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particular field. Rival medical historians have spilled a good deal

M.adness and Civilization

in Early Modern Europe: A Reappraisal of

Michel Foucault
H. C. ERIK MIDELFORT

of ink m vain pateniity suits between alleged fathers; and all too often the argument boils down to finding the really hmnane doctors of the past. Instead of concentrating on the growth of method, or of knowledge, as is common in the history of science, the Whig historians of psychiatry seem to have praised their subjects only because they were humane. The best historians of madness have always avoided these pitfalls, but the Held as a whole remains hostile to a nonprogressive, non-hero-worshiping history. One sad example is the recent massive history of madness by Wemer Leibbrand and Annemarie Wettley, two emdite medical historians who approached their history from a topical and philosophical point of view. Their detailed and profound book has had no perceptible influence on other histories of madness since it appeared nineteen years ago,

and may unfortunately prove to be a mere relic of Gennan idealist

history. Perhaps one can anticipate a happier future for the recent survey of medieval rnadness by Judith Neaman. Her breezy essay exposes in numerous ways a continuation of medieval attitudes toward the insane down to today, thereby throwing out a chal-

lenge of some importance for the history of psychiatry, one that forcefully emphasizes a vast continuity beneath the chatter of
superficial changes.

Despite the flickering hopes that such recent accoimts raise, by

far the most audacious and learned challenge to the medical Whig Historians everywhere have begun to pay close attention to the history of the poor and the downtrodden, the laboring classes and the dangerous classes, even the mad, or mentally ill, who pose peculiar challenges and difficulties. By examining the impact of Michel Foucault, whose book Madness and Civilization is perhaps the single best-known study of mental illness in early modem Europe, I hope to discuss some of these difficulties. I also hope to discuss some of the literature in the field, including the history of medicine, which has displayed a myopic bias toward modem problems, and a Whig point of view that countenances only those progressive movements cuhninating in our own presumably happy time. This bias is pervasive in the history of psychiatry because many of its practitioners lack traming in history and write from a complacent and unquestioning position, often after years of medical practice. The resultmg history is all too often a fonn of hero-worship, the singlmg out of prescient
tradition is Michel Foucault's FoHe et d6iaison: L'Histoire de la

folie d 1'dge classique. This work, written by a philosopher often identified as a structuralist, was an immediate success, despite

gnunblmgs on the part of some reviewers. For one thing, it stood

the medical tradition on its head by debunking the heroes, and by showing how we got into the psychiatric mess we are m.

Foucault, m other words, wrote an antiheroic and antiprogressive

history, which at times seems close to what one could term Tory history, a romantic chronicling of declme from some previous age of greatness. But he did much more than simply invert an en-

crusted orthodoxy, for he comiected the history of madness to the history of civilization and society, suggesting withal a stmctural approach to history aimed at penetrating beneath the facade of
superficial variety to the underlying order that men in any age impose on their perceptions. The first and most obvious impact of Foucault's work was

men who made "advances." These great men mystehously managed to transcend the limitations of their age and to approach the
insiehts of our own aee. thereby becoimne "fathers" of their

among the opponents of traditional psychiatry, especially the antipsychiatrists in Britain, R. D. Laing and David Cooper, who had already begun to regard institutional psychiatry as a hoax and

FOUCAULT 30 CRmCAL TVOUGHT SERIES

31

of view, Erving Goffman and Thomas Szasz in the United States

had also come to distmst the mental hospital. For them, Fou-

cault provided historical legitimation by debunking the origins of modem institutional psychiatry. As the same time, by continuing to develop as a philosopher, and by making L'Histoire de la folie integral to his philosophy, Foucault has also influenced speculative and philosophical pursuits. Although Anglo-Saxon
readers have often objected to his obscure, arrogant, sensation-

dizzying unreason of the world, and the feeble ridicule of naen." In popular literature, in the painting of Bosch and Bruegel, m festivals, "in learned literature too Madness or Folly was at work, at the very heart of reason and tmth," and the late medieval fascination with death becaine, by a slight variation, a fascmation
with madness. "What is in question is still the nothingness of

existence, but this nothingness is no longer considered an extemal final tenn, both threat and conclusion; it is experienced
from within as the continuous and constant form of existence."

alist, and opaque form of discourse, which by his own adnaission is a "labyrinth into which I can venture . . . in which I can lose myself," his philosophy may well become a major force among self-consciously avant-garde intellectuals. But rather than get lost in Foucault's labyrinth, we can perhaps learn to live, at least temporarily, with a double tmth. Following the medieval Averroists, I would like to suggest that something may be tme in philosophy but not necessarily so in history; or, to use less provocative language, that Foucault could be right about language and the human condition, but wrong about the route by which we
have arrived where we are. In this way the historian can hope to

According to Foucault, that is, madness had become the image of man's secret, sinful nature but also the image of wisdom itself.
Since humanists and artists used "folly" as a critical tool for

attacking the vices and vain pretensions of their day, the basic symbol of that age, and the title of Foucault's first chapter, is the ship of fools-a ship representing all the world crowded with various sorts of madness and folly. Far from being merely a theme for painters and poets, the ship of fools had, in Foucault's view, a real existence. He regards it as a common means by which fifteenth-century Rhenish towns dealt with their mad. Foucault

make his own peculiar contribution even if he does not reevaluate the foundations of epistemology or provide a new analysis of mind. I am strengthened in this proposed division by the fact that many of Foucault's readers seem to regard him as a historian and
often extract historical details from him even as they object to the
medium in which he has embedded them.

expoimds beautifully the link of liminality that men made between water and madness and conjures up the wonder of towns-

folk watching the arrival of the latest ship of fools. Slowly in the
course of the sixteenth century, however, the tragic and disturb-

ing dimensions of madness gave way to the rational and moral

critique of the humanists; yet, even in this fonn, madness was only displaced, and scholars like Montaigae and Charron con-

Considered as history, Foucault's argument rests on four basic

contentions. The first, and in some ways the most picturesque, is

tinued to place madness at the heart of reason. "For the truth of

madness is to be inside reason." Thus, the Renaissance basically inade clear what had been unplicit in the Middle Ages. Madness was still accepted as part of truth and life; it was a time "in which the man of madness and the man of reason, moving apart, [were] not yet disjunct." The third major contention of Foucault is that this openness disappeared in the Age of the Great Confinement, beginning in the mid-seventeenth century. As Christian critics of folly over-

the forceful parallel between the medieval isolation of leprosy

and the modem isolation of madness-a parallel that has been

accepted by many and that rests on two suggestions niade by

Foucault: (1) that when leprosy disappeared from western Europe,

it was replaced by venereal disease and then by madness as the

one human defect men refused to contemplate or to deal with on

a day-to-day basis, and (2) that many lazar houses remained empty until filled with the mad two centuries later.
Second is Foucault's contention that in the late Middle Ages

whehned the tragic vision of both painters and writers like

Shakespeare and Cervantes, some thinkers, Descartes, for exam-

and early Renaissance the mad led an "easy wandering life," madness having been recognized as part of truth. Even when ejected from a town, the mad were not shut away. Or if a town did lock up some of its mad, as Foucault briefly concedes, it placed them in gate towers or other "liminal" positions symbolic of the
medieval awareness of the mad limits of its world. Around 1500

pie, even began to regard madness as "impossible." The awareness of madness at the borders of life withered as men began to

conceal, lock up, repress, and confine the mad/as they did beginning with the "Great Confinement" in France, an attempt imder
Louis XTV to eliminate begging by confining the poor in "general hospitals," where they were to receive food and rudimentary care

Foucault claims that the ambiguity and constant presence of

madness became an obsession. "Madness and the madman be-

in exchange for light work. Foucault emphasizes that these gen-

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FOUCAULT

33

house a motley assortment of crimmals, aged, orphans, prosti-

tutes, the poor, the mentally defective, and the mad.

Instead of regarding such persons as basically dissimilar, soci-

medieval society toward the mad, emphasizing instead its openness to folly and unreason. With Foucault, they can shunt responsibility for harsh treatment off to the age of the Great Confineinent. The Dutch scholar, H. H. Beek, for example, cites

ety now lumped them together because of their common refusal

(or inability) "to wofk. Foucault sounds a Marxist note, observing that the new bourgeois order would not tolerate the absence of the basic bourgeois virtue: "good," hard work. Thus, madness was reduced to a form of immorality or scandal rigorously to
be excluded from the life of moral and rational men. A simi-

Foucault with evidertf relief to show that a less religious and less
humane attitude toward the mad came only after the Middle

Ages. Or to cite another example, a recent history of medicine in medieval England glows with pride over the "kindly and tolerant" attitude usually shown toward unbalanced people, and notes

lar development took shape in Germany with the spread of yet a mental illness or even a medical problem of any sort. It was

Zuchthausez, and Foucault implies that the English workhouses were no different. On this view, the madness confined was not

simply man as animal, without reason and often healthier and

stronger (and more dangerous) than his more rational brethren.
Even .hostile critics have accepted this view of matters. The fourth and Bnal contention posits a transition to madness

as mental illness, in which Foucault examines the work of the

reformers, Tuke and Pinel, and concludes that they "invented"

mental illness. By turning to "moral therapy," the reformers suc-

ceeded, that is, in making guilt one of the prime weapons in the arsenal of the physician. By learning to dehumanize and control the insane in asylums, they also seized power as arbiters of sanity, thereby cutting off all hope for continuing the dialogue between reason and unreason, however attenuated that dialogue had become since the seventeenth century. It is at this point that
the invention of mental illness.

with disinay that "it was to be a long time before this attitude returned, for the later history of Bedlam shows how callous the public could become." For historians studying the modem period since 1800, however, Foucault has usually been more of a threat than a help. They have either ignored hiin or found his work too abstract, too angry, or too difficult to be of much use. Some of them have persisted in seeing the refonns of the nineteenth century as one example of the rising tide of huinanitarian refonn at work throughout society. Others have reexamuied the work of Philippe Pinel without so much as mentioning the challenge thrown down by Foucault. Only a few have taken the challenge seriously, and begun the sort of detailed work through which general assertions can be effeclively tested. This common reluctance to take Foucault seriously may have soinething to do with the ideological cominitment of niodem historians, who do not generally regard their own

epoch as the savage wasteland of dehmnanized silence that

Foucault describes. But whatever the reason, the situation poses

many historians and critics have drawn back in horror. Only the antipsychiatrists have eagerly embraced Foucault's version of four arguments have been undemably influential. Authors who
would not dream of accepting Foucault's philosophy or all four of Taken as a simplified summary of Foucault's great work, these

real problems for the historian of early modem Europe. On the

one hand, medievalists have agreed that real cruelty toward the

the arguments here described have not hesitated to call his book
"brilliant." The vast new quagmire of scholarship entitled book on Wahnsinn, did not flinch from calling Foucault's works indispensable for the historian of medicine. Even scholars who oppose Foucault's antiheroic constmction

insane began after 1500. On the other hand, historians of modem inedicine and psychiatry are equally agreed that the late eighteenth and early nineteenth centuries saw the first effective efforts at relieving the iniserable plight of the mad. Early modem Europe, in other words, has been scourged from two sides, by
Foucault and his followers, and by the traditionalists. Unfortu-

ity. And Wemer Leibbrand, one of the authors of the ill-fated

World History of Psychiatry often cites Foucault as an author-

nately, it cannot be said that historians of early modem Europe have responded effectively. Some work has recently appeared on the treatment of madness in the eighteenth century, but much
remains to be done. As for the sixteenth and seventeenth cen-

have been willing to grant his insight in areas other than those under close scrutiny; and because Foucault divides his history into three broad periods, it is not surprising that at least three
kinds of reaction have developed. Happiest, perhaps, have been the medievalists. for they have found in Foucault an unexpected

turies, the waters are largely uncharted. Work is proceeding, however; and a brief consideration of the literature may tell us how
well Foucault's contentions hold up.

Probably the first point concerning the putative analogy between medieval leprosy and early modem madness is that

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FOUCAULT

35

developed from medieval hospitals, and especially from mon-

inad and confining them [inteiner], the crucial distinction is

between small-scale and often ecclesiastical efforts to succor the

asteries. This becomes a point of some importance when one tries to understand the rigid discipline of the eighteenth-century

general hospital or Zuchthaus Moreover, research into the hls"

tory of medieval leprosy may also force a refinement of Foucault's

monolithic image of reiection. One recent study has shown that medieval lepers were treated with a mixture of fear and pity,
contempt and sympathy; that although they sometimes^ expen^

poor, the aged, the sick, and the mad, and larger, often secular atteinpts to encompass all of the poor and to eliminate begging. The problem is ndf only that the poor mad were confined or hospitalized before the seventeenth century. That would be embarrassing but not devastating if late medieval men did have that other way of dealing with the mad, the ships of fools that
Foucault puts on such elaborate display. Rather the central problem is that serious researchers have never found any mention of

enced open persecution, they also received good care. Another study of leprosy in medieval literature concludes that the disease
was both an emblem of sin and a living purgation. In other words, far-from"banishing leprosy from all areas of life, medieval UteratureVeflected a fascination with it. And because leprosy was often confused with venereal disease, it was a condition that threatened

real ships of fools. There are references to deportation and exile of mad persons to be sure, and instances in which towns gave poor, mentally afflicted persons enough pocket money to last until they reached home. Occasionally the mad were indeed sent away
on boats. But nowhere can one find reference to real boats or

all" expressions of lust. One may not be able to say that all lepers

were banished to a living death in remote lazar houses, but as a model of social exclusion, the lazar house still stands as an ideal

ships loaded with mad pilgrims in search of their lost reason. The
sources cited by Foucault merely prove that cities sometimes

type, the embodiment of a social attitude; the religious rituals

that accompanied conHnement in a house of lepers were often strikingly similar to the office of the dead. Yet here Foucault's paraiTel again is forced to bear more than it is able. For con&ne~
menttoamadhouse or asylum did not involve the same kinds of
mortuary ritual or the same extinction of legal rights. In the late Middle Ages and Renaissance, as recent work has

used boats to get rid of a difficult mad person; and at that, there is only one known instance of a madnaan's having been set adrift on a boat, and it is quite possible that the intention was to drown
him, since certain German laws of the fifteenth century intro-

duced the death penalty for stubborn cases. Foucault's rhapsody on the power of water takes on new meaning in light of these
brutal episodes. But even if the mad were often treated roughly, even if they

shown, many of the mad were in fact confined to small cells or Foucault suggests. It seems likely, indeed, that whenever a mad
jails or even domestic cages and not just to gate towers as

were frequently hospitalized or jailed, and even if they were not

set aboard the Nanenschiffe, does it not .remain true nonetheless

person was considered a threat to others or to hun- or herself, society has dictated that the person be restrained, forcibly if necessary, and with chains. The instances of harsh treatment of the
found western Europe's first hospital for the mad at Valencia. The

that naadness was regarded as part of medieval life and truth? To this question a kind of answer has begim to emerge. A literary scholar, Penelope Doob, has detailed the connection made by
niost inedieval commentators between madness and sin, con-

mad could be multiplied ad nauseam. hideed, the Spanish friar

Juan Gilabert Joffre was so moved by the si^it of a group of boys insulting and stoning a poor madman in 1409 that he decided to story is noteworthy on two counts: first, because it is evidence part of life, and second, because it demonstrates that the founding
^Fmental'hospitals did not wait for the "absolutist" or "bourthat'not all elements of medieval society accepted madness as

eluding that, generally speaking, madness was considered either a

consequence of sin, a purgation, or a test of one's virtue. Medieval thinkers may not have accepted madness any more than they accepted sin, but they accepted the reality of both; and

many more of them were obsessed with sm than were obsessed by

or even interested in madness. Then, too, Beek's marvelous book examines some of the other implications of the religious context
within which mental illness was understood. Pilgrimage was a

geois" repression of the seventeenth century Such hospitals

were a medieval Arab invention, which probably explains their
in the sixteenth and seventeenth centuries. Foucault is quite

thoroughly conunon remedy for inadness (and other afflictions),

and other spiritual aids, including exorcism, were widely used as well. According to the Spanish medical historian Pedro Lain

spread in fifteenth-century Spain^and from there to all^ofEiuope wrong in suggesting that they were an invention of the early
nineteenth-centurv reformers. And though he tries to salvage his

Entralgo, the coimection between sin and sickness has been extremely resilient in western culture: "It is not rare that a 'spiri-

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FOUCAULT

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malady' in the medical sense." Foucault is aware of this point; he mentions religious interpretations of madness but does not modify his general conclusion that madness was seen as cosmic tragedy by medieval and Renaissance artists. By underestimating the force of sih'as a source of horror and madness, he grossly exaggerates the Renaissance dialogue with madness. When Foucaiilt turns to literary treatments of folly and madness, he is on more sohd groimd, but his spirited treatment of Sebastian Brant, Erasmus, and the humanist tradition of folly as moral critique appears one-sided in light of recent investigations,
which show that Brant and Erasmus had divergent goals in mind
and that humamsm cannot be reduced to naive moralism.

trary but often implies that the general hospitals confined not just
the poor, but all persons who affronted bourgeois sensibilities. His argument, to be precise, is that the confinement represented a bourgeois attempt to repress and regulate the poor; and here one must emphasize a feature that Foucault notices but does not fully assimilate. These general hospitals, having originally been built on monastic lines by refonners who thought in monastic terms,
coinbined the main features of the monastic enviromnent: asceti-

Barbara Konneker's study in particular contains some very stimu-

lating speculation about why Brant's Narrenschiff became such

an instantaneous success. She insists that the basic idea was the

identification of sinful mankind with a "colorful host of court

fools and shrovetide fools with their ridiculous and grotesque

postures, leaps and dances," and that this was the idea that caught the fancy of the age rather than any deep concern with
madness, melancholy, or mental disturbance. It would be wrong, however, to conclude that madness everywhere encountered only criticism and abuse. Among some of the Renaissance humanists, the melancholy malady was cultivated as a pathway to spiritual growth or to genius. Relying on
the pseudo-Aristotelian Problem (XXX, 1), many Renaissance scholars concluded that all true geniuses were afflicted with madness and melancholy. The researches of Klibansky, Panofsky, and Saxl have made the revival of this idea during the Renaissance
well known. And a recent dissertation has examined the reli-

cism, work, morality, obedience, and supervision. And just as monasteries frequently cared for the sick, the aged, the mad, the orphans, and the poor, so too did the general hospitals. Lumping such diverse groups together was not a classical innovation proinpted by bourgeois reverence for work or by a new episteme, but an echo of a long ecclesiastical tradition of dealmg with misery and dependence. Indeed, the various groups of poor were not usually housed together indiscriniinately, as if there were no difference between orphans and the senile, but were generally separated into wards or floors or even separate buildings. The classical innovation, if there was one, was the massive attempt to compel the poor to enter institutions originally set up on a voluntary basis. And this attenipt has more to do with absolutism and centralization than with bourgeois inspiration.
In another instance, too, Foucault invites misinterpretation. He

implies that the mad were shut away like lepers, that general
hospitals were not medical institutions in any sense, and more remarkably that the mad were not even considered ill. In fact, many mentally disturbed persons in eighteenth-century Paris
came first to the H6tel-Dieu, where they took a six-week ciire,

gious, emotional, poetic, and philosophical reasons for cultivat-

after which they often went home. If they showed no improvement, they might repeat the six-week cure. Only then were they

ing the melancholy humor, which had become a fashion by the

end of the sixteenth century, Yet this rise of melancholy was

eligible for the lunatic wards of Bicetre (for men) or Salpetrifere

(for women). And according to Sebastien Mercier, at least, many

accompanied by a rising resistance to melancholy as well, from

medical, Stoic, and religious points of view.' Thanks to them,

improved enough to be discharged even from those two hospitals,

even though they had been set aside as incurable. Here, too, general hospitals seem to have followed the monastic inspiration of custodial care, redemption, or rehabilitation as opposed to the sepulchral inodel of the leprosariuni. Moreover, recent research has shown the dangers of extrapolating from an idea, as Foucault does, without siifficient attention to chronological or regional differences. Klaus DOmer has paid close attention to these variables and has produced a large, toughminded, inspired history of the way the poor-mad came to public attention in western Europe. By devoting nearly equal attention

the atmosphere was so contentious as to make one doubt whether

the humamsts' attitudes toward mental ilhiess can be reduced to

a single response as Foucaidt suggests. Which brings us to the Great Confinement. On this topic a great deal of material has recently come to light as scholars dig
into the volmninous institutional records of the ancien i6gime.

But one fact stands out; namely, that the grand renfennement
was aimed not at madness or even at deviance, but at poverty. It

was only the poor-mad, the poor-deviant, the poor-crimmal, and

the iust plain poor who were sent to the general hospitals of

to England, France, and Germany, Domer could see the crucial

38 CRITICAL THOUGHT SERIES FOUCAULT

39

eties; by examining social conditions generally before looking at

the fate of the mad, he came up with the first genuine social

posterous. What is basically true is that before 1800 medical

men quite unifonnly tried to relate all mental disturbance to underlying somatic conditions. To that extent there was no purely mental illness until psychiatry subsequently divided itself into two bitter factions, the somatic and psychic (or moral). In turning to the work of Tuke and Pinel as presented by Foucault, it seems only fair, therefore, to interpret Foucault as meaning that they and their refonns created a mental illness whose medical treatinent was really moral repression, the attempt to foster guilt in a patient by setting standards and pimishing him for any transgressions. Some of Foucault's followers have gleaned precisely this message. But it, too, is a polemical distortion. Take Foucault's assessment of William Tuke and Philippe Pinel. Neither of them was the hero that medical hagiography has
inade him out to be. A Gennan scholar has recently taken

history of psychiatry. In other words, where Foucault is often content to speak of the classical experience, Domer emphasizes
the differences between the English, the French, and the Gennan

experience with madness. In so doing, he has been joined by Martin Schrenk, who stresses the way in which German psychiatry took off along different lines from that of France and England,
even while atteinpting to imitate and assiinilate French and En-

glish psychiatry, and by other scholars, who have begun to emphasize how nuinerous purely private madhouses becanie, especially in England. This was a development that Foucault completely overlooked, and that again poses problems for his assumption that confinement of the mad by the state was unifonn
all over Europe.

Nor is Foucault's periodization free of problems. Though he conveys the impression that the age of confinement of the mad coincided with the age of confinement of the poor, the political
and economic failure in confining the poor was evident by the

late eighteenth or early nineteenth century, but it was only then

that the confinement of the mad really got under way. To take

only a couple of examples, it is clear that England experienced

a dramatic rise in confinements during the nineteenth century.

English asylums everywhere filled up much faster than the best

estimates had projected; and it seeins likely that as asylmns becanie available, the definition of madness itself broadened to inelude the "awkward and inconvenient of all descriptions."" In France the picture seems to be much the same. In the United States, the rate of admissions of patients to hospitals for mental disease went from 3.0 per 100,000 to 18.6 per 100,000 between 1831 and 1860. In the next hundred years the rate of admissions jumped to over 200 per 100,000. Canadian statistics show a similar rise. With regard to madness, therefore, we are witness-

Foucault to task for creating the false impression that only the skilled intellectual archeologist (Foucault) can detect the full repression of Tuke's Retreat, when in fact accurate quotation of the source in question would have made the point without hirther delay. It has also become clear that Tuke did not use only the force of judgment, the ever-watchful eye of supervision. He also emphasized the importance of diet, exercise, climate, and surroundings, all of which were echoes of the earlier medical practice of treating mind and body together. Furthennore, recent
scholars have demonstrated thai in England, at least, moral

ing the end of the age of confineinent only now, as drug therapy
and conununity mental health centers increase in popularity at the expense of in-patient hospital care. So far as concerns Foucault's fourth contention, that the reforms of the late eighteenth and early nineteenth centuries ainounted to the invention of mental illness, it is here that his

therapy was far from crucial in the medicalization of mental illness. Indeed, English physicians of the early nineteenth century, regarding nioral therapy quite correctly as a lay threat to medical monopoly, a kind of treatment that was distinctly nonmedical, waged a strong and ultimately successful campaign to coopt or assimilate the new psychiatry of Tuke and Pinel.t Here then is a discontinuity, or at least a wrinkle, in the case for continuity between Tuke and our own age that Foucault tries to make. With regard to Pinel, Foucault similarly clouds the perspective, first, by accepting the story of Pinel's liberating the mad of Bicetre
from their chains and then by showing how hollow that libera-

philosophical frainework blends most perfectly with his history,

and that the empirical historian must tread most cautiously. Foucault frequently implies that prior to the nineteenth century madness was not a niedical problem but was regarded either as a condition having its own truth or as a reduction to brute ani-

tion really was. Careful research has cast doubt on Pinel's famous gesture, showing that it may never have taken place at all and that far too many historians have remained content with the platitudes of psychiatric tradition. The most far-reaching criticism of Foucault's view of Pinel, however, stems from recent scholarship that docmnents Pinel's explicit debt to earlier English
theoreticians and to classical antiquity. Far from standing in

a new environment governed by new rules (a new episteme],

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FOUCAULT

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pocratic-Galenic tradition of Aretaeus, Celsus, and especially Coelius Aurelianus.* If, as Hayden White has argued, the aiin of Foucault is to "disperse" the elements of our casinos, to "defamiliarize" us with the past, to emphasize the large discontinuities in history, fhen it is clear why he must deny the kinds of continuity, dependence, and debt that traditional historical scholarship often affirms. It is also clear that recent research is making Foucault's task ever more difficult. What we have discovered in looking at Madness and Civilization is that many of its arguments fly in the face of empirical evidence, and that many of its broadest generalizations are oversimplifications. Indeed, in his quest for the essence of an age, its epistenie, Foucault seems simply to indulge a whim for arbitrary and witty assertion so often that one wonders why so much attention and praise continue to fall his way. The answer rests only

necessity of reading onuuvorously and of reading closely; the necessity of probing behind a verbal facade to the emotion or
unconscious intention within; and the need for a history of mental stmctiires that dares to imagine discontinuity as well as con-

tinuity. If a disciplined intuition can grasp these things, our confrontation with the past will continue to be a (self-) critical
encounter.

H.C. Eric Midelfort, 'Madness and CivUization in Early Europe: A Reappraisal ofMichel Foucault' m After theReformation:EssaysinHonorofJHHexter, edited by Barbara C. Malament, Manchester University Press,
1980.

partly on his emdite brilliance and on his standing as the man

who "relaunched philosophy in France single-handed." In the history of medicine, his importance rests not so much on his

general philosophy as on his attempt to recast the shape of medical history, to present a history of medicine that does not proceed relentlessly toward the present, and to explore the deepest meanings of madness and the underlying stmctures of knowledge
within a given period. The execution of this important task is not so easy as soine of the bedazzled followers of Foucault seein to assume, though neither is it so unimportant as many orthodox and self-contented historians of medicme suggest. If we are to

have a stmctural, unheroic history, we must recognize the mapr

flaws that run through much of Foucault's work. First, we will have to leam to rethink the historical periods of our past; it is one of the strangest aspects of Foucault's perceptions that for all his iconoclasni, he continues to uphold the firm concepts of the Renaissance, the Classical Period, and the Modem Age. Second,
we will have to learn to work with stmctiues of mind that do not

pretend to underlie all of the thiiiking, or even all of the best thinking, of an age. There is too much diversity in any one period, and too inuch continuity between periods, for the relentless quest for the elusive episteme to prove ultimately useful. Moreover, m trying to extract or apply Foucault's method, we will have to remain aware of the need to control the force of intuition, to leave our arguments open to falsification. Foucault runs mto problems when he extrapolates the structures of the present back into

the past, though it is not clear whether such empirical observations can be of use of philosophers. Historians, however, should not conclude that a catalogue of Foucault's errors vitiates his