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Madness and Civilization: A History of Insanity in the Age of Reason

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"Madness and Civilisation", which was first published in 1959, was the first major work of the cultural critic and maverick structuralist Foucault, and it eloquently and stylishly establishes the main themes, (namely, power, knowledge, confinement) of his later works. Foucault, in his brilliant and forceful exposition, traces the codes or "epistemes" responsible for the shaping of madness from the Reneissance and up to the late nineteenth century. He charts the history of insanity from it being considered as a virtually harmless "wisdom of folly", to it being considered as a disease in the age of confinement and the psychiatric clinic. Drawing on several imprtant representations of madness in culture, which include the Ship of Fools of Jerome Bosch, and "The Disparates" of Goya, as well as the fates of Van Gogh, Nietzsche, Nerval and Artuad in the modern era, he "deconstructs" the concept of "reason" itself, by placing it in an inverse relation to supposedly "mad" experience. He asks the fundamental, and highly philosophical, question of "what does it mean to be mad, and what is the qualitative distinction between 'sanity' and 'insanity'?" This leads him to make the extraordinary claim that the "pathologisation" of madness, its treatment as a disease, is something approximating a disease of the modern era itself. Madness represents a moment of rupture, whose suppression is an attempt to avoid something mysterious, unseizable and dangerous within our own selves. In his examination of the history of confinement, and the supposed devastation that it has caused, Foucault is not trying (as his critics have alleged) to promote insanity in a bid to transgress social modes and conventional wisdom. Rather, he is attempting nothing else than a sociology of madness, by seeing how it arose in the context of modernity, with its work ethic, industrialisation, and its expansion of business enterprise, imperatives which entailed the exclusion of marginal and supposedly "deviant" behaviour. Written with considerable flair and panache, the book is highly opaque, relying much on paradox, wordplay, discontinuity and the need to undermine the rigour and consistency of "reasoned" discourse, which Foucault charges of embedding dangerous authoritarian implications. The obscurity and complexity of his style also illustrates the very pressing difficulty of trying to express any certain or objective truth about reality. The translation of Richard Howard, however, is the superior version, as it retains much of the impact of Foucault's style.

Certain reviewers of this book seem to confuse the categories of operation Focualt addresses in this book and others. He is not making the simplistic argument that "madness" is socially constructed but rather that certain concepts, including the medicalized model of insanity, only become possible under cetain conditions and operate within a specific, historical and culutral formation of knowledge. Understanding what these conditions are, and how these change is important both to become critical concerning the limitations of current organizations of these concepts, but also so that one does not anachronistically project present concepts into the past, ie, seeing 18th century discourses as premature versions of today's ideas. The problem of madness as an object of knowledge is his task within the history of ideas, not discerning its reality.

Those that fail to recognize this, both the cultural relativists and the reactionaries, reveal their own lack of critical thought and say little about the text's strengths or weaknesses.

Madness and civilization is a powerful survey on the historical development of what we call madness today. What the term means today is radically different from what it meant during the age of reason. This book takes a more or less chronological approach to the development of madness. What is most important is it shows how the term mad was manipulated throughout history in order for society to redefine itself against "the other." This book makes a good case as to why we still live under the shadow of Freud, as Foucault credits him with defining the relationship of the clinically insane, and the physician. A must read to understand the current definition seperating the sane and the insane.

I read this book for a graduate class in psychotherapy. Given the choice of Foucault's history versus books on various theoretical perspectives on psychology and psychiatry, chosing this book was a no-brainer. Reading it, however, did take some brains, but it was worth the effort.

The first chapter is especially delightful. Its focuses on the time period from the end of the Middle Ages and into the Rennaisannce. Foucault gives many specific and poignant examples of how the changing view of insanity was intertwined with the changing concepts of God and humanity. I especially enjoyed the descriptions of the "Ship of Fools" and the extensive and elevative literary treatment of Folly during the sixteenth and early seventeenth centuries.

I would recommend this book to anyone in the mental health professions or to people of reason everywhere.

Foucault employs an exacting and yet artistic methodology of historical-sociological interpretation of the history of madness in the age of reason. In this impressive work, he discovers that the origin of insanity, of psychological confinement, corresponds with the diminution of leprosy in Europe, and that the sectors of institutional power sought to find another means of normalization and social control through the imprisonment, and public degradation of the mentally ill, the poor, and the homeless. This power dynamic later manifests itself in the form of absolute confinement and normalcy, in which the insane were subjected to physiological experimentation, which marks an apparent disregard for Descartes' mind-body distinction. Foucault skillfully outlines the means of psychological repair through the exploration of the balancing of the four humors, to the revealing of insanity's non-being and non-reason through its release to the ultimate freedom of nature. Foucault then examines the transition of psychology from the real of biological-intellectual non-reason, to the imposition of moral and religious absolutism and the birth of the asylum, and finally to the (perhaps salvation) of Freud and psychoanalysis, in which the patient-doctor relationship is recreated as a mode of observation, not judgment or condescension, "he made it the Mirror in which madness, in an almost motionless movement, clings to and casts off itself" (pg. 278). Foucault's Madness and Civilization represents an important breakthrough in the field of post-modern philosophy; it is truly an excellent work of scholarship and profound insight.

-As a side note, this edition appears to be an incomplete version of Foucault's book, as it contains nothing on Descartes and his methodoligical relation between madness and doubt raised in the Meditations. This section would later be the focus of Derrida's criticism in his lecture 'Cogito and the History of Madness,' published in 'Writing and Difference,'which caused a rift between the two thinkers. The Vintage edition appears to be only one half of Foucault's original book. The complete version of the text is going to be published by Routledge later this year, so hold off on this one.

The scope of this book is very broad, and while parts of it were tedious for me to read... the parts that benefited me most are likely to be parts that other people find tedious! Foucault's ambitious attempt to tackle so many aspects of our civilizations relationship with madness makes this a book that is not likely to entertain every reader from front to back, but I highly recommend it because the parts that did appeal to me were extremely insightful and actually had a genuine effect on my life.
Foucault discusses madness as the psychological state of a person who becomes engrossed by fantasy to the point where they cannot function in the everyday world. He cites a beautiful image from medieval European art- a bird with a long and delicate neck, symbolic of the time that thoughts take to get from the heart to the mind during contemplation. To demonstrate his concept of madness Foucault poetically warps this image into a bird with a neck so long that it piles up and weaves into a spaghetti-like mess. He states that madness often occurs because... people think too much!
People can become guided by or preoccupied by ideas that are from removed from everyday experience (e.g. a principle based on a theory informed by an idea extrapolated from another persons idea inspired by a theory derived from a principle that refuted an idea stating a theory hypothesized based on an observation... oh, and can we even trust the tools we use to observe the world through?). What I found most ironic while reading this book is that a good number of intellectuals and academics, going by Foucault's principle outlined above, might be considered mad because the ivory tower can be so far removed from the everyday world that people lose their grounding.
Ultimately, I found this book had a profound book on me because it worked as a sort of exorcism. At the time the book found it's way to me I had been heavily wrapped in metaphysical and occult preoccupations, and reading this book made me reconsider how much I know through first hand experience and how much am fantasy have I generated based on hearsay.

In this excellent and interesting history of madness in Western civilization Foucault examines how powerful institutions have operated in response to the irrational, and how the issue has been approached during different eras. How is madness defined, handled and treated- through the Renaissance theory of humours (surprisingly I found this very interesting, if even only for Foucault's explanation of this mystifying topic), to contemporary psychiatric methods (also, Foucault delves into the ways that these different models evolve from one into another). For people who need a bit of sensational spectacle or disturbing gore, the descriptions of asylums and confinement for patients creates a pretty graphic picture of the conditions people have endured during "treatment".

If you are looking to get into Foucault, this is a great place to start. It's a wonderful introduction to the concepts and themes that characterize this brilliant man's work, but the prose is far less dense than that of his later works.

A new edition w footnotes, etc. is out.
Here is a review:
"Foucault the Historian [Mark Bauerlein]
A new translation of the book that launched Michel Foucault's international fame has just come out. The book is Madness and Civilization, and the first translation back in 1965 was a shortened version of the original French publication. When it appeared in English, it was a sensation, and its thesis against Enlightenment reason found fans throughout the social sciences and humanities. Missing in the English version were several chapters and more than a thousand footnotes, and what remained was a sweeping indictment of the human sciences, large claims about the nature of madness and normalcy, and the transition into modernity. People loved it, and to anybody passing through graduate school in the last 30 years Foucault was a Pantheonic figure. It is hard, indeed, to communicate to outsiders just how powerfully Foucault's work and thought gripped substantial and powerful cliques in the academy.

The current translation includes the material left out of the earlier translation, and it offers an entirely different picture of the book. In a word, it includes all the historiographical labor that grounds the grandiloquent theses--all the books Foucault read and cited, the original documents he gathered, his representations of concrete historical situations, the latest scholarship he consulted on the issues.

But there's a problem, and this new version lays it out in detail. The scholarship is a mess. Foucault attributes positions to documents that are not to be found there. He takes dubious 19th-century sources at face value. He gets basic facts wrong. He ignores recent scholarship. The most celebrated and revered historian of the last 50 years, a presiding deity of cultural studies, an icon of gender theory, interdisciplinarity, and poststructuralism, it turns out, committed one historiographical crime after another to push a counter-Enlightenment thesis."

Madness and Civilization: A History of Insanity in the Age of Reason is one of those books that you are meant to have read in graduate school. It is also one of those books that I have read citations from, seen passages from, heard discussed, heard argued about and generally felt bad that I had never gotten around to reading. It's been sitting on my shelf for at least five years, I must admit.

I don't think that I need to say very much about the book itself. Foucault studies attitudes towards insanity throughout history, with particular attention to how the treatment of the mad was reflected by the current popular narrative about madness. The book is often cited as being against psychiatric institutions. After reading it, I tend to see that as an overstatement. I think that he is more or less simply raising the question as to whether what we see as "scientific" treatments for mental illness are not actually bearing out implicit societal biases about the nature of this kind of disease. In the model he examines, the romanticization of madness is dangerous but so is a view of madness as lack of discipline or moral fibre (for example). I think that it would be dangerous to extrapolate too much authorial meaning from the way that he addresses the subject.

I have read Foucault before, and I nearly always have the same reaction to his work. While he was clearly a brilliant man and while he has many interesting things to say, I do sometimes find there to be something quite glib about his thinking. Even here, in what is possibly his most famous work, there are moments where I felt as though he was poised to really dive into something interesting and instead moves on. Certainly thought-provoking, I will admit. But still somehow Madness and Civilization was not entirely satisfying.

I wish that he had included a bibliography. Also, he discusses so much about painting that it would be useful for the edition to contain a few prints. But these are minor quibbles.

Foucault's book is ostensibly about, well, madness and civilization. He examines "madness" in society from the Middle Ages up to the present time, and proposes, I think, that "madness" is an arbitrary social construct created by powerful people and institutions in a given society to define themselves in opposition to and in contrast with "the other". In this case, people who are "mad".

There are a wide variety of mental and neurological illnesses, such as depression or "meloncholia", substance abuse, mania, epilepsy, post traumatic brain injury, dementia, schizophrenia, antisocial personality disorders, etc. etc. that have been described in literature for centuries. They are usually considered unique illnesses with different causes and treatments, and authors and thinkers typically did not put them together in one category. Except Foucault. He seems to have created his own construct of "madness", where he lumped all sorts of behaviour together. He writes that every society creates an arbitrary construct of madness, but if that is true, then isn't his own construct of "madness" just as arbitrary and bounded and limited by his own particular time and place in history?

It is instructive to look at one manifestation of "madness"; schizophrenia. We do not know the incidence of this disease in various cultures in the past. However, we do know that the incidence of this disease is about 0.5% in all cultures at the present time. This suggests that the disease is not an arbitrary construct of a particular society, but rather a scientific fact of life that various cultures react to in different ways (some postmoderns may scoff at the idea of a "scientific fact", but this seems a little hypocritical, since these postmodern scoffers rely on the these facts every time they get on a plane, use a computer, go to the dentist, make coffee, etc etc). Foucault discusses madness in the past, but does not address it in contemporary world civilizations.

Foucault seems to define "civilization" as basically being something French. Their are some references to English and European writers, but they are infrequent. I am surprised at the paucity of references to neurologists and their ilk (OK, he mentions Charcot and Willis). I suspect that Foucault picked and chose his sources to support his construct of "civilization".

Foucault created his own constructs of "madness" and "civilization" to write a book that is interesting and instructive. These constructs were probably influenced by the fact that he was a French intellectual with a controversial personal and professional life who lived in twentieth century Europe. The book is partly about madness, civilization, and partly about Foucault. It should be read because of the content and because of the influence that it has in our society. It should also be taken with a grain of salt.