FOlfCAUI ,T'S CRITICAL PSYCHIATRY AND THE SPIRIT OF THE ENLIGHTENMENT: A HISTORIC° - PHILOSOPHICAL STUDY OF PSYCHIATRY AND ITS LIMITS by Dr. John-Golfinos Il iopoulos Phd University College London July 2012 I, Dr. John-Golfmos Iliopoulos confirm that the work presented in this thesis is my own. Where infOrmation has been derived from other sources. I confirm that this has been indicated in the thesis. 2 Abstract My thesis revolves around three axes: the Foucauldian critical-historical method, its relationship with enlightenment critique and the way this critique is implemented in Foucault’s seminal work, History of Madness. Foucault’s exploration of the origins of psychiatry applieshis owntheories of power, truth and reason anddraws on Kant’s philosophy,shedding new light on the way we perceive the birth and development of psychiatric practice. Following Foucault’s adoption of ‘limit attitude’, which investigates the limits of our thinking as points of disruption and renewal of established frames of reference, the thesis aims to dispel the widely accepted belief that psychiatry represents the triumph of rationalism by somehow conquering madness and turning it into an object of neutral, scientific perception. A history of limits examinesthe birth of psychiatry in its full complexity: in the late eighteenth century, doctors were not simply rationalists but also alienists, philosophers of finitude who recognized madness as an experience at the limits of reason, introducing a discourse which conditioned the formation of psychiatry as a type of medical activity. Since that event, the same type of recognition, the same anthropological confrontation with madness has persisted beneath the calm development of psychiatric rationality, undermining the supposed linearity, absolute authority and steady progress of psychiatric positivism. Foucault’s critique foregrounds this anthropological problematic as indispensable for psychiatry, encouraging psychiatrists to become aware of the epistemological limitations of their practice, and also to review the ethical and political issues which madness introduces into the apparent neutrality of current psychiatric discourse. 3 TABLE OF CONTENTS Introduction 4 1. WHAT IS ENLIGHTENMENT? 19 2. THE HISTORICAL CRITIQUE OF PHENOMENOLOGY 53 3. FOUCAULT’S EPISTEMOLOGY: SUBJECTIVITY, TRUTH, REASON AND THE HISTORY OF MADNESS 86 4 IS FOUCAULT AN ANTI-PSYCHIATRIST? 118 5. HYSTERIA AT THE LIMITS OF MEDICAL RATIONALITY 160 6. FOUCAULT AND PSYCHOANALYSIS: TRAVERSING THE ENLIGHTENMENT 200 Conclusion 242 Bibliography 251 4 Introduction Michel Foucault’s work has been widely represented as a challenge to the Enlightenment. The Enlightenment is generally characterized as a philosophical movement that places faith in rationality and progress. Foucault by contrast is regarded as a postmodern, anti-Enlightenment theorist whose lifelong preoccupation with power, knowledge and discourse is viewed as antithetical to reason and truth.1 Foucault’s seminal work, History of Madness, is considered to be a product of his anti-Enlightenment position, rendering him one of the main figures of anti-psychiatry. His views are widely accepted as an attack on the Enlightenment concern with reason, which supposedly produced the science of psychiatry by silencing what it considered as unreason. According to that commonly held assumption, Foucault undermines the oppressive character of reason and proposes a historical narrative based on power, knowledge and exclusion which refutes the Enlightenment project and questions the whole scientific edifice of modern psychiatry which still prevails in the west. The present study offers a critique of this reading of Foucault, demonstrating how his theoretical approach does not oppose either the Enlightenment or psychiatry tout court but rather strives to foreground their susceptibility to renewal and transformation. Considering his work on Kantian critique and his historical methodology, we shall demonstrate that Foucault conceives the Enlightenment not as a teleological process of reaching scientific objectivity but as a critical attitude to the present moment as difference. 2 The History of Madness adheres to this Kantian understanding of the Enlightenment, offering a critique of the evolution of western psychiatry, tracing the ruptures and discontinuities that challenge the smooth and linear appearance of the progression of psychiatric knowledge. Our reading of that 5 text shows how Foucault’s work does not oppose psychiatry, but unsettles its foundations, exposing its potential for being refounded on new terms. Our analysis will not be restricted to an overview of the History of Madness based on Foucault’s later essays on Kant and the Enlightenment. The existing French and Anglo-saxon literature on these topics is already abundant. The studies of Barry Smart, Frederic Gros, Thomas Osborne and Claire O’ Farrell have offered a reevaluation of Foucault’s relationship with Kant and the Enlightenment, dispelling previous categorizations of Foucault as an anti-Enlightenment, ‘postmodern’ relativist. 3 Similarly, Todd May, Gary Gutting, Colin Gordon, Robert Castel and Nikolas Rose have reexamined the History of Madness, foregrounding its groundbreaking critical-historical method against the criticisms made by those historians and psychiatrists who attacked the book for its supposed lack of accuracy and its seemingly anti-psychiatric spirit.4 The influence of these seminal works on the debate on the Enlightenment, the theoretical implications of psychiatry and the domain of Foucault studies, has been immense. The aim of the present study, however, will not be to synthesize them, but to explore the possibility of using these works as background knowledge for a critical analysis of actual clinical topics. Thus, inspired by these valuable theoretical sources but also going beyond them, our study will focus less on the History of Madness itself and more on the whole spectrum of clinical reflections which Foucault himself conducted from his early analyses on Kantian anthropology and the critique of phenomenology prior to the History of Madness, to his sophisticated analyses of psychiatric topics as they appear in his recently published lectures, Psychiatric Power and Abnormal. These reflections complement the History of Madness and clarify earlier, unrefined themes of Foucault’s critical thinking. In fact, it will be these reflections, along Foucault’s reassessment of his own 6 oeuvre in his later interviews and articles that will serve as a lens through which Foucault’s entire body of work will be reappraised, foregrounding a continuity between his earlier reflections on the birth of psychiatry, his general historical outlook and his detailed clinical observations. This continuity, however, will not constitute an artificial homogenization of Foucault’s thinking, which is known for its inner tensions, its discontinuities and breaks; it will underscore Foucault’s critical attitude as his ‘one great thought’;5 it will show how Foucault’s anthropological exploration of rational forms subsists beneath the apparent contradictions of his work, connecting his diverse and multiple levels of analysis into a coherent critical approach both to the Enlightenment and to psychiatry. While insisting on the uniformity of Foucault’s thinking, however, we shall not attempt to present a general rational theory which will supposedly ‘enlighten’ psychiatrists. Neither shall we aim to provide a sociological analysis of psychiatric knowledge, to suggest more rational ways of exercising psychiatric power or to introduce therapeutic alternatives for clinicians.6 On the contrary, we shall illustrate that what psychiatrists have inherited from the Enlightenment is not the capacity to increase their rationality, but the possibility of its critique. The Enlightenment is not an emancipatory project promising the liberation of the psychiatric subject who asserts her rationality. On the contrary, it is a form of critical thought freeing the psychiatrist from the constraining effects which the excess of this rationality produces. The effect of Enlightenment critique is not to expand, refine or refute the domain of psychiatric knowledge, but to ‘question the limits and powers it has abused’7 and to trace the weak points where the foundation of psychiatric rationality can appear most vulnerable to being overturned. This is not to imply an irrationalist method of approach but, on the contrary, a sceptical stance where psychiatric rationality 7 questions its own sovereignty and its claims to universality. It is a mode of examination of ‘a reason whose autonomy of structures carries with itself the history of dogmatisms and despotisms — a reason which, consequently, has the effect of emancipation only on the condition that it succeeds in freeing itself of itself.’8 As we shall emphasize throughout this study, it was the critical engagement of reason with itself which brought psychiatry as a discipline into existence, and it is the same conflict, the same battle which fuels current debates in psychiatry, bringing psychiatric rationality to its limit. It is this reflection on the limits of psychiatric rationality, this limit-attitude, which will guide our discussion and analysis of Foucault’s consistent involvement with all the major issues preoccupying psychiatry today ─ anthropology, phenomenology, epistemology, anti-psychiatry, simulation and psychoanalysis. Enlightenment critique, we shall argue, can place the mental health worker in a