top of page
  • Sasha Durakov Warren

The Siren Song of the History of Madness: On Foucault’s Doubles

Updated: Mar 11

This is a part of a series on the treatment of madness before psychiatry. You can read my introduction here. As I stated there, Foucault’s influence on this question is so massive, I felt obliged to make some remarks about his work before embarking on the case studies. The next post will be one of however many it takes about the Gheel (or Geel) colony for the mad, which, due to its fame, influence, and depth of scholarship, seems like a good place to begin.


Hieronymus Bosch. The Ship of Fools circa 1490.

‘A book is produced, it is a minuscule event, an object that fits into the hand. But at that moment, it takes its place in an incessant game of repetitions, for its doubles, both near and far, start to multiply; each reading gives it for an instant an impalpable, unique body; fragments of it pass into circulation and are passed off as the real thing, purporting to contain the book in its entirety, and the book itself sometimes ends up taking refuge in such summaries; commentaries double the text still further, creating even more discourses where, it is claimed, the book is itself at last, avowing all that it refused to say, delivering itself from all that which it so loudly pretended to be. A reissue in another place and in another time is yet another of these doubles, something which is neither totally an illusion, nor totally an identical object.’ -Michel Foucault, preface to the 1971 edition of History of Madness, p. xxxvii

Those who embark on the truly foolish journey to discover the history of madness before psychiatry meet many strange travelers and pass through many strange territories. Few are skilled enough captains to navigate through the stormy wake created by Michel Foucault’s History of Madness and not get mired along the way.[1] These waters are positively swarming with doubles, and doubles of doubles—all taking the form of sirens promising the truth of the question of madness in a distant past or an irresistibly shiny surface on which to project every misgiving ever conceived against the critique of psychiatry. What follows is not in essence about Michel Foucault’s History of Madness. It’s an open question whether one can say anything at all about his first major publication without taking it apart and reconstructing it with bits and pieces picked up from sources far outside the text first published in 1961. I won’t even try. Instead, I offer my own double: one made of hacked up desultory material to use to stuff your ears and navigate past the sirens’ song.

Tanning the two hides of mad history

It’s certainly true that some doubles are more credible than others. To call Edward Shorter’s summary of the History (that a centralized state plus capitalists consciously medicalized and incarcerated madness [2]) “shallow” is much too forgiving. These sorts of readings, or the ones that claim Foucault told a celebratory history of a mad Id, never set sail at all and are almost total invention likely based entirely on prefaces, appendices, and secondary texts (which themselves are based on the same). The sheer amount of doubles of the History of Madness might reasonably invoke skepticism about Foucault’s style: maybe if he’d written it more clearly, with less poetry, in fewer editions, with fewer evocative images, or refused to shorten the massive original, it wouldn’t have led us to build a petty little tower of Babel.

But it is a futile gesture to protest against the profusion of doubles. There’s no stopping them and there’s no hope of propping up the “real” text as a corrective at this point. The doubles are as much a part of the historiography of madness as the original text; they’ve informed unique approaches and inspired dramatic receptions of the most diverse variety. They’re real, and tracing Foucault’s degree of responsibility for them is only of interest if one wishes to make him some sort of hero or villain, or because one sees him as so infallible that proving he wrote something is tantamount to that thing being true.

In some senses, the question of the “first” edition is already a question of the duplicate and immediately raises the problem of which Foucault we ought to look to for the “real” history. The earliest copy of the History of Madness was released in 1961 at over 600 pages as Folie et déraison: Histoire de la folie à l’âge classique’ (Madness and Unreason: the History of Madness in the Classical Age). Most readers did not—and still do not—encounter this as the “original” version. For most, the first and only version derives from an abridgement made by Foucault himself in 1964, which is about 300 pages shorter called simply ‘Histoire de la folie’ (History of Madness), and translated by Richard Howard into English as Madness and Civilization with a few additions from the earlier version. In 1972, the original was reissued with a new preface, some changes, and two appendices (one of which is his response to Derrida’s critique and the second about the idea of the “absence of an oeuvre”) called ‘Histoire de la folie à l’âge classique, suivi de Mon corps, ce papier, ce feu et La folie, l’absence d’oeuvre’ (History of Madness in the Classical Age; My Body, this paper, this fire; Madness, the absence of an oeuvre).[3] With this in mind, proving that the doubles are false images is neither entirely possible nor very interesting. But perhaps tracing those doubles and how they formed is still a useful exercise in that such work may allow us to better see how they’ve shaped and continue to shape approaches to the history of madness (lower case). Perhaps if we had a better map, we might be spared from getting too lost or going around the same fixed point in circles.

Of the more credible doubles, for which one can actually find some evidentiary passages, one has taken on a life of its own far overshadowing the others. This is the one that paints the history of madness as an opposition of two molar blocks: a Renaissance openness to the tragic but authentic speech of madness and attuned to the experience of life’s limits standing opposite to the Classical Age’s (circa 17th century) silencing of unreason. David Cooper provided an early exposition of the agonistic history with his introduction to Madness and Civilization in 1967. It seems most likely that it was his reading, and Laing’s implicit engagement with the text in The Politics of Experience, that solidified this particular position. In his introduction to that book, Laing, for his part, suggests the reader turn to Madness and Civilization to get more background for his claim that “humanity is estranged from its authentic possibilities.” (11-12) The critics (like H.C. Midelfort or Peter Sedgwick) negatively took up the theme by protesting Foucault’s romanticization of the Renaissance experience, inadvertently making this interpretation more concrete than it was. From here, it traveled downstream either directly through these readings or through osmosis of the media hubbub around Laing and Cooper that mentioned Madness and Civilization as an aside.[4]

According to Cooper, “madness in our age has become some sort of lost truth.” (vii) It is the necessary process of truth, or “a way of seizing in extremis the racinating groundwork of the truth that underlies our more specific realization of what we are about.” But, in our times, the mad undergo a process of “crucifixion” by means of leucotomy or tranquilizing drugs and this “sacrificial offering becomes some sort of definable and measurable social fact.” And he’s still not done expanding this dichotomous vision, for, according to Cooper, “we all become this sort of fact that denies our core-essentiality and reduces us to a co-essentiality of abstract essences.” (vii-viii) All this “devastation” for the mad has come about by means of a “pseudo-medical perspective” [5] that objectifies madness as a disease, which for Cooper is evidence itself of the “peculiar disease of our civilization.” (viii) In summary, mental illness is the chaotic journey towards truth internal to all, objectified and projected onto a rejected scapegoat as a problem. Cooper feels that those who read Foucault’s book will be “awakened to a tragic sense of the loss involved in the relegation of the wildly charismatic or inspirational area of our experience to the desperate region of pseudo-medical categorization.” (ix) Seizing truth vs the machinations of pseudo-science. Tragic experience vs stale categorization. The reverse argument is easy enough to imagine (objective progress vs. the dark ages of superstition, etc). The molar-opposition reading of the text trims the fat, stretches out a few short paragraphs like the skins of deer until they encompass many centuries of experience, rubs them with its own brains, and leaves them out to dry until they’re ready to be worn as a warrior's hide against the “pseudo-science” psychiatry or the irresponsible romantics.

As is often the case with interpretations of the book, this reading is based almost entirely on the first chapter, “stultifera navis” (“The Ship of Fools”), a little bit of chapter two on the “Grand [or Great] Confinement,” and the second to last chapter “The Birth of the Asylum.” Since my series is on episodes of madness pre-psychiatry—and in the interest of brevity (I realize I’ve already failed)— I will concentrate my commentary on the first, since Foucault’s presentation of madness in the Renaissance is the main point of contention.

Albrecht Dürer. Woodcut of the "Fool carrying the world," 1490s. For Sebastion Brandt's The Ship of Fools

Lost at sea with the ship of fools

Is Foucault’s History of Madness even possible? What exactly is it that’s in question here? In Foucault’s own presentation of the project, he tells us that though he started out in search of “madness itself, in all its vivacity, before it is captured by knowledge,” he found that this was an “impossible task,” for “Any perception that aims to apprehend them in their wild state necessarily belongs to a world that has captured them already. The liberty of madness can only be heard from the heights of the fortress in which it is imprisoned.” (xxxii) The History, then, traces the emergence and evolution of overlapping separations, silences, or alienations of madness. The theoretical argument is that the silence of madness is the necessary historical condition for the birth of the psy-disciplines. (see page xxxiv)

What follows is my own feeble attempt at a brief reconstruction of what this looks like in the transition from the Renaissance to the Classical Age with some small asides.[6] Foucault begins by drawing our attention to the end of the leprosaria in Europe as leprosy became less visible on the social terrain towards the end of the Middle Ages. Even though the figure of the leper receded, the “importance for society of this insistent, fearsome figure, who was carefully excluded only after a magic circle had been drawn around him” (5) did not. European societies inherited the rituals and value of exile, but, finding itself wanting of an object, eventually attached them to madness.

The conversation suddenly pivots to a discussion of the end of the Middle Ages and the Renaissance, “before madness was brought under control towards the mid-seventeenth century,” and a number of abiding figures populating the “imaginary landscape” (8) of this period. Chief among these is the Narrenschiff or the ship of fools. The subsequent discussion, though it only takes up a handful of pages, is one of the two most contentious sections (the other is the section on the “liberty” of moral treatment at the end) that have taken on a life of their own, pretty much distinct from the hundreds of pages in between. Foucault begins innocently enough by introducing the ship of fools as a literary invention centered around a mythical pilgrimage in search of a destined truth, but then he makes the remarkable statement that “among these satirical and novelistic ships, the Narrenschiff alone had a genuine existence, for they really did exist, these boats that drifted from one town to another with their senseless cargo. An itinerant existence was often the lot of the mad.” (9) These two sentences are the primary fodder used to undermine the scholarship of the entire book. The critiques focus on 1. the lack of evidence for such ships, and 2. a bad translation of the second sentence that made ‘‘Les fous avaient alors une existence facilement errante’ read as “Madmen then led an easy wandering existence” instead of the equally plausible “easily led a wandering existence.”

The second is a heavy-handed interpretation inserted into the translation considering what comes after and could be seen as much ado about nothing were it not so influential. The first is harder to be charitable towards. Colin Gordon defends Foucault’s phrasing by arguing that he meant this symbolically. This seems unlikely, since the syntax opposes it to literary ships and provides a description of their supposed travels. In any case, there’s no evidence for this being a general practice in Europe. Among the sparse footnotes he provides is a reference to a German history of psychiatry that cites council records for the city of Nuremberg about the mad in the 14th and 15th centuries. The passages in question list financial expenses paid to deal with the mad and contain records about what they ordered be done to them. Most of these ordered (as Foucault himself later mentions) the mad be confined to jails or basements or else be expelled from the city, sometimes being beaten on their way out. Only one mentions a madman being sent “to the Danube” if the council couldn’t figure out which town he was from but does not say whether he was to board a ship or not once he got there. Others decree that a mad person should be allowed to beg or wander freely. It’s quite a stretch to suggest from such records that the ship of fools was a practice of such scale and frequency that the “arrival in the great cities of Europe of these ships of fools must have been quite a common sight.” (9)

Pieter Bruegel the Elder. The Triumph of Death, 1562

In the end, I think it’s ultimately a mistake to make his tenuous references the fulcrum of a critique of the text, for, in truth, the History of Madness is about madness and the circles drawn around it that enshroud it in silence, not consistently about the mad (the problematic references above are confined to two pages). Naturally, it overlaps at every point with people labeled or treated as mad, but Foucault is tracing an experience simultaneously tied to their personhood, but also fundamentally independent of them such that, in each transitional period, we cannot assume we are dealing with the same group of people. One can quite reasonably criticize the framing, but to say that Foucault set out to but did not properly consider the treatment of the mad in the Middle Ages is to miss the point of the text. What little mention is made of the treatment of the mad in this section is pretty roundly negative: banishment, whipping, confinement, or at best being permitted to beg or wander. There’s no mention of the soothsayers or prophets so many have inserted into the text. That he was more interested in the meaning of the expulsion and its representation as a ship of fools becomes clear as the majority of the remaining 34 pages are on the symbolism of the practice and changes in discourses and literature where he compiles examples of the motif linking water and madness and the perpetual usefulness of the ambiguities inherent to each for morality tales and reflections on death.

The confusion emerges from the fact that Foucault clearly did believe that the dominant social and imaginary organization of madness (again, not exclusive or specific to the mad) given expression in these motifs was more permeable and permitted greater dialogue between what we might call rational experience with experiences of madness. At this point, this openness takes the form of a fascination with limits and a discursive reciprocity, which are distinct but often cross-fertilize: the first is the “tragic experience” of madness (whose descendants are Artaud and Nietzsche) and the second he refers to as the “tight-knit dialectic” between wisdom and madness whose chief representative is Erasmus. Why did the tragic imagery—the visions of exile, and the dances of death—become so prevalent in the late Middle Ages? Foucault does not spell this out, but he does suggest by saying that “succession of dates speaks for itself [1460-1509]” (14) that he implicitly has in mind the previous century’s famines and wars in the midst of the mass death and social chaos wrought by the plague. Hans Holbein and Pieter Bruegel the Elder’s great works on mass death likewise didn’t appear until centuries after the Black Death, which speaks to how deeply such an event imprinted itself in the European consciousness, not to mention its political and demographic aftershocks. Generations of artists and poets living in the wake of catastrophe expressed a deep fascination with the limits of life and knowledge that found their living embodiment in madness, in which they discovered “one of the secret vocations of their nature” and the “forbidden knowledge [of] ultimate happiness and supreme punishment, omnipotence on earth and the descent into hell.” (18–20) Foucault only makes brief mention of my favorite example of this theme, the Dulle Griet, or “Mad Meg” archetype.[7] Likely based on a Flemish proverb about rambunctious or scolding women, who “could plunder in front of hell and remain unscathed,” Mad Meg is shown leading a band of women as they loot and battle their way into the mouth of hell, beset by devilish creatures, basket of assorted wares in hand.

Pieter Bruegel the Elder. Dulle Griet, 1564.

In the critical discourse of madness, ironic distance and satirical wordplay neutralizes madness’ cosmic pretensions, bringing them into the ambit of reason by locking its manifestations in an eternal game of reversals with wisdom. Erasmus’ Praise of Folly is the best example, where nearly every paragraph contradicts another one, and every activity and idea of man is exposed as just another shortsighted misstep. For each human capacity, a folly: “Madness is only in each man, as it lies in the attachments that men have to themselves, and the illusions that they entertain about themselves.” (23) Pointing ahead to what the largest part of the book is concerned with, Foucault suggests that the critical dialectic of madness diverges farther and farther from and starts to slowly overtake the tragic experience, creating an insurmountable gap that “will never be repaired.” (26) Madness and reason become increasingly locked in a relative definition where each acquires its substance only through the negative reflection of the other, but both are ultimately bound together by God’s Wisdom. It was this form that would give way to the “analytical consciousness” of madness and set the stage for the psychiatric revolutions.

Crucially, Foucault’s opposition between the tragic vs critical presentations of madness—which also tends to present as visual arts and poetry vs essays, satires, and stories (see page 26)— is not an empirical set of facts one can prove true or false but a set of interpretations of those materials.[8] Foucault says as much in Remarks on Marx where he contends that “what is essential is not found in a series of historically verifiable proofs; it lies rather in the experience which the book permits us to have. And an experience is neither true nor false.” (36) He gives pride of place to changes in consciousness, and no one has ever announced a change in the structure of consciousness as it happens: “What happened between the end of the Renaissance and the height of the classical age was therefore not simply an evolution of the institutions: it was a change in the consciousness of madness, and thereafter it was the asylums, houses of confinement, gaols and prisons that illustrated that new conception.” (118) That’s not to say that there are no practical consequences for the mad in this early part of the book: Foucault’s final remarks in chapter one that, in the 17th century, “Madness becomes a familiar silhouette on the social landscape. There was a new, intense pleasure to be had from these brotherhoods of fools, their parties, meetings and speeches” (42) suggests that one such consequence of the more reciprocal discourses of madness is that the public existence of mad people was more a matter of course. But if Foucault wanted to write a book about the most prevalent form of the treatment of the mad before psychiatry, he would have had to write a much different book on all manner of eclectic local arrangements. It’s enough to point out that that, in his references to the Nuremberg council records (multiple entries of which order mad people to be cared for in a domestic setting) or the boarding system of Gheel, he chose to talk about the exiles and pilgrimages of the mad instead of the more quotidian facts of social reproduction. His material and his choice of what to do with it demonstrate that he must have been fully aware of the latter and chose not to write about it.

And with that, I believe my double, slipshod though it might be, is at least sufficient for us to be able to move on to some case studies. I’m sure Foucault’s book will pop up now and again[9], but hopefully now as a humble companion rather than a foreboding shadow, in such a way that it can speak a little more modestly, without implying a whole world of meanings whose origins lie elsewhere.


  1. I’m playing with an image conjured by Michael MacDonald in Mystical Bedlam about the text. He wrote: “Anyone who writes about the history of insanity in early modern Europe must travel in the spreading wake of Michel Foucault’s famous book Madness and Civilization.”

  2. Shorter holds Foucault responsible for the conspiratorial “notion that psychiatry was born in some kind of fiendish alliance between capitalism and the central state, enlisting psychiatrists in the larger game of confining deviant individuals in order to instill work discipline into an unmotivated traditional population.” One can easily find such a position in the history of critiques of psychiatry, but one would be better off looking for it in the 1970s left-wing appropriations of Thomas Szasz’ libertarian visions than here. He clearly read Szasz' book and maybe a summary of something else before he made the connection. His book is full of similarly wild caricatures.

  3. This is the version I’ll be using and referencing throughout, in the Routledge translation by Jean Khalfa and Jonathan Murphy.

  4. Refer also to Foucault’s comments on the reception of his History in Remarks on Marx, page 34–6.

  5. I can picture Foucault wincing at the use of “pseudo” here.

  6. One thing that is often lost is that the History is, more than any other Foucault text, concerned with the long arc of slow, overlapping transitions, where kernels of concepts and divisions grow over centuries rather than suddenly snap with ruptures and breaks. The predilection to read hard breaks into the text is perhaps partly a result of imposing Foucault’s later emphasis onto this earlier work and partly because of the abridgement Foucault himself made that shaved off a lot of the details and changed the pace of the book completely. In the intro to part two, he reiterates the importance of the slow metamorphoses within the constellation: “The consciousness of madness, in European culture at least, has never formed an obvious and monolithic fact, undergoing metamorphosis as a homogeneous ensemble. For the Western consciousness, madness has always welled up simultaneously at multiple points, forming a constellation that slowly shifts from one form to another, its face perhaps hiding an enigmatic truth. Meaning here is always fractured.’ (163)

  7. For two very different modern interpretations of Dulle Griet, Bertoldt Brecht imagined Mother Courage as a modern day Mad Meg, since each was “The Fury defending her pathetic household goods with the sword. The world at the end of its tether;” or, if you want a taste of how poor psychiatric art historical interpretation can be, you can read one of the works debating whether this allegorical character from folklore on a painting is psychotic or not. If you know someone who has written something like this, please check in on them!

  8. Other art historians have examined Bruegel’s Dulle Griet as a satire on sin and ultimately a morality tale not unlike those of Erasmus. See: Margaret A. Sullivan “Madness and Folly: Peter Bruegel the Elder's Dulle Griet”, The Art Bulletin vol 59, no 1 (1977): 55-66.

  9. If and when we approach transitional periods into psychiatry, I may decide to do a similar article on the “Great Confinement” especially.


Cooper, David. “Introduction.” Madness and Civilization: A History of Insanity in the Age of Reason. London: Routledge, 2001.

Foucault, Michel. History of Madness. London: Routledge, 2009.

Foucault, Michel. Remarks on Marx. New York: Semiotext(e), 1991.

Gordon, Colin. “Histoire de la folie: An unknown book by Michel Foucault” In Still, Arthur and Irving Velody. Rewriting the History of Madness: Studies in Foucault's `Histoire de la Folie'. London: Routledge, 1992.

Koenig, Anne M. “Nuremberg Town Records: Select Entries Pertaining to the ‘Mad’ and Intellectually Disabled (1377–1492).” In Medieval Disability Sourcebook: Western Europe, edited by Cameron Hunt McNabb, 69–76. Punctum Books.

MacDonald, Michael. Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-century England. Cambridge: Cambridge University Press, 1981.

Midelfort H.C. “Reading and Believing: on the Reappraisal of Michel Foucault.” In Still, Arthur and Irving Velody. Rewriting the History of Madness: Studies in Foucault's `Histoire de la Folie'. London: Routledge, 1992.

Shorter, Edward. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons, 1997.

Sullivan, Margaret A. “Madness and Folly: Peter Bruegel the Elder's Dulle Griet”, The Art Bulletin vol 59, no 1 (1977): 55-66.

275 views2 comments
bottom of page