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Madness and Civilization

Michel Foucault


Doctors and Patients

page 1 of 3

Doctors and Patients

Doctors and Patients

Doctors and Patients

Doctors and Patients


The therapeutics of madness do not work in a hospital, which attempts to "correct". But cures for madness developed in the classical period; they aimed to cure the entire individual, body and soul. Physical cures developed from moral perception and a therapeutics of the body. Foucault lists these cures and their philosophies. 1) Consolidation. Madness has elements of secret weakness, a lack of resistance. A force needs to be found in nature to reinforce nature. 2) Purification. Madness elicits a series of therapeutics that are intended to purify. The ideal is total purification. 3) Immersion. Two themes are present; ablution (washing) and immersion, which modify liquids and solids. Plunging madmen into water offers a chance to return to purity. 4) Regulation of movement. Madness is the irregular agitation of spirits, and also the immobility of limbs and ideas. Walking, running and sea voyages all help to restore movement. The subject must be returned to his original purity and initiated back into the world from pure subjectivity. These techniques lasted longer than their efficacy; when madness received psychological and moral meaning, they remained. The meanings of treatment were impoverished; medicine was now content to regulate and punish. Cures change direction, and start to act on the body or the soul; they are addressed to the various elements that make up a disease. Passion is still used in curing madmen. It represents the acceptance of a reciprocal symbolism of body and soul. Fear is a particularly useful tool. The difference between physical and psychological treatments becomes valid only when fear is no longer used, when the nineteenth century has brought madness and it cure into the arena of guilt. Psychology as a tool for curing becomes organized around punishment. A difference exists between the physical and the moral in modern medical thought.

A psychological element seems to be present in classical techniques. The idea exists that language and ethical ideas can affect the body. A difference exists between techniques that modify qualities common to body and soul and those which treat madness by discourse. The first is a technique of metaphors; the second is a technique of language. Two technical universes always existed in the treatment of madness; addressing madness as passion and seeing madness as a mistake of language and image, or delirium. Three essential configurations exist: 1) Awakening. A need existed to tear the delirious from waking sleep. Descartes tried to achieve absolute awakening, but in madness it is medicine that intervenes to awaken. The physician reproduces the moment of the Cogito in relation to madness. Awakening can be violent, or proceed from wisdom. Slowly, authoritarian awakening became only a return to the good or moral law. 2)Theatrical representation. This is opposed to awakening. Here, therapy operates in the imagination. It continues the delirious discourse, and maintains the grammar and meaning of hallucination. Theatrical representation drives out the madness of delirium. 3)The return to the immediate. If madness is an illusion, the cure of madness can also be brought about by its suppression. To give madness to a nature that cannot deceive because it does not acknowledge non-being is to give it to its own truth. Delirium is contradicted by nature. But the return to the immediate is not absolute or simple; because madness is the experience of the most basic human desires, it is rooted in bestiality. Nature has a fundamental power in the suppression of madness; it can force man from his freedom. In nature man is freed from social constraints and passion, but he is bound by a system of natural obligations. A liberation of madness is possible in which madness is opened to the constraints of nature. But the return to the immediate is effective only if the immediate is controlled.

The classical perception of madness is reduced to the moral perception of madness, which is the core of nineteenth century positive, scientific and experimental concepts. This change began in the techniques of cure but spread generally, reorganizing the experience of madness. Psychology was born as a sign that madness was detached from its truth (unreason) and was adrift. What belonged to disease became organic and what pertained to unreason became psychological.

Freud studied madness at the level of its language. He restored the possibility of dialogue with unreason. Psychology was not involved with psychoanalysis; rather, it was the experience of unreason that psychology was supposed to mask.


After his discussion of the various aspects and conditions that form madness, Foucault examines their treatments. He analyzes a central part of the process of confinement, and the development of the idea of curing or treating madness. Initially, madness was not seen as an illness or something that could be treated. But Foucault suggests that even when the idea of a cure developed, it was not a medical development. Madness was still seen in terms of morality and the links between body and soul that come from a theory of the passions.

The initial cures that he discusses (consolidation, purification, immersion and regulation of movement) all relate to the body, but affect both body and soul, such as purification. There is a great difference between this and nineteenth century techniques which center on the moral improvement of the madman. These techniques force the madman to face up to his abnormal or "bad" behavior. The doctor or warder encourages the madman's conscience to operate; he is made to fear both his captors and the consequences of bad behavior. Earlier, Foucault discussed the idea of madness as a punishment for immoral behavior; here, immoral behavior provoked by madness is punished. The introduction of punishment and guilt into the treatment of the madman represents a more sophisticated kind of confinement. Valuing and using the madman's guilt indicates a certain ideal of sanity and good behavior—the "normal" person observes recognized standards of good behavior and obeys his conscience.

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