Book Review: The History of Reason in the Age of Madness

33368899Review by Burcu Alkan

From his seminal Madness and Civilization (1964) to his later studies on various structures of power, Michel Foucault’s works have instigated a diverse and often contentious set of reactions in many fields. However, John Iliopoulos’s book is not yet another work that argues for or against Foucauldian thought or just another history of psychiatry. The History of Reason in the Age of Madness: Foucault’s Enlightenment and a Radical Critique of Psychiatry (Bloomsbury, 2018) scrutinises the concept of reason as defined by the Enlightenment thinkers and the corresponding changes in psychiatry over the past centuries through Foucault’s meticulous analysis of both. It is an in-depth and highly-informed engagement with Foucault’s oeuvre. Iliopoulos goes beyond the all-too-familiar uses and misuses of the Foucauldian approach and clarifies many misreadings and misinterpretations.

He first positions Foucault’s critique of Enlightenment by underlining that Michel Foucault is “neither [an] anti-Enlightenment thinker who rejects reason and truth” nor does he prescribe to a simplistic “notion of the triumph of rationality” as a resolved, finished product (p. 2). Instead, he is concerned about the relationship between reason and rationality, the limits of that relationship, and what that relationship and its limitations say about the ways in which people relate to reality. Forms of rationality, Iliopoulos explains, “are forms of conduct and a structuring of reality based on reason as a principle of knowledge and action. Forms of rationality constitute the implementation of reason in everyday affairs” (p. 4). Disregarding their distinction as such turns the Enlightenment ideas into self-righteous purveyors of truth.

Given the necessity of such a distinction and the complications that arise from its lack, Iliopoulos spends the first couple of chapters in setting the foundation straight. In the first chapter, he asks the Kantian question of “What is Enlightenment?” and proposes it as being essentially, “the age of critique” (p. 7). About the intrinsic dangers of self-righteousness that underlie the “blackmail of the Enlightenment,” Iliopoulos explains: “Rationality is reason as principle of knowledge, necessary for grasping and manipulating reality, which does not cover the entire field of human experience and when it attempts to extend its powers to domains beyond its limits, undermines itself by falling into arbitrariness and irrationality. The courage to recognize these limits and the rigour to demarcate them belong to the reflective properties of reason” (p. 5). In this context, Iliopoulos examines the impact of Kant’s “Anthropology” on the conception of madness and the limits of psychiatry in the eighteenth century. The acknowledgement of the boundaries in the comprehension of madness enabled the “alienists” to see beyond the normative pressures of rationality. Yet, when the proto-psychiatrists prescribed to the necessity of defining issues incomprehensible to rationality through the lenses of rationality and “incorporate[d] tenets of positivism” into their work, they lost their “scientific rigour” (p. 17).

In the second chapter, Iliopoulos extends his analytical evaluation of Foucault’s work to both philosophical and psychiatric applications of phenomenology. He notes: “Phenomenology is the offspring of a primordial confrontation between reason and madness, the direct derivative of this fundamental tension, which created the rational phenomenological subject capable of contemplating the sick consciousness” (p. 28). Foucault’s analysis of madness and psychiatry through phenomenology maintains a distanciation from external theories, perceptions, and presumptions and focuses on what the manifest reality of “madness” reveals. Such a consideration of madness transcends and transgresses the established truth regimes that limit understanding, as madness itself poses its own truth regime against normative rationalities. The mad consciousness does not have a distorted perception of truth but a unique relationship with it, that is, its own truth regime. An example of this is shown through how the hallucinating person never confuses the voices of the “real” world with the voices that only they hear. Accordingly, madness becomes a category of truth in itself, “an epistemological problem” as it clashes with “the exoteric forms of knowledge,” “the diagnostic truth” that determine and categorise madness (pp. 44-45).

In the third chapter, Iliopoulos moves to the basics of discourse analysis as an examination of how “forms of rationality, infiltrate, make up and organize power relations and their effect in the way reality is perceived” (p. 30). The historicity of Foucault’s approach distinguishes his work from a simplistic relativisation of the experiencing subject, and thus, from direct phenomenological interpretations. The “subjects and objects emerge simultaneously as a result of truth procedures specific to a given historical period” (p. 47) and the said truth procedures are always in a complex relationship with ethics, politics, and jurisprudence. Consequently, for Foucault, the perception of madness and the development of psychiatry from the eighteenth century onwards have been contingent upon the “three modalities of truth”: politics, science, and ethics, and their tension-laden encounters. Whether it is the public hygiene requiring those who do not fit the normative regulations of society to be kept away or the jurisprudential necessities of differentiating between the “real criminals” and those who are “mentally ill,” psychiatric medicine bears immense power and intense pressure.

Accordingly, the fourth chapter brings the debates to Foucault’s critique of the politics of power, discipline, and abuses of psychiatry. It discusses his engagement with anti-psychiatry and his analysis of ethico-politics concerning psychiatric medicine. Although Foucault appreciates the contributions of anti-psychiatric debates, he is not necessarily an advocate. He argues that certain forms of rationality created correlated structures of power through logical truth-regimes that were needed, produced, and disseminated within societies. Yet, he rejects monolithic interpretations of power that identify it only with sovereignty, oppression, and prohibition. He establishes a critical distance with anti-psychiatric movements that maintain only a negative and domineering power model. Hence, he proposes “an anonymous, multiple, pale, colorless power” (p. 83), that of discipline. Psychiatric discourse has been in flux due to a drive to become a reliable scientific enterprise and a dependable forensic field. As much as it was prone to abuses of power, it was also geared towards preventing such abuses by malingerers and aimed at safeguarding the vulnerable. Such complexity and complications mark Foucault’s meticulous historical critique of psychiatry not only as an institution but also as an evolving field and discourse.

The fifth and sixth chapters look at the nineteenth century as a critical threshold in the history of psychiatry before it was medicalised in the contemporary sense with the inclusion of biology, pharmacology, and neurosciences. They focus on two distinct but interrelated subjects: an ailment, hysteria and a model of treatment, psychoanalysis. Under the pressure of external truth-regimes, psychiatry was strained to establish reliable epistemological foundations in order to prove its medical status. The body became “both the foundation of perceived reality and the object of this reality as a set of biological processes, […] the unequivocal source of a knowledge […] not only diagnostic but also prognostic” (p. 109). As madness was not demonstrable anatomically and psychiatry was up against the “somatocracy” of positivism, neurology provided the needed material for a medical identity, engendering neuropsychiatry. However, certain types of “madness,” particularly hysteria resisted such classifications and continued to challenge the position of psychiatry as a branch of medicine. The hysterics demonstrated symptoms of neurological disorders but these symptoms lacked references in the nervous system. Charcot’s application of hypnosis further problematised the situation, as neurological symptoms without anatomical correspondence could also be instigated exogenously through suggestion. Still, Charcot’s technique proved to be a name-making method by enabling the differentiation of “real” neurological symptoms from “simulated” ones.

The nineteenth century became a stage for the clashes between two separate truth regimes within psychiatry: the “dominant scientific truth regime […] that is guided by rationality” and “that has become increasingly positivist” in handling mental illness and the “marginalized truth regime that tests madness” guided by reason and “establishe[d] a relationship with otherness” (p. 125). Psychoanalysis brought their conflict-ridden antagonism into an undeniable focus by weaving back and forth between them and creating its own unique space in the process. Freud proposed psychoanalysis as a medical and psychological practice, expanding the realm of psychiatry but challenged its established structures by means of inverting its diagnostic model. Psychoanalysis employed a traditional medical conception of truth, i.e. the notion of crisis. However, instead of looking for the kernel of truth in the patient’s mind, it focused on the presence of falsity and illusion to simulate crisis and thus render it accessible to a possibility of comprehension. Iliopoulos maintains that Foucault’s analysis was not an attempt at invalidating psychoanalysis as a scientific method but a genealogical study to locate it “in Western rationality and to assess the type of truth that it articulates in relation to psychiatry” (p. 126). What Foucault sees is not an epistemological weakness but “a unique type of discourse that can critique psychology itself as well as historical analysis” (p. 133).

The History of Reason ends with a brief chapter discussing the psychiatrists as intellectuals, showing “how their epistemological status can question current security-oriented rationality” (p. 153). It is an intense and informative book that traces the history of psychiatry through its philosophical veins. Moreover, it is a reconsideration of the threshold between modernity and postmodernity, a fluid space that bears the potential to bring together the critical enterprise of the Enlightenment and the radical edge of the postmodern. It is a reminder of the alertness necessary in critical thinking, a warning regarding the pitfalls of Enlightenment rationality that ignores its dialogue with reason. Yet, it also encourages a renewed faith in critique a la Enlightenment, as John Iliopoulos revisits the potential in Foucault’s work in navigating that fluid, liminal space.

Book Review: Blood Matters

36899154Review by Sarah E. Parker (Associate Professor, Jacksonville University).

This collection of essays, Blood Matters: Studies in European Literature and Thought, 1400-1700 (University of Pennsylvania Press, 2018),  explores the material understanding and figurative use of blood in the late medieval and early modern world. Bringing together the work of scholars in history and literature, this interdisciplinary collection introduces a conversation about the important and multiple roles that blood played in the early modern worldview. That said, the book’s editors, Bonnie Lander Johnson and Eleanor Decamp, are both scholars who focus on early modern theater, and that area of specialization informs much of the collection. The chapters explore in particular the liminal quality of blood; because blood typically hides within the workings of the body, the moments when it appears are laden with meaning.

The chapters are relatively short and grouped thematically. The first group of chapters deals with the blood’s literal and metaphorical circulation. The opening essay, by Margaret Healy, addresses the work of William Harvey, who discovered the circulation of the blood. Healy takes issue with Christopher Hill and John Rogers’ argument that Harvey’s late work on circulation signals a revolutionary and “vitalist” turn in his philosophy and politics. Instead, she argues, Harvey’s vitalism remains consistently Aristotelian throughout his lifetime. The next chapter, by Heather Webb, predates the discovery of circulation as we think of it, but she argues that medieval authors Dante Alighieri and Catherine of Siena nevertheless view blood as a dynamic entity in a constant state of circulation that connects the individual physical body to the body of the church more broadly. One of Catherine’s letters uses her own blood as a metaphor for the warmth and life that she believes her spiritual vigor could bring to a sickly church. Katharine A. Craik’s essay on Shakespeare’s Henriad is one of many essays that deal with Shakespeare and early modern drama in this collection. By examining the character Pistol, Craik draws attention to the class tensions in Henry’s famous lines in the St. Crispin’s Day speech that “he today that sheds his blood with me / Shall be my brother; be he ne’er so vile, / This day shall gentle his condition” (4.3.60-63). While Henry’s speech suggests that war can overcome class divides, Craik shows that Pistol and other characters belie that claim.

The second section groups essays that discuss wounds and wounding. Continuing the volume’s focus on Shakespeare, Hester Lees-Jeffries’ chapter considers the representation of wounds on the Shakespearean stage. Coriolanus is described as “mantled” in his wounds, a metaphor that Lees-Jeffries explores in terms of the material world of the theater where a blood soaked garment would have played the role of both costume and prop to communicate the various wounds in Shakespeare (Macbeth, Julius Caesar, etc.). Gabriella Zuccolin and Helen King shift the focus to the history of medicine and consider the ways that nosebleeds were specifically gendered in the early modern period. In contrast with Laqueur’s theory of the one-sex body, they focus on cases where women were believed to get nosebleeds because of the suppression of their menses, and explore this topic in relation to contemporary beliefs about the humoral system and the benefits of regular bleeding. Joe Moshenska’s final chapter for this section investigates the boundary between animal and vegetable by considering an odd trope in the epic tradition: the hero’s encounter with a bleeding tree. Medieval and Renaissance authors, including Dante, Ariosto, and Spenser, take up the story of a man trapped in a tree from Virgil’s Aeneid, and Moshenska connects the moment of violence in these stories (when the hero breaks the tree’s branch and prompts it to speak) to the violence of poetry more broadly.

The third group of chapters deals with the theme of corruption in the blood. Tara Nummedal offers a fascinating analysis of the relationship between blood and alchemy’s concern with the role that menstrual blood played in generation and corruption. This chapter considers the work of Anna Zieglerin, a German alchemist who claimed that her own body had been purified by alchemy, causing her not to menstruate. Ben Parsons discuses another corrupted demographic, adolescent boys. According to medieval pedagogical treatises, he argues, boys had an excess of blood, a fact that made them both receptive to learning, but also unruly and in need of discipline. In one of the best contributions to this volume, Bonnie Lander Johnson focuses on a specific kind of corruption in Shakespeare’s Romeo and Juliet, namely greensickness, which was believed to affect young people as they reached sexual maturity. She argues that the Nurse’s parallel references to Juliet’s weaning and her maturation “functions as a greensickness narrative” in the play (144).

The fourth section of the book takes up the important role that blood played as a source of proof in legal contexts. Lesel Dawson discusses the bizarre medieval and early modern belief known as “cruentation,” according to which the body of a murder victim would bleed when its murderer approached. Dawson discusses myriad references to this belief in early modern drama. Eleanor Decamp’s important research into the distinctions between barbers, surgeons, and barber-surgeons in the early modern period informs her chapter on the appearance of a basin in the final bloody scene of Titus Andronicus. By showing the association between blood basins and barbery, Decamp unpacks the puns on, references to, and associations with barbery in the climax to Shakespeare’s most gruesome play. Elizabeth Dutton also wonders about blood on the medieval and early modern stage, considering in particular the material fact that it would have been difficult for the actors to get blood off of their hands. Her reflections on this problem cover the anti-Semitic miracle play known as the Croxton Play of the Sacrament, which features a dramatic bleeding host scene, alongside scenes from Macbeth. Patricia Parker’s essay comes back to the importance of blood as proof in an overview of the meanings of the bloody cloth in Cymbeline, which she connects to Sujata Iyengar’s scholarship on the influence of the Passion in Shakespeare’s plays.

The book’s final section, called “Signs and Substance,” is the most loosely connected group of chapters. Frances E. Dolan writes about the association between blood and wine in early modern arguments that England should embrace a domestic viniculture to avoid taking in foreign “blood.” Dolly Jørgensen’s chapter looks at changes in the medieval calendars, specifically the December representation of pig slaughter, which became more graphic in the late medieval period. Helen Barr’s final chapter offers a surprising reading of The Canterbury Interlude (a contemporary response to Chaucer’s Canterbury Tales) where she imagines a Pardoner who is beaten by a phallic pilgrim’s staff as a precursor to the appalling scapegoating that accompanied the AIDS epidemic.

Since many of these chapters focus on drama, the collection will be most useful to Shakespeare enthusiasts and students of early modern drama. The fact that the chapters are fairly short (between 10-15 pages) also makes them good candidates for anyone teaching early modern literature or history with an eye to the history of medicine and the important role of blood as metaphor and substance in the early modern world.

The book is part of a larger “Blood Project,” based at Oxford University. Though it is a bit dated, the website for the project has useful resources for anyone interested in learning more about the role of blood in the history of late medieval and early modern medicine. Readers of this journal might be especially interested in the recorded performance of the Croxton Play of the Sacrament, which is available on that website.

Fall 2018 Table of Contents

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Brandy Schillace, Editor-in-Chief
Hanna Clutterbuck-Cook, Managing Editor
Anna J. Clutterbuck-Cook, Review Editor

Download PDF of 1:3 [link to come]

Editorial

Health, Gender, and Embodiment, Part Two
Brandy Schillace, Editor-in-Chief

Features

Pain, Prestige and Embodiment
by Rosemary Behmer Hanson

#MeToo, Mental health, Revenge Porn, and the Nineteenth Century
by Katherine Gilbert

Sharing Pain: Zines and Mental Illness
by Shelley Lloyd

Maternity Stories as Social Change
by Sarah MacDonald

The ART of Infertility: A Community Project Reimagining Reproduction Advocacy
by Maria Novotny

Embodying Trauma: Acute and Accumulated
by Heather Stewart

Reviews

A Kairotic Moment for Women’s Pain and Illness: A Review of Three Books
Review essay by Caitlin Ray

How to Survive a Plague by David France
Review by Katelyn Smith

Invisible No More by Andrea Ritchie
Review by Ayoola White

The Future of Dósis

Fall 2018 (1:3) is the final issue of Dósis. There will be a Review Supplement (1:3b) issued in November or December of this year, and then the publication will go dormant. For the foreseeable future, this website (medhumdosis.com) will remain online for readers to access the archives going back to March 2011. If you have questions please contact Brandy Schillace at bls10@case.edu.

Download PDF of 1:1 (Winter/Fall 2018).

Download PDF of 1:2 (Summer 2018).

Download PDF of 1:3 (Fall 2018). [link to come]

Download PDF of 1:3b (Fall 2018 Review Supplement). [link to come]