Search

At the beginning of the twentieth century, the French philosopher of science Edmond Goblot wrote three prescient papers on function and teleology. He advanced the remarkable thesis that functions are, as a matter of conceptual analysis, selected effects. He also argued that “selection” must be understood broadly to include both evolutionary natural selection and intelligent design. Here, I do three things. First, I give an overview of Goblot’s thought. Second, I identify his core thesis about function. Third, I argue that, despite its ingenuity, Goblot’s expansive construal of function cannot be right. Still, Goblot deserves long-overdue credit for his work.

Today we live in the era of Darwinian medicine. One implication of Darwinian medicine is that some mental disorders might be adaptations, that is, evolved strategies for dealing with ancient and modern environments. For example, it allows us to think of depression as an evolved strategy for dealing with interpersonal conflict, or anxiety disorders as evolved strategies for remaining vigilant to potential threats. Darwinian medicine, then, puts teleology back into psychiatry, and thereby reverses the trend of the DSM franchise to divest psychiatry of teleology. The idea that Darwinism helps to reintroduce teleology into psychiatry forces us to examine how Darwinism and teleology are inseparable, rather than antagonistic. We can see a natural association between the ancient Greek magicians, the exorcists of the Renaissance, the psychoanalysts, and the evolutionary psychologists, in that they all saw madness as wedded to purpose.

The nineteenth-century German physician Wilhelm Griesinger opened the era of “German imperial psychiatry,” with its insistence that the forms of madness are just so many brain dysfunctions. In this respect, he accepted, entirely, Kant’s dysfunction-centered account of madness, but he biologized it, that is, he located it in the space of the nervous system and its parts. What is surprising, however, is that Griesinger did not entirely abandon teleology. Rather, he saw in delusions, as well as dreams, the operation of wish fulfillment mechanisms. The job of expunging teleology from psychiatry was left to Emil Kraepelin. One of Kraepelin’s core contributions to psychiatry was the idea that careful longitudinal observation of mad patients would be instrumental in identifying the nature of the brain dysfunctions underlying madness. For Kraepelin, to the extent that we can see purpose and goal-directedness in madness, then we are not really dealing with madness but malingering.

Historians and philosophers often view the history of madness as a clash between proponents of a biological perspective and proponents of a psychological perspective. This chapter provides an overview of a very different way of reading the history of psychiatry, namely, in terms of the distinction between madness-as-strategy and madness-as-dysfunction. The first perspective sees madness as having a purposeful, teleological, or functional character. The second sees madness as a dysfunction, defect, or disease. The chapter clarifies that the book is, in the final analysis, neither an exercise in the history of science nor a conceptual genealogy, but a recovery mission. It seeks to recover the madness-as-strategy tradition in order to provide an alternative to madness-as-dysfunction. The chapter also gives a synoptic overview of the major figures and texts the book treats.

A fascinating and neglected nineteenth-century theorist of madness was Arthur Ladbroke Wigan, author of A New View of Insanity: The Duality of the Mind of 1844. Wigan’s thesis is that each hemisphere of the brain is in fact a distinct brain and also a distinct mind. For Wigan, madness happens when one brain is healthy and the other brain is sick, and the healthy brain starts to trust the aberrant reports of the sick brain. The various forms of madness are simply ways that the healthy brain relates to the sick brain: the healthy brain can rebuke the sick brain, it can be deceived by the sick brain, or it can acquiesce to the sick brain. He also considers whether and how religion promotes madness. Although Wigan was sometimes likened to phrenologists like Spurzheim or Gall, his vision of the mind as consisting as two distinct persons was quite original.

This chapter revisits the ancient clash between the Hippocratic physicians and the “magicians, purifiers, charlatans and quacks” whom they opposed. What, precisely, is the nature of this schism? Some scholars frame the divide as one between naturalism and supernaturalism. But classical scholarship puts this reading into question, for the Hippocratics, too, invoke divinity, purification, and prayer. The chapter suggests that we frame the clash as one between dysteleology and teleology. The Hippocratics were wedded to the idea that madness, and disease generally, happens when something inside of a person cannot perform its correct function. The magicians and purifiers, in contrast, thought of madness as embodying a divine strategy, and more specifically, a punishment for offending the gods. Hence, the tension between madness-as-dysfunction and madness-as-strategy is already prefigured in the classical era. In a sense, this book can be read as a long-overdue apologia for the magicians and purifiers.

The early nineteenth-century physician Philippe Pinel is remembered today as the psychiatric reformer who purportedly broke off the chains of the mad patients at the Bicêtre hospital. It is true that Pinel was largely responsible for introducing the moral treatment of the mad into France. What is less well known is that Pinel advanced a thoroughly teleological conception of madness. For Pinel, one of the chief forms of madness, manie périodique ou intermittente, has a goal-directed character. It has a cathartic and salutary effect on the patient. It is for this reason, he thought, that those suffering from this illness should not be medicated but rather that the disease should be allowed to run its course. His moral treatment is a natural consequence of his teleological conception of madness. He was also convinced that most forms of madness do not stem from an organic brain dysfunction.

Since the time of Hippocrates, madness has typically been viewed through the lens of disease, dysfunction, and defect. Madness, like all other disease, happens when something in the mind or brain does not operate the way that it should, or as nature intended. In this paradigm, the role of the healer is simply to find the dysfunction and fix it. This remains the dominant perspective in global psychiatry today. This book presents a different paradigm for conceiving of madness and the forms that it takes. In this paradigm, madness-as-strategy, madness is neither a disease nor a defect, but a designed feature, like the heart or lungs. That is to say, at least sometimes, when someone is mad, everything inside of them is working exactly as it ought and as nature intended. Through engagement with texts spanning from the classical era to Darwinian medicine, Madness: A Philosophical Exploration shows that madness-as-strategy is not a new conception. Thus, more than a history of science or a conceptual genealogy, Madness: A Philosophical Exploration is a recovery mission. In recovering madness-as-strategy, it leads us beyond today’s dominant medical paradigm toward a very different form of thinking and practice. It also draws out the implication of the madness-as-strategy paradigm for philosophers of medicine and psychiatry, historians and sociologists of medicine, and mental health service users, survivors, and activists. It outlines a new conception of mental disorder, it provides a novel reading of the history of madness, and it presents an alternative vision of what it means to be mad.

One of the clearest expressions of madness-as-dysfunction is Kant’s youthful essay of 1764, “Essay on the Maladies of the Head.” There, Kant argues that each form of madness represents a defect in a corresponding faculty of reason. Since there are only three faculties of reason (experience, judgment, and reason), there are only three forms of madness, corresponding to the breakdown of each. Kant gives voice to what was to become a basic protocol for nineteenth-century medical psychiatry: to understand madness, we must first survey the faculties of the sound mind, and then identify the forms of madness as so many different ways that those faculties break. It is astonishing, then, that in his Anthropology from a Pragmatic Point of View of 1798, Kant rediscovers teleology inside of madness. Some forms of madness are bestowed upon us by the “wisdom of nature” in order to protect reason or motivate ethical behavior.

Kurt Goldstein extended Freud’s teleological conception of madness and placed it within a biological, evolutionary context. Mental disturbance is no longer a method that the mind uses for regulating its internal economy. Rather, it represents a method for adjusting the organism to its environment. It is true that many of the injured war veterans Goldstein treated had brain dysfunctions that prevented them from accomplishing ordinary tasks. Goldstein, however, insisted that we view their apparent mental disturbances as a creative means by which they transform their environments in order to minimize their experience of disability. In particular, for Goldstein, the essential characteristic of the organism, healthy or sick, is the project of self-actualization, and madness must be viewed within the context of this project. Despite their differences, both Goldstein and Freud held that madness is a strategic response to a potentially catastrophic situation.

At the beginning of the twentieth century, Freud placed the study of madness on a firm teleological foundation. For Freud, the main forms of madness—hysteria, obsessional neurosis, and delusions—represent strategies the mind utilizes for fulfilling, in a distorted manner, an unconscious wish, while preventing the content of that wish from becoming conscious. This teleological orientation of psychiatry ultimately emerged from a conception of the nervous system that he shared with Griesinger. For Griesinger, as for Freud, an unfulfilled wish is associated with the accumulation of a certain quantity of nervous energy, a Besetzung. The function of the nervous system is to discharge this Besetzung. One of Freud’s enduring legacies was the way in which his teleological conception of madness was woven into the first edition of the Diagnostic and Statistical Manual of Mental Disorders of 1952. For a brief time, madness-as-strategy had become canonized in official psychiatric classification.

The early eighteenth-century physician George Cheyne accepted the Renaissance view that madness, and particularly melancholy, represents a punishment for sin as well as an opportunity for redemption. For Cheyne, however, unlike Robert Burton, the sin that looms largest in his thinking is the sin of intemperance, that is, immoderation in food and drink, or gluttony. We can understand his peculiar fixation with intemperance if we read Cheyne’s masterpiece, The English Malady of 1733, in the context of his monumental works of natural theology. For Cheyne, God has given to the peoples of the globe exactly the sorts of food and medicine that they need to flourish, given the region where God has placed them. Intemperance represents a rejection of God’s place-based providence. Hence, melancholy has the purpose of warning us against the perils of immoderation.

Robert Burton, in his The Anatomy of Melancholy of 1621, embraces the Renaissance view that all forms of madness have a dual purpose: madness is either caused or allowed by God to punish sin and also to provide the sufferer with an opportunity for redemption. Burton, however, marks a transition to a naturalistic worldview: madness does not always require God’s special intervention into the course of nature. Rather, God has designed the material universe in such a way that certain sins will inevitably be followed by certain forms of madness. He also shows how the forms of madness are not just punishments, but portraits, of our sin. For example, mania can be an exaggerated portrait of unchecked anger. It is illuminating, then, to read The Anatomy of Melancholy alongside morality tales such as The Divine Comedy or the “Macro Plays,” rather than alongside other medical treatises.

John Haslam, apothecary to Bedlam hospital at the beginning of the nineteenth century, embraced Kant’s dysfunction-centered model of madness. For Haslam, each form of madness represents a breakdown in a faculty of the sound mind. Haslam, however, identifies a new principle of madness: duplicity or dissimulation. The mad person dissimulates reason in order to evade institutionalization. The theme of dissimulation is on display in his 1810 manuscript, Illustrations of Madness, in which he considers the case of James Tully Matthews and a “remarkable difference in medical opinion” over whether Matthews was, in fact, mad. Ultimately, Haslam concludes that the mad person understands but rejects the claims of reason. In a sense, all madness has a purposeful character insofar as its goal is to deceive others by dissimulating reason. This creates a new challenge for the physician: one role of the physician is to outwit the mad person.

In the Renaissance, madness is not just a disease. It has a divine purpose. God allows madness not merely to punish, but to create an opportunity for redemption. This chapter explores this dual teleology of madness by considering the tension between witch-skeptic and physician Edward Jorden and the exorcists. For Jorden, most cases of alleged demon possession were actually due to an organic dysfunction, hysteria or “suffocation of the mother.” Jorden saw his confrontation with the exorcists as a self-conscious repetition of Hippocrates’ confrontation with the magicians and purifiers. We can see Jorden as attempting to replace a teleological conception of madness (madness-as-strategy) with his dysteleological conception (madness-as-dysfunction). An irony in Jorden’s text is that Jorden never actually banishes the use of amulets, charms, spells, and incantations. He retains them because of their psychological value for treating hysteria.

For Frieda Fromm-Reichmann, madness represents a flight from a painful social reality. In the hands of R. D. Laing, madness is not merely a flight from reality but a refusal to participate in an unjust social order. In this context, Laing and other anti-psychiatrists like Cooper were able to carry out the grand inversion of thought in which madness is a “higher” sanity, and what passes for “sanity” is a form of collective madness. It did not take long for the American counterculture to see, in madness so construed, a mirror of its own plight. In fact, for the counterculture, acid became conceptualized as the link between madness and revolution. In the 1950s, psychiatrists hailed LSD as a psychomimetic drug that could induce temporary madness. By the late 1960s, LSD was construed, by the counterculture, as a drug that opens the door to this higher form of sanity.

The early nineteenth-century German psychiatrist Johann Christian August Heinroth raises the possibility that some forms of madness are coping mechanisms. They represent the mind’s attempt to flee a painful reality. In these cases, he thought, the wise physician should allow the disease to run its course. This view was developed by psychoanalytic psychiatrists in the early twentieth century such as Frieda Fromm-Reichmann and Harry Stack Sullivan. Both Fromm-Reichmann and Sullivan viewed schizophrenia as having a purposeful character, but they disagreed about what exactly its purpose is. For Fromm-Reichman (coiner of the term “schizophrenogenic mother”), schizophrenia is a retreat from the repeated experience of rejection. For Sullivan, schizophrenia is a recovery mission. Its purpose is to recover dissociated portions of the personality. Heinroth, Fromm-Reichmann, and Sullivan illustrate, in different ways, the idea of madness as a purposeful inner journey. This conception reaches its zenith in the work of R. D. Laing.

Theories of function are conventionally divided up into historical and ahistorical ones. Proponents of ahistorical theories often cite the ahistoricity of their accounts as a major virtue. Here, I argue that none of the mainstream “ahistorical” accounts are actually ahistorical. All of them refer, implicitly or explicitly, to history. In Boorse’s goal-contribution account, history is latent in the idea of statistical typicality. In the propensity theory, history is implicit in the idea of a species’ natural habitat. In the causal role theory, history is required for making sense of dysfunction. I elaborate some consequences for the functions debate.

I distinguish two forms of pluralism about biological functions, between-discipline pluralism and within-discipline pluralism. Between-discipline pluralism holds that different theories of ...

Philosophers discuss Jerome Wakefield's influential view of mental disorder as “harmful dysfunction,” with detailed responses from Wakefield himself. One of the most pressing theoretical problems of psychiatry is the definition of mental disorder. Jerome Wakefield's proposal that mental disorder is “harmful dysfunction” has been both influential and widely debated; philosophers have been notably skeptical about it. This volume provides the first book-length collection of responses by philosophers to Wakefield's harmful dysfunction analysis (HDA), offering a survey of philosophical critiques as well as extensive and detailed replies by Wakefield himself. HDA is offered as a definition of mental disorder, but it is also the outcome of a method—conceptual analysis—and contributors first take up HDA's methodology, considering such topics as HDA's influences on the DSM, empirical support for HDA, and clinical practice. They go on to discuss HDA's ultimate goal, the demarcation between normal and abnormal; the dysfunction component of the analysis, addressing issues that include developmental plasticity, autism and neurodiversity, and the science of salience; and the harmful component, examining harmless dysfunction, normal variation, medicalization, and other questions. Wakefield offers substantive responses to each chapter. The open access edition of this book was made possible by generous funding from Arcadia – a charitable fund of Lisbet Rausing and Peter Baldwin. Contributors Rachel Cooper, Andreas De Block, Steeves Demazeux, Leen De Vreese, Luc Faucher, Denis Forest, Justin Garson, Philip Gerrans, Harold Kincaid, Maël Lemoine, Dominic Murphy, Jonathan Sholll, Tim Thornton, Jerome Wakefield, Peter Zachar

There is a certain metaphor that has enjoyed tremendous longevity in the evolution of ageing literature. According to this metaphor, nature has a certain goal or purpose, the perpetuation of the species, or, alternatively, the reproductive success of the individual. In relation to this goal, the individual organism has a function, job, or task, namely, to breed and, in some species, to raise its brood to maturity. On this picture, those who cannot, or can no longer, reproduce are somehow invisible to, or even dispensable to, the evolutionary process. Here, I argue that the metaphor should be discarded, not on the grounds that it is a metaphor, but on the grounds that this particular metaphor distorts our understanding of the evolution of ageing. One reason the metaphor is problematic is that it frames senescence and death as nature’s verdict on the value of older individuals. Instead, we should explore a different metaphor: the lengthy post-reproductive period in humans and some other animals is not an accident of culture, but designed by nature for the purpose of supporting and guiding younger generations. On this alternate picture, different stages of life have their own evolutionary rationales, their distinctive design features, their special mandates.

Over the last 20 years, several philosophers have developed a new approach to biological functions, the organizational (or systems-theoretic) approach. This is not a single theory but a family of theories based on the idea that a trait token can acquire a function by virtue of the way it contributes to a complex, organized system and thereby to its own continued persistence as a token. I argue that the organizational approach faces a serious liberality objection. I examine three different ways organizational theorists have tried to avoid that objection and show how they fail.

I present and defend the generalized selected effects (GSE) theory of function. According to GSE, the function of a trait consists in the activity that contributed to its bearer’s differential reproduction, or differential retention, within a population. Unlike the traditional selected effects (SE) theory, it does not require that the functional trait helped its bearer reproduce; differential retention is enough. Although the core theory has been presented previously, I go significantly beyond those presentations by providing a new argument for GSE and defending it from a recent objection. I also sketch its implications for teleosemantics and philosophy of medicine.

Why do some organisms rely on mental representations for making decisions? Why don’t we rely merely on direct mappings from perception to behavior? Armin W. Schulz’ book, Efficient Cognition: The Evolution of Representational Decision Making, offers a novel and empirically-informed perspective on a problem that has not received the amount of philosophical attention it deserves. In his view, representational decision making evolved because creatures that use it have enhanced cognitive and neurological efficiency. Here I provide an overview of the book’s contents and a critical assessment of his proposal.

Mainstream teleosemantics is the view that mental representation should be understood in terms of biological functions, which, in turn, should be understood in terms of selection processes. One of the traditional criticisms of teleosemantics is the problem of novel contents: how can teleosemantics explain our ability to represent properties that are evolutionarily novel? In response, some have argued that by generalizing the notion of a selection process to include phenomena such as operant conditioning, and the neural selection that underlies it, we can resolve this problem. Here, we do four things: we develop this suggestion in a rigorous way through a simple example, we draw on recent neurobiological research to support its empirical plausibility, we defend the move from a host of objections in the literature, and we sketch how the picture can be extended to help us think about more complex “conceptual” representations and not just perceptual ones.