Madness and Enlightenment

[Arthur Gordon Pym]

Madness and Enlightenment

Public Interest, Wntr, 2000 by Brian C. Anderson

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.

As asylums rapidly opened across Europe throughout the nineteenth century, the authors show, the goal of moral treatment began subtly to shift from that of seeking a cure to that of socialization. The idea was to get the mad patient to fit in with a more or less permanent population of the insane, to set up a perfectly ordered counter-society of the mad. The asylum became a kind of democratic utopia, cut-off from the rest of the world and programmed by the psychiatrist as if men--even madmen--were machines, which could be manipulated and plugged into the collective. Like all utopias, it didn't work. The human parts resisted their incorporation.

Indeed, the asylum was, Gauchet and Swain suggest, "a sort of laboratory of power" where the entire trajectory of modern politics played itself out in microcosm, from the naive faith in human reason in the aftermath of the democratic revolution, to utopian hopes that one could mold human beings into any shape desired, to the dismal failure of those hopes. Despite marking a humanitarian advance--one that Foucault's wholesale condemnation of the modern world did not acknowledge--the history of the asylum also prefigured the totalitarian threat that has haunted the democratic universe from the start.

BUT the asylum's strange and unfortunate story points toward a third era of political history, whose outline is only now coming into focus: a humbled modernity. Gauchet and Swain draw two central lessons for this new political order from the history of the asylum: The first is what the authors term the "impossibility" of totalitarianism. Projects of total control, from the nineteenth-century asylum to the Khmer Rouge's apocalyptic war to send Cambodia back to the year zero, have failed repeatedly over the last two-hundred years, though not without exacting an incalculable toll in human suffering. They fail because the human being, marked by an "indomitable inventiveness," can't be understood or treated like a machine. As Gauchet and Swain aver, "Must we not be sensitive first and foremost to the dimension of impossibility, wherever it is a question of reforming personalities or transforming subjects, whenever we are dealing with the powers of institutions or the integral organization of collective space?"
The failure of the asylum also allows us to see the tragic side of human freedom. Gauchet and Swain argue that the new model of insanity led inexorably to the modern sense of the self. Just as the first alienists discovered in the mad a capacity to reason and an ability, however truncated, to act as free agents, so modern men learn to grapple with their divided selves, which strive to achieve autonomy, without ever completely succeeding. In both instances, the authors say, the point is to avoid hubris. We cannot overcome the divided self, neither by absolutizing freedom and self-mastery nor by abolishing human liberty. We are both free and not free, an uneasy condition that we have yet to come to terms with or truly understand.


So what does this dawning era of humbled modernity, unveiled as a negative image by the asylum, look like? It distrusts any utopian efforts to solve the political problem, though it believes the general democratic drift of the modern world to be just. It is sharply aware of the limits of what the state or any centralized authority can do. It recognizes the deep and impenetrable mystery of the human soul. It has a sense of tragedy. We can see it, I believe, in the abandonment of the most vaulting dreams to recreate the human world; we can see it in the reorganization of businesses away from top-down, heavily bureaucratic management toward more flexible, decentralized practices; and we can see it, too, in our confused, groping steps toward a new approach to the mentally ill that would neither recreate the big asylum nor leave, as did deinstitutionalization, the insane to fend for themselves.

Madness and Democracy, translated with clarity by Catherine Porter, is not without difficulties. It is gnomic in expression and, like Foucault's Madness and Civilization, concentrates too extensively on French history (a useful complement to Gauchet and Swain is Klaus Dorner's Madmen and the Bourgeoisie: A Social History of Insanity and Psychiatry, which draws on German as well as French and English experiences). More troubling, the authors' periodization of history is too rigidly schematic and wrongly downplays the role of actual historical actors in favor of abstract anthropological forces inexorably shifting behind the backs of men. But Gauchet and Swain's Madness and Democracy is impressive: a book of grand aspiration that illuminates crucial aspects of our humbled modern condition.

[source]