- History of Madness
- Routledge, 725 pp.
“Is it not by locking up one’s neighbor that one convinces oneself of one’s own good sense.”
Dostoevsky, A Writer’s Diary
The epigraph above, used by Michel Foucault (1926-84) in his magisterial History of Madness, reveals his angle of entry into the subject. Not only does he recount the history of how we have understood or prejudiced, punished or treated madness, but deconstructs the idea of madness, and offers his own working understanding of the boundary lines which shift so uncertainly in all of us. The English reader is to be grateful for this new 700 page edition of the 1961 Folie et Déraison: Histoire de la folie á l’âge classique, for not only does it restore the c. 300 pages missing in the truncated Madness and Civilization published heretofore, but also includes Foucault’s impassioned, albeit pedantic quarrel with Jacques Derrida over the nuances of terminology and its precarious purchase on something we might call reality.
In approaching the subject of madness, Foucault employs the terms reason and déraison, which does not translate well as “unreason.” Perhaps Creon’s appeal to Oedipus that it is not reason not to listen to reason gets us close enough to “unreason.” That “madness” is defined variously as a spiritual problem, a chemical disorder, a moral defect, and so on, not only has glosses over the various forms of mental suffering, but suggests how provisional our definitions are. And if we can look askance at the superstitions of our predecessors, might not those who follow us also seem perplexed by our “medicalizing” such phenomena?
While Foucault’s scholarship is extensive, one feels that he is always coming from a place in the heart, a silent passion whereby the subject commands both fascination and necessity. He notes that the marginalization of social elements once took such form as the leprosaria where lepers were housed and castigated as God’s judged, and subsequently those having fallen into the venereal “sins,” but by the late Middle Ages, early Renaissance, the appearance of the Narrenshiff, the ship of fools, the outcasts who migrated from port to port on inland rivers, and were memorialized in the phantasmagoria of Bosch, Breughel, and Dürer. The operative metaphor of the ship of fools was of course that of the fragile bark of sanity cast loose upon tempestuous, tenebrous seas.
From these exiled souls, the era of confinement followed where they were housed in monasteries, prisons, or way-stations. By the 1700s the “correctional” metaphor prevails and most of them are placed in moral and physical restraints in order to correct their aberrant attitudes or behaviors. Many of these souls were chained as animals in appalling conditions which would get us convicted if we treated our dogs similarly today. Such unfortunates included those convicted of debauchery, crime, and sexual license “where reason was the slave of desire and a servant of the heart.” (I suppose all of us would require sequestration under those criteria).
In the late eighteenth, early nineteenth century we find the humanization of treatment in the work of Pinel freeing the chained at the Salpêtriére, the Quaker Tuke in England, and Benjamin Rush, signer of the Declaration of Independence, leading the reform movement. As Rush insists, madness is a disease of “mind,” not possession by evil demons. Still, madness remains something “other,” something “not I.” As partial evidence witness the audience who came to watch the “loonies” at Charenton, or in 1815, the c. 96,000 enlightened souls who came to watch the inmates at Bethlehem Hospital in London, and paid a good price for admission to the show.
From the mid-nineteenth century through the present we see a shift in the treatment of madness to the “asylum,” a metaphor suggesting a retreat from the “madness” of the world, and a restoration of those deracinated. By medicalizing madness, we presumably move from moral derision to scientific categories of etiology, nosology, and treatment plans. Psychiatry has its origins in the ancient world and noticeably may be found in the middle ages and the renaissance in the concept of the four humors, an imbalance of which—say black bile which produces melancholia—can presumably be adjusted. The classificatory impulse from Kraepelin and Bleuler and others continues to the present in the continuous revisioning of the Diagnostic and Statistical Manual, which is the Bible of modern therapy and required by an insurance company in a neighborhood near you. Currently the DSM-IV-R (that is, fourth volume, revised, is no doubt being revised further). While Foucault leaves off his history with the nineteenth century, with only a nod toward Freud and company, one suspects that he would likely wish us to consider the history of this concept of “madness” and suspect that we, too, are bewitched by our own language, seduced by our metaphors, and will be subject to the scrutiny and dismay of our descendents.
One last but challenging thought which Foucault leaves us. Does he have a definition of madness? No, and yes. Clearly, the idea of madness is a cultural construct, referring at different times to different phenomena, and fraught always with the moral presuppositions of the observer, still he seems to suggest that the proof is in the pudding, namely, the degree to which one is able to carry on the necessary work of life. As illustrations he refers to the productivity of such “mad” artisans as Hölderlin, Nietzsche, and Artaud, and suggests that madness is found in the absence of the oeuvre; where there is oeuvre, there is no madness—only suffering.