Review of History of Madness

Foucault, M. (2009). History of Madness. (J. Khalfa, Ed., J. Murphy, Tran.). London; New York: Routledge.

History of MadnessIt has been suggested that as Michel Foucault’s first book,[1] the History of Madness presages themes that are found throughout his life’s works—being a 700 page volume it’s hard to deny that practically all of Foucault’s later interests are at least introduced here. Certainly, some are not—there is no discussion of the important concept of “pastoral power”, and the methodology employed is more structuralist than archaeological or genealogical—nonetheless Foucault’s interest in freedom, the history of reason (or thought—what he calls episteme), limit experiences, contingent structures, and the development and shifting relationships of juridical/social/concrete concepts are present. Jean Khalfa argues in the introduction that this particular edition is a new book for the English world, since it has never before been read. Previously, the only English version was a butchered edition—cut to about 200 pages and completely devoid of any footnotes or bibliographic apparatus.

Fully restored, History of Madness needs to be thought in a new light. The previous English edition was released into the temporal and intellectual context of the anti–psychiatric movement; this new edition makes it clear that only a naïve reading would argue that Foucault had psychology so squarely in his sights. In fact, Foucault has denied, with varying consistency, that the book is about “madness itself”. It’s much more likely that the book is about the dialectic of reason and unreason, or perhaps the social and juridical apparatuses of freedom and reason.

History of Madness was also received by a young Jacques Derrida who wrote a scathing critique of it and Foucault’s entire project. Foucault famously offered several responses (changing his foreword in subsequent printings and publishing several long replies), that launched a decade–long silence between Derrida and Foucault. It’s clear from Derrida’s critique and Foucault’s replies that they both took the issue to be central to the work. Derrida’s critique focuses on Foucault’s interpretation of Descartes, specifically with respect to Descartes’ method of doubt. Foucault saw Descartes as the first to set aside madness and make it an experience of sin, as madness shifted from the “renaissance” to the “classical age” (see below for Foucault’s unique use of these terms). Instead, Derrida argues that Descartes was not interested in madness, rather, he sought a hyperbolic doubt to be found in the dream and evil genius hypotheses. Derrida criticises Foucault for starting the history of the division of madness and reason in the Middle Ages, at a point that Foucault calls the Decision. Derrida argues that the division is already present in the Greek notion of logos, and to the extent that Foucault misses this, he is guilty of articulating a view of logos that is “elementary, primordial,  and undivided”—an illusory foundation for which to compare later historical developments against. This foundation would allow Foucault to speak from a privileged position, his own discourse safe from its self–same corrosive effects:

The attempt to write the history of the decision, division, difference runs the risk of construing the division as an event or a structure subsequent to the unity of an original presence, thereby confirming metaphysics in its fundamental operation.[2]

However, Derrida does not even grant Foucault this much, since he denies the corrosive effects, and suggests that reason is not symmetrical, and therefore not amenable to unreason. Here, Derrida misreads Foucault’s historical approach, and believes that the project sets out to give an archeology of “madness itself” (a phrase that Foucault does in fact use at one point). Derrida correctly point out that “madness itself” is self–contradictory, but it’s a shallow reading of the History of Madness to think that Foucault attempts so much.

Much of the History of Madness focuses on the post–Cartesian rupture, but instead of the usual phraseology Foucault does not lump together all experiences after Descartes with the catch–all “modernity”. Instead, here put rather too schematically, Foucault describes three such phrases: renaissance, classical age, and the modern experience. It’s important to note that these three phrases do not correspond to the usual historical epochs, but that Foucault rearticulates their temporal delineation and meaning:

Renaissance

According to Foucault’s phraseology the renaissance starts sometime in the 1500s when “madness was appropriated by reason.” In the renaissance madness was a reflection on wisdom as a kind of religious experience, evaluated by its own forms (as Foucault says, “measured against the truth of essences and God”). At this point madness ceased to be an “fugitive and absolute limit,” instead, violence was defused and the voice of madness was liberated. The paradox of madness in the renaissance is that nothingness and darkness becomes the “opposite pole” of a “forbidden knowledge” symbolically exposed by madness. Foucault argues that by the 1600s society was “strangely hospitable to madness”, and that its influence is an “ironic sign blurring the distinction between the real and the chimerical, but with barely a memory of the great tragic threat.”

Classical age

The classical age starts in the 1600s and continues for most of the 1700s. As described above, Descartes gets the blame for the intellectual milieu that launched the “tragic” age of confinement. The classical age now saw madness as unreason, and while the renaissance exiled the mad to the Ship of Fools or other symbolic markers, the renaissance confined the mad and “came to manifest the negativity of madness in a positive manner.” The age of confinement established semi–juridical structures that used apparatuses such as the lettres de cachet to group the mad with other criminals and misfits (“the veneral, the debauched, the dissolute, blasphemers, homosexuals, alchemists and libertines”). The leper houses were replaced with dungeons that rarely attempted to cure the mad or offer forms of therapeutics, but instead policed mad within society.

The policing of mad corresponded to a social movement of mercantile and bourgeois exclusion that extracted people of unreason from a social world, and judged and sentenced. The gaze of society to the mad was now hidden but exposed, “thereby demonstrating that it was something to be ashamed of; but it put madness on show, pointing it out at arm’s length.” Those confined and labeled as mad were no longer just those of unreason, instead those infringing upon social and ethical standards were confined as mad and sick since it became that “reason is born inside the space of ethics.”

Unlike the renaissance, madness was not “accidental”, rather it was now seen as a “choice constitutive of reason, and consequently of man himself.” Madness was not a sickness, because it was not an affliction on Man, instead, it was the expression of animality. Indeed, the Christian duty of charity was being turned into little more than a civic obligation. Treatment, to the extent that it occurred at all, was largely symbolic. Prescriptions and techniques were moral–medical rather than physical and psychical. This medical science grew out of a “judicial experience of alienation.”

Modern experience of madness

By the end of the 1700s madness became a factual or positive object of science. The modern experience of madness was an alienation of the self from the self, while previously it was alienation from society. As the places of confinement transformed into positive medical spaces madness became an object of scientific observation and experimentation. This became a new form of power over the mad (for example, in the development of the straightjacket or cold water baths).

As part of the transition from the classical to the modern experience of madness economic pressures begun to take root. The “sick poor” were distinguished from the “healthy poor”, and the sick poor were now to be confined in hospitals and to be treated with a form of public charity. Indeed, the sick poor no longer had a place in the mercantilist and bourgeois society. Early on these hospitals pressed the mad into forced work, seen as curative for their condition. The Quaker community became integral in this shift. The Quakers created asylums that sought to rebuild around madness an atmosphere that resembled the Quaker community. Work was used at the Quaker Retreat as a “moral treatment” that had the power to restrain patients into a “system of responsibility.” Now, the lunatic asylum or psychiatric hospital combined the new need to cure or treat the mad with the old need to protect society. Slowly, poverty disappeared into economics and unreason into hospitals.

The relationship to madness begun to take on an objective gaze, such that those who identified it, guarded, and judged it held a neutralized relation. Unlike the spectacle of the mad in the classical era, the modern era put the mad and the non–mad into a relationship of the face–to–face gaze. The old juridical conceptions that removed the civil rights of the mad was now a natural form, in which liberty became “a play—always relative, always mobile—between freedom and its limits.” This was not the liberation of the mad, but “an objectification of the concept of their liberty.” The mad were freed from the inhumanity of their chains, but it “chained the mad to man and his truth… men had access to themselves as true beings; but true being was only given to them in the form of alienation.”

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[1] Technically Foucault’s first book was published in 1954, later amended and translated as Mental Illness and Psychology. The initial publication of this work was disavowed by Foucault, later updated, and then disavowed again. Originally published in 1961, History of Madness stands as the vanguard for Foucault’s thoughts. Foucault, M. (1987). Mental illness and psychology. Los Angeles: University of California Press.

[2] Derrida, J. (2001). Cogito and the history of madness. Writing and Difference (2nd ed.). New York: Routledge.