Literature and Medicine I

6Foucault maintains that the development of the madhouse trade can be viewed within the overarching trend of the great confinement. He places the date of the birth of this movement to confine as 1656 with the foundation of the Hôpital Général in Paris (Madness and Civilization 39). The significance of the Hôpital Général is that it was not intended as a place of medical treatment, but rather “a sort of semijudical structure” or “an administrative entity” charged with maintaining social order that might be disturbed by the unemployed, idle, and mad (Madness and Civilization 40). The founding of the Hôpital Général was subsequently mimicked all over Europe which correlates with the shift in the pre-17^th- and 18^th-century habit of briefly jailing the mad, to the specific, often long-term, penal aspect of confinement. It was during the classical age that “for the first time, madness was perceived through a condemnation of idleness and in a social immanence guaranteed by the community of labor” (Madness and Civilization 58). Thus, Foucault maintains that it was the madperson’s lack of labor and production that so offended the rest of the community. This idleness was partially behind the move to confine the mad; and was evidence of their “inability to integrate with the group” (Madness and Civilization 64). Critics have pointed out the problem of a sudden condemnation of idleness as a primary basis for confinement because of its non-universal applicability. The “socially helpless,” such as the mad, poor, and idle, were confined prior to Foucault’s date, albeit in smaller quantities (Midelfort 107). More problematic, however, is the connection between women’s increasing confinement and the condemnation of idleness. Although women of this period were said to have had freer opportunities than their later counterparts in the late 18^th and 19^th centuries, their frequency of employment outside the family was still relatively negligible compared to their male counterparts. The vast majority of women could not have been considered idle or deviant when running households and raising families. I suggest that the condemnation of idleness can still remain applicable as a deciding factor for women’s confinement by reconsidering our view of production. Women, excluding those of the emerging middling class engaged in business, produced less exchangeable commodities than their male peers. In confining women it is the confinement itself which leads to loss of labor (madness) instead of madness (loss of labor) leading to confinement.[3]Derrida disagrees with this assessment; Derrida states that follies “do not amount to the ‘absence of the work’ – that fate of madness in the classical period that Foucault speaks of. Instead, they make up a work, they put to work” (Derrida 90).

7Some critics disagree with Foucault’s notion of the great confinement, most well-known among them is Roy Porter, noted English medical historian. Porter states that the great confinement did not occur in England in the 18^th century, but instead the move to confine was enacted in the 19^th century. Porter also disagrees with Foucault’s theory of the rationale for confinement being a move to make productive the idle and mad. He notes that some asylums offered gardening and needlework as a distraction for the patients, rather than a means to employ their labor for resources (Manacles 8). Porter also cites a miscalculation in Foucault’s analysis of the great confinement as being an effect of a change in regime. Porter states that Foucault cites the consolidation of central authority as an inciting factor in the legislation that created workhouses and asylums, yet disagrees with this idea as applied to England. He argues that the opposite took place after the Restoration in 1660; “localism and community action rather than programmes emanating from Crown or Parliament” were employed when dealing with social issues, including the confinement of the mad (Manacles 111). This can be shown in the high numbers of small, privately-owned madhouses compared with the static number of large public institutions such as Bethlem Hospital. While it is true that the Victorian age saw the highest percentage of confined mad and the explosion of licensed and unlicensed public and private madhouses, Porter seems unduly harsh in characterizing Foucault’s notion as “hyperbolic” (Manacles 8). While Porter cites the statistic of only 400 people per year being admitted to private madhouses in all of England at the end of the 18^th century as proof that the massive move to confine was not applicable to England because of it paucity of patients, it must be noted that record-keeping, especially in private madhouses, was shoddy to non-existent in some cases (Manacles 8). Likewise, this statistic takes into account only the private madhouses; not included are the numbers of quickly growing public madhouses. 

8The shift in the steady and relatively un-gender-biased confinement of the mad during the latter half of the 18^th century to the exponential growth of confinement, specifically female, during the 19^th century has been thoroughly examined by Jane Kromm in her analysis of visual representations of madness. Through examining various print portrayals of the madhouse and its inhabitants, Kromm identifies the 1780’s as the critical turning-point in the popular conception of the madhouse inmate. From the previous, male-focused imagery of Foucault’s animalistic madman and the melancholic, love-lorn madwoman, the imagery shifts with a stronger feminine representation to images focused primarily on depictions of promiscuous, animalized women (515). She suggests that this shift was initiated by the sexualized stage portrayals of Hamlet’s Ophelia due to a relaxation of the theatre codes and furthered by the development of the moral treatment, in which female patients were encouraged to participate with the “family” of the asylum – the internalization of the doctor/staff’s paternal moral authority was used as a means of behavior control. For Kromm, this shift clearly depicted in print art, elaborates the nature of the demographic shift in confinement during the period. However, I would argue that this position neglects several factors. One factor to consider is that Kromm’s samples are only from male artists, though unsurprising given the period. This othering of the female figure is referenced solely within one social group, educated and reasonably-moneyed white males. Likewise, when one reviews women’s writing of the period, the demarcated shift in the trope of madwoman is absent. Though by no means an exhaustive study, my review of women’s writing about madness noticeably showed no defining change in depictions.

9As mentioned previously, the Retreat at York presented both a more humane and more seductive form of controlling the mad. Even at the Retreat, woman’s new place as an other-sexed being was fulfilled. Whereas Samuel Tuke states that men were encouraged to exercise and converse to maintain health, women were “employed as much as possible in sewing, knitting, or domestic affairs” (Ingram 243). This segregation, though not a new phenomenon, was nevertheless a product of viewing women as a bodied other, rather than as a malformed man, as previous thought in medical discourse, i.e., the Galenic, one-sexed model. By clearly differentiating between male and female patients at the Retreat, Tuke simply reinforced the contemporary construction of gender and sexuality. As Foucault states, “the deployment of sexuality has its reason for being, not in reproducing itself, but in proliferating, innovating, annexing, creating, and controlling populations in an increasingly comprehensive way” (History of Sexuality 170). Thus, Tuke’s asylum as family unit was merely one manifestation of the new deployment of sexuality and its added layer of control over female patients.   

10It is evident that the development of confinement as a way to handle the mad was intended as a punitive measure rather than a means to treat or cure them. In its own creation and rationalization, “the house of confinement in the classical age constitutes the densest symbol of that ‘police’ which conceived of itself as the civil equivalent of religion for the edification of a perfect city” (Foucault, Discipline and Punish 63). In this, confinement assumes authority over the madperson which was previously held by the Church while promoting Enlightenment values of reason and civic responsibility. While England was not the hotbed of dissension as was Foucault’s 17^th- and 18^th-century France, it nonetheless employed some characteristics of the explosive community. It was considered common knowledge that uncontrolled emotions were directly linked with madness: the 1750 Treatise on the Dismal Effects of Low Spiritedness comments on “madness as the vice of unbridled passions” (Porter, Manacles 26). Thus, when Lady Mary Wortley Montagu states that any young woman who considers running away with a man she does not intend to marry should be confined within Bethlem Hospital, she underhandedly comments on the rule of passion over reason (Porter, Manacles 27). The language is significant in that the would-be lover must by physically removed from the community and confined specifically within Bedlam or a Bridewell to remove the taint of her subversive ideas from the community at large, and more specifically, as a moral lesson to other young women. This lesson was easily observable and replicated through the habit of keeping the mad on view in public madhouses like Bethlem Hospital. As Porter states, until 1770, “almost unlimited sightseeing was allowed” with many English families spending the day at the asylum in order to observe the spectacle that was madness (Manacles 37). The spectacle of the madhouse was dramatic as patients were “manacled, naked, foul, sleeping on straw in overcrowded and feculent conditions” all the while being “jeered by ogling sightseers” (10). William Cowper comments that during a previous visit to Bethlem Hospital he felt that “the madness of some of them had such a humorous air, and displayed itself in so many whimsical freaks” (qtd. in Porter, Manacles 91). Thus it was both upper and lower class citizens that attended the spectacle at Bethlem Hospital, enjoying the safe exhibition of madness and the moral lesson it was said to provide.