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

Foucault defines “delirium” as the moment when an individual confuses their imagination with reality, clarifying that imagination on its own is not a form of “madness.” Delirium reveals that “madness” operates within the world of reason, since delirious individuals will often draw entirely logical conclusions from their delusions. Foucault presents the example of a man who believed he was made of glass, who therefore “concludes that he [was] fragile,” and should avoid movement and hard objects (102). 

Foucault identifies two forms of delirium in Enlightenment thought: the first is a symptom of several forms of “madness,” but the second is a broader delirious system of thought (Foucault uses the word “discourse”) that is present in everybody. This second form of delirium manifests in quirks of human behavior, which aren’t dangerous but are not rational either.

“Lazar” is an antiquated term for a person with leprosy, which comes from the biblical figure of Lazarus, a man with leprosy whom Jesus cured. As such, a “lazar house” is an institution dedicated to the confinement and/or treatment of people with leprosy. In contemporary English, such institutions are frequently referred to as “leper colonies.” Howard’s translation, however, uses either “lazar house” or “leprosarium” because many French leper colonies were named Saint Lazare, after Lazarus, who became the patron saint of lepers. Foucault characterizes lazar houses as precursors to the medical prisons and asylums that would eventually be used to house the “mad,” citing the fact that many such prisons were established on sites that had once been lazar houses.

The shifting definition of “madness” over the course of centuries is the subject of the entire text. It does not, therefore, have a single succinct definition in this context. Rather, “madness” has several definitions, as articulated by Foucault, corresponding to different moments in history. In the Middle Ages, there is no coherent definition of “madness.” During the Renaissance, “madness” becomes reason’s negative space, defining humanity by embodying all that is inhuman, including death itself. After the Enlightenment, “madness” was understood as proximal to moral failure as a sort of irrational animality. Finally, in the Modern era, medical developments successfully pathologized “madness,” bringing it closer to twenty-first century concepts of mental illness, while simultaneously retaining a moralist explanation for why such pathologies existed.

Following the theories of René Descartes, Foucault defines “passions” as places where the body and soul intersect. This was a commonly accepted definition during the Enlightenment and influenced medical theories of what caused “madness.” For example, Sauvages theorized that fear (one such “passion”) could generate inordinate tension within the body’s fibers that would lead to “madness” if left untreated. The murky entanglements of the mind-body complex, and the perplexing correspondence between one’s emotional state and physical state, could be explained in this way, with the passions as a bridge between the two. Other phenomena understood to be passions included anger and sadness. As time progresses, Foucault perceives a crucial shift in how Passion was understood to be related to “madness:” rather than being a potential cause of “madness,” it becomes a nascent “madness” in and of itself. As physicians increasingly observed that patients diagnosed as “mad” displayed both physical and spiritual symptoms, passion and “madness” grew increasingly proximal to one another.

Positivism is a school of philosophy that asserts that all knowledge must be either tautological (something that is true by its own definition), or positive (derived from logical observation of the natural world). Foucault critiqued positivism throughout his career and was especially skeptical of its acceptance of tautology, arguing that what positivists claimed to be neutral knowledge was, in fact, a byproduct of historical power dynamics. In Madness, however, Foucault uses the term “positive” throughout to describe knowledge based upon the logical observation of other things. He does not always personally agree with whatever logic he is describing, but uses the basic concepts of positivism to explain how cultural ideas have formed at various points in time.