Summary
In his Preface, Foucault lays out the difficulty of writing a history of madness. “Madmen” themselves don’t write their own histories. Instead, their experiences are written down for them by doctors and other experts, the ones who come up with the categories of “madness” and “non-madness” to begin with. That means there isn’t a dialogue between these two experiences. Instead, the non-mad have a “monologue” about both. They monopolize the discourse, making it hard to get at the experience and transformation of madness during the period Foucault studies, the so-called “classical age” running from the late 1500s through the 1700s.
Despite this difficulty, Foucault sketches out the broad transformation in the understanding of madness during this time period. Note the emphasis is not on the experience of madness, but in how Western societies categorized or made sense of what they called madness. He lays out two major events, one at the beginning and one at the end of the time period he discusses. The first, in 1657, is the creation of the General Hospital in France, which was built to confine the poor, along with the mad. The second, in 1794, is the liberation of prisoners from the Bicêtre Hospital in 1794, leaving only those who were “mad.” From 1657 to 1794, then, we see a movement from thinking of madness as part of a larger category of social delinquency to it being its isolated phenomenon with its own spaces and techniques for treatment. It is this movement, and all the meanings developed around sanity and psychology associated with it, that Foucault will narrate in the pages to come.
In Chapter 1, “Stultifera Navis” (Latin for “Ship of Fools”), Foucault tells the story leading up to this first “great confinement” of the poor and mad in the 1600s. He starts by talking about leper colonies or “lazar houses” in medieval times, where people with leprosy were sent to be separated from the rest of society. By the mid-1600s, Foucault notes that leprosy had largely diminished in Western societies, but these houses remained. In the place of lepers, other social outcasts began to populate these houses, including “poor vagabonds, criminals, and ‘deranged minds.’” There is a symbolic similarity between the leper and these new outcasts. Societies are structured around excluding certain “abnormal” people who present a threat to a society's stability. But importantly, this exclusion was part of society, as these houses are social institutions. There is a space excluded from society but created from within society. For Foucault, this is essential for understanding how society constructs a sense of what is “normal,” by making visible and containing those who are considered abnormal.
The madman, then, starts to play the same role that the leper did in medieval society, as a figure that is placed outside society in order for society to define itself. Placing the leper outside society allowed everyone left inside to define themselves as healthy; now, placing the madman outside society allows everyone to define themselves as sane.
At the time that leprosy was waning, Foucault notes the rise of the “Ship of Fools,” in which madmen were sent away from towns on ships. This separates the “fools” from the society that remains. But Foucault points out that this exclusion is constantly narrated in Western literature beginning in the 15th century. The madman plays an important role in tales and fables, which means he is not being banished from social memory. Indeed, he starts to play a central role in narratives, where the “fool” is often the “guardian of truth.”
This paradox, where the madman is both outside and fundamental to human knowledge, is the beginning of a modern conception of madness. It makes madness into a quality of a person rather than something supernatural. Henceforth, madness is something anyone can become susceptible to, rather than something that falls upon people because of ghosts or fantastic beasts. Foucault looks through to the Renaissance, which proliferates different kinds of madness in, for instance, Shakespeare’s plays. People can become mad because of romantic desire or vanity or desperation. In all cases, the point is that madness arises out of human situations rather than supernatural interventions. Madness is still exceptional, something outside of social norms, but it grows out of social situations and comes to haunt them.
This is what causes the figure of the Ship of Fools to eventually fall out of favor. Madness is no longer something you send outside of civilization, on a ship out to sea. Instead, it is something that needs to be contained and managed within society. Instead of a “fugitive ship,” madness starts to reside in institutions like the prison: something that is excluded from society but still within its limits. Rather than be exiled, madness is confined. Foucault concludes the chapter by noting that the early 1600s were “strangely hospitable” to madness. Its representations were everywhere, as people started to worry they could, in their souls, come to be mad themselves. It became a figure people obsessed over, and with that obsession, new meanings of what it means to be human would eventually emerge.
Analysis
In these opening chapters, Foucault gives us a sense of both what he’s studying and how he’s studying it. He is a historian who understands the past through discourse, or how people understood things through language, including in written documents. That means he isn’t interested in giving a history of madness itself, or how different kinds of mental illness were caused or when they arose. Instead, he wants to understand the meanings attached to madness and how changes in those meanings are connected to larger changes in social and political structures.
A couple of consequences follow from this emphasis on discourse. One is that Foucault never takes for granted that a thing like “madness” exists in the same form across time. Indeed, madness might be an effect of discourse. Sometimes people don’t recognize something until there’s a word for it. And often times, our understanding of something is shaped by the words we have available for describing it. So Foucault is saying that what madness even is, and what it means, are related more to discourse than to physical symptoms. That also means we can’t assume that the things we consider mental illness today can be found or located in the past. In the 20th century, psychiatry gave us new diagnoses like schizophrenia and post-traumatic stress disorder, but those terms would not have been available in the past, and we shouldn’t assume that we can diagnose people of the past with labels from today.
Another consequence of Foucault’s method is that history always has to be incomplete. You might have heard the phrase that history is written by the victors. Foucault takes a similar but perhaps more sophisticated stance. Reading books, pamphlets, and documents from a period tells us how people were thinking about something at a particular time. But people may not write down things they take for granted, because they are so obvious. Or people from marginalized positions may not have a voice to write down something at all. The historical record is always incomplete, which makes it especially difficult to do a history of something that is supposed to be repressed, like madness.
That’s what Foucault means by there being a “monologue” about madness in the discourse. People who think they are reasonable are talking with other reasonable people about unreasonable people. But no one bothers to have a dialogue with the unreasonable, or those considered outside the norm. Thus, this concept of the “other” outside of society is being constructed but never expressed: outsiders are described by insiders, but never get to describe themselves.
For Foucault, when insiders are writing about outsiders, or in this case the sane are writing about the mad, they aren’t just constructing what “mad” means. They’re also constructing what “sane” means. That’s because sanity is defined in opposition to this “madness” that everyone keeps talking about. This may seem counterintuitive at first, if we assume there are “normal” people who have an objective take on “abnormal” people. Foucault’s claim is that the very categories of normal and abnormal are socially constructed. People identify with “normal” and decide what that means by describing the traits of the “abnormal.” This flow of identities will become increasingly important as Foucault’s history progresses.
