Philosophy, Psychiatry, & Psychology

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.