A Crítica de Foucault À Medicina Psquiátrica

HUBERT L.
DREYFUS
FOUCAULT'S CRITIQUE OF PSYCHIATRIC

MEDICINE*
Key Words: normal, mental illness, sexuality, psychoanalysis
I. GENUINE SCIENCES OF NATURE VS.

PSEUDO-SCIENCES OF MAN
By the time Foucault began his History of Sexuality, he was

convinced that the psychoanalytic account of human beings as
subjects motivated by sexual desires that are constantly repressed
and must be continually recovered, is both "dubious" and dan-
Hubert L Dreyfus^ Ph.D., Professor, Department of Philosophy, University of California, Berkeley,

California 94720, U.S.A.
The Journal of Medicine and Philosophy 12 (1987) 3 1 1 - 3 3 3 .
1987 by D. Reidel Publishing Company.
Downloaded from http://jmp.oxfordjournals.org at Universidade de S?o Paulo on July 28, 2010
ABSTRACT. From his earliest published work, Mental Illness and Personality
(1954), to his last project, The History of Sexuality, Foucault was critical of the
human sciences as a dubious and dangerous attempt to model a science of
human beings on the natural sciences. He therefore preferred existential
therapy, which did not attempt to give a causal account of human nature, but
rather described the general structure of the human way of being and its
possible distortions. Foucault focused his attack on psychiatry, which claimed
to have an explanation of normal and abnormal functioning of the personality
modeled on medicine. Freud typified for him this deep mistake which he
traced first to the Kantian understanding of human beings as transcendental/
empirical doubles which must think their own unthought, and then later to
the gradually developing confessional practices which lead people in our
culture to try unsuccessfully to put all their desires into words so as to
conform to the norms of psychoanalysis which in turn are based on an
account of sexuality as a cause of personality. Foucault proposed his genealogical account of how our culture arrived at this view of man as sexual being as
a form of therapy which was to help us free ourselves from this restrictive
self- interpretation.
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The coherence of a psychological life seems . . . to be assured in some way

other than the cohesion of an organism; the integration of its segments tends
toward a unity that makes each possible, but that is compressed and gathered
together in each: this is what psychologists call, in the vocabulary that they
have borrowed from phenomenology, the significant unity of behavior, which
contains in each element dream, crime, gratuitous gesture, free association
the general appearance, the style, the whole historical anteriority and possible
implications, of an existence (Foucault, 1976a, pp. 1014).
These claims need explaining and defending. Explaining, because Foucault is assuming an existential phenomenological conception of the personality and of psychiatry. Defending, because
later Foucault holds that all disciplines, even natural science and
medicine, can make statements that are taken to be true or false
only against a historically conditioned background of shared
practices. Given his concern with "truth-effects" rather than truth
claims, it might seem that his early appeal to "valid abstraction
gerous. Reading Foucault's history of how Western man arrived at

the practices that define him as a sexual being, the philosopher
is bound to ask: What justifies Foucault's claim? There is a
difference between explaining how a practice comes about and
asserting or denying the validity of that practice. Does Foucault
have an argument for his rejection of psychoanalytic theory and, if
he does, does this argument lead to the rejection of all versions of
psychotherapy? If not, what account of psychopathology and of
psychotherapy would be immune to Foucault's critique? Is there a
kind of psychotherapy Foucault would positively recommend?
Does he himself practice a kind of therapy?
The answer to the first of these questions is nearest the surface
in a work Foucault published two years after he received his
degree in Psychopathology from the University of Paris. In this
early work, entitled Mental Illness and Personality (1976a),1 Foucault distinguished anatomy and physiology, which offer medicine
"an analysis that authorizes valid abstractions against the background of organic totality" (p. 10), from psychiatry, where scientific
analysis has no place. Foucault argued that an abstract, theoretical,
causal account of normal and abnormal function is possible in
organic medicine, but that a parallel scientific approach is impossible for psychiatry because the personality must be grasped not as
a totality of functional components but as a unified interpretation
or style of behavior.
Foucault's Critique of Psychiatric Medicine
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Mendel spoke the truth, but he was not dans le vrai (within the true) of
contemporary biological discourse: it simply was not along such lines that
objects and biological concepts were formed . . . . It is always possible to speak
the truth in a void; one would only be in the true, however, if one obeyed the
rules of some discursive "policy". . . (Foucault, 1976b, p. 224).
Since Foucault was interested only in the "dubious disciplines",

the human sciences, however, he tends to overstate his case
concerning the contextual dependence of truth claims, while
seldom discussing truth, as opposed to the practices that make
truth claims possible.
In those few places where he does discuss the truth of natural
science, Foucault remains a philosopher of science in the tradition
of his teacher, Georges Canguilhem, who seems to be some sort of
scientific realist. In an appreciation of the work of Canguilhem,
Foucault writes: "In the history of science one cannot take truth as
given, but neither can one do without a relation to the truth and
to the opposition of the true and the false. It is this reference to
the order of the true and the false which gives to that history its
specificity and its importance" (Foucault, 1985, p. 3).
The Comtean notion that positive science has "taken off" from
traditional religion and metaphysics became Bachelard's "epistemological rupture". When, in The Archaeology of Knowledge, Foucault
(1976b, p. 188) defines the thresholds of positivity, epistemologization, scientiflcity, and formalization through which discursive
formations go, he is speaking of stages of the rationalization of the
physical sciences as seen by a long tradition of French philosophers from Comte to Duhem and Althusser. According to this
view, some sciences, such as physics, because their techniques of
investigation put them in touch with an independent causal
reality, free themselves from the power practices in which they
originate, and gain autonomy and objectivity, while others, whose
techniques do not mesh with their objects, are stuck with meth-
and the determination of . . . real causality" (Foucault, 1976a ; p.

10) would have to be rejected by Foucault himself. Foucault
would then no longer be able to distinguish psychoanalytical
theory as a pseudo-science from valid theories in the natural
sciences, since no science could make valid causal claims.
Yet, even in The Order of Things, Foucault distinguishes the
truth from what is accepted as in the true/false business at a
specific time:
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ods dictated not by their subject matter but by the power practices under which they were developed. At the time of Discipline
and Punish, a relatively late work, Foucault still seems to hold this
view of the natural sciences:
Foucault is interested in the non-autonomous human sciences

and the way they have remained involved with power. Therefore,
he has nothing further to say about the automonomous natural
ones. It seems reasonable to suppose, however, that Foucault has
retained his earlier view that the natural sciences have been able
to arrive at relative autonomy because they have found a level of
analyses that authorizes valid abstractions corresponding to the
natural kinds and causal powers in the physical world.
Not only does Foucault note that the natural sciences have
achieved autonomy but, in the same passage, he implies that such
autonomy may be impossible for the sciences of man. This
suggests that the natural sciences can be right about natural kinds
in the physical and biological world, but there may be no natural
kinds for the human sciences to be right about. At one point in an
interview, Foucault asks himself: "Why should an archaeology of
psychiatry function as an 'anti-psychiatry', when an archaeology of
biology does not function as an antibiology?" (Gordon, 1980, p.
192). And he answers with another question: "[I]s it not . . . that
psychiatry is not on good terms with its own history, the result of
a certain inability on the part of psychiatry, given what it is, to
accept its own history?" (Gordon, 1980, p. 192).
What is it about psychiatry that makes it unable to accept its
own history? I will argue that Foucault thinks this inability has to
do with the impossibility of valid causal theories in the human
sciences and a consequent compromising involvement with power.
My discussion will follow the order of Foucault's development,
first taking up the special relation of the human sciences to causal
laws and then considering the relation of psychiatry to power.
Foucault started out as a student of Heideggerian existential
psychiatry. His first published work, a one hundred page introduc-
What Great Observer will produce the methodology of examination for the
human sciences? Unless, of course, such a thing is not possible. For, although it
is true that, in becoming a technique for the empirical sciences, the investigation has detached itself from the inquisitorial procedure, in which it was
historically rooted, the examination has remained extremely close to the
disciplinary power that shaped it (Foucault 1977a, p. 226).
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tion to Binswanger's Dreams and Existence (1954), begins by

setting out and defending Heidegger's account of human existence, or Dasein, in Being and Time. In this account, there is no
human nature. Rather, "human being" is a self-interpreting way of
being whose practices have enable it to act as if it had a whole
series of different natures in the course of history. To understand
Heidegger's claim, it helps to remember that, in Homeric times,
there were ways of singing of heroes and so men could become
heroes. Later, in Christian times, there were practices for cannonizing saints so men could become saints. At the time of Homer,
there could be no saints but only pathetic losers who let people
walk all over them, and, conversely, in Medieval times there
could be no heroes but only prideful individuals who disrupted
society by denying their dependence on God. Or, to take an
example from Foucault's History of Sexuality, in Antiquity in
some groups men took care of themselves by taking care their
actions were in keeping with the laws of health and society, while
in another, confessional practices produced a new type of man
who identified himself with his desires, and then, since his desires
might be the disguised work of the devil, developed a hermeneutic of suspicion to ferret out their true meaning.
If there is no human nature, we can describe the structure of
self-interpreting beings, but we cannot have a psychology a
scientific theory of psychic components, their causal powers, and
their normal and abnormal functioning. So we are finally in a
position to understand Foucault's claim that physiology can give
us "valid abstractions" that allow "causal determinations", whereas
there can be no theory in psychiatry since what psychiatry must
study is a "style, the whole historical anteriority and possible
implications, of an existence" (Foucault, 1976a, p. 11).
On this view, we can have true, objective theories about DNA,
human reproduction, sexual functions, etc., but there is no objective answer to the questions, What is human nature? Are we
sexual beings? etc. not because we do not yet know the answers
to these questions, but because they are not the sort of questions
that have objective answers. All one can have is a particular
historical understanding of human nature, a self-interpretation
embodied in the current social practices and in each individual
socialized into those practices.
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II. THE COGITO AND THE UNTHOUGHT: SELF-ANALYSIS

AS INTERMINABLE
Later, Foucault argues that psychiatry is not only mistaken in a

general way in trying to be a science of human nature but that
psychoanalysis, as a child of its time, is mistaken in a particular
way. Psychoanalysis seeks to be a science of a particular interpretation of human nature, viz., man. Man, according to Foucault,
is a recent human self-interpretation in response to the collapse of
religion and metaphysics. Kant accepted the finitude of human
reason and sought to make this very finitude the basis of man's
positive powers; "To make the limits of knowledge provide a
foundation for the possibility of knowing" (Foucault, 1970, p.
317). Thus, man, as defined by Kant, became both the source of
all meaning in the universe and a meaningless object in it. Indeed,
it is precisely as finite that he is the source of all order. All
sciences of man are based on, and have to struggle with, this
difficult idea. A science of the psyche based on this notion of man
will thus have a typical convoluted form. Since he is an opaque
object in the world, man's own mental content is foreign and
obscure to him, yet, as source of all meaning, he is "perpetually
summoned towards self knowledge" (ibid., p. 323). If man is to be
intelligible to himself, the unthought must ultimately be accessible
to thought and dominated in action, yet insofar as this unthought,
in its obscurity, is precisely the condition of possibility of thought
and action it can never be fully absorbed into cogito. Thus, "The
modern cogito . . . is not so much the discovery of an evident truth
as a ceaseless task constantly to be undertaken afresh . . ." (Foucault, 1976a, p. 324). Foucault calls this structure, characteristic
of any science of man's mind, the cogito and the unthought, and
he takes Freudian theory to be a perfect example of it.
In his psychological theorizing, Freud presupposed a Cartesian/
Kantian conception of the mind. This epistemological conception
of mind is roughly that the mind consists of a set of ideas,
analogous to images or descriptions, which represent the outside
world and may correspond or fail to correspond to what is
actually out there in the world. At the culmination of this tradition, Franz Brentano, who was one of Freud's teachers, claimed
that mental states such as perception, memory, desire, belief, etc.,
are all "of" something or "about" something. Brentano held that
this directedness or aboutness, called by him "intentionality", is
characteristic of the mind and nothing else.
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Psychoanalysis stand as close as possible . . . to that critical function which, as

we have seen, exists within all the human sciences. In setting itself the task of
making the discourse of the unconscious speak through consciousness, psychoanalysis is advancing in the direction of that fundamental region in which
Freud accepted the intentionalist conception of mind as a set

of states directed toward objects by means of representations.
However, the entire tradition from Descartes to Brentano had
maintained that all intentional states must be conscious, whereas
Freud learned from his work with hypnosis that not every mental
representation was immediately accessible to reflection. Thus,
Freud was led to introduce the notion of an unconscious, which,
just like the conscious mind, was directed toward objects by
means of representations, but whose representations were not
directly accessible to the conscious subject. Yet it is these unconscious representations that motivate us. Unconscious instinctual impulses, according to Freud, are directed via unconscious
ideas. Libidinal energy has its effect on our behavior by catheching
a specific representation or idea of some object, which we then
desire for sexual gratification.
This intentionalist or epistemological conception of mind,
joined with the idea that some mental contents can be unconscious, lead directly to Freud's conception of pathology and
therapy. Freud accounts for pathology by hypothesizing that
representations that are deprived of consciousness remain causally
active but are not integrated into the web of conscious mental
states, and so manifest themselves to consciousness as symptoms.
Thus the epistemological account of mind when used to account
for pathology becomes a depth psychology concerned with representations buried in the unconscious.
Corresponding to this epistemological view of mind and pathology, we find an epistemological conception of the therapeutic
process. In depth psychology, the basic problem is that some
mental contents are unconscious, and not properly integrated into
the ego's overall set of representations. Therapy thus consists of
helping the patient to uncover the hidden contents and to reintegrate them into his overall mental system. With this view of
therapy as the interminable task of searching out and bringing to
light the self's concealed motivations, Freud represents the culmination of the thought of the long line of thinkers who have
been governed by that structure of the sciences of man which
demands that one think the unthought.
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the relations of representation and finitude come into play (Foucault, 1976a,
p. 374).
By following the same path as the human sciences, but with its gaze turned the
other way, psychoanalysis moves towards the moment by definition inaccessible to any theoretical knowledge of man . . . at which the contents of
consiousness . . . stand gaping, upon man's finitude. . . . [a] region where
representation remains in suspense . . . (Foucault, 1976a, p. 374).
Foucault follows Lacan's attempt to rehabilitate Freud. "Freud",

he tells us, "was the first to undertake the radical erasure of the
division between . . . the normal and the pathological, the comprehensible and the uncommunicable, the significant and the
non-significant . . . (1976a, p. 361). Indeed, "nothing is more
alien to psychoanalysis than anything resembling a general theory
of man. . . " (1976a, p. 376).
In his later work, however, when Foucault focuses on the
social effects of the sciences of man rather than on their selfdefeating attempt to recuperate the unthought into the cogito,
he comes to see psychoanalysis not as a liberating step beyond
the human sciences, but as the culmination of a normalizing confessional technology developed by the early Christians. In the
lectures and interviews reflecting the not yet published Confessions of the Flesh, Foucault argues that Christian confessional practices produced a being he calls 'the man of desires'. This Christian
Thus, on Foucault's account, psychoanalytic theory turns out

to be a perfect example not just of a (pseudo) science of human
beings in general but, more specifically, an exemplary human
(pseudo) science in which man's nature as finite is taken to be
explained by an unthought that must be, but can never be, Hilly
recuperated by consciousness.
At the time of The Order of Things, Foucault was under the
influence of structuralism, as was the French psychoanalyst
Jacques Lacan. Foucault therefore goes through some convoluted
moves to argue that Lacanian psychoanalysis, "occupies a privileged position" (1976a p. 373). It is somehow beyond the sciences
of man, because, in facing the primary processes of the unconscious, it comes upon what cannot be interpreted and brought to
consciousness gaps in language, unrepresentable desires "the
mute solidity of a thing, of a text closed upon itself. . ." (1976a, p.
374). In the oracular prose of the period, Foucault explains:
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What has just been said is not intended as an a priori criticism of any attempt
to circumscribe the phenomena of madness or to define a strategy of cure. It
was intended simply to show a particular relation between psychology and
madness and a disequilibrium so fundamental that they rendered vain any
man identifed himself not with his public deeds but with his
most private intentions, desires, fantasies, and dreams. Moreover,
since what one desired might well be forbidden and thus the
desire disguised, one had to be suspicious of one's desires and
constantly work to dredge up one's true motivations. Foucault
quotes a confession manual: "Examine . . . all your thoughts,
every word you speak, and all your actions. Examine even unto
your dreams, to know if, once awakened, you did not give them
your consent. And finally, do not think that in so sensitive and
perilous a matter as this, there is anything trivial or insignificant"
(1978, p. 20). This is the motto of the hermeneutic subjects we
have all become.
In classical Freudian theory, since pathology arises from repressed unsatisfied desires returning as symptoms, health would
consist in constantly retrieving the repressed desires so as either
to satisfy them, substitute other acceptable goals, or maturely
resign oneself to not being able to fulfill one's infantile and antisocial demands. But caught in the confessional practices that
underly the structure of the cogito and the unthought, we can
never suceed. "We convince ourselves that we have never said
enough on the subject, that, through inertia or submissiveness,we
conceal from ourselves the blinding evidence, and that what is
essential always eludes us, so that we must always start out once
again in search of it" (1978, p. 33). Thus, in principle, Freudian
theory advocates the interminable analysis of one's desires, fantasies, and dreams and so contributes to the practices that tend to
make everyone into self-normalizing subjects. Each person is led
to seek the truth about himself, and thus to assure that all his
actions and even his thoughts in every area of life do not deviate
from what science has shown to be normal, healthy, and productive.
Foucault does not deny that people's desires are important
aspects of their personality and that, on occasion, when, for
example, one's actions are self-defeating, it makes sense to ask
oneself what one really wants. He never had reason to retract his
remark at the end of Mental Illness and Personality, that
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attempt to treat the whole of madness, the essence and nature of madness, in
terms of psychology (Foucault, 1976a, p. 76).
The notion of "sex" made it possible to group together, in an artificial unity,

anatomical elements, biological functions, conducts, sensations, and pleasures,
and it enabled one to make use of this fictitious unity as a causal principle . . .
(Foucault, 1978, p. 154).
Moreover, late Foucault maintains that the sexual human nature

to which this pseudo-science appeals is a power-construction.
Causality in the subject, the unconscious of the subject, . . . the knowledge he
holds unbeknown to him, all this found an opportunity to deploy itself in the
discourse of sex. Not, however, by reason of some natural property inherent
in sex itself, but by virtue of the tactics of power immanent in this discourse
(Foucault, 1978, p. 70).
Power, for Foucault, means bio-power, the tendency to bring

norms, allegedly based on science, into every aspect of human
life for ever greater enhancement and control. This tendency is
dangerous according to Foucault not because it represses some
aspect of our nature we haven't any nature but because it
limits freedom of personal choice, a desideratum he presumably
carries over from his early allegiance to existential philosophy.
Not that Foucault supports freedom as constant flexibility and
What makes Freudian theory dangerous, according to Foucault,

is that such self-inspection is not confined to a period of therapy
when dealing with a specific problem. Rather it is supposed to
be based on a science of the psyche that holds that relentless
self-inspection must be practiced as a permanent way of life if
one is to become and remain a mature and healthy human being.
Freudian theory thus reinforces the collective practices of selfanalysis that provide material to fill the dossiers of the human
sciences and allow norms, based on an alleged science of human
nature, to permeate every aspect of our lives. Acording to Foucault, this endless self-analysis, in which each private subject is
urged to speak so as to make itself available to inspection and
correction, has become not our cure, but our curse.
For Foucault, then, Freud's claim to have elaborated a science
of the subject by understanding desire as sexual desire, and sexual
desire as a natural kind about which we can discover laws of
normal development, functioning and causal effects, is unfounded.
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III. EXISTENTIAL PSYCHOTHERAPY: BEYOND THE

SCIENCES OF MAN
Freudian theory is dubious and dangerous, not because what

Freud says about human nature and its norms are not true while
some other theory might get it right, but because, since there is no
human nature, the whole attempt to medicalize psychiatry is
misguided. But, then, we must ask: If the psychiatrist cannot have
a causal theory, explaining normal and abnormal functioning, how
can he understand people and so help those with personality
problems? Early Foucault attempts to answer this question by
first showing how psychoanalytic concern shifted from an em-
self-overcoming for its own sake. Freedom, for Foucault, is freedom from every universal norm, even this post-modern one. It is
freedom to give one's life the stability and uniqueness of a work
of art. As Foucault said in his last interview: "The search for a
form of morality acceptable by everyone in the sense that everyone would have to submit to it, seems catastrophic to me" ("Le
Retour de la Morale," Les nouvelles, 28 June 1984, p. 37).
When the later Foucault approaches psychoanalysis, not just
as a would-be-science of man, but as a power practice characteristic of modern Western society, he includes the Lacanian version of Freud. Even Lacan still assumes an ahistorical knowledge
of human nature, viz., that man's deepest desires can never be
satisfied and that one must therefore accept the meaninglessness
of desire and of human existence. He, therefore, proposes a
therapy based on the need to articulate what one can of the
unthought so as to be liberated from it. In a 1977 interview with
Lacan's successor, Jacques-Alain Miller, Foucault points out that
even in Lacanian psychoanalysis "the subject is incited to produce
a discourse of truth about his sexuality which is capable of having
effects on the subject himself" (Gordon, 1980, pp 215216).
Once we see why Foucault regards psychoanalysis as a dangerous pseudoscience, we are in a position to see why an account
of psychopathology free from a theory of normal functioning along
with a therapy with other aims than liberating us from the supposed causal effects of repressed desires by requiring us to tell the
truth about the contents of our minds, were once, and might still
be, acceptable to him.
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phasis on a causal theory of symptoms to a description of styles of

defenses.
Foucault cites with approval Anna Freud's The Ego and the
Mechanisms of Defense, and suggests that one could and should
describe and treat styles of defenses as they show up in the
present without regarding them as clues to internal unconscious
pathology, as if that were the real cause of the problem. "A style
of psychological coherence must be found that authorizes the
understanding of morbid phenomena without taking as its referential model stages described in the manner of biological phases"
(Foucault, 1976a; pp. 41-42).
The proposal that one avoid pseudo-science by defining pathological patterns of behavior without seeking underlying causes
leads Foucault to Ludwig Binswanger's existential phenomenological psychiatry a form of diagnosis that is not based on
causal theory and a type of therapy that does not advocate a
hermeneutic inspection of desire. Since existential phenomenological psychiatry is now rather unfamiliar, we will need to consider briefly the different understanding of mind and reality
underlying the Freudian and the existential approaches.
We have seen that Freud presupposed a Cartesian/Kantian
view of the mind. Philosophers such as Martin Heidegger and
Maurice Merleau-Ponty, reacting against the Cartesian tradition,
have developed an alternative model of the mind's relation to
reality. This account is so radical that, strictly speaking, these
philosophers do not refer to the mind at all. Rather they prefer
to speak of the way the whole human being is related to the
world. Indeed, even "relation" is misleading, since it suggests the
coming together of two separate entities human beings and
the world whereas these philosophers see mind and world as
inseparable. So they are finally driven to replace the epistemological relation of subject and object with a way of being they call
This notion of psychological defense is of major importance. The whole of

psychoanalysis has centered around it. An investigation of the unconscious, a
search for infantile traumas, the freeing of a libido that supposedly existed
behind all the phenomena of the affective life, an uncovering of such mythical
impulses as the death instinct psychoanalysis has long been just this; but it is
tending more and more to turn its attention to the defense mechanisms and
finally to admit that the subject reproduces his history only because he
responds to a present situation (Foucault, 1976a, p. 36).
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"being-in-the-world" in which human-being or Dasein is a kind of

space in which coping with other beings becomes possible.
This "ontological" view does not deny that human beings sometimes have mental representations by which their minds are
directed toward objects. Rather, the ontologists assert that mental
representations presuppose a context in which objects can show
up and make sense. This context is provided by social practices
(Heidegger, 1962, Chap. 4).2 The shared practices into which we
are socialized provide a background understanding of what counts
as objects, what counts as human beings, and ultimately what
counts as real, on the basis of which we can direct our actions
toward particular things and people. For example, Christian practices imparted an understanding of human beings as creatures of
God with deep selves full of hidden desires and memories out of
reach of consciousness. These aspects of the self could be recovered partially by confession, but only God could know them
exhaustively. At the same time, Christianity introduced an understanding of things as created by God, and thus full of significance
that solicited endless interpretation. This unified understanding
of people and things, viz., that to be is to be a creature given
meaning by God, was embodied in what Foucault came to call the
culture's micro-practices. Such practices are picked up by socialization, itself largely the result of identification and imitation, so
that this understanding need never be conscious or even unconscious. Heidegger calls this background understanding of what it
means to be, which is embodied in the tools, language, and
institutions of a society and in each person growing up in that
society, but which cannot be exhaustively represented in his/her
mind, an understanding of being. Hence the name ontology.
A culture's understanding of being creates what Heidegger calls
a clearing {Lichtung) in which entities can then show up for us.
The clearing is neither on the side of the subject nor the object
it is not a set of implicit and explicit beliefs nor a set of facts
rather it contains both and makes their relation possible. It is an
acquired context that both opens up and limits the kinds of
objects we can deal with or, as Heidegger puts it what things
can show up for us as.
Merleau-Ponty, following Heidegger, compares this clearing to
the illumination in a room. The illumination allows us to perceive
objects, but is not itself an object toward which the eye can be
directed. He argues that this clearing is correlated with our bodily
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The analysis of the dream was not exhausted at the level of a hermeneutic of
symbols; but, starting from an external interpretation which is still a kind of
deciphering, one was to . . . arrive at an understanding of the existential
structures (Foucault, 1955, p. 15).
Binswanger used the ontological structure of a patient's existence rather than a causal, genetic account of intra-psychic forces,
as a framework for constructing a narrative that was intended to
capture the developing pattern of a patient's life. Foucault explains:
It is a question of restoring, through his understanding, both the experience
that the patient has of his illness (the way in which he experiences himself as a
sick or abnormal individual) and the morbid world on which this consciousness
of illness opens . . . . The understanding of the sick consciousness and the
reconstitution of its pathological world, these are the two tasks of a phenomenology of mental illness (Foucault, 1976a, p. 46).
Binswanger's therapy consisted in helping a patient to become

aware of his way of being-in-the-world and to assume responsibility for it. This itself was supposed to produce change, since
according to Binswanger, becoming a person whose life could be
described as a case of sickness to be studied objectively is itself a
choice of an inauthentic form of existence which repudiates its
freedom. But Binswanger does not explain why it is hard for a
person to see the style of his life, nor how his therapy produces
this understanding.
skills and thus with the bodily stance we take toward people and
things. Each person not only incorporates his culture's understanding of human beings and of objects, but also his sub-culture's
and family's variations on the current social practices. Thus, each
person comes to have or to be his own embodied understanding
of what counts as real, which is, of course, not private but is a
variation on the shared public world.
This ontological as opposed to epistemological view of human
being leads to an alternative account of the unconscious, of
psychopathology, and of therapy. Binswanger worked out and
practiced this alternative. He understood psychopathology as a
distortion of the human clearing that makes it narrow and rigid.
Binswanger was concerned with describing the style of a patient's
world. For example, as Foucault explains in his introduction to
Binswanger's book on dreams, he was not interested in the symbolic meaning of the content of dreams but in the personal style of
structuring space and time that dreams reveal.
325
One has only to think of those jealous individuals who justify their mistrust,
their interpretations, their delusional systematizations, by a meticulous genesis
of their suspicions that seems to dilute their symptoms throughout their
existence . . . They see in their morbid jealousy the deepest truth, the most
radical misfortune of their existence. They normalize it by referring it to the
whole of their previous life (Foucault, 1976a, p. 48).
When this happens, the person's world or clearing becomes restricted and rigid. The person suffers from a lack of possibilities
that he cannot understand and over which he has no control. To
highlight the contrast with Freudian depth psychology, this ontological account of psychopathology as the expanding of content
into context, might be called breadth psychology.
This is, of course, a non-representational version of the unconscious. Merleau-Ponty uses as an example of such a generalized
unconscious the case of someone who relates to each person as if
the issue were one of determining who is inferior and who is
superior. In Merleau-Ponty's terms, inferior/superior, once an issue
in the clearing, has become a dimension of the clearing. MerleauPonty uses the notion of context this time called "atmosphere"
to explain why such a self-defeating stance is outside of the
sufferer's awareness and control
An inferiority complex . . . means that I commited myself to inferiority, that I
have made it my abode, that this past, thought not a fate, has at least a specific
weight and is not a set of events over there, at a distance from me, but the
atmosphere of my present. (Merleau-Ponty, 1962, p. 442).
On this ontological account, a child comes to encounter all

significant figures as superior, for example, not because the representation of specific threatening others make him anxious and are
Merleau-Ponty, who was one of Foucault's teachers, offers a

more plausible existential account of pathology that Foucault
seems to integrate into his account Binswanger. In Merleau-Ponty's
ontological view, pathology occurs when a particular way a person
relates to some people or some objects becomes a way of relating
to all people and all objects, so that it becomes the form or
style of all relationships, i.e., some aspect of the epistemological
relation of a subject to other persons and objects, which should
take place in the clearing, becomes a dimension of the clearing
itself. Merleau-Ponty calls the shift from content to context,
"generalization". Foucault uses jealousy as an example of such
generalization:
326
Hubert L. Dreyfus
Power relations can materially penetrate the body in depth, without depending . . . on the mediation of the subject's own representations. If power takes
hold on the body, this isn't through its having first to be interiorised in
people's consciousness (Gordon, 1980, p. 186).
Even after an issue in the world, e.g., who is superior, has

become one of the dimensions of the clearing, however, a person's
world is not completely static and one-dimensional. To
understand the last step to the closed world of pathology requires
explication of one last ontological notion from Heidegger and
Merleau-Ponty. Heidegger, in his later work, introduces the idea
of a particular event in the clearing or "Open" which focuses and
stabilizes the cultural meanings already in the public practices. As
Heidegger (1971) puts it: "There must always be some being in
this Open . . . in which the openness takes its stand and attains
its constancy" (p. 61). He gives as an example the Greek temple
that opens up and organizes a multi-dimensional world by highlighting crucial issues that then become the locus of conflicts of
interpretation, and the starting point of history. Heidegger's
notion of an event that gives constancy to a cultural clearing
might be called a cultural paradigm, for it has much in common
with Thomas Kuhn's notion of a scientific paradigm, a particular
experiment or explanation that serves as a model of good science
therefore repressed and return in disguised form as symptoms and

belief in his inferiority. An unconscious belief that he is inferior
would not adequately account for the pervasive style of his
behavior nor his imperviousness to counter-arguments. Moreover,
a belief, or a schema, does not explain how the person who has it
behaves with the appropriate style in each particular case. For
example, if our patient simply believes he is inferior, or has a rule
such as, 'Whenever asked to do something, claim one is not
adequate for the job,' he would not know how to apply the rule to
all specific situations, even when his wife asks him to take out
the garbage or when his boss suggests he deserves a promotion.3
Yet it is clear that he will exhibit his unique style of inferiority
behavior in each of these situations and indefinitely many others.
According to Merleau-Ponty's account, with which Foucault
would surely agree, the patient's sense of inferiority is sedimented
into his posture and other body-sets that structure his world, so
that he unthinkingly responds in a similar way to each new
situation. As Foucault puts a similar point:
327
It is necessary to have the ontological capacity . . . to take a being as a

representative of Being . . . The fixation of 'character' [takes place] by investment of the openness of Being in an entity and, henceforth, takes place
through this entity. Any entity can be accentuated as an emblem of Being . . .
(Merleau-Ponty, 1969, p. 270).
The emblem, as Merleau-Ponty calls the paradigmatic object, has

the effect of reorganizing the background or clearing in which all
contents appear. Thus, even though it is an object we actually
confront, it performs the same function as the clearing itself.
Heidegger and Merleau-Ponty have noticed two closely related
but antithetical kinds of ontological entities. Heidegger's notion of
an event that gives constancy to a cultural clearing, but allows
multiple interpretations, might be called a positive paradigm.
Merleau-Ponty, on the other hand, is suggesting that there can
also be negative paradigms objects, person, or events that focus
a person's world not by opening it up but by closing it down, thus
substituting a one-dimensional obsession for diversity, suspicion
for openness, and timelessness for history.
According to Foucault (1976a, p. 55), a change in structure
rather than content, is what distinguishes the "morbid world"
from the world of a "normal man". Foucault quotes Binswanger
with approval: "The validity of the phenomenological descriptions
is not limited by a judgment on the normal and abnormal"
(1976a, p. 56). He then adds: "But the morbid manifests itself in
the course of investigation as the fundamental characteristic of this
world . . . [T]his morbid existence is marked by a very particular
style of abandoning the world: by losing the significations of the
world, by losing its fundamental temporality . . ." (1976a, p. 56).
That is, the patient has no open future but is stuck in a past
clearing in which the same issue shows up again and again.
To help the patient out of his closed world, the therapist may
try to lead the patient to remember how things showed up before
a specific issue became one of the dimensions of his clearing. The
structure of dreams could also be used to help break out of the
and organizes the activities of researchers in a scientific community. Soren Kierkegaard (1941) emphasizes that a lover or a cause
to which one is committed can serve the same function in an
individual's life.
Merleau-Ponty introduces a similar idea concerning the role of
particular objects or events in an individual's life.
328
Hubert L. Dreyfus
current closed world of the patient by showing that the world

once had a more open style. Of course, any ordinary memory will
show the past as already colored by the current clearing, but there
can be a kind of spontaneous recall especially in dreams, in which
past events are experienced as they were originally, not as they
have been retroactively interpreted (Schachtel, 1959).4
Another way to get the patient to see he is stuck in a totalizing
interpretation is for the therapist to make it difficult for the
patient to fit the therapist into his world while at the same time
calling attention to the anomalies that arise when he tries. Rather
than following Freud in using transference primarily in dealing
with specific resistances to uncovering the truth of specific desires, the existential therapist would work with transference as an
occasion for showing the patient the inappropriate coloring or
style of his world by pointing out that he is reacting to the
therapist in a typical but inappropriate way. The therapist thus
uses the fact that he inevitably becomes an emblematic focus for
the one dimension through which the neurotic sees everything in
his world to call attention to this dimension and its limitations.
Even if the patient were thus led to recognize the coloring and
cramptedness of his present clearing, however, he would be likely
to insist that a certain time in the past he had discovered that this
is how things really are for him, his "destiny" as Foucault (1976a,
p. 48) puts it. Thus the therapeutic strategy for turning the
ontological back into the epistemological ultimately must undermine the patient's current sense of reality. This is accomplished
by working with the patient to piece together an account of how
the patient's narrow version of reality developed through a series
of accidental events and misunderstandings. The patient must
come to realize that what he takes to be his "destiny" is not
objective reality but his own arbitrary interpretation.
Simultaneously, the patient must be lead to see the connection
between his interpretation of reality and his pain. The therapist
thus tries to get the patient to see that what he takes to be unchangeable reality is really simply his particular and quirky story,
and that this understanding has a high price. Such a "genealogy"
of an individual's world will tend to undermine the patient's
conviction that his way of seeing things is the way things are and
have to be.
None of this would work, however, if every aspect of the
patient's behavior had been infected by his one-dimensional view.
Foncault's Critique of Psychiatric Medicine
329
IV. THE LIMITS OF ALL PSYCHO-THERAPIES

In spite of the attraction of phenomenological psychiatry, Foucault,
in his early essay, holds that, like psychoanalysis, it can account
neither for why some people rather than others with seemingly
similar experience get into psychological trouble nor for the
particular kinds of "madness" that are manifest in a given society.
It would be a mistake to believe that organic evolution, psychological history,
or the situation of a man in the world may reveal these conditions. It is in these
conditions, no doubt, that illness manifests itself, that its modalities, its forms
of expression, its style, are revealed. But the roots of pathological deviation, as
such, are to be found elsewhere . . . (Foucault, 1976a, p. 60).
In an anticipation of a theme that only emerges fully in his later

work, Foucault already holds in his first book that the conditions
of the possibility of pathology lie in the social world. "The analyses
of our psychologists and sociologists, which turn the patient into a
deviant and which seek the origin of the morbid in the abnormal,
are,. . . above all a projection of cultural themes" (1976a, p. 63).
Later Foucault fills this out. The ultimate form of alienation in
our society is not repression but the constitution of the isolated
individual subject to which all psychiatries contribute. Just as an
For then the therapeutic, genealogical, reconstruction of the arbitrariness of the patient's sense of reality would be seen by the
patient merely as showing the strange and idiosyncratic route he
followed in arriving at his truth. Fortunately, however, this need
not be his response. When a patient's world becomes totalized
and one-dimensional, other ways of behaving from earlier days
endure. These marginal stances, interpretations and practices are
not taken up into the one-dimensional clearing precisely because
they are too fragmentary and trivial to be seen as important. The
therapist must recover and focus these lost possibilities. Here, the
therapist as positive paradigm has a curative role.
Thus, without a causal theory of the functional components of
a personality and their normal and abnormal functioning, but with
only a description of human being as a space opened up by
interpretation, and a typology of possible distortions of that
clearing, the phenomenological therapist can give an account of
psychological problems and offer a genealogical cure. No wonder
Foucault favored existential, ontological psychiatry.3
330
Hubert L Dreyfus
V. GENEALOGY AS SOCIAL THERAPY

But how can Foucault convince us of his view? Why can't we
think indeed, as creatures of our age, are we not forced to
think that after a long history of false starts we have finally
learned that human beings really do have a normative nature, a
nature that is sexual through and through, just as we have
learned that the heart is a pump and the brain is not a radiator
but the seat of thought?
Foucault could easily deny the truth of psychoanalysis if he
denied all serious truth claims, but that would be a pyrrhic
victory. Yet once he has granted that some sciences can state
the truth, how can he deny truth to any would-be science
except by entering a long and inconclusive empirical debate?
There is only one other way, and Foucault takes it. Just as in
existential therapy, one does not try to argue the patient out of
his interpretation of reality, but rather starts with the patient's
distress, amplifies and focuses it, and then seeks to dislodge the
understanding of being which is correlated with this distress. So,
similarly, one does not seek a philosophical proof that our sexual
individual, through a series of accidental historical interpretations

focused in a series of paradigms, comes to have a one-dimensional,
normalizing understanding of reality, in which every anomaly
must finally be made to yield its truth and confirm his systematic
interpretation, so our culture, in its pursuit of objective truth and
the total ordering of all beings for the sake of efficiency, health,
and productivity, focused in the paradigms of the panopticon and
the confessional couch, has reached a stage in which human
beings can only show up as sexual individuals, each striving to be
a normal subject so as to maximize his human potential.
Given our modern Western understanding of reality, in all
accounts of ourselves, whether they be pseudo-scientific or existential, "Man has a relation with himself and inaugurates that form
of alienation that turns him into homo psychologicus" (1976a, p.
74). Until one realizes this, all forms of psychotherapy will either
contribute to general social suffering, as Foucault thinks psychoanalysis does, or else provide only isolated and temporary "cures"
in which an individual's narrowing of reality may be opened up,
while the contradictions and normalizing closure of our everyday
social practices continue to produce individual problems and a
general malaise.
331
NOTES
* This is a revised version of an article that appeared in PsychCritique, Vol. 2,
No. 1 (1987), entitled 'Foucault's Therapy', on pages 65 through 83. Copyright
by Ablex Publishing Corporation. Printed with permission.
1
This volume was originally published by Presses Universitaires de France in
interpretation of ourselves is at bottom a social construction, one

writes genealogical histories.
The best way to see that things might be otherwise is to see
that they once were otherwise, and in some areas of life, still are.
And to see how we developed our narrow view. Thus, following
Nietzsche, Foucault sees his work as a genealogy, written to help
us derealize, and so move beyond, a certain constricted and
suffocating understanding of reality which has gradually emerged
in the history of the West. Foucault does not think, any more
than Nietszche did, that such a genealogy will provide an instant
cure, enabling the genealogist to step outside himself and his
culture. Foucault was always clear that what one chooses to look
at in the past, (e.g., Greek sexual practices), and what one finds
acceptable and unacceptable (e.g., the Greek's relative lack of
interest in a normative science of sexuality, on the one hand, but
their obsession with penetration and submission, on the other),
reflect one's own historical perspective. Historical therapy nonetheless consists in loosening the grip of our current understanding
of reality by letting us see how we got where we are, the cost of
our current understanding, and that things might be otherwise.
Without stepping out of history or seeking a philosophical
grounding for an objective truth, genealogy can show us the accidental status of our sense of who we are, and can sensitize us to
practices still alive in our culture that have not been taken up into
the reigning understanding of being.
Foucault is practicing genealogical therapy on modernity at
large. He is trying to historize, and so help dissolve, the "emblemized", one-dimensional, closed, normalized view we have of
ourselves as hermeneutic subjects, so as to ready us for the
possiblity of a new social paradigm with a new interpretation of
the human self that could take up currently marginalized practices
and so open up our world rather than shut it down.6 Foucault
paraphrases and presumably agrees with Nietzsche: "Historical
sense has more in common with medicine than philosophy . . . Its
task is to become a curative science" (1977, p. 156).
332
Hubert L. Dreyfus
REFRENCES
Dreyfus, H.: 1979, What Computers Can't Do, 2nd ed. Harper and Row, New
York.
Dreyfus, H.: forthcoming, Being-in-the-world: A Commentary on Division 1 of
Being and Time, M.I.T. Press, Cambridge, Massachusetts.
Dreyfus, H. and Rabinow, P.: 1983, Michel Foucault: Beyond Structuralism and
Hermeneutics. 2nd ed., University of Chicago Press, Chicago.
Foucault, M: 1955, Introduction to L. Binswanger, Le Reve et I'Existence, Desclee
de Brouwer, Paris.
Foucault, M.: 1970, The Order of Things, Harper and Row, New York.
Foucault, M.: 1976a, Mental Illness and Psychology, Harper and Row, New
York. (To be reprinted by University of California Press in 1987.)
Foucault, M.: 1976b, The Archaeology of Knowledge, Harper and Row, New
York.
Foucault, M.: 1977a, Discipline and Punish: The Birth of the Prison, Pantheon,
New York.
1954. The English version is a translation of the revised second edition,

published in French in 1962.
2
For an elaboration of this interpretation, see Dreyfus (forthcoming).
3
This critique of the way a representational theory of the mind must try
unsuccessfully to account for styles of behavior is worked out in Dreyfus
(1979).
4
Schachtel discusses the way certain memories seem to evade schematization
and thus to evoke the original experience just as it was lived.
3
Since Foucault only addresses the Lacanian revision of Freud, we can only
speculate about what he would say about other major post-Freudian psychoanalytic theories. We have seen that since ego psychology focuses more on
styles of defense than mental content Foucault finds it congenial. Object
relations theory, which emphasizes pre-oedipal factors thus showing the limitations of a purely oedipal account, would also come closer to the ontological
understanding of the self. Still, in their theories both these schools make causal
claims based on an alleged science of human nature which justifies an account
of normal and abnormal psychological function.
In actual practice, however, current psychoanalytic therapy when it
confronts the defenses of the patient or places emphasis on the transference
relation rather than insight is compatible with Foucault's suggestion that one
should focus on styles of defense. What needs to be radically questioned and
rethought is the therapeutic role of expressing desires in words. One must
question Freud's representational account of content and the associated
account of causality modeled on biology.
6
For a detailed account of Foucault's genealogical method, see Dreyfus and
Rabinow(1982).
333
Foucault, M.: 1977b, 'Nietzsche, genealogy, and history', in D. F. Bouchard

(ed.), Michel Foucault: Language, Counter-memory, Practice Selected Essays
and Interviews, Cornell University Press, Ithaca.

Foucault, M.: 1978, The History of Sexuality, Vol. 1, Pantheon, New York.
Foucault, M.: 1984, L'Histoire de la sexualite, Vol 3: Le souci de soi, Gallimard,
Paris.
Foucault, M.: 1985, 'La vie: L'experience et la science', Revue de Metaphysique et
de Morale, 1, 614.
Foucault, M: 1986, The History of Sexuality, Vol. 2: The Uses of Pleasure,
Pantheon, New York.
Gordon C (ed.): 1980, Power/Knowledge: Selected Interviews and Other Writings,
19721977 by Michel Foucault, Pantheon, New York.
Heidegger M: 1962, Beingand Time, Harper and Row, New York.
Heidegger, M.: 1961, The origin of the work of art', in Poetry, Language,
Thought, Harper and Row, New York.
Kierkegaard, S.: 1941 Fear and Trembling, Princeton University Press, Princeton.
Merleau-Ponty, M.: 1962, Phenomenology of Perception, Routledge and Kegan
Paul, London, England.
Merleau-Ponty, M.: 1969, The Visible and The Invisible, Northwestern University Press, Evanston.
Schachtel, E.: 1959, Metamorphosis, Basic Books, New York.

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HUBERT L.

FOUCAULT'S CRITIQUE OF PSYCHIATRIC

Key Words: normal, mental illness, sexuality, psychoanalysis

I. GENUINE SCIENCES OF NATURE VS.

By the time Foucault began his History of Sexuality, he was

Hubert L Dreyfus^ Ph.D., Professor, Department of Philosophy, University of California, Berkeley,

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The coherence of a psychological life seems . . . to be assured in some way

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gerous. Reading Foucault's history of how Western man arrived at

Foucault's Critique of Psychiatric Medicine

Since Foucault was interested only in the "dubious disciplines",

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and the determination of . . . real causality" (Foucault, 1976a ; p.

Foucault is interested in the non-autonomous human sciences

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Foucault's Critique of Psychiatric Medicine

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tion to Binswanger's Dreams and Existence (1954), begins by

II. THE COGITO AND THE UNTHOUGHT: SELF-ANALYSIS

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Later, Foucault argues that psychiatry is not only mistaken in a

Foucault's Critique of Psychiatric Medicine

Psychoanalysis stand as close as possible . . . to that critical function which, as

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Freud accepted the intentionalist conception of mind as a set

Foucault follows Lacan's attempt to rehabilitate Freud. "Freud",

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Thus, on Foucault's account, psychoanalytic theory turns out

Foucault's Critique of Psychiatric Medicine

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The notion of "sex" made it possible to group together, in an artificial unity,

Moreover, late Foucault maintains that the sexual human nature

Power, for Foucault, means bio-power, the tendency to bring

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What makes Freudian theory dangerous, according to Foucault,

Foucault's Critique of Psychiatric Medicine

III. EXISTENTIAL PSYCHOTHERAPY: BEYOND THE

Freudian theory is dubious and dangerous, not because what

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phasis on a causal theory of symptoms to a description of styles of

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This notion of psychological defense is of major importance. The whole of

Foucault's Critique of Psychiatric Medicine

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"being-in-the-world" in which human-being or Dasein is a kind of

Binswanger's therapy consisted in helping a patient to become

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Foucault's Critique of Psychiatric Medicine

On this ontological account, a child comes to encounter all

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Merleau-Ponty, who was one of Foucault's teachers, offers a

Even after an issue in the world, e.g., who is superior, has

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therefore repressed and return in disguised form as symptoms and

Foucault's Critique of Psychiatric Medicine

It is necessary to have the ontological capacity . . . to take a being as a

The emblem, as Merleau-Ponty calls the paradigmatic object, has

Downloaded from http://jmp.oxfordjournals.org at Universidade de S?o Paulo on July 28, 2010

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current closed world of the patient by showing that the world

Foncault's Critique of Psychiatric Medicine

IV. THE LIMITS OF ALL PSYCHO-THERAPIES