Foucualt's seminal work on the history of the concept of madness is more notable for its approach than its content. It was Foucault's first major publication, and amazingly he established the bulk of the hallmarks of his writings for years to come: a blending of art and history, a disregard for the individual in favor of the more permeating "structures" of society, a general kitchen-sink, anything and everything is a window into historical conceptions approach, a meandering disregard for the traditional footnote, a focus on paradox as a discourse and, yes oh yes, some dizzying impenetrability. The quite good Spark Notes summary of this book contains a funny quote which essentially questions whether Foucault's complex sentences are suppose to mirror the entrapped sensation of madness or whether "perhaps he was just incapable of writing clearly." There is no doubt that several passages require re-reading and re-re-reading, sometimes with no fruit for the effort, but overall this is an excellent cross-disciplinary exercise in tracing the formulation of a concept, one whose modern conception we tend to assume AND praise as contextless fact.
Foucault centrally argues that there is a common (mis)perception that our modern conception of insanity as a treatable (and not just curable, but a should-be-cured) disease stems from a humanistic enlightenment, thanks to science, that permitted us to have heart and take pity on the poor madman. We essentially have seen the error of our ways and now extend our altruistic hand to the mad among us, make every effort to heal them and bring them back to the fold as functioning members of society. Foucault argues that while this tends to be the modern functioning concept of madness, the history of the development of this concept is far more complex and far less humanitarian than we convince ourselves to believe. The book traces the history of madness in the West, starting with the void left by the disappearance of leprosy in the 16th century and ending with the incorporation of the physician into the institution that ultimately permitted the idea of "mental illness" to be born and the field of psychiatry to come into existence. The argument is highly nuanced and enormously detailed, but a brief stab at a summary follows:
Madness had long been closely associated with unreason, but the extent of this association ranged from its being tied to ideas of animality to notions that the unreason of madness was the "beyond reason" one encounters when faced with the reason of God. In other words, madness existed in constant paradox: so banal as to belong with the lowly beast, but so high as to be exalted with the deity. Consequently, madness existed relatively comfortably within the walls of the city prior to the 16th century. It was commonplace, and urban centers managed to exist with madness walking amongst them.
After leprosy died out and the leper houses emptied, though, a scapegoat vacuum, a need for the degenerative other, persisted. The marginalization of madness and the occasional exile from the cities of the insane began to occur; Foucault quite mysteriously notes that these years marked the appearance of "The Ship of Fools," a sort of exportation program for the various cities' insane where madmen traveled in boats from city to city. It is unclear whether Foucault claimed that this actually happened or whether he meant that the concept of marginalization became prevalent enough for these Ships of Fools to appear in literature. This system of mad exchange, real or purely conceptual, did not function well, and the ideal of exile of the mad transformed into an ideal of confinement - confinement, in fact, within those same leper houses.
At the same time in the 17th century, the ideal of the work ethic and strong societal contribution came to the fore. Panhandling was declared illegal in several major cities; the argument is that at this point the jailing / confinement of the mad had more to do with their lack of contribution to society than with the danger they posed or their own suffering / sickness. In other words, it was more of a moral punishment than one that addressed either the public's or the madmen's safety. Here Foucault postulates that the West saw "The Great Confinement," publicly justified by the equation of the mad with animals. Jailing of criminals increased in this period, too, and a primary paradox - that the mad were a threat to the criminals and the criminals a threat to the mad - was born of this coupling of madness with moral transgression. In the late seventeenth and into the eighteenth century, the mad were occasionally featured as sideshow freaks within the institutions, a penny's worth of diversion for well-to-do society members. This was perhaps the nadir of Western treatment of the mad as beasts; Foucault notes multiple examples of treatments (dungeon-chaining, beating, freezing, near-drowning) that would qualify as barbaric torture by all standards.
Some of the bizarre behaviors of the mad when confined - refusal of blankets in freezing temperatures, for example - fell into a model of madness as a humoral illess, an illness of the passions, the only connection between mind and body. Madness, and specifically its physical symptoms, began to enter a larger scientific dialogue of practical cause and effect explanations of the condition. The problem of madness began to be conceived more of as a problem of context / condition than one of essence; the asylum was created as an effort to fix the conditions / setting of the mad in order to fix their insane state. Many of these attempted fixes relied heavily on humoral concepts and / or moral concepts of guilt (and the aforementioned work ethic) - cure was attempted by a number of contradcitory methods, ranging from the introduction of shock (surprise, not electricity) to a firm work ethic to pastoral calm. The asylum was a place of freedom, not one of confinement (though one doubts that the mad were free to leave). In other places - notably the Quaker-led asylums - madness, far from being nicely reformulated as an illness that the sufferer could not help, became explained as "moral transgression" and treated accordingly. These various treaments eventually came to be performed under the supervision of physicians; madness gained its association with "illness" instead of "unreason." The path was laid open for the development of psychiatry as an institution and another (it can be argued, thoroughly unscientific) means of "fixing" the insane.
Foucault's scholarship is widely questioned, and truth be told, I had a distinct feeling that I was reading some fairly selective quoting as I drilled my way through this work. A large part of Foucault's method rests on acceptance of the notion that a societal concept, or a structure, will be revealed through works of art from the period as well as through more traditional scholarly routes (historical records and the like). It is specifically his selective quoting of works (and egads, so many French ones!) that I found most difficult to accept as somehow indicative of a major, dominant cultural trend. But regardless of how strictly accurate Foucault's account of the madness narrative is or how uneven-handed he was in selecting literary tidbits to support that narrative, the fact that madness the concept IS a narrative is hard to deny. Our current concept of madness-the-materially-caused-psycho-biological-disease is read as forever and ever true by many, but it is important to note that one, it was not always conceived of in this manner and two, it may not always be conceived of this way in the future, either.
Our own selective editing - the "aren't we great humanistic scientists who now understand and take pity on the crazies" - is interesting in its own right, a G-rated sheen to place over our troublesome history of ill-treatment of the insane. It lauds the scientific endeavors which led to our current conception, a notion the book renders silly at best. Our current understanding of psychiatric illness is fairly blunt-edged, not really the razor of science that purportedly shows up in so many other disciplines. Reading the path of "scientific" inquiry involving humors and the like only emphasizes how blindly stabbing our scientific process can be: not the noble stuff of a humanitarian best of us, but a patchwork attempt at fixing what we barely can with what we barely know on the topic. This was one of my favorite parts of the book: reading the insane contradictions in treatment accounted for by humoral conceptions of the body and insanity. The same doctors would state that patient needed to be dipped into hot or cold water, both in an effort to cool the blood! Interestingly, some of these humoral treatments, hundreds of years old, matched those of today exactly (though we theoretically now understand the mechanisms considerably better). Still: is the correct treatment, however stupidly justified, really all that bad?
On a fundamental level, I heart Foucault. I love the pursuit of deeper explanation, of societal structures that underpin even the most basic understandings of our daily lives. His scholarship, now that I've reread a work and noted its peculiarities, is open for criticism. But his idea that structural concepts drive thought within society, and that their history and transformations severely matter, is brilliant. This work exposes that idea thoroughly in the complex concept of madness, and more than anything shows us how to approach other deeply entrenched ideas within ourselves. Seeing the structure that informs the concepts is hugely difficult, and correctly (meaning sticking to professional scholarly standards) in its pursuit may be near impossible. But with regard to what we now call mental illness, and what should be with regard to all major operative concepts within our culture, this work stands out as an exemplar of a spirited and profound method.
No comments:
Post a Comment