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Foucault’s analysis of mental illness

Kalyan Bhakta Mathema

Critical historian Michel Foucault’s book Madness and Civilization: A History of Insanity in the Age of Reason is a historical study of how the western society viewed and treated insane people.  He examines how the mentally ill people who were treated with much empathy in the pre modern era became the victim of isolation with rise of rationality in modern era. He viewed ‘insanity’ as a term that carried different categories of connotations under it hence urged to see the term in a relativistic way. The study exposed how the science of psychiatry in the modern period instead of making the life of mentally ill people better ended up being a legitimate institution to use scientific means to isolate and repress them.

Foucault begins his book by explaining about huge structures that were created in Middles Ages to put away the people with leprosy because people during that time saw them with disgust. By the end of the Middles Ages these structures began to be used to imprison deviant people as the problem leprosy largely vanished in western Europe. Such practices of imprisoning people whose appearance and thinking caused disturbance to the society developed into the modern institution of prisons and clinics.

Foucault saw the establishment of ‘Hôpital Général’ in 1656 in Paris as an important date because from then on the hospitals began to have “quasi-absolute sovereignty” over the patients under their care.  The extensive use of confinement and forced labor were the core methods used by these institutions in their attempt to cure them.  Those people who were considered as severely insane were chained to the walls or beds.  There were also many instances in which patients with mental illness were locked inside small cages. The only mentally ill patients who  could occasionally taste the life beyond the hospital prisons were those whose deviant physical appearance caused awe among people. Such patients were used as a medium of income by institutions to exhibit them to public in an exchange for money. Many reputed hospitals such as Bethlehem had practiced this to collect funds. On the other hand the patients who could be coerced were forced to labor all day long because idleness and laziness were considered by clinical experts of that time to be the sources of all mental, physical and social disorders. The  systematization of the use of intensive labor became popular in hospitals because the medical experts were doing not only what they believed could cure people but also that the free labor extracted from the people under their care was lucrative for the experts and the institutions.

Perspective of the general population about madness and its treatment was greatly transformed in the eighteenth century. Till then the criminals were confined with the insane in the institutions. In eighteenth century however  a ‘great fear’ swept Europe. The fear was about the contagiousness of disease including madness that could spread from the confinements to inmates and from inmates to towns and cities. Such fears called for a reform in these institutions and as a result the confinement cages and cells began to be cleaned and appeared more humane. The fear however that the criminals who were confined together with the mentally ill could be infected with insanity and they when released could spread it in society. Such fear led to what Foucault called the ‘new division’. It was the division between the institution  for mentally ill people and for criminals.

In late 1700 many people began to speak against the way in which mentally ill people were confined as animals, tortured in name of medical treatment and forced to undertake exhaustive labor throughout the year. Such concern led to the development of a more humane approach in treatment of mentally ill. Samuel Tuke (1784 – 1857)  and Philippe Pinel (1745 – 1826) are the two founding pillars who established an alternative and humane treatment of mentally ill patients. Though Foucault is appreciative of these two reformers because their institutions were much better than confinement and forced labor but the method of treatment they used was the transformation from bodily confinement of the patients to the mental confinement. Both Tuke and Pinel had established a set of rules for the patients in their mental institutions which the patients were to follow. Foucault claimed that medical experts and staffs in these institutions were officially instructed in these institutions to impose these rules on the patients and constantly prevented the patients from ‘being themselves’.

Foucault sees a relationship between passion and mental illness. He argues that sometimes normal people lose their calculability and rationality when they are overwhelmed with strong emotions such as anger, love, fear and jealousy. During this ‘out of their mind’ phase people become something else. After the passing away of these passion storms  then people realize that they were something else in that temporal period. Madness according to Foucault is just like being consumed into the tempest  of passion. The only difference is that the people who are mad are immersed in their passion for a long period of time and sometimes forever. He however carefully cautioned the readers that this sinking into emotion by insane people is not necessarily being in the zone of irrationality. By citing physician Paul Zacchias(1584-1659) he gives an example of a man was engaged in self-starvation and justified his irrational act by using rational logic: ‘The dead do not eat; I am dead; hence I do not eat”. In this case Foucault argues that the mental illness is not associated with the person’s inability to reason but rather is connected with him adopting one of two false premise of thinking himself to be dead. The problem is not the ability to reason but rather the construction of the false proposition due to the error in the premises. This argument however  according to Foucault cannot be applied to all forms of insanity.

Foucault concludes the book by pointing that the modern society which takes pride in being in an ‘age of reason’ becomes insanely appreciative of the philosophy of Friedrich Nietzsche, poems of Antoine Artaud and painting of Vincent Van Gogh. The hypocrisy of modern society is such that on the one hand it deifies insane people like Nietzsche, Artaud and Van Gogh because their works are too deep, too creative, and too beautiful and yet on the other hand this very society is comfortable in their conscience to lockup insane people because they are thought to be lower in their mental standards to have a right to be free in ‘modern’ reason guided society.

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