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  • Katie McWain

Madness, Meds, and Mental Hospitals: A Meditation on Foucault

Francisco Goya, The Madhouse (1812) | Photo credit:

“On all sides, madness fascinates man . . . When man deploys the arbitrary nature of his madness, he confronts the dark necessity of the world” (Foucault 23).


During a recent lazy scroll through Buzzfeed, I clicked on an article entitled “Locked on the Psych Ward.” I’ve been interested in mental illness and its manifestations (and marginalization) for most of my life, ever since depression first coiled around my elementary school self and squeezed. So the article’s lead intrigued me: “Lock them in. Bill their insurer. Kick them out. How scores of employees and patients say America’s largest psychiatric chain turns patients into profits.”

Imagine my full-body chill when I realized the piece began with a scathing indictment of practices at what I’ll call Briartree Hospital in my Texas hometown.

I was hospitalized at Briartree for a week in 2006.


Topics I cannot possibly do justice to in the space of this post:

  • Psychiatric hospitals

  • Health care, especially under a Trump presidency

  • Pharmacology (same)

  • The history and/or legality and/or economics of mental illness, psychotherapy, and/or psychiatric medicine

  • The DSM-5

  • Others’ experiences

  • Foucault

  • Madness and Civilization (I agree with the author of the introduction, José Barchilon, when he says that the book is “a tale of nuances, relative values, and delicate shadings” (viii).)

  • Discipline

  • Power

  • Etc.

Topics I think I can represent adequately in this post:

  • My experience

  • My thoughts and feelings

  • My reading of a little Foucault here and there

  • My desire to break my silence


Language is the first and last structure of madness, its constituent form; on language are based all the cycles in which madness articulates its nature” (Foucault 100).


And now, for some language: in Madness and Civilization Foucault traces the long, long trajectory of madness as a western construct, from the rise of the leprosarium to the fictional Ship of Fools to la folie, from the bodily humors to melancholia to the birth of the asylum. Perhaps most notably, he unpacks the landmark founding of Paris’s first Hôpital Géneral in 1656, ushering in an age of confinement and pathologization for abnormalities of all kinds. Foucault notes that the Hôpital was not “a medical establishment,” but “rather a sort of semijudicial structure, an administrative entity which, along with the already constituted powers, and outside of the courts, decides, judges, and executes” its inhabitants (40).

The BuzzFeed article I read, which traces the growth of private psychiatric hospitals since the 1980s and spotlights their tendency to provide questionable care in exchange for astronomical profits, really got me thinking. Thinking, and thinking, and thinking. I realized that I hardly ever talk about my involuntary hospitalizations (one in 2006 and one in 2011), how deeply those memories have been buried, how tight their hold has been on my imagination, but how rarely they emerge in my scholarship or my creative writing or even my private journals.


Here’s Foucault again:

“That the essence of madness can be ultimately defined in the simple structure of a discourse does not reduce it to a purely psychological nature, but gives it a hold over the totality of soul and body; such discourse is both the silent language by which the mind speaks to itself in the truth proper to it, and the visible articulation in the movements of the body” (100, my emphasis).


Some snapshots:

A room at the center of the psychiatric ward with glass walls on three sides, the only room with a TV, the only room with magazines, the only room with movable furniture in which we were allowed to roam free. We called it “the fishbowl,” an arrangement so reminiscent of Foucault’s Panopticon that it was almost, almost funny. Nurses and counselors and psychiatrists could find us there, quickly and easily, to tell us when it was time for group therapy or meds or visitation hours or meals. They didn’t want us to miss anything.

Passing a note to a male patient on behalf of a female patient, Raquel, who was persuasive and full of swagger and drew fresh eyebrows on her face every morning. Being caught by a nurse and having to eat meals in my room for a day as punishment. Never being asked about this incident in rounds and rounds of therapy. Wondering what Raquel’s affliction was. Wondering what my affliction was.

Wondering when I would get to go home.

Talking on the phone with an old boyfriend, a med student studying neuropsychology. He was looking up drug side effects for me. I told him the psychiatrist spent a few minutes asking broad questions and then prescribed me a cocktail of Xanax, Seroquel, and Lithium. The boyfriend told me Seroquel was classified as an anti-psychotic. Was that a diagnosis?

Having to keep my belongings in paper bags, and also having to use paper bags to throw away trash in my hospital room. Realizing after I was discharged that I accidentally tossed the paper bag with my stuff, but made it home with a mountain of used kleenex, magazine subscription cards, and gum wrappers.

Waiting in line for meds twice a day, morning and night. Washing them down with a gulp from a tiny Dixie cup and opening my mouth for inspection. Like a scene from One Flew Over the Cuckoo’s Nest.

Reading sonnets to pass the time, needing the structure of the language, needing the rhythm of syllables as a bolster against the chaos.

Wondering when I would get to go home.


Et tu, Foucault?

“Hence the Hôpital does not have the appearance of a mere refuge for those whom age, infirmity, or sickness keep from working; it will have not only the aspect of a forced labor camp, but also that of a moral institution responsible for punishing, for correcting a certain moral ‘abeyance’ which does not merit the tribunal of men, but cannot be corrected by the severity of penance alone” (59).

Unsurprisingly, Foucault anticipated the meteoric rise of the medical-industrial complex.


There’s definitely a movement to normalize mental illness in American culture right now, though it’s not without its detractors (see, for example, The Atlantic’s missive against “coddling” emotionally fragile college students). I hear ads on almost every podcast I listen to for Talkspace, an unlimited mobile and online messaging therapy service. I hear people talk about Xanax and social anxiety. I hear people talk about bipolar disorder, mania and depression. I hear people talk about the connection between mental health and gut health, whatever that means. I hear people talk about tryptophobia, compulsions, eating disorders, rough patches, drinking too much, seasonal affective disorder, schizophrenia, and always--always--the healing power of yoga.

I never hear people talk about hospitalization.


A final word from my fearless theorist guide: “Disciplinary normalization consists first of all in positing a model, an optimal model that is constructed in terms of a certain result, and the operation of disciplinary normalization consists in trying to get people, movements, and actions to conform to this model, the normal being precisely that which can confine to this norm, and the abnormal that which is incapable of conforming to the norm. In other words, it is not the normal and the abnormal that is fundamental and primary in disciplinary normalization, it is the norm . . . I would rather say that what is involved in disciplinary techniques is a normation rather than normalization” (57, my emphasis).


What constitutes a mental illness? What constitutes madness, really? Is it even a useful construct? Is it a chemical imbalance? Is it a disability? Is it a set of “deviant” behaviors? Is it addiction? Is it a break with dominant discourse? Is it shameful, distasteful? Is it biting your cuticles until they bleed? Is it wanting to die? Is it feeling ambiguous about wanting to live? Is it a diagnosis, a sickness, a disease? Is it a continuum? Is it faulty neurotransmitters? Is it genetic? Is it learned? Is it a prescription? Is it curable? Is it a lack, an excess? Is it anything at all? And why is our protocol for treating it still so eerily reminiscent of the classical age, still so concomitant with Foucault?

I don’t know. But here it is, out of the hospital, out in the open.

Out in my language.


Thanks to Dillon Rockrohr for letting me borrow one of the 47381 books on his desk for this post. Alternate post title: “Deloused in the Leprosarium.” -----------------------------------------------

Works Cited

Adams, Rosalind. “Locked on the Psych Ward.” BuzzFeed, 9 December 2016, Accessed 21 January 2017.

Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. Pantheon Books, 1965.

Lukianoff, Greg, and Jonathan Haidt. “The Coddling of the American Mind.” The Atlantic, September 2015, mind/399356/. Accessed 21 January 2017.

#foucault #madness #mentalhealth #mentalillness #katiemcwain

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