Does Foucault believe in an unchanging concept of madness?
Madness, for Foucault, essentially has no independent existence; it is the product of the social and cultural conditions that create and define it. Madness is not a natural phenomenon that different societies respond to in different ways; rather, it is a concept that changes as society and its ideas of reason and rationality change. Madness is always defined against reason, but what is seen as "irrational" changes. A good example is the shift that Foucault identifies at the end of the "Great confinement." A wide range of people who society identified as social deviants were confined, including criminals, the idle poor and the insane; madness formed part of a wide spectrum of deviance. In the early nineteenth century madness became a separate category that required medical treatment. It is important to remember, as with many of Foucault's categories, that madness is never an unchanging concept.
To what extent does Foucault allow the mad to speak in Madness and Civilization?
By revealing the social and cultural structures that surround and define the madman, Foucault aims to give the confined and the excluded a voice. This is a project that he develops further in his later work. However, it should be remembered that many of the madmen who speak in Madness and Civilization are literary creations, or famous figures. One could argue that King Lear and Antonin Artaud are not the most representative madmen of all time. It is clear that Foucault's sympathy lies with the idea that poets and playwrights such as Artaud and Nerval represent the hidden voice of unreason. He seems less interested in the voices of more mundane characters. It is up to you to decide whether his source material, which includes little written by less well-known figures really gives everyone the chance to speak. In a later work, a study of the murderer Pierre Riviere, Foucault redresses the balance slightly.
Why does Foucault choose to begin Madness and Civilization with the image of the Ship of Fools?
Foucault traditionally begins his books with a striking image to catch the reader's attention. But the ship of fools has a particular symbolic value. It represents the changing nature of madness, which begins as something that is separate but yet present in the world, before being sent away on a kind of journey. The ship of fools therefore represents the beginning of a new attitude to madness, but also shows Foucault's overall idea of its changeable nature. Interestingly, it is also a controversial image. Foucault claims that it is a literary idea that nevertheless had a real existence. Despite his claim, academics have found little evidence to support his claim. Given that Foucault is frequently criticized for his inaccuracy, this is perhaps unsurprising.