Abstract
Psychiatric Power is based on the edited transcripts of a series of lectures Foucault gave at the College de France in the winter of 1973–1974. The timing of the lectures is significant in that it appears to represent a crystallisation of Foucault's thinking. After writing Madness and Civilisation in 1961, Foucault had published Birth of the Clinic in 1963. Discipline and Punish was not completed until 1975 and his three-volume History of Sexuality would not be completed until just before his death from AIDS in 1984. The ideas conveyed in Foucault's lectures seem to be evidence of his ideas about power, psychiatry and sexuality evolving into their final form.
Foucault starts by redefining ‘power’ as not being the capacity for overwhelming coercive force contained within institutions of the state, but rather the exercise of unbalanced or asymmetrical force acting within a ‘rational controlled game’.
Foucault argues that psychiatric practice is understood along the lines of imbalances of power. In his lecture on 7 November 1973, Foucault returns to a theme he identified in Birth of the Clinic in terms of the ‘medical gaze’ being constitutive of medical knowledge, which is a power relationship characterised by the imposition of some form of order upon the patient's illness. In the asylum, there is a general regulative system endowed with unlimited power without symmetry or reciprocity. Foucault sees madness as a crisis, characterized by a ‘force or explosion of power’ and the psychiatric ‘cure’ being effected by submission of the patient to the power of the asylum and the doctor. His view of psychiatric practice is that its power does not extend the power of the state, but rather the patient's family. Psychiatric treatment becomes a battle of wills. Foucault then differentiates this process from that transacted in clinical medicine, given there is no discourse in terms of pathology or physiology. Foucault is unmoved by what he sees as the ‘myth’ of Pinel and his releasing the fetters of the insane. He sees the story of the insane George III, raging against his doctor who has ordered his guards to restrain the king, as being more apposite in terms of psychiatric power.
It is his lectures in early 1974 that provide the reader with a new insight into Foucault's thought. He sees that the advent of Freud and his collaborations with Charcot and Breuer led to the conflation of psychiatry with the fledgling specialty of neurology. Psychiatry's hold of its power/knowledge in the asylum, enabling it to assert itself over madness, is suddenly vulnerable in the arena of psychoanalysis. Foucault then introduces the idea that ‘hysteria’ is a manoeuvre enabling patients existing outside of the asylum to evade psychiatric power. Foucault sees the advent of Freud and psychoanalysis as psychiatry's ‘first great retreat’. Foucault argues that in its aspirations to medical knowledge akin to that of physical medicine, it allows ‘hysterics’ to side-step this process with their unexplained physical symptoms, an operation that is so perplexing for the psychiatrist that it forces psychiatry out of its power structure manifest in the asylum and making ‘hysterics … the true militants of antipsychiatry’. The ‘hysteric’ avers to the psychiatrist in her ‘illness’: ‘You want to find the cause of my symptoms, the cause that will enable you to pathologize them and enable you to function as a doctor; you want this trauma.’
Thus, we have a situation where psychiatry is forced to confect a syndrome or an illness to legitimize its new self-concept as doctor. The ingenious process transacted in the face of shifting psychiatric power is to comport oneself as possessing an illness, which will beguile the ‘doctor’.
If we are to contextualize this to our current times, Foucault's adumbration of the successful outflanking of psychiatric power finds its contemporary manifestation in the debates in the profession around the borderline state. The sense of powerlessness we feel as clinicians when we deal with these patients may derive from our attempts to medicalize their suffering through our pursuit of biological substrates of their ‘condition’ with their consequent pharmacological remedies, or our reframing them as ‘complex’ mood or post-traumatic disorders. Perhaps Foucault's own travails with his mental health, ego-dystonic homosexuality and chronic suicidality provided an insight into this process as an observer–participant?
Retailing at nearly A$80,this book is one for the dedicated Foucault scholar. Like much of Focault's writing, his verbal discourse is equally dense and perhaps loses a little in the translation. What we do have in Psychiatric Power is a bridge between Foucault's earliest ideas on psychiatry and his later ideas on power and sexuality. Reading his lectures, one is left wondering if we are any more secure in our craft than in the days of ‘hysteria’?
Michael Robertson
Sydney, Australia
© 2007 Michael Robertson