There is a type of knowledge that presents itself as entirely neutral—as if it merely records reality exactly as it is, free from self-interest, ideology, or history. Medicine claims to describe the body. Psychiatry claims to describe the mind. Jurisprudence claims to describe justice. Modernism, that massive intellectual climate that defined the 19th and 20th centuries, operated under the belief that science and reason could objectively illuminate reality and construct a better world upon the firm foundations of truth. Progress was viewed as linear, knowledge as neutral, and institutions as the mere tools of that advancement.

Postmodernism arrives and shatters this assumption to its core. There is no such thing as neutral knowledge, it argues. All knowledge is born somewhere, at a specific moment in time, to serve someone’s interest. The grand narratives of progress, science, and objective truth are not discoveries; they are constructs. And no one demonstrated this with more precision, concrete detail, and devastating impact than Michel Foucault.

But before turning to Foucault, let us consider Wittgenstein for a moment.

In his late works, Ludwig Wittgenstein developed an idea that seems trivial at first glance, but actually dismantles an entire tradition of thought. The meaning of a word, Wittgenstein argues, does not reside in the fact that it “signifies” some concept existing somewhere in the mind or in nature. Meaning is found in its use; a word means what it means within a concrete practice, within what he terms a language game. Ripped from that practice, a word floats in a vacuum and begins to “chase the philosophers,” as he puts it.

Take the word “mad.” In everyday usage, we know what it means—someone is behaving unexpectedly, stepping outside the boundaries of what we consider normal. But when psychiatry co-opts that word and begins to define, classify, and diagnose it, it tears the word from its everyday language game and inserts it into an entirely different one: a medical, institutional, and legal game. In this new language game, “mad” no longer means what it did before. It now means whatever the doctor defines, whatever the diagnostic manual records, whatever the court takes into account. Wittgenstein would say: the nature of the thing did not change; the game did. Foucault would add: and whoever controls the game controls reality.

And that is where the real story begins.

Consider the Middle Ages in the towns of Northern Europe. A person who hears voices, speaks incoherently, and fails to function in daily life is not locked up, treated, or diagnosed. Towns would sometimes quite literally place them on ships and send them down the river to the next municipality. That town would allow them to wander for a bit, then board them once more and ship them further down. They drifted like this, suspended somewhere between exclusion and freedom—with no doctor hovering over them, no diagnosis, and no institution to decide what they were or what should become of them.

Foucault does not view this image as proof of medieval backwardness. He takes it as evidence that madness at the time held no medical status. It was a social category charged with ambivalence; the madman existed on the margins of society, but he was not enclosed within a system that defined him. Furthermore, in the literature and philosophy of that era, the madman frequently speaks truths that the rational dare not utter. Erasmus of Rotterdam dedicated an entire book, In Praise of Folly, to letting Folly deliver a speech, and within its pages, Folly wins every debate against philosophers, theologians, and rulers. In the Renaissance, madness carried a kind of dark wisdom, an intimacy with that which reason could not grasp. It was not an illness; it was an alternative form of truth.

Then comes the 17th century, and everything changes—suddenly and brutally.

In 1656, the Hôpital Général is founded in Paris. Within its first few months of operation, roughly one percent of the entire population of Paris is locked inside. This statistic alone decimates any medical interpretation—it was impossible for that many people to be sick. Gathered within were the poor, vagrants, the unemployed, prostitutes, criminals, and the “mad,” all thrown together without medical staff, without treatment, and without diagnoses. Wardens, not doctors. Over the following decades, this exact institution was replicated across Europe.

Foucault asks: what actually happened here? The answer is not medical; it is economic and moral. A society undergoing industrialisation, beginning to construct capitalism on the twin pillars of discipline and productivity, cannot tolerate unproductivity. Those who do not work, those who disrupt, those who fail to fit into the new order of labour and discipline are locked away. All together, without distinction. The pauper and the madman share the same cell not because they suffer from the same illness, but because they share the same sin: they do not conform to the economic logic of the new era. Madness, at that moment, is not a medical problem. It is a moral failure, an economic threat, a social disturbance that must be removed from sight.

Psychiatry as a profession does not yet exist. There is only confinement.

It is only at the end of the 18th century that we witness what medical history narrates as the great humanitarian turning point. In 1793, Philippe Pinel, a French physician, enters the Paris asylum Bicêtre and orders the removal of chains from patients who had been literally shackled to the walls for years. This scene entered the textbooks as the watershed moment when medicine became humane—here was the man who liberated the mad from brutal treatment, who introduced reason and compassion where brutality reigned, who finally separated madness from crime and poverty, recognizing it as an illness deserving of cure.

Foucault reads this scene entirely differently, and it is precisely here that his analysis becomes uncomfortable in a way that stays with you.

Pinel did not grant freedom. Pinel introduced what he himself called moral treatment. The patient is no longer physically shackled, but they must now sit across from a psychiatrist who observes, analyzes, logs, classifies, and tells them what is wrong with them. The patient must internalise—adopt from within, as their own absolute truth—the idea that they are sick and that the doctor’s authority is indispensable for their own good. The physical chain vanished. It was replaced by a psychological relationship of dependency in which the physician simultaneously assumes the role of father, judge, and scientist. External coercion was replaced by internal acceptance.

And that, Michel Foucault argues, is a subtler but far deeper form of control. When someone binds you with a chain, you know you are confined. When someone convinces you that you are sick and that you need them, you become the warden of your own prison.

The crucial element Foucault notes in this new psychiatric relationship is its radical asymmetry. The doctor observes, notes, and classifies; the patient is the object of that gaze, never its subject. The patient does not define their own situation—the doctor does. The patient’s experience, their narrative of what they feel and think, enters the examination solely as a symptom for the doctor to interpret, never as an equally valid version of reality. And this asymmetry is neither natural nor necessary. It did not spring from the inherent nature of madness or illness. It was historically constructed, institutionally maintained, and politically useful.

The same applies to medicine at large, a point Foucault elaborates in detail in The Birth of the Clinic.

Prior to the modern clinical examination, a doctor primarily listened to the patient. The patient would arrive, speak of their pain, and describe their experience; that narrative was central to the diagnosis. The doctor was the interpreter of the patient’s story. Then, over the course of the 18th century, medicine develops anatomy, pathology, and clinical examination. It begins dissecting corpses, classifying diseases according to what is visible inside the body, and developing instruments that measure and record. In this process, a quiet but revolutionary shift occurs: the patient’s story becomes secondary. What the doctor sees within the body—during the examination, on an X-ray, in blood work, on an ultrasound—becomes the only relevant reality. The body is the object of knowledge, and the person living inside that body somehow vanishes in the process.

Today, we experience this on a daily basis, so much so that we have stopped noticing it. You go to the doctor with a symptom that has been plaguing you for weeks, disrupting your daily life, which you have tried to describe with utmost precision. The doctor sits, stares at a screen, reads the test results, and orders an ultrasound. The ultrasound shows nothing out of the ordinary. The doctor says: “Everything is fine.” And somehow, that sentence carries more weight than everything you just articulated. Your experience became invalid the moment the instrument failed to confirm it. Foucault would argue: this is not a technical advancement that accidentally, as a side-effect, sidelined the human element in medicine. This is the structural logic of medical knowledge which, from its modern inception, built its authority on observing the body rather than listening to the person. The instrument is merely the latest iteration of that very same gaze.

And here we arrive at Foucault’s central thesis, the one that binds all of this into a single, coherent picture.

Knowledge is not neutral. Psychiatry did not discover madness the way astronomy discovers stars—as something that was always there, merely waiting to be catalogued. Through a historical, political, and institutional process, psychiatry constructed the authority to define what is normal and what is not. It authored diagnostic manuals, convinced the state to grant it jurisdiction over bodies and minds, and erected hospitals and clinics as spaces of surveillance. It is a political process masquerading as a scientific one. Every time a doctor declares someone “mad,” every time a psychiatrist issues a diagnosis, every time medicine renders someone’s experience invalid because an instrument cannot verify it, it is not a pure, scientific determination of facts. It is an act of power.

Homosexuality remained in psychiatry’s diagnostic manuals as a mental disorder until 1973. The nature of human beings did not change when it was deleted; the political climate and the pressure of social movements did. Throughout the 19th century, women were diagnosed with “hysteria” whenever they displayed autonomy, a sexuality outside of marriage, or intellectual ambitions. A new disease was not discovered; an undesirable social type was being defined and given a medical name. In both cases, medicine was not a mirror of nature. It was an instrument of normalization.

Modernism believed that institutions like medicine, law, and science stood above politics—that they were neutral servants of truth at the disposal of humanity. Foucault spent his entire intellectual life demonstrating, with the precision of a historian and the sharpness of a philosopher, that this neutrality is itself an ideological construct. Behind every diagnostic manual lies a history. Behind every clinical gaze lies a relation of power. Behind every removal of chains lies a new, more invisible chain.

The Ship of Fools is still sailing. We just don’t see it anymore.

For P.U.L.S.E: Ilhan Kokor

Source: ilhankokorquotes.com/blog

  Ilhan Kokor, Michel Foucault, Philosophy, Psychology