What Do Drugs Do? Rethinking Psychiatric Medications Outside of Biomedical Narratives

Historians of psychiatry conventionally describe its history as a clash between biological and psychological perspectives. Recently, Garson proposed an alternative framework, viewing psychiatry’s history as a tension between “madness-as-dysfunction” and “madness-as-strategy.” Madness-as-dysfunction interprets mental health issues, like extremely low mood or panic attacks, as symptoms of underlying diseases or disorders. Madness-as-strategy, by contrast, regards these states as functional, adaptive, or purposeful in their own right. This paper examines what this shift in perspective might mean for psychiatric medications. Two possible views are explored: an optimistic one, suggesting drugs might be used so long as they do not undermine the natural function of a condition, and a pessimistic one, arguing that such drug use constitutes a “violence against the self” and should only occur in emergencies. The aim is not to decide between these positions, but rather to map out the range of attitudes toward medications from the standpoint of madness-as-strategy.