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Madness and Civilization: A History of Insanity in the Age of Reason is an English edition of an abridged version of Folie et déraison, originally published in 1961. (A full translation titled The History of Madness is due to be published by Routledge on March 31 2006: ISBN 0415277019) This was Michel Foucault's first major book, written while he was the Director of the Maison de France in Sweden. It examines ideas, practices, institutions, art and literature relating to madness in Western history.

Foucault begins his history in the Middle Ages, noting the social and physical exclusion of lepers. He argues that with the gradual disappearance of leprosy, madness came to occupy this excluded position. The ship of fools in the 15th century is a literary version of one such exclusionary practice, the practice of sending mad people away in ships. In 17th century Europe, in a movement which Foucault famously describes as the Great Confinement, "unreasonable" members of the population were locked away and institutionalised. In the 18th century, madness came to be seen as the obverse of Reason, and, finally, with Freud, as mental illness.

Foucault also argues that madness lost its power to signify the limits of social order and to point to the truth and was silenced by Reason. He examines the rise of scientific and "humanitarian" treatments of the insane, notably at the hands of Philippe Pinel and Samuel Tuke. He claims that these new treatments were in fact no less controlling than previous methods. Tuke's country retreat for the mad consisted of punishing the madmen until they learned to act "reasonably". Similarly, Pinel's treatment of the mad amounted to an extended aversion therapy, including such treatments as freezing showers and use of a straitjacket. In Foucault's view, this treatment amounted to repeated brutality until the pattern of judgment and punishment was internalized by the patient.

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