we now
attribute to it. If there is, in classical madness, something which
refers elsewhere, and to other things, it is no longer because the
madman comes from the world of the irrational and bears its
stigmata; rather, it is because he crosses the frontiers of bourgeois
order of his own accord, and alienates himself outside the sacred
limits of its ethic.
In fact, the relation between the practice of confinement and the
insistence on work is not defined by economic conditions; far from
it. A moral perception sustains and animates it. When the Board of
Trade published its report on the poor in which it proposed the
means "to render them
(58)
useful to the public," it was made quite clear that the origin of
poverty was neither scarcity of commodities nor unemployment, but
"the weakening of discipline and the relaxation of morals." The edict
of 1657, too, was full of moral denunciations and strange threats.
"The libertinage of beggars has risen to excess because of an
unfortunate tolerance of crimes of all sorts, which attract the curse
of God upon the State when they remain unpunished." This
"libertinage" is not the kind that can be defined in relation to the
great law of work, but a moral libertinage: "Experience having
taught those persons who are employed in charitable occupations
that many among them of either sex live together without marriage,
that many of their children are unbaptized, and that almost all of
them live in ignorance of religion, disdaining the sacraments, and
continually practicing all sorts of vice." Hence the Hopital does not
have the appearance of a mere refuge for those whom age, infirmity,
or sickness keep from working; it will have not only the aspect of a
forced labor camp, but also that of a moral institution responsible for
punishing, for correcting a certain moral "abeyance" which does not
merit the tribunal of men, but cannot be corrected by the severity of
penance alone. The Hopital General has an ethical status. It is this
moral charge which invests its directors, and they are granted every
judicial apparatus and means of repression: "They have power of
authority, of direction, of administration, of commerce, of police, of
jurisdiction, of correction and punishment"; and to accomplish this
task "stakes, irons, prisons, and dungeons"8 are put at their disposal.
And it is in this context that the obligation to work assumes its
meaning as both ethical exercise and moral guarantee. It will serve
as askesis, as punishment, as symptom of a certain disposition of the
heart. The prisoner who could and who would work would be
released, not so much because he was again useful to society, but
because he had
(59)
again subscribed to the great ethical pact of human existence. In
April 1684, a decree created within the Hopital a section for boys
and girls under twenty-five; it specified that work must occupy the
greater part of the day, and must be accompanied by "the reading of
pious books." But the ruling defines the purely repressive nature of
this work, beyond any concern for production: "They will be made
to work as long and as hard as their strengths and situations will
permit." It is then, but only then, that they can be taught an
occupation "fitting their sex and inclination," insofar as the measure
of their zeal in the first activities makes it possible to "judge that
they desire to reform." Finally, every fault "will be punished by
reduction of gruel, by increase of work, by imprisonment and other
punishments customary in the said hospitals, as the directors shall
see fit." It is enough to read the "general regulations for daily life in
the House of Saint-Louis de la Salpetriere" to understand that the
very requirement of labor was instituted as an exercise in moral
reform and constraint, which reveals, if not the ultimate meaning, at
least the essential justification of confinement.
An important phenomenon, this invention of a site of constraint,
where morality castigates by means of administrative enforcement.
For the first time, institutions of morality are established in which an
astonishing synthesis of moral obligation and civil law is effected.
The law of nations will no longer countenance the disorder of hearts.
To be sure, this is not the first time in European culture that moral
error, even in its most private form, has assumed the aspect of a
transgression against the written or unwritten laws of the
community. But in this great confinement of the classical age, the
essential thing—and the new event—is that men were confined in
cities of pure morality, where the law that should reign in all hearts
was to be applied without compromise, without concession, in the
rigorous
(60)
forms of physical constraint. Morality permitted itself to be
administered like trade or economy.
Thus we see inscribed in the institutions of absolute monarchy—
in the very ones that long remained the symbol of its arbitrary
power—the great bourgeois, and soon re publican, idea that virtue,
too, is an affair of state, that decrees can be published to make it
flourish, that an authority can be established to make sure it is
respected. The walls of confinement actually enclose the negative of
that moral city of which the bourgeois conscience began to dream in
the seventeenth century; a moral city for those who sought, from the
start, to avoid it, a city where right reigns only by virtue of a force
without appeal—a sort of sover eignty of good, in which intimidation
alone prevails and the only recompense of virtue (to this degree its
own reward) is to escape punishment. In the shadows of the
bourgeois city is born this strange republic of the good which is imposed
by force on all those suspected of belonging to evil. This is
the underside of the bourgeoisie's great dream and great
preoccupation in the classical age: the laws of the State and the laws
of the heart at last identical. "Let our politicians leave off their
calculations ... let them learn once and for all that everything can be
had for money, except morals and citizens."9
Is this not the dream that seems to have haunted the founders of
the house of confinement in Hamburg? One of the directors is to see
that "all in the house are properly instructed as to religious and
moral duties. . . . The schoolmaster must instruct the children in
religion, and encourage them, at proper times, to learn and repeat
portions of Scripture. He must also teach them reading, writing and
accounts, and a decent behaviour to those that visit the house. He
must take care that they attend divine service, and are orderly at
it."10 In England, the workhouse regulations devote much space to
the surveillance of morals and
(61)
to religious education. Thus for the house in Plymouth, a
schoolmaster is to be appointed who will fulfill the triple
requirement of being "pious, sober, and discreet." Every morning
and evening, at the prescribed hour, it will be his task to preside at
prayers; every Saturday afternoon and on holidays, he will address
the inmates, exhorting and instructing them in "the fundamental
parts of the Protestant religion, according to the doctrine of the
Church of England." Hamburg or Plymouth, Zuchthausern and
workhouses—throughout Protestant Europe, fortresses of moral
order were constructed, in which were taught religion and whatever
was necessary to the peace of the State.
In Catholic countries, the goal is the same but the religious
imprint is a little more marked, as the work of Saint Vincent de Paul
bears witness. "The principal end for which such persons have been
removed here, out of the storms of the great world, and introduced
into this solitude as pensioners, is entirely to keep them from the
slavery of sin, from being eternally damned, and to give them means
to rejoice in a perfect contentment in this world and in the next; they
will do all they can to worship, in this world, Divine Providence. . . .
Experience convinces us only too unhappily that the source of the
misrule triumphant today among the young lies entirely in the lack
of instruction and of obedience in spiritual matters, since they much
prefer to follow their evil inclinations than the holy inspiration of
God and the charitable advice of their parents."11 Therefore the
pensioners must be delivered from a world which, for their
weakness, is only an invitation to sin, must be recalled to a solitude
where they will have as companions only their "guardian angels"
incarnate in the daily presence of their warders: these latter, in fact,
"render them the same good offices that their guardian angels
perform for them invisibly: namely, instruct them, console them, and
procure their salvation." In the houses of La Charite, the
(62)
greatest attention was paid to this ordering of life and conscience,
which throughout the eighteenth century would more and more
clearly appear as the reason d'etre of confinement. In 1765, new
regulations were established for the Charite of Chateau-Thierry; it
was made quite clear that "the Prior will visit all the prisoners at
least once a week, one after the other, and separately, to console
them, to exhort them to better conduct, and to assure himself that
they are treated as they should be; the subordinate officer will do this
every day."
All these prisons of moral order might have borne the motto
which Howard could still read on the one in Mainz:
"If wild beasts can be broken to the yoke, it must not be despaired
of correcting the man who has strayed." For the Catholic Church, as
in the Protestant countries, confinement represents, in the form of an
authoritarian model, the myth of social happiness: a police whose
order will be entirely transparent to the principles of religion, and a
religion whose requirements will be satisfied, without restrictions,
by the regulations of the police and the constraints with which it can
be armed. There is, in these institutions, an attempt of a kind to
demonstrate that order may be adequate to virtue. In this sense,
"confinement" conceals both a metaphysics of government and a
politics of religion; it is situated, as an effort of tyrannical synthesis,
in the vast space separating the garden of God and the cities which
men, driven from paradise, have built with their own hands. The
house of confinement in the classical age constitutes the densest
symbol of that "police" which conceived of itself as the civil
equivalent of religion for the edification of a perfect city.
Confinement was an institutional creation peculiar to the
seventeenth century. It acquired from the first an importance that left
it no rapport with imprisonment as practiced
(63)
in the Middle Ages. As an economic measure and a social
precaution, it had the value of invendveness. But in the history of
unreason, it marked a decisive event: the moment when madness
was perceived on the social horizon of poverty, of incapacity for
work, of inability to integrate with the group; the moment when
madness began to rank among the problems of the city. The new
meanings assigned to poverty, the importance given to the obligation
to work, and all the ethical values that are linked to labor, ultimately
determined the experience of madness and inflected its course.
A sensibility was born which had drawn a line and laid a,
cornerstone, and which chose—only to banish. The con crete space
of classical society reserved a neutral region, a blank page where the
real life of the city was suspended;
here, order no longer freely confronted disorder, reason no longer
tried to make its own way among all that might evade or seek to
deny it. Here reason reigned in the pure state, in a triumph arranged
for it in advance over a frenzied unreason. Madness was thus torn
from that imaginary freedom which still allowed it to flourish on the
Renaissance horizon. Not so long ago, it had floundered about in
broad daylight: in King Lear, in Don Quixote. But in less than a
half-century, it had been sequestered and, in the fortress of
confinement, bound to Reason, to the rules of morality and to their
monotonous nights.
III
THE INSANE
FROM the creation of the Hopital General, from the opening, in
Germany and in England, of the first houses of correction, and until
the end of the eighteenth century, the age of reason confined. It
confined the debauched, spendthrift fathers, prodigal sons,
blasphemers, men who "seek to undo themselves," libertines. And
through these parallels, these strange complicities, the age sketched
the profile of its own experience of unreason.
But in each of these cities, we find an entire population of
madness as well. One-tenth of all the arrests made in Paris for the
Hopital General concern "the insane," "demented" men, individuals
of "wandering mind," and "persons who have become completely
mad." Between these and the others, no sign of a differentiation.
Judging from the registries, the same sensibility appears to collect
them, the same gestures to set them apart. We leave it to medical
archaeology to determine whether or not a man was sick, criminal,
or insane who was admitted to the hospital for
(65)
"derangement of morals," or because he had "mistreated his wife"
and tried several times to kill himself.
Yet it must not be forgotten that the "insane" had as such a
particular place in the world of confinement. Their status was not
merely that of prisoners. In the general sensibility to unreason, there
appeared to be a special modulation which concerned madness
proper, and was addressed to those called, without exact semantic
distinction, insane, alienated, deranged, demented, extravagant.
This particular form of sensibility traces the features proper to
madness in the world of unreason. It is primarily concerned with
scandal. In its most general form, confinement is explained, or at
least justified, by the desire to avoid scandal. It even signifies
thereby an important change in the consciousness of evil. The
Renaissance had freely allowed the forms of unreason to come out
into the light of day; public outrage gave evil the powers of example
and redemption. Gilles de Rais, accused, in the fifteenth century, of
having been and of being "a heretic, an apostate, a sorcerer, a
sodomite, an invoker of evil spirits, a soothsayer, a slayer of
innocents, an idolater, working evil by deviation from the faith,"
ended by himself admitting to crimes "sufficient to cause the deaths
of ten thousand persons" in extrajudiciary confession; he repeated
his avowal in Latin before the tribunal; then he asked, of his own
accord, that "the said confession should be published in the vulgar
tongue and exhibited to each and every one of those present, the
majority of whom knew no Latin, the publication and confession to
his shame of the said offenses by him committed, in order the more
easily to obtain the remission of sins, and the mercy of God for the
pardon of the sins by him committed." At the trial, the same
confession was required before those assembled: he "was told by the
Presiding Judge that he should state his case fully, and the shame
that he would gain thereby would serve to lessen the pun-
(66)
ishment he would suffer hereafter." Until the seventeenth century,
evil in all its most violent and most inhuman forms could not be
dealt with and punished unless it was brought into the open. The
light in which confession was made and punishment executed could
alone balance the darkness from which evil issued. In order to pass
through all the stages of its fulfillment, evil must necessarily incur
public avowal and manifestation before reaching the conclusion
which suppresses it.
Confinement, on the contrary, betrays a form of conscience to
which the inhuman can suggest only shame. There are aspects of
evil that have such a power of contagion, such a force of scandal
that any publicity multiplies them infinitely. Only oblivion can
suppress them. In a case of poisoning, Pontchartrain orders not a
public trial but the secrecy of an asylum: "As the facts of the case
concerned a good part of Paris, the King did not believe that so
many people should be brought to trial, many of whom had committed
crimes unawares, and others only by the ease of doing so; His
Majesty so determined the more readily insofar as he is persuaded
that there are certain crimes which must absolutely be thrust into
oblivion."1 Beyond the dangers of example, the honor of families
and that of religion sufficed to recommend a subject for a house of
confinement. Apropos of a priest who was to be sent to Saint-
Lazare: "Hence a priest such as this cannot be hidden away with too
much care for the honor of religion and that of the priesthood."2
Even late in the eighteenth century, Malesherbes would defend
confinement as a right of families seeking to escape dishonor. "That
which is called a base action is placed in the rank of those which
public order does not permit us to tolerate. ... It seems that the honor
of a family requires the disappearance from society of the individual
who by vile and abject habits shames his relatives." Inversely,
liberation is in order when the danger of
(67)
scandal is past and the honor of families or of the Church can no
longer be sullied. The Abbe Bargede had been confined for a long
time; never, despite his requests, had his release been authorized; but
now old age and infirmity had made scandal impossible. "And
besides, his paralysis persists," writes d'Argenson; "he can neither
write nor sign his name; I think that there would be justice and
charity in setting him free." All those forms of evil that border on
unreason must be thrust into secrecy. Classicism felt a shame in the
presence of the inhuman that the Renaissance had never
experienced. Yet there is one exception in this consignment to
secrecy:
that which is made for madmen.8 It was doubtless a very old
custom of the Middle Ages to display the insane. In certain of the
Narrturmer in Germany, barred windows had been installed which
permitted those outside to observe the madmen chained within. They
thus constituted a spectacle at the city gates. The strange fact is that
this custom did not disappear once the doors of the asylums closed,
but that on the contrary it then developed, assuming in Paris and
London almost an institutional character. As late as 1815, if a report
presented in the House of Commons is to be believed, the hospital of
Bethlehem exhibited lunatics for a penny, every Sunday. Now the
annual revenue from these exhibitions amounted to almost four
hundred pounds; which suggests the astonishingly high number of
96,000 visits a year.4 In France, the excursion to Bicetre and the
display of the insane remained until the Revolution one of the
Sunday distractions for the Left Bank bourgeoisie. Mirabeau reports
in his Observations d'un voyageur anglais that the madmen at
Bicetre were shown "like curious animals, to the first simpleton
willing to pay a coin." One went to see the keeper display the
madmen the way the trainer at the Fair of Saint-Germain put the
monkeys through their tricks.5 Certain attendants were well known
(68)
for their ability to make the mad perform dances and acrobatics,
with a few flicks of the whip. The only extenuation to be found at
the end of the eighteenth century was that the mad were allowed to
exhibit the mad, as if it were the responsibility of madness to testify
to its own nature. "Let us not slander human nature. The English
traveler is right to regard the office of exhibiting madmen as beyond
the most hardened humanity. We have already said so. But all
dilemmas afford a remedy. It is the madmen themselves who are
entrusted in their lucid intervals with displaying their companions,
who, in their turn, return the favor. Thus the keepers of these
unfortunate creatures enjoy the profits that the spectacle affords,
without indulging in a heartlessness to which, no doubt, they could
never descend."6 Here is madness elevated to spectacle above the
silence of the asylums, and becoming a public scandal for the
general delight. Unreason was hidden in the silence of the houses of
confinement, but madness continued to be present on the stage of the
world—with more commotion than ever. It would soon reach, under
the Empire, a point that had never been attained in the Middle Ages
and the Renaissance; the strange Brotherhood of the Blue Ship had
once given performances in which madness was mimed; now it was
madness itself, madness in flesh and blood, which put on the show.
Early in the nineteenth century, Coulmier, the director of Charenton,
had organized those famous performances in which madmen
sometimes played the roles of actors, sometimes those of watched
spectators. "The insane who attended these theatricals were the
object of the attention and curiosity of a frivolous, irresponsible, and
often vicious public. The bizarre attitudes of these unfortunates and
their condition provoked the mocking laughter and the insulting pity
of the spectators."7 Madness became pure spectacle, in a world over
which Sade extended his sovereignty and which was offered as a
diversion
(69)
to the good conscience of a reason sure of itself. Until the
beginning of the nineteenth century, and to the indignation of Royer-
Collard, madmen remained monsters—that is, etymologically,
beings or things to be shown.
Confinement hid away unreason, and betrayed the shame it
aroused; but it explicitly drew attention to madness, pointed to it. If,
in the case of unreason, the chief intention was to avoid scandal, in
the case of madness that intention was to organize it. A strange
contradiction: the classical age enveloped madness in a total
experience of unreason; it re-absorbed its particular forms, which
the Middle Ages and the Renaissance had clearly individualized into
a general apprehension in which madness consorted indiscriminately
with all the forms of unreason. But at the same time it assigned to
this same madness a special sign: not that of sickness, but that of
glorified scandal. Yet there is nothing in common between this
organized exhibition of madness in the eighteenth century and the
freedom with which it came to light during the Renaissance. In the
Renaissance, madness was present everywhere and mingled with
every experience by its images or its dangers. During the classical
period, madness was shown, but on the other side of bars; if present,
it was at a distance, under the eyes of a reason that no longer felt any
relation to it and that would not compromise itself by too close a
resemblance. Madness had become a thing to look at: no longer a
monster inside oneself, but an animal with strange mechanisms, a
bestiality from which man had long since been suppressed. "I can
easily conceive of a man without hands, feet, head (for it is only
experience which teaches us that the head is more necessary than the
feet). But I cannot conceive of man without thought; that would be a
stone or a brute."8
In his Report on the Care of the Insane Desportes describes the
cells of Bicetre as they were at the end of the eighteenth century:
"The unfortunate whose entire furni-
(70)
ture consisted of this straw pallet, lying with his head, feet, and
body pressed against the wall, could not enjoy sleep without being
soaked by the water that trickled from that mass of stone." As for the
cells of La Salpetriere, what made "the place more miserable and
often more fatal, was that in winter, when the waters of the Seine
rose, those cells situated at the level of the sewers became not only
more unhealthy, but worse still, a refuge for a swarm of huge rats,
which during the night attacked the unfortunates confined there and
bit them wherever they could reach them; madwomen have been
found with feet, hands, and faces torn by bites which are often
dangerous and from which several have died." But these were the
dungeons and cells long reserved for the most dangerous and most
violent of the insane. If they were calmer, and if no one had anything
to fear from them, they were crammed into wards of varying
size. One of Samuel Tuke's most active disciples, Godfrey Higgins,
had obtained the right, which cost him twenty pounds, to visit the
asylum of York as a volunteer inspector. In the course of a visit, he
discovered a door that had been carefully concealed and found
behind it a room, not eight feet on a side, which thirteen women
occupied during the night; by day, they lived in a room scarcely
larger.
On the other hand, when the insane were particularly dangerous,
they were constrained by a system which was doubtless not of a
punitive nature, but simply intended to fix within narrow limits the
physical locus of a raging frenzy. Sufferers were generally chained
to the walls and to the beds. At Bethlehem, violent madwomen were
chained by the ankles to the wall of a long gallery; their only garment
was a homespun dress. At another hospital, in Bethnal Green,
a woman subject to violent seizures was placed in a pigsty, feet and
fists bound; when the crisis had passed she was tied to her bed,
covered only by a blanket; when she
(7/)
was allowed to take a few steps, an iron bar was placed between
her legs, attached by rings to her ankles and by a short chain to
handcuffs. Samuel Tuke, in his Report on the Condition of the
Indigent Insane, gives the details of a complicated system devised at
Bethlehem to control a reputedly dangerous madman: he was
attached by a long chain that ran over the wall and thus permitted the
attendant to lead him about, to keep him on a leash, so to speak, from
outside; around his neck had been placed an iron ring, which was
attached by a short chain to another ring; this latter slid the length of
a vertical iron bar fastened to the floor and ceiling of the cell. When
reforms began to be instituted at Bethlehem, a man was found who
had lived in this cell, attached in this fashion, for twelve years.
When practices reach this degree of violent intensity, it becomes
clear that they are no longer inspired by the desire to punish nor by
the duty to correct. The notion of a "resipiscence" is entirely foreign
to this regime. But there was a certain image of animality that
haunted the hospitals of the period. Madness borrowed its face from
the mask of the beast. Those chained to the cell walls were no longer
men whose minds had wandered, but beasts preyed upon by a natural
frenzy: as if madness, at its extreme point, freed from that moral
unreason in which its most attenuated forms are enclosed, managed
to rejoin, by a paroxysm of strength, the immediate violence of
animality. This model of animality prevailed in the asylums and gave
them their cagelike aspect, their look of the menagerie. Coguel
describes La Salpetriere at the end of the eighteenth century:
"Madwomen seized with fits of violence are chained like dogs at
their cell doors, and separated from keepers and visitors alike by a
long corridor protected by an iron grille;
through this grille is passed their food and the straw on which they
sleep; by means of rakes, part of the filth that surrounds them is
cleaned out." At the hospital of Nantes,
(72)
the menagerie appears to consist of individual cages for wild
beasts. Never had Esquirol seen "such an extravagance of locks, of
bolts, of iron bars to shut the doors of the cells. . . . Tiny openings
pierced next to the doors were fitted with iron bars and shutters.
Quite close to this opening hung a chain fastened to the wall and
bearing at its end a cast-iron receptacle, somewhat resembling a
wooden shoe, in which food was placed and passed through the bars
of these openings." When Francois-Emmanuel Fodere arrived at the
hospital of Strasbourg in 1814, he found a kind of human stable,
constructed with great care and skill: "for troublesome madmen and
those who dirtied themselves, a kind of cage, or wooden closet,
which could at the most contain one man of middle height, had been
devised at the ends of the great wards." These cages had gratings for
floors, and did not rest on the ground but were raised about fifteen
centimeters. Over these gratings was thrown a little straw "upon
which the madman lay, naked or nearly so, took his meals, and
deposited his excrement."
This, to be sure, is a whole security system against the violence of
the insane and the explosion of their fury. Such outbursts are
regarded chiefly as a social danger. But what is most important is
that it is conceived in terms of an animal freedom. The negative fact
that "the madman is not treated like a human being" has a very
positive content: this inhuman indifference actually has an
obsessional value: it is rooted in the old fears which since antiquity,
and especially since the Middle Ages, have given the animal world
its familiar strangeness, its menacing marvels, its entire weight of
dumb anxiety. Yet this animal fear which accompanies, with all its
imaginary landscape, the perception of madness, no longer has the
same meaning it had two or three centuries earlier: animal
metamorphosis is no longer the visible sign of infernal powers, nor
the result of a diabolic alchemy of unreason. The animal in man no
longer
(73)
has any value as the sign of a Beyond; it has become his madness,
without relation to anything but itself: his madness in the state of
nature. The animality that rages in madness dispossesses man of
what is specifically human in him; not in order to deliver him over to
other powers, but simply to establish him at the zero degree of his
own nature. For classicism, madness in its ultimate form is man in
immediate relation to his animality, without other reference, without
any recourse.
The day would come when from an evolutionary perspective this
presence of animality in madness would be considered as the sign—
indeed, as the very essence—of disease. In the classical period, on
the contrary, it manifested the very fact that the madman was not a
sick man. Animality, in fact, protected the lunatic from whatever
might be fragile, precarious, or sickly in man. The animal solidity of
madness, and that density it borrows from the blind world of beasts,
inured the madman to hunger, heat, cold, pain. It was common
knowledge until the end of the eighteenth century that the insane
could support the miseries of existence indefinitely. There was no
need to protect them; they had no need to be covered or warmed.
When, in 1811, Samuel Tuke visited a workhouse in the Southern
Counties, he saw cells where the daylight passed through little
barred windows that had been cut in the doors. All the women were
entirely naked. Now "the temperature was extremely rigorous, and
the evening of the day before, the thermometer had indicated a cold
of 18 degrees. One of these unfortunate women was lying on a little
straw, without covering." This ability of the insane to endure, like
animals, the worst inclemencies was still a medical dogma for Pinel;
he would always admire "the constancy and the ease with which
certain of the insane of both sexes bear the most rigorous and
prolonged cold. In the month of Nivose of the Year III, on certain
days when the ther-
(74)
mometer indicated 10, 11, and as many as 16 degrees below
freezing, a madman in the hospital of Bicetre could not endure his
wool blanket, and remained sitting on the icy floor of his cell. In the
morning, one no sooner opened his door than he ran in his shirt into
the inner court, taking ice and snow by the fistful, applying it to his
breast and letting it melt with a sort of delectation." Madness, insofar
as it partook of animal ferocity, preserved man from the dangers of
disease; it afforded him an invulnerability, similar to that which
nature, in its foresight, had provided for animals. Curiously, the
disturbance of his reason restored the madman to the immediate
kindness of nature by a return to animality.
This is why, at this extreme point, madness was less than ever
linked to medicine; nor could it be linked to the domain of
correction. Unchained animality could be mastered only by
discipline and brutalizing. The theme of the animal-madman was
effectively realized in the eighteenth century, in occasional attempts
to impose a certain pedagogy on the insane. Pinel cites the case of a
"very famous monastic establishment, in one of the southern regions
of France," where a violent madman would be given "a precise order
to change"; if he refused to go to bed or to eat, he "was warned that
obstinacy in his deviations would be punished on the next day with
ten strokes of the bullwhip." If, on the contrary, he was submissive
and docile, he was allowed "to take his meals in the refectory, next
to the disciplinarian," but at the least transgression, he was instantly
admonished by a "heavy blow of a rod across his fingers." Thus, by
the use of a curious dialectic whose movement explains all these
"inhuman" practices of confinement, the free animality of madness
was tamed only by such discipline whose meaning was not to raise
the bestial to the human, but to restore man to what was purely
animal within him. Madness discloses a secret of animality which is
(75)
its own truth, and in which, in some way, it is reabsorbed. Toward
the middle of the eighteenth century, a fanner in the north of
Scotland had his hour of fame. He was said to possess the art of
curing insanity. Pinel notes in passing that this Gregory had the
physique of a Hercules: "His method consisted in forcing the insane
to perform the most difficult tasks of farming, in using them as
beasts of burden, as servants, in reducing them to an ultimate
obedience with a barrage of blows at the least act of revolt." In the
reduction to animality, madness finds both its truth and its cure;
when the madman has become a beast, this presence of the animal in
man, a presence which constituted the scandal of madness, is
eliminated: not that the animal is silenced, but man himself is
abolished. In the human being who has become a beast of burden,
the absence of reason follows wisdom and its order: madness is then
cured, since it is alienated in something which is no less than its
truth.
A moment would come when, from this animality of madness,
would be deduced the idea of a mechanistic psychology, and the
notion that the forms of madness can be referred to the great
structures of animal life. But in the seventeenth and eighteenth
centuries, the animality that lends its face to madness in no way
stipulates a determinist nature for its phenomena. On the contrary, it
locates madness in an area of unforeseeable freedom where frenzy
is unchained; if determinism can have any effect on it, it is in the
form of constraint, punishment, or discipline. Through animality,
madness does not join the great laws of nature and of life, but rather
the thousand forms of a bestiary. But unlike the one popular in the
Middle Ages, which illustrated, in so many symbolic visages, the
metamorphoses of evil, this was an abstract bestiary; here evil no
longer assumed its fantastic body; here we apprehend only its most
extreme form, the truth of the beast which is a truth without content.
Evil is freed from all that its wealth of icono-
(76)
graphic fauna could do, to preserve only a general power of
intimidation: the secret danger of an animality that lies in wait and,
all at once, undoes reason in violence and truth in the madman's
frenzy. Despite the contemporary effort to constitute a positivist
zoology, this obsession with an animality perceived as the natural
locus of madness continued to people the hell of the classical age. It
was this obsession that created the imagery responsible for all the
practices of confinement and the strangest aspects of its savagery.
It has doubtless been essential to Western culture to link, as it has
done, its perception of madness to the iconographic forms of the
relation of man to beast. From the start, Western culture has not
considered it evident that animals participate in the plenitude of
nature, in its wisdom and its order: this idea was a late one and long
remained on the surface of culture; perhaps it has not yet penetrated
very deeply into the subterranean regions of the imagination. In fact,
on close examination, it becomes evident that the animal belongs
rather to an anti-nature, to a negativity that threatens order and by its
frenzy endangers the positive wisdom of nature. The work of
Lautreamont bears witness to this. Why should the fact that Western
man has lived for two thousand years on his definition as a rational
animal necessarily mean that he has recognized the possibility of an
order common to reason and to animality? Why should he have
necessarily designated, by this definition, the way in which he
inserts himself in natural positivity? Independently of what Aristotle
really meant, may we not assume that for the West this "rational
animal" has long been the measure of the way in which reason's
freedom functioned in the locus of unreason, diverging from it until
it constituted its opposite term? From the moment philosophy became
anthropology, and man sought to recognize himself in a
natural plenitude, the animal lost its power of negativity, in order to
become, between the determinism of nature
(77)
and the reason of man, the positive form of an evolution. The
formula of the "rational animal" has utterly changed its meaning: the
unreason it suggested as the origin of all possible reason has entirely
disappeared. Henceforth madness must obey the determinism of man
perceived as a natural being in his very animality. In the classical
age, if it is true that the scientific and medical analysis of madness,
as we shall see below, sought to establish it within this natural
mechanism, the real practices that concern the insane bear sufficient
witness to the fact that madness was still contained in the antinatural
violence of animality.
In any case, it was this animality of madness which confinement
glorified, at the same time that it sought to avoid the scandal inherent
in the immorality of the unreasonable. Which reveals the distance
established in the classical age between madness and the other forms
of unreason, even if it is true that from a certain point of view they
had been identified or assimilated. If a whole range of unreason was
reduced to silence, but madness left free to speak the language of its
scandal, what lesson could it teach which unreason as a whole was
not capable of transmitting? What meaning had the frenzies and all
the fury of the insane, which could not be found in the—probably
more sensible—remarks of the other internees? In what respect then
was madness more particularly significant?
Beginning with the seventeenth century, unreason in the most
general sense no longer had much instructive value. That perilous
reversibility of reason which was still so close for the Renaissance
was to be forgotten, and its scandals were to disappear. The great
theme of the madness of the Cross, which belonged so intimately to
the Christian experience of the Renaissance, began to disappear in
the seventeenth century, despite Jansenism and Pascal. Or rather, it
subsisted, but changed and somehow inverted its meaning.
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It was no longer a matter of requiring human reason to abandon
its pride and its certainties in order to lose itself in the great unreason
of sacrifice. When classical Christianity speaks of the madness of the
Cross, it is merely to humiliate false reason and add luster to the
eternal light of truth; the madness of God-in-man's-image is simply a
wisdom not recognized by the men of unreason who live in this
world: "Jesus crucified . . . was the scandal of the world and appeared
as nothing but ignorance and madness to the eyes of his
time." But the fact that the world has become Christian, and that the
order of God is revealed through the meander-ings of history and the
madness of men, now suffices to show that "Christ has become the
highest point of our wisdom."9 The scandal of Christian faith and
Christian abasement, whose strength and value as revelation Pascal
still preserved, would soon have no more meaning for Christian
thought except perhaps to reveal in these scandalized consciences so
many blind souls: "Do not permit your Cross, which has subdued the
universe for you, to be still the madness and scandal of proud
minds." Christian unreason was relegated by Christians themselves
into the margins of a reason that had become identical with the
wisdom of God incarnate. After Port-Royal, men would have to wait
two centuries—until Dostoievsky and Nietzsche—for Christ to
regain the glory of his madness, for scandal to recover its power as
revelation, for unreason to cease being merely the public shame of
reason.
But at the very moment Christian reason rid itself of the madness
that had so long been a part of itself, the madman, in his abolished
reason, in the fury of his animality, received a singular power as a
demonstration: it was as if scandal, driven out of that superhuman
region where it related to God and where the Incarnation was
manifested, reappeared, in the plenitude of its force and pregnant
with a new lesson, in that region where man has a relation to na-
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ture and to his animality. The lesson's point of application has
shifted to the lower regions of madness. The Cross is no longer to be
considered in its scandal; but it must not be forgotten that
throughout his human life Christ honored madness, sanctified it as
he sanctified infirmity cured, sin forgiven, poverty assured of eternal
riches. Saint Vincent de Paul reminds those assigned to tend the mad
within the houses of confinement that their "rule in this is Our Lord
who chose to be surrounded by lunatics, demoniacs, madmen, the
tempted and the possessed." These men ruled by the powers of the
inhuman constitute, around those who represent eternal Wisdom,
around the Man who incarnates it, a perpetual occasion for
glorification: because they glorify, by surrounding it, the wisdom
that has been denied them, and at the same time give it a pretext to
humiliate itself, to acknowledge that it is granted only by grace. Further:
Christ did not merely choose to be surrounded by lunatics; he
himself chose to pass in their eyes for a madman, thus experiencing,
in his incarnation, all the sufferings of human misfortune. Madness
thus became the ultimate form, the final degree of God in man's
image, before the fulfillment and deliverance of the Cross: "0 my
Savior, you were pleased to be a scandal to the Jews, and a madness
to the Gentiles; you were pleased to seem out of your senses, as it is
reported in the Holy Gospel that it was thought of Our Lord that he
had gone mad. Dicebant quoniam in furorem versus est. His
Apostles sometimes looked upon him as a man in anger, and he
seemed such to them, so that they should bear witness that he had
bome with all our infirmities and all our states of affliction, and to
teach them and us as well to have compassion upon those who fall
into these infirmities."10 Coming into this world, Christ agreed to
take upon himself all the signs of the human condition and the very
stigmata of fallen nature; from poverty to
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death, he followed the long road of the Passion, which was also
the road of the passions, of wisdom forgotten, and of madness. And
because it was one of the forms of the Passion—the ultimate form,
in a sense, before death—madness would now become, for those
who suffered it, an object of respect and compassion.
To respect madness is not to interpret it as the involuntary and
inevitable accident of disease, but to recognize this lower limit of
human truth, a limit not accidental but essential. As death is the limit
of human life in the realm of time, madness is its limit in the realm
of animality, and just as death had been sanctified by the death of
Christ, madness, in its most bestial nature, had also been sanctified.
On March 29, 1654, Saint Vincent de Paul announced to Jean
Barreau, himself a congreganist, that his brother had just been
confined at Saint-Lazare as a lunatic: "We must honor Our Lord in
the state wherein He was when they sought to bind Him, saying
quoniam in frenesim versus est, in order to sanctify that state in
those whom His Divine Providence has placed there."11 Madness is
the lowest point of humanity to which God submitted in His incarnation,
thereby showing that there was nothing inhuman in man that
could not be redeemed and saved; the ultimate point of the Fall was
glorified by the divine presence: and it is this lesson which, for the
seventeenth century, all madness still taught.
We see why the scandal of madness could be exalted, while that
of the other forms of unreason was concealed with so much care.
The scandal of unreason produced only the contagious example of
transgression and immorality;
the scandal of madness showed men how close to animality their
Fall could bring them; and at the same time how far divine mercy
could extend when it consented to save man. For Renaissance
Christianity, the entire instructive value of
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unreason and of its scandals lay in the madness of the Incarnation
of God in man. For classicism, the Incarnation is no longer madness;
but what is madness is this incarnation of man in the beast, which is,
as the ultimate point of his Fall, the most manifest sign of his guilt;
and, as the ultimate object of divine mercy, the symbol of universal
forgiveness and innocence regained. Henceforth, all the lessons of
madness and the power of its instruction must be sought in this
obscure region, at the lower confines of humanity, where man is
hinged to nature, where he is both ultimate downfall and absolute
innocence. Does not the Church's solicitude for the insane during the
classical period, as it is symbolized in Saint Vincent de Paul and his
Congregation, or in the Brothers of Charity, all those religious
orders hovering over madness and showing it to the world—does
this not indicate that the Church found in madness a difficult but an
essential lesson: the guilty innocence of the animal in man? This is
the lesson to be read and understood in its spectacles, in which it
exalted in the madman the fury of the human beast. Paradoxically,
this Christian consciousness of animality prepared the moment when
madness would be treated as a fact of nature; it would then be
quickly forgotten what this "nature" meant for classical thought: not
the always accessible domain of an objective analysis, but that
region in which there appears, for man, the always possible scandal
of a madness that is both his ultimate truth and the form of his
abolition.
All these phenomena, these strange practices woven around
madness, these usages which glorify and at the same time discipline
it, reduce it to animality while making it teach the lesson of the
Redemption, put madness in a strange position with regard to
unreason as a whole. In the houses of confinement, madness
cohabits with all the forms
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of unreason which envelop it and define its most general truth;
and yet madness is isolated, treated in a special manner, manifested
in its singularity as if, though belonging to unreason, it nonetheless
traversed that domain by a movement peculiar to itself, ceaselessly
referring from itself to its most paradoxical extreme.
We have now got in the habit of perceiving in madness a fall into
a determinism where all forms of liberty are gradually suppressed;
madness shows us nothing more than the natural constants of a
determinism, with the sequences of its causes, and the discursive
movement of its forms; for madness threatens modern man only
with that return to the bleak world of beasts and things, to their
fettered freedom. It is not on this horizon of nature that the
seventeenth and eighteenth centuries recognized madness, but
against a background of Unreason; madness did not disclose a
mechanism, but revealed a liberty raging in the monstrous forms of
animality. We no longer understand unreason today, except in its
epithetic form: the Unreasonable, a sign attached to conduct or
speech, and betraying to the layman's eyes the presence of madness
and all its pathological train; for us the unreasonable is only one of
madness's modes of appearance. On the contrary, unreason, for
classicism, had a nominal value; it constituted a kind of substantial
function. It was in relation to unreason and to it alone that madness
could be understood. Unreason was its support; or let us say that
unreason defined the locus of madness's pos sibility. For classical
man, madness was not the natural condition, the human and
psychological root of unreason; it was only unreason's empirical
form; and the madman, tracing the course of human degradation to
the frenzied nadir of animality, disclosed that underlying realm of
unreason which threatens man and envelops—at a tremendous
distance—all the forms of his natural existence. It was not a
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question of tending toward a determinism, but of being
swallowed up by a darkness. More effectively than any other kind
of rationalism, better in any case than our positivism, classical
rationalism could watch out for and guard against the subterranean
danger of unreason, that threatening space of an absolute freedom.
IV
PASSION AND DELIRIUM
THE savage danger of madness is related to the danger of the
passions and to their fatal concatenation.
Sauvages had sketched the fundamental role of passion, citing it
as a more constant, more persistent, and somehow more deserved
cause of madness: "The distraction of our mind is the result of our
blind surrender to our desires, our incapacity to control or to
moderate our passions. Whence these amorous frenzies, these
antipathies, these depraved tastes, this melancholy which is caused
by grief, these transports wrought in us by denial, these excesses in
eating, in drinking, these indispositions, these corporeal vices which
cause madness, the worst of all maladies."1 But as yet, what was
involved was only passion's moral precedence, its re sponsibility, in
a vague way; the real target of this denunciation was the radical
relation of the phenomena of madness to the very possibility of
passion.
(85)
Before Descartes, and long after his influence as philosopher and
physiologist had diminished, passion continued to be the meeting
ground of body and soul; the point where the latter's activity makes
contact with the former's passivity, each being a limit imposed upon
the other and the locus of their communication.
The medicine of humors sees this unity primarily as a reciprocal
interaction: "The passions necessarily cause certain movements in
the humors; anger agitates the bile, sadness excites melancholy
(black bile), and the movements of the humors are on occasion so
violent that they disrupt the entire economy of the body, even
causing death; further, the passions augment the quantity of the
humors; anger multiplies the bile as sadness increases melancholy.
The humors which are customarily agitated by certain passions
dispose those in whom they abound to the same passions, and to
thinking of the objects which ordinarily excite them; bile disposes to
anger and to thinking of those we hate. Melancholy (black bile)
disposes to sadness and to thinking of untoward things; welltempered
blood disposes to joy."2
The medicine of spirits substitutes for this vague idea of
"disposition" the rigor of a physical, mechanical transmission of
movements. If the passions are possible only in a being which has a
body, and a body not entirely subject to the light of its mind and to
the immediate transparence of its will, this is true insofar as, in
ourselves and without ourselves, and generally in spite of ourselves,
the mind's movements obey a mechanical structure which is that of
the movement of spirits. "Before the sight of the object of passion,
the animal spirits were spread throughout the entire body in order to
preserve all the parts in general; but at the presence of the new
object, this entire economy is disrupted. The majority of spirits are
impelled into the muscles of the arms, the legs, the face, and all the
exterior
(86)
parts of the body in order to afford it a disposition proper to the
prevailing passion and to give it the countenance and movement
necessary for the acquisition of the good or the escape from the evil
which presents itself."3 Passion thus disperses the spirits, which are
disposed to passion: that is, under the effect of passion and in the
presence of its object, the spirits circulate, disperse, and concentrate
according to a spatial design which licenses the trace of the object in
the brain and its image in the soul, thus forming in the body a kind
of geometric figure of passion which is merely its expressive
transposition; but which also constitutes passion's essential causal
basis, for when all the spirits are grouped around this object of
passion, or at least around its image, the mind in its turn can no
longer ignore it and will consequently be subject to passion.
One more step, and the entire system becomes a unity in which
body and soul communicate immediately in the symbolic values of
common qualities. This is what happens in the medicine of solids
and fluids, which dominates eighteenth-century practice. Tension
and release, hardness and softness, rigidity and relaxation,
congestion and dryness— these qualitative states characterize the
soul as much as the body, and ultimately refer to a kind of indistinct
and composite passional situation, one which imposes itself on the
concatenation of ideas, on the course of feelings, on the state of
fibers, on the circulation of fluids. The theme of causality here
appears as too discursive, the elements it groups too disjunct for its
schemas to be applicable. Are the "active passions, such as anger,
joy, lust," causes or consequences "of the excessive strength, the
excessive tension, and the excessive elasticity of the nervous fibers,
and of the excessive activity of the nervous fluid"? Conversely,
cannot the "inert passions, such as fear, depression, ennui, lack of
appetite, the coldness that accompanies homesickness, bizarre
appetites, stupidity, lack of memory" be as
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readily followed as they are preceded by "weakness of the brain
marrow and of the nervous fibers distributed in the organs, by
impoverishment and inertia of the fluids"?4 Indeed, we must no
longer try to situate passion in a causal succession, or halfway
between the corporeal and the spiritual; passion indicates, at a new,
deeper level, that the soul and the body are in a perpetual
metaphorical relation in which qualities have no need to be
communicated because they are already common to both; and in
which phenomena of expression are not causes, quite simply because
soul and body are always each other's immediate expres sion. Passion
is no longer exactly at the geometrical center of the body-and-soul
complex; it is, a little short of that, at the point where their opposition
is not yet given, in that region where both their unity and their
distinction are established.
But at this level, passion is no longer simply one of the causes—
however powerful—of madness; rather it forms the basis for its very
possibility. If it is true that there exists a realm, in the relations of
soul and body, where cause and effect, determinism and expression
still intersect in a web so dense that they actually form only one and
the same movement which cannot be dissociated except after the
fact; if it is true that prior to the violence of the body and the vivacity
of the soul, prior to the softening of the fibers and the relaxation of
the mind, there are qualitative, as yet unshared kinds of a. priori
which subsequently impose the same values on the organic and on
the spiritual, then we see that there can be diseases such as madness
which are from the start diseases of the body and of the soul,
maladies in which the affection of the brain is of the same quality, of
the same origin, of the same nature, finally, as the affection of the
soul.
The possibility of madness is therefore implicit in the very
phenomenon of passion.
(88)
It is true that long before the eighteenth century, and for a long
series of centuries from which we have doubtless not emerged,
passion and madness were kept in close relation to one another. But
let us allow the classical period its originality. The moralists of the
Greco-Latin tradition had found it just that madness be passion's
chastisement; and to be more certain that this was the case, they
chose to define passion as a temporary and attenuated madness. But
classical thought could define a relation between passion and
madness which was not on the order of a pious hope, a pedagogic
threat, or a moral synthesis; it even broke with the tradition by
inverting the terms of the concatenation; it based the chimeras of
madness on the nature of passion; it saw that the determinism of the
passions was nothing but a chance for madness to penetrate the
world of reason; and that if the unquestioned union of body and soul
manifested man's finitude in passion, it laid this same man open, at
the same time, to the infinite movement that destroyed him.
Madness, then, was not merely one of the possibilities afforded by
the union of soul and body; it was not just one of the consequences
of passion. Instituted by the unity of soul and body, madness turned
against that unity and once again put it in question. Madness, made
possible by passion, threatened by a movement proper to itself what
had made passion itself possible. Madness was one of those unities
in which laws were compromised, perverted, distorted—thereby
manifesting such unity as evident and established, but also as fragile
and already doomed to destruction.
There comes a moment in the course of passion when laws are
suspended as though of their own accord, when movement either
abruptly stops, without collision or absorption of any kind of active
force, or is propagated, the action ceasing only at the climax of the
paroxysm. Whytt admits that an intense emotion can provoke
madness ex-
(89)
actly as impact can provoke movement, for the sole reason that
emotion is both impact in the soul and agitation of the nervous fiber:
"It is thus that sad narratives or those capable of moving the heart, a
horrible and unexpected sight, great grief, rage, terror, and the other
passions which make a great impression frequently occasion the
most sudden and violent nervous symptoms." But—it is here that
madness, strictly speaking, begins—it happens that this movement
immediately cancels itself out by its own excess and abruptly
provokes an immobility which may reach the point of death itself. As
if in the mechanics of madness, repose were not necessarily a
quiescent thing but could also be a movement in violent opposition
to itself, a movement which under the effect of its own violence
abruptly achieves contradiction and the impossibility of continuance.
"It is not unheard of that the passions, being very violent, generate a
kind of tetanus or catalepsy such that the person then resembles a
statue more than a living being. Further, fear, affliction, joy, and
shame carried to their excess have more than once been followed by
sudden death."6
Conversely, it happens that movement, passing from soul to body
and from body to soul, propagates itself indefinitely in a locus of
anxiety certainly closer to that space where Malebranche placed
souls than to that in which Descartes situated bodies. Imperceptible
movements, often provoked by a slight external impact, accumulate,
are amplified, and end by exploding in violent convulsions. Giovanni
Maria Lancisi had already explained that the noble Romans were
often subject to the vapors—hysterical attacks, hypochondriacal
fits—because in their court life "their minds, continually agitated
between fear and hope, never knew a moment's repose." According
to many physicians, city life, the life of the court, of the salons, led to
madness by this multiplicity of excitations constantly accumulated,
pro-
(90)
longed, and echoed without ever being attenuated. But there is in
this image, in its more intense forms, and in the events constituting
its organic version, a certain force which, increasing, can lead to
delirium, as if movement, instead of losing its strength in
communicating itself, could involve other forces in its wake, and
from them derive an additional vigor. This was how Sauvages
explained the origin of madness: a certain impression of fear is
linked to the congestion or the pressure of a certain medullary fiber;
this. fear is limited to an object, as this congestion is strictly
localized. In proportion as this fear persists, the soul grants it more
attention, increasingly isolating and detaching it from all else. But
such isolation reinforces the fear, and the soul, having accorded it too
special a condition, gradually tends to attach to it a whole series of
more or less remote ideas: "It joins to this simple idea all those
which are likely to nourish and augment it. For example, a man who
supposes in his sleep that he is being accused of a crime, immediately
associates this idea with that of its satellites-judges,
executioners, the gibbet." And from being thus burdened with all
these new elements, involving them in its course, the idea assumes a
kind of additional power which ultimately renders it irresistible even
to the most concerted efforts of the will.
Madness, which finds its first possibility in the phenomenon of
passion, and in the deployment of that double causality which,
starring from passion itself, radiates both toward the body and
toward the soul, is at the same time suspension of passion, breach of
causality, dissolution of the elements of this unity. Madness
participates both in the necessity of passion and in the anarchy of
what, released by this very passion, transcends it and ultimately
contests all it implies. Madness ends by being a movement of the
nerves and muscles so violent that nothing in the course of images,
ideas, or wills seems to correspond to it: this is the case of
91
mania when it is suddenly intensified into convulsions, or when it
degenerates into continuous frenzy. Conversely, madness can, in the
body's repose or inertia, generate and then maintain an agitation of the
soul, without pause or pacification, as is the case in melancholia,
where external objects do not produce the same impression on the
sufferer's mind as on that of a healthy man; "his impressions are weak
and he rarely pays attention to them; his mind is almost totally
absorbed by the vivacity of certain ideas."6
Indeed this dissociation between the external movements of the
body and the course of ideas does not mean that the unity of body and
soul is necessarily dissolved, nor that each recovers its autonomy in
madness. Doubtless the unity is compromised in its rigor and in its
totality; but it is fissured, it turns out, along lines which do not abolish
it, but divide it into arbitrary sectors. For when melancholia fixes
upon an aberrant idea, it is not only the soul which is involved; it is
the soul with the brain, the soul with the nerves, their origin and their
fibers: a whole segment of the unity of soul and body is thus detached
from the aggregate and especially from the organs by which reality is
perceived. The same thing occurs in convulsions and agitation: the
soul is not excluded from the body, but is swept along so rapidly by it
that it cannot retain all its conceptions; it is separated from its
memories, its intentions, its firmest ideas, and thus isolated from itself
and from all that remains stable in the body, it surrenders itself to the
most mobile fibers;
nothing in its behavior is henceforth adapted to reality, to truth, or
to prudence; though the fibers in their vibration may imitate what is
happening in the perceptions, the sufferer cannot tell the difference:
"The rapid and chaotic pulsations of the arteries, or whatever other
derangement occurs, imprints this same movement on the fibers (as
in perception); they will represent as present objects which are not so,
as true those which are chimerical."7
(92)
In madness, the totality of soul and body is parceled out: not
according to the elements which constitute that totality
metaphysically; but according to figures, images which envelop
segments of the body and ideas of the soul in a kind of absurd unity.
Fragments which isolate man from himself, but above all from reality;
fragments which, by detaching themselves, have formed the unreal
unity of a hallucination, and by very virtue of this autonomy impose it
upon truth. "Madness is no more than the derangement of the
imagination."8 In other words, beginning with passion, madness is
still only an intense movement in the rational unity of soul and body;
this is the level of unreason; but this intense movement quickly
escapes the reason of the mechanism and becomes, in its violences, its
stupors, its senseless propagations, an irrational movement; and it is
then that, escaping truth and its constraints, the Unreal appears.
And thereby we find the suggestion of the third cycle we must now
trace: that of chimeras, of hallucinations, and of error—the cycle of
non-being.
Let us listen to what is said in these fantastic fragments.
Imagination is not madness. Even if in the arbitrariness of
hallucination, alienation finds the first access to its vain liberty,
madness begins only beyond this point, when the mind binds itself to
this arbitrariness and becomes a prisoner of this apparent liberty. At
the moment he wakes from a dream, a man can indeed observe: "I am
imagining that I am dead": he thereby denounces and measures the
arbitrariness of the imagination—he is not mad. He is mad when he
posits as an affirmation of his death—when he suggests as having
some value as truth—the still-neutral content of the image "I am
dead." And just as the consciousness of truth is not carried away by
the mere presence of the image, but in the act which limits, confronts,
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unifies, or dissociates the image, so madness will begin only in the
act which gives the value of truth to the image. There is an original
innocence of the imagination: "The imagination itself does not err,
since it neither denies nor affirms but is fixed to so great a degree on
the simple contemplation of an image";9 and only the mind can turn
what is given in the image into abusive truth, in other words, into
error, or acknowledged error, that is, into truth: "A drunk man thinks
he sees two candles where there is but one; a man who has a
strabismus and whose mind is cultivated immediately acknowledges
his error and accustoms himself to see but one."10 Madness is thus
beyond imagination, and yet it is profoundly rooted in it; for it
consists merely in allowing the image a spontaneous value, total and
absolute truth. The act of the reasonable man who, rightly or
wrongly, judges an image to be true or false, is beyond this image,
transcends and measures it by what is not itself; the act of the
madman never oversteps the image presented, but surrenders to its
immediacy, and affirms it only insofar is it is enveloped by it: "Many
persons, not to say all, succumb to madness only from being too
concerned about an object."11 Inside the image, confiscated by it, and
incapable of escaping from it, madness is nonetheless more than
imagination, forming an act of undetermined content.
What is this act? An act of faith, an act of affirmation and of
negation—a discourse which sustains and at the same time erodes the
image, undermines it, distends it in the course of a reasoning, and
organizes it around a segment of language. The man who imagines
he is made of glass is not mad, for any sleeper can have this image in
a dream; but he is mad if, believing he is made of glass, he thereby
concludes that he is fragile, that he is in danger of breaking, that he
must touch no object which might be too resistant, that he must in
fact remain motionless, and so on. Such reasonings are those of a
madman; but again we must note
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that in themselves they are neither absurd nor illogical. On the
contrary, they apply correctly the most rigorous figures of logic. And
Paul Zacchias has no difficulty finding them, in all their rigor, among
the insane. Syllogism, in a man letting himself starve to death: "The
dead do not eat; I am dead; hence I do not eat." Induction extended to
infinity, in a man suffering from persecution delusions: "A, B, and C
are my enemies; all of them are men; therefore all men are my
enemies." Enthymeme, in another sufferer: "Most of those who have
lived in this house are dead, hence I, who have lived in this house,
am dead." The marvelous logic of the mad which seems to mock that
of the logicians because it resembles it so exactly, or rather because it
is exactly the same, and because at the secret heart of madness, at the
core of so many errors, so many absurdities, so many words and
gestures without consequence, we discover, finally, the hidden
perfection of a language. "From these things," Zacchias concludes,
"you truly see how best to discuss the intellect." The ultimate
language of madness is that of reason, but the language of reason
enveloped in the prestige of the image, limited to the locus of
appearance which the image defines. It forms, outside the totality of
images and the universality of discourse, an abusive, singular
organization whose insistent quality constitutes madness. Madness,
then, is not altogether in the image, which of itself is neither true nor
false, neither reasonable nor mad;
nor is it, further, in the reasoning which is mere form, revealing
nothing but the indubitable figures of logic. And yet madness is in
one and in the other: in a special version or figure of their
relationship.
Let us consider an example borrowed from Diemerbroek. A man
was suffering from a profound melancholia. As with all
melancholies, his mind was attached to a fixed idea, and this idea
was for him the occasion of a constantly renewed sadness. He
accused himself of having killed his
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son, and in the excess of his remorse, declared that God, for his
punishment, had assigned a demon to tempt him, like the demon
which had tempted the Lord. This demon he saw, spoke to, heard,
and answered. He did not understand why those around him refused
to acknowledge such a presence. Such then is madness: this remorse,
this belief, this hallucination, these speeches; in short, this complex
of convictions and images which constitutes a delirium. Now
Diemerbroek tries to find out what are the "causes" of this madness,
how it can have originated. And this is what he learns: this man had
taken his son bathing and the boy had drowned. Hence the father
considered himself responsible for his son's death. We can therefore
reconstitute in the following manner the development of this
madness: judging himself guilty, the man decides that homicide is
execrable in the sight of God on High; whence it occurs to his
imagination that he is eternally damned; and since he knows that the
chief torment of damnation consists in being delivered into Satan's
hands, he tells himself "that a horrible demon is assigned to him."
This demon he does not as yet see, but since "he does not cease
thinking of it," and "regards this notion as necessarily true," he
imposes on his brain a certain image of this demon; this image is
presented to his soul by the action of the brain and of the spirits with
such insistence that he believes he continually sees the demon
itself."12
Hence madness, as analyzed by Diemerbroek, has two levels; one
is manifest to all eyes: an unwarranted melancholia in a man who
wrongly accuses himself of having killed his son; a depraved
imagination which pictures demons; a dismantled reason which
converses with a phantom. But at a deeper level, we find a rigorous
organization dependent on the faultless armature of a discourse. This
discourse, in its logic, commands the firmest belief in itself, it
advances by judgments and reasonings which connect
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together; it is a kind of reason in action. In short, under the
chaotic and manifest delirium reigns the order of a secret delirium.
In this second delirium, which is, in a sense, pure reason, reason
delivered of all the external tinsel of dementia, is located the
paradoxical truth of madness. And this in a double sense, since we
find here both what makes madness true (irrefutable logic, perfectly
organized discourse, faultless connection in the transparency of a
virtual language) and what makes it truly madness (its own nature,
the special style of all its manifestations, and the internal structure of
delirium).
But still more profoundly, this delirious language is the ultimate
truth of madness insofar as it is madness's organiz ing form, the
determining principle of all its manifestations, whether of the body
or of the soul. For if Diemerbroek's melancholic converses with his
demon, it is because the demon's image has been profoundly
impressed by the movement of spirits on the still-ductile substance
of the brain. But in its turn, this organic figure is merely the other
side of a preoccupation which has obsessed the patient's mind; it
represents what might be called the sedimentation in the body of an
infinitely repeated discourse apropos of the punishment God must
reserve for sinners guilty of homicide. The body and the traces it
conceals, the soul and the images it perceives, are here no more than
stages in the syntax of delirious language.
And lest we be criticized for elaborating this entire analysis
around a single observation from a single author (a privileged
observation, since it concerns melancholic delirium), we shall also
seek confirmation of the fundamental role of delirious discourse in
the classical conception of madness in another author, of another
period, and apropos of a very different disease. This is a case of
"nymphomania" observed by Bienville. The imagination of a young
girl, "Julie," had been inflamed by precocious reading and
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aroused by the remarks of a servant girl "initiated into the secrets
of Venus, ... a virtuous handmaiden in the mother's eyes" but "a dear
and voluptuous stewardess of the daughter's pleasures." Yet Julie
combats these—to tier-new desires with all the impressions she has
received in the course of her education; to the seductive language of
novels, she opposes the lessons of religion and virtue; and despite the
vivacity of her imagination, she does not succumb to disease so long
as she possesses "the strength to reason thus with herself: it is neither
lawful nor virtuous to obey so shameful a passion."13 But the wicked
remarks, the dangerous readings increase; at every moment, they
render more intense the agitation of the weakening fibers; then the
fundamental language by which she had hitherto resisted gradually
gives way: "Nature alone had spoken hitherto; but soon illusion,
chimera, and extravagance played their part; at length she acquired
the unhappy strength to approve in herself this horrible maxim:
nothing is so beautiful nor so sweet as to obey the desires of love."
This fundamental discourse opens the gates of madness: the imagination
is freed, the appetites continually increase, the fibers reach the
final degree of irritation. Delirium, in its lapidary form of a moral
principle, leads straight to the convulsions which can endanger life
itself.
At the end of this last cycle which had begun with the liberty of
the hallucination and which closes now with the rigor of delirious
language, we can conclude:
1. In madness, for the classical age, there exist two forms of
delirium. A special, symptomatic form, proper to some of the
diseases of the mind and especially to melancholia; in this sense we
can say that there are diseases with or without delirium. In any case,
such delirium is always manifest; it forms an integral part of the
signs of madness; it is immanent to madness's truth and constitutes
only a sector of it. But there exists another delirium which is not
always mani-
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fest, which is not formulated by the sufferer himself in the course
of the disease, but which cannot fail to exist in the eyes of anyone
who, seeking to trace the disease from its origins, attempts to
formulate its riddle and its truth.
2. This implicit delirium exists in all the alterations of the mind,
even where we would expect it least. In cases of no more than silent
gestures, wordless violence, oddities of conduct, classical thought
has no doubt that madness is continually subjacent, relating each of
these particular signs to the general essence of madness. James's
Dictionary expressly urges us to consider as delirious "the sufferers
who sin by fault or excess in any of various voluntary actions, in a
manner contrary to reason and to propriety; as when they use their
hand, for example, to tear out tufts of wool or in an action similar to
that which serves to catch flies; or when a patient acts against his
custom and without cause, or when he speaks too much or too little
against his normal habits; if he abounds in obscene remarks, being,
when in health, of measured speech and decent in his discourse, and
if he utters words that have no consequence, if he breathes more
faintly than he must, or uncovers his private parts in the presence of
those who are near him. We also regard as being in a state of
delirium those whose minds are affected by some derangement in the
organs of sense, or who use them in a fashion not customary to them,
as when, for example, a sufferer is deprived of some voluntary action
or acts inhabitually."14
3. Thus understood, discourse covers the entire range of madness.
Madness, in the classical sense, does not designate so much a
specific change in the mind or in the body, as the existence, under the
body's alterations, under the oddity of conduct and conversation, ofa
delirious discourse. The simplest and most general definition we can
give of classical madness is indeed delirium: "This word is derived
from lira, a furrow; so that deliro actually means to
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move out of the furrow, away from the proper path of reason."15
Hence it is not surprising to find the eighteenth-century
nosographers often classifying vertigo as a madness, and more
rarely hysterical convulsions; this is because it is often impossible to
find in hysterical convulsions the unity of a language, while vertigo
affords the delirious affirmation that the world is really "turning
around." Such delirium is a necessary and sufficient reason for a
disease to be called madness.
4. Language is the first and last structure of madness, its
constituent form; on language are based all the cycles in which
madness articulates its nature. That the essence of madness can be
ultimately defined in the simple structure of a discourse does not
reduce it to a purely psychological nature, but gives it a hold over
the totality of soul and body; such discourse is both the silent
language by which the mind speaks to itself in the truth proper to it,
and the visible articulation in the movements of the body. Parallelisms,
complements, all the forms of immediate communication
which we have seen manifested, in madness are suspended between
soul and body in this single language and in its powers. The
movement of passion which persists until it breaks and turns against
itself, the sudden appearance of the image, and the agitations of the
body which were its visible concomitants—all this, even as we were
trying to reconstruct it, was already secretly animated by this language.
If the determinism of passion is transcended and released in
the hallucination of the image, if the image, in return, has swept
away the whole world of beliefs and desires, it is because the
delirious language was already present—a discourse which liberated
passion from all its limits, and adhered with all the constraining
weight of its affirmation to the image which was liberating itself.
It is in this delirium, which is of both body and soul, of both
language and image, of both grammar and physiol-
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ogy, that all the cycles of madness conclude and begin. It is this
delirium whose rigorous meaning organized them from the start. It is
madness itself, and also, beyond each of its phenomena, its silent
transcendence, which constitute the truth of madness.
A last question remains: In the name of what can this fundamental
language be regarded as a delirium? Granting that it is the truth of
madness, what makes it true madness and the originating form of
insanity? Why should it be in this discourse, whose forms we have
seen to be so faithful to the rules of reason, that we find all those
signs which will most manifestly declare the very absence of
reason?
A central question, but one to which the classical age has not
formulated a direct answer. We must approach it obliquely,
interrogating the experiences which are to be found in the immediate
neighborhood of this essential language of madness: that is, the
dream and the delusion.
The quasi-oneiric character of madness is one of the constant
themes in the classical period. A theme which doubtless derives
from a very old tradition, to which Andre du Laurens, at the end of
the sixteenth century, still testifies; for him melancholia and dreams
have the same origin and bear, in relation to truth, the same value.
There are "natural dreams" which represent what, during the
preceding day, has passed through the senses or the understanding
but happens to be modified by the specific temperament of the
subject. In the same way, there is a melancholia which has a merely
physical origin in the disposition of the sufferer and alters, for his
mind, the importance, the value, and so to speak the coloration of
real events. But there is also a melancholia which permits the
sufferer to predict the future, to speak in an unknown language, to
see beings ordinarily invisible; this melancholia originates in a
supernatural intervention, the same which brings to the sleeper's
mind those
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dreams which foresee the future, announce events to come, and
cause him to see "strange things."
But in fact the seventeenth century preserves this tradition of the
resemblance between madness and dreams only to break it all the
more completely and to generate new, more essential relations.
Relations in which madness and dreams are not only understood in
their remote origin or in their imminent value as signs, but are
confronted as phenomena, in their development, in their very nature.
Dreams and madness then appeared to be of the same substance.
Their mechanism was the same; thus Zacchias could identify in
sleepwalking the movements which cause dreams, but which in a
waking state can also provoke madness.
In the first moments when one falls asleep, the vapors which rise
in the body and ascend to the head are many, turbulent, and dense.
They are so dark that they waken no image in the brain; they merely
agitate, in their chaotic dance, the nerves and the muscles. The same
is true in the frenzied, in maniacs: they suffer few hallucinations, no
false beliefs, but an intense agitation which they cannot manage to
control. Let us continue the evolution of sleep:
after the first period of turbulence, the vapors which rise to the
brain are clarified, their movement organized; this is the moment
when fantastic dreams are born; one sees miracles, a thousand
impossible things. To this stage corresponds that of dementia, in
which one is convinced of many things "which are not in real life."
Then at last the agitation of the vapors is calmed altogether; the
sleeper begins to see things still more clearly; in the transparency of
the henceforth limpid vapors, recollections of the day before
reappear in accordance with reality; such images are at most transposed,
on one point or another—as occurs in melancholies, who
recognize all things as they are, "in particular those who are not
merely distracted." Between the gradual de-
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velopments of sleep—with what they contribute at each stage to
the quality of the imagination—and the forms of madness, the
analogy is constant, because the mechanisms are the same: the same
movement of vapors and spirits, the same liberation of images, the
same correspondence between the physical qualities of phenomena
and the psychological or moral values of sentiments. "To emerge
from the insane no differently than from the sleeping."16
The important thing, in Zacchias's analysis, is that madness is not
associated with dreams in their positive phenomena, but rather to the
totality formed by sleep and dreams together: that is, to a complex
which includes—be sides the image—hallucination, memory, or
prediction, the great void of sleep, the night of the senses, and all that
negativity which wrests man from the waking state and its apparent
truths. Whereas tradition compared the delirium of the madman to
the vivacity of the dream images, the classical period identified
delirium only with the complex of the image and the night of the
mind, against which background it assumed its liberty. And this
complex, transposed entire into the clarity of the waking state,
constituted madness. This is how we must understand the definitions
of madness which insistently recur throughout the classical period.
The dream, as a complex figure of image and sleep, is almost always
present in that definition. Either in a negative fashion—the notion of
the waking state then being the only one that distinguishes madmen
from sleepers; or in a positive fashion, delirium being defined as a
modality of the dream, with the waking state as the specific
difference:
"Delirium is the dream of waking persons."17 The ancients' notion
of the dream as a transitory form of madness is inverted; it is no
longer the dream which borrows its disturbing powers from
alienation—showing thereby how fragile or limited reason is; it is
madness which takes its original nature from the dream and reveals
in this kinship
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that it is a liberation of the image in the dark night of reality.
The dream deceives; it leads to confusions; it is illusory. But it is
not erroneous. And that is why madness is not exhausted in the
waking modality of the dream, and why it overflows into error. It is
true that in the dream, the imagination forges "impossible things and
miracles," or that it assembles lifelike figures "by an irrational
method"; but, Zacchias remarks, "there is no error in these things,
and consequently nothing insane." Madness occurs when the images,
which are so close to the dream, receive the affirmation or negation
that constitutes error. It is in this sense that the Encyclopedic
proposed its famous definition of madness: to depart from reason
"with confidence and in the firm conviction that one is following it—
that, it seems to me, is what is called being mad." Error is the other
element always present with the dream, in the classical definition of
insanity. The madman, in the seventeenth and eighteenth centuries, is
not so much the victim of an illusion, of a hallucination of his senses,
or of a movement of his mind. He is not abused; he deceives himself.
If it is true that on one hand the madman's mind is led on by the
oneiric arbitrariness of images, on the other, and at the same time, he
imprisons himself in the circle of an erroneous consciousness: "We
call madmen," Sauvages was to say, "those who are actually
deprived of reason or who persist in some notable error; it is this
constant error of the soul manifest in its imagination, in its
judgments, and in its desires, which constitutes the characteristic of
this category."
Madness begins where the relation of man to truth is disturbed and
darkened. It is in this relation, at the same time as in the destruction
of this relation, that madness assumes its general meaning and its
particular forms. Dementia, Zacchias says, using the term here in the
most general sense of madness, "lay in this, that the intellect did not
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distinguish true from false." But this breakdown, if we can
understand it only as negation, has positive structures which give it
singular forms. According to the different forms of access to the
truth, there will be different types of madness. It is in this sense that
Chrichton, for example, distinguishes in the order of vesanias, first
the class deliria, which alter that relation to the truth which takes
shape in perception ("general delirium of the mental faculties, in
which the diseased perceptions are taken for realities"); then the class
hallucinations, which alter representation ("error of the mind in
which imaginary objects are taken for realities, or else real objects
are falsely represented"); and last, the class dementias, which
without abolishing or altering the faculties that afford access to truth,
weaken them and diminish their powers.
But we can also analyze madness starting with truth itself and
with the forms proper to it. It is in this manner that the Encyclopedic
distinguishes "physical truth" from "moral truth." "Physical truth
consists in the accurate relation of our sensations with physical
objects"; there will be a form of madness determined by the
impossibility of acceding to this form of truth; a kind of madness of
the physical world which includes illusions, hallucinations, all
perceptual disturbances; "it is a madness to hear choirs of angels, as
certain enthusiasts do." "Moral truth," on the other hand, "consists in
the exactitude of the relations we discern either between moral
objects, or between those objects and ourselves." There will be a
form of madness consisting of the loss of these relations; such is the
madness of character, of conduct, and of the passions. "Veritable
madnesses, then, are all the derangements of our mind, all the
illusions of self-love, and all our passions when they are carried to
the point of blindness; for blindness is the distinctive characteristic
of madness."18
Blindness: one of the words which comes closest to the
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essence of classical madness. It refers to that night of quasi-sleep
which surrounds the images of madness, giving them, in their
solitude, an invisible sovereignty; but it refers also to ill-founded
beliefs, mistaken judgments, to that whole background of errors
inseparable from madness. The fundamental discourse of delirium,
in its constitutive powers, thus reveals to what extent, despite
analogies of form, despite the rigor of its meaning, it was not a
discourse of reason. It spoke, but in the night of blindness; it was
more than the loose and disordered text of a dream, since it deceived
itself; but it was more than an erroneous proposition, since it was
plunged into that total obscurity which is that of sleep. Delirium, as
the principle of madness, is a system of false propositions in the
general syntax of the dream.
Madness is precisely at the point of contact between the oneiric
and the erroneous; it traverses, in its variations, the surface on which
they meet, the surface which both joins and separates them. With
error, madness shares non-truth, and arbitrariness in affirmation or
negation; from the dream, madness borrows the flow of images and
the colorful presence of hallucinations. But while error is merely
non-truth, while the dream neither affirms nor judges, madness fills
the void of error with images, and links hallucinations by affirmation
of the false. In a sense, it is thus plenitude, joining to the figures of
night the powers of day, to the forms of fantasy the activity of the
waking mind; it links the dark content with the forms of light. But is
not such plenitude actually the culmination of the void? The
presence of images offers no more than night-ringed hallucinations,
figures inscribed at the comers of sleep, hence detached from any
sensuous reality; however vivid they are, however rigorously
established in the body, these images are nothingness, since they
represent nothing; as for
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erroneous judgment, it judges only in appearance: affirming
nothing true or real, it does not affirm at all; it is ensnared in the
non-being of error.
Joining vision and blindness, image and judgment, hallucination
and language, sleep and waking, day and night, madness is
ultimately nothing, for it unites in them all that is negative. But the
paradox of this nothing is to manifest itself, to explode in signs, in
words, in gestures. Inextricable unity of order and disorder, of the
reasonable being of things and this nothingness of madness! For
madness, if it is nothing, can manifest itself only by departing from
itself, by assuming an appearance in the order of reason and thus
becoming the contrary of itself. Which illuminates the paradoxes of
the classical experience: madness is always absent, in a perpetual
retreat where it is inaccessible, without phenomenal or positive
character; and yet it is present and perfectly visible in the singular
evidence of the madman. Meaningless disorder as madness is, it
reveals, when we examine it, only ordered classifications, rigorous
mechanisms in soul and body, language articulated according to a
visible logic. All that madness can say of itself is merely reason,
though it is itself the negation of reason. In short, a rational hold
over madness is always possible and necessary, to the very degree
that madness is non-reason.
There is only one word which summarizes this experience,
Unreason: all that, for reason, is closest and most remote, emptiest
and most complete; all that presents itself to reason in familiar
structures—authorizing a knowledge, and then a science, which
seeks to be positive—and all that is constantly in retreat from reason,
in the inaccessible domain of nothingness.
And if, now, we try to assign a value, in and of itself, outside its
relations with the dream and with error, to clas-
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sical unreason, we must understand it not as reason diseased, or
as reason lost or alienated, but quite simply as reason dazzled.
Dazzlement is night in broad daylight, the darkness that rules at
the very heart of what is excessive in light's radaince. Dazzled
reason opens its eyes upon the sun and sees nothing, that is, does not
see; in dazzlement, the recession of objects toward the depths of
night has as an immediate correlative the suppression of vision
itself; at the moment when it sees objects disappear into the secret
night of light, sight sees itself in the moment of its disappearance.
To say that madness is dazzlement is to say that the madman sees
the daylight, the same daylight as the man of reason (both live in the
same brightness); but seeing this same daylight, and nothing but this
daylight and nothing in it, he sees it as void, as night, as nothing; for
him the shadows are the way to perceive daylight. Which means
that, seeing the night and the nothingness of the night, he does not
see at all. And believing he sees, he admits as realities the
hallucinations of his imagination and all the multitudinous
population of night. That is why delirium and dazzlement are in a
relation which constitutes the essence of madness, exactly as truth
and light, in their fundamental relation, constitute classical reason.
In this sense, the Cartesian formula of doubt is certainly the great
exorcism of madness. Descartes closes his eyes and plugs up his
ears the better to see the true brightness of essential daylight; thus he
is secured against the dazzlement of the madman who, opening his
eyes, sees only night, and not seeing at all, believes he sees when he
imagines. In the uniform lucidity of his closed senses, Descartes has
broken with all possible fascination, and if he sees, he is certain of
seeing that which he sees. While before the eyes of the madman,
drunk on a light which is darkness, rise and multi-
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ply images incapable of criticizing themselves (since the madman
sees them), but irreparably separated from being (since the madman
sees nothing).
Unreason is in the same relation to reason as dazzlement to the
brightness of daylight itself. And this is not a metaphor. We are at
the center of the great cosmology which animates all classical
culture. The "cosmos" of the Renaissance, so rich in internal
communications and symbolisms, entirely dominated by the
interacting presence of the stars, has now disappeared, without
"nature" having yet assumed its status of universality, without its
having received man's lyrical recognition, subjecting him to the
rhythm of its seasons. What the classical thinkers retain of the
"world," what they already anticipate in "nature," is an extremely
abstract law, which nonetheless forms the most vivid and concrete
opposition, that of day and night. This is no longer the fatal time of
the planets, it is not yet the lyrical time of the seasons; it is the
universal but absolutely divided time of brightness and darkness. A
form which thought entirely masters in a mathematical science—
Cartesian physics is a kind of mathesis of light—but which at the
same time traces the great tragic caesura in human existence: one
that dominates the theatrical time of Racine and the space of
Georges de la Tour in the same imperious fashion. The circle of day
and night is the law of the classical world: the most reduced but the
most demanding of the world's neces sities, the most inevitable but
the simplest of nature's legatlies.
A law which excludes all dialectic and all reconciliation; which
establishes, consequently, both the flawless unity of knowledge and
the uncompromising division of tragic existence; it rules over a
world without twilight, which knows no effusion, nor the attenuated
cares of lyricism;
everything must be either waking or dream, truth or dark-
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ness, the light of being or the nothingness of shadow. Such a law
prescribes an inevitable order, a serene division which makes truth
possible and confirms it forever.
And yet on either side of this order, two symmetrical, inverse
figures bear witness that there are extremities where it can be
transgressed, showing at the same time to what degree it is essential
not to transgress it. On one side, tragedy. The rule of the theatrical
day has a positive content; it forces tragic duration to be poised upon
the singular but universal alternation of day and night; the whole of
the tragedy must be accomplished in this unity of time, for tragedy is
ultimately nothing but the confrontation of two realms, linked to
each other by time itself, in the irreconcilable. Every day, in Racine's
theater, is overhung by a night, which it brings, so to speak, to light:
the night of Troy and its massacres, the night of Nero's desires,
Titus's Roman night, Athalie's night. These are the great stretches of
night, realms of darkness which haunt the day without yielding an
hour, and disappear only in the new night of death. And these
fantastic nights, in their turn, are haunted by a light which forms a
kind of infernal reflection of the day: the burning of Troy, the
torches of the Praetorians, the pale light of the dream. In classical
tragedy, day and night are arranged like a pair of mirrors, endlessly
reflect each other, and afford that simple couple a sudden profundity
which envelops in a single movement all of man's life and his death.
In the same fashion, in De la Tour'sM adeleine au miroir, light and
shadow confront each other, divide and at the same time unite a face
and its reflection, a skull and its image, a vigil and a silence; and in
the Image Saint-Alexis, the page holding the torch reveals under the
shadow of the vault the man who was his master—a grave and
luminous boy encounters all of human misery; a child brings death
to light.
On the other side, facing tragedy and its hieratic lan-
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guage, is the confused murmur of madness. Here, too, the great
law of the division has been violated; shadow and light mingle in the
fury of madness, as in the tragic disorder. But in another mode. In
night, the tragic character found a somber truth of day; the night of
Troy remained Andromache's truth, as Athalie's night presaged the
truth of the already advancing day; night, paradoxically, revealed; it
was the profoundest day of being. The madman, conversely, finds in
daylight only the inconsistency of the night's figures; he lets the light
be darkened by all the illusions of the dream; his day is only the
most superficial night of appearance. It is to this degree that tragic
man, more than any other, is engaged in being, is the bearer of his
truth, since, like Phedre, he flings in the face of the pitiless sun all
the secrets of the night; while the madman is entirely excluded from
being. And how could he not be, lending as he does the day's
illusory reflection to the night's non-being?
We understand that the tragic hero—in contrast to the baroque
character of the preceding period—can never be mad; and that
conversely madness cannot bear within itself those values of
tragedy, which we have known since Nietzsche and Artaud. In the
classical period, the man of tragedy and the man of madness
confront each other, without a possible dialogue, without a common
language; for the former can utter only the decisive words of being,
uniting in a flash the truth of light and the depth of darkness; the
latter endlessly drones out the indifferent murmur which cancels out
both the day's chatter and the lying dark.
Madness designates the equinox between the vanity of night's
hallucinations and the non-being of light's judgments.
And this much, which the archaeology of knowledge has been
able to teach us bit by bit, was already offered to us in
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a simple tragic fulguration, in the last words of Andromaque.
As if, at the moment when madness was vanishing from the tragic
act, at the moment when tragic man was to separate himself for over
two centuries from the man of unreason—as if, at this very moment,
an ultimate figuration were demanded of madness. The curtain
which falls on the last scene of Andromaque also falls on the last of
the great tragic incarnations of madness. But in this presence on the
threshold of its own disappearance, in this madness incarcerating
itself for good, is articulated what it is and will be for the entire
classical age. Is it not precisely at the moment of its disappearance
that it can best present its truth, its truth of absence, its truth which is
that of day at the limits of night? This had to be the last scene of the
first great classical tragedy; or if one prefers, the first time in which
the classical truth of madness is expressed in a tragic movement
which is the last of the preclassical theater. A truth, in any case, that
is instantaneous, since its appearance can only be its disappearance;
the lightning-flash is seen only in the already advancing night.
Orestes, in his frenzy, passes through a triple circle of night: three
concentric figurations of dazzlement. Day has just dawned over
Pyrrhus's palace; night is still there, edging this light with shadow,
and peremptorily indicating its limit. On this morning which is a
festival morning, the crime has been committed, and Pyrrhus has
closed his eyes on the dawning day: a fragment of shadow cast here
on the steps of the altar, on the threshold of brightness and of
darkness. The two great cosmic themes of madness are thus present
in various forms, as omen, decor, and counterpoint of Orestes'
frenzy.19 It can then begin: in a pitiless clarity which denounces the
murder of Pyrrhus and the treachery of Hermione, in that dawn
where everything finally explodes in a truth so old and at the same
rime so young, a
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first circle of shadow: a dark cloud into which, all around Orestes,
the world begins to withdraw; the truth appears in this paradoxical
twilight, in this matinal night where the cruelty of truth will be
transformed into the fury of hallucination:
Mais quelle epaisse nuit, tout a coup, m'environne?
(But what thick night suddenly surrounds me?)
It is the empty night of error; but against the background of this
first obscurity, a brilliance, a false light will appear: that of images.
The nightmare rises, not in the bright light of morning, but in a
somber scintillation: the light of storm and of murder.
Dieux! quels ruisseaux de sang content autour de moi!
(O Gods! What streams of blood flow around me!)
And then appears the dynasty of the dream. In this night the
hallucinations are set free; the Erinnyes appear and take over. What
makes them precarious also makes them sovereign; they triumph
easily in the solitude where they succeed one another; nothing
challenges them; images and language intersect, in apostrophes
which are invocations, presences affirmed and repulsed, solicited
and feared. But all these images converge toward night, toward a
second night which is that of punishment, of eternal vengeance, of
death within death. The Erinnyes are recalled to that darkness which
is their own—their birthplace and their truth, i.e., their own
nothingness.
Venez-vous m'enlever dans Fetemelle nuit?
(Do you come to bear me off into eternal night?)
This is the moment when it is revealed that the images of madness
are only dream and error, and if the sufferer who is blinded by them
appeals to them, it is only to disappear with them in the annihilation
to which they are fated.
A second time, then, we pass through a circle of night. But we are
not thereby restored to the daylight reality of
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the world. We accede, beyond what is manifested in madness, to
delirium, to that essential and constitutive structure which had
secretly sustained madness from the first. This delirium has a name,
Hermione; Hermione who no longer reappears as a hallucinatory
vision, but as the ultimate truth of madness. It is significant that
Hermione intervenes at this very moment of the frenzy: not among
the Eumenides, nor ahead of them—to guide them; but behind and
separated from them by the night into which they have dragged
Orestes and in which they themselves are now scattered. Hermione
intervenes as a figure of delirium, /as the truth which secretly
reigned from the start, and of which the Eumenides were ultimately
only the servants. Here we are at the opposite of Greek tragedy,
where the Erinnyes were the final destiny and truth which, in the
night of time, had awaited the hero; his passion was merely their
instrument. Here the Eumenides are merely figures in the service of
delirium, the primary and ultimate truth, which was already
appearing in passion, and now declares itself in its nakedness. This
truth rules alone, thrusting images away:
Mais non, retirez-vous, laissez faire Hermione.
(But no, begone, let Hermione do her work.)
Hermione, who has always been present from the beginning,
Hermione who has always lacerated Orestes, destroying his reason
bit by bit, Hermione for whom he has become "parricide, assassin,
sacrilege," reveals herself finally as the truth and culmination of his
madness. And delirium, in its rigor, no longer has anything to say
except to articulate as imminent decision a truth long since commonplace
and laughable:
Et je lui porte enfin mon coeur a devorer.
(And I bring her at last my heart to devour.)
Days and years ago Orestes had offered up this savage sacrifice.
But now he expresses this principle of his madness
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as an end. For madness cannot go any farther. Having uttered its
truth in its essential delirium, it can do no more than collapse in a
third night, that night from which there is no return, the night of an
incessant devouring. Unreason can appear only for a moment, the
instant when language enters silence, when delirium itself is stilled,
when the heart is at last devoured.
In the tragedies of the early seventeenth century, madness, too,
released drama; but it did so by liberating truth; madness still had
access to language, to a renewed language of explanation and of
reality reconquered. It could be at most only the penultimate moment
of the tragedy. Not the last, as in Andromaque, in which no truth is
uttered except the truth, in delirium, of a passion which has found
with madness the perfection of its fulfillment.
The movement proper to unreason, which classical learning
followed and pursued, had already accomplished the whole of its
trajectory in the concision of tragic language. After which, silence
could reign, and madness disappear in the—always withdrawn—
presence of unreason.
What we now know of unreason affords us a better understanding
of what confinement was.
This gesture, which banished madness to a neutral and uniform
world of exclusion, did not mark a halt in the evolution of medical
techniques, nor in the progress of humanitarian ideas. It assumed its
precise meaning in this fact: that madness in the classical period
ceased to be the sign of another world, and that it became the
paradoxical manifestation of non-being. Ultimately, confinement did
seek to suppress madness, to eliminate from the social order a figure
which did not find its place within it; the essence of confinement
was not the exorcism of a danger. Confinement merely manifested
what madness, in its essence, was:
a manifestation of non-being; and by providing this man-
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ifestation, confinement thereby suppressed it, since it restored it
to its truth as nothingness. Confinement is the practice which
corresponds most exactly to madness experienced as unreason, that
is, as the empty negativity of reason; by confinement, madness is
acknowledged to be nothing. That is, on one hand madness is
immediately perceived as difference: whence the forms of
spontaneous and collective judgment sought, not from physicians,
but from men of good sense, to determine the confinement of a madman;
and on the other hand, confinement cannot have any other goal
than a correction (that is, the suppression of the difference, or the
fulfillment of this nothingness in death);
whence those options for death so often to be found in the
registers of confinement, written by the attendants, and which are
not the sign of confinement's savagery, its inhumanity or perversion,
but the strict expression of its meaning: an operation to annihilate
nothingness.20 Confinement sketches, on the surface of phenomena
and in a hasty moral synthesis, the secret and distinct structure of
madness.
Then did confinement establish its practices in this profound
intuition? Was it because madness under the effect of confinement
had really vanished from the classical horizon that it was ultimately
stigmatized as non-being? Questions whose answers refer to each
other in a perfect circularity. It is futile, no doubt, to lose oneself in
the endless cycle of these forms of interrogation. Better to let classical
culture formulate, in its general structure, the experience it had
of madness, an experience which crops up with the same meanings,
in the identical order of its inner logic, in both the order of
speculation and the order of institutions, in both discourse and
decree, in both word and watchword—wherever, in fact, a
signifying element can assume for us the value of a language.
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V
ASPECTS OF MADNESS
IN this chapter we do not wish to write a history of the different
notions of psychiatry in the seventeenth and eighteenth centuries,
but rather to show the specific faces by which madness was
recognized in classical thought. Faces still haunted by mythical
figures, but which have often been essential in the organization of
our practical knowledge.
I. Mania, and Melancholia
The notion of melancholia was fixed, in the sixteenth century,
between a certain definition by symptoms and an explanatory
principle concealed in the very term that designated it. Among the
symptoms, we find all the delirious ideas an individual can form
about himself: "Some think themselves to be beasts, whose voice
and actions they imitate. Some think that they are vessels of glass,
and for this reason recoil from passers-by, lest they break; others
fear
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death, which they yet cause most often to themselves. Still others
imagine that they are guilty of some crime, so that they tremble with
terror when they see another coming toward them, thinking he seeks
to take them prisoner and sentence them to death."1 Delirious themes
that remain isolated and do not compromise reason's totality.
Thomas Sydenham would even observe that melancholics "are
people who, apart from their complaint, are prudent and sensible,
and who have an extraordinary penetration and sagacity. Thus
Aristotle rightly observed that melancholics have more intelligence
than other men."
Now this clear and coherent syndrome was designated by a word
that implied an entire causal system, that of melancholia: "I beg you
to regard closely the thoughts of melancholics, their words, visions,
actions, and you will discover how all their senses are depraved by a
melancholic humor spread through their brain."2 Partial delirium and
the action of black bile were juxtaposed in the notion of
melancholia, unrelated for the moment beyond a disjunct
confrontation of a group of signs by a signifying name. Yet in the
eighteenth century a unity would be found, or rather an exchange
would be made—the nature of that cold, black humor having
become the major coloration of delirium, its positive value in
contrast to mania, dementia, and frenzy, its essential principle of
cohesion. And while Hermann Boerhaave still defined melancholia
as merely "a long, persistent delirium without fever, during which
the sufferer is obsessed by only one thought," Dufour, several years
later, shifted the weight of his definition to "fear and sadness," which
were now supposed to explain the partial character of the delirium:
"Hence it is that melancholies love solitude and shun company; this
makes them more attached to the object of their delirium or to their
dominant passion, whatever it may be, while they seem indifferent to
anything else." The concept is fixed not by a new rigor in observa-
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tion, nor by a discovery in the realm of causes, but by a
qualitative transmission proceeding from a cause implied in the
designation to a significant perception in the effects.
For a long time—until the beginning of the seventeenth century—
the discussion of melancholia remained fixed within the tradition of
the four humors and their essential qualities: stable qualities actually
inherent in a substance, which alone could be considered as their
cause. For Jean Fernel, the melancholic humor, related to earth and
to autumn, is a juice "thick in consistency, cold and dry in temperament."
But in the first half of the century, a debate began over
the origin of melancholia: must one necessarily have a melancholic
temperament to be afflicted with melancholia? Is the melancholic
humor always cold and dry—is it never warm, or humid? Is it the
substance which acts, or the qualities which are transmitted? The
results of this long debate may be summarized as follows:
1. The causality of substances is increasingly replaced by a
movement of qualities, which, without any vehicular means, are
immediately transmitted from body to soul, from humor to ideas,
from organs to conduct. Thus, for Duncan's Apologist the best proof
that the melancholic juice produces melancholia is that in it one
finds the very qualities of the disease: "The melancholic juice
possesses to a far greater degree the conditions necessary to produce
melancholia than your fiery angers; since by its coldness, it
diminishes the quantity of spirits; by its dryness, it renders them
capable of preserving for a long time the type of a strong and
persistent imagination; and by its blackness, it deprives them of their
natural clarity and subtlety."3
2. There is, besides this mechanics of qualities, a dynamics that
analyzes the strength to be found imprisoned in each. Thus cold and
dryness can enter into conflict with the temperament, and this
opposition will generate symptoms of melancholia violent in
proportion to the struggle:
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the strength that prevails and sweeps away all that resists it. Thus
women, whose nature is little inclined to melancholy, fall a prey to it
all the more seriously: "They are cruelly used and violently
disturbed by it, for melancholia being more opposed to their
temperament, it removes them further from their natural
constitution."4
3. But it is sometimes within the quality itself that the conflict is
generated. A quality may alter in the course of its development and
become the opposite of what it was. Thus when "the entrails are
heated, when all simmers within the body . . . and all the juices are
consumed," then this conflagration can turn to cold melancholia—
producing "almost the same thing caused by the flow of wax in a
torch turned upside down. . . . This cooling of the body is the
ordinary effect which follows immoderate heat once it has thrown
off and exhausted its vigor."5 There is a kind of dialectic of qualities
which, free from any constraint of substance, from any
predeterminadon, makes its way through reversals and
contradictions.
4. Finally, qualities may be altered by accidents, circumstances,
the conditions of life; so that a being who is dry and cold can
become warm and humid, if his way of life inclines him to it; as in
the case of women: they "remain in idleness, their bodies tend to
perspire less [than those of men], and heat, spirits, and humors
remain within."6
Thus freed from a confining substantial basis, qualities would be
able to play an organizing and integrating role in the notion of
melancholia. On the one hand, they would trace, among the
symptoms and manifestations, a certain profile of sadness, of
blackness, of slowness, of immobility. On the other, they would
suggest a causal basis which would no longer be the physiology of a
humor, but the pathology of an idea, of a fear, of a terror. The
morbid entity was not defined from observed signs nor from supposed
causes; but somewhere between, and beyond both, it
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was perceived as a certain qualitative coherence, which had its
own laws of transmission, of development, and of transformation. It
is the secret logic of this quality that controls the development of the
idea of melancholia, not medical theory. This is evident as early as
Thomas Willis's texts.
At first glance, the coherence of their analyses is vouched for on
the level of speculative reflection. Willis's explanation is borrowed
whole from animal spirits and their mechanical properties.
Melancholia is "a madness without fever or frenzy, accompanied by
fear and sadness." To the extent that it is delirium—that is, an
essential break with truth—its origin resides in a disordered
movement of the spirits and in a defective state of the brain; but can
that fear, that anxiety which makes melancholics "sad and punctilious,"
be explained by movements alone? Might there be a
mechanism of fear and a circulation of spirits that is peculiar to
sadness? This is obvious to Descartes; it is no longer so for Willis.
Melancholia cannot be treated like a paralysis, an apoplexy, a
vertigo, or a convulsion. In fact, it cannot even be analyzed as a
simple dementia, although melancholic delirium supposes a similar
disorder in the movement of spirits; disturbances in the mechanism
easily explain delirium—that error common to all madness, dementia
or melancholia—but not the quality peculiar to delirium, the
coloration of sadness and fear which makes its landscape so unique.
One must penetrate the secret of predispositions. After all, it is these
essential qualities, hidden in the very grain of the subtle matter, that
explain the paradoxical movements of the spirits.
In melancholia, the spirits are swept by an agitation, but a feeble
agitation, without power or violence: a sort of impotent jostling
which does not follow marked paths, nor open roads (aperta
opercula), but traverses the cerebral matter by endlessly creating
new pores; yet the spirits do not wander far upon the paths they
trace; very soon their
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agitation languishes, their strength fails, and the movement stops:
"they do not reach far."7 Thus such disturbance, common to all
delirium, can produce on the surface of the body neither those
violent movements nor those cries that may be observed in mania
and frenzy; melancholia never reaches violence; it is madness at the
limits of its powerless-ness. This paradox is the result of the secret
alterations of the spirits. Usually they have the quasi-immediate
rapidity and the absolute transparence of luminous rays; but in melancholia,
they are charged with darkness; they become "obscure,
opaque, shadowy"; and the images of things which they bear to the
brain and to the mind are veiled with "shadow and with shades."
They become heavy and closer to a dark chemical vapor than to pure
light. A chemical vapor that would be of an acid nature, rather than
sulfurous or alcoholic: for in acid vapors the particles are mobile,
and even incapable of rest, but their activity is weak, without effect;
when they are distilled, nothing remains in the alembic but an
insipid phlegm. Do not acid vapors have the very properties of
melancholia, whereas alcoholic vapors, always ready to burst into
flame, suggest frenzy; and sulfurous vapors, agitated by a violent
and continuous movement, indicate mania? If, then, one were to
seek "the formal reason and the causes" of melancholia, one would
consider the vapors that rise from the blood to the brain and that
have degenerated into an acid and corrosive vapor. In appearance, it
is a melancholia of the spirits, a chemistry of the humors that
oriented Willis's analysis; but in fact, the principal clue is afforded
by the immediate qualities of melancholic suffering: an impotent
disorder, and then that shadow over the mind, along with that acid
bitterness which corrodes thought and feeling alike. The chemistry
of acids is not the explanation of the symptoms;
it is a qualitative option: a phenomenology of melancholic
experience.
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Some seventy years later, animal spirits lost their scientific
prestige. Now it was from the body's liquid and solid elements that
the secret of disease was sought. The Medical Dictionary which
Robert James published in England in 1743 proposes, under Mania,
a comparative etiology of that disease and of melancholia: "It is
evident that the brain is the seat ... of all diseases of this nature. ... It
is there that the Creator has fixed, although in a manner which is
inconceivable, the lodging of the soul, the mind, genius,
imagination, memory, and all sensations. . . . All these noble
functions will be changed, depraved, diminished, and totally
destroyed, if the blood and the humors corrupted in quality and
quantity are no longer carried to the brain in a uniform and
temperate manner, but instead circulate there with violence and
impetuosity, or move about slowly, with difficulty or with languor."
It is this languishing flow, these choked vessels, this heavy, clogged
blood that the heart labors to distribute throughout the organism, and
which has difficulty penetrating into the very fine arterioles of the
brain, where the circulation ought to be very rapid in order to
maintain the movement of thought—it is all this distress ing
obstruction which explains melancholia. Heaviness, encumbrance—
here again the primitive qualities guide analysis. The explanation
becomes a transfer to the organism of qualities perceived in the
condition, the conduct, the words of the sick person. We move from
qualitative apprehension to supposed explanation. But it is this
apprehension that continues to prevail and always wins out over
theoretical coherence. Anne-Charles Lorry juxtaposes the two main
forms of medical explanation—by solids and by fluids—and
ultimately causes them to intersect, thus distinguishing two kinds of
melancholia. The one whose origin is in solids is nervous
melancholia: a particularly strong sensation agitates the fibers which
receive it; as a result, tension increases in the other fibers, which
become more rigid and at the
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same time susceptible to further vibration. But should the
sensation become even stronger, then the tension increases to such a
degree in the other fibers that they become incapable of vibrating;
the state of rigidity is such that the flow of blood is stopped and the
animal spirits immobilized. Melancholia has set in. In the other form
of disease, the "liquid form," the humors are impregnated with black
bile;
they become thicker; clogged with these humors, the blood
thickens and stagnates in the meninges until it compresses the
principal organs of the nervous system. Then we find again the
rigidity of the fibers, but in this case it is no more than a
consequence of a humoral phenomenon. Lorry distinguishes two
melancholias: actually it is the same group of qualities, affording
melancholia its real unity, that he employs successively in two
explanatory systems. Only the theoretical edifice has been doubled.
The qualitative basis in experience remains the same.
A symbolic unity formed by the languor of the fluids, by the
darkening of the animal spirits and the shadowy twilight they spread
over the images of things, by the viscosity of the blood that
laboriously trickles through the vessels, by the thickening of vapors
that have become blackish, deleterious, and acrid, by visceral
functions that have become slow and somehow slimy—this unity,
more a product of sensibility than of thought or theory, gives
melancholia its characteristic stamp.
It is this undertaking, more than faithful observation, which
reorganizes melancholia's symptoms and mode of appearance. The
theme of a partial delirium increasingly disappears as a major
symptom of melancholics in favor of qualitative data like sadness,
bitterness, a preference for solitude, immobility. At the end of the
eighteenth century, all forms of madness without delirium, but
characterized by inertia, by despair, by a sort of dull stupor, would
be readily classified as melancholia.8 And as early as James's
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Dictionary, an apoplectic melancholia is discussed, in which the
sufferers "refuse to rise from their beds . . . ; once on their feet, they
will not walk unless they are forced by their friends or attendants;
they in no way avoid others, but they seem to pay no attention to
what is said to them;
they make no answer." If, in this case, immobility and silence
prevail and determine the diagnosis of melancholia, there are cases
in which one observes only bitterness, languor, and a preference for
isolation; their very agitation must not deceive the observer nor
authorize a hasty diagnosis of mania; these patients are definitely
suffering from melancholia, for "they avoid company, prefer solitary
places, and wander without knowing where they are going;
they have a yellowish color, a dry tongue as in a person suffering
from great thirst, and their eyes are dry, hollow, never moistened
with tears; their entire body is dry and burning hot, their face dark,
and expressing only horror and sadness."9
The analyses of mania and their evolution during the classical
period obey the same principles of coherence.
Willis opposes mania to melancholia. The mind of the
melancholic is entirely occupied by reflection, so that his
imagination remains at leisure and in repose; the maniac's
imagination, on the contrary, is occupied by a perpetual flux of
impetuous thoughts. While the melancholic's mind is fixed on a
single object, imposing unreasonable proportions upon it, but upon it
alone, mania deforms all concepts and ideas; either they lose their
congruence, or their representative value is falsified; in any case, the
totality of thought is disturbed in its essential relation to truth.
Melancholia, finally, is always accompanied by sadness and fear;
on the contrary, in the maniac we find audacity and fury. Whether
it is a question of mania or melancholia, the cause of the disease is
always in the movement of the animal
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spirits. But this movement is quite particular in mania: it is
continuous, violent, always capable of piercing new pores in the
cerebral matter, and it creates, as the material basis of incoherent
thoughts, explosive gestures, continuous words which betray mania.
Is not such pernicious mobility that of an infernal water, sulfurous
liquid, those aquae stygiae, ex nitro, vitriolo, antimonio, arsenico, et
similibus exstillatae: its particles are in perpetual movement; they
are capable of provoking new pores and new channels in any
substance;
and they have strength enough to spread themselves far, exactly
as the maniacal spirits are capable of spreading agitation through all
the parts of the body. An infernal water gathers in the secrecy of its
movements all the images in which mania takes its concrete form. It
constitutes, in an indissociable way, both its chemical myth and its
dynamic truth.
In the course of the eighteenth century, the image, with all its
mechanical and metaphysical implications, of animal spirits in the
channels of the nerves, was frequently replaced by the image, more
strictly physical but of an even more symbolic value, of a tension to
which nerves, vessels, and the entire system of organic fibers were
subject. Mania was thus a tension of the fibers carried to its
paroxysm, the maniac a sort of instrument whose strings, by the
effect of an exaggerated traction, began to vibrate at the remotest
and faintest stimulus. Maniacal delirium consisted of a continual
vibration of the sensibility. Through this image, the differences from
melancholia became precise and were organized into a rigorous
antithesis: the melancholic can no longer enter into a resonance with
the external world, because his fibers are relaxed or because they
have been immobilized by too great a tension (we see how the
mechanics of tension explains melancholic immobility as well as
maniacal agitation): only a few fibers vibrate in the melancholic,
those which correspond to the precise point of his
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delirium. On the contrary, the maniac vibrates to any and every
stimulus; his delirium is universal; stimuli do not vanish into the
density of his immobility, as in the melancholic's case; when his
organism returns them, they have been multiplied, as if the maniac
had accumulated a supplementary energy in the tension of his fibers.
It is this very fact, moreover, that makes the maniac, in his turn,
insensible, not with the somnolent insensibility of the melancholic,
but with an insensibility taut with interior vibrations; this is
doubtless why maniacs "fear neither heat nor cold, tear off their
clothes, sleep naked in the dead of winter without feeling the cold."
It is also why they substitute for the real world, which nonetheless
continues to solicit them, the unreal and chimerical world of their
delirium:
"The essential symptoms of mania result from the fact that
objects do not present themselves to the sufferers as they are in
reality."10 The delirium of maniacs is not determined by a particular
error of judgment; it constitutes a defect in the transmission of sense
impressions to the brain, a flaw in communication. In the
psychology of madness, the old idea of truth as "the conformity of
thought to things" is transposed in the metaphor of a resonance, a
kind of musical fidelity of the fibers to the sensations which make
them vibrate.
This theme of manic tension develops, beyond a medicine of
solids, into intuitions that are still more qualitative. The rigidity of
fibers in a maniac always belongs to a dry landscape; mania is
regularly accompanied by a wasting of the humors, and by a general
aridity in the entire organism. The essence of mania is desertic,
sandy. Theophile Bonet, in his Sepulchretum anatomicum, declares
that the brains of maniacs, insofar as he had been able to observe
them, always seemed to be in a state of dryness, of hardness, and of
friability. Later, Albrecht von Haller also found that the maniac's
brain was hard, dry, and brittle. Menuret repeats
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an observation of Forestier's that clearly shows how an excessive
loss of a humor, by drying out the vessels and fibers, may provoke a
state of mania; this was the case of a young man who "having
married his wife in the summer-time, became maniacal as a result of
the excessive intercourse he had with her."
What some imagined or supposed, what others saw in a quasiperception,
Dufour proved, numbered, named. During an autopsy, he
removed part of the medullary substance from the brain of a subject
who had died in a state of mania; he cut out "a cube six lines in each
direction" the weight of which was 3 j.g. Ill, while the same volume
taken from an ordinary brain weighed 3 j.g. V: "this inequality in
weight, which seems at first of little consequence, is no longer so
slight if we consider the fact that the specific difference between the
total mass of the brain of a madman and that of a normal man is
around 7 gros less in the adult, in whom the brain's entire mass
ordinarily weighs three livres." Mania's dessication and lightness
show even on the scale.
Were not this internal dryness and this heat further proved by the
ease with which maniacs endured great cold? It was an established
fact that they had been seen walking naked in the snow, that there
was no need to warm them when they were confined in the asylum,
that they could even be cured by cold. Since Jean-Baptiste van
Helmont, the immersion of maniacs in ice water had been widely
practiced, and Menuret states that he knew a maniac who, having
escaped from the prison where he was kept, "walked several leagues
in a violent rain without a hat and almost without clothing, and who
by this means recovered perfect health." Montchau, who cured a
maniac by "pouring ice water upon him, from as high above as possible,"
was not astonished by so favorable a result; to explain it he
united all the themes of organic calefaction that
(128)
had succeeded and intersected each other since the seventeenth
century: "One need not be surprised that ice water produces such a
prompt and perfect cure precisely when boiling blood, furious bile,
and mutinous liquors carried disturbance and irritation everywhere";
by the impression of coldness, "the vessels contracted more violently
and freed themselves of the liquors that crammed them; the irritation
of the solid parts caused by the extreme heat of the liquors they
contained ceased, and when the nerves relaxed, the course of the
spirits that had proceeded irregularly from one side to the other was
re-established in its natural state." The world of melancholia was
humid, heavy, and cold;
that of mania was parched, dry, compounded of violence and
fragility; a world which heat—unfelt but everywhere manifested—
made arid, friable, and always ready to relax under the effect of a
moist coolness. In the development of all these qualitative
simplifications, mania attained both its full scope and its unity. It has
doubtless remained what it was at the beginning of the seventeenth
century, "fury without fever," but beyond these two characteristics,
which were still only descriptive, there developed a perceptual
theme which was the real organizer of the clinical picture. Once the
explanatory myths disappeared, and humors, spirits, solids, fluids no
longer had any currency, there would remain only the schema of
coherent qualities which would no longer even be named, and what
this dynamics of heat and movement slowly formed into a constellation
characteristic of mania would now be observed as a natural
complex, as an immediate truth of psychological observation. What
had been perceived as heat, imagined as agitation of spirits,
conceived as fibrous tension, would henceforth be recognized in the
neutralized transparency of psychological notions: exaggerated
vivacity of internal impressions, rapidity in the association of ideas,
inattention
(129)
to the external world. De la Rive's description already has this
limpidity: "External objects do not produce upon the mind of a
sufferer the same impression as upon the mind of a healthy man;
these impressions are weak, and the sufferer rarely heeds them; his
mind is almost entirely absorbed by the action of the ideas produced
by the deranged state of his brain. These ideas have such a degree of
vivacity that the sufferer believes they represent real objects, and
judges accordingly." But we must not forget that this psychological
structure of mania, as it appeared and was stabilized at the end of the
eighteenth century, is only the superficial sketch of an entire
profound organization, which itself would capsize and which had
developed according to the half-perceptual, half-iconographic laws
of a qualitative world.
No doubt this entire universe of heat and cold, of humidity and
dryness, reminded medical thought, about to accede to positivism, of
the circumstances of its own origin. But this blazon of images was
not simply reminiscence; it was also an undertaking. In order to form
the practical experience of mania or melancholia, this gravitation,
against a background of images, of qualities attracted to each other
by a whole system of sensuous and affective affinities was essential.
If mania, if melancholia henceforth assumed the aspects our science
knows them by, it is not because in the course of centuries we have
learned to "open our eyes" to real symptoms; it is not because we
have purified our perception to the point of transparency; it is
because in the experience of madness, these concepts were organized
around certain qualitative themes that lent them their unity, gave
them their significant coherence, made them finally perceptible. We
have passed from a simple notional description (fury without fever,
delirious idee fixe) to a qualitative realm, apparently less organized,
simpler, less precisely limited, but which alone was able to constitute
(130)
recognizable, palpable units really present in the total experience
of madness. The field of observation of these diseases was
partitioned into landscapes that obscurely gave them their style and
their structure. On the one hand, a sodden, almost diluvian world,
where man remained deaf, blind, and numb to all that was not his
one terror: a world simplified in the extreme, and immoderately
enlarged in a single one of its details. On the other, a parched and
desertic world, a panic world where all was flight, disorder,
instantaneous gesture. It was the rigor of these themes in their
cosmic form—not the approximations of an observing caution—
which organized the experience (already almost our own experience)
of mania and melancholia.
It is Willis, with his spirit of observation, the purity of his medical
perception, whom we honor as the "discoverer" of the maniamelancholia
alternation. Certainly Willis's methods are of great
interest, chiefly in this particular: the transition from one affection to
the other is seen not as a phenomenon of observation for which it
was then a matter of discovering the explanation, but rather as the
consequence of a profound natural affinity which was of the order of
their secret nature. Willis does not cite a single case of alternation
which he had occasion to observe; what he first discovered was an
internal relation which engendered strange metamorphoses: "After
melancholia, we must consider mania, with which it has so many
affinities that these complaints often change into one another": it
happens, in fact, that the melancholic predisposition, if aggravated,
becomes frenzy; frenzy, on the contrary, when it decreases and loses
its force, finally grows calm and turns to melancholic diathesis. A
rigorous empiricism would see two related diseases here, or even two
successive symptoms of the same disease. However, Willis does not
pose the
(131)
problem in terms of symptoms nor in terms of disease; he merely
seeks the link connecting two states in the dynamics of animal
spirits. In the melancholic, we remember, the spirits were somber
and dim; they cast their shadows over the images of things and
formed a kind of dark tide; in the maniac, on the contrary, the spirits
seethed in a perpetual ferment; they were carried by an irregular
movement, constantly repeated; a movement that eroded and
consumed, and even without fever, sent out its heat. Between mania
and melancholia, the affinity is evident: not the affinity of symptoms
linked in experience, but the affinity—more powerful and so much
more evident in the landscapes of the imagination—that unites in the
same fire both smoke and flame. "If we can say that in melancholia,
the brain and the animal spirits are obscured by smoke and a dense
vapor, mania seems to ignite a kind of conflagration hitherto
muffled by them." The flame in its rapid movement dissipates the
smoke; but the smoke, when it falls back, smothers the flame and
extinguishes its brightness. The combination of mania and
melancholy is not, for Willis, a disease; it is a secret fire in which
flame and smoke are in conflict; it is the vehicle of that light and
that shadow.
Virtually all of the physicians of the eighteenth century
acknowledged the proximity of mania and melancholia. Several,
however, refused to call them two manifestations of the same
disease. Many observed a succession without perceiving a
symptomatic unity. Sydenham prefers to divide the domain of mania
itself: on one hand, ordinary mania—due to "an overexcited and too
rapid blood"; on the other, a mania which, as a general rule,
"degenerates into stupidity." The latter "results from the weakness of
the blood which too long a fermentation has deprived of its most
spirituous parts." Even more often, it is acknowledged that the
succession of mania and melancholia is a
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phenomenon either of metamorphosis or of remote causality. For
Joseph Lieutaud, a melancholia that lasts a long time and whose
delirium is exacerbated loses its traditional symptoms and assumes a
strange resemblance to mania:
"the last stage of melancholia has many affinities with mania."
But the status of this analogy is not elaborated. For Dufour, the link
is even looser: it is a remote causal connection, melancholia being
able to provoke mania, as well as "worms in the frontal sinuses, or
dilated or varicose vessels." Without the support of an image, no
observation succeeded in transforming the evidence of succession
into a symptomatic structure that was both precise and essential.
Of course the image of flame and smoke disappeared in Willis's
successors; but it was still by images that the work of organization
was accomplished—images increasingly functional, more firmly
fixed in the great physiological themes of circulation and heating,
increasingly remote from the cosmic figures Willis had borrowed
them from. For Boerhaave and his commentator Gerard van
Swieten, mania formed quite naturally the highest degree of melancholia—
not only following a frequent metamorphosis, but as the
result of a necessary dynamic sequence: the cerebral liquid, which
stagnates in the melancholic, becomes agitated after a certain time,
for the black bile that fills the viscera becomes by its very
immobility "bitterer and more malignant"; there then form in it more
acid and subtler elements which, carried to the brain by the blood,
provoke the maniac's great agitation. Mania is thus distinguished
from melancholia only by a difference of degree: it is its natural
consequence, it results from the same causes, and is ordinarily
treated by the same remedies. For Friedrich Hoffmann, the unity of
mania and melancholia is a natural effect of the laws of movement
and shock; but what is pure mechanics on the level of principles
becomes dialectics in
(133)
the development of life and of disease. Melancholia, in effect, is
characterized by immobility; in other words, the thickened blood
congests the brain where it accumulates;
where it ought to circulate, it tends to stop, immobilized by its
heaviness. But if this heaviness retards movement, it also makes the
shock more violent at the moment it occurs; the brain, the vessels by
which it is traversed, its very substance, more violently jarred, tend
to resist more, therefore to harden, and by this hardening the
thickened blood is sent back more energetically; its movement
increases and it is soon caught up in that agitation which is mania.
We have thus passed quite naturally from the image of an immobile
congestion to images of dryness, of hardness, of rapid movement,
and this by a sequence in which the principles of classical mechanics
are at every moment influenced, deflected, distorted by a fidelity to
iconographic themes which are the true organizers of this functional
unity.
Subsequently other images will be added, but will no longer play
a constitutive role; they will function only as so many interpretive
variations upon the theme of a previously acquired unity. Witness for
example the explanation Spengler proposed for the alternation
between mania and melancholia, borrowing its principle from the
electric battery. First there is a concentration of nervous power and
of its fluid in a certain region of the system; only this sector is
agitated, all the rest is in a state of sleep: this is the melancholic
phase. But when it reaches a certain degree of intensity, this local
charge suddenly expands into the entire system, which it agitates
violently for a certain time, until its discharge is complete: this is the
manic episode. At this level of elaboration, the image is too complex
and too complete, it is borrowed from a model too remote to have an
organizing role in the perception of a pathological unity. It is, on the
contrary, suggested by that perception, which
(134)
itself is based on unifying, though much more elementary, images.
It is these images which are secretly present in the text of James's
Dictionary, one of the first in which the manic-depressive cycle is
given as an observed phenomenon, as a unity easily perceived by an
unprejudiced scrutiny. "It is absolutely necessary to reduce
melancholia and mania to a single species of disease, and
consequently to consider them in one and the same glance, for we
find from our experiments and our day-to-day observations that one
and the other have the same origin and the same cause. . . . The most
exact observations and our daily experience confirm the fact, for we
see that melancholics, especially those in whom the disposition is
inveterate, easily become maniacal, and when the mania ceases, the
melancholia begins again, in such a way that there is a passage and
return from one to the other after certain periods of time."11 What
was constituted, in the seventeenth and eighteenth centuries, under
the influence of images, was therefore a perceptual structure, and not
a conceptual system or even a group of symptoms. The proof of this
is that, just as in a perception, qualitative transitions could occur
without affecting the integrity of the figure. Thus William Cullen
would discover in mania, as in melancholia, "a principal object of
delirium"—and, inversely, would attribute melancholia to "a drier
and firmer tissue of the brain's medullary substance."
The essential thing is that the enterprise did not proceed from
observation to the construction of explanatory images; that on the
contrary, the images assured the initial role of synthesis, that their
organizing force made possible a structure of perception, in which at
last the symptoms could attain their significant value and be
organized as the visible presence of the truth.
(135)
II. Hysteria and Hypochondria
Two problems arise where these are concerned.
1. To what degree is it legitimate to treat them as mental diseases,
or at least as forms of madness?
2. Are we entitled to treat them together, as if they constituted a
virtual couple, similar to that formed quite early by mania and
melancholia?
A glance at the classifications is enough to convince us;
hypochondria does not always appear beside dementia and mania;
hysteria is very rarely found there. Felix Plater mentioned neither
one among the lesions of the senses; and at the end of the classical
period, Cullen still catalogued them in another category than that of
the vesanias: hypochondria among the "adynamias, or diseases
which consist of a weakness or a loss of movement in the vital or
animal functions"; hysteria among "the spasmodic affections of the
natural functions."
Moreover, in nosographic charts one rarely finds these two
diseases grouped in a logical proximity, or even combined in the
form of an opposition. Sauvages classifies hypochondria among the
hallucinations—"hallucinations that concern only the health"—
hysteria among the forms of convulsion. Linnaeus employs the same
distinctions. Are they not both faithful to the teaching of Willis, who
had studied hysteria in his book De morbis convulsivis and
hypochondria in the section of De anima brutorum which dealt with
diseases of the head, giving it the name of passio colica? Here it is
certainly a question of two quite different diseases: in one case, the
overheated spirits are subject to a reciprocal pressure which may
give the impression that they are exploding—provoking those
irregular or preternatural movements whose insane aspect constitutes
hysterical convulsions. On the contrary, in passio colica, the spir-
(136)
its are irritated because of a matter that is hostile and inappropriate
to them (infesta et improportionnata); they then provoke
disturbances, irritations, corrugationes in the sensitive fibers. Willis
therefore advises us not to be surprised by certain analogies of
symptoms: certainly, we have seen convulsions produce pains as if
the violent movement of hysteria could provoke the sufferings of
hypochondria. But the resemblances are deceptive. "The substance is
not the same, but a little different."
But beneath these fixed distinctions of the nosographers, a slow
labor was being performed which tended increasingly to identify
hysteria and hypochondria, as two forms of one and the same
disease. In 1725 Richard Blackmore published a Treatise of the
Spleen and Vapours, or Hypochondriacal and Hysterical Affections;
in it the two illnesses were defined as two varieties of a single
affection-either a "morbific constitution of the spirits" or a "disposition
to leave their reservoirs and to consume themselves." For Whytt,
in the middle of the eighteenth century, the identification was
complete; the system of symptoms is henceforth identical: "An
extraordinary sensation of cold and heat, of pains in several parts of
the body; syncopes and vaporous convulsions; catalepsy and tetanus;
gas in the stomach and intestines; an insatiable appetite for food;
vomiting of black matter; a sudden and abundant flow of clear,
pale urine; marasma or nervous atrophy; nervous cough; palpitations
of the heart; variations in the pulse; periodic headaches; vertigo and
dizzy spells; diminution and failure of eyesight; depression, despair,
melancholia or even madness; nightmares or incubi."
Moreover, during the classical period hysteria and hypochondria
slowly joined the domain of mental diseases. Richard Mead could
still write apropos of hypochondria:
"It is an illness of the whole body." And we must restore its true
value to Willis's text on hysteria: "Among the diseases
(137)
of women, hysterical affection is of such bad repute that like the
semi-damnati it must bear the faults of numerous other affections; if
a disease of unknown nature and hidden origin appears in a woman
in such a manner that its cause escapes us, and that the therapeutic
course is uncertain, we immediately blame the bad influence of the
uterus, which, for the most part, is not responsible; and when we are
dealing with an inhabitual symptom, we declare that there is a trace
of hysteria hidden beneath it all, and what has so often been the
subterfuge of so much ignorance we take as the object of our
treatment and our remedies." With all due regard to the traditional
commentators on this text, which is inevitably cited in any study on
hysteria, it does not mean that Willis suspected the absence of an
organic basis in symptoms of hysterical affection. He merely says,
and in an explicit way, that the idea of hysteria is a catchall for the
fantasies, not of the person who is or believes himself ill, but of the
ignorant doctor who pretends to know why. Nor does the fact that
hysteria is classified by Willis among diseases of the head indicate
that he considered it a disorder of the mind; but only that he
attributed its origin to a change in the nature, the origin, and the
initial course of the animal spirits.
However, at the end of the eighteenth century, hypochondria and
hysteria figured, almost without dispute, on the escutcheon of mental
disease. In 1755 Alberti published at Halle his dissertation De
morbis imaginarus hypochondriacorum; and Lieutaud, while
defining hypochondria by its spasms, recognized that "the mind is
affected as much as and perhaps more than the body; hence the term
hypochondriac has become almost an offensive name avoided by
physicians who would please." As for hysteria, Joseph Raulin no
longer ascribes to it any organic reality, at least in his basic
definition, establishing it from the start in a pathology of the
imagination: "This disease in which women invent,
(138)
exaggerate, and repeat all the various absurdities of which a
disordered imagination is capable, has sometimes become epidemic
and contagious."
There were thus two essential lines of development, during the
classical period, for hysteria and hypochondria. One united them to
form a common concept which was that of a "disease of the nerves";
the other shifted their meaning and their traditional pathological
basis—sufficiently indicated by their names—and tended to integrate
them gradually into the domain of diseases of the mind, beside mania
and melancholia. But this integration was not achieved, as in the case
of mania and melancholia, on the level of primitive qualities,
perceived and imagined in their iconographic values. We are dealing
here with an entirely different type of integration.
The physicians of the classical period certainly tried to discover
the qualities peculiar to hysteria and hypochondria. But they never
reached the point of perceiving that particular coherence, that
qualitative cohesion which gave mania and melancholia their unique
contour. All qualities were contradictorily invoked, each annulling
the others, leaving untouched the problem of what was the ultimate
nature of these two diseases.
Often hysteria was perceived as the effect of an internal heat that
spread throughout the entire body, an effervescence, an ebullition
ceaselessly manifested in convulsions and spasms. Was this heat not
related to the amorous ardor with which hysteria was so often linked,
in girls looking for husbands and in young widows who had lost
theirs? Hysteria was ardent, by nature; its symptoms referred more
easily to an image than to an illness; that image was drawn by
Jacques Ferrand, at the beginning of the seventeenth century, in all
its material precision. In his Maladie d'amour ou melancholie
erotique, he declared that women were
(139)
more often distracted by love than men; but with what art they
could dissimulate it! "In which their mien is similar to alembics
featly resting upon cylinders, without one's being able to see the fire
from without, yet if one looks beneath the alembic, and places one's
hand upon a woman's heart, one will find in both places a fiery
furnace." An admirable image, in its symbolic weight, its affective
overtones, and the referential play of its imagery. Long after
Ferrand, one finds the qualifying theme of humid heat used to
characterize the secret distillations of hysteria and of hypochondria;
but the image yielded to a more abstract motif. Already in Nicolas
Chesneau, the flame of the feminine alembic had grown quite
colorless: "I say that the hysterical affection is not a simple one, but
that we understand by this name several diseases caused by a malign
vapor which arises in some way or other, is corrupted, and
undergoes an extraordinary effervescence." For others, on the
contrary, the heat rising from the hypochondriac regions is completely
dry: hypochondriacal melancholia is a "hot, dry" illness,
caused by "humors of the like quality." But some perceived no heat
in either hysteria or hypochondria: the quality peculiar to these
maladies was on the contrary languor, inertia, and a cold humidity
like that of the stagnant humors: "I think that these affections
[hypochondriacal and hysterical], when they last for some time,
come from the fibers of the brain and the nerves when they are slack
and therefore feeble, without action or elasticity; as a consequence
of which the nervous fluid is impoverished and without force."12
There is probably no text that bears better witness to the qualitative
instability of hysteria than George Cheyne's book The English
Malady: according to Cheyne, the disease maintains its unity only in
an abstract manner; its symptoms are dispersed into different
qualitative regions and attributed to mechanisms that belong to each
of these regions in its own right. All symptoms of
(140)
spasm, cramp, and convulsion derive from a pathology of heat
symbolized by "harmful, bitter, or acrimonious vapors." On the
contrary, all psychological or organic signs of weakness—
"depression, syncopes, inactivity of the mind, lethargic torpor,
melancholia, and sadness"—mani fest a condition of fibers which
have become too humid or too weak, doubtless under the effect of
cold, viscous, thick humors that obstruct the glands and the vessels,
serous and sanguine alike. As for paralyses, they signify both a
chilling and an immobilization of the fibers, "an interruption of
vibrations," frozen so to speak in the general inertia of solids.
It was as difficult for the phenomena of hysteria and
hypochondria to find a place within the compass of qualities as it
was easy for mania and melancholia to be established there.
The medicine of movement was just as indecisive in dealing with
them, its analyses just as unstable. It was quite clear, at least to any
perception that did not reject its own images, that mania was related
to an excessive mobility;
melancholia, on the contrary, to a diminution of movement. For
hysteria and for hypochondria as well, the choice was a difficult one.
Georg Ernst Stahl opts instead for an increasing heaviness of the
blood, which becomes so abundant and so thick that it is no longer
capable of circulating regularly through the portal vein; it has a
tendency to stagnate, to collect there, and the crisis is a result "of the
effort it makes to effect an issue either by the higher or the lower
parts." For Boerhaave, on the contrary, and for Van Swieten,
hysterical movement is due to an excessive mobility of all the fluids,
which become so volatile, so inconsistent, that they are agitated by
the least movement: "In weak constitutions," Van Swieten explains,
"the blood is dissolved; it barely coagulates, the serum is thus
without consistency, without quality; the lymph resembles the se-
(141)
rum, as do the other fluids which the latter provides. . . . In this
way, it becomes probable that the so-called immaterial hysterical
affection and hypochondriacal disease derive from the dispositions
of the particular state of the fibers." It is to this sensibility, this
mobility, that we must attribute the sufferings, the spasms, the
singular pains so readily suffered by "young girls of pale
complexion, and individuals too much given to study and
meditation." Hysteria is indiscriminately mobile or immobile, fluid
or dense, given to unstable vibrations or clogged by stagnant
humors. No one has managed to discover the actual nature of its
movements.
We receive the same impression in the realm of chemical
analogies: for Lange, hysteria is a product of fermentation, quite
precisely of the fermentation "of salts, sent into different parts of the
body," with "the humors that are located there." For others, it is of an
alkaline nature. Michael Ettmuller, on the contrary, considers that
diseases of this kind belong to a chain of acid reactions, "the
immediate cause being the acid rawness of the stomach; the chyle
being acid, the quality of the blood is corrupted; it no longer
furnishes spirits; the lymph is acid, the bile without strength; the
nervous system suffers irritation, the digestive leaven, spoiled, is less
volatile and too acid." Viridet undertakes to reconstitute, apropos of
"vapors which we experience," a dialectic of alkalis and acids whose
movements and violent collisions, in the brain and the nerves,
provoke the signs of hysteria and hypochondria. Certain particularly
volatile animal spirits are alkaline salts that move with great speed
and transform themselves into vapors when they become too
tenuous; but there are other vapors that are volatilized acids; the
ether gives these latter enough movement to carry them to the brain
and the nerves where, "encountering the alkalis, they cause infinite
ills."
Strange, the qualitative instability of these hysterical and
(142)
hypochondriacal illnesses; strange, the confusion of their dynamic
properties and the secret nature of their chemistry! To the very
degree that the diagnosis of mania and melancholia seemed simple
in the context of qualities, so the decipherment of these illnesses
seemed hesitant. No doubt, this imaginary landscape of qualities
which was decisive for the constitution of the melancholia-mania
couple remained secondary in the history of hysteria and
hypochondria, where it probably played no more than the role of
continually shifted scenery. The progress of hysteria did not lead, as
did that of mania, through the world's obscure qualities reflected in a
medical imagery. The space in which it assumed its dimensions was
of another kind: that of the body, in the coherence of its organic
values and its moral values.
It is customary to credit Charles le Pois and Willis with liberating
hysteria from the old myths of uterine displacement. Jean Liebault,
translating or rather adapting Marinello's book to seventeenthcentury
standards, still accepted, despite some restrictions, the idea
of a spontaneous movement of the womb; if it shifted position "it
was to be more at ease; not that this was done out of prudence, behest,
or animal stimulus, but to preserve health and to experience the
enjoyment of something delectable." No doubt, it was no longer
deemed possible for the womb to change place or to course through
the body somersaulting as it went, for it was "strictly attached" by its
neck, by ligaments, by vessels, and finally by the tunic of the peritoneum;
yet it could change position: "And so the womb, though it
be so strictly attached to the parts we have described that it may not
change place, yet often changes position, and makes curious and so
to speak petulant movements in the woman's body. These
movements are various:
to wit, ascending, descending, convulsive, vagrant, pro-
(143)
lapsed. The womb rises to the liver, spleen, diaphragm, stomach,
breast, heart, lung, gullet, and head." The physicians of the classical
period were almost unanimous in refusing to accept such an
explanation.
At the beginning of the seventeenth century, Le Pois could write,
speaking of hysterical convulsions: "Of all these one source is the
father, and this not through sympathy but through idiopathy." More
precisely, their origin is in an accumulation of fluids toward the
posterior part of the skull: "Just as a river results from the
confluence of a quantity of smaller vessels which join to form it, so
the sinuses that are on the surface of the brain and terminate in the
posterior part of the head amass the liquid because of the head's
inclined position. The heat of the parts then causes the liquid to
warm and affect the origin of the nerves." Willis, in his turn, makes
a minute critique of the uterine explanation: it is especially from
affections of the brain and the nervous system "that all the
derangements and irregularities which obtain in the movement of the
blood during this illness derive." And yet all these analyses did not
thereby abolish the idea of an essential link between hysteria and the
womb. But the link is differently conceived: it is no longer regarded
as the trajectory of a real displacement through the body, but as a
sort of secret propagation through the pathways of the organism and
through functional proximities. We cannot say that the seat of the
disease had become the brain, nor that Willis had made possible a
psychological analysis of hysteria. But the brain now played the part
of a relay station and the distributor of a disease whose origin was
visceral: the womb occasioned it along with all the other viscera.
Until the end of the eighteenth century, until Pinel, the uterus and
the womb remained present in the pathology of hysteria, but as the
result of a privileged diffusion by the humors and nerves, and not by
a special prestige of their nature.
(144)
Stahl justifies the parallelism of hysteria and hypochondria by a
curious comparison of menstrual flow and hemorrhoids. He
explains, in his analysis of spasmodic movements, that the hysterical
affection is a violent pain, "accompanied by tension and
compression, which makes itself principally felt below the
hypochondriac regions." It is called a hypochondriacal disease when
it attacks men "in whom nature makes an effort to be rid of excess
blood by vomiting or hemorrhoids"; it is called a hysterical affection
when it attacks women "the course of whose periods is not as it
should be. However, there is no essential difference between these
two affections." Hoffman's opinion is quite similar, in spite of many
theoretical differences. The cause of hysteria is in the womb—
loosening and weakening—but the seat of the disease is to be
sought, as in the case of hypochondria, in the stomach and the
intestines; the blood and the vital humors begin to stagnate "in the
membranous and nervous tunics of the intestines"; gastric
disturbances result, which spread thence throughout the whole body.
At the very center of the organism, the stomach serves as a relay
station and diffuses the maladies that come from the interior and
subterranean cavities of the body: "It is not to be doubted that the
spasmodic affections experienced by hypochondriacs and hysterics
have their seat in the nervous parts, and especially in the membranes
of the stomach and the intestines, from which they are
communicated by the intercostal nerve to the head, to the chest, to
the kidneys, to the liver, and to all the principal organs of the body."
The role Hoffmann assigns to the intestines, the stomach, and the
intercostal nerve is indicative of the manner in which the problem
was presented in the classical period. It was not so much a question
of escaping the old localization in the uterus, but of discovering the
principle and the pathways of a diverse, polymorphous disease
dispersed throughout the entire body. A disease was to be accounted
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for that could attack the head as well as the legs, express itself in a
paralysis or in frenzied movements, that could bring on catalepsy or
insomnia: in short, a disease that traversed corporeal space so rapidly
and so ingeniously that it was virtually present throughout the entire
body.
It is futile to insist on the change of medical horizons that
occurred from Marinello to Hoffmann. Nothing subsists of that
famous mobility ascribed to the uterus, which had constantly figured
in the Hippocradc tradition. Nothing, except perhaps a certain theme
which appeared more clearly now that it was no longer confined to a
single medical theory, but persisted unchanged through the
succession of speculative concepts and explanatory schemas. This
was the theme of a dynamic upheaval of corporeal space, of a tide of
the lower powers, which, too long constrained and, as it were,
congested, began to seethe and ultimately spread their disorder—
with or without the brain's mediation-through the entire body. This
theme remained almost stationary until the beginning of the
eighteenth century, despite the complete reorganization of
physiological concepts. And strangely enough, it was during the
eighteenth century, when no theoretical or experimental innovation
in pathology had occurred, that the theme was suddenly modified,
changed direction—that a dynamics of corporeal space was replaced
by a morality of sensibility. It was then, and only then, that the ideas
of hysteria and hypochondria were to veer, and definitively enter the
world of madness.
We must try now to reconstitute the evolution of the theme, in
each of its three stages:
1. a dynamics of organic and moral penetration;
2. a physiology of corporeal continuity;
3. an ethic of nervous sensibility.
If corporeal space is perceived as a solid and continuous whole,
the disordered movement of hysteria and of hypo-
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chondria could result only from an element whose extreme
tenuousness and incessant mobility permitted it to penetrate into the
place occupied by the solids themselves. As Nathaniel Highmore put
it, the animal spirits, "because of their igneous tenuity, can penetrate
even the densest, the most compact bodies . . . , and because of their
activity, can penetrate the entire microcosm in a single instant." The
spirits, if their mobility increased, if penetration occurred,
chaotically and in an untimely manner, in all the parts of the body to
which they were unsuited, provoked a thousand diverse signs of
disturbance. Hysteria, for Highmore as for Willis, his adversary, and
for Sydenham as well, was the disease of a body indiscriminately
penetrable to all the efforts of the spirits, so that the internal order of
organs gave way to the incoherent space of masses passively subject
to the chaotic movement of the spirits. These latter "move
impetuously and in excessive quantity upon such or such a part,
there causing spasms or even pain . . . and disturbing the function of
the organs, both those which they abandon and those toward which
they move, neither being able to avoid serious damage from this
unequal distribution of spirits, which is entirely contrary to the laws
of animal economy."13 The hysterical body was thus given over to
that disorder of the spirits which, outside of all organic laws and any
functional necessity, could successively seize upon all the available
spaces of the body.
The effects varied according to the regions affected, and the
disease, undifferentiated in the pure source of its movement,
assumed various configurations depending on the spaces it traversed
and the surfaces where it appeared:
"Having accumulated in the stomach, they rush in a host and with
impetuosity upon the muscles of the larynx and the pharynx,
producing spasms throughout the entire area they traverse, and
causing in the stomach a swelling which resembles a large ball." A
little higher, the hysterical affec-
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tion, "seizing upon the colon and upon the region which is below
the heart cavity, causes there an insupportable pain which resembles
the iliac affection." Should it rise still higher, the disease attacks "the
vital parts and causes so violent a palpitation of the heart that the
sick person does not doubt that his attendants must be able to hear
the sound his heart makes as it beats against his ribs." Finally, if it
attacks "the exterior part of the head, between the cranium and the
pericranium, and there remains fixed in a single spot, it causes an
extreme pain that is accompanied by violent fits of vomiting."14
Each part of the body determines in its own right and by its own
nature the form of the symptom produced. Hysteria thus appears as
the most real and the most deceptive of diseases; real because it is
based upon a movement of the animal spirits; illusory as well,
because it generates symptoms that seem provoked by a disorder
inherent in the organs, whereas they are only the formation, at the
level of these organs, of a central or rather general disorder; it is the
derangement of internal mobility that assumes the appearance, on
the body's sufrace, of a local symptom. Actually suffering from the
disordered and excessive movement of spirits, the organ imitates its
own illness; starring from a defect in the movement within internal
space, it imitates a disorder that strictly belongs to itself; in this
manner, hysteria "imitates almost all the maladies to which human
flesh is subject, for in whatever part of the body it lodges, it
immediately produces the symptoms that are proper to that part, and
if the physician does not have great wisdom and experience, he will
easily be deceived and will attribute to an illness essential and
proper to such and such a part, symptoms that are entirely the result
of hysterical affection":15 stratagems of a disease that, traversing
corporeal space in the homogenous form of movement, manifests
itself in specific aspects; but the type, here, is not essence; it is a
ruse of the body.
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The more easily penetrable the internal space becomes, the more
frequent is hysteria and the more various its aspects; but if the body
is firm and resistant, if internal space is dense, organized, and
solidly heterogeneous in its different regions, the symptoms of
hysteria are rare and its effects will remain simple. Is this not exactly
what separates female hysteria from the male variety, or, if you will,
hysteria from hypochondria? Neither symptoms, in fact, nor even
causes form the principle of separation between the diseases, but
only the spatial solidarity of the body, and so to speak the density of
the interior landscape: "Beyond what we may call the exterior man,
who is composed of parts which are visible to the senses, there is an
interior man formed of a system of animal spirits, a man who can be
seen only with the eyes of the mind. This latter man, closely joined
and so to speak united with the corporeal constitution, is more or
less deranged from his state to the degree that the principles which
form the machine have a natural firmness. That is why this disease
attacks women more than men, because they have a more delicate,
less firm constitution, because they lead a softer life, and because
they are accustomed to the luxuries and commodities of life and not
to suffering." And already, in the lines of this text, this spatial
density yields one of its meanings: it is also a moral density; the
resistance of the organs to the disordered penetration of the spirits is
perhaps one and the same thing as that strength of soul which keeps
the thoughts and the desires in order. This internal space which has
become permeable and porous is perhaps only the laxity of the heart.
Which explains why so few women are hysterical when they are
accustomed to a hard and laborious life, yet strongly incline to
become so when they lead a soft, idle, luxurious, and lax existence;
or if some sorrow manages to conquer their resolution: "When
women consult me about some complaint whose nature I cannot
determine, I ask if
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the malady from which they are suffering attacks them only when
they have some sorrow . . . : if they admit as much, I am fully
assured that their complaint is an hysterical affection."16
Thus we have a new formulation of the old moral intuition that
from the time of Hippocrates and Plato had made the womb a living
and perpetually mobile animal, and distributed the spatial ordering
of its movements; this intuition perceived in hysteria the incoercible
agitation of desires in those who had neither the possibility of
satisfying them nor the strength to master them; the image of the
female organ rising to the breast and to the head gave a mythical
expression to an upheaval in the great Platonic tripartition and in the
hierarchy that was intended to assure its immobility. For Sydenham,
for the disciples of Descartes, the moral intuition is identical; but the
spatial landscape in which it is expressed has changed; Plato's
vertical and hieratic order is replaced by a volume which is traversed
by incessant motion whose disorder is no longer a revolution of the
depths to the heights but a lawless whirlwind in a chaotic space.
This "interior body" which Sydenham tried to penetrate with "the
eyes of the mind" was not the objective body available to the dull
gaze of a neutralized observation; it was the site where a certain
manner of imagining the body and of deciphering its internal
movements combined with a certain manner of investing it with
moral values. The development is completed, the work done on the
level of this ethical perception. In this perception the ever pliant
images of medical theory are inflected and altered; in it, too, the
great moral themes are formulated and gradually alter their initial
aspect.
This penetrable body must, however, be a continuous body. The
dispersion of the disease through the organs is only the reverse of a
movement of propagation which per-
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mits it to pass from one to another and to affect them all in
succession. If the body of the hypochondriac or the hysteric is a
porous body, separated from itself, distended by the invasion of
disease, this invasion can be effected only by means of a certain
spatial continuity. The body in which the disease circulates must
have other properties than the body in which the sufferer's dispersed
symptoms appear.
The problem haunted eighteenth-century medicine, and was to
make hypochondria and hysteria diseases of the "nervous type"; that
is, idiopathic diseases of the general agency of all the sympathies.
The nervous fiber is endowed with remarkable properties, which
permit it to integrate the most heterogeneous elements. Is it not
astonishing that, responsible for transmitting the most diverse
impressions, the nerves should be of the same nature everywhere,
and in every organ? "The nerve whose expansion at the back of the
eye makes it possible to receive the impression of so subtle a matter
as light; the nerve which, in the organ of hearing, becomes sensitive
to the vibrations of sonorous bodies, differs no whit in nature from
those which serve the grosser sensations such as touch, taste, and
odor." This identity of nature, in different functions, assures the
possibility of communication between the most distant organs, and
those most dissimilar physiologically: "This homogeneity in the
nerves of the animal, combined with the numerous communications
that all maintain with each other . . . establishes among the organs a
harmony that often makes one or several parts participate in the
affections of those which are injured."17 But what is still more
admirable, a nervous fiber can transmit simultaneously the stimulus
of a voluntary movement and the impression left on the organ by the
senses. Simon-Andre Tissot conceived this double function of one
and the same fiber as the combination of an undulatory movement
for voluntary stimulus ("this is the move-
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ment of a fluid enclosed in a malleable container, in a bladder, for
example, that when I press it would eject liquid through a tube") and
a corpuscular movement for sensation ("this is the movement of a
succession of ivory balls"). Thus sensation and movement can be
produced at the same time in the same nerve: any tension and any
relaxation in the fiber will alter both movements and sensations, as
we can observe in all nervous diseases.
And yet, despite all these unifying virtues of the nervous system,
is it certain that we can explain, by the real network of its fibers, the
cohesion of such diverse disorders as those which characterize
hysteria or hypochondria? How conceive the liaison among the signs
that from one part of the body to the other betray the presence of a
nervous affection? How explain, and by tracing what line of
connection, that in certain "delicate and highly sensitive" women a
heady perfume or the too vivid description of a tragic event or even
the sight of a combat produces such an impression that they "fall
into syncopes or suffer convulsions"? One seeks in vain: no precise
liaison of the nerves;
no path proceeding from the original cause; but only a remote,
indirect action which is rather on the order of a physiological
solidarity. This is because the different parts of the body possess a
"very determined faculty, which is either general and extends
throughout the entire system of animal economy, or particular and
influences certain parts principally." This very distinct property of
both "the faculty of feeling and that of moving" which permits the
organs to communicate with each other and to suffer together, to
react to a stimulus, however distant—is sym pathy. As a matter of
fact, Whytt succeeded neither in isolating sympathy in the ensemble
of the nervous system, nor in defining it in relation to sensibility and
to movement. Sympathy exists in the organs only insofar as it is
received there through the intermediary of the nerves; it is the more
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marked in proportion to their mobility, and at the same time it is
one of the forms of sensibility: "All sympathy, all consensus
presupposes sentiment and consequently can exist only by the
mediation of the nerves, which are the only instruments by which
sensation operates."18 But the nervous system is no longer invoked
here to explain the exact transmission of a movement or a sensation,
but to justify, in its totality and its mass, the body's sensibility with
regard to its own phenomena, and its own echo across the volumes
of its organic space.
Diseases of the nerves are essentially disorders of sympathy; they
presuppose a state of general vigilance in the nervous system which
makes each organ susceptible of entering into sympathy with any
other: "In such a state of sensibility of the nervous system, the
passions of the soul, violations of diet, sudden alternation of heat
and cold or of heaviness and humidity of the atmosphere, will very
readily produce morbific symptoms; so that with such a constitution,
one will not enjoy steady or constant health, but generally suffer a
continual succession of more or less severe pains." Doubtless this
exaggerated sensibility is compensated by zones of insensibility, of
sleep, as it were; in a general way, hysterical sufferers are those in
whom this internal sensibility is the most exquisite, hypochondriacs
possessing it, on the contrary, in a relatively blunted form. And of
course women belong to the first category: is not the womb, with the
brain, the organ that maintains most sympathy with the whole
organism? It suffices to cite "the vomiting that generally
accompanies the inflammation of the womb; the nausea, the
disordered appetite that follow conception; the constriction of the
diaphragm and of the muscles of the abdomen during childbirth; the
headache, the heat and the pains in the back, the intestinal colic
suffered when the time of the menstrual flow approaches." The
entire female body is riddled by obscure but strangely
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direct paths of sympathy; it is always in an immediate complicity
with itself, to the point of forming a kind of absolutely privileged
site for the sympathies; from one extremity of its organic space to
the other, it encloses a perpetual possibility of hysteria. The
sympathetic sensibility of her organism, radiating through her entire
body, condemns woman to those diseases of the nerves that are
called vapors. "The women whose systems have generally more
mobility than those of men are more subject to nervous diseases,
which are also more serious in them."19 And Whytt assures us he
has witnessed that the pain of a toothache caused convulsions in a
young girl whose nerves were weak, and an unconsciousness lasting
several hours and returning when the pain became more acute."
Diseases of the nerves are diseases of corporeal continuity. A
body too close to itself, too intimate in each of its parts, an organic
space which is, in a sense, strangely constricted: this is what the
theme common to hysteria and hypochondria has now become; the
rapprochement of the body with itself assumes, for some, the aspect
of a precise-all too precise—image: such is the celebrated
"shriveling of the nervous system" described by Pomme. Such
images mask the problem, but do not suppress it, and do not keep
the enterprise from continuing.
Is this sympathy, basically, a property hidden in each organ—that
"sentiment" which Cheyne spoke of—or a real propagation through
an intermediary element? And is the pathological proximity which
characterizes these nervous diseases an exasperation of this
sentiment, or a greater mobility of this interstitial body?
It is a curious but doubtless characteristic phenomenon of medical
thought in the eighteenth century, in the period when physiologists
tried to define most precisely the functions and the role of the
nervous system (sensibility and
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irritability; sensation and movement), that physicians used these
ideas indiscriminately in the undifferentiated unity of pathological
perception, articulating them according to a schema entirely
different from that proposed by physiology.
Sensibility and movement are not distinguished. Tissot explains
that the child has more sensibility than anyone else because in him
everything is lighter and more mobile; irritability, in the sense in
which Haller understood a property of the nervous fiber, is
identified with irritation, understood as the pathological state of an
organ aroused by a prolonged stimulus. It would thus be
acknowledged that nervous diseases were states of irritation
combined with an excessive mobility of the fibers.
"On occasion one sees persons for whom the smallest moving
cause occasions much more movement than it produces in healthy
persons; they cannot sustain the slightest alien impression. The
faintest sound, the weakest light affords them extraordinary
symptoms."20 By this deliberately preserved ambiguity in the notion
of irritation, medicine at the end of the eighteenth century could in
effect show the continuity between disposition (irritability) and the
pathological event (irritation); but it could also maintain both the
theme of a disorder proper to an organ which suffers, but in a
fashion all its own, a general attack (it is the sensibility particular to
the organ which assures this nonetheless discontinuous
communication), and the idea of a propagation in the organism of a
single disorder that can attack it in each of its parts (it is the mobility
of the fiber which is responsible for this continuity, despite the
diverse forms it assumes in the organs).
But if the notion of "irritated fiber" certainly plays this role of
concerted confusion, it also permits a decisive distinction in
pathology. On one hand, nervous sufferers are the most irritable,
that is, have the most sensibility: tenu-
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ousness of fiber, delicacy of organism; but they also have an
easily impressionable soul, an unquiet heart, too strong a sympathy
for what happens around them. This sort of universal resonance—
simultaneously sensation and mobility-constitutes the first
determination of the illness. Women who have "frail fibers," who are
easily carried away, in their idleness, by the lively movements of
their imagination, are more often attacked by nervous diseases than
men who are "more robust, drier, hardened by work." But this excess
of irritation has this peculiarity: that in its vivacity it attenuates, and
sometimes ends by extinguishing, the sensations of the soul; as if the
sensibility of the nervous organ itself overcharged the soul's capacity
to feel, and appropriated for its own advantage the multiplicity of
sensations aroused by its extreme mobility; the nervous system "is in
such a state of irritation and reaction that it is then incapable of
transmitting to the soul what it is experiencing; all its figures are
disordered; it can no longer interpret them."21 Thus appears the idea
of a sensibility which is not sensation, and of an inverse relation
between that delicacy which derives as much from the soul as from
the body, and a certain numbness of the sensations that prevents
nervous shocks from reaching the soul. The hysteric's unconsciousness
is only the reverse of his sensibility. It is this relation, which the
notion of sympathy could not define, which was contributed by the
concept of irritability, though so little elaborated and still so
confused in the thinking of pathologists.
But by this very fact, the moral significance of "nervous
complaints" was profoundly altered. Insofar as diseases of the nerves
had been associated with the organic movements of the lower parts
of the body (even by the many and confused paths of sympathy),
they were located within a certain ethic of desire: they represented
the revenge of a crude body; it had been as the result of an excessive
vio-
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lence that one became ill. From now on one fell ill from too much
feeling; one suffered from an excessive solidarity with all the beings
around one. One was no longer compelled by one's secret nature;
one was the victim of everything which, on the surface of the world,
solicited the body and the soul.
And as a result, one was both more innocent and more guilty.
More innocent, because one was swept by the total irritation of the
nervous system into an unconsciousness great in proportion to one's
disease. But more guilty, much more guilty, because everything to
which one was attached in the world, the life one had led, the
affections one had had, the passions and the imaginations one had
cultivated too complacently—all combined in the irritation of the
nerves, finding there both their natural effect and their moral
punishment. All life was finally judged by this degree of irritation:
abuse of things that were not natural, the sedentary life of cities,
novel reading, theatergoing, immoderate thirst for knowledge, "too
fierce a passion for the sex, or that other criminal habit, as morally
reprehensible as it is physically harmful."22 The innocence of the
nervous sufferer, who no longer even feels the irritation of his
nerves, is at bottom only the just punishment of a deeper guilt: the
guilt which makes him prefer the world to nature: "Terrible state! . . .
This is the torment of all effeminate souls whom inaction has
plunged into dangerous sensuality, and who, to rid themselves of the
labors imposed by nature, have embraced all the phantoms of
opinion. . . . Thus the rich are punished for the deplorable use of
their fortune."23
We stand here on the threshold of the nineteenth century, where
the irritability of the fibers will enjoy physiological and pathological
fortunes. What it leaves for the moment, in the domain of nervous
diseases, is nonetheless something very important.
This is, on the one hand, the complete identification of
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hysteria and hypochondria as mental diseases. By the capital
distinction between sensibility and sensation, they enter into that
domain of unreason which we have seen was characterized by the
essential moment of error and dream, that is, of blindness. As long as
vapors were convulsions or strange sympathetic communications
through the body, even when they led to fainting and loss of
consciousness, they were not madness. But once the mind becomes
blind through the very excess of sensibility—then madness ap pears.
But on the other hand, such an identification gives madness a new
content of guilt, of moral sanction, of just punishment which was not
at all a part of the classical experience. It burdens unreason with all
these new values: instead of making blindness the condition of
possibility for all the manifestations of madness, it describes
blindness, the blindness of madness, as the psychological effect of a
moral fault. And thereby compromises what had been essential in
the experience of unreason. What had been blindness would become
unconsciousness, what had been error would become fault, and
everything in madness that designated the paradoxical manifestation
of non-being would become the natural punishment of a moral evil.
In short, that whole vertical hierarchy which constituted the structure
of classical madness, from the cycle of material causes to the
transcendence of delirium, would now collapse and spread over the
surface of a domain which psychology and morality would soon
occupy together and contest with each other.
The "scientific psychiatry" of the nineteenth century became
possible.
It was in these "diseases of the nerves" and in these "hysterias,"
which would soon provoke its irony, that this psychiatry took its
origin.
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VI
DOCTORS AND PATIENTS
THE therapeutics of madness did not function in the hospital,
whose chief concern was to sever or to "correct." And yet in the nonhospital
domain, treatment continued to develop throughout the
classical period: long cures for madness were elaborated whose aim
was not so much to care for the soul as to cure the entire individual,
his nervous fiber as well as the course of his imagination. The madman's
body was regarded as the visible and solid presence of his
disease: whence those physical cures whose meaning was borrowed
from a moral perception and a moral therapeutics of the body.
1. Consolidation. There exists in madness, even in its most
agitated forms, an element of weakness. If in madness the spirits are
subjected to irregular movements, it is because they have not enough
strength or weight to follow the gravity of their natural course; if
spasms and convul-
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sions so often occur in nervous illnesses, it is because the fiber is
too mobile, or too irritable, or too sensitive to vibrations; in any
case, it lacks robustness. Beneath the apparent violence of madness,
which sometimes seems to multiply the strength of maniacs to
considerable proportions, there is always a secret weakness, an
essential lack of resistance;
the madman's frenzies, in fact, are only a passive violence. What
is wanted, then, is a cure that will give the spirits or the fibers a
vigor, but a calm vigor, a strength no disorder can mobilize, since
from the start it will be subject to the course of natural law. More
than the image of vivacity and vigor, it is one of robustness that
prevails, enveloping the theme in a new resistance, a young
elasticity, but subjugated and already domesticated. A force must be
found within nature to reinforce nature itself.
The ideal remedy would "take the part" of the spirits, and "help
them conquer the cause that ferments them." To take the part of the
spirits would be to struggle against the vain agitation to which they
are subject in spite of themselves; it would also permit them to
escape from all the chemical ebullition that heats and troubles them;
finally it would give them enough solidity to resist the vapors that
try to suffocate them, to make them inert, and to carry them off in
their whirlwind. Against the vapors, the spirits are reinforced "by the
most stinking odors"; disagreeable sensation vivifies the spirits,
which in a sense rebel and vigorously flock to the place where the
assault must be repelled; to this effect "asafetida, oil of amber, burnt
leather and feathers will be used—that is, whatever can provide the
soul with strong and disagreeable feelings." Against fermentation,
theriac must be given, "anti-epileptic spirits of Charras," or best of
all, the famous Queen of Hungary water;1 acidity disappears and the
spirits regain their true influence. Finally, to restore their true
mobility, Lange recommends that the spirits be subjected to sensa-
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tions and movements that are both agreeable, measured, and
regular: "When the animal spirits are dispersed and disunited,
remedies are necessary which calm their movement and return them
to their natural situation, such things as give the soul a sweet and
moderate feeling of pleasure:
agreeable odors, walks in delightful spots, the sight of persons
who are in the habit of providing diversion, and Music." This firm
gentleness, a proper gravity, ultimately a vivacity intended only to
protect the body—all these are means to consolidate, within the
organism, the fragile elements connecting body and soul.
But there is probably no better fortifying procedure than the use
of the substance which is both the most solid and the most docile,
the most resistant but the most pliable in the hands of the man who
knows how to forge it to his purposes: iron. Iron unites, in its
privileged nature, all those qualities that quickly become
contradictory when they are isolated. Nothing resists better, nothing
can better obey; it is a gift of nature, but it is also at the disposal of
all of man's techniques. How could man help nature and lend it an
abundance of strength by a surer means—that is, one closer to
nature and more obedient to man—than by the applica tion of iron?
The old example of Dioscorides is always cited, who gave to the
inertia of water the vigorous virtues foreign to it by plunging into it
a bar of red-hot iron. The ardor of fire, the calm mobility of water,
the rigor of a metal treated until it had become supple—all these elements,
united, conferred upon water powers of reinforceent, of
vivification, of consolidation, which it could transmit to the
organism. But iron is efficacious even aside from any preparation;
Sydenham recommends it in its simplest form, by the direct
absorption of iron filings. Whytt instances a man who, in order to
cure himself of a weakness of the stomach nerves involving a
permanent state of hypochondria, took 230 grains of iron every day.
This was
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because to all its virtues, iron added the remarkable property of
transmitting itself directly, without intermediary or transformation.
What it communicated was not its substance but its strength;
paradoxically, though itself so resistant, it immediately dissolved in
the organism, depositing there only its qualities, without rust or
waste. It is evident here that an imagery of wonder-working iron
governs discursive thought and prevails over observation itself. If
experiments were made, it was not to reveal a positive sequence of
effects, but to emphasize this immediate communication of qualities.
Wright fed a dog Mars salts; he observed that an hour later the chyle,
if mixed with tincture of nut gall, did not display that purple color it
invariably assumed if the iron had been absorbed. This must have
been because the iron, without mixing with the digestion, without
passing into the blood, without penetrating the organism
substantially, fortified the membranes and fibers directly. More than
an observed effect, the consolidation of the spirits and the nerves
appears rather as an operative metaphor which implies a transfer of
strength without any discursive dynamics. Strength is supplied by
contact, exclusive of any exchange or substance, any communication
of movements.
2. Purification. Clogging of the viscera, ebullition of false ideas,
fermentation of vapors, violence, corruption of liquids and spirits—
madness elicits an entire series of therapeutics, each of which can be
attached to the identical operation of purification.
The ideal was a sort of total purification: the simplest but also the
most impossible of cures. It would consist of substituting for the
melancholic's overcharged, thick blood, encumbered with bitter
humors, a light, clear blood whose new movement would dissipate
the delirium. In 1662 Moritz Hoffman suggested blood transfusion
as a remedy for melancholia. Some years later, the idea had attained
suffi-
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cient currency for the Philosophical Society of London to plan a
series of experiments upon the subjects confined in Bedlam; Alien,
the doctor entrusted with the enterprise, refused. But Jean-Baptiste
Denis tried it upon one of his patients stricken with amorous
melancholia; he drew off ten ounces of blood, which he replaced
with a slightly smaller quantity taken from the femoral artery of a
calf;
the following day he began again, but this time the operation
involved only a few ounces. The patient became calm;
the following day his mind cleared; he was soon entirely cured;
"all the professors of the Academy of Surgeons attested it." The
technique, however, was quickly abandoned, despite a few later
attempts.
The preferred medications were those that forestalled corruption.
We know "as a result of more than three thousand years of
experience that Myrrh and Aloes preserve corpses."2 Are not these
deteriorations of bodies of the same nature as those that accompany
the diseases of the humors? Then nothing would be more
recommendable against the vapors than products like myrrh or aloes,
and especially the famous elixir of Paracelsus. But more must be
attempted than to forestall corruptions; they must be destroyed.
Whence the therapeutics that attack deterioration itself, and seek
either to deflect the corrupt substances or to dissolve the corrupting
ones: techniques of deflection and techniques of detersion.
To the first belong all the strictly physical methods that seek to
create wounds or sores on the surface of the body, both centers of
infection that relieve the organism, and centers of evacuation into the
outside world. Thus Fallowes explains the beneficial mechanism of
his oleum cephalicum; in madness, "black vapors clog the very fine
vessels through which the animal spirits must pass"; the blood is thus
deprived of direction; it encumbers the veins of the brain where it
stagnates, unless it is agitated by a confused
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movement "that distracts the ideas." Oleum cephalicum has the
advantage of provoking "little pustules on the head";
they are anointed with oil to keep them from drying out and so
that "the black vapors lodged in the brain" may continue to escape.
But burning and cauterizing the body at any point produces the same
effect. It was even supposed that diseases of the skin such as
scabies, eczema, or smallpox could put an end to a fit of madness;
the corruption then left the viscera and the brain, to spread on the
surface of the body, where it was released externally. By the end of
the century, it became customary to inoculate scabies in the most
resistant cases of mania. In his Instructions of 1785, addressed to the
directors of hospitals, Francois Doublet recommends that if
bleedings, purges, baths, and showers do not cure mania, the use of
"cauters, setons, superficial abscesses, inoculation of scabies" will.
But the principal task is to dissolve the fermentations which,
having formed in the body, give rise to madness. To accomplish
this, the chief agent is bitters. Bitterness has all the harsh virtues of
sea water; it purifies by wearing away, it works its corrosion on
everything useless, unhealthy, and impure that the disease may have
deposited in the body and the soul. Bitter and active, coffee is useful
for "fat persons whose thickened humors circulate with difficulty"; it
dries without burning—for it is the property of such substances to
dissipate superfluous humidity without dangerous heat;
there is in coffee, as it were, fire without flame, a purifying power
that does not calcine; coffee reduces impurities:
"those who take it feel by long experience that it restores the
stomach, consumes its superfluous humidity, dissipates wind,
dissolves the phlegm of the bowels, where it performs a mild
abstersion, and what is most considerable, prevents the fumes from
rising to the head and consequently reduces the aches and pains
customarily suffered
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there; finally, it affords strength, vigor, and cleanliness to the
animal spirits, without leaving any great impression of heat, even
upon the most inured persons who are accustomed to use it."3 Bitter,
but tonic also, is the quinine Whytt freely prescribes to persons
"whose nervous system is very delicate"; it is efficacious against
"weakness, discouragement, and depression"; two years of a cure
consisting only of a tincture of quinine, "occasionally discontinued
for a month at most," were sufficient to cure a woman suffering
from a nervous complaint. For delicate persons, quinine must be
associated with "a bitterness pleasant to the taste"; but if the
organism is able to withstand stronger attacks, vitriol, mixed with
quinine, cannot be too strongly recommended. Twenty or thirty
drops of elixir of vitriol are sovereign.
Quite naturally, soaps and soap products inevitably enjoy
privileged effects in this purificatory enterprise. "Soap dissolves
almost anything that is concrete."4 Tissot believes that soap can be
consumed directly, and that it will calm many nervous ailments; but
more often it is sufficient to consume, first thing in the morning, by
themselves or with bread, "soapy fruits"—that is, cherries,
strawberries, currants, figs, oranges, grapes, ripe pears, and "other
fruits of this nature." But there are cases where the difficulty is so
serious, the obstruction so irreducible, that no soap can conquer it.
Soluble tartar is then recommended. Muzzell was the first to have
the idea of prescribing tartar for "madness and melancholia," and
published several triumphant observations on the subject. Whytt
confirms them, and shows at the same time that tartar functions as a
detersive, since it is especially efficacious against obstructive
illnesses:
"Insofar as I have observed it, soluble tartar is more useful in
maniac or melancholic affections produced by harmful humors
amassed in the primary canals, than for those pro-
(165)
duced by a flaw in the brain." Among the dissolvants, Raulin also
cites honey, chimney soot, Oriental saffron, wood lice, powdered
lobster claw, and bezoar.
Halfway between these internal methods of dissolution and the
external techniques of deflection, we find a series of practices of
which the most frequent are applications of vinegar. As an acid,
vinegar dissolves obstructions, destroys foreign bodies as they are
fermenting. But in external application, it can serve as a revulsive,
and draw harmful humors and liquids to the surface. It is curious but
quite characteristic of the therapeutic thinking of this period that no
contradiction was admitted between these two modes of action.
Given what it is by nature— detersive and revulsive—vinegar would
act in any situation according to this double determination, even
though one of these two modes of action can no longer be analyzed
in a rational and discursive fashion. It functions, then, directly,
without intermediary, through the simple contact of two natural elements.
Hence it is recommended to rub the head, shaved if possible,
with vinegar. The Gazette de medecine cites the case of an empiric
who managed to cure "a quantity of madmen by a very swift and
very simple means. Here is his secret. After he has purged them
above and below, he has them soak their head and hands in vinegar,
and leaves them in this situation until they fall asleep, or rather until
they wake up, and most of them are cured upon waking. He also
applies to the patient's shaved head chopped leaves of Dipsacus, or
fuller's weed."
3. Immersion. Here two themes intersect: the theme of ablution,
with all that relates it to the rites of purity and rebirth; and the much
more physiological theme of impregnation or immersion, which
modifies the essential qualities of liquids and solids. Despite their
different origin, and the gap between their levels of conceptual
elaboration, they form, up to the end of the eighteenth century, a
unity
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coherent enough so that their opposition is not experienced as
such. The idea of nature, with its ambiguities, serves as their element
of cohesion. Water, the simple and primitive liquid, belongs to all
that is purest in nature; all the dubious modifications man has been
able to add to nature's essential kindness cannot change the
beneficence of water; when civilization, life in society, the imaginary
desires aroused by novel reading and theatergoing provoke nervous
ailments, the return to water's limpidity assumes the meaning of a
ritual of purification; in that transparent coolness, one is reborn to
one's first innocence. But at the same time, the water naturally
inherent in the composition of all bodies restores each to its own
equilibrium; water serves as a universal physiological regulator. All
these themes were expressed by Tissot, a disciple of Rousseau,
whose imagination was as moral as it was medical: "Nature has
prescribed water as the unique beverage of all nations; she gave it the
power to dissolve all sons of nourishment; it is agreeable to the
palate; choose therefore a good cold water, fresh and light; it fortifies
and cleans the bowels; the Greeks and Romans regarded it as a
universal remedy."
The practice of immersion reaches far back into the history of
madness; the baths taken at Epidaurus alone would bear witness to
this; and cold applications of all kinds must have been current
throughout antiquity, since Soranus of Ephesus, if we are to believe
Caelius Aurelianus, already protested against their abuse. In the
Middle Ages, the traditional treatment of a maniac was to plunge
him several times into water "until he had lost his strength and
forgotten his fury." Franciscus Sylvius recommends immersions in
cases of melancholia or frenzy. And the story, accepted in the
eighteenth century, of Van Helmont's sudden dicsovery of the
usefulness of hydrotherapy, was actually a reinterpretation.
According to Menuret, this invention, supposedly dating from the
middle of the seventeenth cen-
(167)
tury, was the fortunate result of chance: a heavily chained
madman was being transported on an open wagon; he managed,
however, to free himself from his chains and jumped into a lake,
tried to swim, fainted; when he was rescued, everyone thought he
was dead, but he quickly recovered his spirits, which were abruptly
restored to their natural order, and he "lived a long time without
experiencing any further attack of madness." This anecdote
supposedly enlightened Van Helmont, who began to plunge the
insane indiscriminately into the sea or into fresh water; "the only
care that must be taken, is to plunge the sufferers into the water
suddenly and unawares, and to keep them there for a long time. One
need have no fear for their lives."
The truth of the story is of little importance; one thing is certain,
which it conveys in the form of an anecdote: from the end of the
seventeenth century, the water cure takes or regains its place as a
major therapeutics of madness. When Doublet published his
Instructions shortly before the Revolution, he prescribed, for the four
major pathological forms he recognized (frenzy, mania, melancholia,
imbecility), the regular use of baths, adding the use of cold showers
for the first two. And at this period, Cheyne had already long since
recommended that "all those who need to fortify their temperament"
install baths in their house, and use them every two, three, or four
days; or "if they have not the means, to bathe in some manner either
in a lake or in running water, whenever they have occasion."
The advantages of water are evident, to a medicine dominated by
the concern to equilibrate liquids and solids. For if water has powers
of impregnation, which place it first among the humectants, it has,
insofar as it can receive supplementary qualities like cold and heat,
the virtues of constriction, of cooling or of heating, and it can even
have those effects of consolidation attributed to substances like iron.
In fact, the interplay of qualities is very labile, in the
(168)
fluid substance of water; just as it penetrates easily into the web of
all the tissues, it may be easily impregnated by all the qualitative
influences to which it is subjected. Paradoxically, its universal use in
the eighteenth century was not the result of a general recognition of
its effect and mode of action, but of the ease with which the most
contradictory forms and modalities could be attributed to its action. It
is the locus of all possible therapeutic themes, forming an inexhaustible
reservoir of operative metaphors. In this fluid element
occurs the universal exchange of qualities.
Of course, cold water cools. Otherwise would it be used in frenzy
and mania—diseases of heat, in which the spirits boil, solids stretch,
liquids seethe to the point of evaporation, leaving the brains of these
sufferers "dry and fragile," as anatomy can daily testify? Reasonably
enough, Barthelemy-Camille Boissieu cites cold water among the
essential means of cooling cures; as a bath, it comes first among the
"antiphlogistics" which tear from the body the excessive igneous
particles found there; as a drink, it is a "procrastinative dilution"
which diminishes the resistance of fluids to the actions of solids, and
thus indirectly lowers the general heat of the body.
But it can just as well be said that cold water heats and hot water
cools. It is precisely this thesis which Darut defends. Gold baths
attack the blood that is at the periphery of the body and "drive it
more vigorously toward the heart." But the heart being the seat of
natural heat, there the blood is heated, especially because "the heart,
which struggles alone against the other parts, makes new efforts to
drive out the blood and to overcome the resistance of the capillaries.
Whence a great intensity of circulation, the division of the blood, the
fluidity of the humors, the destruction of the encumbrances, the
augmentation of the forces of natural heat, of the appetite of the
digestive forces, of the activity of the body and the mind." The
paradox of the
(169)
hot bath is symmetrical: it draws the blood to the periphery, as
well as the humors, perspiration, and all liquids, useful or harmful.
Thus the vital centers are relieved; the heart now must function
slowly; and the organism is thereby cooled. Is not this fact
confirmed by "those syncopes, those lipothymias, that weakness,
that lack of vigor" which accompany the too constant use of hot
baths?
Further still: so rich is water's polyvalence, so great its aptitude
for submitting to the qualities it bears, that it even manages to lose
its efficacity as a liquid, and to act as a desiccant. Water can conjure
away humidity.' It revives the old principle "like to like," but in
another sense, and by the intermediary of an entire visible
mechanism. For some, it is cold water that dries, heat on the
contrary preserving water's humidity. Heat, in fact, dilates the pores
of the organism, distends its membranes, and permits humidity to
impregnate them by a secondary effect. Heat clears the way for
liquids. It is precisely for this reason that all the hot drinks the
seventeenth century used and abused risk becoming harmful:
relaxation, general humidity, softness of the entire organism—this is
what threatens those who consume too many such infusions. And
since these are the distinctive traits of the female body, as opposed
to virile dryness and solidity, the abuse of hot drinks risks leading to
a general feminization of the human race: "Most men are censured,
not without reason, for having degenerated in contracting the
softness, the habits, and the inclinations of women; there is lacking
only a resemblance in bodily constitution. Excessive use of
humectants immediately accelerates the metamorphosis and makes
the two sexes almost as alike in the physical as in the moral realm.
Woe to the human race, if this prejudice extends its reign to the
common people; there will be no more plowmen, artisans, soldiers,
for they will soon be robbed of the strength and vigor necessary to
their profession."6 In cold water, it is
(170)
the cold that vanquishes all the powers of humidity, for by
tightening the tissues, it closes them to all possibility of
impregnation: "Do we not see how much the vessels, the tissues of
our flesh tighten when we wash in cold water or when we are
numbed with cold?"6 Cold baths thus have the paradoxical property
of consolidating the organism, of guaranteeing it against the softness
of humidity, of "giving tone to the parts," as Hoffmann said, "and
augmenting the systaltic power of the heart and the vessels."
But in other qualitative intuitions, the relationship is reversed;
here it is heat that dries up water's humectant properties, while cold
ceaselessly preserves and renews them. Against diseases of the
nerves due to "a shriveling of the nervous system" and "the dryness
of the membranes," Pomme does not recommend hot baths—which
abet the heat that reigns in the body—but tepid or cold baths that can
permeate the tissues of the organism and restore their suppleness. Is
this not the method spontaneously practiced in America? And are
not its effects, its very mechanism visible to the naked eye in the
development of the cure, since at the most acute point of the crisis,
the sufferers float in the water of the bath—to such an extent has
internal heat rarified the air and the liquids of their bodies; yet if
they remain a long time in the bath water, "three, four, or even six
hours a day," then relaxation takes place, the water gradually
impregnates the membranes and the fibers, the body becomes heavy
and sinks naturally to the bottom.
At the end of the eighteenth century, the powers of water wane in
the very excess of its qualitative versatility: cold, it can heat; hot, it
can cool; instead of humidifying, it is even capable of solidifying, of
petrifying by cold, or of sustaining a fire with its own heat. In it, all
the values of beneficence and maleficence indiscriminately combine.
It is endowed with all possible complicities. In medical thought, it
forms a therapeutic theme which can be used and ma-
(171)
nipulated unconditionally, and whose effect can be understood in
the most diverse physiologies and pathologies. It has so many
values, so many different modes of action, that it can confirm
anything, cancel anything. No doubt it was this very polyvalence,
with all the disputes it generated, that finally neutralized water. By
Pinel's day, water was still used, but it had again become entirely
limpid, its qualitative overtones had been eliminated, and its mode
of action could no longer be anything but mechanical.
Showers, hitherto less used than baths and drinks, now become
the favored technique. And parad6xically, water regains, beyond all
the physiological variations of the preceding epoch, its simple
function of purification. The only quality attributed to it is violence,
an irresistible flow washing away all the impurities that form
madness; by its own curative power, it reduces the individual to his
simplest possible expression, to his merest and purest form of existence,
thus affording him a second birth; it is a matter, Pinel explains,
"of destroying even the smallest traces of the extravagant ideas of
the insane, which can be done only by obliterating, so to speak,
these ideas in a state close to that of death." Whence the famous
techniques used in asylums like Charenton at the end of the
eighteenth and the beginning of the nineteenth century: the shower
proper—"the insane man, fastened to an armchair, was placed
beneath a reservoir filled with cold water which poured directly
upon his head through a large pipe"; and surprise baths— "the
sufferer came down the corridors to the ground floor, and arrived in
a square vaulted room, in which a pool had been constructed; he was
pushed over backwards and into the water."7 Such violence
promised the rebirth of a baptism.
4. Regulation of Movement. If it is true that madness is the
irregular agitation of the spirits, the disordered movement of fibers
and ideas, it is also obstruction of the body
(172)
and the soul, stagnation of the humors, immobilization of the
fibers in their rigidity, fixation of ideas and attention on a theme that
gradually prevails over all others. It is then a matter of restoring to
the mind and to the spirits, to the body and to the soul, the mobility
which gives them life. This mobility, however, must be measured
and controlled;
it must not become a vain agitation of the fibers which no longer
obey the stimuli of the exterior world. The animating idea of this
therapeutic theme is the restitution of a movement that corresponds
to the prudent mobility of the exterior world. Since madness can be
dumb immobility, obstinate fixation as well as disorder and
agitation, the cure consists in reviving in the sufferer a movement
that will be both regular and real, in the sense that it will obey the
rules of the world's movements.
Physicians of the period evoke the firm belief of the ancients, who
attributed salutary effects to various forms of walking and running:
simple walking, which both limbers and strengthens the body;
running at an ever increasing speed, which better distributes the
juices and humors throughout the body, at the same time that it
diminishes the weight of the organs; running fully dressed, which
heats and loosens the tissues, softens too rigid fibers. Sydenham
especially recommends horseback riding in cases of melancholia
and hypochondria: "But the best thing I have yet found to fortify and
animate the blood and the spirits, is to ride almost every day, and in
this manner to make rather long excursions in the fresh air. This
exercise, by the extraordinary jolting it causes the lungs and
especially the viscera of the lower stomach, rids the blood of the
excremental humors that reside there, gives resilience to the fibers,
re-establishes the functions of the organs, reanimates natural heat,
evacuates degenerate juices by perspiration or other means, or else
re-establishes them in their previous state, dissipates obstructions,
opens all passages, and finally,
(173)
through the continual movement it causes the blood, renews it, so
to speak, and accords it an extraordinary vigor."8 The rolling of the
sea, the most regular, the most natural movement in the world, and
the one most in accord with cosmic order—that same movement
which De Lancre once considered so dangerous for the human heart,
offering as it did so many hazardous temptations, improbable and
always unfulfilled dreams, constitutive of the image, in fact, of
infinite evil—was considered by the eighteenth cen tury as a
powerful regulator of organic mobility. In it, the very rhythm of
nature spoke. Gilchrist wrote an entire treatise "on the use of sea
voyages in Medicine"; Whytt found the remedy difficult to apply to
those subject to melancholia; it is "difficult to convince such patients
to undertake a long sea voyage; but a case must be cited of
hypochondriacal vapors that immediately disappeared in a young
man who was constrained to travel in a ship for four or five weeks."
Travel has the additional interest of acting directly upon the flow
of ideas, or at least by a more direct means, since it passes only
through the sensations. The variety of the landscape dissipates the
melancholic's obstinacy: a remedy in use since antiquity, but which
the eighteenth century prescribed with a new insistence, and whose
forms it varied, from real travel to the imaginary voyages of
literature and the theater. Antoine le Camus prescribes "in order to
relax the brain" in all cases of vaporous affections: "walks, journeys,
rides, exercise in the fresh air, dancing, spectacles, diverting
reading, occupations that can cause the obsessive idea to be
forgotten." The country, by the gentleness and variety of its
landscapes, wins melancholics from their single obsession "by
taking them away from the places that might revive the memory of
their sufferings."
But inversely, the agitation of mania can be corrected by the good
effects of a regular movement. This is no longer a,
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restoring of motion but a regulation of agitation, momentarily
stopping its course, fixing the attention. Travel is efficacious not by
its incessant breaks in continuity, but by the novelty of the objects it
affords, by the curiosity to which it gives birth. It should permit the
external distraction of a mind which has escaped all control, and has
escaped from itself in the vibration of its interior movement. "If one
can discover objects or persons who may be able to distract the
attention from the pursuit of deranged ideas and who may be able to
fix it somewhat upon others, they must be presented often to
maniacs; and it is for this reason that advantages may often be
obtained from travel, which interrupts the sequence of former ideas
and offers objects that fix the attention."9
Utilized for the changes it affords in melancholia, or for the
regularity it imposes upon mania, the therapeutics of movement
conceals the idea of a seizure by the world of the alienated mind. It
is both a "falling in step" and a conversion, since movement
prescribes its rhythm, but constitutes, by its novelty or variety, a
constant appeal to the mind to leave itself and return to the world. If
it is true that the techniques of immersion always concealed the
ethical, almost religious memories of ablution, of a second birth, in
these cures by movement we can also recognize a symmetrical moral
theme, but one that is the converse of the first: to return to the world,
to entrust oneself to its wisdom by returning to one's place in the
general order of things, thus forgetting madness, which is the
moment of pure subjectivity. We see how even in empiricism, the
means of cure encounter the great organizing structures of the
experience of madness in the classical period. Being both error and
sin, madness is simultaneously impurity and solitude; it is withdrawn
from the world, and from truth;
but it is by that very fact imprisoned in evil. Its double
nothingness is to be the visible form of that non-being
(175)
which is evil, and to utter, in the void and in the sensational
appearances of its delirium, the non-being of error. It is totally pure,
since it is nothing if not the evanescent point of a subjectivity from
which all presence of the truth has been removed; and totally
impure, since this nothingness is the non-being of evil. The
technique of cure, down to its physical symbols most highly charged
with iconographic intensity—consolidation and return to movement
on the one hand, purification and immersion on the other—is secretly
organized around these two fundamental themes: the subject
must be restored to his initial puriry, and must be wrested from his
pure subjectivity in order to be initiated into the world; the nonbeing
that alienates him from himself must be annihilated, and he
must be restored to the plenitude of the exterior world, to the solid
truth of being.
The techniques were to subsist longer than their meaning. When,
outside the experience of unreason, madness had received a purely
psychological and moral status, when the relations of error and fault
by which classicism defined madness were crammed into the single
notion of guilt, the techniques still remained, but with a much more
restricted significance; all that was sought was a mechanical effect,
or a moral punishment. It was in this manner that the methods of
regulating movement degenerated into the famous "rotatory
machine" whose mechanism and efficacity were demonstrated by
Mason Cox at the beginning of the nineteenth century:10 a
perpendicular pillar is attached to both floor and ceiling; the sufferer
is attached to a chair or a bed hung from a horizontal arm moving
around the pillar; by means of a "not very complicated system of
gears" the machine is set for "the degree of speed desired." Cox cites
one of his own observations; it concerns a man whom melancholia
had thrown into a kind of stupor: "His complexion was dark and
leaden, his eyes yellow, his looks constantly fixed upon the ground,
his limbs motionless, his
(176)
tongue dry and paralyzed, and his pulse slow." This sufferer was
placed upon the rotatory machine, which was set at an increasingly
rapid movement. The effect surpassed expectation; the sufferer
became excessively disturbed: melancholic rigidity gave way to
manic agitation. But this first effect passed, and the invalid relapsed
into his initial state. The rhythm was then changed; the machine was
made to turn very rapidly, but it was stopped at regular intervals, and
in a very abrupt manner. The melancholia was driven out, without
the rotation having had time to release the manic agitation. This
"centrifugation" of melancholia is very characteristic of the new use
of the old therapeutic themes. Movement no longer aimed at
restoring the invalid to the truth of the exterior world, but only at
producing a series of internal effects, purely mechanical and purely
psychological. It was no longer the presence of the truth that
determined the cure, but a functional norm. In this reinterpretation of
the old method, the organism was no longer related to anything but
itself and its own nature, while in the initial version, what was to be
restored was its relation with the world, its essential link with being
and with truth: if we add that the rotatory machine was soon used as
a threat and a punishment, we see the impoverishment of the
meanings which had richly sustained the therapeutic methods
throughout the entire classical period. Medicine was now content to
regulate and to punish, with means which had once served to
exorcise sin, to dissipate error in the restoration of madness to the
world's obvious truth.
In 1771, Bienville wrote apropos of Nymphomania that there were
times when it could be cured "merely by treating the imagination;
but there were none or almost none when physical remedies alone
could effect a radical cure." And a little later, Beauchesne: "One
would undertake in
(177)
vain to cure a man suffering from madness, if one tried to succeed
by physical means alone. . . . Material remedies can never enjoy a
complete success without that succor which a strong and healthy
mind affords a weak and sick one."
Such texts do not discover the necessity of a psychological
treatment; rather they mark the end of an era: the era when the
difference between physical medicaments and moral treatments was
not yet accepted as obvious by medical thought. The unity of the
symbols begins to break down, and the techniques lose their total
significance. They are no longer credited with more than a local
efficacity—on the body or on the soul. The cure again changes
direction;
it is no longer determined by the meaningful unity of the disease,
organized around its major qualities; but, segment by segment, must
address itself to the various elements that compose the disease; the
cure will consist of a series of partial destructions, in which
psychological attack and physical intervention are juxtaposed,
complement each other, but never interpenetrate.
In fact, what to us seems already the outline of a psychological
cure was no such thing to the classical physicians who applied it.
Since the Renaissance, music had regained all those therapeutic
virtues antiquity had attributed to it. Its effects were especially
remarkable upon madness. Johann Schenck cured a man "fallen into
a profound melancholia" by having him attend "concerts of musical
instruments that particularly pleased him"; Wilhelm Albrecht also
cured a delirious patient, after having tried all other remedies in vain,
by prescribing the performance, during one of his attacks, of "a little
song which awakened the sufferer, pleased him, excited him to
laugh, and dispelled the paroxysm forever." Even cases of frenzy
were cited as having been cured by music. Now, such observations
were never meant to suggest psychological interpretations. If
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music cured, it was by acting upon the entire human being, by
penetrating the body as directly, as efficaciously as it did the soul:
did not Diemerbroek know of people stricken with the plague who
had been cured by music? Doubtless most people no longer believed,
as Giambattista della Porta still did, that music, in the material reality
of its sounds, afforded the body the secret virtues hidden in the very
substance of the instruments; no longer believed, as he did, that
lymphatics were cured by "a lively air played on a holly flute," or
that melancholics were soothed by "a soft air played on a hellebore
flute," or that it was necessary to use "a flute made of larkspur or iris
stems to cure impotent and frigid men." But if music no longer
transmitted the virtues sealed in substances, it was efficacious upon
the body because of the qualities it imposed upon it. It even
constituted the most rigorous of all the mechanisms of quality, since
at its origin it was nothing but movement, whereas once it had
reached the ear it immediately became qualitative effect. Music's
therapeutic value occurred because this transformation was undone
in the body, quality there re-decomposed into movements, the
pleasure of sensation became what it had always been: regular
vibrations and equilibrium of tensions. Man, as unity of soul and
body, followed the cycle of harmony in a reverse direction,
redescending from the harmonious to the harmonic. In him, music
was decomposed, but health restored. But there was another avenue,
still more direct and more efficacious: by taking it, man no longer
played the negative role of anti-instrument; he reacted as if he
himself were the instrument:
"If one were to consider the human body as merely an assemblage
of more or less taut fibers, ignoring their sensibility, their life, their
movement, one would easily conceive that music must produce the
same effect on the fibers as it does on the strings of similar
instruments;"11 an effect of resonance which has no need to follow
the long and com-
(179)
plex paths of auditory sensation. The nervous system vibrates
with the music that fills the air; the fibers are like so many "deaf
dancers" whose movement keeps time to a music they do not hear.
And this time, it is within the body itself, from the nervous fiber to
the soul, that the music is recomposed, the harmonic structure of
consonance restoring the harmonious functioning of the passions.
The very use of passion in the therapeutics of madness must not
be understood as a form of psychological medication. To employ
passion against dementia is merely to attack the unity of soul and
body at its most rigorous point, to utilize an event in the double
system of its effects, and in the immediate correspondence of their
meaning. To cure madness by passion implies that one accepts the
reciprocal symbolism of soul and body. Fear, in the eighteenth century,
was regarded as one of the passions most advisable to arouse in
madmen. It was considered the natural complement of the
constraints imposed upon maniacs and lunatics; a sort of discipline
was even imagined which would immediately accompany and
compensate every attack of anger in a maniac by a reaction of fear:
"It is by force that the furies of a maniac are overcome; it is by
opposing fear to anger that anger may be mastered. If the terror of
punishment and public shame are associated in the mind during
attacks of anger, one will not appear without the other; the poison
and the antidote are inseparable."12 But fear is efficacious not only at
the level of the effects of the disease;
it is the disease itself that fear attacks and suppresses. It has, in
fact, the property of petrifying the operations of the nervous system,
somehow congealing its too mobile fibers, controlling all their
disordered movements; "fear being a passion that diminishes the
excitation of the brain, it can consequently calm its excesses, and
especially the irascible excitation of maniacs."13
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If the fear-anger antithesis is efficacious against manic irritation,
it can be used inversely against the unmotivated fears of
melancholics, hypochondriacs, and all those who have a lymphatic
temperament. Tissot, reviving the traditional idea that anger is a
discharge of bile, considers that it is useful for dissolving the
phlegms amassed in the stomach and in the blood. By subjecting the
nervous fibers to a stronger tension, anger gives them more vigor,
thus restoring their lost elasticity and permitting fear to disappear.
The cure by passion is based on a constant metaphor of qualities
and movements; it always implies that they are immediately
transferable in their own modality from the body to the soul, and
vice versa. It must be used, says Scheidenmantel in the treatise he
devotes to this form of cure, "when the cure necessitates in the body
changes identical to those which this passion produces." And it is in
this sense that it can be the universal substitute for all other physical
therapeutics; it is only another way to produce the same sequence of
effects. Between a cure by the passions and a cure by the
prescriptions of the pharmacopoeia, there is no difference in nature;
but only a diversity in the mode of access to those mechanisms
which are common to the body and to the soul. "The passions must
be utilized, if the sufferer cannot be led by reason to do what is
necessary for the restoration of his health."
It is thus not possible to use as a valid or at least meaningful
distinction for the classical period the difference—im mediately
apparent to us—between physical medications and psychological or
moral medications. The difference only begins to exist in all its
profundity the day when fear is no longer used as a method for
arresting movement, but as a punishment; when joy does not signify
organic expansion, but reward; when anger is nothing more than a
response to concerted humiliation; in short, when the nine-
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teenth century, by inventing its famous "moral methods," has
brought madness and its cure into the domain of guilt. The
distinction between the physical and the moral becomes a practical
concept in the medicine of the mind only when the problematics of
madness shifts to an interrogation of the subject responsible. The
purely moral space, which is then denned, gives the exact
measurements of that psychological inwardness where modem man
seeks both his depth and his truth. Physical therapeutics tends to
become, in the first half of the nineteenth century, a cure devised by
an innocent determinism, and moral treatment a cure wrought by a
culpable freedom. Psychology, as a means of curing, is henceforth
organized around punishment. Before seeking to relieve, it inflicts
suffering within the rigor of a moral necessity. "Do not employ
consolations, they are useless; have no recourse to reasoning, it does
not persuade; do not be sad with melancholics, your sadness
sustains theirs; do not assume an air of gaiety with them, they are
only hurt by it. What is required is great sang-froid, and when
necessary, severity. Let your reason be their rule of conduct. A
single string still vibrates in them, that of pain; have courage enough
to pluck it."14
The heterogeneity of the physical and the moral in medical
thought is not a result of Descartes's definition of substances; a
century and a half of post-Cartesian medicine did not succeed in
assimilating that separation on the level of problems and methods,
nor in understanding the distinction of substances as an opposition
of organic to psychological. Cartesian or anti-Cartesian, classical
medicine never introduced Descartes's metaphysical dualism into
anthropology. And when the separation did occur, it was not by a renewed
loyalty to the Meditations, but by a new privilege accorded to
transgression. Only the use of punishment distinguished, in treating
the mad, the medications of the body from those of the soul. A
purely psychological medi-
(182)
cine was made possible only when madness was alienated in
guilt.
Of this, however, a whole aspect of medical practice during the
classical period might stand as a long denial. The psychological
element, in its purity, seems to have its place among the techniques.
How else explain the importance attached to exhortation, to
persuasion, to reasoning, to that whole dialogue in which the
classical physician engages with his patient, independently of the
cure by bodily remedies? How explain that Sauvages can write, in
agreement with all his contemporaries: "One must be a philosopher
to be able to cure the diseases of the soul. For as the origin of these
diseases is nothing more than a violent desire for a thing which the
sufferer envisages as a good, it is part of the physician's duty to
prove to him by solid reasons that what he desires so ardently is an
apparent good but a real evil, in order to make him renounce his
error."
In fact this approach to madness is neither more nor less
psychological than any of those we have already discussed.
Language, the formulations of truth or morality, are in direct contact
with the body; and it is Bienville again, in his treatise on
Nymphomania, who shows how the adoption or the rejection of an
ethical principle can directly modify the course of organic
processes. However, there is a difference in nature between those
techniques which consist in modifying the qualities common to
body and soul, and those which consist in treating madness by
discourse. In the first case, the technique is one of metaphors, at the
level of a disease that is a deterioration of nature; in the second, the
technique is one of language, at the level of a madness perceived as
reason's debate with itself. The technique, in this last form,
functions in a domain where madness is "treated" —in all the senses
of the word—in terms of truth and error. In short, there always
existed, throughout the classical
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period, a juxtaposition of two technical universes in the
therapeutics of madness. One, which is based on an implicit
mechanics of qualities, and which addresses madness as essentially
passion—that is, a certain compound (movement-quality) belonging
to both body and soul; the other, which is based on the discursive
movement of reason reasoning with itself, and which addresses
madness as error, as double inanity of language and image, as
delirium. The structural cycle of passion and of delirium which
constitutes the classical experience of madness reappears here in the
world of techniques—but in a syncopated form. Its unity is expressed
only distantly. What is immediately visible, in capital
letters, is the duality, almost the opposition, in the medicine of
madness, of the methods of suppressing the disease, and of the
forms of treating unreason. These latter can be reduced to three
essential configurations.
1. Awakening. Since delirium is the dream of waking persons,
those who are delirious must be torn from this quasi-sleep, recalled
from their waking dream and its images to an authentic awakening,
where the dream disappears before the images of perception.
Descartes sought this absolute awakening, which dismisses one by
one all the forms of illusion, at the beginning of his Meditations, and
found it, paradoxically, in the very awareness of the dream, in the
consciousness of deluded consciousness. But in madmen, it is
medicine which must effect the awakening, transforming the
solitude of Cartesian courage into an authoritarian intervention, by
the man awake and certain of his wakefulness, into the illusion of
the man who sleeps waking: a short cut that dogmatically reduces
Descartes's long road. What Descartes discovers at the end of his
resolution and in the doubling of a consciousness that never
separates from itself and does not split, medicine imposes from outside,
and in the dissociation of doctor and patient. The physician, in
relation to the madman, reproduces the mo-
(184)
ment of the Cogito in relation to the time of the dream, of
illusion, and of madness. A completely exterior Cogito, alien to
cogitation itself, and which can be imposed upon it only in the form
of an invasion.
This structure of invasion by wakefulness is one of the most
constant forms among the therapeutics of madness. It often assumes
the simplest aspects, simultaneously those most highly charged with
images and those most credited with immediate powers. It is
asserted that a gun discharged near her cured a young girl of
convulsions contracted as the result of severe grief. Without going
so far as this iconographic representation of the methods of
awakening, sudden and strong emotions achieve the same result. It
is in this spirit that Boerhaave performed his famous cure of
convulsives at Haarlem. In the city hospital, an epidemic of
convulsions had broken out. Antispasmodics, administered in strong
doses, did no good. Boerhaave ordered "that stoves filled with
burning coals be brought, and that iron hooks of a certain form be
heated in them; thereupon, he said in a loud voice that since all the
means hitherto employed in attempting to cure the convulsions had
been useless, he knew of only one other remedy, which was to bum
to the bone, with red-hot irons, a certain spot on the arm of any
person, male or female, who suffered an attack of a convulsive
illness."15
Slower, but also more certain of the truth it confronts, is the
awakening that proceeds from wisdom itself and from its insistent,
imperative progress through the landscapes of madness. From this
wisdom, in its various forms, Willis sought the cure of the various
madnesses. For imbeciles, a pedagogical wisdom; an "attentive and
devoted master must educate them completely"; they must be taught,
little by little and very slowly, what children are taught in school.
For melancholics, a wisdom that takes as its model the most
rigorous and most evident forms of truth: what is
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imaginary in their delirium will disappear in the light of an
incontestable truth; this is why "mathematical and chemical" studies
are strongly recommended. For the others, the wisdom of a wellordered
life will reduce their delirium;
there is no need to impose upon them any other truth than that of
their everyday life; remaining in their homes, "they must continue to
manage their affairs, direct their families, order and cultivate their
estates, their gardens, their orchards, their fields." It is, on the
contrary, the exactitude of a social order, imposed from without and,
if necessary, by force, that can gradually restore the minds of
maniacs to the light of truth: "For this, the insane person, placed in a
special house, will be treated, either by the doctor or by trained
assistants, in such a way that he may be always maintained in his
duty, in his appearance and habits, by warnings, by remonstrances,
and by punishments immediately inflicted."16
Little by little during the classical period, this authoritarian
awakening of madness would lose its original meaning and limit
itself to being no more than recollection of moral law, return to the
good, fidelity to the law. What Willis still intended as a
reintroduction to truth would no longer be entirely understood by
Sauvages, who speaks of lucidity in the recognition of the good:
"Thus, one can recall to reason those whom false principles of moral
philosophy have caused to lose their own, as long as they are willing
to examine with us what is truly good, and what things are to be
preferred to others." Already it is no longer as awakener that the
physician is to function, but as moralist. Against madness, Tissot
considers that "a pure conscience, without reproach, is an excellent
preservative." And soon comes Pinel, for whom the awakening to
truth no longer has a meaning in the cure, but only obedience and
blind submission: "A fundamental principle for the cure of mania in
a great number of cases is to resort first of
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all to an energetic repression, and to proceed subsequently to
methods of benevolence."
2. Theatrical Representation. In appearance at least, this is a
technique rigorously opposed to that of awakening. There, delirium,
in all its immediate vivacity, was confronted by the patient work of
reason. Either in the form of a slow pedagogy, or the form of an
authoritarian invasion, reason was imposed, as if by the weight of its
own being. The non-being of madness, the inanity of error, was
forced to yield, finally, to this pressure of the truth. Here, the
therapeutic operation functions entirely in the space of the
imagination; we are dealing with a complicity of the unreal with
itself; the imagination must play its own game, voluntarily propose
new images, espouse delirium for delirium's sake, and without
opposition or confrontation, without even a visible dialectic, must,
paradoxically, cure. Health must lay siege to madness and conquer it
in the very nothingness in which the disease is imprisoned. When
the imagination "is sick, it can be cured only by the effect of a
healthy and active imagination. ... It is all one whether the invalid's
imagination is cured by fear, by a strong and painful impression
upon the senses, or by an illusion."17 Illusion can cure the illusory—
while reason alone can free from the unreasonable. What then is this
dark power of the imaginary?
Insofar as it is of the essence of the image to be taken for reality,
it is reciprocally characteristic of reality that it can mime the image,
pretend to the same substance, the same significance. Without a
break, without a jolt, perception can continue the dream, fill in its
gaps, confirm what is precarious about it, and lead it to its
fulfillment. If illusion can appear as true as perception, perception in
its turn can become the visible, unchallengeable truth of illusion.
Such is the first step of the cure by "theatrical representation":
to integrate the unreality of the image into perceived truth,
(187)
without the latter seeming to contradict or even contest the
former. Thus Zacatus Lusitanus describes the cure of a melancholic
who believed himself damned while still on earth because of the
enormity of the sins he had committed. In the impossibility of
convincing him by reasonable arguments that he could be saved, his
physicians accepted his delirium and caused an "angel" dressed in
white, with a sword in its hand, to appear to him, and after a severe
exhortation this delusive vision announced that his sins had been
remitted.
From this very example, we see the next step: representation
within the image is not enough; it is also necessary to continue the
delirious discourse. For in the patient's insane words there is a voice
that speaks; it obeys its own grammar, it articulates a meaning.
Grammar and meaning must be maintained in such a way that the
representation of the hallucination in reality does not seem like the
transition from one register to another, like a translation into a new
language, with an altered meaning. The same language must
continue to make itself understood, merely bringing a new deductive
element to the rigor of its discourse. Yet this element is not
indifferent; the problem is not to pursue the delirium, but by
continuing it to bring it to an end. It must be led to a state of
paroxysm and crisis in which, without any addition of a foreign
element, it is confronted by itself and forced to argue against the
demands of its own truth. The real and perceptual discourse that
prolongs the delirious language of the images must therefore,
without escaping the latter's laws, without departing from its sovereignty,
exercise a positive function in relation to it; it tightens that
language around its essential element; if it represents it at the risk of
confirming it, it is in order to dramatize it. The case is cited of a
sufferer who thought that he was dead, and was really dying from
not eating; "a group of people who had made themselves pale and
were
(188)
dressed like the dead, entered his room, set up a table, brought
food, and began to eat and drink before the bed. The starving 'dead
man' looked at them; they were astonished that he stayed in bed;
they persuaded him that dead people eat at least as much as living
ones. He readily accommodated himself to this idea."18 It is within a
continuous discourse that the elements of delirium, coming into
contradiction, bring on the crisis. A crisis which is, in a very
ambiguous manner, both medical and theatrical; a whole tradition of
Western medicine dating from Hippocrates here intersects, suddenly
and for only a few years, with one of the major forms of theatrical
experience. Before us appears the great theme of a crisis that
confronts the madman with his own meaning, reason with unreason,
man's lucid ruse with the blindness of the lunatic—a crisis which
marks the point at which illusion, turned back upon itself, will open
to the dazzlement of truth.
This opening is imminent in the crisis; in fact it is this opening,
with its immediate proximity, that constitutes the essential element
of the crisis. But the opening does not result from the crisis itself. In
order for the crisis to be medical and not simply dramatic, in order
for it to be not an annihilation of the man, but simply a suppression
of the disease; in short, in order for the dramatic representation of
the delirium to have an effect of comic purification, a ruse must be
introduced at a given moment. A ruse, or at least an element which
surreptitiously alters the autonomous operation of the delirium, and
which, ceaselessly confirming it, does not bind it to its own truth
without at the same time linking it to the necessity for its own
suppression. The simplest example of this method is the ruse
employed with delirious patients who imagine they perceive within
their bodies an object or an extraordinary animal: "When an invalid
believes that he has a living animal shut up within his body, one
must pretend to have withdrawn it; if it is in
(189)
the stomach, one may, by means of a powerful purge, produce
this effect, throwing such an animal into the basin without the
patient's noticing." 19 The theatrical device represents the object of
the delirium but cannot do so without externalizing it, and if it gives
the invalid a perceptual confirmation of his illusion, it does so only
while ridding him of it by force. The artificial reconstitution of
delirium constitutes the real distance in which the sufferer recovers
his liberty.
But sometimes, there is even no need of this "distancing." It is
within the quasi-perceprion of the delirium that there is established,
by means of a ruse, a perceptual element, silent at first, but whose
gradual affirmation will come to contest the entire system. It is in
himself and in the perception which confirms his delirium that the
sufferer perceives the liberating reality. Trallion reports how a
physician dissipated the delirium of a melancholic who imagined he
had no head, but only a kind of void in its place; the physician,
entering into the delirium, agreed at the sufferer's request to fill up
this space, and placed upon his head a great ball of lead. Soon the
discomfort that resulted from the painful weight convinced the
invalid that he had a head. Ultimately the ruse and its function of
comic reduction can be assured, with the complicity of the physician
but without any other direct intervention on his part, by the
spontaneous reaction of the sufferer's organism. In the case cited
above of the melancholic who was really dying because he would
not eat, believing himself already dead, the theatrical representation
of a dead men's banquet incited him to eat;
this nourishment restored him, "the consumption of food ' made
him quieter," and the organic disorder thus disappearing, the
delirium which was indissociably cause and effect disappeared
forthwith. Thus the real death that would have resulted from the
imaginary death was avoided by reality, by the mere representation
of unreal death. The exchange
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of non-being with itself is carried out in this ingenious play: the
non-being of delirium is turned against the being of the illness, and
suppresses it by the simple fact that it is driven out of the delirium
by dramatic representation. The fulfillment of delirium's non-being
in being is able to suppress it as non-being itself; and this by the pure
mechanism of its internal contradiction—a mechanism that is both a
play on words and a play of illusion, games of language and of the
image; the delirium, in effect, is suppressed as non-being since it
becomes a perceived form of being; but since the being of delirium
is entirely in its non-being, it is suppressed as delirium. And its
confirmation in theatrical fantasy restores it to a truth which, by
holding it captive in reality, drives it out of reality itself, and makes
it disappear in the non-delirious discourse of reason.
3. The Return to the Immediate. Since madness is illusion, the
cure of madness, if it is true that such a cure can be effected by
theater, can also and still more directly be effected by the
suppression of theater. To entrust madness and its empty world
directly to the plenitude of a nature which does not deceive because
its immediacy does not acknowledge non-being, is to deliver
madness both to its own truth (since madness, as a disease, is after
all only a natural being), and to its closest contradiction (since
delirium, as appearance without content, is the very contrary of the
often secret and invisible wealth of nature). This contradiction thus
appears as the reason of unreason, in a double sense: it withholds
unreason's causes, and at the same time conceals the principle of its
suppression. It must be noted, however, that these themes are not
contemporary with the classical period for its entire duration.
Although they are organized around the same experience of
unreason, they follow after the themes of theatrical representation;
and their appearance marks the moment when the debate on being
and illusion begins to yield to a problematics of na-
(191)
ture. Games of theatrical illusion lose their meaning, and the
artificial techniques of iconographic representation arc replaced by
the simple and confident act of a natural reduction. And this in an
ambiguous direction, since it is as much a question of reduction by
nature as of a reduction to nature.
The return to the immediate is the therapeutics par excellence,
because it is the rigorous refusal of therapeutics: it cures insofar as it
is a disregard of all cures. It is in man's passivity with regard to
himself, in the silence he imposes on his art and his artifices, that
nature engages in an activity which is exactly reciprocal to
renunciation. For, to consider it more closely, this passivity of man is
real activity;
when man entrusts himself to medicine, he escapes the law of
labor that nature itself imposes on him; he sinks into the world of
artifice, and of anti-nature, of which his madness is only one of the
manifestations; it is by ignoring this disease and resuming his place
in the activity of natural beings that man in an apparent passivity
(which is in fact only an industrious fidelity) succeeds in being
cured. Thus Bernadin de Saint-Pierre explains how he cured himself
of a "strange disease," in which, "like Oedipus, he saw two suns."
Medicine had offered him its succor, and had informed him that "the
seat of his disease was in the nerves." In vain he applied the most
highly prized medicaments; he soon noticed that the physicians
themselves were killed by their own remedies: "It was to Jean-
Jacques Rousseau that I owed my return to health. I had read, in his
immortal writings, among other natural truths, that man is made to
work, not to meditate. Until that time I had exercised my soul and
rested my body; I changed my ways; I exercised my body and rested
my soul. I gave up most books; I turned my eyes to the works of
nature, which addressed all my senses in a language that neither time
nor nations can corrupt. My history and my newspapers were the
plants of
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the field and forest; it was not my thoughts that struggled to them,
as in the system of men, but their thoughts that came to me in a
thousand agreeable shapes."20
Despite the formulations of it which certain disciples of Rousseau
managed to propose, this return to the immediate was neither
absolute nor simple. For madness, even if it is provoked or sustained
by what is most artificial in society, appears, in its violent forms, as
the savage expression of the most primitive human desires. Madness
in the classical period, as we have seen, is rooted in the threats of
bestiality— a bestiality completely dominated by predatory and murderous
instincts. To entrust madness to nature would be, by an
uncontrolled reversal, to abandon it to that fury of anti-nature. The
cure of madness thus supposes a return to what is immediate, not in
relation to desire, but in relation to the imagination—a return that
dismisses from man's life and pleasures everything that is artificial,
unreal, imaginary. The therapeutics, by the reflective plunge into the
immediate, secretly supposes the mediation of a wisdom which
distinguishes, in nature, between what derives from violence and
what derives from truth. This is the whole difference between the
Savage and the Laborer. "Savages ... lead the life of a carnivorous
animal rather than that of a reasonable being"; the life of the Laborer,
on the other hand, "is in fact happier than that of the man of the
world." On the savage's side, immediate desire, without discipline,
without constraint, without real morality; on the laborer's side,
pleasure without mediation, in other words, without vain stimulus,
without provocation or imaginary achievement. What, in nature and
its immediate virtues, cures madness is pleasure—but a pleasure that
on one hand makes desire vain without even having to repress it,
since it offers a plenitude of satisfaction in advance, and on the other
makes imagination absurd, since it spontaneously contributes the
happy presence of reality. "Pleasures enter
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into the eternal order of things; they exist invariably; certain
conditions are necessary to form them . . . ; these conditions are not
arbitrary; nature has formed them; imagination cannot create, and
the man most devoted to pleasures can increase them only by
renouncing all those which do not bear this stamp of nature."21 The
immediate world of the laborer is thus a world suffused with wisdom
and measure, which cures madness insofar as it renders desire
useless, along with the movements of passion desire gives rise to,
and also insofar as it reduces along with the imaginary all the
possibilities of delirium. What Tissot understands by "pleasure" is
this immediate curative agent, liberated from both passion and
language: that is, from the two great forms of human experience that
give birth to unreason.
And perhaps nature, as the concrete form of the immediate, has an
even more fundamental power in the suppression of madness. For it
has the power of freeing man from his freedom. In nature—that
nature, at least, which is measured by the double exclusion of the
violence of desire and the unreality of hallucination—man is
doubtless liberated from social constraints (those which force him
"to calculate and draw up the balance sheet of his imaginary
pleasures which bear that name but are none") and from the
uncontrollable movement of the passions. But by that very fact, he is
gently and as it were internally bound by a system of natural
obligations. The pressures of the healthiest needs, the rhythm of the
days and the seasons, the calm necessity to feed and shelter oneself,
constrain the disorder of madmen to a regular observance. The
excessively remote inventions of the imagination are dismissed,
along with the excessively urgent disguises of desire. In the
gentleness of a pleasure that does not constrain, man is linked to the
wisdom of nature, and this fidelity in the form of freedom dissipates
the unreason which juxtaposes in its paradox the extreme
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determinism of passion and the extreme fantasy of the image.
Thus one begins to dream, in these mingled landscapes of ethics and
medicine, of a liberation from madness:
a liberation that must not be understood in its origin as the
discovery, by philanthropy, of the humanity of madmen, but as a
desire to open madness to the gentle constraints of nature.
The old village of Gheel which, from the end of the Middle Ages,
still bore witness to the now forgotten relation between the
confinement of madmen and the exclusion of lepers, also received in
the last years of the eighteenth century a sudden reinterpretation.
What had once marked, here, the entire violent, pathetic separation
of the world of madmen from the world of men, now conveyed the
idyllic values of a rediscovered unity of unreason and nature. This
village had once signified that madmen were confined, and that
therefore the man of reason was protected from them; now it
manifested that the madman was liberated, and that, in this liberty
which put him on a level with the laws of nature, he was reconciled
with the man of reason. At Gheel, according to Jouy's description of
it, "four-fifths of the inhabitants are mad, but mad in the full sense of
the word, and they enjoy without restraint the same freedom as the
other citizens.... Healthful food, pure air, all the devices of liberty:
such is the regimen prescribed for them, and to which the greatest
number, by the end of a year, owe their cure." Without anything in
the institutions having as yet really changed, the meaning of
exclusion and of confinement begins to alter: it slowly assumes
positive values, and the neutral, empty, nocturnal space in which unreason
was formerly restored to its nothingness begins to be peopled
by a nature to which madness, liberated, is obliged to submit.
Confinement, as the separation of reason from unreason, is not
suppressed; but at the very heart of its intention, the space it
occupies reveals natural powers,
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more constraining for madness, more likely to subjugate it in its
essence, than the whole of the old limiting and repressive system.
Madness must be liberated from that system so that, in the space of
confinement, now endowed with a positive efficacity, it will be free
to slough off its savage freedom, and to welcome the demands of
nature that are for it both truth and law. Insofar as it is law, nature
constrains the violence of desire; insofar as it is truth, it reduces antinature,
and all the hallucinations of the imaginary.
Here is how Pinel describes that nature, speaking of the hospital
of Saragossa: there has been established here "a sort of counterpoise
to the mind's extravagances by the attraction and the charm inspired
by the cultivation of the fields, by the natural instinct that leads man
to sow the earth and thus to satisfy his needs by the fruit of his
labors. From morning on, you can see them . . . leaving gaily for the
various parts of a vast enclosure that belongs to the hospital, sharing
with a sort of emulation the tasks appropriate to the seasons,
cultivating wheat, vegetables, concerned in turn with the harvest,
with trellises, with the vintage, with olive picking, and finding in the
evening, in their solitary asylum, calm and quiet sleep. The most
constant experience has indicated, in this hospital, that this is the
surest and most efficacious way to restore man to reason."22 Beneath
the conventional images, the rigor of a meaning is easily perceived.
The return to the immediate is effective against unreason only
insofar as the immediate is controlled—and divided against itself; an
immediate in which violence is isolated from truth, savagery
separated from liberty, in which nature can no longer recognize
itself in the fantastic figures of anti-nature. In short, an immediate in
which nature is mediatized by morality. In a space so arranged,
madness will never again be able to speak the language of unreason,
with all that in it transcends the
(196)
natural phenomena of disease. It will be entirely enclosed in a
pathology. A transformation which later periods have received as a
positive acquisition, the accession, if not of a truth, at least of what
would make the recognition of truth possible; but which in the eyes
of history must appear as what it was: that is, the reduction of the
classical experience of unreason to a strictly moral perception of
madness, which would secretly serve as a nucleus for all the
concepts that the nineteenth century would subsequently vindicate
as scientific, positive, and experimental.
This metamorphosis, which occurred in the second half of the
eighteenth century, was initiated in the techniques of cure. But it
very quickly appeared more generally, winning over the minds of
reformers, guiding the great reorganization of the experience of
madness in the last years of the century. Very soon Pinel could
write: "How necessary it is, in order to forestall hypochondria,
melancholia, or mania, to follow the immutable laws of morality!"
In the classical period, it is futile to try to distinguish physical
therapeutics from psychological medications, for the simple reason
that psychology did not exist. When the consumption of bitters was
prescribed, for example, it was not a question of physical treatment,
since it was the soul as well as the body that was to be scoured;
when the simple life of a laborer was prescribed for a melancholic,
when the comedy of his delirium was acted out before him, this was
not a psychological intervention, since the movement of the spirits
in the nerves, the density of the humors were principally involved.
But in the first case, we are dealing with an art of the transformation
of qualities, a technique in which the essence of madness is taken as
nature, and as disease; in the second, we are dealing with an art of
discourse, and of the restitution of truth, in which madness is
significant as unreason.
(197)
When, in the years that followed, this great experience of
unreason, whose unity is characteristic of the classical period, was
dissociated, when madness, entirely confined within a moral
intuition, was nothing more than disease, then the distinction we
have just established assumed another meaning; what had belonged
to disease pertained to the organic, and what had belonged to
unreason, to the transcendence of its discourse, was relegated to the
psychological. And it is precisely here that psychology was born —
not as the truth of madness, but as a sign, that madness was now
detached from its truth which was unreason and that it was
henceforth nothing but a phenomenon adrift, insignificant upon the
undefined surface of nature. An enigma without any truth except that
which could reduce it.
This is why we must do justice to Freud. Between Freud'sF ive
Case Histories and Janet's scrupulous invesgtiations of
Psychological Healing, there is more than the density of a discovery;
there is the sovereign violence of a return. Janet enumerated the
elements of a division, drew up his inventory, annexed here and
there, perhaps conquered. Freud went back to madness at the level of
its language, reconstituted one of the essential elements of an
experience reduced to silence by positivism; he did not make a major
addition to the list of psychological treatments for madness; he
restored, in medical thought, the possibility of a dialogue with
unreason. Let us not be surprised that the most "psychological" of
medications has so quickly encountered its converse and its organic
confirmations. It is not psychology that is involved in
psychoanalysis: but precisely an experience of unreason that it has
been psychology's meaning, in the modem world, to mask.
VII
THE GREAT FEAR
"ONE afternoon, I was there, looking a great deal, speaking rarely,
listening as little as I could, when I was accosted by one of the most
bizarre persons in this country, where God has not let them lack. He
was a mixture of loftiness, baseness, good sense, and unreason."
In doubt's confrontation with its major dangers, Des cartes realized
that he could not be mad—though he was to acknowledge for a long
time to come that all the powers of unreason kept vigil around his
thought; but as a philosopher, resolutely undertaking to doubt, he
could not be "one of these insane ones." Rameau's Nephew, though,
knew quite well—and among his fleeting certainties, this was the
most obstinate—that he was mad. "Before begin ning, he heaved a
profound sigh and raised his hands to his forehead; then he regained
his calm demeanor and said to me: you know I am ignorant, mad,
impertinent, and lazy."1
The eighteenth century could not exactly understand the meaning
expressed in Le Neveu de Rameau. Yet some-
(199)
thing had happened, just when the text was written, which
promised a decisive change. A curious thing: the unreason that had
been relegated to the distance of confinement reappeared, fraught
with new dangers and as if endowed with a new power of
interrogation. Yet what the eighteenth century first noticed about it
was not the secret interrogation, but only the social effects: the torn
clothing, the arrogance in rags, the tolerated insolence whose disturbing
powers were silenced by an amused indulgence. The
eighteenth century might not have recognized itself in Rameau's
Nephew, but it was entirely present in the I who served him as
interlocutor and as a type of "exhibitor," amused yet reticent, and
with a secret anxiety: for this was the first time since the Great
Confinement that the madman had become a social individual; it was
the first time that anyone had entered into conversation with him,
and that, once again, he was questioned. Unreason reappeared as a
classification, which is not much; but it nonetheless reappeared, and
slowly recovered its place in the familiarity of the social landscape.
It was there some ten years before the Revolution, when Mercier
found it without more astonishment than: "Go into another cafe; a
man whispers to you in a calm and confident tone: 'You cannot
imagine, Monsieur, the Government's ingratitude toward me, and its
blindness to its own interests! For thirty years I have neglected my
own affairs; I have shut myself up in my study, meditating,
dreaming, calculating; I have devised a project to pay all the State's
debts; another to enrich the King and assure him an income of 400
million; another to destroy England forever, whose very name
affronts me. . . . When, utterly devoted to these vast operations that
demand all the application of genius, I was distracted by domestic
problems, some nagging creditors kept me in prison for three years. .
. . But, Monsieur, you see how patriotism is valued—I die unknown
and a martyr for my country.' " 2 At a dis-
(200)
tance, such persons form a circle around Rameau's Nephew; they
do not have his dimensions; it is only in the search for the
picturesque that they can pass for his epigones.
And yet they are a little more than a social profile, a caricatural
silhouette. There is something inside them that concerns and touches
the unreason of the eighteenth century. Their chatter, their anxiety,
that vague delirium and that ultimate anguish they experience
commonly enough— and in real existences which can still be traced.
As with the libertine, the debauchee, or the ruffian of the end of the
seventeenth century, it is difficult to say whether they are mad, sick,
or criminal. Mercier himself does not quite know what status to give
them: "Thus there are in Paris some very good people, economists
and anti-economists, who have warm hearts, eager for the public
good; but unfortunately they have cracked heads; that is, they are
shortsighted, they do not know what century they are in, nor what
men they are dealing with; more unbearable than idiots, because with
pennies and false lights they start from an impossible principle and
reason falsely therefrom." They really existed, these schemers with
"cracked heads," adding a muffled accompaniment of unreason to
the reason of the philosophers, and around those plans for reform,
those constitutions, those projects; the rationality of the
Enlightenment found in them a sort of darkened mirror, an
inoffensive caricature. But is it not essential that in a movement of
amused indulgence, a personage of unreason is allowed back into
daylight, at the very moment he was believed to be most profoundly
hidden in the space of confinement? As if classical reason once again
admitted a proximity, a relation, a quasi-resemblance between itself
and the images of unreason. As if, at the moment of its triumph,
reason revived and permitted to drift on the margins of order a
character whose mask it had fashioned in
(201)
derision—a sort of double in which it both recognized and
revoked itself.
Yet fear and anxiety were not far off: in the reaction of
confinement, they reappeared, doubled. People were once afraid,
people were still afraid, of being confined; at the end of the
eighteenth century, Sade was still haunted by fear of what he called
"the black men" who lay in wait to put him away. But now the estate
of confinement acquired its own powers; it became in its turn the
birthplace of evil, and could henceforth spread that evil by itself^
instituting another reign of terror.
Suddenly, in a few years in the middle of the eighteenth century, a
fear arose—a fear formulated in medical terms but animated,
basically, by a moral myth. People were in dread of a mysterious
disease that spread, it was said, from the houses of confinement and
would soon threaten the cities. They spoke of prison fevers; they
evoked the wagons of criminals, men in chains who passed through
the cities, leaving disease in their wake; scurvy was thought to cause
contagions; it was said that the air, tainted by disease, would corrupt
the residential quarters. And the great image of medieval horror
reappeared, giving birth, in the metaphors of dread, to a second
panic. The house of confinement was no longer only the lazar house
at the city's edge;
it was leprosy itself confronting the town: "A terrible ulcer upon
the body politic, an ulcer that is wide, deep, and draining, one that
cannot be imagined except by looking full upon it. Even the air of
the place, which can be smelled four hundred yards away—
everything suggests that one is approaching a place of violence, an
asylum of degradation and infortune."3 Many of these centers of
confinement were built in the very places where the lepers had once
been kept; it was as if, across the centuries, the new tenants had
received the contagion. They revived the blazon and
(202)
the meaning that had been borne in those places: "Too great a
leper for the capital! The name of Bicetre is a word no one can
pronounce without an inexpressible feeling of repugnance, of horror
and contempt. ... It has become the receptacle for all the most
monstrous and vile things to be found in society."4
The evil which men had attempted to exclude by confinement
reappeared, to the horror of the public, in a fantastic guise. There
appeared, ramifying in every direction, the themes of an evil, both
physical and moral, that enveloped in this very ambiguity the
mingled powers of corrosion and horror. There prevailed, then, a sort
of undifferentiated image of "rottenness" that had to do with the
corruption of morals as well as with the decomposition of the flesh,
and upon which were based both the repugnance and the pity felt for
the confined. First the evil began to ferment in the closed spaces of
confinement. It had all the virtues attributed to acid in eighteenthcentury
chemistry: its fine particles, sharp as needles, penetrated
bodies and hearts as easily as if they were passive and friable
alkaline particles. The mixture boiled immediately, releasing harmful
vapors and corrosive liquids: "These wards are a dreadful place
where all crimes together ferment and spread around them, as by
fermentation, a contagious atmosphere which those who live there
breathe and which seems to become attached to them."5 These
burning vapors then rise, spread through the air, and finally fall upon
the neighborhood, impregnating bodies and contaminating souls.
Thus the idea of a contagion of evil-as-rottenness is articulated in
images. The palpable agent of this epidemic is air, that air which is
called "tainted," the term obscurely suggesting that it is not in
conformity with the purity of its nature, and that it acts as the
communicating element of the taint. It is sufficient to remember the
value, both moral and medical, ascribed at about the same period to
country air
(203)
(bodily health, spiritual vigor), to realize the whole complex of
contrary meanings conveyed by the corrupted air of hospitals,
prisons, houses of confinement. By this atmosphere laden with
maleficent vapors, entire cities were threatened, whose inhabitants
would be slowly impregnated with rottenness and taint.
And these are not only reflections halfway between morality and
medicine. We must doubtless take into account an entire literary
development, a whole emotional, perhaps political exploitation of
vague fears. But in certain cities there were movements of panic as
real, as easy to date, as the great crises of horror that wracked the
Middle Ages from time to time. In 1780 an epidemic spread through
Paris: its origin was attributed to the infection of the Hopital
General; there was even talk of burning the buildings of Bicetre. The
police lieutenant, faced with the frenzy of the population, sent a
commission of inquiry which included, together with several staff
doctors, the Dean of the Faculte and the physician of the Hopital General.
According to their findings, Bicetre was subject to a "putrid
fever" which was linked to the bad quality of the air. As for the
original source of the disease, the report denied that it lay in the
internees and the infection they might spread; it must be attributed
quite simply to the bad weather that made the disease endemic in the
capital; the symptoms that were to be observed at the Hopital
General were "in accordance with the nature of the season and exactly
the same as the illnesses observed in Paris at the same period."
The population had to be reassured and Bicetre cleared of its guilt:
"The rumors that have begun to spread concerning a contagious
illness at Bicetre that is capable of infecting the capital are without
foundation." Evidently the report did not check the rumors
completely, since some time later the physician of the Hopital
General issued another in which he made the same statement; he
was forced
(204)
to acknowledge the poor sanitary conditions of Bicetre, but
"matters have not, for all that, reached the cruel extremity of
converting the refuge of these unfortunates into another source of
inevitable evils much more lamentable than those which require a
remedy as prompt as it is efficacious."
The circle was closed: all those forms of unreason which had
replaced leprosy in the geography of evil, and which had been
banished into the remotest social distance, now became a visible
leprosy and offered their running sores to the promiscuity of men.
Unreason was once more present;
but marked now by an imaginary stigma of disease, which added
its powers of terror.
Thus it is in the realm of the fantastic and not within the rigor of
medical thought that unreason joins illness and draws closer to it.
Long before the problem of discovering to what degree the
unreasonable is pathological was formulated, there had formed, in
the space of confinement and by an alchemy peculiar to it, a
melange combining the dread of unreason and the old specters of
disease. From a great distance, the old confusions about leprosy
functioned once again; and it is the vigor of these fantastic themes
which was the first agent of synthesis between the world of unreason
and the medical universe. They first communicated through the
hallucinations of fear, combining the infernal mixtures of
"corruption" and "taint." It is important, perhaps decisive for the
place madness was to occupy in modem culture, that homo wiedicus
was not called into the world of confinement as an arbiter, to divide
what was crime from what was madness, what was evil from what
was illness, but rather as a guardian, to protect others from the
vague danger that exuded through the walls of confinement. It is
easy to suppose that a free and generous sympathy awakened
interest in the fate of the confined, and that a more diligent and
informed medical attention could recognize disease where
previously the authorities
(201)
had indiscriminately punished transgressions. As it happened, the
atmosphere was not one of such benevolent neutrality. If a doctor
was summoned, if he was asked to observe, it was because people
were afraid—afraid of the strange chemistry that seethed behind the
walls of confinement, afraid of the powers forming there that threatened
to propagate. The doctor came, once the conversion of images
was effected, the disease having already assumed the ambiguous
aspects of fermentation, of corruption, of tainted exhalations, of
decomposed flesh. What is traditionally called "progress" toward
madness's attaining a medical status was in fact made possible only
by a strange regression. In the inextricable mixture of moral and
physical contagions,6 and by virtue of that symbolism of Impurity so
familiar to the eighteenth century, very early images rose again to
the surface of human memory. And it was as a result of this
reactivation of images, more than by an improvement of knowledge,
that unreason was eventually confronted by medical thought.
Paradoxically, in the return to that fantastic life which mingles with
the contemporary images of illness, positivism would gain a hold
over unreason, or rather would discover a new reason for protecting
itself against it.
The question, for the moment, was not to suppress the houses of
confinement, but to neutralize them as potential causes of a new
evil. The problem was to organize them while purifying them. The
great reform movement that developed in the second half of the
eighteenth century originated in the effort to reduce contamination
by destroying impurities and vapors, abating fermentations, preventing
evil and disease from tainting the air and spreading their
contagion in the atmosphere of the cities. The hospital, the house of
correction, all the places of confinement, were to be more
completely isolated, surrounded by a purer air: this period produced
a whole literature con-
(206)
cerning the airing of hospitals, which tentatively approaches the
medical problem of contagion, but aims more specifically at themes
of moral communication. In 1776 a decree of the Council of State
appointed a commission to determine "the degree of amelioration of
which the various hospitals in France are in need." Viel was
instructed to rebuild the wards of La Salpetriere. The ideal was an
asylum which, while preserving its essential functions, would be so
organized that the evil could vegetate there without ever spreading;
an asylum where unreason would be entirely contained and offered
as a spectacle, without threatening the spectators; where it would
have all the powers of example and none of the risks of contagion.
In short, an asylum restored to its truth as a cage. It is this
"sterilized" confinement, if we may employ an anachronistic term,
that was still, in 1789, the dream of the Abbe Desmonceaux, in a
little work dedicated to National Benevolence; he planned to create a
pedagogical instrument—a spectacle conclu sively proving the
drawbacks of immorality: "these guarded asylums ... are retreats as
useful as they are necessary. . . . The sight of these shadowy places
and the guilty creatures they contain is well calculated to preserve
from the same acts of just reprobation the deviations of a too
licentious youth; it is thus prudent of mothers and fathers to
familiarize their children at an early age with these horrible and
detestable places, where shame and turpitude fetter crime, where
man, corrupted in his essence, often loses forever the rights he had
acquired in society."
Such are the dreams by which morality, in complicity with
medicine, tried to defend itself against the dangers contained but
insufficiently restricted by confinement. These same dangers, at the
same time, fascinated men's imaginations and their desires. Morality
dreams of exorcising them, but there is something in man which
makes him dream of experiencing them, or at least of approaching
(207)
them and releasing their hallucinations. The horror that now
surrounded the fortresses of confinement also exercised an
irresistible attraction. Such nights were peopled with inaccessible
pleasures; such corrupt and ravaged faces became masks of
voluptuousness; against these dark landscapes appeared forms—
pains and delights—which echoed Hieronymus Bosch and his
delirious gardens. The secrets that escaped from the chateau in the
One Hundred and Twenty Days of Sodom have been murmured ever
since:
"There, the most infamous excesses are committed upon the very
person of the prisoner; we heal" of certain vices practiced
frequently, notoriously, and even publicly in the common room of
the prison, vices which the propriety of modem times does not
permit us to name. We are told that numerous prisoners, simillimi
feminis mores stuprati et constupratores; that they return from this
obscure, forbidden place covered over with their own and others'
debaucheries, lost to all shame and ready to commit all sorts of
crimes."7 And La Rochefoucauld-Liancourt in his turn evoked those
figures of Old Women and Young Women in the correction wards
of La Salpetriere, who from generation to generation communicate
the same secrets and the same pleasures: "The correction ward is the
place of greatest punishment for the House, containing when we
visited it forty-seven girls, most of them very young, more
thoughtless than guilty. . . . And always this confusion of ages, this
shocking mixture of frivolous girls with hardened women who can
teach them only the art of the most unbridled corruption." For a long
time these visions would prowl insistently through the nights of the
eighteenth century. For a moment they would be picked out by the
pitiless light of Sade's work and placed by it in the rigorous
geometry of Desire. They would be taken up again and wrapped in
the murky light of Goya'sM adhouse, or the twilight that surrounds
the Quinta del Sordo. How closely
(208)
the faces of the Disparates resemble them! A whole imaginary
landscape reappears, conveyed by the Great Fear confinement now
inspires.
What the classical period had confined was not only an abstract
unreason which mingled madmen and libertines, invalids, and
criminals, but also an enormous reservoir of the fantastic, a dormant
world of monsters supposedly engulfed in the darkness of
Hieronymus Bosch which had once spewed them forth. One might
say that the fortresses of confinement added to their social role of
segregation and purification a quite opposite cultural function. Even
as they separated reason from unreason on society's surface, they
preserved in depth the images where they mingled and exchanged
properties. The fortresses of confinement functioned as a great, long
silent memory; they maintained in the shadows an iconographic
power that men might have thought was exorcised; created by the
new classical order, they preserved, against it and against time,
forbidden figures that could thus be transmitted intact from the sixteenth
to the nineteenth century. In this abolished time, the Brocken
joined Dulle Griet in the same imaginary landscape, and Noirceuil,
the great legend of the Marechal de Rais. Confinement allowed,
indeed called for, this resistance of imagery.
But the images liberated at the end of the eighteenth century were
not identical at all points with those the seventeenth century had
tried to eliminate. Something had happened, in the darkness, which
detached them from that secret world where the Renaissance, after
the Middle Ages, had found them; they had lodged in the hearts, in
the desires, in the imaginations of men; and instead of manifesting
to sight the abrupt presence of the insane, they seethed as the strange
contradiction of human appetites: the complicity of desire and
murder, of cruelty and the longing to suffer, of sovereignty and
slavery, of insult and humilia-
(209)
tion. The great cosmic conflict whose peripities had been
revealed by the Insane in the fifteenth and sixteenth centuries,
shifted until it became, at the end of the classical period, a dialectic
lacking the heart's mediation. Sadism is not a name finally given to
a practice as old as Eros; it is a massive cultural fact which appeared
precisely at the end of the eighteenth century, and which constitutes
one of the greatest conversions of Western imagination: unreason
transformed into delirium of the heart, madness of desire, the insane
dialogue of love and death in the limitless presumption of appetite.
Sadism appears at the very moment that unreason, confined for over
a century and reduced to silence, reappears, no longer as an image
of the world, no longer as a figura, but as language and desire. And
it is no accident that sadism, as an individual phenomenon bearing
the name of a man, was born of confinement and, within
confinement, that Sade's entireo euvre is dominated by the images
of the Fortress, the Cell, the Cellar, the Convent, the inaccessible
Island which thus form, as it were, the natural habitat of unreason. It
is no accident, either, that all the fantastic literature of madness and
horror, which is contemporary with Sade's oeuvre, takes place,
preferentially, in the strongholds of confinement. And this whole
sudden conversion of Western memory at the end of the eighteenth
century, with its possibility of rediscovering— deformed and
endowed with a new meaning—figures fa miliar at the end of the
Middle Ages: was this conversion not authorized by the survival and
the reawakening of the fantastic in the very places where unreason
had been reduced to silence?
In the classical period, the awareness of madness and the
awareness of unreason had not separated from one another. The
experience of unreason that had guided all the practices of
confinement so enveloped the awareness of madness
(210)
that it very nearly permitted it to disappear, sweeping it along a
road of regression where it was close to losing its most specific
elements.
But in the anxiety of the second half of the eighteenth century, the
fear of madness grew at the same time as the dread of unreason: and
thereby the two forms of obsession, leaning upon each other,
continued to reinforce each other. And at the very moment we note
the liberation of the iconographic powers that accompany unreason,
we hear on all sides complaints about the ravages of madness.
Already we are familiar with the concern generated by "nervous
diseases," and the awareness that man becomes more delicate in
proportion as he perfects himself. As the century advanced, the
concern became more pressing, the warnings more solemn. Already
Raulin had observed that "since the birth of medicine . . . these
illnesses have multiplied, have become more dangerous, more
complicated, more problematical and difficult to cure." By Tissot's
time, this general impression became a firm belief, a sort of medical
dogma: nervous diseases "were formerly much less frequent than
they are nowadays; and this for two reasons:
one, that men were in general more robust, and less frequently ill;
there were fewer diseases of any kind; the other, that the causes
which produce nervous diseases in especial have multiplied in a
greater proportion, in recent times, than the other general causes of
illness, some of which even seem to have diminished. ... I do not
hesitate to say that if they were once the rarest, they are today the
most frequent."8 And soon men regained that awareness, which had
been so intense in the sixteenth century, of the precariousness of a
reason that can at any moment be compromised, and definitively, by
madness. Matthey, a Geneva physician very close to Rousseau's
influence, formulates the prospect for all men of reason: "Do not
glory in your state, if you are wise and civilized men; an instant
suffices to
(211)
disturb and annihilate that supposed wisdom of which you are so
proud; an unexpected event, a sharp and sudden emotion of the soul
will abruptly change the most reasonable and intelligent man into a
raving idiot." The threat of madness resumes its place among the
emergencies of the century.
This awareness, however, has a very special style. The obsession
with unreason is a very affective one, involved in the movement of
iconographic resurrections. The fear of madness is much freer with
regard to this heritage; and while the return of unreason has the
aspect of a massive repetition, connecting with itself outside of time,
the awareness of madness is on the contrary accompanied by a
certain analysis of modernity, which situates it from the start in a
temporal, historical, and social context. In the disparity between the
awareness of unreason and the awareness of madness, we have, at
the end of the eighteenth century, the point of departure for a
decisive movement: that by which the experience of unreason will
continue, with Holderlin, Nerval, and Nietzsche, to proceed ever
deeper toward the roots of time—unreason thus becoming, par
excellence, the world's contratempo—and the knowledge of
madness seeking on the contrary to situate it ever more precisely
within the development of nature and history. It is after this period
that the time of unreason and the time of madness receive two
opposing vectors: one being unconditioned return and absolute
submersion; the other, on the contrary, developing according to the
chronicle of a history.9
1. Madness and Liberty. For a long time, certain forms of
melancholia were considered specifically English; this was a fact in
medicine and a constant in literature. Montesquieu contrasted
Roman suicide, which was a form of moral and political behavior,
the desired effect of a concerted education, with English suicide,
which had to be
(212)
considered as an illness since "the English kill themselves
without any apparent reason for doing so; they kill themselves in the
very lap of happiness." It is here that the milieu plays its role, for if
happiness in the eighteenth century is part of the order of nature and
reason, unhappiness, or at least whatever deters from happiness
without reason, must be part of another order. This order was sought
first in the excesses of the climate, in nature's deviation from its
equilibrium and its happy mean (temperate climates are caused by
nature; intemperate climates by the milieu). But this was not
sufficient to explain la maladie anglaise; already Cheyne had
declared that wealth, refined food, the abundance all the inhabitants
enjoyed, the life of pleasure and ease the richest society led, were at
the origin of such nervous disorders. Increasingly, a political and
economic explanation was sought, in which wealth, progress,
institutions appear as the determining element of madness. At the
beginning of the nineteenth century, Spurzheim made a synthesis of
all these analyses in one of the last texts devoted to them.10
Madness, "more frequent in England than anywhere else," is merely
the penalty of the liberty that reigns there, and of the wealth
universally enjoyed. Freedom of conscience entails more dangers
than authority and despotism. "Religious sentiments . . . exist
without restriction; every individual is entitled to preach to anyone
who will listen to him," and by listening to such different opinions,
"minds are disturbed in the search for truth." Dangers of indecision,
of an irresolute attention, of a vacillating soul! The danger, too, of
disputes, of passions, of obstinacy: "Everything meets with
opposition, and opposition excites the feelings; in religion, in
politics, in science, as in everything, each man is permitted to form
an opinion;
but he must expect to meet with opposition." Nor does so much
liberty permit a man to master time; every man is left to his own
uncertainty, and the State abandons all to their
(213)
fluctuations: "The English are a nation of merchants; a mind
always occupied with speculations is continually agitated by fear and
hope. Egotism, the soul of commerce, easily becomes envious and
summons other faculties to its aid." Besides, this liberty is far from
true natural liberty: on all sides it is constrained and harried by
demands opposed to the most legitimate desires of individuals: this
is the liberty of interests, of coalitions, of financial combinations, not
of man, not of minds and hearts. For financial reasons, families are
here more tyrannical than anywhere else: only wealthy girls are able
to marry; "the others are reduced to other means of satisfaction that
ruin the body and derange the manifestations of the soul. The same
cause favors libertinage, which predisposes to madness." A
mercantile liberty thus appears as the element in which opinion can
never arrive at the truth, in which the immediate is necessarily
subject to contradiction, in which time escapes the mastery and
certainty of the seasons, in which man is dispossessed of his desires
by the laws of interest. In short, liberty, far from putting man in
possession of himself, ceaselessly alienates him from his essence
and his world; it fascinates him in the absolute exteriority of other
people and of money, in the irreversible inferiority of passion and
unfulfilled desire. Between man and the happiness of a world in
which he recognizes himself, between man and a nature in which he
finds his truth, the liberty of the mercantile state is "milieu": and to
this very degree it is the determining element of madness. When
Spurzheim was writing—at the height of the Holy Alliance, during
the restoration of the authoritarian monarchies—liberalism was
readily blamed for all the sins of the world's madness: "It is singular
to see that man's greatest desire, which is his pesronal liberty, has its
disadvantages as well." But for us, the point of such an analysis is
not its critique of liberty, but its very employment of the notion that
designates for Spurz-
(214)
heim the non-natural milieu in which the psychological and
physiological mechanisms of madness are favored, amplified, and
multiplied.
2. Madness, Religion, and Time. Religious beliefs prepare a kind
of landscape of images, an illusory milieu favorable to every
hallucination and every delirium. For a long time, doctors were
suspicious of the effects of too strict a devotion, too strong a belief.
Too much moral rigor, too much anxiety about salvation and the life
to come were often thought to bring on melancholia. The
Encyclopedic does not fail to cite such cases: "The intemperate
impressions made by certain extravagant preachers, the excessive
fears they inspire of the pains with which our religion threatens those
who break its laws, produce astonishing revolutions in weak minds.
At the hospital of Montelimar, several women were reported
suffering from mania and melancholia as a result of a mission held
in that city; these creatures were ceaselessly struck by the horrible
images that had thoughtlessly been presented to them; they spoke of
nothing but despair, revenge, punishment, etc., and one of them
absolutely refused to undergo any cure, convinced that she was in
Hell and that nothing could extinguish the fire she believed was
devouring her." Pinel follows the line of these enlightened
physicians—forbidding books of devotion to be given to
"melancholics by piety," even recommending solitary confinement
for "religious persons who believe themselves to be inspired and
who seek to make proselytes." But this again is more of a critique
than a positive analysis: the religious object or theme is suspected of
arousing delirium and hallucination by the delirious and
hallucinatory nature attributed to it. Pinel reports the case of a
recently cured madman who had "read in a religious book . . . that
each man has his guardian angel; on the following night, he thought
he was surrounded by a choir of angels and imagined he heard celes-
(215)
tial music and received revelations." Religion is considered here
only as an element in the transmission of error. But even before
Pinel, there had been analyses of a more rigorous historical nature, in
which religion appeared as a milieu of satisfaction or repression of
the passions. In 1781 a German author described as happy those
distant eras when priests were endowed with absolute powers: then
idleness did not exist, every moment was marked by "ceremonies,
religious practices, pilgrimages, visits to the poor and the sick,
calendar festivals."11 Time was thus assigned to an organized
happiness, which left no leisure 'for empty passions, for disgust with
life, for boredom. If a man felt guilty, he was subjected to real, often
material punishment which occupied his mind and gave him an
assurance that the transgression was redressed. And when the
confessor encountered those "hypochondriacal penitents who came
too often to confession," he assigned them as penance either a severe
hardship that "diluted their too thick blood," or long pilgrimages:
"The change of air, the length of the road, absence from home,
distance from the things which upset them, their associations with
other pilgrims, the slow and energetic movement of walking, had
more effect upon them than the comfortable journeys . . . that in our
day take the place of pilgrimages." Finally, the sacred nature of the
priest gave each of his injunctions an absolute value, and no one
dreamed of trying to avoid it; "usually the whims of sick people
deny all this to the physician." For Moehsen, religion is the
mediation between man and transgression, between man and
punishment: in the form of an authoritarian synthesis, it suppresses
the transgression by imposing the punishment; if, on the contrary,
religion loosens its hold but maintains the ideal forms of remorse of
conscience, of spiritual mortification, it leads directly to madness;
only the consistency of the religious milieu can permit man to escape
alienation in the excessive delirium of
(216)
transgressions. By accomplishing its rites and its requirements,
man avoids both the useless idleness of his passions before the
transgression, and the vain repetition of his remorse once the
transgression is committed; religion organizes all human life around
fulfillment of the moment. That old religion of happier times was the
perpetual celebration of the present. But once it was idealized in the
modern age, religion cast a temporal halo around the present, an
empty milieu—that of idleness and remorse, in which the heart of
man is abandoned to its own anxiety, in which the passions
surrender time to unconcern or to repetition in which, finally,
madness can function freely.
3. Madness, Civilization, and Sensibility. Civilization, in a general
way, constitutes a milieu favorable to the development of madness.
If the progress of knowledge dissipates error, it also has the effect of
propagating a taste and even a mania for study; the life of the library,
abstract speculations, the perpetual agitation of the mind without the
exercise of the body, can have the most disastrous effects. Tissot
explains that in the human body it is those parts subject to frequent
work which are first strengthened and hardened; among laborers, the
muscles and fibers of the arms harden, giving them their physical
strength and the good health they enjoy until an advanced age;
"among men of letters, the brain hardens; often they become
incapable of connecting their ideas," and so are doomed to dementia.
The more abstract or complex knowledge becomes, the greater the
risk of madness. A body of knowledge still close to what is most
immediate in the senses, requiring, according to Pressavin, only a
little work on the part of the inner sense and organs of the brain,
provokes only a sort of physiological happiness: "The sciences
whose objects are easily perceived by our senses, which offer the
soul agreeable relations because of the harmony of their consonance
. . . perform throughout the entire bodily machine a light ac-
(217)
tivity which is beneficial to all the functions." On the contrary, a
knowledge too poor in these sensuous relations, too free with regard
to the immediate, provokes a tension of the brain alone which
disequilibrates the whole body; sciences "of things whose
relationships are difficult to grasp because they are not readily
available to our senses, or because their too complicated relations
oblige us to expend great application in their study, present the soul
with an exercise that greatly fatigues the inner sense by a too continuous
tension upon that organ." Knowledge thus forms around
feeling a milieu of abstract relationships where man risks losing the
physical happiness in which his relation to the world is usually
established. Knowledge multiplies, no doubt, but its cost increases
too. Is it certain that there are more wise men today? One thing, at
least, is certain: "there are more people who have the infirmities of
wisdom." The milieu of knowledge grows faster than knowledge
itself.
But it is not only knowledge that detaches man from feeling; it is
sensibility itself: a sensibility that is no longer controlled by the
movements of nature, but by all the habits, all the demands of social
life. Modern man—but woman more than man—turns day into night
and night into day: "The moment at which our women rise in Paris is
far removed from that which nature has indicated; the best hours of
the day have Slipped away; the purest air has disappeared; no one
has benefited from it. The vapors, the harmful exhalations, attracted
by the sun's heat, are already riisng in the atmosphere; this is the
hour that beauty chooses to rise."12 This disorder of the senses
continues in the theater, where illusions are cultivated, where vain
passions and the most fatal movements of the soul are aroused by
artifice; women especially enjoy these spectacles "that inflame and
arouse them"; their souls "are so strongly shaken that this produces a
commotion in their nerves, fleeting, in truth, but whose
consequences are usually serious; the
(218)
momentary loss of their senses, the tears they shed at the
performances of our modern tragedies are the least accidents that can
result from them."13 Novels form a still more artificial milieu, and
are more dangerous to a disordered sensibility; the verisimilitude
modern authors attempt to produce, and all the art they employ to
imitate truth, only give more prestige to the violent and dangerous
sentiments they seek to awaken in their female readers: "In the
earliest epochs of French gallantry and manners, the less perfected
minds of women were content with facts and events as marvelous as
they were unbelievable; now they demand believable facts yet
sentiments so marvelous that their own minds are disturbed and
confounded by them; they then seek, in all that surrounds them, to
realize the marvels by which they are enchanted; but everything
seems to them without sentiment and without life, because they are
trying to find what does not exist in nature."14 The novel constitutes
the milieu of perversion, par excellence, of all sensibility; it detaches
the soul from all that is immediate and natural in feeling and leads it
into an imaginary world of sentiments violent in proportion to their
unreality, and less controlled by the gentle laws of nature; "The
existence of so many authors has produced a host of readers, and
continued reading generates every nervous complaint; perhaps of all
the causes that have harmed women's health, the principal one has
been the infinite multiplication of novels in the last hundred years ...
a girl who at ten reads instead of running will, at twenty, be a
woman with the vapors and not a good nurse."15
Slowly, and still in a very scattered fashion, the eighteenth
century constituted, around its awareness of madness and of its
threatening spread, a whole new order of concepts. In the landscape
of unreason where the sixteenth century had located it, madness
concealed a meaning and an origin that were obscurely moral; its
secrecy related it to
(219)
sin, and the animality imminently perceived in it did not make it,
paradoxically, more innocent. In the second half of the eighteenth
century, madness was no longer recognized in what brings man
closer to an immemorial fall or an indefinitely present animality; it
was, on the contrary, situated in those distances man takes in regard
to himself, to his world, to all that is offered by the immediacy of
nature; madness became possible in that milieu where man's relations
with his feelings, with time, with others, are altered; madness
was possible because of everything which, in man's life and
development, is a break with the immediate. Madness was no longer
of the order of nature or of the Fall, but of a new order, in which
men began to have a presentiment of history, and where there
formed, in an obscure originating relationship, the "alienation" of
the physicians and the "alienation" of the philosophers—two
configurations in which man in any case corrupts his truth, but
between which the nineteenth century, after Hegel, soon lost all
trace of resemblance.
(220)
VIII
THE NEW DIVISION
EVERY psychiatrist, every historian yielded, at the beginning of
the nineteenth century, to the same impulse of indignation;
everywhere we find the same outrage, the same virtuous censure:
"No one blushed to put the insane in prison." And Esquirol, listing
the fortress of Ha in Bordeaux, the houses of correction in Toulouse
and Rennes, the "Bicetres" still existing in Poitiers, in Caen, in
Amiens, the "Chateau" of Angers, continues: "Moreover, there are
few prisons where the raving mad are not to be found; these
unfortunates are chained in dungeons beside criminals. What a
monstrous association! The calm madmen are treated worse than
malefactors."
The entire century echoes him; in England, it was the Tukes, who
had turned historians and apologists for their ancestral occupation;
in Germany, after Wagnitz, it was Reil who groaned over those
wretches "thrown, like State criminals, into dungeons where the eye
of humanity never penetrates." The age of positivism, for over half a
century, constantly claimed to have been the first to free the mad
(221)
from a lamentable confusion with the felonious, to separate the
innocence of unreason from the guilt of crime.
Yet it is simple enough to show the vanity of this claim. For years
the same protests had been raised; before Reil, there had been
Franck: "Those who have visited the insane asylums of Germany
recall with dread what they have seen. One is horrified upon entering
these asylums of misery and affliction; one hears only cries of
despair, yet here dwells the man distinguished by his talents and his
virtues." Before Esquirol, before Pinel, there had been La
Rochefoucauld-Liancourt, there had been Tenon; and before them,
an incessant murmur throughout the eighteenth century, composed of
insistent protests, lodged year after year even by those whom one
would have thought the most indifferent, the most eager perhaps that
such a confusion should subsist. Twenty-five years before the
exclamations of a Pinel, we must invoke Malesherbes "visiting the
State prisons with the intention of breaking down their gates. Prisoners
whom he found to be insane . . . were sent to houses where the
society, the exercise, and the care he had scrupulously prescribed
would be sure, he said, to cure them." Still earlier in the century, and
in a lower voice, there had been all those directors, those bursars,
those overseers who from generation to generation always asked and
sometimes achieved the same thing: the separation of madmen from
convicts; there had been the Prior of La Charite in Senlis who
begged the police to remove several prisoners and confine them
instead in any of several fortresses; there had been that overseer of
the House of Correction in Brunswick who asked—and this was only
in 1713— that the madmen not be allowed to mingle with the
internees assigned to the workshops. Had not what the nineteenth
century formulated so ostentatiously, with all the resources of its
pathos, already been whispered and indefatigably repeated by the
eighteenth? Did Esquirol and Reil and the
(222)
Tukes do anything more than shout at the top of their lungs what
had been, for years, commonplaces of asylum practice? The slow
emigration of the mad which we have mentioned, from 1720 to the
Revolution, was probably no more than the most visible effect of that
practice.
And yet, let us listen to what was being said in this half-silence.
When the Prior of Senlis asked that madmen be separated from
certain convicts, what were his arguments? "He is deserving of
mercy, as well as two or three others who would be better off in
some citadel, because of the company of six others who are mad, and
who torment them night and day." And the meaning of this sentence
would be so clearly understood by the police that the internees in
question would be set free. And the demands of the Brunswick
overseer have the same meaning: the workshop is disturbed by the
cries and the confusion of the insane; their frenzy is a perpetual
danger, and it would be better to send them back to the cells, or to
keep them in chains. And already, we can anticipate that from one
century to the next, the same protests did not have, at bottom, the
same value. Early in the nineteenth century, there was indignation
that the mad were not treated any better than those condemned by
common law or than State prisoners; throughout the eighteenth
century, emphasis was placed on the fact that the prisoners deserved
a better fate than one that lumped them with the insane. For Esquirol,
the scandal is due to the fact that the mad are only mad; for the Prior
of Senlis, to the fact that the convicts are, after all, only convicts.
A difference which is perhaps not of such significance, and which
ought to have been easily perceived. And yet, it is necessary to
emphasize it in order to understand how the consciousness of
madness was transformed in the course of the eighteenth century. It
did not evolve in the context of a humanitarian movement that
gradually related it more
(223)
closely to the madman's human reality, to his most affecint g and
most intimate aspect; nor did it evolve under the pressure of a
scientific need that made it more attentive, more faithful to what
madness might have to say for itself. If it slowly changed, it was
within that simultaneously real and artificial space of confinement.
Certain imperceptible shifts in its structures, or at times certain
violent crises, gradually formed the awareness of madness
contemporaneous with the Revolution. No medical advance, no
humanitarian approach was responsible for the fact that the mad
were gradually isolated, that the monotony of insanity was divided
into rudimentary types. It was the depths of confinement itself that
generated the phenomenon; it is from confinement that we must seek
an account of this new awareness of madness.
A political more than a philanthropic awareness. For if the
eighteenth century perceived that there were among the confined—
among the libertines, the debauched, the prodigal sons—certain men
whose confusion and disorder were of another nature, and whose
anxiety was irreducible, this perception was the result of the confined
themselves. They were the first to protest, and with the most
violence. Ministers, police officers, magistrates were assailed with
the same endless and tirelessly repeated complaints: one man writes
to Maurepas, indignant at being "forced to mingle with madmen,
some of whom are so violent that at every moment I risk suffering
dangerous abuse from them"; another—the Abbe de Montcrif—
makes the same complaint to Lieutenant Berryer: "This is the ninth
month that I have been confined here in this dreadful place with
fifteen or twenty raving madmen, pell-mell with epileptics." The farther
we advance into the century, the stronger grow these protests
against confinement: increasingly, madness becomes the specter of
the internees, the very image of their humiliation, of their reason
vanquished and reduced to si-
(224)
lence. The day soon comes when Mirabeau recognizes in the
shameful promiscuity of madness both a subtle instrument of
brutality against those to be punished and the very image of
despotism, bestiality triumphant. The madman is not the first and the
most innocent victim of confinement, but the most obscure and the
most visible, the most insistent of the symbols of the confining
power. Tyranny secretly persists among the confined in this lurid
presence of unreason. The struggle against the established powers,
against the family, against the Church, continues at the very heart of
confinement, in the saturnalia of reason. And madness so well
represents these punishing powers that it effectively plays the part of
an additional punishment, a further torment which maintains order in
the uniform chastisement of the houses of correction. La
Rochefoucauld-Liancourt bears witness to this in his report to the
Committee on Mendicity: "One of the punishments inflicted upon
the epileptics and upon the other patients of the wards, even upon the
deserving poor, is to place them among the mad." The scandal lies
only in the fact that the madmen are the brutal truth of confinement,
the passive instrument of all that is worst about it. Is this not symbolized
by the fact—also a commonplace of all the literature of
confinement in the eighteenth century—that a sojourn in a house of
correction necessarily leads to madness? Having to live in this
delirious world, amid the triumph of unreason, how may one avoid
joining, by the fatality of the site and the event, the very men who
are its living symbol? "I observe that the majority of the insane
confined in the houses of correction and the State prisons have
become so, the latter through the excess of ill-treatment, the former
through the horror of the solitude in which they continually
encounter the harassments of an imagination sharpened by pain."1
The presence of madmen among the prisoners is not the
(225)
scandalous limit of confinement, but its truth; not abuse, but
essence. The polemic instituted by the eighteenth century against
confinement certainly dealt with the enforced mingling of the mad
and the sane; but it did not deal with the basic relation acknowledged
between madness and confinement. Whatever attitude is adopted,
that, at least, is not in question. Mirabeau, the Friend of Man, is as
severe about confinement as about the confined themselves; in his
eyes, no one confined in "the celebrated State prisons" is innocent;
but his place is not in these costly institutions, where he drags out a
useless life; why confine "daughters of joy who, transported to
provincial manufactories, could become daughters of labor"? Or
"rascals who are waiting only for freedom in order to get themselves
hanged? Why are these people, attached to walking fetters, not
employed at those tasks which might prove harmful to voluntary
workers? They would serve as an example . . ." Once this entire
population was removed, who would remain in the houses of
confinement? Those who could not be placed anywhere else, and
who belong there by right: "Some prisoners of State whose crimes
must not be revealed," to whom may be added "old men who, having
consumed in debauchery and dissipation all the fruit of their life's
labor, and having cherished the ambitious prospect of dying in a
hospital, come there in peace"; finally, the mad, who must wallow
somewhere: "These last can vegetate anywhere."2 Mirabeau the
younger conducts his demonstration in the opposite direction: "I
formally defy anyone in the world to prove that State prisoners,
rascals, libertines, madmen, ruined old men constitute I do not say
the majority, but the third, the fourth, the tenth part of the inhabitants
of fortresses, houses of correction, and State prisons." For him the
scandal is thus not that the mad are mingled with the criminal, but
that they do not constitute, together, the essential part of the confined
population; who then can com-
(226)
plain of being forced to mix with criminals? Not those who have
lost their reason forever, but those who in their youth spent their time
in wildness: "I might ask . . . why rascals and libertines are mingled
together. ... I could ask why young men with dangerous dispositions
are left with men who will rapidly lead them to the last degree of
corruption. . . . Finally, if this confusion of libertines and villains
exists, as is all too true, why do we, by this odious, infamous,
atrocious combination, make ourselves guilty of the most abominable
of all crimes, that of leading men into crime?" As for madmen, what
other fate could be desired for them? Neither reasonable enough not
to be confined, nor wise enough not to be treated as wicked, "it is all
too true that those who have lost the use of reason must be hidden
from society."3
We see how the political critique of confinement functioned in the
eighteenth century. Not in the direction of a liberation of the mad;
nor can we say that it permitted a more philanthropic or a greater
medical attention to the insane. On the contrary, it linked madness
more firmly than ever to confinement, and this by a double tie: one
which made madness the very symbol of the confining power and its
absurd and obsessive representative within the world of
confinement; the other which designated madness as the object par
excellence of all the measures of confinement. Subject and object,
image and goal of repression, symbol of its blind arbitrariness and
justification of all that could be reasonable and deserved within it: by
a paradoxical circle, madness finally appears as the only reason for a
confinement whose profound unreason it symbolizes. Still so close
to this eighteenth-century notion, Michelet would formulate it with
an astonishing rigor; he returns to the very movement of Mirabeau's
thought, apropos of the stay the latter made at Vincennes at the same
time as Sade:
First, confinement causes alienation: "Prison makes men
(227)
mad. Those found in the Bastille and in Bicetre were stupefied."
Secondly, what is most unreasonable, most shameful, most
profoundly immoral in the tyranny of the eighteenth century is
represented in the space of confinement, and by a madman: "We
have seen the frenzies of La Salpetriere. A dreadful lunatic existed
at Vincennes, the poisonous de Sade, writing in the hope of
corrupting the time to come."
Thirdly, it is for this one madman alone that confinement ought
to have been reserved, and nothing of the kind was done: "He was
soon set free, and Mirabeau kept in confinement."
Hence an abyss yawns in the middle of confinement; a void which
isolates madness, denounces it for being irreducible, unbearable to
reason; madness now appears with what distinguishes it from all
these confined forms as well. The presence of the mad appears as an
injustice; but for others. The undifferenriated unity of unreason had
been broken. Madness was individualized, strangely twinned with
crime, at least linked with it by a proximity which had not yet been
called into question. In this confinement drained of a part of its
content, these two figures—mad ness, crime—subsist alone; by
themselves, they symbolize what may be necessary about it; they
alone are what henceforth deserves to be confined. Having taken its
distance, having finally become an assignable form in the confused
world of unreason, did not liberate madness; between madness and
confinement, a profound relation had been instituted, a link which
was almost one of essence.
But at the same moment, confinement suffered another, still
deeper crisis that called into question not only its repressive role but
its very existence; a crisis which arose not from within, and which
was not attached to political pro-
(228)
tests, but which slowly appeared on the entire social and economic
horizon.
Poverty was gradually being freed from the old moral confusions.
Men had seen unemployment assume, during crises, an aspect that
could no longer be identified with that of sloth; had seen indigence
and idleness forced to spread into the countryside, where men had
supposed they could recognize precisely the most immediate and the
purest forms of moral life; all this revealed that poverty was perhaps
not only of the order of transgression: "Mendicity is the fruit of
poverty, which itself is the result of accidents occurring either in the
cultivation of the land or in the production of manufactures, or in the
rise of commodity prices, in an excess of population, etc. . . ,"4
Poverty had become an economic phenomenon.
But not contingent—nor destined to be suppressed for ever. There
was a certain quantity of indigence which man would not succeed in
eliminating—a kind of fatality of poverty which must accompany all
the forms of society to the end of time, even where all the idle were
employed: "There need be, in a well-governed state, only those poor
born in indigence, or those who fall into it by accident."5 This basic
poverty was in a sense inalienable: birth or accident, it formed a part
of life that could not be avoided. For a long time, it was
inconceivable to have a state in which there were no paupers, so
deeply did need appear to be inscribed in man's fate and in the
structure of society: property, labor, and poverty are terms which
remain linked in the thought of philosophers until the nineteenth
century.
Necessary because it could not be suppressed, this role of poverty
was necessary too because it made wealth possible. Because they
labor and consume little, those who are in need permit a nation to
enrich itself, to set a high value on its fields, its colonies, and its
mines, to manufacture prod-
(229)
ucts which will be sold the world over; in short, a people would be
poor which had no paupers. Indigence becomes an indispensable
element in the State. In it is concealed the secret but also the real life
of a society. The poor constitute the basis and the glory of nations.
And their poverty, which cannot be suppressed, must be exalted and
revered: "My purpose is merely to attract a share of that vigilant
attention [that of the government] to the suffering portion of the
People . . .; the succor it is owed derives essentially from the honor
and the prosperity of an Empire, of which the Poor are everywhere
the firmest support, for a sovereign cannot preserve and extend his
realm without favoring the population, the cultivation of the Land,
the Arts, and commerce; and the Poor are the necessary agents of
these great powers which establish the true strength of a People."6
Here is an entire moral rehabilitation of the Pauper, which
designates, at a deeper level, a social and economic reintegrarion of
his role and character. In the mercantilist economy, the Pauper, being
neither producer nor consumer, had no place: idle, vagabond,
unemployed, he belonged only to confinement, a measure by which
he was exiled and as it were abstracted from society. With the
nascent industry which needs manpower, he once again plays a part
in the body of the nation.
Thus, economic thought elaborates on new foundations the notion
of poverty. There had been the entire Christian tradition for which
the Poor Man had had a real and concrete existence, a presence of
flesh and blood: an always individual countenance of need, the
symbolic passage of God in man's image. The abstraction of
confinement had removed the Poor Man, had identified him with
other figures, enveloping him in an ethical condemnation, but had not
dissociated him from his features. The eighteenth century discovered
that "the Poor" did not exist as a concrete
(230)
and final reality; that in them, two realities of different natures had
too long been confused.
On one hand, there was Poverty: scarcity of commodities and
money, an economic situation linked to the state of commerce, of
agriculture, of industry. On the other, there was Population: not a
passive element subject to the fluctuations of wealth, but a force
which directly contributed to the economic situation, to the
production of wealth, since it is man's labor which creates—or at
least transmits, shifts, and multiplies—wealth. The "Poor Man" was a
vague notion in which were combined that wealth which is Man and
the state of Need which is acknowledged as essential to humanity.
Indeed, between Poverty and Population, there is a rigorously inverse
relation.
Physiocrats and economists are in agreement on this. Population is
in itself one of the elements of wealth; it forms, indeed, its certain
and inexhaustible source. For Francois Quesnay and his disciples,
man is the essential mediation between the land and wealth: "A man
is worth as much as the land, according to an old proverb. If a man is
valueless, so is the land. With men, one doubles the land one
possesses; one clears it, one acquires it. God alone could from the
earth make a man, whereas all over the world it has been possible to
have land by means of men, or at least the product of the land, which
comes down to the same thing. It follows that the first good is the
possession of men, and the second, of the land."7
For the economists, the population is a good quite as essential, if
not more so, since in their view wealth is created not only in
agricultural labor, but in every industrial transformation, and even in
commercial circulation. Wealth is linked to a labor actually effected
by man: "The State having real wealth only in the annual products of
its lands and in the industry of its inhabitants, its wealth will be at a
(231)
maximum when the product of each acre of land and of the
industry of each individual is raised to its maximum."8
Paradoxically, a population will be precious in proportion to its
numbers, since it will afford industry a cheap labor force, which, by
lowering the cost price, will permit a development of production
and of commerce. In this infinitely open labor market, the
"fundamental price"—what corresponds for Turgot to the worker's
subsistence—and the price determined by supply and demand
ultimately coincide. A nation will therefore be favored in
commercial competition to the degree that it has at its disposal the
greatest potential wealth of a numerous population.
Confinement was a gross error, and an economic mistake: poverty
was to be suppressed by removing and maintaining by charity a poor
population. Actually, it was poverty that was being artificially
masked; and a part of the population was being really suppressed,
wealth being always constant. Was the intention to help the poor
escape their provisional indigence? They were kept from doing so:
the labor market was limited, which was all the more dangerous in
that this was precisely a period of crisis. On the contrary, the high
cost of products should have been palliated by a cheap labor force,
their scarcity being compensated by a new industrial and agricultural
effort. The only reasonable remedy: to restore this entire population
to the circuit of production, in order to distribute it to the points
where the labor force was rarest. To utilize the poor, vagabonds,
exiles, and emigres of all kinds, was one of the secrets of wealth, in
the competition among nations: "What is the best means of
weakening the neighboring states whose power and industry tend to
overshadow us?" asked Josias Tucker apropos of the emigration of
the Protestants. "Is it to force their subjects to remain at home by
refusing to receive and incorporate them among us, or is it
(232)
to attract them to us by good wages, allowing them to enjoy the
advantages of the other citizens?"
Confinement is open to criticism because of the repercussions it
can have on the labor market; but still more, because it constitutes,
and with it the entire enterprise of traditional charity, a dangerous
financing. Like the Middle Ages, the classical period had always
sought to provide aid to the poor by the system of foundations. This
meant that a share of land capital or income was thereby
immobilized. And for good, since, in the just concern to avoid the
commercialization of the charity enterprises, all juridical measures
were taken so that these goods would never return to circulation. But
with the passage of time, their utility diminished; the economic
situation changed, poverty altered its aspect: "Society does not
always have the same needs; nature and the distribution of property,
the division between the different orders of the people, the opinions,
the customs, the general occupations of the nation or of its different
portions, the climate itself, the diseases and other accidents of
human life undergo a continual variation; new needs are born; others
cease to make themselves felt."9 The definitive character of the
foundation was in contradiction to the variable and indefinite rate of
the accidental needs which it was supposed to satisfy. Without the
wealth which it immobilized being restored to circulation, new
wealth had to be created as new needs appeared. The share of funds
and revenues which were set aside constantly increased, thereby
diminishing the productive share. Which inevitably led to a greater
poverty, hence to more numerous foundations. And the process
could extend indefinitely. The moment could come when "the ever
multiplying foundations would ultimately absorb all funds and all
private property." Upon close scrutiny, the classical forms of aid
were a cause of impoverishment, the gradual immobili-
(233)
zation and in a sense the slow death of all productive wealth: "If
all the men who ever lived had had a tomb, it would have been
quite necessary, in order to find land to cultivate, to overturn these
sterile monuments, and to stir the ashes of the dead in order to feed
the living."10
What disappeared, in the course of the eighteenth century, was
not the inhuman rigor with which madmen were treated, but the
evident necessity of confinement, the total unity in which they were
situated without difficulty, and those countless threads that wove
them into the continuous texture of unreason. Madness was set free
long before Pinel, not from the material constraints which kept it in
the dungeon, but from a much more binding, perhaps more decisive
servitude which kept it under the domination of unreason's obscure
power. Even before the Revolution, madness was free: free for a
perception which individualized it, free for the recognition of its
unique features and for all the operations that would finally give it
its status as an object.
Left alone, and detached from its former relations, within the
crumbling walls of confinement, madness was a problem—raising
questions it had hitherto never formulated.
Above all, it embarrassed the legislator who, unable to keep from
sanctioning the end of confinement, no longer knew at what point in
the social sphere to situate it-prison, hospital, or family aid. The
measures taken immediately before or after the beginning of the
Revolution reflect this indecision.
In his circular on the lettres de cachet, Breteuil asked the
administrators to indicate the nature of the detention orders in the
various houses of confinement, and what reasons justified them.
After a year or two of detention at the most, those men were to be
set free "who, having done nothing
(234)
that could expose them to the severity of the punishments
pronounced by the laws, had abandoned themselves to the excesses
of libertinage, debauchery, and dissipation." On the other hand,
those prisoners were to be kept in the houses of confinement "whose
minds are deranged and whose imbecility makes them incapable of
conducting themselves in a world where their rages would make
them dangerous. With respect to these, all that is necessary is to
ascertain whether their condition is still the same, and unfortunately
it becomes indispensable to continue their detention as long as it is
acknowledged that their freedom is harmful to society, or a useless
benefit to themselves." This was the first stage: to reduce as much as
possible the practice of confinement with regard to moral
transgressions, family conflicts, the most benign aspects of
libertinage, yet to leave it untouched in its principle, and with one of
its major meanings intact: the internment of the mad. This is the
moment when madness actually takes possession of confinement,
while confinement itself is divested of its other forms of utility.
The second stage was that of the great investigations prescribed
by the National Assembly and by the Constituent Assembly,
immediately following the Declaration of the Rights of Man: "No
man may be arrested or detained except in the cases determined by
law and according to the forms therein prescribed. . . . The law must
permit only the penalties strictly and evidently necessary, and no
one may be punished under a law established and promulgated
subsequent to the crime." The era of confinement was over. There
remained only an imprisonment shared for the moment by
condemned or presumed criminals and the mad. The Committee on
Mendicity of the Constitutent Assembly designated five persons to
visit the houses of confinement in Paris. The Duke de la
Rochefoucauld-Liancourt presented the report (December 1789); he
declared
(235)
that the presence of madmen gave the houses of correction a
degrading aspect and was likely to reduce the inmates to a status
unworthy of humanity; the melange tolerated there proved a great
frivolity on the part of the authorities and the magistrates: "This
carelessness is far from the enlightened and scrupulous pity for
misfortune whereby it receives all possible alleviation and
consolation . . . ; in seeking to succor poverty, can one ever consent
to appear to degrade humanity?"
If the mad defile those with whom they have been imprudently
confined, a special internment must be reserved for them; a
confinement that is not medical, but that ought to be the most
efficacious and the easiest form of aid: "Of all the misfortunes that
afflict humanity, the condition of madness is still one of those that
with most reason call for pity and respect; it is for this condition that
our attentions must with most reason be prodigal; when there is no
hope of a cure, how many means still remain that can afford these
unfortunates at least a tolerable existence." In this text, the status of
madness appears in all its ambiguity: it is necessary both to protect
the confined population from its dangers, and to grant it the benefits
of a special aid.
The third stage was the great series of decrees issued between the
twelfth and the sixteenth of March 1790. In them, the Declaration of
the Rights of Man received a concrete application: "In the space of
six weeks, beginning with the present decree, all persons detained in
fortresses, religious houses, houses of correction, police houses, or
other prisons whatsoever, by lettres de cachet or by order of the
agents of the executive power, so long as they are not convicted, or
under arrest, or not charged with major crimes, or confined by
reason of madness, will be set at liberty." Confinement is thus
definitively reserved for certain categories of convicted criminals
and for madmen. But for the latter, a special arrangement is in order:
"Persons
(236)
detained for reasons of dementia will be, for the space of three
months, starting from the day of publication of the present decree, at
the suit of our procurators, interrogated by the magistrates in the
usual manner, and by virtue of their disposition visited by physicians
who, under the supervision of the directors of the district, will
pronounce upon the true circumstances of the patients in order that,
after the sentence that will have certified as to their condition, they
may be released or cared for in hospitals indicated for that purpose."
It appears that the choice is henceforth made. On March 29, 1790,
Bailly, Duport-Dutertre, and a police administrator went to La
Salpetriere to determine in what manner this decree could be carried
out; they then made a similar visit to Bicetre. The difficulties were
numerous; to begin with, there existed no hospitals intended or at
least reserved for the mad.
In the face of these material difficulties, to which were added
certain theoretical uncertainties, a long phase of hesitation was to
begin. From all sides, the Assembly was asked to provide a text
which would grant protection from madmen even before the
promised creation of the hospitals. And by a regression, which was
to be of great importance for the future, madmen were brought under
the sway of immediate and unchecked measures adopted not even
against dangerous criminals, but against marauding beasts. The Law
of August 16-24, 1790, "entrusts to the vigilance and authority of the
municipal bodies . . . the care of obviating and remedying the
disagreeable events that may be occasioned by madmen set at
liberty, and by the wandering of vicious and dangerous animals."
The law of July 22, 1791, reinforces this arrangement, making
families responsible for the supervision of the insane, and permitting
the municipal authorities to take all measures that might prove
useful: "The relatives of the insane must care for them, prevent them
from straying, and see that they do not
(237)
commit offenses or disorders. The municipal authority must
obviate the inconvenience that may result from the negligence with
which private persons fulfill this duty." By this detour around their
liberation, madmen regained, but this time within the law itself, that
animal status in which confinement had seemed to isolate them; they
again became wild beasts at the very period when doctors began to
attribute to them a gentle animality. But even though this legal
disposition was put in the hands of the authorities, the problems were
not solved thereby; hospitals for the insane still did not exist.
/
Countless requests flooded the Ministry of the Interior. Delessart
answered one of them, for example: "I feel as you do. Monsieur, how
important it is that we labor without respite toward the establishment
of houses designed to serve as retreats for the unfortunate class of the
insane. . . . With regard to those insane persons whom the lack of
such an establishment has relegated to the various prisons of your
department, I do not see any other means at present of removing
them from those places so unsuited to their state, except to transfer
them temporarily, if possible, to Bicetre. It would therefore be
appropriate for the Directory to write to the Paris establishment in
order to ascertain a way to have them admitted to that house, where
the costs of their upkeep will be paid by your department or by the
communes where these unfortunates reside, if their families are not
in a position to assume that expense." Bicetre thus became the great
center to which all the insane were sent, especially once Saint-Lazare
was closed. The same was true for the women at La Salpetriere: in
1792, two hundred madwomen were taken there who had been
installed five years previously in the former novitiate of the
Capucines on the Rue Saint-Jacques. But in the remote provinces,
there was no question of sending the insane to the former hopitaux
generaux. Generally, they were de-
(238)
tained in the prisons, as was the case for example at the fortress of
Ha, at the Chateau of Angers, or at Bellevaux. The disorder in such
places was indescribable, and continued for a long time—until the
Empire. Antoine Nodier gives some details about Bellevaux: "Every
day, the uproar warns the neighborhood that those confined are
fighting and persecuting one another. The guards rush upon them.
Constituted as they are today, the prison guards are the laughingstock
of the combatants. The municipal administrators are implored to
intervene in order to re-establish peace and quiet; their authority is
flouted; they are shamed and insulted; this is no longer a house of
justice and detention."
The disorders are as great, greater perhaps, at Bicetre; political
prisoners are kept there; hunted suspects are hidden there; poverty
and famine keep many people hungry. The administration never
ceases to protest; it asks that criminals be kept separate; and—it is
important to note-some people still suggest that, in their place of
detention, madmen be confined as well. On the ninth Brumaire, Year
III, the bursar of Bicetre writes to "Citizens Grandpre and Osmond,
members of the Committee on Administration and Tribunals": "I
submit that at a moment when humanity is decidedly the order of the
day, there is no one who does not experience an impulse of horror
upon seeing crime and indigence united in the same asylum." Was it
necessary to recall the September massacres, the continual escapes,
and, for so many innocent eyes, the sight of strangled prisoners, of
swinging chains? The indigent and the old "have before their eyes
nothing but chains, bars, and bolts. Add to this the groans of the
prisoners that sometimes reach them. ... It is on this basis that I urgently
ask either that the prisoners be removed from Bicetre, leaving
only the indigent there, or that the indigent be removed, leaving only
the prisoners." And here, finally,
(239)
is the decisive point, if we remember that this letter was written in
the middle of the Revolution, long before the reports of Georges
Cabanis, and several months after Pinel, according to tradition, had
"liberated" the insane of Bicetre:
"We could perhaps in this latter case leave the madmen there,
another class of unfortunates who cause horrible suffering to
humanity. . . . Make haste, then, citizens who cherish humanity, to
realize such a beautiful dream, and be persuaded in advance that you
will thereupon have deserved well of it." So great was the confusion
of those years; so difficult was it, at the moment when "humanity"
was being re-evaluated, to determine the place madness was to
occupy within it; so difficult was it to situate madness in a social
sphere that was being restructured.
IX
THE BIRTH OF THE ASYLUM
WE know the images. They are familiar in all histories of
psychiatry, where their function is to illustrate that happy age when
madness was finally recognized and treated according to a truth to
which we had too long remained blind.
"The worthy Society of Friends . . . sought to assure those of its
members who might have the misfortune to lose their reason without
a sufficient fortune to resort to expensive establishments all the
resources of medicine and all the comforts of life compatible with
their state; a voluntary subscription furnished the funds, and for the
last two years, an establishment that seems to unite many advantages
with all possible economy has been founded near the city of York. If
the soul momentarily quails at the sight of that dread disease which
seems created to humiliate human reason, it subsequently
experiences gender emotions when it
(241)
considers all that an ingenious benevolence has been able to
invent for its care and cure.
"This house is situated a mile from York, in the midst of a fertile
and smiling countryside; it is not at all the idea of a prison that it
suggests, but rather that of a large farm; it is surrounded by a great,
walled garden. No bars, no grilles on the windows."1
As for the liberation of the insane at Bicetre, the story is famous:
the decision to remove the chains from the prisoners in the
dungeons; Couthon visiting the hospital to find out whether any
suspects were being hidden; Pinel courageously going to meet him,
while everyone trembled at the sight of the "invalid carried in men's
arms." The confrontation of the wise, firm philanthropist and the
paralytic monster. "Pinel immediately led him to the section for the
deranged, where the sight of the cells made a painful impression on
him. He asked to interrogate all the patients. From most, he received
only insults and obscene apostrophes. It was useless to prolong the
interview. Turning to Pinel: 'Now, citizen, are you mad yourself to
seek to unchain such beasts?' Pinel replied calmly: 'Citizen, I am
convinced that these madmen are so intractable only because they
have been deprived of air and liberty.'
"'Well, do as you like with them, but I fear you may become the
victim of your own presumption.' Whereupon, Couthon was taken to
his carriage. His departure was a relief; everyone breathed again; the
great philanthropist immediately set to work."2
These are images, at least insofar as each of the stories derives the
essence of its power from imaginary forms: the patriarchal calm of
Tuke's home, where the heart's passions and the mind's disorders
slowly subside; the lucid firmness of Pinel, who masters in a word
and a gesture the two animal frenzies that roar against him as they
hunt him down; and the wisdom that could distinguish, between the
(242)
raving madman and the bloodthirsty member of the Convention,
which was the true danger: images that will carry far—to our own
day—their weight of legend.
The legends of Pinel and Tuke transmit mythical values, which
nineteenth-century psychiatry would accept as obvious in nature.
But beneath the myths themselves, there was an operation, or rather
a series of operations, which silently organized the world of the
asylum, the methods of cure, and at the same time the concrete
experience of madness.
Tuke's gesture, first of all. Because it is contemporary with
Pinel's, because he is known to have been borne along by a whole
current of "philanthropy," this gesture is regarded as an act of
"liberation." The truth was quite different:" ... there has also been
particular occasion to observe the great loss, which individuals of
our society have sustained, by being put under the care of those who
are not only strangers to our principles, but by whom they are
frequently mixed with other patients, who may indulge themselves
in ill language, and other exceptionable practices. This often seems
to leave an unprofitable effect upon the patients' minds after they are
restored to the use of their reason, alienating them from those
religious attachments which they had before experienced; and
sometimes, even corrupting them with vicious habits to which they
had been strangers."3 The Retreat would serve as an instrument of
segregation: a moral and religious segregation which sought to
reconstruct around madness a milieu as much as possible like that of
the Community of Quakers. And this for two reasons: first, the sight
of evil is for every sensitive soul the cause of suffering, the origin of
all those strong and untoward passions such as horror, hate, and
digust which engender or perpetuate madness: "It was thought, very
justly, that the indiscriminate mixture, which
(243)
must occur in large public establishments, of persons of opposite
religious sentiments and practices; of the profligate and the virtuous;
the profane and the serious; was calculated to check the progress of
returning reason, and to fix, still deeper, the melancholy and
misanthropic train of ideas ..."4 But the principal reason lies
elsewhere: it is that religion can play the double role of nature and of
rule, since it has assumed the depth of nature in ancestral habit, in
education, in everyday exercise, and since it is at the same time a
constant principle of coercion. It is both spontaneity and constraint,
and to this degree it controls the only forces that can, in reason's
eclipse, counterbalance the measureless violence of madness; its
precepts, "where these have been strongly imbued in early life . . .
become little less than principles of our nature; and their restraining
power is frequently felt, even under the delirious excitement of
insanity. To encourage the influence of religious principles over the
mind of the insane is considered of great consequence, as a means of
cure."5 In the dialectic of insanity where reason hides without
abolishing itself, religion constitutes the concrete form of what
cannot go mad; it bears what is invincible in reason, it bears what
subsists beneath madness as quasi-nature and around it as the
constant solicitation of a milieu "where, during lucid intervals, or the
state of convalescence, the patient might enjoy the society of those
who were of similar habits and opinions." Religion safeguards the
old secret of reason in the presence of madness, thus making closer,
more immediate, the constraint that was already rampant in classical
confinement. There, the religious and moral milieu was imposed
from without, in such a way that madness was controlled, not cured.
At the Retreat, religion was part of the movement which indicated in
spite of everything the presence of reason in madness, and which led
from insanity to health. Religious segregation has a very precise
meaning: it does not
(244)
attempt to preserve the sufferers from the profane presence of
non-Quakers, but to place the insane individual within a moral
element where he will be in debate with himself and his
surroundings: to constitute for him a milieu where, far from being
protected, he will be kept in a perpetual anxiety, ceaselessly
threatened by Law and Transgression.
"The principle of fear, which is rarely decreased by insanity, is
considered as of great importance in the management of the
patients."6 Fear appears as an essential presence in the asylum.
Already an ancient figure, no doubt, if we think of the terrors of
confinement. But these terrors surrounded madness from the
outside, marking the boundary of reason and unreason, and enjoying
a double power: over the violence of fury in order to contain it, and
over reason itself to hold it at a distance; such fear was entirely on
the surface. The fear instituted at the Retreat is of great depth;
it passes between reason and madness like a mediation, like an
evocation of a common nature they still share, and by which it could
link them together. The terror that once reigned was the most visible
sign of the alienation of madness in the classical period; fear was
now endowed with a power of disalienation, which permitted it to
restore a primitive complicity between the madman and the man of
reason. It re-established a solidarity between them. Now madness
would never—could never—cause fear again; it would be afraid,
without recourse or return, thus entirely in the hands of the
pedagogy of good sense, of truth, and of morality.
Samuel Tuke tells how he received at the Retreat a maniac, young
and prodigiously strong, whose seizures caused panic in those
around him and even among his guards. When he entered the
Retreat he was loaded with chains; he wore handcuffs; his clothes
were attached by ropes. He had no sooner arrived than all his
shackles were removed, and he was permitted to dine with the
keepers;
(245)
his agitation immediately ceased; "his attention appeared to be
arrested by his new situation." He was taken to his room; the keeper
explained that the entire house was organized in terms of the greatest
liberty and the greatest comfort for all, and that he would not be
subject to any constraint so long as he did nothing against the rules
of the house or the general principles of human morality. For his
part, the keeper declared he had no desire to use the means of coercion
at his disposal. "The maniac was sensible of the kindness of his
treatment. He promised to restrain himself." He sometimes still
raged, shouted, and frightened his companions. The keeper reminded
him of the threats and promises of the first day; if he did not control
himself, it would be necessary to go back to the old ways. The
patient's agita tion would then increase for a while, and then rapidly
decline. "He would listen with attention to the persuasions and
arguments of his friendly visitor. After such conversations, the
patient was generally better for some days or a week." At the end of
four months, he left the Retreat, entirely cured. Here fear is
addressed to the invalid directly, not by instruments but in speech;
there is no question of limiting a liberty that rages beyond its
bounds, but of marking out and glorifying a region of simple
responsibility where any manifestation of madness will be linked to
punishment. The obscure guilt that once linked transgression and
unreason is thus shifted; the madman, as a human being originally
endowed with reason, is no longer guilty of being mad; but the
madman, as a madman, and in the interior of that disease of which
he is no longer guilty, must feel morally responsible for everything
within him that may disturb morality and society, and must hold no
one but himself responsible for the punishment he receives. The
assignation of guilt is no longer the mode of relation that obtains
between the madman and the sane man in their generality; it
becomes both the concrete form of coexist-
(246)
ence of each madman with his keeper, and the form of awareness
that the madman must have of his own madness.
We must therefore re-evaluate the meanings assigned to Tuke's
work: liberation of the insane, abolition of constraint, constitution of
a human milieu—these are only justifications. The real operations
were different. In fact Tuke created an asylum where he substituted
for the free terror of madness the stifling anguish of responsibility;
fear no longer reigned on the other side of the prison gates, it now
raged under the seals of conscience. Tuke now transferred the ageold
terrors in which the insane had been trapped to the very heart of
madness. The asylum no longer punished the madman's guilt, it is
true; but it did more, it organized that guilt; it organized it for the
madman as a consciousness of himself, and as a non-reciprocal relation
to the keeper; it organized it for the man of reason as an
awareness of the Other, a therapeutic intervention in the madman's
existence. In other words, by this guilt the madman became an object
of punishment always vulnerable to himself and to the Other; and,
from the acknowledgment of his status as object, from the awareness
of his guilt, the madman was to return to his awareness of himself as
a free and responsible subject, and consequently to reason. This
movement by which, objectifying himself for the Other, the madman
thus returned to his liberty, was to be found as much in Work as in
Observation.
Let us not forget that we are in a Quaker world where God blesses
men in the signs of their prosperity. Work comes first in "moral
treatment" as practiced at the Retreat. In itself, work possesses a
constraining power superior to all forms of physical coercion, in that
the regularity of the hours, the requirements of attention, the
obligation to produce a result detach the sufferer from a liberty of
mind that would be fatal and engage him in a system of responsibilities:
"Regular employment is perhaps the most generally
(247)
efficacious; and those kinds of employment are doubtless to be
preferred, both on a moral and physical account, which are
accompanied by considerable bodily action; that are most agreeable
to the patient and which are most opposite to the illusions of his
disease."7 Through work, man returns to the order of God's
commandments; he submits his liberty to laws that are those of both
morality and reality. Hence mental work is not to be rejected; yet
with absolute rigor, all exercises of the imagination must be
excluded as being in complicity with the passions, the desires, or all
delirious illusions. On the contrary, the study of what is eternal in
nature and most in accord with the wisdom and goodness of
Providence has the greatest efficacity in reducing the madman's
immoderate liberties and bringing him to discover the forms of his
responsibility. "The various branches of the mathematics and natural
science furnish the most useful class of subjects on which to employ
the minds of the insane." In the asylum, work is deprived of any
productive value; it is imposed only as a moral rule; a limitation of
liberty, a submission to order, an engagement of responsibility, with
the single aim of disalienating the mind lost in the excess of a liberty
which physical constraint limits only in appearance.
Even more efficacious than work, than the observation of others,
is what Tuke calls "the need for esteem": "This principle in the
human mind, which doubtless influences in a great degree, though
often secretly, our general manners;
and which operates with peculiar force on our introduction into a
new circle of acquaintance." In classical confinement, the madman
was also vulnerable to observation, but such observation did not,
basically, involve him; it involved only his monstrous surface, his
visible animality; and it included at least one form of reciprocity,
since the sane man could read in the madman, as in a mirror, the
imminent movement of his downfall. The observation Tuke now
instituted as
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one of the great elements of asylum existence was both deeper
and less reciprocal. It pursued in the madman the least perceptible
signs of his madness, in the place where madness becomes secretly
distinct from reason, begins to detach itself from it; and the madman
cannot return this observation in any form, since he is merely
observed; he is a kind of new arrival, a latecomer in the world of
reason. Tuke organized an entire ceremonial around these observations.
There were social occasions in the English manner, where
everyone was obliged to imitate all the formal requirements of social
existence; nothing else circulated except the observation that would
spy out any incongruity, any disorder, any awkwardness where
madness might betray itself. The directors and staff of the Retreat
thus regularly invited several patients to "tea-parties"; the guests
"dress in their best clothes, and vie with each other in politeness and
propriety. The best fare is provided, and the visitors are treated with
all the attention of strangers. The evening generally passes with the
greatest harmony and enjoyment. It rarely happens that any
unpleasant circumstance occurs; the patients control, to a wonderful
degree, their different propensities; and the scene is at once curious
and affectingly gratifying." Curiously, this rite is not one of
intimacy, of dialogue, of mutual acquaintance; it is the organization
around the madman of a world where everything would be like and
near him, but in which he himself would remain a stranger, the
Stranger par excellence who is judged not only by appearances but
by all that they may betray and reveal in spite of themselves.
Incessantly cast in this empty role of unknown visitor, and
challenged in everything that can be known about him, drawn to the
surface of himself by a social personality silently imposed by
observation, by form and mask, the madman is obliged to objectify
himself in the eyes of reason as the perfect stranger, that is, as the
man whose strangeness does not
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reveal itself. The city of reason welcomes him only with this
qualification and at the price of this surrender to anonymity.
We see that at the Retreat the partial suppression of physical
constraint was part of a system whose essential element was the
constitution of a "self-restraint" in which the patient's freedom,
engaged by work and the observation of others, was ceaselessly
threatened by the recognition of guilt. Instead of submitting to a
simple negative operation that loosened bonds and delivered one's
deepest nature from madness, it must be recognized that one was in
the grip of a positive operation that confined madness in a system of
rewards and punishments, and included it in the movement of moral
consciousness. A passage from a world of Censure to a universe of
Judgment. But thereby a psychology of madness becomes possible,
for under observation madness is constantly required, at the surface
of itself, to deny its dissimulation. It is judged only by its acts; it is
not accused of intentions, nor are its secrets to be fathomed. Madness
is responsible only for that part of itself which is visible. All the rest
is reduced to silence. Madness no longer exists except as seen. The
proximity instituted by the asylum, an intimacy neither chains nor
bars would ever violate again, does not allow reciprocity: only the
nearness of observation that watches, that spies, that comes closer in
order to see better, but moves ever farther away, since it accepts and
acknowledges only the values of the Stranger. The science of mental
disease, as it would develop in the asylum, would always be only of
the order of observation and classification. It would not be a
dialogue. It could not be that until psychoanalysis had exorcised this
phenomenon of observation, essential to the nineteenth-century
asylum, and substituted for its silent magic the powers of language. It
would be fairer to say that psychoanalysis doubled the absolute
observation of the watcher with the endless mono-
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logue of the person watched—thus preserving the old asy lum
structure of non-reciprocal observation but balancing it, in a nonsymmetrical
reciprocity, by the new structure of language without
response.
Surveillance and Judgment: already the outline appears of a new
personage who will be essential in the nineteenth-century asylum.
Tuke himself suggests this personage, when he tells the story of a
maniac subject to seizures of irrepressible violence. One day while
he was walking in the garden of the asylum with the keeper, this
patient suddenly entered a phase of excitation, moved several steps
away, picked up a large stone, and made the gesture of throwing it at
his companion. The keeper stopped, looked the patient in the eyes;
then advanced several steps toward him and "in a resolute tone of
voice . . . commanded him to lay down the stone"; as he approached,
the patient lowered his hand, then dropped his weapon; "he then
submitted to be quietly led to his apartment." Something had been
born, which was no longer repression, but authority. Until the end of
the eighteenth century, the world of madmen was peopled only by
the abstract, faceless power which kept them confined; within these
limits, it was empty, empty of all that was not madness itself; the
guards were often recruited among the inmates themselves. Tuke
established, on the contrary, a mediating element between guards and
patients, between reason and madness. The space reserved by society
for insanity would now be haunted by those who were "from the
other side" and who represented both the prestige of the authority
that confines and the rigor of the reason that judges. The keeper
intervenes, without weapons, without instruments of constraint, with
observation and language only; he advances upon madness, deprived
of all that could protect him or make him seem threatening, risking
an immediate confrontation without recourse. In fact, though, it is
not as a concrete person that he confronts
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madness, but as a reasonable being, invested by that very-fact, and
before any combat takes place, with the authority that is his for not
being mad. Reason's victory over unrea son was once assured only by
material force, and in a sort of real combat. Now the combat was
always decided beforehand, unreason's defeat inscribed in advance in
the concrete situation where madman and man of reason meet. The
absence of constraint in the nineteenth-century asylum is not
unreason liberated, but madness long since mastered.
For this new reason which reigns in the asylum, madness does not
represent the absolute form of contradiction, but instead a minority
status, an aspect of itself that does not have the right to autonomy,
and can live only grafted onto the world of reason. Madness is
childhood. Everything at the Retreat is organized so that the insane
are transformed into minors. They are regarded "as children who
have an overabundance of strength and make dangerous use of it.
They must be given immediate punishments and rewards; whatever
is remote has no effect on them. A new system of education must be
applied, a new direction given to their ideas; they must first be
subjugated, then encouraged, then applied to work, and this work
made agreeable by attractive means."8 For a long time already, the
law had regarded the insane as minors, but this was a juridical
situation, abstractly denned by interdiction and trusteeship; it was not
a concrete mode of relation between man and man. Minority status
became for Tuke a style of existence to be applied to the mad, and
for the guards a mode of sovereignty. Great emphasis was placed on
the concept of the "family" which organized the community of the
insane and their keepers at the Retreat. Apparently this "family"
placed the patient in a milieu both normal and natural; in reality it
alienated him still more: the juridical minority assigned to the
madman was intended to protect him as a subject of law; this ancient
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structure, by becoming a form of coexistence, delivered him
entirely, as a psychological subject, to the authority and prestige of
the man of reason, who assumed for him the concrete figure of an
adult, in other words, both domination and destination.
In the great reorganization of relations between madness and
reason, the family, at the end of the eighteenth century, played a
decisive part—simultaneously imaginary land scape and real social
structure; it is from the family that Tuke starts out, and toward it that
he progresses. Lending it the prestige of primitive values not yet
compromised in the social, Tuke makes the family play a role of
disalienadon; it was, in his myth, the antithesis of that "milieu"
which the eighteenth century saw as the origin of all madness. But he
introduced it as well, in a very real way, into the world of the
asylum, where it appears both as truth and as norm for all relations
that may obtain between the madman and the man of reason. Thus
minority under family tutelage, a juridical status in which the
madman's civil status is alienated, becomes a concrete situation in
which his concrete liberty is alienated. The entire existence of
madness, in the world now being prepared for it, was enveloped in
what we may call, in anticipation, a "parental complex." The prestige
of patriarchy is revived around madness in the bourgeois family. It is
this historical sedimentation which psychoanalysis would later bring
to light, according it through a new myth the meaning of a destiny
that supposedly marked all of Western culture and perhaps all civilization,
whereas it had been slowly deposited by it and only
solidified quite recently at the turn of this century, when madness
was doubly alienated within the family—by the myth of a
disalienation in patriarchal purity, and by a truly alienating situation
in an asylum constituted in the family mode. Henceforth, and for a
period of time the end of which it is not yet possible to predict, the
discourse of
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unreason will be indissociably linked with the half-real, halfimaginary
dialectic of the Family. So that what, in their violence, it
was once obligatory to interpret as profanations or blasphemies, it
would henceforth be necessary to see as an incessant attack against
the Father. Thus in the modem world, what had been the great,
irreparable confrontation of reason and unreason became the secret
thrust of instincts against the solidity of the family institution and
against its most archaic symbols.
There is an astonishing convergence of the movement of
fundamental institutions and this evolution of madness in the world
of confinement. The liberal economy, as we have seen, tended to
entrust the care of the poor and the sick to the family rather than to
the State: the family thus became the site of social responsibility.
But if the patient can be entrusted to the family, he is nonetheless
mad, which is too strange and inhuman. Tuke, precisely,
reconstitutes around madness a simulated family, which is an
institutional parody but a real psychological situation. Where the
family is inadequate, he substitutes for it a fictitious family decor of
signs and attitudes. But by a very curious intersection, the day
would come when the family was relieved of its responsibility to
care for the patient in general, while it kept the fictitious values that
concern madness; and long after the diseases of the poor had again
become an affair of state, the asylum would keep the insane in the
imperative fiction of the family; the madman remains a minor, and
for a long time reason will retain for him the aspect of the Father.
Closed upon these fictitious values, the asylum was protected
from history and from social evolution. In Tuke's mind, the problem
was to constitute a milieu which would imitate the oldest, the
purest, the most natural forms of coexistence: the most human
milieu possible, while being the least social one possible. In fact, he
isolated the social structure of the bourgeois family, reconstituted it
symbol-
(254)
ically in the asylum, and set it adrift in history. The asylum,
always oriented to anachronistic structures and symbols, would be,
par excellence, inadapted and out of time. And exactly where
animality manifested a presence without history, an eternal return,
would slowly reappear the immemorial scars of old hatreds, old
family profanations, the forgotten signs of incest and punishment.
Pinel advocates no religious segregation. Or rather, a segregation
that functions in the opposite direction from that practiced by Tuke.
The benefits of the renovated asylum were offered to all, or almost
all, except the fanatics "who believe themselves inspired and seek to
make converts." Bicetre and La Salpetriere, according to Pinel's intention,
form a complementary figure to the Retreat.
Religion must not be the moral substratum of life in the asylum,
but purely and simply a medical object: "Religious opinions in a
hospital for the insane must be considered only in a strictly medical
relation, that is, one must set aside all other considerations of public
worship and political belief, and investigate only whether it is
necessary to oppose the exaltation of ideas and feelings that may
originate in this source, in order to effect the cure of certain
alienated minds."9 A source of strong emotions and terrifying images
which it arouses through fears of the Beyond, Catholicism
frequently provokes madness; it generates delirious beliefs,
entertains hallucinations, leads men to despair and to melancholia.
We must not be surprised if, "examining the registers of the insane
asylum at Bicetre, we find inscribed there many priests and monks,
as well as country people maddened by a frightening picture of the
future." Still less surprising is it to see the number of religious madnesses
vary. Under the Old Regime and during the Revolution, the
strength of superstitious beliefs, or the violence of the struggles in
which the Republic opposed the Catholic
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Church, multiplied melancholias of religious origin. With the
return of peace, the Concordat having erased the struggles, these
forms of delirium disappeared; in the Year X, 50 per cent of the
melancholics in Bicetre were suffering from religious madness, 33
per cent the following year, and only 18 per cent in the Year XII. The
asylum must thus be freed from religion and from all its iconographic
connections; "melancholics by devotion" must not be allowed their
pious books; experience "teaches that this is the surest means of
perpetuating insanity or even of making it incurable, and the more
such permission is granted, the less we manage to calm anxiety and
scruples." Nothing takes us further from Tuke and his dreams of a
religious community that would at the same time be a privileged site
of mental cures, than this notion of a neutralized asylum, purified of
those images and passions to which Christianity gave birth and which
made the mind wander toward illusion, toward error, and soon
toward delirium and hallucinations.
But Pinel's problem was to reduce the iconographic forms, not the
moral content of religion. Once "filtered," religion possesses a
disalienating power that dissipates the images, calms the passions,
and restores man to what is most immediate and essential: it can
bring him closer to his moral truth. And it is here that religion is
often capable of effecting cures. Pinel relates several Voltairean
stories. One, for example, of a woman of twenty-five, "of strong
constitution, united in wedlock to a weak and delicate man"; she
suffered "quite violent fits of hysteria, imagining she was possessed
by a demon who followed her in different shapes, sometimes
emitting bird noises, sometimes mournful sounds and piercing cries."
Happily, the local cure was more concerned with natural religion
than learned in the techniques of exorcism; he believed in curing
through the benevolence of nature; this "enlightened man, of kindly
and persuasive character, gained ascendancy over the patient's mind
and
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managed to induce her to leave her bed, to resume her domestic
tasks, and even to spade her garden. . . . This was followed by the
most fortunate effects, and by a cure that lasted three years."
Restored to the extreme simplicity of this moral content, religion
could not help conniving with philosophy and with medicine, with all
the forms of wisdom and science that can restore the reason in a disturbed
mind. There are even instances of religion serving as a
preliminary treatment, preparing for what will be done in the asylum:
take the case of the young girl "of an ardent temperament, though
very docile and pious" who was torn between "the inclinations of her
heart and the severe principles of her conduct"; her confessor, after
having vainly counseled her to attach herself to God, proposed
examples of a firm and measured holiness, and "offered her the best
remedy against high passions: patience and time." Taken to La
Salpetriere, she was treated, on Pinel's orders, "according to the same
moral principles," and her illness proved "of very short duration."
Thus the asylum assimilates not the social theme of a religion in
which men feel themselves brothers in the same communion and the
same community, but the moral power of consolation, of confidence,
and a docile fidelity to nature. It must resume the moral enterprise of
religion, exclusive of its fantastic text, exclusively on the level of
virtue, labor, and social life.
The asylum is a religious domain without religion, a domain of
pure morality, of ethical uniformity. Everything that might retain the
signs of the old differences was eliminated. The last vestiges of rite
were extinguished. Formerly the house of confinement had inherited,
in the social sphere, the almost absolute limits of the lazar house; it
was a foreign country. Now the asylum must represent the great
continuity of social morality. The values of family and work, all the
acknowledged virtues, now reign in the asylum. But their reign is a
double one. First, they prevail in
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fact, at the heart of madness itself; beneath the violence and
disorder of insanity, the solid nature of the essential virtues is not
disrupted. There is a primitive morality which is ordinarily not
affected even by the worst dementia; it is this morality which both
appears and functions in the cure: "I can generally testify to the pure
virtues and severe principles often manifested by the cure. Nowhere
except in novels have I seen spouses more worthy of being
cherished, parents more tender, lovers more passionate, or persons
more attached to their duties than the majority of the insane
fortunately brought to the period of c6nvalescence."10 This
inalienable virtue is both the truth and the resolution of madness.
Which is why, if it reigns, it must reign as well. The asylum reduces
differences, represses vice, eliminates irregularities. It denounces
everything that opposes the essential virtues of society: celibacy—
"the number of girls fallen into idiocy is seven times greater than the
number of married women for the Year XI and the Year XIII; for
dementia, the proportion is two to four times greater; we can thus
deduce that marriage constitutes for women a kind of preservative
against the two sorts of insanity which are most inveterate and most
often incurable"; debauchery, misconduct, and "extreme perversity
of habits"—"vicious habits such as drunkenness, limitless
promiscuity, an apathetic lack of concern can gradually degrade the
reason and end in outright insanity"; laziness—"it is the most
constant and unanimous result of experience that in all public asylums,
as in prisons and hospitals, the surest and perhaps the sole
guarantee of the maintenance of health and good habits and order is
the law of rigorously executed mechanical work." The asylum sets
itself the task of the homogeneous rule of morality, its rigorous
extension to all those who tend to escape from it.
But it thereby generates an indifference; if the law does
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not reign universally, it is because there are men who do not
recognize it, a class of society that lives in disorder, in negligence,
and almost in illegality: "If on the one hand we see families prosper
for a long series of years in the bosom of harmony and order and
concord, how many others, especially in the lower classes, afflict the
eye with a repulsive spectacle of debauchery, of dissensions, and
shameful distress! That, according to my daily notes, is the most
fertile source of the insanity we treat in the hospitals."11
In one and the same movement, the asylum becomes, in Pinel's
hands, an instrument of moral uniformity and of social denunciation.
The problem is to impose, in a universal form, a morality that will
prevail from within upon those who are strangers to it and in whom
insanity is already present before it has made itself manifest. In the
first case, the asylum must act as an awakening and a reminder,
invoking a forgotten nature; in the second, it must act by means of a
social shift in order to snatch the individual from his condition. The
operation as practiced at the Retreat was still simple: religious
segregation for purposes of moral purification. The operation as
practiced by Pinel was relatively complex: to effect moral syntheses,
assuring an ethical continuity between the world of madness and the
world of reason, but by practicing a social segregation that would
guarantee bourgeois morality a universality of fact and permit it to
be imposed as a law upon all forms of insanity.
In the classical period, indigence, laziness, vice, and madness
mingled in an equal guilt within unreason; madmen were caught in
the great confinement of poverty and unemployment, but all had
been promoted, in the proximity of transgression, to the essence of a
Fall. Now madness belonged to social failure, which appeared
without distinction as its cause, model, and limit. Half a century
later,
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mental disease would become degeneracy. Henceforth, the
essential madness, and the really dangerous one, was that which
rose from the lower depths of society.
Pinel's asylum would never be, as a retreat from the world, a
space of nature and immediate truth like Tuke's, but a uniform
domain of legislation, a site of moral syntheses where insanities
born on the outer limits of society were eliminated. The entire life
of the inmates, the entire conduct of their keepers and doctors, were
organized by Pinel so that these moral syntheses would function.
And this by three principal means:
1. Silence. The fifth chained prisoner released by Pinel was a
former ecclesiastic whose madness had caused him to be
excommunicated; suffering from delusions of grandeur, he believed
he was Christ; this was "the height of human arrogance in delirium."
Sent to Bicetre in 1782, he had been in chains for twelve years. For
the pride of his bearing, the grandiloquence of his ideas, he was one
of the most celebrated spectacles of the entire hospital, but as he
knew that he was reliving Christ's Passion, "he endured with
patience this long martyrdom and the continual sarcasms his mania
exposed him to." Pinel chose him as one of the first twelve to be
released, though his delirium was still acute. But Pinel did not treat
him as he did the others; without a word, he had his chains struck
off, and "ordered expressly that everyone imitate his own reserve
and not address a word to this poor madman. This prohibition,
which was rigorously observed, produced upon this self-intoxicated
creature an effect much more perceptible than irons and the
dungeon;
he felt humiliated in an abandon and an isolation so new to him
amid his freedom. Finally, after long hesitations, they saw him come
of his own accord to join the society of the other patients;
henceforth, he returned to more sensible and true ideas."12
Deliverance here has a paradoxical meaning. The dun-
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geon, the chains, the continual spectacle, the sarcasms were, to
the sufferer in his delirium, the very element of his liberty.
Acknowledged in that very fact and fascinated from without by so
much complicity, he could not be dislodged from his immediate
truth. But the chains that fell, the indifference and silence of all
those around him confined him in the limited use of an empty
liberty; he was delivered in silence to a truth which was not
acknowledged and which he would demonstrate in vain, since he
was no longer a spectacle, and from which he could derive no exaltation,
since he was not even humiliated. It was the man himself,
not his projection in a delirium, who was now humiliated: for
physical constraint yielded to a liberty that constantly touched the
limits of solitude; the dialogue of delirium and insult gave way to a
monologue in a language which exhausted itself in the silence of
others; the entire show of presumption and outrage was replaced by
indifference. Henceforth, more genuinely confined than he could
have been in a dungeon and chains, a prisoner of nothing but
himself, the sufferer was caught in a relation to himself that was of
the order of transgression, and in a non-relation to others that was of
the order of shame. The others are made innocent, they are no
longer persecutors; the guilt is shifted inside, showing the madman
that he was fascinated by nothing but his own presumption; the
enemy faces disappear; he no longer feels their presence as observation,
but as a denial of attention, as observation deflected; the
others are now nothing but a limit that ceaselessly recedes as he
advances. Delivered from his chains, he is now chained, by silence,
to transgression and to shame. He feels himself punished, and he
sees the sign of his innocence in that fact; free from all physical
punishment, he must prove himself guilty. His torment was his
glory; his deliverance must humiliate him.
Compared to the incessant dialogue of reason and mad-
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ness during the Renaissance, classical internment had been a
silencing. But it was not total: language was engaged in things rather
than really suppressed. Confinement, prisons, dungeons, even
tortures, engaged in a mute dialogue between reason and unreason—
the dialogue of struggle. This dialogue itself was now disengaged;
silence was absolute; there was no longer any common language
between madness and reason; the language of delirium can be
answered only by an absence of language, for delirium is not a fragment
of dialogue with reason, it is not language at all; it refers, in an
ultimately silent awareness, only to transgression. And it is only at
this point that a common language becomes possible again, insofar
as it will be one of acknowledged guilt. "Finally, after long
hesitations, they saw him come of his own accord to join the society
of the other patients ..." The absence of language, as a fundamental
structure of asylum life, has its correlative in the exposure of
confession. When Freud, in psychoanalysis, cautiously reinstitutes
exchange, or rather begins once again to listen to this language,
henceforth eroded into monologue, should we be astonished that the
formulations he hears are always those of transgression? In this
inveterate silence, transgression has taken over the very sources of
speech.
2. Recognition by Mirror. At the Retreat, the madman was
observed, and knew he was observed; but except for that direct
observation which permitted only an indirect apprehension of itself,
madness had no immediate grasp of its own character. With Pinel, on
the contrary, observation operated only within the space defined by
madness, without surface or exterior limits. Madness would see
itself, would be seen by itself—pure spectacle and absolute subject.
"Three insane persons, each of whom believed himself to be a
king, and each of whom took the title Louis XVI, quarreled one day
over the prerogatives of royalty, and defended them somewhat too
energetically. The keeper ap-
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preached 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."18 This is the first phase, that of exaltation. Madness is
made to observe itself, but in others: it appears in them as a baseless
pretense—in other words, as absurd. However, in this observation
that condemns others, the madman assures his own justification and
the certainty of being adequate to his delirium. The rift between presumption
and reality allows itself to be recognized only in the object.
It is entirely masked, on the contrary, in the subject, which becomes
immediate truth and absolute judge: the exalted sovereignty that
denounces the others' false sovereignty dispossesses them and thus
confirms itself in the unfailing plenitude of presumption. Madness,
as simple delirium, is projected onto others; as perfect unconsciousness,
it is entirely accepted.
It is at this point that the mirror, as an accomplice, becomes an
agent of demystification. Another inmate of Bicetre, also believing
himself a king, always expressed himself "in a tone of command and
with supreme authority." One day when he was calmer, the keeper
approached him and asked why, if he were a sovereign, he did not
put an end to his detention, and why he remained mingled with
madmen of all kinds. Resuming this speech the following days, "he
made him see, little by little, the absurdity of his pretensions, showed
him another madman who had also been long convinced that he
possessed supreme power and had become an object of mockery. At
first the maniac felt shaken, soon he cast doubts upon his tide of
sovereign, and finally he came to realize his chimerical vagaries. It
was in
(263)
two weeks that this unexpected moral revolution took place, and
after several months of tests, this worthy father was restored to his
family."14 This, then, is the phase of abasement: presumptuously
identified with the object of his delirium, the madman recognizes
himself as in a mirror in this madness whose absurd pretensions he
has denounced; his solid sovereignty as a subject dissolves in this
object he has demystified by accepting it. He is now pitilessly
observed by himself. And in the silence of those who represent
reason, and who have done nothing but hold up the perilous mirror,
he recognizes himself as objectively mad.
We have seen by what means—and by what mystifica tions—
eighteenth-century therapeutics tried to persuade the madman of his
madness in order to release him from it. Here the movement is of an
entirely different nature; it is not a question of dissipating error by
the impressive spectacle of a truth, even a pretended truth; but of
treating madness in its arrogance rather than in its aberration. The
classical mind condemned in madness a certain blindness to the
truth; from Pinel on, madness would be regarded rather as an
impulse from the depths which exceeds the juridical limits of the
individual, ignores the moral limits fixed for him, and tends to an
apotheosis of the self. For the nineteenth century, the initial model
of madness would be to believe oneself to be God, while for the
preceding centuries it had been to deny God. Thus madness, in the
spectacle of itself as unreason humiliated, was able to find its
salvation when, imprisoned in the absolute subjectivity of its delirium,
it surprised the absurd and objective image of that delirium in
the identical madman. Truth insinuated itself, as if by surprise (and
not by violence, in the eighteenth-century mode), in this play of
reciprocal observations where it never saw anything but itself. But
the asylum, in this community of madmen, placed the mirrors in
such a way that
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the madman, when all was said and done, inevitably surprised
himself, despite himself, as a madman. Freed from the chains that
made it a purely observed object, madness lost, paradoxically, the
essence of its liberty, which was solitary exaltation; it became
responsible for what it knew of its truth; it imprisoned itself in an
infinitely self-referring observation; it was finally chained to the
humiliation of being its own object. Awareness was now linked to
the shame of being identical to that other, of being compromised in
him, and of already despising oneself before being able to recognize
or to know oneself.
3. Perpetual Judgment. By this play of mirrors, as by silence,
madness is ceaselessly called upon to judge itself. But beyond this, it
is at every moment judged from without; judged not by moral or
scientific conscience, but by a sort of invisible tribunal in permanent
session. The asylum Pinel dreamed of and partly realized at Bicetre,
but especially at La Salpetriere, is a juridical microcosm. To be
efficacious, this judgment must be redoubtable in aspect; all the
iconographic apanage of the judge and the executioner must be
present in the mind of the madman, so that he understands what
universe of judgment he now belongs to. The decor of justice, in all
its terror and implacability, will thus be part of the treatment. One of
the inmates at Bicetre suffered from a religious delirium animated
by a fear of hell; he believed that the only way he could escape
eternal damnation was by rigorous abstinence. It was necessary to
compensate this fear of a remote justice by the presence of a more
immediate and still more redoubtable one: "Could the irresistible
curse of his sinister ideas be counterbalanced other than by the
impression of a strong and deep fear?" One evening, the director
came to the patient's door "with matter likely to produce fear—an
angry eye, a thundering tone of voice, a group of the staff armed
with strong chains that they shook noisily. They set some soup
beside
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the madman and gave him precise orders to eat it during the
night, or else suffer the most cruel treatment. They retired, and left
the madman in the most distressed state of indecision between the
punishment with which he was threatened and the frightening
prospect of the torments in the life to come. After an inner combat
of several hours, the former idea prevailed, and he decided to take
some nourishment."15
The asylum as a juridical instance recognized no other. It judged
immediately, and without appeal. It possessed its own instruments of
punishment, and used them as it saw fit. The old confinement had
generally been practiced outside of normal juridical forms, but it
imitated the punishment of criminals, using the same prisons, the
same dungeons, the same physical brutality. The justice that reigned
in Pinel's asylum did not borrow its modes of repression from the
other justice, but invented its own. Or rather, it used the therapeutic
methods that had become known in the eighteenth century, but used
them as chastisements. And this is not the least of the paradoxes of
Pinel's "philanthropic" and "liberating" enterprise, this conversion of
medicine into justice, of therapeutics into repression. In the
medicine of the classical period, baths and showers were used as
remedies as a result of the physicians' vagaries about the nature of
the nervous system: the intention was to refresh the organism, to
relax the desiccated fibers; it is true that they also added, among the
happy consequences of the cold shower, the psychological effect of
the unpleasant surprise which interrupted the course of ideas and
changed the nature of sentiments; but we were still in the landscape
of medical speculation. With Pinel, the use of the shower became
frankly juridical; the shower was the habitual punishment of the
ordinary police tribunal that sat permanently at the asylum:
"Considered as a means of repression, it often suffices to subject to
the general law of manual
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labor a madman who is susceptible to it, in order to conquer an
obstinate refusal to take nourishment, and to subjugate insane
persons carried away by a sort of turbulent and reasoned humor."
Everything was organized so that the madman would recognize
himself in a world of judgment that enveloped him on all sides; he
must know that he is watched, judged, and condemned; from
transgression to punishment, the connection must be evident, as a
guilt recognized by all:
"We profit from the circumstance of the bath, remind him of the
transgression, or of the omission of an important duty, and with the
aid of a faucet suddenly release a shower of cold water upon his
head, which often disconcerts the madman or drives out a
predominant idea by a strong and unexpected impression; if the idea
persists, the shower is repeated, but care is taken to avoid the hard
tone and the shocking terms that would cause rebellion; on the
contrary, the madman is made to understand that it is for his sake
and reluctantly that we resort to such violent measures; sometimes
we add a joke, taking care not to go too far with it."16 This almost
arithmetical obviousness of punishment, repeated as often as
necessary, the recognition of transgression by its repression—all this
must end in the internalization of the juridical instance, and the birth
of remorse in the inmate's mind: it is only at this point that the
judges agree to stop the punishment, certain that it will continue
indefinitely in the inmate's conscience. One ma niac had the habit of
tearing her clothes and breaking any object that came into her hands;
she was given showers, she was put into a straitjacket, she finally
appeared "humiliated and dismayed"; but fearing that this shame
might be transitory and this remorse too superficial, "the director, in
order to impress a feeling of terror upon her, spoke to her with the
most energetic firmness, but without anger, and announced to her
that she would henceforth be treated with
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the greatest severity." The desired result was not long in coming:
"Her repentance was announced by a torrent of tears which she shed
for almost two hours." The cycle is complete twice over: the
transgression is punished and its author recognizes her guilt.
There were, however, madmen who escaped from this movement
and resisted the moral synthesis it brought about. These latter would
be set apart in the heart of the asylum, forming a new confined
population, which could not even relate to justice. When we speak of
Pinel and his work of liberation, we too often omit this second
reclusion. We have already seen that he denied the benefits of
asylum reform to "fanatics who believe themselves inspired and seek
to make converts, and who take a perfidious pleasure in inciting the
other madmen to disobedience on the pretext that it is better to obey
God than man." But confinement and the dungeon will be equally
obligatory for "those who cannot be subjected to the general law of
work and who, in malicious activity, enjoy tormenting the other
inmates, provoking and ceaselessly inciting them to subjects of discord,"
and for women "who during their seizures have an irresistible
propensity to steal anything they can lay their hands on."
Disobedience by religious fanaticism, resistance to work, and theft,
the three great transgressions against bourgeois society, the three
major offenses against its essential values, are not excusable, even
by madness; they deserve imprisonment pure and simple, exclusion
in the most rigorous sense of the term, since they all manifest the
same resistance to the moral and social uniformity that forms the
raison d'etre of Pinel's asylum.
Formerly, unreason was set outside of judgment, to be delivered,
arbitrarily, to the powers of reason. Now it is judged, and not only
upon entering the asylum, in order to be recognized, classified, and
made innocent forever; it is caught, on the contrary, in a perpetual
judgment, which
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never ceases to pursue it and to apply sanctions, to proclaim its
transgressions, to require honorable amends, to exclude, finally,
those whose transgressions risk compromising the social order.
Madness escaped from the arbitrary only in order to enter a kind of
endless trial for which the asylum furnished simultaneously police,
magistrates, and torturers;
a trial whereby any transgression in life, by a virtue proper to life
in the asylum, becomes a social crime, observed, condemned, and
punished; a trial which has no outcome but in a perpetual
recommencement in the internalized form of remorse. The madmen
"delivered" by Pinel and, after him, the madmen of modern
confinement are under arraignment; if they have the privilege of no
longer being associated or identified with convicts, they are
condemned, at every moment, to be subject to an accusation whose
text is never given, for it is their entire life in the asylum which
constitutes it. The asylum of the age of positivism, which it is Pinel's
glory to have founded, is not a free realm of observation, diagnosis,
and therapeutics; it is a juridical space where one is accused, judged,
and condemned, and from which one is never released except by the
version of this trial in psychological depth—that is, by remorse.
Madness will be punished in the asylum, even if it is innocent
outside of it. For a long time to come, and until our own day at least,
it is imprisoned in a moral world.
To silence, to recognition in the mirror, to perpetual judgment, we
must add a fourth structure peculiar to the world of the asylum as it
was constituted at the end of the eighteenth century: this is the
apotheosis of the medical personage. Of them all, it is doubtless the
most important, since it would authorize not only new contacts
between doctor and patient, but a new relation between insanity and
medical thought, and ultimately command the whole modem
experience of madness. Hitherto, we find in the asy-
(269)
lums only the same structures of confinement, but displaced and
deformed. With the new status of the medical personage, the deepest
meaning of confinement is abolished: mental disease, with the
meanings we now give it, is made possible.
The work of Tuke and of Pinel, whose spirit and values are so
different, meet in this transformation of the medical personage. The
physician, as we have seen, played no part in the life of
confinement. Now he becomes the essential figure of the asylum. He
is in charge of entry. The ruling at the Retreat is precise: "On the
admission of patients, the committee should, in general, require a
certificate signed by a medical person. ... It should also be stated
whether the patient is afflicted with any complaint independent of
insanity. It is also desirable that some account should be sent, how
long the patient has been disordered; whether any, or what sort of
medical means have been used."17 From the end of the eighteenth
century, the medical certificate becomes almost obligatory for the
confinement of madmen. But within the asylum itself, the doctor
takes a preponderant place, insofar as he converts it into a medical
space. However, and this is the essential point, the doctor's intervention
is not made by virtue of a medical skill or power that he
possesses in himself and that would be justified by a body of
objective knowledge. It is not as a scientist that homo medicus has
authority in the asylum, but as a wise man. If the medical profession
is required, it is as a juridical and moral guarantee, not in the name
of science. A man of great probity, of utter virtue and scruple, who
had had long experience in the asylum would do as well. For the
medical enterprise is only a part of an enormous moral task that
must be accomplished at the asylum, and which alone can ensure the
cure of the insane: "Must it not be an inviolable law in the
administration of any establishment for the insane, whether public or
private, to grant the maniac all the
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liberty that the safety of his person and of that of others permits,
and to proportion his repression to the greater or lesser seriousness
of danger of his deviations ... , to gather all the facts that can serve to
enlighten the physician in treatment, to study with care the particular
varieties of behavior and temperament, and accordingly to use
gentleness or firmness, conciliatory terms or the tone of authority
and an inflexible severity?"18 According to Samuel Tuke, the first
doctor appointed at the Retreat was recommended by his
"indefatigable perseverance"; doubtless he had no particular
knowledge of mental illnesses when he entered the asylum, but "he
entered on his office with the anxiety and ardor of a feeling mind,
upon the exertion of whose skill, depended the dearest interest of
many of his fellow-creatures." He tried the various remedies that his
own common sense and the experience of his predecessors
suggested. But he was soon disappointed, not because the results
were bad, or that the number of cures was minimal: "Yet the medical
means were so imperfectly connected with the progress of recovery,
that he could not avoid suspecting them, to be rather concomitants
than causes." He then realized that there was little to be done using
the medical methods known up to that time. The concern for humanity
prevailed within him, and he decided to use no medicament
that would be too disagreeable to the patient. But it must not be
thought that the doctor's role had little importance at the Retreat: by
the visits he paid regularly to the patients, by the authority he
exercised in the house over all the staff, "the physician . . .
sometimes possesses more influence over the patients' minds, than
the other attendants."
It is thought that Tuke and Pinel opened the asylum to medical
knowledge. They did not introduce science, but a personality, whose
powers borrowed from science only their disguise, or at most their
justification. These powers,
(271)
by their nature, were of a moral and social order; they took root in
the madman's minority status, in the insanity of his person, not of his
mind. If the medical personage could isolate madness, it was not
because he knew it, but because he mastered it; and what for
positivism would be an image of objectivity was only the other side
of this domination. "It is a very important object to win the
confidence of these sufferers, and to arouse in them feelings of
respect and obedience, which can only be the fruit of superior
discernment, distinguished education, and dignity of tone and
manner. Stupidity, ignorance, and the lack of principles, sustained by
a tyrannical harshness, may incite fear, but always inspire distrust.
The keeper of madmen who has obtained domination over them
directs and rules their conduct as he pleases; he must be endowed
with a firm character, and on occasion display an imposing strength.
He must threaten little but carry out his threats, and if he is
disobeyed, punishment must immediately ensue."19 The physician
could exercise his absolute authority in the world of the asylum only
insofar as, from the beginning, he was Father and Judge, Family and
Law—his medical practice being for a long time no more than a
complement to the old rites of Order, Authority, and Punishment.
And Pinel was well aware that the doctor cures when, exclusive of
modem therapeutics, he brings into play these immemorial figures.
Pinel cites the case of a girl of seventeen who had been raised by
her parents with "extreme indulgence"; she had fallen into a "giddy,
mad delirium without any cause that could be determined"; at the
hospital she was treated with great gentleness, but she always
showed a certain "haughtiness" which could not be tolerated at the
asylum; she spoke "of her parents with nothing but bitterness." It
was decided to subject her to a regime of strict authority; "the
keeper, in order to tame this inflexible character, seized the moment
of the bath and expressed himself forcibly concerning cer-
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tain unnatural persons who dared oppose their parents and disdain
their authority. He warned the girl she would henceforth be treated
with all the severity she deserved, for she herself was opposed to her
cure and dissimulated with insurmountable obstinacy the basic cause
of her illness." Through this new rigor and these threats, the sick girl
felt "profoundly moved . . . she ended by acknowledging her wrongs
and making a frank confession that she had suffered a loss of reason
as the result of a forbidden romantic attachment, naming the person
who had been its object." After this first confession, the cure became
easy: "a most favorable alteration occurred . . . she was henceforth
soothed and could not sufficiently express her gratitude toward the
keeper who had brought an end to her continual agitation, and had
restored tranquillity and calm to her heart." There is not a moment of
the story that could not be transcribed in psychoanalytical terms. To
such a degree was it true that the medical personage, according to
Pinel, had to act not as the result of an objective definition of the
disease or a specific classifying diagnosis, but by relying upon that
prestige which envelops the secrets of the Family, of Authority, of
Punishment, and of Love; it is by bringing such powers into play, by
wearing the mask of Father and of Judge, that the physician, by one
of those abrupt short cuts that leave aside mere medical competence,
became the almost magic perpetrator of the cure, and assumed the
aspect of a Thaumaturge; it was enough that he observed and spoke,
to cause secret faults to appear, insane presumptions to vanish, and
madness at last to yield to reason. His presence and his words were
gifted with that power of disalienation, which at one blow revealed
the transgression and restored the order of morality.
It is a curious paradox to see medical practice enter the uncertain
domain of the quasi-miraculous at the very moment when the
knowledge of mental illness tries to assume
(273)
a positive meaning. On the one hand, madness puts itself at a
distance in an objective field where the threats of unreason
disappear; but at this same moment, the madman tends to form with
the doctor, in an unbroken unity, a "couple" whose complicity dates
back to very old links. Life in the asylum as Tuke and Pinel
constituted it permitted the birth of that delicate structure which
would become the essential nucleus of madness—a structure that
formed a kind of microcosm in which were symbolized the massive
structures of bourgeois society and its values: Family-Child relations,
centered on the theme of paternal authority; Transgression-
Punishment relations, centered on the theme of immediate justice;
Madness-Disorder relations, centered on the theme of social and
moral order. It is from these that the physician derives his power to
cure; and it is to the degree that the patient finds himself, by so
many old links, already alienated in the doctor, within the doctorpatient
couple, that the doctor has the almost miraculous power to
cure him.
In the time of Pinel and Tuke, this power had nothing
extraordinary about it; it was explained and demonstrated in the
efficacity, simply, of moral behavior; it was no more mysterious
than the power of the eighteenth-century doctor when he diluted
fluids or relaxed fibers. But very soon the meaning of this moral
practice escaped the physician, to the very extent that he enclosed
his knowledge in the norms of positivism: from the beginning of the
nineteenth century, the psychiatrist no longer quite knew what was
the nature of the power he had inherited from the great reformers,
and whose efficacity seemed so foreign to his idea of mental illness
and to the practice of all other doctors.
This psychiatric practice, mysterious even to those who used it, is
very important in the situation of the madman within the medical
world. First because medicine of the
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mind for the first time in the history of Western science was to
assume almost complete autonomy: from the time of the Greeks, it
had been no more than a chapter of medicine, and we have seen
Willis study madness under the rubric "diseases of the head"; after
Pinel and Tuke, psychiatry would become a medicine of a particular
style: those most eager to discover the origin of madness in organic
causes or in hereditary dispositions would not be able to avoid this
style. They would be all the more unable to avoid it in that this
particular style—bringing into play increasingly obscure moral
powers—would originally be a sort of bad conscience; they would
increasingly confine themselves in positivism, the more they felt
their practice slipping out of it.
As positivism imposes itself upon medicine and psychiatry, this
practice becomes more and more obscure, the psychiatrist's power
more and more miraculous, and the doctor-patient couple sinks
deeper into a strange world. In the patient's eyes, the doctor
becomes a thaumaturge; the authority he has borrowed from order,
morality, and the family now seems to derive from himself; it is
because he is a doctor that he is believed to possess these powers,
and while Pinel, with Tuke, strongly asserted that his moral action
was not necessarily linked to any scientific competence, it was
thought, and by the patient first of all, that it was in the esotericism
of his knowledge, in some almost daemonic secret of knowledge,
that the doctor had found the power to unravel insanity; and
increasingly the patient would accept this self-surrender to a doctor
both divine and satanic, beyond human measure in any case;
increasingly he would alienate himself in the physician, accepting
entirely and in advance all his prestige, submitting from the very
first to a will he experienced as magic, and to a science he regarded
as prescience and divination, thus becoming the ideal and perfect
correlative of those powers he
(275)
projected upon the doctor, pure object without any resistance
except his own inertia, quite ready to become precisely that hysteric
in whom Charcot exalted the doctor's marvelous powers. If we
wanted to analyze the profound structures of objectivity in the
knowledge and practice of nineteenth-century psychiatry from Pinel
to Freud,20 we should have to show in fact that such objectivity was
from the start a reification of a magical nature, which could only be
accomplished with the complicity of the patient himself, and
beginning from a transparent and clear moral practice, gradually
forgotten as positivism imposed its myths of scientific objectivity; a
practice forgotten in its origins and its meaning, but always used and
always present. What we call psychiatric practice is a certain moral
tactic contemporary with the end of the eighteenth century,
preserved in the rites of asylum life, and overlaid by the myths of
positivism.
But if the doctor soon became a thaumaturge for the patient, he
could not be one in his own positivist doctor's eyes. That obscure
power whose origin he no longer knew, in which he could not
decipher the patient's complicity, and in which he would not consent
to acknowledge the ancient powers which constituted it,
nevertheless had to be given some status; and since nothing in
positivist understanding could justify such a transfer of will or
similar remote-control operations, the moment would soon come
when madness itself would be held responsible for such anomalies.
These cures without basis, which must be recognized as not being
false cures, would soon become the true cures of false illnesses.
Madness was not what one believed, nor what it believed itself to
be; it was infinitely less than itself: a combination of persuasion and
mystification. We can see here the genesis of Babinski's pithiatism.
And by a strange reversal, thought leaped back almost two centuries
to the era when between madness, false madness, and
(276)
the simulation of madness, the limit was indistinct—identi cal
symptoms confused to the point where transgression replaced unity;
further still, medical thought finally effected an identification over
which all Western thought since Greek medicine had hesitated: the
identification of madness with madness—that is, of the medical
concept with the critical concept of madness. At the end of the
nineteenth century, and in the thought of Babinski's contemporaries,
we find that prodigious postulate, which no medicine had yet dared
formulate: that madness, after all, was only madness.
Thus while the victim of mental illness is entirely alienated in the
real person of his doctor, the doctor dissipates the reality of the
mental illness in the critical concept of madness. So that there
remains, beyond the empty forms of positivist thought, only a single
concrete reality: the doctor-patient couple in which all alienations
are summarized, linked, and loosened. And it is to this degree that
all nineteenth-century psychiatry really converges on Freud, the first
man to accept in all its seriousness the reality of the physicianpatient
couple, the first to consent not to look away nor to
investigate elsewhere, the first not to attempt to hide it in a
psychiatric theory that more or less harmonized with the rest of
medical knowledge; the first to follow its consequences with
absolute rigor. Freud demystified all the other asylum structures: he
abolished silence and observation, he eliminated madness's
recognition of itself in the mirror of its own spectacle, he silenced
the instances of condemnation. But on the other hand he exploited
the structure that enveloped the medical personage; he amplified its
thaumaturgical virtues, preparing for its omnipotence a quasi-divine
status. He focussed upon this single presence—concealed behind the
patient and above him, in an absence that is also a total presence—
all the powers that had been distributed in the collective existence of
the asy-
(277)
him; he transformed this into an absolute Observation, a pure and
circumspect Silence, a Judge who punishes and rewards in a
judgment that does not even condescend to language; he made it the
Mirror in which madness, in an almost motionless movement, clings
to and casts off itself.
To the doctor, Freud transferred all the structures Pinel and Tuke
had set up within confinement. He did deliver the patient from the
existence of the asylum within which his "liberators" had alienated
him; but he did not deliver him from what was essential in this
existence; he regrouped its powers, extended them to the maximum
by uniting them in the doctor's hands; he created the
psychoanalytical situation where, by an inspired short-circuit,
alienation becomes disalienating because, in the doctor, it becomes
a subject.
The doctor, as an alienating figure, remains the key to
psychoanalysis. It is perhaps because it did not suppress this
ultimate structure, and because it referred all the others to it, that
psychoanalysis has not been able, will not be able, to hear the voices
of unreason, nor to decipher in themselves the signs of the madman.
Psychoanalysis can unravel some of the forms of madness; it
remains a stranger to the sovereign enterprise of unreason. It can
neither liberate nor transcribe, nor most certainly explain, what is
essential in this enterprise.
Since the end of the eighteenth century, the life of unreason no
longer manifests itself except in the lightning-flash of works such as
those of Holderlin, of Nerval, of Nietzsche, or of Artaud— forever
irreducible to those alienations that can be cured, resisting by their
own strength that gigantic moral imprisonment which we are in the
habit of calling, doubtless by antiphrasis, the liberation of the insane
by Pinel and Tuke.
CONCLUSION
THE Goya who painted The Madhouse must have experienced
before that grovel of flesh in the void, that nakedness among bare
walls, something related to a contemporary pathos: the symbolic
tinsel that crowned the insane kings left in full view suppliant
bodies, bodies vulnerable to chains and whips, which contradicted
the delirium of the faces, less by the poverty of these trappings than
by the human truth which radiated from all that unprofaned flesh.
The man in the tricorne is not mad because he has stuck an old hat
upon his nakedness; but within this madman in a hat rises—by the
inarticulate power of his muscular body, of his savage and
marvelously unconstricted youth—a human presence already
liberated and somehow free since the beginning of time, by his
birthright. The Madhouse is less concerned with madness and those
strange faces one finds elsewhere in the Caprichos, moreover, than
with the vast monotony of these new bodies, shown in all their
vigor, and whose gestures, if they invoke their dreams, celebrate
especially their dark freedom: its language is close to the world of
Pinel.
(279)
The Goya of the Disparates and the Quinta del Sordo addresses
himself to another madness. Not that of madmen cast into prison,
but that of man cast into darkness. Does Goya not link us, by
memory, with the old world of enchantments, of fantastic rides, of
witches perched on the branches of dead trees? Is not the monster
whispering its secrets into the ears of the Monk related to the gnome
who fascinated Bosch's Saint Anthony? But they are different for
Goya, and their prestige, which overshadows all his later work,
derives from another power. For Bosch or Brueghel, these forms are
generated by the world itself;
through the fissures of a strange poetry, they rise from stones and
plants, they well out of an animal howl; the whole complicity of
nature is not too much for their dance. Goya's forms are born out of
nothing: they have no background, in the double sense that they are
silhouetted against only the most monotonous darkness, and that
nothing can assign them their origin, their limit, and their nature.
The Disparates are without landscape, without walls, without
setting—and this is still a further difference from the Caprichos;
there is not a star in the night sky of the great human bats we see in
the Way of Flying. The branch on which these witches jabber—out
of what tree does it grow? Does it fly? Toward what sabbath, and
what clearing? Nothing in all this deals with a world, neither this
one nor any other. It is indeed a question of that Sleep of Reason
which Goya, in 1797, had already made the first image of the
"universal idiom"; it is a question of a night which is doubtless that
of classical unreason, that triple night into which Orestes sank. But
in that night, man communicates with what is deepest in himself,
and with what is most solitary. The desert of Bosch's Saint Anthony
was infinitely populous; and even if it was a product of her
imagination, the landscape that Dulle Griet moved through was
marked by a whole human language. Goya's Monk,
(280)
with that hot beast against his back, its paws on his shoulders and
its mouth panting at his ear, remains alone: no secret is revealed. All
that is present is the most internal, and at the same time the most
savagely free, of forces: the power which hacks apart the bodies in
the Gran Disparate, which breaks free and assaults our eyes in the
Raging Madness. Beyond that point, the faces themselves
decompose; this is no longer the madness of the Caprichos, which
tied on masks truer than the truth of faces; this is a madness beneath
the mask, a madness that eats away faces, corrodes features; there
are no longer eyes or mouths, but glances shot from nowhere and
staring at nothing (as in the Witches' Sabbath); or screams from
black holes (as in the Pilgrimage of Saint Isidore). Madness has
become man's possibility of abolishing both man and the world—
and even those images that challenge the world and deform man. It
is, far beyond dreams, beyond the nightmare of bestiality, the last
recourse: the end and the beginning of everything. Not because it is
a promise, as in German lyricism, but because it is the ambiguity of
chaos and apocalypse: Goya's Idiot who shrieks and twists his
shoulder to escape from the nothingness that imprisons him—is this
the birth of the first man and his first movement toward liberty, or
the last convulsion of the last dying man?
And this madness that links and divides time, that twists the
world into the ring of a single night, this madness so foreign to the
experience of its contemporaries, does it not transmit—to those able
to receive it, to Nietzsche and to Artaud—those barely audible
voices of classical unreason, in which it was always a question of
nothingness and night, but amplifying them now to shrieks and
frenzy? But giving them for the first time an expression, a droit de
cite, and a hold on Western culture which makes possible all
contestations, as well as total contestation? But restoring their primitive
savagery?
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Sade's calm, patient language also gathers up the final words of
unreason and also gives them, for the future, a remoter meaning.
Between Goya's broken drawings and that uninterrupted stream of
words continuing from the first volume of Justine to the tenth of
Juliette, there is doubtless nothing in common except a certain
movement that retraces the course of contemporary lyricism, drying
up its sources, rediscovering the secret of unreason's nothingness.
Within the chateau where Sade's hero confines himself, within
the convents, the forests, the dungeons where he endlessly pursues
the agony of his victims, it seems at first glance that nature can act
with utter freedom. There man rediscovers a truth he had forgotten,
though it was manifest: what desire can be contrary to nature, since
it was given to man by nature itself? And since it was taught by
nature in the great lesson of life and death which never stops
repeating itself in the world? The madness of desire, insane murders,
the most unreasonable passions—all are wisdom and reason, since
they are a part of the order of nature. Everything that morality and
religion, everything that a clumsy society has stifled in man, revives
in the castle of murders. There man is finally attuned to his own
nature; or rather, by an ethic peculiar to this strange confinement,
man must scrupulously maintain, without deviation, his fidelity to
nature: a strict task, a total enterprise: "You will know nothing
unless you have known everything; if you are timid enough to stop
with Nature, she will escape you forever."1 Conversely, if man has
wounded or changed nature, it is man's task to repair the damage
through the mathematics of a sovereign vengeance: "Nature caused
us all to be born equal; if fate is pleased to disturb this plan of the
general law, it is our responsibility to correct its caprice, and to
repair by our attention the usurpations of the stronger."2 The
slowness of revenge, like the insolence of
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desire, belongs to nature. There is nothing that the madness of
men invents which is not either nature made manifest or nature
restored.
But this is only the first phase of Sade's thought: the ironic
justification, both rational and lyrical, the gigantic pastiche, of
Rousseau. Beyond this demonstration-by-absurdity of the inanity of
contemporary philosophy, beyond all its verbiage about man and
nature, the real decisions are still to be made: decisions that are also
breaks, in which the links between man and his natural being
disappear.3 The famous Society of the Friends of Crime, the project
of a Swedish Constitution, once we remove their stinging references
to the Social Contract and to the proposed constitutions for Poland
or Corsica, establish nothing but the sovereign rigor of subjectivity
in the rejection of all natural liberty and all natural equality:
uncontrolled disposal of one member by the other, the unconditional
exercise of violence, the limitless application of the right of death—
this entire society, whose only link is the very rejection of a link,
appears to be a dismissal of nature—the only cohesion asked of
individuals is intended to protect, not a natural existence, but the free
exercise of sovereignty over and against nature.4 The relation
established by Rousseau is precisely reversed; sovereignty no longer
transposes the natural existence; the latter is only an object for the
sovereign, which permits him to measure his total liberty. Followed
to its logical conclusion, desire leads only in appearance to the
rediscovery of nature. Actually, for Sade there is no return to the
natal terrain, no hope that the first rejection of social order may
surreptitiously become the reestablished order of happiness, through
a dialectic of nature renouncing and thus confirming itself. The
solitary madness of desire that still for Hegel, as for the eighteenthcentury
philosophers, plunges man into a natural world that is
immediately resumed in a social world, for Sade merely
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casts man into a void that dominates nature in a total absence of
proportion and community, into the endlessly repeated nonexistence
of gratification. The night of madness is thus limitless; what might
have been supposed to be man's violent nature was only the infinity
of non-nature.
Here is the source of Sade's great monotony: as he advances, the
settings dissolve; the surprises, the incidents, the pathetic or
dramatic links of the scenes vanish. What was still vicissitude in
Justine — an event experienced, hence new—becomes in Juliette a
sovereign game, always triumphant, without negativity, and whose
perfection is such that its novelty can only be its similarity to itself.
As with Goya, there are no longer any backgrounds for these meticulous
Disparates. And yet in this absence of decor, which can as
easily be total night as absolute day (there are no shadows in Sade),
we advance slowly toward a goal: the death of Justine. Her
innocence had exhausted even the desire to torment it. We cannot
say that crime had not overcome her virtue; we must say inversely
that her natural virtue had brought her to the point of having
exhausted all the possible means of being an object for crime. And
at this point, when crime can do nothing more than drive her from
the domain of its sovereignty (Juliette expels her from the Chateau
de Noirceuil), Nature in her turn, so long dominated, scorned,
profaned,5 submits entirely to that which contradicted her: Nature in
turn enters madness, and there, in an instant, but for an instant only,
restores her omnipotence. The storm that is unleashed, the lightning
that strikes and consumes Justine, is Nature become criminal
subjectivity. This death that seems to escape from the insane
domain of Juliette belongs to Nature more profoundly than any
other; the night of storm, of thunder and lightning, is a sufficient
sign that Nature is lacerating herself, that she has reached the
extreme point of her dissension, and that she is revealing in this
golden flash a sovereignty
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which is both herself and something quite outside herself: the
sovereignty of a mad heart that has attained, in its solitude, the
limits of the world that wounds it, that turns it against itself and
abolishes it at the moment when to have mastered it so well gives it
the right to identify itself with that world. That lightning-flash
which Nature drew from herself in order to strike Justine was
identical with the long existence of Juliette, who would also
disappear in solitude, leaving no trace or corpse or anything upon
which Nature could claim her due. The nothingness of unreason, in
which the language of Nature had died forever, has become a
violence of Nature and against Nature, to the point of the savage
abolition of itself.6
For Sade as for Goya, unreason continues to watch by night; but
in this vigil it joins with fresh powers. The non-being it once was
now becomes the power to annihilate. Through Sade and Goya, the
Western world received the possibility of transcending its reason in
violence, and of recovering tragic experience beyond the promises
of dialectic.
After Sade and Goya, and since them, unreason has belonged to
whatever is decisive, for the modern world, in any work of art: that
is, whatever any work of art contains that is both murderous and
constraining.
The madness of Tasso, the melancholia of Swift, the delirium of
Rousseau belong to their works, just as these works belong to their
authors. Here in the texts, there in the lives of the men, the same
violence spoke, or the same bitterness; visions certainly were
exchanged; language and delirium interlaced. But further, the work
of art and madness, in classical experience, were more profoundly
united at another level: paradoxically, at the point where they limited
one another. For there existed a region where madness
challenged the work of art, reduced it ironically, made of
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its iconographic landscape a pathological world of hallucinations;
that language which was delirium was not a work of art. And
conversely, delirium was robbed of its meager truth as madness if it
was called a work of art. But by admitting this very fact, there was
no reduction of one by the other, but rather (remembering
Montaigne) a discovery of the central incertitude where the work of
art is born, at the moment when it stops being born and is truly a
work of art. In this opposition, to which Tasso and Swift bore
witness after Lucretius—and which it was vain to at tempt to separate
into lucid intervals and crises—was dis closed a distance where the
very truth of a work of art raised a problem: was it madness, or a
work of art? Inspiration, or hallucination? A spontaneous babble of
words, or the pure origins of language? Must its truth, even before its
birth, be taken from the wretched truth of men, or discovered far
beyond its origin, in the being that it presumes? The madness of the
writer was, for other men, the chance to see being born, over and
over again, in the discouragement of repetition and disease, the truth
of the work of art.
The madness of Nietzsche, the madness of Van Gogh or of
Artaud, belongs to their work perhaps neither more nor less
profoundly, but in quite another way. The frequency in the modem
world of works of art that explode out of madness no doubt proves
nothing about the reason of that world, about the meaning of such
works, or even about the relations formed and broken between the
real world and the artists who produced such works. And yet this frequency
must be taken seriously, as if it were the insistence of a
question: from the time of Holderlin and Nerval, the number of
writers, painters, and musicians who have "succumbed" to madness
has increased; but let us make no mistake here; between madness and
the work of art, there has been no accommodation, no more constant
exchange, no
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communication of languages; their opposition is much more
dangerous than formerly; and their competition now allows no
quarter; theirs is a game of life and death. Artaud's madness does not
slip through the fissures of the work of art; his madness is precisely
the absence of the work of art, the reiterated presence of that
absence, its central void experienced and measured in all its endless
dimensions. Nietzsche's last cry, proclaiming himself both Christ and
Dionysos, is not on the border of reason and unreason, in the
perspective of the work of art, their common dream, finally realized
and immediately vanishing, of a reconciliation of the "shepherds of
Arcady and the fishermen of Tiberias"; it is the very annihilation of
the work of art, the point where it becomes impossible and where it
must fall silent; the hammer has just fallen from the philosopher's
hands. And Van Gogh, who did not want to ask "permission from
doctors to paint pictures," knew quite well that his work and his
madness were incompatible.
Madness is the absolute break with the work of art; it forms the
constitutive moment of abolition, which dissolves in time the truth of
the work of art; it draws the exterior edge, the line of dissolution, the
contour against the void. Artaud's oeuvre experiences its own
absence in madness, but that experience, the fresh courage of that
ordeal, all those words hurled against a fundamental absence of
language, all that space/of physical suffering and terror which surrounds
or rather coincides with the void—that is the work of art
itself: the sheer cliff over the abyss of the work's absence. Madness
is no longer the space of indecision through which it was possible to
glimpse the original truth of the work of art, but the decision beyond
which this truth ceases irrevocably, and hangs forever over history. It
is of little importance on exactly which day in the autumn of 1888
Nietzsche went mad for good, and after which his texts no longer
afford philosophy but psychiatry: all of
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them, including the postcard to Strindberg, belong to Nietzsche,
and all are related to The Birth of Tragedy. But we must not think of
this continuity in terms of a system, of a thematics, or even of an
existence: Nietzsche's madness—that is, the dissolution of his
thought—is that by which his thought opens out onto the modem
world. What made it impossible makes it immediate for us; what
took it from Nietzsche offers it to us. This does not mean that
madness is the only language common to the work of art and the
modern world (dangers of the pathos of malediction, inverse and
symmetrical danger of psychoanalyses);
but it means that, through madness, a work that seems to drown in
the world, to reveal there its non-sense, and to transfigure itself with
the features of pathology alone, actually engages within itself the
world's time, masters it, and leads it; by the madness which
interrupts it, a work of art opens a void, a moment of silence, a
question without answer, provokes a breach without reconciliation
where the world is forced to question itself. What is necessarily a
profanation in the work of art returns to that point, and, in the time
of that work swamped in madness, the world is made aware of its
guilt. Henceforth, and through the mediation of madness, it is the
world that becomes culpable (for the first time in the Western world)
in relation to the work of art; it is now arraigned by the work of art,
obliged to order itself by its language, compelled by it to a task of
recognition, of reparation, to the task of restoring reason from that
unreason and to that unreason. The madness in which the work of art
is engulfed is the space of our enterprise, it is the endless path to
fulfillment, it is our mixed vocation of apostle and exegete. This is
why it makes little difference when the first voice of madness
insinuated itself into Nietzsche's pride, into Van Gogh's humility.
There is no madness except as the final instant of the work of art—
the work endlessly drives madness to its limits; inhere there
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is a work of art, there is no madness; and yet madness is
contemporary with the work of art, since it inaugurates the time of
its truth. The moment when, together, the work of art and madness
are born and fulfilled is the beginning of the time when the world
finds itself arraigned by that work of art and responsible before it for
what it is.
Ruse and new triumph of madness: the world that thought to
measure and justify madness through psychology must justify itself
before madness, since in its struggles and agonies it measures itself
by the excess of works like those of Nietzsche, of Van Gogh, of
Artaud. And nothing in itself, especially not what it can know of
madness, assures the world that it is justified by such works of
madness.
NOTES
CHAPTER I. "stultifera navis"
1. Cf. J. Lebeuf, Histoire de la ville et de tout le diocese de Paris
(Paris, 1754-58).
2. Tristan et Iseut, Bossuat edition, pp. 219-22.
3. Pierre de Lancre, Tableau de Vinconstance des mauvais anges
(Paris, 1612).
4. In this sense, the experience of madness exhibits a rigorous
continuity with the experience of leprosy. The ritual of the leper's
exclusion showed that he was, as a living man, the very presence of
death.
5. Erasmus, The Praise of Folly, § 9.
6. Louise Labe, Debut de folie et d'amour (Lyons, 1566), p. 98.
7. Sebastian Brant, Stultifera navis, Latin translation of 1497, fol. II.
8. Saint-fivremond, Sir Politik would be, act V, scene ii.
9. Cervantes, Don Quixote, Part II, Chap. i.
10. T. Gazoni, L'Ospedale de fassi incurabil (iFerrara, 1586). Cf.
Charles de Beys, HOspital des fous (1635).
11. Mathurin Regnier, Satire XIV, vv. 7-10.
CHAPTER II. the great confinement
1. Edict of 1656, article IV. Later the Saint-Esprit and the Enfants-
Trouves would be added, and the Savonnerie withdrawn.
2. Ibid., article XII.
3. La Rochefoucauld-Liancourt's report in the name of the
Committee on Mendicity to the Constituent Assembly (Proces
verbaux de I'Assemblee nationale V. ol. XXI).
(291)
4. From a spiritual point of view, poverty at the end of the sixteenth and the
beginning of the seventeenth century was experienced as an apocalyptic
threat. "One of the most evident signs that the coming of the Son of God and
the end of time are at hand is the extreme of both spiritual and temporal
poverty to which the world is reduced. These are evil days . . . afflictions
have multiplied because of the multitude of transgressions, pain being the
inseparable shadow of evil." (Jean-Pierre Camus, De la mendicite legitime
des pauvres [Douai, 1634], pp. 3-4.)
5. Musquinet de la Pagne, Bicetre reforme ou etablissement d'une maison de
discipline (Paris, 1790), p. 22.
6. Bossuet, elevations sur les mysteres, Sixth Week, Twelfth Elevation.
7. "We seek that God should serve our mad appetites, and that He should be
as though subject to ourselves." Calvin, forty-ninth Sermon on
Deuteronomy, July 3, 1555.
8. Regulations of the Hopital General, articles XII and XIII.
9. Jean-Jacques Rousseau, Discours sur les sciences et les arts.
10. John Howard, The State of the Prisons in England and Wales
(London, 1784), p. 73.
11. Sermon cited in Pierre Collet, Vie de saint Vincent de Paul (Paris,
1818).
CHAPTER III. THE INSANE
1. Fran9ois Ravaisson, Les Archives de la Bastille (Paris, 1866-1904), Vol.
XIII, pp. 161-62.
2. Bibliotheque national, Fonds Clairambault, 986.
3. It did happen, but very late, and doubtless under the influence of the
practice which concerned madmen, that those afflicted with venereal
disease were also exhibited. Pere Richard, in his Memoires, tells of the
visit the Prince de Conde made to them with the Duke d'Enghien in
order to "inspire him with a horror of vice." (Memoires du Pere Richard,
manuscript in the Bibliotheque de la Ville de Paris, fol. 25.)
(292)
4. Ned Ward, in The London Spy (London, 1700), cites the figure of
twopence.
5. "Everyone used to be admitted to visit Bicetre, and in good weather you
might see at least two thousand persons a day. After paying your money,
you were led by a guide into the section for the insane." (Memoires du Pere
Richard, loc. cit., fol. 61). The visit included an Irish priest "who slept on
straw," a ship's captain whom the sight of men made furious, "for it was the
injustice of men that had driven him mad," a young man "who sang in a
ravishing fashion" (ibid.).
6. Mirabeau (H.), Observations d'un voyageur anglais (Paris, 1788), p.213,
n. i.
7. Jean-fitienne-Dominique Esquirol, "Memoire historique et statisdque sur
la Maison Royale de Charenton," in Des maladies mentales (Paris, 1838),
Vol. II, p. 212.
8. Pascal, Pensees (Brunschvicg edition), no. 339.
9. Bossuet, Panegyrique de saint Bernard, Preamble.
10. Saint Vincent here alludes to the text of Saint Paul (I Cor., I, 23): "to
the Jews, indeed, a stumbling-block and to the Gentiles foolishness." 11.
Correspondance de saint Vincent de Paul, Coste edition (Paris, 1920-24),
Vol. V, p. 146.
CHAPTER IV. passion AND delirium
1. Francois Boissier de Sauvages, Nosologie methodique (Lyons, 1772),
Vol. VII, p. 12.
2. F. Bayle and H. Grangeon, Relation de I'etat de quelques personnes
pretendues possedees faite d'autorite au Parlement de Toulouse
(Toulouse, 1682), pp. 26-27.
3. Malebranche, Recherche de la verite, Book V, Chap. 3.
4. Sauvages, op. cit.. Vol. VII, p. 291.
5. Robert Whytt, Traite des maladies nerveuses (French trans., Paris, 1777),
Vol. II, pp. 288-91.
6. Charles-Gaspard de la Rive, "Sur un etablissement pour la guerison des
alienes," Bibliotheque britannique. Vol. VIII, p. 304.
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7. Encyclopedic, article on Mania.
8. L'Ame materielle, ou nouveau systeme sur les purs principes
des philosophes anciens et modernes qui soutiennent son
immaterialite. Arsenal, manuscript no. 2239, p. 169.
9. Paul Zacchias, Quaestiones medico-le gales (Avignon, 1660-
61), Book II, Vol. II, question 4, p. 119.
10. Sauvages, op. cit., Vol. VII, p. 15. 11. Ibid., p. 20.
12. Ysbrand van Diemerbroek, Disputationes practicae, de
morbis capitis, in Opera omnia anatomica et medica (Utrecht,
1685), Historia III, pp. 4-5.
13. J.-D.-T. Bienville, De la nymphomanie (Amsterdam, 1771),
pp.140-53.
14. Robert James, Dictionnaire universel de medecine (French
trans., Paris, 1746-48), Vol. Ill, p. 977.
15. Ibid.
16. Zacchias, op. cit.. Book I, Vol. II, question 4, p. 118.
17. Archibald Pitcaime, quoted by Sauvages, op. cit., Vol VII, pp. 33
and 301.
18. Encyclopedie, article on Madness.
19. We should add Andromache herself, widow, and bride, and
widow again, in her mourning garments and festive garb which
ultimately mingle and say the same thing, and the luster of her
royalty in the night of her slavery.
20. Cf. for example annotations like the following, apropos of a
madman confined for seventeen years at Saint-Lazare: "His
health is fading greatly; it is to be hoped that he will soon die."
(Bibliotheque national, Fonds dairambault, 986, fol. 113)
CHAPTER V. aspects OF madness
1. Johann Weyer, De praestigiis daemoimm (1563).
2. Ibid.
3. Apologie pour Monsieur Duncan.
4. Ibid.
5. Hippolyte-Jules la Mesnardiere, Traite de la melancolie
(LaFleche, 1635), p. l0.
(294)
6. Apologie pour Monsieur Duncan.
7. Thomas Willis, Opera omnia (Lyons, 1681), Vol. II, p. 242.
8. "A soldier became melancholic because of his parents' rejection
of a girl he desperately loved. He was distracted, complained of a
severe headache, and of a continual heaviness in that part. He grew
visibly thinner; his face turned pale and he became so weak that he
voided his excrement without noticing it. ... There was no delirium,
although the patient gave no positive answers and seemed to be entirely
absorbed. He never asked for either food or drink." (Gazette
salutaire, March 17, 1763)
9. Robert James, Dictionnaire universel de medecine (French
trans., Paris, 1746-48), Vol. IV, p. 1215.
10. Encyclopedic, article on Mania.
11. William Cullen, Institutions de medecine pratique (French
trans., 2 vols., Paris, 1785), Vol. II, p. 315.
12. M. Flemyng, Nevropathia sive de morbis hypochondriacis et
hystericis (Amsterdam, 1741), pp. i-ii.
13. Thomas Sydenham, Medecine pratique (French trans.,
Paris,1784), pp.400-404.
14. Ibid., pp. 395-96.
15. Ibid., p. 394.
16. Ibid., p. 394.
17. Jean-Baptiste Pressavin, Nouveau traite des vapeurs (Lyons,
1770), pp.2-3.
18. Robert Whytt, Traite des maladies nerveuses (French trans.,
Paris, 1777), Vol. I, pp. 23-24, 50-51.
19. Ibid., pp. 47, 126—27, 166-67.
20. Simon-Andre Tissot, Traite des nerfs et de lews maladies (Paris,
1778-80), Vol. I, Part 2, p. 302.
21. Ibid., pp. 278-79, 302-3.
22. Pressavin, op. cit., p. 65.
23. Louis-Sebasrien Mercier, Tableau de Paris (Amsterdam, 1783),
Vol. Ill, p. 199.
CHAPTER VI. doctors AND patients
1. Madame de Sevigne used it a great deal, finding it "good
against sadness" (cf. letters of October 16 and 20, 1675).
(295)
2. Lange, Traite des vapeurs (Paris, 1689), p. 251.
3. Consultation de la Closure, Arsenal, manuscript no. 4528, fol.
119.
4. Joseph Raulin, Traite des affections vaporeuses du sexe (Paris,
1758), p. 339.
5. Jean-Baptiste Pressavin, Nouveau Traite des vapeurs (Lyons,
1770), Foreword, not paginated.
6. A. Rostaing, Reflexions sur les affections vaporeuses (Paris,
1778), p-75.
7. Jean-Etienne-Dominique Esquirol, Des maladies mentales (Paris,
1838), Vol. II, p. 225.
8. Thomas Sydenham, "Dissertation sur Faffection hysterique,"
Medecine pratique (French trans., Paris, 1784), p.425.
9. William Cullen, Institutions de medecine pratique (French trans.,
Paris, 1785), Vol. II, p. 317.
10. There is still some question whether the inventor of the rotatory
machine was Maupertuis, Darwin, or the Dane Katzenstein.
11. Encyclopedie, article on Music.
12. Alexander Crichton, On Mental Diseases, cited in filias
Regnault, Du degre de competence des medecins (Paris, 1828),
pp.187-88.
13. Cullen, op. cit., p. 307.
14. Fran9ois Leuret, Fragments psychologiques sur la folie
(Paris,1834), pp.308-21.
15. Cited by Robert Whytt, Traite des maladies nerveuses (French
trans., Paris, 1777), Vol. I, p. 296.
16. Thomas Willis, Opera omnia (Lyons, 1681), Vol. II, p. 261.
17. M. Hulshorff, Discours sur les penchants, read at the Academy
of Berlin. Cited in the Gazette salutaire, August 17,1769.
18. lbid., loc. cit.
19. Encyclopedic, article on Melancholy.
20. Bernardin de Saint-Pierre, Preambule de L'Arcadie. Oeuvres
(Paris, 1818), Vol. VII, pp. 11-14.
21. Simon-Andre Tissot, Avis aux gens de lettres sur leur sante
(Lausanne, 1767), pp. 90-94.
(296)
22. Philippe Pinel, Traite medico-philosophique sur l'alienation
mentale (Paris, 1801), pp. 238-39.
CHAPTER VII. the great fear
1. Denis Diderot, Le Neveu de Rameau. Oeuvres (Pleiade edition), p.
435.
2. Louis-Sebastien Mercier, Tableau de Paris (Amsterdam, 1783),
Vol. I, pp. 233-34.
3. Ibid., Vol. VIII, p. i.
4. Ibid., p. 2.
5. Musquinet de la Pagne, Bicetre reforme ou etablissement d'une
maison de discipline (Paris, 1790), p. 16.
6. "I knew, as did everyone, that Bicetre was both hospital and
prison; bat I did not know that the hospital had been built to nurture
sickness, the prison to nurture crime." (Mirabeaa [H.], Observations
d'un voyageur anglais[ Paris, 1788], p. 6.)
7. Mirabeaa, op. cit., p. 14.
8. Simon-Andre Tissot, Traite des nerfs et de lews maladies (Paris,
1778-80), Vol. I, pp. iii-iv.
9. In nineteenth-century evolutionism, madness is indeed a return,
but along a chronological path; it is not the absolute collapse of
time. It is a question of time turned back, not of repetition in the
strict sense. Psychoanalysis, which has tried to confront madness and
unreason again, has found itself faced with this problem of time;
fixation, death-wish, collective unconscious, archetype define more
or less happily this heterogeneity of two temporal structures: that
which is proper to the experience of Unreason and to the knowledge
it envelops; that which is proper to the knowledge of madness, and
to the science it authorizes.
10. Johann Christoph Spurzheim, Observations sur la folie (Paris,
1818).
11. J. C. N. Moehsen, Geschichte der Wissenschaften in der Mark
Brandenburg (Berlin and Leipzig, 1781).
12. Edme-Pierre Beauchesne, De l'influence des affections de
l'ame dans les maladies nerveuses des femmes (Paris, 1783), p. 31.
(297)
13. Ibid.,p.33.
14. Ibid., pp. 37-38.
15. "Causes physiques et morales des maux des nerfs," Gazette
salutaire, October 6, 1768 (anonymous article).
CHAPTER VIII. the new division
1. Mirabeau (H.), Des lettres de cachet et des prisons d'etatC, hap.
11. Oeuvres (Merilhou edition). Vol. I, p. 264.
2. Mirabeau (V.), L'Ami des hommes (Paris, 1758), Vol. II,
pp.414ff.
3. Mirabeau, Des lettres de cachet, p. 264.
4. Jean-Pierre Brissot de Warville, Theorie des his criminelles
(Paris, 1781), Vol. I, p. 79.
5. Encyclopedie, article on Hospital.
6. Abbe de Recalde, Traite sur les abus qui subsistent dans les
hopitaux du royaume (Paris, 1786), pp. ii, iii.
7. Mirabeau, L'Ami des hommes V, ol. I, p. 2 2.
8. Turgot, "filoge de Goumay," Oeuvres (Schelle edition), Vol. I, p.
607.
9. Turgot, article on Foundation in the Encyclopedie.
10. Turgot, "Lettre a Trudaine sur le Limousin," Oeuvres (Schelle
edition). Vol. II, pp. 478-95.
CHAPTER IX. THE BIRTH OF THE ASYLUM
1. Charles-Gaspard de la Rive, letter to the editors of the
Bibliotheque britannique concerning a new establishment for
the cure of the insane. This text appeared in the Bibliotheque
britannique, then in a separate brochure. De la Rive's visit to the
Retreat dates from 1798.
2. Scipion Pinel, Traite complet du regime sanitaire des alienes
(Paris, 1836), p. 56.
3. Samuel Tuke, Description of the Retreat, an Institution near York
for Insane Persons of the Society of Friends (York, 1813), p.50.
4. Ibid., p. 23.
5. Ibid., p. 121.
6. Ibid., p. 141.
(298)
7. Ibid., p. 156.
8. De la Rive, loc. cit., p. 30.
9. Philippe Pinel, Traite medico-philosophique sur Falienation
mentale (Paris, 1801), p. 265.
10. I bid., p. 141.
11. Ibid., pip. 29-30.
12. Scipion Pinel, op. cit., p. 63.
13. Cited in Rene Semelaigne, 'Alienistes et philanthropes( Paris,
1912), Appendix, p. 502.
14. Philippe Pinel, op. cit., p. 256.
15. Ibid., pp. 207-8.
16. Ibid., p. 205.
17. Cited in Tuke, op. cit., pp. 89-90.
18. Philippe Pinel, op. cit., pp. 292-93.
19. John Haslam, Observations on Insanity with Practical Remarks
on This Disease (London, 1798), cited by Philippe Pinel, op.
cit., pp. 253-54.
20. These structures still persist in non-psychoanalytic psychiatry,
and in many aspects of psychoanalysis itself.
Conclusion
1. Cent vingt joumees de Sodome, quoted by Maurice Blanchot,
Lautreamont et Sade (Paris, 1949), p. 235.
2. Ibid., loc. cit., p. 225.
3. Infamy must be able to go as far as "to dismember nature and
dislocate the universe." Cent vingt journees de Sodome (Paris,
1935), Vol. II, p. 369.
4. This cohesion imposed on the socii consists, in effect, of not
admitting among themselves the validity of the right of death,
which they can exercise over others, but of recognizing among
themselves an absolute right of free disposal; each must be able
to belong to the other.
5. Cf. the episode of the volcano at the end of Juliette (Pauvert
edition, Paris, 1954), Vol. VI, pp. 31-33.
6. "One would have said that Nature, weary of her own works, was
ready to mingle all the elements together in order to force them
into new forms." Ibid., p. 270.
(299)
ABOUT THE AUTHOR
Michel Foucault was born in Poitiers, France, in 1926. He lectured
in many universities throughout the world and served as director at the
Institut Francais in Hamburg, and the Institut de Philosophic at the
Faculte des Lettres in the University of Clermont-Ferrand. He wrote
frequently for French newspapers and reviews, and held a chair at
France's most prestigious institution, the College de France.
In addition to Madness and Civilization, his works available in
Vintage are The Order of Things, The Birth of the Clinic, Discipline
and Punish, and The History of Sexuality.
Michel Foucault died in June 1984.
Books by Michel Foucault
"The brilliance of his style, his irony, and his ease of
paradox endear Foucault's writing to sophisticated
readers."
— Washington Post Book World
THE ORDER OF THINGS
AN ARCHAEOLOGY OF THE HUMAN SCIENCES eng/ russ
With vast erudition, Foucault cuts across disciplines and reaches back into the
seventeenth century to trace the great rift that separates classical systems of knowledge
from their modem counterparts.
"An extraordinary range of information and imagination, and its theses ought to be
taken note of and learned from." — Neva Republic
Philosophy/Hiscory/0-679-75335-4
THE BIRTH OF THE CLINIC / russ
AN ARCHAEOLOGY OF MEDICAL PERCEPTION
In The Birth of the Clinic, Foucault shows how our definition of pure science is
shaped by social and cultural attitudes, and he sheds new light on the origins of our
current notions of health and sickness, life and death.
"Learned [and] rewarding." — The New York Times Boot Review
Philosophy/History/0-679-75334-6
MADNESS AND CIVILIZATION eng/ russ
A HISTORY OF INSANITY IN THE AGE OF REASON
What does it mean to be mad? In Madness and Civilization, Foucault examines the
archaeology of madness in the West from 1500 to 1800— from the Middle Ages, when
insanity was considered part of everyday life, to the time when such people began to be
considered a threat.
"Superb scholarship rendered with artistry." — The Nation
History/Psychology/0-679-72110-X
THE HISTORY OF SEXUALITY, VOLUME 1 / russ
AN INTRODUCTION
The dazzling, iconoclastic exploration of modern sexual history that has become
required reading for students of philosophy, psychology, and cultural history.
"A disconcerting but ultimately compelling reversal of accepted ideas."
— Richard Poirier, The New York Times Book Review
Philosophy/0-679-72469-9
THE HISTORY OF SEXUALITY, VOLUME II / russ
THE USE OF PLEASURE
Foucault's brilliant sequel toT he History of Sexuality, Volume I, analyzes the way
sexuality was perceived in ancient Greece and discusses why sexual experience
became a moral issue in the West.
"Breathtaking throughout...a tour de force." — Boston Globe
Philosophy/0-679-75122-1
HISTORY OF SEXUALITY, VOLUME III / russ
THE CARE OF THE SELF
The third and final volume of Michel Foucault's widely acclaimed examination of
"the experience of sexuality in Western society."
"A monument to the audacity and ambition of modern French scholarship and
philosophy. He leaves us in his debt." — San Francisco Chronicle
History/Psychology/0-394-74115-2
DISCIPLINE AND PUNISH
THE BIRTH OF THE PRISON
In this brilliant study, Foucault sweeps aside centuries of sterile debate about
prison reform and gives a highly provocative account of how penal institutions and
the power to punish became a part of our lives.
"Must be reckoned with by humanists, social scientists and political activists."
— The Ness York Times Book Reviews
Philosophy/Criminology/0-394-72767-3
AVAILABLE AT YOUR LOCAL BOOKSTORE, OR CALL TOLL-FREE TO ORDER: 1-800-793-2665
(CREDIT CARDS ONLY).

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