A groundbreaking new philosophical analysis is challenging long-held psychiatric beliefs about delusion, urging the field to reconsider whether so-called “madness” is truly a sign of dysfunction or evidence of meaningful, adaptive strategy. The latest work, highlighted in a recent article on Mad in America and anchored in research from the European Journal of Analytic Philosophy, proposes that delusions may be better understood not as isolated symptoms of mental disorder, but as purposeful responses to overwhelming distress—responses that are systematically misunderstood, and unjustly marginalized, by conventional psychiatric practice (Madin America; European Journal of Analytic Philosophy).
This emerging view stands in stark contrast to the dominant model which, for decades, has positioned delusions as clear markers of a broken or malfunctioning mind. In Thai context, these ideas resonate deeply: mental health stigma remains a significant barrier to care, and many Thais with psychiatric diagnoses report experiences of alienation or misunderstanding—both within their communities and broader society (WHO Thailand). By questioning the “dysfunction model,” the new research offers a framework that could help combat stigma and encourage compassion in mental health discourse, both globally and in Thailand.
Delusions—defined as persistent beliefs in the face of overwhelming evidence to the contrary—have long been the focus of psychiatric inquiry. In the classic dysfunction approach, mental health professionals see delusions as symptoms of underlying biological or psychological breakdown. According to the analysis by a philosophy expert at the University of Birmingham, this diagnostic lens may obscure the real, human logic at play: “The dysfunction approach has it that, ‘when someone is mad, it is because something has gone wrong inside of that person; something in the mind, or in the brain, is not working as it ought. Madness results from the breakdown of a well-ordered system; it is a defect or a dysfunction…’ The strategy approach on the other hand has it that, ‘[I]n the mad, we have a purpose being fulfilled, a movement toward a goal, a machine operating as it ought’” (Madin America).
This turn toward a “strategy” perspective takes inspiration from philosophical and biological scholarship, notably Justin Garson’s work ‘Madness: A Philosophical Exploration.’ Garson argues that forms of madness, including delusion, might fulfill specific adaptive functions—a concept that challenges the notion of mental illness as merely a defect (NDPR Review; BJPS Review). As reviewer Lisa Bortolotti summarizes, “delusions fulfil the mad person’s wishes” and may serve healing or protective functions, particularly in the face of trauma, adversity, or social exclusion.
Recent empirical studies support these philosophical claims. Research published in psychiatric and psychological journals highlights how individuals coping with distress—such as those with schizophrenia or affective disorder—frequently develop personal, sometimes idiosyncratic strategies, including delusional beliefs, to manage overwhelming experiences. One 2015 study found that self-generated coping strategies can be protective, suggesting that “enhancing coping strategies may be effective in the treatment of psychotic symptoms” (PubMed). Meanwhile, trauma-informed inquiries—including among high-risk populations—show that unusual beliefs may often be rooted in intense adversity exposure, with delusions serving as adaptive frameworks for meaning-making (PubMed).
Expert voices from psychiatry and philosophy alike are echoing these points. A renowned philosophy lecturer interviewed by the European Journal of Analytic Philosophy observes: “When we listen to those experiencing delusions, their stories, however seemingly irrational, often map onto very real emotional wounds or needs. By pathologizing these beliefs, clinicians may inadvertently perpetuate epistemic injustice, denying validity to experiences outside of the mainstream.” This concept of “epistemic injustice”—or the systematic marginalization of certain kinds of knowledge and testimony—has gained traction as an ethical concern in mental health, and is particularly relevant in Thailand where hierarchy and deference to authority shape clinical encounters (Psychology Today).
For Thai society, the implications are far-reaching. Traditional Thai approaches to mental health often emphasize harmony, merit, and spiritual explanation, and may sometimes clash with Western biomedical paradigms. As Thailand continues to modernize its mental health care system, integrating these global insights offers an opportunity to honor local wisdom and promote inclusive care. Recognizing delusions as adaptive efforts to cope, rather than mere aberrations, aligns with Buddhist perspectives on dukkha (suffering) and the dynamic nature of mind—offering a bridge between scientific research and local culture.
Historically, Thai attitudes toward madness have been shaped by both Buddhist compassion and stigmatizing superstitions. The recent suicide prevention projects and destigmatization campaigns led by the Ministry of Public Health stress the importance of respectful listening and social support for Thais suffering from mental distress (WHO Thailand). By incorporating the strategy approach, Thai healthcare providers and family members may develop greater empathy, regarding unusual beliefs not only as symptoms to be eliminated but also as signals of underlying need—an insight that can enhance both treatment and social integration.
Looking to the future, researchers and clinicians urge a balanced path. Integrating the strategy approach does not mean abandoning scientific rigor; instead, it calls for a “both-and” perspective, recognizing the potential for biological, psychological, and social factors to interact in complex ways. The recent Nature article on predictive coding models in psychiatry suggests that contemporary neuroscience, too, is moving towards a multi-levelled understanding—foregrounding not only brain mechanisms, but the personal and cultural meaning of symptoms (Nature). As digital tools and data science gain prominence in Thai mental health services, clinicians will be well-placed to personalize interventions, allowing for both symptom management and the honoring of patient experience (Springer).
For Thai readers—whether patients, caregivers, or professionals—the call to action is clear: challenge stigma by asking about the stories behind unusual beliefs, not just the beliefs themselves. If you or someone you know is experiencing distressing delusions, consider seeking help from mental health professionals who take a holistic, person-centered approach. Be prepared to share your perspective, but also demand respect and curiosity from those providing care. For policymakers, incorporating these findings into Thailand’s mental health curriculum and national strategy can foster greater inclusion and understanding.
For further reading on this evolving topic, see the original report on Mad in America (Madin America), the philosophical work by Justin Garson (NDPR Review), and latest research in PubMed, Nature, and Springer.