Madness and Civilization is a deep and complex treatment of the role of madness in Western society. It begins by describing end of leprosy in Europe and the emergence of madness as a replacement for leprosy at the end of the Middle Ages. The Ship of Fools which wandered the waterways of Europe was a symbol of this process. Great uneasiness arose about madmen. Fantastic images of madness, that associated it with dark secrets and apocalyptic visions became important. A change occurred in the seventeenth century. Madness became tamed and existed at the center of the world.
The position of madness changed in the classical period. A "Great Confinement" occured. Madness was shut away from the world, along with a range of other social deviants. Houses of confinement were places where power was exercised, not medical establishments. Confinement represented a series of practices and disciplines: Foucault explains attitudes toward madness in terms of economic ideas, attitudes to labor and ideas of the city. Confinement was related to the police, which Foucault sees as a range of measures that make work possible and necessary for those who cannot do without it. Madness was constructed in this period as a place set apart from a world that valued work. The theme of the animality of madness was central to confinement.
The passions were also important in classical madness; because they unite body and soul, they allow madness to occur. Foucault analyses the concept of delirium, which is a discourse that essentially defines madness. Classical madness is a discourse that departs from the path of reason. The link between madness and dreams was also an important part of the classical conception of madness. There were four key themes within the classical conception of madness: melancholia/mania and hysteria/hypochondria. They were located within medical and moral debates, and were eventually seen as mental diseases as time progressed.
Cures and treatments for various aspects of madness emerged. For the first time, society attempted to cure and purify the madman. This change in the techniques of confinement occurred at the same time as a shift in epistemology, exemplified by Descartes's formula of doubt. A further evolution in the status if confinement occurred. The madman appeared as a figure with social presence. Madness altered human relations and sentiments. But public fear developed around confinement.
A shift occurred in the nineteenth century. Confinement was condemned and attempts were made to free the confined. Confinement was represented as an economic error as much as a humanitarian issue. A need developed to separate madness from other deviants. The place of madness became insecure. The asylum replaced the house of confinement. In an asylum, the madman became a moral outcast, and his keepers tried to act upon his conscience and feelings of guilt. The model of the family now structured madness. At the end of the nineteenth century, madness became moral degeneracy. From the asylum, a new relationship between the doctor and the patient developed, culminating in Freud's psychoanalysis. The work ends with Foucault's interpretation of the complex relationship between madness and art.