Summary of Chapters 4 – 6
In Chapters 4 – 6, Foucault discusses the new ways in which madness was categorized and understood after the institution of the General Hospital. Chapter 4, “Passion and Delirium,” is primarily about how madness was understood in relation to, but ultimately distinct from, other phenomena including passion and dreams. This is how madness starts to become its own unique domain of experience. Chapter 5, “Aspects of Madness,” explores how this new domain was differentiated, or the different kinds of madness people diagnosed, especially melancholia, mania, hysteria, and hypochondria. Finally, Chapter 6, “Doctors and Patients,” analyzes the different treatments originally proposed by doctors to manage or cure these different kinds of madness.
In Chapter 4, Foucault proposes that madness is structured as a language. 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. Foucault then distinguishes this delirious discourse from the “oneiric and the erroneous,” that is, from dreaming and from simple mistakes. Madness is like a dream, in that it hallucinates something that is not real, but it occurs while waking 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.
Foucault then considers how madness is primarily defined negatively, which means people define madness as what it is not rather than what it is. In particular, madness is unreason, or the negation of reason. This in turn constructs what reason even means, but more importantly, it also “authorizes” the study of madness from within reason. Madness is the opposite of reason, but it can only be understood through reason. This is a paradox. Madness should be, by definition, invisible, since it is the opposite of what is visible, which is reason. But the madman makes unreason visible, and therefore disturbs the discourse that is meant to contain or exclude him.
In “Aspects of Madness,” Foucault differentiates four types of madness or unreason. He begins with melancholia, which until the 1600s was understood as a physical disease related to the humors, or fluids people thought circulated in human bodies. Beginning in the classical age, people instead decided that melancholia was caused by more psychological conditions or “qualities.” The same happened with mania, which is the opposite of melancholia: a hyper-excitement instead of a deadening sadness. At first thought to be caused by animal spirits possessing humans, it then came to be thought of as caused by nerve fibers or tensions within the body, before finally being understood as an effect of social situations or behaviors. There is a movement in both melancholia and mania from primarily physiological to primarily psychological explanations, from body to mind.
Foucault then discusses two other diseases that came to be seen as mental, rather than primarily physical, illnesses: hysteria and hypochondria. The path towards mental illness is similar to melancholia and mania. They were first diagnosed as symptoms of nerve damage before they were understood as mental damage. What is interesting in this development is that people conceived of the mental damage as an effect of an innocent or guilty consciousness. In turn, mental illness starts to look like a punishment for something bad that someone has done, causing them to feel guilty and then nervous as a result, either through hysteria or hypochondria. This means that understandings of madness start to have meanings that are moral as well, and madness might be an effect of moral failure.
With these understandings of the possible causes of mental illness as understood in the classical period, Foucault turns his attention to “Doctors and Patients,” in particular the kinds of cure doctors developed for the mad. At first, Foucault describes physiological cures, which aligned with an earlier understanding of madness as an issue of the body. Doctors sought to strengthen a body they thought was weak or else to purify a body they thought was full of bad spirits. This led to different nutritional and purging programs. Doctors also tried to regulate movement, thinking exercise might cure disease, or else tried “immersion,” in which bodies were dunked in water to re-calibrate an equilibrium of liquids.
Longer lasting, though, is the legacy of psychological cures doctors offered to confront the sense of guilt they thought was underlying madness. Foucault classifies three types of psychological cure. The first is an “awakening” to moral law, often imposed by an authoritarian figure. The second is “theatrical representation,” which acts out the role of madness in order to chase it away. Finally, there is what Foucault calls "the return of the immediate,” which essentially means solitude in which the mad has to confront his own madness. These are all more “psychological” cures. But Foucault concludes by pointing out that it would not have made sense during this period to separate physiological from psychological cures, because psychology as a science did not yet exist. These are cures aimed more at the mind, but they might not have been thought of as very different from the cures aimed at the body.
Analysis
A key theme throughout Foucault’s many works is the relation between power and knowledge. On the one hand, power produces knowledge. As the mad were confined, or subject to the power of being excluded from society, they could become objects of study. This led to the production of new kinds of knowledge, including about different kinds of madness and different kinds of treatment. Exercising power through confinement proliferates new sciences and ideas about the phenomenon being confined.
On the other hand, knowledge also produces power. A new discourse of madness shapes how people are understood and treated in society. Once people can be slotted into different categories, their bodies can be controlled through the identities assigned to them. Foucault’s point is that power doesn’t just operate on a category of people, so that there are mad people that society then contains. Rather, power operates in the production of the category itself, so that simply calling someone mad is already to confine them to a category that reduces a sense of their complexity and humanity.
Another theme in these chapters in particular is the relation of the physical and the spiritual, or between the body and the mind. On the one hand, Foucault sees a transition from more physical to more mental understandings of madness, so it starts to seem less like a disease and more like a psychological problem. This larger transition is something we see throughout this period, and going back to the Renaissance. Descartes famously said “I think, therefore I am,” forever tying the existence of a person to his mind, rather than merely his body. The discourse of madness elaborates this point by seeing a disturbance of mind as a disturbance of a person’s very being.
But on the other hand, this transition from physiological to psychological understandings demonstrate the ultimate impossibility of considering those two things separately. Foucault reminds us that the period he is studying doesn’t have “psychology” as a science. Therefore, to read psychology as a distinct thing is reading our own contemporary understandings into the past. Instead, Foucault shows how messy these concepts are.
What is ultimately important for Foucault is language. Madness starts to be seen as a disturbance in how people talk about themselves or think about themselves or their world. Language is supposed to be logical. Disordered language shows disordered thinking. And language relates to both mind and body, so connects them in one domain. This is a bit of a shift in how Foucault has been describing discourse. Now, it’s not only how people talk about madness. It’s also how madness itself is conceived as a kind of talking, a talking that breaks the rules and norms of social logic.
