ISSN: 1705-6411
Volume 10, Number 2 (July 2013)
Author: Dr. John Iliopoulos

I. Introduction
Michel Foucault’s groundbreaking work altered our perception of psychiatry. Although generally labeled anti-psychiatric for its supposed narrative of exclusion of madness by the oppressive power of Enlightenment reason, its scope reaches far beyond the simple refutation of mental illness (Foucault, 1989: 418). It is a more radical cultural approach to the conditions of possibility of current psychiatric practice in the west. It is at once a historical, philosophical and anthropological endeavor which explores the foundations of psychiatric rationality and displays its epistemological, ethical and political limitations. Foucault’s historical analyses of madness have created a new type of critique which, instead of attacking the relations of domination inside the psychiatric institution or the objectivity of psychiatric discourse, they question the very conditions which shape our stable images of power relations and the universality of the medical model governing psychiatric practice.

In this paper I show how Baudrillard follows closely Foucault’s line of reasoning. He too carries out a cultural and anthropological study which repeats, revives and extends Foucault’s analyses of madness. Like Foucault, he performs a genealogy of western reason to illustrate the evolution of the prevalent rational schemas which have determined a specific relationship of western culture with its limits. Baudrillard’s sociological reflections are permeated by the social and cultural division between reason and madness, and, while less focused on the analysis of the psychiatric institution itself, they take up and deepen Foucault’s observations, exploring the fate of madness in contemporary societies of the west, contributing to critical psychiatry, which is not part of anti-psychiatry but a more radical type of critique of the psychiatric institution and its operation inside the wider context of today’s global rationality.

The affinity between the two thinkers needs to be accentuated, as it is not immediately obvious, especially after their apparent break since the publication of Forget Foucault. In that book, Baudrillard had attacked Foucault’s preoccupation with power, putting forward his own theory of simulation and seduction in order to punctuate his distance from Foucault’s methodology (1987). Foucault’s brief response to Baudrillard’s polemical thesis did not help to clarify the underlying kinship between the two thinkers (1989: 360-361). The similarities, as I show, however, are greater than they appear, as both thinkers not only theorize power, but also carry out an almost identical genealogy of its transformations. Moreover, both thinkers explore simulation in depth and in remarkably similar terms, as both the symptom of current power relations and their underside. Finally, they reach strikingly similar conclusions regarding madness and its problematization since the Enlightenment. Taking their analyses beyond the narrow field of the psychiatric institution, they tackle madness not simply as a medical issue, but also as the most general problem of society. They examine the political factors which have contributed to formation of madness as an object of medical perception, but also the way in which madness challenges politically and ethically the exercise of reason in western societies.

II. Foucault and the History of Madness
Foucault’s History of Madness gained renown for its supposed preoccupation with an event that took place in the sixteenth and eighteenth centuries in Europe: the ‘Great Confinement’ of the unproductive members of society — vagabonds, beggars, libertines, criminals and the mad (2006a). This episode of massive exclusion allegedly marked a basic division between reason and unreason which appeared for the first time in the history of the west as a social phenomenon. This exclusion was supposedly theorized by the ‘rationalist’ thinkers of the seventeenth and eighteenth centuries (Descartes, Locke, Hume, Montesquieu, Rousseau) and allegedly became a political reality after the French Revolution and its professed faith in reason as the absolute power of progress and science. Thus, according to this interpretation, the ‘Great Confinement’ was the effect of the Enlightenment: claiming superiority over religious authority, tradition and superstition, reason excluded all forms of unreason which could threaten the image of an ordered society and undermine the universal trust in man’s powers.

This widespread reading of the History of Madness gave rise to two opposing receptions of Foucault’s work; on the one hand, mainstream psychiatrists welcomed the premise that their science was born from the rationalism of the Enlightenment which set the conditions for the total elimination of madness and the dangers it entails for the human mind and society in general. One the other hand, anti-psychiatrists saw Foucault’s narrative as a confirmation of their skepticism toward the excess of rationality, which, as they argue, exercises its inherently oppressive powers by subjugating individuals whom it labels as ‘mad’, depriving them of their natural liberties.

Foucault, however, chooses neither of these alternatives. He rejects the ‘blackmail’ of the Enlightenment, as a rational project one has either to accept or reject (Foucault, 1997: 119). He refutes those who limit his work to the simple tautology ‘I, reason, exercise power over you, madness’ (Foucault, 1989: 259). He rather observes a phenomenon peculiar to the late eighteenth century: the emergence of a new form of power, a new form of rationality which he called ‘disciplinary.’ This rationality, this logic, was not intrinsically oppressive in the sense that it exhaustively monitored individuals in order to suppress their natural liberties; it was not liberating either, meaning that it trained individuals so as to secure the exercise of their legal rights. It was a form of power which established a norm, seeking to regulate human behavior according to a judicial model, a system of correction and training, and a social rationality expressed in the social pact. Crucially, Foucault argues, the norm could only be delineated according those who escaped it and should be restored to it – the delinquents, the ill, the mad (Foucault, 2006b: 46-58). Madness, in particular, was the common thread connecting all these social outcasts. It was the underlying irrational force linking death, crime and idleness. Madness figured as a special case of unreason, the hidden disorder of unintelligible criminals, retarded children, dangerous vagabonds – the residues of society (Ibid.: 109). It was only with reference to the incomprehensibility of madness as a special category of truth, Foucault suggests, that special institutions could be built, specialists possessing knowledge of the clinical manifestations of irrationality could be formed, and legal provisions had to emerge to protect society from the danger that madness posed. This is how psychiatry was born.

Thus the ‘Great Confinement’ is not the central theme of the History of Madness. Foucault’s main concern was the establishment, during the Enlightenment, of a relationship with otherness which madness represented:

there is a history of madness, I mean of madness as a question, posed in terms of truth, within a discourse in which human madness is held to signify something about the truth of what man, the subject, reason is. From the day madness ceased to appear as the mask of reason but was inscribed as prodigious Other […] something like a history of madness begins, or at least a new episode in the history of madness (Foucault, 1980: 213).

As soon as western rationality posed for the first time the problem of universality, the problem of the norm as a universal frame of reference, the mad as radically other appeared, posing a legal and administrative problem to which the first psychiatrists were asked to provide a rational solution in terms of correction and treatment. As a result, the proto-psychiatrists became engaged in a paradoxical operation: their task was to construct a rational medical discourse whose reference point was the irrational subject of insanity. Foucault’s concern was to highlight this paradox which brought about a discontinuity in the history of western medicine: during the enlightenment, he argues, the proto-psychiatrists introduced a break with all previous psychological theories and hypotheses of humoral aetiology concerning the ‘maladies of the spirit’ (Foucault, 1991:64) They did not refine the existing psychiatric knowledge with more sophisticated analyses and elaborate theories about the brain or psychology. They were theorists of impossible, foreign experiences, of alienation and enstrangement — hence their name: alienists (Foucault, 2003a: 156-161). Their enterprise followed the formal rules of medicine — classification, diagnosis, taxonomy — but, contrary to the standard medical practice of differential diagnosis, alienism functioned at a more elementary level, in the dual field, in the binary domain of deciding between madness and sanity in order to determine compulsory admission or legal irresponsibility (Foucault, 2006b: 266). This indispensable duality, this absolute diagnosis, marginal to the rest of medicine since it was not a strictly medical act but also a reflection on a limit experience, rendered proto-psychiatry a quasi-scientific and quasi-philosophical enterprise bearing on the limits of reason, in line with Kant’s anthropology (Foucault, 1998: 257 and 2008). It was on the basis of this duality, this division between reason and insanity, that madness was excluded spatially, generating psychiatry as a form of medical anthropology which institutionalized for the first time the problem of alterity.

III. Biopower and Simulation as Resistance
Soon an important reversal took place: from the middle of the nineteenth century onward, madness lost its position of alterity and was gradually incorporated into the sameness of positive knowledge. Alienism was abolished and psychiatry as we know it today was born. This reversal took place not because reason reached a higher level of maturity or because psychiatry was equipped with greater technological sophistication. There was a crucial modification in the logic of society, a new type of power which effectuated the closing down of the asylum and the development of positivism. This type of power was biopower, a notion which Foucault introduced to denote a form of rationality which still prevails today and whose objective is to remove madness from its status of exclusion and to insert it into a complex network of natural and biological mechanisms centered around social protection and demographic control (Foucault, 2003b: 254-265). It was a form of power which fabricated reality and functioned as its agent in order to impose itself on the irreality of madness (Foucault, 2006b: 173-201).

Thus, in the biopolitics of the middle nineteenth century, Foucault suggests, rationality was concerned with security and the management of the population, which involved the study and management of epidemics, the use of statistics for the observation of large-scale phenomena, the elimination and prevention of risks (Foucault, 2007: 55-68). Here the notion of reality emerged as the most significant aspect of government. It became paramount to intervene at the level of variables, unforeseeable elements of the environment, and potential accidents. The processes of the external world had to be studied, plotted on statistical graphs, manipulated in order to be put in check, nullified and regulated. Contrary to, and in juxtaposition to the disciplinary logic which postulated the imaginary by reference to reality, security ‘trie(d) to work within reality, by getting the components of reality to work in relation to each other, thanks to and through a series of analyses and specific arrangements.’ (Ibid.: 47). Reality was not established in opposition to the imaginary, but as a continuum between the actual and the virtual. The fake, simulation, ceased to be an argument against it, but it began to function as its necessary correlate. Any real event which threatened security could be measured against its preconceived statistical existence and its simulation models, and conversely, any simulated event could be refuted by recourse to scientific proof of actual processes. Even the concept of normality became a correlate of what counted as real: whereas in discipline the abnormal existed at the limits of the norm — which Foucault calls normation — in security the norm is derived from the reality which sanctions the interplay of potentialities, setting up the process of normalization in the strict sense (Ibid.: 57).

In this hyperreal universe in which alternative realities exist only as statistical variables, all forms of negativity — madness, delinquency, death and sex — were submitted to the power of reality, and it was in terms of meaning, knowledge and perception that they all became objects of scientific and medical understanding. With the notions of the instinct and degeneration, it became possible for biology and psychology to reify those limit experiences which in the late eighteenth century had constituted only conceptual entities. Inside the asylum, neurology provided a medium of continuity between the sameness of medical knowledge and the otherness of madness, dispensing with alienism and the para-scientific diagnostic duality madness/non-madness, inserting madness in the strictly medical act of differential diagnosis (Foucault, 2006b: 307-308). In a forensic context, psychiatry became the science not of the mad but of the abnormal, that is, of a vast field of deviant behaviors whose level of pathology was determined not on the basis of some alien truth but according to varying degrees of automatism and lack of free will. Neurobiology and genetics were superimposed on the theories of the humoral constitution of the body of classical medicine, offering a formula, a matrix of bodily interactions which could reduce mental disorder to molecular processes (Foucault, 2003a: 313-314). Diagnosis was grounded on the micro-reality of pathological anatomy and prognosis sought to capture the virtuality of dangerous behavior and the transmission of hereditary traits. Protecting both society and man-as-species, psychiatry became the agent both of the real and the virtual. It became hyperreal and abstract. It became the queen of biopower (Ibid.: 122).

Armed with this hyperreality and abstraction, psychiatry managed to cancel and incorporate its main rival of the twentieth century: anti-psychiatry. Anti-psychiatry, a movement which gained popularity in the 1960s, was a voice of protest against the involuntary incarceration of madness, supportThus, it is ration from the falsifying and oppressive psychiatric categories that excluded it. It sought to disprove psychiatric knowledge through the claim that its low medical status renders it vulnerable to simulation, to imitation of madness by sane individuals. The main line of argument of anti-psychiatry is that if psychiatrists can be easily deceived by healthy imitators, it is because psychiatry lacks the adequate level of anatomical and neurobiological knowledge to substantiate the presence of madness. This is why, the anti-psychiatrists argue, mental illness is a myth (Szasz, 1977). As Foucault shows, however, psychiatry has managed to encompass the anti-psychiatric opposition. The argument of exclusion became outdated as mainstream psychiatry had already passed to the stage of inclusion, liberation and socialization of madness. As for the argument of simulation, it served only to reinforce the hyperreality of the medical model which, claiming to able to refine its understanding of the reality of pathological processes, was in a position to refute simulation and apply itself more effectively (Foucault, 2006b: 135).

IV. Neo-Alienism as Resistance
Foucault, on the other hand, observes phenomena of subversion which do not derive from anti-psychiatric theories or revolutionary ideologies, now that the system of biopower is abstract and all-encompasssing enough to neutralize them. On the contrary, all forms of resistance to psychiatric biopower seem to reverse the anti-psychiatric positions.1 Thus, it is not sanity but madness itself, the horizon of biomedicine, which operates at the limits of biopower. Madness does not rebel but through hyperconformity it reverses all the processes of inclusion and positivity, passively withdrawing from the mechanisms of integration. Madness does not protest against its exclusion, it does not proclaim its rights; on the contrary, it silently and insidiously disrupts the medical truth model and resists medicalization and inclusion by wearing a mask, by using disguise, deception and more subtle forms of simulation.

Madness displays an extraordinary capacity to imitate itself, to adjust perfectly to the medical model which represents it, while resisting any possible aetiology, interpretive meaning or anatomical localization. This, Foucault notes, was the case with hysteria, which posed an insoluble problem for late nineteenth century asylum neuro-psychiatry. Hysteria was not a false but a truer than true illness. It was not genuine madness, but not clear simulation either. If simulation was a stable falsity, hysteria produced unstable truth. The hysterics presented with specific patterns of symptomatology – tonic-clonic seizures, anaesthesias, paralyses, stigmata — which were not diagnostically identical with known neurological disorders, they did not simply imitate other illnesses, so as to raise the suspicion of simulation. However, despite their specificity, these symptoms could not be explained anatomically, therefore they did not fit into the neurological model. Even more paradoxically, the hysterical symptoms could only be stabilized through suggestion and hypnosis, forcing doctors to face the question of whether the symptoms they observed actually belonged to the nature of hysteria or were a product of their own intervention (Foucault, 2006b: 308-316). Since neurologists could not give a definite response to all these problems, they failed to provide a psychiatry that would simply overlap with neuropathology. Neurology could not be safely used for differential diagnosis in psychiatry, and theories of the mind had to be used as an explanation for the phenomenon of hysteria (Freud). The truth model of neuropathology, the use of neurology in the establishment of differential diagnosis involving the mad, failed. By putting on the mask of medical truth, by turning the game of truth and falsity to its own advantage through hysteria, madness remained beyond the grasp of medicine (Ibid.: 136).

Foucault observes a similar subversive phenomenon of simulation in forensic psychiatry. The most notable case of simulation in the late eighteenth century was not the criminal who pretended to be mad in order to escape prison, but the mad who took on the appearance of a criminal: the human monster. The human monster was not the flagrantly delirious criminal or the delinquent who transgressed the law in order to satisfy his own interests. The human monster was the author of unpredictable, unexpected motiveless crimes, crimes without interest, crimes without reason. It constituted a unique category, monomania, which was ‘a crime that is insanity, a crime that is nothing but insanity, an insanity that is nothing but crime’ (Foucault, 2000: 182). Monstrosity was totally unpredictable insofar as there was a crack, a break between the patient’s earlier life and the behaviour during the crime; it was a condition that offered a minimum of warning signs since it was a sudden, abrupt and temporary disturbance leading to criminal behaviour in an otherwise normal individual. As it was so difficult, impossible in fact, to foresee and spot the monstrous crime with enough clarity, late nineteenth century biopolitical psychiatry began to perform preventive compulsory admissions where heterogeneous forms of abnormal conduct were hospitalized on the basis of their suspected criminality. Everyone became a suspected monster, the everyday commonplace crime could potentially become the object of psychiatric scrutiny. The non-clinical concept of dangerousness became the object of forensic analysis, and the issues tackled were more relevant to social defense than cure (Foucault, 1989: 252). Psychiatry undermined its own role and lost its epistemological validity and its humanist face. It contradicted its own efforts to submit mental illness to a pacifying, inclusive network of socialization. Haunted by the simulacrum of the human monster, psychiatry was obliged to recognize and exclude madness by incarcerating ordinary members of society, exactly at the point when it sought to eliminate madness through inclusion in the social field. This is why the monstrous face of madness still inflicts fear and bewilderment among mental health workers, constituting a deep political, juridical and anthropological problem for security-oriented societies.

Through hysteria and monstrosity, therefore, madness manages to conform perfectly to the medical model, turning its truth against the power of the doctors who implement it. It is madness itself, Foucault insists, which reintroduces alienism by dismantling the positivist pretentions of psychiatrists, forcing them to recognize its alterity precisely at the point when they claim to have dispensed with it entirely. The evil genius of madness pushes psychiatric rationality to its limits, reversing power relations inside the asylum, and creating a legal and administrative stumbling block for extra-asylum authorities.

V. Baudrillard’s ‘History of Madness’
Let us now turn to Baudrillard. He too constructed a history of madness which follows closely Foucault’s methodology. This assertion may seem odd, as Baudrillard criticized Foucault’s genealogy (Baudrillard, 1987:73-74), and frequently expressed his mistrust toward the notion of power and his skepticism toward Kant and the Enlightenment (Baudrillard, 2004: 45-45, 81 and 1993: 44,135). A closer reading, however, reveals Baudrillard’s consistent preoccupation with these themes. Like Foucault, Baudrillard explores the historically determined ways through which western rationality imposes its power on those practices and mentalities that it deems irrational. He shares Foucault’s problematic of the Enlightenment, refuting its commonsensical rationalist optimism, showing instead how in the age of the Enlightenment madness became the west’s radical other, and how this alterity still haunts today’s globalizing rationality which seeks total performance and positivity.

Thus, from his early writings Baudrillard uses Foucault’s inspiration to challenge the stable and self-evident notion of the social. Referring explicitly to Foucault’s critical historical method (Baudrillard, 2002b: 29), Baudrillard’s genealogy locates the founding moment, the very origin of the concept of the social in the massive exclusion which took place in the sixteenth and seventeenth centuries. Inspired by Foucault, Baudrillard refutes the traditional Marxist perspective to put forward an original hypothesis: it was not the social that exploited or repressed its residues according to the model of the bourgeoisie or the irrational rationality of capitalism. On the contrary, it was after the exclusion, the ‘Great Confinement’ of unproductive groups that the social emerged: ‘1544 saw the opening of the first great poorhouse in Paris: vagrants, lunatics, the sick, everyone not integrated by the group and discarded were taken in charge under the emerging sign of the social.’(Baudrillard, 1983: 73). The social appeared as the effect of the rational management and control of residues, not as the timeless and transhistorical agent suppressing difference.

What particularly interests Baudrillard, however, is the historical moment when this rationalization of the social became systematized and organized in an institutional form. This event took place in the Enlightenment, which is why, like Foucault, Baudrillard treats the Enlightenment as the defining moment of modernity. The moral philosophy of the Enlightenment of the late eighteenth century, Baudrillard suggests, elevated its values of liberalism, human rights, culture and democracy to the status of the universal, the law and the norm. It institutionalized the social, it gave political, legislative and executive meaning to the representative functions of the state whose reference was the will of the people, the constitution and the transparency of morals. It was with reference to these institutions, to the scientifically and juridically legitimated norm, that the mad were excluded. Irrationality came to designate savagery, barbarism and otherness, everything that escaped the universal law of value, the rules of transparency, the social pact and the democratic ideal (Baudrillard, 1975: 56, 135). With its universalization ‘by excess, in an ascending course of progress’ (Baudrillard, 2003: 89), the Enlightenment produced its irrational members in the margins of its institutions, in a state of anomie. It generated the concept of the mass, the silent, anonymous and irrational force of the inassimilable part of society (Baudrillard, 1983: 17-19). By the same movement that it established the values of the Good, the Enlightenment liberated the irreducible, reversible and asymmetrical forces of Evil (Baudrillard, 2003: 13-14). The Enlightenment introduced a bifurcation, a fundamental duality, an anthropological division whereby singularity constituted its frame of reference and at the same time its radical, irreducible alterity resisting integration to this day:

Between these people and the world that, since the enlightenment, has been developed around the universal, I have the impression that the gulf is expanding. At the same time that the universal was invented, the other was discovered, the real other, precisely the one that does not fall back into universal, the one whose singularity is insistent, even when disarmed and impotent (Baudrillard, 2005a: 143).

It was in the Enlightenment, therefore, that madness emerged as pure difference, as the alterity, the outside of western reason. Madness was the symbolic ferment of society, its ‘dividing line between the mad and the normal’ (Baudrillard, 2002b: 127), necessitating its spatial isolation and its architectural confinement: the asylum. It was with reference to the insane that psychiatry was asked to define scientifically all the concepts of the human, of what constitutes normality and rationality. At the dawn of modernity, psychiatry, like medicine, ethnology and pedagogy, responded to this need to substantiate the primordial cultural division between reason and madness, a division which inserted those categories in the fringes of normality, into the concept of the inhuman (Ibid.: 125-126). Madness was the anthropological concept around which all medical and philosophical knowledge could be built and developed. Pure alterity was the limit, the impossibility but also the condition for the formation of theoretical and institutionalized truth about man. The mad was the west’s ‘dream’ (Baudrillard, 1993: 148), the ungraspable other, irreducible to all medical, political and sociological categories, but also the condition of possibility for all these discourses. He was the starting point for the production of types of knowledge which gave birth to the human sciences.

Soon, Baudrillard argues, the dream of the radical alterity of the insane was over. In keeping with Foucault’s historical analyses, he maintains that since the demise of the Universal and the development of dialectical thinking, madness, like all other limit experiences, was inserted into an endless interplay of exchanges and equivalences. It ceased to designate the outside of reason and became its paradoxical limit, the internal contradiction of reason: ‘madness becomes the paradoxical form of reason for a society too long haunted by its absence and dedicated this time to its (normalized) cult under the  sign of its own liberation’(Baudrillard,1987: 36). This sublation of madness put an end to its exclusion, to its incomprehensibility and its exteriority, and engulfed it into the categories of rational thought, the world of significations and the mechanisms of psychological interpretation. Madness became an object of knowledge, it was reduced to the laws of causality and the methods of statistical analysis.

Over recent centuries all forms of violent otherness have been incorporated willingly or under threat or force, into a discourse of difference which simultaneously implies inclusion and exclusion, recognition and discrimination. Childhood, lunacy, death, primitive societies — all have been categorized, integrated and absorbed as parts of a universal harmony. Madness, once its exclusionary status has been revoked, was caught up in the far subtler toils of psychology (Baudrillard, 1993: 128).

In order to explain this transformation, Baudrillard uses a grid of analysis similar to Foucault: power. Since the nineteenth and extensively throughout the twentieth century, he argues, the models of domination and discipline have been increasingly replaced by hegemony (Baudrillard, 2010: 33-42). Contrary to domination and its relationship between master and slave, and unlike discipline which is defined by the constant reference to law, norm and transgression, hegemony is an all-encompassing type of power, a form of logic with no alternative, negativity or otherness. Hegemony seeks to integrate its opposite, to use it as an argument for its own functioning. It rests on positivity, performance and control, aspiring not to exclude the negative but to incorporate it, exorcize it and eliminate it. It is a hyperreal type of power, resting on a strong ‘reality and truth principle’ (Baudrillard, 1987: 12), and using simulation to support itself against imaginary or alternative positions. Hegemony cannot tolerate otherness — it subjects it to comprehension, intelligible models and scales of measurement.

In light of these transformations of power, psychiatry also became hegemonic. As the ‘queen’ of biopower, as Foucault would say, psychiatry became the leading force in the integration and elimination of madness. The most immediate and explicit manifestation of this project was deinstitutionalization. Constructing a space for the socialization, normalization and peaceful medicalization of madness, required the abolition of the enclosed spaces of confinement. There was no longer any need for the asylum, now that all its spatial, scientific and pedagogical functions could be accommodated in the community:

today the asylum walls have been removed, not because of some miraculous tolerance, but because madness has completed its normalizing labour on society: madness has become pervasive, while at the same time it is forbidden a resting place. The asylum has been absorbed into the core of the social field, because normality has reached the point of perfection and assumed the characteristics of the asylum, because the virus of confinement has worked its way into every fibre of ‘normal’ existence (Baudrillard, 2002b: 127)2

The initial purpose of the asylum had been to isolate the patient from his milieu in order to extract the truth of his madness and submit his pathological will to the confrontation with the reality of the therapeutic environment. With the expansion and supposed sophistication of psychiatric knowledge, isolation was not only rendered unnecessary but also undesirable. The patient should be made capable of incorporating society’s ‘reality principle’ and of adjusting to a therapeutic network based in the community. This is why the aim of this new model of psychiatric hegemony was not to impose its knowledge by force, nor to coerce the mad subject or deprive it of its rights, as the anti-psychiatrists would claim. Its method relied less on violence and more on persuasion.

If the bourgeois order first got rid of crime and madness by elimination or confinement, then secondly it neutralized all this on a therapeutic basis[…] In the psychiatric and ergonomic cures, however, it is very much a matter of an equivalent to death. Here the individual is treated as a functional survivor, as an object to be retained; we surround him with care and solicitude, so many traits of his anomaly, and we invest in him […] Delinquents, criminals, children and madmen will suffer the effects of this clinical operation (Baudrillard, 2002b: 171).

Nowadays the insane are subjected to a constant network of control, correction, training and education. They are surrounded by psychiatrists, psychologists, nurses and social workers whose objective is prevention, prophylaxis and crisis intervention. Even the violence stemming from madness in its unpredictability and its catastrophic forms, is spotted in advance, isolated and reduced to a scale of probabilities and the calculation of risks. Ideally, it is neutralized through psychology and behavior modification.

On the clinical level, Baudrillard observes the same hegemonic exercise of psychiatric power. The current form of psychiatric knowledge aspires to capture madness in its smallest anatomical and biochemical detail. The brain has hegemonic priority over the rest of the body, which is in turn reduced to molecular processes, genetic formulas and neurobiological connections of a Deleuzian type (Baudrillard, 2010: 125-126 and 1987: 33-35, 39). The experience of madness is explained — as in all forms of contemporary medicine — as a set of mutations and anomalies in the cerebral circuits. The psychotropic body, the body of synapses and neurochemical interactions, is an abstract machine, ‘a silent, mental, already molecular (and no longer specular) body, a body metabolized directly, without alterity, without a mise en scene, without transcendence, a body consecrated to the implosive metabolism of cerebral, endocrinal flows…’ (Baudrillard, 1981: 101-102). Drugs are used as a biochemical model for the understanding of the morbid experience of the insane, yet they only provide an imitation, a simulacrum of madness, a formal equivalence where any kind of otherness is bypassed and an abstract neuronal connection with transcendence is established (Baudrillard, 2002a: 96-102 and 2008b: 77).

VI. Resistance — Simulation Revisited
Like Foucault, Baudrillard does not advocate ideological theories of liberation as a response to the totalizing, hegemonic logic of psychiatric biopower. On the contrary, he insists that the more the current system of total exchangeability, forced participation, inclusion and integration is expanding, the more madness itself resists spontaneously through exclusion. Thus, like Foucault, Baudrillard refuses the blackmail of the enlightenment. He does not support the increase of rationality in order to further eliminate madness and the forms of negativity, violence and subversion associated with it. If today’s rationality regards any form of madness as pathological deviance and as an anomaly in the general equation of successes and failures, there is no point adding further calculation to mental health policies: ‘it is no use looking to the rationality of the system to combat its excrescences. It is a total delusion to think extreme phenomena can be abolished. They will, rather, become increasingly extreme as our systems become increasingly sophisticated’ (Baudrillard, 2002a: 7). Equally, there is no point siding with the anti-psychiatrists to disprove psychiatric rationality through simulation. As we have shown, in the hyperreality of hegemony simulation represents a weak form of critique. In Simulacra and Simulation, Baudrillard analyzes the futility of this anti-psychiatric argument. Simulation is simply a form of accentuation of the dialectical opposition between reality and the imaginary, it does not disrupt it. It merely adds further speculation in a system drawing its hegemony from conflicting interpretations and the exhaustive manipulation of signs. Thus, mainstream psychiatric rationality can refute simulation by injecting realness and referentiality with its causal theories, its biomolecular explanations or the psychoanalytic truth of desire, or, alternatively, it uses simulation itself as evidence of madness, as a sign of pathology. Such is the strategy of the real:

[…] order always opts for the real. In a state of uncertainty, it always prefers this assumption (thus in the army they would rather take the simulator as a true madman) […] As long as it was historically threatened by the real, power risked deterrence and simulation, disintegrating every contradiction by the means of the production of equivalent signs. When it is threatened today by simulation (the threat of vanishing in the play of signs), power risks the real, risks crisis, it gambles on remanufacturing artificial, social, economic or political stakes. This is a question of life or death for it. But it is too late (Baudrillard, 1981: 21, 22).

The indistinguishability between truth and falsity, the disappearance of truth criteria, as in a holographic image, constitutes the strength of hegemonic power and its logic. All discourse, even counter discourse, is effectively integrated into the game of speculation, and all acts of resistance or revolution are absorbed by the system which consolidates around its very opposition. Just as a scandal can inject morality into an otherwise amoral political system, transgression can reinforce the law, liberty can intensify security, crisis can prove the system, strike can prove work, and revolution can prove capital, so anti-psychiatry can prove psychiatry, because it is effectively absorbed by the all-encompassing hegemonic logic of the real (Ibid.: 19).

Baudrillard goes on to spot another, crucial weakness of anti-psychiatric critique. Anti-psychiatry holds that the mad are unjustly and unlawfully excluded by the psychiatric establishment, which misdiagnoses and forcibly confines them to serve the oppressive aims of the state (Szasz, 2007). What the anti-psychiatrists advocate is the reintegration of the insane into society and the transformation of the psychiatric institution in a way that would give the mad to opportunity to voice their suffering and restore their violated rights. Baudrillard proposes the exactly opposite hypothesis: the mad do not need a voice of expression — the system of hegemony already ensures that they are deprived of their silence through psychological meaning, forms of psychodrama and endless interpretation. On the contrary, it is the silence of the mad which, for Baudrillard constitutes their absolute weapon of subversion. In a world of transparency, excess of information and forced confession, the silence of madness introduces zones of reversibility, resistance and exclusion. Violent outbursts, suicides and crimes with no motive, are all unintelligible forms which defy rational comprehension, forced integration and socialization. These ambiguous, singular and spontaneous acts introducing death in a system obsessed with survival and hygiene, take hegemonic logic to its limits, not as a reaction to oppression, but as a refusal to submit to the universal gospel of humanitarian sociology and the omnipresent therapeutic society:

One day soon, that sphere will be fully realized, and the only people remaining will be the ‘excluded’. In a perfectly conformist sociality, only anomalous individuals and desocialized categories will be left, and they won’t even have any relationship, dialectical or otherwise, with the social institutions. This is what’s happening today at an increasingly rapid rate (Baudrillard, 1998: 67-68).

Baudrillard neither condemns nor supports this anomalous, virulent and uncontrollable violence. In fact, as he points out, the singularity of madness does not have to be violent, since it can also be expressed in non-destructive ways through language, art and the body (Baudrillard, 2003: 96).3 But in a system preoccupied with the elimination of negativity, it can acquire the most violent and extreme forms. As the inevitable outcome of the expanding system of perfection and absolute positivity and as a response to the impersonal and abstract violence of homogeneity and forced harmony, irrational aggression is a blind, unjustifiable violence with no particular aim or identifiable enemy. It is different from the traditional revolutionary acting-out of the oppressed, it presents with no demands and it is not directed against those who deprive the mad of their freedom and the human rights, but ‘against the absence of destiny and the democratic leukaemia of all our cells’ (Baudrillard, 1998: 66). As the whole world, and not just the psychiatric institutions, has become a global asylum, these violent and senseless phenomena of resistance cover the entire field of interactions, becoming terrorist acts, objectless violence and the suicidal destruction of one’s neighborhood (Baudrillard, 1983: 48-58 and 2008a: 212-21).

Crucially, despite its aimless, random and senseless character, this violence of madness has a precise strategy: it targets the truth that claims to represent it, it ‘smashes the mirror of representation’ (Baudrillard, 2007: 111) by adapting perfectly to it, while turning it against the hegemonic logic of power. Thus, it takes on the form of pure simulacrum. Hence Baudrillard’s attention to simulation, a notion emblematic of his thinking, which, as I shall now show, does not merely describe the condition of hyperreal postmodernity, but also a subversive logic undermining hegemony.4 Baudrillard discusses extensively this paradoxical, delusional logic of simulation as a barrier which madness erects against the endless expansion of global rationality, and, interestingly, like Foucault, he uses the clinical examples of hysteria and monstrosity to prove his point. This is not to say that he tackles these cases in actual clinical settings, as Foucault had done. Baudrillard’s strictly clinical observations are limited to a brief classification of neuroses and perversions inaccordance to his notion of seduction and on occasions he uses clinical concepts to describe current social pathology (Baudrillard, 1990a: 69-70 and 1990b: 119-130). However, given that Baudrillard treats society as a whole as a field assuming the characteristics of the asylum, his analyses of global events are replete with clinical terminology. Thus, speaking as an alienist and not as a positivist, he employs the notions of hysteria and monstrosity literally, and not metaphorically, in order to describe the relationship of western culture with the madness of those singularities which escape its grasp.

Thus, the first asylum images are employed in The Gulf War did not Take Place. For Baudrillard the Gulf war indeed did not take place precisely because it was a clinical rather than a strictly military operation. The aim of the allies was to insert the other into the postmodern world of negotiation, exchange and indifference. Since the Iranian revolution — an insane act of resistance, as Foucault had characterized it (Foucault, 2005a: 222) — Islam had excluded itself as the west’s radical other with its totally foreign religious practices and traditional values. As the west had launched its globalizing project of expansion and exportation of its principles, it was necessary to cancel the radical alterity of those who refused to subscribe to liberal democracy, free market ideology and the rules of total transparency. In the Gulf war the allies conducted a war with the intention not to exclude or destroy, but to domesticate the madness of Islam. The war was a clinical, psychotropic operation: a global nervous system was established, an electronic brain and a universal mental screen (CNN) was the cerebral coordinator of communication, of instantaneous and simultaneous sensory inputs which could synchronize the world’s perception in relation to the actual events on the battlefield. But this battlefield was a pure image, devoid of referentiality (Baudrillard, 1995: 40, 44, 48). It was an immense laboratory where weapons and speculation rather than actual battles were displayed. The enemy was also experimental — he was the mad other, the silent partner who had to be electrocuted and lobotomized in order to deprive him of his foreignness and his secret: ‘It all began with the leitmotif of precision, of surgical, mathematical and punctual efficiency, which is another way of not recognizing the enemy as such, just as lobotomy is a way of not recognizing madness as such.’(Ibid.: 43). The other had to submit to negotiation and was forced to play the game of media speculation, becoming a ‘pure extra(s) in the consensual and policed New World Order.’(Ibid.: 53-54).

The other’s strategy, on the other hand, was subversive and unpredictable. In response to the stealthy machinery and abstract technological and neurotropic manipulation of world perception, the other defended himself through a more cunning simulation. He used decoys, manipulated the media and turned the flow of information to his advantage (Ibid.: 39, 42, 46). Saddam Hussein was a hysteric: his position was undecideable between reason and madness, he confused the aims of the invaders but also created ambivalent feelings among the Arabs. He adopted all the signs with which the allies wanted to inscribe him, and, rather than attacking them head on, he constantly metamorphosed, erecting a deadlock to the initial programming of his enemies. Like a true hysteric, his tactic was not one of defying the model of negotiation — he did not censor images, he willingly played the game of mutual blackmail — but that of fully adopting to it in an ironic fashion: ‘the secret of the underdeveloped is to parody their model and render it ridiculous by exaggeration.’(Ibid.: 47). In the end, with his ruses he kept his secret intact, and increased the uncertainty and suspicion on the side of those who were striving for a clean, zero-death war: ‘Saddam the hysteric. The hysteric cannot be crushed: he is reborn from his symptoms as though from his ashes. Confronted by the hysteric, the other becomes paranoid, he deploys a massive apparatus of protection and mistrust.’(Ibid.: 56-57).

Saddam, like Charcot’s patients, was a traitor to his own lie. With his hyperconformity to the perceptual apparatus that sought to subjugate him, he both assisted the Americans into winning the war on the level of programming, technological sophistication and economic objectives, but at the same time prevented them from winning it on a symbolic level. The Americans failed to diagnose the other, proselytize him into the New World Order, insert him into the therapeutic universe of global morality, humanitarianism and scientific progress. Saddam’s hysterical tactics blocked access to the incomprehensible other. The Arab world neither rebelled, nor attacked the west, but, on the contrary, receded into greater depths, it was excluded even further and its secret remained intact (Ibid.: 72, 73).

Baudrillard went on to make similar clinical remarks regarding September 11. The attacks on the World Trade Center can be approached in clinical terms, not because they were performed with a ‘surgical’ precision, but because they represented a violent reaction of madness itself. September 11 was a crime without motive. Like the monstrous monomaniacs described by Foucault, the terrorists carried out their crime with no intelligible motive. They were normal individuals who were ‘sleeping in their suburbs, reading and studying with their families, before activating themselves suddenly like time bombs’ (Baudrillard, 2003: 19-20). They were rich and not poor, disaffiliated anarchists. They turned the signs weapons of power against it (media coverage, stock market speculation, aeronautics). They used their suicides as weapons against the system. But there was no obvious aim to destroy the system or conquer it by force. For a long time no one claimed responsibility for the attacks. No ‘normal’ individual supporting their ‘cause’ could possibly hope that such a murderous act would gain worldwide approval so as to attract others to some revolutionary movement. The terrorists did not want to destroy or appropriate anything; they were content to destabilize the system and ‘wreck’ it (Ibid.: 73). No medical, political or psychological categories could account for their act: ‘when it is said that Islam is evil, the implication is that it is not well, that it issick, and that it is violent because it is sick […] There is the same inability to contemplate for one moment that these ‘fanatics’ might commit themselves ‘freely’, without in any way being blind, mad or manipulated’ (Ibid.: 66). No plausible arguments can prove that the terrorists were schizophrenics or psychopaths, but still their act remains unintelligible, inexplicable and therefore more horrific and singular — ‘neither positive nor negative’, but ‘of another order.’(Ibid.: 96). This is why the west’s response to this event was literally, and not metaphorically, a therapeutic enterprise: indefinite involuntary detention of suspected terrorists in Guantanamo (Ibid.: 101),5 torture, humiliation, forced confession and electrocution of the prisoners of Abu Ghraib (Baudrillard, 2005a: 205-209). These preventive measures were a clear continuation of the practices of involuntary incarceration of the ‘dangerous individuals’ of nineteenth century forensic psychiatry: the aim was to cancel a monstrous act already committed and to provide prophylaxis against future acts of similar nature, while ‘sabotaging’ the democratic values of liberty by combatting an anonymous enemy in the name of security (Baudrillard, 2005b: 118-119 and 2010: 97).

VII. Conclusion
Baudrillard and Foucault are at bottom anthropologists, in the Kantian sense, and men of the Enlightenment (Foucault, 1997 and 2008, and Baudrillard, 2004b:8). Reflecting on the limits of western rationality, they investigate madness as an anthropological category, as the pure other of reason. They are not anti-psychiatrists but diagnosticians of civilization, illustrating how madness constitutes not only a medical but also a political and ethical problem. They both criticize psychiatry, not for the validity of its statements, but for the normalizing role it plays in the contemporary milieu of globalization. Their main criticism targets the effort of psychiatry to turn the whole world into a therapeutic site, colonizing madness and death.

Foucault and Baudrillard are attentive to limit experiences, to those marginal situations which globalization seeks to incorporate into our virtual state of affairs. They are not, however, nostalgic of the Universal as it was posed in the Enlightenment, in order to resuscitate madness. As Baudrillard asserts, ‘globalization seems irreversible, whereas the universal would seem, rather, to be on the way out.’(Baudrillard, 2003: 88). Anthropological thought highlights instead the reemergence of alterity which takes place spontaneously in the form of singularities as products of the surplus power of globalization: ‘The immanent mania of globalization generates madness, just as an unstable society produces delinquents and psychopaths.’(Baudrillard, 2004b: 5). In the current state of things, madness resurfaces not as a form of dialectical opposition to the forces of reality, not as a transcendental universal, or as a revolutionary force overthrowing the established order, but as a ‘blowback of duality’(Baudrillard, 2005b: 185-190), an ‘anthropological mutation’(Baudrillard, 2010: 91) destabilizing the very logic of current power relations. Spotting this mutation, this resurgence of the most irrational singularities in the heart of hegemonic rationality, does not imply a theoretical irrationalism. On the contrary, it requires the operation of reason itself, in the sense of Kant’s pure reason, which, as a paradoxical form of thought operating at the limits of rationality, is responsible for the critical act of discerning divisions, conflicts and points of antagonism. ‘Discrimination is the violent founding act of Reason,’ Baudrillard points out (1987: 37). It is reason which announces ruptures, events and discontinuities which today multiply and proliferate causing tears in the universal, becoming themselves the most general and ineluctable rule of the game: ‘The Universal is not for everyone. Only discrimination is universal.’(Baudrillard, 2010: 105).

About the Author
John Iliopoulos completed his PhD [thesis title: Foucault’s critical psychiatry and the spirit of the Enlightenment: a historico-philosophical study of psychiatry and its limits], at University College London, UK (French Department). He is a consultant psychiatrist in Adult and Old Age Psychiatry at 251 Hellenic Air Force Hospital, Athens, Greece. He completed his MA in the Philosophy and Ethics of Mental Health at the University of Warwick (2007). John  has also published “Foucault’s notion of Power and Current Psychiatric Practice” in the journal: Philosophy, Psychiatry, Psychology (2012). Another recent paper: “Foucault, biopower, and psychiatric racism” appears in the Italian online journal Materiali Foucaultiani (January, 2013).

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1 – For Foucault power is at bottom a set of reversible relations (Foucault, 2005b: 252). Reversibility is therefore central to his thinking, as in Baudrillard. See Gerry Coulter, ‘Reversibility: Baudrillard’s “One Great Thought” (2004).
On the reversibility of psychiatric power, see my paper ‘Foucault’s Notion of Power and Current Psychiatric Practice’(2012: 49-58).

2 – Baudrillard witnessed the phenomenon of deinstitutionalization during his visit in New York: ‘In New York, the mad have been set free. Let out into the city, they are difficult to tell apart from the rest of the punks, junkies, addicts, winoes, or down-and-outs who inhabit it. It is difficult to see why a city as crazy as this would keep its mad in the shadows, why it would withdraw from circulation specimens of a madness which has in fact, in its various forms, taken hold of the whole city.’ (Baudrillard, 1988:19).

3 – See for example Baudrillard’s analysis of David Nebreda’s photographs. Nebreda was a known schizophrenic whose work was not overtly violent, but it was nevertheless a singular creation, disruptive in artistic and symbolic terms. (Baudrillard, 2001: 125-127).

4 – Baudrillard does discuss hysteria and monstrosity as clinical cases. He considers hysteria as the last fatal strategy of sexuality in the nineteenth century (1996: 120); he shows how hysteria defies psychological laws, resists the psychoanalytic truth of desire and opposes the reversibility of seduction to the linear logic of masculine power (1990a: 120, 1990b: 12-27). Likewise, he comments on forensic cases such as Romand and Pauli, the murderer from Guadeloupe; both are cases of motiveless, monstrous crimes escaping rational psychological explanation and representing singular types of violence springing from an objectless passion, a violence of indifference and intolerance to the permissiveness of society (2005a: 146, 2005b: 60-62). In the present study, however, I focus more on Baudrillard’s more extensive political analysis of these clinical types and their implications for the general exercise of reason in western society.

5 – on current forms of indefinite detention of certain citizens on the grounds of their potential threat and suspected involvement in criminal activities, Judith Butler draws a parallel between contemporary forms of monstrosity and Foucault’s madmen who appear at the margins of the legal system and outside the bounds of rationality. There is an analogy, Butler points out, between ‘the suspected terrorist or the captured soldier and the mentally ill’ (Butler, 2004: 72).