"Something happens whose ambiguity has left the historians of medicine at a loss: blind repression in an absolutist regime, according to some; but according to others, the gradual discovery by science and philanthropy of madness in its positive truth. As a matter of fact, beneath these reversible meanings, a structure is forming which does not resolve the ambiguity but determines it. It is this structure which accounts for the transition from the medieval and humanist experience of madness to our own experience, which confines insanity within mental illness. In the Middle Ages and until the Renaissance, man's dispute with madness was a dramatic debate in which he confronted the secret powers of the world; the experience of madness was clouded by images of the Fall and the Will of God, of the Beast and the Metamorphosis, and of all the marvelous secrets of Knowledge. In our era, the experience of madness remains silent in the composure of a knowledge which, knowing too much about madness, forgets it. But from one of these experiences to the other, the shift has been made by a world without images, without positive character, in a kind of silent transparency which reveals— as mute institution, act without commentary, immediate knowledge — a great motionless structure; this structure is one of neither drama nor knowledge; it is the point where history is immobilized in the tragic category which both establishes and impugns it."