Summary
In Chapter 2, “The Great Confinement,” Foucault explores more deeply the foundational event he introduced in the preface: the creation in the mid-1600s of the General Hospital in Paris to confine the mad and poor. He begins by laying out why this confinement is a radical development from the history of the Renaissance he provided in the previous chapter. In the Renaissance, we saw an explosion of representations of madmen all the way through Shakespeare. This was both a “liberation” and a “taming” of the voices of madmen. It liberated because they were all over, but it tamed them because the kinds of voices we hear are not a great threat to society, but instead provide a foundation for society’s understanding of itself. In the great confinement, however, the voice is not so much tamed as silenced altogether.
The General Hospital in Paris was founded to house the poor, especially beggars. That means it’s not a hospital in the sense we have today of a medical establishment. It was more like a prison, or at least a “semijudicial structure” that nonetheless operated outside the traditional judicial system of judges and courts. It was an expression of monarchical power, created during the reign of Louis XIII, because confinement is ultimately a “police” matter, governed by the executive.
The Hospital was a necessary development for a society that was moving into a capitalist system and whose population was growing but could not all be employed. It was, in other words, an answer to an economic crisis. The poor could sacrifice their freedom in order to be fed. As other hospitals popped up across Europe, they similarly responded to economic crisis, as a place “to contain the unemployed, the idle, and vagabonds.” But soon the hospitals began to develop a function even when economies were not in crisis. This was when it instituted labor among those it confined. Now, the hospitals didn’t just confine those out of work, but also gave work to those it confined, serving a larger function in the social economy as a whole.
Foucault argues that this system for confining the poor ultimately shaped classical understandings of madness. The hospitals made it so that poverty and unemployment were seen as unethical. Thus, by contrast, for individuals to be understood as normal, they had to work. The mad were confined along with the poor because of this original fact of their being: they were not employable labor. They needed to be separated from a more functional, because laboring, segment of society.
However, as Foucault describes in Chapter 3, “Insanity,” the mad experienced a slightly different kind of confinement. In general, confinement seems to be about hiding a secret: putting the shameful poor out of sight, for instance. This is not the case with madness. Going back to the Middle Ages, the mad were not so much put out of sight behind solid brick walls, but made observable by being placed in cells with barred windows to the outside world. This made the mad a spectacle. People enjoyed seeing the mad in all their madness, in ways they did not enjoy seeing the poor in all their destitution.
This makes madness less a hidden secret and more a public scandal. Madness is publicized rather than avoided. People find it fascinating rather than merely shameful or disgusting. In turn, the aim of the hospitals is not to hide madness but to “organize it.” Madness is not a disease but a “glorified scandal” to be managed, seen, even enjoyed by people outside the hospital. Again, we see how something placed outside of society is actually central to it, amassing lots of attention.
If the madman viewed in his cell in a hospital starts to sound like an animal looked at in his cage at a zoo, that was precisely the point. The classical period begins to proliferate lots of understandings of the “animality” of the madman. This made the madman in some ways not a “man” at all, but a beast to be tamed. On the one hand, this made it possible to treat the madman brutally without fear that this was inhumane, since you were dealing with a part-beast instead of a human to begin with. There was then at this time no concept of “treating” the madman. He was simply to be “disciplined and brutalized.” This is also how madness differentiated from poverty, although both the poor and the mad were caught up in the hospitals. The poor were immoral humans, while the mad were not so much immoral as inhuman.
Analysis
In these chapters, Foucault shows himself to be somewhere between we have come to call a “sturcturalist” and a “post-structuralist.” In the previous chapter, we say that Foucault thought categories like sanity/madness were not a neat binary pair of mutually exclusive opposites. Instead, the definition of sanity requires the definition of madness in order to make sense. Thus, although we might have thought of sanity as being normal and neutral and madness as being inferior, sanity is actually dependent on madness. You have to have a concept of madness before you can have a concept of sanity. This is a post-structuralist view, because it rejects the commonsense structure of definition in which sanity comes first and defining madness comes second.
But Foucault also has structuralist tendencies, because he is interested in how elements of human society make sense when understood as part of a larger structure. He is also interested in how these structures can persist even if some of their contents change. Thus, a structure of confinement persists from the Middle Ages through the classical age, but who is being confined changes: from the person with leprosy to the person experiencing poverty. Foucault’s point is that societies need these structures of exclusion in order to organize themselves. This is where structuralism meets post-structuralism. Societies need to exclude some concept of the “other” in order to understand what is inside society, or who gets to be a part of society.
Notice how strange this structure of exclusion is when it comes to confinement. It’s not that people are being shipped off to some remote island. They are being confined within society, which means they are excluded from inside. The point, for Foucault, is that this makes exclusion all the more visible for people. And because the ultimate aim is the organization of society, letting people see what is excluded from society—what society is not—confinement is better than shipping people off to an island.
These chapters introduce a theme that Foucault will take up in future chapters as well: the relation between madness and morality. Notice how the definition of morality here has less to do with, say, religion, and more to do with economics. The poor are considered immoral not because they have sinned, but because they are not contributing to the economic structure of society. Foucault has an enduring interest in economics and how our understanding of the world is shaped by economic imperatives. Here, he is tracking how economics provides a kind of secularization of morality. That means we can have concepts of morality that aren’t tied to gods or churches, but tied to social principles.
At the same time, it is important that, at this stage in Foucault’s history, the mad themselves are not considered immoral. They are swept up in the larger category of the poor who are the exemplars of immorality, but they are differentiated by being more inhuman rather than immoral. By the end of the classical age, madness will have developed a stronger tie to immorality itself. This is a transition to watch out for as the book progresses: how the mad went from being viewed as animals or subhuman, to being viewed as deficient humans with failings that needed to be remedied rather than tamed.
