In Madness and Civilization, Foucault traces the cultural evolution of the concept of insanity (madness) in three phases:
- the Renaissance;
- the Classical Age;[4] and
- the Modern era
Middle Ages
In the Middle Ages, society distanced lepers from itself, while in the "Classical Age" the object of social segregation was moved from lepers to madmen, but in a different way. The lepers of the Middle Ages were certainly considered dangerous, but they were not the object of a radical rejection, as would be demonstrated by the fact that leper hospitals were almost always located near the city gates, far but not invisible from the community. The relative presence of the leper reminded everyone of the duty of Christian charity, and therefore played a positive role in society.[5]
Renaissance
In the Renaissance, art portrayed insane people as possessing wisdom (knowledge of the limits of the world), whilst literature portrayed the insane as people who reveal the distinction between what men are and what men pretend to be. Renaissance art and literature further depicted insane people as intellectually engaged with reasonable people, because their madness represented the mysterious forces of cosmic tragedy.[2] Foucault contrasts the Renaissance image of the ship of fools with later conceptions of confinement. The Renaissance, rather than locking up madmen, ensured their circulation, so that the madman as a "passenger" and "passing being" became the symbol of the human condition: "Madness is the anticipation of death".[6]
Yet Renaissance intellectualism began to develop an objective way of thinking about and describing reason and unreason, compared with the subjective descriptions of madness from the Middle Ages.[1]
Classical Age
At the dawn of the Age of Reason in the 17th century, there occurred "the Great Confinement" of insane people in the countries of Europe; the initial management of insane people was to segregate them to the margins of society, and then to physically separate them from society by confinement, with other anti-social people (prostitutes, vagrants, blasphemers, et al.) into new institutions, such as the General Hospital of Paris.[1] According to Foucault, the creation of the "general hospital" corresponds to Descartes's Meditations, and the desire to eliminate the irrational from philosophical discourse. "Classical reason" would have produced a "fracture" in the history of madness.[7] Moreover, Christian European society perceived such anti-social people as being in moral error, for having freely chosen lives of prostitution, vagrancy, blasphemy, unreason, etc. To revert such moral errors, society's new institutions to confine outcast people featured way-of-life regimes composed of punishment-and-reward programs meant to compel the inmates to choose to reverse their choices of lifestyle.[1]
The socio-economic forces that promoted this institutional confinement included the legalistic need for an extrajudicial social mechanism with the legal authority to physically separate socially undesirable people from mainstream society; and for controlling the wages and employment of poor people living in workhouses, whose availability lowered the wages of freeman workers.[8] The conceptual distinction, between the mentally insane and the mentally sane, was a social construct produced by the practices of the extrajudicial separation of a human being from free society to institutional confinement. In turn, institutional confinement conveniently made insane people available to medical doctors then beginning to view madness as a natural object of study, and then as an illness to be cured.[1][2]
Modern era
The Modern era began at the end of the 18th century, with the creation of medical institutions for confining mentally insane people under the supervision of medical doctors. Those institutions were product of two cultural motives: (i) the new goal of curing the insane away from poor families; and (ii) the old purpose of confining socially undesirable people to protect society. Those two, distinct social purposes soon were forgotten, and the medical institution became the only place for the administration of therapeutic treatments for madness. Although nominally more enlightened in scientific and diagnostic perspective, and compassionate in the clinical treatment of insane people, the modern medical institution remained as cruelly controlling as were mediaeval treatments for madness.[1] In the preface to the 1961 edition of Madness and Civilization, Foucault said that:
Modern man no longer communicates with the madman ... There is no common language, or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange, between madness and reason, was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence.[9]
