Foucault’s Folie et déraison : its influence and its contemporary relevance

In 2007, the Web of Science announced that Michel Foucault was the most cited scholar in the world in the humanities. His influence was evident across a whole spectrum of academic disciplines, from history and sociology to political science, anthropology and literature (less so in Anglo-American philosophy, somewhat oddly given that Foucault was a trained philosopher). But when I first encountered Foucault’s work in the late 1960s, he was still a somewhat obscure French intellectual as far as most North American scholars were concerned. This situation would change dramatically over the following decade, and by the time Foucault first visited to teach at the University of California at Berkeley in 1981, he had become a major figure, seen in most quarters as one of the most prominent intellectuals in the world.

Foucault’s rise to eminence had occurred sooner in France, but only by a few years. ¹ His first book, Maladie mentale et personnalité (written in 1954 when he was in the midst of much emotional turmoil and in the aftermath of at least one suicide attempt), had attracted little attention at the time; there was only one published review of it that I can trace. Foucault subsequently attempted to prevent the publication of an English translation, and disavowed the book. ² Although he had graduated from the École Normale Supérieure, Foucault’s academic career got off to a spluttering start. In 1955, his connections secured him a post in Uppsala, Sweden, directing the Maison de France, teaching French language and literature, and working on a doctoral thesis. ³ When Foucault attempted to submit this thesis to the University of Uppsala, however, it was roundly rejected as a poor work of history (Eribon, 1991: 81–6; Macey, 1993: 79–80). He then left for a similar marginal post at Warsaw University, where he found himself unwillingly sharing the characteristic privations of life in a Communist satellite. His tenure there was brief, as a potential scandal about one of his many homosexual affairs led to a forced departure. ⁴ Again, his sponsors helped him secure another marginal position, this time in Hamburg running the Institute Français.

It was in Hamburg that Foucault completed the thesis which he submitted to the University of Paris in 1960, and the doctorate finally brought him a university appointment, albeit in the depths of la France profonde, at Clermont-Ferrand. ⁵ The thesis became the book published by Plon in May 1961 (Foucault, 1961), but only after it had been rejected by Gallimard; a second rejection after the one in Uppsala must have stung (Eribon, 1991: 105–7; Macey, 1993: 106–9). Although it was later to be seen as perhaps Foucault’s major work, it did not initially catapult him to fame. Jacques Derrida was harshly critical of it in a lecture at the University of Paris, prompting a savage response from Foucault that would belatedly find itself into English translation as an appendix to the full translation of History of Madness into English in 2006. Leading intellectual figures such as Roland Barthes, Gaston Bachelard and Fernand Braudel were more positively disposed, but Foucault was forced to continue to commute from Paris to Clermont-Ferrand. His second book, Naissance de la Clinique, published by Presses Universitaires de France in 1963, met with a cool critical reception, despite its interesting discussion of the changing face of medicine in the late eighteenth and early nineteenth centuries (Macey, 1993: 140–2).

Foucault first attracted major attention in 1966, when he published his third major book, Les mots et les choses, finally with the imprimatur of Gallimard. Its literary style attracted great admiration among French readers, some of whom were tempted to compare it to Claude Lévi-Strauss’s Tristes Tropiques. Foucault would later disavow the label of structuralist but, when the book appeared, he was viewed as a major exponent of its doctrines, alongside Lévi-Strauss, Lacan and Barthes. A few months after the publication of Les mots et les choses, Foucault took a position at the University of Tunis, largely because his partner, Daniel Defert, had been posted there, but he was now recognized as a rising star, and two years later he returned to Paris to take up an appointment at the University of Vincennes. Two years after that, he became a fellow of the Collège de France. ⁶ He had arrived, and from then on his fame grew year on year.

In most of the English-speaking world, the reception of Foucault’s work, and his rise to prominence, came more slowly. One telling measure of this situation is that when Richard Howard was commissioned to translate Folie et déraison, the publisher refused to countenance the publication of the entire text, considering it unsaleable. ⁷ They thought no one would plough through such a lengthy text by a then-obscure Parisian intellectual. For this reason, the English book (Foucault, 1967) was a translation of the greatly abbreviated French paperback edition of 1964 that had been published as Histoire de la folie a l’âge classique (into which Richard Howard had managed to smuggle a few more passages from the original edition). The publisher, seeking a larger audience for the book, came up with the brilliant idea of creating a new English title, Madness and Civilization. ⁸ Les mots et les choses did appear in an English translation in 1970 (Foucault, 1970), and a translation of Naissance de la clinique followed three years later (Foucault, 1973); both these translations were produced by a different translator, Alan Sheridan, who (along with some errors and mistranslations) produced texts that were reasonably faithful to the French originals. That did not ease their reception into the world of Anglophone scholarship in the first instance, for the structuralist idiom in which Foucault was then writing was almost entirely alien to an English-speaking audience, and Sheridan’s rendition made few concessions to such readers’ knowledge and expectations (Bennett, 2017). Once Foucault had become a major international figure, these issues loomed less large, but initially the character of these translations slowed the growth of interest in his work in Britain and the USA in most intellectual circles.

There were two partial exceptions to the cool early reception of Foucault’s work among Anglo-American scholars. When Foucault was first invited to lecture in the USA (and this, I suggest, is significant), it was not at one of the leading research universities in the country, but at the relatively obscure State University of New York at Buffalo (Miller, 2000: 246). Also, the invitation came from the French department, not (as might have been the case a decade later) from the Department of Philosophy or from one of the social sciences, disciplines where he did not yet have much of a reputation. Foucault taught at Buffalo as a visitor in 1970, and again in 1972, and he did so as one of a number of French intellectuals whom the literature departments invited during that period – a group that included Roland Barthes, Hélène Cixous, and Jacques Derrida. Within the field of literary studies, this upstate New York initiative did much to launch the interest in ‘French theory’, which had such a pervasive impact in literature departments in the last decades of the twentieth century (Cusset, 2005, 2008).

On another front, Madness and Civilization had received a relatively warm welcome in some other portions of the Anglo-American academy fairly early on, and not just because of the book’s clever re-titling. Richard Howard was (and is) a much-admired poet, and his rendering of Foucault’s prose was far more appealing to an English-speaking audience than Sheridan’s. Besides, Foucault’s critique of the world of psychiatry and of the asylum resonated with an audience already primed to be highly sceptical of that profession and the institutions it ran. In 1961, Erving Goffman’s famous book Asylums: Essays on the Social Situation of Mental Patients and Other Inmates had appeared and had made the equation of asylums with prisons and even concentration camps commonplace. Goffman (1961: 321–68) had proceeded to denounce psychiatry as a ‘tinkering trade’ that constructed an elaborate impression of possessing a medical identity, but in reality undertook such strenuous efforts because it deserved nothing of the sort. Goffman’s fellow sociologist Thomas Scheff (1966) had followed up with the suggestion that mental illness was simply the product of the imposition of stigmatizing labels. From within psychiatry, Thomas Szasz (1961) had denounced his profession as an agent of social control and excoriated The Myth of Mental Illness; and then the renegade Scottish psychiatrist R.D. Laing (1967) had claimed it was society that was mad, and that schizophrenics were engaged in a voyage towards super-sanity. Laing, indeed, had reviewed the manuscript of Madness and Civilization and had enthusiastically endorsed its publication. He pronounced it ‘an exceptional book . . . brilliantly written, intellectually rigorous, and with a thesis that thoroughly shakes the assumptions of traditional psychiatry’. ⁹

In it was this larger intellectual context, which some have called the rise of anti-psychiatry, that I first encountered Madness in Civilization, at the very outset of my training as a graduate student at Princeton University. Its provocative arguments, and its attention to the longue durée had a strong attraction for me. Although I was nominally studying for a PhD in sociology, my personal romance with history was one that had its roots all the way back to my high school education in England, and had been reinforced by the wide-ranging undergraduate education I had received at Oxford. Goffman and Scheff had neither any grasp of history, nor any apparent appreciation of its nuances. Foucault, in contrast, placed his critique of the place of madness in the modern world firmly in a wide-ranging survey of centuries of European history that I found immensely appealing. It was reading Madness and Civilization that did most to persuade me that the history of mental illness and its place in the modern world was a serious intellectual subject, worthy of sustained attention, and, of course, it had a similar effect on many others. Although I did not, at the time, appreciate how fateful that encounter with Foucault’s work would be – it provoked what became a life-long obsession with the subject – it was, as much as any other single intellectual event, an abbreviated version of Foucault’s first major book which prompted me to become a historian of psychiatry. That scarcely distinguished me from other psychiatric historians of my generation. ¹⁰ We all had cause to be grateful to someone who had helped to rescue the subject from the dead hand of dull historians of administration or the clutches of psychiatrists in their dotage.

But if reading Madness and Civilization helped to propel me into a career studying the history of psychiatry, my researches over the next half dozen years led to a growing disenchantment with many of Foucault’s claims and arguments. That first English translation of Foucault’s work was quite brief, a small portion of the larger treatise from which it was drawn, and it lacked virtually all the apparatus of professional scholarship. Footnotes were few and far between, and large generalizations were perforce oracular obiter dicta, unmoored to much by way of evidence. I was, moreover, engaged at the time in an enterprise that was very different from the construction of a history of the longue durée, which Foucault’s book (in its abbreviated or full form) unquestionably was. Like most neophyte historians, my own thesis project was an exercise in histoire événementielle – in this case, the history of lunacy reform in Victorian England. ¹¹ Inevitably, then, large generalizations about the sweep of the European encounter with madness in the modern age were juxtaposed to gritty details that one immersed oneself in when trawling through the archives.

It is, perhaps, not surprising that my more focused look at the history of madness in England during just over a century led to the discovery of a series of factual errors, large and small, in Foucault’s passing remarks about developments across the Channel. The accumulating questions about the historical accuracy of his work soon drove me to read the full text of Folie et déraison, in an effort to get a better grasp of his methods, and to examine in its original form the evidentiary basis upon which he had reached his wide-ranging conclusions. Madness and Civilization, after all, omitted a thousand and more footnotes that populated the original edition, and gave only the most glancing clues about the scholarship upon which Folie et déraison rested.

Unfortunately, rather than putting my incipient doubts to rest, the encounter with the magnum opus only amplified them. To my great surprise, I discovered that Foucault’s argument had remarkably little to do with the world of contemporary scholarship. Granted, the historiography of madness was in a distinctly impoverished state when Foucault undertook his researches, yet it was still eye-opening to discover the degree to which his vast edifice rested upon the flimsiest of factual foundations. Central to Foucault’s arguments about folie and its treatment, for example, were discussions of responses to poverty and dependence, not just in France, but all across Europe. There were claims about the connections of asylums to monasteries and to the exclusion of lepers, talk about ships of fools that floated down rivers and visited harbours all across Europe, and assertions about how medieval Europeans regarded and responded to Unreason.

These were all topics to which twentieth-century social historians had devoted much time and attention. Yet Foucault appeared to have read and absorbed essentially none of this scholarship. To an extent that astonished me, the overwhelming bulk of his work depended on dated and long-superseded work by eighteenth- and nineteenth-century writers whose methods and findings no reputable scholar would depend upon now. Folie et déraison was divided into three parts. Part One contained almost 400 references; only 28 of them cited twentieth-century scholars. The relevant bibliography was equally troubling. It contained only 25 pieces of scholarship published after 1900, and only one of these was published after World War II. Part Two listed but a single book published in Foucault’s own century, and that was an amateurish look at the history of witchcraft written by a psychoanalyst with no training whatsoever in history, a book regarded with scorn by anyone with a nodding acquaintance with serious work on the persecution of witches. Part Three was almost equally bereft of any reference to contemporary scholarship, listing a mere 11 books and articles written in the twentieth century. I was not surprised when I learned in the early 1990s that Foucault’s submission of a previous draft of his thesis had been rejected out of hand at Uppsala (Sten Lindroth, the Professor of the History of Science since 1957, is reported to have complained that it was full of speculative generalizations and was unacceptable for a doctorate in history). For the most part, those criticisms can be levelled against the (presumably heavily revised) version that appeared in print. It is, as I have said elsewhere (Scull, 2019: 27–37), as if nearly a century of scholarly work had produced nothing of interest or value for Foucault’s project. The upshot is a history, most of whose central contentions can now be shown to be distorted or wrong.

What had attracted me to Foucault’s writing on psychiatry in the first place (and I suspect this is true of other historians of psychiatry of my generation) was its iconoclasm, its sheer intellectual ambition, its determination to demonstrate that the history of society’s most extreme outcasts, the mad, had important things to teach us about society and its ordering. The discoveries I made about the unstable and inadequate empirical foundations upon which his elaborate theoretical edifice was constructed did not diminish for me the value of the provocations his work offered, but they did invite a far more sceptical assessment of its value as history.

I want to be clear here: I shared (and still share) some of Foucault’s scepticism about the vision of psychiatry as an unambiguously liberating enterprise. But I share only some of his stance. Foucault was fundamentally a foe of the Enlightenment and its values. I am fundamentally one of its disciples and defenders. I have written extensively about the complexities of psychiatry’s past and the uncertainties of its present. If not quite an emperor with no clothes, it is certainly one in a state of advanced déshabillé. There is much in its past and present deserving of critical attention. But that is very different from dismissing the whole enterprise tout court. Likewise, Foucault seems to me to ignore or misrepresent the disruptions and the suffering madness brings in its train, and more seriously still, to misconstrue many of the complexities that mark the tortured relationship between madness and civilization.

I cannot, of course, in the space of an essay necessarily as brief as this one, spell out in any detail the alternative vision of the longue durée of the history of unreason that I would offer in place of Foucault’s. I have, as it happens, recently set out my own attempt to grapple with that vast subject. In Madness in Civilization (Scull, 2015), I have sought to plot the cultural history of insanity across a much larger geographical and temporal framework than Foucault’s; and to do so as broadly as possible, moving beyond just the relations of madness and medicine and madness and confinement to examine its place as well in religion and in popular and high culture: in music, the plastic arts, in literature and on the stage, even in movies. Insanity haunts the human imagination. It reminds us of how tenuous our own hold over reality may sometimes prove to be. It challenges our very sense of what it means to be human. Madness continues to tease and to bewilder us, to frighten and to fascinate, to challenge us to probe its ambiguities and its depredations. In wrestling with its profound mysteries, Madness in Civilization seeks to give psychological medicine its due, but no more than its due. It stresses how far we remain from any adequate understanding of the roots of madness, let alone from effective responses to the miseries it entails. Also, it argues that madness has social and cultural salience and importance that dwarf any single set of meanings and practices. Madness remains, above all, a fundamental puzzle, a reproach to reason, inescapably part and parcel of civilization itself. I thought it otiose to spend much time in my own book arguing explicitly against Foucault’s visions and contentions, but the two texts can readily be compared by others, and their respective arguments and intellectual and evidentiary foundations examined.

When I received Olivier Postel-Vinay’s invitation to contribute to a symposium on the reception and contemporary relevance of Foucault’s scholarship, I was asked to comment on how Foucault had influenced my own work and my decision to become a historian of psychiatry. I hope the preceding text has cast some light on these questions. But I was also asked to provide some commentary about the reasons for Foucault’s success and the longevity of his theses. I have provided some preliminary answers to this second question in the earlier parts of this essay. But I would like to make a few additional remarks about these matters in closing.

First, the continuing visibility and influence of Foucault’s discussion of madness cannot be divorced from the way his larger oeuvre has captured the imagination of scholars across a wide spectrum of academic disciplines. There is a vast industry of Foucault studies, and legions of scholars who display varying degrees of fealty to the intellectual project he launched. Foucault represents for many the most powerful critic of the Enlightenment, nowhere more so than in the book that attacks the idea of progress in our responses to Unreason, and dismisses the ‘reforms’ of Tuke, Pinel and the asylum era as a ‘gigantic moral imprisonment’ (Foucault, 1967: 278). Rather like the Freud Wars that have served to resuscitate someone who might otherwise have turned into an intellectual corpse (Scull, 2017), even those who spend their days arguing with Foucault’s position thereby validate his importance.

In its abbreviated and even in its full-length guise, Histoire de la folie is read by many who have no pretensions to be, and no intension to become, historians of psychiatry. Among the most important reasons why they are attracted to the book, I suggest, is that psychiatry, almost uniquely among medical specialties, seems to be trapped in a perpetual crisis of legitimacy (Rosenberg, 1975). Complaints and controversies have dogged the field since its inception, and show no signs of abating as we approach the second decade of the new millennium (Scull, 2019: 54–72). Self-evidently, in an environment like this one, Foucault’s fierce critique of our responses to madness is likely to enjoy a continuing appeal, and that has to constitute another reason for the on going attention he receives.

Among professional historians of psychiatry, I think the situation is now rather different. The éclat that eventually greeted Folie et déraison in its various incarnations spread far outside the Francophone world. Its impact on Anglo-American scholarship was clearly immense, even if most Anglophone readers were acquainted with only a truncated version of Foucault’s thesis. Not least, Madness and Civilization, by helping to attract a whole generation of social historians to the subject matter, served as one of the principal midwives attending the birth of the modern profession of the history of psychiatry. It was, I would argue, far from the only attendant on that nativity, for I suspect that the growing interest among historians in ‘history from below’ would ultimately have brought sustained attention to this most alienated of all subject matters, but Foucault’s ministrations certainly hastened its arrival, and gave a critical impetus (in many senses of the term) to the new specialty. But the social history of psychiatry is nearly six decades old now. As a perusal of its flagship journal, History of Psychiatry, or a close examination of the many monographs and articles that appear annually would show, less and less of the new scholarship in the field refers to Foucault’s work, except perhaps to make a ritual genuflection in his direction. Contemporary historians’ inspirations and preoccupations lie elsewhere. The field has moved on, as most fields do. Foucauldians continue to debate and to parse the Master’s writings. But whatever of substance is of value to the historians who rummage through madness’s past has long since been absorbed, and its heuristic value is a long way from what it once was.