疯癫与文明 详细读书报告

疯癫与文明理性时代的疯癫史 Madness and Civilization A History of Insanity in the Age of Reason米歇尔福柯（Paul-Michel Foucault）著 一、福柯简介法国哲学家米歇尔福柯（19261984）是二十世纪后现代主义大师，被誉为“继萨特之后法国最为深刻的思想巨人”1。他1948年毕业于巴黎高等师范学校哲学系，后攻读心理学与精神病理学学位。曾任教于克莱蒙菲兰特文学院、巴黎大学文森学院，1970年起任法兰西学院思想系统史（History of Systems of Thought）教授，直至逝世。他涉猎甚广，大多数研究致力于考察具体的历史，发掘被遗忘的边缘领域如疯癫，疾病，犯罪和性等。他的主要代表作有：疯癫与文明（Madness and Civilization 1961）、临床医学的诞生（The Birth of the Clinic 1963），词与物（The Order of Things 1966），知识考古学（The Archaeology of Knowledge 1969），规训与惩罚（Discipline and Punish 1975），性史三卷（History of Sexuality，3 volumes：Introduction， The Uses of Pleasure，and Care of the Self 1976-1984）。其中，博士论文疯癫与文明理性时代的疯癫史是他早期的代表作，也是他运用“考古学”研究方法的开山之作。该书是福柯对西方传统理性主义批判的开端，对于理解福柯的后现代思想和考古学的研究方法具有较为重要的意义。2、 疯癫与文明概述 福柯的理想是要在“伟大的尼采式求索的光辉照耀下，展开一系列文化边界研究，以被拒斥的历史体验来批判现代西方文明” 2273-274；在这本书中他将被常人当作自然现象或疾病的疯癫变成了一种文明现象，论述了理性时代的疯癫史。福柯从文献中发现，疯癫不是一种自然的现象，而是一种文明的产物，疯癫的历史是各种文化把这种现象说成疯癫并将其建构成理性的对立面而加以迫害，使其沉默的历史。因此福柯在书中坦言：“精神病学的语言是关于疯癫的理性独白。我的目的不是撰写精神病学语言的历史，而是论述那种沉默的考古学。”33疯癫与文明全书共计十个章节：第一章：“愚人船”、第二章：大禁闭、第三章：疯人、第四章：激情与谵妄、第五章：疯癫诸相、第六章：医生与病人、第七章：大恐惧、第八章：新的划分、第九章：精神病院的诞生和结论。（内容提要）疯癫与文明全面考察了文艺复兴时期、古典时期和近现代三个阶段中疯癫与理性的关系，表明“疯癫不是自然的产物，而是文化的产物”46；因而，“疯癫在不同时期的话语体系中，也就呈现出截然不同的面貌”552：在文艺复兴时期，疯癫是作为一种美学现象或日常现象出现在社会领域中，疯癫成了神秘的启示。在古典时期，由于禁闭，疯癫经历了一个沉默和被排斥的时期，疯癫变成了罪恶；“它丧失了在莎士比亚和塞万提斯的时代曾经具有的展现和揭示的功能（例如，麦克白夫人变疯时开始说出真理）”2273。在近现代，疯癫是病情。疯癫被套上颈圈，被归为自然现象，并系于这个世界的真理。“这种实证主义的粗暴占有所导致的，一方面是精神病学向疯人显示的居高临下的博爱，另一方面是从奈瓦尔到阿尔托的诗作中所能发现的抗议激情。这种抗议是使疯癫体验恢复被禁闭所摧毁的深刻有力的启示意义的努力。”2273在福柯看来，“疯癫史并不是疯癫本身的历史，而是人们怎样看待疯癫的历史，也就是他者意识的历史。因此，福柯所关注的并不是对于疯癫的治疗，而是要对疯癫进行考古学式的研究，要追问关于疯癫的知识和话语的历史建构过程。福柯对人类社会中疯癫历史的真实再现，揭示了福柯对历史理性的颠覆和对传统历史观的瓦解。”548三、部分章节导读第一章：“愚人船” (Stultifera Navis)文艺复兴时期的疯癫体验 福柯从谈论麻风病开始他的论述，他将疯癫的历史最早追溯到中世纪对麻风病的态度里。在中世纪结束时，麻风病从西方世界消失了；在那里，麻风病人原本被禁闭在专设的麻风病院中。疯癫与麻风病看似没有关联，但福柯从中提取出欧洲社会隔离麻风病人的一种特殊有效的方式：隔离，并认为这样一种方式被隐秘的保留下来，并在几个世纪后的古典时代被再次用来对付疯癫行为。“在麻风病院被闲置多年之后，有些东西无疑比麻风病存留得更长久，而且还将延续存在。这就是附着于麻风病人形象上的价值观和意象，排斥麻风病人的意义，即那种触目惊心的可怕形象的社会意义。”34随着麻风病的消失，出现了“愚人船”这一有着现实基础的文学词语。福柯首先论述了愚人船这一形象来描述文艺复兴时期对待疯癫的态度，并认为在愚人船这一形象中隐藏着“净化”的意图。疯人乘船进行航行是通过水域的净化和具有宗教意味的朝圣来追求理性的救赎：“这些萦扰着整个文艺复兴早期想象力愚人船很可能是朝圣船。那些具有强烈象征意义的疯人乘客是去寻找自己的理性。”36-7福柯进一步提出疑惑，为什么在文艺复兴时期突然出现了愚人船？他认为这是因为对疯癫形象的不安。与中世纪时疯癫的平淡相比，文艺复兴时期疯癫的形象一下子变得光彩夺目起来。福柯从故事和道德寓言，学术作品，造型艺术，文学和哲学中展现了疯癫的意象。并认为在文艺复兴时期，疯癫具有一定启示性质。在傻剧中，疯子会用愚蠢的傻瓜寓言来说出理性的词句；在学术作品中，疯癫代替了死亡这一主题，但福柯认为这并不代表思考的断裂，而代表一种忧虑的内在转向，疯癫被用来教导人们对理智的尊崇，因为疯癫即意味着死亡。福柯还对这样一种疯癫的突然出现进行了解剖分析，福柯认为这种疯癫的体验背后体现的是理性世界的变迁。这时候的理性处于一个变革的时代，由哥特文明向启蒙文明的过渡阶段（中世纪，在全知、全能的上帝的阴影之下，人的意义仅在于原罪与救赎；而文艺复兴时代，人开始觉醒，人文主义大行其道），因此在事物与意义之间带来了裂痕，这种裂痕成为滋生梦幻的温床。此时通过疯癫人们看到了某种诱惑：一方面是人们希望通过疯癫来发现人性的秘密和秉性，人们通过对外部疯癫的认识来认识内心隐藏的徒劳的疯癫。另一方面，疯癫也代表着一种知识，代表着人们难以接近的自然的真理。但在同一时期，在文学，哲学和道德方面，疯癫带有另一种含义。人们开始用道德的观念来衡量疯癫，疯癫带有邪恶性，被认为是人类弱点的领袖，但人们看出疯癫并不危险，而只是一种普通的司空见惯的现象。同时，在文学作品中，出现了不同的疯癫形态：浪漫化的疯癫（例如塞万提斯的堂吉诃德）、狂妄自大的疯癫（例如文学作品中的虚妄自恋者）、正义惩罚的疯癫（例如高乃依的梅丽特）和绝望情欲的疯癫（例如哈姆雷特中的奥菲利娅）。由此我们回过头来看文艺复兴时期的疯癫体验，我们可以看到，在文艺复兴时期理性与疯癫的关系。疯癫虽然被构建成为理性的他者，但理性与疯癫却并不是完全对立，更多的是一种平行的关系，理性并不具有统治疯癫的权力。因此福柯总结说道：“从任何意义上看，这个世界在17世纪初对疯癫是特别友善的。疯癫在人世中是一个令人啼笑皆非的符号，它使现实与幻想之间的标志错位，使巨大的悲剧性威胁仅成为记忆。它是一种被骚扰多于骚扰的生活，是一种荒诞的社会骚动，是理性的流动。”332 第二章： 大禁闭 (The Great Confinement) 古典时期（前期）的疯癫体验福柯所说的古典时期指的是从1660年到19世纪末这一时期。对于古典时期疯癫的命运，福柯说道：“新的要求正在产生”。 332在17世纪产生了大量的禁闭所。福柯将1656年巴黎总医院的建立作为古典时期对待疯癫转变的历史标志。作为禁闭所的巴黎总医院并不是一个医疗机构，而是一个半司法机构，一个独立的行政机构。首先，禁闭是一种治安手段。该时期法国正在形成的专制王权与资产阶级联合的统治阶级通过总医院这样的禁闭所将由于经济危机而人数增多的穷人、流浪者、游民、违法者和精神病人都囚禁于高墙之内，而行乞和游手好闲在当时被当作一切混乱的根源。此外，禁闭对于资产阶级还具有经济意义。禁闭“不再仅仅是禁闭不工作的人，而且还包括给被禁闭者提供工作，使他们对民族繁荣做些贡献。”346禁闭所对游手好闲和流浪的乞丐进行肉体和道德的规训，迫使其参加劳作，目的是为工业化大生产提供足够的劳动力，“所有的强壮劳力都被用于实现最大的效益，即都被便宜地加以利用。”347但事实上，禁闭所似乎没有有效地发挥吸收失业和降低生产成本的双重作用。然而福柯认为，禁闭虽然在实用价值方面并没有取得很好的成效，但他关注的是在禁闭中所表现出的基于劳动的道德评价体系。“按照古典时期的解释，劳动所具有的消除贫困的力量和特点，与其说是源于其生产能力，不如说更多地源于某种道德魅力。自从人类堕落以后，人类就把劳动视为一种苦修，指望它具有赎罪的力量。”350因此，游手好闲乃人世的最大祸根。在古典时期，正是具有赎罪力量的劳动使疯人的“特殊之处”暴露无遗：疯人没有工作能力，不能跟上集体生活的节奏。因而人们第一次通过对游手好闲的谴责和劳动的道德意义来认识疯癫，此时疯癫不再是文艺复兴时期带有神秘启示的象征，也不是善意的嘲笑对象，而是代表着一种懒散的形象。这种懒散，使得疯癫背离了劳动的神圣，所以被打上了不道德的烙印。所以在疯癫的历史上，禁闭标志着一个决定性时刻：此时人们从贫困、没有工作能力、没有与群体融合的能力等社会角度来认识疯癫；疯癫被列为城市问题。资产阶级的统治秩序之中的贫困的新意义，工作义务的重要性以及所有与劳动相关的伦理价值，最终决定了人们对疯癫的体验。“理性通过一次预先为它安排的对狂暴的疯癫的胜利，实行着绝对的统治，这样，疯癫就被从想象的自由王国中强行拖出，它被关押起来，在禁闭的城堡中听命于理性，受制于道德戒律，在漫漫黑夜中度日。”357-58第九章：精神病院的诞生(The Birth of the Asylum)19世纪到现代的疯癫体验在第八章新的划分中，福柯认为，从18到19世纪初，禁闭的性质在发生着改变：首先，疯癫对于其他罪犯，既是被惩罚的对象，又是惩罚他人的主体。在18世纪，人们认为犯人应该有比把他们与精神失常者关在一起更好的命运，因为犯人毕竟只是犯人。而在19世纪初，人们的义愤在于疯人受到的待遇并不比刑事犯人或政治犯更好些，因为疯人仅仅是疯人。其次，被禁闭的穷人、游手好闲者被用一种新的眼光来看待。因为贫困此时正在逐渐从以往的道德混合体中分离出来，它成了一种经济现象。“人们已经看到这经济危机时失业与懒惰无关。”3213贫困不再“属于违反劳动伦理意识的罪恶世界，贫困从禁闭所解脱出来。”7 最后，“拘留疯人成了禁闭的一个主要意义”，3218在禁闭的时代结束之后，如何安置疯癫成了一个难题。正是在这样的情况下，精神病院诞生了。福柯集中分析了图克（Tuke）和皮内尔（Pinel）建立的精神病院。在图克的休养院里，疯人被解除了枷锁，但休养院的看护通过谴责疯人的错误行为以及道德和宗教的说教来使疯人带上负罪感，用一种负罪（guilt）与观察（observation）相结合的方式使疯人克制自己。在那里，代表理性权威的看护观察疯人的行为举止，并审判其行为是正常还是失常的。因此福柯评价说：“在19世纪的精神病院中没有强制措施，并不意味着非理性获得解放，而是意味着疯癫早已被制服了。”3233同时，在这种新的理性统治了的精神病院，疯癫“代表的是幼稚，一种未成年状态，因此休养院强调模拟家庭的概念。疯人是家庭中的孩子，应该服从于理性的权威”7。皮内尔组建的精神病院认为“在疯人院里，宗教不应成为生活的道德基础，而应纯粹是一个医疗对象”3236，因为出于对彼岸世界的强烈恐惧常常引发疯癫。但皮内尔的精神病院仍保持宗教的道德内容,是一个没有宗教的宗教领域，一个纯粹的道德领域和道德教育场所。皮内尔为了保证道德教育发挥作用，运用了如下手段：1、缄默。即解除疯人的枷锁，却用周围人的冷漠和缄默束缚他，给他戴上无形的耻辱的“枷锁”。因此，福柯认为，文艺复兴时期理性与疯癫的对话以及古典时期理性与非理性之间一种斗争的对话（dialogue of struggle）已经停止了。“在疯癫和理性之间不再有任何共同语言。”3242 2、镜象认识。治疗者通过引导疯人观察其他疯人表现出的疯癫和荒谬来确认何为真理，并对自己所认识的 真理负责。因此疯人就陷入不断的自我对照的观察中，从而意识到自己的疯癫与无理性。3、无休止的审判。皮内尔希望疯人院能成为一个小型的司法世界，因为他相信“恐怖无情的司法气氛也应是医治疯人的一部分条件”3246，使疯人认识到自己身处一个审判世界，受到监视、审判和谴责，任何抗拒道德和社会一律化的越轨行为必定招致惩罚。因此“疯癫被禁闭在一个道德世界之中。”3249另外，图克和皮内尔的精神病院的一种共通的结构是对医务人员的神话。疯人院引进医务人员并非科学的需要，而是当作司法和道德的保证。疯人院因医疗人员的引入而成为一个医疗空间，但实际上这个空间并没有引进科学，而是引入了一种以科学为面具的人格力量，这种人格力量属于道德和社会范畴。医生凭借其代表着家庭和法律的父亲和法官的形象而能够在疯人院行使绝对权威。医生只需要“一种包含着家庭、权威、惩罚和爱情的秘密的威信”发挥作用，而不是精神方面的专业知识。但实证科学的发展掩盖了医生这一新父亲形象权威的来源。最后福柯谈到了精神分析，他认为精神分析是精神病学的一种进步，但他仍质疑精神分析能够进入疯癫的世界，探析这个非理性领域的本质。福柯相信唯有艺术作品才能做到。福柯在本章结尾不无讽刺的说道，皮内尔等人将疯人从肉体的禁闭中解放出来，却又将他们投入一个巨大的道德桎梏中。显然，疯人（疯癫）并不能从这种解放中获得真正的自由。四、文本摘抄1、Stultifera NavisP6: A strange disappearance, which was doubtless not the long-sought effect of obscure medical practices, but the spontaneous result of segregation and also the consequence, after the Crusades, of the break with the Eastern sources of infection. Leprosy withdrew, leaving derelict these low places and these rites which were intended, not to suppress it, but to keep it at a sacred distance, to fix it in an inverse exaltation. What doubtless remained longer than leprosy, and would persist when the lazar houses had been empty for years, were the values and images attached to the figure of the leper as well as the meaning of his exclusion, the social importance of that insistent and fearful figure which was not driven off without first being inscribed within a sacred circle. P7: Leprosy disappeared, the leper vanished, or almost, from memory; these structures remained. Often, in these same places, the formulas of exclusion would be repeated, strangely similar two or three centuries later. Poor vagabonds, criminals, and deranged minds would take the part played by the leper, and we shall see what salvation was expected from this exclusion, for them and for those who excluded them as well. With an altogether new meaning and in a very different culture, the forms would remainessentially that major form of a rigorous division which is social exclusion but spiritual reintegration. P7-9: Something new appears in the imaginary landscape of the Renaissance; soon it will occupy a privileged place there: the Ship of Fools, a strange drunken boat that glides along the calm rivers of the Rhineland and the Flemish canals. But of all these romantic or satiric vessels, the Narrenschiff is the only one that had a real existencefor they did exist, these boats that conveyed their insane cargo from town to town. Madmen then led an easy wandering existence. The towns drove them outside their limits; they were allowed to wander in the open countryside, when not entrusted to a group of merchants and pilgrims. It is possible that these ships of fools, which haunted the imagination of the entire early Renaissance, were pilgrimage boats, highly symbolic cargoes of madmen in search of their reason: some went down the Rhineland rivers toward Belgium and Gheel; others sailed up the Rhine toward the Jura and Besancon. P13-14: But if the navigation of madmen is linked in the Western mind with so many immemorial motifs, why, so abruptly, in the fifteenth century, is the theme suddenly formulated in literature and iconography? Why does the figure of the Ship of Fools and its insane crew all at once invade the most familiar landscapes? Why, from the old union of water and madness, was this ship born one day, and on just that day? Because it symbolized a great disquiet, suddenly dawning on the horizon of European culture at the end of the Middle Ages. Madness and the madman become major figures, in their ambiguity: menace and mockery, the dizzying unreason of the world, and the feeble ridicule of men. In farces and soties, the character of the Madman, the Fool, or the Simpleton assumes more and more importance. He is no longer simply a ridiculous and familiar silhouette in the wings: he stands center stage as the guardian of truth-playing here a role which is the complement and converse of that taken by madness in the tales and the satires. If folly leads each man into a blindness where he is lost, the madman, on the contrary, reminds each man of his truth; in a comedy where each man deceives the other and dupes himself, the madman is comedy to the second degree: the deception of deception; he utters, in his simpletons language which makes no show of reason, the words of reason that release, in the comic, the comedy: he speaks love to lovers, the truth of life to the young, the middling reality of things to the proud, to the insolent, and to liars. P26-27: In a general way, then, madness is not linked to the world and its subterranean forms, but rather to man, to his weaknesses, dreams, and illusions. There is no madness but that which is in every man, since it is man who constitutes madness in the attachment he bears for himself and by the illusions he entertains. Philautia is the first figure Folly leads out in her dance, but that is because they are linked by a privileged relation: self-attachment is the first sign of madness, but it is because man is attached to himself that he accepts error as truth, lies as reality, violence and ugliness as beauty and justice. This man, uglier than a monkey, imagines himself handsome as Nereus; that one thinks he is Euclid because he has traced three lines with a compass; that other one thinks he can sing like Hermogenes, whereas he is the ass before the lyre, and his voice sounds as false as that of the rooster pecking his hen. In this delusive attachment to himself, man generates his madness like a mirage. The symbol of madness will henceforth be that mirror which, without reflecting anything real, will secretly offer the man who observes himself in it the dream of his own presumption. Madness deals not so much with truth and the world, as with man and whatever truth about himself he is able to perceive. P36: Tamed, madness preserves all the appearances of its reign. It now takes part in the measures of reason and in the labor of truth. It plays on the surface of things and in the glitter of daylight, over all the workings of appearances, over the ambiguity of reality and illusion, over all that indeterminate web, ever rewoven and broken, which both unites and separates truth and appearance. It hides and manifests, it utters truth and falsehood, it is light and shadow. It shimmers, a central and indulgent figure, already precarious in this baroque age.2、The Great ConfinementP41: From the very start, one thing is clear: the Hopital General is not a medical establishment. It is 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. The directors having for these purposes stakes, irons, prisons, and dungeons in the said Hopital General and the places thereto appertaining so much as they deem necessary, no appeal will be accepted from the regulations they establish within the said hospital; and as for such regulations as intervene from without, they will be executed according to their form and tenor, notwithstanding opposition or whatsoever appeal made or to be made, and without prejudice to these, and for which, notwithstanding all defense or suits for justice, no distinction will be made. A quasi-absolute sovereignty, jurisdiction without appeal, a writ of execution againstwhich nothing can prevailthe Hopital General is a strange power that the King establishes between the police and the courts, at the limits of the law: a third order of repression. The insane whom Pinel would find at Bicetre and at La Salpetriere belonged to this world. P45-46: Proof that even at this period, a certain meaning had been lost: that which had so hastily, so spontaneously summoned into being all over Europe the category of classical order we call confinement. In a hundred and fifty years, confinement had become the abusive amalgam of heterogeneous elements. Yet at its origin, there must have existed a unity which justified its urgency; between these diverse forms and the classical period that called them into being, there must have been a principle of cohesion we cannot evade under the scandal of pre-Revolutionary sensibility. What, then, was the reality represented by this entire populationwhich almost overnight found itself shut up, excluded more severely than the lepers? We must not forget that a few years after its foundation, the Hopital General of Paris alone contained six thousand persons, or around one per cent of the population. There must have formed, silently and doubtless over the course of many years, a social sensibility, common to European culture, that suddenly began to manifest itself in the second half of the seventeenth century; it was this sensibility that suddenly isolated the category destined to populate the places of confinement. To inhabit the reaches long since abandoned by the lepers, they chose a group that to our eyes is strangely mixed and confused. But what is for us merely an undifferentiated sensibility must have been, for those living in the classical age, a clearly articulated perception. It is this mode of perception which we must investigate in order to discover the form of sensibility to madness in an epoch we are accustomed to which, by tracing the locus of confinement, conferred upon it its power of segregation and provided a new homeland for madness, though it may be coherent and concerted, is not simple. It organizes into a complex unity a new sensibility to poverty and to the duties of assistance, new forms of reaction to the economic problems of unemployment and idleness, a new ethic of work, and also the dream of a city where moral obligation was joined to civil law, within the authoritarian forms of constraint. Obscurely, these themes are present during the construction of the cities of confinement and their organization. They give a meaning to this ritual, and explain in part the mode in which madness was perceived, and experienced, by theclassical age. P46: Confinement, that massive phenomenon, the signs of which are found all across eighteenth-century Europe, is a police matter. Police, in the precise sense that the classical epoch gave to itthat is, the totality of measures which make work possible and necessary for all those who could not live without it; the question Voltaire would soon formulate, Colberts contemporaries had already asked: Since you have established yourselves as a people, have you not yet discovered the secret of forcing all the rich to make all the poor work? Are you still ignorant of the first principles of the police? Before having the medical meaning we give it, or that at least we like to suppose it has, confinement was required by something quite different from any concern with curing the sick. What made it necessary was an imperative of labor. Our philanthropy prefers to recognize the signs of benevolence toward sickness where there is only a condemnation of idleness. P55: In this first phase of the industrial world, labor did not seem linked to the problems it was to provoke; it was regarded, on the contrary, as a general solution, an infallible panacea, a remedy to all forms of poverty. Labor and poverty were located in a simple opposition, in inverse proportion to each other. As for that power, its special characteristic, of abolishing poverty, laboraccording to the classical interpretationpossessed it not so much by its productive capacity as by a certain force of moral enchantment. Labor effectiveness was acknowledged because it was based on an ethical transcendence. Since the Fall, man had accepted labor as a penance and for its power to work redemption. It was not a law of naturewhich forced man to work, but the effect of a curse. The earth was innocent of that sterility in which it would slumber if man remained idle: The land had not sinned, and if it is accursed, it is by the labor of the fallen man who cultivates it; from it no fruit is won, particularly the most necessary fruit, save by force and continual labor. 3、The Birth of the AsylumP274: We must therefore re-evaluate the meanings assigned to Tukes work: liberation of the insane, abolition of constraint, constitution of a human milieuthese are only justifications. The real operations were different. In fact Tuke created an asylum where he substituted for the free terror of madness the stifling anguish of responsibility; fear no longer reigned on the other side of the prison gates, it now raged under the seals of conscience. Tuke now transferred the age-old terrors in which the insane had been trapped to the very heart of madness. The asylum no lo