Book Collector, from the Narrenschiff by Sebastian Brant (1494) When someone is to receive health care or social care, it is important to know how that care is going to be funded. In the past, the question could be a difficult one to answer, and delay – and occasionally litigation – was often the result. This was especially so in the case of mental health patients (see, for example: R v Mental Health Review Tribunal, ex parte Hall [1999] 3 All ER 132.) As ever, Michel Foucault has shed an interesting light on the question.
The responsible commissioner
Where care is concerned, funding responsibilities are set out in secondary legislation (see: National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administration Arrangements) (England) Regulations 2002, regs 3(7)-(10)). And now, there is even detailed official guidance (see: Department of Health, 2007, Who Pays? Establishing the responsible commissioner). Amongst other things, the guidance attempts to ensure that a patient who is discharged from detention under the Mental Health Act can gain access to the after-care services he or she needs (see: ibid, paras 84-87). Rival commissioners – usually, Primary Care Trusts – should not compete to rid themselves of responsibility for funding the patient’s care. Whether or not the problem will be solved by the guidance, it is clearly one of great vintage.
Where care is concerned, funding responsibilities are set out in secondary legislation (see: National Health Service (Functions of Strategic Health Authorities and Primary Care Trusts and Administration Arrangements) (England) Regulations 2002, regs 3(7)-(10)). And now, there is even detailed official guidance (see: Department of Health, 2007, Who Pays? Establishing the responsible commissioner). Amongst other things, the guidance attempts to ensure that a patient who is discharged from detention under the Mental Health Act can gain access to the after-care services he or she needs (see: ibid, paras 84-87). Rival commissioners – usually, Primary Care Trusts – should not compete to rid themselves of responsibility for funding the patient’s care. Whether or not the problem will be solved by the guidance, it is clearly one of great vintage.
The ship of fools
In his magisterial work, Madness and Civilization (1961, Librairie Plon), Michel Foucault writes at length about the stultifera navis or ‘ship of fools’ (ibid, chapter 1). This was typical of an allegorical device, used particularly in literature and painting, which depicted an often pilot-less boat, whose passengers, oblivious and ignorant, symbolised human weakness and vice. For Foucault, such boats came increasingly to represent the fear of unreason. Foucault argued that the origin of the ship of fools might be found in the Argonaut cycle or even the myth of Tristan and Iseult. In fact, the idea might even derive from Book VI of Plato's Republic.
Renaissance Europe exhibited a particular fondness for allegorical ships. There were, for example, Jacob van Oestvoren’s Blauwe Schute of 1413; the Stultiferae naviculae scaphae fatuarum mulierum published by Josse Bade in 1498; and the Ship of Princes and Battles of Nobility and the Ship of Virtuous Ladies, both of which were created by Symphorien Champier in 1502-03. But the ship of fools stood apart from the rest, because it was more than merely allegorical; Foucault, somewhat controversially, asserts that it actually did exist. He notes, “Often the cities of Europe must have seen these ‘ships of fools’ approaching their harbours.”
The ship of fools was the creation of Sebastian Brant (1457-1521), an Alsatian theologian and lawyer, who, at Basel in 1494, published the Narrenschiff, a monumental satire on humankind and its condition. Brant’s work was, and remains, hugely popular. It is likely, for example, to have influenced Heironymous Bosch’s own famous painting, The Ship of Fools, which dates from circa 1500. Brant’s ship was populated, in particular, by the deranged, who, Foucault says, were often “entrusted to mariners because folly, water, and sea, as everyone then ‘knew’, had an affinity for each other.” Such vessels “criss-crossed the sea and canals of Europe with their comic and pathetic cargo of souls.”
The reasons for this great exodus are numerous and complex, but, as Foucault explains: “The towns drove [madmen] outside their limits […] The custom was especially frequent in Germany; in Nuremberg, in the first half of the fifteenth century, the presence of 63 madmen had been registered; 31 were driven away; in the fifty years that followed, there are records of 21 more obligatory departures; and these are only the madmen arrested by the municipal authorities. Frequently they were handed over to boatmen: in Frankfort, in 1399, seamen were instructed to rid the city of a madman who walked about the streets naked; in the first years of the fifteenth century, a criminal madman was expelled in the same manner from Mainz.”
For Foucault, all this had a symbolic, almost a purifying, function. But it also had a very practical effect: “We may suppose that in certain important cities – centers of travel and markets – madmen had been brought in considerable numbers by merchants and mariners and ‘lost’ there, thus ridding their native cities of their presence.” The ship of fools was, Foucault tells us, “a general means of extradition by which municipalities sent wandering madmen out of their own jurisdiction”, for “to hand a madman over to sailors was to be permanently sure he would not be prowling beneath the city walls; it made sure that he would go far away.”
The reports of the Health Ombudsman contain no mention of barges full of mental health patients cast adrift on the unforgiving waters of the Manchester Ship Canal. But that shouldn’t blind us to the truth. Isn’t the problem to which the ship of fools was apparently the solution one for our age too? Isn’t it because too many cities tried to ensure that ‘madmen’ were no longer prowling beneath their walls that, more than half-a-millennium later, we needed the responsible commissioner guidelines?
In his magisterial work, Madness and Civilization (1961, Librairie Plon), Michel Foucault writes at length about the stultifera navis or ‘ship of fools’ (ibid, chapter 1). This was typical of an allegorical device, used particularly in literature and painting, which depicted an often pilot-less boat, whose passengers, oblivious and ignorant, symbolised human weakness and vice. For Foucault, such boats came increasingly to represent the fear of unreason. Foucault argued that the origin of the ship of fools might be found in the Argonaut cycle or even the myth of Tristan and Iseult. In fact, the idea might even derive from Book VI of Plato's Republic.
Renaissance Europe exhibited a particular fondness for allegorical ships. There were, for example, Jacob van Oestvoren’s Blauwe Schute of 1413; the Stultiferae naviculae scaphae fatuarum mulierum published by Josse Bade in 1498; and the Ship of Princes and Battles of Nobility and the Ship of Virtuous Ladies, both of which were created by Symphorien Champier in 1502-03. But the ship of fools stood apart from the rest, because it was more than merely allegorical; Foucault, somewhat controversially, asserts that it actually did exist. He notes, “Often the cities of Europe must have seen these ‘ships of fools’ approaching their harbours.”
The ship of fools was the creation of Sebastian Brant (1457-1521), an Alsatian theologian and lawyer, who, at Basel in 1494, published the Narrenschiff, a monumental satire on humankind and its condition. Brant’s work was, and remains, hugely popular. It is likely, for example, to have influenced Heironymous Bosch’s own famous painting, The Ship of Fools, which dates from circa 1500. Brant’s ship was populated, in particular, by the deranged, who, Foucault says, were often “entrusted to mariners because folly, water, and sea, as everyone then ‘knew’, had an affinity for each other.” Such vessels “criss-crossed the sea and canals of Europe with their comic and pathetic cargo of souls.”
The reasons for this great exodus are numerous and complex, but, as Foucault explains: “The towns drove [madmen] outside their limits […] The custom was especially frequent in Germany; in Nuremberg, in the first half of the fifteenth century, the presence of 63 madmen had been registered; 31 were driven away; in the fifty years that followed, there are records of 21 more obligatory departures; and these are only the madmen arrested by the municipal authorities. Frequently they were handed over to boatmen: in Frankfort, in 1399, seamen were instructed to rid the city of a madman who walked about the streets naked; in the first years of the fifteenth century, a criminal madman was expelled in the same manner from Mainz.”
For Foucault, all this had a symbolic, almost a purifying, function. But it also had a very practical effect: “We may suppose that in certain important cities – centers of travel and markets – madmen had been brought in considerable numbers by merchants and mariners and ‘lost’ there, thus ridding their native cities of their presence.” The ship of fools was, Foucault tells us, “a general means of extradition by which municipalities sent wandering madmen out of their own jurisdiction”, for “to hand a madman over to sailors was to be permanently sure he would not be prowling beneath the city walls; it made sure that he would go far away.”
The reports of the Health Ombudsman contain no mention of barges full of mental health patients cast adrift on the unforgiving waters of the Manchester Ship Canal. But that shouldn’t blind us to the truth. Isn’t the problem to which the ship of fools was apparently the solution one for our age too? Isn’t it because too many cities tried to ensure that ‘madmen’ were no longer prowling beneath their walls that, more than half-a-millennium later, we needed the responsible commissioner guidelines?
