How does bio-power influence our understanding of the sane and insane? How does it separate the rational from irrational? What are the causes, symptoms, behaviour of madness/ insanity/ unreason? what was the idea of Psychiatry in the beginning? Does madness reflect social order? Did the stationary non-human role of women throughout the history of centuries affect their mental wellness?
Through this paper, I will attempt to discuss the analysis of madness through three books/texts namely; Madness and Civilisation by Michel Foucault, Madness in Civilization: A Cultural Study Of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine by Andrew Scull and lastly, Madness a brief history by Roy porter.
All these texts have a subtext of Biopolitics channelled through biopower. For Foucault, life can’t be understood as a biological force independent from political determinants; he describes biopolitics from the 17th century as a historical development and transformation where the rights of the state or sovereign to repress and destroy life is complemented by a new power wherein it secures, optimize and develop life. Biopower designates this type of productive power. This includes inventing personalised and general technologies which enable the centre to control and manage individual bodies while it also intervenes on a societal level.1
In Madness and Civilization, Michel Foucault deals with order in relation to madness in the Age of reason. Through the book, he explored how societies expressed power to control subjects that were labelled “mad” or those who were psychologically unfit to fit into a societal structure. They were subjected to extradition, expulsion, incarceration, condemnation, medication, meditation and immersion. Foucault’s penned the history of social responsibility of societies changing responses to the attitudes of madness, which was dubbed mental illness, rather describe a history of madness.
He employs biopower, subjectivation which is a person’s ability to shape personality and behaviour from their political and philosophical ideas and, discourse analysis which is the study of language beyond the sentence while describing how people dealt with this peculiar “disease” in Western civilization. In the process of engaging withthe texts, Foucault writing reveals his Marxists and quasi-structuralist views along with the latent expression of his mental state. He perceived mental illness within humans to align to external factors such as the illness of poverty, loneliness, worklessness and illness of upbringing in difficult social environments revealing that mental disturbance arises due to conflict-ridden capitalist society, thus excluding those borne of higher social statuses or those in the urban areas.
Foucault’s sources were limited to literary writings, medical and philosophical texts such as Praise of Folly by Desiderius Erasmus2, King Lear by Shakespeare3, Cervantes4, Sauvages5, Nietzsche6 etc. He traces the history of West’s treatment of the insane from the Renaissance7, the Middle ages8, the Classical Age or Age of Reason9 and the late 18th and 19th century10.
From “Madness and the madman (excluding madwomen in the analysis) become major figures, in their ambiguity: menace and mockery, the dizzying unreason of the world, and the feeble ridicule of men”11 in the introduction and the contents from self-proclaimed experts on women’s affairs such as George Ernst Stahl12 in the chapter ‘Aspects of Madness’, what becomes clear of Foucault’s work is the second-class citizenship of the female, they were considered to be hysterical, symptomatic of different kinds of illness and were related to as objects in society by the dominant male ruling class.
Foucault accounts from literary sources that in the 15th century, madness was considered a “divine spectacle”13 or the wrath of God for deviation from the faith and that only holy miracles could cure them. He briefly explored the belief that madness was the lowest point of humanity according to God in the Bible. These religious themes echoed in the questionable cure of immersion or hydrotherapy in the chapters ‘Birth of Asylum’ and ‘Doctors and Patients’, wherein he attributes primitive and pure powers to the cold water being showered involuntarily on the ‘mad’ as a rebirth of baptism which could alleviate an individual of mental illness. Foucault discusses idleness at length and explored how it was regarded as the mother of all evils in the economic crisis of the 17th century.14 He attributes an economic standpoint to the establishment of the Hospital General, which was to mask poverty more than to provide jobs for the unemployed. 15 Foucault also stresses on the non-medical or non-assistive nature of such socially constructed facilities as they hunted and contained the idle, vagabonds and the unemployed in prison-like-wards.16
Foucault accounts from literary sources that in the 15th century, madness was considered a “divine spectacle”13 or the wrath of God for deviation from faith and that only holy miracles could cure them. He briefly explored the belief that madness was the lowest point of humanity according to God in the Bible. These religious themes echoed in the questionable cure of immersion or hydrotherapy in the chapters ‘Birth
Civilization to Foucault centred mostly on the western sphere of the world, particularly France and England. Madness and Civilization doesn’t take into consideration the narrative accounts of what drove these individuals to be labelled as mad but explores how madness originates from passion into an extreme and irrational movement of the unity of body and soul revealing a deep relationship between madness and unreason.17 He regards the delusional aspect of madness as unreason and critiques Sigmund Freud for attempting to bridge a dialogue between medicine and unreason. According to Foucault, madness was an objectivised political weapon created by the state to control the masses, thereby asserting a “third order of repressing”18 major populations of society deemed insane. He also writes a great deal of art; Bosch’s paintings, George De Scudery’s theatre19 revolving around the theme of death in the 15th century and seems hugely influenced by it.
Foucault accounts that the essence of madness is animality or bestiality as Mmadness had become a spectacle like animals with strange behaviour and because animals were considered to be irrational and unreasonable. He describes animality as bringing out a dark rage in humans and it was due to this essence that madness was never linked to medicine. 20
Scull and Porter criticised the Foucault’s views on the Europe-wide Great confinement stating that there was no real evidence to prove this and painted Foucault as an anarchist who mistrusted institutions perhaps due to his abusive past of a bully father, self-harm and a suicide attempt in 1948. After reading Foucault’s history of madness, I can relate to the history of the system. Foucault believed that psychiatry that originated in Germany was a form of social control (an exercise of biopower) and political, economic, and institutional motivations were the main reasons whilst establishing an institution of such professionals.
The main theme which permeates this text is the displacement of what he considers to be sovereign power from pre-modern to modern forms of society. The power residing in the body of the monarch is channelled through disciplinary power which invests in the bodies of the large population.21 However, he described madness as free and fast-spreading which posed problems to the impuissant legislation as to where to confine these individuals; the hospital, prison or family and, when to end the confinement.22
Borrowing from Foucault, yet unlike him, Andrew Scull traces the cultural history of “Madness” in Madness in Civilisation: A Cultural History from the Bible to Freud, from Madhouse to Medicine. He doesn’t attribute mythical or fantastical origins to madness and recognises it as a medical issue, unlike Thomas Szasz. In attempts to be authentic, he addresses mental illness by its age-old umbrella term as madness. 23
Scull borrows heavily from novels24, biographies25, autobiographies26, plays27, films28, paintings29, sculptures30 physician’s writing, medical writing and more. Scull critiqued Foucault’s view of the madness of it being restricted to certain sections or classes of society in the histories of Western civilization, describing that mental illness or “Madness” as an occurrence is common to every society and their social fabric. He rethinks civilisation by weaving the histories of madness and medicine from the Eastern (China)31 and Islamic worlds32 evidence to the Western world of Europe and Christianity bringing forth religious solutions to healing and illness, although in limited ways.
Scull traces madness from ancient Greek and Roman mythology33 through to the pharmaceutical and diagnostic revolutions of the late 20th century; from demonic possessions in the Middle ages34, Melancholia in the Renaissance – a theme discussed by Foucault in his chapter ‘Aspects of Madness’, to early hospitals and asylums, transformations in care and emergence of occupations concerned with treatment and incarceration of the mentally Ill, all hinting at Foucault’s themes.
A major determining factor and cause of madness were considered to be religion. Demons or Jinn were strongly prevalent in old Arabic concepts from ancient Islam who was responsible for several types of disorder and disease. Islamic followers were unaware and had no equivalent of Christian ritual of Exorcisms.35
There is a clear distinction in the writing of Scull with relation to psychiatry replacing religious explanations and that the treatment of the mentally ill should be handled by medical professionals who claim jurisdiction over mental issues. He traces these ideas to Ancient Greece, where Hippocrates saw madness as a product of biological faults or humoral imbalance as compared to supernatural explanations; Hippocratic texts emphasised the importance of gender differences in understanding temperament and behaviour. The womb was the root of all disease in the female species.36
The book encapsulates rich and thematic imagery which was inspired by the growing fascination of madness such as Phillipe Pinel’s freeing the Lunatics from their chains37, John Everett Millais’ Ophelia38 etc. Scull’s focuses on madhouses and their doctors while describing institutions begin; He argues that 17th century onwards, the poor, idle and mad were preyed upon to promote the new trend of ‘shutting people up’ or institutional confinement in parts of Europe.39 Scull links these practices to the business of supervising people in life and death revealing a new underlying economic structure which he coined the ‘rising trade in lunacy’.40 Scull investigates the idea of population degeneration through practices of institutional isolation; Degeneration shaped the interpretation of these institutions in the 19th century as a clinic for the weak and othered.41
Scull focused on deinstitutionalisation to uncover that the eventual decline of institutions or hospitals for the insane was due to questioning of the significance and authority of asylums by populations as changes on a local level fared better and, the advent of psychotropic drugs42
Foucault believed that records are all that’s left as time progresses, Andrew Scull centred his text around traces of madness or delusions which were clinically recorded, written or documented. However, there is a prejudice or a biased tendency in historical, philosophical and medical writing about psychiatry and madness which endows patients with intense interpretations from a “objective or sane” standpoint. Accordingly, what is the certainty and accuracy that Scull’s compilation of cultural representations and iconography of madness say much about madness at all? The cultural images may do nothing more than capture, arguably ‘sane or normal’ people’s imaginations of madness.
Madness: A Brief History by Roy Porter begins with the chapter ‘What is Madness? However, the author doesn’t define madness rather describes how madness has been defined over the centuries. Porter highlights the temporariness of who is categorised as insane? What causes mental illness and how should mental ailments be treated? He stresses on the unfortunate consistency of the mistreating suffers by evoking the imagery of man’s inhumanity to man in the Bedlam asylum43. In his introduction, he emphasizes the patient’s voice and the idea that his book takes on a human-centric approach.
Every age gets the lunatics it deserves.-Roy porter, Madness: A Brief History
The organisation of society’s understanding of madness stems from a time when skulls were bored with holes to enable demons to escape44, to madness as a trial of another’s soul45, to imbalances of humour, i.e. black bile, yellow bile, phlegm and blood,46 to ‘divine fury’ or artistic genius47, to sanity in a world gone mad or the ideas of civilization being psychopathogenic48 and/or, brain degeneration or brain chemistry gone faulty49. He describes religious treatments of exorcism50, alienist treatments such as immersion in a tub of eels (adaptation of a Foucauldian concept) and sealing wax dropped onto palms51, psychiatric methods of shock therapy and psychosurgery52, psychoanalysis53 and medication54 etc.
He critiques Foucault’s understanding of mental Illness as a cultural construct and his emphasis on accounts of madness and its treatment rather than on knowledge, freedom and power. 55 Porter criticises Foucault’s theory of the Great Confinement with historical facts that the 17th century saw a surge of institutionalisation only in France and that the 19th century saw the act for permitting the use of public funds for asylums in England.56 His critique of Freud, unlike Foucault and Scull, is based on the fact that Freud claimed to be a natural scientist, but his research guided more by influence than science; his psychoanalytic technique was used to gain socio-sexual control over ethnic minorities, homosexuals and women.57 However, his interest was not in commanding polemic but in the variety of attitudes to Madness across centuries.
Porter examines the interface of Madness and genius while referring to ‘The Sanity of the True Genius’ by Charles Lamb and ‘The Insanity of Genius’ by J.F Gisbet to reveal the dichotomies in mental illness, an idea that Foucault dabbled with58. His fresh take on the asylums was its history was used to stigmatise and separate inmates but also provide a venue for specialised and focused care.59 However, highlights the importance
given to the architecture of asylums; the segregation of man and woman, curable and incurables, confinement of different degrees of lunatics etc.60 Building on the work of Scull, Porter adds that while similar ideas emerge again and again through centuries, the notion of madness and genius are not only closely related but may be mutually dependent states.61 Following similar themes to Scull; from Graeco-Roman Philosophers and doctors to Christian interpretations, he interestingly focuses on medieval witch-hunting to the age of reason62 and that hysterical women were condemned as witches.63 From literary and artistic sources such as representations of the bedlam institution64, he shifts to rise of psychiatry and use of prescription drugs such as Valium, imipramine, Prozac etc.65 He examines different perceptions of psychiatric disease and similarities between depression66 and psychosis while studying artistic expression of madness in art and literature.
He conclusively stands by the fact that insanity and madness cannot be fully defined, there will always be an air of mystery surrounding it. Through the social history of madness, Porter attempted to reveal who had been thought as mad? What were the reasons for their madness and what action had been taken to cure and secure them?
In conclusion, the analysis of the three texts representing a socio-economic, cultural history and a social history respectively, reveals an unwavering presence of responsibility and authority of the social order in dictating what is sane or insane/ rational from irrational/reason from unreason is a constant. There is a clear resonance of ideas in all three texts; there is transience in the social fabric and social order as well as the change in their attitudes towards mental illness. Unlike Foucault, Porter and Scull both attributed insanity in the form of mania and melancholy to organic or biological causes. The sources are mostly based on the great books or illustrations of Western civilization, hence, begging the question of madness in other imagined civilizations and their respective sources. Another question that riddled nearly all paragraphs outlining the causes, symptoms or behaviour of madness, insanity and unreason was, what consisted of normality or sanity in civilisation? Additionally, the interaction of religion and science in the treatment of the mentally ill and later, a shift towards rationality and the development of a new paradigm that is psychiatry are themes encountered in all three books. Undoubtedly, social values of an order are reflected in the treatment of those who are labelled as mad, however, could it possible that madness also mirrors or reflects the fabric of social order? The minute or nearly absent role of women, the stationary non-human role attributed to women in the histories of the centuries considered is highly problematic as a separate set of external or social factors along with scientific biological differences affect them and its analysis would uncover new knowledge enabling the state with better treatment and understanding of mental illness. It is also interesting to note the development of mental-help institutions from an economic, political, social and cultural stance as these institutions came to be feared by the very people they were trying to help.
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