Michel Foucault (1926 to 1984) was a French philosopher and historian who held that what a society counts as madness, and how it treats the mad, has a history, and that knowledge about people is never separate from power over them. In History of Madness (1961) he traced how Europe moved from confining the mad alongside the poor and idle to treating madness as mental illness, and in The Birth of the Clinic (1963) he described the ‘medical gaze’ that came to read illness as a lesion inside the body. Therapeutic Shamanism shares his question about who decides what is mad, whilst holding, unlike some of his readers, that madness and healthy shamanic experience are not the same thing.
Who was Michel Foucault? #
He was born in Poitiers in 1926, the son and grandson of doctors, and studied philosophy and psychology at the École Normale Supérieure in Paris. His doctoral thesis on the history of madness was published in 1961, and an abridged English version appeared in 1965 as Madness and Civilization.1 He taught in Clermont-Ferrand, Tunis and Paris, and in 1969 was elected to the Collège de France, where he held a chair in the History of Systems of Thought until his death in Paris in 1984. His later books, Discipline and Punish (1975) on the prison and the volumes of The History of Sexuality, made him among the most widely read writers of the twentieth century.2
What did he say about madness? #
That madness is not a fixed thing which medicine simply discovered, but something each age has seen and handled in its own way. History of Madness begins with the leper houses of the Middle Ages, emptied as leprosy faded, and asks why they came to be filled with the mad. Its central event is what he called the Great Confinement. In 1656 the Hôpital Général was founded in Paris, and within a few years about one person in every hundred in the city had been shut away, the mad together with beggars, the poor and the idle, all those who did not fit the new order of reason and work.3
The usual story says that at the end of the eighteenth century reformers such as Philippe Pinel in France and the Tuke family in England freed the mad from their chains and gave them humane, medical care. Foucault disputed that this was simply liberation. In his account the new asylum replaced chains with a moral and medical control just as strong, and calling madness ‘mental illness’ did not end the silencing of the mad; the authority of medicine could also serve to keep a challenge to the morality of the day in its place.4 He also held that madness had spoken in art and thought, in Goya, Nietzsche, Van Gogh and Artaud, in ways that reason found hard to hear.3
What is the medical gaze? #
The way of seeing that Foucault thought modern medicine was built on. In The Birth of the Clinic he described how, around 1800, doctors stopped following a disease through the story of its symptoms and began looking through the body to find a fixed lesion inside it, confirmed by the post-mortem and practised in the new teaching hospitals. The French word is le regard, translated as ‘the gaze’, and it was an active way of looking, not a neutral one: the patient became the place where the disease was found, and seeing and knowing were joined in the clinic.5 Seen this way, Western clinical medicine is one historically located way of understanding illness, not simply the discovery of what was always there.5 In Discipline and Punish he took the same idea further, to the prison, the school and the barracks, where watching and examining people are themselves a form of power. In knowing people we control them, and in controlling them we come to know them.6
Is his history of madness accurate? #
Historians still argue about it. The medical historian Andrew Scull, reviewing the full English translation in 2007, charged that many of its historical claims are not supported by the sources, and the historian Roy Porter showed that France was the only European country to centralise care of the pauper mad in this way, so the Great Confinement was not the Europe-wide event the book can seem to describe.7
On the other side, Colin Gordon, a translator and editor of other works by Foucault, has replied that much of the criticism rested on the heavily abridged 1965 translation and misread what the book set out to do, which was a history of how a culture draws its limits, not a history of madness itself. He also notes that Porter, who first dismissed Foucault, later called him the greatest historian of psychiatry.8
How does Foucault’s work connect with Therapeutic Shamanism? #
Most of all in the question of who gets to decide what is mad. From a shamanic perspective the Taker society most of us live in is itself a deeply psychopathic one, and growing up in it we absorb ways of seeing that are profoundly un-shamanic: that humans are more intelligent or conscious than other species, that the world divides into living and non-living things, that we may use the Earth as we wish.9 When indigenous animists and shamans look at Taker society and say that its people are mad, they are not joking or using a figure of speech.10 People who do not buy into the dominant culture are seen as weird or threatening, and the culture’s institutions, hospitals among them, usually rest on its values.9 Foucault came at this from inside Western history; Therapeutic Shamanism comes at it from the long view of the FallThe Fall. The catastrophe at the root of the whole diagnosis: the shift from animist, egalitarian hunter-gatherer life to owning, agricultural Taker culture. In domesticating other species we domesticated ourselves, cutting ourselves off from Mother Earth (Power-loss) and from parts of our own nature (soul-loss). When dated precisely, the Fall begins with the first city-state cultures, around 4000 BCE (Domestication begins earlier, with the Neolithic). A sickness, not our true nature. ‘Fallen culture’ is used interchangeably with Taker culture; the Great Rupture is a looser alternate name. Read the full answer. See What are Leaver and Taker cultures, the Great Forgetting and the Great Remembering?
The same question runs through the teaching on the Wild Mind and the Domesticated Mind. Even the word neurodiverse, Therapeutic Shamanism suggests, may still be “pathologising us”, treating the neurotypical as normal, when what passes for normal may be “neurodomesticated”, a product of domesticationDomestication. The process by which, in domesticating other species, we domesticated ourselves. When dated precisely, Domestication begins with the Neolithic era, before the Fall proper, which begins with the first city-state cultures around 4000 BCE. What rewilding works to undo. More about this and the Fall. See What is neurodiversity, and how does Therapeutic Shamanism see it?
The medical gaze has a counterpart too. A healer of any kind, doctor, counsellor or shaman, can impose their own perception and agenda on the person in front of them. Therapeutic Shamanism holds that it is the client’s session and the client decides what is worked on, because the aim is to empower, never to have power over.11 And the shamanic view of illness looks beyond the lesion to the whole person in relationship: power-loss, for example, is disconnection from nature and from the web of life and our place in it.12
Where does Therapeutic Shamanism see things differently? #
On madness itself. His history is sometimes taken to mean that madness is only a label, or a hidden wisdom that society silences. Therapeutic Shamanism does not go there. It is often said in the West that all madness is really a shamanic awakening, and an awakening can feel like madness, but it is not at all true that all madness is a shamanic awakening. Shamanic cultures clearly tell healthy shamanic experience apart from madness, and the mark of the shaman is the ability to move between realities at will; having both feet in shamanic reality all the time is not shamanism, but madness.13 See Were traditional shamans mentally ill? and How is shamanic journeying different from psychosis?
Nor does Therapeutic Shamanism set itself against medicine. Not all illness has a shamanic cause. A renowned shaman in Peru, filmed by two visiting English doctors, asked them for cream for a fungal infection on his foot, and later healed a sick child whose illness did have a shamanic cause; he knew when something needed Western medicine and when it needed shamanic medicine.14 The medical way of seeing is one slice of a larger picture, useful in its place, never the whole of it. See How do shamans diagnose illness?
