Simulation et dissimulation de la folie dans les asiles au XIXe siècle

Abstract

ObjectivesThis study explores two borderline forms of alienation–simulation and dissimulation of insanity in the asylums of the 19th century. The issues raised are related to their historical setting, where the alienist profession was forming and entering into debate with the legal sphere. At the start of the 19th century, magistrates were disputing the authority of medical experts to assess penal responsibility. In the second half of the 19th century, the debate revolved around the issue of arbitrary internment, casting doubt on both the methods and the expert knowledge of alienists. MethodsThis study is based on an analysis of textual sources devoted directly or indirectly to alienist science and legal expertise in the second half of the 19th century. Some are polemic articles evidencing the tensions between the two professions. Numerous medical authors published writings, in particular in Delasiauve's Journal de Médecine Mentale, which was an essential vehicle in the debate for some ten years. ResultsThe study of borderline or peripheral forms of mental illness led alienists to consolidate their diagnostic criteria, and also to seek to convince their partners in the public authorities. There was a need to proclaim specific knowledge making it possible to assess whether or not there was alienation, on the basis of common criteria. They concluded that simulated madness was not genuine madness, either because the simulator confuses madness and stupidity, or because the simulator invents an atypical behaviour that does not resemble any mental illness. Following on from Pinel's partial delirium and Esquirol's monomania, “lucid madness” according to Ulysse Trélat refers to a type of alienated subject in whom delirium coexists with preserved reasoning faculties. This debate shows how nosography can constitute a response to social accusations aimed at the alienist corporation by magistrates and journalists. DiscussionIt is the debate between two different conceptions of madness that was reappraised in the course of this controversy between legal and medical authorities–the holistic conception of Maine de Biran, for whom no faculty of the alienated subject escapes alienation, and the partial conception propounded by Royer-Collard, where alienation is never total. ConclusionAll madness is partial. It is on the basis of this axiom, which emerged at the time of the French Revolution, that the alienist science of the 19th century was constructed. This is the necessary condition for any treatment to be able to act. This preservation of reasoning faculties can also serve to deceive–and alienists and magistrates alike learn this to their cost. But if madness can be simulated or dissimulated, it is because its codes can be parodied and reoriented. The semiology of mental illnesses is not that of bodily medicine, which bases its semiology on an anatomical, clinical lesion. Because the semiology is mental, it can only be vouched for by the Other. This aspect of the exercise of medicine in the area of mental illness requires alienists to obtain strong social consensus on their actions. Thus alienists have come to defend a conception of their profession that is based on both knowledge on the subject of alienation, and on know-how and life skills in dealing with alienated people.