Madness, Meaning, and Message

a reaction to Awais Aftab

Reading Awais Aftab’s short essays on Substack is always rewarding. His recent post “Can a Psychiatric Crisis Save Your Life?” especially caught my attention because it ties back (explicitly) to Justin Garson’s notion of ‘Madness as Strategy,’ an idea that has been on the mind lately, as I was recently asked to compose an essay connected to Garson’s general idea. (The essay will appear, according to the rather slow cadence of academic publishing, in the Journal of Medicine and Philosophy. It is a much-extended version of a post made some time ago, “Hallucination as Memory of the Present,” with elements of the two preceding posts included as well.)

Odilon Redon, L’Œil, comme un ballon bizarre se dirige vers l’infini (1882, public domain)

In a post from last month, Awais Aftab argues that “first-person perceptions of an illness experience ‘saving’ one’s life from ‘self-destruction’…need not correspond to the existence of functional, adaptive mechanisms.” This conclusion is clearly true. Behind it seems to lie some doubts about Garson’s general idea of ‘madness as strategy’, although Awais acknowledges some merit to the idea in at least some circumstances. The present post is intended as a foil to Awais’ post, not by way of directly contradicting anything that he writes, but coming at it from a different angle, mainly in an attempt to clarify the concept of ‘madness as strategy’ by making one distinction that appears to be important for achieving a clear understanding of the idea.

A proviso: What follows is just one person’s understanding of Garson’s central idea. No attempt will be made, here, to justify this understanding as an interpretation of Garson’s text, and it could be that the understanding that your author has gleaned from that text differs from Garson’s intention in important ways, a possibility that, however, will be neither explored nor denied here.

Before the distinction, let’s use the question of Awais’ title—“Can a Psychiatric Crisis Save Your Life?”—to home in on the main concept. The answer to this question is, of course, ‘yes’, and Awais cites two rather spectacular and extreme examples. (To answer a question that might occur to readers familiar with this Substack: No, your author does not consider his own psychotic breakdowns to have saved his life, though they certainly changed his life in a variety of ways, some of which could be construed as contributing to beneficial long-term outcomes.)

But this observation is, by itself, trivial. Almost anything could save one’s life. After the 7/7 bombings in London, several stories emerged of people who narrowly missed the ill-fated train for a variety of random reasons (oversleeping and the like). This sort of example is not what Awais (nor Garson) has in mind.

Slightly more to the point, people who were on the train but survived have also reported that the experience changed their lives, perhaps not to the point of saving their lives, but significantly changing it in ways that seem similar to what people sometimes mean when they say that some dramatic and at least superficially destructive event ‘saved my life’. For example, twenty years after surviving the bombing, one man recalled: “I can’t describe how much my life had changed,” a change that included quitting his long-time career and dedicating himself to a new career oriented to helping others.

The connection between this event (surviving the bombing of a train) and changing one’s life is, moreover, not arbitrary (which is why the example is slightly more to the point—we’re creeping up on it!). This survivor describes a harrowing experience of hearing dying people call for help. It isn’t hard to understand why that experience might motivate one to make major changes in one’s own life, for example by helping one to realize the importance and value of helping others. But it is still not the sort of thing that Garson has in mind when he suggests that madness can sometimes be ‘strategy’.

Awais constructs an example that is yet closer to the mark: A man develops an addiction to alcohol and winds up in a car crash while intoxicated. The crash is seen by him as a ‘wake-up call’, reform follows. This example is still closer to the point because the event that occasioned the man’s realization is closely (causally and conceptually) connected to the reform that it motivates, inasmuch as his own irresponsibility both caused the event and is the target of reform. (Our bombing-survivor sought to help people but did not seek, specifically, to make train travel more safe, for example.)

Awais points out, correctly of course, that such events are still not thereby “adaptive protective responses” to one’s life-situation. The crash, as Awais puts it, was not “trying to tell them something.”

Indeed car crashes are not ‘adaptive’, but there is something nearby that is adaptive, namely, the capacity to learn from bad outcomes, especially when those outcomes are connected (causally or conceptually) to correctable problems in one’s life. Some people reported missing the ill-fated train because they overslept, or arbitrarily decided to take a different route that morning. It would be a mistake to reform their lives accordingly (sleeping in more often, making arbitrary decisions about one’s travel plans more often, etc.). But it would be correct for the man who survived his drunk-driving incident to reform, to address the apparent cause of that event.

This observation leads to our distinction: Meaning versus message.

People do sometimes characterize life-changing events as a kind of ‘message’, and occasionally Garson’s historical examples come close to the idea that madness is a ‘message’. The protagonists in Awais real-life examples also characterize events in their lives in this way. But this notion of ‘madness as message’ is both not the central idea in Garson, and probably not the best way to think about what is happening in these cases. Many of us do it, of course. I used to run a lot, at one time getting up over 100 miles per week. Unless one is very lucky, one hits that kind of mileage only by ‘listening to your body’. You might thus say that the pain in your foot is “my body trying to tell me something.”

But it’s a metaphor that depends on treating meaning as if it were message, as if there were an agent responsible for ‘sending’ that meaning as a message. One can unpack the metaphor: “There’s a pain in my foot; it seems to be a consequence of damage to my foot that further running could exacerbate, so to avoid that outcome, I should cut back on running a bit until the pain subsides.” It isn’t really a message (from ‘my body’ to ‘me’), but it does bear meaning.

Garson’s phrase “madness as strategy” is catchy, and conveys a useful idea, but it does also encourage this mistake of taking the metaphor (‘message’) for the real thing (‘meaning’), because strategies are devised by persons, while meanings need not be. The notion here is ‘meaning’ as it might be used in exchanges like:

“What does red sky in the morning mean?”

“It means we are likely to get rain later today.”

“What does that rash mean?”

“It means allergy season is upon us.”

It’s a causal sense of ‘meaning’ (allergies caused the rash), but one that is mediated by human concerns. For example, the intended notion is not captured by the exchange “What does red sky in the morning mean?” “It means that there is a large concentration of particles in the atmosphere.” That answer is true, and causal, but does not appropriately capture (typical) human concerns.

The alcoholic’s crash also has this sort of meaning. “What does this crash mean?” the man might ask himself. And he might answer: “It means I’ve allowed myself to prioritize drinking over well-being,” or something like that. This meaning is not a message. It is an interpretation of the causal entanglements of the crash in light of the concern of living a good life. (Other concerns could also drive ‘interpretation as meaning’ in the intended sense while producing a different outcome—a judge, for example, may be concerned with legal responsibility.)

The crucial point is that although ‘madness as message’ is compatible with Garson’s concept of ‘madness as strategy’, they are not the same. Awais’ protagonists might have characterized their difficult experiences as (quoting him paraphrasing them) “communications from disavowed parts of the psyche” or from some “unconscious, protective self,” but that characterization, as helpful as it might have been to those people at that time (but which your author, for what it’s worth, takes to be implausible), is not implied by ‘madness as strategy.’

It’s important, as well, to remain broad-minded about what kinds of meaning we are talking about. Sometimes (as in Awais’ examples, and some of Garson’s as well) the meaning is something very dramatic, like “reform your life,” but it need not always be so. Perhaps (nobody knows), it is not even the most common sort of meaning. In the earlier post Hallucination as Memory of the Present, it was suggested that hallucinations could be meaningful, but those meanings are more circumscribed or situational, rather than concerning ones ‘entire life’ or the need for major life-changes.

In other words, we should agree to discard the implausible idea that the car crash—and passing back through the analogy, the ‘madness’—is a message sent or caused by some agent. Madness ‘as strategy’ need not (and probably in general does not) involve messages of that sort, and yet it could still be ‘strategic’, ‘meaningful’, or ‘functional’ in some manner. As Garson suggests, thinking of madness in this manner might enable one to “modulate the logic of intervention” (2022, 12), to understand madness not merely as a dysfunction but also as the occasion for an attempt—dare one say a reasonable attempt?—to make sense of one’s world in light of one’s experience.

The difference is real. Most doctors to whom I’ve spoken over the years have the same response to my continued hallucinatory experience: It must be subdued (typically with heavy medication). That approach works for some people. Not me. I need to be able to understand the ‘meaningful’ side to hallucination and approach it from that direction.

A final point, alluded to just now and already made in a comment on Awais’ post but worth repeating out loud: The idea of ‘madness as strategy’ does not exclude the idea that madness is also dysfunctional. Both aspects can be present at the same time. (So even if the car crash were a ‘message’, a ‘strategy’, it could also, at the same time, be destructive. The bombings of Japan in WWII were, arguably, strategically successful but also massively destructive, and the latter could reasonably be taken to speak for preventing such events in the future.) Similarly, a hallucinated voice can be disruptive, disturbing, and distracting. It might also at the same time be meaningful in a way that can be helpful. There is just no simple answer to the question “should we squash or otherwise prevent such experiences?” because it will in many cases involve the inherently difficult task of weighing the potential benefits of the experience against its potential harms (and factoring in the potential harms of squashing it). So, like Awais, we are finishing with yet another version of the “on the one hand, on the other” conclusion, which feels about right.