Foucault rightfully regards the appearance of the first asylums a significant step forward for the whole world. It meant that the medical community accepted psychological diseases as a medical problem and basically announced that it was going to try to treat it. Madness did not seem like some kind of curse or other superstitious phenomenon nobody knew what to do with anymore. This point is delivered well by the author in the first part of the article.
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When Faucault describes how the asylums treated their patients, he turns to the models proposed and implemented by Samuel Tuke and Phillippe Pinel: Tuke’s idea was to define madness as the opposite of reason and try to battle it with reason; Pinel thought that madness should be isolated from religious influences (for they, in his opinion, mostly caused it) and be cured in an anti-religious environment.
The detailed concentration on the views, achievements, and underachievements of the two reformers is an undoubtedly important tool of driving certain points across as well as a solid basis for theories and a convenient starting place for the formation of new views. However, the fact that Faucault uses only their research and avoids talking about other reformers that also have made an impact on shaping the principles of psychiatry gives the article a bit of tunnel vision.
If we look at his mentioning of Tuke and Pinel individually, we will see another arrangement of problems and strong points. Faucault spends a lot of time talking about Tuke’s model of the asylum as a family where the mentally ill were treated like children in need of nursing. In my opinion, this approach did not seem very respectful towards the patients, and it also discredited a concept of family in a way.
The parallels between the “asylum family” and a “real family” sometimes would be taken too literally. Were children in normal families supposed to be regarded as mentally unstable just because they were children, and were parents considered sane just because they were their caretakers and adults? These questions were hard to avoid in such context. I think Faucault should have elaborated on this. The ethical implications in the matter were obvious.
What I do like about Faucault’s narration, however, is the way he emphasizes the position of physicians in Tuke’s system. As Samuel Tuke founded his mental asylum, the York Retreat, he made physicians and therapists the ones in charge of treatment, starting with the admission of patients and ending with individual recommendations for every patient’s health state. I think that Faucault’s use of quotes in this part is most relevant.
I also like the way he describes Tuke’s rather philanthropic aspirations: “It is not a scientist that homo medicus has authority in the asylum but as a wise man. If the medical profession is required, it is a juridical and moral guarantee, not in the name of science” (Foucault 159). The approach seems to be just as romantically sounding as it is agreeable: this way doctors treat the patients and try to assist them in overcoming their diseases, not research diseases by the example of the patients.
The idea of a neutralized asylum proposed by Pinel made a huge focus on an anti-religious campaign; this much is conveyed by Foucault. In Pinel’s opinion, religion harbored many potential threats to the human mind. Although there was a certain inconsistency in this theory: Pinel did not have anything against the positive religious dogmas such as the prohibition of murder and theft. Foucault underlines this fact.
He also creates an interesting conflict by contrasting the inconsistency of this method with the contribution it made to the development of the moral therapy creating an interesting conflict. Foucault’s opinion lies with the conviction that moral righteousness unavoidably lead to bourgeois influences affecting the scale of sanity assessment, therefore, proclaiming everything socially unacceptable as abnormal. It is hard not agree with him here.
It seems that, to Foucault, the concepts and models he was describing looked like promising solution-searching formations. He meant to show that at that time psychiatry made rapid progress and kept up with changing trends. Although it might be true in some aspects, a little bit of criticism is due nevertheless. Given that he mostly concentrates on Tuke and Pinel, we get only a semi-full picture of how the introduction of asylums was going at the time.
I would especially like to concentrate on a certain aspect of the article. In the York Retreat, reason and patience were the main methods of dealing with mentally unstable individuals instead of any instances of violence. It gave positive results, according to beholders. As for the “familial” aspect of Tuke’s asylums, according to Foucault’s descriptions, it created a make-believe environment, a false social construct within the retreat which helped the therapists and the physicians to control the patients.
It was ironic since the mere idea of family represented something right, proper, and healthy in all senses of the word, which “families” in the York Retreat definitely were not. Mentally unstable individuals were guarded, observed, and chaperoned through every aspect of their lives in the asylum like children growing up. The resemblance and the forceful parallel both looked uncanny to the respected members of society, especially in the bourgeois circles. Tuke only wanted to establish a connection between madness and something normal. To Foucault’s dismay, this symbol of “normality” stood too close to the “bourgeois family” concept which was way behind its time.
Despite admitting the fact that the system worked well when it came to restraining patients (observation techniques helped a lot since mentally unstable people hesitated to do anything violent or strange while under surveillance), Foucault still criticized the system for using outdated social models. I agree with him in this regard as modern inventions should be based on modern technology and modern mind frame. It is a bit hypocritical when you talk about progress in a system of outmoded methods and means.
When he talks about Pinel, Foucault draws the line between the negative influences of religion on the human mind and utilization of some seemingly harmless religious rules to cultivate some form of moral conscience in patients. Pinel managed to separate people with mental problems from criminals and wanted to give them a so-called moral compass, so their actions would not be that unreasonable and uncanny.
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These are fascinating observations. I also liked to see Foucault criticize the fact that the moral standards were copied from the usual values of the typical modern society. Everything that was not fitting the requirements was considered abnormal and not socially functional.
Of course, making patients understand that they still had hope to rejoin the social system as “normal” human beings was important, although it did not cancel the fact that the humane approach was sometimes focused on instilling the fear of judgment in patients so they would strive to “become normal”. However, despite the process of forcing the moral code on the insane looking somewhat harsh, it was hard to deny that it was an improvement compared to the previous practices of treatment of madness.
Foucault, Michel. Birth of the Asylum. From Madness and Civilization; A History of Insanity in the Age of Reason, New York, New York: Pantheon Books, 1965. Print.