Madness and Civilzation ( A History of Madness)

by Foucault, Michel -

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  logue of the person watched—thus preserving the old asy­lum structure of non-reciprocal observation but balancing it, in a non-symmetrical reciprocity, by the new structure of language without response.

  Surveillance and Judgment: already the outline appears of a new personage who will be essential in the nineteenth-century asylum. Tuke himself suggests this personage, when he tells the story of a maniac subject to seizures of irrepressible violence. One day while he was walking in the garden of the asylum with the keeper, this patient suddenly entered a phase of excitation, moved several steps away, picked up a large stone, and made the gesture of throwing it at his companion. The keeper stopped, looked the patient in the eyes; then advanced several steps toward him and "in a resolute tone of voice . . . commanded him to lay down the stone"; as he approached, the patient lowered his hand, then dropped his weapon; "he then submitted to be quietly led to his apartment." Something had been born, which was no longer repression, but authority. Until the end of the eighteenth century, the world of madmen was peopled only by the abstract, faceless power which kept them con­fined; within these limits, it was empty, empty of all that was not madness itself; the guards were often recruited among the inmates themselves. Tuke established, on the contrary, a mediating element between guards and patients, between reason and madness. The space reserved by soci­ety for insanity would now be haunted by those who were "from the other side" and who represented both the pres­tige of the authority that confines and the rigor of the reason that judges. The keeper intervenes, without weap­ons, without instruments of constraint, with observation and language only; he advances upon madness, deprived of all that could protect him or make him seem threatening, risking an immediate confrontation without recourse. In fact, though, it is not as a concrete person that he confronts

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  madness, but as a reasonable being, invested by that very-fact, and before any combat takes place, with the authority that is his for not being mad. Reason's victory over unrea­son was once assured only by material force, and in a sort of real combat. Now the combat was always decided be­forehand, unreason's defeat inscribed in advance in the concrete situation where madman and man of reason meet. The absence of constraint in the nineteenth-century asy­lum is not unreason liberated, but madness long since mas­tered.

  For this new reason which reigns in the asylum, madness does not represent the absolute form of contradiction, but instead a minority status, an aspect of itself that does not have the right to autonomy, and can live only grafted onto the world of reason. Madness is childhood. Everything at the Retreat is organized so that the insane are transformed into minors. They are regarded "as children who have an overabundance of strength and make dangerous use of it. They must be given immediate punishments and rewards; whatever is remote has no effect on them. A new system of education must be applied, a new direction given to their ideas; they must first be subjugated, then encouraged, then applied to work, and this work made agreeable by attrac­tive means."8 For a long time already, the law had regarded the insane as minors, but this was a juridical situation, ab­stractly denned by interdiction and trusteeship; it was not a concrete mode of relation between man and man. Minority status became for Tuke a style of existence to be applied to the mad, and for the guards a mode of sovereignty. Great emphasis was placed on the concept of the "family" which organized the community of the insane and their keepers at the Retreat. Apparently this "family" placed the patient in a milieu both normal and natural; in reality it alienated him still more: the juridical minority assigned to the madman was intended to protect him as a subject of law; this ancient

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  structure, by becoming a form of coexistence, delivered him entirely, as a psychological subject, to the authority and prestige of the man of reason, who assumed for him the concrete figure of an adult, in other words, both domina­tion and destination.

  In the great reorganization of relations between madness and reason, the family, at the end of the eighteenth cen­tury, played a decisive part—simultaneously imaginary land­scape and real social structure; it is from the family that Tuke starts out, and toward it that he progresses. Lending it the prestige of primitive values not yet compromised in the social, Tuke makes the family play a role of disalienadon; it was, in his myth, the antithesis of that "milieu" which the eighteenth century saw as the origin of all mad­ness. But he introduced it as well, in a very real way, into the world of the asylum, where it appears both as truth and as norm for all relations that may obtain between the mad­man and the man of reason. Thus minority under family tutelage, a juridical status in which the madman's civil status is alienated, becomes a concrete situation in which his con­crete liberty is alienated. The entire existence of madness, in the world now being prepared for it, was enveloped in what we may call, in anticipation, a "parental complex." The prestige of patriarchy is revived around madness in the bourgeois family. It is this historical sedimentation which psychoanalysis would later bring to light, according it through a new myth the meaning of a destiny that sup­posedly marked all of Western culture and perhaps all civi­lization, whereas it had been slowly deposited by it and only solidified quite recently at the turn of this century, when madness was doubly alienated within the family—by the myth of a disalienation in patriarchal purity, and by a truly alienating situation in an asylum constituted in the family mode. Henceforth, and for a period of time the end of which it is not yet possible to predict, the discourse of

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  unreason will be indissociably linked with the half-real, half-imaginary dialectic of the Family. So that what, in their violence, it was once obligatory to interpret as profanations or blasphemies, it would henceforth be necessary to see as an incessant attack against the Father. Thus in the modem world, what had been the great, irreparable confrontation of reason and unreason became the secret thrust of instincts against the solidity of the family institution and against its most archaic symbols.

  There is an astonishing convergence of the movement of fundamental institutions and this evolution of madness in the world of confinement. The liberal economy, as we have seen, tended to entrust the care of the poor and the sick to the family rather than to the State: the family thus became the site of social responsibility. But if the patient can be entrusted to the family, he is nonetheless mad, which is too strange and inhuman. Tuke, precisely, reconstitutes around madness a simulated family, which is an institutional par­ody but a real psychological situation. Where the family is inadequate, he substitutes for it a fictitious family decor of signs and attitudes. But by a very curious intersection, the day would come when the family was relieved of its re­sponsibility to care for the patient in general, while it kept the fictitious values that concern madness; and long after the diseases of the poor had again become an affair of state, the asylum would keep the insane in the imperative fiction of the family; the madman remains a minor, and for a long time reason will retain for him the aspect of the Father.

  Closed upon these fictitious values, the asylum was pro­tected from history and from social evolution. In Tuke's mind, the problem was to constitute a milieu which would imitate the oldest, the purest, the most natural forms of coexistence: the most human milieu possible, while being the least social one possible. In fact, he isolated the social structure of the bourgeois family, reconstituted it symbol-

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  ically in the asylum, and set it adrift in history. The asy­lum, always oriented to anachronistic structures and sym­bols, would be, par excellence, inadapted and out of time. And exactly where animality manifested a presence with­out history, an eternal return, would slowly reappear the immemorial scars of old hatreds, old family profanations, the forgotten signs of incest and punishment.

  Pinel advocates no religious segregation. Or rather, a segregation that functions in the opposite direction from that practiced by Tuke. The benefits of the renovated asy­lum were offered to all, or almost all, except th
e fanatics "who believe themselves inspired and seek to make con­verts." Bicetre and La Salpetriere, according to Pinel's in­tention, form a complementary figure to the Retreat.

  Religion must not be the moral substratum of life in the asylum, but purely and simply a medical object: "Religious opinions in a hospital for the insane must be considered only in a strictly medical relation, that is, one must set aside all other considerations of public worship and political belief, and investigate only whether it is necessary to oppose the exaltation of ideas and feelings that may originate in this source, in order to effect the cure of certain alienated minds."9 A source of strong emotions and terrifying im­ages which it arouses through fears of the Beyond, Cathol­icism frequently provokes madness; it generates delirious beliefs, entertains hallucinations, leads men to despair and to melancholia. We must not be surprised if, "examining the registers of the insane asylum at Bicetre, we find in­scribed there many priests and monks, as well as country people maddened by a frightening picture of the future." Still less surprising is it to see the number of religious mad­nesses vary. Under the Old Regime and during the Revolu­tion, the strength of superstitious beliefs, or the violence of the struggles in which the Republic opposed the Catholic

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  Church, multiplied melancholias of religious origin. With the return of peace, the Concordat having erased the struggles, these forms of delirium disappeared; in the Year X, 50 per cent of the melancholics in Bicetre were suffering from religious madness, 33 per cent the following year, and only 18 per cent in the Year XII. The asylum must thus be freed from religion and from all its iconographic connec­tions; "melancholics by devotion" must not be allowed their pious books; experience "teaches that this is the surest means of perpetuating insanity or even of making it in­curable, and the more such permission is granted, the less we manage to calm anxiety and scruples." Nothing takes us further from Tuke and his dreams of a religious com­munity that would at the same time be a privileged site of mental cures, than this notion of a neutralized asylum, puri­fied of those images and passions to which Christianity gave birth and which made the mind wander toward illusion, toward error, and soon toward delirium and hallucinations.

  But Pinel's problem was to reduce the iconographic forms, not the moral content of religion. Once "filtered," religion possesses a disalienating power that dissipates the images, calms the passions, and restores man to what is most immediate and essential: it can bring him closer to his moral truth. And it is here that religion is often capable of effect­ing cures. Pinel relates several Voltairean stories. One, for example, of a woman of twenty-five, "of strong constitu­tion, united in wedlock to a weak and delicate man"; she suffered "quite violent fits of hysteria, imagining she was possessed by a demon who followed her in different shapes, sometimes emitting bird noises, sometimes mournful sounds and piercing cries." Happily, the local cure was more con­cerned with natural religion than learned in the techniques of exorcism; he believed in curing through the benevolence of nature; this "enlightened man, of kindly and persuasive character, gained ascendancy over the patient's mind and

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  managed to induce her to leave her bed, to resume her domestic tasks, and even to spade her garden. . . . This was followed by the most fortunate effects, and by a cure that lasted three years." Restored to the extreme simplicity of this moral content, religion could not help conniving with philosophy and with medicine, with all the forms of wisdom and science that can restore the reason in a dis­turbed mind. There are even instances of religion serving as a preliminary treatment, preparing for what will be done in the asylum: take the case of the young girl "of an ardent temperament, though very docile and pious" who was torn between "the inclinations of her heart and the severe prin­ciples of her conduct"; her confessor, after having vainly counseled her to attach herself to God, proposed examples of a firm and measured holiness, and "offered her the best remedy against high passions: patience and time." Taken to La Salpetriere, she was treated, on Pinel's orders, "accord­ing to the same moral principles," and her illness proved "of very short duration." Thus the asylum assimilates not the social theme of a religion in which men feel themselves brothers in the same communion and the same community, but the moral power of consolation, of confidence, and a docile fidelity to nature. It must resume the moral enter­prise of religion, exclusive of its fantastic text, exclusively on the level of virtue, labor, and social life.

  The asylum is a religious domain without religion, a domain of pure morality, of ethical uniformity. Everything that might retain the signs of the old differences was elimi­nated. The last vestiges of rite were extinguished. Formerly the house of confinement had inherited, in the social sphere, the almost absolute limits of the lazar house; it was a foreign country. Now the asylum must represent the great continuity of social morality. The values of family and work, all the acknowledged virtues, now reign in the asy­lum. But their reign is a double one. First, they prevail in

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  fact, at the heart of madness itself; beneath the violence and disorder of insanity, the solid nature of the essential virtues is not disrupted. There is a primitive morality which is ordinarily not affected even by the worst dementia; it is this morality which both appears and functions in the cure: "I can generally testify to the pure virtues and severe prin­ciples often manifested by the cure. Nowhere except in novels have I seen spouses more worthy of being cherished, parents more tender, lovers more passionate, or persons more attached to their duties than the majority of the in­sane fortunately brought to the period of c6nvalescence."10 This inalienable virtue is both the truth and the resolution of madness. Which is why, if it reigns, it must reign as well. The asylum reduces differences, represses vice, eliminates irregularities. It denounces everything that opposes the es­sential virtues of society: celibacy—"the number of girls fallen into idiocy is seven times greater than the num­ber of married women for the Year XI and the Year XIII; for dementia, the proportion is two to four times greater; we can thus deduce that marriage constitutes for women a kind of preservative against the two sorts of insanity which are most inveterate and most often incurable"; debauchery, misconduct, and "extreme perversity of habits"—"vicious habits such as drunkenness, limitless promiscuity, an apa­thetic lack of concern can gradually degrade the reason and end in outright insanity"; laziness—"it is the most constant and unanimous result of experience that in all public asy­lums, as in prisons and hospitals, the surest and perhaps the sole guarantee of the maintenance of health and good habits and order is the law of rigorously executed mechanical work." The asylum sets itself the task of the homogeneous rule of morality, its rigorous extension to all those who tend to escape from it.

  But it thereby generates an indifference; if the law does

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  not reign universally, it is because there are men who do not recognize it, a class of society that lives in disorder, in negligence, and almost in illegality: "If on the one hand we see families prosper for a long series of years in the bosom of harmony and order and concord, how many others, es­pecially in the lower classes, afflict the eye with a repulsive spectacle of debauchery, of dissensions, and shameful dis­tress! That, according to my daily notes, is the most fertile source of the insanity we treat in the hospitals."11

  In one and the same movement, the asylum becomes, in Pinel's hands, an instrument of moral uniformity and of social denunciation. The problem is to impose, in a univer­sal form, a morality that will prevail from within upon those who are strangers to it and in whom insanity is al­ready present before it has made itself manifest. In the first case, the asylum must act as an awakening and a reminder, invoking a forgotten nature; in the second, it must act by means of a social shift in order to snatch the individual from his condition. The operation as practiced at the Re­treat was still simple: religious segregation for purposes of moral purification. The operation as practiced by Pinel was relatively complex: to effect moral syntheses, assuring an et
hical continuity between the world of madness and the world of reason, but by practicing a social segregation that would guarantee bourgeois morality a universality of fact and permit it to be imposed as a law upon all forms of insanity.

  In the classical period, indigence, laziness, vice, and mad­ness mingled in an equal guilt within unreason; madmen were caught in the great confinement of poverty and un­employment, but all had been promoted, in the proximity of transgression, to the essence of a Fall. Now madness belonged to social failure, which appeared without distinc­tion as its cause, model, and limit. Half a century later,