In lieu of an abstract, here is a brief excerpt of the content:On the Importance of Conceptual ContrastsMadness, Reason, and Mad PrideAwais Aftab, MD (bio)Garson (2023) offers an engaging historical and philosophical discussion around the importance Late Modern thinkers assigned to the task of differentiating madness from idiocy (or more specifically, to the tripartite distinction of sanity, madness, and idiocy). Based on this analysis, Garson’s identifies the need to offer a positive account of mental illness—one that does not define the (...) essence of mental illness exclusively as the absence, lack, or failure of the power of reasoning. Following the Late Modern thinkers (Locke, Kant, Wigan, and Heinroth), Garson concludes that madness is infused with reason, and what characterizes madness is the presence of reason in an altered and mutated form. This is all worth taking seriously. My own assessment of this historical and philosophical material nonetheless differs from that of Garson. To recognize madness as possessing reason within it in an altered form may be of less profound significance than he thinks it is. Garson’s discussion commendably highlights the importance of making conceptual contrasts explicit in definitional debates, and this should indeed lead us to search for contrasts that are more philosophically illuminating (what is better will depend on the context of inquiry). However, in my view, the recognition of madness as altered reason neither reframes the project of defining “mental disorder” nor does it provide an intellectual scaffolding for mad activism.The significance of “madness contains reason within in but in an altered or perverse form” is difficult to translate into contemporary scientific terms, and the fuzziness and historical baggage around the terms “madness,” “reason,” and “perversion” does not make it easy. “Mental disorder” or “psychopathology” means to us something quite different than what madness meant to Late Modern thinkers, and while “madness” remains a popular term in philosophical literature, there is no clarity on the nature of overlap between the domain of madness and the domain of conditions currently classified by the diagnostic manuals. Mental disorders, as currently conceptualized, include a motley of conditions that were previously characterized using terms such as idiocy, madness, neuroses, and psychopathic personalities. [End Page 297]From our contemporary vantage point, to compare idiocy and madness is to make a distinction within the domain of psychopathology. We are comparing two groups of psychiatric conditions. The lessons we derive from this comparison do not necessarily extrapolate well to a comparison of mental disorders with something outside the domain of psychopathology. To the extent that psychopathology is inclusive of both idiocy and madness, psychiatric disorders both contain and do not contain “reason” within them. The domain is heterogenous in this regard, and broad generalizations about the nature of reason in the mental disorders would be simplistic at best and inaccurate at worst. Other distinctions that we have made within the domain of psychopathology have included organic versus functional, neurosis versus psychosis, categories versus continua, and distinctions used within nosology have included operationalized criteria versus phenomenology, idiographic versus nomothetic, medical versus non-medical, description versus explanation, and so on (Aftab & Ryznar, 2021; Zachar, Banicki, & Aftab, 2023), all of which have the potential to offer a positive account of some aspect of psychopathology.It is worth nothing that the distinction between “absence of reason” versus “perversion of reason” is analogous to the common distinction between absence of function and altered function in patho-physiology. Such a distinction exists for almost every function that exists. Consider vision: absence of vision (blindness) and altered vision (illusions, distortions, hallucinations). Consider hypoesthesia (reduced sense of touch) and paraesthesia (altered sense of touch—tingling, pricking, burning, etc.). Garson alludes to diminished sexual capacity versus paraphilia as an analogy, but he does not seem to appreciate that the analogy applies much more broadly. Is the distinction between absence of reason versus perversion of reason of any greater significance than the distinction between blindness and hallucination? If we were to say, “What distinguishes hallucination from blindness is not the failure, absence, or lack of sight, but its presence—albeit in a perverse and mutated form,” how profound would it really be for our notions of disorder? Or imagine some Late Modern physician saying that a disturbance of speech and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lack, Perversion, ShameJustin Garson, PhD (bio)I am extremely grateful to the commentators for giving me so much food for thought. Space considerations prevent me from engaging with all of the interesting points they raise, or responding at the length they warrant. For that reason, I chose to structure my response in terms of three recurring themes or distinctions: lack/perversion, madness/mental illness, and shame/pride. Hopefully, the philosophical richness of the (...) commentaries has already indicated the fruitfulness of returning, anew, to the Late Modern distinction between madness and idiocy.Lack and PerversionSeveral commentators directly challenge my characterization of the distinction between idiocy and madness as one between a lack, and a perversion, of the ordinary powers of reason.On the one hand, commentators point to the extent to which Late Modern theorists of madness still frame madness in terms of a lack, rather than a positive being. Jeppsson points out correctly that the Late Modern theorist still insists that madness stems from a lack of some sort or another: “one lacks proper premises to draw conclusions from, lacks a proper appreciation of reality.” Madness is not merely a different mode of reasoning about the world, but one that issues from a certain absence. Kusters, similarly, points out that the projects of Locke and Heinroth “remain insufficient because they remain focused on the mad as lacking something…a lack that prevents them from being part of the communal,” although he thinks Kant’s Aberwitz comes closest to a genuinely positive account. Tsou minimizes the relevance of the distinction between madness and idiocy by pointing out that both represent deviations from (hence they both “lack”) “normal psychological reason.”On the other hand, Banicki points out that even to construe madness in terms of a “lack” or “failure” (a failure of function, of reason, of action) is to presume, at least indirectly, a positive account of madness: after all, the mad person can only properly be said to “fail” in the exercise of their reason because they are the sort of being that participates in reason. A tree or a stone cannot be said to “fail” in the exercise of its reason (as Gipps puts it, “a baobab cannot jump to conclusions”). These commentators have helped me to clarify and sharpen the distinction between lack and perversion and the way they intersect with the categories of idiocy and madness.To put my view summarily: idiocy is, in its essence, just a way of lacking reason, in the same way that being poor is, in its essence, just a way of lacking wealth. But madness is not, in its essence, [End Page 327] a way of lacking reason. It is a way of exercising reason, but via perversion, where perversion must be understood as having the resonance both of excessive and also of driving toward an unexpected end.As I indicated in the paper, the distinction between lack and perversion is easiest to think about in terms of sexuality. A person may lack sexual desire: They may find themselves for long stretches of time with little to no desire for sex, the absence of sexual fantasies, and the inability to stimulate themselves or be stimulated by others. Crucially, being devoid of sexual desire is not a way of being sexual, any more than being dead is a way of being alive, or being a fish a way of being a mammal. By contrast, having a meager sexual desire is a way of being sexual, but via a lack or diminution: It is a way of not having much of it around.In contrast, one can have what is called a “perverse” sexuality: Sexuality infused with the desire to dominate, or be dominated, or to be watched from afar, or to couple with beasts or machines. This is a way of being sexual; it is even a kind of rampant sexuality. One talks of “harnessing” their sexuality, “restraining” it, “unleashing” it. For some, perversions may be terrifying to contemplate, almost unthinkable, even revolting. For others perversion is ecstatic; it transports one to another world in which one sees everything differently; the one who exercises her perversions morphs into an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How to Reason Beyond Reason? Toward a Philosophical Understanding of MadnessWouter Kusters, PhD (bio)To analyze the situation of madness on the ground, we need a grounded perspective, close to the situation at hand. The closer we come to the subject under scrutiny, the clearer its outlines, fine-grained details, and its dynamics, and the better we reach an explanation and understanding. The closer the approach, however, the higher the chances (...) are of becoming myopic and losing the connections with broader—or higher—perspectives: the view from above. It has been due to philosophical and historical approaches from above to the practices of philosophically inspired psychiatry that we may gain new insights into what is going on on the ground—and underground. This article by Garson provides such a view that may lead to a change in perspective, a new way to draw boundaries on the ground, to discover similarities and dissimilarities through space and time, without thereby losing the lived connection to the problematic ground.Garson proposes to replace a binary opposition of madness (in the sense of sick or insane) versus sanity (in the sense of healthy), with a triad of concepts, sanity, madness, and idiocy, taken from the work of philosophers of psychiatry avant la lettre in the early modern times, Locke, Kant, Wigan, and Heinroth. This triad is to be understood in terms of reason, where idiocy consists of the diminishment of some aspects of reason, while madness would be characterized by a perversion of reason. By examining how this perversion—or more neutrally said, this change—of reason was conceived by the four thinkers, Garson sheds a new light on research and theory within the philosophy of madness and the philosophy of psychiatry today. He examines the question of “how is it that the mad person “has” reason, but is still not reasonable?” with the help of the four authors mentioned above (of which I discuss three).In answering this question, Garson refers specifically to my work as an example of “exactly the kind of ontology we need for rethinking madness in a positive manner—not necessarily ‘positive’ in the sense of good, helpful, or ennobling, but in the sense of going beyond a mere lack, absence, or failure.” I wholeheartedly agree with this assessment, [End Page 317] and Garson’s proposal of this tripartite schema is helpful and valuable for thinking through how we can further nourish a positive view of madness, especially with reference to Mad Pride.Locke and HeinrothGarson discusses some fragments from Locke and concludes that according to Locke “the mad person, in contrast to the idiot, possesses reason by virtue of possessing an intact inferential capacity. What ultimately makes them mad, and not reasonable, is that their premises are flawed by the unhinged power of association.” So, with Locke the capacity for inferential logic is not disturbed, and in that sense reason is intact. The unreasonable behavior would be due, according to Locke, to an unbridled increase in imagination and associations, which are taken for reality. Instead of reason the capacity to align imagination and reality is afflicted. When we translate this Lockean view into contemporary terms, we could say that it is not their cognition, their way of processing stimuli that is problematic, but their being overwhelmed by impressions or stimuli. This is akin to “bottom-up” theories: Something is wrong with perception or experience, and ‘higher’ capacities of cognition and reasoning remain intact. Reason may seem ‘perverted,’ but at a closer look, this is a result of their being victim to anomalous experience, too many stimuli or too strong imaginations.Heinroth also explicitly distinguishes madness from idiocy, that is, from a diminishment of mental capacities. Instead, he considers madness as a reaction to what Garson calls “a reality that is too awful to bear.” Madness is then “a wholesome desire of nature to cure a perversion through another perversion.” Again, madness is then not in itself a diminishment of reason, but an attempt to cure something that went wrong, in a way that is also only seemingly wrong (perverted reason). Madness then is again within reason, but this core of intact reason is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What, Exactly, Does the Madperson Lack?Sofie Jeppsson, PhD (bio)Justin garson has already received well-earned recognition for his Madness: A philosophical exploration (2022), in which he distinguishes the view of madness as a dysfunction from madness as a strategy—a distinction that cuts across traditional distinctions between, for example, biological/neurological and psychological/social views. On the dysfunction view, going mad might be comparable to something like having an asthma attack or, more (...) long-term, developing type 1 diabetes. If the trachea closes up and prevents air from passing through, that is a dysfunction in the breathing apparatus. If the islets of Langerhans in the pancreas cease to produce insulin, making the person dependent on insulin shots to stay alive, that is a dysfunction. On the strategy view, going mad is rather like getting a fever when already infected with some pathogen. Given that you have the pathogen reproducing inside you, a rising body temperature provides a strategy (although not, of course, something the ill person chose) to keep the reproduction rate down, thus giving the immune system a better chance at vanquishing the infection. That does not mean that fevers are harmless—if a fever becomes high enough, it might itself do damage to the body. Still, it is a strategy, not a mere dysfunction. Analogously, on the Madness as strategy view, going mad might help a person deal with old traumas or an ongoing terrible situation, even as the madness may also be damaging in itself.In this paper, Garson introduces us to another interesting distinction: between seeing madness as a lack of reason, or as a perversion of or difference in reason. Garson writes that present-day psychiatry tends to see madness as a lack, whereas the late modern thinkers conceived of it as a perversion of reason. The late moderns clearly saw madness as something negative, but if we retain something like their basic view, merely change our evaluation from the negative perversion to the more neutral difference, we have a better basis for regarding Madness as a complicated and problematic but still cherished identity, and for Mad Pride.This is another interesting distinction well worth calling attention to. I’m uncertain how well the J.C.A. Heinroth example works—the text cited seems to show that he had a Madness as strategy view, but is it a Madness as a different kind of reason view?—but the other examples work better. Nevertheless, I want to push back a little against the claim that present-day psychiatry and philosophy of psychiatry tend to regard madness as a lack of something whereas the early moderns saw it as a difference. (Just a friendly little push, mind you, but still.)Arthur Wigan’s description of two brains, one functional and one dysfunctional, still seems to posit a lack of proper function in one of them. Sure, he does not say that the madperson lacks as much as the [End Page 313] idiot, who has two dysfunctional brains whereas the madperson has one functional and one dysfunctional. Still, there’s a lack. This two-brain picture also has its modern analogues: It brings to mind (albeit in a less biologically concrete and reified form) much psycho-educational material on, for example, how to live with bipolar disorder, according to which a supposed sane and rational part of the psychiatric patient’s mind should learn to handle and control the other, mad part (e.g., Miklowitz, 2012).According to John Locke, madpeople reason just fine, but they start from false premises. Is not this, too, something that madpeople are supposed to lack? Correct and realistic premises to start from? Locke writes that madpeople have “taken their fancies for realities,” but “make right deductions from them.” Moreover, Locke’s theory is reminiscent of modern bottom-up theories like Brendan Maher’s (1999)—madpeople have bizarre experiences on the basis of which they form bizarre beliefs, but we need not postulate that they suffer from any problems with, for example, reasoning and drawing inferences to explain why they believe what they do. Theorists who instead argue for a top-down or two-factor account of why madpeople stick... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Though This Be Madness, Yet There Is Method in ’T”A Positive Account of MadnessValentina Cardella, PhD (bio)What does it mean to be mad? How can we define mental disorder? The question is still widely discussed among psychiatrists and philosophers, and what exactly distinguishes sanity and insanity remains unclear. Despite this lack of clarity, the common conceptualization of madness is that mental disorders are impairments in rationality: people with mental (...) disorders are generally believed to have impairments in reasoning and logic (Bermúdez, 2001; Edwards, 1981; Harvey, Watkins, Mansell, & Shafran, 2004).Yet, the result of this conception is that we fail to understand madness. We do not understand how, for example, schizophrenic patients can be more logical than healthy people in some reasoning tasks (Mellet et al., 2006; Owen, Cutting, & David, 2007), or delusional patients can be perfectly rational in defending their ideas (Cardella, 2020), or depressive people can be more realistic than non-clinical subjects (Moore & Fresco, 2012). In contrast, if we consider rationality as the core feature of sanity, we fail to understand sanity, too, because normal people exhibit many kinds of biases and heuristics, and thus irrationality is widespread in the general population (Bortolotti, 2020; Johnson-Laird, 2006; Evans, 2002; Kahneman, Tversky, & Slovic, 1982).In his paper, Garson focuses on Late Modern theorists of madness (Locke, Kant, Wigan, and Heinroth) to reframe the problem and provide a positive account of mental disorder. These authors contrast madness to idiocy, rather than sanity, and therefore their conception of madness is very different: “while idiocy is marked by the diminished, or even abolished, functioning of the reasoning power, madness is marked by its perverse functioning. The mad person “has” reason, but deploys it in a perverse, improper, or unseemly manner” (Garson, 2023, p. 286).In his reading of Late Modern authors, Garson provides a new ontology of mental disorder, that goes beyond an absence of reason, and has also political and social implications. Furthermore, he reminds us that every scientific discipline has its philosophical assumptions. In defining madness, [End Page 305] we cannot help but choose a contrasting class, and each choice will have very different consequences. Even if psychiatry is a medical discipline, which aims to endorse a neutral view of mental disorder, it is impossible for it to be unbiased and impartial. All the more so, for it has to deal with human suffering and fragility.But, in this article, there is one crucial question that remains unanswered. In his analysis of Late Modern theorization of madness, Garson comes to the conclusion that madness is marked by a perverse deployment of reason. Yet, who decides when reason is deployed in a perverse manner? While the lack of rationality is something that we can detect easily enough, the task of defining precisely what is an ‘improper’ or ‘perverse’ use of reason is much harder. In other words, it seems to me that, in replacing the ‘lack of rationality’ paradigm with ‘the perverse rationality paradigm,’ the question of what is madness still remains open, and, most important, some normative aspects remain necessary. To recognize when rationality is improperly used, we have to adopt an evaluative stance, which defines what a proper use of reason would be.Valentina [email protected] University of MessinaValentina Cardella Valentina Cardella is Associate Professor of Philosophy of Language at the University of Messina, Italy. Her research interests encompass cognitive sciences, philosophy of language, and psychopathology.The author reports no conflicts of interest.Commentary submitted on June 13, 2023Accepted on June 13, 2023ReferencesBermúdez, J. L. (2001). Normativity and rationality in delusional psychiatric disorders. Mind and Language 16, 457–93. Google ScholarBortolotti, L. (2020). The epistemic innocence of irrational beliefs. Oxford: Oxford University Press. Google ScholarCardella, V. (2020). Rationality in mental disorders: too little or too much? European Journal of Analytic Philosophy 16 (2), 13–36. Google ScholarEdwards, R. B. (1997). Mental health as rational autonomy. In Edwards, R. B. (ed.), Ethics of psychiatry: Insanity, rational autonomy, and mental health care. New York: Prometheus Books. Google ScholarEvans, J. (2002). Logic and human reasoning: an assessment of the deduction paradigm. Psychological Bulletin 128... (shrink)