Madness and Enlightenment. - Review - book reviews

IN his highly influential book, Madness and Civilization, Michel Foucault indicted the modern West for its treatment of the "insane." According to Foucault, Western societies, bowing before the Enlightenment idol of Reason, built a theoretical and institutional quarantine against madness. The Cartesian rational mind must not suffer from exposure to irrationality; the madman must not roam freely through town and country as he did during the Middle Ages, a mocking reminder of human mortality and God's infinite wisdom. Instead, Foucault claimed, the insane were thrown into cells with other dissidents from the rising bourgeois moral order--the poor, the criminal, and the licentious. The supposed liberation of the mad during the late eighteenth and early nineteenth century by "alienists" Phillippe Pinel in France and William Tuke in England, he argued, only furthered their exclusion. These reformers herded the mad into asylums, where an arid "science" of psychiatry silenced their Dionysian voices. Enlightenment, Foucault held, was bought at the cost of excluding the mad: Such was the heavy price of Reason's "progress."

Though many scholars rightly questioned its historical accuracy, Foucault's book strongly influenced the anti-psychiatry movement, whose baleful legacy of deinstitutionalization of the insane we still live with today, and it remains a much-taught text in the university. It is significant, then, that Marcel Gauchet and Gladys Swain's Madness and Democracy: The Modern Psychiatric Universe [+]--first published in France in 1980--has newly appeared in abridged form in Princeton's commendable New French Thought series. When the publisher Gallimard launched the original edition, Foucault agreed to review it for several major publications, then neglected to write any reviews, assuring the book a muted initial reception. Foucault's biographer claims the philosopher was intimidated. It is easy to see why. Gauchet and Swain offer a richly historical analysis of the birth of the asylum and the development of psychiatry sharply at odds with Foucault's relentlessly anti-Enlightenment approach. Though the authors are not uncritical of modern psychiatry, or, for that matter, of the Enlightenment and the modern world, their work is refreshingly sober in its conclusions, far removed from Foucault's romantic excesses.

GAUCHET, editor of the prestigious journal Le Debat and one of France's foremost political philosophers, and Swain, a practicing psychiatrist until her untimely death in 1995 at the age of 48, shine a Tocquevillian light on the historical emergence of psychiatry and the insane asylum, revealing them to be inseparable from the development of modern democracy. The authors ambitiously divide Western political history into three broad eras, looking at each one through the lens of the social history of insanity: the premodern, theocratic universe; democratic modernity; and something new, only now opening before us, which I would call a humbled modernity.

In premodern societies, Gauchet and Swain observe, the mad were indeed free to wander about, just as Foucault claimed--the religiously ordered universe of the Middle Ages reserved a place for the insane, as it did for every other creature in God's Great Chain of Being. Yet toleration of the mad did not mean society considered them fully human or that their lot was enviable, the authors stress. On the contrary, mocked and derided, often displayed for public amusement or chased through the streets by cruel children, the insane inhabited the margins of the premodern world, a place of natural hierarchy and exclusion rather than of equality and inclusion. These were creatures "set apart in their difference," Gauchet and Swain suggest, with whom reasoning beings had nothing in common.

In Gauchet and Swain's view, democratic modernity--their second era--changed everything. Shattering the Great Chain of Being, refounding society on the basis of the social contract, remaking everything in man's image, and unleashing a powerful wave of equality that still sweeps us along, modern democratic societies dramatically transfigured the status of the insane. Gauchet and Swain credit Pinel and his ally, Jean-Etienne Esquirol--the two French fathers of "moral treatment" (i.e., psychiatry) and the asylum--for the new social attitudes toward madness. Contrary to Foucault, who dismissed "moral treatment" as an insidious form of exclusion, Gauchet and Swain convincingly argue that it expressed confidence in the possibility of communicating with the insane, signaling, for the first time in Western history, that the mad were in some important sense human beings like us with the capacity to reason. The reach of democratic equality now extended to the insane.

Both Pinel and Esquirol, working in the immediate aftermath of the French Revolution, were initially optimistic about curing the insane and making them full citizens through moral treatment. After all, what was not possible for Revolutionary Man, in full possession of himself and his society? Pinel and Esquirol's optimism quickly faded, though, as most of the mad remained stubbornly deranged and often dangerous after treatment. It was soon evident to the alienists that long-term institutional care was unavoidable.