Michel Foucault’s first major study, History of Madness, documents the unjust social exclusion of the disabled in the modern era but fails to offer a coherent and credible way to transcend it. Initially a teacher of psychology and a psychiatric researcher, then the famous philosopher and radical social critic, Foucault (1926‒1984) followed an intellectual path astonishingly similar to that of Friedrich Nietzsche, his chief influence, from a questioning sense of the tragic condition of modern man in the 1961 edition of History of Madness (cf. Nietzsche’s Gay Science, books 1-4), to a firmer confidence in the potential for uninhibited self-creation in the additions to the 1972 reissue (cf. Gay Science, book 5). Thus, by contrast to the more certain and total rejection of moral objectivity exhibited in his later work, this early work portrays the author’s own difficulty in deciding how to respond to social oppression.
David Macey, Foucault’s biographer, noted the difficulty of History of Madness and how it “defies attempts to summarize its contents” because its expansive investigation into various social strata weaves together complex analyses of diverse historical sources, including famous works of visual art, literature, philosophy, and theology, as well as obscure legal and medical documents. But it does display a philosophically-tinged historical logic, including a definite method as well as key terms and claims, which are susceptible to concise description and critical engagement. With regard to methodology, Foucault explicitly states his purpose to avoid the common presumption of “narratives of progress” that read history as if scientific reason and institutions were its inevitable telos. Thus, rather than portray the history of madness as a movement toward the triumph of modern psychiatry, he shows how the genesis of social structures from the Middle Ages to today founded the unique concepts and experiences of madness in these distinct eras.
Foucault’s assessment of Christianity here fails to sufficiently consider its claim that divine wisdom is the foolishness of love, which gladly suffers on the cross for the beloved (see 1 Cor 1-2).
This method is matched by a set of key terms, including “madness,” “reason,” and “unreason.” In contrast to mental illness, which is a physical illness that affects reason, madness for Foucault is strictly socially-constructed. He defines it most concisely as the “absence of an oeuvre,” which is to say, the lack of any effective role in the culture. To be clear, he is not claiming that madmen lack the capacity for creativity but rather that those deemed mad in any era are preemptively deprived of creative influence in being excluded by the dominant culture. Madness, then, is an exclusory name for what he calls unreason: those dark, subterranean forces of nature that exceed the grasp of reason, including animal passions, especially sexual passion, disease, and death. His basic thesis is that Western reason, particularly since the 17th century, has unknowingly constituted itself as the mastery of unreason through an act of exclusion by which it assigns to unreason the name of madness, rather than entering into dialogue with it. Although his method claims to avoid morality and teleology, this thesis implies a moral imperative: the oppression of the “mad” should give way to the celebration of unreason; that is, the power of reason should join forces with the irrational powers of nature in the act of free self-creation. Accordingly, dispositions of mental illness, disease, and disability, should not be considered abnormal, but should be seen as apt material for the creativity of reason.
Foucault’s historical investigation begins in late medieval and renaissance Europe where the mad were sometimes exiled and reduced to wandering but remained part of the social fabric. On the one hand, they were an occasion for charity, as shown by the way that hospitals began to reserve a special place of care for them. On the other hand, they were a sign for the imagination of hidden worlds and cosmic forces, as shown by the paintings of Dürer and Bosch. But as Christian thought advances, the dark powers represented by madness were integrated into an order of divine reason that unilaterally determined their ultimate meaning. Foucault’s assessment of Christianity here fails to sufficiently consider its claim that divine wisdom is the foolishness of love, which gladly suffers on the cross for the beloved (see 1 Cor 1-2). Accordingly, “madmen” like St. Francis who love too much, far from being absorbed or excluded, are exemplars of Christian wisdom, and the mentally ill and disabled with their capacity for empathy have a unique potential to become sacraments of divine love. The claim that reason and infinite passion are one in Love would challenge Foucault’s basic division between reason and unreason and point to a positive sense of madness.
Foucault’s more illuminating account of the shift from the Renaissance to classical modernity focuses on a major symbolic event: the founding of the Hôpital Général in France in 1657 where madmen, the poor, sexual deviants, and thieves, among others, were confined together en masse in harsh conditions without distinction. Initiated throughout Europe in order to overcome the unrest and moral decay associated with idleness—the chief sin of the emerging bourgeois order—this mass confinement created a “uniform world of Unreason” apart from society. Thus the mad, now associated with the limitless frenzy of animal passion, were indiscriminately grouped together with homosexuals, adulterers, and victims of venereal disease, all of whom were considered moral threats to the bourgeois family.
Foucault then focuses on another symbolic event: Philippe Pinel’s mythologized liberation of the mad from their chains at Bicêtre Hospital in 1794 and the founding of a new kind of mental asylum at Salpêtrière (the analogy in America is Dorothy Dix and William Tuke in England). While familial conflicts became more and more a private affair, a problem of guilt over the failure to achieve bourgeois ideals, the severely deranged continued to be confined in these new asylums modeled on the patriarchal family. In this space, unchained madmen were preemptively silenced by the authoritarian gaze and moral monologue of the doctor who stands as reason over against unreason. Although Freudian psychoanalysis restored speech to the mad, Foucault sees this too as a form of “the absolute Gaze,” a kind of mirror for madness that controls it by showing it to be such. Despite the development of authentic physical cures for mental illness, psychiatry today continues to blindly constitute itself as dual control of bourgeois immorality or “madness,” on the one hand, and physical disease, on the other.
But the book’s conclusion expresses hope for an unspecified change in light of the enduring artwork of excluded “madmen” like Van Gogh and Nietzsche who entered into dialogue with unreason, called into question the domination of reason, and thus make the world “aware of its guilt.” With this surprising ending, Foucault seems to call into question his a-moralism and relativism, for he suggests here that the beauty of the persecuted and their persistent creativity make a claim on the human community and reveal its failure to secure its own common good. In other words, this uncertain but subtly hopeful conclusion points to the idea that the beauty and goodness of others, especially of marginalized “madmen,” make a claim on “the world,” calling for shared repentance and social transformation. Foucault implies, then, that there is common good and objective beauty transcending not only bourgeois morality but also individualistic self-creation.
However, in the added preface and appendices to the 1972 edition, a more optimistic tone accompanies a more radical acceptance of his original presuppositions: human reason is unrestrained self-creation through the control and appropriation of unreason, disorder, and destruction. Foucault, an avid political activist for freedom from social norms, hoped that mankind could share in this pursuit together, despite the fact that nothing good, true, or beautiful could possibly endure. But his own life and work, like Nietzsche’s, casts doubt on this celebration of pure self-creation in the face of ultimate destruction. For while they both succumbed to disease before old age (Foucault of AIDS, Nietzsche supposedly of syphilis), their thought-provoking critiques of the modern epoch and their pathos for those oppressed by it continue to raise the question of whether there is more for which to be hoped. While Foucault, moreover, should be commended for helping us to separate the ideas of moral culpability and mental disability, his total denial of norms for personal health or wholeness undercut the possibility for the integral healing of mind and body. Even more importantly, his false ideal of individualistic power undermines the true power of the mentally ill and disabled: the power to receive, give, and elicit mutual love.