A severe synopsis of Foucault's first major work might show how Foucault charts the journey of the mad from liberty and discourse to confinement and silence and how this is signposted by the exercise of power. He starts in the epoch when madness was an "undifferentiated experience" (ix), a time when the mad roamed the countryside in "an easy wandering existence" (8); Foucault shows the historical and cultural developments that lead to "that other form of madness, by which men, in an act of sovereign reason, confine their neighbors" (ix), challenging the optimism of William Tuke and Phillipe Pinel's "liberation" of the mad and problematizing the genesis of psychiatry, a "monologue of reason about madness" (xi).

Central to this is the notion of confinement as a meaningful exercise. Foucault's history explains how the mad came first to be confined; how they became identified as confined due to moral and economic factors that determined those who ought to be confined; how they became perceived as dangerous through their confinement, partly by way of atavistic identification with the lepers whose place they had come to occupy; how they were "liberated" by Pinel and Tuke, but in their liberation remained confined, both physically in asylums and in the designation of being mad; and how this confinement subsequently became enacted in the figure of the psychiatrist, whose practice is "a certain moral tactic contemporary with the end of the eighteenth century, preserved in the rites of the asylum life, and overlaid by the myths of positivism." Science and medicine, notably, come in at the later stages, as practices "elaborated once this division" between the mad and the sane has been made (ix).


This history is one of Foucault's most fascinating explorations of the relationship between knowledge and power. It would be simplistic to say that an exercise of power is then justified by a body of knowledge which forgets how it is related to that exercise of power, but that is one message that can be derived from Foucault's project here: the role of discourses, imaginary figures, political and economic developments, all play a role in organizing the relationships between people, power, and knowledge.

Says Foucault: "the essential thing is that the enterprise did not proceed from observation to the construction of explanatory images; that on the contrary, the images assured the initial role of synthesis, that their organizing force made possible a structure of perception, in which at last the symptoms could attain their significant value and be organized as the visible presence of truth" (135). This could be a criticism of psychiatry, of science, or of Foucault's project itself.

The book provides a deeply challenging portrait of madness and, Foucault argues, the loss of madness as a voice in dialogue with reason: although many psychologists, psychiatrists and psychoanalysts may argue that the analyst's couch (or chair, etc) has allowed this voice to return, they might want to consider Foucault's provocative arguments to the contrary, that the Freudian development of therapeutic listening was, though a return of sorts to listening to madness, nevertheless undertaken under such circumstances and in such a relationship that it "can unravel some of the forms of madness [but] it remains a stranger to the sovereign enterprise of unreason. It can neither liberate nor transcribe, nor most certainly explain, what is essential in this enterprise" (278).

As he will do in Birth of the Clinic, Foucault watches men describe other men and women, and sees how their observations begin to take a shape recognizable to us today: but this is not "because in the course of centuries we have learned 'to open our eyes' to real symptoms; it is not because we have purified our perception to the point of transparency: it is because in the experience of madness, these concepts were organized around certain qualitative themes that lent them their unity, gave them their significant coherence, made them finally perceptible" (130). This is a challenging book for psychologists, psychiatrists, and other physicians, and is a gauntlet thrown that few have chosen to take up.


First Published in the United States by Pantheon Books in 1965, and in France as Histoire de la Folie in 1961 by Librarie Plon


Random House

Place Published

New York


1988 (Vintage)

Page Count