An Exchange with Michel Foucault

The following comments by Michel Foucault on Lawrence Stone’s review, “Madness,” in the December 16 issue were sent to the editors but are addressed to Professor Stone.

1) You ascribe to me the thesis that, as from 1650, a new principle emerged according to which “madness is shameful” and “the best treatment is forcible isolation from society under management by professionally trained doctors.” This view is precisely the opposite of that which I have set forth as the main argument of my book and enlarged upon through the full five chapters of the first part. Namely, that the procedures and institutions of confinement evolved throughout the whole of the sixteenth and seventeenth centuries, and did not begin in 1650; that they were essentially extramedical; that the results aimed at were only partially therapeutic. The dates, conditions and regulations of these nonmedical confinements are analyzed on pages 56-123 of my book; the limited space allotted to medical practice is analyzed on pages 124-177. Why do you not take into account these 120 pages which utterly refute the thesis you credit me with? And why do you ascribe to me an untenable thesis, never, to my knowledge, maintained by anyone and certainly not by me?

2) You credit me with the idea that this was merely the result of “a conspiracy of professionals to seize power for themselves to lock people up.” This is, once again, the exact opposite of what I have said. To begin with, I never had recourse to the notion of “conspiracy” to analyze this historical phenomenon, or any other. Moreover—and this forms the subject matter of my book—I have attempted to show the length, the diversity and the complexity of the processes which finally, after a century and a half or more, led to the setting up of a specialized psychiatry and of a body of alienists who were able to claim the exercise of medical authority within the framework of the institutions of confinement. What I wrote is therefore not the description of a conspiracy; I never set down 1650 as the date of a medicalization; and I never considered doctors to be the sole agents of such a medicalization. You are entirely mistaken on all three points. Why?

3) You raise the objection that there is evidence of the confinement of madmen during the Middle Ages, as if I did not know or mention such facts. Now, I refer precisely to such accounts of confinement as can be found and I point out that there existed, in this respect, a very old tradition that assumed, in later years, another dimension; I mention a certain number of examples on pages 20-21 and 125-127; I also point out (pp. 161-162) that, throughout the Middle Ages, madmen were sometimes locked up and displayed like animals. Assuming that you have read my book, could you have copied what I said the better to reproach me with not having said it? Or should I believe that you have not read it?

4) Yet another objection on your part: madmen were not “isolated” since tourists went to see them where they were kept in chains.

Two comments:

a) Do you really believe that locking people up and making an exhibition of them proves that they are not submitted to segregation? Just tell me if, fettered and howling in a yard or writhing behind bars, subject to the jibes of gawking onlookers, you would not feel slightly isolated?

b) Now, it so happens that I have mentioned, with appropriate references for both France and England, these visits to madmen made a show of in this way (pp. 161-163). I consider these facts as an aspect of the complex attitude toward madmen: they were hidden away and at the same time exposed; both attitudes are borne out by my references.

A little more attention would have prevented you both from over-hastily leveling at me an ill-founded reproach, and from supporting the said reproach with such a wondrous strange chain of reasoning.

5) You argue that there are “enormous differences in the degree and organization of incarceration from country to country,” England specializing in private institutions and France in state-supported ones. Now, on pages 67-74 and 483-496, I insist on the pronounced differences between a country like France and a country like England where religious organization, legislation, institutions and attitudes provide much more scope for private initiative; I point out, in particular, the long tradition with which Tuke is in keeping and which evolved throughout the eighteenth century. Nevertheless, you are wrong in thinking that everything in France was state-controlled.

6) When you argue that the incarceration of the indigents occurred mainly in the seventeenth and eighteenth centuries, and that of the insane in the nineteenth century—it is true that I know not what to answer any more than I can guess to which passage of my book you refer, since it is entirely concerned with the slow evolution from one form of confinement, intended mainly for the poor, into a confinement involving medical treatment. You content yourself with repeating my general thesis while twisting it into an objection.

7) Contrary to what you claim, I never compared “the treatment of the mad” to that of lepers. I pointed out that a certain number of disused leprosaria were employed for other purposes and in particular [for] a confinement which was, in the seventeenth and eighteenth centuries, only very partially therapeutic.

8) You reproach me with having placed under the same “conceptual umbrella” the treatment of schoolchildren, the poor, criminals and the insane. And you emphasize the fact that the condition of the indigents has greatly improved in the last two hundred years and that children “at least up to the 1960s” are increasingly better educated. Now,

a) I never denied what you put forward in these last two propositions; I never even broached the subject.

b) I did not, in my book on insanity, ever touch upon the question of schoolchildren and their education. Can you quote the passage where I am supposed to have done so?

c) Neither is the presence of criminals (often enjoying a special status) alongside the poor and the insane in the same places of isolation pure invention on my part. It is a fact borne out by documents I quote, more particularly on pages 56-123 and pages 414-421. Are you in a position to deny this fact and to back your denial with convincing documents?

My problem was to understand the logic of a practice which could concern madmen, criminals and the poor. But which in no way concerned children, or the nineteenth and the twentieth centuries, as you would have the reader believe.

9) Finally, harking back once more to this thesis I never upheld (according to which doctors were “behind the great confinement of the insane”), you argue that society was anxious to “pay for incarceration” and that there was, in this respect, an important social demand on the part of the family circle and the entourage; in France, the lettre de cachet, which was one of the means of administrative incarceration, was more often than not demanded by the families, and confinement, even at Bicêtre, had to be paid for, in many cases. Besides, you must not imagine that it was only the “well-to-do families” you mention who made such requests and were willing to pay for the subsequent upkeep.

All in all: nine major errors, spread out over two small columns and a bit; that’s a lot. I am not in the habit of replying to criticisms as I consider the reader quite capable of putting blatant adulterations right all by himself. However, the regard in which you are held prompts me to submit to you these few answers, which could be far more detailed. Indeed, they provide me with an opportunity to ask you a few questions.

1) The “fidelity” you show to my book surprises me. You could have quoted from sources other than those I refer to, mentioned different facts, opened new perspectives. You have done no such thing. Out of the nine reproaches you level at me, four (numbers 3, 4, 5, and 6) consist in repeating what I said while pretending I never said it; three others (1, 2, and 8) consist in turning round, word for word, what I said and ascribing to me the subsequent thesis which has become untenable. As for the ninth reproach, it combines, rhetorically, the two methods used throughout the development.

2) I fear you have taken a considerable risk. Think of those who have read my book; think of those who will read it and want to collate it with your review of it. Is it of no importance to you that people may believe you to be “unconcerned with historical detail of time and place, or with rigorous documentation”?

3) Don’t you agree that the probity essential to any scientific work should rule out such procedures? Don’t you agree that only by respecting the work and the thought of an author can one prevent criticism from falling prey to the bad habits of hurried journalism?

4) I first published my book more than twenty years ago. It was, at the time, a little “solitary” in a field the historians had, perhaps, not fully explored. It is of course necessary that it should be revised, refined, corrected, enlarged upon. Fortunately, since then, the problem has developed, as you justly point out, into a topical question. However, doesn’t the fact that, twenty years later, it gives rise to so many obvious adulterations on the part of someone who should have stayed cool-headed signify that the problems it has attempted to deal with are still charged with passion? All the more reason then for one to be, in discussion, as attentive and as scrupulous as possible. Even when madness is restricted to a subject matter, it has something of a blinding effect on the mind.

It is for this reason I suggest we resume, amicably and in all serenity, the debate on these problems, in as agreeable a manner as possible to both sides. But first, I would appreciate a paragraph-by-paragraph collation of what you have written about my book with what I have actually written. The reader is entitled to know where the truth lies.

Do let us try, together, to provide the means to this end.

Michel Foucault

Paris, France

Lawrence Stone replies:

I am sorry that Professor Foucault is disturbed by my criticism of his ideas. Today he enjoys an almost unparalleled position of intellectual dominance over the interpretation of many key aspects of the evolution of Western civilization since the seventeenth century. We are none of us infallible, and Professor Foucault would surely concede that someone in his well-deserved position of preeminence must expect his ideas to be subjected to reasoned and temperate critical scrutiny. The historian faces several problems in dealing with the writings of Professor Foucault. One is that he is not at all easy to understand, because of what an unkind critic has called “his obscure, arrogant, sensationalist, and opaque form of discourse, which by his own admission is a ‘labyrinth into which I can venture…in which I can lose myself.’ “¹

A second problem is caused by the tenuous connection of structuralism to history. Even if they can be understood, the systematic structures of discourse that are alleged to underlie major intellectual changes cannot always be made to conform to the intractable realities of historical evolution as revealed in the records: the facts don’t always support the theory. Thus Foucault may be superbly insightful in propounding certain brilliant conceptualizations about the eighteenth century, such as “the great confinement,” or “the desire to know” about sex, or “the birth of the clinic,” or the transformation of grammar. But he may also have made mistakes, perhaps not fatal ones, in his chronology, typology, and causal explanations, and may be lacking hard data needed to prove his hypotheses.

For example, on the basis of a small number of quotations, he has postulated a major shift in consciousness in the eighteenth century, from believing that it was cruel to criminals to confine them with madmen to believing that it was cruel to madmen to confine them with criminals. To the historian, such a shift of mentalité would require a lot more proof than a bare handful of quotations and the fact that the two groups were indeed separated.²

A third problem is that Foucault’s generalizations lend themselves so easily to adaptation and extension, and perhaps distortion, by others. Thus his remarks about “the Doctor as an alienating figure” gave support and encouragement to others, like R.D. Laing in Britain and Thomas Szasz in America, to press their belief that institutional psychiatry is largely a conspiracy for power and prestige by a professional group with very dubious scientific credentials.³ Foucault certainly never sank to such mundane sociological explanations, but his writings led logically to it. Similarly he has never mentioned schoolchildren among the confined; but a host of American and English critics of the school as a repressive institution have drawn that conclusion from his work. Lastly, the English version of Madness and Civilization is a translation of an abridged version made by the author, only one third of the original 613 pages, which is possibly the cause of some confusion among English readers, and certainly for the sense that many of the ideas are poorly documented.

On reflection, I think I did Professor Foucault an injustice on two counts. First, I did not make sufficiently clear what everyone knows, namely that his true originality lies in his structuralist mode of explanation, concerned not with such mundane matters as how men pursue self-interest, or the way in which professional and bureaucratic groups develop independent interests of their own, or even what it is they think about their work. He is concerned with structural ways of how they think, their modes of discourse, which according to him determine everything else.

The second way in which I did Professor Foucault an injustice was that I failed to make it clear that I was dealing with a large international body of thought covering many disciplines, namely Foucaultism. Now it is probable that not all the ramifications of Foucaultism meet with the approval of the master himself, although he has so far done nothing, so far as I know, to repudiate them. It is his followers who have taken up his denial of humanitarian or Enlightenment motives behind the evolution of the moral care of the mad, or a medical approach to disease, to put forward a more sociological conspiracy theory about psychiatrists and doctors; and it is they who have taken up his concept of the great confinement in prisons, asylums, and hospitals, and added schools to the list.

One can, I think, debate the extent to which an original thinker is responsible for the ramifications, or extensions, or perversions, of his work by others. Can Marx be held responsible for Marxism? Can Foucault’s pessimistic evaluation of lunatic asylums be held to have been a factor in the recent discharge of thousands of helpless psychiatric patients onto the pitiless streets of New York? Dr. Gerald Weissmann of the New York University School of Medicine believes that these tragic cases are indeed a remote byproduct of Foucault’s negative evaluation of the philanthropic dream of Pinel, coupled with the fashionable claims by the English revisionist psychiatrist R.D. Laing that schizophrenia is not a disease.⁴

This leads directly to the central criticism I made of Professor Foucault’s ideas, but one to which he has not responded. Although he claims moral neutrality, in practice he denies any philanthropic motive to the great reformers of mental treatment in the late nineteenth century. In Madness and Civilization he denigrates Tuke, since “the religious and moral atmosphere was imposed from without, in such a way that madness was controlled, not cured” (p. 244) in a place “where any manifestation of madness will be linked to punishment” (p. 246). The key principles of Tuke are defined as “surveillance and judgment” (p. 251). Foucault firmly links the new reformed asylum to patriarchy and the bourgeois family.

Nor does Pinel fare any better at Foucault’s hands: with him the asylum becomes “an instrument of moral uniformity and of social denunciation” (p. 259). Foucault describes it as one of “the paradoxes of Pinel’s ‘philanthropic’ and ‘liberating’ enterprise, this conversion of medicine into justice, of therapeutics into repression” (p. 266). In consequence “Madness will be punished in the asylum, even if it is innocent outside it” (p. 269). He writes that “our philanthropy recognizes the signs of benevolence towards sickness where there is only a condemnation of idleness” (p. 46).

This stress on control, repression, and punishment has been combined by Foucault with emphasis on the growing power of “the medical personage…” (p. 269) “whose powers borrowed from science only their disguise, or at most their justification” (p. 271). “In the patient’s eyes, the doctor becomes a thaumaturge…” (p. 275). “The doctor, as an alienating figure, remains the key to psychoanalysis” (p. 278). (Why alienating?) Foucault’s final words on the late-eighteenth-century transformation of the treatment of mental illness describe it as “that gigantic moral imprisonment which we are in the habit of calling, doubtless by antiphrasis, the liberation of the insane by Pinel and Tuke” (p. 278). Small wonder that the sociologists of professionalization were stimulated by him to look for an explanation in a struggle for turf and dominance by doctors and psychiatrists.

Exactly the same pessimistic evaluation has been applied by Foucault to the concurrent evolution of clinical medicine, which he summarizes in the following way: “The abyss beneath illness, which was the illness itself, has emerged into the light of language—the same light, no doubt, that illuminates the 120 Journées de Sodome, Juliette, and the Désastres de Soya.”⁵ Here again we find a denial of the Enlightenment as an advance in human understanding and sensibility, and a causal linkage of it to the sexual fantasies of domination, violation, and torture which obsessed the mind of Sade. As for the charitable investment of money by the rich in building hospitals for the poor, in Birth of the Clinic Foucault ascribes this act to a self-interested desire to obtain subjects for human medical experimentation: “what is benevolence towards the poor is transformed into knowledge that is applicable to the rich…” (p. 84). “The doctor’s gaze is a very small saving in the calculated exchanges of a liberal world” (p. 85). “Like civilization, the hospital is an artificial locus in which the transplanted disease runs the risk of losing its essential identity” (p. 17). Small wonder that such language has led to a host of conspiracy theories about both the medical profession and the rise of the hospital.

The main objection to this “dominance and control” model of human relationships is that it is based on an obscure structuralist theory of discourse, which may or may not be well founded. It is model so all-embracing as to be virtually meaningless. It can include anything from using forced labor in the Gulag Archipelago to teaching children to brush their teeth. Since man is a social animal, and since all of social life involves some form of influence, molding, direction, or compulsion, the reduction of all social relationships to issues of power renders it almost impossible to make the fine intellectual, moral, and material distinctions necessary for any serious evaluation of change in history.

For example, when does social control end and socialization begin? One definition of the latter is “a neutral concept concerned with the objective needs of society to guide, restrain and control the members so that they generally observe accepted conventions in thought and behaviour.”⁶ No society has ever existed, or can exist, without socialization. Moreover, the iron law of oligarchy usually causes attempts at some degree or other of the imposition, if necessary by force, of the views of one group upon another. For historians, it is precisely these fine distinctions which make one society at one time different from another, but Foucault’s blanket structuralist affirmation of dominance and control severely limits any discussion of such refinements.

The second weakness of Foucault’s model is that it totally neglects the near-certainty of serious differences in beliefs and aims among the so-called controllers, as well as in the methods they use. Third, it ignores the gap between intentions and results. As often as not in history, the movers and shakers either fail in their objectives, or the consequences turn out very differently from what they expected, due partly to the perverse recalcitrance of human nature among the controlled. Fourth, the model reduces the actors in history to two, the controllers and the controlled, ignoring the pluralism extant in all social systems, and the wide variety of influences of state, church, family, and peer groups, which are at work to mold men’s minds.

Fifth, Foucault’s model assumes not only that all controllers seek power for the same end, but also that all the controlled, given a free choice, would reject the mold imposed upon them. The idea, for example, that many of the poor might be positively anxious, of their own free will, to adopt bourgeois values and behavior for themselves and their children in order to get on in the world, or the sick to be cured, or the mad to be treated and protected in an asylum, is all but eliminated in Foucault’s dominance model. Curiously enough, this is where liberal historians link up with Marxists, for the latter also dislike the control model since it appears to be incompatible with their class-conflict concept of society.⁷

The “dominance and control” model, therefore, tends to oversimplify the historical process, reduce society to two polarized groups, distort the psychology and values of the controllers, make unwarranted assumptions about their success in imposing their will, underestimate the strength and independence of the culture of the supposedly controlled, and eliminate any possibility that the society, including the controlling elite, is pluralistic and divided in its objectives.

Finally, the Foucault model ignores the moral dilemmas of society past and present. It is of no help to us in tackling the real and difficult task of today, which is to decide which kinds of state intervention in personal life are justified by the social benefits accruing, and which are not. Foucault’s model is useless in solving the real dilemmas we face in dealing with such delicate moral issues as the right of the individual to on-demand divorce, pornography, abortion, a minimum standard of living, equal access to financially limitless health care and to as many finite resources—whether oil or rhinoceros horn—as he can pay for, and so on.

After this statement of retractions and general objections, let me now turn briefly to the points of detail raised by Professor Foucault.

1. a) Madness as shameful and so to be hidden: “the shameful promiscuity of madness”(Madness, p. 225); “L’internement cache la déraison et trahit la honte qu’elle suscite” (Folie, pp. 162-163).

b) Dating: “the first moments of the ‘Confinement’…, that royal edict of April 27, 1656 that led to the creation of the Hôpital Général” (Madness, pp. 46-47); “From the creation of the Hôpital Général…until the end of the eighteenth century, the age of reason confined” (Madness, p. 65); “Le classicisme a inventé l’internement” (Folie, p. 64); “…aussi soudain que le grand Renfermement du XVII siècle…” (Folie, p. 404).

There is one page of random accounts of confinement of the poor in sixteenth-century England, but little is drawn from it (Folie, p. 65).

1. “A conspiracy of professionals.” This is admittedly not Professor Foucault’s motive of change, but I have shown how his writings can lead, and have led, others to this conclusion.
2. Confinement of the mad in the Middle Ages: there is only one page (p. 10) about this in the English abridged edition, although more in the French. But I cannot see that even there it plays any part in Foucault’s argument. I fail to understand how one can be “hidden away and at the same time exposed.” To my mind this is an unintelligible contradiction in terms.

3. Differences between France and England: not discussed in the English edition, and only discussed in passing in the French on pp. 67-74; pp. 483-496 concern Tuke and Pinel. I can find no serious discussion of the proliferation in eighteenth-century England of private madhouses, as opposed to French state-supported ones (it is possible that I am defeated by the absence of indexes).

4. Exactly: but the evidence does not fully support the thesis, in my opinion.

5. Treatment of lepers and madmen: In Madness and Civilization, “The leper was removed from the world, and from the community of the Church visible…” (p. 6). Then leprosy disappeared, and after an interval (filled in the French version [pp. 16-18] by the victims of venereal disease), the mad were placed in some of the old leprosaria. Here “the formulas of exclusion would be repeated, strangely similar two or three centuries later. Poor vagabonds, criminals, and ‘deranged minds’ would take the part played by the leper” (p. 7). “The asylum was substituted for the lazar house…. The old rites of excommunication were revived, but in the world of production and commerce” (p. 57).

6. Correct: the school as a place of confinement is part of Foucaultism, especially in America. Foucault has never, to my knowledge, mentioned schools as a part of the era of repression, but it is a typical, almost inevitable, extension of his ideas.

7. We both agree that people—relatives or the parish—paid to have their mad relatives put away. In England in the eighteenth century this was the normal method of incarceration, very different from the Foucault model in which the doctor is the decision maker. The main motive was demonstrably shame.

In brief, I do not believe I have distorted Professor Foucault’s thoughts in any way, except the two which I have freely admitted, and for which I apologize. He, however, has not directed himself to the central issue of my criticism, namely his pessimistic evaluation of Enlightenment thought, and the institutions and professions that grew out of it. It is his recurrent emphasis on control, domination, and punishment as the only mediating qualities possible in personal and social relationships that I find one-sided.