Madness and Civilisation: David Cooper on Michel Foucault
This is a series of notes made on David Cooper’s introduction to Michel Foucault’s famous text Madness and Civilisation. The construction of madness is a chimera running through many different ages and societies, and changing in form over time. Now we face the chemical age, the age which superseded the use of straight jackets as restraints and destructive physical surgery to pacify people placed under the medical authority. Indeed the modern medical models came from attempts to use pre-operation anesthetics to sedate patients as managed inmates.
There are no simple answers and where one answer is to be claimed as the account of what goes on in the name of what ‘civilised’ people do to ‘mad’ people, when closely scrutinised the rationalisations break down. This suggests that the chimera of of madness is a compound problem – that is, it is something which is composed of many problems different in nature each requiring its own complex analysis. Significant in all of this are the mass collective forms of madness – the forms of truth which nation, community and species struggle to accept.
The reasons are many and it helps to look at the past to elucidate the possibilities of what could be going on in the present. For example it takes no great researching skill to find in the history of organised religion infamous and inhumane cruelties wholly and complicity bought into from those outside positions of power in these organised structures of agency within a society. What room is there in our collective thoughts for checking and re-checking the intellectual and moral compass of those institutions in which faith is placed for the fact of what they represent – not necessarily what they are. The cowl does not make the monk !
Then there are the terrors which some abdicate from thinking about because they seem too terrible to contemplate – notions like the pollution of our food chain and environment, the air and water, with things which alter our psychology and damage our capacity to think, feel and interact in appropriate ways. There are clear and magnitudinal examples of this which we have to face up to as frightening realities; the exposure to lead and mercury are still present as examples. But more so, we now have to find ways of parsing and scientifically investigating thousands upon thousands of chemicals which biological life has never had to deal with in the past as they are products of human ingenuity not of nature.
In the 21st century we are now facing clear breaks with prior phenomenological and epistemic terrains with which the human organism and mind had co-evolved for millions of years. Some people live lives which never exit the urban designed architecture; the environment has been influenced by a sort of practical solipsism; it has been colonized by the anaemic visions of architects, city planners and construction companies and following this our internal world is following a similar transformation with the rise of digitised somatic norms.
David Cooper represents a part of a group of thinkers who radically questioned the construction of madness along with R. D. Laing and others from within the professional discipline. He gained a following during a time when pharmacy had spilled its banks and washed through the communities and lives of the general population with the introduction of waves of drugs like barbiturates and benzodiazepines, stimulants and ‘antipsychotics’.
This was an age when the marketing of chemicals to alter psychological perspective had reached Wall Street and economies had boomed around the arts and culture. This backdrop offered a divergent strand of thinking which started to use non-sanctioned drugs for altering of psychology – instead of alcohol cannabis and hallucinogens started growing in the chemical mix promoting alternative thinking which challenged the political and medical orthodoxies. Add to this the political war on drugs used to appeal to middle class voting populations by politicians as a fulcrum to power – a prohibition to replace the debunked prohibition.
This piece riffs off the ideas which David Cooper raises in his appreciative introduction to Foucault as an exploratory set of notes. As a piece of writing it does not necessarily represent Cooper or Foucault but uses them as lightening rods in a longer term investigation of madness important to this author. This is important to this author because in my time I have seen so many people affected by diagnoses, prejudice, psychological disruption, by poverty and punitive societal apparatus, by drugs – prescription and otherwise – that it appears to be a problem bigger than anyone likes to acknowledge. As a part of a generation who is statistically blighted with a raft of psychiatric and drug related problems, and as a part of a generation which is now encountering pre-geriatric manifestations of disrupted memory and cognition, it seems incumbent on me to make enquiries which otherwise are not being made.
David Cooper opens his introduction to Foucault’s Madness and Civilisation with “Madness has in our age become some sort of lost truth”. He suggests Foucault formulates ‘madness’ as a way of seizing the rooting preparations which give foundations to more specific realisations of what we are about. He follows this with an apparently tautological statement “…the truth of madness is what madness is”, but this may be notionalised as an idea contained in ‘lived experience’ or apprehensions of situational knowledge. This could suggest that nuanced understandings of what the multivalent word ‘madness’ is used to refer to may only be fully realized via direct experience. If this is congruous with what Cooper is voicing it can also speak to the sovereign nature of the ‘patient’ in the patient/doctor-principal/agent juncture in that the essential symptoms of what phenomena the patient encounters are necessarily understood and relayed to the physician by the patient. The premises of the physician is that of extrinsically acquired knowledge assembled through study, training and observation of the objective signs of the phenomena.
Cooper goes on to elaborate “What madness is is a form of vision that destroys itself by its own choice of oblivion in the face of existing social tactics and strategy”. This notion of self destruction is of interest as a motif; similarly exploring the idea of oblivion is powerful in the analysis of madness as it refers to the destruction of memory or the oblation of recognition and acknowledgement. Residing within these ideas we could read notions of a psychical form of autoimmunity, psychological forms of antibody to self which have arisen for some reason or another to give rise to self directed violence focused on the self; a converse of the autopoiesis which Niklas Luhmann discusses in his sociological reasoning, one which speaks of a kind of provoked apoptosis of being. If we accept this for a moment we are plunged into a situation of which calls for meaning or which is sated by a rite of tautism that forms so much of cultural lore entrenching frontiers rather than pushing them back.
Tautological accounts of ideas offer self referential deadends that please vanities of neatness and status obtained of the idea of knowledge without advancing knowledge itself. Knowledge or ‘knowingness’ relies on the state of memory as well on the processes involved in recognition and acknowledgement. Exploring this line of theory, oblivion could mean interference with cognition, the learning and relearning, reference checking and questioning of encounters with the noumenal that give rise to forms of knowingness. By inference, interference with cognition and the acquisition of knowingness can give rise to madness from various roots. Destruction of memory is therefore destruction of knowingness and of noumenal being; it is a destruction of self and being brought about by varying approaches. It may be the choice of the dominating in social behaviours to oblate an individual of their knowledge/knowingness and ultimately their being which brings about a type of madness; or if we view it in terms of transcendental existentialism it may be a madness as an insanity brought on another as is found in the social models of mental illness – the madness which may be interpreted of this embodied by the dominant could be conceived of as actions which toxify the world, that the dominant must thus not just be dominating others but dominating themselves by proxy.
This may be via depersonalising and dehumanising processes such as non-acknowledgement and/or manifesting violence social, psychological or physical. Alternatively self destruction and oblivion may be formed as sociological action on the self alienating and excising something of their being which is in dissonant conflict or at odds. As such it is a strategy to deal with a dueling narrative going on within the self.
In his marginalia notes Steve Tilley writes strategy, tactics and rhetoric in relation to this commentary in the book possibly observing these in sociological terms of interaction with others, possibly in terms with the interaction with the inner dialogue. His noted inclusion of rhetoric speaks of the art of winning over public opinion introducing the perception of ‘madness’ as something of a political object defined by shifting social mores/morals and insinuating the socially constructed nature of how people are conceived of in a cultural setting. In to this mix we might remind ourselves anthropologically of just how affected we are by lineages of habits of thought.
For example, if we look at Malinowski’s work, ‘mental defectiveness’ is rooted in some places in magical beliefs where those who have physical problems that interfere with their ability to produce speech are devoid of magical power and as a result, mentally defective. There are no significant reasons to think that ‘modern’, secular, cultures do not and have not reinvented such magical beliefs in their own form using different lexical repertoires of rite, ritual, incantation and superstition – for example in the trappings of bureaucracy, esoterically kept knowledge and officious ceremony. There seem to be a great number of self fulfilling beliefs and meme forms which psychiatry and psychology harbour that offer identities without insights, thereby providing a medium to project all manner of behaviours, practices and esoteric non-sense that when inspected closely break down, failing due to a lack of cohesive logical framework.
Enigmatically it is also these amorphous catch all projection spaces which are mediums capable of imaging cultural silences and cultural failings which bring about ailment and harms. Take for instance the widespread industrial use of the heavy metal mercury in modern times found at junctures such as vaccination medicines (Thimersal), widespread in mercury-silver amalgam dental fillings, and found particularly concentrated as an environmental pollutant in Tuna fish. There is no doubt about the capacity for mercury to disrupt the nervous system and negatively affect the behaviour, health and psychology of people. However there remains a cultural prohibition and silence surrounding this as a reality which factors into psychiatric and psychological diagnoses.
These silences are largely due to the utilitarian equation privileging financial growth over wellbeing; it is only when a perceived threshold of collateral damage is reached and a social tipping point demanded that these cultural silences are broken, prior to which whistleblowing is perceived as dissent, malcontent behaviour, neurotic and delusional fantasy and selfish disruption. Not uncommonly such breaches are internalized silently by institutions and instituters so to protect the establishment of the given practice whilst implementing a change to practice prior to the costliness of taking liability for the collective practice. Take for example the use of Thioridazine as a psychiatric medicine which was withdrawn due to its killing people through producing heart attacks. Again, conflict and dissonance are a motif in this field.
Returning to Cooper’s commentary on Foucault he leads into “Madness, for instance is a matter of voicing the realization that I am (or you are) Christ. There are many available forms of crucifixion in our age; apart from the cross, there are the shock box and operation of Leucotomy, as well as the mass tranquillizing drugs that flood the ready market of well trained but gullible psychiatrists. The sacrificial offering becomes some sort of definable and measurable social fact. But that is not all. By implication we all become this sort of fact that denies our core-essentiality and reduces us to a co-essentiality of abstract absences”.
Here we have Cooper making a keen provocation about the political upstart of the figure of Jesus Christ, relating this icon as an archetype which we can all embody but for doing so is an act of madness in a sense. This he relays as presumably someone who is the target of a societal punishment for choosing their beliefs in the face of pressure to acquiesce with the prescribed and prevailing social norms.
He relates directly the instruments of psychiatry as forms of sanction, and as capital ones. He implicates an economy of driving the practices through socialising people who lack critical capacity to act out the roles that realise the psychiatric system as a whole. He also implicates the focus of the psychiatric attentions as choosing to challenge the status quo, the patient, as a sacrificial offering. Whether he means a sacrifice made to demonstrate the transcendence of dominance through non-acquiescence in spite of the costs; whether he means the patient is sacrifice to reinforce the unassailability of the system for the public perception; or whether he may possibly mean these simultaneously Cooper relates these junctures as articulate and measurable social phenomena and by nature of these sacrifices throughout our lives we are left with an incompleteness we are reduced to through these abstractions, negations which have peppered our cultural landscape as vacuums where something wholesome once was.
These represent the future losses of conflicts we live now; absences which are normalised through shifting baselines – once we could understand the brutalities inflicted by their immediate and material evidence of the corporal workhouse or bully; now we are left hermeneutically bereft of a lexicon to identify and communicate the harms felt, lived and bestowed through the managerial digital algorithmic financial nexus. De facto there is no murder weapon to form a conviction with. Our immaterial world of psychology has been overruled by the material world where possession is nine tenths of the law, and even when the effects are manifest as if the causes are not then liability is immaterial too.
Cooper identifies Foucault as authoring a learned account of “the nature of the violence that mental patients meet”. Foucault is giving a representation in culture of what has been devastated, an account of psychological dissidents previously rendered silent through the authority of the cultural injunction of the psychiatric institution.
Cooper identifies these harms and damages under the territory banner of mad experience and behaviour as come about by a pseudo-medical perspective. He charges Foucault with clarifying the distinct “invention of madness as a disease” correlating it directly as a “disease of our civilisation”. This conjures questions of how do we reconcile the medical world with its mistakes ? What can act as medicine to the culture of medicine if indeed the attempts of civilisation has introduced disease ? What measures are sufficient and necessary to distinguish the pseudo-medical from the medical ? How might a parent come to terms with the notion that they manifest the blight of their child ? How might a child find peace when they discover what they manifest as ‘care’ hastens the demise of their parent ? These strong meats no doubt bring strong aversions but such aversions return to the motif of madness earlier brought up as oblivion.
Cooper continues “We choose to conjure up this disease in order to evade a certain moment of our own existence – the moment of disturbance, of penetrating vision into the depths of ourselves, that we prefer to externalise into others. Others are elected to live out the chaos that we refuse to confront in ourselves. By this means we escape a certain anxiety but only at a price that is as immense as it is unrecognized”. Here is the indictment proper of the anthropological organisation of madness which we can arguably see sketched out in the rudimentary beginnings of James Frazer’s Golden Bough.
Here is a detail of Leon Festinger’s cognitive dissonance and the primary impulse to close down the dissonance or avoid it. Here is everybodys discomfort with discomfort and natural draw towards dissociative pleasure and quietness from the impendingness of revelation. Here is the horror of the monsters we are in all the actions we cannot take back; the krystalnacht banality which Arendt spoke of at the cost of becoming a pariah of her own community. Here we have suggested the abandonment of a ritualized heritage which washed clean our sin from our eyes but not from the sight of the sin eaters; this is the blood of the church and national alter that cannot be washed out of history, it speaks of the silence as a pearl wrapped round of many layers of sheen to bring omission through sheen, beauty and in it a narcissistic face to stare in out at. All these revelations and apocalypses laid down with rites to oblivion and opposed to the madness resurrect the anxious facts of paradise lost as what is left extant under foot.
“Recent psychiatric, or perhaps anti-psychiatric research into the origins of the major form of madness in our age, schizophrenia, has moved round to the position that people do not in fact go mad, but are driven mad by others who are driven into the position of driving them mad by a peculiar convergence of social pressures”.
In this section Cooper contrasts perhaps how the medical is anti-psychiatric, or how the psychiatric is anti-pseudoscience if we are to frame it as a true part of medicine – medicines of the psyche. Here he brings in the modern deconstructions of the amorphous label schizophrenia possibly in the Palo Alto work of Gregory Bateson and colleagues rehearsing the conflicted mind in terms of no-win situations – those of double binds.
Possibly Cooper is bringing into view the work of R.D Laing working through the existential subjectivities of the self estranged from its authentic possibilities alienated in a world which has been made in an image shared of a species that has dominated all; we need only see the impact of homo sapiens on the planet and every other form of life to draw together conceptions of the kind of behaviours it enacts upon its self. Possibly included are a host of others who, of an age, felt strong enough to take on the discomfort of criticality voicing things like Rosenhans and Seligmans Sane People in Insane places and Learned Helplessness; sociological and systems based prolematisations of previous arcane practices as inevitable as it was that the comfortable institutions built up around the legacies of Galen were to fall to progress casting our redundant tautological lore and nonsense in favour of collective advance.
The major form of madness may be by no coincidence a word concatenated of split mind. Perhaps it is a concept where a vacuum lay due to the lack of substance therein whereupon the polarisation of tribal group behaviour led cultures is projected onto the concept as a medium where we see our spectres and fears and hopes in the darkness of the void. The drive for sameness in human psychology is a powerful one and one which brings with it a number of problems.
The insistence and imposition of sameness could be understood both as a narcissistic vanity and a neurotic fear of the unknown related to desire of control. The insider-outsider configuration of perception sits both at the heart of dehumanization mechanics and as a key dynamic of cult behaviour. Dehumanization occurs though processes of perceiving people as other and less than or incapable of the same apprehensions and experiences and the perceiver; less explicit forms detailed by Ann Cahill are derivatisation behaviours where targets are perceived only as derivative of the targerters perception, value system, goals or desires or not at all beyond these bounds.
The criteria of cult behaviours mentioned comes from Prof Arthur Deikman’s analysis of cults where devaluing the outsider, conformity with the group, dependence on a leader, and avoiding dissent form the defining posits. He likens cult behaviour to the allure of the security of not having to question anything, like the experience of being sat in the back seat of a car being driven to a destination and not having to think or make any decisions, free of control or input.
We can certainly find in the teaching of medicine clear definitions of medical dehumanization and depersonalisation as part of the training proposed for medics being able to function in the role effectively. What we find in psychiatry are extra measures for the alienation of the individual from normative perception which creates the circumstances required for frank dehumanization to take place. We can also find in the medics environ the ingroup-outgroup statuses, vertical rule and status investments required to prime for cult behaviour which can be understood as unthinking, unquestioning behaviour in the face of social pressures.
The sociological questioning of societal pressures and structures is a necessary part of a responsible and ethical medical and psychiatric profession if they are to be regarded as healing institutions rather than as profiting from a pathogenic status quo. The question of sub-legal anti-social behaviours is a question which society has yet to deal with as they clearly represent a category of harms that comes about through chronic and persistent exposure. The fact that actions when delivered subtly and non-materially (i.e. not physical but psychological and sociological violence) do not meet legal thresholds for state intervention is a doubled edged problem.
The effect of attempting to create legal interventions in the interpersonal and private space brings about harms in itself and to some extent the reach and power of the state to intervene must be limited to prevent authoritarian possibilities and the unintended social consequences of a legalistic and mechanistic society. These points acknowledge to some extend human society is charged with dealing with its predatory and dominative behaviours.
Criminal law and policing institutions have been set up and to varying extents elected to address the issues of anti-social behaviour when it arises however remains impotent beyond the extents of the constraints it has been set in – even when the chronic sub legal aberrations of behaviour enacted from one actor upon another may amount to seemingly equivalent disastrous outcomes that otherwise would be dealt with by the law. Take for example the driving of a person to suicide or mental breakdown or death through misadventure via drug use; the actions of a malevolent romantic partner, sibling, parent, child friend or stranger when kept within certain legal and social considerations may amount to death and harms without any clear liability being attributable beyond a sense of justice.
This realm of adult bullying, gas lighting, manipulation, coercion, and imposition might be perceived of as forms of social predation distinct from a category of psychological harms we could conceive of as systems effects of differing levels of ignorant practice; the significant difference being that of intentionality. Examples of this category might be the investment of a parent or teacher or social worker in the idea punitive behaviourism or indirect financial investment in organophosphate herbicides and pesticides which damage nervous system functioning. Systems effects are another area of life which societies have yet to find satisfactory ways of dealing with because the allocation of extra-individual liability confounds the function of the law. There exists problems of demarcation of liability in areas such as corporate manslaughter and negative externalities.
Cooper continues “These social pressures hinted at by Foucault, are mediated to certain selected individuals by their families – themselves selected by processes that are intelligible – through various mystifying and confusing manoeuvres. These manoeuvres have a cultural and historical significance that has long eluded us; they are apprehended by Foucault although not minutely defined, and relate to many other mystifying situations in our society”.
Here in the marginalia of Steve Tilley – whose copy of the book I am working from – is found the note ‘The history of practices/manoeuvres/transmission’. The social pressures of human society are by and large the results of the actions of individuals as they work in accordance with their values and identities which socialise them into groupings. This human theatre is significantly shaped by the injunctions forged in the kinship experience which in turn goes on to pattern wider kith and societal relations. Societal relations are shaped through rituals of tradition, rites of storytelling and incantation of justification through and over time as means of transmission in culture.
Encoded into this theatre is the destructive war loving, pathogenic character traits represented as much as any other evident natures of homo sapiens. The capacity and propensity of human beings to convince themselves they only exhibit virtues and do not carry embroidered in their actions and thoughts those things they vocally despise in public display is a chief characteristic at play in the embodiment of disease and illness. Cooper breaks the taboo to indict the family and makes the point that the cause of illness are understandable; the pathogenicity in certain relationship structures can be revealed and their mysteries undone.
There is suggested in his writing mystifying and confusing manoeuvres associated with the converging social pressures he mentions that give rise to forms of madness. These manoeuvres of mystification might be interpreted as processes of esoterisation used for the purposes of accounting for why some things must be – from an anthropological perspective these are incantations of justification to provision that something occur in such a given way. As Malinowski suggests, a myth is a charter for action and as such myths are created and curated by the presiding agents in a culture so that a narrative can continue and be seen to cohere.
Famously Frazer wrote on Scapegoats being ceremonially loaded with the evil spirits which had caused an ill and whipped out of the village or sacrificed. Other magical thinking has been implicated by Max Marwick as part of the epistemology of science. It seems a reasonable investigation in the face of the infallibility ascribed to the images of the family to scrutinize psychiatry for magical thinking which serves to obfuscate and esoterise the potentially painful and true origins of mental disorder.
Like the notion of exegesis in religion, the critical examination of the scriptures of psychiatry is a necessary station to be able to get to the healing art if it is to be understood as that and not simply a placation of the impulse to heal. Understanding the origin and creation of the political myths which pattern our lives and actions along with a detailed understanding of how they are re-created and transmitted is a vital part of excavating the truths of human society, the psyche and psychiatry.
“Above all, in reading this book, one is awakened to a tragic sense of loss involved in the relegation of the wildly charismatic or inspirational area of our experience to the desperate region of pseudo-medical categorisation from which clinical psychiatry has sprung. We are beginning to recognise the prevalent tradition of clinical psychiatry today as a convenient but ultimately misguided way of evaluating the social meaning of madness”.
Here we have a lament at the idea of losing a part of our unfiltered experience and expression to patterns of colonial edits on behaviour and thought. It is a lament of the pathologisation of homo sapiens when held against templates of social engineering aims, targets and designs to domesticate lowerarchies of impulse. From the citadel of the clinic decisions are issued from the privileged role of the medic/secular cleric to heal society of its aberrations excised and exorcised as pestilence which threatens the wellbeing of the social order.
The institution of medicine as a prevalent tradition written over the cultures which were conquered, like indigenous medicines is a part of the history of its monocultural dominance we see today heavily invested in petrochemical pharmacology. Another part is that of convenience to the established modes and cultures of thinking – medicine under the streetlight effect is prone to surgical excision and ablation of that it conceives as causing a problem to its ordained scheme of things; it fails with any social meaning other than its own forged majorly in empire and war – it derivatizes and others what it cannot marshal neglecting to imagine its own humble origins.
Possibly ‘medicine’ is the scar site of a shatter culture of an impulse to survive over millennia despite the pecuniary vanities, idiocracies, and misappropriations which permanently are to mark its soul; cousin to the church and its relation to spirituality it bears all its history amalgamated into a single impossible but real categorical imaginary added to week by week, century by century by diverse ideologies.