Is there hidden meaning in “madness”?

Rationality typically occupies a hallowed space in both healthcare policymaking and individual medical treatment. However, recent scholarship and activism show there may be unappreciated value in what we typically associate with irrationality – “madness.”

When a person’s beliefs and worldview are thought to lack a crucial connection to reality, those beliefs are often labeled as irrational. This is one way that some philosophers and psychologists have proposed we understand delusions, as fixed, irrational beliefs (or systems of beliefs) that conflict with the way the world is and are resistant to counterevidence.

Delusions can be a symptom of several distinct conditions, such as schizophrenia, delusional disorder, acute psychotic disorder and schizoaffective disorder. In “Getting Well Again,” a first-person account of schizophrenia, Susan Weiner shares a delusion she experienced about being a spy for the resistance in a fictitious war.

As psychologist Mark Ruffalo writes in Psychiatric Times, often the delusions present in conditions like schizophrenia have been seen as lacking meaning, being incomprehensible to anyone (often, including the person experiencing them), or otherwise random. This has meant that psychodynamic therapy – a form of therapy that fosters introspection and reflection on the meaning of a patient’s experiences and their experience with the therapist – has not often been employed to treat schizophrenia due to the perceived mismatch between the purpose of psychotherapy and the apparent meaninglessness of delusions.

Yet, some recent work in philosophy of psychology is questioning this understanding of delusions. For example, philosophers Rosa Ritunnano and Lisa Bortolotti argue in “Do delusions have and give meaning?”, that delusions are not meaningless or utterly unmoored from reality but instead can be laden with meaning for the person experiencing them such that the delusions are ‘sense-making’ of unusual experiences and can assist in reinforcing a person’s agency (even if temporarily and incompletely).

In his book Madness: A Philosophical Exploration, philosopher Justin Garson goes a bit further than this, reframing what he calls ‘madness’ as a purposeful and functional experience. Garson describes how witnessing the role delusions played in his father’s life led him to investigate the idea that, like a fever, delusions and perhaps other symptoms of mental disorders serve a specific purpose.

This idea of madness lies at the center of a recent movement that has emerged called Mad Studies, which arose out of the work of psychiatric service users and survivors. As survivor activist Peter Beresford writes, “Mad studies originated from consumer/survivor movements. It rejects a bio-medical approach to the domain widely known as ‘mental illness’ or ‘mental health’ and substitutes instead a framework of ‘madness’.”

One dimension of this movement is to reclaim terms like ‘mad’ from their sanist/ableist history and repurpose them as tools of activism and enrichment. Sanism, akin to racism or sexism, is “an irrational prejudice against people with mental illness” such as believing someone with schizophrenia is dangerous to others.

Yet, as Beresford points out, some people find words like ‘Mad’ and ‘Madness’ “unreclaimable” and so the movement must also be responsive to those who reject this language and label. Like identifying as disabled, being Mad is more about how one identifies and conceives of themselves rather than having one or more specific conditions, etc.

Similarly, many who identify as Mad also promote and participate in Mad Pride, a celebration and acceptance of Mad identity. In an interview about Mad Pride, Meghann O’Leary, academic and activist, writes: “Most anti-stigma campaigns are just mitigating the stigma by comparing it to diabetes, or some other chronic or physical illness, but mad pride takes it much further and says that we should actually have pride in our mad identities.”

Some academic researchers who embrace this language and self-identify as Mad have used philosophy to assist them in understanding experiences like delusion and psychosis. For example, partly through her own experience, psychologist Nev Jones came to believe that schizophrenia and similar conditions were overly medicalized and that it was philosophy, rather than medicine, that offered an avenue for understanding madness. Jones was particularly influenced by Michel Foucault’s critique of the medicalization of Madness by society which works to depict the Mad as alienated from human nature and rationality.

Not only can philosophy help us understand Mad experiences, but experiences of Madness can inform our philosophical theorizing as well, such as how the ‘radical doubt’ in psychosis informs epistemology.“  As one example, Philosopher Sofia Jeppsson argues that: “Madpeople might actually doubt most of reality in a way that sane people rarely do and of which they may not even be capable.” In this way, the existence and experience of ‘Madpeople’ serve as a kind of living counterexample to mainstream views about knowledge in academic philosophy.

Associate editor of the Schizophrenia Bulletin, Laura Rowland, argues that including first-person reports provides indispensable context for researchers, caregivers, and others with schizophrenia. First-person accounts also provide a humanizing aspect, reducing overall stigma and providing others the opportunity to identify similar behaviors or symptoms they may see in their own life or that of a loved one.

Other ways people with lived experience of psychiatric conditions are being involved in research are through the focused training and hiring of clinicians and researchers with lived experience (as in social work and sociology), as well as ‘co-production’ where relevant stakeholders can affect research at various stages of the process and have more of an overall impact of the direction of research (e.g. what questions are being asked, or ignored).

Regardless of whether we accept the biomedical view of delusions as irrational beliefs or something more along the lines of madness-as-strategy, including those with lived experience in academic discussions, research, and theorizing can have many benefits and take different forms.

By Jared Smith, Ph.D., postdoctoral associate with the Center for Medical Ethics & Health Policy