In this article, I examine the relation between philosophy and madness. It is often assumed that madness has to be suppressed, excluded, or conquered before a philosophically sensible text, logical argument, or world of meaning can appear. I argue, instead, that a certain concept of madness, when grafted on phenomenological psychiatry and philosophical mysticism, is intrinsically related to the project of philosophy. With the help of experiences of madness as presented in psychiatry and articulated in mad autobiographical reports, including my (...) own, I will show that philosophy and madness are in closer connection than is commonly assumed. In the introduction, I refer to some superficial... (shrink)

BACKGROUND: Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential alterations. (...) This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. METHODS: In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, to analyse their accounts. FINDINGS: Between March 2, 2020, and Sept 30, 2020, 18 adults participated in the interview study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality experience can differ from standard reality in various ways, across multiple dimensions, and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. INTERPRETATION: Increased awareness and recognition of the distinctive nature of delusional reality experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for individuals with delusions whose lived realities are not always evident from an everyday perspective. FUNDING: FWO Flanders. TRANSLATION: For the Dutch translation of the abstract see Supplementary Materials section. (shrink)

ABSTRACT In this article, I will examine the question why it is so difficult to understand madness. First, I will examine what the third-person approach of psychosis or madness has to offer, and where its limitations lie with respect to its proper understanding. Next I will examine if and how the first-person perspective on madness contributes to our understanding. I will demonstrate that there is a stalemate between third- and first-person perspectives, which on the one hand hinders a free sight (...) on madness, but which is on the other hand exemplary of the problem that is presented by madness. This turns out to be a paradox that haunts both the concept and experience of madness itself, as well as those who try to understand it. In the fourth section, I will unpack some of the operations of the paradox as it is found both in philosophy and madness, both by their producers as by their consumers. In the fifth section, I will tentatively sketch (im)possibilities of escaping paradoxes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How to Reason Beyond Reason? Toward a Philosophical Understanding of MadnessWouter Kusters, PhD (bio)To analyze the situation of madness on the ground, we need a grounded perspective, close to the situation at hand. The closer we come to the subject under scrutiny, the clearer its outlines, fine-grained details, and its dynamics, and the better we reach an explanation and understanding. The closer the approach, however, the higher the chances (...) are of becoming myopic and losing the connections with broader—or higher—perspectives: the view from above. It has been due to philosophical and historical approaches from above to the practices of philosophically inspired psychiatry that we may gain new insights into what is going on on the ground—and underground. This article by Garson provides such a view that may lead to a change in perspective, a new way to draw boundaries on the ground, to discover similarities and dissimilarities through space and time, without thereby losing the lived connection to the problematic ground.Garson proposes to replace a binary opposition of madness (in the sense of sick or insane) versus sanity (in the sense of healthy), with a triad of concepts, sanity, madness, and idiocy, taken from the work of philosophers of psychiatry avant la lettre in the early modern times, Locke, Kant, Wigan, and Heinroth. This triad is to be understood in terms of reason, where idiocy consists of the diminishment of some aspects of reason, while madness would be characterized by a perversion of reason. By examining how this perversion—or more neutrally said, this change—of reason was conceived by the four thinkers, Garson sheds a new light on research and theory within the philosophy of madness and the philosophy of psychiatry today. He examines the question of “how is it that the mad person “has” reason, but is still not reasonable?” with the help of the four authors mentioned above (of which I discuss three).In answering this question, Garson refers specifically to my work as an example of “exactly the kind of ontology we need for rethinking madness in a positive manner—not necessarily ‘positive’ in the sense of good, helpful, or ennobling, but in the sense of going beyond a mere lack, absence, or failure.” I wholeheartedly agree with this assessment, [End Page 317] and Garson’s proposal of this tripartite schema is helpful and valuable for thinking through how we can further nourish a positive view of madness, especially with reference to Mad Pride.Locke and HeinrothGarson discusses some fragments from Locke and concludes that according to Locke “the mad person, in contrast to the idiot, possesses reason by virtue of possessing an intact inferential capacity. What ultimately makes them mad, and not reasonable, is that their premises are flawed by the unhinged power of association.” So, with Locke the capacity for inferential logic is not disturbed, and in that sense reason is intact. The unreasonable behavior would be due, according to Locke, to an unbridled increase in imagination and associations, which are taken for reality. Instead of reason the capacity to align imagination and reality is afflicted. When we translate this Lockean view into contemporary terms, we could say that it is not their cognition, their way of processing stimuli that is problematic, but their being overwhelmed by impressions or stimuli. This is akin to “bottom-up” theories: Something is wrong with perception or experience, and ‘higher’ capacities of cognition and reasoning remain intact. Reason may seem ‘perverted,’ but at a closer look, this is a result of their being victim to anomalous experience, too many stimuli or too strong imaginations.Heinroth also explicitly distinguishes madness from idiocy, that is, from a diminishment of mental capacities. Instead, he considers madness as a reaction to what Garson calls “a reality that is too awful to bear.” Madness is then “a wholesome desire of nature to cure a perversion through another perversion.” Again, madness is then not in itself a diminishment of reason, but an attempt to cure something that went wrong, in a way that is also only seemingly wrong (perverted reason). Madness then is again within reason, but this core of intact reason is... (shrink)