Madness and Civilization: A History of Insanity in the Age of Reason

In Chapter 4, Foucault examines how Enlightenment thought related passion to “madness.” According to the 17th-century French philosopher René Descartes, passion was the locus where the body and soul met. Medical practice in the 17th century, based on a theory of the humors and spirits, used these “passions” to explain physical reactions to certain emotions. Passions were thought to be a gateway to “madness,” but Foucault argues that “madness” was itself a passion, since it constituted a connection between the body and soul.

Having established passion’s relationship to “madness,” Foucault turns to another related phenomenon, delirium. He asserts that Enlightenment thought defined delirium as an instance in which a man believes his own imagination to be reality. Delirium reveals that “madness” actually operates in a state of logic. For example, an individual who convinces themself that they are made of glass may respond in a number of reasonable ways to that delirious conclusion: they may be so afraid of colliding with something and shattering that they choose to remain perfectly still. Classical thought constructed two forms of delirium. The first kind is symptomatic of an individual’s “madness,” the second is an implicit form of delirium which occurs in any altered state of mind. These two forms encompass the entire range of “madness,” which was not thought to be a pathology of the mind or body, but rather a “delirious discourse” within the mind.

Foucault enumerates some of the categories into which Enlightenment doctors divided “madness.” He groups these categories into two juxtaposed pairs: melancholia and mania, and hysteria and hypochondria. Melancholia was identified as a form of delirium about oneself. As medicine moved away from theories about humors and toward theories of qualities that move between the body and soul by means of “fibers,” melancholia became increasingly associated with dispositional symptoms, such as sadness. Melancholia was also associated with a general feebleness of the fibers that channeled the movement of these metaphysical qualities. Mania, by contrast, was associated with a hyperactivity of those fibers. Whereas the melancholic patient was observed to be unresponsive to external influence, the maniac was observed to be oversensitive to it.

Foucault presents hysteria and hypochondria as more difficult to analyze within the framework of “madness.” Prior to the Enlightenment, hysteria (a uniquely feminine affliction) was described as s “wandering womb,” or the physical movement of a woman’s uterus throughout her body. In the 17th and 18th centuries, however, physicians gradually came to understand hysteria as a disease of the mind and nerves. When this change occurred, physicians realized that they could not distinguish hysteria from hypochondria, which was also defined as a disease of the mind and nerves. The definitions of each of these diseases were constantly in flux as physicians struggled to justify their belief in hysteria as a disease tied to the female reproductive system. Nevertheless, the invention of diseases “of the nerves,” marked a step towards the pathologization of “madness” as a whole.

Having categorized various forms of “madness,” Enlightenment physicians set about proposing treatments. Foucault addresses four types of Enlightenment-era cures: consolidation, purification, immersion, and regulation. Consolidation attempted to fortify the weakness of spirit that supposedly underlay “madness.” Iron was thought to be particularly useful for consolidation, and physicians prescribed cures such as the consumption of iron filings. Purification aimed at purging compromised humors that were thought to cause “madness.” Doctors prescribed everything from bloodletting to the consumption of bitters to achieve this. Immersion addressed “madness” by submerging the afflicted person in water. Water therapy became increasingly popular during the period, in part because water’s material flexibility (it could be hot or cold) allowed it to address various theories of the humors. Finally, regulation of movement sought to heal through consistent physical activity. This particular form of cure would continue to be used long after medical science progressed towards a pathology of “madness.”

Foucault divides physicians’ theories of “madness” during the Enlightenment into two basic categories. The first group understood “madness” to be a form of passion, and the second understood it as a form of delirium. The latter group had several different theories of how to address delirium. Some devised medicines that would “awaken” patients from the waking sleep of delirium. Others thought that by engaging in delirious discourse with their patients (i.e., entertaining their delusions), they could ultimately reveal the unreason of the delirium and subsequently unravel it. Still others thought that they could suppress “madness” by forcing their patients to focus on their immediate physical world. These theories marked the very beginning of psychology’s birth, an event which was tied (Foucault asserts) to the moralist attitudes towards “madness” of the previous centuries.