Madness is a complex and contested term. Through time and across cultures it has acquired many formulations: for some, madness is synonymous with unreason and violence, for others with creativity and subversion, elsewhere it is associated with spirits and spirituality. Among the different formulations, there is one in particular that has taken hold so deeply and systematically that it has become the default view in many communities around the world: the idea that madness is a disorder of the mind. -/- (...) Contemporary developments in mental health activism pose a radical challenge to psychiatric and societal understandings of madness. Mad Pride and mad-positive activism reject the language of mental 'illness' and 'disorder', reclaim the term 'mad', and reverse its negative connotations. Activists seek cultural change in the way madness is viewed, and demand recognition of madness as grounds for identity. But can madness constitute such grounds? Is it possible to reconcile delusions, passivity phenomena, and the discontinuity of self often seen in mental health conditions with the requirements for identity formation presupposed by the theory of recognition? How should society respond? -/- Guided by these questions, this book is the first comprehensive philosophical examination of the claims and demands of Mad activism. Locating itself in the philosophy of psychiatry, Mad studies, and activist literatures, the book develops a rich theoretical framework for understanding, justifying, and responding to Mad activism's demand for recognition. (shrink)

The enlarging domain of psychiatric intervention is frequently associated with the undue medicalization of unusual experiences. In such a climate, it becomes of utmost importance to carefully choose appropriate candidates for the psychiatric gaze. This suggests a need to draw a distinction between religious experiences (with psychotic form) and pathological psychotic experiences. As Jackson and Fulford (1997) maintain, “spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine. It (...) would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political .. (shrink)

Central to the identity of modern medical specialities, including psychiatry, is the notion of hypostatic abstraction: doctors treat conditions or disorders, which are conceived of as “things” that people “have.” Mad activism rejects this notion and hence challenges psychiatry’s identity as a medical specialty. This article elaborates the challenge of Mad activism and develops the hypostatic abstraction as applied to medicine. For psychiatry to maintain its identity as a medical speciality while accommodating the challenge of Mad activism, it must develop (...) an additional conception of the clinical encounter. Toward elaborating this conception, this article raises two basic framing questions: For what kind of understanding of the situation should the clinical encounter aim? What is the therapeutic aim of the encounter as a whole? It proposes that the concepts of “secondary insight” and of “identity-making” can allow the clinical encounter to proceed in a way that accommodates the challenge of Mad activism. (shrink)

The centenary of Karl Jaspers' General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work. Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers (...) a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: Is second-order empathy possible? Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices. (shrink)

At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently (...) disabling: the first arises from the normative nature of disability judgements, and the second from the implications of political activism in terms of being a social subject. In the process of arguing for these two bulwarks, the paper explores the basic structure of the social model of disability in the context of debates on naturalism and normativism; the applicability of the social model to madness; and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter. (shrink)

Proposing narratives that reflect our values and address what we believe to be, and what in fact in this case are, valid concerns is no doubt an attractive venture. But good intentions are not enough, and often it is careful analysis that shows why this is the case. Alastair Morgan's (2023) essay Power, Threat, Meaning Framework: A Philosophical Critique is a bright example of philosophy-in-action; it demonstrates, to use a popular expression, that the road to hell is paved with good (...) intentions. In this commentary I argue that while the concerns of the authors of the Power Threat Meaning Framework (PTMF) are valid, their proposed solutions lead us to yet another master narrative.The PTMF presents itself as an... Read More. (shrink)

Among the different approaches in mental health activism, there is an ongoing concern with the concepts and meanings that should be brought to bear upon mental health phenomena. Aspects of Mad Pride activism resist the medicalisation of madness, and seek to introduce new, non-pathologizing narratives of psychological, emotional, and experiential states. This essay proposes a view of Mad Pride activism as engaged in no less than the creation of a new culture of madness. The revisioning and revaluing of madness requires (...) transformations in the basic concepts constitutive of current mental health narratives. This process is illustrated with the concept of self and its relation to passivity phenomena (thought insertion). The essay concludes with some of the challenges facing Mad Pride's ambition to enrich the cultural repertoire. (shrink)

Cultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture (...) as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct. (shrink)

The challenge of understanding psychotic phenomena is one of the enduring problems in the philosophy of psychiatry. The first to formulate the problem in its philosophical dimension was Karl Jaspers in General Psycho-pathology. Jasper’s solution was rather pessimistic, for he argued that we cannot extend empathic understanding to certain phenomena, such as primary delusions. His work was followed by a long period of philosophical silence on the issue, and it was only three decades ago that philosophy began to engage once (...) again with the problem of understanding. Today there is a rich literature that explores this problem: from philosophy of language to European phenomenology, and from theories... (shrink)

Political activity on the basis of a shared identity has been with us for several decades. Race, sexual orientation, gender, and myriad other categories form the center-of-gravity around which social groups demand recognition of the validity and value of their self-understandings. How should social and political institutions respond to these demands? In contemporary social and political philosophy much of the weight of answering this question has fallen on developing a theory of recognition. That theory would then perform several functions: It (...) could provide an explanation as to the emergence and subsequent contestation of shared social norms; it could offer an account of the motivation that drives people to... (shrink)