Reconceptualizing Delusion

In his bold and illuminating book Madness: A Philosophical Exploration, Justin Garson makes a case for thinking about madness as strategy, rather than as dysfunction. The reader is invited to take away a better appreciation of the historical provenance of madness as strategy, that is, this is not a new idea, destined for the fringes or of interest only to those of a more radical bent. It is rather an idea which has firm roots in the history of psychiatry. Garson’s lens is wide, he is advocating a strategy over dysfunction approach for, at least, anxiety, depression, schizophrenia (and its spectrum disorders), and delusion. In this exploratory paper, we focus on delusion. We discuss what a madness-as-strategy approach might say about delusion, and how that fits with the idea that such beliefs are evolutionarily adaptive. We turn then to explore the implications of this reconceptualization of delusion for epistemic injustice in psychiatry. Our discussions will support the idea that much of the theoretical action lies not in the distinction between dysfunction and strategy, but rather in the distinction between everyday and abnormal dysfunction.