Foucault begins by discussing leprosy. Leprosy vanished from the Western world at the end of the Middle Ages. Lepers were formerly isolated within the community in special sanatoria. Although the disease of leprosy disappeared, the structures that surrounded it remained.

The Ship of Fools, or Narrenschiff, appeared as leprosy vanished. It was a literary device that had a real existence. Towns dealt with madmen by expelling them. Places to care for the insane did exist in towns, but they often only attracted the mad. The expulsion of madmen was only one of a number of ritual exiles. Complex symbolism was involved in the expulsion. The madman had to be both excluded and enclosed. Foucault asks why, if this theme is so deeply embedded in European culture, the Ship of Fools suddenly appeared. He says that it appeared because of a great uneasiness that began at the end of the Middle Ages. Madmen became dangerous and ambiguous figures.

Madness or folly is important in tales and fables. In such tales, the madman speaks the truth. Folly is also important in learned literature; it is at the heart of reason. From the fifteenth century on, madness has haunted the Western imagination. Initially, death was the dominating theme. Madness was substituted for death, but both were part of the same theme. Madness formerly meant not realizing that death is close at hand. Now, madness became like death.

The image and the word, painting and text, are closely linked in this idea of madness. But in fact the two are pulling apart. Slowly, images separate from language and revolve around their own world of madness. A fascination develops with images of madness. Fantastic animals reveal man's dark, hidden nature. Madness also fascinates because it is knowledge; absurd figures and images are part of a complex system of learning. The madman possesses a kind of forbidden knowledge that relates to the end of the world. The end of the world is the triumph of madness. The Renaissance expressed what it understood of the threats and secrets of the world in madness. In the same period, literary, philosophical and moral themes of madness were different. In the Renaissance, madness moves from being one of many vices to being the key human weakness. This concept has little to do with the dark world. No mystery is concealed. Knowledge is linked to madness; madness is the truth of knowledge because knowledge is absurd. Fake learning leads to madness.

Madness is linked to man and his weaknesses and self-perception. In literary and philosophical expression, the fifteenth century experience of madness takes the form of a commonplace spectacle. But new forms of madness develop; madness by romantic identification, as in Cervantes; the madness of vain presumption, which is present in all men to an extent; the madness of just punishment; and the madness of desperate passion, as in Ophelia and King Lear. Shakespeare's and Cervantes' experiences of madness are vital to understanding seventeenth- century literary madness. For Shakespeare and Cervantes, madness was beyond appeal; it is situated in ultimate regions. But madness becomes the image of punishment rather than the real thing. It is deprived of dramatic seriousness because it is fake. Madness takes one thing for another. It establishes a kind of false equilibrium.

The classical idea of madness was born. The threat it posed in the fifteenth century subsided. It was no longer associated with the end of the world, and was no longer the absolute limit. The ship of fools became moored and became a hospital. Madness was tamed. A new pleasure was taken in it. The world of the seventeenth century was strangely hospitable to madness. Madness was at the heart of things, but few memories of its former disturbing incarnation survive.

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