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I must admit, I didn't read this entire book. However, I do feel I read enough of it to get the general idea. Foucault is trying to distance himself from history here. He dislikes the "victorious" narrative of history and instead seeks to build an anthropology based around one aspect of the human sciences, employing the method of "archaeology." Borrowing Nietzsche's genealogy approach, Foucault excavates various uses of confinement or separation of the "madman" overtime, and looks at shifts and discontinuities in the usage of madness and how society (of course, always French) seeks to deal with them. First the mad are put in boats and floated out to see, then they are kept in general penal facilities, and then put in their own special asylums, where even more shades of madness can be teased out. The mad are deemed unreasonable and unintelligible by society, and therefore no attempt is made to hear their voice, which Foucault represents as "silence" or a "murmur." Rational man, throughout all of these periods, finds it necessary to find a mad Other and cordon him off. Reason needs an intelligible unreason in order to define itself. Enter "homo dialecticus." In the appendix we see a hint of what may be Foucault the cultural theorist, hypothesizing that humans need unreason, in the form of dreams, fantasies, madness, etc., in order to define our existences. In the end, however, it is hard to get to any idea of a real "truth" beneath these dialectics, as each side is a cultural construct. In this text, we also see the beginnings of Foucault's ideas about sites serving as technologies of policing, which he will expand in later works dealing both with external policing and internal "self-care."