Summary of Chapter 9 and Conclusion
In Chapter 9, we finally reach the endpoint of Foucault’s narrative: “The Birth of the Asylum.” The institution of the asylum, which grows out of but departs from the General Hospital that had confined the poor, marks the last transformation in the understanding of madness during the period Foucault analyzes. We saw in the last chapter how madness differentiated itself from mere criminality, to the point that criminals actually had to be freed from confinement alongside the mad. Now, in the asylum where the mad alone are housed, the question becomes how to manage, discipline, or possibly cure the mad. Alongside this is the rise of new techniques and new sciences, like psychology, that explain what madness is and how to organize it.
In this chapter, Foucault explores at length the work of two important asylum creators and managers. The first is Samuel Tuke, who created the Tuke Retreat in England for the treatment of the mad. Tuke was a Quaker, and his treatment of madness was guided by religious principles. His aim was to make the madman confront his own guilt and actions in order to learn to function sanely once more. Thus the main principles of the Retreat were surveillance and judgment: a constant sense of observation, ritualized throughout the Retreat, in which madmen were judged and could learn to judge themselves. This, Tuke believed, would lead them to repair their actions and behaviors in line with a moral vision of the world.
To achieve this aim, Tuke essentially conceptualized the Retreat as a family, where the mad were children who needed to be disciplined by the figure of a Father. Madness starts to look less like a disease and more like a rebellion against familial authority, which a child must learn to obey. This also shifted the terms of confinement. Children are dependent on their families but are not locked up within them. Similarly, the mad at the Retreat had physical freedom to move around at the same time that they were confined morally, to operate within a strict system of norms. This marks, in Foucault’s words, not the liberation of madness from chains, but the mastery of madness by norms.
The second asylum developer Foucault considers is Philippe Pinel. Pinel was more skeptical of religion than Tuke, but he was committed as well to a moral explanation of madness. In other words, he also saw madness as a moral failure. Pinel's moral code came from his own social background and included family and economic values: being a good member of a family and a productive laborer in society. Conceiving of madness as a failure to meet these norms meant that madness was essentially a “social failure,” the failure of someone to conform to society, and the asylum was essentially “an instrument of moral uniformity and of social denunciation,” disciplining people into conformity.
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 assess their actions in relation to social norms in order to then act in a way that did not transgress them.
Pinel and Tuke, in France and in England, used different techniques in their different asylums. But Foucault concludes this chapter by considering one important thing they had in common: their contribution to the rise of the “medical personage.” Remember that the General Hospital at the beginning of the classical age was essentially a prison, run by a prison administrator. But at the asylums of Tuke and Pinel, the person in charge was not just a warden, but a physician. Henceforth, the mad were to be managed by doctors, and it was necessary to develop not a system of criminal reform, but of medical knowledge. That the asylum should be run by a controlling doctor was continued into more contemporary understandings of madness as well. In closing, Foucault gestures toward Sigmund Freud, who created the practice of psychoanalysis, in which the psychoanalyst is in charge of the patient’s cure. The authority of the doctor remains.
In his conclusion, Foucault considers the relation between art and madness in Western culture. We tend to obsess over artists we think of as mad, such as Vincent Van Gogh. In fact, Van Gogh thought his madness and his art incompatible. In a sense, art is directly opposed to madness, because it was after all created by someone who is skilled and is communicating something to 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. As Foucault writes, “the world that thought to measure and justify madness through psychology must justify itself before madness.” Thus, art might be a way of shifting the relation between madness and civilization, as it comes from civilization but makes us confront madness.
Analysis of Chapter 9 and Conclusion
In these chapters, we reach the endpoint of Foucault’s narrative, as well as the end of the period he covers, up until roughly 1800. The thread throughout has been confinement: that, even more than madness, is the master theme. But there has been a transformation in who gets confined and what it means to be confined. First, there was leprosy in the Middle Ages. Then there was eventually a larger category of "Unreason" which included poverty, criminality, and madness. By the end of his narrative, madness has its own separate meanings and its own separate institutions.
The rise of institutions is Foucault’s main contribution here. We have already seen how power and knowledge go together. Power creates new knowledge and it is through knowledge, or the ways in which people are perceived and categorized, that power also operates. The sign that a new kind of power and knowledge has ascended and married together is the rise of a new institution. Thus, knowledge about madness and power in confining and manipulating madness come together in the “birth of the asylum,” an institution distinct from prisons, shelters for the homeless, etc.
These chapters also show Foucault’s historical method at work in new ways. Here, he contrasts two different creators of asylums, Tuke and Pinel, and shows how they differed in methods and context. But he is especially interested in what they have in common, which is the authority they give doctors to rule over asylums as well as patients. This is what Foucault’s method does: it looks for the common assumption underlying different things happening at the same time. In this case, it is the rise of the doctor as authority figure. In previous chapters, we saw something similar with how the understanding of mania, melancholia, hysteria, and hypochondria, though different diseases, shifted from physiological to psychological explanations.
Foucault’s critique of the rise of doctors anticipates some of the historical work he will go on to do later in his career. For instance, here, Foucault suggests a line of connection between Tuke and Pinel and Sigmund Freud, the father of psychoanalysis whose work began to be vastly influential in the early 1900s. As Foucault describes in his later History of Sexuality, psychoanalysis assumes the psychoanalyst, or a doctor like Freud, can hold the key to unlocking his patient’s illness, and it is his task to guide his patient to confront his own psychosis and thus cure it. Foucault is suspicious of this kind of dynamic, where experts have ultimate power over the understanding of individual lives.
Another critique that resonates between the conclusion of Madness and Civilization and some of Foucault’s later works is the function of the family. For Tuke, according to Foucault, the family was supposed to be the cure for patients, and asylums should simulate families in order to relieve madness. This can lead to the dominance of particular family values that might actually restrain individual behavior. It makes it seem like families are the cornerstone of society, and people who do not have families or are estranged from them are automatically thought of as abnormal or mad. Foucault is suspicious of this equation, where family equals sanity.
