Positive images of the asylum are familiar from histories of psychiatry. Asylums act as evidence that madness was finally treated properly. Pinel's liberation of the insane from Bicetre and Tuke's asylum, are also famous. They reveal a series of operations that organized the asylum. Tuke is not a philanthropist; in fact, his Retreat shows the moral and religious segregation of a Quaker community. Tuke saw the exercise of religious principles over the insane as a cure. Religion controlled and confined madness. Religious segregation created an environment in which the individual was constantly anxious, threatened by law and transgression. In such an environment, the madman became afraid and morally responsible for disturbing society. It was claimed that Tuke's work liberated the insane, abolished constraint and created a human milieu. In fact, he replaced free terror by anguished responsibility. The asylum organized the madman's guilt and conscience in an attempt to make him free.
Work was important in Tuke's Quaker asylum. Work rescued the worker from dangerous liberty. In the asylum, work was deprived of productive value; it was imposed only as a constraint and a moral rule. The need for esteem was also important. At Tuke's Retreat, self-restraint replaces physical constraint. Madness passed from a world of censure to a universe of judgment. A psychology of madness became possible, in which madness was judged only by its acts. Madness exists only as it is seen. The science of mental disease that developed in the asylum was always about observation. It could not be a dialogue until the development of psychoanalysis.
In the section, "Surveillance and Judgment," Foucault describes the emergence of a new authority figure. Until the eighteenth century, the world of the mad contained only madness and the faceless power that confined it. Tuke created a mediating element between reason and madness. The asylum keepers confronted madness with madness and reason alone. The absence of constraint in the nineteenth century asylum was not the liberation of unreason, but evidence that madness had been long since confronted. Madness became childhood, grafted onto the world of reason. The community of the asylum became a family. The family is important in the reorganization of madness; it appeared as the norm in the asylum, a structure in which madness is located. The discourse of unreason was now associated with the family. What had been a conflict of reason with unreason became a revolt against family institutions. Tuke substitutes an artificial family for a real family. In a way, Tuke isolated the bourgeois family, located it in the asylum and separated it from history.
Pinel did not advocate religious segregation. Rather, religion was a potential cause of madness for him. A neutralized asylum was created, free of dangerous religious passions. Pinel aimed to preserve the positive moral content of religion. The asylum was a place of pure morality without religion. The social values of family and work reigned in the asylum. The asylum under Pinel became an instrument of moral uniformity and social denunciation. Pinel's asylum aimed to create an ethical continuity between the world of madness and the world of reason. This combination allowed bourgeois morality to be imposed as law, and linked madness to social failure.
Fifty years later, mental disease became degeneracy. Pinel's asylum was a place where insanity as social deviancy was eliminated. The life of inmates was organized so that moral syntheses could operate, in three ways. First, keeping the madman in silence confines him and shames him before others. The Renaissance dialogue with madness and the eighteenth century dialogue of struggle had ended. Second, Pinel allowed madness to see itself. By causing the mad to recognize their condition, he felt he could cure their madness. After Pinel, madness was seen as an impulse by which the individual ignores moral limits. For the nineteenth century, the model of madness was to believe that you were God; in preceding centuries, to be mad was to deny God's existence. Thirdly, madness was called upon to judge itself and was judged constantly by an invisible tribunal. Pinel converted eighteenth century therapeutic techniques into justice and repression. The madman would recognize himself in a world of judgment; those who resisted this new justice were set apart and confined. The great bourgeois offenses of theft, religious fanaticism and resistance to work were punished even amongst the mad. Now unreason was caught in perpetual judgment. The asylum was a juridical space in which the insane were judged and condemned. The medical personage, which altered the relationship between madness and medical thought, was equally important. Mental disease was made possible by this development. The physician now became a key figure; he was in charge of entry to the asylum. But the physician was more important as a wise man. The medical enterprise was part of a moral project. Tuke and Pinel opened the asylum to medical knowledge. The physician became father, judge, law and family. The presence and words of the doctor were often enough to effect a cure. Various relations were created between the doctor and patient: family-child, transgression-punishment, madness-disorder. But from the nineteenth century onwards, the psychiatrist no longer knew what the nature of his power was.
Psychiatry assumed priority for the first time. Psychiatrists would increasingly confine themselves in positivism the more they felt their practice slipped into moral areas. Positivism imposed itself more on medicine; the doctor became more powerful in the patient's eyes. Structures of objectivity in psychiatry from Pinel to Freud were a reification of magic, achieved through the patient himself. Psychiatric practice was in fact a moral tactic of the late eighteenth century, preserved in the asylum and overlaid with positivism.