"A thinker is a person whose part it is to symbolize time according to his vision and understanding. He has no choice; he thinks as he has to
think. Truth in the long run is to him the picture of the world which
was born at his birth. It is that which he does not invent but rather
discovers within himself. It is himself over again: his being expressed
in words; the meaning of his personality formed into a doctrine which so far as concerns his life is unalterable, because truth and his life are identical. This symbolism is the one essential, the vessel and the
expression of human history. The learned philosophical works that arise
out of it are superfluous and only serve to swell the bulk of a
professional literature."
"[...] I am convinced that it is not merely a question of writing one out of
several possible and merely logically justifiable philosophies, but of
writing the philosophy of our time, one that is to some extent a natural philosophy and is... dimly presaged by all. This may be said without presumption; for an idea that is historically essential that does not occur within an epoch but
itself makes that epoch is only in a limited sense the property of him
to whose lot it falls to parent it. "
Spengler, The Decline of the West, 1917.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The fictions of Foucault's scholarship by Andrew Scull
Michel Foucault
HISTORY OF MADNESS
Translated by Jonathan Murphy and Jean Khalfa
725pp. Routledge. £35.
978 0 415 27701 3
History of Madness is the book that launched Michel Foucault's career as
one of the most prominent intellectuals of the second half of the twentieth
century. It was not his first book; that was a much briefer volume, Maladie
mentale et personnalité, that had appeared seven years earlier, in 1954, in
the aftermath of a bout of depression and a suicide attempt. (A translation
of the second edition of that treatise would appear in English in 1976, in
spite of Foucault's vociferous objections.) But History of Madness was the
first of his works to attract major attention, first in France, and a few
years afterwards in the English-speaking world. Still later would come his
swarm of books devoted to the "archaeology" of the human sciences, the
place of punishment in the modern world, the new medical "gaze" of Paris
hospital medicine, the history of sex – the whole vast oeuvre that
constituted his deconstruction of the Enlightenment and its values, and
that served to launch the Foucault industry, influencing and sometimes
capturing whole realms of philosophical, literary and sociological inquiry.
[image: *] But in the beginning was Madness – a book introduced to the
anglophone world by a figure who then had an iconic status of his own, the
renegade Scottish psychiatrist R. D. Laing. It was Laing, fascinated by
existentialism and other things French, who recommended the project to the
Tavistock Press, pronouncing it "an exceptional book . . . brilliantly
written, intellectually rigorous, and with a thesis that thoroughly shakes
the assumptions of traditional psychiatry". In those days, his imprimatur
counted for much.
In its English guise, at least, Foucault's history of madness had one great
merit for a book introducing a difficult and then unknown author – someone
working in an intellectual tradition that was not just foreign to the
idioms of most English-speaking people, but also remote from their interest
or sympathy. That merit was brevity, a delightful quality, little valued by
most academics. Short yet sweeping, spanning the whole of the Western
encounter with unreason from the high Middle Ages to the advent of
psychoanalysis, the book in its first English incarnation also possessed a
wonderful title. Madness and Civilization advertised its wares far more
effectively than its plodding French counterpart: Folie et déraison:
Histoire de la folie à l'âge classique. Quite where the new label came from
– from Foucault himself, from Laing, from the publisher, from the first
translator, Richard Howard – remains obscure; but it was a remarkable piece
of packaging, arresting and provocative, and calculated to pique the
interest of almost anyone who came across it.
Madness and Civilization was not just short: it was unhampered by any of
the apparatus of modern scholarship. What appeared in 1965 was a truncated
text, stripped of several chapters, but also of the thousand and more
footnotes that decorated the first French edition. Foucault himself had
abbreviated the lengthy volume that constituted his doctoral thesis to
produce a small French pocket edition, and it was this version (which
contented itself with a small handful of references and a few extra pages
from the original text) that appeared in translation. This could be read in
a few hours, and if extraordinarily large claims rested on a shaky
empirical foundation, this was perhaps not immediately evident. The
pleasures of a radical reinterpretation of the place of psychiatry in the
modern world (and, by implication, of the whole Enlightenment project to
glorify reason) could be absorbed in very little time. Any doubts that
might surface about the book's claims could always be dismissed by gestures
towards a French edition far weightier and more solemn – a massive tome
that monoglot English readers were highly unlikely, indeed unable, to
consult for themselves, even supposing that they could have laid their
hands on a copy.
None of this seems to have rendered the book's claims implausible, at least
to a complaisant audience. Here, indeed, is a world turned upside down.
Foucault rejects psychiatry's vaunted connections with progress; he rejects
the received wisdom about madness and the modern world. Generation after
generation had sung paeans to the twin movement that took mad people from
our midst and consigned them to the new world of the asylum, capturing
madness itself for the science of medical men; Foucault advanced the
reverse interpretation. The "liberation" of the insane from the shackles of
superstition and neglect was, he proclaimed, something quite other – "a
gigantic moral imprisonment". The phrase still echoes. If the highly
sceptical, not to say hostile, stance it encapsulates came to dominate four
decades of revisionist historiography of psychiatry, there is a natural
temptation to attribute the changed intellectual climate, whatever one
thinks of it, to the influence of the charismatic Frenchman. But is it so?
There were, after all, myriad indigenous sources of scepticism in the
1960s, all quite separately weakening the vision of psychiatry as an
unambiguously liberating scientific enterprise.
It is not as though such a perspective had ever gone unchallenged, after
all. Psychiatrists' pretensions have seldom been given a free pass. Their
medical brethren have always been tempted to view them as witch doctors and
pseudo-scientists, seldom demonstrating much respect for their abilities,
or much willingness to admit them to fully fledged membership in the
profession. And the public at large has likewise displayed few illusions
about their performance and competence, dismissing them as mad-doctors,
shrinks, bughouse doctors and worse. The crisis of psychiatric legitimacy,
as Charles Rosenberg once shrewdly remarked, has been endemic throughout
the profession's history.
But the years when Foucault came to prominence were a particularly
troubling time for defenders of the psychiatric enterprise. There was the
work of Erving Goffman, the brilliant if idiosyncratic American sociologist
whose loosely linked essays on asylums lent academic lustre to the
previously polemical equation of the mental hospital and the concentration
camp. Goffman dismissed psychiatry as a "tinkering trade" whose object was
the collection of unfortunates who were the victims of nothing more than
"contingencies". Then there was the renegade New York psychiatrist Thomas
Szasz, who declared that the very existence of mental illness was a myth,
and savaged his fellow professionals as oppressors of those they purported
to "help", self-serving creatures who were nothing more than prison guards
in disguise. And there was Ronnie Laing himself, now dismissed in most
quarters as yesterday's man, but welcomed, in the feverish atmosphere of
the 1960s, as the guru who had shown the adolescent mental patient to be
the fall girl, the designated victim of the double bind of family life; and
who had, yet more daringly, launched the notion of schizophrenia as a form
of super-sanity. More prosaically, a new generation of historians,
abandoning their discipline's traditional focus on diplomacy and high
politics, were in these years embracing social history and "history from
below", and doing so in an intellectual climate of hostility to anything
that smacked of Whig history and its emphasis on progress. The birth of the
revisionist historiography of psychiatry was thus attended by many
midwives.
Still, Foucault's growing stature both in serious intellectual circles and
among the luminaries of café society was not without significance. He
undoubtedly helped to establish the centrality of his subject, and to
rescue the history of psychiatry from the clutches of a combination of
drearily dull administrative historians and psychiatrists in their dotage.
It is curious, particularly in the light of Foucault's prominence in the
Anglo-American as well as the francophone world, that it has taken almost
half a century for the full text of the French original to appear in
translation. Certainly, the move does not reflect any increase in the ranks
of French-speaking scholars in Britain and the United States. To the
contrary, linguistic incompetence and insularity even among humanists seems
to have grown in these years. So one must welcome the decision of Routledge
(the heirs of Tavistock) to issue a complete translation. The publishers
have even included the prefaces to both the first and second full French
editions (Foucault had suppressed the former on the book's republication in
1972). And they have added Foucault's side of an exchange with Jacques
Derrida over the book's thesis, a lecture given at the Collège
Philosophique in March 1963. But the warmth of the welcome one accords to
the belated appearance of History of Madness depends upon a variety of
factors: the nature of the new material now made available to anglophone
readers; the quality of the new translation; the facts that the complete
text reveals about the foundations of Foucault's scholarship on the subject
of madness; and – an issue I shall flag, but not expand on here – one's
stance vis-à-vis his whole anti-Enlightenment project.
As to the first of these, the "new" version is more than twice as long as
the text that originally appeared in English, and contains almost ten times
as many footnotes, not to mention an extended list of Foucault's sources.
The major additions are whole chapters that were omitted from the first
English edition: a chapter examining "the correctional world . . . on the
threshold of modern times" and its associated "economy of evil" – a survey
that claims to uncover the abrupt creation of "grids of exclusion" all over
Europe, and of "a common denominator of unreason among experiences that had
long remained separate from each other"; a chapter discussing "how
polymorphous and varied the experience of madness was in the classical
age"; a series of chapters that make up much of the early sections of Part
Two of Foucault's original discussion, including a lengthy introduction,
and a chapter-and-a-half of his examination of how eighteenth-century
physicians and savants interrogated and came to understand the phenomenon
of madness; the greater part of a long chapter on "the proper uses of
liberty", which examines the fusion of what Foucault insists were the
previously separate worlds of medical thought and of confinement. In place
of the few pages on Goya, Sade and Nietzsche that were labelled
"Conclusion" in the Richard Howard translation, there is a much longer set
of musings on the nineteenth century that begins with an adjuration that
"There is no question here of concluding", not least because "the work of
[Philippe] Pinel and [William] Tuke" – with which the substantive portion
of Foucault's analysis concludes – "is not a destination". To these
formerly untranslated chapters, one must add the restoration in other
portions of the text of a number of individual paragraphs and sometimes
whole sections of Foucault's argument that were simply eliminated from the
abridged version of his book: elaborations, for example, of portions of his
famous opening chapter on "the ship of fools"; a long concluding section
previously omitted from his chapter on the insane; and passages originally
left out of his discussion of "doctors and patients".
Even confining ourselves to this brief and cursory summary of what is now
translated for the first time, the potential interest and importance of
Madness is clear. How many people will actually plough through the extended
text is less clear, and the new translation by Jonathan Murphy and Jean
Khalfa is not much help in that regard. Often dreary and dispirited, it is
also unreliable and prone to inaccurate paraphrase. Howard's version,
however incomplete the text from which he worked, sparkles by comparison.
Compare, for example, their respective renditions of the book's famous
opening lines: Foucault's text reads:
A la fin du Moyen Âge, la lèpre disparaît du monde occidental. Dans les
marges de la communauté, aux portes des villes, s'ouvrent comme des grandes
plages que le mal a cessé de hanter, mais qu'il a laissées stériles et pour
longtemps inhabitables. Des siècles durant, ces étendues appartiendront à
l'inhumain. Du XIVe au XVIIe siècle, elles vont attendre et solliciter par
d'étranges incantations une nouvelle incarnation du mal, une autre grimace
de la peur, des magies renouvelées de purification et d'exclusion.
Murphy and Khalfa give us:
At the end of the Middle Ages, leprosy disappeared from the Western world.
At the edges of the community, at town gates, large, barren, uninhabitable
areas appeared, where disease no longer reigned but its ghost still
hovered. For centuries, these spaces would belong to the domain of the
inhuman. From the fourteenth to the seventeenth century, by means of
strange incantations, they conjured up a new incarnation of evil, another
grinning mask of fear, home to the constantly renewed magic of purification
and exclusion.
Howard's version runs as follows:
At the end of the Middle Ages, leprosy disappeared from the Western world.
In the margins of the community, at the gates of cities, there stretched
wastelands which sickness had ceased to haunt but had left sterile and long
uninhabitable. For centuries, these reaches would belong to the non-human.
>From the fourteenth to the seventeenth century, they would wait, soliciting
with strange incantations a new incarnation of disease, another grimace of
terror, renewed rites of purification and exclusion.
But what even a weak translation does not disguise is the kind of evidence
upon which Foucault erected his theory. Those thousand and more
untranslated footnotes now stand revealed, and the evidence appears for
what it is. It is not, for the most part, a pretty sight.
Foucault's research for Madness was largely completed while he was in
intellectual exile in Sweden, at Uppsala. Perhaps that explains the
superficiality and the dated quality of much of his information. He had
access to a wide range of medical texts from the seventeenth and eighteenth
centuries – English, Dutch, French and German – as well as the writings of
major philosophers like Descartes and Spinoza. A number of the chapters
that now appear for the first time in English make use of these primary
sources to analyse older ideas about madness. One may object to or accept
Foucault's reconstructions, but these portions of his argument at least
rest on readings of relevant source material. By contrast, much of his
account of the internal workings and logic of the institutions of
confinement, an account on which he lavishes attention, is drawn from their
printed rules and regulations. But it would be deeply naive to assume that
such documents bear close relationship to the realities of life in these
places, or provide a reliable guide to their quotidian logic. There are,
admittedly, references to a handful of archival sources, all of them
French, which might have provided some check on these published documents,
but such material is never systematically or even sensibly employed so as
to examine possible differences between the ideal and the real. Nor are we
given any sense of why these particular archives were chosen for
examination, what criteria were employed to mine them for facts, how
representative the examples Foucault provides might be. Of course, by the
very ambitions they have set for themselves, comparative historians are
often forced to rely to a substantial extent on the work of others, so
perhaps this use of highly selective French material to represent the
entire Western world should not be judged too harshly. But the secondary
sources on which Foucault repeatedly relies for the most well-known
portions of his text are so self-evidently dated and inadequate to the
task, and his own reading of them so often singularly careless and
inventive, that he must be taken to task.
Foucault alleges, for example, that the 1815–16 House of Commons inquiry
into the state of England's madhouses revealed that Bedlam (Bethlem) placed
its inmates on public display every Sunday, and charged a penny a time for
the privilege of viewing them to some 96,000 sightseers a year. In reality,
the reports of the inquiry contain no such claims. This is not surprising:
public visitation (which had not been confined to Sundays in any event) had
been banned by Bethlem Royal Hospital's governors in 1770, and even before
then the tales of a fixed admission fee turn out to be apocryphal. Foucault
is bedevilled by Bethlem's history. He makes the remarkable claim that
"From the day when Bethlem, the hospital for curative lunatics, was opened
to hopeless cases in 1733, there was no longer any notable difference
between the London hospital and the French Hôpital Général, or any other
house of correction". And he speaks of Bethlem's "refurbishment" in 1676.
In reality, it had moved in that year from its previous location in an old
monastery in Bishopsgate to a grandiose new building in Moorfields designed
by Robert Hooke.
Monasteries surface elsewhere in his account. We are told with a straight
face that "it was in buildings that had previously been both convents and
monasteries that the majority of the great asylums of England . . . were
set up". This is a bizarre notion. First, there were no "great asylums" set
up in England in the classical age. Vast museums of madness did not emerge
until the nineteenth century (when they were purpose-built using taxpayers'
funds). And second, only Bethlem, of all the asylums and madhouses that
existed in the seventeenth and eighteenth centuries, was ever housed in a
former convent or monastery, and when it was, its peak patient population
amounted to fewer than fifty inmates, hardly the vast throng conjured up by
Foucault's image of "grands asiles". It is odd, to put it mildly, to rely
exclusively on nineteenth- and early twentieth-century scholarship to
examine the place of leprosy in the medieval world. It is peculiar to base
one's discussion of English and Irish poor law policy from the sixteenth to
the eighteenth centuries on, in essence, only three sources – the dated and
long superseded work of Sir George Nicholls (1781–1865), E. M. Leonard's
1900 textbook, and an eighteenth-century treatise by Sir Frederick Morton
Eden. For someone purporting to write a history of the Western encounter
with madness, it is downright astonishing to rely on a tiny handful of
long-dead authors as a reliable guide to English developments: Jacques
Tenon's eighteenth-century account of his visit to English hospitals,
supplemented by Samuel Tuke's Description of the Retreat (1813) and Hack
Tuke's Chapters in the History of the Insane (1882).
But then, Foucault's sources for his accounts of developments in Germany,
in Austria, even in France, are equally outdated and unsatisfactory. The
whole of Part One of Madness has a total of twenty-eight footnotes (out of
399) that cite twentieth-century scholars, and the relevant list of sources
in the bibliography mentions only twenty-five pieces of scholarship written
from 1900 onwards, only one of which was published after the Second World
War. Things do not improve as the book proceeds. Foucault's bibliography
for Part Two lists a single twentieth-century work, Gregory Zilboorg's The
Medical Man and the Witch During the Renaissance (1935) – scarcely a source
on that subject calculated to inspire confidence among present-day
historians (and one that Foucault himself criticizes). For Part Three, he
lists a grand total of eleven books and articles written in his own
century.
Narrowness of this kind is not confined to footnotes. Foucault's isolation
from the world of facts and scholarship is evident throughout History of
Madness. It is as though nearly a century of scholarly work had produced
nothing of interest or value for Foucault's project. What interested him,
or shielded him, was selectively mined nineteenth-century sources of
dubious provenance. Inevitably, this means that elaborate intellectual
constructions are built on the shakiest of empirical foundations, and, not
surprisingly, many turn out to be wrong.
Take his central claim that the Age of Reason was the age of a Great
Confinement. Foucault tells us that "a social sensibility, common to
European culture . . . suddenly began to manifest itself in the second half
of the seventeenth century; it was this sensibility that suddenly isolated
the category destined to populate the places of confinement . . . the signs
of [confinement] are to be found massively across Europe throughout the
seventeenth century". "Confinement", moreover, "had the same meaning
throughout Europe, in these early years at least." And its English
manifestations, the new workhouses, apparently appeared in such "heavily
industrialised" places as seventeenth- century Worcester and Norwich. But
the notion of a Europe-wide Great Confinement in these years is purely
mythical. Such massive incarceration simply never occurred in England in
the seventeenth and eighteenth centuries, whether one focuses one's
attention on the mad, who were still mostly left at large, or on the
broader category of the poor, the idle and the morally disreputable. And as
Gladys Swain and Marcel Gauchet argue in Madness and Democracy (reviewed in
the TLS, October 29, 1999), even for France, Foucault's claims about the
confinement of the mad in the classical age are grossly exaggerated, if not
fanciful – for fewer than 5,000 were locked up even at the end of the
eighteenth century, a "tiny minority of the mad who were still scattered
throughout the interior of society". Foucault's account of the medieval
period fares no better in the light of modern scholarship. Its central
image is of "the ship of fools", laden with its cargo of mad souls in
search of their reason, floating down the liminal spaces of feudal Europe.
It is through the Narrenschiff that Foucault seeks to capture the essence
of the medieval response to madness, and the practical and symbolic
significance of these vessels loom large in his account. "Le Narrenschiff .
. . a eu une existence réelle", he insists. "Ils ont existé, ces bateaux
qui d'une ville à l'autre menaient leur cargaison insensée." (The ship of
fools was real. They existed, these boats that carried their crazed cargo
from one town to another.) But it wasn't; and they didn't.
The back cover of History of Madness contains a series of hyperbolic hymns
of praise to its virtues. Paul Rabinow calls the book "one of the major
works of the twentieth century"; Ronnie Laing hails it as "intellectually
rigorous"; and Nikolas Rose rejoices that "Now, at last, English-speaking
readers can have access to the depth of scholarship that underpins
Foucault's analysis". Indeed they can, and one hopes that they will read
the text attentively and intelligently, and will learn some salutary
lessons. One of those lessons might be amusing, if it had no effect on
people's lives: the ease with which history can be distorted, facts
ignored, the claims of human reason disparaged and dismissed, by someone
sufficiently cynical and shameless, and willing to trust in the ignorance
and the credulity of his customers.
_________________________________________________________
Andrew Scull's book *Madhouse: A tragic tale of megalomania and modern
medicine* will appear in a new paperback edition this autumn.
_______________________________________________
Foucault-L mailing list
think. Truth in the long run is to him the picture of the world which
was born at his birth. It is that which he does not invent but rather
discovers within himself. It is himself over again: his being expressed
in words; the meaning of his personality formed into a doctrine which so far as concerns his life is unalterable, because truth and his life are identical. This symbolism is the one essential, the vessel and the
expression of human history. The learned philosophical works that arise
out of it are superfluous and only serve to swell the bulk of a
professional literature."
"[...] I am convinced that it is not merely a question of writing one out of
several possible and merely logically justifiable philosophies, but of
writing the philosophy of our time, one that is to some extent a natural philosophy and is... dimly presaged by all. This may be said without presumption; for an idea that is historically essential that does not occur within an epoch but
itself makes that epoch is only in a limited sense the property of him
to whose lot it falls to parent it. "
Spengler, The Decline of the West, 1917.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
The fictions of Foucault's scholarship by Andrew Scull
Michel Foucault
HISTORY OF MADNESS
Translated by Jonathan Murphy and Jean Khalfa
725pp. Routledge. £35.
978 0 415 27701 3
History of Madness is the book that launched Michel Foucault's career as
one of the most prominent intellectuals of the second half of the twentieth
century. It was not his first book; that was a much briefer volume, Maladie
mentale et personnalité, that had appeared seven years earlier, in 1954, in
the aftermath of a bout of depression and a suicide attempt. (A translation
of the second edition of that treatise would appear in English in 1976, in
spite of Foucault's vociferous objections.) But History of Madness was the
first of his works to attract major attention, first in France, and a few
years afterwards in the English-speaking world. Still later would come his
swarm of books devoted to the "archaeology" of the human sciences, the
place of punishment in the modern world, the new medical "gaze" of Paris
hospital medicine, the history of sex – the whole vast oeuvre that
constituted his deconstruction of the Enlightenment and its values, and
that served to launch the Foucault industry, influencing and sometimes
capturing whole realms of philosophical, literary and sociological inquiry.
[image: *] But in the beginning was Madness – a book introduced to the
anglophone world by a figure who then had an iconic status of his own, the
renegade Scottish psychiatrist R. D. Laing. It was Laing, fascinated by
existentialism and other things French, who recommended the project to the
Tavistock Press, pronouncing it "an exceptional book . . . brilliantly
written, intellectually rigorous, and with a thesis that thoroughly shakes
the assumptions of traditional psychiatry". In those days, his imprimatur
counted for much.
In its English guise, at least, Foucault's history of madness had one great
merit for a book introducing a difficult and then unknown author – someone
working in an intellectual tradition that was not just foreign to the
idioms of most English-speaking people, but also remote from their interest
or sympathy. That merit was brevity, a delightful quality, little valued by
most academics. Short yet sweeping, spanning the whole of the Western
encounter with unreason from the high Middle Ages to the advent of
psychoanalysis, the book in its first English incarnation also possessed a
wonderful title. Madness and Civilization advertised its wares far more
effectively than its plodding French counterpart: Folie et déraison:
Histoire de la folie à l'âge classique. Quite where the new label came from
– from Foucault himself, from Laing, from the publisher, from the first
translator, Richard Howard – remains obscure; but it was a remarkable piece
of packaging, arresting and provocative, and calculated to pique the
interest of almost anyone who came across it.
Madness and Civilization was not just short: it was unhampered by any of
the apparatus of modern scholarship. What appeared in 1965 was a truncated
text, stripped of several chapters, but also of the thousand and more
footnotes that decorated the first French edition. Foucault himself had
abbreviated the lengthy volume that constituted his doctoral thesis to
produce a small French pocket edition, and it was this version (which
contented itself with a small handful of references and a few extra pages
from the original text) that appeared in translation. This could be read in
a few hours, and if extraordinarily large claims rested on a shaky
empirical foundation, this was perhaps not immediately evident. The
pleasures of a radical reinterpretation of the place of psychiatry in the
modern world (and, by implication, of the whole Enlightenment project to
glorify reason) could be absorbed in very little time. Any doubts that
might surface about the book's claims could always be dismissed by gestures
towards a French edition far weightier and more solemn – a massive tome
that monoglot English readers were highly unlikely, indeed unable, to
consult for themselves, even supposing that they could have laid their
hands on a copy.
None of this seems to have rendered the book's claims implausible, at least
to a complaisant audience. Here, indeed, is a world turned upside down.
Foucault rejects psychiatry's vaunted connections with progress; he rejects
the received wisdom about madness and the modern world. Generation after
generation had sung paeans to the twin movement that took mad people from
our midst and consigned them to the new world of the asylum, capturing
madness itself for the science of medical men; Foucault advanced the
reverse interpretation. The "liberation" of the insane from the shackles of
superstition and neglect was, he proclaimed, something quite other – "a
gigantic moral imprisonment". The phrase still echoes. If the highly
sceptical, not to say hostile, stance it encapsulates came to dominate four
decades of revisionist historiography of psychiatry, there is a natural
temptation to attribute the changed intellectual climate, whatever one
thinks of it, to the influence of the charismatic Frenchman. But is it so?
There were, after all, myriad indigenous sources of scepticism in the
1960s, all quite separately weakening the vision of psychiatry as an
unambiguously liberating scientific enterprise.
It is not as though such a perspective had ever gone unchallenged, after
all. Psychiatrists' pretensions have seldom been given a free pass. Their
medical brethren have always been tempted to view them as witch doctors and
pseudo-scientists, seldom demonstrating much respect for their abilities,
or much willingness to admit them to fully fledged membership in the
profession. And the public at large has likewise displayed few illusions
about their performance and competence, dismissing them as mad-doctors,
shrinks, bughouse doctors and worse. The crisis of psychiatric legitimacy,
as Charles Rosenberg once shrewdly remarked, has been endemic throughout
the profession's history.
But the years when Foucault came to prominence were a particularly
troubling time for defenders of the psychiatric enterprise. There was the
work of Erving Goffman, the brilliant if idiosyncratic American sociologist
whose loosely linked essays on asylums lent academic lustre to the
previously polemical equation of the mental hospital and the concentration
camp. Goffman dismissed psychiatry as a "tinkering trade" whose object was
the collection of unfortunates who were the victims of nothing more than
"contingencies". Then there was the renegade New York psychiatrist Thomas
Szasz, who declared that the very existence of mental illness was a myth,
and savaged his fellow professionals as oppressors of those they purported
to "help", self-serving creatures who were nothing more than prison guards
in disguise. And there was Ronnie Laing himself, now dismissed in most
quarters as yesterday's man, but welcomed, in the feverish atmosphere of
the 1960s, as the guru who had shown the adolescent mental patient to be
the fall girl, the designated victim of the double bind of family life; and
who had, yet more daringly, launched the notion of schizophrenia as a form
of super-sanity. More prosaically, a new generation of historians,
abandoning their discipline's traditional focus on diplomacy and high
politics, were in these years embracing social history and "history from
below", and doing so in an intellectual climate of hostility to anything
that smacked of Whig history and its emphasis on progress. The birth of the
revisionist historiography of psychiatry was thus attended by many
midwives.
Still, Foucault's growing stature both in serious intellectual circles and
among the luminaries of café society was not without significance. He
undoubtedly helped to establish the centrality of his subject, and to
rescue the history of psychiatry from the clutches of a combination of
drearily dull administrative historians and psychiatrists in their dotage.
It is curious, particularly in the light of Foucault's prominence in the
Anglo-American as well as the francophone world, that it has taken almost
half a century for the full text of the French original to appear in
translation. Certainly, the move does not reflect any increase in the ranks
of French-speaking scholars in Britain and the United States. To the
contrary, linguistic incompetence and insularity even among humanists seems
to have grown in these years. So one must welcome the decision of Routledge
(the heirs of Tavistock) to issue a complete translation. The publishers
have even included the prefaces to both the first and second full French
editions (Foucault had suppressed the former on the book's republication in
1972). And they have added Foucault's side of an exchange with Jacques
Derrida over the book's thesis, a lecture given at the Collège
Philosophique in March 1963. But the warmth of the welcome one accords to
the belated appearance of History of Madness depends upon a variety of
factors: the nature of the new material now made available to anglophone
readers; the quality of the new translation; the facts that the complete
text reveals about the foundations of Foucault's scholarship on the subject
of madness; and – an issue I shall flag, but not expand on here – one's
stance vis-à-vis his whole anti-Enlightenment project.
As to the first of these, the "new" version is more than twice as long as
the text that originally appeared in English, and contains almost ten times
as many footnotes, not to mention an extended list of Foucault's sources.
The major additions are whole chapters that were omitted from the first
English edition: a chapter examining "the correctional world . . . on the
threshold of modern times" and its associated "economy of evil" – a survey
that claims to uncover the abrupt creation of "grids of exclusion" all over
Europe, and of "a common denominator of unreason among experiences that had
long remained separate from each other"; a chapter discussing "how
polymorphous and varied the experience of madness was in the classical
age"; a series of chapters that make up much of the early sections of Part
Two of Foucault's original discussion, including a lengthy introduction,
and a chapter-and-a-half of his examination of how eighteenth-century
physicians and savants interrogated and came to understand the phenomenon
of madness; the greater part of a long chapter on "the proper uses of
liberty", which examines the fusion of what Foucault insists were the
previously separate worlds of medical thought and of confinement. In place
of the few pages on Goya, Sade and Nietzsche that were labelled
"Conclusion" in the Richard Howard translation, there is a much longer set
of musings on the nineteenth century that begins with an adjuration that
"There is no question here of concluding", not least because "the work of
[Philippe] Pinel and [William] Tuke" – with which the substantive portion
of Foucault's analysis concludes – "is not a destination". To these
formerly untranslated chapters, one must add the restoration in other
portions of the text of a number of individual paragraphs and sometimes
whole sections of Foucault's argument that were simply eliminated from the
abridged version of his book: elaborations, for example, of portions of his
famous opening chapter on "the ship of fools"; a long concluding section
previously omitted from his chapter on the insane; and passages originally
left out of his discussion of "doctors and patients".
Even confining ourselves to this brief and cursory summary of what is now
translated for the first time, the potential interest and importance of
Madness is clear. How many people will actually plough through the extended
text is less clear, and the new translation by Jonathan Murphy and Jean
Khalfa is not much help in that regard. Often dreary and dispirited, it is
also unreliable and prone to inaccurate paraphrase. Howard's version,
however incomplete the text from which he worked, sparkles by comparison.
Compare, for example, their respective renditions of the book's famous
opening lines: Foucault's text reads:
A la fin du Moyen Âge, la lèpre disparaît du monde occidental. Dans les
marges de la communauté, aux portes des villes, s'ouvrent comme des grandes
plages que le mal a cessé de hanter, mais qu'il a laissées stériles et pour
longtemps inhabitables. Des siècles durant, ces étendues appartiendront à
l'inhumain. Du XIVe au XVIIe siècle, elles vont attendre et solliciter par
d'étranges incantations une nouvelle incarnation du mal, une autre grimace
de la peur, des magies renouvelées de purification et d'exclusion.
Murphy and Khalfa give us:
At the end of the Middle Ages, leprosy disappeared from the Western world.
At the edges of the community, at town gates, large, barren, uninhabitable
areas appeared, where disease no longer reigned but its ghost still
hovered. For centuries, these spaces would belong to the domain of the
inhuman. From the fourteenth to the seventeenth century, by means of
strange incantations, they conjured up a new incarnation of evil, another
grinning mask of fear, home to the constantly renewed magic of purification
and exclusion.
Howard's version runs as follows:
At the end of the Middle Ages, leprosy disappeared from the Western world.
In the margins of the community, at the gates of cities, there stretched
wastelands which sickness had ceased to haunt but had left sterile and long
uninhabitable. For centuries, these reaches would belong to the non-human.
>From the fourteenth to the seventeenth century, they would wait, soliciting
with strange incantations a new incarnation of disease, another grimace of
terror, renewed rites of purification and exclusion.
But what even a weak translation does not disguise is the kind of evidence
upon which Foucault erected his theory. Those thousand and more
untranslated footnotes now stand revealed, and the evidence appears for
what it is. It is not, for the most part, a pretty sight.
Foucault's research for Madness was largely completed while he was in
intellectual exile in Sweden, at Uppsala. Perhaps that explains the
superficiality and the dated quality of much of his information. He had
access to a wide range of medical texts from the seventeenth and eighteenth
centuries – English, Dutch, French and German – as well as the writings of
major philosophers like Descartes and Spinoza. A number of the chapters
that now appear for the first time in English make use of these primary
sources to analyse older ideas about madness. One may object to or accept
Foucault's reconstructions, but these portions of his argument at least
rest on readings of relevant source material. By contrast, much of his
account of the internal workings and logic of the institutions of
confinement, an account on which he lavishes attention, is drawn from their
printed rules and regulations. But it would be deeply naive to assume that
such documents bear close relationship to the realities of life in these
places, or provide a reliable guide to their quotidian logic. There are,
admittedly, references to a handful of archival sources, all of them
French, which might have provided some check on these published documents,
but such material is never systematically or even sensibly employed so as
to examine possible differences between the ideal and the real. Nor are we
given any sense of why these particular archives were chosen for
examination, what criteria were employed to mine them for facts, how
representative the examples Foucault provides might be. Of course, by the
very ambitions they have set for themselves, comparative historians are
often forced to rely to a substantial extent on the work of others, so
perhaps this use of highly selective French material to represent the
entire Western world should not be judged too harshly. But the secondary
sources on which Foucault repeatedly relies for the most well-known
portions of his text are so self-evidently dated and inadequate to the
task, and his own reading of them so often singularly careless and
inventive, that he must be taken to task.
Foucault alleges, for example, that the 1815–16 House of Commons inquiry
into the state of England's madhouses revealed that Bedlam (Bethlem) placed
its inmates on public display every Sunday, and charged a penny a time for
the privilege of viewing them to some 96,000 sightseers a year. In reality,
the reports of the inquiry contain no such claims. This is not surprising:
public visitation (which had not been confined to Sundays in any event) had
been banned by Bethlem Royal Hospital's governors in 1770, and even before
then the tales of a fixed admission fee turn out to be apocryphal. Foucault
is bedevilled by Bethlem's history. He makes the remarkable claim that
"From the day when Bethlem, the hospital for curative lunatics, was opened
to hopeless cases in 1733, there was no longer any notable difference
between the London hospital and the French Hôpital Général, or any other
house of correction". And he speaks of Bethlem's "refurbishment" in 1676.
In reality, it had moved in that year from its previous location in an old
monastery in Bishopsgate to a grandiose new building in Moorfields designed
by Robert Hooke.
Monasteries surface elsewhere in his account. We are told with a straight
face that "it was in buildings that had previously been both convents and
monasteries that the majority of the great asylums of England . . . were
set up". This is a bizarre notion. First, there were no "great asylums" set
up in England in the classical age. Vast museums of madness did not emerge
until the nineteenth century (when they were purpose-built using taxpayers'
funds). And second, only Bethlem, of all the asylums and madhouses that
existed in the seventeenth and eighteenth centuries, was ever housed in a
former convent or monastery, and when it was, its peak patient population
amounted to fewer than fifty inmates, hardly the vast throng conjured up by
Foucault's image of "grands asiles". It is odd, to put it mildly, to rely
exclusively on nineteenth- and early twentieth-century scholarship to
examine the place of leprosy in the medieval world. It is peculiar to base
one's discussion of English and Irish poor law policy from the sixteenth to
the eighteenth centuries on, in essence, only three sources – the dated and
long superseded work of Sir George Nicholls (1781–1865), E. M. Leonard's
1900 textbook, and an eighteenth-century treatise by Sir Frederick Morton
Eden. For someone purporting to write a history of the Western encounter
with madness, it is downright astonishing to rely on a tiny handful of
long-dead authors as a reliable guide to English developments: Jacques
Tenon's eighteenth-century account of his visit to English hospitals,
supplemented by Samuel Tuke's Description of the Retreat (1813) and Hack
Tuke's Chapters in the History of the Insane (1882).
But then, Foucault's sources for his accounts of developments in Germany,
in Austria, even in France, are equally outdated and unsatisfactory. The
whole of Part One of Madness has a total of twenty-eight footnotes (out of
399) that cite twentieth-century scholars, and the relevant list of sources
in the bibliography mentions only twenty-five pieces of scholarship written
from 1900 onwards, only one of which was published after the Second World
War. Things do not improve as the book proceeds. Foucault's bibliography
for Part Two lists a single twentieth-century work, Gregory Zilboorg's The
Medical Man and the Witch During the Renaissance (1935) – scarcely a source
on that subject calculated to inspire confidence among present-day
historians (and one that Foucault himself criticizes). For Part Three, he
lists a grand total of eleven books and articles written in his own
century.
Narrowness of this kind is not confined to footnotes. Foucault's isolation
from the world of facts and scholarship is evident throughout History of
Madness. It is as though nearly a century of scholarly work had produced
nothing of interest or value for Foucault's project. What interested him,
or shielded him, was selectively mined nineteenth-century sources of
dubious provenance. Inevitably, this means that elaborate intellectual
constructions are built on the shakiest of empirical foundations, and, not
surprisingly, many turn out to be wrong.
Take his central claim that the Age of Reason was the age of a Great
Confinement. Foucault tells us that "a social sensibility, common to
European culture . . . suddenly began to manifest itself in the second half
of the seventeenth century; it was this sensibility that suddenly isolated
the category destined to populate the places of confinement . . . the signs
of [confinement] are to be found massively across Europe throughout the
seventeenth century". "Confinement", moreover, "had the same meaning
throughout Europe, in these early years at least." And its English
manifestations, the new workhouses, apparently appeared in such "heavily
industrialised" places as seventeenth- century Worcester and Norwich. But
the notion of a Europe-wide Great Confinement in these years is purely
mythical. Such massive incarceration simply never occurred in England in
the seventeenth and eighteenth centuries, whether one focuses one's
attention on the mad, who were still mostly left at large, or on the
broader category of the poor, the idle and the morally disreputable. And as
Gladys Swain and Marcel Gauchet argue in Madness and Democracy (reviewed in
the TLS, October 29, 1999), even for France, Foucault's claims about the
confinement of the mad in the classical age are grossly exaggerated, if not
fanciful – for fewer than 5,000 were locked up even at the end of the
eighteenth century, a "tiny minority of the mad who were still scattered
throughout the interior of society". Foucault's account of the medieval
period fares no better in the light of modern scholarship. Its central
image is of "the ship of fools", laden with its cargo of mad souls in
search of their reason, floating down the liminal spaces of feudal Europe.
It is through the Narrenschiff that Foucault seeks to capture the essence
of the medieval response to madness, and the practical and symbolic
significance of these vessels loom large in his account. "Le Narrenschiff .
. . a eu une existence réelle", he insists. "Ils ont existé, ces bateaux
qui d'une ville à l'autre menaient leur cargaison insensée." (The ship of
fools was real. They existed, these boats that carried their crazed cargo
from one town to another.) But it wasn't; and they didn't.
The back cover of History of Madness contains a series of hyperbolic hymns
of praise to its virtues. Paul Rabinow calls the book "one of the major
works of the twentieth century"; Ronnie Laing hails it as "intellectually
rigorous"; and Nikolas Rose rejoices that "Now, at last, English-speaking
readers can have access to the depth of scholarship that underpins
Foucault's analysis". Indeed they can, and one hopes that they will read
the text attentively and intelligently, and will learn some salutary
lessons. One of those lessons might be amusing, if it had no effect on
people's lives: the ease with which history can be distorted, facts
ignored, the claims of human reason disparaged and dismissed, by someone
sufficiently cynical and shameless, and willing to trust in the ignorance
and the credulity of his customers.
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Andrew Scull's book *Madhouse: A tragic tale of megalomania and modern
medicine* will appear in a new paperback edition this autumn.
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