Madness and Democracy: The Modern Psychiatric Universe

By Marcel Gauchet; Gladys Swain et al. | Go to book overview

CHAPTER I
La Salpêtrière, or The Double
Birth of the Asylum

Establish a Hospice for the
Cure of the Insane

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 insanity” at Charenton was made, it took five more years—five years of obstinate persistence in following the old model of the Hôtel-Dieu and of rapid disenchantment with the brand-new substitute—before the formula that was to succeed historically could be found and put into concrete practice. For what was established in 1802 at La Salpêtrière was beyond question an asylum in the modern sense. And in contrast to the archaic structures in which the attempt at Charenton was foundering during the same period, we can see what paths institutional modernity will take. The new structures entail the inauguration of an undivided, unchallenged medical authority, as has been widely recognized; but they also entail—and this has rarely been noted, though it is one of their essential features—a complete transformation of the therapeutic framework, based on a profound mutation of the representation of insanity in terms of its curability.

This mutation is widely translated as an awareness of a break and a feeling of discovery—the discovery that “the illness commonly known as insanity is not incurable.” The break has been attributed to the effects of Philippe Pinel's Traité de la Manie (A treatise on insanity). At the literal level, this attribution is false, for Pinel was not the first to learn that the insane could be cured. And yet in that empirically inaccurate conviction there is a profound truth. For, in a special sense, Pinel was unquestionably

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