The original text of this work was published in Paris, in 1961, as Folie et Déraison: Histoire de la Folie à l'âge Classique. Madness and Civilisation was the English translation (by Richard Howard) of an abridged French version from which 300 pages had been cut. A substantial number of the references from the first text were also omitted, and the deep scholarship of Foucault's original work was not fully available to English readers until 2006, when Routledge published a comprehensive translation of the full book by Jonathan Murphy and Jean Khalfa. This delay in translation of the full text may explain the very different reactions to the work in France and in the English-speaking world. The former were positive in the main. French historians celebrated the depth of research and Foucault's methodological originality. English-speaking historians, working with the abbreviated version only, were generally dismissive. A chorus of reviews challenged the accuracy of Foucault's historical scholarship. In an important defence of Foucault, published in 1990, Colin Gordon argued that Histoire de la Folie was an ‘unknown book’ in the English-speaking world and went on to show how the answers to most of these historical challenges could be found in the original French version.
Madness and Civilisation was Foucault's first major work. He traced the way in which madness was understood and responded to in European societies from the medieval period up until the early part of the 19th century. Most histories of psychiatry celebrate the origins of the discipline in the European Enlightenment. Psychiatry is seen as emerging from a progressive cultural shift towards a prizing of reason and rationality. Foucault also sees psychiatry originating in this way. However, he refuses to see this as a purely benign development. He argues that the Age of Reason gave rise to a cultural sensibility which was directly responsible for the massive incarceration of people who were seen as ‘unreasonable’ across the Western world in the 19th and early 20th century. This incarceration was not a medical act, initiated by doctors. Instead, it was, in the language of today, a gigantic act of social exclusion. For Foucault, it emerged from a ‘moral condemnation of idleness’ not from a ‘desire to cure’. However, once mad people were both excluded and confined they came under the authority of medical superintendents and their staff, and this was the context in which psychiatry could grow and assume the power that it has today. The British historian Roy Porter agrees. He wrote: ‘the rise of psychological medicine was more the consequence than the cause of the rise of the insane asylum. Psychiatry could flourish once, but not before, large numbers of inmates were crowded into asylums’.
The idea that our discipline emerged as the result of an act of social exclusion is not an easy one to accept. However, we are not the only profession with a questionable historical record. The challenge for us is to engage positively with the history that Foucault and other historians present to us. If we fail to do so, I believe that we will continue to struggle to develop a genuine collaboration with the growing service user movement around the world.
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