Underlying Foucault’s accounts of asylums, hospitals, prisons, and schools was a continuing concern with power and knowledge. In the field of mental health, his preoccupation with power relations and the construction of narratives of exclusion and repression in the History of Madness have led many scholars to consider Foucault an anti-psychiatrist (Freeman 1967; Laing 1967; Leach 1967; Shorter 1997, 274). They question the book’s historical data, which prioritize power relations and political analysis over the actual experience of doctors and patients, undermining its scientific worth. Even thinkers sympathetic to Foucault’s ideas argue that, despite the cultural discontinuities that he sought to foreground in his historical analysis, he nevertheless offered a continuous narrative of confinement and exclusion as a result of the oppressive powers of reason (Dreyfus and Rabinow 1983, 4). But for Foucault, power is not unilateral, dominant, and oppressive, but distributional. Power is not a substance or a property one can claim to possess. It is not a political structure, a government or a dominant social class. Power is mobile, unstable, and reversible and is not blind but is determined by an internal logic. There is a form of rationality behind the exercise of power, and when that form of rationality is undermined, power loses its foundations. This can be observed in current forms of psychiatric practice, where psychiatric power is in fact being undermined while apparently being ever more closely inscribed in social practices.

No abstract

No abstract

SUMMARY Critical trends in psychiatry are abundant today. Their impact on how psychiatry is currently practised is considerable. Yet what deserves close examination is the extent to which these modes of critique (anti-psychiatry, liberation movements, activism, existential, narrative or hermeneutic approaches, theories of values, psychoanalysis) inherently belong to or have become part of the very system that they criticise. Despite their political, social or scientific influence, which is undeniable, their critical power is often limited by their inability to radically challenge the deeper anthropological and philosophical presuppositions on which mainstream psychiatry rests. It can be argued that Foucault offers such a challenge. Implementing his historico-philosophical method, Foucault is sceptical of the anti-psychiatric quest for non-oppressive modes of psychiatric power and the humanist and postmodern efforts to moralise or relativise psychiatric truth. All these modes of critique rest on preconceived notions of nature, power and truth and have been integrated by the pluralism of the psychiatric universe. Yet Foucault's critique seeks precisely the opposite: to explore a new anthropological conception of insanity that has the power to challenge the legal, moral or reductionist constraints under which medical truth currently operates.