Defining Madness

A few years ago, one of my colleagues told me a funny story. One of his students had said to him, “It’s a good thing that someone invented universities. Otherwise, there would be no place in the world for people like you to fit in.” I was thinking about this story recently, because I just finished reading a very thought-provoking book called Mad Matters, which contained a collection of essays Mad Matters by people who challenge standard ideas about mental illness, and how we should respond to it. I meant to briefly explore some of these ideas, because the book got me thinking about the ethical dimensions of our attributions of “normal” and “abnormal” behavior, and about our unwillingness to tolerate certain kinds of thinking and behavior that falls outside of accepted norms – even as we tolerate other kinds of thinking and behavior that we perhaps have good reason to be critical of.

Many of the contributors to Mad Matters describe themselves as “Mad activists,” who want to claim the term “mad” as a form of identity and a source of pride, in much the same way that proponents of “gay pride” have done. These writers make three claims which I think are both philosophically and ethically interesting, and from which we can draw larger conclusions.

First, these critics observe that attributions of what constitutes “mental illness” are problematic, because they are dependent as much on the time and place in which they are made as they are on objective judgments about an individual’s mental state. For example, behaviors and beliefs that, in a more religious time and place, might have been understood as indicative of a profound religious experience (for example, as demonstrating that someone had had a vision) would now be understood as symptoms of mental illness.

In addition, increasingly, behaviors that would have been seen as part of the normal range of human responses to the social environment (such as shyness or anxiety) are now medicalized. I am lucky to work in an environment in which a relatively wide range of eccentricities is tolerated (hence the student’s comment), but I suspect that behaviors demonstrated by “absent-minded professors” or professors who are intensely passionate about their sometimes arcane subjects, would be considered indicative of mental health issues in other environments. If universities were to disappear, there will, indeed, be few places for typical academics to find a home.


Second, Mad activists are concerned about the incredibly pernicious consequences that follow from a designation of mental illness, and of the power wielded by the psychiatrists who make this designation. They point out that it is widely accepted in the medical world that people have the right to refuse treatment – even lifesaving treatment – unless they have been diagnosed as suffering from a mental illness. If they have been given this particular diagnosis, then their refusal can be seen as merely another symptom of the mental illness, which means that they can be treated against their will.

Third, these activists point out, the drugs used to treat mental illness are often ineffective; indeed, I was surprised to learn, they can actually cause the disordered thinking and bizarre behavior that is then seen as further evidence the person is mentally ill. Moreover, I was sad to learn, these drugs actually lower the life expectancy of someone taking them by an average of 10 to 25 years. It’s hard to think of other medical treatments with such poor outcomes that would be imposed on people.

Qanon supporters at Trump rally.

QAnon supporters at Trump rally. (Source: ABC news)

What is most interesting to me, and what is the real ethical subject matter of this column, is the questions the analysis provided by these Mad activists raise about why we consider certain beliefs and behaviors to be normal and acceptable, and others to be indicative of mental health issues. Why, for instance, might believing that angels or aliens from another planet have spoken to you be enough to get you committed to a mental hospital, while believing that most immigrants are probably rapists or terrorists, and that mainstream media outlets peddle nothing but “fake news” get you elected President of the United States of America?

Why do so many people today believe in conspiracy theories, and support politicians who tell them obvious lies (“Brexit will be easy!” “Mexico will pay for the wall!”), and why are such claims considered to be a normal part of our political discourse, rather than as willful deceptions or symptoms of mental illness on the part of those who utter them? Which would be worse: discovering that Donald Trump believes his own lies (which would indicate mental health issues on his part), or discovering that he cynically knows that they are false, but that his supporters will believe them (which would indicate that he is a kind of democratically elected demagogue)?

I don’t know the answer to these questions, but it seems to me that trying to objectively examine our beliefs to determine which ones we ought to hold and which ones we ought to reject (this is, of course, the central task of philosophy) is a good place to start.


Rachel Haliburton

Wolfville native
Rachel Haliburton teaches philosophy at the University of Sudbury. Her latest book, The Ethical Detective: Moral Philosophy and Detective Fiction, was published in February by Lexington Books.