Michel Foucault analyzed how attitudes toward madness changed in Western Europe from the sixteenth to the nineteenth centuries. He used a “history of mentalities” approach in Madness and Civilization to argue that social exclusion was the fate for those who failed to act in a logical or rational manner or whose actions made life uncomfortable for the ruling class.
In 1960, Michel Foucault defended his doctoral dissertation on the evolution of attitudes toward mental illness in Western Europe between the early sixteenth century and the middle of the nineteenth century. In 1961, his dissertation was published under the title Folie et déraison: Histoire de la folie à l’âge classique. Three years later, Foucault abridged his dissertation. This revised version, which included less extensive historical documentation, served as the basis for Madness and Civilization: A History of Insanity in the Age of Reason (1964).
Foucault showed that in the late fifteenth century and during the early decades of the sixteenth century, the two illnesses most feared by Europeans were leprosy and the plague. Leper colonies and leprosariums had been established throughout Europe to segregate lepers from the general community. This fear of leprosy (or Hansen’s disease, as it is now called) is understandable because the disease is highly contagious and had no cure until the 1940’s. Europeans were terrified of Hansen’s disease for two major reasons. First, it was then absolutely impossible for a leper to avoid both disfigurement and death. Second, those diagnosed as suffering from Hansen’s disease were forcibly separated from their families, and they could not leave the leper colonies to which they were assigned. Bubonic plague, which had killed so many people during the Middle Ages, continued to inspire profound terror throughout Europe.
Mental illness, on the other hand, was considered to be a medical condition that society had to learn to accept. In his Moriœ Encomium
For sound theological reasons, Europeans were tolerant of madness during the better part of the sixteenth century. Foucault showed, however, that this tolerant attitude toward the mentally ill was replaced in the early seventeenth century by the belief that society no longer needed to accept forms of behavior that offended its sensitivities or value systems.
A basic thesis in Foucault’s Madness and Civilization is that the ruling classes in England, Germany, and France during the seventeenth and eighteenth centuries decided quite deliberately to exclude from society those who failed to act in a logical or rational manner or whose actions made life uncomfortable for their families. Foucault showed that there was then no systematic attempt to distinguish between true mental illness and voluntary or involuntary actions that struck the political elite as odd or abnormal. Among those imprisoned as insane were epileptics, mildly depressed people, spendthrift or sexually active unmarried adolescents, men and women who had contracted sexually transmitted diseases, and even priests who had mistresses. A priest who chose not to respect his vow of chastity was subject to imprisonment for reason of insanity simply because his behavior might scandalize his parishioners. Epileptics whose involuntary seizures scared ignorant people were systematically removed from society and incarcerated.
With an impressive amount of historical documentation, drawn largely from France and England but also from Germany, Foucault showed that no effort was made to cure or treat the mentally ill or to separate them from the general prison population. Prison directors and even some clergymen whose ministry dealt with prisoners affirmed that the insane were more like animals than like human beings possessing feelings and immortal souls. This extraordinary arrogance on the part of the ruling class and its administrators enabled generations of the English and the French in the seventeenth and eighteenth centuries to deceive themselves into believing that it was permissible and even praiseworthy to imprison the insane so that society would not be bothered by their presence.
Foucault demonstrated that this deplorable situation in France and England did not change until the 1790’s, when enlightened social reformers and psychiatrists established asylums in which the mentally ill received humane treatment from medical doctors who tried their best to cure them and to help them resume normal lives in society. Until the 1790’s, people imprisoned in France and England for reason of insanity received no regular psychiatric treatment from medical doctors. Although Foucault questioned the effectiveness of some of the psychiatric treatments implemented by the French psychiatrists Jean-Étienne-Dominique Esquirol and Philippe Pinel and by the English social reformers Samuel and William Tuke in the late eighteenth century and in the early years of the nineteenth, one should not underestimate the importance of their contributions to the history of psychiatry. Esquirol, Pinel, and the Tukes were the first major reformers to establish asylums in which the mentally ill received the best medical care then available.
While Foucault was writing his doctoral dissertation in the 1950’s, he was unable to obtain a teaching position at a French university. Between 1954 and 1960, he taught French courses at universities in Sweden, Poland, and Germany. His dissertation was received so favorably by his colleagues that he was offered not only a professorship but also the position of head of the department of philosophy at the University of Clermond-Ferrand in central France. This was quite an unusual honor for a scholar who had just received his doctorate. Why was Madness and Civilization considered to be such an important book? A large part of the reason is the basic lens that Foucault applied to modern history, one that he would later use to discuss the history of the clinic, of the prison, and of sexuality. Foucault believed that there was a disjunction within history, that the advent of modernity represented a fundamental break or paradigm shift, and that humanity was essentially different before and after the break. This concept of temporal disjunction would become a powerful lens for understanding the nineteenth century and the birth of what Foucault, following Friedrich Nietzsche, referred to as the “modern soul.”
Since its publication in 1961, critics of Madness and Civilization have pointed out its import for many different fields, including social and cultural history, cultural studies, political science, ethics, the history of ideas, and the history of psychiatry. Many scholars have asked whether Foucault was more a historian or a philosopher. This opposition between history and philosophy assumes that the traditional objective analysis of social history is somehow incompatible with theoretical and philosophical reflections on the history of ideas. Foucault believed, however, that such a distinction between history and philosophy was artificial because historical research based on extensive analysis of primary sources can lead to an understanding of how people perceived ethical, social, or religious problems in earlier centuries or in foreign cultures.
This approach to history and philosophy, which combined rigorous historical research with a study of the history of ideas, represented the method developed by the eminent French historians Marc Bloch
Foucault argued persuasively that the justification for this egregious mistreatment of the mentally ill was the specious assumption that those whose behavior, opinions, or even religious beliefs did not conform to socially accepted norms were unreasonable and therefore should not be allowed to remain free. Freedom was then considered a privilege and not a right. Until the French Revolution, a person in France could be imprisoned for insanity without a judicial hearing if the king signed a lettre de cachet (a letter bearing the royal seal) ordering that the individual be imprisoned until the king decided otherwise. This use (or abuse) of power was absolute, and people imprisoned for insanity were not permitted to challenge such royal decisions in a court of law. Lettres de cachet constituted an overt form of political repression designed to discourage all types of resistance to the ruling class. Anyone who did not conform to specific socially accepted norms could be imprisoned without a judicial hearing.
Between the publication in 1961 of Madness and Civilization and his death on June 24, 1984, Foucault wrote extensively on a wide variety of topics including prison reform, the treatment of the mentally ill, linguistics, homosexuality, and the history of psychiatry and sexuality. It is ironic that Foucault died in the neurological hospital of La Salpetrière in Paris. Until the French Revolution, La Salpetrière had been one of the major prisons in which large numbers of people were incarcerated because of insanity. In Madness and Civilization, Foucault had written extensively about the terrible mistreatment in La Salpetrière of the mentally ill before the French Revolution.
Although there was considerable diversity in Foucault’s writings, a major focus in his books was the analysis of the diverse techniques that societies have used over the centuries to control those whose behavior does not conform to specific norms. In his works published in the 1960’s, he analyzed extensively the mistreatment of the mentally ill. In his three-volume Histoire de la sexualité
Foucault’s writings probably influenced, at least indirectly, reforms that occurred from the 1960’s onward in mental health treatment, though critics have been reluctant to posit such links. Abuses of power by Soviet officials, who claimed that dissidents were mentally ill and hospitalized them as a poorly concealed means of incarceration, were exposed and gradually eliminated. Even in the United States, treatment of the mentally ill came under closer examination. Foucault’s influence is more noticeable in the humanities. His use of historical materials as a means of examining the values of society has been emulated by later scholars, and Foucault is required reading in courses ranging from cultural studies to philosophy and psychology and history.
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Arac, Jonathan, ed. After Foucault: Humanistic Knowledge, Postmodern Challenges. New Brunswick, N.J.: Rutgers University Press, 1988. Contains insightful essays by nine scholars who examine Foucault’s writings on social history, feminism, politics, linguistics, and literary theory. -
Foucault, Michel. Madness and Civilization. 1964. New ed. New York: Routledge, 2006. Part of the Routledge Classics series. Foucault’s foundational work on mental illness and the institutionalization of the mentally ill. -
_______. Psychiatric Power: Lectures at the Collège de France, 1973-74. Translated by Graham Burchell, edited by Jacques Lagrange. New York: Palgrave Macmillan, 2006. Collected lectures presented by Foucault on the subjects of psychiatric history and psychiatry and their relationship with institutional power and ways of thinking. -
Gutting, Gary. Foucault: A Very Short Introduction. New York: Oxford University Press, 2005. A brief but thorough introduction to Foucault and his work, with chapters on “madness” and “crime and punishment.” -
O’Farrell, Clare. Foucault: Historian or Philosopher? New York: St. Martin’s Press, 1989. Examines the debate over Foucault as either social historian or as a moral philosopher. O’Farrell concludes that the approaches are equally valid. Contains an extensive bibliography on Foucault. -
Scott, Charles E. “Ethics Is the Question: The Fragmented Subject in Foucault’s Genealogy.” In The Question of Ethics: Nietzsche, Foucault, Heidegger. Bloomington: Indiana University Press, 1990. Examines Foucault’s reflections on ethical problems and discusses the profound influence of the German philosophers Friedrich Nietzsche and Martin Heidegger on Foucault. -
Scull, Andrew. The Insanity of Place, the Place of Insanity: Essays on the History of Psychiatry. New York: Routledge, 2006. Part of the Routledge Studies in Cultural History series. Explores psychiatry’s problematic past, with a chapter on the reception of Madness and Civilization by historians in the United States. -
Shumway, David R. Michel Foucault. Boston: Twayne, 1989. Presents an excellent general introduction to the philosophical and ethical dimensions in Foucault’s works. Describes very well Foucault’s importance in modern French philosophy. Contains an annotated bibliography on Foucault. -
Smart, Barry. Michel Foucault. 1985. Rev. ed. New York: Routledge, 2002. Presents a sociological interpretation of Foucault’s writings on the use and abuse of political power to limit personal freedom. Describes well the unity of Foucault’s social philosophy.
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