The simulators: truth and power in the psychiatry of José Ingenieros

Abstract

Using Michel Foucault’s lectures on “Psychiatric power” as its starting point, this article analyzes the book Simulación de la locura (The simulation of madness), published in 1903 by the Argentine psychiatrist José Ingenieros. Foucault argues that the problem of simulation permeates the entire history of modern psychiatry. After initial analysis of José Ingenieros’s references to the question of simulation in the struggle for existence, the issue of simulation in pathological states in general is examined, and lastly the simulation of madness and the problem of degeneration. Ingenieros participates in the epistemological and political struggle that took place between experts-psychiatrists and simulators over the question of truth.

simulation; psychiatry; madness; José Ingenieros (1877-1925); Michel Foucault (1926-1984)

Resumen

Tomando como punto de partida el curso de Michel Foucault “El poder psiquiátrico”, se analiza el libro Simulación de la locura, publicado en 1903 por el psiquiatra argentino José Ingenieros. Foucault afirma que el problema de la simulación recorre transversalmente toda la historia de la psiquiatría moderna. Inicialmente se analizan las referencias que José Ingenieros dedica a la cuestión de la simulación en la lucha por la vida, para luego abordar la temática de la simulación en los estados patológicos en general y, por fin, la simulación de la locura y la problemática de la degeneración. Ingenieros participa de esa lucha epistemológica y política que se establece entre peritos-psiquiatras y simuladores en torno a la cuestión de la verdad.

simulación; psiquiatría; locura; José Ingenieros (1877-1925); Michel Foucault (1926-1984)

The problem of the simulation of madness seems to be contemporaneous with the birth of modern psychiatry. We see this problem appearing in the principal texts of the history of psychiatry throughout the nineteenth and early twentieth centuries. Initially it emerged as a topic of interest in Pinel’s treatise (2005, p.271), particularly in the chapter on simulated mania and how to recognize it. Later, in the mid-nineteenth century, it was a topic of concern to degenerationists. Bénédict Augustin Morel (1857) analyzes a particular case of simulation, the Desrosières case, published in the Annales Médico-psychologiques. Both the Annales Médico-psychologiques and the Annales d’Hygiène Publique et de Médicine Legal devoted several articles to the problem of the simulation of madness. They both published texts and studies referring to actual cases of simulation that aimed to provide strategies for unmasking simulators – subjects who raised permanent questions about the possibilities, reach and limits of psychiatric power.

The psychiatrist Armand Laurent devoted himself insistently and almost obsessively to problematizing the issue of stimulation, and he published various articles on the topic. He wrote the Étude médico-légale sur la simulation de la folie (Laurent, 1866). Later, the issue of simulation returned to prominence thanks to Charcot (1887), in connection with the peculiar disease of hysteria, for example in his Leçons sur les maladies du système nerveux, faites à la Salpêtrière. In this case, Charcot sought to denounce the association between hysteria and simulation as an error hindering correct understanding of the disease. From that same perspective, the problem of simulation appeared subsequently in the preclinical studies of Freud (1992, p.14), such as, for example, his Report on my studies in Paris and Berlin.

Foucault (2003) devotes particular attention to Charcot’s “Lessons.” He argues that by analyzing the neurologist’s work using hypnosis on women diagnosed as hysterics, one could understand the great problem of the history of psychiatry in the nineteenth century up until Charcot: the problem of simulation:

That simulation that madness exercises with regard to itself, the way in which madness simulates madness, the way in which hysteria simulates hysteria, the way in which a true symptom is a certain way of lying and the way in which a false symptom is a way of being truly ill (p.135).

However, as I shall attempt to show, the problem of simulation did not disappear from the field of psychiatry with Charcot. Far from it; an enormous proliferation of new simulators populated the pages of journals and books on psychiatry and forensic medicine throughout the nineteenth and much of the twentieth century.¹

It is possible to argue that simulation and psychiatry have gone hand in hand up to the present day, each of them in opposition to the other, renewing a long-standing power struggle between madness and experts that has been going on for over two hundred years. Therefore, we can say – as Foucault (2003) does – that simulation is an initial, spontaneous form of anti-psychiatry, a way of opposing a counter-power to the enunciations of truth upon which the diagnostic strategies and therapeutic prescriptions of psychiatric knowledge were constructed. The simulator’s task thus resembles that of an epistemologist, a critic interested in questioning the construction and validation of the enunciations of truth and the certainties upon which psychiatry was founded.

Simulation in the struggle for existence

I shall base my analysis on the lectures on “Psychiatric power” given by Michel Foucault (2003) in the Collège de France from 1973-1974. In this lecture series, Foucault argues that the problem of simulation can be seen throughout the history of modern psychiatry, and that it was the first strategy capable of questioning the enunciations of truth and falsehood upon which psychiatry was articulated. What simulation reveals (according to Foucault) is nothing other than the epistemological tenuousness of that knowledge.

[T]he reason for this absence of a connection between discourses of truth and psychiatric practice, for this gap, pertains to this function of the enhanced power of the real, which is the basic function of psychiatric power (Foucault, 2003, p.133).

The psychiatrist is someone who must give reality that constraining force by which it will be able to take over the madness, completely penetrate it, and make it disappear (p.131).

If the task of the simulator is to undermine psychiatric knowledge and thus limit the reach of its power strategies, it is psychiatry’s job to defy and unmask those enigmatic figures. Thus it is possible to observe how much the micro-powers found throughout the space of the asylum constitute the foundation of a knowledge, a science and a group of discourses of truth.

Based on these claims by Foucault, I will analyze the book Simulación de la locura (The simulation of madness), published in 1903 by the Argentine psychiatrist José Ingenieros (1877-1925). This text initially arose out of the thesis Ingenieros presented in 1900 for his medical degree. In 1903, it was published as a book, with an additional opening chapter entitled “Simulation in the struggle for existence” (Ingenieros, 1962d, p.21-118). Thus, as Cristina Fernández (2006) argues, The simulation of madness clinched Ingenieros’s fame as the most prestigious Argentine alienist, sociologist and criminalist of his time.²

José Ingenieros’s work is inscribed within a key historical moment in Argentina’s formation as a nation-state. He formed part of a group of positivist intellectuals who, from the 1880s until 1910,³ created strategies and discourses designed to construct a process for modernizing and urbanizing the country. This circumstance imposed new challenges in terms of the biopolitical management of the masses in Argentina, and it led to great debates about phenomena such as urban reorganization, children’s education and childcare. Around that time, it also became necessary to come up with new ways of handling the problems arising from this modernizing process, such as crime, madness, prostitution and immigration, without overlooking the problems stemming from racial issues. This is the context within which we need to situate José Ingenieros, one of Argentina’s most important intellectuals at the time. His work involved not only psychiatry but also sociology, psychology and, fundamentally, the emerging field of criminology and forensic medicine.⁴

In The simulation of madness, Ingenieros dialogues with various strains of psychiatry and forensic medicine during the last half of the nineteenth century (Stagnano, 2006). He dialogues with French psychiatry, represented by names like Laurent (1866), Morel (1857), Magnan (1887) and Legrain (1895); with the German school, particularly Kraepelin (1907) and Krafft-Ebing (1903); with Latin American psychiatrists like the Brazilian Nina Rodriguez (1899); and, fundamentally, with Italian psychiatry, criminology and forensic medicine.⁵ Although he makes multiple references to Lombroso, he considered himself indebted to the so-called New School of Positivist Criminology, represented by Garofalo (1885) and Ferri (1895), who in his view succeeded in overcoming some of the limitations present in the theory of the born criminal espoused by Lombroso (1892).

However, Ingenieros does not propose that the ultimate foundation for explaining and anticipating the phenomenon of simulated madness lies in the various schools or trends in psychiatry and criminology. On the contrary, he proposes that a scientific explanation for this phenomenon lies in the field of biology, particularly in the evolutionary theory of Darwin (1859) and Wallace (1889).

He devotes the first chapter of the book to this topic, returning again and again to the same issue in subsequent chapters. Simulation is explained by analogy with animal mimicry. He claims that by analyzing the evolution of species, he has managed to ascertain the general law explaining the phenomenon of simulation: “Simulation is a form of struggle for survival that results in the simulator being better adapted to the environmental conditions” (Ingenieros, 1962e, p.121).

This is the general conclusion that he uses as an explanatory framework for analyzing the issue of simulation. Ingenieros (1962d, p.70) claims that the complex problem of simulated madness can be only solved by starting with that general law and following “a rigorous scientific method.” For Ingenieros (1962e, p.120), medicine cannot be accorded the status of true scientific knowledge; on the contrary,

even for studying the most technical issues in medicine, the doctor cannot possibly arrive at a scientific and philosophical interpretation if he remains within the narrow limits of a purely professional point of view. Schools of medicine make good doctors, distinguished professionals, but not men of science.

For that type of analysis, he believed it was necessary to turn to the biological and social sciences, whose expertise could illuminate the field of medical and psychiatric knowledge. Evolutionism, the most innovative branch of biological knowledge, would lay the foundation for a better understanding of the role played by simulators in the social world. Given that every human phenomenon must have a precedent in the biological evolution of species, the study of simulated madness needed to be prefaced by a study of the evolution of living beings.

This is why we feel it is necessary, according to determinist evolutionism – the basis for scientific biology – to proceed to the study of simulated forms of madness after a study of the phenomena of simulation in the biological and social world. The simulation of madness, as the best form of adaptation to special conditions in the struggle for existence, is simply a special case of the simulation of pathological states (Ingenieros, 1962e, p.122).

Just as a moth of a certain color (gray, for example) is better adapted to its environment and has a better chance of winning the struggle for survival than a multicolored moth, which is more likely to be identified by its predators, Ingenieros argues, proceeding by analogy, that many people use mimetic strategies in human life. They simulate so as to adapt themselves better to their environment. Thus, simulation has not only a biological use but also a social use in the struggle for survival. There are people who simulate a disease corresponding to their profession to obtain an economic benefit, those who simulate certain pathologies in order to avoid military service and, in the field of mental alienation, those who simulate madness in order to avoid being convicted of a crime.

In this last case, the criminal faces an external environment hostile to him: the legal world. The criminal establishes an adaptive relationship to that environment, using simulation as a privileged strategy. Something similar occurs in psychiatry. Many mentally ill people housed in insane asylums simulate symptoms of madness that do not form part of their clinical diagnosis, or even pretend to be cured in order to obtain the benefit of liberty. Simulation allows these patients to adapt to their environment, to obtain benefits they had not had previously, or to get themselves freed. For Ingenieros, “hypersimulation” exists when a mental patient simulates a pathological state that is not his own and “dissimulation” when the patient hides symptoms characteristic of his illness. Thus,

[b]etween the bollweevil which dissimulates its body under cotton fluff and the criminal who dissimulates his legal responsibility behind a mental illness, a link must logically exist: both were disguising themselves for self-defense from their enemies, so simulation is a defensive resource in the struggle for existence (Ingenieros, 1962d, p.23).

However, the process of establishing analogies between the biological or animal world and the human one only allows somewhat limited consequences to be deduced. Simulators tend to adopt characteristics of illnesses they do not suffer as an adaptive strategy to the hostile environment they live in. They can benefit from the new place they occupy to achieve their objectives, so that for Ingenieros (1962e, p.124), “the madman becomes mad to enjoy life.” At the same time, Ingenieros talks about social phenomena in evolutionary terms, arguing that while primitive societies overcome their environment by violence and forms, civilized societies resort to less violent and more fraudulent means. The escalation of cases of simulation, which were multiplying in advanced societies, make sense in this context (Falcone, 2012, p.225).

Referring to evolutionist theories as a means of scientific legitimation was a widespread practice in the late nineteenth and early twentieth century, both in forensic medicine and psychiatry and in criminology. In the field of psychiatry, from Magnan (1887) to Kraepelin (1907), Darwinian rhetoric about the struggle for existence and the survival of the fittest appears repeatedly (Huertas, 1987; Campos, Huertas, 2000). Ingenieros returns to this tradition in the first chapter of his book, “Simulation in the struggle for existence,” which he presents as the scientific foundation for his subsequent arguments.

I believe, however, that it is possible to understand Ingenieros’s arguments about the simulation of madness without relying on evolutionist theory in any way. We can say that because he analyzes social phenomena like crime, disease or madness according to the laws governing the biological evolution of species, the rigorous scientific procedure he claims to use to ends up overdetermining his arguments without, in fact, providing a solution to the problem of simulation.

Ingenieros (1962e, p.294) concludes the chapter titled “Simulation in the struggle for existence” thus:

The conditions under which the struggle for existence takes place in civilized social environments can make the simulation of madness individually profitable, as the best form of adaptation to the conditions of struggle; either by directly favoring the simulator, or indirectly, by diminishing environmental forms of resistance to personality development and expansion.

Ingenieros is interested in pointing out the social usefulness of simulation. He claims that studying the circumstances which make simulation advantageous reveals the principle of utility permanently at work (Ingenieros, 1962e, p.124). However, the association between simulation and social utility was already present in the discourse of psychiatrists, alienists and criminologists long before evolutionist theory, with its references to the struggle for existence and mimicry, became integrated into medical and psychiatric discourse. One of the axes of Armand Laurent’s book Étude médico-légale sur la simulation de la folie, published in 1866, was precisely the search to understand what the simulation of madness represented for the simulators in terms of self-interest or usefulness, without any reference to evolutionism.

Laurent (1866, p.44) asks, “What is the motivation behind this action?” or rather, how simulation benefits the simulator. For criminals, it means avoiding a conviction; for the insane it means obtaining some sort of benefit in the asylum; for those who want to get out of work, it means not working. Laurent’s text, which Ingenieros cites a number of times, became a privileged reference in the late nineteenth and early twentieth centuries for all psychiatrists interested in defining strategies to help recognize and unmask those who were pretending to be insane.

Something similar occurred with Pinel’s remarks (2005, p.301) one hundred and fifty years earlier on simulated manias. Long before anything resembling natural selection had been thought of, Pinel referred to the usefulness of simulation. It is possible to argue, therefore, that the question of utility or motivation was linked to the problem of simulation regardless of the references to evolutionism with which Ingenieros’s book begins. These references, I should stress, are purely rhetorical; they have no theoretical relevance. There is no doubt that Ingenieros was seeking to validate himself by appealing to Darwin (Molloy, 1999, p.190); but this strategy does not shed any light on the nature of the problem that he was actually raising, nor on the solution he outlines.

It is true that, using biological language, the simulation Ingenieros discusses can be described as defensive behavior on the part of an individual organism. But in fact, despite Ingenieros’s claim (1962b, p.26 and ff.), the evolutionist theories he invokes in “Simulation in the struggle for existence” do not allude to individual behaviors. “Mimicry” and other similar phenomena (which could be described as “simulation,” even though the term was not used by naturalists to describe them) were believed by the Darwinist biologists who were actually studying them to be character states of certain species that were the result of natural selection. This phenomenon explains such processes on a populational and not on organismic level (Jacob, 1970, p.186; Mayr, 1982, p.490).

For the naturalists who studied these phenomena (Poulton, 1897; Peckman, 1889), from Henry Bates, Fritz Müller and Alfred Russell Wallace on, just as for evolutionist ecologists nowadays (Ruxton, Speed, 20 ene. 2005), it is not the individual moth that modifies its behavior or appearance to deceive its predators (Carpenter, Ford, 1933, p.5-19). Mimicry and other similar phenomena are always modifications that must be studied within the framework of the evolutionary history of each line of descent (Wallace, 1889, p.243; Poulton, 1890, p.14), as with any evolutionary adaptation (Sober, 1984, p.203). Between the coloration of Lepidoptera heliconidae (Bates, 1861) and behavior of any individual organism, including a member of the Homo sapiens species, there is an ontological gap that was not lost on nineteenth-century evolutionists – one that Ingenieros ignores in his analogy.

Simulation in the human world

The biggest problem for Ingenieros (1962e) in The simulation of madness was not the phenomenon of mimicry, nor the struggle for existence, but how to build arguments that would allow him to refute the premises upon which criminal law was based – in particular, defense of the justice system by the Escuela Jurídica Clásica (Classic Legal School), which centered on criminal liability and mental incompetence. This theory of criminal liability is founded entirely on an argument that Ingenieros (1962e, p.292) saw as metaphysical: the free will argument. According to this theory, only a person who had carried out a criminal act without coercion, freely, and who could therefore be considered responsible for his actions, could be convicted of a crime. The task of the criminals who were simulators was none other than to show, by their actions or statements, that they could not be held responsible. Because they suffered from a mental illness, they were deprived of free choice and thus had to be held not responsible, not competent to stand trial.

Here we enter an area that really has little or nothing to do with biology. It involves justice and criminology, but fundamentally it is the province of psychiatry. This is because Ingenieros insists on claiming that the only people able to discover whether or not a criminal was feigning madness were neither judges nor criminologists, but rather psychiatrists. Within this framework, there are two interconnected issues: (1) who is capable of uncovering the truth that lies hidden behind simulated lies, and (2) who should be in charge of these subjects who are simulators. This question cannot be resolved with biological, medical or legal arguments, but only with psychiatric ones – in other words, by referring to the figure of the psychiatrist, who is recognized as the “master of madness” (Foucault, 2003, p.129), the only one capable of discovering the truth and exercising a certain power over those who persist in defending themselves from social condemnation with falsehoods and lies.

A real struggle emerges regarding simulation, but it is not a biological struggle. On the contrary, it is an epistemological dispute, a conflict that involves ways of enunciating, concealing or discovering the truth. In the confrontation between the expert and the simulator it involves the enunciation of the truth about madness, and the criteria and methods that had to be followed to gain access to that truth; ultimately, it was about the extent, the borders and the limits of what could be considered a mental illness. Foucault argued that this conflict proceeded as follows. On the one hand, the psychiatrist, with his expert knowledge, declared that “I will not pose the problem of truth with you who are mad, because I possess the truth myself in terms of my knowledge, on the basis of my categories, and if I have a power in relation to you, the mad person, it is because I possess this truth” (Foucault, 2003, p.135).

On the other side, the discourses and actions of the simulators may be understood as a response to those enunciations of truth, confronting or resisting a psychiatric knowledge legitimized by referring to medical discourse and its classification, diagnostic and therapeutic procedures. Thus, faced with the association of power-truth that characterizes psychiatry, simulators presented their strategy for resistance as follows:

At this point madness replied: If you claim to possess the truth once and for all in terms of an already fully constituted knowledge, well, for my part, I will install falsehood in myself. And so, when you handle my symptoms, when you are dealing with what you call illness, you will find yourself caught in a trap, for at the heart of my symptoms there will be this small kernel of night, of falsehood, through which I will confront you with the question of truth (Foucault, 2003, p.135).

For this reason Foucault (2003, p.137) eventually claimed that the first attempt at depsychiatrization lay in the phenomenon of simulation. However, the problem of simulation did not arise initially as an internal problem of psychiatric hospitals; it was not simply that madmen could feign their symptoms, nor exclusively about the much-discussed simulation in hysteria. The same problem recurs again and again, from the case analyzed by Morel in the Annales d’Hygiéne Publique et de Médecine Legal, in 1857, the Desrosières case (Morel, 1857), and even the case of Randle Patrick McMurphy, a 38-year-old man played brilliantly by Jack Nicholson in the film One flew over the cuckoo’s nest (1975). The same question concerned Ingenieros: how to create strategies that would allow him to respond to the recurrent problem of criminals feigning madness (Lakoff, 2005).

Ingenieros argues that his position differs from the studies carried out prior to that point, which centered on the madness-crime axis, in that he proposes broadening the frame of analysis in order to integrate social facts and biological phenomena such as mimicry. Therefore, one of his favorite targets of attack is Laurent’s book Étude médico-légale sur la simulation de la folie (1866).

Whatever the case, ever since Laurent’s classic work – which was written from a narrow and exclusively clinical mindset and informed by antiscientific ideas that are only pardonable thanks to the date it was written – there has been, to our knowledge, no other book especially and systematically devoted to this extremely important topic (Ingenieros, 1962d, p.25).

He is closer to the analytical standpoint of Pasquale Penta (2010) in his book La simulazione della pazzia, the second edition of which appeared in 1900, the same year that Ingenieros defended his thesis. He remarks that this volume of Penta’s was “full of astute observations and written from a broad scientific background, although it lacks a general method, which leads him to inaccurate conclusions” (Ingenieros, 1962d, p.25).

Ingenieros says that his work, unlike existing studies, presents a systematic scientific examination of the problem of simulation. He believes that “simulation in general must be studied firstly through its manifestations in the biological series; only then shall we find its manifestations in superorganic life, in human societies” (Ingenieros, 1962d, p.24). This will yield the key for studying human simulations of all types; the most relevant involved simulation of pathological states. Then, and “only then, will we be equipped for useful study of the simulation of madness by criminals” (p.26). The scientific method he proposes assumes a linked analysis of simulation’s various modes of manifestation, articulated in a series of increasingly complex fields of study: “From the simulation of the weevil to that of the criminal” (p.24).

In Chart 1, there is one field that stands out: the “simulation of pathological states,” a particular case of simulation in human life in general. Only within that framework (according to Ingenieros), could answers be found to the problem that had bedeviled psychiatrists and criminologists at the turn of the nineteenth century: the “simulation of madness in criminals.” This constituted the end point on a continuum of fraud and deception that could be seen on a daily basis, both in the biological world (such as the dog who limps) and in the human world in general.

Chart 1: The different forms of simulation

In short, the essay presents an overview of simulation as part of the struggle for existence, examining it from its first, unconscious manifestations in the biological world up to its complex modalities in the life of civilized men. Complementing this study, we shall attempt to analyze the psychology of simulators, classifying the most notable varieties among that group, which consists of individuals in whom the propensity for simulation constitutes the dominant feature of their character and their preferred way of struggling for existence (Ingenieros, 1962d, p.25).

For Ingenieros, each individual human act of simulation, whether conscious or unconscious, voluntary or unintentional, must be analyzed as a psychological strategy used to adapt to the conditions and restrictions imposed by the environment. This resource, he claims, is not exclusive to the world of criminals and the underclass; on the contrary, it can be identified in the most widespread spheres of human activity.

He argues, for example, that simulation is a much-used resource in the feminine sphere, both in terms of external appearance and in terms of feelings/emotions. Women who lack the characteristics of “female superiority,” which are enshrined by the norms defining what constituted beauty, will supplement what they lack naturally by simulating those characteristics. In Ingenieros’s words (1962d, p.54):

Height, a firm bosom, shapely hips, youthful freshness, pink cheeks, attractive teeth, rosy lips and sparkling pupils are true indicators of female eugenics and suitability for motherhood. When nature has been miserly with those attributes or when age begins to erase them, they are all simulated by women, with clothing, footwear and wigs that disguise imperfection and old age. The simulation of feelings is no less frequent; hundreds of women are prepared to simulate intense affection for any stranger who lets them glimpse the hope of an advantageous marriage.

This is one of the examples used by Ingenieros to refer to simulation as a winning strategy in the battle between the sexes. In exactly the same year that Ingenieros defended his thesis in medicine, a short, well-known and highly controversial pamphlet was published in Leipzig by Paul Moebius (1982) on The mental inferiority of women. Many of the arguments on female simulation used by Ingenieros can be found in the pamphlet. Moebius (1982, p.6) was a famous psychiatrist and neurologist, and a faithful supporter of Magnan’s theory of degeneration. Like Ingenieros, Magnan advocated for rigorous application of “the latest methods and scientific theories accepted by the international community.” The responses to Moebius’ publication show that, at that point, the much-vaunted unity of the scientific method did not exist. Not only feminists but also psychiatrists, doctors and legislators reacted to the pamphlet, arguing that it was an act of true provocation and that Moebius’s thesis was devoid of rigor.

Ingenieros uses similar arguments in reference to simulation in the struggle for existence in the working world. Members of various professions, particularly civil servants and bureaucrats, he writes, can make a real profession out of simulation; those who do not wish to work will feign constant fatigue and exhaustion. He believes there are “entire legions of parasites and hangers-on who live by feigning work” (Ingenieros, 1962d, p.58). This same type of activity is used, Ingenieros claims, by other individuals, as well as by women and bureaucrats: children, propagandists, writers with no talent, social parasites and dishonest merchants, as well as criminals-simulators.

For the common man, knowing how to live is equivalent to knowing how to feign. Only a few superior individuals with special gifts in the struggle for existence can impose their personality on their environment without without having to subject themselves to feigning so as to adapt (Ingenieros, 1962d, p.62).

However, according to Ingenieros (1962d, p.62), the majority accepted fraud and simulation without question in order to achieve their goals:

Imagine for a moment a crafty speculator who does not feign honesty; a hack writer who doesn’t feign qualities of celebrated authors; a tradesman who doesn’t feign interest in his clients; … a parasite who doesn’t feign usefulness to his host; an oaf [who doesn’t feign] intelligence or an intelligent man oafishness, according to the circumstances; [a] rogue who doesn’t simulate stupidity and a superior being inferiority, according to the case; a child [who doesn’t feign] an illness and a queer, femininity.

Sylvia Molloy (1999, p.190-194) focuses specifically on this last case, that is, how the problem of homosexuality and simulation enter Ingenieros’s explanatory structure.⁶

The simulation of pathological states

Within the wide universe of simulations, general cases of simulation featuring cases of fraud, mendacity and concealment must be differentiated from a special type of simulation, namely the feigning of pathological states.

Ingenieros presents various cases showing simulation of pathologies. He tells stories about young women who feigned illness in order to get married, women who feigned hysteria in order to find an opportunity to be unfaithful to their husbands, and healthy individuals who feigned accidents to receive a pension from public assistance, among many other cases. In the face of this variety of manifestations, he concludes that it is possible to identify three predominant forms of simulation that cover the majority of medico-legal problems. They are: (1) feigning an illness to get out of military service; (2) feigning on the part of false beggars so to profit from charity; and (3) feigned madness in general and that of criminals in particular.

The first two cases he considers of lesser importance, since there are simple solutions to counteract both of them. He devotes a few pages to these cases before going on to focus on the simulation of madness.⁷ Regarding the first case, he stresses military doctors’ difficulty and lack of training to be able to see through the simulators’ tricks, since they invent a wide assortment of illnesses to get out of having to do military service.

The feigning of illnesses by conscripts will not be overcome by the meager resources of military doctors, nor can it be effectively combatted by coercion … We know of the following case: in a Mental Health institution, a deaf-mute was subjected to one hundred and eighty applications of a red-hot instrument, over several sessions, because he was suspected of feigning (Ingenieros, 1962d, p.99).

According to Ingenieros, it is no good searching for medical, coercive or punitive strategies to uncover fakes who wish to get out of military service; nor does the true solution to the problem lie in the hands of doctors, even competent ones. He knows that, as Foucault stated later (2003, p.134), “we can always deceive a doctor by getting him to believe that we have this or that illness or symptom – anyone who has done military service knows this – and medical practice is not thereby called into question.”

Faced with the difficulty that medical knowledge was encountering in unmasking simulators, other intervention strategies were needed. Ingenieros proposes looking beyond the individual to the social environment, and trying to modify external conditions. In the case of military service, this meant attenuating the rigors of an archaic national defense system based on the militarization of relations between the nations. He proposes altering the conditions of obligatory military service which, by law, transformed those who did not accept it into deserters. “Militarism ought to attenuate itself in civilized peoples. This attenuation will be progressive, restricting the period of [military] service … [and] thus the need to simulate illnesses in order to evade it” (Ingenieros, 1962d, p.99). Ingenieros concludes that it is necessary to advocate for military service being gradually phased out, since this was the only possible prophylaxis to counteract this type of simulation.

With regard to the second type of simulation, his analysis is neither as pertinent nor as sensible as before. This involves the simulation of illnesses in order to exploit charity. He speaks of “social parasitism,” of large groups of beggars who have made begging a genuine profession, benefiting from the charity of others and, often amassing real fortunes. He relates the case of a famous club of beggars in the city of Chicago: “a committee of extremely healthy and cheerful individuals who ate, drank, gambled and smoked and who possessed a library of ancient philosophers to enjoy in their free time. All of them, during the day, pretended to be lame, blind, mute or imbeciles” (Ingenieros, 1962d, p.100).

Ingenieros thus reiterates an extremely widespread cliché among philanthropists and charitable associations in the latter half of the nineteenth century. It was a discourse also seen in literature and cinema, for example in the novels of Émile Zola (1877) or Victor Hugo (1862) and in the Argentine movie Dios se lo pague (1948). In different ways, all these discourses refer to a phenomenon that plagued the emerging social protection structures being created in the second half of the nineteenth century in response to conflicts and political struggles. What was repeatedly described as a problem was the difficulty of clearly differentiating between worthy and unworthy poverty and poverty; between working people who deserved social protection strategies and the undeserving poor (Himmelfarb, 1988).

In this context, the references to evolutionism, Darwinism and the struggle for existence that Ingenieros considered necessary to construct a scientific theory on simulation, reappear to defend politically conservative arguments.⁸ He returns to the analogy drawn between the animal and human worlds in the first chapter of The simulation of madness as a way of justifying excluding non-workers, a group containing various kinds of “degenerates,” from social assistance. Thus, referring to the disadvantages of granting social assistance inspired by the needy and by simulators, he writes:

While the hard-working and fertile masses lack the bare necessities, it is painful to see the madhouses, jails and asylums contributing to the comfortable laziness of beings who are unproductive and even harmful. [It is] the eternal problem of the struggle against the social parasitism of degenerates as opposed to the just protection of the working classes. Sergi, in Le degenerazione umane [The varieties of the human species in English translation, 1894], has dedicated a wonderful study to the survival of the weak and inferior (Ingenieros, 1962d, p.93).

For this reason, he argues, the social function of medicine needed to focus on selective goals to defend the human species, as a biological species, “tending towards the conservation of superior characters and the extinction of the incurable and degenerate” (Ingenieros, 1962d, p.94). This biopolitical strategy would help avoid two social evils: the waste of energy and resources spent in aiding inferior beings, which leads to social parasitism, and the hereditary transmission of degenerative characteristics, which are harmful to the evolution of the species (p.95).

For Ingenieros, prophylaxis is the way to respond to the social plague represented by the simulation of diseases in order to benefit from charity aid. He calls for labor reform to make work an agreeable obligation for all and not a disagreeable imposition or “a terrible yoke for some” (Ingenieros, 1962d, p.100). To combat simulation by sham beggars, Ingenieros therefore proposes a true biopolitical strategy of population management articulated around the opposites “to take life and let die” (Foucault, 1978, 2004, 2005). He defends social and eugenic interventions capable of establishing a distinction in social life between the world of hard-working men who deserve public assistance and who “tend to conserve the superior characteristics of the species,” and on the other hand the world of the weak, in which all assistance should be denied, “tending towards extinction of the incurable and degenerate” (Ingenieros, 1962d, p.99).

The simulation of madness

I have referred so far to that complex world inhabited by simulators: from the unfaithful wife to the beggar, including those who wish to avoid military service and civil servants. All these figures are covered in greater or lesser detail in Ingenieros’s text. However, of the three major groups mentioned – simulation to avoid military service, to obtain welfare benefits and simulation of madness – Ingenieros proposes focusing on the third: the simulation of madness in general and simulation by criminals in particular.

A large proportion of the cases of simulation analyzed by Ingenieros involve the fields of healthcare, madness and degeneration: women with hysteria, homosexuals, men shirking work or beggars. He attributes inherited pathologies to many of them, sees degenerate behavior characteristics in others and says that most of them possessed the physical stigmata of degeneration. The two groups of simulators of pathological states that I shall analyze here – those who wished to avoid military service and those who wish to exploit welfare benefits – are also situated in a space that is both inside and outside madness. Within that general framework, since there do not appear to be defined frontiers for differentiating madness and sanity, we must inscribe the analysis Ingenieros provides of the third group: the simulation of madness.

To carry out his analysis of the simulation of madness, Ingenieros begins by differentiating three major sub-groups: (1) the simulation of madness in general; (2) the simulation of madness by the truly insane and (3) the simulation of madness by criminals.

Of these three sub-groups, the first would appear, in principle, to be the least interesting. The simulation of madness in general occurs when it is convenient for a healthy individual to simulate madness for reasons that were not necessarily of a judicial or legal nature. Ingenieros describes a few actual cases, such as that of a young woman who presented all the symptoms of hysteria so that she could get married instead of entering a convent. Here, the young woman’s supposed insanity prevented her from becoming a nun as her mother had planned. He also describes the case of a writer who claimed to have episodes of delirium and hallucination in order to gain a name for himself; he was trying to simulate madness so as not to suffer restrictions on his freedom, so that attitudes or actions that would be prohibited in other contexts would be accepted as minor and unavoidable manifestations of his state of insanity.

Cases like these, involving creative acts and free decisions, might lead us to agree with Foucault (2003, p.134) that the problem of simulation, for psychiatric power and knowledge, is not limited to the issue of the sane individual pretending to be mad.

By simulation I do not mean the way in which someone who is not mad could pretend to be mad, because this does not really call psychiatric power into question. Pretending to be mad when one is sane is not something like an essential limit, boundary, or defect of psychiatric practice and psychiatric power, because, after all, this happens in other realms of knowledge, and in medicine in particular.

But if we take a closer look at the examples given by Ingenieros, we see that even when it is the patient himself, under the direction and interventions of the psychiatrist, who ends up acknowledging that his acts are feigned, it is impossible to identify simulation with health and non-simulation with madness. The case studies show the difficulty of distinguishing between the notions of simulation, madness, health and cure. There is no clear demarcation line between the mad and the non-mad, and nothing indicates that unmasking the simulator is the same as declaring them to be sane.

In “Psychiatric power” (2003), building on his work in The birth of the clinic (1987), Foucault set out to show that even when nineteenth-century psychiatry constructed itself as a scientific discourse whose legitimacy derived from general medicine procedures, that is by referencing anatomical-pathological and clinical or classificatory discourse, there were great differences between the identification and diagnostic procedures used in each case. With the exception of general paralysis, it was not possible to establish anatomical-pathological correlations or organic explanations for mental illnesses. “These two discourses were just sorts of guarantees of truth for a psychiatric practice that wanted to be given truth once and for all and for it never to be called into question” (Foucault, 2003, p.133).

When Foucault argues that it is not true that pretending to be mad when one is sane represents the limit or failure of psychiatric power, because this also occurs in general medicine, he uses the example of the simulator who seeks to avoid military service. Coincidentally, this was the first group analyzed by Ingenieros.

In the case discussed by Ingenieros, we read that hundreds of burns on the skin of a deaf-mute who was thought to be faking led to his military doctors being discredited when it was discovered that he did indeed have that condition. We can contrast this example with the procedure used daily by psychiatrists such Laurent (1866), who repeatedly subjected patients or simulators to cold showers in order to determine whether they were truly insane. This strategy had a guaranteed result – repeated cases of pneumonia – but it did not mean that simulation could be eliminated or that a diagnosis of mental alienation could be pronounced. Even so, the procedure was repeated for decades, and was defended by many leading psychiatrists.

In fact, the procedures used by psychiatry to identify simulation replicate the very strategies used to define the existence of mental pathologies in general. Even though the validity and prestige of this model derived from general medicine, in practice it dispensed with any reference to anatomical-clinical knowledge (Foucault, 2003, p.133).

The simulator is situated at the precise apex or tenuous and ambiguous border between sanity and madness – a border heavily dependent both on internal circumstances in the form of hereditary pathology and on external circumstances involving environmental conditions, as seen in the cases discussed by Ingenieros.

As we saw earlier, one of the cases of general simulation he presents is that of a young woman who decides to feign symptoms of hysteria⁹ in order to be able to marry and escape becoming a nun as her mother wishes. Regarding this case, Ingenieros (Ingenieros, 1962e, p.126) concludes that: “when she began simulating, she was merely feigning mild hysteriform attacks; but just as function makes the organ, in a few days the simulator imperceptibly upped the scale [of her attacks], until she was simulating full-blown hysterical delirium.” He added that voluntary repetition of certain mechanisms leads them to become involuntary and automatic and that, in general, individuals who feign a morbid state for a long time end up developing the condition they are feigning.

The second case of general simulation presented by Ingenieros involves the behavior of a young man who feigns maniacal excitement and delirious ideas so as “to avoid the tyranny of the barracks.” His father was of “nervous” temperament, his mother normal and one of his brothers “neuropathic.” His biggest problem was that “he suffered a deep aversion to work.” His physical characteristics are described as “cranial asymmetry, dome-shaped soft palate, poorly-implanted teeth, irregularities in the hair system and other stigmata of degeneration. Mental state corresponding to hereditary degenerates, with no fixed phenomena” (Ingenieros, 1962e, p.126). This case, among many others, leads Ingenieros to conclude that there is a link common to the three main sub-groups of people simulating madness: general simulation, oversimulation and the criminal simulator.

The tenuousness of descriptive procedures used to delineate normality and pathology in the field of psychiatry allows Ingenieros to describe simulation as a continuum.¹⁰ The three sub-groups form part of a succession of states, each of increasing gravity and connected by a common denominator: degeneration theory and the insanity of degenerates. Thus, “simulation of madness appear in normal individuals, the weak-minded, and neuropaths with degenerative defects” (Ingenieros, 1962e, p.127).

Therefore, neither the confession of simulation nor the expert’s ability to recognize a simulator allow identification of a state of sanity. Ingenieros constructs this argument based on the theory of Krafft-Ebing (1903), who defended the existence of a morbid tendency prior to simulation that could be conscious, subconscious or automatic. But it is degeneration theory that allows Ingenieros to establish a continuum between normality and pathology: “Falsity of character is also a frequent anomaly in the degenerate; they are irresistibly drawn to lies, pretense, dissimulation and slander. Many weave a life full of fabrication ... Herein lies the origin of unconscious simulation seen in so many degenerates” (Ingenieros, 1962d, p.87).

Final considerations

Ingenieros’s proposed biopolitical strategy ends up blurring the boundaries he himself had established between the three types of simulated madness. The distinction gets watered down and disappears on that theoretical continuum where any and all simulation reveals the existence of some pathological state. We can argue, then, based on Foucault (2003, p.135), that in Ingenieros’s case also,

the simulation that was the historical problem of psychiatry in the nineteenth century is simulation internal to madness, that is to say, that simulation that madness exercises with regard to itself, the way in which hysteria simulates hysteria, the way in which a false symptom is a way of being truly ill. All this constituted the insoluble problem, the limit and, ultimately, the failure of nineteenth century psychiatry that brought about a number of sudden developments.

In the struggle that emerges between the expert and the simulator, Ingenieros’s task was to limit and forestall any possibility of victory by the simulators. And in order to do that, he would resort to the same strategy used by degenerationists: extending the foundations of psychiatry by multiplying the number of mental pathologies (Foucault, 1999). Thus, even when simulators did not possess any identified mental illness, they would come to be seen as individuals who suffered from some character anomaly or psychic deficiency. According to Ingenieros, that anomaly could be the underlying cause of simulation, as in the case of the degenerate simulator who was avoiding work, or it could come into play a posteriori, as an undesired effect of the repetition of simulated actions, as we saw in the case of the young woman who was simulating a case of hysteria.

In this way, Ingenieros distances himself from what he saw as “old-fashioned clinical psychiatry,” inherited from Pinel (2005) and Esquirol, which was limited to a small number of pathological states: mania, melancholy, dementia, idiocy and monomanias. He argues that analyzing the topic of simulation reveals the limitations of classic psychiatry, which limited the psychiatric doctor’s field of action to a few pathologies and refused to integrate “cases it cannot explain, [but] which are striking to the conscientious psychologist who contemplates the infinite variety of anomalies” (Ingenieros, 1962e, p.174).

We are a long way here from the problem of simulation as seen in Pinel’s classic psychiatric text. Ingenieros felt it was necessary to return to the work of psychiatrists like Morel and Magnan, whose set of psychiatric pathologies had been extended, making it possible to think of simulation of various forms of pathology without a determined clinical presentation. This was a reality that forensic medicine declined to consider, limiting the judgement of non-responsibility and legal liability to the few cases of madness defined by classic psychiatry. Thus, for Ingenieros (1962e, p.173), the key questions we should formulate in order to understand the problem of simulation are the following:

Where does mental health end? Where does madness begin? This is one of the trickiest questions dealt with by alienists, and there is no definitive formula to solve these unknowns. The last half of the nineteenth century saw the growth of curious and interesting studies on psychopathology that were never dreamed of by earlier clinicians. Alongside the normal man and the madman, by anastomosis with both of them, unbalanced types were described, who fluctuated from genius to criminality, from mendacity to sexual inversion.

In Ingenieros’s view, while establishing a boundary between complete sanity and organic pathology was a complex matter, it was also impossible to establish a clear partition between normality and madness. He felt it was necessary to speak of a continuum between normality to madness, and to identify intermediate pathologies, small anomalies and character deviations without confining oneself to the narrow limits prescribed by the psychiatric treatises used by the majority of university departments. On the contrary, it was by studying intermediate states, showing “deviant subjects of an intermediate type due to neuropathy or degeneration” (Ingenieros, 1962e, p.177) that an answer would be found to the problem of simulation.

Thus, thanks to a strategy that broadened the field of psychiatry – and that was made possible by degeneration theory – Ingenieros comes to the conclusion that there are no true simulators, since they always possess “true psychological abnormalities.” This strategy ultimately permits Ingenieros to guarantee the desired triumph of experts over simulators in that epistemological and political struggle over truth that, as Michel Foucault has shown, was repeated time and time again over the course of the nineteenth century.

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• 1
  On this issue, see Laurent (1866), Garbini (1906), and Morel (1857).
• 2
  On the influence of José Ingenieros on the development of positivism in Argentina see, among others, Biagini (1980), Vermeren y Villavicencio (1998), Falcone (2012), and Stagnano (2006).
• 3
  See Oscar Terán (1987) and Hugo Vezzetti (1988). Both analyze this precise historical moment in turn-of-the-century Argentina. According to Oscar Terán (1987, p.14), “in the area of the positivist essay in Argentina, the most significant and central [contributions] involve the works of José Ramos Mejía, Agustín Alvarez, Carlos Octavio Bunge, and José Ingenieros.”
• 4
  José Ingenieros succeeded Ramos Mejía as head of the Neuropathology department (known at the time as Nervous Pathology) at the University of Buenos Aires. In 1904, Ramos Mejía published Los simuladores de talento (Talent simulators), which took up some of the ideas discussed by Ingenieros in The simulation of madness.
• 5
  See Madness in Argentina (La locura en Argentina, Ingenieros,1962a) and Criminology (Criminología,Ingenieros,1962b).
• 6
  The author points to two possible readings; one argues that homosexuals disrupt Ingenieros’s explanatory framework for fraudulent simulators in that, by simulating femininity, they are not resorting to deception or lies; rather, by exhibiting their femininity, they are highlighting what they really are. According to this reading, defended by Molloy, femininity is an inherent characteristic of male homosexuality. A second reading concludes that “a man poses as what he is not – a woman – because, Ingenieros tell us, he is really a man” (Molloy, 1999, p.192). Sylvia Molloy builds her critique of Ingenieros around that second reading, thereby falling into a certain anachronism. She argues that this way of viewing homosexuality represents a “brutal reduction to an essentialist binarism” (p.192).
• 7
  We shall leave out criminal simulators here. A specific analysis is needed of that topic, which is central to Ingenieros’s book.
• 8
  Something similar occurred with the Escuela Jurídica Positiva (Positivist Legal School), defended by Enrico Ferri. See Galfione (2012) on this.
• 9
  See also “Histeria y sugestión” (Ingenieros, 1962c).
• 10
  Foucault (1999) dealt extensively with the rise of a psychiatry of the non-pathological in his lecture series Abnormal (Los anormales), given at the Collège de France in1975.

Publication Dates

• Publication in this collection
  Oct-Dec 2016

History

• Received
  July 2014
• Accepted
  Dec 2014