To be labeled mad is not just to be diagnosed—it is to be exiled. In Madness and Civilization, Michel Foucault traces a haunting genealogy: from the Middle Ages, where madness was often seen as a form of divine or poetic insight, to the modern era, where it became something to be confined, corrected, and silenced.
What emerges from Michel Foucault’s inquiry is not a history of mental illness, but a history of how societies define the “reasonable” self—and what they do to those who fall outside that boundary.
The Great Confinement
In the seventeenth century, Europe underwent what Foucault calls the Great Confinement. Madmen, paupers, libertines, and the unemployed were rounded up and placed in institutions—not necessarily to be treated, but to be removed from the social order. Madness became less a condition to be understood and more a threat to be managed.
This was not a medical act, but a moral and political one. The confinement did not hinge on biological diagnosis; it was a way of regulating the boundaries of acceptable behavior. In other words, madness was constructed not only in the clinic but in the courtroom, the church, and the town square.
The Birth of the Asylum
As the Enlightenment progressed, reason became not just a virtue but a requirement. The asylum emerged as a paradoxical institution—it claimed to cure madness by enforcing the very rationality that the patient allegedly lacked. Silence, obedience, hygiene, and work were the tools of this new therapy. The cure was conformity.
Yet, Foucault suggests, the asylum often functioned less as a place of healing and more as a theater of power. It was not merely that the doctor treated the patient, but that the doctor defined what it meant to be sane, healthy, and whole. The doctor’s authority became a form of normalization.
The Danger of Definitions
In today’s society, we have made great strides in mental health awareness, yet the Foucauldian question lingers: Who decides what counts as normal? Who benefits from these definitions?
Consider how psychiatric labels are unevenly distributed. Studies show that marginalized communities are disproportionately diagnosed with certain disorders—like schizophrenia—while similar symptoms in privileged groups may be labeled as stress or eccentricity. Diagnosis, in this light, can become a mode of social control.
Moreover, the language of mental health has been absorbed into the workplace, education, and media. Employees are coached on “resilience,” students are screened for “attention,” and everyone is expected to manage their “emotional regulation.” These trends blur the line between care and discipline.
The Border Is Porous
Foucault does not deny the existence of mental suffering. Rather, he insists that suffering alone does not explain how societies respond to it. Madness and reason are not natural opposites; they are culturally constructed poles in an ever-shifting spectrum.
The border between them is porous. We may all cross it at some point—in grief, in crisis, in dream or delirium. And the way society reacts to that crossing reveals much about its values.
Toward an Ethics of Listening
Foucault’s work invites not only critique, but also compassion. If madness is a mirror, then we must ask: what does our treatment of the mad say about us?
Rather than seeking ever more refined diagnostic criteria or pharmaceutical interventions, perhaps we should invest more in listening, in care without coercion, in spaces where difference is not pathology. To understand madness is not to fix it—it is to be changed by the encounter.