ISSN: 1705-6411

Volume 12, Number 1 (January 2015)

ISSN: 1705-6411

Volume 12, Number 1 (January 2015)

Baudrillard and a Short History of Psychiatric Architecture

John Iliopoulos

(Chairman of Philosophy and Psychiatry, Hellenic Psychiatric Association, Athen's Greece)

Architecture and war are not incompatible. Architecture is war. War is architecture. I am at war with my time, with history, with all authority that resides in fixed and frightened forms (Lebbeus Woods, 2002:1).

Any relationship between a building and its users is one of violence, for any use means the intrusion of a human body into a given space, the intrusion of one order into another (Tschumi, 2001: 122).

I. Introduction

Can we speak of truth in architecture? (Baudrillard, 2002a: 37). Baudrillard's philosophical question echoes the greatest challenge that constructed space poses to philosophers, scientists, politicians and urbanists. Experts usually try to judge architecture by its goals, the things it wants to signify, and the scientific and social objectives it aims to accomplish. Specialists of space tend to seek the truth of architecture in its historical or social contexts, in the conformity between its internal structure and the social and urban order which it transcribes, in the level of its functionality and programmatic efficiency, or in its aesthetic value. Baudrillard reverses this approach: he asks the question, 'Where is the radicality of architecture? What is it that constitutes the radicality of architecture? That's how we should pose the question of truth in architecture' (Ibid.: 37). The radicality of architecture is measured by its capacity to run counter to its contexts, to destabilize its concepts and to go beyond its initial goals and finalities: 'That truth is to some extent what architecture is trying to achieve without wanting to say it — which is a  form of involuntary radicality' (Ibid.: 37).Not linearity, conformity and functionality but reversal, seduction and alterity are the focal points of architecture, the points of rupture where architecture discovers the illusions about itself in the struggles with the actual persons to whom it is addressed: 'it's what the user makes of it, what happens to it through use, when in the grip of an uncontrollable actor' (Ibid. : 37). There is a fundamental duality between the rationality beneath the architectural project and its unpredictable manipulation by the users to whom it is intended, which constitutes the radical truth of architecture. This duality is not a metaphysical necessity but it is intrinsic to the specific conditions staged by the constructed space, and the antagonism of the real actors who populate it.

As the architectural site of alterity and duality par excellence, the mental hospital can serve as a clear paradigm for what architectural radicality actually means for Baudrillard. Tracing the historical transformations of the asylum since its birth in the early 19th century to its current mode of functioning amidst the prevalent spirit of deinstitutionalization, we shall analyse the features of psychiatric architecture and its relationship with medical truth. We shall focus on two crucial moments in the history of psychiatry, in which architecture has played a significant role: the spatial exclusion of madness during the first years of the formation of psychiatry, and its inclusion into the network of therapeutics and socialization which dominates today's practice. This major transition, as we shall show, does not constitute a sign of scientific, technical or technological progress, nor an advance towards a deeper truth of architecture, but merely a transformation mirroring different scientific and social models of controlling insanity. In fact, as we shall demonstrate, the most radical scientific transformations in psychiatry have not occurred as a result of its theoretical achievements or the increased sophistication of the architectural management of the mentally ill. On the contrary, it is the bodily presence of the patients inside the asylum space, their agonistic relationship with medical authorities, their uncontrollable, unintelligible and violent behavior, which unsettle the architectural and scientific models of psychiatry. The patients themselves deconstruct the exclusion/inclusion binarism, they disrupt the geographical as well as mental coordinates of positivist psychiatry, introducing ritual spaces of crisis and reversibility, with a profound spatial but also epistemological impact on the medical models used to normalize and integrate madness.

II. The wild phenomenology of space
In his conversations with Jean Nouvel, Baudrillard stated, 'I've never been interested in architecture. I have no specific feelings about it one way or the other. I'm interested in space, yes, and in anything in so-called 'constructed' objects that enables me to experience the instability of space'(Ibid. : 4). Space is a central epistemological, metaphysical and anthropological theme in Baudrillard's analyses, which, as 'the primal scene of architecture'(Proto, 2006 : 125), will inevitably guide our exploration of Baudrillard's architectural writings and the way they can be incorporated into an investigation of the architecture of the mental institution.

Baudrillard draws inspiration from the phenomenologists who revolutionized the way we think about space. For phenomenology, space, like time, is a form of knowledge, perception and intuition. It is an inherent faculty of human cognition, an intrinsic  property of the mind. There is a homogeneity, the phenomenologists argue, between space, consciousness and meaning. Space is immanent to human perception, it is its constitutive element. Only in the spatial structure of perception can meaning be generated and distributed. This is why, the phenomenologists have theorized, mental pathology is first and foremost a disorder of the spatial coordinates of the mind (Minkowski, 1970), and, conversely, when space is transformed, distorted or invaded by technology or speed, altered states of consciousness emerge (Virilio, 1999: 48).

The fundamental phenomenological continuity between space and meaning was a breakthrough in the transdisciplinary study of architecture and the spatial organization of human interactions. Speaking in phenomenological terms, by managing space, the architect generates meaning and shapes perception. Through his project, the architect translates forms of rationality into concrete realities and institutionalizes truths. She materializes the collective intentionality of society and crystallizes the perception and the evaluation of things. By  responding to the user's needs, fulfilling a program, realizing some political or social ideal or accomplishing some pedagogigal, cultural or humanitarian mission(Proto,2006: 129), the architect gives her project a force of truth through the superimposition of official discourse and a field of visibility.

Baudrillard contests the phenomenological conception of space and its structural connection with consciousness. He is skeptical towards the idea that meaning exists as such and that space is simply the matrix for its production and circulation. He is critical of the notion that space is merely invested with the intentionality of its creator, and that it acquires sense within the confines of the finality and referentiality imposed on it. This is evident, as we shall show, in Baudrillard’s critique of contemporary architecture which has taken phenomenology to its most extreme consequences; exhausting all the possibilities of space, saturating it with meaning, interactions and creative play, materializing an ideality, have not liberated the truth of modern (or postmodern) architecture, but have attached it to a strong reality principle. Contemporary architecture has become virtual, hyperreal and holographic by virtue of its excess of meaning, abundance and random multiplicity of finalities and hallucinatory modes of expression which annul its sense, cancel its objectives and reverse its functions. Whether hyperreal, hyperfunctional or deconstructive, phenomenological architecture fully colonizes space, multiplies its programmatic functioning and extends its powers of visibility and security, only to conform to a reality principle which imposes the dictatorship of total transparency, endless interpretation and control.

Baudrillard holds a Nietzschean view of space. Space, for Nietzsche, is external to human consciousness, it is the 'primitive rock onto which knowledge attaches itself' (Foucault, 2000: 6). It is a battlefield in which knowledge, truth and subjectivity are expressed, produced and dismantled in the course of struggles, conflicts and agonistic interactions. When Baudrillard points out that 'meaning, truth, the real cannot appear except locally, in a restricted horizon, they are partial objects, partial effects of the mirror and of equivalence'(Baudrillard, 1994: 108), he is opposing phenomenology in a Nietzschean way; he does not mean that truth is relevant, ephemeral or subjective, but that it always emerges in certain places, at certain moments, and in the localizable field of interactions between specific subjects. Truth and meaning are not universal, surfacing everywhere and all times, but they appear or disappear in accordance to the kairos, the right moment, in concrete spatial coordinates and between contingent subjects and objects. What particularly interests Baudrillard, is the disappearance of truth and meaning in those specific spatio-temporal conditions which reverse the perceptual field of interactions where meaning is produced, exerting a negative attraction where sense is absorbed by a void.  Hence Baudrillard’s fascination with the void; the void is the point of rupture, asymmetry and discontinuity, where identities fall apart, alterity emerges and all sense is lost. The void is the non-place of the event, of confrontation, absurdity and reversibility. It is the occasion of pure appearance, where things lose their gravity of meaning and the sense of discourse is contested by the image of objects. The void is the ceremonial space of violence against meaning, reality, and the peaceful and unifying order of self-evidence, total positivity and the illusion of a uniform rationality.

This is why Baudrillard poses the question of the radicality of architecture in terms of the void, singularity and reversibility. He looks at those instances, those conditions inherent to spatial relationships which take architecture beyond its truth, its finality and its end. He is attentive to those forces which divert, subvert and undermine the references, procedures and functions of architecture. These reversals constitute sites of illusion running counter to the dominant truth of the architectural project, they are loci of secrecy undermining the visibility of the architectural structure and its accompanying official discourse. 

Reversals take on concrete forms which undermine the abstraction of today’s phenomenologically inspired space. They are even more concrete and singular than accidents, contingencies or risk — Baudrillard argues that the architectural space is always already a place of non-knowledge and risk (Proto, 2006: 127) — because they spring from the very persons to whom architecture is addressed. It is the users who, rather than being passive recipients of meaning, they destroy it (Ibid.: 144). Either voluntarily or through blind perversions of the prevailing functions imposed on them, the users pose 'a challenge to space […], challenge to this society […], challenge to architectural creation itself, challenge to creative architects or the illusion of their mastery'(Ibid.: 125). It is the users who, through their apathy, open resistance, hyperconformity or terroristic use of the space designed to control them, defy the initial programming of the institution, make a parody of its meaning and its models, refuse to subscribe to its regulations (Ibid.: 74). As in photography, Baudrillard proposes here a 'wild phenomenology' (Iliopoulos, 2014) in which surface events, meaningless occurrences and anonymous agents, bracket, suspend any scientific or aesthetic judgment of architecture and absorb into a vacuum the intentionality of a universal meaning-giving subject represented by the architect.

It is precisely this wild phenomenology which can find its fullest application and greatest relevance in the study of the architecture of the mental institution. Since the birth of psychiatry, architecture has consistently attempted to make use of the phenomenological properties of space in order to establish a medical visibility of lived experience so as to gain total control and full grasp of insanity. Supplementing the phenomenological descriptive discourse on mental disorders, the architectural design of the mental hospital aspires to increasingly fill up the space of confinement with meaningful connections in order to subject madness to medical understanding, make it susceptible to dialogue and programmed exchange and to render it receptive to the rules of normality. Madness, however, is the site par excellence of seduction, secrecy and invisibility (Baudrillard, 1990b: 82). Through their most irrational, unpredictable, violent and uncontrollable behavior, the mad 'do not necessarily play by the rules or respect the rules of dialogue'(Proto, 2006: 129); through 'accidents, resistance, blind denial, ill will, indifference'(Ibid.: 75) the insane create 'another space, another scene'(Ibid. 129);  to the architectural contract to which they are asked to sign up, the mentally ill respond with  'a symbolic architectural pact'(Ibid.: 75), creating a 'dual (and not merely interactive) relation[...]a relation of contradiction, misappropriation and destabilization’(Ibid.: 129), where the endless proliferation, circulation and flow of meaning is interrupted, the architectural and, by extension, therapeutic functions are distorted, and the control exerted by the creator is questioned — 'whenever one is tempted to assign a function to a place, everyone else will take it upon themselves to make a non-place of it, to invent another set of rules'(Ibid.: 130). It is through these internal 'visual feedback effects' brought about by the patients themselves, the 'misappropriation of other elements or spaces, through an almost unconscious conjuring'(Ibid.: 127), that, not only psychiatric architecture but the whole theoretical and conceptual edifice of psychiatry undergoes a radical transformation.

Even when the 'programme (all programmes: not only architectural ones, but political, cultural and economic programmes) seeks to circumvent this bad part,' it will never be able to eliminate it (Ibid.:78). The patients will always have the capacity, voluntary or otherwise, to decontextualize the medical concepts used to interpret their behavior (Ibid.: 129), they will always have the potential to destabilize the very epistemology of psychiatry, not because madness is a theoretical impossibility, a transcendental Kantian thing-in-itself, but because it resists understanding, it resists integration into medical knowledge by its concrete existence, by the enigmatic and ambiguous features of its real, physical presence in the immanent and actual conflict with the authorities, the doctors and the establishment itself.

III. The Asylum as Heterotopia
In order to grasp Baudrillard’s understanding of the radicality of architecture, and the way it is related to the transformations of the built environment in psychiatry, it is crucial to look closely at the notion of heterotopia. Sharing Baudrillard’s preoccupation with the topology of crisis, void and reversibility, Foucault coined the term heterotopia, to denote real, existing places which, from the 19th century, emerged as singular sites set apart from the rest of society (Foucault, 1998: 175-186). These places were primarily sites of exclusion, where the deviant, the unwanted and the undesirables of society were confined. The common characteristics of heterotopias (prisons, hospitals, asylums) as Foucault analyzes them, are well-known and have been widely studied: large, baroque-style, stone-and iron-walled buildings in suburban locations, the panopticon, systems of surveillance and record –keeping, hygiene, ventilation, strict division of spaces. What distinguishes these places as heterotopic, however, is not only their structure or their property of being sites for the excluded. More profoundly, it is the reversibility of power relations and forms of knowledge, which, for Foucault, is the direct result of the sequestration of individuals (Ibid. :178). In other words, inside heterotopias there is a production of new forms of truth and new objects of perception, which paradoxically result from reversions, from interruptions of meaning which appear as soon as the marginalization of individuals takes effect in the space of confinement.

Thus, the early 19th century asylum was a heterotopic medical space in the sense that it tackled illness not only as deviance but also as crisis and reversibility. The sequestration of insane individuals in the buildings of exclusion was not based on biological theories or psychological interpretations, but almost exclusively on ruptures, unintelligible and reversible relationships. The very phenomenology of madness was not sought in the causal chain of a known mental pathology, but in its violent discontinuity with all prior causality. A criminal was judged and incarcerated as mad when she did not present with any motive or interest (Foucault, 2003:126-130). When a person exhibiting disruptive behavior was sequestered, the intention was not to explore her disturbed family life or poor upbringing, but to explain her sudden rupture with an otherwise normal family milieu (Ibid.:302-303). The spatio-temporal crisis of madness, by definition foreign to meaning, etiology and causality, was the cornerstone for the decision to incarcerate individuals, with the further aim to isolate them from the environment which could mask, trigger, muddle or exaggerate the clinical presentation of an irrational paroxysm1 (Foucault, 2006:339). The space of the asylum was first and foremost the place where the crisis of insanity could be observed in its naked state as the locus of rupture and upheaval in the patient’s consciousness and behavior.

Thus, it soon became obvious that the asylum could not simply be a space of medical demonstration and rigorous scientificity. It was not only epistemologically impossible but also too risky to use the asylum both as the milieu suitable for the full manifestation of the crisis and violence of insanity, and as a place of domestication where madness would be inserted calmly into a risk-free, safe, well-defined, and recognized medical discourse and practice. This is why, while the phenomenological approach of nosography and medical classification existed in the minds of the proto-psychiatrists, it was not used inside the asylum (Ibid:134). The mad patients could not be managed according to medical taxonomy and pathologoanatomical knowledge. Diagnosis could not determine the spatial distribution of the patients. A ritualized division was required, according to the level of their agitation, the possibility of cure, their potential compliance, their ability to work and the need for total or partial surveillance. (Ibid.: 180). Importantly, therapy did not involve any of the usual somatic treatments of the time, due to lack of bodily evidence, but was focused on restraints, torture and a system of deprivations. The insane individual underwent a ritual in which he was subjected to isolation, minimal satisfaction of needs, punishments (cold showers, rotating chairs) and constant questioning. This ceremony, aspects of which are still in existence in today’s mental hospitals, has been studied and criticized by sociologists and anti-psychiatrists as an unscientific and shameful practice of psychiatry (Goffman, 1961, Szasz, 2007).  However, its cruelty, barbarity and violence can only be judged as such by the standards of ‘the moral, sentimental and democratic order in which we live’ (Baudrillard, 1990a: 168), an order for which madness has ceased to exist as a limit experience. What must be kept in mind is that this practice was performed by a proto-psychiatry conscious of its confrontation with meaninglessness. The fact that it constitutes a truth modality foreign to scientific proof and positive demonstration is no argument against its value as a testing ground for madness, a truth ordeal involving bodily interactions as the sole evidence of delirium when all that the psychiatrists had at their disposal was the patient’s discourse. As Baudrillard would suggest, in the face of madness, only the ceremony would provide ‘inexplicable evidence’(Ibid.: 107). In fact, ceremonial truth was the center of ancient medicine where it enjoyed an equal apodeictic status as deductive reasoning and scientific demonstration, and has survived for more than twenty centuries in  the medicine of cultures more ritualistic, more sensitive to alterity and tolerant to cruelty and torture, than the rationalistic, moral and pacifying cultures of modernity (Foucault, 2006: 242-244 , Dubois, 1991).  

What appears, therefore, as archaic violence in the space of the ritual is merely the expression of a truth procedure foreign to meaning, to the real and to representation, all of which have become the sacred principles of societies governed by the values of rationalism.  There is no point in resorting to psychologistic or vulgar sociological interpretations in order to discredit the ceremonial staging of madness (the psychiatrist’s sadistic impulses, his oppressive role in a system of constraint and prohibition); in the early asylums, the ‘degradation ceremony’ (Goffman, 1961, Garfinkel, 1956) was not ‘a confrontation, a rapport of force, but a stratagem, that is to say, the agonistic illustration of a ruse, of a non-frontal violence of a parallel and mobile strategy’ (Baudrillard, 1990a:176). Its tactics aimed at contrasting the patient’s world of appearances to the external world in order to make the distinction more pronounced so as to drive madness out of the patient; insofar as the ceremony ‘is of the order of power’(Ibid.: 170), its  purpose was to subdue the patient’s internal law and omnipotent will to the superior authority of the doctor, and to the rules of asymmetrical reciprocity between them; finally, stripping the patient of her identity had a force of therapy, to the extent that the patient should be able to acknowledge the rigid, tautological truth of her delirium, in order to recognize her status as mad and engage in a therapeutic relationship with the doctor.    

Thus, the asylum was not a strictly medical space but a site of ceremony, duality, agonistics and reversibility. In reality, it was from the beginnings of psychiatry that the patients invented their own particular rules of actual psychiatric practice, imposing another scene, turning the asylum into a second order simulacrum, a place which, while it was designed externally in such a way as to imitate as closely as possible the surrounding buildings(Foucault, 2006: 166), it masked the absence of a profound reality, which is why it was an ‘unidentified, unidentifiable object’, posing a ‘challenge to the surrounding order and stand(ing) in a dual — and potentially ‘duelling’— relation with the order of reality’(Proto, 2006:128)

IV. From Heterotopia to Utopia Realized                                        
The duality of psychiatric theory and practice, the ceremonial division between madness and non-madness which governed the intra-asylum relationships and dominated psychiatric discourse, was gradually deemed unacceptable for the newly born psychiatric discipline which aspired to align itself with medical science. Medicine is a science of research, differential diagnosis and somatic cure, not a ceremonial field of involuntary treatment, coercion and restraint. Moreover, it is intolerable for a science to rely on crises, permitting violence and crime to escape its prognostic knowledge and power of control. It was therefore imperative that the whole edifice of psychiatry be reconsidered and its actual care of the insane be reformulated in practical and spatial terms.

Thus, in the middle of the 19th century, psychiatry ceased to consider the patients as irrational, radically other, legally irresponsible, and began to tackle them as abnormal, neurologically degenerate, genetically flawed and instinctually pathological. The insane were treated as unfortunate individuals struck by poverty, bad morality and psychologically detrimental environmental factors, mostly related to urban lifestyles. This new medical stance was immediately reflected in the architectural design of the asylum. The new asylum space set safety on an equal footing as surveillance, placed emphasis on the environmental conditions which could help the patients regain a sense of normality; it modeled its function on the values of family and work so as to prepare the mentally ill for their reintegration into the community. The asylum space was transformed from a place of exclusion to one of inclusion.

These transformations occurred gradually throughout the rest of the 19th century in Europe, assuming their fullest expression in the United States. In fact, looking at the American asylums of the time, there is a striking similarity with Baudrillard’s architectural observations in his America a hundred years later. Under the guidance of neurologist Dr. Thomas Kirkbride, the famous Kirkbride plan set the foundations for what was to become the liberal and hyperreal model for the 20th century in the west. First, instead of the large, monumental European establishments like Bedlam with their thick, stone walls, their majestic appearance which gave a sense of transcendence and stability to inmates, relatives and the public, Kirkbride proposed one-story, linear and humble buildings with thin walls, more windows for more light, ventilation and contact with the outside world (Yanni, 2007:18, 51-54).  While early 19th century European asylums resembled prisons or factories in terms of panopticism, hierarchy, rhythm and discipline, Kirkbride’s American asylums intentionally sought to avoid this resemblance which was not appealing to the public, making the asylum look more like a college in terms of its outward appearance (neo-classical façade, u-shape, elongated wings with no bars), in its location(quiet, peaceful, isolated countryside away from the noise and distraction of the city) and its internal functioning (the psychiatrist is not the instructor but the ‘father’, the patients are all considered curable and able to work, moral therapy is at work through education, training and benevolence)(Ibid.: 54-55, 95). In the famous cottage plan, the asylum is attached to a farm to enhance creativity, and wooden structures are used in order to promote a sense of naturalness (Ibid.: 79, Baudrillard, 1996:37). In short, all the elements of third order simulation and the sense of utopia realized which Baudrillard identified as inherent to American mentality, are indeed already at work in the 19th century American psychiatric institution: diffusion of protestant ethics and its fusion with medicine, morality, pedagogy and the work ethic(Baudrillard, 1988: 91); the model of the university as the remote, ideal ‘microcity’(Ibid.:44-45) with its intellectual and hygienic ideality, the political correctness and its pedagogical formation of souls, the construction of an idyllic suburban community with its gardens, its funereal tranquility(Ibid,: 30). All this as part of a utopian project intended to be materialized through the vast availability of space and its transformation, with the help of ‘religion as special effects’, into ‘another universe full of transparency and supernatural, otherworldly cleanness’(Ibid.: 2).

During the same period in Europe, the tendency was the same: the York retreat in England, the Villa Plan in Germany, the Gheel colony in Belgium, represented similar efforts to absorb, integrate, and include madness into the expanding system of psychiatric rationality (Topp et al.,: 85-104, 171-189, 241-262) The difference with America lay in the emphasis on theories that sought to understand and conquer madness in biological terms (Magnan-Morel-degeneration, Greisinger-Baillanger-brain disease) and the importance on state intervention. Thus, the highly developed welfare state in England attached the asylum more and more to community care, whilst in Germany the asylum was part of the university where research promised a neurological clarification of mental illness, the discovery of its etiology and the improvement of its medical taxonomy (Doerner, 1981).

V. From Realized Utopia to Integral Reality
By the turn of the 20th century, the new mental hospital architecture had failed to facilitate a genuine understanding and treatment of the mad, who continued to undermine its dream of full functionality modeled on the clinic. Kirkbride’s paradisiac institution was heavily criticized for not being able to separate the dangerous patients from the calm ones. Overcrowding, custodial rather than therapeutic functioning, poor record-keeping, were the commonest reproaches (Yianni, 2007: 84). Europe faced similar problems which projected a poor public image in terms of safety, effectiveness and ethics. All these shortcomings, coupled with the use of violent therapies such as lobotomy, electroconvulsive therapy and insulin coma, created an embarrassing public image of the asylum as a space of torture, coercion and repression.

After the second World War, psychiatry, attempting to rid itself of this predicament, intensified its efforts to integrate anything that had to do with the negativity and incomprehensibility of insanity. This time it had the technological, administrative and political means not only to eliminate madness but to dispense with anything resembling the asylum entirely. This is the age of deinstitutionalization. It involved a vast and ambitious enterprise, global and totalizing, which altered the very ontology of space in order to exterminate alterity. Thus, it has colonized all mental spaces and has established a gigantic network of connections permeated by abstraction and transparency, Baudrillard encapsulates this process clearly:

By contrast with the cosmic evolution of matter, which seems to pass from the wave state (the first phase after the Big Bang) to the gaseous, and then to form liquids and solids, our social mechanics, the mechanics of the masses, seems to move from the solid (our primitive notion of the mass is of something solid, compact and inert) to the liquid (the mass of flows and networks, a fluid, viscous, floating mass), and then to the gaseous state(the mass of even higher dilution, an intangible substance, scattered, infinitesimal in its density, but one which still makes up the main part of social matter, just as the scattered, gaseous mass makes up the main part of cosmic matter), to end up as a pure wave form, where the very concept of the mass disappears (Baudrillard, 1997: 58-59).

Postmodern ultra-rationalism establishes a generalized immateriality transforming all oppositions into a gaseous state which homogenizes heteroclite elements in a nebulous abstraction. All forces and elements are reduced to the smallest common denominator of fractality, hidden structures, micro-processes and analytic truth. Madness acquires a rational unit of measurement in the radical objectivity of elementary procedures, losing its liquid, fluid and elusive property which used to separate it from the solidity of ‘rocky reason’(Foucault, 2001: 268-272).  This immateriality is at work everywhere: biology concentrates the phenomena of irrationality in the region of the brain, considering madness as the secretion of neurochemical and hormonal substances of the nervous system or the mutant messages of its genetic matrix, which, if controlled, can minimize the emergence of dangerous crises. As in any other illness, the body of the insane is not a form but a formula which can be modified mathematically. Psychoanalysis is an accomplice in this operation, producing the unconscious, a disembodied ‘logistical mechanism that permits us to think madness […] in a system of meaning opening to nonmeaning’ (Baudrillard, 1994: 136). In fact, psychoanalysis dispenses both with the body and the territory, operating inside the abstract space of verbal exchange between the therapist and the disembodied patient ‘supposed to speak’ (Ibid.: 42). In addition, phenomenology, with its revolution of ‘lived experience’, deprives madness of its status as exceptional, borderline experience, dispensing with the need to stage its singularity ceremonially in the ‘theater of cruelty.’ Being subject to transparency, discourse and dramatourgy, madness joins other ordinary and everyday types of experience in the ‘theater of banality’ (Baudrillard, 1997:98). It is a theater of total immateriality and transparent psychodrama, which generates the ecstasy of progress and creates a general optimism that universal understanding can be finally achieved and reason can expel the negativity of madness and its dangers.         

Inside the mental hospital, it is the abstraction of power which creates a sense of immateriality and ethereal comfort. Abstract is now the power of the psychiatrist who is no longer needed as an element of domination over the patient, as it was in the proto-psychiatric asylum. There is no longer a need for strict hierarchy of staff and personnel that would place the doctor in the center of knowledge and action. The psychiatrist no longer holds an unquestionable authority; he does not need to be the ‘father’ but a coordinator of a contractual relationship of mutual respect with the patient. His knowledge and competence are not the sole points of reference; he is part of the mental health team which supervises the course of the patient’s hospitalization and organizes his treatment after discharge. A new visibility is in place, more immaterial and ‘psychotropic’, replacing the ‘prehension of objects involving the whole body’, with ‘a simple contact[...] and simple surveillance (by the eye or, occasionally, the ear […].What is called for here is less a neuromuscular praxis than [...] a system of cerebro-sensory vigilance)’(Baudrillard, 1996: 49). Psychopharmacology now removes the need for physical restraint, ensuring a rapid, effective and humane tranquilization of the mad. The mad themselves are considered capable of engaging in meaningful dialogue with their therapists as well as capable of receiving harmless, painless therapies which are formally equivalent to those offered in a medical ward (pills). Finally, the hospital space is no longer considered a milieu, but an ‘environment’ populated by messages which must circulate freely in order to solidify the therapeutic relationship and ensure an endless, free-floating communication between patients and therapists, creating a multiplicity of narratives and interplays which are considered essential for perceptual change (Baudrillard, 1981:185-203, Halpern, 1995).

Transparency is another major factor. This involves not only the continuous and universal confessional which aspires to cure through the disclosure of secrets, but the very structure of the hospital itself. The psychiatric ward must resemble the other hospital clinics as closely as possible. No doors locked, no bars, access to every possible comfort, close contact between patients and staff — everything creates a warm atmosphere of intimacy, free expression of needs and communication. The use of glass, this immaterial, odorless, colorless, weightless and transparent substance, serves multiple purposes, all enhancing the general feeling of comfort, unrestrained visibility and contact. ‘Glass is to matter as a vacuum is to air […] at once proximity and distance, intimacy and the refusal of intimacy, communication and non-communication. Whether as packaging, window or partition, glass is the basis of transparency without transition: we see, but cannot touch. The message is universal and abstract.’(Baudrillard, 1996: 41-42) Glass allows the free play of light, and light provides hygiene, it cures depression just as it can cure tuberculosis or arthritis (Guerther& Vittory, 2013). The glass wall of the quiet room for agitated patients offers the advantage of both a permanent and uninterrupted visibility of the patient and a more civilized form of confinement free of the horrors of the cage or the dungeon: ‘Transparency — people can no longer stand seeing the animals behind bars, so these are now being replaced by armored glass’ (Baudrillard, 1997: 28). Glass as the exterior wall offers both doctors and patients the happy osmosis (Virilio, 2012: 34) of interior and exterior, creating the illusion that the hospital space is the extension of the external world (Baudrillard, 1996: 42-43).

Yet, however hallucinatory, this osmosis constitutes the ultimate expression of the ecstasy of transparency, abstraction, safety and information. There is a literal reciprocity and mutual exchange between the hospital and the surrounding world. The mental hospital now becomes a ‘nucleus’, a temporary site of ‘controlled socialization’ (Proto, 2006: 102, 103), a micromodel for a generalized process of therapy, integration and recovery, which can and must take place in the community, in the free and public urban space. Hospital architecture is now a second home for urban space (Ibid.: 73), and urban space is a site of absorption and dispersion of madness in a diffuse field of therapeutics and pedagogy. This is why, as Baudrillard characteristically puts it, urban space has become ‘basically a spatial asylum. We guard against the psychosis threatening us all with the mild neurosis of space’ (Ibid.: 74); at the same time, the asylum space has become a satellite of urban space, and a form of ‘spatial therapy’(Ibid.: 74).

There is a perfect continuum between community and the hospital and the same forms of treatment are applied both inside and outside the hospital space. Pharmacotherapy, play therapy, ergotherapy, drama-therapy establish the same reality principle on both sides of the asylum wall. The unreal, infantile world of the mental hospital (familial model, interactive utopia of exchange and playful recreation) can no longer be contrasted to the real world outside, insofar as outside the asylum an equally mobile, reflective, interactive and therapeutic world is dominant. This is fourth order simulation, the condition of hyperreality at its fullest expression: just like it is meaningless to juxtapose the irreality of Disneyland to its hyperreal urban surroundings where all activity takes on a therapeutic and institutional meaning, in a similar way the unreal world of the asylum is the mere extension of the totality of socially institutionalized behaviors which today are all considered potentially abnormal. The restoration of the disturbed functions of the mind inside the asylum loses its specificity; there is an equivalent therapeutic process in the outside world, where people ‘recycle(s) lost faculties, or lost bodies, or lost sociality, or the last taste for food’(Baudrillard, 1994: 13), through special institutes, community nursing and social work. The system of deprivations inside the asylum finds its extension in the extra-asylum space, in a simulation of mad behavior and a constant experimentation with ‘penury, asceticism, vanished savage naturalness: natural food, health food, yoga.’(Ibid.: 13-14).          

However, Baudrillard warns: 'We could believe in the transparency of our social relationships or our relation to power. Now it's turning into a form of terror'(Baudrillard, 2002a: 64). The transfusion between the urban and the architectural, although it generates the optimism of happy conviviality and playful synergy, it also produces a generalized confusion of spaces, subjectivities and discourses. In fact, this generalized trans-psychiatrization bears similarities with a phenomenon which Baudrillard observed with the regard to the art institution: the museum. In the field of art, Baudrillard argues, there has been an increasing generalization of aesthetics(Baudrillard, 2002c: 14-19). Through fashion, computer technology and advertizing and the influence of anti-art and conceptual art, the museum is no longer the indisputable space for the storage of genuine works of art. Today art is spread throughout society, imbuing everyday objects and the most banal consumer products with aesthetic values. ‘The museum, instead of being circumscribed as a geometric site, is everywhere now, like a dimension of life’ (Ibid.: 8).Conversely, any type of object, however insignificant or worthless, is a potential museum object, an object which can acquire a transcendental aesthetic value. This is the conspiracy of art: everyone, consumers, curators and artists participate in this trans-aesthetic operation (Baudrillard, 2005: 25-29). Likewise, there is a conspiracy of psychiatry; the generalized psychologization coupled with issues of security, humanitarian values and anti-psychiatric ideology, psychologizes every possible behavior as potentially abnormal and dangerous(‘Now that the mad have been let out of the asylums everyone is seen as a potential madman,’(Baudrillard, 1988: 60). As it becomes more and more difficult to separate the mad from other marginalized groups roaming the streets(Ibid.:19), the criterion of dangerousness to self or others hardly functions as the discriminant for the hospitalization of those really in need of psychiatric treatment. In fact, it paves the way for the involuntary commitment into the hospital of the most clinically obscure cases (Castel, 1982: 107). Everyone conspires in this trans-psychiatrization: patients, doctors, jurists, families and the public.

The result is a confusion of roles: the psychiatrist finds himself cought up in a vast social, judicial and administrative network. He loses his dual relationship with the patient. Through the impersonal, contractual therapeutic relationship, the psychiatrist is deprived of the private, antagonistic interaction with the patient, the relationship of obedience and defiance. With the dictatorship of transparency and the generalization of the panopticon (Baudrillard, 1994: 27-32) he assumes a defensive attitude as a result of potential media exposure and public accountability (Iliopoulos, 2012). As for the patients, their hospitalization is frequently speculated between magistrates and psychiatrists, in many cases they are detained preventively for crimes they have not yet committed, their pathological consciousness, which is, in the final analysis, the object of medical care, is confused with their status as bearers of risk.

VI.  …and back to heterotopia
The virtual state of psychiatry and as a consequence the current virtuality of its architecture, stem from the effort to expel madness as negativity, as secrecy and as enigma. It is an effort to saturate the field of mental health with meaning, to reject absurdity and its dangers, leaving both the intra- and extra-asylum world in a state of total ‘promiscuity, so that there are no gaps, no voids, no nothingness’ (Baudrillard, 2002a: 16). In this overdetermined universe, Baudrillard locates resistance, seduction and defiance in the order of the event. As he points out, ‘in every building, every street, there is something that creates an event, and whatever creates an event is unintelligible’ (Ibid.: 16). Only the event, the most absurd occurrence, the most unpredictable behavior can bring about the most radical transformation in a world already ‘designed for change’ (Ibid.: 45), mutation, multiplicity and randomness. Only the force of duality can generate disruption and innovation. Only madness itself can protect society from the uncontrollable neurosis of space which, if left to the endless proliferation of its fusions, would lead to a generalized state of kitch and confusion.

How can seduction, reversibility and singularity emerge inside the mental institution? Certainly they cannot be inscribed into the architect’s project. Events are spontaneous, unpredictable and unintelligible, therefore programmed seduction would be a contradiction in terms (Ibid.: 16). Hence the futility of the architectural reforms promoted by deconstructive architects and the proponents of anti-psychiatry. Deconstructive architecture, the architecture of free expression and liberation of desires is already part of the integral reality we have analyzed, it is part of its illusions and contradictions, therefore it does not offer a radical alternative. For example, Tschumi's deconstructive project in La Villette comprises of little ‘madnesses’, follies, constructing a public space where everyone is given the opportunity to invent their own rules of the game, to play freely with reality and illusion, control and spontaneity. The ambition, however, to impose an irrational pattern of public behavior as a model, annuls such a project a priori. This is why, as Baudrillard observes, La Villette merely establishes ‘the smallest common denominator of madness and delirium’ (Proto, 2006: 73). Similarly, anti-psychiatric architecture, the type of architecture whose objective would be to liberate madness from the shackles of the institution, has had minimal political effects. Its strategy is not seduction but provocation, and provocation ‘is an attempt to make something visible through contradiction, through scandal’ (Baudrillard, 2002a: 16), in order to pose demands, promote blackmail from a defensive trade-union angle, and make the adversary show forth in its strength, not its weakness. This is the reason why, instead of producing critical reform, anti-psychiatry only ended up reinforcing the globalizing control of mainstream psychiatry over insanity.

As we have explained earlier, the patients themselves are the most effective agents of crisis, catastrophe and reversion — in a word, seduction. To Foucault's  concern about the  potential for organized resistance on the part of the patients (Foucault, 1977: 230), Baudrillard would reply by foregrounding spatial relationships which anyone can use for the purpose of rebellion and defiance. These geographical strategies may not necessarily be political (Baudrillard, 2002a.:20) but can have serious political consequences: ‘for better or for worse what one finds is that these programmatic intentions are always hijacked by the very people at whom they were aimed. They are reformulated by the users, by that mass of people whose original — or perverse — response can never be written into the project’ (Proto, 2006: 129). Hijacking the mental institution amounts, like any other type of hostage taking, to turning it into a highly ceremonial place, a fractal zone, a non-territorial zone (Baudrillard, 1990a: 38), putting the whole system of security, responsibility and statistical indifference in a state of radical emergency and panic. The patients as hijackers respond to the system of total prevention, solicitude and control with irresponsibility, alienation and immorality, transgressing the rules of the institution in an anonymous and motiveless way, ready to sacrifice themselves in the process.  But how can patients hijack the mental hospital? They can take literally the institution hostage as in the Lincoln Hospital, a detoxification center in South Bronx, where, in the 1960s, paraprofessionals, political militants and patients occupied the building for several weeks, taking over the authority and management of the hospital. Self-management, internal police and alterations in methadone use policies rendered the hospital a black hole in the community treatment of the area, and a blind spot in the American ‘war on drugs’2 (Guattari, 2009: 293-294). Another way to hijack the institution is through hyperconformity (Baudrillard, 1983: 62). The patients overflow the hospital, its outpatient clinics, with revolving door admissions, demanding more medical care, more and more benefits. This is especially true for certain groups of patients such as the hysterics, the hypochondriacs, psychosomatic patients, the personality disordered, whose dependent attitude towards the excessive availability of psychiatric care saturates the system to the point of collapse. Overconsumption of psychotropics (Baudrillard, 1998a: 138-140), insoluble problems in managing their absurd needs, all lead to economic and administrative deadlocks and overcrowding inside the hospital (Make Beaubourg bend! A new motto of revolutionary order. Useless to set fire to it, useless to contest it. Do it! It is the best way of destroying it.’(Baudrillard, 1994: 69). Another way to hijack the system is through the violent and blind acting outs which disturb the order of the mental hospital. A single suicide attempt or a violent outburst inside an open-door clinic will immediately provoke a violent response by the otherwise liberatory, democratic and humane psychiatric authority(physical and chemical restraint, the patient’s isolation, the lock-up of the ward); the clinic will have to readjust its entire architectural physiognomy(padded walls, removal of sharp or wired objects, fire extinguishers) in order to prevent similar future events regardless of whether such an architectural transformation would reverse the initial planning, would be intolerable to other patients who are docile and cooperative, and would force the liberal functioning of the hospital to sabotage itself democratically3 (Sine, 2008).

Analogous hijackings may occur in an urban context. Already in the 60s the release of the mad into the streets unleashed phenomena quite opposite to what had initially been envisioned. The number of the unemployed suffering from mental illness has been estimated as high as 30%. Moreover, the patients gradually took entire neighborhoods hostage by their mere presence on the streets, as carriers of all the problems usually associated with mental illness — crime, drugs, disturbance, poverty, unemployment. In some neighborhoods in the US during the first stages of deinstitutionalization, not only the residents but the patients themselves requested the re-opening of the asylums (Castel, 1982: 86-95).  Urban riots is another, insoluble case; it is impossible to say with certainty who among those delinquents, immigrants and unemployed who set their own neighborhoods on fire, destroy the institutions created for their socialization and therapy, are mentally ill. The general climate of aimless hate, objectless rejection of unconditional care, management and control, the insane 'reaction to an over-calculated solicitude which instinctively feels the same as exclusion and repression'(Baudrillard, 2006a: 4),  is spread anonymously throughout the masses, who turn entire neighborhoods into impenetrable, isolated areas, establishing zones of ‘impossible exchange between space and the city'(Proto, 2006: 129). This psychotic ghettoization of neighborhoods, imposing violent, sometimes archaic and anti-urban territorial rules to entire suburbs, is a necessary evil. It is a spontaneous, self-regulating, protective mechanism against the violence of mass communication, excessive mobility and immateriality of the suburban space, which penetrate and dismantle the unity of the traditional neighborhood (Virilio, 2000: 62-63, 2012: 28).

VII. Conclusion
Baudrillard is skeptical towards the process of deinstitutionalization which seems irreversible as much as the rationality of globalization which supports it. For Baudrillard, rationalized society is destined to be ‘irremediably contaminated by this mirror of madness that is has held up to itself,’ and ‘nothing changes when society breaks the mirror of madness (abolishses the asylums, gives speech back to the insane)’(Baudrillard, 1994: 9).This does not mean, however, that he is in favor of a reinstitutionalization which would monumentalize madness, treating it as transcendence or a universal. If the inclusion of madness is the realized utopia of our times, a nostalgic return to the clearly defined spatial exclusion of the mad is no less illusory; it corresponds to states of deferred utopia, either in the form of a biologistic psychiatry of ideologies and rigid structures (Baudrillard, 2006b: 292), or in the racist form where madness retains its alterity, but in an artificial, arbitrary and phobic mode (Baudrillard, 1996:132). For Baudrillard, space illustrates in the most concrete way the undecidability, the instability of the alternatives inclusion/exclusion. To the medical rationality of confinement and discipline, the mad responded by inventing new rules belonging to the order of ceremony and seduction. To the new rationality which subjects them to total transparency, interpretation and security, the mad respond through defiance, secrecy and evasion. They force the otherwise liberal and globalizing system to build ‘protective walls to preserve the correct use of freedom’ (Baudrillard, 2010:105); they ‘deliberately exclude themselves […] without waiting to be excluded […] from the universal and play their own game, at their own risk and peril’(Ibid.: 103).Whatever the spatial form of the mental institution, no psychiatric authority and no architect can foresee, control or prevent the rules, forms of knowledge and relations of power that will emerge as a result of the conflicts and struggles which take place among its users. What architecture can do is avoid the temptation of submitting unconditionally to the censorship of transparency or the illusion of total safety, accepting the inevitability of secrecy, duality, crisis and antagonism, and the disintegration that these situations might bring about.

Madness, like death, animality and disease, belongs to the order of secrecy, territory and symbolic exchange. Whatever the efforts of the hospital to eliminate these limit experiences, medical rationality cannot dispense with the 'initiatory value' of madness and disease; it cannot dispense with the spatio-temporal coordinates necessary for the ritual enactment of madness and the ceremonial revelation of its truth. From the conception of disease among the primitives as 'social crisis' and 'rupture and breakdown of social exchanges' (Baudrillard, 2002b: 193) and the medico-religious spaces of archaic Greece, to the cloisters and monasteries of Christianity as spaces of spiritual crisis and healing(Barthes, 2013), up to the early 19th century asylums, the history of architecture reveals the spaces of diagnosis and cure as initiatory spaces, as spaces of crisis, derealization, rituals and reversibility, which persist today in spite of the globalizing pretensions of medical rationality to a fully colonized, linear space of information and virtuality.  

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



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1. I am making a deliberate use of the term paroxysm here, to allude to one of the most fundamental concepts of ancient medicine. It is a term used extensively by Galen to denote the critical point when the disease reaches its climax, bringing about either the complete recovery of the patient, or her death ( Cooper, 2011: 150-153). It is also one of Baudrillard’s favorite concepts, denoting the critical moment just before the end, when there is nothing more left to say. (Baudrillard, 1998b).

2. In contrast to Guattari who saw little revolutionary potential in this phenomenon (little political organization, involvement of gangs and racial struggles), Baudrillard would view such a hijacking as a profound challenge to medical rationality, precisely on account of its lack of political orientation and its racial overtones, which put the universal psychiatric code of drug use and mental health care on the spot (see for example, Baudrillard, 2006: 263)

3. I have had a personal experience with a schizophrenic patient whose nearly fatal suicide attempt in the open clinic where I currently work provoked the set of spatial changes which I describe here.