During the seventeenth and eighteenth centuries, humanity was beginning to discover and explore the connections and differences between the mind and the body, the body and the soul, the body and the surrounding world. It was during this period that “psychology was more neurological than it has been at any time” and the mind and the body became separated; a psychological problem of the mind was not always directly related to a physiological aspect within the body (Rousseau 112). One such exploration was that of madness and insanity. Originally thought to be the result of an imbalance of the four humours within the body, advances in science led to the discovery of a disconnect between the mind of an insane person and their body. What was it in the brain that led to an individual losing their sense of reality? This essay aims to explore various primary medical texts exploring the disease in comparison with Michel Foucault’s Madness and Civilization: A History of Insanity in the Age of Reason, and whether the period’s fascination in madness was indeed scientific, or as Foucault suggests, cultural.
Writers, whether medical, creative, or philosophical, were searching for a means to understand insanity and where it came from, what it caused, ways to cure it, and anything else they could discover. Curiosity was not new to them, but advanced studies of the body and the brain were. There were enough previous discoveries to make them aware of a separation, but not enough to establish what that separation was. This awareness was what gave momentum to their studies and explorations. There existed an unprecedented blending of literature and science. Medical discoveries influenced literary authors’ works and the directions in which they took their stories, while literary writings influenced the directions scientists took their discoveries. Some saw the disease as a mysterious and almost romantic condition, which was the source of creativity and the result of intense passions, feelings, and anger. Others saw it as a debilitating condition, reproachful, and the result of inactivity, laziness, and a weak, unsound mind.
Foucault opens with the idea that insanity was merely replacing a societal gap created with the disappearance of leprosy, the previously excluded group. Society maintains a need for exclusivity, which is achieved by removing unwanted members, thus leading to the introduction of workhouses and asylums as a new means of removal. He suggests that “from the middle of the seventeenth century, madness was linked with this country of confinement, and with the act which designated confinement as its natural abode” (Foucault 39). Insanity was only just beginning to be understood. Misunderstanding incites fear, as it always has and always will do within a society. With the new knowledge that insanity was linked to the mind alone, but not knowing what that link was, people needed to learn its causes and cures, before allowing it to spread dangerously. The desire for knowledge goes far beyond mere curiosity, into the realm of self-understanding and protection. If people can understand the causes behind what leads to a person going insane, they are attempting to defend themselves from ever falling into such a disease.
However it was not just the insane that were sent away, but also criminals and the poor. The confinement of all these groups together, under the impression of individuals who needed to be cured, suggests a cultural purpose, not a scientific one. At the same time, madness, criminality, and homelessness were all conditions believed to be the result of the individual; people allowed themselves to fall into those categories. Categories that allotted them “a special modulation which concerned madness proper, and was addressed to those called, without exact semantic distinction, insane, alienated, deranged, demented, extravagant” (Foucault 66). Certain conditions were preventable depending upon how one lived their life. If you remain sensible and levelheaded, avoiding eccentricities and refraining from too strong a desire for wealth, and other calm-inducing efforts, you can help prevent most conditions. If it is preventable, than the individual can be held responsible. Blame falls on a person, not their situation and other lifestyle factors.
In his “Observations on the nature, kinds, causes, and prevention of insanity, lunacy, or madness”, Thomas Arnold, a medical doctor, traces aspects of the disease based upon his own observations in the field. This piece, chosen for the interesting comparisons to be made between it and Foucault’s work, works to define the disease, distinguish the different types, and explore treatments. In his preface, he makes known the fact that his work is neither perfect nor complete, merely the result of his own observations on the subject. He acknowledges that “whatever may be their defects, they have at least the merit of being founded on observation, and experience…it is not a fancy-piece; but a real copy, how little soever it may discover the hand of a master, drawn with some care and exactness immediately from nature” (Arnold ii). His language simultaneously suggests a level of confidence about his own skills and intelligence on the subject, as well as some uncertainty as to the reception of his work in the scientific world. He further on exhibits an almost hesitant nature about releasing his observations, suggesting doubt in his abilities or the expectation of his work to be disputed. His preface and introductory passages, lengthy in their own right, reveal that Arnold feels the need to explain himself and his purposes behind the study. He acknowledges where he has taken information from studies done before him, and reasons for why he incorporated them. Like many others, Arnold is following his own curiosities and explorations. The ideas are his, based upon his own knowledge and search for understanding. His own medical expertise as a doctor and interest in the profession fuel his desire for further knowledge. This attitude is the same one possessed by many scholars of the Age of Reason. Arnold, like others, is searching for reason within an unreasonable disease.
Arnold also includes an interesting piece exploring the popular quester of whether insanity is more prevalent “in England than in any other Countries”, though he primarily discusses the comparison between England and France (Arnold 15). He allows the possibility of it, but that “this is certain, that it is not uncommon among the French, as their medical writings abundantly testify. I am inclined however to allow that they have less of it” (Arnold 16). It is interesting that he would acknowledge this, while Foucault acknowledges that “it is less commonly known that more than one out of every hundred inhabitants of the city of Paris found themselves confined there, within several months” (Foucault 38). Arnold’s knowledge is clearly limited by the lack of information, in a period that lacks the technology for word to be spread as quickly as it is today. Foucault’s book, like Arnold’s, seems to focus more on madness within the French and English societies. Though clearly not comprehensive, this does beg the question of whether the fascination was stronger within these two societies, or perhaps whether their interests in science were more extensive, or even that their cultures were more intent on purging society of the abnormal.
Dr. John Johnstone, in his Medical Jurisprudence. On Madness, begins his work with the acknowledgement that “The trial of Hadfield has however interested the public mind so deeply, that it cannot be unseasonable, nor useless to publish them at the present moment, while all are anxious, and many doubting, and some without question are entirely ignorant of the subject” (Johnstone i). This follows Foucault’s idea of the interest in insanity being cultural to the period. In stating that he is publishing his works as such, and the intent for it to be read by the public, indicates it has become a more social issue. It is not the medical world who bares sole interest in the subject as it has branched out into the interest of the general public. Clearly the subject is becoming a social issue, the curiosity has expanded beyond the world of science. In the fear of scandal and desire for exclusivity, interest has spread. Taking into consideration the high number of people who were confined at some point or other, it is easily conceivable that most members of society were directly affected by insanity, whether through a family member or acquaintance. The web of insanity had spread wide, infecting the tiniest corners of the world. Its profound existence meant everyone was aware and affected, which is why it was such an issue.
Johnston makes an attempt towards a humanitarian approach, disagreeing with the opinion “that madmen who commit great crimes should not merely be shut out of society, but like all other rabid animals, should be hunted out of life” and instead that “society may obtain an adequate protection by the confinement of maniacs, without blood” (Johnstone vi). He claims society merely needs to imprison the insane, criminal and other, as a means of protection. He defends confinement as being a means of protection, not a way to study or observe. It is a culture that demands the confinement of those that don’t fit perfectly into it, but at the same time, the interest shows that it is not a desire to be hidden. Society would want to hide criminals, hide away those that do shame and damage, but with the insane, they want to separate them but at the same time explore them. There are those society wishes to banish and never see and those that it wishes to remove but the fascination is so strong they must be removed within view, where they can be observed, studied, and gazed upon. Foucault equates this to “a very old custom of the Middle Ages to display the insane…which permitted those outside to observe the madmen chained within. They thus constituted a spectacle at the city gates” (Foucault 68). The intent to publicly exploit the insane removes it from the realm of science and medicine as the definition of spectacle implies the purpose to amuse. In equating the custom of the Middle Ages to the eighteenth century public interest, it is difficult to argue the interest is anything but cultural. It is a custom that existed into 1815, and “if a report presented in the House of Commons is to be believed, the hospital of Bethlehem exhibited lunatics for a penny, every Sunday” (Foucault 68). There exists no scientific purpose behind such displays of so-called entertainment. The idea that madness had transformed into a form of entertainment, at the cost of its victims dignity, shows there was little to no respect or pity from society. A society’s interest in the less fortunate, the different, the misunderstood, makes it a purely cultural phenomenon, whereby though the interest began with science, it has transitioned far beyond that.
Johnston possibly hints at the awareness of the cultural fascination in a negative manner when claiming “I am not disposed to enlarge my treatise with those dark, but important enquiries, so often affording scope to the figments and whimsies of men of sense” (Johnstone vii). His term “figments and whimsies of men” suggests he knows the interest has expanded beyond the scientific world and has become a source of spectacle and amusement. He seems to want to avoid playing into such types of interest. He declares his interest is “to familiarize the scientific doctrines of insanity” and even though it is to the public, his intent remains scientific. The public needs to be aware of the scientific discoveries, but such discoveries are for the purposes of understanding, not whims and amusing curiosity.
Understanding its origins was primary to the exploration of insanity. Arnold identifies “some of the most powerful causes of this kind of insanity are- religion, -love, -commerce, and the various passions which attend the desire, pursuit, and acquisition of riches, -every species of luxury, -and all violent and permanent attachments whatever” and the most powerful, “invincible love, that has made more Madmen in every age and nation than any other passion beside, -perhaps more than all of them together” (Arnold 17, 19). Passion is what arises insanity in a man; strong emotions incite such intense feelings that a person loses all sense of reason. Here one see’s the romantic affiliations with the disease. Its strong affiliation with love was its attraction for artist and writers. Writers often had characters, primary or secondary, suffering from insanity or melancholy as a means of furthering their narrative. There was a purpose behind the disease, it didn’t just exist for the sake of existence; it was given meaning.
Johnstone, too, cites sources of high emotion and passions as the sources, that “in all states of civilization, thinking beings have been subject to derangement of the intellectual faculties; Love the most ardent of our instincts, Ambition the most restless inciter to action, and disturber of our repose, jealousy, fear, revenge, and all the malignant passions, ever must in a partial degree, have produced this malady” (Johnstone 3). In a society that requires composure, discipline, and strict adherence to social protocol, any person too overtaken by their emotions was deemed at risk. Control over one’s emotions showed self control and a sound mind. Emotions led to instability, instability led to unreasoning, unreasoning led to madness.
Both doctors match Foucault’s connection that “the savage danger of madness is related to the danger of the passions and to their fatal concatenation” (Foucault 85). Passions are often associated with desire, a human’s want for certain things in life. Passion is what inspires an individual’s actions. Taking into consideration the religious influences of the period, if a person is expected to live a humble life, worshiping God above all worldly possessions of wealth, loving him above all other people, and having ambitions that were deemed not to exceed that of God himself, the associations between religion and insanity become a tad clearer. Having too high a feeling for anything other than God seems to be a primary cause for insanity. Anger, a strong, powerful anger, also leads one to madness and it goes against the religious notion that one should ‘love thy neighbor’. A human’s vices and sins influence their mind towards madness, so the correct lifestyle keeps them sane. Even before the separation of the mind and body, when passion was seen “to be the meeting ground of body and soul; the point where the latter’s activity makes contact with the former’s passivity”, passion was deemed to the the source of insanity in a person (Foucault 86). It would “necessarily cause certain movements in the humors; anger agitates the bile, sadness excites melancholy (black bile), and the movements of the humors are on occasion so violent that they disrupt the entire economy of the body” (Foucault 86). In previous centuries, religion openly played a part in a persons sanity; the blame for an imbalance of humours to cause such a condition was placed upon a poor relationship with God. If an individual was not close to God, it caused a lack of harmony among their humours, resulting in some abnormal condition of the mind or body. The religious influence is still clear in the Age of Reason, however, even after the differentiation between the mind and the body. Science had expanded, but only so far as it could, while still being influenced by God. Perhaps a person’s relationship directly with God doesn’t cause their madness, but veering away from a lifestyle the church encourages does. Again, we see the blame is able to be placed upon the sufferer; they are responsible for their condition. If passionate tempers are the cause of insanity and the best way to keep sane is to adhere to strict codes of conduct, it seems to lean towards a cultural explanation and less scientific. Science led to the understanding, but the level of understanding keeps within cultural boundaries. The eighteenth century society limits themselves and their understanding by confining their understanding to within religious standards. Is it a coincidence that ambition can lead to insanity, when greed and pride are sins? Is it a coincidence that passionate love can lead to insanity, when lust is a sin, and ‘thou shalt not covet’? Is it a coincidence that anger can lead to insanity, when wrath is a sin and a person is expected to ‘love thy neighbor’? God and religion and a ‘faithful servant’ are reason and losing sight of them leads to disillusioned sense of reality. God is what keeps one grounded in reality.
There was also the question of where does one draw the line between insanity and eccentricity? Artists, literary and visual, were often found to struggle with periods of insanity and melancholy, having seemed to lose their ability to reason. In a civilization where imagination can so easily be mistaken for insanity, the two tended to overlap. Known for being the Age of Reason, “it is an ironic contrast that [it] should have produced so many cases of insanity among its writers” (Rousseau 117). The distinction was that there existed “two kinds of imagination; healthy and sick, normal and diseased, and the distinction was increasingly discussed” (Rousseau 117). Imagination requires the ability to see outside the ordinary realm of reality; to create based upon images in one’s own mind. It works as a reflection of the internal workings of a persons mind, a way to see into their thoughts. It fed into the fears and hysteria over insanity in the seventeenth and eighteenth centuries. It is what influenced so many of their stories to take a direction towards insanity. Does imagination push one towards madness, or does imagination arise out of madness? Where is the real connection?
They viewed imagination as “an irrational ‘super passion,’ as significant for the body as gravity was for the earth, and as the totality of an infinite number of sensations associated and combined in patterns as yet unexplained” (Rousseau 122). Essentially the difference is the ability to reunite oneself with reality and reason; an individual suffering from the disease is unable to disconnect from the imaginative world and to separate himself from unreasoning. Foucault distinguishes the difference; “Imagination is not madness. Even if in the arbitrariness of hallucination, alienation finds the first access to its vain liberty, madness begins only beyond this point, when the mind binds itself to this arbitrariness and becomes a prisoner of this apparent liberty” (Foucault 93). Imagination can be a sign, or even a gateway towards insanity, but it is not insanity until an individual can no longer see a difference between his imagination and reality. An awareness, rationality, reasoning; if an individual can present clarification between these and his imagination, then he is safe. The two are connected and even though “Madness is thus beyond imagination, and yet it is profoundly rooted in it; for it consists merely in allowing the image a spontaneous value, total and absolute truth” (Foucault 94). If an image is created in the mind, it is not necessarily and undeniably unreal; imagination goes beyond reality. It essentially comes down to reasoning. Reality can be created, destroyed, manipulated. An individual’s reality exists solely within their own mind. If everyone see’s the world through different eyes, how can every reality be exactly the same; how can humanity distinctly define reality? Reasoning is the real breaking point. Realities may be different, but reasoning and an awareness of the surrounding world are the final threads of sanity. Our interpretations of the world may vary, but its existence does not. If one can still reason that ‘this world exists in the realm of humanity, and this world exists within my imagination’ their sanity can still be deemed intact. A loss of the ability to reason between these different worlds culminates in madness.
The obsession with observing and studying mental illnesses also included attempts to treat or cure insanity. Taking into consideration what was understood about the origination of insanity: what conditions caused madness, the variety of symptoms and types of insanity, how different symptoms manifested, et cetera, medical professionals explored many methods of treatments and cures. Each individual symptom must be treated and the body and the soul must be treated separately. With regards to discovering a cure as understandings change, “it is no longer determined by the meaningful unity of the disease, organized around its major qualities; but, segment by segment, must address itself to the various elements that compose the disease; the cure will consist of a series of partial destructions, in which psychological attack and physical intervention are juxtaposed, complement each other, but never interpenetrate” (Foucault 178). There are different elements to the disease; curing a patients hallucinations alone while they still suffer from melancholia is not enough, a cure must happen in entirety, a complete healing of body and mind.
In his Select Cases in the Different Species of Insanity, Lunacy, or Madness William Perfect, also a medical doctor, discusses some of his patients suffering from the aforementioned conditions. Unlike Arnold and Johnstone’s works, he focuses less on definitions and terms and more on specific patients, their conditions, and his treatments for them. He claims his cases are “collected with care, chosen with a view to real utility, and reported with fidelity, it will be easily seen that the author has no design to obtrude any nostrum or specific upon the public, but merely to exhibit the result of his own practice and observations, in a malady of the greatest importance” (Perfect v). He intends purely to observe and document his own experience in the area, to hopefully allow for further understanding of the subject. Unlike Johnstone and Arnold, he does not intend to uncover any new information, form any new theories or methods, or argue any previous knowledge in the study. His work, he hopes, will merely provide background and material for future work. Are his intentions cultural or scientific?
Perfect’s first subject is “a gentleman, aged fifty-eight, was, in the beginning of January, 1770, put under my care” for insanity as a result of “a sudden transition in his circumstances, which, from being easy and comfortable, were become doubtful and precarious” (Perfect 2). This gentleman’s malady was the result of the loss of his lifestyle; he saw himself “ruined, lost, and undone! which was his incessant exclamation both by night and day” (Perfect 2). Perfect describes this man in an objective manner, attempting to be as factual as possible, thus allowing the impression of credibility as he refrains from making the writing too personal. He seems to truly be wanted merely to document, with as much accuracy as he can allow. He provides a thorough description, from the origin of his patient’s condition, what occurred for the disease to manifest to very specific aspects of his symptoms, physically and mentally. As previously quoted, Foucault mentioned the importance of separating the symptoms, treating each individually, to cure the entire body and mind. For the patient’s impatient, confrontational, and easily upset nature during social situations, Perfect forbade any interaction with the patient’s friends and family. However, aside from this, he fails to provide further reasoning behind his methods of treatment, such as “making a seton between his shoulders, and confining the patient to a still, quiet, and almost totally darkened room: I never suffered him to be spoken with, either by interrogation or reply, nor permitted any one to visit him” (Perfect 4). He confirms the results he hopes to achieve and the results that occur, but fails to justify the purpose behind his chosen treatments. His methods suggest imprisonment rather than treatment. Were his methods in fact designed to cure or just to sustain, so observation could be made? Were his best interests in the patient or in his own studies? Psychology was such a new and still foreign subject that doctors were allowed much freedom with what they could and could not do. In an enlightened age that claimed to have left the cruel and torturous ways of medieval days, these ways had, in truth, not entirely disappeared. Is it a humanitarian approach to parade the insane in displays for the general public to observe and mock? Is it humane to shut them up and hide them away? Granted, it was done under the impression it would cure the sick, but who regulated the methods used? In such a foreign area of study, little to no rules existed to protect the insane. Doctors were at their leisure to use whatever methods seemed effective or interesting based upon their real intentions. Was the sake of the patient really put first, or had it become a mad race to uncover the aspects of madness?
Perfect further explains his treatments, including prescribing opium which made the patient easier and less anxious, and eventually “he talked rationally and justly seldom breaking out into any frantic rhapsodies, or passionate expressions whatever” and after four months “his reason now returned, his imagination grew stronger, his ideas were more collected, and he spoke of things as they really were, and of the primary cause of his mental infirmity” (Perfect 6). Two interesting parts to this include his use of the word ‘imagination’ and the patient’s ability to speak of the cause of his malady. The term imagination clearly bears multiple meanings, as evidenced by Rousseau’s article and Foucault’s book. Though Perfect does not clarify, one can rightly assume he is referring to the healthy and normal imagination, as opposed to the sick and diseased. His lack of clarification hints at one of the ways studies in the period varied. Another doctor might refuse to incorporate the imagination of a healthy patient, as it was so often associated with madness. If a medical observer is trying to prove the success of his methods of treatment, he may want to avoid the term ‘imagination’ because of it’s dual and construed meanings. In the patient’s ability to speak about the primary cause of his brief insanity follows the idea that reasoning means sanity; he can now reason with himself, separate his delusions from reality.
Though Foucault definitively links madness to the culture of confinement within the period, and a connection obviously exists, the two ultimately exists in separate worlds; one scientific, the other cultural. The culture of confinement occurred as a result of societal needs, “explained, or at least justified, by the desire to avoid scandal” while the fascination in madness, specifically, occurred as a result of scientific advancements and interests (Foucault 69). Once the distinction of insanity was made, the public’s interest fueled the fire for the confinement of its abnormal members. Increased interest in such a curious condition spread, simultaneously increasing the need to cut certain members out of society, for their own sake as well as others. Eventually, science and culture blended together. The Age of Reason was a period of cultural interest in science. The overlap is undeniable. This interest in insanity existed everywhere; it was not a purely scientific fascination. So many people were affected directly or indirectly and the disease produced such interesting cases and conditions. The initial interest may have been purely scientific, the natural result of intellectual developments within a society, but it became such a big issue, such an important part of their world, that their culture is defined, not by confinement, but by the fascination with understanding the human mind.
Arnold, Thomas. Observations on the Nature, Kinds, Causes, and Prevention of Insanity, Lunacy, or Madness. Leicester, 1782. Eighteenth Century Collections Online. Gale. University of Exeter. Web. 17 April 2012.
Foucault, Michel. Madness and Civilisation: A History of Insanity in the Age of Reason. New York: Random House Inc, 1965. Print.
Johnstone, John. Medical Jurisprudence. On Madness. Birmingham, 1800. Eighteenth Century Collections Online. Gale. University of Exeter. Web. 13 April 2012.
Perfect, William. Select Cases in the Different Species of Insanity, Lunacy, or Madness, with the Modes of Practice as Adopted in the Treatment of Each. Rochester, 1787. Eighteenth Century Collections Online. Gale. University of Exeter. Web. 15 April 2012.
Rousseau, G. S. “Science and the Discovery of the Imagination in Enlightened England.” Eighteenth Century Studies 3.1 (1969): 108-135. JSTOR. Web. 20 April 2012.