Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Vintage, New York: 1988.

Foucault describes the disappearance of leprosy throughout the western world allowed for the "wastelands" for those sick with leprosy to be inhabited by another group the public wished to exclude from their cities (3).
-The High Middle Ages lead to the opening of leprosariums all over western world by the end of the Crusades. There were over 2,000 leprosariums in France in 1226, 43 in Paris alone (3-4).
-By the fifteenth century the leprosariums were empty (4).
-Some empty leprosaiusms were turned into Hospitals Generals in France.
-The empty leper houses were soon used for the poor in Scotland.
-In Germany empty leper houses became filled with "incurables and madmen" (6).

"What doubtless remained longer than leprosy, and would persist when the lazar houses had been empty for years, were the values and images attached to the figure of the leper as well as the meaning of his exclusion, the social importance of that insistent and fearful figure which was not driven off without first being inscribed within a sacred circle" (6).

As the lepers disappeared the "poor vagabonds, criminals and ‘dangerous minds’" would take the place of the leper.

The forms of the leper would remain after they had long disappeared. "With an altogether new meaning an in a very different culture, the form of a rigorous division which is social exclusion but spiritual reintegration" (7).

"Ship of Fools"
-Became of importance around the time leprosy "vanished"
-"Narrenschiff" is a literary creation
-Boats had loads of insane people on them who were dropped off at various ports along the way (8).
-Madmen were arrested and given over crew men, who were told to drop them off at specific ports. They were specifically told not to return them to the cities they had come from.
-The mad had the tendency to congregate at certain cities with "shrines."
-Madmen were publicly whipped and literally run out of the cities (10).
-Putting them on ships meant the fools would not be bothering those in the cities.
-Foucault states that the image of the water also has a "purifying" effect. Despite the freeness that comes with the water, the madman is trapped on the ship (11). -One thing at least is certain: water and madness have long been linked to dreams of European man." (12) Foucault provides a number of literary references to water and madness being a part of western culture, particularly of note in the fifteenth century (15).

Madness was seen as akin to death, something that haunted people’s minds in the fifteenth c.

Fascination with madness by the culture
-find mad figures "one of the secrets and one of the vocations of his nature" (21)
-madness is knowledge because "absurd figures are in reality elements of a difficult, hermetic, esoteric learning" (21)
-this madness was of interest, but was hidden "like a secret." (23)

In literature, philosophy and moral themes madness appears different
-evil, in the hierarchy of vices (24)
-folly is the reign over whatever is bad in men
-madness is seen as ruling everything that is easy and frivolous (25)
-madness as the "comic punishment of knowledge"
-madness is expressed in the 15^th century as moral satire (27)

Various expressions of madness
-"madness by romantic identification" (28)
-"madness of vain presumption" (29)
-"madness of just punishment" (30)
- madness of "desperate passion"

"The classical experience of madness is born." (35)
-madness is then dealt with using the hospital, not boats.
-madness as something stationary
-images of the "Hospital of mad men" and the "mad house" in literature and art

"This world of the early seventeenth century is strangely hospitable, in all senses, to madness. Madness is here, at the heart of things and of men, and ironic sign that misplaces the guideposts between the real and chimerical, barely retaining the memory of the great tragic threats—a life more disturbed than disturbing, an absurd agitation in society, the mobility of reason." (37)

During the 17^th century there were large number of houses of confinement. One out of every hundred persons in Paris were confined. Madness was linked to confinement throughout the century and confinement came to be seen as natural for the mad (38).

1656-Hospital General was founded in Paris
-place for not only the poor, but "sick, invalid, convalescent, curable or incurable" (39)
-had to accept, lodge and feed those who presented themselves or who were sent by the courts, king or police.
-directors of these hospitals were appointed for life and had power over people both in and out of the hospital
-Not a medical establishment
-directors had chains, prisons, stakes, dungeons and irons within the hospital for their use
-functioned as "an order, of monarchical and bourgeois order being organized in France during this period" (40).
-administration of the hospitals was run by those who were from the best of bourgeois families, they had "disinterested views and pure intentions" (41).

1676-Edict called for the establishment of a hospital general in each city in France. Even before that the church had gotten involved and various parishes and orders opened similar types of hospitals (42).

In England these houses took the form of "houses of correction." By the seventeenth century these houses had been taken over by businesses and had trades installed within them (milling, spinning, and weaving). Later, in 1697 the first work houses were established in England. These houses were for the poor and generally turned away the sick, trying not to become a hospital general (44).

John Howard at the end of the 18^th century toured these houses of confinement (jails, work houses, hospitals) and found that the poor, criminal and insane were all being housed together (45).
-confinement had become abusive
-move to isolate these groups of people even more than they previously were

Initial reasons for confinement and royal edict
-"preventing mendicancy and idleness as the source of all disorders" (47)
-last great measure since the enlightenment to get rid of poverty and begging
-the city of Paris (population 100,000) had over 30,000 beggars at one point
-archers were positioned at the city gates and told to kill any indigents that came in
-was an answer to the poverty, lack of coin in the seventeenth century (49)

The coming of the hospital was a change for Europe, no longer were they forbidding the poor from coming, but taking charge of them at "the expense of their individual liberty" (48).

Work houses in England and elsewhere caused some of the problems they were meant to solve. If products can be made at a workhouse, why pay "honest people" to do the work. Therefore, the more work accomplished in the work house the more likely folks outside the workhouse would be unemployed (52). As folks realized this problem many of the work houses stopped having "work" be a part of them.
-there were several attempts to turn the hospital into a manufacturing plant.
-entrepreneurs were always looking for free/cheep labor from the hospitals.
-notion that work was needed in order to "heal" people (54)
-sloth in the 17^th century was seen as the fall of man, work houses combated that sin

Houses of confinement were a failure. These houses began to disappear at the beginning of the nineteenth century (54).

The insane (58)
-were always with the poor
-noted for not being able to do repetitive jobs such as weaving.
-couldn’t follow rhythms of collective life

Work required of those confined wasn’t for the economic benefit of the house or the country, instead it was to the ethical/moral benefit to those who were confined. If you could work and did work you were likely to be released because they had learned (61).

During the time of confinement, madness took on sinister position. During the renaissance madness was part of the arts, being especially prominent in literature; in the seventeenth century it was something to be hidden. (64).

Entire population of madness, one-tenth of all arrests made in Paris for the Hospital General were concerning "the insane, demented men, individuals of a wandering mind, and persons that have completely gone mad" (65).

Until the seventeenth century insanity was something dealt with in the open, but changes came and the insane and their actions were hidden from the public. There is a notion of "shame" that is tied to insanity (66). "All those forms of evil that boarder on unreason must be thrust into secrecy" (68).
-priests that had gone crazy were hidden away
-those who had attachments to the thrown or powerful people where also hidden.
-a way for families to escape dishonor

Only time in which the insane were not secretly locked away was when they were put on display. Barred windows were even installed at some hospitals so that the passers by could see the insane inside. People were charged a penny on Sunday to come and see the insane…the amount of revenue from this was astonishingly high. Attendants of the insane were known to put on a "show" using the mad men (68).

The insane lived in deplorable conditions. One man only had a straw pallet to lay on and his cell was flooded with water (71). As water rose and filled basement cells rats came of such a large size that people died from the bites, but those were the extremely unruly of the insane. It was noted at one hospital thirteen women were forced to sleep in an eight by eight foot cell (71).

The most violent of the insane were chained to walls and beds. Though a horrible practice,

Those who were restrained were not done so in order to punish, but instead just to keep them from hurting themselves (70-2).

There was an animalism that began in these hospitals. The insane occupants were no longer seen as people after a certain point and were believed to be and treated like animals. Some people slept on hay, were tied with collars to walls and fed through the use of troughs (72). Foucault notes that the rooms for the insane look more like cages for wild beasts (73). Animality was not seen as evil or as a "sign from Beyond" as in earlier times, instead it is seen as madness.

This animality/insanity was something that could be suppressed through discipline. For instance, the insane were given specific instructions throughout the day and if they deviated from the prescribed course of action they were physically beaten (75).

Madness was seen as something that protected the insane from ailments or poor conditions. It was noted that insane were left in below freezing temperatures, only to be found "well" after such a situation. At the time it was also felt that the insane were protected from disease by their insanity (75).

The insanity of the cross in Christianity was dealt with during this time. Through this, insanity started to be seen with more respect and compassion. If Christ could be seen as insane during his time, in fact suffering it during the passion then the average insane person could be viewed with respect. By Jesus submitting to insanity on the cross, He humanized it (80-1).

"The savage danger of madness is related to the danger of the passions and to their fatal concatenation." (85)

"The distraction of our mind is the result of our blind surrender to our desires, our incapacity to control or to moderate our passions. Whence these amorous frenzies, these antipathies, these depraved tastes, this melancholy which is caused by grief, these transports wrought in us by denial, these excesses in eating, drinking, these indispositions, these corporeal vices which cause madness, the worst of all madness." (85)
-more constant, deserves and persistent cause of madness
-passion as some how related to madness
-passion as the meeting ground between body and soul
-medicine of humors
-medicine of spirits

"The possibility of madness is therefore implicit in the very phenomenon of passion." (88)
-for the Greeks passion was madness penetrating the world of reason
-passion as the union of body and soul
-participates in both passion and the anarchy from it

"Madness ends by being a movement of nerves and muscles so violent that nothing in the course of images, ideas or wills seems to correspond to it: it is the case of mania when it suddenly intensified into convulsions, or when it degenerated into continuous frenzy" (91-2).

"Madness is no more than a derangement of the imagination" (93).

Chimeras, hallucinations and the cycle of non-being
-Hallucinations: demons taunting men (96)
-The cycle starts with hallucination, moving to chimeras and then to delirious language.

From this cycle it can be concluded that:
-"In madness, for the classical age, there exists two forms of delirium" (98).
-"Delirium exists in all alterations of the mine" (99).
-"Discourse covers the entire range of madness" (99).
-"Language is the first and last structure of language" (100).

"In the name of what can this fundamental language be regarded as a delirium" (101). If it is the truth of madness, what makes it true madness and the original form of insanity? -17^th century thought that dreams and madness are from the same source
-image>hallucination>memory>prediction>sleep>night of senses>negativity (cycle) -"delirium is the dream of the waking persons" (103) -"Madness begins where the relation of man to truth is disturbed and darkened." (104) -different types of madness based on there being different ways to access truth (105). -deleria -perception -hallucinations -.representation -dementias

Blindness as a metaphor for insanity (105)

"Madness designates the equinox between the vanity of night’s hallucinations and the non-being of light’s judgments" (111).

"Madness in the classical period ceased to the sign of another world and that it became the paradoxical manifestation of non-being" (116-7). -confinement served to try to suppress madness and eliminate it from the social order -manifestation of non-being -by confinement madness is acknowledged to be nothing

In this chapter Foucault does not want to write a history of psychiatry, instead he wants "to show the specific faces by which madness was recognized in classical thought" (117).

Melancholia and Mania -was a fixed idea in the sixteenth century (117) -certain symptoms: imitation, thinking they are vessels of glass, belief that they are beasts, often scared of death, feelings of guilt -the word melancholia indicates a specific causal system: they are all depraved of "melancholic humor spread throughout their brain." (118)

"Hence melancholic’s love solitude and shun company; this makes them more attached to the object of their delirium or to their dominant passion, whatever it may be, which they seem indifferent to anything else" (118).

Melancholia was thought to be something related to the four humors and was fixed in the minds of doctors until the beginning of the seventeenth century. Then a debate began about the problem. There were several conclusions: -"the causality of substances is increasingly replaced by a movement of qualities which are transmitted directly from the body to the soul" (119) -"there are mechanics of qualities" (119) -sometimes there are problems within the qualities themselves -qualities maybe altered by accidents and conditions of life (120)

There is a need to get down to the level of the spirit when it comes to melancholia (121).

In 1743 Robert James published the Medical Dictionary where he placed mania and melancholia under the same definition. -liquid vs. solid forms of the disease (122-4)

"It is this languishing flow, these choked vessels, this heavy, clogged blood that the heart labors to distribute throughout the organism, and which has difficulty penetrating into the brain, where the circulation ought to be very rapid" (123).

Dr’s other than James, namely Willis, sees melancholia as opposed to mania. -manic people tend to deform all concepts and ideas; they tend to loose all "representative value" -melancholic’s minds tend to be fixed on one object and experiences sadness and fear (125) -both the diseases are seen to be caused by the movement of animal spirits (126)

Often in the eighteenth century the image of animal spirits was replaced by more physical systems. The thought were that the tension of a channel of nerves and vessels were the culprit of these disorders. Mania is caused by the vibration of these over tense vessels, and melancholia is an over relaxation of this tension (126).

Forestier thought that mania occurred because of "dryness." He stated that the brains of those with mania were always lighter than normal brains and this lightness must be due to a lack of liquid in the brain (128).

There was also the notion that this dryness was caused by over heating, this "heat" was attested to by maniacs being able to withstand the bitter cold and such cold was known to cure some patients (128).

Willis is honored with being the discoverer of "mania-melancholia alteration." Willis did not see someone change from mania to melancholia, but realized that the symptoms were related and the both symptoms of the same disease (131). Willis sought to see how both of the symptoms were related to animal spirits (132).

The understanding of this disease did not move from observation to explanations, instead metaphors doctors came up with went to fuel observations (135).

When hysteria and hypochondria are discusses two major problems arise:
-Is either a legitimate form of madness?
-Should the two be treated together or as separate problems? (136)

Hysteria and hypochondria would come to be seen as symptoms of the same disease (136).

Willis noted that when it came to hysteria, woman were often labeled has having the problem if the doctor was unable to diagnose another problem. Willis was upset by such medical imprecision.

Doctors noted that "all symptoms of spasm, cramp and convulsion derive from a pathology of heat symbolized by harmful, bitter or acrimonious vapors" (141).

It was unclear for many years what kind of problem hysteria and hypochondria were and where they fit in the scope of medicine. These diseases were thought at different times to have different causes; at one time or another the root of the problem was thought to be caused by physical problems, acid, fermentation and chemical reactions (142).

Pois and Willis are credited with "liberating hysteria from the old myths of uterine displacement." It was thought that the womb shifted, and spontaneously moved during pregnancy (143).

It wasn’t until the beginning of the eighteenth century that Pois and Willis’ notions were taken up and hysteria and hypochondria were to be seen as forms of psychological problems—of madness.

Hysteria -a disease of "a body indiscriminately penetrable to all the efforts of spirits, so that the internal organs gave way to the incoherent space of masses passively subject to the chaotic movement of the spirits" (147). -is known to "seize up" the stomach, colon and the "area below they heart cavity" -can cause violent heart palpitations, extreme head pains and vomiting -effected more women than men because women have a more delicate, less firm constitution, because they lead a softer life and are accustomed to luxuries and commodities of life and not to suffering" (149)

Diseases of the nerves "had been associated with the organic movements of the lower parts of the body, they were located within a certain ethic of desire: they represented the revenge of the a crude body" (156).

By the 19^th century hysteria are beginning to be seen as mental diseases (158).

"The therapeutics of madness did no function in the hospital, whose chief concern was to sever or ‘correct’" (159) Outside of hospitals, treatment for the mentally ill continued to be developed throughout the classical period.

"The madman’s body was regarded as the visible and solid presence of his disease: whence those physical cures whose meaning was borrowed from a moral perception and a moral therapeutics of the body.
-consolidation
-purification
-immersion
-regulation of movement

"one would undertake in vain to cure a man of suffering from madness, if one tried to succeed by physical means alone…material remedies can never enjoy a complete success without that succor which a strong and healthy mind affords a weak and sick one." (178)

The physical and moral divide that was not seen in the classical era (178) The physical and the psychological were not divided (181)

Forms of treating psychological diseases
-awakening
-theatrical representation
-the return to the immediate

Can’t make the divide between psychological and physical during the classical period because "the psychological simply did not exist." (197)

"The unreason that had been relegated to the distance of confinement reappeared, fraught with new dangers and as if endowed with a new power interrogation" (200).

The mad man came to be seen as a social individual.
 -Rameau’s Nephew
-Conversations with the insane
-Unreason began to become part of the social system again

The insane came to be known, "in Paris some are very good people, economists and anti-economists, who have warm hearts, eager for the public good; but unfortunately they have cracked heads; that is, they are short-sighted…they start from the impossible principle and reason falsely therefrom" (201).

In the middle of the eighteenth century people began to fear a mysterious disease that spread from the houses of confinement and threatened the cities (202). -images of prisoners with "prison fevers" leaving disease in their wake -The image of horror was reborn in the notions of the houses of confinement

The houses of confinement were seen as "a terrible ulcer upon the body politic, and ulcer that is wide, deep, and draining, one that cannot be imagined except by looking full upon it. Even the air of the place cannot be smelled four hundred yards away—everything suggests that that one is approaching a place of violence, an asylum of degradation and infortune." (202) -it was as if the contagion from the lepers remained and diseased the new people living in the houses. -idea of contagion as evil (203) -country air vs. corrupt air of hospitals and houses of confinement -ideas somewhere between medicine and morality -great movements of panic in some cities

"What the classical period had confined was not only an abstract unreason which mingled madmen and libertines, invalids and criminals, but also an enormous reservoir of the fantastic, a dormant world of monsters…." (209)

"The fortress of confinement functioned as a great, long silent memory"

The images and ideas that were "liberated" at the end of the eighteenth century don’t match-up with the ones that the seventeenth century tried to eliminate

Sadism is a "cultural fact" that appeared at the end of the eighteenth century and was one of the "greatest conversions of the Western imagination: unreason transformed into delirium of the heart, madness of desire, the insane dialogue of love and death in the limitless presumption of appetite." (210) -language as desire -sadism was born in confinement

The notion arose that "Nervous diseases ‘were formerly much less frequent than they are now a days; and this is for two reasons: one, that men were in general more robust, and less frequently ill…if they were once the rarest, they are today the most frequent" (211).

"The fear of madness is much freer…the awareness of madness is, on the contrary accompanied by a certain analysis of modernity, which situates it from the start in temporal, social and historical context" (212).

Madness and Liberty (212-3) -Madness as specific to a political focus or location -Roman suicide, English melancholia, English suicide -"Madness, ‘more frequently in England than anywhere else’"

Madness, Religion and Time (215-6) -doctors are suspicious of too much religious devotion -too much thinking about the life to come causes melancholia -religion is thought to arise delirium and hallucination.

Madness, Civilization, and Sensibility (217-9) -civilization constitutes a favorable environment for the "development of madness" -academics are likely to have their brain "harden" and dementia set in

"Madness was no longer of the order of nature or of the Fall, but of history, and where there formed, in an obscure originating relationship, the ‘alienation’ of the physician and philosopher" (220).

"No one blushed to put the insane in prison." (221)

"Moreover, there are few prisons where the raving mad are not to be found; these unfortunates are chained in dungeons beside criminals. What a monstrous association! The calm madmen are treated worse than malefactors." (221)

"Those who have visited the insane asylums of Germany recall with dread what they have seen. One is horrified upon entering these asylums of misery and affliction; one hears only cries of despair, yet here dwells the man distinguished by his talents and his virtues." (222)

Twenty-five years before Pinel, Malesherbes visited state prisons demanding that the insane be taken elsewhere. Over the period of confinement many of those managing the houses all over Europe attempted to separate the man men from the prisoners, poor, etc…but not for the right reason. (222). -wanted the separation for the wrong reasons -the insane were bothering the criminals -the insane were slowing those working -thoughts that it was cruel to lock up the prisoners with the insane

Putting the criminals and epileptics in with the insane was used as a punishment for the criminals

People spoke out against all different types of people being confined together, but not necessarily the mad. They were concerned why the poor and the criminal were put together…etc (227).

Confinement causes alienation, represented what was immoral about the eighteenth century, and those who should have been confined (the mad) were often let free (228)

In the eighteenth century poverty stopped being a moral problem and started being seen as an economic issue (229).

Confinement was a "gross error" and "an economic mistake: poverty was to be suppressed by removing and maintaining by charity a poor population." Part of the population was being suppressed, but the wealth was staying constant (232).

In the eighteenth century the necessity of confinement disappeared. Therefore, madness was "set free" long before Pinel (234).

Confinement was first separated from morality-those who were a danger to themselves or others were confined, those who were not we freed. The second step in reforming confinement was to have each house of confinement investigated. Thirdly, confinement was reserved for those who are mad and those who committed serious crimes.

There were problems: there were no hospital just for the insane and therefore relatives for a time were charged with caring for the mad (237).

Finally, there were orders to either let all of the mad go and keep the criminals confined, or the other way around (240).

"The worthy Society of Friends…sought to assure those of its members who might have the misfortune to lose their reason without a sufficient fortune to resort to expensive establishments all the resources of medicine and all the comforts of life compatible at their state…" (241)

"This house is situated a mile from York, in the midst of a fertile and smiling countryside; it is not at all the idea of a prison that it suggests, but rather a large farm; it is surrounded by a great, walled garden. No bars, no grilles on the windows" (242).

The liberation of the insane at Bicetre is famous (242-3) -removal of the chains from the dungeons -find any of the ill hidden away -Pinel "freed" them, " I am convinced that these madmen are so intractable only because they have been deprived of air and liberty" (242).

"The legends of Pinel and Tuke transmit mythical values, which nineteenth century psychiatry would accept as obvious in nature." Beneath the myths are a series of operations that "silently organized" the asylum (242).

The Retreat -similar to the first Quaker communities -moral and religious segregation -religion plays a double role of nature and rule -madness as being controlled and not cured -fear as used to control the patients

"Fear appears as an essential presence in the asylum" (245). "The fear instituted at Retreat is of great depth; it passes between reason and madness like a mediation." "Now madness would never-could never-cause fear again; it would be afraid."

Manic patients become sensible when they are treated with respect (246).

"The obscure guilt that once linked transgression and unreason is thus shifted…the madman is no longer guilty, must feel morally responsible for everything within him that may disturb morality or society, and must hold no one but himself responsible for the punishment he receives" (246).

The asylum no longer punished the madman’s guilt…but it did more, it organized that guilt as an awareness of the other (247).

Work "comes first" in moral treatment. -"Through work, man returns to the order of God’s commandments; he submits his liberty to laws that are those of both morality and reality" (248).

The use of social occasion, to train those in the asylum (249) -tea parties -dressed in their best clothes -mingle with outsiders -seen as tests for those in the asylum

"The science of mental disease, as it would develop in the asylum would always be only the order of observation classification" (250).

Madness is seen at the Retreat as child-like, those who are insane are treated like children. They must be subjugated, encouraged, and made agreeable.

The style of existence is an attempt to recreate the family.

Pinel and Tuke are different when it comes to religious segregation (255-6) -the asylum must be free of religion -patients become obsessed with it -some thought religion was the source of madness -the asylum is a religious domain without religion, pure morality

Pinel had three principles for organizing the asylum (260-8) 1-Silence 2-Recognition by mirror 3-Perpetual judgment

Role of medical personnel in the asylum -authority figure -the personality of the doctor

Movement in the eighteenth century by Tuke and Pinel toward the psychoanalytical (273) Freud used the structures of Tuke and Pinel and transferred them to his own work.

Madness as something between persuasion and mystification (276).

Images of madness in art and language (279-82).

Role of Nietzsche and Artaud (286-88)

Sade -unreason continues to watch by night; but in this vigil it joins with fresh powers. The non-being it once was now becomes the power to annihilate (285).

The role of madness in art, "where there is a work of art there is no madness." (289)