(The following essay is reprinted from the last issue of The New York Review, where it appeared with certain passages out of order.)

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 chapters 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 Vieth’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 makind, 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 evelopment 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 recenly. 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.

THUS AS MADNESS CONTINUED to be internalized, observed, circumscribed, and classified, it sank ever deeper into solitude and silence. What was once a dialogue between reason and unreason—even if that dialogue consisted only in delirium on the one hand and insults and punishments of the other—was disengaged for good. Madness became either a “monologue in a language which exhausted itself in the silence of others,” or sank into final and wordless stupefaction. For the language or delirium was also rejected by the nineteenth century as non-language, and this rejection, this absence of language, has remained until today “a fundamental structure of asylum life.” Since the end of the eighteenth century the life of unreason has, with two exceptions, withdrawn from view. It is manifest only in the work of the great half-mad poets and thinkers of the nineteenth and twentieth centuries, and in the work of Freud, who had the genius to “return to madness at the level of its language…he restored, in medical thought, the possibility of a dialogue with unreason.” This dialogue is still only a possibility, and Foucault holds out little hope for its realization.

I have in the foregoing paragraphs tried to clarify a rich, complex, and frequently contradictory and incoherent account. Its implications seem to me very large indeed. On one side Foucault’s work is a study of what is called “differentiation”—he shows how certain generalized intellectual and institutional structures of the Middle Ages split apart and became specialized, distinct, and isolated as the modern world emerged. In this respect Madness and Civilization has much in common with Philippe Ariès’s Centuries of Childhood, which follows the development of the ideas and institutions of childhood, the school, and the family along essentially similar lines. Unlike Ariès, however, Foucault deplores this process; in his mind “differentiation” is always the equivalent of “dissociation.” For example, he judges later therapies for madness as “the impoverishment of the meanings which had richly sustained the therapeutic methods throughout the entire classical period.” At this point it scarcely seems to matter to him that those older therapeutic methods were crazy themselves; what counts is that they made for rich metaphoric constructions. At another point he comments on the same development: “The unity of the symbols begins to break down, and the techniques lose their total significance.” Foucault is extraordinarily astute at discovering the myths by which cultures sustain themselves, but in this connection it seems to me one that may be more familiar to readers of English than of French literature. He literally believes in “the dissociation of sensibility”; he believes that the culture of the Middle Ages was possessed of a unified sensibility from which virtually all subsequent developments are fallings away. This is not only a myth, and a shockingly unhistorical one in the bargain; it is rather heartless as well, and in such passages Foucault momentarily forgets that madmen are human beings and not metaphors for poetry.

Madness and Civilization also follows the evolution in Europe of reason and self-consciousness and demonstrates how, in the course of that progress, madness was transformed from an objective to a subjective state. It demonstrates analogously how society internalized madness by confining it within soundproof walls. “Subjectivity,” “self-consciousness,” “internality”—these terms come to Foucault from Hegel, who used them to describe the growth of freedom. Foucault turns them inside out, and applies them with a quasi-Freudian twist; to his way of thinking Western society performed what amounted to an act of repression in an effort to rid itself of madness, and I suspect that Foucault hopes that the repression will be removed. He may not have long to wait.

FOUCAULT’S WORK is in addition a study of the growth of secularization. For the Middle Ages the madman was a sacred object. He was both cursed and inspired with demonic truths; he was a manifestation of God’s judgment of the world and a symbol of things to come. History divested the madman of his holy rags and made him into what he is today, only a madman, a poor fellow who is very sick in the head. It was Hegel once again who described modern history as the secularization of the spiritual. Foucault would agree with the accuracy of this description but not with the positive judgment it implies. In his view secular reason is almost wholly positivistic and barren of content; its triumph over madness was won through denial and constraint. As reason and unreason ceased to confront each other, Foucault’s argument suggests, reason was increasingly cut off from one of its chief sources of strength, its dialectical counterpart. Whether one agrees with Foucault’s thesis or the tendency of his mind, a point of considerable importance is being made here.

Madness and Civilization shows how madness, bit by bit, lost all its metaphysical and occult powers, how it was demystified. Max Weber was fond of saying that the fate of our times was characterized in Schiller’s phrase “the disenchantment of the world” (die Entzauberung der Welt). This magisterial epigram owes much of its force to its ambiguity; it fully expresses both the emancipation and the attrition which have accompanied reason’s historical transformation of reality. It is not being harshly critical of Foucault to remark that in the present work he responds only to the attrition. Given the difficult nature of his undertaking, it is hard to imagine what other possible attitude he could have taken.

Although I have been dealing with that part of Foucault’s analysis which is conducted at a very high level of generality, it should not be concluded that his book is barren of historical substance. On the contrary, it is full of the most valuable kind of specific insights. Here, for example, is a typical instance. “For the nineteenth century, the initial model of madness would be to believe oneself to be God, while for the preceeding centuries it had been to deny God.” A radical transformation of sensibility is captured in such a remark. And Foucault’s work should have a considerable effect on the way the literature of the eighteenth century is conventionally written about and taught. For he demonstrates with abundant clarity that the age’s desperate insistence on the values associated with reason was accompanied by an awareness—however muted it may have been—that society itself might also become a mad-house. Nevertheless, Foucault’s work is not to be understood within the usual categories of intellectual or social history. At one point, he describes his method as “the archeology of knowledge”; and at another he states that he has attempted to write “the archeology of that silence” in which madness has been immured. What he has actually written, however, is a phenomenology of madness and of its historical confrontation with several of the faces of reason. He has attempted exhaustively to describe, and dramatize from within, the appearances ascribed to madness during the last five hundred years. He has not, however, attempted to explain why this all happened or what it all means—if we think of explanation as involving something more than minutely detailed representation and internal analysis.

He has not done so because he does not, in the first place, believe in the validity of such kinds of explanation; and in the second, he does not believe that madness or unreason can be explained. For him it is both a fundamental and ultimate category of human existence, and its utterances reveal ultimate truths. And at this point it seems to me relevant to say that Foucault has written a history of the Devil’s party, and knows it, and that Madness and Civilization is a kind of contemporary version of The Marriage of Heaven and Hell. Here is Foucault’s Descartes, who in order to be “secured against the dazzlement of the madman” “closes his eyes and plugs up his ears the better to see the true brightness of essential daylight.” Whom does this ironically drawn philosopher resemble except Blake’s typical modern man who “has closed himself up, till he sees all things thro’ narrow chinks of his cavern”? The Christ whom Foucault is interested in was the Christ who honored and sanctified madness, “who chose to be surrounded by lunatics, demoniacs, madmen, the tempted and the possessed,” who was a scandal to the world, and whose own madness was his glory. How far is this from the antinomian Jesus of Blake’s devil, who states that “no virtue can exist without breaking these ten commandments,” and that “Jesus was all virtue, and acted from impulse, not from rules”? Indeed the interplay of reason and madness in Foucault’s history is hardly to be distinguished from the dialectic of Heaven and Hell, Reason and Energy, in Blake. And Foucault’s imagery of confinement and sequestration is equally integral to Blake’s vision of the modern world.

I HAVE INSTITUTED this comparison not so much to demonstrate the astonishing and perennial modernity of Blake as to suggest the direction in which Foucault’s thinking moves. He is concerned to articulate the “truth” of madness and direct our attention to “the sovereign enterprise of unreason.” It is difficult to determine just what this truth and this enterprise are, if they are anything more than the principal generalities of Nietzschean and existentialist discourse—namely, that existence cannot be ethically justified; that life has no rational meaning, is founded on nothing, suspended over nothing, and passes away into nothing; that it is a mad world we inhabit and create, and that reason in its effort to defecate the world of its madness has if anything made it even madder, turning the earth itself into a universal madhouse. These are among the gravest and most poignant contentions of modern thought, but Foucault implies that madness is something more than the sum of such assertions. In criticizing the modern institution of the asylum he states that it “substituted for the free terror of madness the stifling anguish of responsibility.” One can agree with the second part of this assertion without assenting to the first. For Foucault does not simply mean that madness was at one time unchained and unconfined; he means that madness is really a form of freedom. To advance such an unqualified statement, even within the context of the dialectics of Blake and Nietzsche, is to precipitate oneself into a swamp of hopelessly reversible propositions. For if reason is only constraint and madness freedom, then it is equally plausible to affirm without modification that reason is freedom and madness total impotence. (Passion is slavery, said Spinoza, our instinctual drives are conservative, circular, and tyrannical, added Freud.) Moreover, at such points—as when he also speaks of “the serene world of mental illness”—Foucault is at his most literary and rationalistic, and farthest removed from experience. Thus, although Foucault discusses King Lear, he has no way of explaining why Lear should cry, “O! let me not be mad, not mad, sweet heaven: Keep me in temper; I would not be mad!” In the urgencies of his argument, Foucault himself occasionally loses sight of certain existential realities: the anguish of mental affliction, the quiet despair of psychosis, the often unspeakable agonies suffered by those who are the victims of their own imaginations and fears, these sometimes appear in his text as chimeras, pure contrivances of consciousness. Inheritor of the great tradition of rationalism and in rebellion against that tradition, Foucault none the less regularly reveals its famous indifference to concrete experience.

Still, Foucault is genuinely in favor of freedom; it is more precise to say, perhaps, he is opposed to authority, particularly the authority of physicians and psychiatrists. One cannot take issue with him here. No one who is at all acquainted with the history of the medical profession will be inclined to disagree with the notion that the personal and moral authority attributed to and arrogated by physicians has been and continues to be out of all proportion to their knowledge or their powers; or that the conceit of the profession as a whole is nowhere more clearly revealed than in the history of the treatment of mental afflictions. Foucault’s ambivalence to Freud is in part a result of Freud’s having been a physician, although, as Foucault himself states, Freud’s use of his professional authority was of a new and inspired order.

WHAT FOUCAULT IS FINALLY AGAINST, however, is the authority of reason. In this connection he is correct to regard Freud as a presiding figure; in his work the great intellectual systems of explanation invented by the nineteenth century reach some kind of culmination. From Hegel and the historians, to Marx and Darwin and on through Freud and Weber and Durkheim, the nineteenth century brought forth a series of vast analytical systems through which history, society, and the individual self were made to appear as complex, coherent wholes. The principle of coherence in these systems was essentially a historical one, the belief that causal and genetic explanations were in some ultimate sense binding. The methods of these systems all finally referred to reason, although their content was almost always the world of unreason. Although he knows and thoroughly understands such systems, Foucault no longer has any use for them or any belief in their authority. They have been around for a long time now; they are no longer fresh or vivid or surprising; there is much that they have failed to explain and much that they have explained inadequately or incorrectly. The great historical systems have themselves become part of the history that they both invented and transformed.

In this Foucault represents an important tendency in advanced contemporary thought. In his despair of the transcendent powers of the rational intellect Foucault embodies one abiding truth of our time—the failure of the nineteenth century to make good on its promises. This is partly why he turns at the end to the mad and half-mad artists and thinkers of the modern age, to Goya and Sade, Hölderlin and Nietzsche, Van Gogh, Nerval, et. al. Through their utterances the world is arraigned; mediated by their madness, the language of their art dramatizes the culpability of the world and forces it to recognize itself and reorder its consciousness. One cannot in good conscience deny the force and the truth of these observations; they catch a reality of the intellectual situation of the present moment—a moment that is coming to think of itself as post-everything, post-modern, post-history, post-sociology, post-psychology. Yet I should like to enter one reservation, a reservation which Foucault’s remarkable work brings continually to mind. Post-everything as we are, we are in the position of having rejected the great nineteenth-and twentieth-century systems of thought without having superseded them, of having outworn them without having transcended them with new truth, or discovered anything of comparable magnitude to take their place. I take this to reveal not so much the desperate situation of intellectual life. For even as we reject the large categories invented by the past, we continue to live on their capital. Those bearded old men left us an inheritance so rich that—short of blowing it all up—we can hardly fritter it away. It is this condition of unprecedented affluence that has permitted Foucault to write a brilliant work about the history of psychology while rejecting psychology itself, and without feeling any compunction to subsume the repudiated categories within some more inclusive and deeper set of analytic ideas. It has also permitted him to write a work about the relation of reason and madness which is consciously and in itself an instance of the phenomenon it is discussing, and which rejects transcendance as a game not worth the effort. This kind of intellectual relaxation, this easy living of the spirit—in which. I might repeat, most of us participate—is only possible in an age which is aware of how much it still has to fall back on.

This Issue

November 17, 1966