Standard histories of psychiatry rely heavily on the distinction between psychogenic and biogenic approaches to mental illness. This distinction provides a framework for grouping actors into larger configurations, tracing the tensions between those configurations, and explaining psychiatry’s major transitions. For example, the “medicalization” of American psychiatry in the 1970s is often described as a transition from a psychogenic to a biogenic paradigm; the traitement moral of early nineteenth-century France, a transition from a biogenic to a psychogenic one. I propose an alternative framework, which reads the history of psychiatry in terms of a clash between two paradigms, madness-as-strategy and madness-as-dysfunction. Proponents of the first paradigm, madness-as-strategy, view psychiatric problems as strategies that the person or organism is deploying to achieve some (perhaps unconscious) end. The researcher’s goal is to identify the purpose of the patient’s symptoms, and to use that knowledge to inform treatment. Proponents of the second paradigm, madness-as-dysfunction, view psychiatric problems in terms of the breakdown or dysfunction of the mind or brain. The researcher’s goal is to locate that dysfunction and fix it. The dysfunction/strategy distinction crosscuts the biogenic/psychogenic one in interesting ways. One benefit of this framework is that it creates new configurations of actors and it provides alternative descriptions of major transitions. For example, the “medicalization” of American psychiatry can be seen as a transition from a madness-as-strategy paradigm to a madness-as-dysfunction paradigm, and the evolutionary psychology of today can be shown to have stronger liaisons with psychoanalysis than with neuropsychopharmacology.
