Are ‘Mental Disorders’ Diseases, or Strategies?


From Psychology Today/Justin Garson PhD: “Depression is a pathology of normal sadness. Psychopathy comes from a deformed amygdala. Delusions come from broken dopamine circuits. The key to healing the mad? Find the dysfunction and fix it—just like you’d repair a defective thermostat or an iPhone dropped in the toilet.

This disease model isn’t new. The unknown author of On the Sacred Disease, penned around 400 B.C., says that people become mad when their brains are too hot, cold, moist, or dry. Nearly 2,500 years later, in 2012, the head of the U.S. National Institute of Mental Health declared flatly that ‘mental disorders can be addressed as disorders of brain circuits.

This way of thinking is so entrenched in modern psychiatry that it’s hard to see as just one perspective among others—that is, as a style of interpreting data. We mistakenly treat it as an objective fact in its own right. Mental disorders are diseases. Also, the sun rises every day. Also, tuna fish sandwiches have tuna in them.

Outside the Disease Paradigm

I find it hard to wriggle out of an old paradigm without giving it a name. I’ve named this old paradigm madness-as-dysfunction. It says that when someone is mad, something inside of them has broken down. Something in their mind, brain, spirit, or body isn’t working the way nature intended.

As a philosopher and historian of medicine, I’ve recently identified a very different paradigm, one that’s just as old as madness-as-dysfunction, and that tags alongside it like an annoying little brother. I call this alternative paradigm madness-as-strategy.

Madness-as-strategy holds that some forms of madness are designed responses to the trials of life. They’re not defects, but solutions to existential crises that have haunted our species for thousands of years.

Calluses are designed responses to friction. Fevers are designed responses to infection. Are delusions a designed response to a painful reality? Is depression a designed response for navigating delicate interpersonal situations? Well, why not?

Evolutionary psychologists often flirt with the idea that some mental disorders have a purpose, function, or goal. But what they’ve failed to see is that this view is a modern incarnation of a very old style of medical wisdom, one with its own figureheads and founders.”


Back to Around the Web


  1. Dependency as Strategy –
    A group of professional narcissists write a book of alphabetical gimmicky while handing out powerful substances, the mechanisms of which they know little about, but claim to be safe and non-addicting (though mounting evidence proves the contrary).
    1. Self acceptance
    2. Self reliance
    3. Self respect

    Dependency as Strategy –
    A group of professional narcissists rely on a book of alphabetical gimmicky which lures people into unbalanced relationships.
    1. Self acceptance
    2. Self reliance
    3. Self respect

    Report comment

  2. I did a presentation on understanding “psychosis” as an attempt to solve problems, you can access it at

    Here’s the description for it: While psychosis is commonly understood as something going wrong within a person, and while many treatment approaches attempt simply to stop that process, this workshop focuses on an alternative view that sees psychosis as resulting from attempts to resolve problems that preceded the psychosis. In this view, psychosis may be initiated by a dangerous type of experimentation or creative process, where people (especially young people) consciously or unconsciously try out new ways of seeing, believing and behaving to address life and spiritual dilemmas caused by their stressful or traumatic experiences. These are dilemmas which they were not able to master using tools provided by their family and their cultural background. Psychosis can deepen when this process of experimentation leads to errors in beliefs, perceptions and behavior, resulting in more trauma and distress, and then typically more misguided responses by self and others, in an increasingly severe vicious circle. There remains however the possibility that with assistance by people who understand this process, and with continued experimentation rather than suppression of experimentation, both the original difficulties and the difficulties resulting from attempted solutions that backfired can be resolved in ways that lead to personal and possibly even cultural renewal and health.

    Report comment

    • Ron Unger, LSCW says, “
an alternative view that sees psychosis as resulting from attempts to resolve problems that preceded the psychosis”, and, “
.where people consciously or unconsciously try out new ways of seeing, believing, and behaving to address life and spiritual dilemmas caused by their stressful or traumatic experiences.”

      I agree. Psychosis can be nature’s way of protecting the mind from what it can’t process, consciously or unconsciously –

      Thank you for the enlightened link –

      Report comment

  3. Dr. Garson’s “madness as strategy” paradigm is on the right track, imo. His study of philosophy and history has served him well, in that it’s taught him to use his imagination and intelligence in ways it was intended: broadly, creatively, and kindly; after all, are these not the very things that make us human?

    But it seems a lot of people never got this memo, as you’re hard-pressed to have this kind of discussion with the bungling, technology-obsessed idiots swarming the medical schools and research labs of today, as so many of the so-called “educated” have been swept off their feet by an all-encompassing, quasi-scientific, egoistically/egotistically driven zeitgeist – though this does bring to light the need to get psychic distress out of the medical profession. And it doesn’t take a genius to figure out what most psychotic states really represent: the inability of the conscious mind to face/process/reconcile an unbearably painful reality.

    So it’s too bad philosophy and history have been tossed out the window in places where it’s needed the most. But it does explain why today’s “mental health system” is populated by so many annoyingly complacent, maddeningly unimaginative, humility-deficient and brutally unfeeling “mental health professionals” –

    Report comment

    • Unfortunately in today’s world, Dr. Garson’s “madness as strategy” paradigm will most likely have a hard time getting off the ground, because most of the so-called “educated” have been swept off their feet by the all-encompassing quasi-scientific, egoistically/egotistically – and most of all – ECONOMICALLY DRIVEN zeitgeist –

      And while it’s not easy to stem the tide when something’s so economically driven, the pendulum usually finds a way of shifting –

      Report comment

  4. And I would venture to guess that it’s having to deal too much with those who are annoyingly complacent, maddeningly unimaginative, humility-deficient, and most of all, brutally unfeeling that drives some into psychotic states in the first place –

    Report comment

  5. It’s disheartening how many of of today’s “mental health professionals” aren’t much more than a bunch of narrow-minded technocrats caught in an endless loop of self-serving groupthink. They get an idea in their heads and they’re off and running, all reciting the same script over and over to a T. But Dr. Garson’s approach is a refreshing take on some old, but very sound, ideas.

    Report comment