When the Symptom Creates the Disease: Foucault and the Politics of Intelligibility

Introduction

What if the symptom did not disclose an illness but instead brought it into existence? Such a possibility unsettles one of the most durable assumptions of modern medicine: that disease precedes its signs and awaits discovery through clinical observation. During the 1971 debate with Noam Chomsky, Michel Foucault articulated a striking inversion of this logic, suggesting that the act of classification may itself generate the very pathology it claims to identify. Far from being a passing provocation, this remark condenses a broader philosophical position concerning the historical conditions that allow objects of knowledge to emerge.

The Medical Model Reversed

Medical reasoning typically follows a familiar sequence: an underlying disorder produces symptoms, which physicians then interpret. Foucault disrupts this chain by proposing that social practices first mark certain behaviors as symptomatic, thereby forming the category of disease retroactively. As he observes:

“The definition of disease and of the insane, and the classification of the insane has been made in such a way as to exclude from our society a certain number of people” (Chomsky & Foucault, 1971).

His claim is not that suffering is fictitious. Distress, hallucination, or disorientation have long been part of human experience. The point concerns the transformation of such experiences into scientific objects. Once behaviors are codified within a diagnostic framework, a recognizable figure—the “mentally ill subject”—takes shape.

Foucault pushes the argument further with a paradox that captures his method in miniature:

“Our society has been afflicted by a disease… and this mental disease has a very curious symptom, which is that the symptom itself brought the mental disease into being” (Chomsky & Foucault, 1971).

The remark gestures toward a reversal in which knowledge does not merely describe reality but participates in organizing it.

Grids of Intelligibility

Underlying this inversion is the idea that thought operates within historically specific fields that determine what can appear as meaningful. In History of Madness, Foucault (2006) traces how madness gradually shifted from a diffuse social presence to an object of specialized knowledge. This transformation required institutions, administrative practices, and conceptual distinctions that rendered certain forms of conduct visible while relegating others to obscurity.

Such frameworks function less as explicit theories than as conditions of perception. They shape the horizon within which statements acquire sense and phenomena become recognizable. What emerges is not fabrication but intelligibility. Suffering may be perennial; the manner in which it is apprehended is not.

Diagnosis as Boundary-Making

Classification rarely operates neutrally. To designate a behavior as pathological is simultaneously to define a norm from which it deviates. Diagnosis therefore draws boundaries that structure social space. Those situated beyond the line may find themselves confined, treated, or corrected—not only medically but symbolically.

Foucault suggests that this impulse toward exclusion often presents itself as reform. Declaring society “ill,” he notes, can become “a cunning way of excluding certain people or certain patterns of behaviour” (Chomsky & Foucault, 1971). The language of care thus intersects with mechanisms of regulation.

Seen from this angle, the target of his analysis is less madness than normality itself. A culture preoccupied with identifying disorders reveals an underlying investment in stabilizing its own standards of reason.

The Debate Beneath the Debate

The exchange with Chomsky exposes a deeper divergence concerning the grounds of knowledge. Chomsky approaches human inquiry by investigating innate structures that make learning and creativity possible. Foucault, by contrast, directs attention toward the historical arrangements that permit certain objects to enter discourse at all.

Their disagreement is not simply political. It concerns where one locates the conditions of possibility, within the architecture of the mind or within networks of practice. While Chomsky seeks durable features of human nature, Foucault asks how particular forms of understanding become authoritative in specific epochs.

The Disease Without a Name

Foucault’s enigmatic reference to “a disease lacking a name” invites a reflexive reading. Perhaps what is being diagnosed is neither schizophrenia nor paranoia but the modern compulsion to diagnose itself. Contemporary societies display an ever-expanding vocabulary of disorders, accompanied by refined instruments for detection. This proliferation may signal a growing sensitivity to suffering, yet it also suggests an environment increasingly oriented toward categorization.

A community that continually identifies new pathologies may be responding to its own uncertainty, attempting to secure coherence through the language of expertise. In that sense, the “symptom” is the classificatory impulse itself.

Conclusion

Foucault’s paradox leaves a lingering question. If symptoms can generate the diseases they appear to reveal, then the issue is no longer limited to who is considered mad. What demands examination is the historical process through which a society determines what must count as madness in order to affirm its rationality. Knowledge, on this view, does more than illuminate the world; it participates in shaping the contours of what can be seen.

References

Chomsky, N., & Foucault, M. (1971). Human nature: Justice versus power [Debate transcript].

Foucault, M. (2006). History of madness (J. Khalfa, Trans.). Routledge. (Original work published 1961)

Foucault, M. (1981). The order of discourse. In R. Young (Ed.), Untying the text: A post-structuralist reader (pp. 48–78). Routledge.