What Is the Philosophy of Madness?

Justin Garson on the philosophy of madness, and the importance of listening to what madness is trying to say.

Descartes’ Meditations of 1641 begins by plunging the reader into the quagmire of doubt. How can I be sure of anything? True, I seem to be sitting by a fire, in my winter gown, with paper in hand. But can I be sure I’m not dreaming? Can I be sure an evil demon is not tricking me about what I’m seeing and hearing? Abandoned by God and alone, can I even be sure I exist?

He realises that such thoughts resemble a lunatic’s, like those who “say they are dressed in purple when they are naked, or that their heads are made of earthenware, or that they are pumpkins, or made of glass”. Yet he assures us that nothing could be farther from the truth: “such people are insane, and I would be thought equally mad if I took anything from them as a model for myself”. He may be dreaming or deceived, but he’s not mad.

Why is it that, of all the outrageous possibilities Descartes is willing to entertain, the possibility of his own madness is unthinkable? Foucault famously argued that Descartes gives voice to a fundamental divorce between philosophy and madness – and that philosophy, at least in the West, has followed suit. In medieval times, the mad person had a truth of their own to reveal. Like Nebuchadnezzar, they had the power to speak to us about the secrets of nature and the cosmos, the character of God, the mysteries of death, resurrection, and the coming judgement. With Descartes, the mad are no longer fit to listen to, much less reason with. The very idea of a philosophy of madness would have struck Descartes as repugnant, even perverse.

A recent movement in philosophy is forcefully challenging Descartes’ assumption. At present, the movement is so larval, so incipient, that it is impossible to pin down a canon. In fact, the inability to pin down a canon may be rather essential to the philosophy of madness. Nonetheless, a trio of recent texts form a reasonable starting point: Wouter Kusters’ A Philosophy of Madness, Sofia Jeppsson’s “Radical Psychotic Doubt and Epistemology,” and Richard Saville-Smith’s Acute Religious Experiences.

A shared premise of these texts is that madness can be a window onto reality. The mad person, far from having a defective form of reasoning, has a distinctive style of reasoning. The mad mind is not always severed from the world. Sometimes it’s plugged into the suffocating thickness of it.

It’s helpful to approach the philosophy of madness indirectly, by what it is not. First – as my student Mallory Gonzalez pointed out to me – the philosophy of madness is not, or not merely, a philosophical discourse about madness. We already possess such a discourse. It's called “philosophy of psychiatry”. In the philosophy of psychiatry, one (presumptively sane) person speaks to other (presumptively sane) people about the nature of this other thing, madness. They speak of it in the way one might speak of an exotic pet housed in a cage on the opposite side of the room. Often enough, it's motivated by the altruistic desire to better classify, manage, or “treat” madness – or its lesser forms, such as depression or anxiety.

Nor is the philosophy of madness simply a matter of supplementing the philosophy of psychiatry with reflection on lived experience of madness (its “phenomenology”). When I was 19, I was hospitalised for a substance-induced psychotic episode. In the hospital, I looked down at my feet, which did not look like my own because they were pale, cut and dirty. I was convinced I'd entered another person’s body. Maybe I had even reanimated a corpse. A nurse was in the hallway and I politely asked for a mirror. Growing up, my dad was often hospitalised for hearing voices other people couldn’t hear and forming beliefs about them that other people found strange. Perhaps growing up with him prepared me for some of those unusual experiences.

That episode in the hospital shaped how I think about topics in the philosophy of psychiatry. One topic is the nature of delusions. Philosophers argue about whether delusions are inherently irrational, or whether they represent reasonable responses to strange experiences. Still, it seems to me that supplementing one’s philosophy of psychiatry with reflection on experience is not quite philosophy of madness. That’s because the philosophy of madness takes as its object nothing less than the whole of reality: the nature of the world, the existence of God, and the mind’s place in the scheme of things. For example, taking that same episode as the starting point for reflection on the nature of personal identity – say, to argue that “body-switching” is both coherent and possible – brings us closer to the philosophy of madness, as it uses mad experience as a window onto reality.

There are numerous ways madness can illuminate reality. Kusters argues, for example, that Western philosophy has often focused solely on “the furniture of the world”, the kinds of things that make up reality. Is there just one substance, or more? Does the world divide neatly into natural kinds? Kusters argues, on the basis of his own experiences with psychosis, that reality doesn't just come parcelled into kinds, but degrees. In psychosis, the world sometimes seems really real; everything is infused with meaning and significance. At other times, the world seems hollow, insubstantial: a play of shadows that conceals the true reality behind it. Sometimes the world can toggle back and forth between being more real and less real. Perhaps this observation should make us take more seriously the notion that reality comes in degrees.

As Sofia Jeppsson points out, madness also carries deep lessons for the nature of knowledge. Philosophers have often approached the problem of scepticism about the external world in a detached, theoretical way. Sure, they admit, perhaps one can’t prove that the world exists outside of the mind. But belief in an external world, they hold, is a postulate of practical reason. It’s something we need to believe in order to go about our lives. This comforting philosophy contradicts the experience of many mad people who've managed to survive, and even thrive, despite a deep-seated doubt about the world's realness, its solidity and stability.

Madness can illuminate problems in the philosophy of religion and philosophy of mind. Philosophers of religion around the turn of the twentieth century, like William James and Rudolf Otto, insisted upon a sharp distinction between madness and mystical enlightenment. Richard Saville-Smith, through painstaking analysis of philosophical and religious texts, shows that the boundary between the mad person and mystic is always historically relative and open to interpretation. His analysis undermines a standard assumption that there’s an objective fact of the matter about whether a historical figure like Margery Kempe “was” or “was not” insane. His exploration of religious experience also suggests ways of moving beyond medical framings of madness which see it as a disease or dysfunction.

Having sketched what the philosophy of madness is, it’s important to resist two temptations. The first temptation is to try to define it rigorously, anthologise it, or decide too hastily that this or that philosophical work does or does not belong to the philosophy of madness. Arguably, the felt need for precise definitions and sharp boundaries is itself a legacy of a kind of sanist bias in philosophy. Language doesn't lend itself in a ready-made way to all forms of human experience. It wasn’t designed to. Moreover, I don’t mean to suggest that lived experience of madness is a requirement for doing philosophy of madness, but that it must arise from the soil of that experience, whether first-hand or by testimony.

More importantly, we must resist the temptation to settle on a clear, fixed definition of madness itself, or to universalise specific experiences as if they represent the form of all madness. As Nev Jones and Mona Shattell emphasise in their “Not What the Textbooks Describe: Challenging Clinical Conventions About Psychosis”, the categories mental health professionals use often fail to reflect the sheer diversity of mad experiences. The philosophy of madness is about stretching our grasp of reality and the mind’s place in it to accommodate a wider range of experiences and forms of thought, rather than to dictate which experiences or thought-forms are “authentically mad”.

The philosophy of madness is poised to overturn our deep-seated assumptions about the nature of philosophy, by showing how the world might be weirder, more exhilarating, and perhaps more frightening, than we thought. More importantly, it throws into question our understanding of madness itself, or its medically-sanitised sibling, “mental disorder”. Perhaps it will lead us to stop seeing madness merely as a curious medical phenomenon, or an unfortunate aberration of reason, and to listen to what it’s trying to say.

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Justin Garson is professor of philosophy at City University of New York, and author of Madness: A Philosophical Exploration (2022), with Oxford University Press. He is also the author of The Madness Pill: The Quest to Create Insanity and One Doctor’s Discovery that Transformed Psychiatry, forthcoming with St. Martin’s Press.