What Is Madness?

What is Madness? begins beautifully, echoing R.D. Laing's 1960 manifesto The Divided Self, with references to European (and especially French) thinkers that few of its readers may be familiar with, disparaging references to Emil Kraepelin, catatonia and dementia praecox, and a central claim that the apparently normal may be madder than the apparently mad. Browsing four or five pages anywhere in this book would fascinate almost everyone; tackling 10 to 15 pages would begin to lose some of us; having to read all 300-plus would lose most of us.

The message is summarised at the end, where Darian Leader suggests that a crucial line has been crossed when biologically oriented researchers ask for brain scans to validate the internal life of the patient - "the illusion of objective external assessment has taken the place of sensitivity to human speech". Instead, he suggests "an investment in dialogue and a curiosity about the logic of a (psychotic) person's world...can offer a possibility of change" and can "help the psychotic person do what they have been trying to do all their lives, create a safe space in which to live".

This sounds wonderful, but part of the problem is that many of the analysts that Leader refers to have done a great deal to undermine our ability to be sensitive to human speech. Freud, after all, quickly came to deny that the abuse patients told him about had actually happened, transmuting their accounts into Oedipal myths. It was this in part that led to the crisis that gave rise to the brain scanning and drug treatments that Leader now decries, and helped create the ghetto of biological psychiatry with its bio-babble, and the dynamic therapies ghetto with its psychobabble, with no one able to speak across the divide.

When an analyst writes as well as Leader, there is hope. He picks a compelling vehicle - the madness that often lies beneath the apparent normality of everyday life. This madness is not a matter of trivial eccentricity; he tackles frank psychosis. His descriptions of individual madness are eloquent; but then so too were the descriptions of sin in the Malleus Maleficarum, the 15th-century treatise on witches. The problem here is that when we are asked to take on trust a model developed by analysts such as Jacques Lacan as to how these psychoses arise, the same difficulties arise as would for anyone attempting to use the Malleus Maleficarum - both require commitment to a belief system.

We have now reached a circle in Hell where terrible things happen during the course of physical treatments but doctors and patients cannot believe the evidence before them - a world where we really do need to restore sensitivity to human speech. This is a world where controlled trials, rather than Freud, have undercut our abilities to believe patients to the extent that people injured by treatment are routinely told that the treatment has not caused their injuries even when company documents record the treatment as the cause of the problem.

We have close to a mass psychosis when articles in the British Medical Journal, seen by tens of thousands of readers, that show an increased risk of suicide on Prozac are used to justify claims that Prozac poses no risk of suicide. A world in which doctors could do with a training in defence mechanisms in order to recognise when they trap patients suffering from treatment into medical versions of Stockholm syndrome, or to recognise the delegated narcissism that leads them and others to turn bureaucrats in the regulatory apparatus into parental figures. The times call for a Divided Self. What Is Madness? is probably not that book.