Madness and Civilization: A History of Insanity in the Age of Reason (1961), a philosophy book by French author and philosopher Michel Foucault, examines the history and evolution of madness as defined by Western thought since the Renaissance. Foucault was inspired to write the book by his experience working as a research intern at the psychiatric institute of the Sainte-Anne Hospital in Paris. The first chapter is titled "Stultifera Navis," which in Latin translates to "Ship of Fools," referring to an allegory found in Book IV of Plato's Republic. Foucault embarks on his discussion of madness by describing the end of leprosy at the outset of the Middle Ages. Because leprosy was contagious and without a cure, lepers were herded into quarantined enclosed areas such as islands or sanitariums. However, when leprosy vanished from the world, the systems of isolation and quarantine persisted. Thus, the Ship of Fools, long a literary device, became reality, as lunatics were shuffled off into the sanatoriums or onto islands formerly reserved for lepers. During the fifteenth century, Foucault writes, madness began to take on new connotations in the public imagination. While the reasonable observe and accept the world as it is, the unreasonable or mad observe what exists beyond the limits of "normal" human experience and perception, thus being afforded a kind of secret knowledge. Madmen are also increasingly depicted during this era as exploring the outer limits of human emotion. Foucault cites characters like Shakespeare's Ophelia and King Lear, lost in the madness of desperate passion pushed to its utmost reaches. Madness, as such, became a source of fascination to artists like Shakespeare and Cervantes. With the Age of Reason, however, came a recognition of its opposing force: "unreason." Rather than viewing madness as an extremity existing beyond the bounds of regular human beings, it was seen as the opposite of sanity, with sanity and insanity existing at the ends of two poles on one spectrum. As such, the Western world embarked on what Foucault refers to as "The Great Confinement." To preserve order and reduce chaos, madmen were again isolated from society, to prevent their deviancy from infecting the greater populace like lepers. Madness was essentially criminalized, as the police became enforcers of sanity. Other emergent power structures also came into play. The Industrial Revolution and the rise of an urban labor force gave wealthy industrialists incentive to cordon off their workers and keep them away from the influence of the mad. This confinement directly led to the third, "modern" era of madness, Foucault writes. By isolating madness into specific places, it provided medical doctors with a convenient arena in which to observe madmen. This led to a greater desire to treat the mad and to rehabilitate them so they might re-engage with the rest of society. But while Foucault respects the humanitarian intent of this endeavor, he writes that the treatment of madness as an illness requiring confinement has the same cruel and controlling result as some of the older, less therapeutic forms of confinement. The three eras of madness—the Renaissance, the Classical era, and the modern era—represent the following evolution of insanity: First, madness is thought to exist beyond reason. Next, it is thought to exist in opposition to reason. Finally, there emerges an attempt by reason to reshape madness in reason's image. All of these formulations bring about their own problems, Foucault writes. Foucault concludes by observing the preponderance of madness as a theme in art throughout the nineteenth century. He pays close attention to the painter Francisco Goya, contrasting his famous asylum depiction, The Madhouse, with his Los disparates (The Follies) series. In the former, the madman is cast into prison. In the latter, the madman is cast into darkness. Madness is thus depicted less as state-sanctioned isolation, as determined by levers of power, and more as a plunge into the void, first internalized and then expressed outwardly by the artist. In this way, Foucault writes, the artist that recognizes and depicts madness through art is able to reclaim madness from the psychiatrists who only wish to separate it, study it, and cure it. This isn't to say that madness is a prerequisite for creating great art. Foucault acknowledges that Vincent Van Gogh considered his art and his madness to be at odds with one another. Rather, the new art of madness creates a formulation wherein madness isn't expected to justify itself to reason. On the contrary, reason must now justify itself to madness. While the field of psychiatry and the study of mental illness has changed significantly since the publication of Madness and Civilization, the book's long view of Western attitudes toward madness is likely to prompt contemporary readers to interrogate and possibly re-evaluate their own preconceived notions about the subject.

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