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Madness and Civilization

Michel Foucault

Aspects of Madness

Passion and Delirium

Doctors and Patients

Summary

Foucault shows the different kinds of madness in classical thought. He first discusses madness and melancholia. The idea of melancholia was fixed in the sixteenth century. Its symptoms were the ideas that a delirious person formed about himself. Up to the seventeenth century, discussions of melancholia remained fixed within a tradition of the four humors. But debate began over the origin of melancholia. This debate resulted in a causality of substances being replaced by a movement of qualities. Qualities, which can be affected by circumstances, organized and integrated melancholia. Foucault discusses various humoral and spiritual explanations of melancholia. The theme of partial delirium disappeared, and was replaced by qualitative data like sadness, solitude and immobility.

Analyses of mania followed similar principles to analyses of melancholia. Mania was opposed to melancholia, but both were believed to be due to a movement of animal spirits. In the eighteenth century, though, the image of animal spirits was replaced by the image of tension in nerve fibers. Objects did not present themselves as "real" to the maniac. A psychological explanation replaced ideas of humors and tension. Willis (an English physician) was responsible for discovering the alternation of mania and melancholia. Most eighteenth century physicians acknowledged the similarity between mania and melancholia. The study of melancholia began with observation and then explained images. Images were the starting point for study, and their organizing force made the structure of perception possible.

Foucault then discusses hysteria and hypochondria. Two problems arise in analyzing these qualities. To what extent are hysteria and hypochondria madness? And, are they a couple, like mania and melancholia? The two were rarely classified together, but slowly began to be seen as same disease. During the classical period, hysteria and hypochondria slowly became seen as mental diseases. Two essential lines of development existed in the classical period for hysteria and hypochondria. Firstly, the illnesses were united to form the concept of a "disease of the nerves." Secondly, they were integrated into "diseases of the mind." But classical physicians could not discover the particular qualities of hysteria and hypochondria.

Hysteria progressed and assumed its dimensions in the space of the body. Classical physicians saw the problem as identifying the system through which disease dispersed itself. By the eighteenth century nothing remained of the idea of the mobility of the womb except the theme of corporeal space. In the eighteenth century the idea of the dynamics of corporeal space changed to a morality of sensibility. The evolution of this theme had three stages; the dynamics of organic and moral penetration; the psychology of corporeal continuity; and the ethic of nervous sensibility.

The disordered movement of hysteria and hypochondria was believed to result from the disordered movement of animal spirits. Hysteria was a deceptive disease because it had various symptoms. Doctors said that it affected women more because they had "softer" bodies. The idea that the womb "rose" above its place was replaced by the belief that spirits moved chaotically within the body. A body that is penetrated by disease must also be continuous. This problem haunted eighteenth century medicine. It would make hysteria and hypochondria diseases of the general agency of all sympathies. The nervous system was used to explain the body's sensibility with regard to its own phenomena. The sympathetic sensibility of women predisposed them to the "vapors" and nervous disease.

Foucault asks what sympathy is. To understand classical conceptions of sympathy, it is important to understand the idea of irritated nerve fibers. It was believed that too much sensibility resulted in unconsciousness or nervous shock. One could fall ill from too much exposure to outside, worldly stimulation. As a result, people were both more innocent and more guilty. They were guilty because their lifestyle and passions irritated their nerves. The innocence of the nervous sufferer was seen as evidence of a deeper guilt and its punishment. On the threshold of the nineteenth century, the view that hysteria and hypochondria were mental diseases remained. However, by the distinction between sensibility and sensation, they were associated with unreason, characterized by blindness. Once the mind became blind, through an excess of sensibility, madness appeared. Madness acquired a content of guilt, moral sanction and just punishment. The manifestation of non-being became the natural punishment of moral evil. Psychology and morality now contested the same domain. Nineteenth century scientific psychiatry was now possible.

Analysis

This is Foucault's first analysis of the different conditions and syndromes seen by the eighteenth century as forming madness. He analyzes two sets of ideas that were held in opposition to each other. Both involve body and mind in different ways. Foucault explores the way in which doctors and theorists of madness describe the causes and effects of mental illness. In doing so, Foucault delves into the history of medicine.

Foucault's definition of melancholia is unique, and does not refer to depression. A melancholic person could have a range of delirious symptoms, including unreal or false beliefs, combined with an otherwise normal personality. The tradition of humors that Foucault discusses was a central part of early modern medicine. Doctors believed that there were four humors—blood, phlegm, choler and black bile—which corresponded to the four elements of fire, water, air and earth. Different personality types had a different balance of humors; the melancholic personality had too much black bile. The doctor's task was to balance out the humors.

The shift that Foucault describes is a subtle one. Instead of believing that melancholia was caused by an imbalance of physical substances (humors) within the body, classical doctors now believed that melancholia could be caused by the patient's mental state. Foucault describes the narrowing down of a condition and the establishment of firm definitions.

A similar process occurred with the concept of mania. Whereas melancholics could have a range of symptoms, maniacs were highly excitable, wild and uncontrollable. Doctors came to realize that mania was the exact opposite of melancholia. Foucault charts a change in medical thought, from the emphasis on animal spirits to an emphasis on tension within the nervous system. Another key shift was the idea that the two conditions alternated within one person. As medical understanding developed, they became more closely linked.

The discussion of hysteria and hypochondria centers on the idea of mental disease. Mental disease is a condition affecting the mind that is treated by doctors and that has recognized symptoms. Madness, on the other hand, is a state of being linked to unreason that has a complex relationship with reason itself.

Hypochondria is falsely believing yourself to be ill; hysteria is essentially a disease of spasm, convulsion and over-excitement. It is particularly common in women. From ancient medicine onwards, it was seen as relating to the uncontrolled movement of the womb within the body. The word hysteria is derived from the Greek word for "womb".

Foucault describes the transition from focusing on the movement of spirits through the space of the body, focusing on a moral judgment of the sensibility or emotional state of the patient. The idea of movement in the space of the body is derived from the ancient explanation of hysteria. The penetration of the body by various spirits assumed that the body was essentially open inside. The shift from the idea of movement and space to that of moral judgment comes through the notion of sympathy. Sympathy implies a certain sensitivity of the nervous system. By over-stimulating the emotions and nerves, a drastic response could ensue.

For the first time outside influences on the body became important. Rather than an imbalance of the interior parts of the body, hysteria and hypochondria were diseases resulting from lifestyle. The fact that they had a clear external cause was important in the labeling of these conditions as mental disease. However, they were also a kind of madness. Hysterical people were blinded by experiencing too much. This blindness left the way open for madness.

By a complicated route, hysteria and hypochondria offer a way for medicine to pass moral judgment on madness. The development of certain ideas about the relationship between mental disease and lifestyle was the beginning. Because disease was created by lifestyle, medicine can disapprove of that way of life. When that disease becomes associated with madness, madness can be seen as something of which to disapprove. Morality has a new power over madness, which became a punishment for a "bad" lifestyle. This is different to the morality of labor that helped to create confinement because it was linked to medicine and idea about the body. Psychiatry, which Foucault views with some suspicion, rests upon this idea of applying morality to madness.

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