I’ve just finished reading Michel Foucault’s book History of Madness. It is a tour de force that is at times almost impossible to understand, but I find if I am patient the loose ends usually are brought back together. It is also highly upsetting to read for me as someone who has been locked up as mad. The layers of history that Foucault uncovers demonstrate conceptual as well as legal and social forms of exclusion that are with us to the present day, although some of them have become transformed over time.
There is still some way that madness is dimly perceived as independent of reason and a dark force that tells truths reason cannot, and some ways that the madwoman or madman is always a stranger on an endless journey, as Foucault describes in his chapters on the Renaissance. There is still a linkage and assimilation (or degree of indistinguishability) between madness and unreason, understood as error and alienation from a truth taken as universal (which includes moral error), as Foucault describes in his chapters on the Great Confinement during the Classical period of the seventeenth and eighteenth centuries. The exhibition of the mad as bestial also feels familiar – how many of us have talked about the feeling of being in a zoo when visitors come – though it is most stark where places of confinement look chaotic and where the similarity to animal cages is most evident.
Even the interesting ways that eighteenth century physicians looked at mind/body unwellness, though labored and often both alienated and alienating (and violent), aren’t always so far away from holistic medicine; and some of the practices are related to ways that we are now looking at alternatives. (For example: bringing people to the countryside with opportunities to work in a garden – Foucault calls this a belief in the restorative value of nature but a nature from which violence and frenzy have been erased, a nature with the addition of morality. Or entering into a person’s reality to persuade them of a beneficial act – Foucault gives the example of a man who believes he is dead and therefore won’t eat, so he is starving himself to death. Some clever person brought people in costumed to appear like dead persons, and they promptly sat down to eat, which helped to persuade the starving man to eat also. I have no idea if this is apocryphal, and it is also ethically questionable as being a deception, but it is a kind of practice that happens.) The eighteenth century also used the concept of “animal spirits” in the body that seem similar to the chi or prana of Eastern medical systems.
The moral treatment of the Quakers, which many in the movement have expressed a desire to return to, is denounced by Foucault as a means of domination through imposition of the values and form of the patriarchal family. It is not just a matter of having folks sit down to dinner dressed nicely; such dinners were a kind of pageant or demonstration of ability to conform to social norms, and the inmates were watched intently for any mistakes. Just as we experience in the pageantry of some psychiatric wards, in the morning “community meetings” and the creation of any kind of event as “therapy” – including “milieu therapy,” a term taken from this time, which I always thought was a rather cynical way of saying that it’s good for us to be locked up. Actually that is what they believed, according to Foucault – that putting a person into this highly controlled environment under the authority of doctors was therapeutic. Not because the doctors did anything helpful but because of their socially constituted paternalistic authority.
Pinel who is lauded for “liberating the mad” – well, he liberated folks from chains but kept them locked up. He used the threat of punishment, social ostracism and ridicule (all within the locked institution) as a means to stop people from behaving in ways that got them labeled as mad. Sound familiar? Foucault says that madness was liberated but not to be itself. In the earlier form of confinement with chains, there was no attempt to make mad people not be mad.
It was interesting and even made me angry at times that Foucault never discusses writings by people who were labeled as mad – some were surely available when he wrote, but either he did not know of them or they did not suit his purpose of analyzing the historical changes in madness as a social construct. He discusses individual men who were accomplished writers or artists – such as Van Gogh, Nietzsche, Artaud – who later went mad, and says that rather than madness being the source of their “oeuvre”, it was the point at which their “oeuvre” both stopped being such and entered into the world; that it was their madness that accused the world and made it take notice. Foucault reaches a conclusion that some day there will be no concept of madness, and our discussions about it will be a mere curiosity – but he also says that madness is separating from mental illness, which will be controlled by science and technology. He does not speak approvingly of this control, but it stands in a strange contrast to the visionary proclamation that madness will cease to exist. I don’t think Foucault is simply saying that biopsychiatry will triumph; it is also that (his prediction writing in the 1950s; the book was published in 1961) we will simultaneously experience something new, more a philosophical reconfiguration that I think he believes is positive and integrative, that will obliterate the function of madness as a social denunciation.
Foucault himself reportedly attempted suicide several times, including in his youth, in response to which his father sent him to psychiatrist Jean Delay at a psychiatric hospital. So we can claim him as one of us in that sense. But he does not seem to be interested in activism or in the denunciations of the system made by people who were locked up as mad (such as Elizabeth Packard – who lived and wrote in the United States, which Foucault does not deal with in his account, focusing on Europe and particularly on France and England). There is a gender dimension to this as well; the modern survivor movement with its commitment to collective knowledge from the standpoint of lived experience as both means and end – as a basis for action and as a way of creating change in itself – stands on the shoulders of the consciousness-raising groups of Women’s Liberation, as well as the self-affirmation of Outsider existence that we learned from Black Liberation and other anti-colonial movements.
Foucault’s legacy to us is substantial, and serves both as a starting point from which we have already gone further, and as a caution. The human rights movement has brought international law to the point of acknowledging that madness no longer has any legitimacy as a social denunciation: the legal construct of incapacity, which predates and partially underpins this social denunciation, is similarly to be abolished. Our movement has created substantial space for people to see each other and ourselves as fully human, over and against the social denunciation enacted against us (the movement was itself created out of these encounters) – and we are developing theory and practice that move towards an obliteration of social distinctions in our common humanity.
Reflecting a gaze back on oppression, we can say that it is simply not polite to make distinctions based on an allegation of madness or its any of its relatives (incapacity, mental illness, etc.). At the same time we are in the thick of biopsychiatry’s reign, which continues to spread globally and threaten cultures as a colonial imposition even while it is in crisis at home; despite the crisis it has a real hold on the popular imagination, on legislation, politics and social discourse, while the contrary vision of social as well as legal equality is still only a seed, and even alternatives in the mental health framework are marginal.
Psychiatric profiling in the U.S. – an extreme, irrational form of the social denunciation that seeks to justify ever-greater restrictions on our freedom by invoking a fear of madness that draws on all the old figures – madness as unreason and viciousness, madmen and madwomen as bestial and as irreconcilably strangers to the world, as children in a patriarchal family who can be controlled by means of both medical authority and science – is on the rise and endorsed by politicians on the right and left, marking a thorough political exclusion in order to maintain and strengthen the social and legal exclusions. Not only the general public but also most people who are labeled as mentally ill believe in this construct. I therefore wonder (if Foucault is correct, and if our human rights work succeeds in the legal abolition of discrimination based on alleged incapacity) whether we will reach a point where biopsychiatry will operate without legal force and coercion, but still as a system of control by virtue of the construct of medical authority and the deadening and disabling effects of their methodologies such as drugs and electroshock.
Luckily our movement – globally – is challenging the constructs of biopsychiatry and “mental illness” as well as madness, so that maybe we will prove Foucault wrong. I hope that it will not be a case of only one parameter being able to change while the other remains constant.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.