Jodie Russell argues for Philosophy of Mind scholarship to move beyond the conception of the psyche as either rational/irrational. It is only through abandoning this opposition- and engaging with Mad Studies- that a more inclusive account of human experience can be engendered.
Mad and ‘Normal’ Minds
In the Philosophy of Mind, madness is often conceptualised as a counterpart to the so-called ‘rational faculties.’ Philosophers have historically contrasted madness with non-pathological conceptions of mind in order to learn something about ‘typical’ mental capacities, such as perception, reason or belief. The use of madness as a case study to highlight what the mind is really like, by pointing out how it goes wrong, has done much harm to individuals who suffer from mental illness as well as those who identify as ‘mad’.
While the Mad Studies movement, led by those who identify as ‘mad’, has focussed on reclaiming public and academic discourse around madness, there has been little uptake of its principles within mainstream philosophy of mind and cognitive science. The binary between the ‘irrational’ mind and the ‘normal’ mind has not only been used to justify excluding the mad perspective in research, but has also been used to justify the historic marginalisation of mad people.
I make the case that if philosophy wants to move forward from the false dichotomy of sanity and insanity, it is necessary to integrate madness into its understanding of how the mind works: not as the opposite of a healthy or rational mind but as another way of “being minded” that is congruent with the ‘normal’. In avoiding this harmful binary, we may establish a more ethical approach.
Mad Studies and a History of Prejudice
Before I go on to say how traditional philosophy of mind might include madness, I should say more here about Mad Studies. Mad Studies is a movement that arose in the late twentieth century, characterised by its critical approach to mainstream psychiatry and its treatment of madness. In contrast to the other critical movements, such as anti-psychiatry and critical psychiatry, Mad Studies is importantly led by mad individuals themselves (Reaume 2022).
Key to psychiatry is its reliance on the medical model, a conceptualisation of mental disorder which delineates which particular ‘dysfunctions’ or ‘abnormalities’ may be considered appropriate for medical intervention. The medical model involves characterising individuals as ‘sick’ (known as ‘the sick role’; see Parson in Klerman 1977). It argues that the person in question is simultaneously lacking relevant agency and responsibility for their wellbeing, which is what both permits and necessitates medical intervention. As such, this has led to mad people, who are conceptualised through this model, to be lacking rational agency and needing medical treatment.
Mad Studies objects to this model being enshrined in law because it has facilitated, and continues to permit, mad individuals to be forcibly treated, and abused, by medical institutions (Beaupert and Brosnan 2022).
It would be a mistake to think that the abuse of psychiatric patients in medical care is a relic of past ignorance and apathy. For many, the term ‘institution’ conjures up the image of Victorian mental asylums. However, even in the present-day individuals experience coercion and discrimination by medical establishments- particularly oriented around race.
A recent BBC article has noted that in the UK the rate of detainment for Black people under the Mental Health Act has increased, while the rate for White people has been maintained. In the same article, the mental health charity Mind described the Mental Health Act as “systemically racist”. The medical model, from the perspective of many within the Mad Studies movement, has been used to perpetuate institutional discrimination.
Mad Liberation and Living Well
The Mad Studies movement does not converge upon one solution to the harms that psychiatric treatment can cause (Reaume 2022). Some activists argue that psychiatry should be modified to diminish harm while others call for it to be abolished altogether. Nonetheless, central to the movement is the perspective that mad voices have been lost in the conversation around psychiatric treatment. Gambinga Gambinga claims, for example, that mental health staff fail to understand important cultural differences, such as practices around how one deals with an individual’s mental health, which results in systemic discrimination within mental health services (see Brewer 2022). This suggests to me that the inclusion of lived experience, which is intersectional and diverse, within our discussions of what madness and mindedness is, is an essential step to reducing some of the harms that come along with the medical model.
I do not suggest that we should do away with psychiatry all together. While the medical model may perpetuate biases, having a diagnosis is important and even beneficial for some. Having a distinctly medical understanding of one’s experiences may bring comfort, relief or understanding. However, what Mad Studies tells us is that one need not be medicalised in order to ‘live well’ with experiences of disorder. Many who identify as mad have found communities and ways of living and managing their experiences that are not directly dependant on medical institutions or medical diagnoses.
Mad activist María Isabel Cantón describes in her chapter in The Routledge International Handbook of Mad Studies (2022) feeling more liberated after ‘de-medicalising’ and meeting a group of psychiatric survivors. This suggests that madness need not be opposed to living a good life and, furthermore, that the mad life need not exist in opposition with the ‘normal’ life.
Madness in Philosophy of Mind
In Philosophy of Mind, recent work has been done to include and emphasise the lived experience of people with mental disorder, but madness is still positioned as opposed to ‘healthy’ and ‘normal’ mental functioning. Insofar as health and illness are juxtaposed like this, there is the danger that normative considerations of correcting illness will creep in, and that a perceived difference will be used to non-consensually treat individuals.
Given that many individuals like Cantón live well with madness, it’s not clear on what grounds the dichotomy between sanity and insanity is justified. If the mark of a ‘healthy’ or ‘normal’ mind is one where a person fully participates in her environment, then some mad individuals do not diverge so widely from ‘normal’ individuals, as traditional philosophy of mind has assumed. They may even participate more widely in the world than some ‘sane’ individuals through forming their own communities and a shared language of madness.
The recent Feminist Philosophy of Mind (2022) anthology attempts to radicalise our understanding of mind by unpacking how cognition is shaped by gender, race, and sexuality, as well as trauma and mental disorder. However, these latter aspects are under-explored; a stronger case could be made for how madness may be another aspect of being cognitively minded, just as someone may be minded as a woman. By characterising madness as something that structures our mind in particular ways, like gender, madness may be understood to mean less that one is losing one’s mind but, rather, one is navigating the world in a ‘mad’ way.
How can we then make our study of the mind more ethical, so it doesn’t perpetuate harmful dichotomies? And how can we make it more metaphysically sound, insofar as the distinction between sanity and insanity is more ambiguous? The key, I suggest, is to take the lived experience of mad individuals seriously. Including lived experience as part of our research is an important step, but it should also involve suspending preconceived notions of what constitutes mental illness or illness categories altogether. In doing so, we should allow mad individuals to speak for themselves, to use the terms and concepts they prefer. Additionally, as researchers, we should orientate ourselves towards the way that mad individuals see themselves, their own madness and their world (which is, ultimately, our world).
As a consequence, I think we’ll find a plurality of rationalities, and sanities, that tell us how different people perceive, reason and form beliefs about our shared environment. Some of these may be labelled as ‘normal’, if we even want to keep the term, but all are insightful manifestations of the mind in their own right.
About the Author
Jodie Russell is a philosopher at the University of Edinburgh, working on a project to develop models of mental disorder that are more ethical and metaphysically sound. She has recently published an article criticising enactive conceptions of mental disorder and is currently working on a paper integrating enactivism with Mad Studies. She can be found on Twitter @jelliedsours.
References
Beaupert, F. and Brosnan, L. 2022..”Weaponizing Absent Knowledges: Countering the violence of mental health law”, In The Routledge International Ha
ndbook of Mad Studies, edited by Peter Beresford and Jasna Russo, 119-131, Routledge; London and New York.
Brewer, Hayley. 2022. “Sheffield: Call to tackle ‘systemic racism’ in mental health care.” BBC News, https://www.bbc.co.uk/news/uk-england-south-yorkshire-63313351
Cantón, María Isabel. 2022. “Why we must talk about de-medicalisation.” In The Routledge International Handbook of Mad Studies, edited by Peter Beresford and Jasna Russo, 205-216, Routledge; London and New York.
Keya Maitra and Jennifer McWeeny (ed), 2022. Feminist Philosophy of Mind, Oxford Academic: New York.
Klerman, Gerald L. 1977. “Mental illness, the medical model, and psychiatry.” The journal of Medicine and Philosophy 2.3, 220-243.
Reaume, G. 2022. “How is Mad Studies Different from Anti-psychiatry and Critical Psychiatry?” In The Routledge International Handbook of Mad Studies, edited by Peter Beresford and Jasna Russo, 98-107, Routledge; London and New York.
Brava! Your point dovetails well with a 2023 book by psychiatrist and philosopher Richard Gipps, “On Madness: Understanding the Psychotic Mind.” His overall point is that naming mental maladies is a mine field. He doesn’t reject the notion of diagnosis, per se, but as you read the book, he wears down our enthusiasm for default phrases in mental health; one gets less and less keen on using terms like schizophrenia, start trailing off and mumbling and stutterstopping sentences as we start sweeping statements about mental illness.
The most interesting aspect to me is that he’s making a philosophical point, one not particularly tied to mental illness. He borrows from theology the notion of “negative theology”, or being apophatic, which consists of defining by explaining what a thing is not. Kind of like a tattoo in which the tattoo itself serves as a focusing and limiting background to the image made by the enclosed, uncolored skin. You kind of did some of it above. He leverages his clinical background to make the power of the philosophical point come alive . His book is a damning, surprisingly practical, and detailed set of examples of what madness isn’t.
I think this apophatic principle can be leveraged in our work with the mind, nuomena, love, and consciousness, as it is with the divine, for similar reasons- we can’t get at the notion exactly with words, and when we think we can, we’re taking risks we should try to explore. It’s decidedly poetic and open-ended in spirit, also, which can open up our analytical selves to a contrasting set of mental gifts, for a more robust understanding of what’s going on.
What surprised me about Gipps’ book is how complementary his apophatic treatement ends up being to the “positive theology” of the field- how precise- useful- one can be about the harms naming and defining can introduce, as opposed to being merely morally or empathically or commonsensically concerned about harm. The precision of the negations has the potential to allow space or doorways to a practical use of diagnosis where helpful. I think he’d say that we need to start with a wise, experienced understanding of what the patient isn’t to wend our way all the way to a helpful (“positive”, active, normative) treatment plan for who s/he is.