, Volume 196, Issue 6, pp 2217–2241 | Cite as

Collectively ill: a preliminary case that groups can have psychiatric disorders

  • Ginger A. HoffmanEmail author
S.I.: Psych&Phil


In the 2000s, several psychiatrists cited the lack of relational disorders (what I call “collective disorders”—disorders of groups rather than individuals) in the DSM-IV as one of the two most glaring gaps in psychiatric nosology, and campaigned for their inclusion in the DSM-5. This campaign failed, however, presumably in part due to serious “ontological concerns” haunting such disorders. Here, I offer a path to quell such ontological concerns, adding to previous conceptual work by Jerome Wakefield and Christian Perring. Specifically, I adduce reasons to think that collective disorders are compatible with key metaphysical commitments of contemporary scientific psychiatry, and argue that if one accepts the existence of mental disorders in individuals as medical, then one has good reasons to accept the existence of collective disorders as medical. First, I outline how collective disorders are reconcilable with both the harmful dysfunction model of disorder and a denial of mind-body dualism. I then identify some potential weaknesses in the main pre-existing example of a collective disorder, offering my own examples as supplements. These examples’ medical plausibility is bolstered by: (1) work in philosophy of biology on the generalized selected effects theory of function (largely from Justin Garson), and (2) work in analytic philosophy of mind on collective mentality (largely from Bryce Huebner). Finally, after offering preliminary responses to the objection that the recognition of collective disorders may lead to an overpathologization of everyday life, I spell out ways in which this recognition may have empowering effects for some would-be patients; for example, by providing substance to the notion of a “sane response to an insane world.”


Collective illness Relational disorder Biological function Mental illness Collective mind Group mind Sanism Neurodiversity Harmful dysfunction Extended mind 



I sincerely thank Justin Garson, Bhob Rainey, Şerife Tekin, and two anonymous reviewers for their helpful feedback on earlier drafts of this manuscript.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  2. Armstrong, T. (2010). The power of neurodiversity: Unleashing the advantages of your differently wired brain. Cambridge, MA: Da Capo Press.Google Scholar
  3. Armstrong, T. (2015). The myth of the normal brain: Embracing neurodiversity. AMA Journal of Ethics, 17(4), 348–352.CrossRefGoogle Scholar
  4. Barnes, E. (2016). The minority body. Oxford: Oxford University Press.CrossRefGoogle Scholar
  5. Beach, S. R. H., Wamboldt, M. Z., Kaslow, N. J., Heyman, R. E., & Reiss, D. (2006). Describing relationship problems in DSM-V: Toward better guidance for research and clinical practice. Journal of Family Psychology, 20(3), 359–368.CrossRefGoogle Scholar
  6. Berenbaum, H. (2013). Classification and psychopathology research. Journal of Abnormal Psychology, 122(3), 894–901.CrossRefGoogle Scholar
  7. Biegler, P. (2011). The ethical treatment of depression: Autonomy through psychotherapy. Cambridge, MA: MIT Press.CrossRefGoogle Scholar
  8. Block, N. (1978). Troubles with functionalism. In C. W. Savage (Ed.), Minnesota studies in the philosophy of science (Vol. IX, pp. 261–325). Minneapolis, MN: University of Minnesota Press.Google Scholar
  9. Carson, S. H. (2011). Creativity and psychopathology: A shared vulnerability model. Canadian Journal of Psychiatry, 56(3), 144–153.CrossRefGoogle Scholar
  10. Clark, A., & Chalmers, D. (1998). The extended mind. Analysis, 58, 7–19.CrossRefGoogle Scholar
  11. Cooper, R. (2008). Psychiatry and philosophy of science. McGill: Queen’s University Press.Google Scholar
  12. Cramond, B. (1994). Attention-deficit hyperactivity disorder and creativity–What is the connection? The Journal of Creative Behavior, 28(3), 193–210.CrossRefGoogle Scholar
  13. Dolnick, E. (1993). Deafness as culture. The Atlantic Monthly, 272(3), 37–53.Google Scholar
  14. Drayson, Z. (2009). Embodied cognitive science and its implications for psychopathology. Philosophy, Psychiatry & Psychology, 16(4), 329–340.CrossRefGoogle Scholar
  15. Elliott, C. (1998). The tyranny of happiness: Ethics and cosmetic psychopharmacology. In E. Parens (Ed.), Enhancing human traits: Ethical and social implications (pp. 177–188). Washington, DC: Georgetown University Press.Google Scholar
  16. Farber, S. (2012). The spiritual gift of madness: The failure of psychiatry and the rise of the mad pride movement. Rochester: Inner Traditions.Google Scholar
  17. First, M. B. (2006). Relational processes in the DSM-V revision process: Comment on the special section. Journal of Family Psychology, 20(3), 356–358.CrossRefGoogle Scholar
  18. First, M. B., Bell, C. C., Cuthbert, B., Krystal, J. H., Malison, R., Offord, D. R., et al. (2002). Personality disorders and relational disorders: A research agenda for addressing crucial gaps in DSM. In D. J. Kupfer, M. B. First, & D. A. Regier (Eds.), A research agenda for DSM-V (pp. 123–199). Washington, DC: American Psychiatric Association.Google Scholar
  19. Garson, J. (2012). Function, selection, and construction in the brain. Synthese, 189(3), 451–481.CrossRefGoogle Scholar
  20. Garson, J. (2015). The biological mind. London: Routledge.Google Scholar
  21. Garson, J. (2016). A critical overview of biological functions. New York: Springer.CrossRefGoogle Scholar
  22. Gilbert, M. (1989). On social facts. London: Routledge.Google Scholar
  23. Hoffman, G. A. (2012). What, if anything, can neuroscience tell us about gender differences? In R. Bluhm, A. J. Jacobson, & H. L. Maibom (Eds.), Neurofeminism: Issues at the intersection of feminist theory and cognitive science (pp. 30–55). New York: MacMillan.CrossRefGoogle Scholar
  24. Hoffman, G. A. (2013). Treating yourself as an object: Self-objectification and the ethical dimensions of antidepressant use. Neuroethics, 6(1), 165–178.CrossRefGoogle Scholar
  25. Hoffman, G. A. (2016). Out of our skulls: How the extended mind thesis can extend psychiatry. Philosophical Psychology, 29(8), 1160–1174.CrossRefGoogle Scholar
  26. Hoffman, G. A., & Zachar, P. (2017). RDoC’s metaphysical assumptions: Problems and promises. In Ş. Tekin & J. Poland (Eds.), Extraordinary science: Responding to the crisis in psychiatric research (pp. 59–86). Cambridge, MA: MIT Press.Google Scholar
  27. Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press.Google Scholar
  28. Huebner, B. (2011). Genuinely collective emotions. European Journal for Philosophy of Science, 1(1), 89–118.CrossRefGoogle Scholar
  29. Huebner, B. (2014). Macrocognition. Oxford: Oxford University Press.Google Scholar
  30. Huebner, B., Bruno, M., & Sarkissian, H. (2010). What does the nation of China think about phenomenal states? Review of Philosophy and Psychology, 1, 225–243.CrossRefGoogle Scholar
  31. Hutchins, E. (1995). Cognition in the wild. Cambridge, MA: MIT Press.Google Scholar
  32. Jamison, K. (1993). Touched with fire: Manic-depressive illness and the artistic temperament. New York: Free Press.Google Scholar
  33. Jamison, K. (1995). An unquiet mind: A memoir of moods and madness. New York: Knopf Inc.Google Scholar
  34. Kaslow, F., & Patterson, T. (2006). Relational diagnosis–A brief historical overview: Comment on the special section. Journal of Family Psychology, 20(3), 428–431.CrossRefGoogle Scholar
  35. Kendler, K. (2001). A psychiatric dialogue on the mind-body problem. American Journal of Psychiatry, 158, 989–1000.CrossRefGoogle Scholar
  36. Levy, N. (2007). Neuroethics. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  37. Lewis, B. (2006a). Moving beyond Prozac, DSM and the new psychiatry: The birth of postpsychiatry. Ann Arbor: University of Michigan Press.CrossRefGoogle Scholar
  38. Lewis, B. (2006b). A mad fight: Psychiatry and disability activism. In L. J. Davis (Ed.), The disability studies reader (pp. 115–131). London: Routledge.Google Scholar
  39. Manninen, B. A. (2006). Medicating the mind: A Kantian analysis of overprescribing psychoactive drugs. Journal of Medical Ethics, 32, 100–105.CrossRefGoogle Scholar
  40. Menary, R. (Ed.). (2010). The extended mind. Cambridge, MA: MIT Press.Google Scholar
  41. Middleton, A., Hewison, J., & Muelller, R. (2001). Prenatal diagnosis for inherited deafness–What is the potential demand? Journal of Genetic Counseling, 10, 121–131.CrossRefGoogle Scholar
  42. MindFreedom. Mad pride campaign. Resource document. Accessed 20 Aug 2016.
  43. Moncrieff, J. (2016). Myth of the chemical cure. In W. Hall (Ed.), Outside mental health: Voices and visions of madness (pp. 155–162). Madness Radio.Google Scholar
  44. National Association of the Deaf. (2000). NAD position statement on cochlear implants. Accessed 20 Aug 2016.
  45. National Institute of Mental Health. Research Domain Criteria (RDoC) website. Resource document. Accessed 19 Aug 2016.
  46. Ortega, F. (2009). The cerebral subject and the challenge of neurodiversity. BioSocieties, 4(4), 425–445.CrossRefGoogle Scholar
  47. Perring, C. D. (2014). Are relationship problems disorders? In C. D. Perring & L. A. Wells (Eds.), Diagnostic dilemmas in child and adolescent psychiatry (pp. 98–108). Oxford: Oxford University Press.Google Scholar
  48. Pettit, P. (2003). Groups with minds of their own. In Fred Schmitt (Ed.), Socializing metaphysics (pp. 167–193). New York: Rowman and Littlefield.Google Scholar
  49. Santosa, C. M., Strong, C. M., Nowakowska, C., Wang, P. W., Rennicke, C. M., & Ketter, T. A. (2007). Enhanced creativity in bipolar disorder patients: a controlled study. Journal of Affective Disorders, 100(1–3), 31–39.CrossRefGoogle Scholar
  50. Tekin, Ş. (2011). Self-concept through the diagnostic looking glass: Narratives and mental disorder. Philosophical Psychology, 24(3), 357–380.CrossRefGoogle Scholar
  51. Tekin, Ş. (2014). Self-insight in the time of mood disorders. Philosophy, Psychiatry, & Psychology, 21, 135–137.CrossRefGoogle Scholar
  52. Theiner, G., Allen, C., & Goldstone, R. (2010). Recognizing group cognition. Cognitive Systems Research, 11, 378–395.CrossRefGoogle Scholar
  53. Theiner, G., & O’Connor, T. (2010). The emergence of group cognition. In A. Corradini & T. O’Connor (Eds.), Emergence in science and philosophy (pp. 78–117). London: Routledge.Google Scholar
  54. Tollefsen, D. P. (2002). Organizations as true believers. Journal of Social Philosophy, 33(3), 395–411.CrossRefGoogle Scholar
  55. Tollefsen, D. P. (2006). From extended mind to collective mind. Cognitive Systems Research, 7(2–3), 140–150.CrossRefGoogle Scholar
  56. Vedantam, S. (2002). Doctors consider diagnosis for “ill” relationships. The Washington Post. Available from Accessed 8 Aug 2016.
  57. Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373–388.CrossRefGoogle Scholar
  58. Wakefield, J. C. (2006). Are there relational disorders? A harmful dysfunction perspective: Comment on the special section. Journal of Family Psychology, 20(3), 423–427.CrossRefGoogle Scholar
  59. Walters, S. (2011). Autistic ethos at work: Writing on the spectrum in contexts of professional and technical communication. Disability Studies Quarterly, 31(3). doi: 10.18061/dsq.v31i3.1680.
  60. Wamboldt, M. Z., & Reiss, D. (2006). Genetic strategies for clarifying a nosology of relational distress. Journal of Family Psychology, 20(3), 378–385.CrossRefGoogle Scholar
  61. Wilson, R. (2005). Collective memory, group minds, and the extended mind thesis. Cognitive Processing, 6(4), 227–236.CrossRefGoogle Scholar
  62. Wolframe, P. (2013). The madwoman in the academy, or, revealing the invisible straightjacket: Theorizing and teaching saneism and sane privilege. Disability Studies Quarterly, 33(1). doi: 10.18061/dsq.v33i1.3425.

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© Springer Nature B.V. 2017

Authors and Affiliations

  1. 1.Department of PhilosophySaint Joseph’s UniversityPhiladelphiaUSA

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