Madness and Civilization | Michel Foucault

Summary of: Madness and Civilization: A History of Insanity in the Age of Reason
By: Michel Foucault


Embark on a journey through the fascinating evolution of our understanding and treatment of mental illness, as showcased in Michel Foucault’s ‘Madness and Civilization: A History of Insanity in the Age of Reason’. Explore the changing perspectives towards those deemed ‘mad’, from their freedom in the late Middle Ages to being confined in institutions in the following years. Learn how the confinement practices evolved and expanded to different groups of people, eventually leading to the establishment of separate facilities and the emergence of modern psychiatry.

Madness and Marginalization in Europe

During the late Middle Ages in Europe, people with mental illness were seen simply as “different” and often wandered freely. Mentally ill city dwellers were customarily shipped off to sparsely populated areas or other cities. This practice gave rise to the term “ship of fools,” which was popularized in literature and art. It wasn’t until the decline of leprosy in Western Europe that those with mental illness began to be detained. Facilities that were once used to confine leprosy patients were repurposed to detain criminals, derelicts, and people with mental illness. These new detainees were seen as carriers of disease and were marginalized and stigmatized, associating the term “madness” with being an outcast. Cities began to hold mentally ill people in fortified locations, such as the tower within the walls of Caen, France.

The Great Confinement

In the seventeenth century, the ruling class considered idleness dangerous to society and created institutions to confine the idle and unwanted. The police ensured the poor worked, and general hospitals were established to confine beggars, petty criminals, and the mentally ill. This led to the “great confinement” and a significant population was being confined to these institutions in several European countries. The residents of general hospitals were forced to work and manufacture goods to combat idleness and unemployment. However, the economic output of the residents was less than the cost of their confinement. The great confinement reflected the moral standards of the ruling classes and the moment when madness began to be associated with the inability to work and integrate into society.

The Unsettling Origin of Hospitals

Hospitals were initially created to contain social outcasts and those who brought shame to families. The mentally ill were often put on display like animals for those willing to pay. Between the 17th and 18th centuries, there was little understanding of mental illness, resulting in inhumane treatment. Potentially violent patients were chained and kept under brutal discipline. Hospitals functioned as a way for the authorities to avoid public scandal and for families to maintain their reputation.

The Evolution of Confinement Conditions

In the eighteenth century, there was a growing public concern about the treatment of individuals with mental illnesses and petty criminals in confinement. Facility directors initially separated the two groups for the safety of the criminals, but by the late eighteenth century, concern shifted towards those with mental disorders. Economic reasons also played a role in the reconsideration of confinement conditions, with the ruling classes recognizing the potential benefits of utilizing the idle labor of petty criminals and the poor. Ultimately, this led to the separation of those with mental illnesses from the workforce and the improvement of their confinement conditions.

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