Madness and Civilization is Michel Foucault’s history of how Western societies, especially France and England, came to conceptualize “madness” and mental illness by the end of the 1700s. His history begins with discussion of the Middle Ages, but his focus is on what he calls the “classical age” beginning in the late 1500s and continuing through the late 1700s. He argues that during this period, madness came to be thought of as a distinct phenomenon requiring its own special medical knowledge and cures.
In Chapter 1, Foucault gives a sort of pre-history to the period he studies. He begins by describing the emergence of leper colonies and houses in the Middle Ages, which were places used to separate and contain leprosy apart from the rest of society. This confinement of something perceived to be a threat to the social order continued into the Renaissance and classical age, but the people confined changed. As leprosy waned, the houses meant to confine it were instead re-purposed to confine those who were thought of as mad. And just as society used to obsess over the social threat of leprosy, it now turned to obsessing over madness.
Chapter 2 continues this discussion of madness to consider what Foucault calls the “Great Confinement” of the classical age. His starting point is the creation of the General Hospital of Paris in 1657. This was not a “hospital” in the modern sense, but more like a prison for confining a large number of people considered a threat to the social order. This category of people, which Foucault classes under the name “Unreason,” included poor people, criminals, and the mad. The primary aim, Foucault says, was confinement of the poor, because poverty was seen more as a moral failing that needed to be separated from society rather than a product of society’s own economic weaknesses and structures. The mad, by being confined along with the poor, were similarly thought of in ethical terms, according to their lack of productivity or contribution to society.
As Foucault explores in Chapters 3 – 5, however, people slowly began to think of madness as its own distinct thing. This was in part because of a proliferation of scientific and philosophical attention to different kinds of madness, such as mania, melancholia, hysteria, and hypochondria. During the classical age, the knowledge around madness shifted from viewing it as a physiological problem to more of a psychological problem. Madness used to be thought of as a problem with one’s body, something caused by a build-up of "humors," or certain fluids. Now, madness started to be thought of as a mental problem, in some cases as a result of feelings of guilt people had for something bad they had done. As Foucault describes in Chapter 6, this also led to new kinds of “cure” in which people had to confront their perceived moral failings in order to achieve sanity.
In Chapters 7 and 8, Foucault argues that as more and more specialized knowledge developed around madness, people no longer thought it made sense for the mad to be confined along with all the others in the original category of “unreason,” including the poor and the criminal. This wasn’t because mad people needed to be protected from criminals. On the contrary, it was other people who had to be protected from the mad, because people feared madness as a terrible and possibly contagious condition.
This ultimately led to a new, separate kind of confinement, exclusively for the mad, which Foucault explores in Chapter 9. The mad were to be confined in asylums rather than prisons, in order for their uniquely psychological problem to be studied and reformed. Foucault concludes his study with a discussion of two innovators of asylums, Samuel Tuke in England and Philippe Pinel in France. What they have in common is an investment in the figure of the “medical personage,” or doctor, who is supposed to be the ultimate authority of the asylum and in charge of curing the patients. This is a new innovation, with the medical expert replacing the role of the more judicial or warden-like figures of the earlier confinement.
