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Michel Foucault: Beyond Structuralism and Hermeneutics

The University of Chicago Press

Practices and Discourse in Foucault's Early Writings

The History of Madness

Madness and Civilization (1961) opens with a description of the exclusion and confinement of lepers in a vast network of leper houses scattered at the edges of European cities throughout the Middle Ages. Within these enclosures lepers were isolated from the inhabitants of the city and, at the same time, kept close enough to be observed. Their liminal position—at the edge but not beyond—was paralleled by the acute ambivalence with which they were regarded. Lepers were seen as dangerous and wicked; they had been punished by God but by the same token they were physical, bodily reminders of God's power and of the Christian duty of charity.

Dramatically and abruptly at the end of the Middle Ages the leper houses across Europe were emptied. But the physical site of social separation and moral connection was not to be left unoccupied. It was to be filled again and again by new occupants, bearing new signs and heralding new social forms. "With an altogether new meaning and in a very different culture, the forms would remain—essentially that major form of rigorous division which is social exclusion but spiritual reintegration" (MC 7). These twin themes of spatial exclusion and cultural integration which structure all of Madness and Civilization are captured in the first few pages.

Foucault follows his images of woe-begotten yet holy lepers with equally compelling descriptions of the Ship of Fools, Narrenschiff. During the Renaissance the mad were loaded onto ships and sent off to sail down Europe's rivers in search of their sanity. Bound on his ship, the madman was "a prisoner in the midst of what is the freest, the openest of routes ..." (MC 11). The madman in the Renaissance began to make his appearance as a cultural figure of major concern, replacing death as a focus of deep and pervasive concern about order and meaning. At first, he appeared as part of a larger number of different types who were lumped together: the fool, the simpleton, the drunkard, the debauchee, the criminal, the lover.

The theme of disorder was cast in terms of excess and irregularity, not in terms of medical or bodily dysfunction. Foucault's elaboration on the emerging contrast of reason and madness occupies a very large section of Madness and Civilization. It is this new cultural content—reason and madness in the Classical Age, sanity and insanity in our age—which changes radically from period to period, and which seems to be a series of approximations to an unseizable ontological condition of pure otherness, that lies at the center of Foucault's analysis. Foucault seems to have thought that there was "something" like pure madness which all these different cultural forms were groping after and covering up—a view he later abandons.

Foucault's analysis of these cultural discontinuities is always juxtaposed to a description of a rather more continuous story of confinement and exclusion. The meaning changes with some frequency, but a longterm continuity of form of what can only be called power is (and was) the counterpoint to these dramatic shifts in cultural classifications. It is this tension, played out with significant shifts in emphasis, which runs throughout all of Foucault's works. The simple juxtaposition of continuity and discontinuity, power and discourse as parallel pairs is most clearly stated in Madness and Civilization. But the connections and the specific mechanisms which order discourse and power remain highly undefined. This need for specification is the center of Foucault's attention in his later books, first on the side of discourse, then on the side of power.

The seventeenth century marked the change already mentioned—from the Renaissance to the Classical Age. The leper houses across Europe were suddenly emptied of their lepers and turned into houses of confinement for the poor. Foucault wants to understand both the social forces at work throughout Europe which produced such a dramatic organization of the poor and the cultural classification system of the age which lumped so many people together into a single category. Why was it, Foucault asks, that within the space of several months in 1656 one out of every hundred people in Paris was confined?

Foucault isolates the establishment by the king of the Hôpital Général as a major historical event. At first glance, this regrouping of a series of buildings and welfare functions under a single rubric would seem to be little more than an administrative reform. These various Parisian buildings—one had housed an arsenal, another was a rest home for military veterans—were now given over to the charge of caring for the poor, the mad, the homeless. The king's edict provided that all the poor, "'of both sexes, of all ages, and from all localities, of whatever breeding and birth, in whatever state they may be, able-bodied or invalid, sick or convalescent, curable or incurable'" (MC 39) had the right to be fed, clothed, housed, and generally looked after. A new series of high level administrators were appointed by the king, who had jurisdiction not only over the poor confined in the actual buildings but throughout the city of Paris. The edict declared the power of these administrators to be almost absolute: "'They have all power of authority, of direction, of administration, of commerce, of police, of jurisdiction, of correction and punishment over all the poor of Paris, both within and without the Hôpital Général'" (MC 40).

Although doctors were assigned to make the rounds of the various houses of confinement, Foucault strongly emphasizes that they were not primarily medical institutions. It was the poor, the recalcitrant, the vagabonds as well as the madmen who were thrown together. Foucault is at pains to point out that the sudden emergence of "the great internment" should not be understood as the muddled prescientific appearance of what would later become our mental hospitals and medical clinics. Here and elsewhere Foucault is most definitely not telling the story of scientific progress. Rather, the story for Foucault is the other way round. It is in the first major moves toward social internment, toward the isolation and observation of whole categories of people, that the first glimmerings of our modern medical, psychiatric, and human sciences are to be seen. These human sciences will later develop their methods, refine their concepts, and sharpen their professional defenses, but they will continue to operate within institutions of confinement. Foucault interprets them as playing an ever more crucial role in the specification and articulation of the classification and control of human beings, not as giving us ever purer truth.

In Madness and Civilization Foucault explicitly identifies the establishment of the Hôpital Général as the direct policy of royal authority. He sees it as "an instance ... of the monarchical and bourgeois order being organized in France during this period" (MC 40). The actors are identified, the actions given rather straightforward motivational accounting and the effects of their actions duly noted. In his later works, Foucault will rarely be this explicit about causal explanations of who acts and why; later, social, structural, and political dynamics will be problematized and recast. But, in Madness and Civilization it is only the discontinuous content of the cultural changes which remain free-floating and unexplained. The institutional and power side of things is given an explicit account. Foucault explains, for example, that by 1676 the king had extended this system of confinement and care throughout France. By the time of the French Revolution there was a great profusion and variety of these welfare institutions both in France and elsewhere on the continent. But at the beginning, Foucault explains, "there must have formed, silently and doubtless over the course of many years, a social sensibility common to European culture, that suddenly began to manifest itself in the second half of the seventeenth century; it was this sensibility that suddenly isolated the category destined to populate the places of Confinement" (MC 45). A new form of discourse and a new form of social institution emerged. So, Foucault tells us, "there must have existed a unity which justified its urgency" (MC 45). And indeed there was. The great confinement "organizes into a complex unity a new sensibility to poverty and to the duties of assistance, new forms of reaction to the economic problems of unemployment and idleness, a new ethic of work, and also the dream of a city where moral obligation was joined to the civil law, within the authoritarian forms of constraint" (MC 46).

Foucault lists the imperatives which made possible and necessary the appearance of the houses of confinement. First was the necessity of labor as both a moral and a social imperative. In the charter of the Hôpital the dangers of idleness and mendicancy for the city were stressed. As new forms of economic organization appeared, the hold of the guilds was weakened and social upheaval and dislocation followed. But whereas in previous periods of great unemployment the city protected itself against bands of vagabonds by putting guards at its gates, it now set up houses of internment within its walls. "The unemployed person was no longer driven away or punished; he was taken in charge, at the expense of the nation but at the cost of his individual liberty. Between him and society, an implicit system of obligation was established: he had the right to be fed, but he must accept the physical and moral constraint of confinement" (MC 48).

Foucault explains in a relatively straightforward way this linking of the welfare of the individual (and populations) to the administrative control of the state as the result of economic and social pressures. His analysis of the forms it took and particularly of the cultural idiom in which it played itself out is highly original, but the causal dimension of Foucault's analysis is not. He says, "Throughout Europe, confinement had the same meaning, at least if we consider its origin. It constituted one of the answers the seventeenth century gave to an economic crisis that affected the entire Western world: reduction of wages, unemployment, scarcity of coin ..." (MC 49). In Foucault's later works the periodization, the relative importance of these socioeconomic imperatives, the complex relations to the "sensibility of the age" and to scientific discourse, and the specific mechanisms of its operations will be problematized and rarely set into such straightforward causal terms. But the thematic unity, at least, of Foucault's interests is clear enough.

Our modern relations with the insane emerged abruptly after the French Revolution. "Every psychiatrist, every historian yielded, at the beginning of the nineteenth century, to the same impulse of indignation; everywhere we find the same outrage, the same virtuous censure" (MC 221). This outrage turned on the newly perceived fact that the insane and the criminal were thrown together in the same houses of confinement. Clearly, or clearly to those holding this newly emergent sensibility, this was a shocking violation of categories. The modern separation of the insane from the criminal, the indigent, the debauched and their incorporation into the realm of the medical first appears in scores of shocked and outraged cries of humanitarian pain. Foucault quickly asserts that this was not some simple advance of humane treatment of others advancing under the guidance of science. No, "it was the depths of confinement itself that generated the phenomenon; it is from confinement that we must seek an account of this new awareness of madness" (MC 224). Although this sounds mysterious Foucault presents a straightforward account on two levels.

First, there was, as it were, an efficient cause. It was the protests of the imprisoned "criminal" nobility and intelligentsia who called attention to the mixing of the criminal and the insane. They demanded, for themselves, a separation of what they saw as an incompatible and suddenly incongruously promiscuous intermingling of different categories of persons. They called not for a freeing of the insane or even better treatment for them. They demanded only that ordinary criminals not be mixed with the insane lest they too leave the houses of confinement without their reason. "The presence of the mad appears as an injustice; but for others" (MC 228).

Second, a deep restructuring of both social sensibility and economic relations was taking place. Poverty, which had been seen as a vice and a danger to the social body, was now seen as a hidden but essential advantage for the nation. Those poor who were willing to work for low wages and to consume little constituted one of the essential ingredients of a nation's wealth. The notion of population as a crucial economic and social resource to be taken into account, to be organized, to be made productive comes to the fore.

Foucault treats the theme of population at greater length in several of his other books. In The Order of Things the analysis of labor and its changing discursive organization in the Classical Age and in our current Age of Man constitutes roughly one-third of the book, along with parallel analyses of life and language. In Discipline and Punish Foucault moves beyond his analysis of the discursive structure of labor and population and situates this analysis in the shifting development of what he now calls "bio-power." Bio-power (see chapter 6), our modern form of power, is characterized by increasing organization of population and welfare for the sake of increased force and productivity. In this analysis the discursive and the institutional are once again brought back into a complex relationship. But in their later form less emphasis is given to the state and to capitalist growth, which Foucault takes for granted as an essential part of the story, and more attention is given to pinpointing exactly how this form of power is made to work on the local level.

It follows that if population was a potential component of the nation's wealth, then "confinement was a gross error, and an economic mistake" (MC 232). General confinement had to be abolished. It was replaced by a more scientific and humane specific confinement which separated certain categories of criminals (discussed by Foucault in Discipline and Punish ) and the insane. The mad, it was now felt, must be liberated from their chains and cages and returned to health. What Foucault refers to as the mythic history of our progressive humanization of treatment of the insane hides "beneath the myths themselves ... an operation, or rather a series of operations, which silently organized the world of the asylum, the methods of cure, and at the same time the concrete experience of madness" (MC 243). Foucault concentrates on the Quaker reformers in England associated with the name Tuke and the medical rationalists in France led by Pinel. His descriptions of the techniques developed and the general strategy for the treatment of madness used by these two schools are paralleled by those used for the treatment of criminal behavior by the same groups.

The strategy of the Quakers was to make each inmate or patient take responsibility for his crime or his illness. "Tuke created an asylum where he substituted for the free terror of madness the stifling anguish of responsibility; fear no longer reigned on the other side of the prison gates, it now raged under the seals of conscience" (MC 247). The emphasis was on getting the patient to accept his own guilt and responsibility. This involved a complex series of institutional arrangements. There was a structured hierarchy of relations in the asylum, in which the patients were at the bottom.

Since the patient was seen to be responsible for his illness, therapeutic intervention in the form of punishments became a standard mode of treatment. The goal of these interventions was to bring the patient to an awareness of his status as a subject, responsible for his own actions. Hence the subject, observed and punished by his warders, was led by a carefully structured series of procedures to do the same thing to himself. Once this internalization was accomplished, so the theory goes, the patient would be cured. "This movement by which, objectifying himself for the Other, the madman thus returned to his liberty, was to be found as much in Work as in Observation" (MC 247).

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Excerpted from Michel Foucault: Beyond Structuralism and Hermeneutics by Hubert L. Dreyfus, Paul Rabinow. Copyright © 1983 The University of Chicago. Excerpted by permission of The University of Chicago Press.
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