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Despite the reassuring pleasure that historians of medicine may feel when they recognise in the great ledgers of confinement what they consider to be the timeless, familiar face of psychotic hallucinations, cognitive deficiencies, organic consequences or paranoid states, it is impossible to draw up a coherent nosological map from the descriptions that were used to confine the insane. The formulations that justify confinement are not presentiments of our diseases, but represent instead an experience of madness that occasionally intersects with our pathological analyses, but which could never coincide with them in any coherent manner. The following are some examples taken at random from entries on confinement registers for those of ‘unsound mind’: ‘obstinate plaintiff’, ‘has obsessive recourse to legal procedures’, ‘wicked cheat’, ‘man who spends days and nights deafening others with his songs and shocking their ears with horrible blasphemy’, ‘bill poster’, ‘great liar’, ‘gruff, sad, unquiet spirit’. There is little sense in wondering if such people were sick or not, and to what degree, and it is for psychiatrists to identify the paranoid in the ‘gruff’, or to diagnose a ‘deranged mind inventing its own devotion’ as a clear case of obsessional neurosis. What these formulae indicate are not so much sicknesses as forms of madness perceived as character faults taken to an extreme degree, as though in confinement the sensibility to madness was not autonomous, but linked to a moral order where it appeared merely as a disturbance. Reading through the descriptions next to the names on the register, one is transported back to the world of Brant and Erasmus, a world where madness leads the round of moral failings, the senseless dance of immoral lives.
And yet the experience is quite different. In 1704, an abbot named Bargedé was confined in Saint-Lazare. He was seventy years old, and he was locked up so that he might be ‘treated like the other insane’. His principal occupation was
lending money at high interest, beyond the most outrageous, odious usury, for the benefit of the priesthood and the Church. He will neither repent from his excesses nor acknowledge that usury is a sin. He takes pride in his greed. Michel Foucault (1961) [2006] History of Madness, Translated by Jonathan Murphy and Jean Khalfa, pp. 132-133
In larger context, Foucault is describing how during the seventeenth and eighteenth centuries (the so-called 'classical age') a great number of people (Foucault suggests a number of 1% of the urban population) were locked up in a system of confinement orthogonal to the juridical system (even though such confinement was often practically indistinguishable from prison--both aimed at moral reform through work and sermons). This 'great confinement' included people with venereal disease, those who engaged in sodomy and libertine practices as well as (inter alia) those who brought dishonor (and financial loss) to their families alongside the mad and frenzied.
To the modern reader the population caught up in the 'great confinement' seems rather heterogeneous in character, but their commonality becomes visible, according to Foucault, when one realizes that it's (moral) disorder that they have in common from the perspective of classical learning. According to Foucault there is "no rigorous distinction between moral failings and madness." (p. 138) Foucault inscribes this (moral disorder of the soul/will) category into a history of 'Western unreason' that helps constitute (by way of negation) the history of early modern rationalism (with special mention of Descartes and Spinoza). Like a true Kantian, Foucault sees (theoretical) reason as shaped by practical decision as constitutive of the whole classical era (see especially p. 139). My present interest is not to relitigate the great Derrida-Foucault debate over this latter move, or Foucault's tendency to treat -- despite his nominalist sensibilities -- whole cultural eras as de facto organically closed systems (of the kind familiar from nineteenth century historiography).
My interest here is in the first two sentences of the quoted passage. It describes what Thomas Kuhn called 'incommensurability' in The Structure of Scientific Revolutions. Kuhn's Structure appeared in 1962, and initially there seems to have been no mutual influence. I don't want to make Foucault more precise than he is, but we can fruitfully suggest that for Foucault incommensurability involves the general inability to create a coherent mapping between two theoretical systems based on their purported descriptive content. I phrase it like to capture Foucault's emphasis on 'descriptions' and to allow -- mindful of Earman and Fine ca 1977 -- that some isolated terms may well be so mapped. As an aside, I am not enough of a historian of medicine (or philosopher of psychology) to know whether nosological maps can be used for such an exercise. (It seems like a neat idea!)
So, Foucault is thinking about ruptures between different successive scientific cultures pretty much from the start of his academic writing (recall this post on the later The Order of Things). In fact, reading History of Madness after reading a lot of Foucault's other writings suggests a great deal of continuity in Foucault's thought--pretty much all the major themes of his later work are foreshadowed in it (and it also helps explain that he often didn't have to start researching from scratch in later writings and lectures).
In fact, reading Foucault with Kuhn lurking in the background helps one see how important a kind of Kantianism is to Foucault's diagnosis of incommensurability. I quote another passage in the vicinity that I found illuminating:
The psychopathology of the nineteenth century (and perhaps our own too, even now) believes that it orients itself and takes its bearings in relation to a homo natura, or a normal man pre-existing all experience of mental illness. Such a man is in fact an invention, and if he is to be situated, it is not in a natural space, but in a system that identifies the socius to the subject of the law. Consequently a madman is not recognised as such because an illness has pushed him to the margins of normality, but because our culture situates him at the meeting point between the social decree of confinement and the juridical knowledge that evaluates the responsibility of individuals before the law. The ‘positive’ science of mental illness and the humanitarian sentiments that brought the mad back into the realm of the human were only possible once that synthesis had been solidly established. They could be said to form the concrete a priori of any psychopathology with scientific pretensions.--pp. 129-130
For Foucault, a concrete a priori is itself the effect of often indirect cultural construction or stabilization. In fact, for Foucault it tends to be an effect of quite large-scale and enduring ('solidly') social institutions (e.g., the law, penal/medical institutions) and material practices/norms. The discontinuity between concrete a priori's track what we may call scientific revolutions in virtue of the fact that systems of knowledge before and after a shift in a concrete a priori cannot possibly be tracking the same system of 'objects' (or 'empirical basis').
I don't mean to suggest that for Foucault a system of knowledge cannot be itself a source/cause of what he calls a 'synthesis' that makes a concrete a priori possible. That possibility is explicitly explored in (his discussion of Adam Smith in) his The Order of Things. But on the whole a system of knowledge tends to lag the major cultural shifts that produce a concrete a priori.
Let me wrap up. A full generation after Structure appeared there was a belated and at the time revisionary realization that Structure could be read as a kind of neo-Kantian text and, as such, was actually not very far removed from Carnap's focus on frameworks and other projects in the vicinity that were committed to various kinds of relativized or constitutive a prioris. This literature started, I think, with Reisch 1991. (My own scholarship has explored [see here; here] the surprising resonances between Kuhn's Structure and the self-conception of economists and the sociology of Talcott Parsons at the start of twentieth century and the peculiar fact that Kuhn's Structure was foreshadowed in Adam Smith's philosophy of science.) I mention Carnap explicitly because not unlike Carnap [see Stone; Sachs, and the literature it inspired], Foucault does not hide his debts to Nietzsche.
So here's my hypothesis and diagnosis: it would have been much more natural to read Structure as a neo/soft/extended-Kantian text if analytic philosophers had not cut themselves off from developments in Paris. While I do not want to ignore major differences of emphasis on scope between Kuhn and Foucault, their work of 1960 and 1962 has a great deal of family resemblance despite non-trivial differences in intellectual milieus. I actually think this commonality is not an effect of a kind of zeitgeist or the existence of an episteme--as I suggested in this post, it seems to be a natural effect of starting from a broadly domesticated Kantianism. But having said that, that it was so difficult initially to discern the neo-Kantian themes in Kuhn also suggests that not reading the French developments -- by treating 'continental thought' as instances of unreason (which is Foucault's great theme) -- also created a kind of Kuhn loss in the present within analytic philosophy.
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