Madness & Civilization
Madness and Civilization is a deep and complex treatment of the role of madness in Western society. It begins by describing end of leprosy in Europe and the emergence of madness as a replacement for leprosy at the end of the Middle Ages. The Ship of Fools which wandered the waterways of Europe was a symbol of this process. Great uneasiness arose about madmen. Fantastic images of madness, that associated it with dark secrets and apocalyptic visions became important. A change occurred in the seventeenth century. Madness became tamed and existed at the center of the world.
The position of madness changed in the classical period. A "Great Confinement" occured. Madness was shut away from the world, along with a range of other social deviants. Houses of confinement were places where power was exercised, not medical establishments. Confinement represented a series of practices and disciplines: Foucault explains attitudes toward madness in terms of economic ideas, attitudes to labor and ideas of the city. Confinement was related to the police, which Foucault sees as a range of measures that make work possible and necessary for those who cannot do without it. Madness was constructed in this period as a place set apart from a world that valued work. The theme of the animality of madness was central to confinement.
The passions were also important in classical madness; because they unite body and soul, they allow madness to occur. Foucault analyses the concept of delirium, which is a discourse that essentially defines madness. Classical madness is a discourse that departs from the path of reason. The link between madness and dreams was also an important part of the classical conception of madness. There were four key themes within the classical conception of madness: melancholia/mania and hysteria/hypochondria. They were located within medical and moral debates, and were eventually seen as mental diseases as time progressed.
Cures and treatments for various aspects of madness emerged. For the first time, society attempted to cure and purify the madman. This change in the techniques of confinement occurred at the same time as a shift in epistemology, exemplified by Descartes's formula of doubt. A further evolution in the status if confinement occurred. The madman appeared as a figure with social presence. Madness altered human relations and sentiments. But public fear developed around confinement.
A shift occurred in the nineteenth century. Confinement was condemned and attempts were made to free the confined. Confinement was represented as an economic error as much as a humanitarian issue. A need developed to separate madness from other deviants. The place of madness became insecure. The asylum replaced the house of confinement. In an asylum, the madman became a moral outcast, and his keepers tried to act upon his conscience and feelings of guilt. The model of the family now structured madness. At the end of the nineteenth century, madness became moral degeneracy. From the asylum, a new relationship between the doctor and the patient developed, culminating in Freud's psychoanalysis. The work ends with Foucault's interpretation of the complex relationship between madness and art.
Beginning with leprosy, Foucault analyzes a complex series of themes. He attempts to show the position of madness before the classical period. He charts a series of intellectual changes and a reorganization of knowledge about madness. The Narrenschiff, or ship of fools, is a symbol of the changing status of madness, which is linked to a wider network of symbols. The fifteenth century book from which the Narrenschiff is drawn, written by Sebastian Brandt, mixes woodcut images of madness with text. Many readers have pointed out that this is Foucault's only source for the ship of fools; there is little evidence that the ship actually existed.
Writers before Foucault have discussed the great significance of death in European culture in the late middle ages. Churches and tombs had images of skeletons and of Death itself. Death was not marginalized, but existed at the heart of people's life. However, it was also something that was opposed to life. This is how Foucault can see madness as both replacing and resembling death. Madness resembled death because it was a frightening phenomenon that threatened life and reason. But it also replaced death as a concern because people's concerns changed.
Madness took up the role of death, but also became linked to the theme of apocalypse. The apocalypse was a Christian explanation of the end of the world and the second coming of Christ; it was an absolutely central idea in the Middle Ages and Renaissance. Foucault feels that madness was a way of expressing and locating concerns about the darker side of life and fear about the end of the world. These shifts in the cultural meaning of madness had an underlying structure. For Foucault, the relationship between language and madness is an important one. This period is one in which language and imagery changed. In Brandt's book, text and pictures were closely related. Writing about madness and seeing it were almost the same thing. Brandt's images cannot express or explain madness on their own, but in the Renaissance they slowly create their own freestanding representation of madness.
Foucault considers the development of the literary representation of madness by Shakespeare and Cervantes. Madness in King Lear and Don Quixote becomes a kind of ultimate limit. Being mad is the worst thing that can happen to anyone, partly because it destroys humanity. But Foucault recognizes that this is an image of madness that reverses and alters reality. It is a "trompe d'oeil" (French for an image that deceives the eye) because it misleads the audience about its essential truth.
All these themes and images slowly alter in the classical period. Madness no longer relates to the apocalypse or the limit of human experience; it also moves to the forefront of human consciousness. As it becomes the most important sin, it has a greater cultural role. A situation arises that gives the mad a kind of temporary respite. While madness is not the source of fear, it is located in the world and accepted by the majority of people. It can do this because its intellectual context had changed; certain cultural themes change, and madness changes with them. Perhaps the ultimate contrast in this book is between madness in the Renaissance and in the present day, where it is located and isolated within certain medical and psychiatric disciplines, and marginalized within the world. By drawing this contrast, Foucault is not claiming that the Renaissance had a "better" idea of madness, or that we should return to such a relatively tolerant attitude. Indeed, he would argue that such a return is absolutely impossible. What he wants to do is to make us consider the role of madness in the modern world, and stop believing that "modern" madness is the only form that insanity can take.
Foucault sees the physical disappearance of leprosy, and of leper houses, as just as important as the cultural changes he charts. A space opens up as leprosy vanishes. It is almost as if a permanent space exists in which certain people can be defined and excluded; when leprosy no longer fills this space, madness appears to occupy it. Madness did not exactly replace leprosy, but the shift between the two conditions represented a move from a concern with diseased bodies to a concern with abnormal behavior, and diseased minds. Foucault can be criticized for his analysis of leprosy, which did not vanish entirely. He frequently uses such flamboyant contrasts to point out the contrast between classical madness and its predecessors.
The Great Confinement
Madness and Civilization is organized around key shifts in the status of madness within society. The Great Confinement is one of these shifts. Confinement involves a series of measures—building houses of confinement and prisons, the creation of a new kind of social space, and the realignment of madness within this space.
Buildings were important as the means by which confinement was achieved. They also have great symbolic value. The Hopital General represents the beginning of confinement and the only place of confinement that Foucault analyzes. Taking one building or text as representative of a whole movement is typical of Foucault's approach.
The creation of a new form of social space was related to the disappearance of leprosy. Foucault sees confinement as a series of social and economic measures that surround certain people and tendencies. Foucault sees society as creating a kind of safe place where it put those who it saw as abnormal: criminals, those who do not work and the mad. Unreason, or the irrational included all these people. They were not confined because they need medical attention, or out of humanitarian concern, but because the power of the state needs to control them. It needs to do this because by separating them from "normal" society the state helps to define itself. Only by controlling the abnormal can the "normal" exist. This is a theme that Foucault returns to in almost all his work. In Discipline and Punish, for example, he explains the rise of the prison system in similar terms.
The realignment of madness is central to Foucault's explanation of confinement. In the classical period madness became part of a wider class of social deviancy, which was defined by its relationship to work. Foucault argues that the mad did not really exist as a separate group, but only as part of a wider deviancy. Criminals and the idle were inseparable from madmen.
The contemporary European political context is central to Foucault's argument. Houses of confinement emerged at a time when European states were expanding and exercising greater control over their citizens. In a way, confinement is linked to the creation of larger armies, and more sophisticated methods of collecting taxes. All of these phenomena express a desire to control, and to define people. However, the problems of a more sophisticated economy were also important. Foucault emphasizes the importance of economics and morality in explaining the development of confinement.
Fundamentally, those who were confined had a negative relationship with labor and the economy. Increasing economic sophistication and production led to cities wanting to resolved labor problems; those who did not want to work were problematic. The seventeenth century economic crisis that Foucault describes was serious and widespread. It involved high inflation, harvest shortages and was matched by political crises in many countries. Confinement was a one response to these problems. An age that tried to define "normality" in terms of economic productivity attempted to isolate and exclude those who could not or would not produce.
But Foucault also stresses the moral dimension of confinement. Economic development was supported by an ethical theory that argued that work was morally good. This was only partly a Christian theory. Morality and work were closely linked, and so those who were confined became bad people. The police, as a series of measures that allowed work to take place, had a moral dimension because law and custom disapproved of idleness and insanity. A great transformation took place. From being integrated into the world at the end of the seventeenth century, madness in the classical period was silenced and isolated. It was not allowed to speak, and was seen as a moral and economic evil. Similarly, the concept of unreason was extended include a wide range of "dangerous" people.
Foucault explores the changing relationship between madness and unreason. Irregular and abnormal people were the lazy, wife-beaters, tramps, the work-shy and the mad. Foucault says that that these people were defined as abnormal by their society. They were not inherently odd, but were seen as such by society. Foucault uses the example of these people to show how a split emerged between madness and unreason. Evil unreason, such as those who committed terrible crimes, or pornographers and libertines such as the Marquis de Sade, were hidden away out of shame, and to protect society.
Madness, however, had to be revealed. This was partly to separate it from other forms, but more importantly so that it could be observed. The idea that observation is a form of control and organization is important to Foucault, and is repeated in his later work. The public who paid to see madmen helped to set them in their place, and by being observed the insane could be placed in a particular social space within unreason. An important distinction is drawn between this situation of observation, and the Renaissance experience. Foucault's image of the Renaissance has madness present as a force in society. It was part of everyday experience, not observed in particular situations. Experiencing madness in this way did not involve controlling it.
Foucault's discussion of animality and madness is contradictory and complex. He charts the move from fantastic images of madness in the Renaissance, to one in which the madman was part animal. Seeing madness as bestial justified treating the madman like a beast, but also offered a deeper explanation of his actions and place in the world. Rather than seeing animal qualities as being similar to those that human have, or seeing humans as highly developed animals, this attitude robs the madman of all humanity. By removing his humanity, madness makes the madman dangerously free. He cannot be bound by human laws, and so has to be confined.
Foucault's picture of animality as anti-nature is also confusing. The "animal" is not part of nature because the order of nature implies a rational order. In a way, the practices of confinement are justified by this conception of madness; they attempt to hide away this irrationality.
Foucault develops the relationship between madness and unreason further in this section. He needs to explain why madness is seen as different to the range of deviant behavior that is confined. He explains it in terms of religious change, adding another dimension to the economic and moral elements already discussed. Foucault argues that unreason and religious ecstasy were less important after the seventeenth century, which is commonly seen as a period of great religious enthusiasm. As religious enthusiasm declined, madness appeared to fill it place. In a sense, the Church needed the structure of madness to replace something it had lost; the parallel with the decline of leprosy is obvious. Explaining the Church's concern with madness in terms of kindness or Christian charity is meaningless to Foucault. What matters to him are changes in demand for certain figures or roles, such as the leper or the madman.
The reorganization of madness and unreason is a general theme of Madness and Civilization. In this section Foucault argues that the classical period confined a range of dangerous and liberated behavior, but that this unreason represented the only way of understanding madness. Madness and the way the mad were treated made sense only against a background fear of absolute liberty. Confining madness, Foucault argues, was the eighteenth century's way of dealing with this fear.
Passion and Delirium
Foucault's treatment of madness and the passions emphasizes the intellectual and cultural role of the passions in creating a space where madness could occur. Descartes's analysis of the passions, The Passions of the Soul (1649) is one of the most famous works of passions psychology. Descartes and other writers argue that the passions are feelings and emotions that move people to action. Anger, envy, and lust are all passions. Passions are experienced in the mind, but have a physical effect, provoking bodily movement. Seventeenth century philosophers, particularly Descartes, were greatly interested in the relationship between mind and body. The passions link mind and body, because they begin in the mind and lead to action.
There is a long tradition of opposing the passions to reason, and discussing their harmful effects. As Foucault points out, the link between passion and madness was well-established. But Foucault goes further by arguing that a theory of the passions which links body and soul helps to create something like madness, which affects both body and soul. Foucault automatically assumes that madness affects body and mind, even though very few passion theorists argue about madness in these terms.
Foucault's analysis of classical madness and passion deals with the effects of madness on the body. But what interests him more are the products of the insane mind: delirium and hallucinations. He examines the insane mind by contrasting madness with two similar states, imagination and dreaming. Both involve strange and unreal images that are similar to those seen and experienced by madmen.
However, for Foucault the key difference between madness and these unreal images is truth. Foucault says that madness exists when someone believes that fantastic images are true. Madness involves a distortion of the truth as the mad person experiences it. Foucault stresses the coherence and logic of madness. It has its own language, and the delusion of the madman makes sense within his distorted world. While delirium is a symptom of certain kinds of mental disease, Foucault identifies a different form of delirium, which he calls a discourse.
Discourse is a central concept for Foucault. He first introduces the concept in Madness and Civilization. A discourse is essentially a total system of knowledge that makes true or false statements possible. The madman believes unreal things to be true because the discourse that structures his belief dictates it. In Foucault's later work, he examines the discourses of psychiatry, medicine, and sexuality. Here, he emphasizes the unreal but powerful nature of delirium. Delirium structures perception and truth and makes "unreal" beliefs possible.
Delirious discourse is a phenomenon of language and belief, but it affects the body and mind. Foucault is clear that delirious discourse does not originate in the mind or body. The idea of discourse and truth underlies all the different types of madness that the classical period identified. Deliria, dementia and hallucinations were seen as different types of madness, but in fact they all relate to truth and to a distorted discourse.
Blindness shows the relationship of madness to reason. The madman sees the same reason as the sane man, but in a different way. This is also the first appearance of Foucault's analysis of Descartes. Descartes's argument against skepticism about his own existence and sanity, the Cogito, is seen by Foucault as evidence of the self-assurance of classical reason. For Descartes, the fact that he doubts proves his own existence, and proves that he cannot be mad. Essentially, his reason denies the possibility of madness. Foucault's interpretation of Descartes is one of the most controversial sections of this work, and provoked a controversy with the philosopher Jacques Derrida.
Foucault argues madness is expressed and explored through art. Tragedy and madness are the outer limits of reason for Foucault, and in tragedy the tragic figure and the madman confront each other. The two limits come together. A final shift occurs at the end of the section. Whereas the animal nature of classical madness took away the humanity of the madman, now the idea of non-being takes away everything. Madness ultimately becomes an expression of nothing and non- existence.
Aspects of Madness
This is Foucault's first analysis of the different conditions and syndromes seen by the eighteenth century as forming madness. He analyzes two sets of ideas that were held in opposition to each other. Both involve body and mind in different ways. Foucault explores the way in which doctors and theorists of madness describe the causes and effects of mental illness. In doing so, Foucault delves into the history of medicine.
Foucault's definition of melancholia is unique, and does not refer to depression. A melancholic person could have a range of delirious symptoms, including unreal or false beliefs, combined with an otherwise normal personality. The tradition of humors that Foucault discusses was a central part of early modern medicine. Doctors believed that there were four humors—blood, phlegm, choler and black bile—which corresponded to the four elements of fire, water, air and earth. Different personality types had a different balance of humors; the melancholic personality had too much black bile. The doctor's task was to balance out the humors.
The shift that Foucault describes is a subtle one. Instead of believing that melancholia was caused by an imbalance of physical substances (humors) within the body, classical doctors now believed that melancholia could be caused by the patient's mental state. Foucault describes the narrowing down of a condition and the establishment of firm definitions.
A similar process occurred with the concept of mania. Whereas melancholics could have a range of symptoms, maniacs were highly excitable, wild and uncontrollable. Doctors came to realize that mania was the exact opposite of melancholia. Foucault charts a change in medical thought, from the emphasis on animal spirits to an emphasis on tension within the nervous system. Another key shift was the idea that the two conditions alternated within one person. As medical understanding developed, they became more closely linked.
The discussion of hysteria and hypochondria centers on the idea of mental disease. Mental disease is a condition affecting the mind that is treated by doctors and that has recognized symptoms. Madness, on the other hand, is a state of being linked to unreason that has a complex relationship with reason itself.
Hypochondria is falsely believing yourself to be ill; hysteria is essentially a disease of spasm, convulsion and over-excitement. It is particularly common in women. From ancient medicine onwards, it was seen as relating to the uncontrolled movement of the womb within the body. The word hysteria is derived from the Greek word for "womb".
Foucault describes the transition from focusing on the movement of spirits through the space of the body, focusing on a moral judgment of the sensibility or emotional state of the patient. The idea of movement in the space of the body is derived from the ancient explanation of hysteria. The penetration of the body by various spirits assumed that the body was essentially open inside. The shift from the idea of movement and space to that of moral judgment comes through the notion of sympathy. Sympathy implies a certain sensitivity of the nervous system. By over-stimulating the emotions and nerves, a drastic response could ensue.
For the first time outside influences on the body became important. Rather than an imbalance of the interior parts of the body, hysteria and hypochondria were diseases resulting from lifestyle. The fact that they had a clear external cause was important in the labeling of these conditions as mental disease. However, they were also a kind of madness. Hysterical people were blinded by experiencing too much. This blindness left the way open for madness.
By a complicated route, hysteria and hypochondria offer a way for medicine to pass moral judgment on madness. The development of certain ideas about the relationship between mental disease and lifestyle was the beginning. Because disease was created by lifestyle, medicine can disapprove of that way of life. When that disease becomes associated with madness, madness can be seen as something of which to disapprove. Morality has a new power over madness, which became a punishment for a "bad" lifestyle. This is different to the morality of labor that helped to create confinement because it was linked to medicine and idea about the body. Psychiatry, which Foucault views with some suspicion, rests upon this idea of applying morality to madness.
Doctors and Patients
After his discussion of the various aspects and conditions that form madness, Foucault examines their treatments. He analyzes a central part of the process of confinement, and the development of the idea of curing or treating madness. Initially, madness was not seen as an illness or something that could be treated. But Foucault suggests that even when the idea of a cure developed, it was not a medical development. Madness was still seen in terms of morality and the links between body and soul that come from a theory of the passions.
The initial cures that he discusses (consolidation, purification, immersion and regulation of movement) all relate to the body, but affect both body and soul, such as purification. There is a great difference between this and nineteenth century techniques which center on the moral improvement of the madman. These techniques force the madman to face up to his abnormal or "bad" behavior. The doctor or warder encourages the madman's conscience to operate; he is made to fear both his captors and the consequences of bad behavior. Earlier, Foucault discussed the idea of madness as a punishment for immoral behavior; here, immoral behavior provoked by madness is punished. The introduction of punishment and guilt into the treatment of the madman represents a more sophisticated kind of confinement. Valuing and using the madman's guilt indicates a certain ideal of sanity and good behavior—the "normal" person observes recognized standards of good behavior and obeys his conscience.
Foucault associates nineteenth-century treatments for madness with punishment and the regulation of behavior. They also split up an earlier whole. Nineteenth century treatments relate to different diseases, which have a specific location, rather than to the patient's entire body and soul.
The idea of madness as moral evil is still a central theme. The relationship between madness and morality is characteristic of nineteenth century psychology. Psychology for Foucault is more about morality than science. Only when morality and madness are completely linked is psychology possible. Although classical physicians may talk to or reason with their patients, and appear to treat their minds, this is not a truly psychological approach. Reasoning is not enough; only moral judgment and an attempt to use guilt as a treatment represents a truly psychological approach.
After making this key distinction, Foucault analyzes specific methods of treatment. Most cures center on the concept of delirium. They attempt to alter or reconfigure the discourse of delirium. They therefore work with language and idea rather than with the body. In its classical form, delirium essentially means a movement away from the correct path of reason. These treatments try to direct it back onto the right track.
The various cures differ in their attitude to the discourse of delirium. "Awakening" moves the patient back towards reason by reasoning with him. Foucault's reference to Descartes is important here; he refers to a another aspect of the Cogito this time. Foucault uses the idea that Descartes confirms his own existence by reasoning. The physician does not literally make the madman recite Descartes' arguments, but he does attempt to lead him towards reason and an awareness of sanity by means of reason.
Theatrical representation is very different because it involves continuing delirium. By agreeing with the patient and even acting out insane fantasies, the physician hopes to reestablish rationality. Playing along with a madman who believes himself to be Louis XIV, then slowly directing him away from this belief is a good example of this approach. It is a concerted attempt to manipulate madness back into reason from within.
The return to the immediate is the most complex of all these techniques. It draws upon earlier ideas of the animal quality of madness, and of "anti-nature". The madman can be like a beast, and is opposed to the rational order of nature. But by confronting him with the order of nature, the physician can make him rational again. "Natural obligations" like the need for food and sleep, and the rhythm of the seasons can restrain madness through their own inner logic. Ultimately, this kind of treatment supposes that the doctor can control and shape nature as well as his patient.
Finally, Foucault's discussion of Sigmund Freud's psychoanalysis is important. Foucault sees psychoanalysis, which involves the idea of deciphering the symbols and language of madness and mental disease in a dialogue with the patient as a way of restoring contact with unreason. The absence of moral judgment and punishment in psychoanalysis means that it can access areas closed to nineteenth century psychology
The Great Fear
Here, Foucault deals with the reorganization of the relationship between unreason and madness. Rameau's Nephew is a work by the French philosopher Denis Diderot (1713–1784), which represents the turbulent and romantic character of its protagonist in a dialogue with the author. Confinement still exists in the latter part of the classical period, but unreason reappears within it. This movement acknowledges the closeness of reason and unreason. As with Rameau's Nephew, the world debates and interrogates madmen to see if they knew hidden truths.
Fear developed at the same time, however. The fear of leprosy with which Foucault begins Madness and Civilization mutated into a fear of the whole structure of confinement, not just of the madman. The fact that they were partly fears of the diseases that madmen could transmit involved doctors in the process of confinement. Again, however, Foucault emphasizes that madness was not a medical matter. The doctor protected madmen and the public, but did not create or define madness in any way.
The reform movement that Foucault describes aimed to purify the place where madness was confined, just as earlier treatments tried to purify the madman's body. This was perhaps a good idea given squalid conditions of most houses of confinement at the time. Houses of confinement became reservoirs of disease, but also of imagery. Secret, hidden and dangerous things were locked away there. The Marquis de Sade, in whom Foucault took a particular interest, is a good example of this fantastic horror. He was a madman and a libertine, confined at his family's request, who recorded his violent, erotic fantasies in works such as 120 Days of Sodom. His private delirious discourse was eventually published; in this case, secret fantasies leaked out of confinement.
Unreason adopted fantastic forms. Foucault argues that confinement preserved such fantastic imagery by separating it from the world. Madness and unreason intertwine at this point; it becomes difficult to divide the two concepts. But madness increasingly becomes a cultural phenomenon, related to society, time and human lifestyles. The relationship between madness and civilization emerges as a theme, madness is related to external factors, and becomes a disease of society.
Montesquieu, the author of the famous eighteenth century work The Spirit of the Laws, established the link between politics and forms of government and external factors such as climate and geography. Foucault extends and develops this interpretation into a political and economic explanation of madness. He argues that Montesquieu represents the beginning of a theoretical approach to madness that sees it as dependent on the kind of society in which it exists. Religion is another social and economic factor influencing madness that was first recognized at this time.
Sensibility, meaning emotion or sensitivity, is an important eighteenth century idea. Foucault relates it to explanations of hysteria and nervous sensitivity; the "sensible" person essentially stimulated their nervous system too much. A key development according to Foucault is the creation of a link between inner, nervous sensitivity and external influences. Reading, watching too many plays and generally behaving in an inappropriate manner could lead to nervous collapse or madness. A new kind of moral disapproval was now possible; the madman's behavior could be blamed for his condition.
Foucault sees the development of new "causes" of madness as making a change in its status possible. Madness is now related to the world around the madman. Foucault's argument, developed in later sections, is that madness changed itself before the system of confinement altered.
The New Division
The "new division" that Foucault discusses here is the split that emerges between madness and other forms of confinement in the late eighteenth century. The nineteenth century division between madmen and criminals puts considerable value on the madman. But it does not do so simply because society feels that the madman deserves sympathy. Foucault always denies such humanitarian motives. Instead, he sees structural changes in the nature of confinement as more important. Within confinement, madness mutated into something different.
Foucault emphasizes that the voices of the mad are silenced in confinement, but that these changes show how powerful their voice can be. Foucault is generally concerned to allow the voices of the confined, prisoners and the mad to be heard.
Changes of confinement are due to two factors: first, a change in the status of madness and second, economic change. It was no longer appropriate for madmen and otherwise sane deviants to be mixed together; therefore madness had to be isolated. It was separated from other social ills to become a special category. The second cause was perhaps the most powerful. In the second section of Madness and Civilization, Foucault explains how confinement was structured by the seventeenth century economic crisis and changing attitudes to labor. The role of confinement within society depended to a great extent on its economic value. When its economic value disappeared, its profile had to change.
Eighteenth century French economic thought replaced the figure of the pauper with two variables. In doing so, it found a new role for poor people. If they could be put to work, then confining them was a mistake. Changes in confinement essentially involved removing certain things from the domain of unreason. Poverty and madness were no longer unreason. Madness was set free because it was no longer seen as something that needed to be confined, even if in practice it was.
The revolutionary reforms that Foucault refers to began by separating madmen from political subversives and counter-revolutionaries in prison. At its center was the idea taken form the Declaration of the Rights of Man that people could only be detained according to the law. According to this notion, criminals should be put in prison, but madmen should be treated. All the other deviants and social undesirables must be set free. This led to certain problems. The position of madness was uncertain. Reforms intended to treat the mad, but no facilities existed for this. Again, Foucault is somewhat cynical about the aim of the reformers. He sees the revolutionary decrees as attempting a difficult restructuring of society, rather than a humanitarian attempt to set people free. Problems with madness and confinement arose from social uncertainty. As society changed, the role of the madman had to change too.
The economic and social explanations for these changes in confinement may surprise some people. Foucault's critics generally accuse him of imposing general, abstract theories and ignoring more practical historical detail. However, he is interested in the systems of knowledge and culture that define and create certain terms and structures; for him, these systems can be economic, political or intellectual. Foucault does not ignore economic and social explanations, even if he views them in different ways to other historians.
The Birth of the Asylum
Foucault suggests that the images of lunatic asylums that he discusses are a strategy aimed at showing psychiatry as a positive, developing force that could understand and resolve the problem of madness. But he tries to see beneath this facade to examine what is really happening.
Characteristically, Foucault chooses only two people to represent the development of the asylum system: Philippe Pinel (1745–1826) and Samuel Tuke. Tuke founded the York Retreat as a rural, Quaker institution to take an enlightened attitude to madness. The Quakers, a Protestant sect, stress the principles of self-examination and internal dialogue. This is what Foucault means by replacing terror with repression. Patients at the Retreat were not locked up, chained or shut in dungeons. Instead, their warders rebuked them for bad behavior, reasoned with them and talked to them. This aimed to awaken the individual madman's conscience. A combination of guilt and observation makes the madman behave in a normal way.
Foucault again proposes the idea that observation is a form of control. The knowledge that he is being watched restrains the madman. Observation is related to judgment. Those in charge of the asylum looked at behavior and decided what was good, bad and abnormal. This combination of observation and judgment made the modern science of psychiatry possible. Judgment and observation replaced earlier ideas of talking with madmen. Psychoanalysis was later to offer the hope of dialogue with madness, but this hope was not realized.
Tuke represents other changes, especially in the conception of the family. The family is a way of locating and controlling the madman, who was formerly set apart from society. The nineteenth century family represents society in miniature, and also a standard against which the mad were judged. The family became "normal" and reasonable. Foucault sees this as an insidious move that excludes groups other than the mad. The "bourgeois family" was a creation of eighteenth and nineteenth century Europe. Foucault's charge against the asylum is that it preserves this social structure after it ceased to exist in the world.
Pinel is the second representative of the development of the asylum. In 1794, Pinel freed the madmen confined in the Bicetre prison. This move initially had political overtones. Separating madmen from political criminals was necessary for the French government of the time. After this famous act, Pinel went on to develop a system of treatment for madness based on conscience.
Pinel's asylum condemned religion as a dangerous irritant, but aimed to instill a kind of non-religious morality in madmen. He aimed to enforce moral standards drawn from the outside world on the madman. Ignoring or exceeding the world's morality became madness. But to enforce this morality, madness had to be recognized. Madmen were allowed, indeed forced, to speak in order to recognize their madness. But it could not speak freely. Delirious discourse was silenced.
The idea of judgment was powerful and chilling. The madman was observed, judged and condemned as an abnormal phenomenon. In his later work, Discipline and Punish, Foucault analyzes how this system was extended to other modern institutions such as the hospital and the school. The imposition of a moral code onto madness was not an irreversible change, but it was a powerful one.
The system of judgment and observation was supported by the appearance of the doctor-figure. Madness now becomes a medical complaint, in the sense that the authority of science and medicine justifies the treatment of madmen in asylums. The doctor is a wise man because he has the authority of science behind him. He guarantees the value and correctness of what goes on in the asylum. The doctor's power does not end with this validation, however. He also develops a great power over his patients. He gets this power from structures developed by Pinel and other asylum-builders. The development of science covers up the source of this power of this new father-figure. Doctors no longer examine the origins of their power and its moral character.
In a way, Foucault reduces the complexity of asylum to the unequal and misunderstood relationship between doctor and patient. Neither side has any clear idea of how it develops, or works. The doctor's power is almost magical, because the patient has great faith in it without any understanding. Foucault returns to psychoanalysis. He almost sees it as the ultimate form of psychiatry or medicine, because it centers on a dialogue with the therapist. It is separate from the kind of judgment and morality that medicine involves. However, Foucault is not sure that psychoanalysis can really engage with unreason. That kind of engagement is possible only through art. The final paradox of this section is that, in freeing madmen from physical constraint, Pinel and others make them prisoners of their own consciences. Foucault argues that this is not real freedom.
Foucault analyzes the modern experience of unreason. He believes that the only was to do this is by looking at the work of certain writers and artists. He cites artists who express madness in their art as a way of counteracting the medical and psychiatric appropriation of madness. This is his way of showing that unreason can be expressed in the modern world, despite the various medical structures created to hide it.
Foucault does not examine the work of any artist in great depth. In fact, he uses names alone as symbols representing a certain attitude to unreason. His choice of names is perhaps explained by his interest in the work of Artaud. Artaud saw himself as part of a distinct tradition of mad writers, including those named above, and even wrote a study of the painter Van Gogh's madness. Much of this section can be related to Foucault's interest in Artaud.
Foucault suggests that madness can create art, but in the end it destroys it. Madness becomes the absence of a work of art. Foucault sees art as a way for madness to fight back against the world. Madness is measured against a moral scale by psychiatrists and psychologists, but art asks the world disturbing questions and requires answers. The very fact that it does not support the way that society represents and treats madness calls society itself into question. Art attempts to redress the balance between madness and civilization.
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