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

Madness and Civilization: A History of Insanity in the Age of Reason is the second monograph by French intellectual historian and philosopher Michel Foucault (1926-1984). Originally published in French in 1961, it follows the development of Western European conceptions of “madness” beginning in the Late Middle Ages and ending in the early 19th century. Foucault argues that following the decline of leprosy in the 15th century, Western European societies demanded that the figure of the leper be replaced with a new form of social outcast, ultimately resulting in the confinement and ostracization of the “mad.” This moment catalyzed a centuries-long process of defining “madness” that would ultimately result in the creation of “insane asylums” in the late 18th century and the invention of psychoanalysis by Sigmund Freud in the late 19th century. The book focuses on Developing Concepts of “Madness” in Early Modern Europe, Shifting Relations Between the “Mad” and the General Population, and Medical Treatments as Institutional Policing of “Madness.”

This guide refers to the 1988 eBook edition of the text, translated by Richard Howard and published by Vintage Books.

Content Warning: This guide and its source text contain discussions of medical abuse, psychiatric illness, ableism, and sexual violence.

Note on Language: Foucault uses the term “madness” as an umbrella term to reflect a historical concept that contemporary thought differentiates into various phenomena, such as psychiatric illnesses, emotional disorders, neurodivergence, and developmental disabilities. When discussing this historical concept, the guide places “mad” and “madness” in quotation marks, or uses the term as part of a larger quote from the source text. Likewise, “leper,” is considered a derogatory term and is either used in quotes or replaced with another phrase to denote someone who has the condition of leprosy, now known as Hansen’s disease.

Summary

Madness and Civilization tracks the evolution of Western European understandings of “madness,” beginning in roughly the 14th century, and ending at the turn of the 19th century. In this span of 500 years, he discerns four distinct periods in the history of “madness”: the Middle Ages, the Renaissance, the Classical Age, and the modern era. Foucault is not interested in what differentiates the eras, but rather how the transitions between these periods corresponded to shifting attitudes towards “madness.”

For the purposes of Foucault’s argument, The Middle Ages serve as the moment prior to the history of madness. Medieval society was preoccupied with ostracizing lepers and therefore there was no social utility in designating some community members as “mad,” and others as “sane.” “lazar houses”—living and treatment centers for those with leprosy— were always located a safe distance from city centers so as to prevent the spread of leprosy, but close enough to remind community members of its existence. Leprosy was bound up with the belief in Christianity’s concept of divine wrath, and the disease was seen as God’s punishment for sinners. When rates of leprosy declined in the 17th century, this social and religious function was left unfulfilled, and society needed to create a new ostracized class.

In the Renaissance, nascent definitions of “madness,” began to emerge, enabling societies to identify and exclude the “mad.” Renaissance artists, authors, and philosophers understood “madness” to conceal a mysterious, cosmic, form of wisdom that revealed the limits between humanity and inhumanity. Contact with the “mad” was therefore a social necessity, since it served to define reason through contrast. Rather than confining the “mad” to isolated buildings, people perceived as “mad” were placed on ships with sailing crews, thereby transplanting them to other communities. The Renaissance motif of the “Ship of Fools” was commonly used in the art and literature as a metaphor for human nature.

At the beginning of the Classical Age, or Enlightenment, Western European societies began to confine their “mad” populations to the same institutions that had once served as lazar houses, as well as some new institutions. One of these new institutions was l’Hôpital Général de Paris, established by royal edict in 1656. Foucault places great importance on the foundation of l’Hôpital Général, treating it as the starting point of the imprisonment and institutionalization that was society’s reflexive response to “madness”. Institutionalization was the “blind repression in an absolutist regime, according to some; but according to others, the gradual discovery by science and philanthropy of madness in its positive truth” (10). The societal impulse to ostracize “madness” by means of captivity, Foucault asserts, corresponds to Enlightenment thought’s disdain for anything deemed irrational. As an intellectual movement, the Enlightenment’s belief in its own ability to vanquish irrationality from society demanded the violent suppression of the “mad,” since they embodied irrationality within the community.

During the Classical Age, religious thought conflated moral error with “madness;” just as it had with leprosy. Conditions that could be explained by socioeconomic circumstances, such as unemployment and engagement in sex work, were instead reduced to signs of a moral weakness that needed to be treated or punished. For this reason, those imprisoned in institutions like l’Hôpital Général were not necessarily mentally ill. Once confined, however, physicians interested in studying the phenomenon of “madness” had access to anyone labeled as such and could therefore begin to study it as a disease with potential cures. Doctors like François Boissier de Sauvages de Lacroix began to develop categories that distinguished between different forms of “madness,” theorized their potential causes, and ascribed different cures to each of them.

As medical science progressed and social mores shifted, the longheld practice of imprisoning and experimenting on the “mad” began to seem archaic. Foucault designates “the invention of the asylum” as the Modern era’s definitive contribution to the history of madness. He distinguishes “asylums” from Enlightenment-era “prisons,” such as l’Hôpital Général, even though many contemporary scholars would also describe both as prisons. Foucault’s definition of “asylum” is dependent upon what he calls the “apotheosis of the medical personage,” that is, the doctor’s newfound position as the figure responsible for treating and controlling “madness.” Before, this had been the role of prison guards and was achieved through violent, rather than psychiatric, means. Reformers, most notably William Tuke and Phillippe Pinel, spearheaded this change and have since been heralded by many as champions of humane mental health treatment. 

The final assertion of Madness, however, is that medical treatment in asylums— despite its relative nonviolence— was intrinsically founded upon the punitive theories of imprisonment that arose during the Enlightenment and simply sought to punish “madness” in new ways.