Madness and Democracy: The Modern Psychiatric Universe

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

CHAPTER IX
Openings and Aporia of
Moral Treatment

“They All Reason, More or Less”

ESQUIROL'S TEXT is remarkable precisely because it sets forth the first determining point of inflection 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 betting—a notion that Pinel for his part fails to grasp and situate, as we have seen, even though he constantly presupposes it—achieves a more or less consciously assured expression for the first time. Furthermore, Esquirol does much more than simply spell out what remained implicit in Pinel: while he, too, deals with conceptualizations in a cursory and fleeting manner, he nevertheless draws a particularly decisive inference, as we shall see, from the new idea. In this way Esquirol definitively surpasses Pinel; he completes and provides a solid basis for the transformation of the image of madness that his predecessor inaugurated. But this development (which takes to the extreme limit the idea that there is always a way to appeal to the presence to himself that the insane patient has retained) has a counterpart in the other direction, namely, the discovery that there is an inherent limit to the therapeutic possibilities offered by the reflective return toward the self.

If one is seeking to cure the insane patient, there is little one can count on but the new grasp that brings the patient back to himself and pulls him away from his incoercible impulsive plunge into nonreflection. And yet this grasp does not suffice. The lucid distance with respect to his disorder that has been conquered can coexist, in the patient, with an invincible persistence of the same disorder. Something else is needed, something that Esquirol provisionally seeks, out of desperation, by reactivating the ancient doctrine of crises. However, he quickly localizes it instead in the instrument that is also capable par excellence of “making the insane patient reflect upon his state,” capable of totally reshaping him, of recom

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