Madness and Civilzation ( A History of Madness)

by Foucault, Michel -

  Orestes, in his frenzy, passes through a triple circle of night: three concentric figurations of dazzlement. Day has just dawned over Pyrrhus's palace; night is still there, edg­ing this light with shadow, and peremptorily indicating its limit. On this morning which is a festival morning, the crime has been committed, and Pyrrhus has closed his eyes on the dawning day: a fragment of shadow cast here on the steps of the altar, on the threshold of brightness and of darkness. The two great cosmic themes of madness are thus present in various forms, as omen, decor, and counterpoint of Orestes' frenzy.19 It can then begin: in a pitiless clarity which denounces the murder of Pyrrhus and the treachery of Hermione, in that dawn where everything finally ex­plodes in a truth so old and at the same rime so young, a

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  first circle of shadow: a dark cloud into which, all around Orestes, the world begins to withdraw; the truth appears in this paradoxical twilight, in this matinal night where the cruelty of truth will be transformed into the fury of hal­lucination:

  Mais quelle epaisse nuit, tout a coup, m'environne?

  (But what thick night suddenly surrounds me?)

  It is the empty night of error; but against the back­ground of this first obscurity, a brilliance, a false light will appear: that of images. The nightmare rises, not in the bright light of morning, but in a somber scintillation: the light of storm and of murder.

  Dieux! quels ruisseaux de sang content autour de moi!

  (O Gods! What streams of blood flow around me!)

  And then appears the dynasty of the dream. In this night the hallucinations are set free; the Erinnyes appear and take over. What makes them precarious also makes them sov­ereign; they triumph easily in the solitude where they suc­ceed one another; nothing challenges them; images and lan­guage intersect, in apostrophes which are invocations, presences affirmed and repulsed, solicited and feared. But all these images converge toward night, toward a second night which is that of punishment, of eternal vengeance, of death within death. The Erinnyes are recalled to that dark­ness which is their own—their birthplace and their truth, i.e., their own nothingness.

  Venez-vous m'enlever dans Fetemelle nuit?

  (Do you come to bear me off into eternal night?)

  This is the moment when it is revealed that the images of madness are only dream and error, and if the sufferer who is blinded by them appeals to them, it is only to disappear with them in the annihilation to which they are fated.

  A second time, then, we pass through a circle of night. But we are not thereby restored to the daylight reality of

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  the world. We accede, beyond what is manifested in mad­ness, to delirium, to that essential and constitutive structure which had secretly sustained madness from the first. This delirium has a name, Hermione; Hermione who no longer reappears as a hallucinatory vision, but as the ultimate truth of madness. It is significant that Hermione intervenes at this very moment of the frenzy: not among the Eumenides, nor ahead of them—to guide them; but behind and separated from them by the night into which they have dragged Orestes and in which they themselves are now scattered. Hermione intervenes as a figure of delirium, /as the truth which secretly reigned from the start, and of which the Eumenides were ultimately only the servants. Here we are at the opposite of Greek tragedy, where the Erinnyes were the final destiny and truth which, in the night of time, had awaited the hero; his passion was merely their instru­ment. Here the Eumenides are merely figures in the service of delirium, the primary and ultimate truth, which was al­ready appearing in passion, and now declares itself in its nakedness. This truth rules alone, thrusting images away:

  Mais non, retirez-vous, laissez faire Hermione.

  (But no, begone, let Hermione do her work.)

  Hermione, who has always been present from the begin­ning, Hermione who has always lacerated Orestes, destroy­ing his reason bit by bit, Hermione for whom he has become "parricide, assassin, sacrilege," reveals herself fi­nally as the truth and culmination of his madness. And delirium, in its rigor, no longer has anything to say except to articulate as imminent decision a truth long since com­monplace and laughable:

  Et je lui porte enfin mon coeur a devorer.

  (And I bring her at last my heart to devour.)

  Days and years ago Orestes had offered up this savage sacrifice. But now he expresses this principle of his madness

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  as an end. For madness cannot go any farther. Having ut­tered its truth in its essential delirium, it can do no more than collapse in a third night, that night from which there is no return, the night of an incessant devouring. Unreason can appear only for a moment, the instant when language enters silence, when delirium itself is stilled, when the heart is at last devoured.

  In the tragedies of the early seventeenth century, mad­ness, too, released drama; but it did so by liberating truth; madness still had access to language, to a renewed language of explanation and of reality reconquered. It could be at most only the penultimate moment of the tragedy. Not the last, as in Andromaque, in which no truth is uttered except the truth, in delirium, of a passion which has found with madness the perfection of its fulfillment.

  The movement proper to unreason, which classical learn­ing followed and pursued, had already accomplished the whole of its trajectory in the concision of tragic language. After which, silence could reign, and madness disappear in the—always withdrawn—presence of unreason.

  What we now know of unreason affords us a better un­derstanding of what confinement was.

  This gesture, which banished madness to a neutral and uniform world of exclusion, did not mark a halt in the evolution of medical techniques, nor in the progress of humanitarian ideas. It assumed its precise meaning in this fact: that madness in the classical period ceased to be the sign of another world, and that it became the paradoxical manifestation of non-being. Ultimately, confinement did seek to suppress madness, to eliminate from the social order a figure which did not find its place within it; the essence of confinement was not the exorcism of a danger. Confine­ment merely manifested what madness, in its essence, was:

  a manifestation of non-being; and by providing this man-

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  ifestation, confinement thereby suppressed it, since it re­stored it to its truth as nothingness. Confinement is the practice which corresponds most exactly to madness ex­perienced as unreason, that is, as the empty negativity of reason; by confinement, madness is acknowledged to be nothing. That is, on one hand madness is immediately per­ceived as difference: whence the forms of spontaneous and collective judgment sought, not from physicians, but from men of good sense, to determine the confinement of a mad­man; and on the other hand, confinement cannot have any other goal than a correction (that is, the suppression of the difference, or the fulfillment of this nothingness in death);

  whence those options for death so often to be found in the registers of confinement, written by the attendants, and which are not the sign of confinement's savagery, its in­humanity or perversion, but the strict expression of its meaning: an operation to annihilate nothingness.20 Con­finement sketches, on the surface of phenomena and in a hasty moral synthesis, the secret and distinct structure of madness.

  Then did confinement establish its practices in this profound intuition? Was it because madness under the effect of confinement had really vanished from the classical horizon that it was ultimately stigmatized as non-being? Questions whose answers refer to each other in a perfect circularity. It is futile, no doubt, to lose oneself in the end­less cycle of these forms of interrogation. Better to let clas­sical culture formulate, in its general structure, the experi­ence it had of madness, an experience which crops up with the same meanings, in the identical order of its inner logic, in both the order of speculation and the order of institu­tions, in both discourse and decree, in both word and watchword—wherever, in fact, a signifying element can assume for us the value of a language.

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  ASPECTS OF MADNESS

  in this chapter we do not wish to write a history of the different notions of psychiatry in the seventeenth and eigh­teenth centuries, but rather to show the specific faces by which madness was recognized in classical thought. Faces still haunted by mythical figures, but which have often been essential in the organization of our practical knowl­edge.

  I. Mania, and Melancholia

  The notion of melancholia was fixed, in the sixteenth cen­tury, between a certain definition by symptoms and an explanatory principle concealed in the very term that des­ignated it. Among the symptoms, we find all the delirious ideas an individual can form about himself: "Some think themselves to be beasts, whose voice and actions they imi­tate. Some think that they are vessels of glass, and for this reason recoil from passers-by, lest they break; others fear

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  death, which they yet cause most often to themselves. Still others imagine that they are guilty of some crime, so that they tremble with terror when they see another coming toward them, thinking he seeks to take them prisoner and sentence them to death."1 Delirious themes that remain iso­lated and do not compromise reason's totality. Thomas Sydenham would even observe that melancholics "are people who, apart from their complaint, are prudent and sensible, and who have an extraordinary penetration and sagacity. Thus Aristotle rightly observed that melancholics have more intelligence than other men."

  Now this clear and coherent syndrome was designated by a word that implied an entire causal system, that of melancholia: "I beg you to regard closely the thoughts of melancholics, their words, visions, actions, and you will dis­cover how all their senses are depraved by a melancholic humor spread through their brain."2 Partial delirium and the action of black bile were juxtaposed in the notion of melancholia, unrelated for the moment beyond a disjunct confrontation of a group of signs by a signifying name. Yet in the eighteenth century a unity would be found, or rather an exchange would be made—the nature of that cold, black humor having become the major coloration of delirium, its positive value in contrast to mania, dementia, and frenzy, its essential principle of cohesion. And while Hermann Boerhaave still defined melancholia as merely "a long, per­sistent delirium without fever, during which the sufferer is obsessed by only one thought," Dufour, several years later, shifted the weight of his definition to "fear and sadness," which were now supposed to explain the partial character of the delirium: "Hence it is that melancholies love solitude and shun company; this makes them more attached to the object of their delirium or to their dominant passion, what­ever it may be, while they seem indifferent to anything else." The concept is fixed not by a new rigor in observa-

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  tion, nor by a discovery in the realm of causes, but by a qualitative transmission proceeding from a cause implied in the designation to a significant perception in the effects.

  For a long time—until the beginning of the seventeenth century—the discussion of melancholia remained fixed within the tradition of the four humors and their essential qualities: stable qualities actually inherent in a substance, which alone could be considered as their cause. For Jean Fernel, the melancholic humor, related to earth and to au­tumn, is a juice "thick in consistency, cold and dry in tem­perament." But in the first half of the century, a debate began over the origin of melancholia: must one necessarily have a melancholic temperament to be afflicted with melan­cholia? Is the melancholic humor always cold and dry—is it never warm, or humid? Is it the substance which acts, or the qualities which are transmitted? The results of this long debate may be summarized as follows:

  1. The causality of substances is increasingly replaced by a movement of qualities, which, without any vehicular means, are immediately transmitted from body to soul, from humor to ideas, from organs to conduct. Thus, for Duncan's Apologist the best proof that the melancholic juice produces melancholia is that in it one finds the very qualities of the disease: "The melancholic juice possesses to a far greater degree the conditions necessary to produce melancholia than your fiery angers; since by its coldness, it diminishes the quantity of spirits; by its dryness, it renders them capable of preserving for a long time the type of a strong and persistent imagination; and by its blackness, it deprives them of their natural clarity and subtlety."3

  2. There is, besides this mechanics of qualities, a dynam­ics that analyzes the strength to be found imprisoned in each. Thus cold and dryness can enter into conflict with the temperament, and this opposition will generate symp­toms of melancholia violent in proportion to the struggle:

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  the strength that prevails and sweeps away all that resists it. Thus women, whose nature is little inclined to melancholy, fall a prey to it all the more seriously: "They are cruelly used and violently disturbed by it, for melancholia being more opposed to their temperament, it removes them fur­ther from their natural constitution."4

  3. But it is sometimes within the quality itself that the conflict is generated. A quality may alter in the course of its development and become the opposite of what it was. Thus when "the entrails are heated, when all simmers within the body . . . and all the juices are consumed," then this conflagration can turn to cold melancholia—pro­ducing "almost the same thing caused by the flow of wax in a torch turned upside down. . . . This cooling of the body is the ordinary effect which follows immoderate heat once it has thrown off and exhausted its vigor."5 There is a kind of dialectic of qualities which, free from any con­straint of substance, from any predeterminadon, makes its way through reversals and contradictions.

  4. Finally, qualities may be altered by accidents, circum­stances, the conditions of life; so that a being who is dry and cold can become warm and humid, if his way of life inclines him to it; as in the case of women: they "remain in idleness, their bodies tend to perspire less [than those of men], and heat, spirits, and humors remain within."6

  Thus freed from a confining substantial basis, qualities would be able to play an organizing and integrating role in the notion of melancholia. On the one hand, they would trace, among the symptoms and manifestations, a certain profile of sadness, of blackness, of slowness, of immobility. On the other, they would suggest a causal basis which would no longer be the physiology of a humor, but the pathology of an idea, of a fear, of a terror. The morbid entity was not defined from observed signs nor from sup­posed causes; but somewhere between, and beyond both, it

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  was perceived as a certain qualitative coherence, which had its own laws of transmission, of development, and of trans­formation. It is the secret logic of this quality that controls the development of the idea of melancholia, not medical theory. This is evident as early as Thomas Willis's texts.

  At first glance, the coherence of their analyses is vouched for on the level of speculative reflection. Willis's explanation is borrowed whole from animal spirits and their mechanical properties. Melancholia is "a madness without fever or frenzy, accompanied by fear and sadness." To the extent that it is delirium—that is, an essential break with truth—its origin resides in a disordered movement of the spirits and in a defective state of the brain; but can that fear, that anxiety which makes melancholics "sad and punc­tilious," be explained by movements alone? Might there be a mechanism of fear and a circulation of spirits that is pecu­liar to sadness? This is obvious to Descartes; it is no longer so for Willis. Melancholia cannot be treated like a paralysis, an apoplexy, a vertigo, or a convulsion. In fact, it cannot even be analyzed as a simple dementia, although melan­cholic delirium supposes a similar disorder in the movement of spirits; disturbances in the mechanism easily explain de­lirium—that error common to all madness, dementia or melancholia—but not the quality peculiar to delirium, the coloration of sadness and fear which makes its landscape so unique. One must penetrate the secret of predispositions. After all, it is these essential qualities, hidden in the very grain of the subtle matter, that explain the paradoxical movements of the spirits.

 
In melancholia, the spirits are swept by an agitation, but a feeble agitation, without power or violence: a sort of impotent jostling which does not follow marked paths, nor open roads (aperta opercula), but traverses the cerebral matter by endlessly creating new pores; yet the spirits do not wander far upon the paths they trace; very soon their

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  agitation languishes, their strength fails, and the movement stops: "they do not reach far."7 Thus such disturbance, common to all delirium, can produce on the surface of the body neither those violent movements nor those cries that may be observed in mania and frenzy; melancholia never reaches violence; it is madness at the limits of its powerless-ness. This paradox is the result of the secret alterations of the spirits. Usually they have the quasi-immediate rapidity and the absolute transparence of luminous rays; but in mel­ancholia, they are charged with darkness; they become "obscure, opaque, shadowy"; and the images of things which they bear to the brain and to the mind are veiled with "shadow and with shades." They become heavy and closer to a dark chemical vapor than to pure light. A chem­ical vapor that would be of an acid nature, rather than sulfurous or alcoholic: for in acid vapors the particles are mobile, and even incapable of rest, but their activity is weak, without effect; when they are distilled, nothing re­mains in the alembic but an insipid phlegm. Do not acid vapors have the very properties of melancholia, whereas alcoholic vapors, always ready to burst into flame, suggest frenzy; and sulfurous vapors, agitated by a violent and con­tinuous movement, indicate mania? If, then, one were to seek "the formal reason and the causes" of melancholia, one would consider the vapors that rise from the blood to the brain and that have degenerated into an acid and corrosive vapor. In appearance, it is a melancholia of the spirits, a chemistry of the humors that oriented Willis's analysis; but in fact, the principal clue is afforded by the immediate qual­ities of melancholic suffering: an impotent disorder, and then that shadow over the mind, along with that acid bit­terness which corrodes thought and feeling alike. The chemistry of acids is not the explanation of the symptoms;