Philosophy, Psychiatry, & Psychology

Garson’s Exercise of Conceptual Geography/Grammar

The paper by Justin Garson (2023) can be understood as a successful attempt at helping us to find our bearings in such a troublesome conceptual domain. As such, it can be framed as a skillful exercise of so-called conceptual analysis. The latter, in turn, with all due recognition of the variety of projects subsumed under the label, is very vividly illustrated by two metaphors. The first piece of imagery was developed by Gilbert Ryle (1949/2002) and focuses on the idea of conceptual geography preventing us from “intellectual and conceptual shipwreck” (Strawson, 1992, p. 3). The second one, in turn, refers to conceptual grammar (Strawson, 1992) as a project of elucidation or making explicit those aspects of our linguistic practices that usually remain hidden and obscure (for conceptual analysis as applied to medical contexts, see also Fulford [1990]).

Both conceptual geography and conceptual grammar, as a matter of fact, belong to the movement of thought or intellectual dynamism motivated by “revelation” or revealing. In the case of Garson, in particular, there are some usually neglected features of our mental health-related maps and grammar manuals that are explored and shed light on. And, especially, there are some [End Page 301] strategic or “editorial” choices made, like 1) the substitution of maps showing mental disorders for those of madness and 2) the conceptual habit of defining mental disease in contrast to sanity, which are investigated in terms of their overall consequences including those related to “closing off certain fruitful avenues of thought” (Garson 2023, p. 285).

The Relational Character of the Notion of Madness/Mental Disorder

The transition, often an implicit one, from the discussion of madness to conceptual and empirical exploration of the latter’s “medically sanitized analogue”, or the notion of mental disorder, is a conceptual move constitutive of so-called medicalization. As such, in turn, it has been heavily covered both from the perspectives of critical psychiatry (e.g., Middleton & Moncrieff, 2019) and from those affirmative of madness’ medicalization (e.g., Huda, 2019). It is a non-trivial discussion of the second feature or a conceptual practice of defining mental disorder in terms of its opposition to sanity, in effect, that is an original and truly valuable contribution of Garson.

And it is for exactly this reason that conceptual insights provided by the author deserve closer attention. What he puts to the fore, in most general terms, is a strictly relational character of the concept of mental disorder or the fact that the latter is always defined via its relation to a relevant reference class. For common contemporary approaches, as different as those offered by Wakefield (1992), Fulford (1989), or Bermúdez (2001), Garson argues that it is sanity that is chosen with mental condition becoming, respectively, the failure, absence, or the lack of reason. For the Late Modern theorists of madness, on the other hand, it is “idiocy” that operates as the point of reference (for this concept conceived as denoting particular conceptual space, see Garson [2023]) with madness, respectively, remaining infused with reason “albeit in a perverse or mutated form” (Garson, 2023, p. 290).

There are at least two issues connected with this account that require scrutiny. First, as it seems, it is not only an unspecific relation that exists between mental disorder and sanity or “idiocy,” but a very particular relation of contrast or opposition. Being ‘in contrast’ with something certainly involves being ‘different’ than that thing (with mental disorder and sanity, respectively, becoming values of a so-called...