The book Madness and Civilization: A History of Insanity in the Age of Reason, written by Michel Foucault in 1961, is a classic in 20th century Continental philosophy. It offers a sharp historical analysis of the relations between rationality and mental disorder. The book marks a turning from phenomenological method towards structuralism: the change in the relationship between madness and rationality is driven by powerful social structures. The person with the mental disorder is seen as "the other," and the attempts to dialog and understand the person affected by the disease are increasingly replaced by a monolog of reason. Institutions of health care, like hospitals or asylums, separate craziness from what is seen as normal. They become disciplinary agencies, and prisons are the final stations for many mentally sick people. The creation of psychiatric institutions introduce a social mechanism that allows the extra-judicial confinement of undesirable people for the protection of society. One can apply moral categories to human behavior like prostitution, addiction, anxiety or depression, or one can make it an object of study, create a classification for mental problems and aberrant behavior, and make it an object of medical study. Foucault wrote this book based on his own psychological difficulties, and his experiences working in a mental hospital.

Quotes

• ...modern man no longer communicates with the madman ... There is no common language: or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence. Foucault, Preface to the 1961 edition

• 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.

• “Once leprosy had gone, and the figure of the leper was no more than a distant memory, these structures still remained. The game of exclusion would be played again, often in these same places, in an oddly similar fashion two or three centuries later. The role of the leper was to be played by the poor and by the vagrant, by prisoners and by the 'alienated', and the sort of salvation at stake for both parties in this game of exclusion is the matter of this study.”

• “People know what they do; frequently they know why they do what they do; but what they don't know is what 'what they do' does.”

• “What desire can be contrary to nature since it was given to man by nature itself?”

• “Confined on the ship, from which there is no escape, the madman is delivered to the river with its thousand arms, the sea with its thousand roads, to that great uncertainty external to everything. He is a prisoner in the midst of what is the freest, the openest of routes: bound fast at the infinite crossroads. He is the Passenger par excellence: that is, the prisoner of the passage. And the land he will come to is unknown - as is, once he disembarks, the land from which he comes. He has his truth and his homeland only in that fruitless expanse between two countries that cannot belong to him.”

• “Death as the destruction of all things no longer had meaning when life was revealed to be a fatuous sequence of empty words, the hollow jingle of a jester’s cap and bells.”

• “self-attachment is the first sign of madness, but it is because man is attached to himself that he accepts error as truth, lies as reality, violence and ugliness as beauty and justice.”

• “And now, if we try to assign a value, in and of itself, outside its relations to the dream and with error, to classical unreason, we must understand it not as reason diseased, or as reason lost or alienated, but quite simply as reason dazzled.”

• “A symbolic unity formed by the languor of the fluids, by the darkening of the animal spirits and the shadowy twi­light they spread over the images of things, by the viscosity of the blood that laboriously trickles through the vessels, by the thickening of vapors that have become blackish, deleterious, and acrid, by visceral functions that have be­come slow and somehow slimy - this unity, more a product of sensibility than of thought or theory, gives melancholia its characteristic stamp.”

• “Matthey, a Geneva physician very close to Rousseau's influence, formulates the prospect for all men of reason: 'Do not glory in your state, if you are wise and civilized men; an instant suffices to disturb and annihilate that supposed wisdom of which you are so proud; an unexpected event, a sharp and sudden emotion of the soul will abruptly change the most reasonable and intelligent man into a raving idiot.”

• “For the madness of men is a divine spectacle: “In fact, could one make observations from the Moon, as did Menippus, considering the numberless agitations of the Earth, one would think one saw a swarm of flies or gnats fighting among themselves, struggling and laying traps, stealing from one another, playing, gamboling, falling, and dying, and one would not believe the troubles, the tragedies that were produced by such a minute animalcule destined to perish so shortly.”

• “madness is the false punishment of a false solution, but by its own virtue it brings to light the real problem, which can then be truly resolved.”

• “Sadism ... is a massive cultural fact that appeared precisely at the end of the eighteenth century and that constitutes one of the greatest conversions of the occidental imagination ... madness of desire, the insane delight of love and death in the limitless presumption of appetite.”

• “This knowledge, so inaccessible, so formidable, the Fool, in his innocent idiocy, already possesses.”

• “Menuret repeats an observation of Forestier's that clearly shows how an excessive loss of a humor, by drying out the vessels and fibers, may provoke a state of mania; this was the case of a young man who 'having married his wife in the summertime, became maniacal as a result of the excessive intercourse he had with her.”

• “The head that will become a skull is already empty. Madness is the déjà-là of death.”

• “All life was finally judged by this degree of irritation: abuse of things that were not natural, the sedentary life of cities, novel reading, theatergoing, immoderate thirst for knowledge,”

• “Through Sade and Goya, the Western world received the possibility of transcending its reason in violence....”

• “And if it is true that the image still has the function of speaking, of transmitting something consubstantial with language, we must recognize that it already no longer says the same thing; and that by its own plastic values painting engages in an experiment that will take it farther and farther from language, whatever the superficial identity of the theme. Figure and speech still illustrate the same fable of folly in the same moral world, but already they take two different directions, indicating, in a still barely perceptible scission, what will be the great line of cleavage in the Western experience of madness.”

• “it becomes probable that the so-called immaterial hysterical affection and hypochondriacal disease derive from the dispositions of the particular state of the fibers. It is to this sensibility, this mobility, that we must attribute the sufferings, the spasms, the singular pains so readily suffered by young girls of pale complexion, and individuals too much given to study and meditation.”

• “At the opposite pole to this nature of shadows, madness fascinates because it is knowledge. It is knowledge, first, because all these absurd figures are in reality elements of a difficult, hermetic, esoteric learning. These strange forms are situated, from the first, in the space of the Great Secret, and the Saint Anthony who is tempted by them is not a victim of the violence of desire but of the much more insidious lure of curiosity; he is tempted by that distant and intimate knowledge which is offered, and at the same time evaded, by the smile of the gryllos; his backward movement is nothing but that step by which he keeps from crossing the forbidden limits of knowledge; he knows already.”

• “From a Christian point of view, human reason is madness compared to the reason of God, but divine reason appears as madness to human reason.”

• “nervous sufferers are the most irritable, that is, have the most sensibility: tenuousness of fiber, delicacy of organism; but they also have an easily impressionable soul, an unquiet heart, too strong a sympathy for what happens around them.”

• “the intense Catholic renaissance during the Counter-Reformation produced in France a very particular character of simultaneous competition and complicity between the government and the Church.”

• “The great hospitals, houses of confinement, establishments of religion and public order, of assistance and punishment, of governmental charity and welfare measures, are a phenomenon of the classical period:”

• “From being the object of a religious experience and sanctified, poverty became the object of a moral conception that condemned”

• “The marvellous logic of the mad which seems to mock that of the logicians because it resembles it so exactly, or rather because it is exactly the same, and because at the secret heart of madness, at the core of so many errors, so many absurdities, so many words and gestures without consequence, we discover, finally, the hidden perfection of a language.”