Madness and Democracy: The Modern Psychiatric Universe

Madness and Democracy: The Modern Psychiatric Universe

Marcel Gauchet
Gladys Swain
Translated by Catherine Porter
With a Foreword by Jerrold E. Seigel
Copyright Date: 1999
Pages: 350
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    Madness and Democracy: The Modern Psychiatric Universe
    Book Description:

    How the insane asylum became a laboratory of democracy is revealed in this provocative look at the treatment of the mentally ill in nineteenth-century France. Political thinkers reasoned that if government was to rest in the hands of individuals, then measures should be taken to understand the deepest reaches of the self, including the state of madness. Marcel Gauchet and Gladys Swain maintain that the asylum originally embodied the revolutionary hope of curing all the insane by saving the glimmer of sanity left in them. Their analysis of why this utopian vision failed ultimately constitutes both a powerful argument for liberalism and a direct challenge to Michel Foucault's indictment of liberal institutions.

    The creation of an artificial environment was meant to encourage the mentally ill to live as social beings, in conditions that resembled as much as possible those prevailing in real life. The asylum was therefore the first instance of a modern utopian community in which a scientifically designed environment was supposed to achieve complete control over the minds of a whole category of human beings. Gauchet and Swain argue that the social domination of the inner self, far from being the hidden truth of emancipation, represented the failure of its overly optimistic beginnings.

    Madness and Democracycombines rich details of nineteenth-century asylum life with reflections on the crucial role of subjectivity and difference within modernism. Its final achievement is to show that the lessons learned from the failure of the asylum led to the rise of psychoanalysis, an endeavor focused on individual care and on the cooperation between psychiatrist and patient. By linking the rise of liberalism to a chapter in the history of psychiatry, Gauchet and Swain offer a fascinating reassessment of political modernity.

    eISBN: 978-1-4008-2287-4
    Subjects: Philosophy

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Foreword
    (pp. vii-xxvi)
    Jerrold Seigel

    As its English title suggests,Madness and Democracycouples the history of insanity and psychiatry with the history of politics. On one level, what Marcel Gauchet and Gladys Swain give us is a story about the innovations 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 another level, this history becomes the material for a meditation on modern democratic society, in particular on the relationship...

  4. Editor’s Note
    (pp. xxvii-2)
  5. Introduction
    (pp. 3-18)

    In a sense, an intellectual “accident” is at the origin of this book, which began as the preface to a new edition of J.E.D. Esquirol’sDes passions considérées comme causes, symptômes et moyens curatifs de l’aliénation mentale(The passions viewed as causes, symptoms, and treatments of mental alienation, 1805). The text’s disproportionate growth was surprising: the work first appeared limited and easily controlled but turned out during the writing process to be voracious, uncontrollable in its dimensions, prolific in demands, illuminations, and unexpected inspirations. Writers will attest that this is a perfectly ordinary experience of loss of control. But it...

  6. ABSTRACT I: The Moment of Origin
    (pp. 19-20)

    The opinions of Etienne Esquirol (1772–1840) on mental illness, as expressed in his important bookDes Passions considérées comme causes, symptômes et moyens curatifs de l’aliénation mentale(On passions considered as causes, symptoms, and cures of mental alienation [Paris: Didot Jeune, 1805]), continued the work of his teacher, Philippe Pinel (1745–1826). Esquirol, like Pinel, believed that the origin of mental illness lies in the passions of the soul and was convinced that madness does not fully and irremediably affect the patient’s reason. While Esquirol’s later work, particularly hisMaladies mentales(Mental maladies [Paris: Baillière, 1838]), mostly focused on...

  7. Part One: Advent, Apotheosis, and Failure of the Asylum Establishment
      (pp. 23-24)

      Esquirol’sDes Passionscapitalizes on the experience its author gained at La Salpêtrière, an insane asylum founded in 1802 by the French government. From its inception, La Salpêtrière aimed at isolating mentally ill patients from society in order to cure them. The idea of curing madness was not entirely new at that time: the asylum at Charenton had been pursuing this goal since 1797. From a humanitarian point of view, Charenton represented a considerable advance over the old Parisian institution of the Hôtel-Dieu, where the insane were imprisoned in gruesome conditions, with no effort made to heal them. Like La...

    • CHAPTER I La Salpêtrière, or The Double Birth of the Asylum
      (pp. 25-48)

      Charenton, or the experiment that went nowhere: that would be one way to sum up the meaning of the episode. Charenton bears witness to the prominent inscription of the problem on the agenda of the times. But it also attests to the difficulty of finding an adequate response to the problem from the start, finding a balance between the weight of the past and the seductions of false novelty. After the decision to set up a program for “full and complete treatment of insanity” at Charenton was made, it took five more years—five years of obstinate persistence in following...

    • CHAPTER II The Politics of the Asylum
      (pp. 49-83)

      If we try to reconstruct the way the crucial conversion came about, it appears as though the insane asylum began to dominate medical thinking with its own logic, that is to say, its own phantasmatic construction, almost from the start. For it is clear that the pattern of authority within which psychiatric practice was integrated is a borrowed model, endowed with an abstract general validity. While this pattern found an exemplary embodiment in the insane asylum, it could not have been invented there. Doctors did not use the asylum to create a unique, unprecedented structure. They took their cue from...

    • CHAPTER III Impossible Power
      (pp. 84-99)

      Need we dwell on the inexorable, obligatory, constitutive failure of the phantasmagoric totalitarian mechanism? Perhaps so; for some of our contemporaries have a peculiar tendency to be credulous. They are inclined to take a project literally, no matter how excessive, and put it on display like a scarecrow; they remain untroubled by any hints of the inherent lack of realism that makes the project impotent or inapplicable. They act as if the project could work; as if, for example, the “eye of power” that is positioned at the core of the panoptic machine, infinitely open and theoretically infallible in its...

    • CHAPTER IV A Socializing Machine
      (pp. 100-144)

      However accurate our evaluation of the failure inherent in the asylum project itself may be, we must not allow it to blind us to the critical operation that was actually carried out in that context, or to keep us from examining its unintentional success. Although a certain number of insane patients were surely cured in asylums, the asylum itself could hardly have been “the instrument for curing” that its advocates expected. Even so, it was not without an instrumental function. In other words, from a historical point of view, its role was not limited to the purely segregative function of...

  8. Part Two: The Passions as a Sketch of a General Theory of Mental Alienation
    • ABSTRACT V: Esquirol in 1805
      (pp. 149-149)

      Esquirol published his doctoral dissertationDes Passionsat age 33. A continuation and systematization of Pinel’s theses on mental illness,Des Passionsis more directly oriented toward psychiatric practice than the writings of Pinel....

    • ABSTRACT VI: The Clinical Resolution
      (pp. 149-149)

      Des Passionsrests on the assumption that an adequate clinical treatment can cure mental illness. While arguing in favor of a detailed analysis of all symptoms of mental alienation, Esquirol is never a mere empiricist; by postulating that the root of mental illness is located in the passions, he achieves a theoretical breakthrough in the understanding of madness....

    • ABSTRACT VII: Between the Will to Madness and Brain Lesions
      (pp. 149-149)

      According to Esquirol, madness does not affect the intellectual faculties alone; it is a total phenomenon that touches upon all aspects of human personality. Yet madness does not completely abolish the self; it allows the mentally ill to preserve part of their personality and presence to the world. For Esquirol, madness is neither simply a brain lesion nor a failure of the intellect, but a divisive force that affects the entire human being by turning the sick half against the healthy one....

    • ABSTRACT VIII: What the Passions Make It Possible to Think (Beginning)
      (pp. 150-150)

      Esquirol insists that madness cannot be understood without reference to the human body, yet the presence of madness in the body does not take the form of visible brain lesions. Pinel had already polemicized against the idea that madness is caused by incurable organic lesions. Mania, for instance, was in Pinel’s view “a purely nervous state” that does not involve lesions and could be cured by an appropriate diet and moral treatment. Esquirol agrees with Pinel: madness affects the nervous system without destroying it physically.

      Both Pinel and Esquirol subscribed to the theory that passions are governed by the epigaster....

    • CHAPTER V What the Passions Make It Possible to Think
      (pp. 151-162)

      Introducing the passions into discussions of insanity offers a threefold conceptual benefit. First, it confers consistency on the idea that, in a general way, what is “altered, perverted, or annihilated” in alienation at a given moment nevertheless remains potentially intact. Second, it lends support to the idea that there is a certain distance between the patient and her illness, even though the illness affects her presence to herself and her power to separate herself from herself. The distance is grounded in anatomy and physiology, but it is experienced and sublimated as “psychological” distance. The ultimate image of the insane patient...

    • CHAPTER VI Reducing Insanity: The Mirror of Alterity
      (pp. 163-166)

      We have moved from viewing the subject as abolished to making the subject responsible for his or her alienation: this sums up the break in the implicit overall understanding of madness that its causal decentering induced. Thus the manifestations of madness could be reinscribed within the space of what makes human sense; its signs and forms could be recuperated and incorporated within the general sphere of the comprehensible. This is the other aspect of the reconquest allowed by the interpretive recourse to the passions, which are now viewed assymptoms. Indeed, as long as the intervention of obliterating causes is...

    • CHAPTER VII The Society of Individuals and the Institution of Speech
      (pp. 169-193)

      In the genesis of moral treatment, we can see distinctly the conjunction and articulation of the two basic factors whose determining role in the origins of the psychiatric phenomenon in general we have spelled out above: a revolution in the representation of human beings, and a revolution in the practice and in the symbolics of the relationship of one human being with another. It is easy enough to understand how the presuppositions of moral treatment are related to what we have called the reversal of the moral conception of madness. That conception has implications for the individual’s capacity to make...

    • CHAPTER VIII The Conquest of Dissymmetry
      (pp. 194-229)

      In practice, it was exceedingly difficult for therapists to free themselves from the old attitudes and assume fully the new possibilities at the heart of the bond of communication, with all their uncertainties and dangers. One written account in particular offers exemplary testimony to the difficulties. Affecting in its honesty, the text is all the more enlightening in that its author was situated precisely at the crossroads between two periods. He could see clearly what strategy was required and what institutional arrangements were needed, but he was also invincibly held back, in spite of everything, by old reflexes and insurmountable...

    • CHAPTER IX Openings and Aporia of Moral Treatment
      (pp. 230-254)

      Esquirol’s text is remarkable precisely because it sets forth the first determining point of inflection of the not-very-linear historical process by which the newly acquired power over the other was explored and gradually elucidated.Des Passionsconstitutes a goal reached by indirection. In that text the notion of a reflective foundation on which moral treatment is betting—a notion that Pinel for his part fails to grasp and situate, as we have seen, even though he constantly presupposes it—achieves a more or less consciously assured expression for the first time. Furthermore, Esquirol does much more than simply spell out...

  9. EPILOGUE: Social Divide, Division of the Subject, Mad Rupture
    (pp. 255-282)

    We have changed. We have become individuals, primary, free, and self-sufficient social atoms. The constitutive paradox of the anthropology of democratic societies is that human beings are for the first time recognized as possessing original and inalienable rights that antedate the collective phenomenon. We are masters of ourselves before the law, externally independent in terms of the community to which we belong; and we are also, and correlatively, the first beings to discover that we are subjugated from within, internally dependent, dispossessed of ourselves by something that comes from nowhere but ourselves. The social emancipation of the individual has as...

  10. Notes
    (pp. 283-310)
  11. List of Works Cited
    (pp. 311-316)
  12. Index
    (pp. 317-323)