Thursday, 8 March 2012


I was eager to read this – what a subject! What a brief! How can anyone know what madness is, especially someone who is not an expert by experience? I have been mad and am no longer; who’s to say they could have looked into my psyche and read and understood what I was thinking or feeling or how I was interpreting the world?  For all the brain scans that are touted now as diagnostic tools, madness is elusive, particular , peculiar and totally individual – and anyone not mad will have to base their assumptions on anecdotal evidence…

To give Darien Leader a break, he is not a psychiatrist, which is a relief. To his disadvantage, he is a Lacanian psychoanalyst; thus the whole book is slathered with factor 50 Lacan which makes it very hard to scrape away to the bare flesh underneath.

The very great Gail Hornstein set out to understand the meaning of madness in Agnes’ Jacket, which is a must-read as a balance to this. She is a psychologist, thus has a much enhanced and less culty vantage point. Through wonderfully vivid tales, first –person interviews and a detective style, she gets there in the closest way possible without being mad herself.  I must admit to a suspicion of psychoanalysis,  though admire the movement for pushing the talking cure. Much of Freud’s fringier theories have been debunked and are seen as almost laughable, and his denouncement of his finding that abuse leads to mental distress still horrifies.  The five-times-a-week grip that analysis often holds over its clients is surely outdated, unproven and wrong as a successful technique. Feminists have deconstructed psychoanalysis and found it deeply wanting.

However, Leader has a refreshing take on mental ‘illness’  and does not believe that distress is an illness to be chemically treated.  He sees creativity in some aspects of psychosis, and reads into mental ‘illness’ an attempt to ‘respond to and elaborate..difficulties’. He also acknowledges the huge potential for recovery,  set against the depressing prevalence of the ‘science’ led clinicians’ doom and gloom scenarios as told to many patients today.

What he deals with mainly is what he calls the ‘discreet psychoses’ – subtle, reserved madness – those who are paranoid without developing breakdown or crisis,  He cites Bleuler’s theory that the most common form of schizophrenia was latent ‘subtle, reserved madness’ also called ‘everyday psychosis’.

He is refreshingly candid about the damage done by 20th century ‘treatments’ – from insulin coma to shock to knockout pharmaceuticals.He interrogates DSM and finds it severely wanting. He aims to understand delusions as a way of understanding one’s experiences. When Leader introduces basic psychoanalytic ideas – including mirrors, symbols,  reformed Oedipus complexes , paternal metaphors, the Other, localization of libido, phallic lenses etc I started to lose the will to continue the book, I’m afraid. I felt like a nonbeliever being bashed on the head by a fervent proselytiser. I ploughed on though and there was enough to engage with. 

He examines the meaningless and confusion of trying to diagnose ‘schizophrenia’. He seems more at ease describing paranoia and the paranoid delusion. He delves into language and psychosis, and the logic of it (the Other is always walking beside..). He visits diagnosis again, and foregrounds startling moments in the lives of those who developed unshakeable beliefs or delusional ideas,  such thinking random people were their real parents.

He is brave enough to tackle causes of psychosis – a field littered with IEDs. He acknowledges the vogue for genes and biological explanations that predominates now,  and successfully busts it theoretically. He dwells on the parents shaping a child’s early life and perhaps seeding later psychosis. Its all rather muddied with Lancanography, but there’s some sound stuff. Not enough about the effects of the overwhelming stress of early abuse, loss and trauma though. 
His filtered look at madness deals essentially with the ‘quiet psychoses’, the world he mainly comes across.  He does not deal much at all with the ‘louder’ psychoses – ‘schizophrenia’, bipolar disorder/manic depression or severe depression.  He revisits the Wolf Man story and rubs on the magic lamp of  Lacan way too often in mid book.

His chapter on Shipman is revealing and frightening, and highlights the equation of madness and normality. Shipman, later revealed to have murdered over 200 people, was sought out as a GP by many people. Leader is careful and considered and delves sagely into Shipman’s past to try and gain answers. 

‘The diagnosis here is not ‘ pure evil’ but paranoia; he occupied the place of an exception, and was committed to imposing his own knowledge on the world around him, which he deemed contained a fault’.

His final chapter Working with Psychosis could be used to inform and educate a lot of the medical-modellers in psychiatry – listen, take note, believe, hear properly, and trust. Celebrate psychosis’ creative side  - encourage and facilitate communication. ‘Create a safe space in which to live’.

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