I’d like to preface this article with a content warning. While philosophy often contains difficult subject matter, there are times when it might be necessary to be open about the content in a piece, so that the reader can judge for themself whether or not they wish to continue reading. This is particularly true when content can be dark and triggering. As such, I would like to point out that the following article concerns the history of institutionalization and mental illness in society. As such, suicidality and other similar themes can be expected. Please, take care of yourself and your good mental health with this in mind.

During the latter part of the 20th century, a bald guy known for wearing turtlenecks became one of the last philosopher rockstars. Michel Foucault (1926 - 1984) made his way into the ranks of philosophers and famous queer people through his genealogical research, questioning and critiquing power structures.

We probably best know Michel Foucault for his thought experiment about the panopticon, which we have discussed several times in other of our blog posts. The panopticon experiment became pivotal in the criticism of prison systems and structures, and the societies that create and nurture them. Others would go on to critique these institutional structures (such as Michelle Alexander in The New Jim Crow) in more specific and equally important ways, but Foucault was one of the first to thoroughly write on the nature of the prison industrial complex, in Discipline and Punish.

Foucault’s work spanned the gamut from incarceration to sexuality to language, and to the nature of mental illness. Foucault, never one to simply accept anything for face value, offered some incredible insights into the ruling structures that govern our societies and our lives.

A Biographical Note

I think sometimes it’s important to know a little about the personal lives of philosophers. Foucault is no exception. A Frenchman who grew up in the upper middle class in the middle of the 20th century, Foucault’s queer sexuality was not seen in a positive light. Foucault himself often engaged in self-harm and made several suicide attempts, which some speculate to be due in part to his shame of being gay in a world that wanted everyone to be straight.

Foucault, while studying and critiquing power systems as a writer and philosopher, was often part of protests against these same power structures. Throughout his life, the philosopher was a fierce activist against incarceration, racism, and abuses of power. He was hardly armchair in his views.

In 1984, Michel Foucault passed away from complications due to AIDS. He left an illustrious and lively career and life behind him, however abbreviated.

What Is a Genealogy?

When we think of genealogy, we might often think of researching family history. Who came from whom and where. Sites such as Ancestry rely on our enthusiasm for finding our roots. And frankly, it can be fun to find out that you are a very distant relation to a locally famous farmer with the best cows in the town.

In philosophy, genealogies are similar, but their scope is wide ranging. A genealogy is a historical look at the history of ideas. It is a heavy task, looking through the history of civilization and finding patterns in thought and their evolution. One of the most famous philosophers to use genealogy in his work (and a huge influence on Foucault) is that 19th century German Friedrich Nietzsche.

The most obvious example of this in Nietzsche is his Genealogy of Morals, in which he details the evolution of morality from antiquity to his present time. He works to explain the zeitgeist, or spirit of the times, for each epoch, showing how societal ideas of good and evil changed over time. The process of genealogy requires not only a knowledge of philosophy, but also a minute study of history.

In Genealogy of Morals, Nietzsche discusses ancient Greek practices that contributed to their ideas of morality, for instance. To make larger connections, he takes primary sources and connects them to create a larger pattern, like sewing together a quilt, but with patches of human experience and thought instead of fabric squares.

Genealogy is essential in understanding the work of Michel Foucault. An avid fan of Nietzsche, Foucault undertakes the task of genealogy in his work, including his work on the history of hospitalization and mental illness.

The Role of the Institution in History

Foucault wrote an impressive near-thousand page dissertation on the history of how people with perceived madness were treated in human history, and what their respective societies did to them. Folie et déraison: Histoire de la folie à l'âge classique (1960, Madness and Insanity: A History of Madness in the Classical Age) was a genealogy in which Foucault painstakingly explained the role of societal authority structures in relation to those who were characterized mentally ill. This was the start of broader work on the subject of institutionalization.

According to Foucault, in many cases, the mad person was not necessarily deemed mad because of being sick in a certain way. In many cases in history, the mad person was deemed mad because they were inconvenient or somehow undesirable to the maintaining of the society’s status quo.

During the Modern period, the demarcation between the sane and insane was more clearly delineated. Foucault cites the work of several philosophers as pivotal to this. With thinkers such as René Descartes, reason and rationality become the defining characteristics of what it means to be human. If reason is central to the human experience, what happens when it is not as functional to a human being?

In the modern era that Foucault describes in Madness and Civilization: A History of Insanity in the Age of Reason, this demarcation becomes essential to maintaining the status quo in the Western world. As such, institutions such as Bethlem Royal Hospital (better known as “Bedlam”), could and would house patients who simply did not fit the appropriate idea of what a human being should be.

In fact, the institution is instrumental in sorting out the “bad” people from the “good” people. In Western society, dichotomies are made when it comes to people: good/bad, sane/insane, rational/irrational. There is very little room for nuance here. You are either one or the other, and, depending on how well you fit your society, you could easily move from one to the other.

It becomes clear that the role of these institutions is not to help people heal. Foucault visits documents and other primary sources from asylums, sanatoriums, or institutions. During the 19th century especially, these houses of “confinement” are used not to heal but to correct. Foucault describes the hard labor and punishments given to patients who did not align with the orderly, submissive views of the hospital administration.

These hospitals stashed away women who did not behave well, people who did not conform to gender or sexuality norms, and enslaved people in the United States who had the audacity to try to escape or disobey. We might remember Bertha Rochester creeping around in the attic in Jane Eyre as an example of a person who was not desired stashed away for being different or difficult.

Madness versus Reason: A Societal Dichotomy

In his research, Foucault understands many power structures to rely on dichotomies to keep socially approved people away from those who are not approved. We can see the rejection of certain classes or types of people in widespread racism, antisemitism, or patriarchal oppression, for instance. In fact, this sorting of people into the desired and undesirable is essential to how human beings and power structures work. Basically, governmental and societal structures work like Mean Girls, with less pink wearing on Wednesdays.

In defining reason as an essential human trait, something that separates human beings from animals, the Enlightenment philosophers opened the door to the idea that maybe people without reason aren’t as human, or maybe aren’t human at all. This leads to the middle class family stuffing their schizophrenic cousin in an asylum, yes. But it could also lead to a similar family shutting away a disobedient daughter in an institution, or literally into the attic.

And what if there is something to those who do not practice reason? What if there is a value in such a different way of being? In the age of a mental health progressive movement, even now, those who suffer from brain ailments such as bipolar disorder, schizophrenia, personality disorders, etc., are still seen as the raving lunatic who may snap at any moment.

Foucault suggests that the creation of institutions was never done for the sake of helping, healing, or rehabilitating those inside of them. No, these places were created because, even in the prisons where those with mental illness were housed in the 18th century, they made the other prisoners uncomfortable.

And it is this discomfort that keeps those on the other side of the sane/insane dichotomy stigmatized. The sort of fear of something that appears outside of the norm of human behavior, the norm of good human behavior.

Foucault’s Genealogy in the 21st Century

Michel Foucault passed away in 1984 at the Hôpital de la Salpêtrière, a place he had studied for Madness and Civilization, from complications from AIDS. During his lifetime, his work on the history of psychiatry and institutionalization made few waves among his intellectual peers, unlike many of his other works. Some anti-psychiatry proponents latched on, but it otherwise didn’t seem to stick.

However, flash forward to the 21st century. In the United States, at the start of the late 19th century, people began exposing the deplorable conditions of institutions. In 1887, reporter Nellie Bly went undercover, revealing subhuman living conditions and rampant abuse in a New York asylum for women. In the 1950s, an intrepid reporter for the Atlanta Journal Constitution dug into the conditions of Central State Hospital in Georgia, the largest such hospital in the world. Patients were elected to act as nurses because the overcrowding was such that there were not enough staff for the number of patients.

As a result of this and other exposés, the United States government finally took action, slowly closing down these institutions because of the public shock. By the early 2000s, most of the inpatient state hospitals of this sort were either closed down or limited in their bed capacities. Central State Hospital in Milledgeville, Georgia ceased most of its operations over a decade ago. The expansive campus is often a desirable location for ghost hunters, though no one is allowed in the decaying structures. It houses the largest cemetery of the disabled in the world.

But where did the inmates of such places go? Many were given bus tickets to “go home,” but there were no homes for them. When it’s hard to take care of yourself and you only know the hospital, getting a job and pulling yourself up by bootstraps you don’t have is incredibly difficult. Currently, the largest institution to house those with mental health issues in the United States is the prison.

In a way, we come full circle from Foucault’s genealogy. Undesirable people end up in jails because there is no way to get help when you are poor or marginalized. The resources are far too few. As such, those with mental differences often find themselves in the prison bed rather than the hospital bed.

A Brief Personal Note

In 2008, I worked on my honors thesis at Wesleyan College. As someone whose bipolar disorder manic episodes started coming out in college, I was fascinated by the idea of mental illness and culpability. I was also heavily influenced by the physiological theories of mental illness at the time. I avidly studied the Diagnostic and Statistical Manual of Mental Disorders(DSM), the defining text of the American Psychiatric Association.

I remember one of my (political science) professors suggesting at my presentation that I should read and cite Foucault in my work. I growled at the idea, as I knew enough of Foucault to assume that, in his work, he was denying what, for me, was a legitimate ailment: my own. For a while, I dismissed Foucault altogether.

In graduate school for technical writing, nearly 20 years later, I began to rediscover Foucault. I read Mab Segrest’s Administrations of Lunacy, a very difficult to read genealogy of its own about the aforementioned Central State Hospital and its relation to racism. It was a strange sort of comfort to read this and to revisit Foucault’s work on institutionalization, because, in 2022, I experienced my first visit to a mental hospital.

A few factors created a perfect storm for a visit to an inpatient hospital, which led to a breakdown after several years of severe suicidal ideation. I would return to these places three more times, even receiving electroconvulsive therapy (ECT, or “shock therapy”) out of desperation.

The modern psychiatric hospital is a slightly more coddled form of the institution prior, in the sense that, at least in Georgia, people are slapped into one, then spat back out once they are “stabilized,” whatever that means. Cleanliness of the facilities varies wildly, as do the activities. If the facility has more money, both tend to be better.

I found the other inmates at these places were not much different from people I knew in my daily life. Even when I was placed with more severe (“acute”) patients at first, I found them to be just people with differences. It was the staff of such places that were often the most problematic.

In one such place, a woman having a pancreatitis flare up was denied a trip to the emergency room for over 24 hours. I was told to clean her vomit from the bathroom, then reprimanded when I asked to wear gloves to do so. A woman not feeling well ran screaming into the room I shared with a person with PTSD, banging on the barred windows.

Just as Foucault’s genealogy suggests, modern hospitals for mental illness do not tend to be places of healing. People end up drifting in and out of such places for a week or so at a time. The biggest memory I have of every experience was the feeling that I was being punished. I was a bad person for having thoughts of ending my own life, even though these were just a part of my bipolar depression, and my own PTSD.

And so, Foucault helped me learn, in my own recovery journey, that those of us who have a chronic mental health ailment do have value as human beings. This does not necessarily mean that we need to dismiss psychiatry altogether. It can be helpful to take medications for basic functionality, and can definitely be helpful to seek the aid of a therapist.

But what I learned when I was hospitalized was that those in the hospital were just having the worst day of their lives. They were not dirty, crawling Bertha Rochesters. They were not irredeemably wrong. They were not bad. And we are not bad people for having mental health issues, even if we don’t fit perfectly into society.