Introduction

A woman is walking the streets raving, her breast bared. A man throws money in the air, shouting sorrow. The neighbors are filled with fear, wondering: ‘What is going on here? What to do?’ Enter: A number of smoothly collaborating professionals, casting their well attuned nets of ideas. They are ‘in control’. They breathe Be-Griff: “We’re talking ‘medical emergency’ here, people. Go home, nothing to see here. Delusions, hallucinations, nothing we haven’t seen before. It will be over soon. All will go back to normal…”

Radical change and transformation however, the opposite of going-back-to-normal, that is, according to several of the authors in this volume, the promise and potential of psychosis. Where can someone turn to for recognition let alone appreciation of the elusive, ineffable experience of madness?

Aiming to foster generative, emancipatory perspectives on psychosis, the editors, Marie Brown and Robin Brown, gathered a rich array of emancipatory approaches to psychosis. With this collection the editors and authors delivered an important impulse to free madness “from the entrapment of being an individual, bodily “problem” and transform it into an experience that is connected with the wider humanity” (p. 5).

The master story (dominant narrative) on madness is about delusions and hallucinations, negative symptoms, illness (insight, or lack thereof), psychotropic drugs, compliance and recovery (clinical, personal, societal). We are witnessing an endless sea of academic publications on first-episode psychosis (FEP), schizophrenia, schizoaffective disorder, bipolar disorder, etcetera, focused on curing psychosis and eradicating madness. To study the prevention of mental illness, millions of euros are being invested in The Netherlands. Most of the time, those that are deemed mad are supposed to return to normality, stimulated by the combined, corrective efforts of psychiatry, police, and their social networks. Stories other than the biomedical narrative are mostly rejected, or incorporated – congruent with the usual dynamic of master story and counter stories.

In the face of this endless sea of causal-reductive negativity, the editors psychologist Marie Brown and psychoanalist Robin Brown have admirably chosen to stimulate and/or critically discuss various non-reductive and noncausal counter stories on madness. Cutting some corners, the contributors can be characterized as clinicians from various countries (mainly US and UK), attracted to philosophy, spirituality and mysticism. The book has ten chapters and 182 pages in total. Chapters are structured almost like academic articles, with an abstract and keywords. The information density as well as the conceptual level is high. The overall writing is high quality, evocative and literary, well-read (sometimes a bit too well, I sometimes felt flooded with names and references).

To begin with, the use of the term ‘madness’ as synonymous for psychosis is an emancipatory move. The abovementioned connection to the wider humanity as an argument for using the term ‘madness’ is also found in the work of the Dutch philosopher and expert-by-experience Wouter Kusters, author of the seminal A Philosophy of Madness (2020) to which I will turn later in this review.

The book contains much philosophy (esp. Plato, Foucault, Heidegger) and psychoanalysis (esp. Lacan and Jung). In fact, almost all articles could be called ‘hybrids’, bridging the two disciplines. The volume’s subtitle is ‘psychological, social, and spiritual dimensions’. However, I can imagine that the editors had a few fierce discussions whether they should replace ‘psychological’ with ‘psychoanalytical’, since the book contains plenty psychoanalysis. Generally speaking (and explicitly in Ch. 7) the volume conveys the message that some schools of psychoanalysis have more emancipatory qualities than others. Particularly the schools of Lacanian and Jungian thought are addressed, applied, and being built upon.

The collection sets off with an affectively and theoretically strong introduction by Marie Brown. Brown insists on the urgency of setting madness free while highlighting the difficulty in this endeavor, since madness often leads to limiting a person’s freedom; firstly, through incarceration and hospitalization, and secondly, by means of the normative ideas and presuppositions that psychiatry abounds with (the power of ideas), and thirdly, the very phenomenology of madness itself, e.g. feeling controlled or caged in.

Dwelling a bit longer on this third aspect of feeling imprisoned or enslaved as an aspect of enduring madness, I would like to share an example from my ongoing PhD fieldwork of my PhD study, concerned with the lives of people with psychosis in supported housing contexts. Ayden (pseudonym), one of my research respondents, had several psychotic episodes, varying in intensity, during our multiple interactions in the Fall of 2020. He spoke to me many times about the implementation of a chip (‘neuralink’, Elon Musk) in his brain, resulting in a never-ending “telephone conversation” in his head. Furthermore, he said he frequently experienced punishment for certain acts (e.g. listening to metal music) through electrical shocks in his head caused by a so-called ‘stimoceiver’ (Delgado). He shared with me a recording of his voice, singing the song ‘I, Melvin’ by the band NOFX:

“Like a puppet on strings / Look he strums and he sings / I feel like a cartoon / I'm alone on the stage / I'm the man on the moon / I'm the deer in the headlights / I'm the fish in the bowl / I'm on automatic pilot / I am remote controlled”

While this type of madness sounds awful, still, for Ayden, it was not ‘all bad’. He also expressed the feeling of being ‘chosen’, specially selected, and ‘in control’, able to take ‘revenge’ – also for the sake of others, who he believed, were chipped in the head just like him. For him it was perhaps worse that his parents did not acknowledge these ‘facts’ that he experienced. As he said to me: “With my parents I do not talk about this… They hide all this as a lie. Even though they know that I have this – the chip in my head.” Moreover, Ayden spoke about being treated not as a unique individual, but “like a monkey” within the psychiatric system, which of course leads back to the first two aspects of the problematic yet pressing emancipation of madness. Above all, Ayden said he often felt “not taken seriously”, by other people.

While even the best emancipatory efforts on madness to date risk to remain unengaged with by many clinicians because these are (supposedly) ‘romanticizing’ psychosis, Brown in her introduction focuses on the “harmfully reductive” effects on people when clinicians one-sided ‘awfulize’ madness, referring to the work of clinical social worker and therapist Ron Unger (2019).

Making the case for the liberation of psychosis, Brown refers to the famous (critical) psychiatrist R.D. Laing, writer and expert-by-experience Daniel Paul Schreber, and contemporary mad(wo)men such as Erin Soros and Pat Deegan. In addition, she discusses the research paradigm of Mad Studies, and initiatives like CRAZYWISE and The Icarus Project, quoting from the latter:

“We believe we have a dangerous gift to be cultivated and taken care of, rather than a disease or disorder to be “cured” or “eliminated”.” (p. 7)

As a lens for the rest of the chapters, Brown introduces the Spanish philosopher and psychologist Martín-Baró and his Writings for a Liberation Psychology (1996). Martín-Baró has identified three limiting presuppositions within Euro-American psychology: Positivism, individualism and ahistoricism, which seem to be helpful in crafting emancipatory theory on madness.

Take positivism, for example. With treatment approaches and protocols depending mostly on studies deploying randomized controlled trials (RCT’s) one needs to be aware that “positivism disregards any phenomenon that cannot be quantified, measured, or interpreted through logic and reason.” Brown quotes Martín-Baró: “Dividing things up in this way, positivism becomes blind to the most important meanings of human existence”. Psychiatry and psychology as areas of research have developed itself over the last few decades significantly in the quantifiable direction of neuroscience. But why? To gain more credibility and respect among the other health care disciplines?

Some would argue, as I would too, that studying phenomena such as psychosis, psychiatry and psychology would be well advised to engage much more with the field of the medical humanities, like the contributing clinicians do with this book. In this context, it is heartening to see the rise of (or the return to) qualitative research methodology such as (neo)phenomenology (e.g. Interpretative Phenomenological Analysis) in academic ‘psy’ departments, and the increasing acceptance of this type of research articles in peer-reviewed journals.

The various chapters

CHAPTER ONE For some, it seems to be quite liberating to discuss madness in conjunction with trauma, instead of illness talk. One is then willing to admit that psychosis holds meaningful content, which is then selected, fitted and translated in psychosocial terms of individual and/or intergenerational trauma, and (when someone is ‘stable’ enough) trauma therapy is offered. In this context it is interesting that Robin Brown in this first chapter expands upon the limits of trauma-informed approaches to psychosis.

Brown sets a strong example of the often problematic positivist, individualized, and ahistorical notions (Martín-Baró), in thinking about madness. When clinicians track the mechanisms of trauma in individuals, viewing trauma as “a deficit in the experience of early relationships”, this involves “a clear risk of conceptualizing psychotic experience merely in terms of an environmental shortfall” (p. 18). Despite (eventual) liberatory intentions, causal-reductionist reasoning is being perpetuated, and the connection to wider humanity is missing.

To avoid a mechanist, causal-reductionist, deficit oriented and highly individualized view of the madness-trauma relationship, Brown starts with building his argument through an exploration of teleology in psychoanalysis, and then starts to draw heavily on the trauma-theoretical work of psychoanalysts Davoine & Gaudillière, particularly their History beyond trauma (2004). Connecting madness to events of our collective history, they view “patients as researchers” and “clinicians (…) as assistant to the work of historical research”. Since mad(wo)men can feel tormented to explain their madness in causal terms, forced by others, a considerable role is assigned to ‘coincidence’ in the encounter of two ‘human gateways’ into our shared history. This is emancipatory because, as Brown states:

“the question of a deficit is no longer imputed to the patient, but rather to the collective, and it is the patient who seeks to ameliorate for this deficit by attending to an absence in the historical record. The dignity thus reserved for the individual in this scheme is in stark contrast to the treatment of intergenerational trauma understood in terms of a correction to the patient’s developmental shortcomings realized by way of relationship to the therapist.” (p. 19, 20)

CHAPTER TWO Françoise Davoine herself continues in chapter 2 to advocate for coincidence, collectivism and sensitivity to (local) history. Lacanian psychoanalysis meets indigenous knowledge, in this well-crafted story, titled ‘Encounters with Sioux medicine men’. Carefully positioned between pieces from the editors in chapter one and three, Davoine’s contribution affected me the most. For example, the application of the experience of the Sioux ‘Give Away’ (Potlatch ritual) to psychosis made me wonder about the role of power in psychiatry. Today, critical voices usually scrutinize the power of systems over the life world (Habermas, Kunneman), and emphasize the power asymmetry in the relationship of mental health care workers and their patients, thereby invoking the concept of ‘epistemic injustice’ by Miranda Fricker (2007).

In another kind of discourse Davoine stresses “the power of powerlessness”. Particularly since feelings of powerlessness, uncertainty and doubt so often befall (and overwhelm) relatives, clinicians and other workers, involved in the lives of those that go “raving mad”:

“During critical sessions when our patients force us to experience powerlessness by making us fail, there is a chance for a new link to be created by acknowledging our blunders and monitoring our dreams. Only when we abandon our pretense to succeed with the patient’s cure, only when we Give Away our professional qualities, can we reach the knowledge our patients paid so much to learn. Only then can we stand at the side of the patients and share the resources which help them in the crazy situations, when the laws of humanity have collapsed on the site of catastrophes and abuses which tore people from all trust in others. Medicine men call those helpers spirits. We call them voices or visions. They stem from an entrenched unconscious which speaks through things, animals, or trees, where human speech does not hold.” (p. 28)

To continue in this line of thinking, we could wonder, what is the meaning of madness in the era of the Anthropocene – in this time of human history in which we as humans have risen to become the dominant factor in the pending destruction of all living things, including ourselves? One could consider these words by Davoine, on the intersection of the sixth mass extinction – the species that have vanished from the face of the earth – and events of madness in individuals:

“Folly may claim "unclaimed experiences" denied by ruthless agencies, and take care of those who have disappeared. By telling untold stories and singing unsung songs, a freedom of speech is opened for voices and visions, which give birth to a "Political self" on the site of destruction.” (p. 33)

CHAPTER THREE Subsequently, Brown and Brown join forces in a piece, called ‘Transpersonal enactments and the teleology of paranoia’. Referring to the framework of Martín-Baró, the authors retell the Western (his)story of the rise of empirical science since Enlightenment, liberating societies from irrational religious and folkloristic practices, and ultimately producing a world in a state of ‘disenchantment’ (Entzaubering, Max Weber) characterized by: “a loss of communal belonging, an emphasis on private experience, and the rise of widespread alienation” (p. 37).

Brown and Brown discuss the problematic relation between disenchantment and madness, i.e. the positivist isolation of the research subject, since “the hallmark of madness is considered to be the incapacity to separate oneself from the other” (p. 37). This problematic Cartesian separation is questioned in multiple ways. Notably, the authors discuss the transpersonal psychology of Stanislav Grof, whose distinction between ‘medical psychosis’ and ‘spiritual emergency’ they critique, due to its inconsistency. Instead, they prefer the transpersonal work done by Jorge Ferrer (2002), who asserts that “inner spiritual practices are not merely aimed at changing the self, but at the actual transformation of the world”.

Promoting re-enchantment, they employ the concept of ‘synchronicity’ as developed by C.G. Jung. This chapter is well-structured and has a clear and convincing line of argumentation. Between these first chapters, there is a reader-friendly cohesiveness, due to the application of ideas from Davoine & Gaudillière in the analysis of shared delusions (Folie à famille) in the case example of Anja, her family and their Sámi ancestors. What is more, they promise an additional dosage of ‘mad re-enchantment’ in the following chapter, by critical psychologist Rachel Liebert, who, according to Brown & Brown, in order to unsettle “Western hegemony”,

“argues that the otherworldly nature of paranoia has a decolonizing potential, particularly in so far as it stands as a direct challenge to scientific discourse”. (p. 47)

CHAPTER FOUR ‘Re-turning the Psykhe’ by Liebert is a chapter filled with metaphor and linguistics, circling around ritual and experiment Missed Connections, a collaboration with visual artist Holli McEntegart. Liebert undertook an “apprenticeship with paranoia by turning to magical ideation”, hoping to contribute to the decolonization of psychology, to stand up to “a colonizing Science”, that casts a “think-net over the world, disciplining it, settling it.” Unsettling and re-imagining psychological praxis, means to Liebert to allow for the “more-than-human”, for imagination and the supernatural. This is an especially evocative chapter, for those that have an open mind towards paranoia’s potential, a love for language games, and – most importantly – are aching for air, in this “state of breathlessness”, due to the smothering activity of Science.

CHAPTER FIVE In ‘Divine madness: exceedance and not-knowing’, John Gale, philosopher and psychotherapist and former Benedictine monk, discusses various forms of madness since antiquity. This can be called liberatory, because in Ancient Greece, and early Christianity, madness was not (always) regarded as something that one should avoid at all costs. On the contrary, madness sometimes even was feigned and strived for, i.e. “Cynic philosophers and Christian monks chose to adopt a subversive and unconventional “mad” lifestyle. They acted as if they were mad.” This is an informative chapter on the four forms of divine madness, that Plato distinguishes, on poetry, prophets, mysticism, and philosophy – all the while circling around the notion of ‘ecstasy’. Starting from the introductorily useful descriptive third person perspective provided by Gale in this chapter, I advise the reader to move on to more evocative reading and writing practices (including first and ‘zero person’ perspectives) of ‘divine madness’, mysticism and philosophy, notably in A Philosophy of Madness by Wouter Kusters.

CHAPTER SIX Regarding psychosis, there is an ongoing debate in Western psychiatry about the bio-psycho-socio model. Aside from the much contested dominance of the ‘bio’-layer as fundamental, something essential is conspicuous by its absence, or put differently: something resists capture altogether. In ‘Archetypal dimensions of expanded states’, Tim Read, the only contributing psychiatrist in this collection, proposes a bio-psycho-socio-archetypal (BPSA) model, to allow for the application of the idiom of ‘spiritual emergency’ to madness. Using the term ‘archetypal’ could have implied quite a large role for C.G. Jung in this chapter, however Read illustrates the archetypal domain with the allegory of Plato’s cave, after which he primarily draws on the transpersonal work of Stanislav Grof, using the “inner turmoil” of Christina Grof and C.G. Jung as data.

Remembering the hesitancy of Brown & Brown (Ch. 3) regarding the emancipatory quality of Grof’s transpersonal psychology, this chapter enters tricky terrain when – indeed, led on by Grof – Read begins to differentiate between archetypal crisis and mental illness:

“In psychiatric practice, it is not uncommon for people in excited states to overattribute meaning to unconnected events. It may seem to them as though there are synchronicities everywhere. This may amount to delusions of references, a pathological state where, for example, a person may feel that every passing car registration number is imbued with a personal meaning. Clearly such states are dysfunctional and do not have integrative or growth potential, at least in the short term – but psychiatrists do need to be able to distinguish between genuine synchronicities and psychosis, and avoid treating all unusual phenomena as mental illness.” (p. 107)

In A Philosophy of Madness (2020), Kusters analyses at length a similar attempt to sort the wheat from the chaff, in the well-known work Healing the Split by John Nelson. Kusters identifies that Nelson’s distinction: “is based on the erroneous transpersonal idea that insight and anxiety are incompatible”.

Just like Brown & Brown, Kusters warns against the split between spiritual emergency and psychosis, and I agree that psychiatrists should be very cautious to do so, since it is diminishing the self-determination of people themselves.

CHAPTER SEVEN “Delusions should be respected rather than pathologized”, is the message of ‘Reconceptualizing John Nash’s psychosis: A Lacanian perspective’ by Derek Hook, professor in psychology. Hook delivers a clear discussion of the ‘case’ of John Nash Jr., the schizophrenic mathematician widely known because of the biography A Beautiful Mind written by Sylvia Nasar (1998), and the film adaptation by Ron Howard (2001). Building on a Lacanian basis, Hook develops a convincing argument for a much more emancipatory and benevolent approach of Nash’s supposed “highly narcissistic personality”. He does so in response to the work of Donald Capps, which, he argues, results in the “implicit devaluing of psychotic subjects” as infantile, inferior, primitive, and so on. In short, “a second-class order of subjectivity”.

Hook chiefly allocates emancipatory potential in Lacan’s accentuation of “delusions as modes of recovery and the associated notion of the delusional metaphor as a way of stabilizing triggered forms of psychosis”. To be more specific, when viewing ‘the work of psychosis’ as a meaningful activity, full of agency and creativity, then Nash’s narcissism should be re-evaluated as Nash trying to achieve

“that which he was most lacking and seemingly desperate for: (…) a viable, adaptive ego that would substantiate and give definition to an inchoate and imperiled sense of self.” (p. 124)

CHAPTER EIGHT ‘The touch from without/the force from within’ by Jungian analyst Ronald Schenk is a rather enjoyable ride through cultural history, exploring “the idea of madness” with the Greeks, in the Renaissance, and the treatment approach by Philippe Pinel around 1900, picked up by Auguste Forel and Eugene Bleuler, C.G. Jung and John Weir Perry. The contribution by Schenk is pleasantly structured, beginning with Frank, a young man diagnosed with schizophrenia in the context of Western psychiatry, and closing the chapter “full circle” with Frank encountering an African shaman, and his “capacity to know two different worlds” – “to dwell in two homes , the spiritual and the material” (p. 149)

I especially like the section with Schenk’s analysis of the Mad King Lear, and the Renaissancean idea that “madness holds a separate dark, tumultuous cosmic reality” (p. 135). What is this paradoxical reality, which also has something to do with Frank’s ability to walk in two worlds?

“Through his encounter with the underworld of madness Lear has come to “know” (one of the first words he utters in the play) himself in his humble essence, the true king, and to come to a sensibility of the human condition as essentially seething with madness. By divesting himself of home, land, the accoutrements of social life, and even the natural order of intergenerational loyalty, the paradoxical reality is revealed that nothing is more irrational than the rational order, “the great stage of fools,” conceived by man in conjunction with the natural order of the cosmos. Madness then becomes its own language, a system of metaphors known through feeling in a storm of interaction signifying to the world a different reality - one that does not lend itself to rational order, control, certainty or authorization" (p. 142)

CHAPTER NINE ‘Creative transformations: The establishment, the mystic and the aesthetic drive’ is a contribution by psychologist and psychoanalyst Marilyn Charles. Reading the title and the abstract, I was ready to dive into this chapter, and ‘devour this text’. And there are interesting parts in this chapter, e.g. the interesting example of a psychotic young man as “Atlas, holding up the world”, with the appropriate analysis of Charles that:

“his speech is unconventional, which has resulted in various labels, including “psychotic,” even though his speech is quite precise and cogent, but lodges at that odd juncture of concrete metaphor that is often called psychotic.” (p. 154)

However, to avoid for readers to feel like the valuable insights offered in this chapter have eluded them, I think this chapter would have benefitted from a) deleting many references (see p. 155 for an ironic reflection on the “dense enterprise” of psychoanalysis), b) clarifying the point of giving extensive auto-biographical material, c) improving and clearly stating the structure and storyline throughout the chapter, and d) never allowing for the reader to wonder ‘where is ‘madness’ in all of this?’

CHAPTER TEN ‘Soul is crying’, the final chapter, is written by Michael Eigen, who is a psychologist and psychoanalyst. It includes three dialogues of Eigen as a therapist, with three persons familiar with psychosis first-hand: Alma, Philip and Leda. The introduction is ultra-short, with just a few things on “the double rhythm of bad and good states”, referring to Bion and Winnicott. It is nice to read the wise and beautiful insights offered by Alma, Philip and Leda, and Eigen himself. However, although I agree that “selections [the choice of these specific conversations] are partial and suggestive”, surely Eigen could have tried to say something about his choices? And add a little more analysis of the dialogues of his own?

Also, I wondered while reading: what exactly is emancipatory in Eigen’s approach, presented in this chapter? This remains a bit too implicit. When I think about it myself, I have learned that between two people there always is a certain space where certain things can (not) be (said). Perhaps this chapter is a taste of what encounters in clinical practice can be(come) possible when we enlarge the relational space; allowing for the good and the bad, to ebb and flow, instead of aiming to suppress or eradicate the ‘bad-mad’? Quoting Philip, who addresses Eigen:

“You talk about “making room.” I think something like that happened, is happening. More room for me, what’s in me, the wood critters, scary presences, wounds, voids.” (p. 171)

CONCLUSION To sum up my review, I think that this collection of emancipatory perspectives can be of interest to many who are somehow intrigued by madness, and are prepared to approach it with a curious and open mind. When engaging with the ideas and approaches in this volume, mental health workers such as clinicians, nurses and social workers may broaden their view far beyond the biomedical gaze, when they become aware of the positivist, individualizing and ahistorical tendencies in Western ‘psy’ Science. Perhaps not every chapter will be immediately useful to their daily practices  in a tangible manner, nonetheless I would highly recommend everyone to read this book. For those of us with direct experience of extreme states, of madness and psychosis, for us – as the “underground sensitive intelligentsia” (Ch. 10) – it offers air to breathe (Ch. 4), dignity and a sense of community, and all kinds of languages and ideas to refine our own critical reflections on the psychiatric system, and polish our own mad insights.

Alke Haarsma-Wisselink

Emancipatory Perspectives on Madness. Psychological, Social, and Spiritual Dimensions - Marie Brown and Robin S. Brown (eds.) Published December 29, 2020 by Routledge. 192 pages. Available here.