Cover

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Title Page, Copyright

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Contents

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p. v

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Foreword

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pp. vii-xxvi

As its English title suggests, Madness and Democracy couples the history of insanity and psychiatry with the history of politics. On one level, what Marcel Gauchet and Gladys Swain give us is a story about the innovations in theory and treatment made by the French alienists Philippe Pinel and Jean-Etienne Esquirol in the years around 1800, about their utopian hopes for effecting radical and complete cures of mental illness, and about the institutions...

Editors' Note

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p. xxvii

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Introduction

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pp. 3-18

In a sense, an intellectual "accident" is at the origin of this book, which began as the preface to a new edition of J.E.D. Esquirol's Des passions considérées comme causes, symptômes et moyens curatifs de l'aliénation mentale (The passions viewed as causes, symptoms, and treatments of mental alienation, 1805). The text's disproportionate growth was surprising: the work first appeared limited and easily controlled but turned out during the writing process to be voracious, uncontrollable in its dimensions, prolific in demands...

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Abstract I: The Moment of Origin

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pp. 19-20

The opinions of Etienne Esquirol (1772±1840) on mental illness, as expressed in his important book Des Passions considérées comme causes, symptômes et moyens curatifs de l'aliénation mentale (On passions considered as causes, symptoms, and cures of mental alienation [Paris: Didot Jeune, 1805]), continued the work of his teacher, Philippe Pinel (1745± 1826). Esquirol, like Pinel, believed that the origin of mental illness lies in the passions of the...

Part One: Advent, Apotheosis, and Failure of the Asylum Establishment

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Abstract II

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pp. 23-24

Esquirol's Des Passions capitalizes on the experience its author gained at La Salpêtrière, an insane asylum founded in 1802 by the French government. From its inception, La Salpêtrière aimed at isolating mentally ill patients from society in order to cure them. The idea of curing madness was not entirely new at that time: the asylum at Charenton had been pursuing this goal since 1797. From a humanitarian point of view, Charenton represented a considerable..

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Chapter I: La Salpêtrière, or The Double Birth of the Asylum

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pp. 25-48

Charenton, or the experiment that went nowhere: that would be one way to sum up the meaning of the episode. Charenton bears witness to the prominent inscription of the problem on the agenda of the times. But it also attests to the difficulty of finding an adequate response to the problem from the start, finding a balance between the weight of the past and the seductions of false novelty. After the decision to set up a program for "full and complete treatment of...

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Chapter II: The Politics of the Asylum

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pp. 49-83

If we try to reconstruct the way the crucial conversion came about, it appears as though the insane asylum began to dominate medical thinking with its own logic, that is to say, its own phantasmatic construction, almost from the start. For it is clear that the pattern of authority within which psychiatric practice was integrated is a borrowed model, endowed with an abstract general validity. While this pattern found an exemplary embodiment in the insane asylum, it could not have been invented there. Doctors did not use the...

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Chapter III: Impossible Power

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pp. 84-99

Need we dwell on the inexorable, obligatory, constitutive failure of the phantasmagoric totalitarian mechanism? Perhaps so; for some of our contemporaries have a peculiar tendency to be credulous. They are inclined to take a project literally, no matter how excessive, and put it on display like a scarecrow; they remain untroubled by any hints of the inherent lack of realism that makes the project impotent or inapplicable. They act as if the project could work; as if, for example, the "eye of power" that is positioned at the core of the panoptic...

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Chapter IV: A Socializing Machine

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pp. 100-144

However accurate our evaluation of the failure inherent in the asylum project itself may be, we must not allow it to blind us to the critical operation that was actually carried out in that context, or to keep us from examining its unintentional success. Although a certain number of insane patients were surely cured in asylums, the asylum itself could hardly have been "the instrument for curing" that its advocates expected. Even so, it was not without an instrumental...

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Abstract III: Crisis, Agony, and Repetition

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pp. 145-145

The massive failure of the nineteenth-century insane asylum-a failure caused by the contradictory attempts both to isolate and to socialize the insane-led to a gradual disintegration of the institution, despite various attempts to revive it in the first half of the twentieth century. For the dream of total visual control over the insane, more recent psychiatry substituted the attempt to master the mentally ill by listening to their speech. Ultimately, however...

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Abstract IV: Esquirol at La Salpêtrière

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pp. 145-146

The appointment of Esquirol at La Salpêtrière as "supervisor of the insane " in 1811 signals the ascendancy of institutional treatment of the insane over individualized "moral treatment." Throughout his career, Esquirol vigorously defended the large hospitals in which a sizable population of patients could be rationally divided into categories appropriate to their behavior, then...

Part Two: The Passions as a Sketch of a General Theory of Mental Alienation

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Abstract V: Esqirol in 1805

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pp. 149-149

Esquirol published his doctoral dissertation Des Passions at age 33. A continuation and systematization of Pinel's theses on mental illness, Des Passions...

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Abstract VI: The Clinical Resolution

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pp. 149-149

Des Passions rests on the assumption that an adequate clinical treatment can cure mental illness. While arguing in favor of a detailed analysis of all symptoms of mental alienation, Esquirol is never a mere empiricist; by postulating...

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Abstract VII: Between the Will to Madness and Brain Lesions

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pp. 149-149

According to Esquirol, madness does not affect the intellectual faculties alone; it is a total phenomenon that touches upon all aspects of human personality. Yet madness does not completely abolish the self; it allows the mentally ill to preserve part of their personality and presence to the world. For Esquirol,...

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Abstract VIII: What the Passions Make It Possible to Think (Beginning)

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pp. 150-150

Esquirol insists that madness cannot be understood without reference to the human body, yet the presence of madness in the body does not take the form of visible brain lesions. Pinel had already polemicized against the idea that madness is caused by incurable organic lesions. Mania, for instance, was in Pinel's view "a purely nervous state" that does not involve lesions and could...

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Chapter V: What the Passions Make It Possible to Think

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pp. 151-162

Introducing the passions into discussions of insanity offers a threefold conceptual benefit. First, it confers consistency on the idea that, in a general way, what is "altered, perverted, or annihilated" in alienation at a given moment nevertheless remains potentially intact. Second, it lends support to the idea that there is a certain distance between the patient and her illness, even though...

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Chapter VI: Reducing Insanity: The Mirror of Alterity

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pp. 163-166

We have moved from viewing the subject as abolished to making the subject responsible for his or her alienation: this sums up the break in the implicit overall understanding of madness that its causal decentering induced. Thus the manifestations of madness could be reinscribed within the space of what makes human sense; its signs and forms could be recuperated and incorporated within the general sphere of the comprehensible. This is the other...

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Abstract IX: Approaches to Healing; How to Speak to the Insane

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pp. 167-168

Esquirol's originality consists in his incorporation of the therapeutic dimension into the definition of madness. By speaking to the insane, he aimed at reaching the human subject who is present behind his delirium and can hear the alienist. Esquirol sought to provoke a reflexive turn within the mad...

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Chapter VII: The Society of Individuals and the Institution of Speech

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pp. 169-193

In the genesis of moral treatment, we can see distinctly the conjunction and articulation of the two basic factors whose determining role in the origins of the psychiatric phenomenon in general we have spelled out above: a revolution in the representation of human beings, and a revolution in the practice and in the symbolics of the relationship of one human being with another...

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Chapter VIII: The Conquest of Dissymmetry

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pp. 194-229

In practice, it was exceedingly difficult for therapists to free themselves from the old attitudes and assume fully the new possibilities at the heart of the bond of communication, with all their uncertainties and dangers. One written account in particular offers exemplary testimony to the dif®culties. Affecting in its honesty, the text is all the more enlightening in that its author was situated...

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Chapter IX: Openings and Aporia of Moral Treatment

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pp. 230-254

Esquirol's text is remarkable precisely because it sets forth the first determining point of infection of the not-very-linear historical process by which the newly acquired power over the other was explored and gradually elucidated. Des Passions constitutes a goal reached by indirection. In that text the notion of a reflective foundation on which moral treatment is bettingÐa notion that Pinel for his part fails to grasp and situate, as we have seen, even though...

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Epilogue: Social Divide, Division of the Subject, Mad Rupture

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pp. 255-282

We have changed. We have become individuals, primary, free, and self-suffcient social atoms. The constitutive paradox of the anthropology of democratic societies is that human beings are for the first time recognized as possessing original and inalienable rights that antedate the collective phenomenon. We are masters of ourselves before the law, externally independent in terms of the community to which we belong; and we are also, and correlatively...

Notes

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pp. 283-310

List of Works Cited

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pp. 311-316

Index

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pp. 317-323