Justin Garson

Justin Garson is an American philosopher of biology at the City University of New York whose work on biological function and psychiatric thought has helped reframe debates over what counts as mental illness. His 2022 book Madness: A Philosophical Exploration (Oxford University Press) reconstructs two long-running and competing ways of thinking about madness across roughly twenty-five centuries of Western thought: madness as the breakdown of mental function, and madness as a goal-directed strategy for coping with an intolerable situation. Garson is not a clinician, and he writes as a historian of ideas rather than as a partisan of either tradition. The book’s contribution is to make the second tradition visible again as a coherent way of seeing, after a half-century in which the first had become close to a default assumption in academic psychiatry.

Position and Approach

Garson works primarily on the philosophy of biological function: what makes it correct to say that a heart is “for” pumping blood, or that fear is “for” detecting threats. The dominant modern answer, sometimes called the selected-effects theory of function, holds that a trait’s function is whatever past beneficial effect explains why the trait still exists. This account ties function to natural selection, and Garson has been one of its sharpest defenders and historians.(Garson, 2022)

His turn toward psychiatry in Madness uses this background. Garson identifies Wakefield’s harmful-dysfunction analysis and Boorse’s biostatistical theory as philosophical formalizations of madness-as-dysfunction that converted historical entrenchment into apparent logical necessity.(Garson, 2022) The orthodox view holds that diseases (including madness) involve dysfunctions or failures of function.(Garson, 2022) Consequently, the framework of dysfunction is revealed as a particular interpretive choice with a contested history, not a self-evident fact about what mental disorders are.(Garson, 2022)

The Two Thought Styles

The central move in Madness is the distinction between two ways of thinking about mental disturbance:

Madness-as-dysfunction holds that “when someone is mad, it is because something has gone wrong inside of that person.” The mind has parts or faculties; madness is what happens when one or more of those parts fails to do its job.(Garson, 2022) Garson traces this picture from the Hippocratic authors, through Kant’s Essay on the Maladies of the Head, through nineteenth-century German psychiatry, into the DSM and the Research Domain Criteria project of the National Institute of Mental Health.(Garson, 2022)

Madness-as-strategy holds, by contrast, that madness has a purpose, that it is the organism (or the mind, or the wish, or the symptom) operating as it ought to operate given the situation it faces. The same evidence cards Garson uses to map this tradition include the Greek magicians and purifiers (madness as divine retribution), Burton’s Anatomy of Melancholy (madness as misuse), Pinel (mania as nature’s salutary attack), Freud (symptoms as wish-fulfillments), Goldstein (disease as self-actualization within a narrower range), and the Darwinian psychiatrists of the late twentieth century.(Garson, 2022)

Garson is careful that this is not a Kuhnian succession of frameworks. The two traditions have always coexisted; most actual thinkers mix them; what changes over time is which has the cultural upper hand.(Garson, 2022) He also insists that the teleology/dysteleology distinction is logically independent from the biogenic/psychogenic distinction: the madness-as-strategy thesis cuts across the biogenic/psychogenic divide rather than coinciding with either of them, so neither brain-based nor mind-based approaches to psychiatry have any privileged claim to the strategy framework (Garson, 2022).

Method

Garson borrows from the philosopher of science Ludwik Fleck the term Denkstil (thought style) to describe each tradition. A thought style, on Fleck’s account, can become so settled that any departure from it begins to look not merely wrong but unintelligible. That, Garson argues, is what madness-as-dysfunction has become in late twentieth-century psychiatry. The book’s purpose is to recover the older tradition not as a hidden truth but as a live alternative, so that the dominant tradition is forced to admit it is one option among others rather than the only available framework.(Garson, 2022)

A related move concerns the DSM. Most accounts of the DSM-III (1980) describe it as a “biological turn” in psychiatry, away from Freudian psychoanalysis and toward a medical model.(Garson, 2022) Garson rejects this reading.(Garson, 2022) The DSM-III, he argues, was not a victory of biology over psychology; its definition of mental disorder explicitly admits “behavioral, psychological, or biological” dysfunctions.(Garson, 2022) What the DSM-III actually did was abolish teleology.(Garson, 2022) [GAP: Claim that DSM-I described psychotic, neurotic, and personality disorders as different strategies for coping with stress is unsupported by the cited card.] The shift was from teleology to dysfunction, not from mind to brain.(Garson, 2022)

Reception and Limits

Madness is a recent book, published by an academic press, and at the time of writing its reception is still forming. Some of Garson’s most provocative readings (for example, his treatment of Edward Jorden’s “suffocation of the mother” as the prototype of medicalization, or his claim that R. D. Laing and George Cheyne, a 1730s physician, share a structural argument) are likely to be contested by specialists in the relevant periods. The historical compass of the book is also unusually wide; few specialists will be equally well-placed to evaluate his readings of the Hippocratics, the Renaissance witch trials, German Romantic psychiatry, mid-century psychoanalysis, and current Darwinian medicine.

For the Encyclopaedia’s purposes, Garson is best read as one synthesizing voice rather than as the lead authority on any of the figures he treats. His framework is useful for organizing the field; his interpretations of individual thinkers (Burton, Kant, Pinel, Goldstein, Laing) deserve to be checked against the lead scholars on those thinkers.

Influence on Mad Studies

Garson’s epilogue offers a provocation borrowed from the nineteenth-century brain anatomist Wigan: on reflection, sanity is the surprising phenomenon, not madness, given how precarious the conditions for unified mental function actually are (Garson, 2022). Garson explicitly positions his project as scaffolding for the Mad Pride and mad-activist movements led by mental health service users who reject the language of mental illness. By recovering madness-as-strategy as a tradition with twenty-five hundred years of intellectual history behind it, he gives that movement a way of arguing that its position is not a recent or marginal heterodoxy but a recurring strand of medical thought that has been temporarily displaced rather than refuted.(Garson, 2022)

See Also

• Madness as Strategy
• Madness as Dysfunction
• Anti-Psychiatry
• R. D. Laing
• Sigmund Freud
• Kurt Goldstein
• Robert Burton
• Philippe Pinel
• Vis Medicatrix Naturae
• 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]