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

The first three chapters of Madness cover the Middle Ages and the Renaissance, focusing on Developing Concepts of “Madness” in Early Modern Europe. Out of the eras addressed in the book, these are the ones that Foucault was least familiar with as a historian. The body of evidence that he uses to make his arguments in these sections, therefore, is highly conjectural, as he selects data from the records of a smattering of towns and cities across medieval France and England. Historians who specialize in the Middle Ages have put forward arguments that refute Foucault’s. For example, “Martin Schrenk (himself a severe critic of Foucault) has shown, early modern madhouses developed from medieval hospitals and monasteries rather than as reopened leprosaria” (Merquior, 28). The basis of Foucault’s argument, that leprosy simply disappeared at the end of the Middle Ages, is part of what makes it so vulnerable to critique. While it is convenient for the purposes of constructing a neat historical narrative, this generalized claim would later be recognized as one of the book’s biggest weaknesses.

In his analysis of the Renaissance, Foucault makes heavy use of literature as primary source evidence. He treats the story of the “Ship of Fools,” which originated with Plato and was popularized after the publication of German author Sebastian Brant’s moral satire Das Narrenschiff (The Ship of Fools) in 1494 as a reflection of historical fact. “The Narrenschiff is the only [mythical ship] that had a real existence,” he asserts, “for they did exist, these boats that conveyed their insane cargo from town to town” (18). Foucault does not accompany this argument with a citation of any historical source other than the body of allegorical literature that included Das Narrenschiff. In the years following Madness’s publication, historians have searched for evidence that backs this claim, and have come up empty-handed. This use of fiction as evidence of historical events, rather than as a reflection of historical ideas and attitudes, calls into question the validity of his arguments based on literature throughout the rest of the book. It is up to readers to decide for themselves which pieces of Foucault’s literary analysis they find credible.

Upon arriving in the early stages of the Enlightenment, Foucault’s historical narrative becomes much more solidly founded on primary source material. In “The Great Confinement,” one of the key sources he uses is the Edict of 1656, the document that established l’Hôpital Général. The Edict of 1656 explicitly states the French government’s desire to imprison any Parisian who was not contributing to the economy, so Foucault’s argument that confinement had an economic underpinning has immediate credibility. Furthermore, he cites several other primary sources that voice this same sentiment, such as the social critique pamphlet Grievous Groan for the Poor by English playwright Thomas Dekker (1622). Although Foucault continues to write in his characteristic lyrical style in this chapter, his use of primary source material grounds the historical analysis in verifiable facts. Implicitly critiqued in this portrayal of confinement as violent repression are the social and religious institutions of the time—which were the targets of both Brant and Dekker’s writings—as well as political entities (including the French Monarchy and its successor the French Republic) that viewed themselves as moral authorities over the general population.

In these chapters, Foucault lays the groundwork for his demystification of the Enlightenment’s construction of “madness” as a new, coherent concept and Medical Treatments as Institutional Policing of “Madness.” This is another one of his assertions that has come under the scrutiny of scholars. “Long before the Great Confinement,” Merquior writes, “many insane people had been in custody… There were several hospitals with special accommodation for the mentally ill in towns across the Rhine valley… There was a nationwide chain of charitable asylums, specially for the insane, from the fifteenth century, in… Spain” (Merquior, 27). What Foucault views as an invention of the Enlightenment, therefore, is viewed by others simply as the continuation of a gradually developing asylum culture. Foucault hesitates to label any institution prior to the reforms of Tuke and Pinel an asylum, instead opting for the terms “house of confinement,” or “prison.” He makes this distinction the basis of these early institutions’ lacking medical credibility, but this is a subtle distinction that other historians do not emphasize. While Foucault’s ideas throughout these early chapters are certainly debatable, they were conceptually groundbreaking at the time of the book’s publication. Foucault was questioning assumptions, such as the objective existence of mental illness and the ultimate authority of medical practitioners, that had rarely been challenged in Western European culture.