‘Madness was imagined through the lens of economic value’

What's the central thesis of your book?

Madness and Enterprise argues that psychiatrists across Europe and North America encountered a diagnostic dilemma over the course of the 19th century with respect to ambiguous or indeterminable states of mental pathology – behavioral abnormalities that were neither clearly healthy nor unhealthy. In order to resolve them, they tacitly supplemented their diagnostic assessments with economic appraisals of patients' everyday conduct. Determining whether a patient was good with money, whether they could manage their wealth, whether otherwise abnormal behaviors were nevertheless lucrative or not, could offset and even redeem suspicions of madness.

Through this 'economic' style of reasoning, which eventually came to suffuse much of North Atlantic psychiatric thought by the start of the 20th century, prominent psychiatrists either implied or else explicitly resolved that successful economic behaviors could counteract apparent pathological states. The economic style of psychiatric reasoning also led to the medical conclusion that some of the severest mental and neuro-pathologies could indeed be compatible with economic activity and that, in some cases, madness could even be beneficial to economic success.

Madness was not, in other words, a dangerous threat to be removed from the socio-economic order; rather, its social status and acceptability was hinged on its economic worth, or what I dub its 'pathological value'. It was economised – suffused with economic meaning and rationality and imagined through the lens of the value it could conceivably generate or forfeit. It was a condition to be excused or even extolled if it generated remunerative financial benefits, or disavowed if it turned out to be economically detrimental.

Tell me about the book excerpt we've selected.

It comes from the book's third chapter, titled 'From Disorders of Enterprise to Entrepreneurial Madness'. It focuses on the turn-of-the-century British psychiatrist Charles Arthur Mercier – somewhat forgotten now, though an otherwise prominent medical figure in the early 20th century – who gives us one of the best examples of what it meant to 'economise' madness.

Mercier believed that insanity was defined only by virtue of a person's conduct and not their mental state alone. An abnormal mind, even a fully delusional mind, was not entirely pathological if a patient could nevertheless act appropriately in spite of their mental incapacitations… earlier chapters set the stage for why Mercier could arrive at such a medical conclusion. And the best gauge, Mercier proposed, for determining whether a patient's conduct was healthy even in the face of mental disturbances was an economic standard.

Mercier developed an entire psychophysiological theory of action in order to make the point, and through which to align mental health and unhealth to different sorts of economic behaviors. The excerpt ends with Mercier's discussion of the 'man of action'. In the book, that section is followed by an extended discussion of the economist Joseph Schumpeter's theory of the entrepreneur, another enterprising 'man of action', and how the early 20th century concept of the entrepreneur was constructed at the intersections of economic and psychiatric thought.

You write about 'borderland figures' – can you explain, with an example?

The 'borderland figure' was a loose psychiatric classification which I argue represented something of a diagnostic crisis for psychiatric thought during the 19th century, and which instigated psychiatry's turn to an economic style of reasoning. If anybody could recognise every instance of mental pathology, no matter how subtle, then psychiatry could no longer lay claim to its purported diagnostic expertise. It was, in other words, necessary to posit genres of mental illness that presented pathological features which remained inscrutable to the laity, to purport that the mad were not simply confined to asylums or clearly discernible in everyday social life, that there were pathological populations that effectively remained, if not invisible, then at least undetectable to the untrained eye.

Eventually, however, these borderland figures became too inscrutable for even psychiatry itself, forcing psychiatry to adopt extra-medical styles of diagnostic reasoning… an economic style in particular. The best example, the one with which I open and close the book, is the figure of the eccentric, who had been an object of apprehension within transatlantic psychiatry since the early 19th century.

Who exactly are eccentrics?

They're individuals who do not fit neatly into clear-cut categories of social propriety; they are certainly abnormal, but not abnormal enough to be deemed patently insane. They trouble a set of modern social imperatives: to be decipherable, predictable, and transparent to others, at least in some measure. At the same time, they are not necessarily transgressive, disruptive, or disobedient; they aren't criminals, delinquents, or wrongdoers, for the social norms they seem to upend relate to only the most implicit demand that we be legible to one another, and that our behaviors remain comprehensible to others. To that end, they are not dangerous. The dangerous madman was the classic story around which the psychiatric profession first developed and justified itself; many historians have told this tale, the story of psychiatry's formalisation with respect to the legal apparatus across Europe and North America.

Eccentricity, however, introduced a very different legacy, as it was not psychiatry's appeal to the law that could render the eccentric coherent and comprehensible, as it did for the dangerous madman; it was instead, psychiatry's appeal to the norms of economic conduct that stabilised the legibility of the otherwise illegible eccentric. Eccentrics who squandered their wealth evinced an irrationalism consonant with madness, but eccentrics who turned a profit were redeemed. They were not necessarily judged to be sane or rational; enterprising eccentrics were still perceived as abnormal, but redemptively so. The profitable eccentric was instead perceived as the anomalous virtuoso, the financial prodigy, the unconventional entrepreneur.

I found the chapter on 'sinistrose' fascinating… can you talk us through that 'disorder'?

One of the major points that I try to make in Madness and Enterprise is that the real psychiatric dichotomy with respect to economic success was not between mental health and unhealth, with the presumption that healthy people make money and unhealthy people lose it. The dichotomy I posit is instead a division within the nature of pathology itself, that some mental pathologies could be regarded as lucrative advantages whereas others were perceived as pernicious and costly detriments. It's the latter condition that I discuss in the chapter on 'sinistrose'.

The chapter 'The Pathology of Work', tells a story not unfamiliar to many historians and social theorists about the relationship between industrial accidents, occupational psychopathologies (particularly trauma disorders), and the politics of insurance industries and worker compensation legislation in Europe during the late 19th and early 20th century. The emergence of the very category of traumatic psychopathology was linked, from as early as the 1860s, to the political economy of the modern industrial and workplace accident. The trauma concept, in other words, first emerged at the intersection of medicine and political economy before becoming more familiarly promulgated as an effect of the distresses of warfare. In fact, the very idea of psychological, as opposed to simply physical, trauma was a core topic of dispute and debate after the 1860s and featured prominently in the litigation proceedings following industrial, initially railway, accidents. The crucial question posed in the legal proceedings was: is the purported psychological trauma real or is the plaintiff, usually a worker, a malingerer who is feigning injury for money?

But this question became far more complicated in the 1870s and 1880s, when determinations of the 'reality' of psychological trauma were rendered even more confusing as a consequence of the rise of new psychopathologies, such as the reworked concept of hysteria, which proposed that mimicries and simulative behaviors were often legitimate symptoms of traumatic injuries. So, the question was no longer, are the symptoms presented by plaintiffs or patients seeking compensation genuine or feigned? For, as it turned out, some unintentionally simulated symptoms could be the genuine effect of a real injury. Not all simulations, in other words, were fraudulent.

Then this complication takes on another level of complexity when psychiatrists proposes that some traumatic simulations could be prompted by an actual psychogenic injury, whereas other traumatic simulations were the involuntary reaction to, or a kind of unconscious artifact of, the fact that a plaintiff stood to gain financially from litigation or from an insurance payout. In other words, traumatic simulations could be involuntarily induced by actual injuries, or they could be involuntarily induced by, say, worker compensation policies. In neither case was the patient acting deliberately, which is to say, fraudulently; but in the former case, an actual accident was regarded as the pathogenic source of traumatic injury, whereas in the latter case, the pathogenic source was deemed to be economic policy itself.

There were a number of different ways that psychiatrists across Europe attempted to reckon with all of these complexities, particularly the idea that economic policies were themselves virulent and pathogenic and could cause patients to morbidly imagine themselves as having incurred an injury. German physicians used the term 'pension hysteria', an admittedly derisive and cynical moniker to describe the inadvertent effects that economic policies had on industrial workers. 

Sinistrosis (my translation of the French sinistrose) is an interesting case, in the first instance an analogue to the German 'pension hysteria', but something more important still. For unlike pension hysteria, sinistrosis was posited as a genuine disease category, a kind of delusional psychosis that industrial workers experienced, and to which all workers were susceptible, when they felt that they were owed recompense for an occupational injury, even if the injury was real in only a simulated sense. That belief, that fixed idea, was a veritable hallucinatory state, what one physician dubbed the 'pathology of work', and which demanded its own diagnostic category. And the etiology of sinistrosis was consistently posited as France's 1898 workplace accident insurance legislation, which guaranteed compensation to workers who sustained occupational injuries. So unlike pension hysteria, which was mainly a kind of moral rebuke, sinistrosis was intended to be a genuine diagnostic category that formally listed economic policy as the virulent source of psychogenic injury. Sinistrosis was the exemplary and paradigmatic case whereby the economisation of mental pathology intersected with the pathologisation of economic policy.

Do you still see this relationship between madness and enterprise at play in the modern day? What's changed?

Indeed I do, and I would add that the book is largely intended to illuminate something about our present moment rather than simply unearth something about the past. I would say that the relationship between madness and enterprise that I explore in the book is relevant to our present in both a narrow and general sense.

Narrowly, I can say that many of the chapters of the book very intentionally address major themes in the history and theory of capitalism – e.g., financial enterprise, wealth inheritance, the political economy of labour. These themes, I propose, not only intersect with the history of madness, but it's actually the history of madness that illuminates something about these economic concepts, which bears out for our present moment. 

So, for example, in the chapter 3, 'From Disorders of Enterprise to Entrepreneurial Madness', I sketch out a kind of genealogy of the cultural tendency to overvalue 'innovation' and why, relatedly, we continue to link entrepreneurial novelty and market virtuosity with personality traits that appear idiosyncratic, eccentric, or irregular. As it turns out, the relationship between creativity and abnormality – a relationship that is often romanticised with respect to artistic and scientific invention and unconventionality, is the expression of a profoundly economised psychiatric legacy – a glorification of certain expressions of madness that can only be celebrated insofar as they are remunerative or redeemable on economic grounds.

That link, I should add, between abnormal creativity and financial prodigiousness, is fundamentally entwined with the politics of what I call 'pathological privilege', by which I mean that entrepreneurial idiosyncrasies are typically entitlements and affordances largely organised around racial and gender markers (e.g., masculine whiteness), which is a theme I explore throughout the book, and which continues to circulate as an embedded norm for us today.

Another chapter ('The Aphasic's Will, or Dispensations for the Propertied') looks at the relationship between aphasia and testamentary competency, or the question as to whether a patient with a severe neuropathological language disorder can write a will. This is admittedly a relatively circumscribed historical issue; the question, 'can an aphasic write a will?', was routinely posed by aphasia researchers from the 1870s until around WWI, but then precipitously disappeared. That question in its specificity is clearly no longer relevant to us today, but the underlying thematic of the chapter, the affordances allotted to inheritance and personal wealth distribution, certainly is. The chapter itself argues that even the severest form of neuropathology could not disqualify patients from bequeathing their wealth, from partaking in what at the end of the 19th century was one of the most lucrative forms of wealth accumulation in Europe and the North America. As such, the chapter tacitly asks, if even severe pathology cannot counter or curtail the will to amass wealth, then what possibly can?

And the more general sense in which these ideas are still relevant in the modern day?

I would posit that it's still the case today that mental illnesses are economically valuated, that their meaningfulness remains fundamentally hinged on their perceived lucrativeness or costliness, that mental illnesses remain as much economic categories as medical and moral ones. Indeed, I'd go so far as to propose that mental illnesses are actually mostly meaningful according to their economic worth, in other words, that we perceive both their medical and moral value in tacitly economic ways.

This is an admittedly pessimistic reading, but it ultimately gets to what I think is a central ramification of the book, which is that while our normative appraisals of social value are large medical, moral, and economic in nature, it is economic value that has fundamentally suffused and potentially even warped much of how we appraise social worth in general. If, after all, an economic sense can saturate and thus recoup the most profound form of modern irrationality, indeed something as seemingly uneconomic as madness itself – the most irrational of modern irrationalisms – then what else? What other apparent irrationalities in our moral and political life can an economic logic suffuse and subsequently redeem?

To the end, Madness and Enterprise is as much a historical and theoretical analysis of psychiatry as it is a cautionary tale about the present and future of our moral and political world.

• Nima Bassiri's Madness and Enterprise: Psychiatry, Economic Reason, and the Emergence of Pathological Value is published by the University of Chicago Press on 18 January. The following extract is published with their kind permission: © 2024 by The University of Chicago. All rights reserved.

Economic Vitality and the 'Man of Action'

Charles Arthur Mercier's position that conduct alone was the key to determining psychiatric health and that even delusional individuals could, through their (largely eco­nomic) behaviors, evince a sufficient degree of sanity never reached the de­gree of endorsement and embrace that Mercier had hoped for from his British and international colleagues. Unfortunately, Mercier's skeptics mistook for an overly forensic approach to insanity what was instead a profoundly ho­listic theory of health, human nature, and social inclusion. At issue for Mer­cier was not simply that competency in the management of one's own affairs could function as a clinical stopgap against diagnostic suspicions of madness. Something more was at stake, for conduct was not only an indicator of mental disease but also a gauge of vitality, a benchmark that could signal medical vigor and well-being. It was a person's actions, nothing more or less, and their retroactive coherence and justifiability that above all defined organic success and social viability. In his systematic account of conduct, Mercier developed a praxeological theory of health, which was epitomized by a particular an­thropological model of vital success – the agent of commerce, better known as the "businessman."

Conduct for Mercier denoted the successful ad­justment of an organism to its own specific environment by way of activity that could be described as "purposive." Purposiveness for Mercier did not necessarily entail psychological intent but simply the appearance of teleo­logical behavior. Proper environmental adjustments were never contingent or accidental; they were ends-oriented processes that responded to specific external triggers and exigencies. The criterion of success was retroactive, based simply on whether an organism could maintain its vitality as before. Pathologies such as insanity were simply "disorders of the adjustment of the individual to his surroundings, or of the organism to its environment."

But adjustments could vary on the basis of their success, that is, on the quality of adaptation itself, which Mercier judged on the novelty and the complexity of the adjustment. In this way, some forms of conduct could be considered more successful, more intelligent, and thereby healthier than others. The most exemplary forms of conduct among human actors, Mercier explained, were to be found among certain select social types, namely, scien­tific intellectuals, artistic virtuosos, and above all the "wealthy parvenu – the man who has forced his way to the front over heads of numberless rivals, the man whose business capacity has enabled him to make a fortune early in life." For Mercier, the enterprising prodigy, "said to exhibit superior ability," repre­sented an exemplary case of vital conduct and adaptational success. "He is a man of unusual intelligence," Mercier wrote. "Hundreds of his fellow-citizens entrust their money to the companies of which he is director, on the strength and in the belief that he is better able to carry out adjustments to circum­stances than they are themselves." The businessman – gendered exclusively male – represented, in his conduct, archetypal adaptational success and intel­ligence, which he displayed "solely in dealing with circumstances in such a way as to extract from them the maximum benefit."

Conduct, then, was not simply defined according to its disorders and de­viations from normalcy but also in terms of its level of health, robustness, and intelligence. The healthiest and most intelligent kinds of conduct dis­played a variety of crucial characteristics. They were novel but also elabo­rate, capable of adjusting to "circumstances more and more distant in space; more and more separated in time; more special; more comprehensive; more complex." Mercier illustrated the point through an allegorical comparison of professions, hierarchically depicted according to what he believed was the requisite intelligence of conduct needed to successfully carry out the tasks of each occupation. Laborers, for instance, whose occupation Mercier charac­terized as beholden to a mechanistic regimen, demanded the least elaborate and novel conduct. Their environmental circumstances, he felt, likely did not demand new combinations of behavior. Laborers were, therefore, ranked at the bottom of the professional hierarchy, followed in ascending order by arti­sans, managers, manufacturers, and finally statesmen.

Another indicator of healthy conduct was the conservational strength em­bodied in the adaptation—that is, the degree to which any single adjustment could sustain and promote the general preservation of the organism in the face of future environmental changes. Mercier, again, deployed a financial illustration. "It is not merely ability to conduct business successfully that con­stitutes intelligence of [conservation]," Mercier explained, "for if a man con­ducts his business capably and successfully, but squanders the income that he makes, or lives beyond it, he is considered less sensible, that is less intelligent, than if he were to live within his means and lay up something against a rainy day." The man who saved, who acted prudently in the present according to potential and unknown risks of the future, was most effectively "[secur­ing] the full benefit from his circumstances." And the greater the amount of "benefit" that could be extracted, the more intelligent could the conduct be said to be. It was precisely this "shrewdness or common sense" that Mercier proclaimed to be "the distinguishing characteristic of the 'practical' man."

"Shrewdness" was a crucial notion for Mercier, a quintessential attribute of praxeological intelligence. Shrewdness was idealized on the grounds that the condition most diametrically and morbidly opposed to it was insanity in the most definitive sense. "However deficient a man may be in either of the other forms of intelligence," Mercier wrote, "he is not considered insane unless this last form [shrewdness] is defective; and when there is defect in this, he is allowed to be insane in however high a degree he may exhibit those other forms." In no other context was shrewdness better demonstrated than in business and financial dealings. Consider, Mercier insisted, how readily the evidence of shrewd financial behavior could offset misgivings about otherwise eccentric personalities. Take, for example, occultists, spiritualists, fanatics – "no one would dream of calling such people insane, so long as their business was successfully conducted and their homes properly maintained – so long, that is to say, as they contrive to extract from their circumstances a due amount of benefit."

The question of whether people could successfully manage their affairs was not associated with healthy conduct in a merely contingent fashion. Suc­cessful economic adaptation, or shrewdness, was emblematic of health in the fullest sense, and its failure was the very epitome of pathology. And the dif­ference between the two was surprisingly severe. Mercier described the hypo­thetical case of a man whose mind and money were thoroughly occupied in some "chimerical object," to the point of appearing eccentric to those around him. If, Mercier warned, such a man were to lose himself in this pursuit – to sink his fortune entirely into it and to neglect his family, friends, and self – then "he is no longer considered of sound mind." And yet, Mercier pro­posed, let us imagine that after having sacrificed everything, his misfortunes take an auspicious turn, and his chimerical object becomes a success. What happens then?

He takes out his patent; his device is adopted. Manufactures compete for his services, wealth returns, friends return, wife and children are reinstated in their position. He becomes chairman of companies, enters Parliament, he is knighted – ennobled. Where are now those who said he was mad? They ac­knowledge their mistake. They were blind, foolish, misled.

The fact of this hypothetical individual's earlier bizarreries had not altered; in­stead they were retroactively reinterpreted as an enigmatic expression of vir­tuosity rather than mental disease. But, Mercier cautioned, if this very same man had prematurely died before his chimerical object had been completed, such that its success could never have been observed and confirmed, what would the onlookers have thought then? "He would still have been mad," Mercier concluded. "Ought we then to blame the onlookers? By no means. Praise and blame would be alike inappropriate."

In this sense, and in the determination of the shrewdness of conduct, there was no such thing as action viewed in principle, that is, in isolation from its context, which would determine on its own the medical, moral, and financial value that ought be ascribed to it. The very same action performed in two separate circumstances might generate profit in one context and give way to loss in the other. "We must recognize," wrote Mercier, "that their criterion of sanity was the success of the man in obtaining benefit from his circumstances. So long as the balance was in his favor, the question of his sanity did not arise. When he began to decline in wealth, people began to whisper that he was 'not right.'" Even the strangest, most apparently destructive behaviors could be retroactively justified through the demonstration of adaptational success – in this case, the shrewdness of invention and business acumen.

For Mercier, the quality of behavioral adjustments, that is, the intelligence and health of conduct, corresponded to a tripartite social pyramid. Most people adjusted to their circumstances in typical, habituated, and uninven­tive ways, according to what Mercier somewhat contemptuously viewed as the conduct of the masses. Above them, however, stood a smaller popula­tion of the ordinarily to moderately ingenious, those whom Mercier dubbed the clever and reasonably shrewd and whose adjustments displayed some degree of elaborateness, novelty, and conservational strength. At the top of this pyramid, however, towering above the rest, was the genius, a "rare" social type "who originates extremely novel ways of dealing with circumstances, and who adjusts these novel operations to the end in view with such accuracy as to ensure its attainment." Enumerating social types eventually became something of an intellectual diversion for Mercier. Toward the end of his life, he anonymously published over the course of six months a series of short character sketches, organized loosely around the notion of "human tempera­ment," in the pages of a weekly medical journal.

Mixing an incipient personality psychology with an unmistakable interest in philosophical anthropology, these sketches enumerated broad dispositional traits within the social body. Some traits, like the "artistic temperament" or the "suspicious temperament," were little more than loose taxonomies, while others, such as the "business man" or the "philosopher," were more formal­ized classifications. Mercier soon republished the sketches collectively into a single volume, Human Temperaments, making no changes to the individual articles save altering the order in which they appeared. The "suspicious tem­perament," for example, was originally published as the last entry, but in the first edition of Human Temperaments, it was the "philosopher" that appeared as the final entry – a surprising decision for Mercier, fixated as he was on the concept of conduct, for as he concluded, "With action the philosopher as such has nothing to do."

In 1918, however, just a year before his death, Mercier revised his study of human temperaments a final time, adding four new types, and changing their order once again so as to conclude the volume with entries for the "man of business," the "practical man," and the "man of action" – typologies that not only shared an underlying affinity with each other, but that collectively embodied the substance of Mercier's medical philosophy. While the "man of business" was characterized as the one "who extracts the maximum benefit from his circumstances," a business temperament was not an essentially economic disposition, for it was defined by a shrewdness that could just as easily appear in distinctly noneconomic circumstances. According to Mer­cier, Napoleon Bonaparte, on account of his political and military virtuos­ity, best personified "the supreme example of the business temperament." The "practical man" was similarly defined through the lens of the health and intelligence of conduct, as a personality trait that was in this case energeti­cally and impulsively moved to action – sometimes detrimentally, but never without purpose.

It was, however, the "man of action," who took up the position of the fi­nal and culminating human temperament, the one who most quintessentially consummated what Mercier had all along sought to express through his vital praxeology. The "man of action" displayed a strong "proclivity to action," but a proclivity that was met with self-control. "The man of action is the born leader of men," Mercier explained, someone who possessed the shrewdness of the "man of business" and the vibrancy of the "practical man." "Men of action" were not quite the revolutionizers that their counterpart "men of thought" were – such as the philosophers whose ideas could well come to shape the contours of civilizations. Unfortunately, Mercier observed, while "men of thought" were often capable of leaving a mark on history, their ac­tual lived lives were rarely defined through the rubric of adaptational success, which is why "the man of thought does not enter into his kingdom till after he is dead." The "men of action," on the other hand, did nothing but exhibit a profound health and intelligence of conduct. Their contribution was neither posthumous nor historical but defined through a remunerative value – we can call it profit – that could be imminently realized and expeditiously procured. "The man of action reaps his reward during his lifetime," Mercier concluded, and while history may not remember these exemplary archetypes of human conduct – these prodigious praxeological virtuosos, in Mercier's mind – their role and function in the ongoing development of society as a matrix of cus­tomary actions and behaviors could not go unremarked.