Background for Foucault’s Lectures on Psychiatric Power

by Arran James

Antipsychiatry, in general

By 1973 the antipsychiatry movement was well etablished. Although not an antipsychiatrist himself the work of Jacques Lacan had already been challenging psychoanalytic orthodoxy for decades, and he had laid the basis for a theoretical movement that would proclaim psychosis as intelligible. In the 1960s there would be an explosion of theoretical critiques of psychiatric theory and institutional practice, most of which would focus on the Aslyum as a what Erving Goffman called a  “total institution”. Thomas Szasz had challenged the entire edifice of psychiatry in his The Myth of Mental Illness, and the American sociologist Thomas Scheff developed the idea of labelling theory that almost all high school kids are now aware of. In the UK RD Laing and David Cooper- the later of whom had coined the name “antipsychiatry”- had already written extensively on madness as an understandable reaction to society, an existential response to impossible situations, and had gone on to experiment with new forms of psychiatric care.

Of these the most famous are probably RD Laing’s Kingsley Hall and David Cooper’s Villa 21, emphasising an approach to care that attempted to systematically subvert the features of the asylum. Similarly the US saw the emergence of Loren Mosher’s Soteria model of mental health care in the 1960s. What Laing, Cooper and Mosher’s experiments had in common was the idea of providing a genuine space of sasanctuary from the world, a disalienated-disalienating space in which people could go mad safely, without an emphasis on restraint, either physical or chemical. But perhaps no part of the antipsychiatry movement went further than Franco Basaglia’s reform of the Italian psychiatric system. Preferring the name “democractic psychiatry”- almost all the antipsychiatrists would at some point or another reject the name- Basaglia’s Law made it illegal to build any more hospitals, and started the process of deinstitutionalisation in Italy. Basaglia’s experiment might have been the most radical of all, given as it took place within an existing psychiatric facility. He and a team around him set about desegregating patients from staff, and progressively handing over more and more control of the his ward’s treatment and administrative powers to those patients. In many respects Basaglia’s experiment in Gorizia is closer to Guattari’s experiences at La Borde than any Laing and Cooper attempted. Guattari himself became involved in the network for an alternative psychiatry that Basaglia was also a member of, and all these experiments would be profoundly important to his development as a thinker of political therapeutics, as well as in his capacity as Deleuze’s accomplice in writing of capitalism and schizophrenia.

Of course throughout all this there was also grass roots movements outside the walls of the hospital and the academy. Among the most dramatic examples of this were the gay rights activists throughout the world who challenged the idea that homosexuality was a pathology. Arguably one of the high points of gay militancy was the Stonewall riots of 1969. The riots broke out in Greenwich Village after the police raid of a public meeting of “homophile” groups, the name for proto-gay liberation organisations. The riots accelerated and radicalised large amounts of the young gay community, many of whom turned against the previous homophile acceptance of the idea that homosexuality was a medical condition, a psychopathology. In 1970, during a film screening about the use of ECT as a treatment for same-sex attraction (ie. ECT as a cure for homosexual desire), a number of gay activists began to shout “torture!”, “barbarism!”, and rushed the stage to yell and, eventually, to explain how psychiatrists were complicit in the torture of gay men and women. The film screening was an event held and hosted by the American Psychiatric Association. This, and other similar protests, eventually led to homosexuality being dropped from the nosology of mental disorders in 1973.Similar fights are still ongoing in relation to trans people, but that exceeds the context setting of an immediate potted history prior to Foucault’s 1973 lectures.

Elsewhere, the Socialist Patients Collective- a group heavily influenced by Hegelian Marxism- was a group of people founded via a therapy group run by psychiatrist Wolfgang Huber. It was Huber’s belief that his patients were only mad because of the pathogenic effects of capitalism and that only a communist revolution could effect a cure of their condition. Huber’s higher-ups would try to fire him and his patients would form the SPK as a group to protest this. The SPK occupied the hospital, held protests. They also produced some of the most militant communiques and manifestos of the antipsychiatric period, and even secured Sartre’s approval (he wrote a preface for their manifesto). By the mid-1970s most of the SPK had disbanded- although it exists today in an attenuated form- and had joined the Red Army Faction. By this point the SPK had already begun engaging in acts of terrorism.

At the same time, this period of history also saw the abuses of the Soviety psychiatry coming to public attention, a topic I hardly need to elaborate on here.

For the sake of space I’ll leave it at that. I’m not trying to give a history of the antipsychiatric movement or attitude or orientation, but to give some context as to what had been going on around the issues of madness and politics before Foucault took to the stage to lecture of Psychiatric Power at the end of 1973. Of course, Foucault had already penned Madness and Civilisation by this point, as well as numerous other essays and interviews (notably the paper on dangerous individuals).

Foucault’s antipsychiatry, in general

By 1973 we see Foucault wanting to distance himself somewhat from Madness and Civilisation. This is the period in which Foucault is moving from his archaeological/structuralist methodology to the genealogical/post-structuralist period. Or, if we prefer, he is moving towards what he will call in the first volume of the History of Sexuality, “the law of immanence”. This transition in his thinking marks a movement from an analysis of institutions towards a pragmatics of dispositifs. In the Lectures of Psychiatric Power Foucault is keen to point this out:

 

Here, in this second volume [on madness], I would like to see if it is possible to a make a radically different analysis [than that of Madness and Civilisation] and if, instead of starting from the analysis of this kind of representational core, which inevitably refers to a history of mentalities, of thought, we could start from an apparatus (dispositif) of power. That is to say, to what extent can an apparatus of power produce statements, discourses, and, consequently, all the forms of representation that may then derive from it (2008, 13).

 

Without going any further into this quote for now, we can see Foucault himself identifying the relevant shift in his thinking: away from representation and towards that from which representation is assembled. We are on the move from the inherited image of power as constraint and repression, towards that in which power is also seen as productive.

Jacques Lagrange goes explains further in the “Course Summary” that appears at the end of my edition of the Lectures. For Lagrange, the Foucault of Madness had been concerned with ‘putting psychiatry on trial and accusing it of concealing the real conditions of mental pathology behind nosological abstractions’ (2008, 350). It is arguable that this has always been the main stock of the antipsychiatry movement. Even today the bulk of the critiques (at least the more academic ones) are focussed on a critique of the nosological noumenclature of the DSM. Its not exactly that this work is unimportant, that such critiques shouldn’t be carried out, but that they operate at the level of representations, of ‘mentalities’, and so on the terrain of psychiatry itself. The more interesting question, and the one that is much more in the spirit of Foucault’s Lectures, and of the work of Deleuze and Guattari, is the question of what these diagnoses do, what function they perform, what tactics they enact, how they come to operate between the body of the patient and the body of the psychiatrist on the field of battle. Foucault’s new approach, that both Habermas and Deleuze would identify as functionalist, although functionalism of a different kind, would emphasised what went on beneath the level of these representations, asking the questions of how they emerged, which conjunctions they emerged from, to whose benefit, and to whose loss?

Lagrange returns us to the question of Soviet psychiatry in order to point out that this placed a severe limit on what French antipsychiatry could achieve. The psychiatrists of France didn’t want to draw too much attention to their own practice in case they too would be accused of committing crimes against humanity, of abusing the status of their profession, of political torture. As we saw above, the APA had been getting accused of exactly that in the United States, so the French psychiatrists were probably not being paranoid in fearing the same. Foucault comments that French psychiatrists ‘found themselves blocked by a political situation…taking place in the Soviet Union’ (cited in 2008, 352) and goes on to state that psychiatrists could thus ‘struggle against medicine and the administration without being able to free themselves from either one or the other’ (cited in 2008, 352). In essence, Foucault’s problem with his old form of analysis- although he stated in Madness that he wasn’t doing a history of psychiatry but of madness itself- was that it to remained caught within the medical-administrative problem. That is to say that the old critiques remained focussed on the institution of the asylum and so were operating within a territory that was demarcated and set out in advance by the institution itself. The question of psychiatric power, of what it is composed and how is operates, can never be raised when one’s focus is a critique of the institution and the attempt to discover a new institutional arrangement. Left to their own devices the psychiatrists could never really question their own power. This wasn’t simply because they were corrupt agents of domination- a position still in keeping with institutional analysis- but because they were themselves ‘state employees’, as Foucault notes. To challenge psychiatric power effectively would be to dissolve their own positions in relation to the mode of production. A true antipsychiatry would produce superfluous psychiatrists, plunging them into the mass of the relative surplus population and unemployment and poverty with it.

As we saw above almost all the other radical antipychiatrists took the institution as their target, and many of them attempted new institutional modalities. Even Szasz attempted to defend a particular model of the consensual contracted psychotherapeutic relationship (and completely misunderstood how psychotherapy works in the process). In a certain sense Foucault believes that his critique of psychiatry goes further than the others because it refuses to speak on its grounds or about its problematics. Just as Foucault would announce that he had yet to cut off the king’s head, so to he thought that we hadn’t truly left the asylum. As long as we remained within and with the institution we would not be able to really expose the multiplicity of operations of power that lay beneath it, upon which it rested, and which could not be confined to the institution itself. In later entries we’ll see that Foucault is keen to see that the institution had always been in the process of an immanent auto-deinstitutionalisation insofar as its principles and strategies of functions and operations were also bleeding beyond its own discursive and concrete walls:

 

 

The first consequence [of the psychiatric colonisation of childhood] is that psychiatry will now be able to plug into a whole series of disciplinary regimes existing around it, on the grounds of the principle that it alone is both the science and power of the abnormal. Psychiatry will be able to claim for itself everything abnormal…The generalisation, diffusion, and dissemination of psychiatric power took place in our society by way of this carving out of the abnormal child (2008, 222).

This moment in Foucault’s text can hardly be underemphasised. Foucault is one of the few antipsychiatristic theorists who is not a psychiatrist or psychotherapist of some order. When he critiques the emphasis on the institution I think we have a legitimate reply in the form of asking Foucault what he would see happen to people who go mad in capitalist societies. Does he not think that they deserve any kind of refuge or care? For those of us who are mental health workers and those of us who have experienced mental suffering understand that there will also be a need for a place to go. Even within utopian conditions of full luxury communism do we really expect madness to disappear? Suffering is part of the human condition- dreams of its eradication are just that…dreams. We can reduce the amount of unnecessary suffering we undergo but we can’t expunge suffering as such. Of course Foucault would probably shrug at this question: “I’m not suggesting the mad should be left to go mad, unattended, alone, that suffering should just be allowed…but that isn’t my question; my question is more along the lines of how your question even comes to appear as a problem, and about how has tried to answer it, with what technologies, by what techniques, in what circumstances”. This is the way of Foucault, and its what causes many of his critics to regard him as a flake who can’t pick a side. I think that’s the wrong way to reprimand Foucault.

At any rate, if Foucault doesn’t provide us with an alternative form of psychiatry, or an alternative to psychiatry, he does provide us with a theory of psychiatric power that sees it functioning beneath and beyond the asylum walls even before the movement of deinstitutionalisation. Foucault’s grasp on psychiatry thus offers us a very important insight: that deinstitutionalisation, the closure of the hospitals and the creation of community psychiatric organisations, was already occurring in a much more subtle form within psychiatry itself. The ongoing dissemination of psychiatry reaches a fever pitch in our society- even as the asylum seems to be coming back into fashion: we are forced to defend hospital closures, bed losses, and find it necessary to gather around calls for the reinvention of the asylum. Foucault predicts all this. Psychiatry will always have us defending it, he seems to suggest. And it becomes more and more mobile. Foucault never lived to see the emergence and the massive over-prescription of compulsory treatment orders, but if he had I’m sure he would agree that they are little more than a fractal of the institution circulating openly in the fabric of society itself, rendering the patient’s home into an institutional space without the institution having to exist. Speaking otherwise, Foucault already begins to present us with a history of the psychiatric movement from discipline to control.

Who are the militants?

Foucault disregards many of the antipsychiatrists then. His antipsychiatry is different. It has different concerns. We see this also playing out in where Foucault identifies an authentic antipsychiatry. For Foucault the ‘front of resistance ‘ (2008, 253) to psychiatric power is to be seen in the figure of the hysteric. Foucault is unamiguous about this:

 

The hysteric has magnificent symptoms, but at the same time she sidesteps the reality of her illness; she goes against the current asylum game and, to that extent, we salute the hysterics as true militants of antipsychiatry (2008, 254).

Foucault’s Lectures are thus important for another reason. He doesn’t identify antipsychiatry as a phenomena led or even comprised by psychiatrists and other mental health workers, although he doesn’t deny their place in it. Instead Foucault asserts that the mad themselves, specifically in the form of the hysteric, are the militants. In the course of looking into the Lectures more deeply I think this will become very important for today’s nascent antipsychiatry. The question becomes, who are today’s hysterics? And a number of candidates come to mind. The most obvious that comes to mind are those people who are diagnosed with personality disorders, among the most spurious of all diagnoses. Personality disorder, especially histrionic personality disorder, has a clear historical continuity with hysteria, actually being a rebranding of the DSM-II entry “hysterical personality”. The hysteric is always suspected of faking-it, or “simulation” in Foucault’s terms, and this is quite clearly the case with personality disorder. Almost everyone that works in mental health will tell you, PD really means “I can’t work with you/you’re an attention-seeker/ you’re a cunt”. But hysteria also has links to anorexia, which may have been a subset of hysterical illness in the 19th century, and to self-harm.

It may well be that Foucault would regard people subjectivated via these diagnostic categories as today’s true antipsychiatric militants. Certainly they all share with the hysteric not just a common history but also occupy a similar position in relation to psychiatry itself (are they “real” disorders? are they treatable? are they actually forms of resistance to power? are they faking it?) as well as sharing a certain series of strategies with the hysteric, not least of which is the capacity for magnificent symptoms. Of course, we would have to be careful in these articulations not to run away with ourselves and forget the suffering that the experiences codified as these conditions also bring with them.

Yeh well….

So I’ve laid out a little general background, any of which could be expanded on. What I haven’t given much of here is a picture of French antipsychiatry in particular- perhaps that can come another time. But what I’ve tried to give myself here is some way to place Foucault’s theories in the context of his own time, in regards to antipsychiatry, and to identify certain carry overs with our own, certain concerns that are still live for us today. Among those is the question of the place of the child in relation to psychiatry, which I haven’t much gone into in the above. Foucault certainly sees it as crucial, and today we could hardly disagree. Childhood psychiatric disorders have exploded, as have the number of psychoactive drugs being prescribed to children, and the child has become recodified in many instances as an “ulta-high risk” patient. The UHR patient has no symptoms but has been identified as at a very high risk of developing symptoms. This is established via actuarial risk assessment (and maybe by gene-screening and/or neuroimagining screening as the technology improves) and parental concern. Many of these children might never develop symptoms without treatment, but you can be sure the fact that they never do will be attributed to the prophylactic doses of psychoactive substances they’re taking.

At any rate, we’ve got a series of questions to focus on while reading Foucault’s Lectures.

What is psychiatric power?- and all the related questions (how does it operate? when? where? etc).

What is the difference between the apparatus and the representation?

What is the asylum, and how does Foucault depart from it?

Who are the agencies of psychiatry and who are the agencies of resistance?

How does Foucault relate to the rest of antipsychiatry?

These are good questions to bear in mind to begin with…

References

Foucault, M. 2008[1973]. Psychiatric power: lectures at the College de France 1973-1974. Hampshire: Palgrave MacMillan.

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