In older decks, The Fool was sometimes known as Il Matto, or the Madman. Contemporary interpretations of this card regard The Fool as an innocent or naif, blithely starting out on a journey. Il Matto, on the other hand, was someone who because of mental illness or possibly a developmental disability, would have been uncharitably regarded as a simpleton or idiot. This card is not numbered, or is sometimes assigned the number zero, which is apt, because in the socially stratified society of the Middle Ages and Renaissance, Il Matto would have been considered a nobody, a person of no status, importance, or consequence. Yet this very absence of position or rank gave the poor Matto freedom as well. He was not bound by the conventions and restrictions of a particular class, because he existed completely outside the class system. He is often depicted being on the road. While this can obviously symbolize being on a journey, it also reinforces the idea that he exists outside of civilized society, and its laws. It can also suggest homelessness, both actual and metaphorical.

The Visconti-Sforza deck shows Il Matto as a ragged, destitute, pathetic figure; one who inspires pity and revulsion in equal measure. Yet in spite of his lowly state, or because of it, he possesses his own kind of power. With his crown of feathers, he is the king of all he surveys, at least in his own mind, and he cannot be toppled from his imaginary throne. He cannot go any lower, and therefore he is not affected by the changes in fortune and circumstances that bedevil others. Having nothing, Il Matto has nothing to lose.