Leprosy disappeared, the leper vanished, or almost, from memory; these structures remained. Often, in these same places, the formulas of exclusion would be repeated, strangely similar two or three centuries later. Poor vagabonds, criminals, and "deranged minds" would take the part played by the leper, and we shall see what salvation was expected from this exclusion, for them and for those who excluded them as well.
In this quote, Foucault describes a major transition between the Middle Ages and the classical age at a later period. He says that what is similar is a structure of confinement, but what changes is who is confined. There is a movement from confining people who are physically diseased (lepers) to confining those perceived as morally or ethically deficient (the mad and poor). In both cases, society needs someone to “exclude” in order to organize what is normal and abnormal.
Throughout Europe, confinement had the same meaning, at least if we consider its origin. It constituted one of the answers the seventeenth century gave to an economic crisis that affected the entire Western world: reduction of wages, unemployment, scarcity of coin.
This quote explains the underlying cause of the “Great Confinement,” exemplified in the rise of General Hospitals to house large segments of Western populations. What was conceived of as a moral crisis was actually an economic crisis: people were impoverished because of the weakness of the European economy, but their poverty was perceived as a failure on the part of the individual instead of the larger structure. Confinement emerged in response to the need to manage this large population of people whose poverty was produced by the state of the economy.
The new meanings assigned to poverty, the importance given to the obligation to work, and all the ethical values that are linked to labor, ultimately determined the experience of madness and inflected its course … Madness was thus torn from that imaginary freedom which still allowed it to flourish on the Renaissance horizon. Not so long ago, it had floundered about in broad daylight: in King Lear, in Don Quixote. But in less than a half-century, it had been sequestered and, in the fortress of confinement, bound to Reason, to the rules of morality and to their monotonous nights.
At first, madness was not thought of as a distinct social ill, but as part of a larger category of “unreason.” This category primarily emerged in response to the confinement of the poor. In this time, poverty was seen less as a result of an economic structure and more as a personal moral failure, which is why the poor had to be confined. Foucault argues that, because madness was confined along with poverty, the same ethical and moral principles behind the criminalization of the poor applied to the mad. The mad were understood as ethically deficient, too, because of their similar lack of contribution to society.
Confinement hid away unreason, and betrayed the shame it aroused; but it explicitly drew attention to madness, pointed to it. If, in the case of unreason, the chief intention was to avoid scandal, in the case of madness that intention was to organize it.
Although madness was caught up in the larger category of “unreason” including poverty and criminality, it nonetheless always had a special relation to publicity. Whereas other perceived social ills were thought of as shameful secrets to be repressed, madness was always a public spectacle. That means the mad were put on display, for instance being placed in cells with barred windows so the outside could watch them instead of hidden behind solid brick walls. Madness was always a “scandal” rather than a secret, and the public enjoys scandals, rather than feeling ashamed of them. This gives to madness a special quality in how widely it is discussed and imagined in the public sphere.
Madness is precisely at the point of contact between the oneiric and the erroneous; it traverses, in its variations, the surface on which they meet, the surface which both joins and separates them. With error, madness shares non-truth, and arbitrariness in affirmation or negation; from the dream, madness borrows the flow of images and the colorful presence of hallucinations. But while error is merely non-truth, while the dream neither affirms nor judges, madness fills the void of error with images, and links hallucinations by affirmation of the false. In a sense, it is thus plenitude, joining to the figures of night the powers of day, to the forms of fantasy the activity of the waking mind; it links the dark content with the forms of light.
In the classical age, madness was thought of as related to but distinct from dreams (the oneiric) and mere human mistakes (the erroneous). Madness is like a dream, in that it hallucinates something that is not real, but it occurs while awake instead of while sleeping. And madness is like an error, because it has a mistaken understanding of the truth, but madness does not correct its error, instead filling in the void with more and more images to make the error seem true.
However, there is a difference in nature between those techniques which consist in modifying the qualities common to body and soul, and those which consist in treating madness by discourse. In the first case, the technique is one of metaphors, at the level of a disease that is a deterioration of nature; in the second, the technique is one of language, at the level of a madness perceived as reason's debate with itself.
Foucault proposes the madness is structured as a language. This is because of its relation to reason or a “rational” discourse. That means madness is seen in and through language, in particular in breaking rules of grammar and logic. Thus, Foucault speaks less of, for instance, a delirious mind or body, but a delirious “discourse” when people do not speak in a coherent unified language. Importantly, this discourse does not belong exclusively to either the body or the mind, but expresses them both together.
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.
A major transition Foucault notices in the classical period, parallel to a transition from confining madness along with other forms of unreason to confining it by itself, was a change in how people theorized the causes of madness. At first, madness was thought of as a physiological problem, like other diseases that affected the body. People developed theories of nerve damage and humors, or fluids circulated in the body that might get blocked and lead to madness. Eventually, however, people viewed madness as a more psychological phenomenon, related to people’s mental lives rather than physical bodies. This led to theories about people becoming mad out of a feeling of guilt over something they had done wrong, for instance. Such a psychological view also made it possible for people to think of madness as a sign of moral failure, more than physiological weakness. But at the same time, Foucault argues, this distinction which is apparent to us today was all blurred during the classical period. That’s because madness was thought of as a “language” that included the body and the mind together.
Hence an abyss yawns in the middle of confinement; a void which isolates madness, denounces it for being irreducible, unbearable to reason; madness now appears with what distinguishes it from all these confined forms as well. The presence of the mad appears as an injustice; but for others. The undifferentiated unity of unreason had been broken.
In this quote, Foucault explains how madness separated off from the larger category of “unreason,” which had originally included poverty and criminality as well. All these people were caught up in the great confinement, housed together in the General Hospitals, for instance. But by the end of the period Foucault analyzes, madness began to be seen as distinct from poverty and criminality, and it was also feared more than these other things. Thus, madness had to be separated from them not to treat the mad more humanely than the criminal, for instance, but to protect the criminal from the mad. This led to madness having its own special kind of confinement, in the asylum, with its own special kinds of cure or treatment.
Everything was organized so that the madman would recognize himself in a world of judgment that enveloped him on all sides; he must know that he is watched, judged, and condemned; from transgression to punishment, the connection must be evident, as a guilt recognized by all.
In this quote, Foucault describes one of the aims of Pinel’s asylums for the treatment of the mentally ill. Pinel’s asylum pursued three main principles to achieve its aim of social conformity. First, silence: leaving the madman alone would force him to reflect upon and confront his social failures. Second, and similarly, madmen would be encouraged to view themselves in a mirror, rather than being primarily observed by others, as they were in Tuke’s asylum. Third, this cultivated sense of always watching one’s self would lead to “perpetual judgment.” The mad would learn to constantly monitor themselves and asses their actions in relation to social norms in order to then act in a way that did not transgress them.
The world that thought to measure and justify madness through psychology must justify itself before madness.
In this quote, Foucault examines the relation between art and madness and civilization. On the one hand, we think of art as coming from madness, for instance the “mad” genius of someone like Van Gogh. On the other hand, art is opposed to madness, because it was after all created by someone who is skilled, and it communicates with the viewer. Foucault concludes there is no madness in the work of art itself, but rather in the interaction between the work of art and the world which judges it. People who have tried to tame madness find themselves now confronted by an art that they would have destroyed if they destroyed madness.
