If you are interested in modern philosophy, you should know the French thinker Michel Foucault, one of the most popular names in the age of post-modernism and continental philosophy. He wrote Folie et Deraison: Historie de la Folie a L’age Classique, known as Madness and Civilization because of his experiences in a mental institution while dealing with his own psychological issues and his deep interest in the history and practice of psychology.
As Foucault mentioned before, our relationship with mental illnesses, and how we recognize, understand, and treat them has changed dramatically. However, we’ve acted ignorantly so Foucault focused primarily on the end of the Middle Ages which represents also the Enlightenment, began in the early to mid-1700s. Foucault recognized the ‘’great confinement’’; it was stigmatized in the eyes of the public, including the undesired elements of society, including the poor, illegal and so-called insane.
Mental patients, criminals and even animals have been treated differently for hundreds of years, but our understanding of the mind eventually develops as we will see in this summary.
Facilities for leprosy patients were used for the mentally ill and other social exclusions after the Middle Ages.
In Europe, during the late Middle Ages from 1250 to 1500, what was called ‘’madness’’ was understood differently from that of hundreds of years later. People with psychological problems were actually seen as ‘’different’’ from others. It was even considered as a pearl of wisdom, some of which showed the limits of reason.
During this time, most of those with a mental illness or disorder were free to roam in the backyard of others. If s/he was found to be an alleged ‘’insane’’ in a European city, s/he would be sent to a sailor or merchant to leave them to another city or a sparsely populated rural area.
This tradition was particularly prevalent in Germany. According to the records in Nuremberg in the fifteenth century, 31 out of 63 mentally ill people were removed from cars and ships in the city. Also, at the end of the fourth century, sailors were instructed to eliminate such people by rolling around in Frankfurt.
A popular literary and artistic phrase used throughout the years, the ‘’ship of fools’’ comes from the shipping application for the mentally ill city residents.
There are some works which are related to the Narrenschiff, or ‘’ship of fools’’, sailed the waters of the Rhine and Flemisch canals and removed the city’s ‘’madmen’’. For instance, a painting had this image, The Ships of Fools, was made by famous Dutch painter Hieronymous Bosch between 1490 and 1500.
A few years later, following the decline of leprosy in Western Europe, people with mental illnesses began to be removed.
Leprosy was an infectious disease affecting the skin, and when the disease spread across Europe, patients were placed in Lazar houses which were special facilities located on the outskirts of the cities.
These facilities were started to use for separating criminals, derelicts, and people with mental illnesses when the leprosy outbreaks diminished in Europe. Perhaps it was not surprising that new detainees were seen as carriers of disease. Just as medieval societies began to marginalize and stigmatize people whom they once called ‘’lepers’’, the societies of the classical ages did the same to these new people: Say ‘’madness’’ and exclude!
However, Lazar houses were not the only place that holding people with mental problems. There were also some cities in the early eighteenth century that hold people in restricted places such as the ‘’Tour aux Fous’’, the tower within the walls of Caen, France.
The result of general hospitals’ opening: Systematic confinement of social exclusion.
A reduction of interest in working or idleness was a characteristic that the ruling classes not only insulting; it was also dangerous for the society at the beginning of the seventeenth century. For this reason, the authorities had to find a way to prevent this behavior and to hide it from the public eye.
According to Foucault, the start of the ‘’great confinement’’ was based on the original role of the police. This appeared firstly in the European countries around that time and poor people were forced to work. In the same way, the reason for creating the ‘’Hopital General’’ or general hospital was limiting the idle and the unwanted rather than treating illnesses.
One of the leading Lazar houses, St. Lazare was turned into a general hospital in 1632. Then, the king of France, Louis XIV, opened his own general hospital in 1656. The opening was accompanied by a decree forbidding begging to the city, and anyone apprehended while begging would be brought by a less arch militant to the hospital.
Such developments were not limited to France alone. Other European countries have made similar adjustments to their behavior against undesirable people, and in a short period of time, they limited an important population to these institutions.
A few years after opening the gates of Paris’s general hospital, it was home to more than 6,000 people, one percent of the city’s population! Who did not exist! There were beggars, pretty criminals, social outcasts and of course those who suffer from a mental illness.
In the fight against idleness and unemployment, general hospital residents had to work and produce goods. While many attempts have been made to turn some buildings of the general hospitals into factories in Paris, residents carded and spun the wool for a local businessman in Tulle, the city of France.
As a result, the benefits of the policies of the work were questioned by the residents because the cost of their confinement was more than their economic output.
First and foremost, the great confinement was a reflection. This reflection included the standards of the church, the state and the bourgeoisie, and their sanctions on the poor. It was also emphasized that the term madness was related to non-integration with society and the inability to work.
‘’Madmen’’ were treated like animals whereas others in confinement had no treatment.
When hospitals were established, the authorities easily maintained the impression that there were no problems in the public sphere, because the people there were pretty criminals, homeless and other socially excluded. In most cases, this limitation was a way of removing undesirable elements from people’s eyes.
However, while these hospitals were a way for authorities to avoid scandal, it was a way for families to avoid unwanted attention. In the Middle Ages, if there was someone who accused of being guilty, an open trial was opened against which the accused would be required to confess publicly.
Of course, hospital confinement was an attractive alternative for the families of the accused one because of the feeling of shame. When we considered many cases, we saw that the accused being put in the hospital without a public hearing could be arranged. As a result, the authorities were happy because streets were clear of ‘’undesirables’’ and the families were happy because there was no scandal.
However, life wasn’t so ideal for those in custody because between the seventeenth and eighteenth centuries, science and medicine did not understand that those who seen as ‘’mad’’ actually suffer from a form of sickness or psychological disorder. Tragically, these people were often treated as exotic animals.
At that time, people with a mental illness or disorder were only ten percent of the limited population and they were exhibited for curious people unlike petty criminals and others who were in hospitals. Surprisingly, one of these shows took place every Sunday at the Bicetre hospital just south of Paris and continued until the revolt of the French Revolution.
Honore Mirabeau, an early leader of the revolution, described the rebel practice in his book Observations D’Un Voyageur Anglais (1788). He mentioned that: ‘’Madmen were shown like curious animals, to the first simpleton willing to pay a coin.’’
Also, London’s Bethlehem hospital opened their doors to people who paid customers on Sundays until 1815, so anyone paying a penny could look at them.
Potentially violent madmen were often tied to the walls with chains around the ankles and only wore hospital gowns. They were placed in individual iron cages in a hospital in Nantes, France. Surprisingly, hospitals in Europe found some methods to treat them. For instance, they believed that these people needed pain, cold, and discomfort to be disciplined.
People with mental disorders and criminals were separated because of economic reasons at the turn of the eighteenth century.
People called ‘’madmen’’ filled out hospitals, as well as petty criminals and convicts and both groups, had terrible conditions to live. At the dawn of the Enlightenment in the eighteenth century, the public had a growing concern about maltreatment. But which group did they really care about?
The safety of the criminals was provided by several facility directors who controlled the confinement, and therefore the idea that criminals should be separated from those with mental illness has emerged. In 1713, the headquarters at the Brunswick detention center in Germany ordered that both groups be kept separate in order to find the screams and confusion of the mentally ill people.
However, there was concern about those with mental disorders from the end of the eighteenth century to the nineteenth century. While public officials visiting hospitals in France, Germany, and the UK, they were appalled by the conditions that patients were exposed to.
A German physician, Johann Christian Reil, complained about the situation and mentioned that madmen such as state criminals were being thrown into dungeons where humanity disappeared.
The complaint of Reil was found a supporter, French psychiatrist Jean-Etienne Esquirol, in the early nineteenth century. He claimed that there were a few prisons that have no madmen and these misfortunes were chained to the dungeons as well as criminals. What a terrible association!
However, most of the time the reasons for reviewing the confinement rules were economic.
The purpose of the ruling class when they began the great confinement in the late seventeenth century was keeping the idle away from sight but at the same time making those people work to maintain the status quo. However, the cost of confinement was economically severe at that time. When the seeds of the industrial revolution were being thrown away, the turn of the eighteenth century, the benefits of the idle labor behind the hospital walls was reconsidered by economic thinkers.
This time, the authorities realized that people with mental illness would slow down the workforce so they understood that cheap labor would come from small criminals and poor people, rather than ‘’madmen’’. As a result, criminals and poor people were separated from madmen to provide more work.
The explanation of what is called ‘’madness’’ would slowly move away from physical discomfort to psychological explanations.
Doctors still believed that mental disorders came from physical reasons at the end of the Middle Ages.
According to popular belief, there were four ‘’humors’’ in our body which were black bile, yellow bile, blood, and phlegm and these were responsible for every illness and mood that emerged. Early treatments for mental illness focused on ways to prevent these conditions, including exercise and nutrition regimens, fresh or seawater baths and cold showers.
On the other hand, the different types of mental disorders were accepted as related to the humors: Melancholia, mania, hypochondria, and hysteria.
Melancholia and mania were the oldest diagnosed mental disorders and their treatment was the same since the ancient Greek days. Melancholia seemed to be like today’s depression, while mania represented the opposite, an overexcitement situation.
Hypochondria and hysteria were relatively new disorders in the seventeenth century.
People with hypochondria tend to be like that although there was no diagnosed disease; they felt like they were sick. On the other hand, the term of hysteria has been used as an umbrella to identify mental disorders which were related to the state of over-excitement and unstable emotions. Remember that the term of hysteria was based on the ancient Greek word ‘’uterus’’ so female patients were generally seen as hysterical.
By the ‘’classical period’’ definition of Foucault, the concept of mental illness or disorder began to contain the psychological causes beyond the physical causes in the seventeenth and eighteenth centuries. For instance, Portuguese-Dutch physician Zacatus Lusitanus (1575-1642) made some special practices by combining psychological treatments and physical treatments together. This type of practice provided a wider approach.
Here is one of the practices: Do you want to direct patients to ideal morality and behavior? So, think them as children and educate them for acceptable behaviors.
In other cases, delusional behavior was treated by various methods, such as the theater. For example, a heavy ball was placed on the head of a patient who believed that he had no head. The pressure and great discomfort was designed to make the patient realize that he really had a head.
We can consider these developments as the first steps of treating the mind rather than simply thinking about treating them physically. However, the concept of psychology was not revealed at that time. Nevertheless, although these treatments were considered physical treatment for the body, these early treatments started to provide psychologically different perspectives.
The modern psychiatric institution emerged in the nineteenth century because prison administrators and doctors changed places in hospitals.
French physician Philippe Pinel and the English philanthropist and businessman William Tuke made early psychological institutions happen. The role of these institutions included the separation of people with psychological problems from other victims of the great confinement. Also, the first modern ‘’mental asylums’’ were created based on the idea that psychological treatments were in people’s infancy.
In rural area York, England, Tuke had a facility known as The Retreat and it opened its doors in 1796. Tuke’s institution was founded on adherence to certain moral rules and to avoiding barbarian dungeons and abusive treatment. There was an education for wardens to prevent physical punishment and to teach discussing the reason for patient’s undesirable behavior.
In France, there were some changes done by Philippe Pinel and many people with mental illness got rid of physical bondage and pain thanks to him. Pinel pulled out the chains at the Bicetre hospital in Paris and soon did the same thing for the Salpetriere hospital before three years to the opening of The Retreat.
Also, he ended up the harsh treatments such as bleeding, purging, and blistering by changing them with more humanistic and psychological approaches. Thanks to him, patients became more conscious of their actions and tended to reflect on their transgressions.
As a result, patients were no longer exposed to such abuse thanks to Pinel and Tuke. However, these institutions were still serving the values and power dynamics of bourgeois society. But this time, roles a little changed. The relationship between the staff and the inmate turned into a similar relationship to a father-child dynamic.
Other changes in the treatment methods of those psychological problems required the replacement of the old prison administration with doctors.
Any facility holding people with mental illness needed a medical certificate from the end of the eighteenth century. Also, these certificated facilities represented the modern psychiatric practice because doctors had a central role in here: Regularly visit patients, control their health and progress.
The work of ‘’madness’’ didn’t develop enough to be regarded as its own medicine before the late eighteenth century. However, after the emergence of psychiatric disorders, the discipline of psychiatry developed as an independent science. Finally, treatments became testable in a controlled environment and experimental evidence can be collected.
Madness and Civilization: A History of Insanity in the Age of Reason by Michel Foucault, Richard Howard Book Review
The understanding of ‘’madness’’ in European society has changed a lot from ancient Greece to the Enlightenment and eventually to the 1960s when Foucault wrote Madness and Civilization. People with mental illness weren’t wanted in society, so they were out of sight and at the same time they were poor, criminals and others called ‘’unwanted’’.
According to authorities, these people were cheap and idle labor so they could be treated with abusive and controlled ways. Finally, psychiatric ascents were created and mental problems began treatment based on more humanistic conditions. Gradually, mental illness was based on psychology.
