Madness and Civilization (1961) is Michel Foucault’s first major work and forms, together with The Birth of the Clinic (1963), his first examination of the way our unconscious a priori linguistic structures order our knowledge of the world – in particular the way how specific syntaxes determine our perception, communication and action regarding life, death, health, disease and madness. While The Birth of the Clinic is a rather straightforward text and can be understood on a first reading, Madness and Civilization is much less accessible as a work. This is because Foucault, in most chapters, uses a highly peculiar literary style that weaves science, art, religion, etc.
together in a narrative that purports to portray the radical change in our perception of madness in the eighteenth century. The work is full of metaphors and illustrations from artworks.
This leaves the reader with a problem of interpretation: since Foucault purports to simply describe (and not explain) phenomena; each description being unconnected (whether causally or chronologically) to others; and each description being heavily entrenched in contemporary political ideology, social structures and a plethora of cultural factors; this all makes it very hard to evaluate Foucault’s descriptions. Add to this the highly selective nature of the work (similar to The Birth of the Clinic), and we have a very difficult book. Difficult in both interpreting, understanding and evaluating.
The parameters of Madness and Civilizations are the late Middle Ages/Renaissance and mid-nineteenth century. Within this historical period, Foucault explores how each time and place differed in respect to how people perceived madness, talked about it, reacted to it, and institutionalized it in social structures. This, according to Foucault, reveals how a major and radical shift happened in the eighteenth century – a shift that is still with us to today.
Without going into all the intricacies and meticulous descriptions of Foucault’s analysis, the central thesis seems to be as follows.
During the late Middle Ages and the Renaissance leprosy formed a principle of exclusion and rituals – sufferers were excluded from society and there was a whole web of rituals woven around them. With the disappearance of leprosy this whole structure broke down. Gradually, madness took over the role as principle of exclusion and ritual. But not in the same way. Depending on the historical period, fools were regarded as either a confrontation with death or a transcendence of death. In other words: the fool was moved by transcendental inspiration – this, of course, often had a highly religious connotation. Fools were visible for society and many a time even regarded with approval – they were the hope of transcendental inspiration for the fallen lot of human beings.
This all started to change in the seventeenth century. Religious wars, famines and economic crises changed the social-economic structures of society. For the first time since the disappearance of leprosy there emerged a new line of demarcation in society: that between those that worked and those that didn’t (for whatever reason). Since poverty was deemed to be the effect of not working, poverty was viewed as a sin, transforming not working into morally reprehensible behaviour. This radicalized into European-wide programmes to lock up beggars, vagabonds, the poor, the sick, the elderly, etc. Of course, the mad were included in this programme.
As an effect, the seventeenth century saw the institutionalization of General Hospitals (France), workhouses (England) and Zuchthäusern (Germany) – all different names for the same concept: a concentration camp for forced labour and moral re-education. Foucault emphasizes the bourgeois social structures underlying this movement. Even though the mad were imprisoned and horribly mistreated, they were not seen as a distinct group of people, demanding a separate approach. All people who couldn’t or wouldn’t work were simply rounded up and put into these camps.
This all changed in the eighteenth century. This was the age of Enlightenment: in the wake of Newton’s mechanics the entire universe, including mankind, had to be understood by reason. This also meant that human behaviour, and thus morality, had to be founded in reason. With reason as the summum bonum of humanity, there inevitably has to open up a schism: there are always people who act unreasonable – if not simply in the eyes of others (those Enlightened minds, for example). This period saw the emergence of Unreason as a concept: while man was a rational animal (echoing Aristotle), sometimes he is unreasonable – and to the extent he is unreasonable, he is inhuman.
Unreason and inhumanity in human beings were perceived with shame by (reasonable) society. The solution to this social problem is confinement: simply remove the unreasonable from society. Lock them up, make them – literally – disappear. Only release them when they have regained their reason. But Unreason is not madness. While unreasonable people were deemed to have lost (a port of) their humanity, there was a logical endpoint to this: the point were a human being has lost all his humanity. This was madness: it was inhumanity at its highest, transforming itself at this point in animality. In other words: the mad have fallen to animal nature, while the unreasonable still have some degree of humanity. Whereas inhumanity provoked shame and thus removal through confinement, animality means all restrictions of confinement can be removed.
The madman wasn’t considered as a sick human but rather as a healthy animal which in its pure state of nature roamed in ultimate freedom. And like wild beasts, the madman was controlled through discipline and brutalization. And like animals, he wasn’t removed from society but exposed to it – people could visit madhouses (after paying, of course) to witness the Fall of Man and to wallow in experiences of superior compassion. In short: during the Enlightenment madness was viewed as the extreme empirical appearance of unreason, or as Foucault writes: “unreason is the canvas on which madness is painted.” Madness only appears on the horizon of Unreason; and while the latter demanded removal through confinement, the former demanded exposure and punishment through confinement.
Of course, this is only one side of the question of madness. Another side is the way madness was viewed as a natural manifestation through the scientific lens. This also changed radically over the period Foucault describes. In general outlines: up to the sixteenth century medicine was based on humours; during the seventeenth century (starting with Descartes) this changed to a mechanical model of animal spirits moving through the material body and interacting with the soul (introducing the notion of causality); and during the eighteenth century this culminated in a medicine of solids and fluids (bodily qualities and their relations). Since passion was viewed as the necessary condition for madness (or even as a radicalization of them), and passions being explained differently on these different medical models, the notion of madness changed as well.
During the Enlightenment, the madman was deemed to be a manifestation of nothingness. That is because madness was deemed to be the affirmation of absurd imaginations – i.e. the dreamer isn’t mad since he doesn’t affirm his absurd imaginations, while the madman does affirm those. With introducing the notion of affirmation, Foucault is able to insert his theory that language serves as an a priori structure of perception and behaviour: affirmation is nothing but an instance of the faculty of judgement, and judging is a deliberate process guided by implicit (linguistic) principles. Language thus serves as an organizing principle of all spiritual and bodily manifestations of madness – as well as dreams, hallucinations, and everyday waking life, etc.
This claim by Foucault is a huge one: it means that madness in a sense is essentially different from a healthy life. Both are superstructures founded on their own implicit discourse. In this sense, madness is ‘reason blinded’ – i.e. the point where untruth and dream touch each other. In another sense, madness is not-reason, non-being – it is a nothingness (e.g. it is always not-truth, not-reality, etc.) Yet, even though madness literally is nothing, it manifests itself as something, i.e. in bodily and mental states that can be observed by outsiders. So we end up, in the Enlightenment, with the strange notion that madness, as nothing, manifests itself as something, meaning it literally is unreason.
According to Foucault, after he ditches all these abstract speculations up from a handful of selective historical sources, there has appeared a major distinction between the tragic man – the rational being doomed to always long for the impossible (i.e. knowing everything) – and the mad man – unreason in the flesh, not simply rejecting the impossible but negating it by its sheer existence. From this moment on, madness has been given a distinct status.
Parallel to this, medical practice developed and started to view diseases – of which madness in all its forms was one part – as spatiotemporal objects, to be observed and studied by doctors. Positivistic medicine became the norm: applying the analytical method to the medical field and viewing the ‘medical gaze’ as the sole entry to scientific knowledge. It is easy to see what this implies for madmen: they have by now become objects of study, to be observed and spoken about, being literally subjected to the medical regime. Confinement has become institutionalized long ago and has, by now, transformed from a regime of sheer discipline and punishment into a medical clinic.
Foucault ends Madness and Civilization with a conclusion, in which he makes some rather vague and ambiguous claims about the relationship between art and madness. From what I understand, modern man views in art madness, while madness can only exist after art has ceased to exist. That is, the artist continuously moves on the frontier between art and madness – art exists insofar madness doesn’t and vice versa. It is senseless to ask when Nietzsche started to turn mad and try to locate this moment in his works – all of Nietzsche’s works spring from his madness in the sense that it hadn’t manifested itself. Foucault seems to imply that madness only exists after the fact – which makes it an ungraspable and fascinating phenomenon. (Correct me if I’m wrong regarding this interpretation!)
To be honest, I find Foucault’s claims rather unbelievable. I simply remain unconvinced after reading through this book. His selectivity when it comes to sources, his loose interpretations and the ambiguous language they are told with, but mostly his hidden agenda. With this last remark I mean his use of the phenomenological method to purely describe phenomena as they appear, yet using these descriptions themselves to implicitly argue for a particular interpretation of events. This is the insurmountable contradiction of postmodernism in a nutshell: if everything is simply an amalgam of interpretations, what criterion do we have to prefer your interpretation above others? Or value your interpretation at all?
To be fair, Foucault was not really a postmodernist, he always rejected the label – although he is used as one of the founding father by many postmodernists. But he stumbles on the same contradiction, and this is due to the similar method of doing philosophy. For Foucault specifically, this comes across as if he is simply amassing a selection of historical facts, offering his own interpretations (although never unfounded!), and in the end supporting and validating his own preconceived theses. Combine this with the peculiar style in which he presents the material – half philosophy, half literature, sprinkled with some sociology – and you’ll end up with a book like Madness and Civilization. Interesting reading, insightful historical analyses and original interpretations, yet as a whole remaining unconvincing to me.