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

“What doubtless remained longer than leprosy, and would persist when the lazar houses had been empty for years, were the values and images attached to the figure of the leper as well as the meaning of his exclusion, the social importance of that insistent and fearful figure which was not driven off without first being inscribed in a sacred circle.”

Foucault invests leprosy with great social importance, one which some critics have argued is overblown. Throughout Madness, Foucault utilizes horror imagery and religious imagery in conjunction with one another as a poetic evocation of the feelings that “madness” inspired in historical moments. Here, that response is anticipated by responses to people with leprosy, who were considered, by some, as holy by virtue of their disease, which was seen as a sign of divine election. To others, leprosy was seen as a horrible stigma and punishment for sin.

“There is no madness but that which is in every man, since it is man who constitutes madness in the attachment he bears for himself and by the illusions he entertains.”

This is the Renaissance’s definition of “madness,” as paraphrased by Foucault. The chiasmic construction, alternating between the words “man” and “madness” links humanity and “madness,” both verbally and conceptually. As such, Foucault highlights how Renaissance culture could not fully ostracize “madmen,” as the Enlightenment would go on to do, since Renaissance thinkers recognized themselves in the “madmen” that they witnessed. This begins the theme of Shifting Relations Between the “Mad” and the General Population.

“Madness is the false punishment of a false solution, but by its own virtue it brings to light the real problem, which can then truly be resolved. It conceals beneath error the secret enterprise of truth.”

The trope of the “wise fool” in Renaissance literature and art reveals that Renaissance culture treated “madness” as a means of revealing the truth. This concept did not register as a contradiction for the Renaissance audience, revealing how profoundly constructions of “madness” have changed in the intervening centuries.

“From the very start, one thing is clear: the Hôpital Général is not a medical establishment. It is rather a semijudicial structure, an administrative entity which, along with the already constituted powers, and outside of the courts, decides, judges, and executes.”

Early on in Madness, Foucault clarifies that the so-called “hospitals” of Early Modern Paris and other cities, were not medical institutions in the modern sense. This is an important distinction, because it makes clear how, from early on, medical treatment of the “mad” was functionally a form of policing, establishing the theme of Medical Treatments as Institutional Policing of “Madness.” Later, when modern medicine attempted to distinguish itself from the inhumane prison system, it obscured the ways in which it had previously been reliant on that very same system.

“Measured by their functional value alone, the creation of the houses of confinement can be regarded as a failure…And yet, in this very failure, the classical period conducted an irreducible experiment. What appears to us today as a clumsy dialectic of production and prices then possessed its real meaning as a certain ethical consciousness of labor, in which the difficulties of the economic mechanisms lost their urgency in favor of an affirmation of value.”

This quote is emblematic of how Foucault treats moral, economic, and social structures as interrelated. While the economic and social functions of “houses of confinement” are more immediately obvious than their moral function, it is implicit in their design. In later chapters, this entanglement of morality with public infrastructure becomes a recurrent theme, especially in regard to the development of asylums.

“Between labor and idleness in the classical world ran a line of demarcation that replaced the exclusion of leprosy. The asylum was substituted for the lazar house, in the geography of haunted places as in the landscape of the moral universe. The old rites of excommunication were revived, but in the world of production and commerce.”

The original division that justified confinement, crucially, was not between the “mad” and non-”mad” but between the idle and the employed. “Madmen” fell into the category of the “idle” but their madness itself, as a distinct medical condition, was not what justified their imprisonment, but rather their inability to contribute to the economy.

“Madness was thus torn from that imaginary freedom which still allowed it to flourish on the Renaissance horizon. Not so long ago, it had floundered about in broad daylight: in King Lear, in Don Quixote. But in less than a half-century, it had been sequestered and, in the fortress of confinement, bound to Reason, to the rules of morality and to their monotonous nights.”

In his discussion of Renaissance thought, Foucault makes heavy use of art and literature as primary sources. Here, Don Quixote and King Lear evidence the era’s relative tolerance of “madness” being visible in public. Readers should consider whether they find this kind of evidence, which is by nature fictional, sufficient for making assertions about the real-life experiences of “mad” people in the 16th century.

“In the Renaissance, madness was present everywhere and mingled with every experience by its images or its dangers. During the classical period, madness was shown, but on the other side of bars; if present, it was at a distance, under the eyes of reason that no longer felt any relation to it and that would not compromise itself by too close a resemblance.”

Since the Middles Ages, a massive shift has occurred in public understanding of “madness.” Whereas humanity was previously thought to contain “madness” and reason within itself, here, “madness” has been othered to the point of being external to humanity. This process of othering is, in essence, the historical plotline that Foucault is aiming to highlight, challenging traditional understandings of the Enlightenment as a fully progressive age.

“The animality that rages in madness dispossesses man of what is specifically human in him; not in order to deliver him over to other powers, but simply to establish him at a zero degree of his own nature.”

Foucault introduces the new imagery of animals and animality to explain Enlightenment understandings of “madness,” marking a new stage in the Shifting Relations Between the “Mad” and the General Population. This is imagery that he draws from the primary source record, indicating its effectiveness for both historical thinkers and for the audience reading the book. In moments like this one, the iconography of Enlightenment thought is recognizable to modern thinkers, even if modern thinkers might take issue with how that iconography dehumanized the mentally ill.

“All these phenomena, these strange practices woven around madness, these usages which glorify and at the same time discipline it, reduce it to the animality while making it teach the lesson of the Redemption, put madness in a strange position with regard to unreason as a whole.”

The religious themes of the Renaissance are carried forward into the Enlightenment despite the Enlightenment’s conviction in itself as a radically secular age. The distinction between “unreason” and “madness” is a subtle one (see Index of Terms), and Foucault underscores how that distinction was itself in flux as other social structures, like religious ideology, changed.

“Madness is precisely at the point of contact between the oneiric and the erroneous; it traverses, in its variations, the surface on which they meet, the surface which both joins and separates them. With error, madness shares non-truth, and arbitrariness in affirmation or negation; from the dream, madness borrows the flow of images and the colorful presence of hallucinations. But while error is merely non-truth, while the dream neither affirms nor judges, madness fills the void of error with images, and links hallucinations by affirmation of the false.”

Foucault attempts to tease apart Enlightenment philosophy’s taxonomy of “madness” and its related concepts. This taxonomy is often inconsistent with itself, and was not a unified theory shared by all physicians. But by sketching in broad strokes how physicians and philosophers distinguished “madness” from, for example, hallucinations, he works towards cultivating a snapshot of what “madness” had become in the mind of the 18th century. This carries forward the theme of Developing Concepts of “Madness” in Early Modern Europe.

“If mania, if melancholia henceforth assumed the aspects our science knows them by, it is not because in the course of centuries we have learned to ‘open our eyes’ to real symptoms; it is not because we have purified our perception to the point of transparency; it is because in the experience of madness, these concepts were organized around certain qualitative themes that lent them unity, gave them their significant coherence, made them finally perceptible.”

Melancholia and mania are still referred to in the modern day as identifiable mental illnesses, even though they originate in the highly flawed medicine of the 17th and 18th centuries. By critiquing the construction of familiar mental health disorders in this way, Foucault asks readers to question the supposedly objective nature of the 20th-century mental health industry.

“This ‘interior body’ which Sydenham tried to penetrate with ‘the eyes of the mind’ was not the objective body available to the dull gaze of neutralized observation; it was the site where a certain manner of imagining the body and of deciphering its internal movements combined with a certain manner of investing it with moral values.”

Sydenham, like Sauvages, is one of the Enlightenment physicians who set about defining “madness” in its various forms. Here, Foucault distinguishes his work from that of modern physicians who have a more scientifically founded understanding of the human body. The pervasiveness of medical theories like that of the “humors,” or that of “spirits in motion,” hampered physicians’ ability to objectively observe patients. In this sense, the theories that Sydenham and others put forward were not medical, but rather new ways of justifying inhumane treatment of the imprisoned “mad.”

“Such an identification gives madness a new content of guilt, of moral sanction, or just punishment which was not at all part of the classical experience. It burdens unreason with all these new values: instead of making blindness the condition of possibility for all the manifestations of madness, it describes blindness, the blindness of madness, as the physiological effect of a moral fault.”

Morality once again appears as a concept central to historical constructions of “madness.” In general, Foucault treats morality culture as a repressive force aimed at generating shame in different subpopulations of the general public, including the “mad.” The goal is to maintain the power imbalance of religious, social, and political institutions over the populace. Deeming someone “mad” instantly invalidated their thoughts or concerns, which is one reason why women were often considered “mad” without any clear cause.

“The technique of cure, down to its physical symbols most highly charged with iconographic intensity…is secretly organized around these two fundamental themes: the subject must be restored to his initial purity, and must be wrested from his pure subjectivity in order to be initiated into the world; the non-being that alienates him from himself must be annihilated, and he must be restored to the plenitude of the exterior world, to the solid truth of being.”

Foucault identifies what he believes to be the structural logic that underpinned 18th-century methods of curing “madness.” These two “fundamental themes,” highlight one of the most puzzling dilemmas of understanding “madness:” there is a recurring question of how much “madness” is an internal phenomenon, and how much it is a phenomenon that affects an individual’s interactions with the outside world. As theories of mental illness gradually became more accepted, “madness” would be recognized as a phenomenon internal to the body. But here, Foucault demonstrates that Enlightenment medicine was aimed at addressing both the internal and external components of “madness.”

“A purely psychological medicine was made possible only when madness was alienated in guilt.”

Another one of Foucault’s major arguments is that modern medicine’s scientific approach to “madness” rests on the foundation of repressive systems like confinement. This advances the discussion of Medical Treatments as Institutional Policing of “Madness.” The cause-and-effect relationship that he asserts here confronts medicine’s self-image as a progressive force that rescued the mentally ill from centuries of inhumane imprisonment.

“People were once afraid, people were still afraid, of being confined; at the end of the 18th century, Sade was still haunted by fear of what he called ‘the black men’ who lay in wait to put him away.”

Foucault uses the Marquis de Sade as representative of the average 18th-century person’s emotional relationship to systems of confinement. Although the author’s sympathetic presentation of Sade may be questionable because of the severity of his sexual crimes (see Key Figures), here Sade’s account does provide insight into the profound fears inherent to living in a world that hunted and imprisoned “madness” on the basis of fluid definitions of what “madness” was.

“It is in the realm of the fantastic and not within the rigor of medical thought that unreason joins illness and draws closer to it. Long before the problem of discovering to what degree the unreasonable is pathological was formulated, there had formed, in the space of confinement and by an alchemy peculiar to it, a mélange combining the dread of unreason and the old specters of disease.”

Leprosy reappears in a personified form, presented by Foucault as a ghost that haunted Western European societies hundreds of years after its disappearance. This personification reflects the actual attitudes of the Enlightenment, which conflated disease with mystical horror, once again calling into question the rationality of the so-called “Age of Reason.”

“Hence an abyss yawns in the middle of confinement; a void which isolates madness, denounces it for being irreducible, unbearable to reason; madness now appears with what distinguishes it from all these confined forms as well. The presence of the mad appears as an injustice; but for others.”

Once again, economic changes result in a new social infrastructure surrounding “madness.” Foucault treats these economic changes, tied to the French Revolution, as background knowledge required to understand his work (much like he treated the economic changes tied to the end of the French Wars of Religion). This approach to certain pieces of historical information reveal the book’s bias towards French readers, who are much more likely to have a thorough understanding of their country’s economic history than international readers.

“So great was the confusion in those years; so difficult was it, at the moment when ‘humanity’ was being re-evaluated, to determine the place madness was to occupy within it; so difficult was it to situate madness in a social sphere that was being restructured.”

The social turmoil generated by the French Revolution was universal, especially in Paris, which is the city Madness focuses most clearly on. Foucault vividly evokes that turmoil here, framing it not just as a government restructuring, but as a total reevaluation of what humanity is. This double-meaning of the Revolution, as both moral and civic, mirrors the double meaning of “madness” itself throughout the Enlightenment.

“Now madness would never—could never—cause fear again; it would be afraid, without recourse or return, thus entirely in the hands of the pedagogy of good sense, of truth, and of morality.”

In Foucault’s understanding, fear was utilized as a currency by asylums to maintain power over inpatients. Whereas the non-”mad” were once afraid of being perceived as “mad” because of its associations with immorality, now inpatients were made to be afraid of this same thing (even though they had already been labeled “mad”). Power dynamics thus made “madness” afraid of itself.

“Madness had escaped from the arbitrary only in order to enter a kind of endless trial for which the asylum furnished simultaneously police, magistrates, and tortures; a trial by which any transgression in life, by virtue proper to life in the asylum, becomes a social crime, observed, condemned, and punished.”

Foucault metaphorically links doctors to various figures previously involved in the policing of madness, such as judges, and the asylum itself to the houses of confinement, another nod to the theme of Medical Treatments as Institutional Policing of “Madness.” As with the prison system, he asserts that asylums were structured around the presumption of moral guilt on the part of the “mad.” By this logic, the birth of asylums was essentially a rebranding of the old repressive systems.

“The physician could exercise his absolute authority in the world of the asylum only insofar as, from the beginning, he was Father and Judge, Family and Law—his medical practice being for a long time no more than a complement to the old rites of Order, Authority, and Punishment.”

One innovation of the reform movement was to introduce a theory of paternalism to the treatment of the “mad.” Hence, the Father appears alongside the Judge as an essential authority figure. Although asylums were characterized by their continuity with old houses of confinement, Tuke’s introduction of family terminology to the system did distinguish the two from one another, if only subtly.