Some background: A few weeks ago on Twitter I floated around the idea of writing a semi-regular blog post on my experiences reading Foucault for the first time as a neuroscience grad student/MRI researcher.  There was some interest, so here’s my first write-up on my experiences and reactions to reading Michel Foucault’s History of Madness, as part of Professor Lynne Huffer’s course (WGS 475) here at Emory.

In this first chapter, Foucault is retracing/uncovering/attempting to uncover the basis of Western ideas related to insanity and institutionalization. We learn about the role of the leper, leprosy, and the leper colony in the European middle ages, where infected individuals were isolated and contained outside city walls, providing a sort of delineation between society and these outcasts. How is this related to insanity or madness? Well, Foucault is building a case for the replacement of the leper, as the infection began to disappear from Europe, with the mad. This did not happen immediately, however, and Foucault briefly mentions how those infected with “venereal disease” were for period of time quarantined as the number of individuals with leprosy declined.

The neuroscientist in me got curious about the linkage between leprosy and the later movement to banish the insane into asylums, as lepers before. Specifically, syphilis is a well-known sexually-transmitted infection that often progresses to neurosyphilis, causing a range of cognitive and behavioral symptoms including memory problems, mood swings, psychosis, seizures, apathy, and dementia. (Don’t worry, everybody, we can treat this stuff with penicillin now before it ever gets that bad).

Neurosyphilis can cause brain shrinkage resulting in ventricular enlargement (the large white areas in this MR T2 scan (solid tissue is dark, fluid is white). This patient was treated successfully with antibiotics and the neurological symptoms improved. Figure 2 from Schiff and Lindberg (2002) Southern Medical Journal 95:9.

I don’t know how the rate of syphilis infection was among other forms of “venereal disease” in the 15th century, but it seems reasonable to speculate that the behavior of neurosyphilitic patients may have created a space for the concept of “madness” and the move towards quarantining and confining the mad. I do want to stress here that our current epidemiological descriptions of syphilis and neurosyphilis are surely contingent upon what our current medical criteria are for neurological symptoms like “psychosis”, as well as societal understandings of what sequelae we might expect from a neurological infection. Put another way, I am asking: would neurosyphilitic patients of the 15th century have produced symptoms of psychosis that a modern physician would recognize? And, on the flip side, without the modern concept of psychosis existing in 15th century Europe, how would those caring for afflicted individuals interpret their behavior?

It’s impossible to know the answers to these questions, but we can at least start from a material place to get some footing. Syphilis is an infection produced by the same spirochete then as now. The neural substrate it infects, from a cellular point of view, is the same. The change from treating leprosy to rather severe forms of STIs (I say severe because I doubt those with mild, non-noticeable infections would have been quarantined in this way) may have transformed the social environment within the quarantine itself. Foucault writes “A new leprosy was born, which took the place of the former, but not without difficulty or conflict. For these new lepers too struck fear into the hearts of the old” (p. 7). The STI patients became lepers among lepers – interesting. Even if the shunning of these patients was rationalized at the time as being a moral issue, it seems then that that which is painted as immoral (the symptomatic individual) could spread from the physical symptoms to the behavioral or cognitive. Perhaps behavior that seems unusual could also be redrawn as another symptom of moral failing, or perhaps a basis or cause for moral failing.

Later in the chapter, Foucault returns many times to the relationship between madness and reason, God and man, man and inner demons, and madness as a form of sin. It will be interesting to learn more on society’s perceptions of madness and morality, as well as morality and reason.

All for now – stay tuned for my next installment.