MADNESS
AND CIVILIZATION
A History of Insanity in the Age of Reason
Also by Michel Foucault
The Order of Things: An Archaeology of the Human Sciences English / Russian
The Archaeology of Knowledge (and The Discourse on Language) / Russian
The Birth of the Clinic: An Archaeology of Medical Perception / Russian
I, Pierre Riviere, having slaughtered my mother, my sister, and my brother... .A Case of Parricide in the Nineteenth Century
Discipline and Punish: The Birth of the Prison
The History of Sexuality, Volumes 1, (russ) 2 (russ) and 3 (russ)
Herculine Barbin, Being the Recently Discovered Memoirs of a Nineteenth-Century French Hermaphrodite
Power/Knowledge (russ): Selected Interviews and Other Writings, 1972-1977
The Foucault Reader (edited by Paul Rabinow)
Translated from the French by RICHARD HOWARD
Vintage Books
A DIVISION OF RANDOM HOUSE
New York
MADNESS
AND
CIVILIZATION
A History of Insanity in the Age of Reason
MICHEL FOUCAULT
This translation is of the edition abridged by the author and published in the Plon 10/18 series. However, the author has added some additional material from the original edition, including the chapter "Passion and Delirium."
Library of Congress Cataloging in Publication Data
Foucault, Michel. Madness and civilization.
Translation of Folie et deraison; histoire de la folie.
Includes bibliographical references. 1. Psychiatry—History. 2. Mental illness. I. Title.
Manufactured in the United States of America 13579C8642
INTRODUCTION
michel foucault has achieved something truly creative in this book on the history of madness during the so-called classical age: the end of the sixteenth and the seventeenth and eighteenth centuries. Rather than to review historically the concept of madness, the author has chosen to recreate, mostly from original documents, mental illness, folly, and unreason as they must have existed in their time, place, and proper social perspective. In a sense, he has tried to re-create the negative part of the concept, that which has disappeared under the retroactive influence of present-day ideas and the passage of time. Too many historical books about psychic disorders look at the past in the light of the present; they single out only what has positive and direct relevance to present-day psychiatry. This book belongs to the few which demonstrate how skillful, sensitive scholarship uses history to enrich, deepen, and reveal new avenues for thought and investigation.
No oversimplifications, no black-and-white statements, no sweeping generalizations are ever allowed in this book; folly is brought back to life as a complex social phenomenon, part and parcel of the human condition. Most of the time, for the sake of clarity, we examine madness through one of its facets; as M. Foucault animates one facet of the problem after the other, he always keeps them related to each other. The end of the Middle Ages emphasized the comic, but just as often the tragic aspect of madness, as in Tristan and Iseult, for example. The Renaissance, with
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Erasmus's Praise of Folly, demonstrated how fascinating imagination and some of its vagaries were to the thinkers of that day. The French Revolution, Pinel, and Tuke emphasized political, legal, medical, or religious aspects of madness; and today, our so-called objective medical approach, in spite of the benefits that it has brought to the mentally ill, continues to look at only one side of the picture. Folly is so human that it has common roots with poetry and tragedy; it is revealed as much in the insane asylum as in the writings of a Cervantes or a Shakespeare, or in the deep psychological insights and cries of revolt of a Nietzsche. Correctly or incorrectly, the author feels that Freud's death instinct also stems from the tragic elements which led men of all epochs to worship, laugh at, and dread folly simultaneously. Fascinating as Renaissance men found it— they painted it, praised it, sang about it—it also heralded for them death of the body by picturing death of the mind.
Nothing is more illuminating than to follow with M. Foucault the many threads which are woven in this complex book, whether it speaks of changing symptoms, commitment procedures, or treatment. For example: he sees a definite connection between some of the attitudes toward madness and the disappearance, between 1200 and 1400, of leprosy. In the middle of the twelfth century, France had more than 2,000 leprosariums, and England and Scotland 220 for a population of a million and a half people. As leprosy vanished, in part because of segregation, a void was created and the moral values attached to the leper had to find another scapegoat. Mental illness and unreason attracted that stigma to themselves, but even this was neither complete, simple, nor immediate.
Renaissance men developed a delightful, yet horrible way of dealing with their mad denizens: they were put on a ship and entrusted to mariners because folly, water, and sea, as everyone then "knew," had an affinity for each
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other. Thus, "Ships of Fools" crisscrossed the seas and canals of Europe with their comic and pathetic cargo of souls. Some of them found pleasure and even a cure in the changing surroundings, in the isolation of being cast off, while others withdrew further, became worse, or died alone and away from their families. The cities and villages which had thus rid themselves of their crazed and crazy, could now take pleasure in watching the exciting sideshow when a ship full of foreign lunatics would dock at their harbors. The seventeenth and eighteenth centuries saw much social unrest and economic depression, which they tried to solve by imprisoning the indigents with the criminals and forcing them to work. The demented fitted quite naturally between those two extremes of social maladjustment and iniquity.
A nice and hallowed tradition has labeled Tuke and Pinel as the saviors of the mentally ill, but the truth of the matter is not so simple. Many others had treated them with kindness, pleading that they belonged first and foremost with their families, and for at least two hundred years before the i78os, legislation had been considered or passed to segregate criminals and indigents from fools. But this legislation was prompted, as often as not, by a desire to protect the poor, the criminal, the man imprisoned for debts, and the juvenile delinquent from the frightening bestiality of the madman. As the madman had replaced the leper, the mentally ill person was now a subhuman and beastly scapegoat; hence the need to protect others. While the Quaker Tuke applied his religious principles, first to demented "friends" and later to foes also, partly to convert them, the great Pinel was not sure at times that he was dealing with sick people; he often marveled at their unbelievable endurance of physical hardship, and often cited the ability of schizophrenic women to sleep naked in subfreezing temperatures without suffering any ill effects. Were not these
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people more healthy, more resistant than ordinary human beings? Didn't they have too much animal spirit in them?
Naturally, it is impossible to discuss a book as complex as Madness and Civilization without oversimplifying and doing it an injustice. It is a tale of nuances, relative values, and delicate shadings. Yet, it is an impressive monument: in a dispassionate manner it marshals overwhelming evidence to dispel more effectively than many previous attempts the myth of mental illness, and re-establishes folly and unreason in their rightful place as complex, human—too human—phenomena. The roots and symptoms of folly are being looked for today in psychology, medicine, and sociology, but they were and still are as present and important in art,* religion, ethics,
and epistemology. Madness is really a manifestation of the "soul," a variable concept which from antiquity to the twentieth century covered approximately what came to be known, after Freud, as the unconscious part of the human mind. + Only time will tell how much better students of the psyche can look at the future, after reading this sobering re-creation of yesteryear's madness and the ineffective attempts of humanity to treat it by amputation, projections, prejudices, and segregation.
jose barchilon, M.D.
* My only quarrel with the book is the lack of emphasis on the humoristic elements in psychoses and neuroses: i.e., the patient laughs at himself, or laughs at the world through his illness.
+ The fear and dread of madness is as real a factor in social and medical attitudes or measures as anxiety, symptoms, and resistance in coping with impulses from the individual unconscious; even though the author does not explicitly compare madness with the unconscious, he equates madness and dream activity so that the inference is clear enough.
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PREFACE
pascal: "Men are so necessarily mad, that not to be mad would amount to another form of madness." And Dostoievsky, in his diary of a writer: "It is not by confining one's neighbor that one is convinced of one's own sanity."
We have yet to write the history of that other form of madness, by which men, in an act of sovereign reason, confine their neighbors, and communicate and recognize each other through the merciless language of non-madness; to define the moment of this conspiracy before it was permanently established in the realm of truth, before it was revived by the lyricism of protest. We must try to return, in history, to that zero point in the course of madness at which madness is an undifferentiated experience, a not yet divided experience of division itself. We must describe, from the start of its trajectory, that "other form" which relegates Reason and Madness to one side or the other of its action as things henceforth external, deaf to all exchange, and as though dead to one another.
This is doubtless an uncomfortable region. To explore it we must renounce the convenience of terminal truths, and never let ourselves be guided by what we may know of madness. None of the concepts of psychopathology, even and especially in the implicit process of retrospections, can play an organizing role. What is constitutive is the action that divides madness, and not the science elaborated once this division is made and calm restored. What is originative is the caesura that establishes the distance between reason and non-reason; reason's subjugation of non-reason, wrest-
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ing from it its truth as madness, crime, or disease, derives explicitly from this point. Hence we must speak of that initial dispute without assuming a victory, or the right to a victory; we must speak of those actions re-examined in history, leaving in abeyance all that may figure as a conclusion, as a refuge in truth; we shall have to speak of this act of scission, of this distance set, of this void instituted between reason and what is not reason, without ever relying upon the fulfillment of what it claims to be.
Then, and then only, can we determine the realm in which the man of madness and the man of reason, moving apart, are not yet disjunct; and in an incipient and very crude language, antedating that of science, begin the dialogue of their breach, testifying in a fugitive way that they still speak to each other. Here madness and non-madness, reason and non-reason are inextricably involved: inseparable at the moment when they do not yet exist, and existing for each other, in relation to each other, in the exchange which separates them.
In the serene world of mental illness, modem man no longer communicates with the madman: on one hand, the man of reason delegates the physician to madness, thereby authorizing a relation only through the abstract universality of disease; on the other, the man of madness communicates with society only by the intermediary of an equally abstract reason which is order, physical and moral constraint, the anonymous pressure of the group, the requirements of conformity. As for a common language, there is no such thing; or rather, there is no such thing any longer;
the constitution of madness as a mental illness, at the end of the eighteenth century, affords the evidence of a broken dialogue, posits the separation as already effected, and thrusts into oblivion all those stammered, imperfect words without fixed syntax in which the exchange between madness and reason was made. The language of psychiatry,
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which is a monologue of reason about madness, has been established only on the basis of such a silence.
I have not tried to write the history of that language, but rather the archaeology of that silence.
The Greeks had a relation to something that they called ******;. This relation was not merely one of condemnation; the existence of Thrasymachus or of Collides suffices to prove it, even if their language has reached us already enveloped in the reassuring dialectic of Socrates. But the Greek Logos had no contrary.
European man, since the beginning of the Middle Ages, has had a relation to something he calls, indiscriminately, Madness, Dementia, Insanity. Perhaps it is to this obscure presence that Western reason owes something of its depth, as the ******| of the Socratic reasoners owes something to the threat of ******. In any case, the Reason-Madness nexus constitutes for Western culture one of the dimensions of its originality; it already accompanied that culture long before Hieronymus Bosch, and will follow it long after Nietzsche and Artaud.
What, then, is this confrontation beneath the language of reason? Where can an interrogation lead us which does not follow reason in its horizontal course, but seeks to retrace in time that constant vertically which confronts European culture with what it is not, establishes its range by its own derangement? What realm do we enter which is neither the history of knowledge, nor history itself; which is controlled by neither the teleology of truth nor the rational sequence of causes, since causes have value and meaning only beyond the division? A realm, no doubt, where what is in question is the limits rather than the identity of a culture.
The classical period—from Willis to Pinel, from the frenzies of Racine's Oreste to Sade's Juliette and the Quinta
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del Sordo of Goya—covers precisely that epoch in which the exchange between madness and reason modifies its language, and in a radical manner. In the history of madness, two events indicate this change with a singular clarity: 1657, the creation of the Hopital General and the "great confinement" of the poor; 1794, the liberation of the chained inmates of Bicetre. Between these two unique and symmetrical events, something happens whose ambiguity has left the historians of medicine at a loss: 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. As a matter of fact, beneath these reversible meanings, a structure is forming which does not resolve the ambiguity but determines it. It is this structure which accounts for the transition from the medieval and humanist experience of madness to our own experience, which confines insanity within mental illness. In the Middle Ages and until the Renaissance, man's dispute with madness was a dramatic debate in which he confronted the secret powers of the world; the experience of madness was clouded by images of the Fall and the Will of God, of the Beast and the Metamorphosis, and of all the marvelous secrets of Knowledge. In our era, the experience of madness remains silent in the composure of a knowledge which, knowing too much about madness, forgets it. But from one of these experiences to the other, the shift has been made by a world without images, without positive character, in a kind of silent transparency which reveals— as mute institution, act without commentary, immediate knowledge—a great motionless structure; this structure is one of neither drama nor knowledge; it is the point where history is immobilized in the tragic category which both establishes and impugns it.
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CONTENTS
I
"Stultifera Navis"
3
II
The Great Confinement
/>
38
III
The Insane
65
IV
Passion and Delirium
85
V
Aspects of Madness
117
VI
Doctors and Patients
159
VII
The Great Fear
199
VIII
The New Division
221
IX
The Birth of the Asylum
241
Conclusion
219
Notes
201
MADNESS AND CIVILIZATION
A History of Insanity in the Age of Reason
I "Stultifera Navis"
at the end of the Middle Ages, leprosy disappeared from the Western world. In the margins of the community, at the gates of cities, there stretched wastelands which sickness had ceased to haunt but had left sterile and long uninhabitable. For centuries, these reaches would belong to the non-human. From the fourteenth to the seventeenth century, they would wait, soliciting with strange incantations a new incarnation of disease, another grimace of terror, renewed rites of purification and exclusion.
From the High Middle Ages to the end of the Crusades, leprosariums had multiplied their cities of the damned over the entire face of Europe. According to Mathieu Paris, there were as many as 19,000 of them throughout Christendom. In any case, around 1226, when Louis VIII established the lazar-house law for France, more than 2,000 appeared on the official registers. There were 43 in the
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