Madness and Civilization summary

By the start of the seventeenth century, idleness – or a perceived lack of interest in working – had become a characteristic that the ruling classes not only despised, they considered it dangerous to society. Therefore, the authorities had to find a way to both curb this behavior and hide it from the public eye.

The original role of the police, which first appeared in the European countries around that time, was to ensure that poor people worked. In the same spirit, the Hôpital Général, or general hospital, was created not to treat the ill, but to confine the idle and the unwanted. Foucault points to this development as the start of the “great confinement.”

When hospitals were first created, the people confined there were petty criminals, the homeless and other social outcasts. In most cases, this confinement was a way for undesirable elements to be placed out of sight, thereby allowing the authorities to maintain the illusion that there are no problems in the public sphere.

But these hospitals weren’t just a way for the authorities to avoid scandal, they were a way for families to avoid unwanted attention. In the Middle Ages, if someone was charged with criminal behavior, an open trial was held where the accused would be asked to publicly confess their transgressions.

When so-called “madmen” populated hospitals alongside petty criminals and convicts, the conditions of detainment were miserable for both groups. By the eighteenth century, with the dawn of the Enlightenment, there was a growing public concern about mistreatment. But which group were they actually concerned about?

Several facility directors overseeing the confinement were concerned primarily with the safety of the criminals and therefore requested they be separated from those with a mental illness. Finding the screams and confusion caused by them disturbing, in 1713, the director at the Brunswick detention center in Germany ordered both groups to be kept apart.

By the end of the Middle Ages, doctors still believed there were only physical reasons for mental disorders.

The popular belief was that our bodies held four “humors” that were responsible for every ailment and mood that arose: black bile, yellow bile, blood and phlegm. Early treatments for mental illness centered around ways to counteract these conditions and included exercise and nutritional regimens, fresh or seawater baths and cold showers.

As those with psychological issues were separated from other victims of the great confinement, and psychological treatments were in their infancy, the first modern “mental asylums” were created. Much of the credit for bringing these early institutions to life goes to illustrious French physician Philippe Pinel and the English philanthropist and businessman William Tuke.

Tuke’s facility in rural York, England, was known as The Retreat – opening its doors in 1796. Being a Quaker, Tuke’s institution also practiced a certain morality that did away with barbaric dungeons and abusive treatments. Rather than using physical punishment, the wardens were trained to use reason and discussion when a patient displayed undesirable behavior.