The medicalisation of madness in our physicalist age has consequences. Once upon a time the mad were thought to have access to divine truth, but now madness is just a symptom of unhealthy neurobiology and any realisations come to in altered states are ignored. Of course, madness can be dangerous and damaging. But from Wittgenstein to Nietzsche, some of our greatest philosophers have experienced periods of madness and yet, their philosophy is just as vital in spite of, or possibly because of, this madness, writes Wouter Kusters.

In his seminal work Madness in Civilisation the American sociologist Andrew Scull examines the way madness has been both an ineradicable aspect of any ordered human society, a haunting image of fear and terror, as well as a fascinating realm that inspires and attracts artists and thinkers. With the Greeks the Hippocratian tradition began, in which physicians tried to explain deviations from the average mental and bodily behaviour in natural terms, with the four humoral elements; blood, phlegm, black bile and yellow bile. Meanwhile, folk explanations of what today is often called mental illness were given in terms of the influence of spirits and demons, as well as the actions, lessons, warnings and spells of the gods. Thirdly, it was also thought, in at least some cases, that the mad were perceiving something real, as Plato says: “We made four divisions of the divine madness, ascribing them to four gods, saying that prophecy was inspired by Apollo, the mystic madness by Dionysus, the poetic by the Muses, and the madness of love, inspired by Aphrodite and Eros, we said was the best.” In this third view, Plato’s view, the madman is not a patient with a disease, neither a sufferer from divine fate, but a seeker close to something of high value.

Madness has been translated as the inner individual working through of feelings of guilt, shame, stress, and recurring traumas, all of which are interacting with the neurobiological level of the brain.

Many centuries later, the medical attitude has become dominant in this domain; since the 20^th century the profession and discourse of psychiatry has claimed to know best how to deal with madness, and its accounts have been soaked in ‘naturalist’, medical terms. The earlier folk explanations that interpreted madness as a curse, a revenge, or as a whim of gods, demons or spirits, have been transformed into the dry spiritless jargon of modern psychology. Stripping the gods from their ‘real’ character in a communal world, madness has been translated as the inner individual working through of feelings of guilt, shame, stress, and recurring traumas, all of which are interacting with the neurobiological level of the brain.

But what has become of the third way of interpreting madness, namely as mysticism, prophecy and inspiration? About that possibility from times past Andrew Scull remarks: “Madness might represent another possible way of seeing: bacchic, erotic, creative, prophetic, transformational… there was another concealed kind of knowledge, intuitive, visionary and transformative knowledge and madness might provide the keys to this mystical kingdom.” In our modern age however, this search for ‘concealed knowledge’ has been forced to be played out in the open, in the form of science, which led to ‘exact’ and general knowledge about nature and its ‘concealed’ patterns and laws. Knowledge and truth count only as valid today when they are communicable, explicit, and expressible. The visionary and prophetic, on their part, have been banned from any claims on knowledge and truth, and have been referred to the fictional domains of the narrative and the religious. And the transformative? Searching for transformation has become one lifestyle option among many, permissible as long as it remains an individual striving. This transformational drive has been captured and spelled out in self-help books, coaching trajectories, management books etc.

When, what Scull and Plato refer to as mysticism and as divine madness, is fully translated and reduced to the field of mental health, something risks becoming smothered, neglected or even suppressed and denied.

Such conformist adaptions and down to earth elaborations of what were once ‘mad transformations’ have however not exhausted the underlying longing for platonic ‘divine madness’, and the ways that people still long for – whatever we call it – freedom, the Other, infinity, being or nothingness, are numerous. Some of those longing for these things put their feet on the philosophical path, and lean to the explicit, active, overt or even academic forms of philosophizing. Others go their own way in a more intuitive and passively seeking and dreaming manner. Both run the risk that at some point their strivings are considered to be nothing else than expressions of individual psychological problems, or as by-product of a supposed disturbed dopamine transmission. That is, they run the risk that their roamings and free-floating searches for divine madness are ‘psychologised’ – ascribed to their personal identity, or to personal problems, or even reduced to the only one level that is considered to be ‘basic’ with respect to life: the neurobiological level.

These psychologising and psychiatric views on that ideal realm of Plato are, to be sure, not bad in themselves. Society’s well-being depends on mutual trust and care, and is helped by the professionalisation of health care. But when the vague, ineffable area that Scull and Plato refer to as mysticism and as divine madness, is fully translated and reduced to the field of mental health, something risks becoming smothered, neglected or even suppressed and denied. Some of the more thoughtful practitioners and careful psychiatrists in the mental health field are aware of this, and have attempted to approach the inner life, the experiences and desires of their patients, from a  perspective without presuppositions and prejudices about madness, and with an open mind as far as possible. And indeed, some of them, like Ronald Laing or Louis Sass have succeeded to a considerable extent to sketch the worlds of those that are involved in divine madness wander through. But all the more often, those that start from this psychiatric philosophical position remain hampered by the plain fact, that their starting point is the psychiatric diagnosis, and when tracking that diagnostic conclusion or end point back to its origins, they infuse the origins with the supposed crippledness of the endpoint. The diagnosis they make becomes a new identity for the patient, which throws its shadow back to earlier phases. What was once considered day-dreaming, or a peculiar whim, or capricious experience and deviant thoughts, become reinterpreted as only early signs of natural mental disorders: ADHD, autism, schizophrenia, bipolar disorder, etc. – nothing divine to find there! Not only the present state of a person becomes reduced to an amalgam of neurobiological patterns and psychological reactions, but also preceding experiences, thoughts, feelings and behaviour are drawn and reinterpreted into the diagnosis.