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.
Tina, thank you for this thoughtful commentary on a book I’ve always felt I should read but never actually attempted (yet). It is fascinating that although Foucault was in some sense one of us (madpeople), he did not bother to discuss the writings of other people deemed mad.
The following example form my own experience illustrates the idea of “entering into a person’s reality to persuade them of a beneficial act.” I had a friend on a locked unit who wanted to leave, but because he kept telling the staff he was Jesus Christ, they wouldn’t release him. I advised him that if he wanted out, he should stop saying that. And he said “But Jesus cannot lie.” I’m not sure where this came from, but I responded “But Jesus doesn’t brag, either,” and he agreed that he could stop telling them who he was, and they let him go the next day.
I love that Darby. Makes me laugh. Good example.
Darby, I love that you pointed that out. I call it ‘work with our symptoms’. Though I do not want to say it is a symptom however, due to the lack of understanding by others I have to frame my words in a certain ‘conformity’. Although, I realized by after doing that, they could see beyond the symptoms (especially if they did not have a background in psychology). I often have a difficult time explaining it to those within the practice or who have just graduated.
Just curious, as someone whose medical records state, “Don thought she was the second coming of Jesus,” “voices of God talk through her,” “Jesus talks through her,” who doesn’t think I’m Jesus. But I do believe “something from childhood and the church” (the medically concluded etiology for “bipolar”), which is I do believe “Jesus loves me” and he died for my sins.
And I have medical proof he died for my sins now. I survived a bunch of anticholinergic intoxication poisoning and a ten day, torturous “snowing” by V R Kuchipudi and Humaira Saiyed.
But I don’t understand why psychiatry is obsessed with force medicating Jesus. And all who believe in Him, the Holy Spirit and God. Technically, killing Christians is illegal in this country.
Plus, I’m quite certain the god complex, chemical lobotomizing doctors are much more of a danger to society as a whole, than is Jesus.
I agree with you – it is interesting how psychiatry is obsessed with force medicating Jesus and those who have strong beliefs – I have witnessed it happening both to Christians and to Muslims, and to pagans and those who are just awakening to their own spiritual needs and listening to hear what wisdom might be there for them.
There are some good arguments from a human rights perspective that tie in to the freedom of thought and the freedom of religion. In creating the Convention on the Rights of Persons with Disabilities I focused on the issues of forced psychiatry as torture, involuntary commitment as an arbitrary and discriminatory detention, and the right to legal capacity to make one’s own decisions, as the most strategic. Freedom of thought is absolute but freedom to express one’s religious beliefs can be limited, according to the standards of international law. I thought that freedom from torture, while it encompasses torture that is aimed at making a person give up certain beliefs or incapacitating the person from experiencing and adhering to their beliefs, is broader. I think this was the right judgment call at the time, but we should now go further and work on articulating the right to freedom of thought and freedom of religion more profoundly when it is being violating by forced psychiatry.
And what you are raising from a cultural and spiritual perspective, yes it is certainly ironic that this country persecutes religious people in psychiatry while the first amendment is widely believed to be sacrosanct.
Best wishes to you,
Thank you for expressing your concerns about what’s taking place to people of faith. IMO, psychiatry has little place for spirituality, viewing it as an “illness.”
Some of the check-lists for diagnosing bipolar disorder list “thinking about God” as a symptom. It’s used at UT Southwestern in Dallas.
IMO, psychiatry is frightened of two things:
1) The internal locus of control
I suppose an argument could be made that these two things are quite different; although IMO, can work in tandem.
They both threaten the profession more than anything else, because they allow an individual to be *free* of dependency – on psychiatrists, drugs, “treatment”.
Thank you, Tina. I am grateful for all lawyers who work to fight involuntary treatment. I wish there were more. Absolutely the UN is correct when it states “forced psychiatric treatment is torture.” And I’m grateful, despite not getting justice personally, that at least the doctor who had me medically unnecessarily shipped to him and had me “snowed,” has been arrested for doing the same thing, and worse, to others. But I do wonder how many people Kuchipudi killed for profit between 2006, when I first complained about him, and 2013 when the FBI arrested him. I think the FBI was aware of 6 or so deaths, just during their brief investigation, prior to his arrest.
And why was I shipped to him? To cover a prior “bad fix” on a broken bone, “Foul up” with a drug, and a child abuse cover up initiated by a pastor. Psychiatrists are regularly covering up malpractice for doctors and sodomy of little children for religions. Absolutely the world needs to know why psychiatry is being given credibity within our society. It’s not because it’s a legitimate field of medicine.
The sad thing is psychiatry has bought out at least some of the religions, with promises to cover up pastoral / priestly sins by defaming, drugging, torturing, and trying to murder people for them.
But I am a believer, who does still trust God will bring about justice, albeit in His own time. You may get a kick out of this, my medical records literally state the “Christian” therapist who originally misdiagnosed me, did so based upon her belief the Holy Spirit was a “voice” requiring drugs. I had asked her about a religious dream, not a “voice.”
If you bother to read the actual Holy Bible, there’s one and only one “unforgivable” sin. You may have the exact quote, but the only unforgivable sin in the bible is denying the Holy Spirit. And that’s exactly what my former therapist did. So I have faith God will bring about justice eventually. Since He promised He would long ago.
Plus, just after Kuchipudi and Saiyed’s “snowing” didn’t result in brain death (I used to be an organ donor, and now recommend getting off that list), or a need for a tracheotomy (Kuchipudi’s typical MO). The psychiatrist who examined me couldn’t seem to find anything abnormal about me, other than the fact I believed in God.
I realize I saw the underbelly of the Chicagoland medical community. But I don’t think what happened to me is nearly as rare as one, including me, initially assumed. Especially since all the doctors, including Kuchipudi, who’d colluded to cover up malpractice and child abuse, are still practicing medicine. The HIPPA laws are not benefiting the patients.
And, as a society, we can’t figure out why medical mistakes are the third or first leading cause of death in this country? We need to actually get the bad doctors out of the medical industry. But those organizations who are supposed to be doing this in the US, aren’t. And the lawyers aren’t taking the cases (no offense, Tina, I know you are). And the medical Wall of Silence is also helping to make a mockery of the entire mainstream medical industry.
Psychiatrists claim to be experts in something they do not think exists (“psychiatrist” lit. Greek: “doctor of the soul”).
“The spirit of a man can endure a sick body, but who can bear a broken spirit?” (Prov 18:14)
Check out: The Clinical Textbook of Biblical Psychiatry
Tina, it’s great to read your thinking on Foucault. I studied Foucault as a student as a way of understanding how we understand history and ideas. Two things I thought were extremely valuable are that the subtext or underpinnings of the dogma/discourse the “what’s being said,” are the key to understanding them – and that history is not locked in, 1 dimensional but dynamic and multi-dimensional. It is strange considering how out of the box his thinking was that he did not consider the discourse of those identified as mentally ill. I have to think whether this is true in his others books on prisons and medicine. But what is exciting to me is that the historical dynamic and the social discourse can change because there is a growing voice that challenges what madness is, how we regard it and how it can/should be treated.
Yes. I wonder if Foucault himself intended his work to be “purely” academic as a study of what is and has been, or if he wanted to open up possibilities for change by demonstrating how social discourse is humanly constructed. Certainly he has contributed to the opening up though in complex ways. I would be interested to look at his other books too – maybe another winter when I can get more deeply immersed, or sooner, who knows? Would be interested to hear what you discover or remember about this.
“… 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.”
Politicians on both the *right* and *left* have it wrong.
Incarceration and forced outpatient treatment is endorsed and promoted by both sides – for *different* reasons.
IMO, the *right* sees this as a law enforcement (crime prevention) issue (outrageous); and the *left* as a mistakenly *compassionate* thing to do (equally outrageous).
In short, the inhumane and illegal (mis)-treatment needs to be addressed – by *both sides*.
In short, I agree. Thanks for commenting.
I read Foucault’s History of Madness years ago, and I have my own misgivings about the book, in part, as you pointed out, due to his focus on mad cultural icons such as Van Gogh, Artaud, and Nietzche to the exclusion of the more obscure residents of asylums so typically ignored. There was no psychiatric survivor movement, nor a mad pride movement, at the time when his book was published–not in the USA, nor abroad–and that fact must have much to do with why there was no connection there. I am under no illusion that bio-psychiatry, nor psychiatric oppression, are going to vanish altogether with the end of forced treatment. I think it is perhaps works by Michel Foucault other than History of Madness that might be more instructive to our movement. If you get a chance, you should watch the discussion/debate on YouTube between Noam Chomsky and Michel Foucault. Chomsky did well to critique BF Skinner’s Behavioral Mod, but Foucault, unlike Chomsky, seems to have little affinity for bio-psychiatry itself. For Foucault, as with Karl Marx, it is this matter of the struggle between the powerful and the powerless, between the oppressor and the oppressed, that is crucial, and in that sense, I see him as an ally. This struggle doesn’t end. It just takes different forms. Ending forced psychiatry is not going to end more subtle forms of oppression, nor is it going to end internalized oppression. Once one aim is achieved, the struggle for rights isn’t over, but it must go on and on.
I think History of Madness is valuable despite its flaws, particularly for me in its dealing with madness as a social construct that is closely related to both legal incapacity and social denunciation – and even more, to a kind of moral shaming and segregation.
What I’ve been thinking in relation to the medical model – part of the reason it is so damaging is that it is not a healing model but rather a model of social denunciation and moral condemnation. The concept of “mental illness” is different from the belief in a mind-body continuum that is part of many systems of holistic medicine. The main reason for this in my opinion is the moral values that adhere to “mental illness” – so that it operates irrespective of whether a person suffers subjectively or not, objectifying the person. Some of the versions of what people consider “alternatives to the medical model” still retain a reference to mental health, and in that sense still seem to be partly situating themselves within a model of health and illness, or distress and well-being – whereas there may be many other ways to conceptualize what is going on: social conflict, spiritual crisis, good and evil, etc. I’d like for us to explore what “mental health” means and whether we still want to use that terminology and concept, even if we are coming at it from a perspective of empathy and respect for a person’s self-representation and self-knowledge.
What I’m aiming to do in some of my work now is to explore how the current forms of psychiatric oppression are connected to deeper structures precisely in order to work on ending those deeper structures or anticipating them at the same time to the extent possible.
All the best,
Forgive me for talking about my story over and over, but an English teacher I had when I was a child told us to write our stories. I’m still working on healing enough to properly write mine, but perhaps it is relevant to your goals.
Because I totally agree with you, the “medical model … is not a healing model but rather a model of social denunciation and moral condemnation.” Absolutely, this is true. Based upon my personal experience, and my last eight years of psycho / pharmaceutical and medical research, the DSM is not a “bible” of “mental illnesses.” It is a book of stigmatizations that describes the “mental illness” symptoms that the psychotropic drugs CAUSE.
And this comes from a lady who had lived a “semi-charmed life.” I had no prior family or personal history of mental health issues. (Other than my grandmother was briefly made ungodly sick with Stelazine, and quickly taken off it. And she was given it because she knew when and how others had died, before told. She was psychic.) And I am a woman with an IQ in the near genius range – both prior to, and after, psychotropic drugging to cover up a “bad fix,” “Foul up” with drugs, and a cover up of an “inflamed anus” in my child.
I’m glad someone is writing about Foucault here – I like his work a lot. I think he gives us tools to ‘think against the present’, that is, to see how certain ‘truths’ are socially produced over time, & to question the value & utility of these (particularly to those ‘caught up’ as subjects of them – prisoners, ‘psychiatric patients’, etc). I think his main point was, if we can work out how these things (assumptions, practices, claims to truth) are put together, we can undo them, & your statement ‘What I’m aiming to do in some of my work now is to explore how the current forms of psychiatric oppression are connected to deeper structures precisely in order to work on ending those deeper structures or anticipating them at the same time to the extent possible’ seems a very Foucauldian project to me. All power to you in that 🙂 Ian
Thanks for that comment. I agree.
When I first discovered Foucault it was in his speeches on psychiatric power, and I didn’t like him. It took me quite a while to discover that part of the problem was in translation. The other part was, though he sometimes seemed disgusted with the treatment of the mentally ill, he didn’t seem motivated to change anything. I know that Western politics and propaganda limited his view as far as the system in the US. He was very aware that it it part of American politics to subjugate and oppress one group to unite the rest. What I did learn from Foucault oddly enough is that Sociology is different in America than any other country, and I loved the foreign version. If you haven’t, pick up Emile Durkheim’s study on suicide which is oddly still rather relevant, but especially his Division of Labor.