Sunday, April 19, 2015

Foucault on the History of Madness: A Critique

Foucault’s elaborate theories of madness, mental illness and the history of the asylum were expounded in the following works:
(1) Mental Illness and Psychology (1954; 2nd edn. 1962):
Foucault, Michel. 1954. Maladie mentale et personnalité (1st edn.). Presses universitaires de France, Paris.

Foucault, Michel. 1962. Maladie mentale et personnalité (2nd rev. edn.). Presses universitaires de France, Paris. Presses universitaires de France, Paris = Foucault, Michel. 1976. Mental Illness and Psychology (trans. Alan Sheridan). Harper and Row, New York.
(2) The Birth of the Clinic (1963):
Foucault, Michel. 1963. Naissance de la clinique: une archéologie du regard médical . Presses universitaires de France, Paris. 212 p. = Foucault, Michel. 1973. The Birth of the Clinic (trans. Allan M. Sheridan). Pantheon, New York; and Foucault, Michel. 2003. The Birth of the Clinic: An Archaeology of Medical Perception (trans. Allan M. Sheridan). Routledge, London. 266 p.
(3) Madness and Civilization: A History of Insanity in the Age of Reason (1961; abridged version 1964; new full edition 1972):
Foucault, Michel. 1961. Folie et déraison: Histoire de la folie à l’âge classique [Madness and Unreason: History of Madness in the Classical Age]. Plon, Paris. 673 p. (the best translation of this appears to be Foucault, Michel. 2006. History of Madness (ed. Jean Khalfa; trans. Jonathan Murphy and Jean Khalfa). Routledge, New York, from the 1972 Gallimard edition).

Foucault, Michel. 1964. Folie et déraison: Histoire de la folie à l’âge classique [abridged version of Folie et déraison: histoire de la folie à l’âge classique 1961]. Union générale d’éditions, Paris. 308 p. = Foucault, Michel. 1965. Madness and Civilization: A History of Insanity in the Age of Reason [some material from the 1961 edn. put back in by Foucault but cut from the French 1964 edn.] (trans. Richard Howard). Pantheon Books, New York. 299 p.; and Foucault, Michel. 2006. Madness and Civilization: A History of Insanity in the Age of Reason (trans. Richard Howard). Taylor & Francis, London and New York.

Foucault, Michel. 1972. Histoire de la folie à l’âge classique [History of Madness in the Classical Age; 2nd edn.; new preface and appendices]. Gallimard, Paris. 613 p. = Foucault, Michel. 2006. History of Madness (ed. Jean Khalfa; trans. Jonathan Murphy and Jean Khalfa). Routledge, New York. 725 p.
These books were written when Foucault was in his Marxist and structuralist phase, though it is known that Foucault dropped a lot of the Marxist theory in Maladie mentale et personnalité by the time of the second edition in 1962. It should also be pointed out that some commentators see Foucault’s work up to the 1960s as being greatly influenced by structuralism even though he was not a full-blown structuralist (Olssen 2003: 191).

His major work L’histoire de la folie à l’âge classique [Madness and Civilization: A History of Insanity in the Age of Reason] (1961) was written in Foucault’s structuralist or quasi-structuralist phase and was based on his PhD thesis. The original French edition of 1961 ran to 673 pages, but an abridged version of 308 pages appeared in 1964, which was translated into English and which has been generally used by English commentators, until a complete translation of the 1961 edition appeared in 2006 as the History of Madness (Foucault 2006).

I will provide a critique of the History of Madness in what follows.

Immediately, the issue of objective truth arises. Even defenders of Foucault admit frankly that the consensus of historians is that Foucault’s work on this subject is “bad history” (Gutting 2005: 51) – that is, it contains too many errors of fact. Some apologists for Foucault even try and counter this by claiming that Foucault’s works are not even meant to be history at all! (Gutting 2005: 51; Flynn 2005: 40).

This is an appalling admission of failure: if Foucault was not writing history, then what was he writing? If apologists for Foucault wish to complain that he wasn’t really doing history and his work can’t be held to standards of objective truth, they have effectively admitted that Foucault’s “history” was an utter joke, since there would be no theories or facts in it to be judged as true or false. Foucault’s work would be in a different genre altogether: it would belong to the realm of theology, fiction, poetry or supernatural metaphysics.

Any rational criticisms of Foucault’s work must start from the premise that it is supposed to be history. If we do not admit there was an objective truth to what happened in history, any attempt by Foucault to do “history” cannot even be taken seriously.

I take it, then, that we must presuppose objective truth and facts in history, which we can discern through the surviving evidence and best historical research.

So what was Foucault’s thesis on madness?

Foucault divided the history of the West’s treatment of the insane into the following periods:
(1) the Middle Ages;

(2) the Renaissance: the discourse of ironic high reason;

(3) the Classical Age or Age of Reason: the 17th to the 18th centuries: the Great Confinement;

(4) the late 18th century and 19th century: the treatment of madness as psychiatric disorder.
We should note that the “Age of Reason” or “Classical Age” for Foucault was from about 1650 to the eighteenth century.

Foucault thought the following about madness in the West. In the Middle Ages, madness was more or less a recognised part of the truth of existence and there was a general open tolerance for the mad (Scull 1990: 62). Even when they were ejected from towns, the mad were not generally confined but could often lead an itinerant existence (Foucault 2006: 9). Even in the Renaissance there was a relative openness to the treatment of the mad who were not locked away en masse (Midelfort 1980: 250).

In the “Age of Reason” (17th to 18th centuries) there was a fundamental break in the treatment of the mad. There began a “Great Confinement” as the insane were locked away in “general hospitals,” workhouses, and later asylums, and often with the poor, aged, criminals, prostitutes and beggars (Midelfort 1980: 250). Madness became a type of immorality and the mad were regarded as those who had lost their reason and as being like animals.

From the late 18th century, there was another transition: madness was now considered a mental illness and medical problem. Modern insanity as a mental illness was “invented” by medical reformers (Midelfort 1980: 251).

Furthermore, Foucault’s interpreters argue that his fundamental thesis is that modern scientific psychiatry has not progressed towards the truth about human mental illness, but that modern psychiatric medicine is just a new form of “social control” (Khalfa 2006: xvi). In other words, Foucault is supposed to have proved that madness is just a “social construct” (Gutting 2005: 50). I strongly disagree, but I will return to this at the end of the post.

A central element of Foucault’s ideas on the treatment of madness in the Middle Ages is the idea of the “ship of fools” (Narrenschiff). These were ships in which the mad were sent on journeys or pilgrimages together away from towns so that they could “find” their reason and sanity. Foucault is quite clear that the ship of fools was a real phenomenon (Foucault 2006: 9). Unfortunately, there is not a shred of evidence that such ships – as Foucault understood them – actually existed (Midelfort 1980: 254; Scull 2007: 4; Scull 1990: 63). They were just literary or artistic themes in medieval and Renaissance art and literature, such as, for example, Hieronymus Bosch’s painting the Ship of Fools (c. 1490–1500).

Foucault’s contention that before the Age of Reason madness was considered a natural part of life and that there was even a positive attitude to it is one-sided. In fact, one prominent negative medieval and Renaissance view of madness seems to have been that madness was the consequence of sin (Midelfort 1980: 254), and this contradicts Foucault’s theory of a relative openness in ideas on madness before the Classical age. As late as the 16th century, madness was still sometimes explained by demonic possession (Midelfort 1999: 9), and treated with fear and horror.

Worse still, despite Foucault’s myth of openness in the Medieval period, historians find many instances of extreme cruelty to the mad in the Middle Ages, and dangerous madmen were generally locked up, sometimes in chains (Midelfort 1980: 253). The imprisonment of the insane (especially dangerous ones) in cells, prisons or cages was not infrequent in the later Middle Ages and Renaissance (Midelfort 1980: 253).

One of the first hospitals for the mad was established by the friar Juan Gilabert Joffre in Spain in 1409 (Pérez et al. 2012), and by the later 15th century in Spain, there was a network of charitable hospitals for the mad (Midelfort 1980: 253; Merquior 1991: 27), and elaborate theories on how madness was a human physiological disorder were well known in late medieval Europe, often from Islamic medicine (Merquior 1991: 27; Midelfort 1980: 253). Even cruel medical treatments for madness as an illness were practiced in the Middle ages and go right back to the ancient Greek and Roman world (Merquior 1991: 27).

It is clear, then, that treatment of madness as an illness existed well before the 18th century (Midelfort 1980: 253), and if Foucault meant to suggest that the Medieval age was one of relative tolerance and permissiveness towards madness, it turns out to be largely a fiction.

What of Foucault’s “Great Confinement”? Defenders of Foucault argue that his major point was the exclusion and confinement of the mad in the Age of Reason occurred in a way fundamentally distinct from earlier ages (Gutting 2005: 52). This is wrong. In England and Germany, the facts do not fit Foucault’s theory of the Great Confinement (Merquior 1991: 28; Midelfort 1980: 256–257; Midelfort 1999: 7–8; Porter 1990: 48). There was no European-wide “Great Confinement” as imagined by Foucault (Scull 2007: 4).

But there was a real phenomenon: a forced confinement in the 17th and 18th centuries in France and some other countries that was directed against poverty, poor beggars, poor deviants, poor criminals and poor madmen (Midelfort 1980: 255). But it was only a narrow class of madmen who were affected by a Great Confinement in France who were sent to general hospitals (Midelfort 1980: 255). Even in this confinement, the general hospitals largely developed out of medieval hospitals and monasteries, not largely from reopened leprosaria as in Foucault’s theory (Merquior 1991: 28; Midelfort 1980: 256).

Foucault’s “Great Confinement” – the idea that a general confinement by a rising bourgeois society of the work-shy poor, mad, deviants, beggars and criminals to general hospitals in the Age of Reason – is therefore a quasi-Marxist fantasy (Midelfort 1980: 257; Windschuttle 1994: 140).

Moreover, even in the Classical age madness was often treated as an illness and the mad were given medical cures (Midelfort 1980: 256). If anything, the increasing “medical” attitude to madness in Foucault’s Classical age was just a stronger development of trends already seen in the Middle Ages, and did not constitute a sharp break with some earlier golden age of tolerance (Merquior 1991: 27).

If there was no Great Confinement directed at all madmen (but simply at poor ones), then it follows that many of the mad continued to have a great deal of freedom right down to the 18th century. The evidence confirms this. Even by the late 18th century in France recent research shows that only about 5,000 mad or mentally-disturbed people were locked up in the hôpital general institutions – a small of minority of the total number of mentally-ill people who were mostly still at large in French society (Midelfort 1990: 43; Scull 2007: 4).

In Britain, the story is similar. Even by the late 18th century most of the mad remained at large or were looked after at home by relatives (Windschuttle 1994: 146). There were some few private asylums but the numbers of people incarcerated here were small (Windschuttle 1994: 146). Even Foucault’s claims about Britain’s infamous Bethlem Royal Hospital (or “Bedlam”) are untrue. Foucault asserted that in the early 1800s the inmates of Bedlam were put on public display on Sundays, and that this attracted some 96,000 visitors a year (Foucault 2006: 143). In reality, none of this is true (Scull 2007: 4). In England, within the small numbers of private asylums for the mad, the tendency was to separate the insane from other social outcasts like beggars, the elderly and the poor, which, once again, contradicts Foucault’s theory (Porter 1990: 49).

Even more damagingly, it was in the 19th century that the confinement of the mad really became strong and intensified and was much more prevalent than in the Classical age (Merquior 1991: 28). It was the 19th century that was the age of confinement, if we want to use that term (Midelfort 1990: 43; Midelfort 1980: 257).

Yet at this time in 19th century America there was even a well-documented turn away from psychiatric treatment towards merely custodial care of the insane (Merquior 1991: 29) – contradicting Foucault’s theory.

Finally, regarding the idea that madness has just been “invented” by modern doctors and psychiatrists, what can we say about this? There is fallacy of equivocation here, however. Are we talking about
(1) each age’s definition of madness, explanation of madness, its attempts to categorise it and attempts to cure it, or

(2) actual biological and empirical questions about whether mental illness is produced by brain dysfunction, and the evidence for and against this?
That people in the past had different views of madness and its causes (and in turn prescribed different things for its treatment) hardly proves that modern science-based, clinical psychiatric medicine has done no better in actually identifying the causes of mental illness and providing effective treatment (N.B.: I am utterly excluding Freudian psychoanalytic pseudo-science from science-based medicine here). On the contrary, the very success of modern medicine and the highly effective treatments for many mental disorders as against past “treatments” for madness are strong evidence that science has got something right which people in the past have got wrong.

People in the past were just incredibly ignorant about many things, and their science was weak. They made bad mistakes. We can easily apply this to the history of infectious disease, cancer and all other maladies from which human beings suffer. The fact that different ages classified diseases in different ways from us and had different explanations and cures for them hardly proves that modern scientific medicine is just a “narrative” or “social construct,” or that it has no strong claim to coming closer and closer to objective truth about disease.

BIBLIOGRAPHY
Foucault, Michel. 2006. History of Madness (ed. Jean Khalfa; trans. Jonathan Murphy and Jean Khalfa). Routledge, New York.

Flynn, Thomas. 2005. “Foucault’s Mapping of History,” Gary Gutting (ed.), The Cambridge Companion to Foucault (2nd edn.). Cambridge University Press, Cambridge, U.K. and New York. 29–48.

Gutting, Gary. 2005. “Foucault and the History of Madness,” in Gary Gutting (ed.), The Cambridge Companion to Foucault (2nd edn.). Cambridge University Press, Cambridge, U.K. and New York. 49–73.

Khalfa, Jean. 2006. “Introduction,” in Michel Foucault, History of Madness (ed. Jean Khalfa; trans. Jonathan Murphy and Jean Khalfa). Routledge, New York. xiii–xxvi.

Merquior, José Guilherme. 1991 Foucault (2nd edn.). Fontana, London.

Midelfort, H. C. Erik. 1980. “Madness and Civilisation in Early Modern Europe: A Reappraisal of Michel Foucault,” in Barbara C. Malament (ed.), After the Reformation: Essays in Honour of J. H. Hexter. Manchester University Press, Manchester. 247–265.

Midelfort, H. C. Erik. 1990. “Comment on Colin Gordon,” History of the Human Sciences 3.1: 41–45.

Midelfort, H. C. Erik. 1999. A History of Madness in Sixteenth-Century Germany. Stanford University Press, Stanford, Calif.

Olssen, Mark. 2003. “Structuralism, Post-Structuralism, Neo-Liberalism: Assessing Foucault’s Legacy,” Journal of Education Policy 18.2: 189–202.

Pérez, Jesús, Baldessarini, Ross J., Undurraga, Juan and José Sánchez-Moreno. 2012. “Origins of Psychiatric Hospitalization in Medieval Spain,” Psychiatric Quarterly 83.4: 419–430.

Porter, Roy. 1990. “Foucault’s Great Confinement,” History of the Human Sciences 3: 47–54.

Scull, Andrew. 1990. “Michel Foucault’s History of Madness,” History of the Human Sciences 3: 57–67.

Scull, Andrew. 2007. “Scholarship of Fools,” Times Literary Supplement no. 5425, 23 March 2007, pp. 3–4.

Still, Arthur and Irving Velody. 1992. Rewriting the History of Madness: Studies in Foucault’s ‘Histoire de la folie’. Routledge, London and New York.

Windschuttle, Keith. 1994. The Killing of History: How a Discipline is being murdered by Literary Critics and Social Theorists. Macleay Press, Sydney.

Windschuttle, K. 1998. “Foucault as Historian,” in Robert Nola (ed.). Foucault. F. Cass, London and Portland, Or. 5–35.

4 comments:

  1. Thanks a lot for compiling all these critiques, wonder how MF can continue to be regarded so highly still!

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  2. It's been a long time since I read this book, and it's probably Foucault's worst, but I have a couple comments:

    "a well-documented turn away from psychiatric treatment towards merely custodial care of the insane – contradicting Foucault’s theory."

    The book is basically just about how the idea of madness changed over time. He talks about tendencies he's noticed over this time, but this example hardly 'contradicts' what he claims to be a tendency (as a result of changing views on what madness is). This strikes me as similar to arguing his idea about epistemes (Order of Things) isn't true because there were some theorists during a certain era would don't fall into the episteme (like people who believe in pseudo-science today, but it doesn't refute the notion that we're a such-and-such era w/ respect to how we think about certain scientific issues). Maybe there's a more specific contradiction here that I can't remember.

    "...or that it has no strong claim to coming closer and closer to objective truth about disease."

    I'm not sure Foucault ever made this claim. He emphasized that we often take it for granted that we're always making steady progress on these types of issues, but it's a notion that takes more work to demonstrate than most people assume to think because of the huge changes in scientific thinking (paradigm shifts/epistemes).

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  3. "a well-documented turn away from psychiatric treatment towards merely custodial care of the insane – contradicting Foucault’s theory." What?

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