History of Madness

Michel Foucault

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134473793
• Topic: Philosophy
• Subtopic: Philosophy History & Theory
• Edition: 1

When it was first published in France in 1961 as Folie et Déraison: Histoire de la Folie à l'âge Classique, few had heard of a thirty-four year old philosopher by the name of Michel Foucault. By the time an abridged English edition was published in 1967 as Madness and Civilization, Michel Foucault had shaken the intellectual world.

This translation is the first English edition of the complete French texts of the first and second edition, including all prefaces and appendices, some of them unavailable in the existing French edition.

History of Madness begins in the Middle Ages with vivid descriptions of the exclusion and confinement of lepers. Why, Foucault asks, when the leper houses were emptied at the end of the Middle Ages, were they turned into places of confinement for the mad? Why, within the space of several months in 1656, was one out of every hundred people in Paris confined?

Shifting brilliantly from Descartes and early Enlightenment thought to the founding of the Hôpital Général in Paris and the work of early psychiatrists Philippe Pinel and Samuel Tuke, Foucault focuses throughout, not only on scientific and medical analyses of madness, but also on the philosophical and cultural values attached to the mad. He also urges us to recognize the creative and liberating forces that madness represents, brilliantly drawing on examples from Goya, Nietzsche, Van Gogh and Artaud.

The History of Madness is an inspiring and classic work that challenges us to understand madness, reason and power and the forces that shape them.

Part One

I
Stultifera Navis

At the end of the Middle Ages, leprosy disappeared from the Western world. At the edges of the community, at town gates, large, barren, uninhabitable areas appeared, where the disease no longer reigned but its ghost still hovered. For centuries, these spaces would belong to the domain of the inhuman. From the fourteenth to the seventeenth century, by means of strange incantations, they conjured up a new incarnation of evil, another grinning mask of fear, home to the constantly renewed magic of purification and exclusion.

From the High Middle Ages until the end of the crusades, leprosaria had sprung up and multiplied across the surface of Europe. The exact figure is unknown, but according to Mathieu Paris, there were some 19,000 of these cities of the damned spread throughout Christendom.¹ In the years leading up to 1266, when Louis XIII ordered a set of statutes to be drawn up for the lazar houses, there were more than 2,000 such institutions in France. They numbered forty-three in one diocese in Paris alone, and Bourg-la-Reine, Corbeil, Saint-Valère, and the sinister Champ Pourri (Rotten Row) all figure on the list. Charenton, a name that would resonate down the centuries, is there too. The two largest houses — Saint-Germain and Saint-Lazare — were on the immediate outskirts of Paris, and their names too will crop up in the history of another sickness.² From the turn of the fifteenth century, a new emptiness appears: Saint-Germain becomes a home for young offenders the following century, and before Saint Vincent, Saint-Lazare counted only one leper, ‘Le Sieur Langlois, a practitioner in the civil court’. The leprosarium in Nancy, which had been one of the largest in Europe, had only four inmates during the regency of Marie de Médicis. The Mémoires of Catel recount that there were twenty-nine hospitals in Toulouse at the end of the medieval period, seven of which were leprosaria, but at the end of the seventeenth century the number had shrunk to three — Saint-Cyprien, Arnaud Bernard and Saint-Michel.³ Festivities were widespread to celebrate the disappearance of leprosy: in 1635 for instance, the inhabitants of Reims processed solemnly to thank God for delivering their town from its plight.⁴

By that time, the French crown had already been reorganising the immense land bank that the leper houses represented for more than a century. François I had ordered a census and an inventory of all such institutions on 19 December 1543 ‘to put an end to the great disorder apparent in leper houses’, and in his turn Henri IV decreed in 1606 that the accounts of such institutions be revised ‘and that revenue accruing from this review be used for the upkeep of poor gentlemen and invalid soldiers’. Another such overview was ordered on 24 October 1612, with the idea that this time the surplus revenue be used to feed the poor.⁵

In fact the leprosaria question wouldn’t be settled in France before the close of the seventeenth century, and the economic importance of the question would be at the base of many a conflict. In 1677, there were still forty-four leprosaria in the province of Dauphiné alone.⁶ On 20 February 1672 Louis XIV transferred control of all military and hospital orders to the orders of Saint Lazare and Mont Carmel, which were entrusted with the administration of all the remaining leprosaria in the kingdom.⁷ Twenty years later the 1672 edict was revoked and, by means of series of measures that came into force from March 1693 to July 1695, the goods of the leper houses were redistributed among other hospitals and institutions for the succouring of the afflicted. The few lepers who still inhabited the 1,200 leprosaria that remained were grouped together in Saint-Mesmin near Orleans.⁸ These new orders were first brought into force in Paris where Parliament transferred the revenue in question to the Hôpital Général, and the example was soon being followed in the provinces. In Toulouse, all leprosy possessions were redirected to the hospital for Incurables in 1696, revenue from Beaulieu in Normandy was transferred to the main hospital in Caen, and in Voley, the money was transferred to the Sainte-Foy hospital.⁹ Together with Saint-Mesmin, only Les Ganets near Bordeaux retained its former status.

For their million-and-a-half inhabitants in the twelfth century, England and Scotland had opened 220 leper houses. But even by the fourteenth century they were beginning to empty: when Richard III ordered an inquiry into the state of Ripon hospital in 1342, it emerged that there were no more lepers, and the foundation was charged with the care of the poor instead. By 1434, in the hospital founded in the late twelfth century by Archbishop Puisel, there were only two remaining beds reserved for lepers, and they were often unoccupied.¹⁰ In 1348 the great leper house of Saint-Alban had only three inhabitants; Romanall hospital in Kent was abandoned twenty-four years later as no more lepers could be found. In Chatham, the Saint Bartholomew leper house founded in 1078 had been one of the biggest in the country: by the time of Queen Elizabeth it had only two inmates, and it was finally closed altogether in 1627.¹¹

The same regression of the disease was witnessed in Germany, although there the process was slightly slower. As in England, the Reformation hastened the transfer of control of the leper houses to local city authorities, who converted them into houses for the poor or hospitals, as was the case in Leipzig, Munich and Hamburg. In 1542, all possessions of the leper houses of Schleswig-Holstein were handed over to hospitals. In Stuttgart, a magistrate’s report indicated in 1589 that no leper had been recorded in the city’s lazar house for more than fifty years. In Lipplingen, the lazar house was soon peopled with the insane and the incurably ill.¹²

This strange disappearance was probably not the long-sought-after result of obscure medical practices, but rather a spontaneous result of segregation, and the consequence, with the coming of the end of the crusades, of cutting the cord that led to the main source of infection in the Middle East. Leprosy retreated, and the lowly spaces set aside for it, together with the rituals that had grown up not to suppress it but to keep it at a sacred distance, suddenly had no purpose. But what lasted longer than leprosy, and persisted for years after the lazar houses had been emptied, were the values and images attached to the leper, and the importance for society of this insistent, fearsome figure, who was carefully excluded only after a magic circle had been drawn around him.

If lepers were socially excluded and removed from the community of the visible church, their existence still made God manifest, as they showed both his anger and his bounty: ‘Dearly beloved’, says a ritual from a church in Vienne in the south of France, ‘it has pleased God to afflict you with this disease, and the Lord is gracious for bringing punishment upon you for the evil that you have done in this world.’ The leper was then dragged out of the church by the priest and his acolytes gressu retrogrado but he was assured that he was God’s witness: ‘however removed from the church and the company of the saints, you are never separated from the grace of God’. Brueghel’s lepers watch from afar, but forever, as Christ climbs Mount Calvary accompanied by a whole people. Hieratic witnesses of evil, their salvation is assured by their exclusion: in a strange reversal quite opposed to merit and prayers, they are saved by the hand that is not offered. The sinner who abandons the leper to his fate thereby opens the door to his salvation. ‘Thus be patient in your sickness, for the Lord does not underestimate your ills, nor separate you from his company. If you have patience, so shall you be saved, like the leper who died outside the door of the rich man, and was carried straight up to Heaven.’¹³ Abandonment is his salvation, and exclusion offers an unusual form of communion.

Once leprosy had gone, and the figure of the leper was no more than a distant memory, these structures still remained. The game of exclusion would be played again, often in these same places, in an oddly similar fashion two or three centuries later. The role of the leper was to be played by the poor and by the vagrant, by prisoners and by the ‘alienated’, and the sort of salvation at stake for both parties in this game of exclusion is the matter of this study. The forms this exclusion took would continue, in a radically different culture and with a new meaning, but remaining essentially the major form of a rigorous division, at the same time social exclusion and spiritual reintegration.

*

But let’s not get ahead of ourselves.

The role that leprosy had played was first taken by venereal disease. Such diseases were the natural heir to leprosy in the late fifteenth century, and the disease was treated in several leper hospitals. Under François I, an attempt was made to confine it to the hospital of the Parish of Saint-Eustache, and then in the parish of Saint-Nicolas, both of which had served as lazar houses. Twice more, under Charles VIII and again in 1559, various buildings and outhouses at Saint-Germain-des-Prés previously used for lepers were converted for venereal diseases.¹⁴ Soon the disease was so common that the construction of special buildings was being considered ‘in certain spacious areas surrounding towns and suburbs, segregated from passers-by’.¹⁵ A new leprosy was born, which took the place of the former, but not without difficulty or conflicts. For these new lepers too struck fear into the hearts of the old.

Lepers were far from overjoyed at being forced to share their space with these newcomers to the world of horror: ‘Est mirabilis contagiosa et nimis formidanda infirmitas, quam etiam detestantur leprosi et ea infectos secum habitare non permittant’ (‘This astonishing and contagious disease is much to be feared: even the lepers themselves reject it in horror, and refuse to permit those who have contracted the disease to keep their company’).¹⁶ But despite their longstanding right to stay in these segregated areas, there were too few of them to make their voices heard, and the venereal, more or less everywhere, had soon taken their place.

Yet in the classical age it was not venereal diseases that would take over the role that leprosy had played in medieval culture. Despite these initial measures of exclusion, venereal disease was soon classed as simply another disease once more, and despite the reservations of the population sufferers were soon being treated in hospitals. They were taken in at the Hôtel-Dieu in Paris,¹⁷ and despite several attempts to expel them, they soon blended in with the other sick.¹⁸ In Germany, special houses were built for them not to ensure their exclusion, but so that appropriate treatment could be given, and the Fuggers in Augsburg set up two such hospitals. The city of Nuremberg appointed a special physician who claimed to able to ‘control the French malady’.¹⁹ The major difference with leprosy was that venereal diseases became a medical affair very early on, to be dealt with by doctors. Treatments sprang up on all sides: the order of Saint-Côme followed the Arab example and used mercury,²⁰ whereas in the Hôtel-Dieu in Paris treatment relied mainly on theriac, the classical world’s cure for snakebite. Then came the great vogue for gaiac, more precious than American gold, if Ulrich von Hutten and Fracastor’s Syphylidis are to be believed. Sweat cures were practised everywhere. In the course of the sixteenth century, venereal diseases took their place among other ills requiring medical treatment. The place of venereal diseases was fixed in a whole network of moral judgements, but that horizon brought only minor modifications to the essentially medical apprehension of the disease.²¹

Curiously, it was only under the influence of the world of confinement in the seventeenth century that venereal disease became detached to some extent from this medical context, and like madness entered a space of social and moral exclusion. It is not in venereal disease that the true heir of leprosy should be sought, but in a highly complex phenomenon that medicine would take far longer to appropriate.

That phenomenon is madness.²² But only after a long latency period of almost two centuries did that new obsession take the place of the fear that leprosy had instilled in the masses, and elicit similar reactions of division, exclusion and purification, which are akin to madness itself. But before madness was brought under control towards the mid-seventeenth century, and before ancient rituals were resuscitated in its honour, it was linked obstinately to many of the major experiences of the Renaissance.

A brief overview of this presence and some of the essential figures is now in order.

*

The simplest of these figures is also the most symbolic.

A new object made its appearance in the imaginary landscape of the Renaissance, and it was not long before it occupied a privileged place there; this was the Ship of Fools, a strange drunken boat that wound its way down the wide, slow-moving rivers of the Rhineland and round the canals of Flanders.

This Narrenschiff was clearly a literary invention, and was probably borrowed from the ancient cycle of the Argonauts that had recently been given a new lease of life among mythological themes, and in the states of Burgundy at least now had an institutional function. Such ships were a literary commonplace, with a crew of imaginary heroes, moral models or carefully defined social types set out on a great symbolic voyage that brought them, if not fortune, at the very least, the figure of their destiny or of their truth. Symphorien Champier for example composed successively a Ship of Princes and Battles of the Nobility in 1502 and a Ship of Virtuous Ladies the following year; there is also a Ship of Health, together with Jacop Van Oestvoren’s Blauwe Schute of 1413, Brant’s Narrenschiff of 1497 and Josse Bade’s Stultiferae naviculae scaphae fatuarum mulierum of 1498. Naturally, Bosch’s painting belongs to this same oneiric flotilla.

But among these satirical and novelistic ships, the Narrenschiff alone had a genuine existence, for they really did exist, these boats that drifted from one town to another with their senseless cargo. An itinerant existence was often the lot of the mad.²³ It was common practice for towns to banish them from inside the city walls, leaving them to run wild in the distant countryside or entrusting them to the care of travelling merchants or pilgrims. The custom was most common in Germany. In Nuremberg during the first half of the fourteenth century the presence of sixty-two madmen was recorded, and thirty-one were chased out of town. There were twenty-one more enforced departures over the fifty years that followed, and this was merely for madmen arrested by the municipal authorities.²⁴ They were often entrusted to the care of the river boatmen. In Frankfurt in 1399, boatmen were given the task of ridding the city of a madman who walked around naked, and in the earliest years of the following century a criminal madman was expelled in the same manner from Mainz. Sometimes the boatmen put these difficult passengers back ashore earlier than they had promised: one Frankfurt blacksmith returned twice from being expelled in such manner, before being definitively escorted to Kreuznach.²⁵ The arrival in the great cities of Europe of these ships of fools must have been quite a common sight.

It is hard to pin down the precise meaning of the practice. It is tempting to think of it as a general means of expulsion used by the municipalities to punish vagabondage among the mad, but that hypothesis doesn’t quite fit the facts as this was a fate that only befell certain madmen, as some were treated in hospitals, even before the construction of special houses for the insane began. In the Hôtel-Dieu in Paris they had specifically allocated bunks in some dormitories reserved for them,²⁶ and in most of the great cities of Europe throughout the Middle Ages and the Renaissance there was always a special place reserved for the detention of the insane, like the Melun Châtelet²⁷ or the famous Tour aux Fous in Caen.²⁸ In Germany there were countless Narrtürme, like the gates of Lübeck or the Hamburg Jungpfer.²⁹ So the mad were not systematically run out of town. It could be argued that only foreign madmen were expelled, and that each town only took responsibility for its own citizens who had lost their wits, and indeed in the accounts of various medieval cities there are...