83: Michel Foucault V:
The Great Confinement & The Birth of the AsylumSummary by: Jeff McLaren Michel Foucault's genealogical method always starts with historical facts and dates but asks questions designed to discover the systems of thought that made the events possible. Today we will look at two chapters from his book “Madness and Civilization,” to illustrate his approach on a topic that is usually not considered to have a history: madness. (Q1)
Basic history tells us that the first Hôpital Général, was set up on April 27, 1656. Within 6 months 1% of the people of Paris were in hospital. There were no more dead bodies or sick people on the streets.
Advanced history looks at the text of the royal edict that created the first general hospital to reveal: it had nothing to do with medicine; its purpose was to prevent “mendicancy and idleness as the source of all disorders.” Advance history also looks at more specific events such as orders to have city archers [ie police] hunt down and confine the idle, sick and poor to the hospital and at the fact that the Grand Almonry (the city's food and clothing bank) closed shortly after the creation of the General Hospital. One of many possible conclusions from this is that the general hospital was created in order to facilitate the forced labour of the idle, sick and poor and save the government the costs of alms to the Grand Almonry. (Q2)
Genealogy asks: How could this come about? One notion that was in vogue at the time was the definition of “police”: “...the totality of measures which make work possible and necessary for all those who could not live without it.” in other words the purpose of the police was to make the poor work for the rich. “Hospital” in 17th century France had no modern sense of benevolence or charity to the sick. It had the sense of a condemnation of idleness. “...the Hôpital does not have the appearance of a mere refuge for those whom age, infirmity, or sickness keep from working; it will have not only the aspect of a forced labor camp, but also that of a moral institution responsible for punishing, for correcting a certain moral 'abeyance' which does not merit the tribunal of men, but cannot be corrected by the severity of penance alone. The Hôpital Général has an ethical status. It is this moral charge which invests its directors, and they are granted every judicial apparatus and means of repression...” (Q3)
The Emergence of the hospital as a system of confinement and forced labour created an implicit new understanding and system of obligation: people could now count on being fed by the authorities (rather than tortured and driven out of the city) in exchange for their consent to the confinement rules of the hospital. However, in these hospitals a new category of idleness was discovered: the mad man who could not be forced into productive labour.
Up until the 17th century, what the 17th century started calling 'madness' was a sign of heightened sensitivity to the transcendent. Among the general values that were in flux were the spiritual values of the middle ages (contemplation and prayer) and the new bourgeois values of the Renaissance (labour and profit). The bourgeois values inverted the middle age values: contemplation was renamed idleness, expanded to include unemployment, and judged evil. This moral judgment (not the economic value) animated the development of the hospital. (Q4)
Basic history claims that asylums (an extensions of or special hospitals) were created to house the insane. Genealogy asks: What change in the common thought took the insane from being close to God to necessitating their separate confinement? “It was in a certain experience of labor that the indissociably economic and moral demand for confinement was formulated.” Because work was considered a moral virtue and idleness a moral vice; because governments, receiving some level of legitimation from the church's moral authority, were concerned with the moral status of their citizens, it can be seen why institutions of forced labour might proliferate. However, the person who could not be made to work posed a certain problem: If idle people were allowed to be thought of as “good” in any way they would infect the morally good hard working citizens with the vice of idleness. Thus the logic of the Lazar House (or the special segregation of lepers in leper colonies for the public good) was applied to the asylums: madmen had to be segregated for their and our protection.
The asylums of the 17th and 18th centuries followed the older logic of the church sacrament of reconciliation or confession. The asylum is “... not a free realm of observation, diagnosis, and therapeutics; it is a juridical space where one is accused, judged and condemned, and from which one is never released except by the version of this trial in psychological depth – that is by remorse.” In other words remorse for one's madness was the criteria of having regained one's sanity and the possibility of release.
A sinner in the church had to go to a priest and confess his sins. If one showed remorse the priest would give absolution and a work of penance. In the asylum the function of the priest was as an accident of history replaced by a medical personage. The head director of any asylum could come from any profession (general, doctor, professor etc.) or from a high rank (ie Bishop, nobleman, etc.) but historically in France two asylums preformed relatively better at rehabilitating madmen (that is getting remorse out of their inmate population). These two asylums where headed by physicians. These two outliers set the stage for the medical take over of asylums and hospitals. Foucault goes to great lengths to show that “It is not as a scientist that homo medicus has authority in the asylum, but as a wise man....It is thought that Tuke and Pinel [the two directors of the two “successful” general hospital asylums] opened the asylum to medical knowledge. They did not introduce science, but a personality, whose powers borrowed from science only their disguise, or at most their justification. These powers, by their nature, were of a moral and social order; they took root in the madman's minority status, in the insanity of his person, not of his mind.” the examples in the books show that these two doctors were very good at tricking the madmen into wanting to work and showing remorse: this is what constituted a successful cure to madness. “These cures without basis, which must be recognized as not being false cures, would soon become the true cures of false illnesses. Madness was not what one believed, nor what it believed itself to be; it was infinitely less than itself: a combination of persuasion and mystification.”
Within these two chapters Foucault covers about 300 years of the genealogical history of madness. It went from being a sign of divine closeness (in which the subject is left alone because God has made him/her that way) to a vice (which required correction and punishment to cure) to a trick (which required further trickery from a doctor to cure).
Q1 According to Foucault the experience, meaning and categories linked to the phenomenon we label as “insane” or “crazy” have a history. The phenomenon of a madman in ancient Rome who expresses identical actions and symptoms to a mental disorder today would nonetheless experience something different in his lived experience; he would mean vastly different things to himself and his contemporaries and the thought categories in which people of both eras would make sense of the phenomenon would be different. Foucault claims that the lived meaning and experience of any otherwise identical phenomena is different in different time periods. Do you accept this postulate? Why or why not?
Q2 Would a basic or advance historical explanation be enough for your understanding of past events?
Q3 The reason that the General Hospital was created was to fix a very precise problem of morality: the vice of idleness in the lower classes. (certainly, idleness was not a vice for the wealthy nobles). How does this strike you?
Q4 Foucault is quite adamant that the economic value was secondary to the moral value due in part to the number of arguments that mention each and due to the sum of the existing system of thought of the time. Marx would have countered that the economic value was primary but could not be called directly due to the influence of the church at the time. Given that both economic and moral arguments had weight, which one would you find more believable? If you answered Marx's economic argument then I believe that Foucault would claim that that is due to you being the product of the modern world in which the market and economic factors do count for the primary motivation of most people. Foucault claims that this world was not always the same. Can you imagine the 17th and 18th century as ones in which economic arguments are not the deciding factor in actions and beliefs?
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