Madness and Civilization explores the changing relationship between madness and unreason. The true nature of both terms is rarely expressed or allowed to speak, and frequently one forms part of the other. Unreason is defined as "reason dazzled" or confused in the period of confinement. In the modern period, however, unreason is pushed further beneath the surface of society, and is understandable only through certain artists; madness on the other hand, becomes mental illness, and is treated and controlled by medical and psychiatric practices. Unreason is somehow lost after the eighteenth century, a situation which Foucault laments.
This is Foucault's central idea. Throughout Madness and Civilization, Foucaulut insists that madness is not a natural, unchanging thing, but rather depends on the society in which it exists. Various cultural, intellectual and economic structures determine how madness is known and experienced within a given society. In this way, society constructs its experience of madness. The history of madness cannot be an account of changing attitudes to a particular disease or state of being that remains constant. Madness in the Renaissance was an experience that was integrated into the rest of the world, whereas by the nineteenth century it had become known as a moral and mental disease. In a sense, they are two very different types of madness. Ultimately, Foucault sees madness as being located in a certain cultural "space" within society; the shape of this space, and its effects on the madman, depend on society itself.
The idea of structure is implicit in all of Foucault's work. In writing a history of madness, he wants to penetrate beneath the surface of society to find the cultural, intellectual and economic structures that dictate how madness is constructed. He is concerned with changing patterns of knowledge, sets of relations, and broad themes. In this account, the actions of individuals are less important; people such as Samuel Tuke and Philippe Pinel represent certain tendencies and a certain discourse about madness. Madness and Civilization is ultimately a book about madness, not individual madmen. This tendency to consider deep structures instead of individual personalities is extended in Foucault's later work, where his concept of the discourse is seen to control and define the lives of individuals in subtle and powerful ways.
The convoluted relationship between madness and art is explored, but never fully explained in Madness and Civilization. The work as a whole shows Foucault's interest in literature, and his belief in the importance of using literary works as sources in a historical or sociological work. His discussion of madness in the Renaissance, for example, draws heavily on the works of Shakespeare and Cervantes; for Foucault, the fictional character of King Lear reveals much about the role of madness in society.
His central argument, however, rests on the idea that modern medicine and psychiatry fail to listen to the voice of the mad, or to unreason. According to Foucault, neither medicine nor psychoanalysis offers a chance of understanding unreason. To do this, we need to look to the work of "mad" authors such as Nietzsche, Nerval and Artaud. Unreason exists below the surface of modern society, only occasionally breaking through in such works. But within works of art inspired by madness, complex processes operate. Madness is linked to creativity, but yet destroys the work of art. The work of art can reveal the presence of unreason, but yet unreason is the end of the work of art. This idea partly derives from Foucault's love of contradiction, but he feels that it reveals much about modern creativity.
Foucault relies heavily on contrast and contradiction. From the contrasting images of leprosy and the Ship of Fools at the beginning of the work onwards, Madness and Civilization is structured around a series of conceits and paradoxes. The experience of madness and unreason is complex, Foucault suggests, and this complexity is echoed in his work. Academics have criticized Foucault for what they see as his chronic obscurity, but at least part of the problem comes from his attitude to language and discourse. Those who are labeled as mad can become "trapped" within their own delirious discourse and within the structures designed to confine them: perhaps the experience of being trapped inside some of Foucault's more difficult sentences is meant to echo this. Or perhaps he was just incapable of writing clearly