Does Madness Pay? Nima Bassiri Explores Madness and Enterprise

Nima Bassiri, assistant professor of Literature. (Photo courtesy Nima Bassiri)

“There’s a particular tradition in the history of philosophy of science that doesn’t just ask what people said and thought in the past, but why they were incited to speak and think one way rather than another,” said Nima Bassiri.

This is the question that Bassiri, assistant professor of Literature and codirector of Duke’s Institute for Critical Theory, examines in his book Madness and Enterprise: Psychiatry, Economic Reason, and the Emergence of Pathological Value, released earlier this year by the University of Chicago Press.

“In the 19th century,” Bassiri said, “psychiatrists felt compelled to diagnostically approach madness through an economic lens. Why? What sorts of problems did this resolve for them? How did this way of thinking come to be deemed acceptable and even necessary?”

We caught up with Bassiri to find out the answers to these questions, and how 19th century modes of psychiatric thinking continue to influence our values systems today.

This interview has been edited for length and clarity.

First, let’s start with the title of your book. What do “economic reason” and “pathological value” mean?

“Economic reason” refers to a style of thinking that permeated psychiatric thought in the 19th century. It became important for psychiatrists to supplement their diagnostic assessments of anomalous and potentially pathological behaviors with economic questions such as whether a suspected madman was good with money, whether they could manage their wealth or whether otherwise abnormal behaviors were lucrative or not.

This led to a surprising medical conclusion: economic success could counteract and offset suspicions of madness. But it also led other psychiatrists to conclude — somewhat more radically — that some of the most severe mental and neuro-pathologies could be compatible with economic activity and could even, in some cases, be beneficial to economic success. Madness, in other words, became a medical condition that was measured largely on the basis of its economic output: It was not necessarily a dangerous threat to be removed from the socio-economic order; rather, the social status and acceptability of madness was hinged on its economic worth, or what I dub its “pathological value.”

Why did clinicians turn to economic reasoning to judge a person’s sanity?

Over the course of the 19th century, psychiatrists across Europe and North America encountered a diagnostic dilemma with respect to behavioral abnormalities that were neither clearly healthy nor unhealthy. In order for the burgeoning profession of psychiatry to claim its medical expertise, it had to construct typologies of madness that weren’t evident to non-experts. If anybody could recognize every instance of mental pathology, no matter how subtle, then what function did psychiatry serve?

Eventually, however, these subtle and ambiguous types — that I refer to as “borderland” —  became too inscrutable for even psychiatry itself, forcing psychiatrists to adopt extra-medical styles of diagnostic reasoning.

Economic behaviors were a much clearer way of determining the propriety and acceptability of social conduct. Through an economic lens, the behavior in question either made/preserved wealth, in which case it could be assigned the status of medical normalcy and social propriety; or it was costly/financially ruinous, in which case it could be assigned the status of disorder and disease.

madness and enterprise
Bassiri's new book, Madness and Enterprise: Psychiatry, Economic Reason, and the Emergence of Pathological Value, was released earlier this year from the University of Chicago Press.

If the risk-taking entrepreneur was seen as the embodiment of positive pathological value at the turn of the 20th century, how did race and gender play into the equation?

The relationship between creativity and abnormality, a relationship that is often romanticized, is the glorification of certain expressions of madness that can only be celebrated insofar as they are redeemable on economic grounds.

However, that link between abnormal creativity and financial prodigiousness was fundamentally entwined with the politics of what I call “pathological privilege.” Entrepreneurial idiosyncrasies are typically organized around racial and gender markers (e.g., masculine whiteness). A central contention I put forward is that the concept of the modern entrepreneur has been, at least from the beginning of the 20th century, entwined not only within the history of feminist erasure but also the history of racial capitalism; and it’s an entwinement that the history of madness allows us to register.

The entrepreneur was likened to a creative genius whose madman attributes were justified so long as profit could be accrued.  Coded through white masculinity, entrepreneurialism could circulate through the social body and economic sphere as an acceptable and even idealized pathological form precisely for its remunerative unconventionality. Entrepreneurialism represented both the masculinization of pathology and replicated a crucial logic of racial capitalism — namely, racialized expropriation — with respect to Black and other non-white economic actors.

You discuss the field of psychiatry emerging as a gatekeeper of moral order and posit that, to a large extent, it still is. What do you mean by this?

We need to think through the implications of psychiatric medicine largely defining the boundaries of everyday behavioral normalcy. For example, we tend to not only question forms of transgressive or unacceptable behavior but to pathologize them. This is one of the lasting legacies of psychiatry, which throughout the 19th century established the belief that pathological individuals are diffusely and dangerously — though often imperceptibly — among us, and that only the professional scrutiny of psychiatric clinicians can identify them.

I suggest that the psychiatric inflections of even our most ordinary sense of moral propriety go deeper than we imagine and have become commingled with economic norms. So, what we think of as proper, acceptable and reasonable behavior is both medically and economically fashioned. It is not just a historical analysis that I make here, but a philosophical one as well: Psychiatry has always been concerned with the status of human conduct and behavioral normalcy, even as it purports to be a medicine of the mind. To that extent, one must read psychiatry through the lens of the history of social thought and social theory.

In your conclusion, you encourage us to think beyond pathological value and to ask how far the structures of capital have reached into all spheres of our lives. Do you plan future research into these questions?

The concept of pathological value considers to what extent economic valuations have permeated our social valuations, including our most salient and cherished forms of moral appraisal. If what is healthy and unhealthy is a binary, both informed and blurred by the force of economic value, then why wouldn’t the binary between good and bad, virtuous and vicious, not be equally transfigured, given how readily we equate good with healthy and bad with unhealthy?

I see this as a caution that the work of resistance against structures of inequity and violence may be more demanding and counterintuitive than we realize. How can we hope for a rational society when we have yet to fully appreciate how much value is attributed to the entire domain of the irrational? Irrationality is both productive and valuable — as the notion of pathological value tries to show. Until we reckon with the pervasiveness of the irrational on our social order, we risk embracing forms of resistance steeped in the language of reasonableness and moral righteousness that are complicit with the very violence that they seek to undo. This is a question around which much of my current and future research is headed.