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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
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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 mystifications—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 maniac 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.
Madness and Civilzation ( A History of Madness) Page 28