Table Of ContentMadness and Democracy
N E W F R E N C H T H O U G H T
SERIES EDITORS
Thomas Pavel and Mark Lilla
TITLES IN THE SERIES
Mark Lilla, ed., New French Thought: Political Philosophy
Gilles Lipovetsky, The Empire of Fashion: Dressing Modern Democracy
Pierre Manent, An Intellectual History of Liberalism
Jacques Bouveresse, Wittgenstein Reads Freud: The Myth of the Unconscious
Blandine Kriegel, The State and Rule of Law
Alain Renault, The Era of the Individual: A Contribution to a History of Subjectivity
Marcel Gauchet, The Disenchantment of the World: A Political History of Religion
Pierre Manent, The City of Man
Marcel Gauchet and Gladys Swain, Madness and Democracy:
The Modern Psychiatric Universe
Marcel Gauchet and Gladys Swain
Madness and Democracy
THE MODERN PSYCHIATRIC UNIVERSE
Translated by Catherine Porter
With a Foreword by Jerrold Seigel
NEW FRENCH THOUGHT
PRINCETON UNIVERSITY PRESS * PRINCETON, NEW JERSEY
Copyright(cid:211) 1999byPrincetonUniversityPress
PublishedbyPrincetonUniversityPress,41WilliamStreet,
Princeton,NewJersey08540
IntheUnitedKingdom:PrincetonUniversityPress,Chichester,WestSussex
TranslatedfromtheFrencheditionofMarcelGauchetandGladysSwain,LaPratiquede
l’esprithumain(Paris:(cid:211) EditionsGallimard,1980)
AllRightsReserved
LibraryofCongressCataloging-in-PublicationData
Gauchet,Marcel
[Lapratiquedel’esprithumain.English]
Madnessanddemocracy:themodernpsychiatricuniverse/MarcelGauchetand
GladysSwain;translatedbyCatherinePorterforPrincetonUniversityPress;witha
forewordbyJerroldSeigel.
p. cm.—(NewFrenchthought)
Includesbibliographicalreferencesandindex.
ISBN0-691-03372-2(cl:alk.paper)
1.Psychiatrichospitalcare.2.Power(Socialsciences).3.Mentalillness—Socialaspects.
I.Swain,Gladys,1945–1993.II.Gauchet,Marcel,1938– .III.Title.IV.Series.
[DNLM:1.MentalDisorders—therapy.2.Hospitals,Psychiatric.3.Power(Psychology)
4.Psychotherapy—methods.WM400G265p1999a]
RC439.G2813 1999
362.2¢—dc21
DNLM/DLC
forLibraryofCongress 98-45014
PublishedwiththeassistanceoftheFrenchMinistryofCulture.
ThisbookhasbeencomposedinAdobeBauerBodoni
Thepaperusedinthispublicationmeetstheminimumrequirementsof
ANSI/NISOZ39.48-1992(R1997)(PermanenceofPaper)
http://pup.princeton.edu
PrintedintheUnitedStatesofAmerica
10 9 8 7 6 5 4 3 2 1
Contents
ForewordbyJerroldSeigel vii
Editor’sNote xxvii
Introduction 3
AbstractI:TheMomentofOrigin 19
Part One: Advent, Apotheosis, and Failure
of theAsylum Establishment
AbstractII 23
Chapter I
LaSalpêtrière,orTheDoubleBirthoftheAsylum 25
Chapter II
ThePoliticsoftheAsylum 49
Chapter III
ImpossiblePower 84
Chapter IV
ASocializingMachine 100
AbstractIII:Crisis,Agony,andRepetition 145
AbstractIV:EsquirolatLaSalpêtrière 145
Part Two: The Passions as a Sketch of a General
Theoryof MentalAlienation
vi CONTENTS
AbstractV:Esqirolin1805 149
AbstractVI:TheClinicalResolution 149
AbstractVII:BetweentheWilltoMadnessand
BrainLesions 149
AbstractVIII:WhatthePassionsMakeItPossibleto
Think(Beginning) 150
Chapter V
WhatthePassionsMakeItPossibletoThink 151
Chapter VI
ReducingInsanity:TheMirrorofAlterity 163
AbstractIX:ApproachestoHealing;HowtoSpeak
totheInsane 167
Chapter VII
TheSocietyofIndividualsandtheInstitutionofSpeech 169
Chapter VIII
TheConquestofDissymmetry 194
Chapter IX
OpeningsandAporiaofMoralTreatment 230
Epilogue:
SocialDivide,DivisionoftheSubject,MadRupture 255
Notes 283
ListofWorksCited 311
Index 317
Foreword
A
s its English title suggests, Madness and Democracy couples the
historyofinsanityandpsychiatrywiththehistoryofpolitics.Ononelevel,
whatMarcelGauchetandGladysSwaingiveusisastoryabouttheinno-
vations in theory and treatment made by the French alienists Philippe
Pinel and Jean-Etienne Esquirol in the years around 1800, about their
utopian hopes for effecting radical and complete cures of mental illness,
and about the institutions that developed as these hopes waned. But at
anotherlevel,thishistorybecomesthematerialforameditationonmod-
erndemocraticsociety,inparticularontherelationshipbetweenindividu-
als,power,andcollectivelifethatemergedintheeraoftheFrenchRevolu-
tion. The book belongs to a genre that is little practiced in the United
States,so that aword or twoabout its methodatthestartmayhelp pre-
parereadersforwhattheywillfindinit.
The history Gauchet and Swain write is also philosophy. Their way of
combiningthetwodisciplinesbelongsneithertothe“analytical”philoso-
phy of history practiced by Anglo-American thinkers who descend from
Wittgenstein,nortothe“speculative”philosophyofhistorythatweiden-
tifywith such greatnineteenth-centurynamesasHegel,Marx,Ranke,or
Michelet. As historians our authors pay close attention to persons and
movements,textsandcontexts,butasphilosopherstheyoftenmeditateon
thesematterswithaconceptualintensitytowhichhistorians—happily or
not—seldomaspire.Nordohistoriansusuallyaimforashighlytheorized
an understanding of modernity, of how itcontrasts with theforms of life
that preceded it, and ofwhat it has so farbeen and meant,as theone at
workhere.
OnewriterwithwhosemethodGauchetandSwainshareagooddealis
theveryoneagainstwhomtheirworkisinmanywayswritten,butwhose
powerfulexampleandinfluencetheyacknowledge,MichelFoucault.The
subjectofinsanityanditstreatmentisoneofmanytopicsthathavebeen
enlivened by Foucault’s provocative dealings with them; it was he who
first made clear how forcefully the understanding of mental illness bears
on questions of modern individuality, freedom, and power.1 Like Fou-
cault,ourauthorsmakethesecrucialissuestheirintellectualquarry;their
interpretations,however,theirunderstanding ofthehistoryofpsychiatry
andtheirsenseforthewayitsemergencehelpstorevealtheinnershapeof
modernlife,arestronglyatoddswithhis.Onewaytodescribethisdiffer-
viii FOREWORD
ence,quicklyandinakindofshorthand,istosaythattheydrawsomeof
the basic conceptual armature of their analysis not from Friedrich
Nietzscheorthetwentieth-centuryartisticavant-garde(twoofFoucault’s
inspirations), but, like some other recent French scholars and theorists,
from the problematic of modern democracy and liberty elaborated by
AlexisdeTocqueville.ThisisnottosaythatTocquevillewastheirpointof
departure, or that he is their only theoretical reference point, any more
thanNietzscheortheavant-gardewasforFoucault.Buttheirgeneralper-
spectiveowesmuchtoTocqueville’smeditationsondemocracy.Likehim,
theysimultaneouslyacceptdemocraticsocietyandworrydeeplyaboutits
implications; theydo not, inthemannerofaNietzsche,rejectitasadis-
guisefortheruleoftheweakorsearchforwaystoliberatetheprimordial,
prerationalhumanpowersitissupposedtohavedeniedandrepressed.
For Gauchet and Swain, as for Foucault, what joins the history of in-
sanity and its treatment to the history of politics and democracy is the
question of human subjectivity: what does it mean that human beings
regardthemselvesasthefocalpointsandinsomedegreethedeterminants
of their own experiences and actions? Such questions have long framed
arguments about knowledge and agency. Immanuel Kant held that the
verypossibilityofcoherentexperience,andofthescientificunderstanding
thatmayarisefromit,dependsonsomeinnatecapacityofrationalbeings
togivepersistenceandcoherencetotheever-shiftingfluxofsenseimpres-
sionsthattiesthemtotheworld.Andheidentifiedthepossibilityoffree-
dom, and henceofmoralityand ofpoliticalliberty, withwhateverpower
mindfulcreaturesmaypossesstodeterminetheirownactionsthroughthe
principlesofreasonitself.AcenturylaterNietzschewouldturnthisvision
onitshead,arguingthatthecoherenceandpersistenceKantsoughtwere
protective barriers set up by weak creatures against the unceasing flux
thatwasthe world’sdeep, fearsometruth,and thatactionsmandatedby
transcendentprinciplesofrationalitydidnotliberatehumansubjectsbut
enslaved them to a power outside themselves (no less constraining for
bearingthenameofreason),cuttingthemofffromtheenergizingforceof
theirownvital,creativewills.
Foucault’s remarkable history of insanity, Madness and Civilization
(originallypublishedin1961,atatimewhenGauchetandSwainwerestill
students),recastthebeginningsofmodernpsychiatryintheseNietzschean
terms,findingnewandmoreinsidiousformsofoppressionwhereEnlight-
enmentreasonandhumanitysawemancipation.Thelong-celebratedim-
age of Pinel freeing asylum inmates from their chains,2 the practices he
andhisEnglishcontemporaryWilliamTukeadoptedinordertoacknowl-
edgethehumanityoftheinsaneandtoinstitutea“moraltreatment”that
sought cures through mobilizing the reason that even humans afflicted
withmadnessstillpossessed,theseFoucaultinterrogatedinordertoreveal
JERROLD SEIGEL ix
adifferentcontentbehindthem.Thenewdoctors“substitutedforthefree
terror of madness the stifling anguish of responsibility,” instilling in the
patient an organized sense of guilt that made him or her “an object of
punishment always vulnerable tohimselfand totheOther;andfromthe
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 re-
sponsible subject, and consequently to reason.”3 Foucault would later
generalize this view of theliberation offeredto mad people so thatit ap-
pliedtomodernindividuals moregenerally,whenheofferedJeremyBen-
tham’smodelprison,thePanopticon,asablueprintforalltheinstitutions
andpracticesofdisciplinarynormalizationthatformmodernindividuals:
whereverpeopleassumethestatusoffreesubjects,theydosoincontexts
of confinement and domination that subject them to the powers infused
throughsocialandculturallife.
AlthoughononelevelGauchetandSwainofferadifferentgenealogyof
themodern subject, on another their accountrendersthesearchforsuch
origins beside the point. What distinguishes human beings from other
earthly creatures is their ability to objectify their individual and social
being,tobecomeawareofthepersonalandcollectivedimensionsoftheir
existence in ways that give them some degree of independence from the
world and fromthemselves,andthussomemeasureofpowertoalterthe
conditions of their lives. That human beings are, by their very nature,
subjectsinthissensehasbeendeniedoftenenoughinhumanhistory(who
but subjects could proffer such denials?), not just by modern figures in
search of an intimate, mystical unity with cosmic being, such as Martin
Heidegger,butbyeveryhumancommunitythathasclaimeddescentfrom
godsorheroes,therebydelegitimizinganyclaimbyordinarypeopleinthe
present to participate in determining the principles that organize their
lives. Marcel Gauchet has analyzed the structures and strategies of such
denials, and the consequences of their disempowerment, in his recently
translatedbook,TheDisenchantmentoftheWorld.4
Butsuchhumansubjectivityisneverpureorcomplete,neverindepen-
dentoftheexternalconditionsthatshapeandmoldit,ortheinternalones
thatoftenlimitorweakenit.Itispreciselyinrelationtotheselimitations
of human subjectivity that Gauchet and Swain think modern theories of
insanityacquiretheirgreatestinterest.Whatdistinguishesmodernunder-
standingsofmadnessanditstherapiesfromearlieronesistherecognition
thateven in themaimedconditionofmentalbreakdown, with allits loss
of conscious control over thought and action, human beings retain their
subjectiveintegrityonsomelevel.Theirconditionstillbelongstothemas
theparticularindividuals theyare;theirinsanitydoesnotobliteratetheir
personality and mayevenbeamoreemphatictranslationofit. And they
remainabletobecomeawareoftheirstateinsomedegree,tolookuponit
