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-
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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
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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,
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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 century 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 consti�
�tutes, 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
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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 non-being 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
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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
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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-
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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;
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