About the Author
Lydia Alix Fillingham has taught literary theory, Victorian literature, and writing, at Stanford University, University of Colorado, and Harvard University. She is currently an independent author, and also an attorney. She lives with her husband and two cats in Concord, Massachusetts.
Read an Excerpt
FOUCAULT FOR BEGINNERS
By LYDIA ALIX FILLINGHAM, Moshe Süsser
For Beginners LLCCopyright © 1993 Lydia Alix Fillingham
All rights reserved.
MADNESS & CIVILIZATION
What we have in English is only a great abridgment of the original book, which is over 600 pages long.
Well, suppose you see a man who has odd violent outbursts at no one in particular and strikes out at the air meet around him.
Now you meet another man who tells you that the FBI has planted a radio receiver in his brain and is monitoring his thoughts, and he believes they will soon take control of him. (Let's assume you don't believe him.)
Then you meet a man who sits perfectly still and does not move or speak, though you discover that he is physically capable of doing so.
Look at these three men, forgetting for a moment everything you have heard about insanity. Clearly each of them has a problem that may keep him from functioning well in our society.
They might seem to be using logic very rigorously. If the FBI had placed a transmitter in your brain to monitor your thoughts, it would make sense to suspect them of trying to take control of you.
But then, suddenly, in the 14th century, leprosy disappeared!
Everyone was happy about it, but what were they supposed to do with these big places to lock people up? They left them empty, but just for a while ...
In the 15th century a new idea cropped up, and became a central image in the popular imagination:
Wandering down a river, a ship of outcast men are taken from one town to the next, always expelled, frequently with a payment to the captain to keep them on their way.
Why did this image suddenly pop up? A cultural fascination with madness. A terrifying threat that may contain an even more terrifying truth. Erasmus (1466-1536), a Dutch philosopher, wrote The Praise of Folly (Moriae Encomium, 1509). It and Shakespeare's King Lear (1605) both focus on the dangerous insights the madman may have.
IN the 17th century, suddenly as many people as possible were locked up. Criminals, yes, for any small infraction, and madmen, anyone acting strangely (and this certainly included epileptics), and the sick who might earlier have been taken care of at home, but the poor as well, anyone out of work. One Parisian in a hundred was confined. This is where the old leprosy houses came in very handy.
The mad became thought of as a subcategory of the unemployed. You might think that the poor were victims of an economic problem, but no, they were creators of a moral one.
Madness was now shameful and must be hidden.
In the 17th and 18th centuries, not content with pinning down the madman, people wanted to pin down the idea of madness as well.
How did they think of madness?
By the end of the 18th century, it was said that physical treatment alone would not cure madness.
This did not mark the beginning of psychological treatment, but rather the breakdown of the unity of body and soul, the breakdown of the internal consistency of the symbol system.
Mirabeau and the Marquis de Sade, two French Counts were both in prison at the same time, as incorrigible upper-class libertines.
Sade, father of sadism, the "true madman, and truly immoral," is let out first, while Mirabeau, soon to be the hero of his country, rots in jail for no real reason; this irony symbolizes, for the Revolutionaries, the whole problem with the world.
THEN THE REVOLUTION HAPPENS. STORMING OF THE BASTILLE. MIRABEAU WILL LEAD THE PEOPLE IN THEIR FIGHT AGAINST
THE PEOPLE ARE IN POWER! GET RID OF THE KING! GET RID OF THE CHURCH! GET RID OF THE RICH!
Until, eventually, too many people are being gotten rid of.
But meanwhile, this is not quite how the mad experienced it. After the Revolution began, they were supposed to be taken out of prisons (mostly because it was too humiliating to the prisoners to be locked up with them), and put in special hospitals.
But the hospitals didn't exist. So they were sent home to their families.
Then they were sent away from their homes because they were too much trouble (or at least seemed like they might be).
Myths developed of the two great liberators of the mad; noble and wise men who humanized the treatment of insanity:
Pinel (Philippe Pinel), the great liberator of the mad during the French Revolution, walks into the prisons and throws off the chains of the madmen. When questioned, he says, "Citizen, I am convinced that these madmen are so intractable only because they have been deprived of air and liberty."
The mad have their own revolution, and their own liberator.
Samuel Tuke, a gentle Quaker, sets up a rural retreat for the mad. No bars, no chains. Looks like a farm, feels like a family.
The REAL story behind the myth:
Tuke—Yes, the retreat is a family, and the mad are the children, who must learn to respect the authority of the father, Tuke himself. The mad must be raised and disciplined as children. They must be taught religion, the source of all morality, and they must have chores, since work is enormously important in teaching one to regulate oneself. The chains are taken off, but if you are bad, they will be put back on, and you will have only yourself to blame.
As an 18th century madman you had a certain kind of freedom from responsibility that was now utterly removed. Now madness was your own fault, your responsibility, and because other people were always watching you, you learned to watch yourself.
Tuke and his attendants would conduct tea-parties for the patients, but far from being social treats, they were fearsome tests. The patients each had to act the part of an unknown stranger visiting from afar, and had to behave with decorum and make small talk. Thus the new ideal is set for patient behavior. They must each learn to become the perfectly anonymous "normal" person, with no unusual traits, no individuality.
Pinel established a system of morality very much connected to the newly dominant middle-class as the absolute power within the asylum, and thus the standard for society as a whole. The danger of madness now came from lower-class people who did not wish to conform to this standard.
The keepers continually sat in judgment on the mad, meting out punishment for every transgression.
The pattern of judgment and punishment had to be repeated until firmly internalized by the patient.
Enter ... the Doctor!
(He wasn't there in the older asylums.)
What good can someone trained in medicine do to those who are not physically ill? THE DOCTOR IS A CERTIFIED WISE AND NOBLE MAN. Both Tuke and Pinel found the most important thing to be the presence of a great moral authority, and both hired doctors for their asylums. Gradually the doctor took over as THE FATHER from such non-specialists as Tuke and Pinel. The only problem was that doctors forgot that they were there because they were noble and wise. They thought that medicine was a hard science, that they were in the asylum as scientists, and that they could shed exact light upon this disease.
To the patients, and to the world at large, the doctor's power seemed increasingly magical, even as the doctors told us how scientific it was.
Everything centers on the doctor-patient relationship—only there can the sickness be understood; only there can the cure be effected. And here, at the end of the trail, we find PAPA FREUD.
Freud knew that the doctor was a wise father, and that it was all about parental authority. Freud knew that the doctor had to be a wise man, and that everything hinged on the doctor-patient relationship—in fact, the cure could be found exactly there—in how the patient reacted to the doctor.
Having been to an analyst himself, Foucault had some doubts.
Foucault started thinking about Freud in writing this book, but he wasn't finished by a long shot.CHAPTER 2
THE BIRTH OF THE CLINIC
What exactly does Foucault mean by the Clinic?
Actually, you've seen it on TV. Think of Dr. Kildare, Dr. Welby, St. Elsewhere, or Doogie Howser (pick the one from your generation). In all of those shows you've seen the experienced doctor making the rounds of the wards, along with eager and scared novices.
If you've been in a hospital you may have seen the same thing. You probably accept it as a natural part of being sick and in a hospital, part of what helps you. But notice what happens to the patient in these interchanges.
A bunch of people crowd around the bed staring at her, perhaps poking and feeling. She is supposed to be silent unless she is asked a question, and at times she is used as the basis for the ritual humiliation of a student. She becomes a thing, a disease, as the doctors are not interested in anything else about her. (Except, of course, the TV doctor-hero who always sees and understands the real person lying there.)
All of this, the teaching hospital and the notion of clinical medicine as the best method of treating patients and of training doctors, at the same time, is what Foucault refers to by "LA CLINIQUE."
One big element in its creation was, once again: The French Revolution
There were two great medical dreams of the Revolution:
1 ... A nationalized, almost religious order of doctors, who would care for the body as the priests had formerly cared for the soul.
2 ... a perfected social order, with no more disease at all!
The diseases of the poor are products of the horrible conditions in which they live, and the diseases of the rich are the result of their dissipation.
But how do you put such policies into place?
In the Revolution, the first move was to get rid of the old ways. The Universities were seen as the bastions of the elite, so they were done away with. The hospitals were seen as a waste of money—people could be cared for more efficiently at home, within the family. So no more hospitals. Hospital funds were seized, and sometimes saved, sometimes used to fund public charity, and sometimes turned into ready cash.
So certainly doctors were needed. Medical officers were needed, and pretty much anyone was accepted and given a little bit of training. These people would return to civilian life as doctors and, unsupervised, could do a lot of damage.
Something had to be done.
University-trained doctors began teaching students in secret.
After the Revolution, the whole system was rebuilt from scratch. Hospitals had to be rebuilt, and they were usually connected to the rebuilt universities.
So what is important about the Clinic?
* Teaching is united with practice.
* The Clinic becomes a basis for the licensing of doctors, which gradually became much more restricted.
* THE PROFESSOR OF MEDICINE becomes a very powerful figure. He examines the patient, and then "examines" the students. At the same time, the professor is always taking a risk. If he makes a blunder, it may be seen by all the students.
* Patients accept the clinical rounds as part of their necessary service to the state. Yes, they may die, but nobly, since they will add to human knowledge.
* As the place of medical learning, the clinic offers up a series of diseases. All examples of a particular disease may be located in a single ward. The disease is what is important, the individual patient is just an accident. The more unusual the disease, the more interesting the patient. So the diseases are laid out spatially, and the professor walks from one to another, turning his all-powerful eye on each one.
A kind of active vision, what Foucault calls
A desire develops for a complete nosology (a system of classifying all disease) that would be like Linnaeus' taxonomy of plants and animals.
But not enough is known about disease—too much is hidden from the eye. Suddenly there is a new focus:
"For twenty years, from morning to night, you have taken notes at patients' bedsides ... and all is confusion for you in the symptoms which, refusing to yield up meaning, offer you a succession of incoherent phenomena. Open up a few corpses: you will dissipate at once the darkness that observation alone could not dissipate." —Marie-Francois-Xavier Bichat, speaking to students, 1803
OPEN UP A
Dissecting corpses was not actually so new, but deciding that it was central was very different. Suddenly the eye can see inside the body, and all of disease is visible to the Gaze.
Death and disease change from purely negative ideas to crucial elements in the process of life.
Science focuses on general principles, not on individual circumstances. Newton did not stop his thought at the particular apple that fell on his individual head; he developed a principle that would account for all apples, all objects, falling.
But such science has a great deal of difficulty dealing with human beings. For some reason, we can be very abstract about apples, but when humans are concerned, we tend to care very much about the actual individual.
A round the end of the 18th and the beginning of the 19th centuries, many sciences began to focus on humans, namely the Human Sciences: economics, anthropology, linguistics, psychology and so on.
Medicine is more like HARD SCIENCE than the others, but it has always focused on humans. Opening up the corpses, Foucault maintained, gave medicine the opportunity to subject all of the Body to the scientific Gaze.
The doctor could look at a person's outsides and see the insides, and his power came from his way of seeing rather than from his abstract theories.CHAPTER 3
In his next book, The Order of Things, Foucault looked at the history of the Human Sciences as a whole.
Oddly enough, this enormously complex and difficult book became an immediate hit in France. Suddenly everybody had to have one, and Foucault was famous. He liked the recognition, but suspected that not everyone who bought the book really read and understood it.
As a matter of fact, he always felt that his work was not for everyone. He thought you needed to have a very good background in philosophy and history or his work would just be misunderstood. He wouldn't have approved of this book at all.
Foucault starts The Order of Things by quoting a passage from the Argentine writer Jorge Luis Borges:
This passage quotes "a certain Chinese encyclopedia" in which it is written that "animals are divided into:
(a) belonging to the Emperor,
(d) suckling pigs,
(g) stray dogs,
(h) included in the present classification,
(k) drawn with a very fine camelhair brush,
(l) et cetera,
(m) having just broken the water pitcher,
(n) that from a long way off took like flies."
This impossible collection of kinds of animals is so funny to us less because these kinds of animals are all that funny in themselves than because this ridiculous way of categorizing things violates all our sense of order, indeed of the order of things.
We all know when categories make sense and when they don't. Foucault wanted to see what it is "we all know," what that knowledge of how to form categories is, and how it would have been different in earlier times.
In The Order of Things he examines three major areas of the human sciences, LINGUISTICS BIOLOGY ECONOMICS
He looks at the structure of knowledge of a time, its way of establishing order. But he starts long before the existence of the human sciences, and examines the development of the fields known in the 17th and 18th centuries as GENERAL GRAMMAR NATURAL HISTORY ANALYSIS OF WEALTH
What marks the shift into the modern world?
Before the 18th century, Man did not exist.
Now what the hell does that mean?
Of course human beings existed before that, and may even have looked at themselves as the center of the universe.
But they were central because God had made them that way. God was necessarily more central, and was the source of all knowledge. Human knowledge was limited, God's was infinite. In the 18th and 19th centuries, God lost his place as the firm center of all, who made all knowledge possible. Man was left with only himself at the center, as the source of knowing, and thus turned to intense examination of what this knowing being was.
The Human Sciences sprang up as old fields were reexamined with a new notion of Man as both the object and the subject of study.
But this modern age will not last forever.
"Man is neither the oldest nor the most constant problem that has been posed for human knowledge."
As Nietzsche had heralded the death of God, Foucault now predicted a death of Man.
These huge new claims, that Man was an invention, and that he might die, catapulted Foucault into the highly visible forefront of French thought.
As I said at the beginning, every intellectual of Foucault's generation had to see himself as coming after Sartre.
What was Foucault challenging?
Sartre's famous dictum, "Existence precedes essence," established the idea that the essence, or meaning of things, was not predetermined by any outside force. Instead, meaning is constructed by men. (As Beauvoir would say, "Yes that's right. By men. That's the whole problem.") The world does not contain any transcendent meaning, we make up the meaning as we go along, filtering the world through language.
So far so good. Foucault built on these ideas, as did everyone else around him.
But the problem comes in with Sartre's notion of Existential freedom. Because no meaning is predetermined, each person is free to create his own meaning through his own actions. But that freedom itself is a given, something we either have to accept or try to deny or hide from. Any time we do not accept our essential freedom, we are acting in bad faith.
Simone de Beauvoir (1908-1986) started to question whether the role of social conditions in limiting freedom might not be more severe than Sartre said it was. Later thinkers agreed with her questions and amplified this doubt.
They started by resurrecting the work of Ferdinand de Saussure (1857-1913), a theorist in the emerging field of linguistics, who had been largely ignored until the 50's and 60's.
In any language, the relationship of signifier to signified is arbitrary.
Excerpted from FOUCAULT FOR BEGINNERS by LYDIA ALIX FILLINGHAM, Moshe Süsser. Copyright © 1993 Lydia Alix Fillingham. Excerpted by permission of For Beginners LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Madness and Civilization,
The Birth of the Clinic,
The Order of Things,
Discipline and Punish,
The History of Sexuality,