HISTORY OF MADNESS. Translated by Jonathan Murphy and Jean Khalfa. By Michel Foucault. 725pp. Routledge. Pounds 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 personnalite, 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.
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 deraison: Histoire de la folie a l'age 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 cafe 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 College 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-a-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 Age, la lepre disparait du monde occidental. Dans les marges de la communaute, aux portes des villes, s'ouvrent comme des grandes plages que le mal a cesse de hanter, mais qu'il a laissees steriles et pour longtemps inhabitables.
Des siecles durant, ces etendues appartiendront a l'inhumain. Du XIVe au XVIIe siecle, elles vont attendre et solliciter par d'etranges incantations une nouvelle incarnation du mal, une autre grimace de la peur, des magies renouvelees 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 Hopital General, 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 reelle", he insists. "Ils ont existe, ces bateaux qui d'une ville a l'autre menaient leur cargaison insensee." (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.