Madness as Strategy

Madness-as-strategy is the view that mental disturbance is purposive: what looks like breakdown is in fact the mind, the body, or the wider organism doing something for a reason. The reason might be religious (madness as divine punishment that is also an invitation to repent), interpersonal (madness as withdrawal from a rejecting environment), evolutionary (depression as disengagement from a hopeless pursuit), or physiological (a manic attack as nature’s effort to clear an obstruction). What unites these views is that the symptom is read as accomplishment rather than miscarriage. The label and the framework are most fully developed in the philosopher Justin Garson’s 2022 book Madness: A Philosophical Exploration, which traces the tradition from the Greek magicians through Freud, Goldstein, Laing, and contemporary Darwinian psychiatry. The view has never been the dominant one in academic medicine, but it has never disappeared.

Working Definition

Garson uses the term madness-as-strategy to designate “this special way of thinking that sees, in the mad, a purpose being fulfilled, a movement toward a goal, a machine operating as it ought.”(Garson, 2022) The contrast is with madness-as-dysfunction, which holds the opposite axiom: when someone is mad, something inside that person has gone wrong.

Two clarifications are essential. First, the distinction is not the same as the older split between psychogenic and biogenic accounts of mental illness. Strategy-style explanations can be biological (Goldstein’s organism, Darwinian psychiatry) or non-biological (Freud’s wishes, Burton’s sins). Dysfunction-style explanations can also be either (Kant’s faculty failures, the DSM and RDoC’s brain circuits). The two distinctions cut across each other.(Garson, 2022)

Second, the two traditions are not chronologically successive. They have always coexisted, with one or the other holding a slight cultural edge in different eras, and most actual thinkers exhibit some intermingling of both.(Garson, 2022) Madness-as-strategy is not a continuous lineage in the way Hippocratic medicine is; it has no proper succession of teacher to pupil. It surfaces and resurfaces in different costumes, what Garson calls a “spiritual brotherhood” rather than a tradition with formal transmission.(Garson, 2022)

Greek Magicians: Madness as Divine Retribution

The earliest figures Garson treats are the katharoi, the Greek magicians and purifiers whom the Hippocratic author of On the Sacred Disease (probably fifth century BCE) attacks. The standard reading of that text holds that the Hippocratics broke from magical medicine by adopting naturalism over supernaturalism. Garson rejects this reading. The Hippocratics themselves prayed to gods, advocated dream interpretation, and preserved oath structures borrowed from Near Eastern covenants.(Garson, 2022)

The real distinction, on Garson’s account, is teleological. For the magicians, disease served a purpose: divine retribution. Identifying the right deity to appease was the heart of their differential diagnosis: a goat-like seizure pointed to the Mother of the Gods, a horse-like cry to Poseidon, foaming at the mouth to Ares.(Garson, 2022) The Hippocratic author, by contrast, treated epilepsy as the failure of bodily parts to perform their functions, with the symptoms produced by air trapped in the veins by phlegm and different symptoms tied to which part was deprived of air. The magicians were the first proponents of madness-as-strategy; the Hippocratics were the first proponents of madness-as-dysfunction.(Garson, 2022) Teleology, on Garson’s reframing, cuts across the natural/supernatural divide; the question is whether the symptom serves a purpose, not whether that purpose comes from a god, an organism, or natural selection.(Garson, 2022)

The Christianized Dual Teleology

In the Middle Ages and Renaissance the magicians’ view was Christianized. Madness now served two purposes simultaneously: it was punishment for sin, and it was an opportunity for redemption. Garson calls this the dual teleology of madness, since it fuses God’s justice and God’s mercy.(Garson, 2022) By the sixteenth and seventeenth centuries this framework was so pervasive that even the disputes between physicians and exorcists did not contest it; both sides agreed madness was God’s, and only argued over jurisdiction.(Garson, 2022) Within this shared cosmos, the physician Edward Jorden carved out a distinct zone by insisting that the womb’s disruptive action on the body was simply a natural, mechanistic process, accountable to the physician rather than the exorcist. Garson reads Jorden’s move as the ascendancy of madness-as-dysfunction inside madness-as-strategy: dysteleology operating freely within a divinely ordered teleological cosmos, “like a virus within its host.”(Garson, 2022)

Robert Burton’s Anatomy of Melancholy (1621) is the most fully worked-out version. For Burton the organizing principle of madness is not defect but misuse. Faculties given by God are willfully misused, through unprocessed grief, unchecked anger, or covetousness; the resulting madness is both a natural consequence of the vice and a portrait of it. Maniacal fury reflects unchecked anger; paranoia reflects covetousness; melancholy reflects unprocessed grief.(Garson, 2022) (Garson, 2022) The mechanism is psychophysiological: repeated indulgence in vice alters the body’s humors and temperatures until the disposition crystallizes into a fixed habit, which is itself a form of madness.(Garson, 2022)

George Cheyne’s The English Malady (1733) is the last major openly dual-teleological treatment. Cheyne understood the eighteenth-century English suicide wave as a divine warning against a national lifestyle of imported French sauces, sedentary indulgence, and intemperance unsuited to a cold northern climate. Symptoms (loss of appetite, melancholy, vapors) were “infinitely wise contrivances” planted by God as an early warning system before mortal damage set in.(Garson, 2022) One striking aspect of Cheyne’s account, and one Garson highlights, is that it already contains the inversion later associated with twentieth-century anti-psychiatry: what English society calls sanity (the frenetic chase after luxury and consumption) is the real madness, and the melancholic withdrawal from that chase can be the higher sanity.(Garson, 2022)

Persistent Teleology in the Age of Dysfunction

By the second half of the eighteenth century the dual teleology had lost cultural authority. Kant’s Essay on the Maladies of the Head (1764) gave the clearest expression of madness-as-dysfunction: each form of madness is the failure of a corresponding mental faculty, and the system of faculties is closed and graspable a priori. But Garson argues that even committed dysfunctionalists kept finding teleology where they were trying to eliminate it.

Kant himself, by the time of his 1798 Anthropology, had begun to import teleology back. Affect, in the Anthropology, becomes a “temporary surrogate of reason”: nature implants compassion in children before reason can do its work, and implants systematizing tendencies even at the highest pitch of insanity “so that the faculty of thought does not remain idle.”(Garson, 2022) (Garson, 2022)

Arthur Wigan’s A New View of Insanity (1844) reframed the whole question. Wigan held that each person has two minds, one per cerebral hemisphere. Madness, on his account, is built into the structure of reason itself: the possibility of disagreement between hemispheres is the a priori condition of having a mind at all. This produced an inversion as striking as Cheyne’s: the central question of psychiatry is not “how is madness possible?” but “how is sanity possible?”(Garson, 2022) Wigan classified forms of madness by the stance reason takes toward the sick brain (reason rebuking madness, reason seduced by madness, reason acquiescing to madness), each a distinct teleological structure. His treatment proceeded by fortifying the remnant of reason in the patient against the mad brain, never addressing the mad brain directly.(Garson, 2022) In a brief and startling passage, Wigan introduced a third form, almost too repugnant to discuss: reason knowingly choosing madness as refuge. His example was a man who had lost his fortune and chose to live as if he were still wealthy, because the truth was unbearable.(Garson, 2022)

Johann Christian August Heinroth, who in 1818 published the first textbook to use the term Psychiatrie, argued that some forms of madness are strategic flights from intolerable reality. His category Wahnsinn mit Verruecktheit und Tollheit (insanity with dementia and rage) described the mind, after a life of suffering and humiliation, withdrawing into a dream world. Heinroth called this “a wholesome desire of nature to cure a perversion through another perversion.”(Garson, 2022)

Pinel, working at the Bicetre and Salpetriere around 1800, offered the secular form of the same intuition. His 1800 Traité médico-philosophique opens with an extended treatment of manie périodique because, for Pinel, this form is paradigmatic of madness in general: its intermittent attacks of fury reveal the teleological and goal-directed character he held to be present, in less visible form, throughout mental disturbance.(Garson, 2022) His central case was precisely this form: violent attacks of fury that reliably preceded the patient’s recovery of reason. Five young men admitted “with obliterated faculties” each underwent a violent maniacal episode, after which all recovered.(Garson, 2022) Pinel framed these attacks through the older doctrine of vis medicatrix naturae, citing Stahl’s view of fever as the body’s healing reaction rather than the disease itself. Just as fever is nature working, so mania can be nature working.(Garson, 2022) Garson notes that Stahl’s therapeutic teleology anticipates Darwinian medicine by three centuries, and that Pinel inherited this naturalistic purposivism directly from the Stahlian tradition.(Garson, 2022) The clinical consequence was non-intervention: “if there is an art for administering medications, there is an even greater art in knowing when to do without them.”(Garson, 2022) Garson notes that Pinel’s teleology, unlike Burton’s, no longer needs theology; nature itself possesses the purposiveness that Burton had to attribute to God.(Garson, 2022) Pinel also argued, sharply, that the brain-dysfunction view of madness is itself part of the structural pattern of asylum cruelty: regarding the mad as carrying a brain lesion encourages sequestering them and refusing them the ordinary care all infirmities deserve.

Freud, Goldstein, and the Twentieth Century

The twentieth century is bookended by two upsurges of teleological psychiatry: psychoanalysis at the opening and Darwinian psychiatry near the close, with the behaviorist and biological-psychiatry interludes in between representing the sharpest reversals to dysfunction-thinking.(Garson, 2022)

Wilhelm Griesinger’s 1845 textbook biologized Kant: mental faculties became brain organs, dysfunctions became brain disorders. But even within this materialist program Griesinger found teleology. Delusions, like dreams, were partial wish-fulfillments, and Freud cited Griesinger’s passage with approval in The Interpretation of Dreams. Reason, in Griesinger no less than in Wigan, can choose madness as a buffer against the pain of living.(Garson, 2022)

Freud’s contribution was to give the teleology of madness a new source. Freud introduced three principles that set his account apart from all predecessors: madness is functional (the symptom does something), it derives from an unconscious wish (a source unavailable to prior frameworks), and it takes the form of a strategy — a compromise between satisfaction and concealment.(Garson, 2022) For Burton it had come from God; for Pinel from a vital principle; for Kraepelin, the only purposiveness that could be recognized was the conscious will, which is why he diagnosed apparent purposiveness in patients as malingering. Freud located purposiveness in the unconscious wish, a source unavailable to all his predecessors.(Garson, 2022) Symptoms were compromises rather than failures: hysterical conversion, transposition with false connection (in obsessions and phobias), and frank denial were three different strategies the psychic system used to partly satisfy a forbidden wish while keeping it from consciousness.(Garson, 2022) Schreber’s paranoid delusion, on Freud’s reading, was not the pathology itself; it was “an attempt at recovery, a process of reconstruction.”(Garson, 2022)

The DSM-I of 1952 incorporated this thinking explicitly. Psychotic, neurotic, and personality disorders were defined as three different strategies the personality uses for dealing with internal and external stress. Adolf Meyer’s term “reaction” (anxiety reaction, conversion reaction) designated a goal-directed coping mechanism, not the expression of an underlying lesion.(Garson, 2022) (Garson, 2022)

Kurt Goldstein, working with brain-injured veterans of the First World War, gave a biologized version of the same intuition. His central concept, Selbstverwirklichung des Organismus (self-actualization of the organism), framed disease as the organism’s self-actualizing tendency operating within a more limited jurisdiction than usual.(Garson, 2022) A patient who arranged his paper precisely along the table edge and his pencil parallel to the paper was managing anxiety by reducing affordances, structuring his environment so each object proclaimed a single function. The behavior was not failed function; it was the same drive toward self-actualization, narrowed.(Garson, 2022) (Garson, 2022) Canguilhem extolled Goldstein for recognizing that “diseases are new ways of life,” not deviations from healthy life.(Garson, 2022)

Frieda Fromm-Reichmann and Harry Stack Sullivan extended the strategy framework into mid-century interpersonal psychiatry. Fromm-Reichmann read schizophrenia as reasonable behavior — motivated by fear of further rejection after devastating early relational injury.(Garson, 2022) For Sullivan, grounding psychiatry required teleology: the therapist’s primary task was to understand “what the patient is trying to do.”(Garson, 2022) Sullivan believed schizophrenia was a regression aimed at recovering parts of the self that had been dissociated as “not me” in childhood. He distinguished a “good madness” (catatonic schizophrenia, the genuinely healing form) from a “bad madness” (paranoid and hebephrenic forms, which represented the healing process aborted because the patient lost hope or needed to evade guilt). Sullivan’s clinical method actively pushed paranoid patients back into catatonia, which he understood as the productive form.(Garson, 2022) The role of the clinician, latent in Heinroth and Pinel, articulated by Sullivan, became fully explicit only in Laing: shepherd and guide rather than interventionist.(Garson, 2022)

Anti-Psychiatry and the Inversion

By the 1960s the strategic tradition had radicalized. Gregory Bateson’s double-bind theory described schizophrenia as a tactical response to communicative situations where any coherent answer would be punished, going beyond earlier accounts that read it only as withdrawal.(Garson, 2022) R. D. Laing extended this from the family to society. Schizophrenia, on Laing’s reading, was a refusal to participate in the socialization process that produced wars and concentration camps. From this came anti-psychiatry’s two-part formula: the sanity society demands is itself madness, and what society calls madness is the higher sanity that refuses to participate.(Garson, 2022) The clinician’s role, on Laing’s account, was not to cure the sick. It was to teach the mad how to be mad: to shepherd the patient through an inner transformation before assuming the political role Laing thought madness made possible.

Garson treats Laing and Szasz as continuous with the older tradition: their inversion of “sanity is madness, madness is sanity” was already present in Cheyne in the 1730s, and the figure of the clinician as guide rather than interventionist had antecedents in Heinroth and Pinel.

Darwinian Medicine and the Recent Revival

Around 1990, with no apparent awareness of any of this prior tradition, the Darwinian medicine movement began to argue that many psychiatric symptoms are evolved adaptations rather than dysfunctions — reintroducing teleology into biology in precisely the form Garson’s whole history had been tracing.(Garson, 2022) Randolph Nesse and George Williams’s Why We Get Sick (1994) treated morning sickness, fever, and many psychiatric symptoms as “defenses akin to fever and cough,” adaptations to threats rather than diseases themselves.(Garson, 2022) Garson notes that Darwinian medicine reconceives mental disorders as adaptations in precisely the same structural move the magicians, Pinel, Freud, and Goldstein had each made in their respective frameworks.(Garson, 2022) Low mood became a mechanism for disengaging from hopeless pursuits, allowing reallocation of effort to alternatives. Phobias became calibrated responses to ancestral dangers (heights, falling, predators) even when triggered by novel stimuli (flying, driving).(Garson, 2022) Some neuroscientists working on schizophrenia have proposed that delusions function as coherent frameworks that allow people with low-level perceptual abnormalities to keep operating socially, making delusions adaptive responses to a perceptual problem, not the problem itself.(Garson, 2022)

Garson notes that this Darwinian revival is, philosophically, the naturalistic vindication of teleology rather than its rejection. Darwin himself approved his friend Asa Grey’s observation that he had “brought back to natural science Teleology.” A trait’s function, on the selected-effects theory worked out by Edmond Goblot and later by Larry Wright, Karen Neander, and Ruth Millikan, is the past beneficial effect that explains why the trait still exists. Selectionist explanations are teleological explanations.(Garson, 2022)

The Argument for One Umbrella

Garson’s argument for unifying these scattered episodes under a single concept rests on what they share: the structural assumption that the symptom serves a purpose, accompanied by a corresponding shift in the logic of clinical intervention. If a symptom is read as adaptive, the clinician does not attack the symptom as if it were the problem; the clinician targets the situation to which the symptom is responding.(Garson, 2022) Pinel’s withdrawal of medication, Sullivan’s pushing of patients back into catatonia, Laing’s shepherding, and the contemporary call to leave Darwinian-functional symptoms alone all share this structure.

The unification is contested. Critics may reasonably object that lumping the Greek magicians, Burton, Pinel, Freud, Goldstein, Laing, and Nesse under one heading flattens enormous differences in metaphysics, method, and clinical practice. Garson’s defense is that the unification is structural rather than substantive: what the figures share is a way of asking about the symptom rather than a doctrine of human nature. Whether the answer comes from God, from natural selection, from the unconscious, or from the organism’s whole-body response to its environment, the question is the same: what is this for? That structural similarity is what Garson calls a Denkstil in Fleck’s sense.(Garson, 2022)

Contemporary Significance

Garson explicitly positions the recovery of madness-as-strategy as intellectual scaffolding for the Mad Pride and mad-activist movements. These movements, led by mental health service users, demand that society engage with madness on different terms, treating it as having a positive truth of its own rather than as deficit.(Garson, 2022) The argument is that this position is a recurring strand of medical thought, displaced rather than disproven, not a recent heterodoxy.

Whether one accepts the activist conclusions, Garson’s reframing has consequences for clinical practice and for the philosophy of psychiatry. If symptoms can be read as strategies, then the standard logic of intervention (identify the dysfunction and correct it) becomes one approach among others, not the default. Clinicians working in trauma-informed, recovery-oriented, and open-dialogue traditions already operate something like this logic; Garson’s contribution is to show that they are working within a tradition with deep historical roots.

See Also

• Madness as Dysfunction
• Justin Garson
• Anti-Psychiatry
• Vis Medicatrix Naturae
• R. D. Laing
• Sigmund Freud
• Kurt Goldstein
• Robert Burton
• Philippe Pinel
• Mad Pride

Sources

All claims cite evidence cards from:

• Garson, J. (2022). Madness: A Philosophical Exploration. Oxford: Oxford University Press. [Source ID: garson-madness-philosophical-exploration-2022]

Editorial Notes

Gaps the encyclopaedia compiler flagged for future evidence work, collected from inline markers in the body and frontmatter.

Contemporary Significance