There is much to be said in criticism of Foucault’s study of madness. It is written in a prose of an obscurity so dense as to be often impenetrable. This is not so much the result of its genuine difficulty of thought as of the author’s arrogance, carelessness, and imprecision. Helterskelter he employs whole sets of technical philosophical terms which are only half-assimilated to the matters he is discussing. Indeed he rarely bothers to define them, much less to use them consistently. The tone of the prose is high-flown and portentous. Foucault’s powers of exposition are equally uncertain. Although his book is organized generally along chronological lines, and although each chapter focuses upon a distinct topic, reading through most of these chapter is like wading through several feet of water: paragraphs do not follow one another in logical and sometimes not even in associative order; great lacunae open up between what are apparently supposed to be consecutive parts of a discussion; conclusions are sometimes offered in advance of evidence, and sometimes they are offered in place of evidence.
The author’s scholarship is to say the least irregular; one need only compare his discussion of seventeenth- and eighteenth-century medical theories of mental ailments with those contained in a recent standard work of medical history—Ilza Veith’s Hysteria: the History of a Disease (Chicago, 1965), for example—to see at once how idiosyncratic is his use of sources. His scholarship is in addition surprisingly provincial. The sub-title is “A History of Insanity in the Age of Reason,” but the book’s conclusions apply in fact almost exclusively to France. Italy is pretty much ignored as being apparently outside history; Germany seems hardly to have made it to the Age of Reason; and of much of Foucault’s material on England, well, the less said the better.
Such charges would be grave indeed if they were brought to bear upon another book. In Foucault’s work they seem in the end hardly to matter. In spite of all the defects I have listed, it seems to me that Foucault has written a work of unquestionable originality and importance. It is certainly worth putting up with its flaws in order to get what it has to offer, and one’s disagreements should be reserved for the arguments in the book itself.
FOUCAULT BEGINS his account with a discussion of leprosy. Throughout the Middle Ages leprosariums, or lazar-houses, had been established at the gates and margins of the towns of Europe. Within these precincts an immense number of sufferers were segregated, removed to a “sacred distance” from the world. It is revealing of the ambivalence with which medieval society regarded the leper that it simultaneously drove him out of it and confined him within it, at its very periphery—a periphery which, as the cities expanded, was to become in turn a new center. As a figure in the religious consciousness of the time, the leper was invested with equally ambiguous qualities. Visible emblem of man’s wickedness and God’s angry punishment, his malady was at the same time a sign of his salvation—he literally embodied the grace of affliction, a grace whose visitation was accomplished by means of his very abandonment and exclusion. At the end of the Middle Ages leprosy mysteriously disappeared from the Western World. The lazar-houses were emptied but remained standing; these structures and the institutional structures of exclusion associated with them were to become the model for many of society’s later efforts of segregation and confinement, including the confinement of the mad.
Foucault then turns to an examination of the variety of ways in which madmen were treated during the early Renaissance. One of the most interesting practices of the period was to pack madmen onto a Ship of Fools and send them sailing off into the beyond, in search, presumably, of the sanity they had somewhere lost. Part pilgrim, part vagabond, part exile, the madman on his Narrenschiff soon came to represent in the imagination of the times something more than himself, and the Ship of Fools became a central motif in the literature and iconography of the period. It is Foucault’s thesis that during the fifteenth century a large change occurred in the consciousness of Europe: madness and the madman became “major figures,” and from that time on, “the face of madness has haunted the imagination of Western man.” The obsession with madness in the Renaissance displaced the medieval obsession with death, the mockery of the one replacing the solemnity of the other. “From the discovery of that necessity which inevitably reduces man to nothing,” he writes, “we have shifted to the scornful contemplation of that nothing which is existence. Fear in the face of the absolute limit of death turns inward in a continuous irony… Death’s annihilation is no longer anything because it was already everything, because life itself was only futility, vain words, a squabble of cap and bells. The head that will become a skull is already empty.” And although madness had replaced death as a dominant theme, it none the less retained death’s eschatological powers: The madness that sweeps through humanity reminds us of the chaos that is to come and of the imminent end of the world.
The figure of the madman did not, however, emerge at once in separate and defined clarity. He first makes his appearance in the company of other figures given over to the vices and faults that perpetually plague mankind, who are all gathered together under the rule or misrule of Folly, “a sort of great unreason for which nothing, in fact, is exactly responsible, but which involves everyone in a kind of secret complicity.” The Madman, the Fool, and the Simpleton were often fused together and were always exemplary in function: if folly leads every man into “a blindness where he is lost, the madman, on the contrary, reminds each man of his truth.” Folly was at work everywhere, even at the very heart of reason and truth, and the madman was beheld in juxtaposition not only with the drunkard, the debauched, and the criminal, but with the scholar, the pedant, and the lover as well. He was part of the moral universe of excess, irregularity, and disorder that at certain times are thought to be synonymous with the human universe itself. And he embodied the tragic essence of this universe. Mad in his excess, he was not insane in the sense we put to that term today.
DURING THE SIXTEENTH and seventeenth centuries this generalized conception of madness gradually declined. As a critical consciousness inexorably developed, as the powers of reason inevitably expanded, the idea of madness steadily lost its powers of reference, its significance as a commentary on experience. Madness became only the extreme instance of error and illusion—of reason suspended or gone astray, of human self-enclosure. Together with this intellectual development went a social change. Foucault calls it “the Great Confinement”: the creation in the latter half of the seventeenth century of large General Hospitals, although General Prisons would be a more precise term. Into these great spaces of detention, the poor, the unemployed, the criminal, and the insane were indiscriminately herded. During the age of reason itself, society’s characteristic way of dealing with its problems was by sequestering or excluding them. Indigence, idleness, moral irregularity, criminal license, and madness were all grouped together by a society that had begun to organize itself along consciously “rational” principles. The value of work was now thought of as ethically transcendent, and confinement was in part a punishment for idleness, sloth, and economic inutility, and in part a means of rationally “administering” the unreasonable. It was at this moment too that those confined were required to work, not simply in order to keep them occupied or even to add to the productive powers of society, but as “an exercise in moral reform,” reason and morality now being used interchangeably.
The author then turns his attention, in several awkwardly organized chapters, to how the mad were treated during the seventeenth and eighteenth centuries, the various theories proposed to account for madness, and to how the varieties of madness were classified. Space does not permit me to comment upon all of this fascinating material, but Foucault’s main point can, I think, be summarized. Even during the height of the modern “classical age” madness was still not thought to be a mental disease. The mad were sometimes considered men turned into beasts, and were exhibited in a freak show and beaten to tame their animality. Sometimes their disorders were considered physical irregularities, malfunctionings of the animal spirits or nervous fibers; and then the mad were shocked or soothed, boiled or frozen, bled or purged, gorged or starved—a variety of treatments, quite comparable in both humanity and effectiveness to those administered in numbers of our own institutions until very recently. And yet Foucault believes that all this battering was in some ways preferable to what followed. Throughout the eighteenth century the tendency increased to understand madness as strictly a condition of moral error, waywardness, or failure; in the degree that madness is progressively moralized, so is the madman charged with the responsibility for his condition—he is guilty of having freely chosen his escape into insanity—by the encompassing world of reason and order. To this accusation he must inwardly assent if he is ever to enter that other world again. From here, according to Foucault, it is but one step to the early modern theories of madness as a mental disease.
The era of confinement ended, both actually and symbolically, at the time of the French Revolution. But for the mad, it may be said, this juncture only marks the beginning of their deeper incarceration. During the eighteenth century objections had been made to the indiscriminate imprisonment of the insane among the indigent, the criminal, and the debauched. The point of these objections was that the mad were an annoyance and a danger to the other prisoners, who required protection from the moral contagion bred in the person of the lunatic. At the end of the eighteenth century, humanitarian sentiment reversed this formulation; Pinel and Tuke struck off the madman’s chains and demonstrated that as a rule the madman is harmless to others, and that it is he who requires protection—from himself. It was at this point that madness was finally separated out as an entity distinct from all the other forms of unreason. It was at this moment too that the insane asylum as we know it was brought into existence. Isolated as both a spiritual phenomenon and a physical reality from all other forms of aberration, insanity henceforth took on the shape we recognize today. Under the dispensation of the asylum the madman was no longer beaten, reviled, or punished for his guilt; but, according to Foucault, the asylum did something more which was just as bad, if not worse: “it organized that guilt.” It organized it by its concentration, its isolation, but most of all by its structure of authority, a structure modeled upon that of the bourgeois family. Under this regime the madman was treated as a minor or a child, and his keeper, and later his physician or psychiatrist, represented patriarchal authority. This circumstance, the fiction of the asylum-as-family, remains as true today as it was when it was invented more than one hundred and fifty years ago.