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The insane question of enlightenment
The Dispositive of Psychiatry Transformations of a Laboratory
Basic Principles of Detention
Robert Castel starts "Die psychatrische Ordnung" (The Psychiatric Order) (1983) with Article 9 of a legislation which was laid down by the revolutionary, constitutional assembly. On March 27th, 1790, it was decided that the "lettres de cachet" should be abolished: "At our prosecutor’s request, a person detained on the grounds of insanity [...]is to be examined by the judges in the usual manner and on their instruction referred to the physicians. Under supervision of the district's guardians the physicians discuss the actual situation of this person and, in accordance with their judgement on the person's condition, whether she/he is to be released or to be cared for in a hospital specifically ascertained for the purpose." (p.9) Hence Article 9 presupposes: judges and prosecutors - the Judiciary; they instruct physicians - the medical profession; they perform their examination under the supervision of the district's guardians - the local authority; subsequently, the result of the medical examination goes back to the judges who consider and include the result in their final decision on "whether the person is to be released or to be cared for in a hospital specifically ascertained for the purpose."If one was to follow Castel, then Article 9 of the Abolition of the "lettres de cachet" Act contained the "entire modern problem of insanity" that had determined the basic principles of detention and the anthropological status. In view of the problem three aspects are crucial. Firstly, the political context of a revolutionary break between absolutism and the rule of law. The judiciary and administrative bodies ceased to refer to the sovereign and also to the family, as it was with the "lettres de cachet" where a royal order for detaining a person could be initiated by the family, the local authorities, or by a ministerial official at the court. Instead, from then on the judiciary and administrative bodies referred to the medical profession. Secondly, the apparently new emergence of old authorities. Judiciary, administrative bodies and the medical profession had already existed in absolutism but within the rule of law they formed new relations. The main role was assigned to the medical profession, or better, would be assigned to them because they still lacked the "text" necessary for fulfilling this role. Thirdly, should the judgement confirm the person's insanity, also considering the medical examination's result, then those "people who are under detention" in prisons, work- and poorhouses, as it was common in an absolutist society, needed a new definition. "Thanks to the special features of the apparatus which [was] to treat and to care for [them]" they were befitted with the "medical status" of the insane (p.10), the person's "sacred illness" became profaned.
These aspects are connected with four structural elements, which still determine the history of psychiatry in relation to the basic principles of its social detention. On the one hand, the new rule-of-law relations between the judiciary, administrative bodies and the medical profession form an institutional dispositive which includes a corpus of experts and lay persons, the insane. On the other hand, the decisive role of the medical profession is based on specialised knowledge of the subject and the judiciary and the administrative bodies, foremost the police, are a precondition to it. Also, the treatment resulting from this knowledge has to be seen as intervention technology that aims at "recovery" on the condition of conviction. Finally, the place of treatment, even today, is a "special institution" despite fundamental changes in the political context, between the 18th and 19th centuries and the 20th and 21st centuries.
Today, a transformation of psychiatry is taking place which is similar to that of its emergence during the revolutionary break between absolutism and the rule of law. Yet, in spite of this transformation process the "special institution" context of psychiatry will not be given up since its basic principles of detention offer a "milieu" that can be used as a "Laboratory". The cloister or monastery serves as a paradigm for this "Laboratory", "an ideal instrument of power [...] the [so far] most systematic institutional apparatus to kill personality and to reconstruct a new and complete definition of the human being on the basis of this termination, in short [according to Castel] the most technically advanced of the laboratories to perform human experimentation." (p.109) No secular institution of the modern or post-modern age has ever reached up to the "Laboratory" of the cloister or monastery, not even psychiatry.
Pinel, the main apologist of modern psychiatry, follows an order-utopia that is orientated towards the cloister because confinement is a requirement for all therapy and treatment of insanity. Thus it is only a break with the outer world, which makes this "new social laboratory" for the reprogramming of the human being possible. Consequently, Pinel rids the insane of hishe/her chains of absolutist imprisonment whereas Esquirol, his contemporary, declares the "special institution" itself to be the "curing instrument". But the order-utopia became the opposite in the asylums of the 19th century. And that its institutional apparatus, which thoroughly organised the individual behaviour of thousands of inadequately provided for people "killed" was a criticism that became increasingly obvious and which would remain with psychiatry. During the transition from the 19th to the 20th century this critique led to an institutional change that laid the foundation for today's situation.
Status of the Insane
If the insane, within the framework of the basis principles of social detention and analogous to the monk, should subject themselves to the transformation of their personality what would be the anthropological status? It is nothing other than the fact of defining him (or her) as a human being as it was done by the Enlightenment during that revolutionary break. Subjective reason superseded the objective reason of God. The human being as God's creation was passé. From then on humankind was its own and would bring forth itself alone, consisting of two parts and thereby reproducing the mind and body separation of religion. Human beings existed in the body in so far as they were empirical beings and preconceived themselves as a concept. They could relate to themselves as empirical beings on the one hand, on the other, however, they could act independently. For this reason this concept remains a transcendental one; it applies to the empirical being and also, it does not. Even if all human beings were to die, the concept of it would still exist. Descartes demonstrated this on the example of wax - although molten, the concept or idea of it would still be there.Equally, the insane never really threatened the concept of the human being but simply became classified as an empirical part of it that cannot grasp the transcendental concept of being. "I think, therefore I am," says Descartes. And Kant states that, "I think what needs to attend all my actions". The insane who has no grasp of her/himself within this concept is a lunatic. She/he is not from this world. Hence, she/he does not have to adhere to worldly "rules" and if they were aware of their condition they would know they were insane. In French the condition is termed "aliéné" and refers to a person who has become an "alien", a stranger to others. Perhaps because the person is beside her/himself. Had the person internalised their trauma, pain, anger, hate etc. the others would have recognised him/her. Instead, it is the person him/herself who becomes intern[alis]ed and contained until they are unknown and aliens to themselves. The unknown is the uncanny, which is kept secret in the home and forcefully brought out into the open at the "special institutions". Up to today the latter is surrounded by an inaccessible wall of silence. It is the other of reason, un-reason, so to speak which reason cannot tolerate. The person who wants to be in control of their being by grasping their own concept has to question her/himself continuously: Am I abnormal or normal? With this question the subject objectifies her/himself in order to be "objective" in their behaviour. The empirical part has to submit to the transcendental part and with both parts being inherent in one individual it is likely to cause a personality split. Those parts, here equated with the mind and there equated with the body, exclude one another. Consequently, the problem of modern insanity's anthropological status lies exactly in this division of the self. It is normal but becomes abnormal as soon as someone deviates from the norm because one's own sense of being contradicts with what one is supposed to think. Whatever one desires becomes unattainable and the lack, the loss, the void cannot be filled - and least with a concept. Whether the split of the self is called hysteria, schizophrenia, dementia praecox or endogenous psychosis - all terms which mean nothing else than an alienation or estrangement (defamiliarisation) from and of the familiar, the split of the self always corresponds to the modern structure of the subject which stems from the monastic tradition of separating mind and body.
The final split of the bifurcated self occurs when the person finds him/herself unable to objectify, materialise, instrumentalise or regulate their existential desires and longings which results, due to the loss of pleasure, in a state of panic. The panic aspect refers to Pan, the mythical epitome of pleasure and lust. It is the loss of pleasure and lust, which causes depression, the "second biggest cause of illness in the industrial nations". Statistics of the WHO (World Health Organisation) show a reversal of pleasure into pain and suffering and it is indicated that the reversal is an effect of the "industrial nations" for their factories started in the monasteries. Under the condition of the mind-body-separation they were further developed in the prisons, work- and poorhouses of absolutism according to the maxim that the body should give up its pleasures in favour of capitalism's demon that is the modern substitute for the spirit of God.
The monastic mind-body relation is repeated in the modern subject-object relation but intensified. No longer is the contradiction between mind and body measured against creation and God and Satan but it is dealt with on the scale of the individual and reason and un-reason. Satan had unleashed Hell on earth; the individual inhabits this "hell" within him/herself. The individual has to intern un-reason in favour of reason; and the less she/he wants to be detained in a "special institution" the more she/he has to go along with the institution of the "factory". In doing so, the individual reverses their pleasure into a "burden of illness" beneficial to their health because the individual would be deemed ill if she/he did not subject to this reversal. The consequence of this is that the concept of health is "mentally ill", ill because of a spirit whose demon of capitalism poses, more than ever before, as an embodiment of mental health.
Construction of a Social Contract
The effect of this form of "mental health", the depression, points at a repression that is no longer discernible. It has become internalised as a form of preventive measure which can rely on 200 years of Enlightenment and education. Since then - due to the knowledge of one's self - one has had to sense any disorder of the split and dejected part in advance. Since then all one's actions have had to be accompanied by the question of whether or not one is normal or abnormal. Since then one has had to delay existential desires and longings in order to prevent that predicted disorder. Since then one's self-control has had to be inextricably linked to a rationalisation through ratio which was practised as "moral treatment" in the "laboratories" of the "special institutions" of the 19th century. In this respect, the "moral" refers to the judiciary, the "treatment" to the medical profession: a division which repeats itself in the transcendental-empirical structuring of the human being on the one hand, and on the other, in the composition of the state and society as the state reacts transcendentally to the empiricism of society. And, comparing it to the concept of the human being, the state remains - even if society ceased to exist or disappeared - which holds particularly true for the First and the Second World War.However, this assumes the form of the state under the rule of law - as it was successfully established in France in the process of the revolution and within the German and Austrian republics respectively after the First World War. The state under the rule of law is based on a social contract. With regard to the despotic nature of absolutism its legalism must be seen as an alternative version of the contract. According to Hobbes, the social contract only reaches a conclusion when all citizens agree on handing over their reason to the "Leviathan", and do so voluntarily. Hobbes employs the "Leviathan" - the apocalyptic monster - as a metaphor for the capitalist, industrial nation. Yet, the citizens would not be left without any reason since they are dually structured and have two "reasons" as this is characteristic of the divided self. One is the private, the other the public reason. Both act as separate parts as well as being linked together. The same principle applies to the state and society. As long as the citizens transfer their public reason to the state it is separate from society. But as soon as the citizens's public reason is included in their private reason, state and society become inextricably linked. Thus, the social contract consists of exactly this relation. It includes the assumption that the citizens submit to the state voluntarily and are therefore free social beings. This, however, is only possible if they understand their voluntary submission as a self-submission which means, their public reason must take effect in their private reason.
In short, the subjects have to transform themselves into objects. Only then can they also be objective in the legal sense, which is also always the moral sense. It enables them to manage and handle themselves and medical intervention becomes superfluous. They are seen as politically and socially mature citizens who do not interrupt themselves because their split or dejected part, alienated or beside her/himself, does not protest. Only this transformation prevents defamiliarisation from one's self. What is more, the citizens can be counted upon, which, in view of the social contract being a model for all agreements, is an indispensable requirement. Private vices can turn into public benefits that are calculable and legally correct. Anyone who goes "round the bend" will be put into a straitjacket, to straighten them again, so to speak. The person will be legally incapacitated and through "moral treatment" their mental resistance can be broken.
In a legal context, incapacitation simply denotes that the person who is declared "un-reasonable" is unable to apply the principle of the assumed, voluntary submission to the state on to him/herself. Or, as Castel puts it: "What makes the insane so specific is the fact that they resist conformity (the bringing into line by the contractual society) so strongly that in order to fit them into the new social order society is actually forced to grant them a specific status. On the one hand the status has to be particular and on the other hand, it has to be complementary with those citizens who comply with the social contract." (p.42) The aspect of deviation marks the specific and particular nature of the status, whereas the complementary element of the status manifests itself in the fact that deviation contributes to maintaining the norm. The insane is temporarily "shut up" and will be released or allowed to speak as soon as she/he has been made listen to reason. The medical profession is faced with the problem of having to provide the proof for incapacitation and of having "to construct a medical justification" (p.44) which plausibly explains the lack of the public within the private reason. Otherwise the law breached the social contract and in doing so, it would display the same despotic features that had characterised absolutism. Yet, only within the frames of psychiatry does the medical profession find itself in this difficult position. It neither has to confront the problem in clinics and hospitals nor in prisons - that is the proper patients and the real criminals. The proper patient, the really ill, can be treated; the criminal has already acted and offended - but the insane is detained in order to prevent actions. The treatment of the insane is supposed to supply the evidence for something it actually prevents.
The consequences of that are: firstly, already legally enforced penalisation can subsequently be accounted for; secondly, the account or justification can only be a preventive one as something is anticipated that has not yet occurred. In other words, on behalf of the judiciary and the administrative body, the medical profession of psychiatry has to construct a non-existing illness and even if it should exist it would be nothing else but proof of an arbitrary conviction. But the extent to which this proof is only subsequently provided shows that the law breaches itself and also, in this case, the contractual society turns out to be a fiction as the state authorities - the judiciary and administrative body - have the power to intervene and to intern without sufficient proof. What is more, the medical proof certifying insanity has to cover up any breach of law which owes its arbitrariness to the state's monopoly on the use of force - the "Leviathan"- and according to Hobbes, "Leviathan" only promises social protection at the expense of the state's threat to all. And if he wishes he could make an example of it and psychiatry might give its medical "blessing".
Therapy as Penance
Nevertheless, fundamental changes occurred in the process of transition from absolutism to legalism. One reason for this lies in the fact that the state under the rule of law executes its powers indirectly instead of openly using its monopoly on the use of force and controlling life and death. In absolutism, the sovereign had executed his powers directly and openly. In legalism, the state's powers are socially governed without the state being identical with society. Yet, they are linked and due to this the general of the state pervades the particular of the institutions; a combination of two dispositives: the force and power of law coming from the state, and the so-called biological power coming from society. The latter comprises the life of the individuals, they form a single population but at the same time they are all single, separate and physical entities in themselves. In a capitalist industrial society these individuals just have to function as useful physical entities, which is what disciplinary training has to achieve and it also refers to their role within the governing law and the running of the economy. Psychiatry is situated at the centre of the imparting of the general and the particular and it is indirectly linked to state power. At the same time, psychiatry acts directly. This is evident in the cover-up of the breaches of law which are actually incompatible with a contractual society and which disappear behind the thick and inaccessible walls of silence surrounding the "special institutions".With reference to the law on the one hand and to the medical profession on the other psychiatry manages and controls the physical entities transcendentally as well as empirically. At the centre or intersectional point of the general - in relation to the law - and the particular - in relation to the biological power the individual is to be disciplined in their "laboratories". The making of a diagnosis would only be in the highest interest of the individual as they had their legally incapacitated, and therefore socially declined, lives returned to them. Furthermore, a diagnosis provides clear evidence of their penalisation and they can do their penance - or as it is, serve their sentence - by means of therapy until the incapacitated can take self-responsibility and becomes socially acceptable again. However, should the insane "make fun of all conceivable means of penalisation" (p.174) then the idea of medical technology of being life-saving and preserving turns into a technology of leaving-to-die (euthanasia) without it becoming visible. Individuals who cannot accept what is best and for their own good have to blame themselves. Between the possibility of being "silenced" or the chance of "having a voice" again, the insane has to confess and confirm the reasons for his/her incapacitation of which the penalisation is the evidence. And in the form of therapy penalisation is subjected to empirical observation and transcendental evaluation. As a result, the combination of physical symptom and mental norm creates a medical instrument of power based on knowledge and gained through the "minuscule mechanism of examination". According to Foucault, it consists of the ceremonial of the powers of law and of the biological power's experiments. While being treated, the confessing insane has to subject him/herself to that norm. Both lead to "secret conditioning" (dressage) which seems indispensable for the public courts since the spectacular punishments of absolutism have long been abolished.
"Whether it concerns the judiciary or the medical profession," Castel writes, "the order is always the same": the judiciary passes the laws. Psychiatry administers their indirect power by tracking down the incapacitated person's deviation in favour of the norm of being a responsible citizen. It translates the law into a norm, the right into control, penalisation into a technique where only the name is a medical term. As a matter of fact psychiatry is a "political science" since it solved an "administrative problem" by means of medicine. "Through medicine, thus through the medical profession as such, insanity can be administered - and if there is any repression it lies therein." (p.21) Yet it finds expression in the opposite. Pity and compassion become philanthropically founded by the state's welfare and provided services of psychiatry and under this form of protection any threat seems absent. That repression is not absent emerges in matters of guardianship of the incapacitated person which a representative of the medical profession, a doctor, increasingly and indisputably assumes. Therefore, within the legalism of the doctor-patient relationship the despotism of a (paternalistic) relationship - superior vs. inferior - is repeated. Only by submitting to a superior power, as embodied in another person, will the insane be able to retrieve their humanity. On their own accord the insane have no access to the contractual order (p.101) because as "have-nots" they do not even possess any reason. Today access can be claimed but in how far this "right of the patient" can be successfully implemented remains an open question.
It is obvious that in this institutional dispositive where a host of lay persons faces a corpus of medically authorised experts of administrative knowledge psychiatry cannot acquire any "scientific basis". Instead it is intervention technology. The terminology with which psychiatry controls the insane belongs to an antiquated medical code (that of the nasal-physiognomical classification of the 18th century). Applied to the new environment of the "special institutions" it is forced through in the "laboratories" as "authoritarian pedagogy" of "moral treatment" without any reference to the clinical work. Hence, in Castel's opinion, the establishment of modern psychiatry did not lead to a change of the order of knowledge but to the emergence of a new group of welfare service experts. They emerged in the context of the "threshold of modernity", a term coined by Foucault. When, in the middle of the 19th century, biology appeared on the political scene this threshold had surely been crossed. A "prophetic" contemporary put the far-reaching effects of this crossing as follows: "There can be no doubt about the fact that the question of the insane constitutes one of the most important branches of political and social medicine and whose workings will affect vast areas of modern societies." (p.153)
The Hereditary Deadlock
The crossing of the threshold touches the institutional dispositive of psychiatry fundamentally. Whereas its paternalistic model of "moral treatment", which equates the insane with the child becomes transformed, the infinite perfectibility of the finite human life, which provided psychiatry’s approach of „authoritarian pedagogy" with an Enlightenment framework, becomes reformulated. On a political level biology reshapes the disciplinary structure of the biological power into an evolutionary one. Up to that point the administration and management of insanity were in philanthropical hands, now they fall into the hands of racism. Although having not completely broken away from the progressive continuum of Enlightenment this form of racism violates the framework. In this process of evolutionary reshaping the infinite perfectibility of the finite human life regresses to pre-human life forms and on an empirical level insanity relapses into where Darwin's "ape" raises its "brutish" skull. The transcendental concept of the human being remains undoubtedly valid but it will be charged with the burden of the survival of the species and what stands opposite this is the concept of degeneration as a horror vision.The "special institution" is the centre of this horror because it "imbrutes" their inmates. By means of an organisational formula incorporating Darwin's Theory of Evolution psychiatry wants to catch up with general medicine and for this reason develops their first theory of degeneration. In this respect, Morel and his "Traité des dégénérences physiques, intellectuelles et morales de l'espèce humaine" (Paris 1857) must be seen as a watershed. Apart from Morel it is also "pioneers" such as Griesinger or Kraeplin (and, of course, many others) who diagnose the insane and conclude an "abnormal deviation from the normal human type" through recessive hereditary transmission to which Morel's answer is "anticipatory prophylaxis". Medically speaking it extends the ethical prevention policy of Enlightenment to a hereditary level while considering evolution which Darwin's cousin, Galton, examined eugenically. The psychiatry-based model of Morel is equally exemplary for the fact that within the "special institution" degeneration becomes an object of medicine. Furthermore, it proves how a host of welfare experts with a hygienic-eugenic objective make their way into a society, via the "special institution", because, as Morel states, the human race must be saved: "We are not dealing with the individual, the single human being, but with society as a whole and the means to such important an end have to be measured accordingly". (p.297) Whoever is to respond to the doctor's call against the degeneration of the human species coming from psychiatry, "all [are] expected to achieve regeneration" and thus to follow the call, "Heil". [Note: the German "Heil" can be translated as "well-being" but it also pinpoints developments that were to come as it also refers to Hitler's "Hail"]
With this call the relationship between the medical profession, the doctor, and society becomes reversed. Following Pinel's concept, a doctor working in a "special institution" used to withdraw from the external world whereas now he is about to enter it. These developments occur at a time, the mid 19th century, when the force of criticism directed against psychiatry is similar to that of the criticism emerging a hundred years later, in the 1960s. Its advocates leave the "special institutions" in order to found their own communities in the country (Landkommunen). Also, in contrast to the fact that its definition (Reil 1803) derides welfare of the soul as does idolatry image worship, psychiatry takes a psychological direction: Psychoanalysis and Behaviourism are being adopted. Yet, the crisis psychiatry found itself to be in during the transition from the 19th to the 20th century is still prevalent today and evident in the processes of desinstitutionalisation and psychologisiation. The asylum of that transitional period, according to Castel, was "about to burst asunder" and should have been closed, once and for all. But the doctor's new and expanding role and Morel's proclaimed postulate, "whatever happens inside the asylums needs to be extended to the outside," lead to a redefining of psychiatry. The restructuring is attached to a condition: the more a doctor functioning as a psychiatrist tackles an unlimited area of intervention the more "night" has to "descend" over the asylums. Prophylaxis and evaluation are two different branches of a socio-political medicine that, first of all, is a social and racial hygiene in combination with intervention technology of eugenics. As an evolutionary model the binary logic - racial enhancement on the one hand, extermination on the other - takes the place of "authoritarian pedagogy" which equated the insane person with a child. From now on the hereditary degeneration of insanity is dealt with by including it into general medical practice for general medicine expects eugenics to be a more effective treatment than "moral treatment".
The Euthanasia Programme
It can thus be said that inside as well as outside the "special institution" all necessary conditions which form crucial elements of National Socialism's euthanasia programme become fulfilled: Firstly, homes and asylums for the incurable cases as their treatment is no longer based on a moral code but blood relation, that is the hereditary element; secondly, a host of welfare service specialists and social engineers aiming at a healthy and hygienic Volkskörper (nation), and did so long before 1933; thirdly, the extension of a psychiatric body that provides expert evaluation and reports for the euthanasia programme. The Law for the Prevention of Hereditary-Diseased Progeny by means of sterilisation (in the case of schizophrenia, manic-depressive disorders etc.) already existed before the democratically elected Hitler assumed his office. Drawn up by two psychiatrists (Rüdin and Rutt) in 1933 it only requires ratification (400,000 sterilisations between 1934 and 1939). Under Hitler the "Leviathan" of the capitalist state under the rule of law becomes reactivated and radicalised on the basis of the social contract causing the biological force which is inextricably linked to the force of law to act from below. Public reason has changed into a racial norm, which now becomes incorporated into private reason. The NSDAP (National Socialist Democratic Workers' Party) as a party as well as a movement is widely supported by the people and their enthusiasm for socio-technically pure and perfected bodies. When in 1935 the Law against Racial Defilement in Marriage and the Law for the Protection of German Blood and Honour were enacted they met no resistance.The eugenic-racist education of the citizens is intensified by a propaganda claiming biological superiority. It equally aims at life-creating measures through racial enhancement as it does at administering euthanasia ("mercy killings") through extermination. Sterilisation and prohibition of marriage here, euthanasia there - both are two sides of the same thing. Its ratio is the rationalisation of a racially hygienic cost-benefit calculation. Interestingly, at the turn of the century there had been a number of competitions asking for a solution to exactly the same "problem". In a brochure of 1920, the psychiatrist Alfred Hoche and Karl Binding, an expert in criminal law, demand "The Release of the Termination of Unworthy Life - its Extent and Objectives". Hitler's euthanasia programme corresponds to the objectives, for instance, promising people their own home instead of accommodating the insane. In its form the programme echoes the "lettres de cachet" of the Sovereign, or, the relationship between the doctor and the patient in psychiatry which is based on the same principle of superior versus inferior. What is more, the programme decreed is unofficial, unaccompanied by any forms (issued on private writing paper): it is a purely arbitrary act, a breach of the social contract, direct power and force. Within the institutional dispositive of psychiatry however, it can rely upon indirect administration and their intervention technology since psychiatry relates equally direct to that force, it camouflages the breach.
Hitler's pen-stroke is effective and as effective as it could and should be in a democracy whose citizens submit voluntarily to the monopoly of the "Leviathan". But the acknowledgement of enforced power runs parallel to an assumption of their own freedom. The more the people realise the aspect of self-subjugation and keep silent about it the more they have to deny it, for one of the alternatives offered is extermination if they become so schizophrenic, manic-depressive, so insane as not to fit in with the social contract's social order any longer. Both the euthanasia programme and the beginning of the Second World War come together in Hitler's extermination concept. As supreme leader and authorised by the state's rule of law, Hitler backdates the euthanasia decree from October to September 1st. As far as extermination of "unworthy life" is concerned no difference is made between the inner and the outer enemy. At the same time the "mercy killings" are supposed to atone for the heroic deaths (Note: usually means "to be killed in action") while sterilisation and prohibition of marriage in the case of racial defilement are meant to guarantee the survival of the hero. Correspondingly, the racially pure marital bed turns into a battlefield as for each heroic death a new life must be begotten. The simultaneous beginning of the external war of extermination and the internal euthanasia actions, according to Hitler, also has to raise acceptance of the threat of violence but without making concessions to the protective violence. With regard to selection, transport and ways of killing the euthanasia programme is, as camouflage, conducted from the headquarters on Tiergartenstrasse 4 in Berlin (hence, T4 Programme). One could thus make a connection between the transfer of the headquarters into Tiergartenstrasse (Note: the German word Tier means "animal; beast") and the statement of a psychiatrist who, "while working in the service of the mentally ill, in hundreds and thousands of cases experienced the horror of patients regressing into a pre-human, brutish state." (Dr. Valentin Faltlhauser in a statement given to the American authorities in 1945 in his defence of murder)
The camouflage-action succeeds on the basis of the social contract and "runs smoothly" - on the judiciary part: the Reich Home Office sends off registration forms to all relevant institutions of the Deutsche Reich; on the administrative part: the medical staff of the institutions fill in these forms; on the part of the psychiatric evaluators and experts: they select according to the forms, in the "Reichsarbeitsgemeinschaften Heil- und Pflegeanstalten" (special committees dealing specifically with asylums and mental institutions); on the part of the social engineers: the "Gemeinnützige Kranken-Transport-GmbH" (charitable organisation for transportation of sick people) is in charge of the transport to the location of the killings; on the part of the social welfare service experts: specifically targeted members of the NSDAP and the SS and individuals liable for service of the "Gemeinnützige Stiftung zur Anstaltspflege" (charity for preservation of institutions): they kill (70,000 deaths by gassing between 1939-41; in "special children's wards" 10,000 deaths between 1940-45 by injections and overdoses). There are signs of disapproval and growing criticism on the part of the families when in the immediate vicinity of those institutions situated in greener, often suburban, residential areas (villas, baroque castles, convents) the pungent stench of the smoke, the frequency of the grey busses and the errors in the obituary notices (through the registry offices at the psychiatric institutions) become simply too obvious. It causes Hitler to bring the actions to an official end. In practice, however, the programme goes on up to the end of the war and is known as "wild euthanasia" - a euphemism for the fact that the programme resumes its course without any interruption.
The killing goes on and "patients" continue to be exterminated at the institutional "laboratories" by a "special diet" - gradual starvation (90,000 deaths between 1942-45) or on specifically designed "special wards and units" by injections and deliberate pill abuse (killing until 1948, number of victims unknown). As far as the internal war is concerned Hitler can rely on his standard society which speculates on the ultimate victory regarding the external war for which it wants to get rid of all "superfluous lives" (unworthy life). And it is to the same degree as the T4-action group is identical with parts of the group that prepared the "final solution of the Jewish question" (Aktion Reinhard) that the euthanasia-institutions of psychiatry assume the work of the concentration camps's crematoriums. In fact Jews were not to be granted death by "mercy killing" as it was meant to be restricted to the own, the Aryan race. That, however, was fighting an external battle and the more it was beaten the more it fought back: the "objective enemy", first of all, part of the subject, the split part, the dejected part, whether "patient" or Jew is nothing and already before extermination. For that reason she/he has become exchangeable.
Post-human Perspective
By now the end of the subject-object construct consisting of the general and the particular, public and private reason has also reached the weekly magazine Der Spiegel where a recent headline announced "The end of privacy" (issue 27, 5 July 1999). It summarised the effects of electronic surveillance devices capable of overcoming any distance, of penetrating any wall and which can be implanted in any body. A subject that keeps her/himself as "objective enemy" under surveillance is therefore equally "outdated" as psychiatry in the form of the asylum which had found its presently final expression in the euthanasia institutions and concentration camps despite the fact that the asylum was once designed to cure, an "instrument of cure", as Esquirol put it. Today, psychiatry, which first emerged at the turn of 18th to the 19th century and almost disappeared a hundred years later, is again, at the millennial turn, confronted with the issue of dissolution. Unless it reinvented and restructured itself yet once more in order to take part in society's transformation into an institution where "electronic shackles" replace those chains Pinel once removed from the insane.Anyone can be detained at home, for whatever reason. Important is that the force remains "under cover" as the electronically charged social contract implies. At present, its legal- and biological-force-dispositive are crossing another threshold as it was succinctly announced in the title of the 1999-psychiatry world congress, "New Thresholds". Analogous to the "threshold of modernity" of the 19th century it can be deemed "threshold of post-modernity" and this time it is molecular biology that appears on the political scene. The crossing leads to the post-human concept that is once and for all determined to get rid of the "brutish" skull of the pre-human ape. Not only can the transcendental concept of the human being no longer be maintained, because of its empirical, genetical reduction, but also a subject that defined and administered her/himself in accordance with a concept became superfluous. The physicist Stephen Hawking for instance is absolutely convinced of the "coming " of the "genetic human being". Although personally he does not consent, "but what is possible will be done". No one will recognise him. With the advent of the "genetic human being" eugenics are given up in favour of euphenics, that is, in favour of an intervention technology aiming directly at the genetic make-up. The genetic manufacture can continue to take place in the "laboratories" of psychiatry while at the same time keeping its "bridgehead function" (G. Bruns) between the judiciary, administrative body and the medical profession and occupying it as the decisive place of the final decision: who will be allowed to cross the bridge, and who will not - and consequently ends up "down the drains":
Desinstitutionalisation and psychologisation of psychiatry today do not stand in contradiction to that scenario. As the World Congress of Psychiatry has already pointed out - and especially considering designer drugs of pharmaceuticals companies- psycho-social services and alternative psycho-communes will expand the network around their genetic- and IT field of experimentation. Without any doubt the field of experimentation functions in accordance with the "minuscule mechanism of examination" which is never independent from the ceremonial of medical power. Psychiatry is no longer obliged to justify itself and to prove its legitimacy, neither on a philanthropical nor on a racist level. Bioethics has become the keyword and in the foreseeable future the European Bioethics Convention will be passed globally. The extent, however, to which the convention implies a shift - a shift away from therapy and towards research - to that extent 200 years of psychiatric tradition can only be but indispensable in human manufacturing and genetic engineering. As a consequence, at the millennial turn of the century psychiatry calls once more for a redefinition and a fresh starting point.
Two brochures that were laid out during the World Congress pointed at the direction revaluation and redefinition would take: one referred to the following congress, "Brain 2000" propagating brain research, "for a better understanding of mental illness", as the leading science of the 21st century in co-operation with the industry and experts in the field of Artificial Intelligence. The second pointed at the next world congress of Biological Psychiatry 2001 and if one was to follow its title, "Gateway to Biological Psychiatry in the next Millennium," then psychiatry of the new millennium is about to pass through a gate. Here, the threshold of post-modernity can be recognised. Furthermore, it leads to the post-human, the more molecular biology is included in the area of brain research and the more it is approached and becomes incorporated by biological psychiatry. Indeed, biological psychiatry will join the "futurological perspective" of that research by providing new definitions of genetic defects on the one hand and, on the other hand, by following suit with new genetically oriented therapies. Yet, under the conditions of the judiciary and administration these therapies have still to be seen as a form of penance for an illness-related definition serving as penalisation. Subsequently, as far as biological psychiatry is concerned there will be no shortage of "test subjects". Bio-ethically legitimate, the subjects will be tested in the "laboratories" in order for psychiatry to reshape and redefine itself, together with brain research, the industry and the experts of Artificial Intelligence - a joint venture of creating the new "genetic human being". However, in view of its developments of desinstitutionalisation and psychologisation psychiatry should better shut its gates, as it should have done already during the transition from the 19th to the 20th century. In fact the gates should never have been opened in the first place, never since the turn of the 18th to the 19th century.
