I'm going to be upfront and let you know that this is not going to be my most complete or insightful review.
A small part of that is actually not my fault but the book's: I found out after I had started reading it that even though this has traditionally been the definitive English version of Foucault's early work on madness, in fact it is a subset of a much larger work that was not published in English in its entirety until quite recently. So like many much more knowledgeable and insightful commentators that have preceded me, I am really just responding to a couple of courses rather than the whole meal.
However, most of the lesser status of this review is more about my reading of the text than the text itself. For one thing, the actual process of reading was unusually disjointed and disrupted because of the other things I've been trying to accomplish at the same time. Beyond that, though, most of the books I read don't have quite the same classic status as Foucault's work, and the reading of it felt a bit odd to me. I haven't read any Foucault at all before, but because of his influence on all manner of scholarship in the subsequent decades, there was something about his approach and the movement of his thought that felt very familiar. At the same time, much of the raw material from which he put his story together were sometimes very much not familiar to me. It seemed to truly appreciate this book's arguments, to really be able to decide if they hold water or not, you would need to have a much different education than I have had -- probably one that emphasized continental European history since 1500 and all sorts of artistic, literary, and philosophical classics from that same era. I really don't have that, so I don't feel I can evaluate how well the book argues for its thesis about the changing material and discursive role of madness in European society between 1500 and 1800. In fact, there are a few sections I can't even really read effectively because the references from which they are built mean very little to me, though these are a small minority.
Responding to a text in such circumstances then becomes a question of purpose: Why am I reading it? Where is my effort best deployed?
Well, I am reading this as part of preparing to write a chapter in my book on anti-psychiatry organizing in Toronto in the 1970s and 1980s. As such, I really do not need to have mastered and be able to critique the subtleties of Foucault's tracings of the transitions in madness from the end of the Middle Ages to the dawn of modernity. So I am not going to go to the trouble to get a firm enough grip on the details to sketch 'em here. I should note, though, that I feel bad about this, because I think in doing that there is a lot to be learned not just about the specific topic at hand but about unearthing and describing social meaning, and about the interplay of what we often refer to as distinct material and discursive realms.
Mostly, though, I'm looking for general background, and for ideas that might tickle my fancy or jump out at me as useful for framing the interview at the heart of my chapter. I know that if I feel it necessary I can come back to this work, though I suspect it will not be. Though I do see some resonances between Foucault's descriptions of the asylum as an institution when it took its modern form in the early 19th century and some of the experiences of psychiatric inmates in Canada related in Shrink Resistant, which I recently reviewed. For instance, when Foucault observes,
[W]ithin the asylum itself, the doctor takes a preponderant place, insofar as he converts it into a medical space. However, and this is the essential point, the doctor's intervention is not made by virtue of a medical skill or power that he possesses in himself and that would be justified by a body of objective knowledge. It is not as a scientist that homo medicus has authority in the asylum, but as a wise man. If the medical profession is required, it is a juridicial and moral guarantee, not in the name of science. 
And when he goes on to examine the power of the asylum-based mind doctor as being based not so much on any ability to guarantee a particular outcome but on a particular kind of power-over based in other aspects of social (material and discursive) organization, it sounds very much like how some of the inmates experienced shrinks during their incarceration.
In any case, it is possible that I may return to this book. The next one on the menu is also Foucault writing about madness, this time in a series of lectures written a decade or two later. We'll see what I make of that...
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