Madness and Civilzation ( A History of Madness)

by Foucault, Michel -

  But sometimes, there is even no need of this "distancing." It is within the quasi-perceprion of the delirium that there is established, by means of a ruse, a perceptual element, silent at first, but whose gradual affirmation will come to contest the entire system. It is in himself and in the percep­tion which confirms his delirium that the sufferer perceives the liberating reality. Trallion reports how a physician dis­sipated the delirium of a melancholic who imagined he had no head, but only a kind of void in its place; the physician, entering into the delirium, agreed at the sufferer's request to fill up this space, and placed upon his head a great ball of lead. Soon the discomfort that resulted from the painful weight convinced the invalid that he had a head. Ulti­mately the ruse and its function of comic reduction can be assured, with the complicity of the physician but without any other direct intervention on his part, by the spontane­ous reaction of the sufferer's organism. In the case cited above of the melancholic who was really dying because he would not eat, believing himself already dead, the theatrical representation of a dead men's banquet incited him to eat;

  this nourishment restored him, "the consumption of food ' made him quieter," and the organic disorder thus disappear­ing, the delirium which was indissociably cause and effect disappeared forthwith. Thus the real death that would have resulted from the imaginary death was avoided by reality, by the mere representation of unreal death. The exchange

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  of non-being with itself is carried out in this ingenious play: the non-being of delirium is turned against the being of the illness, and suppresses it by the simple fact that it is driven out of the delirium by dramatic representation. The fulfillment of delirium's non-being in being is able to sup­press it as non-being itself; and this by the pure mechanism of its internal contradiction—a mechanism that is both a play on words and a play of illusion, games of language and of the image; the delirium, in effect, is suppressed as non-being since it becomes a perceived form of being; but since the being of delirium is entirely in its non-being, it is sup­pressed as delirium. And its confirmation in theatrical fan­tasy restores it to a truth which, by holding it captive in reality, drives it out of reality itself, and makes it disappear in the non-delirious discourse of reason.

  3. The Return to the Immediate. Since madness is illu­sion, the cure of madness, if it is true that such a cure can be effected by theater, can also and still more directly be effected by the suppression of theater. To entrust madness and its empty world directly to the plenitude of a nature which does not deceive because its immediacy does not ac­knowledge non-being, is to deliver madness both to its own truth (since madness, as a disease, is after all only a natural being), and to its closest contradiction (since delirium, as appearance without content, is the very contrary of the often secret and invisible wealth of nature). This contra­diction thus appears as the reason of unreason, in a double sense: it withholds unreason's causes, and at the same time conceals the principle of its suppression. It must be noted, however, that these themes are not contemporary with the classical period for its entire duration. Although they are organized around the same experience of unreason, they follow after the themes of theatrical representation; and their appearance marks the moment when the debate on being and illusion begins to yield to a problematics of na-

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  ture. Games of theatrical illusion lose their meaning, and the artificial techniques of iconographic representation arc replaced by the simple and confident act of a natural re­duction. And this in an ambiguous direction, since it is as much a question of reduction by nature as of a reduction to nature.

  The return to the immediate is the therapeutics par ex­cellence, because it is the rigorous refusal of therapeutics: it cures insofar as it is a disregard of all cures. It is in man's passivity with regard to himself, in the silence he imposes on his art and his artifices, that nature engages in an activity which is exactly reciprocal to renunciation. For, to con­sider it more closely, this passivity of man is real activity;

  when man entrusts himself to medicine, he escapes the law of labor that nature itself imposes on him; he sinks into the world of artifice, and of anti-nature, of which his madness is only one of the manifestations; it is by ignoring this dis­ease and resuming his place in the activity of natural beings that man in an apparent passivity (which is in fact only an industrious fidelity) succeeds in being cured. Thus Bernadin de Saint-Pierre explains how he cured himself of a "strange disease," in which, "like Oedipus, he saw two suns." Medicine had offered him its succor, and had in­formed him that "the seat of his disease was in the nerves." In vain he applied the most highly prized medicaments; he soon noticed that the physicians themselves were killed by their own remedies: "It was to Jean-Jacques Rousseau that I owed my return to health. I had read, in his immortal writings, among other natural truths, that man is made to work, not to meditate. Until that time I had exercised my soul and rested my body; I changed my ways; I exercised my body and rested my soul. I gave up most books; I turned my eyes to the works of nature, which addressed all my senses in a language that neither time nor nations can corrupt. My history and my newspapers were the plants of

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  the field and forest; it was not my thoughts that struggled to them, as in the system of men, but their thoughts that came to me in a thousand agreeable shapes."20

  Despite the formulations of it which certain disciples of Rousseau managed to propose, this return to the immediate was neither absolute nor simple. For madness, even if it is provoked or sustained by what is most artificial in society, appears, in its violent forms, as the savage expression of the most primitive human desires. Madness in the classical pe­riod, as we have seen, is rooted in the threats of bestiality— a bestiality completely dominated by predatory and mur­derous instincts. To entrust madness to nature would be, by an uncontrolled reversal, to abandon it to that fury of anti-nature. The cure of madness thus supposes a return to what is immediate, not in relation to desire, but in relation to the imagination—a return that dismisses from man's life and pleasures everything that is artificial, unreal, imaginary. The therapeutics, by the reflective plunge into the immedi­ate, secretly supposes the mediation of a wisdom which distinguishes, in nature, between what derives from vio­lence and what derives from truth. This is the whole differ­ence between the Savage and the Laborer. "Savages ... lead the life of a carnivorous animal rather than that of a reasonable being"; the life of the Laborer, on the other hand, "is in fact happier than that of the man of the world." On the savage's side, immediate desire, without discipline, without constraint, without real morality; on the laborer's side, pleasure without mediation, in other words, without vain stimulus, without provocation or imaginary achievement. What, in nature and its immediate virtues, cures madness is pleasure—but a pleasure that on one hand makes desire vain without even having to repress it, since it offers a plenitude of satisfaction in advance, and on the other makes imagination absurd, since it spontaneously contributes the happy presence of reality. "Pleasures enter

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  into the eternal order of things; they exist invariably; cer­tain conditions are necessary to form them . . . ; these conditions are not arbitrary; nature has formed them; imag­ination cannot create, and the man most devoted to plea­sures can increase them only by renouncing all those which do not bear this stamp of nature."21 The immediate world of the laborer is thus a world suffused with wisdom and measure, which cures madness insofar as it renders desire useless, along with the movements of passion desire gives rise to, and also insofar as it reduces along with the imagi­nary all the possibilities of delirium. What Tissot under­stands by "pleasure" is this immediate curative agent, liber­ated from both passion and language: that is, from the two great forms of human experience that give birth to un­reason.

  And perhaps nature, as the concrete form of the immedi­ate, has an even more fundamental power in the suppression of madness. For it has the power of freeing man from his freedom. In
nature—that nature, at least, which is measured by the double exclusion of the violence of desire and the unreality of hallucination—man is doubtless liberated from social constraints (those which force him "to calculate and draw up the balance sheet of his imaginary pleasures which bear that name but are none") and from the uncontrollable movement of the passions. But by that very fact, he is gently and as it were internally bound by a system of natu­ral obligations. The pressures of the healthiest needs, the rhythm of the days and the seasons, the calm necessity to feed and shelter oneself, constrain the disorder of madmen to a regular observance. The excessively remote inventions of the imagination are dismissed, along with the excessively urgent disguises of desire. In the gentleness of a pleasure that does not constrain, man is linked to the wisdom of nature, and this fidelity in the form of freedom dissipates the unreason which juxtaposes in its paradox the extreme

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  determinism of passion and the extreme fantasy of the image. Thus one begins to dream, in these mingled land­scapes of ethics and medicine, of a liberation from madness:

  a liberation that must not be understood in its origin as the discovery, by philanthropy, of the humanity of madmen, but as a desire to open madness to the gentle constraints of nature.

  The old village of Gheel which, from the end of the Middle Ages, still bore witness to the now forgotten rela­tion between the confinement of madmen and the exclusion of lepers, also received in the last years of the eighteenth century a sudden reinterpretation. What had once marked, here, the entire violent, pathetic separation of the world of madmen from the world of men, now conveyed the idyllic values of a rediscovered unity of unreason and nature. This village had once signified that madmen were confined, and that therefore the man of reason was protected from them; now it manifested that the madman was liberated, and that, in this liberty which put him on a level with the laws of nature, he was reconciled with the man of reason. At Gheel, according to Jouy's description of it, "four-fifths of the inhabitants are mad, but mad in the full sense of the word, and they enjoy without restraint the same freedom as the other citizens.... Healthful food, pure air, all the de­vices of liberty: such is the regimen prescribed for them, and to which the greatest number, by the end of a year, owe their cure." Without anything in the institutions hav­ing as yet really changed, the meaning of exclusion and of confinement begins to alter: it slowly assumes positive val­ues, and the neutral, empty, nocturnal space in which un­reason was formerly restored to its nothingness begins to be peopled by a nature to which madness, liberated, is obliged to submit. Confinement, as the separation of reason from unreason, is not suppressed; but at the very heart of its intention, the space it occupies reveals natural powers,

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  more constraining for madness, more likely to subjugate it in its essence, than the whole of the old limiting and re­pressive system. Madness must be liberated from that sys­tem so that, in the space of confinement, now endowed with a positive efficacity, it will be free to slough off its savage freedom, and to welcome the demands of nature that are for it both truth and law. Insofar as it is law, nature constrains the violence of desire; insofar as it is truth, it reduces anti-nature, and all the hallucinations of the imag­inary.

  Here is how Pinel describes that nature, speaking of the hospital of Saragossa: there has been established here "a sort of counterpoise to the mind's extravagances by the attraction and the charm inspired by the cultivation of the fields, by the natural instinct that leads man to sow the earth and thus to satisfy his needs by the fruit of his labors. From morning on, you can see them . . . leaving gaily for the various parts of a vast enclosure that belongs to the hospital, sharing with a sort of emulation the tasks appro­priate to the seasons, cultivating wheat, vegetables, con­cerned in turn with the harvest, with trellises, with the vintage, with olive picking, and finding in the evening, in their solitary asylum, calm and quiet sleep. The most con­stant experience has indicated, in this hospital, that this is the surest and most efficacious way to restore man to rea­son."22 Beneath the conventional images, the rigor of a meaning is easily perceived. The return to the immediate is effective against unreason only insofar as the immediate is controlled—and divided against itself; an immediate in which violence is isolated from truth, savagery separated from liberty, in which nature can no longer recognize itself in the fantastic figures of anti-nature. In short, an immedi­ate in which nature is mediatized by morality. In a space so arranged, madness will never again be able to speak the language of unreason, with all that in it transcends the

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  natural phenomena of disease. It will be entirely enclosed in a pathology. A transformation which later periods have received as a positive acquisition, the accession, if not of a truth, at least of what would make the recognition of truth possible; but which in the eyes of history must appear as what it was: that is, the reduction of the classical experi­ence of unreason to a strictly moral perception of madness, which would secretly serve as a nucleus for all the concepts that the nineteenth century would subsequently vindicate as scientific, positive, and experimental.

  This metamorphosis, which occurred in the second half of the eighteenth century, was initiated in the techniques of cure. But it very quickly appeared more generally, winning over the minds of reformers, guiding the great reorganiza­tion of the experience of madness in the last years of the century. Very soon Pinel could write: "How necessary it is, in order to forestall hypochondria, melancholia, or ma­nia, to follow the immutable laws of morality!"

  In the classical period, it is futile to try to distinguish physical therapeutics from psychological medications, for the simple reason that psychology did not exist. When the consumption of bitters was prescribed, for example, it was not a question of physical treatment, since it was the soul as well as the body that was to be scoured; when the simple life of a laborer was prescribed for a melancholic, when the comedy of his delirium was acted out before him, this was not a psychological intervention, since the movement of the spirits in the nerves, the density of the humors were principally involved. But in the first case, we are dealing with an art of the transformation of qualities, a technique in which the essence of madness is taken as nature, and as disease; in the second, we are dealing with an art of dis­course, and of the restitution of truth, in which madness is significant as unreason.

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  When, in the years that followed, this great experience of unreason, whose unity is characteristic of the classical period, was dissociated, when madness, entirely confined within a moral intuition, was nothing more than disease, then the distinction we have just established assumed an­other meaning; what had belonged to disease pertained to the organic, and what had belonged to unreason, to the transcendence of its discourse, was relegated to the psycho­logical. And it is precisely here that psychology was born —not as the truth of madness, but as a sign, that madness was now detached from its truth which was unreason and that it was henceforth nothing but a phenomenon adrift, insignificant upon the undefined surface of nature. An enigma without any truth except that which could reduce it.

  This is why we must do justice to Freud. Between Freud's Five Case Histories and Janet's scrupulous investi­gations of Psychological Healing, there is more than the density of a discovery; there is the sovereign violence of a return. Janet enumerated the elements of a division, drew up his inventory, annexed here and there, perhaps con­quered. Freud went back to madness at the level of its language, reconstituted one of the essential elements of an experience reduced to silence by positivism; he did not make a major addition to the list of psychological treat­ments for madness; he restored, in medical thought, the possibility of a dialogue with unreason. Let us not be sur­prised that the most "psychological" of medications has so quickly encountered its converse and its organic confirma­tions. It is not psychology that is involved in psychoanalysis: but precisely an experience of unreason that it has been psychology's meaning, in the mode
m world, to mask.

  VII

  THE GREAT FEAR

  "one afternoon, I was there, looking a great deal, speaking rarely, listening as little as I could, when I was accosted by one of the most bizarre persons in this country, where God has not let them lack. He was a mixture of loftiness, base­ness, good sense, and unreason."

  In doubt's confrontation with its major dangers, Des­cartes realized that he could not be mad—though he was to acknowledge for a long time to come that all the powers of unreason kept vigil around his thought; but as a philoso­pher, resolutely undertaking to doubt, he could not be "one of these insane ones." Rameau's Nephew, though, knew quite well—and among his fleeting certainties, this was the most obstinate—that he was mad. "Before begin­ning, he heaved a profound sigh and raised his hands to his forehead; then he regained his calm demeanor and said to me: you know I am ignorant, mad, impertinent, and lazy."1

  The eighteenth century could not exactly understand the meaning expressed in Le Neveu de Rameau. Yet some-

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  thing had happened, just when the text was written, which promised a decisive change. A curious thing: the unreason that had been relegated to the distance of confinement re­appeared, fraught with new dangers and as if endowed with a new power of interrogation. Yet what the eigh­teenth century first noticed about it was not the secret interrogation, but only the social effects: the torn clothing, the arrogance in rags, the tolerated insolence whose dis­turbing powers were silenced by an amused indulgence. The eighteenth century might not have recognized itself in Rameau's Nephew, but it was entirely present in the I who served him as interlocutor and as a type of "exhibitor," amused yet reticent, and with a secret anxiety: for this was the first time since the Great Confinement that the madman had become a social individual; it was the first time that anyone had entered into conversation with him, and that, once again, he was questioned. Unreason reappeared as a classification, which is not much; but it nonetheless reap­peared, and slowly recovered its place in the familiarity of the social landscape. It was there some ten years before the Revolution, when Mercier found it without more astonish­ment than: "Go into another cafe; a man whispers to you in a calm and confident tone: 'You cannot imagine, Monsieur, the Government's ingratitude toward me, and its blindness to its own interests! For thirty years I have neglected my own affairs; I have shut myself up in my study, meditating, dreaming, calculating; I have devised a project to pay all the State's debts; another to enrich the King and assure him an income of 400 million; another to destroy England for­ever, whose very name affronts me. . . . When, utterly devoted to these vast operations that demand all the appli­cation of genius, I was distracted by domestic problems, some nagging creditors kept me in prison for three years. . . . But, Monsieur, you see how patriotism is valued—I die unknown and a martyr for my country.' "2 At a dis-