'Mentall Illness and Psychology' by Michel Foucault (1962)

Although Mental Illness and Pyschology shares many themes with Madness and Civilization, it is less literary and allegorical and more clinical and descriptive in style, resembling a work of existential psychiatry more than a work of history, thus situating it more in the discourse of psychiatry than historiography.

[Work in Progress]

Part 1: The Psychological Dimensions of Mental Illness

Mental Illness and Evolution

...the duplication of the body and the constitution of an alter ego in which the subject reads as in a mirror his thoughts, his wishes, and his gestures, of which this demonic double dispossess him in advance.

...the myth, to begin with, of a certain psychological substance..., which is seen as the raw material of evolution and which, progressing in the course of individual and social development, is subject to relapses and can fall back, through illness, to an earlier state; the myth, too, of an identity between the mentally ill person, the primitive, and the child.

Mental Illness and Individual History

Regression is not a natural falling back into the past; it is an intentional flight from the present. A recourse rather than a return.

What is this permanent danger that appeared at the dawn of his psychological life, that will constantly stand out against his world, and that threatens with the ever changing faces of a danger which has remained identical?

The pathological mechanism is... a protection against a conflict, a defense in face of the contradiction that arouses it. 
But not every conflict elicits a morbid reaction, and the tension it arouses is not necessarily pathological; it may even be the web of all psychological life. The conflict revealed by the neurotic compromise is not simply an external contradiction in the objective situation, but an immanent contradiction, in which the terms intermingle in such a way that the compromise, far from being a solution, is in the last resort a deepening of the conflict.  [...] Pathological contradiction is not normal conflict: normal conflict tears apart the subject's affective life from the outside; it arouses in him opposed forms of conduct; it disturbs his stability; it causes actions, then leads to remorse; it may even raise contradiction to the level of incoherence. But normal incoherence is, strictly speaking, different from pathological absurdity, which is animated from the inside by contradiction... .  [...] Where the normal individual experiences contradiction, the ill person undergoes a contradictory experience; the experience of the first opens onto contradiction, that of the second closes itself against it. In other words: normal conflict, or ambiguity of the situation; pathological conflict, or ambivalence of experience.
 Just as fear is a reaction to external danger, anxiety is the affective dimension of this internal contradiction. It is a total disorganization of the affective life, the major expression of ambivalence, the form in which that ambivalence is fulfilled; it is the vertiginous experience of simultaneous contradiction, the experience of a simultaneous wish for life and death, love and hate... . Beneath all the protective mechanisms that particularize the illness, anxiety reveals itself and each type of illness defines a specific way of reacting to it: the hysteric represses his anxiety, obliterates it by embodying it in a physical symptom; the obsessional neurotic ritualizes, around a symbol, actions that enable him to satisfy both sides of his ambivalence; while the paranoiac justifies himself mythically by attributing to others by projection all the feelings that bear within them their own contradiction- he distributes among others the elements of his ambivalence and masks his anxiety beneath the forms of his aggressivity.  

Mental Illness and Existence

Eugene Minkowski studied disturbances in the temporal forms of the morbid world. In particular, he analyzed a case of paranoid delusion in which the patient felt threatened by catastrophes that no precautions could obviate: at every moment the imminence was renewed, and the fact that the apprehended misfortune never took place could not prove that it would not take place in the next few moments. The catastrophe with which he felt threatened was being crushed to death by all the waste material, dead matter, and garbage in the world. It is easy enough to see a significant relation between this content of delusion and the anxious theme of imminent catastrophe: being haunted by "remains" expresses, for the subject, an inability to conceive how a thing might disappear, how what is no more cannot but still remain. The accumulation of the past can no longer, for him, be liquidated; and, correlatively, past and present cannot anticipate the future; no acquired security can serve as a guarantee against the threats that it contains; in the future everything is absurdly possible. Thus, in their insane intertwining, these two themes reveal a major disturbance in temporality; time no longer projects itself or flows; the past piles up; and the future, which opens up, can contain as promise only the crushing of the present by the ever increasing weight of the past.
Thus each disorder involves a specific alteration in experienced time. For example, Binswanger... defined the temporal disturbance of mania: time is rendered instantaneous by fragmentation; and, lacking any opening on to the past and future, it spins round upon its axis, proceeding either by leaps or by reptitions. It is against such a background of disturbed temporality that the "flight of ideas," with its characteristic alteration of thematic reptitions of leaping, illogical associations, must be understood. The schizophrenic's time is also subject to interruption, but this occurs through the imminence of the Sudden and the Terrifying, which the patient can escape only through the myth of an empty eternity; the schiozphrenic's temporality is thus divided between the fragmented time of anxiety and the formless, content-less eternity of delusion.

Space, as as structure of the experienced world, lends itself to the same kind of analysis.
Sometimes distances disappear, as in the case of those delusional subjects who recognize here people they know to be somewhere else, or those subjects suffering form hallucinations who hear their voices, not in the objective space in which sound sources are situated, but in a mythical space, in a sort of quasi space in which the axes of reference are fluid and mobile.... . The transparent space in which each object has its geographical place and in which perspectives are articulated one upon another is replaced by an opaque space in which objects are mingled together, move forward and away in an immediate mobility, are displaced without movement, and finally fuse in a perspectiveless horizon. As Minkowski says, "clear space" blurs into "obscure space," the space of fear and night; or rather they come together in the morbid world instead of being separated, as in the normal world.
In other cases, space becomes insular and rigid. Objects lose the index of insertion that also marks the possibility of using them; they are offered in a singular plenitude that detaches them from their context, and they are affirmed in their isolation, without any real or potential link with other objects; instrumental relations have disappeared. Roland Kuhn has studied from this angle the delusions of "limits" in certain schizophrenics: the importance given to limits, to frontiers, to walls, to anything that encloses and protects, is a function of the absence of internal unity in the arrangement of things; it is to the extent that things do not "hold" together that they must be protected from the outside and maintained in a unity that is not natural to them. Objects have lost their cohesion and space has lost its coherence, as in the case of the patient who spent his whole time drawing the plan of a fantastic city whose endless fortifications protected only a group of insignificant buildings.

It is not only the spatiotemporal world, the Umwelt, that, in its existential structures, is disturbed by the illness, but also the Mitwelt, the social and cultural world. For the patient, others cease to be partners in a dialogue or task; they present themselves to him against the background of social implications, they lose their reality as socii and become, in this depopulated world, Strangers. It is to this radical alteration that the frequent syndrome of "symbolic derealization of others" refers- or the feeling of strangeness when confronted by others' language, systems of expression, bodies; this difficulty in attaining any certainty about others' existence; the heaviness and distance of an inhuman universe in which things freeze when expressed, in which significations have the massive indifference of things, and in which symbols assume the gravity of enigmas: this is the rigid world of the psychasthenic and of most schizophrenics. Mme. Sechehaye's patient described one of her first feelings of unreality thus:

'I found myself in the principal's office; the room suddenly became huge, as if lit up by a terrible light. [...] From time to time, a single word would stand out from the rest. It would repeat itself in my brain, as if cut off with a knife, absurd.'

The child was afraid, the teacher spoke to her, reassuringly:

'She smiled at me kindly... . But instead of reassuring me, her smile merely increased my anxiety and confusion; for I became aware of her white, regular teeth. Her teeth gleamed in the bright light and, though I never forgot that they were the teacher's teeth, they soon occupied my whole vision, as if the entire room were nothing but teeth under that pitiless light.'

At the other pole of pathology, there is the infinitely fluid world of hallucinatory delusion: a constantly recommenced tumult of pseudo-recognitions, in which each other individual is not simply another, but the major Other, constantly re-encountered, constantly pursued and found again; a single presence with the thousand faces of the abhorred man who betrays and kills, of the devouring woman who weaves the great spell of death. Each face, whether strange or familiar, is merely a mask, each statement, whether clear or obscure, conceals only one meaning: the mask of the persecutor and the meaning of persecution.
The masks of psychasthenia, the masks of hallucinatory delusion: it is in the monotony of the first that the variety of human faces begins to be lost; it is beneath the innumerable profiles of the second that the delusional experience of the hallucinated subject, single, stable, and burdened with a pitiless meaning, is rediscovered.
...mental illness may reach man in the individual sphere in which the experience of his own body takes place. The body then ceases to be the centre of reference around which the ways of the world open up their possibilities. At the same time, the presence of the body on the horizon of consciousness alters. Sometimes it thickens to the point of assuming the heaviness and immobility of a thing; it veers into an objectivity in which the consciousness can no longer recognize its own body; the subject experiences himself only as a corpse or as an inert machine, all of whose impulses emanate from a mysterious exteriority.
Sometimes... the full consciousness of the body, with its spatiality and the density in which the proprioceptive experiences are inserted, so declines that it is no more than a consciousness of an incorporeal life and a delusional belief in an immortal existence; the world of one's body, the Eigenwelt, seems to be voided of content, and this life, which is simply a consciousness of immortality, is exhausted in a slow death, which it prepares by the refusal of all food, all bodily care, and all material concerns."

Part 2: Madness and Culture

The Historical Constitution of Mental Illness.

Madness: An Overall Structure

...the Renaissance, after the great terror of death, the fear of the apocalypses, and the threats of the other world, experience a new danger in this world: that of a silent invasion from within, a secret gap in the earth, as it were. This invasion is that of the insane, which places the Other world on the same level as this one, and on ground level, as it were. As a result, one no longer knows whether it is our world that is duplicated in a fantastic mirage; whether, on the contrary, it is the other world that takes possession of this world; or whether the secret of our world was to be already, without our knowing, the other world. This uncertain, ambiguous experience... allows strangeness to reside at the very heart of the familiar... .


'Homo psychologicus', possessor of internal truth, fleshless, ironical, and positive of all self-consciousness and all possible knowledge.