Foucault begins by discussing leprosy. Leprosy vanished from the Western world at the end of the Middle Ages. Lepers were formerly isolated within the community in special sanatoria. Although the disease of leprosy disappeared, the structures that surrounded it remained.
The Ship of Fools, or Narrenschiff, appeared as leprosy vanished. It was a literary device that had a real existence. Towns dealt with madmen by expelling them. Places to care for the insane did exist in towns, but they often only attracted the mad. The expulsion of madmen was only one of a number of ritual exiles. Complex symbolism was involved in the expulsion. The madman had to be both excluded and enclosed. Foucault asks why, if this theme is so deeply embedded in European culture, the Ship of Fools suddenly appeared. He says that it appeared because of a great uneasiness that began at the end of the Middle Ages. Madmen became dangerous and ambiguous figures.
Madness or folly is important in tales and fables. In such tales, the madman speaks the truth. Folly is also important in learned literature; it is at the heart of reason. From the fifteenth century on, madness has haunted the Western imagination. Initially, death was the dominating theme. Madness was substituted for death, but both were part of the same theme. Madness formerly meant not realizing that death is close at hand. Now, madness became like death.
The image and the word, painting and text, are closely linked in this idea of madness. But in fact the two are pulling apart. Slowly, images separate from language and revolve around their own world of madness. A fascination develops with images of madness. Fantastic animals reveal man's dark, hidden nature. Madness also fascinates because it is knowledge; absurd figures and images are part of a complex system of learning. The madman possesses a kind of forbidden knowledge that relates to the end of the world. The end of the world is the triumph of madness. The Renaissance expressed what it understood of the threats and secrets of the world in madness. In the same period, literary, philosophical and moral themes of madness were different. In the Renaissance, madness moves from being one of many vices to being the key human weakness. This concept has little to do with the dark world. No mystery is concealed. Knowledge is linked to madness; madness is the truth of knowledge because knowledge is absurd. Fake learning leads to madness.
Madness is linked to man and his weaknesses and self-perception. In literary and philosophical expression, the fifteenth century experience of madness takes the form of a commonplace spectacle. But new forms of madness develop; madness by romantic identification, as in Cervantes; the madness of vain presumption, which is present in all men to an extent; the madness of just punishment; and the madness of desperate passion, as in Ophelia and King Lear. Shakespeare's and Cervantes' experiences of madness are vital to understanding seventeenth- century literary madness. For Shakespeare and Cervantes, madness was beyond appeal; it is situated in ultimate regions. But madness becomes the image of punishment rather than the real thing. It is deprived of dramatic seriousness because it is fake. Madness takes one thing for another. It establishes a kind of false equilibrium.
The classical idea of madness was born. The threat it posed in the fifteenth century subsided. It was no longer associated with the end of the world, and was no longer the absolute limit. The ship of fools became moored and became a hospital. Madness was tamed. A new pleasure was taken in it. The world of the seventeenth century was strangely hospitable to madness. Madness was at the heart of things, but few memories of its former disturbing incarnation survive.
Beginning with leprosy, Foucault analyzes a complex series of themes. He attempts to show the position of madness before the classical period. He charts a series of intellectual changes and a reorganization of knowledge about madness. The Narrenschiff, or ship of fools, is a symbol of the changing status of madness, which is linked to a wider network of symbols. The fifteenth century book from which the Narrenschiff is drawn, written by Sebastian Brandt, mixes woodcut images of madness with text. Many readers have pointed out that this is Foucault's only source for the ship of fools; there is little evidence that the ship actually existed.
Writers before Foucault have discussed the great significance of death in European culture in the late middle ages. Churches and tombs had images of skeletons and of Death itself. Death was not marginalized, but existed at the heart of people's life. However, it was also something that was opposed to life. This is how Foucault can see madness as both replacing and resembling death. Madness resembled death because it was a frightening phenomenon that threatened life and reason. But it also replaced death as a concern because people's concerns changed.
Madness took up the role of death, but also became linked to the theme of apocalypse. The apocalypse was a Christian explanation of the end of the world and the second coming of Christ; it was an absolutely central idea in the Middle Ages and Renaissance. Foucault feels that madness was a way of expressing and locating concerns about the darker side of life and fear about the end of the world. These shifts in the cultural meaning of madness had an underlying structure. For Foucault, the relationship between language and madness is an important one. This period is one in which language and imagery changed. In Brandt's book, text and pictures were closely related. Writing about madness and seeing it were almost the same thing. Brandt's images cannot express or explain madness on their own, but in the Renaissance they slowly create their own freestanding representation of madness.
Foucault considers the development of the literary representation of madness by Shakespeare and Cervantes. Madness in King Lear and Don Quixote becomes a kind of ultimate limit. Being mad is the worst thing that can happen to anyone, partly because it destroys humanity. But Foucault recognizes that this is an image of madness that reverses and alters reality. It is a "trompe d'oeil" (French for an image that deceives the eye) because it misleads the audience about its essential truth.
All these themes and images slowly alter in the classical period. Madness no longer relates to the apocalypse or the limit of human experience; it also moves to the forefront of human consciousness. As it becomes the most important sin, it has a greater cultural role. A situation arises that gives the mad a kind of temporary respite. While madness is not the source of fear, it is located in the world and accepted by the majority of people. It can do this because its intellectual context had changed; certain cultural themes change, and madness changes with them. Perhaps the ultimate contrast in this book is between madness in the Renaissance and in the present day, where it is located and isolated within certain medical and psychiatric disciplines, and marginalized within the world. By drawing this contrast, Foucault is not claiming that the Renaissance had a "better" idea of madness, or that we should return to such a relatively tolerant attitude. Indeed, he would argue that such a return is absolutely impossible. What he wants to do is to make us consider the role of madness in the modern world, and stop believing that "modern" madness is the only form that insanity can take.
Foucault sees the physical disappearance of leprosy, and of leper houses, as just as important as the cultural changes he charts. A space opens up as leprosy vanishes. It is almost as if a permanent space exists in which certain people can be defined and excluded; when leprosy no longer fills this space, madness appears to occupy it. Madness did not exactly replace leprosy, but the shift between the two conditions represented a move from a concern with diseased bodies to a concern with abnormal behavior, and diseased minds. Foucault can be criticized for his analysis of leprosy, which did not vanish entirely. He frequently uses such flamboyant contrasts to point out the contrast between classical madness and its predecessors.