Underlying Foucault’s accounts of asylums, hospitals, prisons, and schools was a continuing concern with power and knowledge. In the field of mental health, his preoccupation with power relations and the construction of narratives of exclusion and repression in the History of Madness have led many scholars to consider Foucault an anti-psychiatrist (Freeman 1967; Laing 1967; Leach 1967; Shorter 1997, 274). They question the book’s historical data, which prioritize power relations and political analysis over the actual experience of doctors and patients, undermining its scientific worth. Even thinkers sympathetic to Foucault’s ideas argue that, despite the cultural discontinuities that he sought to foreground in his historical analysis, he nevertheless offered a continuous narrative of confinement and exclusion as a result of the oppressive powers of reason (Dreyfus and Rabinow 1983, 4). But for Foucault, power is not unilateral, dominant, and oppressive, but distributional. Power is not a substance or a property one can claim to possess. It is not a political structure, a government or a dominant social class. Power is mobile, unstable, and reversible and is not blind but is determined by an internal logic. There is a form of rationality behind the exercise of power, and when that form of rationality is undermined, power loses its foundations. This can be observed in current forms of psychiatric practice, where psychiatric power is in fact being undermined while apparently being ever more closely inscribed in social practices.


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pp. 49-58
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