Pinel is the second representative of the development of the asylum. In 1794, Pinel freed the madmen confined in the Bicetre prison. This move initially had political overtones. Separating madmen from political criminals was necessary for the French government of the time. After this famous act, Pinel went on to develop a system of treatment for madness based on conscience.

Pinel's asylum condemned religion as a dangerous irritant, but aimed to instill a kind of non-religious morality in madmen. He aimed to enforce moral standards drawn from the outside world on the madman. Ignoring or exceeding the world's morality became madness. But to enforce this morality, madness had to be recognized. Madmen were allowed, indeed forced, to speak in order to recognize their madness. But it could not speak freely. Delirious discourse was silenced.

The idea of judgment was powerful and chilling. The madman was observed, judged and condemned as an abnormal phenomenon. In his later work, Discipline and Punish, Foucault analyzes how this system was extended to other modern institutions such as the hospital and the school. The imposition of a moral code onto madness was not an irreversible change, but it was a powerful one.

The system of judgment and observation was supported by the appearance of the doctor-figure. Madness now becomes a medical complaint, in the sense that the authority of science and medicine justifies the treatment of madmen in asylums. The doctor is a wise man because he has the authority of science behind him. He guarantees the value and correctness of what goes on in the asylum. The doctor's power does not end with this validation, however. He also develops a great power over his patients. He gets this power from structures developed by Pinel and other asylum-builders. The development of science covers up the source of this power of this new father-figure. Doctors no longer examine the origins of their power and its moral character.

In a way, Foucault reduces the complexity of asylum to the unequal and misunderstood relationship between doctor and patient. Neither side has any clear idea of how it develops, or works. The doctor's power is almost magical, because the patient has great faith in it without any understanding. Foucault returns to psychoanalysis. He almost sees it as the ultimate form of psychiatry or medicine, because it centers on a dialogue with the therapist. It is separate from the kind of judgment and morality that medicine involves. However, Foucault is not sure that psychoanalysis can really engage with unreason. That kind of engagement is possible only through art. The final paradox of this section is that, in freeing madmen from physical constraint, Pinel and others make them prisoners of their own consciences. Foucault argues that this is not real freedom.

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