Water and navigation had that role to play. Locked in the ship from which he could not escape, the madman was handed over to the thousand-armed river, to the sea where all paths cross, and the great uncertainty that surrounds all things. A prisoner in the midst of the ultimate freedom, on the most open road of all, chained solidly to the infinite crossroads. He is the Passenger par excellence, the prisoner of the passage. It is not known where he will land, and when he lands, he knows not whence he came. His truth and his home are the barren wasteland between two lands that can never be his own. [...] One thing is certain: the link between water and madness is deeply rooted in the dream of the Western man.

Navigation brought man face to face with the uncertainty of destiny, where each is left to himself and every departure might always be the last. The madman on his crazy boat sets sail for the other world, and it is from the other world that he comes when he disembarks. This enforced navigation is both rigorous division and absolute Passage, serving to underline in real and imaginary terms the liminal situation of the mad in medieval society. It was a highly symbolic role, made clear by the mental geography involved, where the madman was confined at the gates of the cities. His exclusion was his confinement, and if he had no prison other than the threshold itself he was still detained at this place of passage. In a highly symbolic position he is placed on the inside of the outside, or vice versa. A posture that is still his today, if we admit that what was once the visible fortress of social order is now the castle of our own consciousness.

At the end of the Middle Ages, leprosy disappeared from the Western world. In the margins of the community, at the gates of cities, there stretched wastelands which sickness had ceased to haunt but had left sterile and long uninhabitable. For centuries, these reaches would belong to the non-human. From the fourteenth to the seventeenth century, they would wait, soliciting with strange incantations a new incarnation of disease, another grimace of terror, renewed rites of purification and exclusion.

In the history of madness, two events signal this change with singular clarity: in 1657, the founding of the Hôpital Général, and the Great Confinement of the poor; and in 1794, the liberation of the mad in chains at Bicêtre. Between these two singular and symmetrical events, something happened, whose ambiguity has perplexed historians of medicine: blind repression in an absolutist regime, according to some, and, according to others, the progressive discovery, by science and philanthropy, of madness in its positive truth. In fact, beneath these reversible meanings, a structure was taking shape, which did not undo that ambiguity but was decisive for it. This structure explains the passage from the medieval and humanist experience of madness to the experience that is our own, which confines madness in mental illness.

But what then is this confrontation below the language of reason? Where might this interrogation lead, following not reason in its horizontal becoming, but seeking to retrace in time this constant verticality, which, the length of Western culture, confronts it with what it is not, measuring it with its own extravagance?

The constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence.

The gesture that divides madness is the constitutive one, not the science that grows up in the calm that returns after the division has been made.

In the tragedies of the early seventeenth century, madness too provided the dénouement, but it did so in liberating the truth. It still opened onto language, to a renewed form of speech, that of explanation and of the real regained. The most it could ever be was the penultimate moment of tragedy. Not the closing moment, as in Andromaque, where no truth appears, other than, in Delirium, the truth of a passion that finds its fullest, most perfect expression in madness.