Foucault, Michel. Madness & Civilization: A History of Insanity in the Age of Reason. New York: Vintage Books, 1988.

Chapter One: “Stultifera Navis”

Michel Foucault begins his book by discussing leprosy, which vanished from the Western world at the end of the Middle Ages. At its peak, lepers were relegated to special sanatoria. These structures were designed to isolate the leper from the community. Although leprosy eventually disappeared, these structures remained in place. The shift from leprosy to madness represents a shift in a concern with diseased bodies to a concern with diseased minds. At the end of the Middle Ages, madmen were seen as dangerous and ambiguous. The Ship of Fools, or Narrenschiff, was a literary device that also existed in real life. Communities would deal with madmen by exiling them out to sea. Madness or folly were especially important in tales and fables. Madness haunted the Western imagination from the fifteenth century on, but eventually the threat that madness posed faded and madness was tamed. The Ship of Fools became moored and was turned into a hospital. The world of the seventeenth century was more hospitable to madness.

Chapter Two: The Great Confinement

The Classical Age reduced madness to silence after the Renaissance liberated it. Houses of confinement were created in the seventeenth century to house “the poor, the unemployed, prisoners, and the insane” (p. 39). From the mid-seventeenth century, madness was linked to confinement. In 1656, Hôpital Général was founded. It was not a medical establishment, but a semijudicial structure meant to control the social sphere and to clean public spaces of “problem” people (p. 41). Foucault saw houses of confinement as places to put those who were seen as abnormal: criminals, those who do not work, and the mad. These individuals were not confined because they needed medical attention, but rather for the purpose of control by the state. By separating the abnormal from the rest of society, the state helped define itself as “normal.” Confinement in the eighteenth century was a police matter. Confinement was first and foremost an imperative of labor, not a place to care for the sick. It was a solution to various economic and social problems in the seventeenth century across Europe as “it was feared the people would overrun the country” (p. 51). Houses of correction spread across the country in the seventeenth century and they were economic institutions. They contained peasants, beggars, disbanded soldiers, impoverished students, and the sick. These houses of confinement emerged at a time when European states were exercising greater control over citizens and sought ways to control and define them. Outside of economic crisis, confinement came to take on a new meaning and its repressive function were put to the task of getting people to work. The Classical Age used confinement as a way to reabsorb unemployment and to reduce labor costs. Labor had an ethical status during this period, it was believed that idleness was a great sin. Houses of confinement sought to instill religious and moral order in their prisoners. Confinement as an institution became important in the history of unreason. It marked the point at which madness became a problem in a society and became bound to reason and morality.

Chapter Three: The Insane

The seventeenth and eighteenth centuries only recognized madness against a backdrop of unreason. The lazy, the violent, tramps, and the mad were defined as abnormal by society. This was not to say that they actually were abnormal, only that it was the label that society had placed on them. Confinement was primarily concerned with scandal. Unreason and madness were hidden away out of shame and the protection of society. The big exception to this rule was the public presentation of madmen in asylums. “Confinement hid away unreason,” Foucault writes, “and betrayed the shame it aroused; but explicitly drew attention to the madness, pointed to it. If, in the case of unreason, the chief intention was to avoid scandal, in the case of madness, that intention was to organize it” (p. 70). Madness had to be revealed in order for it to be organized and observed. This observation was a form of control which Foucault gets into in his later work in Discipline and Punish. This public display of madness differed from that of the Renaissance where madness was a part of everyday experience and there was no desire to control it. Now madness was on public exhibition, but it was from behind caged bars and at a distance. Madmen were shown like animals in a menagerie. Madmen were considered similar to beasts and treated as such. Madness was not linked to medicine or correction, it was thought that the only way to treat animality was through “discipline and brutalizing” (p. 75). Foucault’s discussion of animality and madness is complex and confusing.

Chapter Four: Passion and Delirium

Foucault explores the relationship between madness and passion. Passion created a space where madness could occur. Foucault refers to Descartes who argues that passions are feelings and emotions such as anger, jealousy, and lust that move people to action. They are experienced in the mind, but also have physical effect that can provoke bodily movement. Passion was the place where soul and body met. Before the eighteenth century, madness and passion were closely related. Moralists from the Greco-Latin tradition defined passion as “temporary and attenuated madness” (p. 89). The Classical period offered the chance for madness to enter into the world of reason. Foucault defines hallucination as “beginning with passion, madness is still only an intense movement in the rational unity of the soul and body; this is the level of unreason; but this intense movement quickly escapes the reason of the mechanism and becomes, in its violences, its stupors, its senseless propagations, an irrational movement; and it is then that, escaping the truth and its constraints, the Unreal appears” (p. 93). What distinguished these unreal images from madness was truth. Foucault argued that madness existed when someone believed that fantastic images were true. Imagination was not the same thing as madness. Madness was considered beyond imagination because it asserted that imagination as truth. Foucault stressed the logic of madness. It had its own language and the delusions made sense within the madman’s distorted world. Discourse is a central concept to Foucault, but I found the discussion to be extremely complex and it didn’t make sense to me. I know I am missing something big and important here and will need to revisit.

Jamison, Kay Redfield. An Unquiet Mind: A Memoir of Moods and Madness. New York: Vintage Books, 1996.

Kay Redfield Jamison provides a personal history of her life living with bipolar disorder (also known as manic-depressive illness and manic depression) by giving a powerful phenomenological description of the condition. Raised in a military family with a history of mental illness, her first experience with tumultuous moods occurred during her teenage years. These experiences escalated and by the time she was in the mid-twenties, manic depression had taken ahold of her life. This memoir traces the dizzying upward spirals and the crushing downward crashes that characterize manic-depressive illness. In the end, Jamison finds solace through a combination of therapy, lithium, and love. The events in Jamison’s life flow into her understanding of the illness, just as the illness has shaped her life. Her writing is clear and beautiful and her descriptions are on point. The cycle of moods she articulates are furiously alive. She eloquently describes the exhilaration and despair that are part of manic depression:

I now move more easily with the fluctuating tides of energy, ideas, and enthusiasm that I remain so subject to … My high moods and hopes having ridden briefly to the top car of the Ferris wheel will, as suddenly as they came, plummet into a black and gray and tired heap….then at some unknown time, the electrifying carnival will come back into my mind. (p. 213)

Jamison does not limit her accounts to the sharp opposing poles of mania or depression. She explores the complexity of this disease that to many is indescribable. For example, she address psychosis and mixed-states, where mania and depression coexist at the same time honesty and accuracy.

Jamison’s memoir is one of the most brilliant and brutally honest books I have ever read on bipolar disorder. Nothing I have read has fully captured the anguish and invigoration of this strange illness. This is a book that I would highly recommend to both those suffering with bipolar disorder and those on the outside of the illness.

Martin, Emily. Bipolar Expeditions: Mania and Depression in American Culture. Princeton: Princeton University Press, 2009.

Emily Martin seeks to answer the question of how popular notions of mania are related to psychiatric conceptions of bipolar disorder (also known as manic-depressive illness). The purpose of her research is to explore the experience of people living under the description of manic depression. Martin explores the concept of mania across a range of settings: support groups, clinical presentations, and media coverage. She proceeds in her ethnography as both a participant and an observer: “In my life, as in this book,” she writes, “I stand in a doubled position as a person who appreciates the benefits of psychopharmacology and other therapies and who is curious about their historical and cultural significance” (p. xviii). Like her informants, Martin herself has bipolar disorder. Her aim in this book is to explore bipolar disorder as the framework for understanding new conceptions of rationality, irrationality, mood, and motivation.

Martin presents a social history of irrationality and rationality and demonstrates that a diagnosis of manic depression blurs the dividing line between the two. She explores how concepts of rationality and irrationality are fitted into a framework of mania and wonders if individuals diagnosed as manic depressive can be considered rational beings. Martin critiques the dichotomies that exist to bifurcate the world into opposing spheres (self/other, rational/irrational, sane/insane) and suggests that individuals with bipolar disorder do not neatly cling to one side of the opposition but that people experience themselves at multiple points along the bipolar continuum. She explains that mania is, in the words of Maurice Merleau-Ponty, an “expressive space” defined by both the mediation of these poles and some element of control over movement between them. She describes performances of mania where individuals control the activation of their mania under the right conditions rather than have it overpower them completely. Those with manic depression are “incompletely rational” beings. The irrationality assumed in a diagnosis of manic depression does not define one’s personhood entirely.

Additionally, the diagnostic taxonomy and medical categories of mood disorders are not strictly defined, but have their own inherent fuzziness. This is especially the case when Martin sits in on medical rounds and listens as doctors diagnose patient’s illnesses with little regard for the patient’s own subjective experiences. In this context, medical authority reigns supreme and controls the terms of debate over one’s mental illness. “No matter what anyone wishes,” Martin writes, “if the doctors say you are manic depressive and write that down in your chart, then that is what you are, in contexts in which medical authority operates” (p. 133). Martin argues that the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has created convenient scientific categories for people to use in describing their mental illness and as a result they fail to explore the phenomenology of their condition. This observation frustrates Martin’s “hope of finding a rich, individually and culturally nuanced language about interior states” (p. 134). She argues that individuals may impose a scientific framework on their mental illness as a way to control and protect themselves against potential harms that come with being outed as having a mood disorder.

In the new millennium, mania has become a way of making sense of individuals, making sense of economic markets, and demonstrating an individual’s worth. Individuals have begun assigning numerical values to their moods through use of mood charts. These charts are created to encourage individuals to rationally manage their psychological states and categorize their own subjectivity, keeping in line with the neoliberal ideas of self-responsibilization and self-governance. Once a person writes down their subjective information in some form, they can learn to manage it in new ways. Martin examines different perspectives on mania ranging from considering it as an asset to be valued and as a “thing” that makes it seem possible to identify, manipulate and optimize mania through medical taxonomy and psychopharmacology. Manic depression as a metaphor has been used in our current conceptions of economic markets. Manic behavior is increasingly linked with economic rationality and is idealized in the widespread images of successful and creative risk-taking entrepreneurs because it offers “continuous wakefulness, boundless energy, high motivation, and productivity” (p. 210). Motivation is the part of mania that our economic system places at a premium. But this positively valued aspect of mania does not exist in isolation from the total context of American life. American media have propagated the mood of the economic market reflects the mood of individual consumers and investors, but the media have not addressed the ways that the economy itself creates individuals with mood disorders.