The eighteenth century developed a new range of concepts around madness. In the sixteenth century, the secrecy of madness related it to sin and animality. In the eighteenth century, madness was situated in a place where man's relations to time, sentiment and other people were altered. Madness no longer related to nature or the fall of Adam and Eve but to a new order in which man had an idea of history, and in which the alienation of the physician and the philosopher operated.


Here, Foucault deals with the reorganization of the relationship between unreason and madness. Rameau's Nephew is a work by the French philosopher Denis Diderot (1713–1784), which represents the turbulent and romantic character of its protagonist in a dialogue with the author. Confinement still exists in the latter part of the classical period, but unreason reappears within it. This movement acknowledges the closeness of reason and unreason. As with Rameau's Nephew, the world debates and interrogates madmen to see if they knew hidden truths.

Fear developed at the same time, however. The fear of leprosy with which Foucault begins Madness and Civilization mutated into a fear of the whole structure of confinement, not just of the madman. The fact that they were partly fears of the diseases that madmen could transmit involved doctors in the process of confinement. Again, however, Foucault emphasizes that madness was not a medical matter. The doctor protected madmen and the public, but did not create or define madness in any way.

The reform movement that Foucault describes aimed to purify the place where madness was confined, just as earlier treatments tried to purify the madman's body. This was perhaps a good idea given squalid conditions of most houses of confinement at the time. Houses of confinement became reservoirs of disease, but also of imagery. Secret, hidden and dangerous things were locked away there. The Marquis de Sade, in whom Foucault took a particular interest, is a good example of this fantastic horror. He was a madman and a libertine, confined at his family's request, who recorded his violent, erotic fantasies in works such as 120 Days of Sodom. His private delirious discourse was eventually published; in this case, secret fantasies leaked out of confinement.

Unreason adopted fantastic forms. Foucault argues that confinement preserved such fantastic imagery by separating it from the world. Madness and unreason intertwine at this point; it becomes difficult to divide the two concepts. But madness increasingly becomes a cultural phenomenon, related to society, time and human lifestyles. The relationship between madness and civilization emerges as a theme, madness is related to external factors, and becomes a disease of society.

Montesquieu, the author of the famous eighteenth century work The Spirit of the Laws, established the link between politics and forms of government and external factors such as climate and geography. Foucault extends and develops this interpretation into a political and economic explanation of madness. He argues that Montesquieu represents the beginning of a theoretical approach to madness that sees it as dependent on the kind of society in which it exists. Religion is another social and economic factor influencing madness that was first recognized at this time.

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