Since the 1970s, Western psychiatry has been locked into a disease paradigm of madness. This paradigm has such an ironclad grip on our thinking that it’s sometimes hard to see outside of it. I call this paradigm madness-as-dysfunction. In essence, it sees the forms of madness – delusions, dissociative episodes, depression – as so many different ways that the mind can break down, or fail to function as it should.
We all know the slogans. “Depression is like diabetes.” “Schizophrenia is like cancer.” These give voice to madness-as-dysfunction while investing it with the force of an ethical imperative.
But what if madness-as-dysfunction is fundamentally limited? What if this perspective is actually beginning to stifle research, produce inefficient treatments, and increase stigma?
What if some forms of madness are designed responses to the problems of life, not diseases? What if they’re purposeful, not pathological? What if delusions, depression, and dissociative episodes, represent the proper functioning of our minds, not their malfunctioning? In short, what if mental disorders are more like calluses than cancer?
I call this paradigm “madness-as-strategy.” We see glimmerings of madness-as-strategy in some contemporary research trends. For example, some see delusions as having a protective role. Or depression, as nature’s signal that something in our lives needs to change. Or autism, as an evolved cognitive style that emerged among early humans to benefit the group.
Such research heralds the birth of a massive paradigm shift.
As a rule, however, contemporary workers in this field don’t see themselves as the cutting edge of a rich intellectual legacy – a legacy with its own founders and figureheads. The purpose of my book, Madness: A Philosophical Exploration, is to unearth that legacy, from the ancient Greek physicians to the evolutionary psychiatrists of today.
Simply being able to see madness-as-strategy as a distinctive intellectual tradition that has always run alongside madness-as-dysfunction is the first step in dislodging the silent dominion of the latter.
Some important figures in this intellectual legacy include Robert Burton, George Cheyne, Johann Christian August Heinroth, Philippe Pinel, Sigmund and Anna Freud, Frieda Fromm-Reichmann, Harry Stack Sullivan, Kurt Goldstein, and recent evolutionary thinkers like Vivette Glover and Randolph Nesse.
In the course of my research, I found academic historians of psychiatry to be of little help – not because their work isn’t valuable, but because they simply haven’t addressed the question that I’m after. They tend to approach the history of madness in terms of a clash between “mental” and “bodily” perspectives, rather than function and dysfunction perspectives. Instead, my book centers around careful readings of primary texts, some well-known and some obscure.
My goal in this book is not to destroy madness-as-dysfunction, but to force it to make room for another way of seeing, madness-as-strategy. Put differently, I want to make it possible to even raise the question of whether madness-as-dysfunction applies in any particular case. Allowing it to persist as a silent default is bad for research, and it’s bad for people who seek professional help.