This is an attempt to give some practical advice on a problem most people don’t have much experience of but is becoming increasingly common amongst those on the margins of society. Most people realise that carting someone off to the thought police in the loony bin is, if anything, worse than handing them over to the real police – but it’s very difficult to think of an alternative when faced with an extremely exhausting and terrifying situation.
What is madness? Well, we’re all, and that certainly includes me, pretty fucked up, and we live in a society where there is a great deal of oppression – that is we don’t have real control over our lives a lot of the time. We have to conform to what those at the top of the hierarchy think we should do, whether at work or in other relationships. That is what is known as alienation. However, people aren’t really free to talk about this as it affects them directly in their actual relationships at work and elsewhere. Imagine trying to talk openly about who makes decisions at work – you would be got rid of first.
No, a lot of people’s feelings about their lives are kept suppressed, and only come out in madness, in strikes, or riots. What represses this, the language of those on top, is ideology; in other words, lies which serve to disguise reality. People who try to express themselves too openly about what they feel are likely to experience hostility and rejection and, if they [push it too far, actual violence. Anyway, the more people try to open up about their feelings, the more fear they cause in other people, and in themselves. That increasing fear, paranoia, sense of being a lonely spirit in a hostile world, leads to the extreme perceptions of reality and desperation known as madness.
The kind of threatening ideas that mad people have about the world are very rational, in fact often a much more rational assessment of their increasingly extreme position in the community than those which most of us consider normal. That does not mean that these ideas are necessarily correct, but the fact that they are a much deeper and frightening insight into life than we are used to is very threatening. As the ‘mad’ person, and those around him or her who are frightened of catching this madness grow more terrified, violence breaks out, with the mad person afraid of what the others will do to him or her, and seeing them in extreme terms. There is a lot of punching and kicking and smashing objects, and sometimes the thoughts of the mad person are so speeded up that their whole command of language and ability to form coherent sentences, or string sentences together, breaks down completely, which is terrifying for them.
Fear multiplies as people get less sleep, and it is at this stage that people, despite their moral scruples, feel they can’t cope and hand the person over to the authorities. So what can be done about this situation? The first thing that needs to be pointed out is that nothing should be done without consulting the mad person concerned, and they have total authority in every decision. That doesn’t prevent you pointing out the situation and making suggestions to which they can say no. This can be frustrating, but is very important to them in restoring to them the power of their personal autonomy, which has probably been threatened or invalidated in some way, making them go mad in the first place.
Firstly, the situation needs to be faced as a problem that needs organised action. The more people involved, the better. A small number of people is much more likely to suffer from fear or exhaustion, a large number of people, acting supportively as a community, has the resources to cope. If the person’s madness has arisen out of the relationships with the people he or she is living with, he or she may feel safer if he or she goes to stay in a safe house somewhere else, where they have the space to see who they want or be alone. Madness often due to a lack of safe space.
In the past I have organised a rota of people to be with the person at all times, but it occurs to me that I have never asked them if they wanted to see those people or be alone. In situations of emergency it is often very difficult to communicate with someone who is mad and you end up taking decision for them, which is bad but sometimes unavoidable. You should ask their permission first, though. Anyway, in this situation the people concerned need a lot of support themselves, both emotionally and physically, with good food and money. It’s important to make sure that everyone eats well.
In dealing with the person it is very important to constantly reassure them that they are safe and that no-one is going to harm them, or do anything against their will. Madness is basically about fear, and when people realise they’re safe and cared about, they will quite quickly calm down again but this may take a month or more. Never use violence against someone who is obviously being violent because they’re terrified. You can restrain someone by holding them down until they calm down.
It’s very important to be honest with someone who is mad about what you think and feel, especially if you feel scared or threatened by them. Probably a lot of the reason they went mad was because people were emotionally dishonest to them. Ultimately, if people are given enough love and care, and someone to talk to, however frightening it all is, it will eventually come right. It is also a good idea to go off to the country as its much more peaceful and everybody can let go without fear of the police.
Ultimately, if you can’t cope or communicate with them, you can at least take care of them physically, by feeding them for a couple of weeks, and put them in a bare, soft room. Try smiling. It works wonders. So does giving someone a cuddle. Even if you don’t understand at all where a person is at, if you just patiently sit with them over a period of time and listen, you will eventually piece together some kind of meaning. But its takes patience and experience to know how to cope with these ideas and talk someone through/ But you only learn by trying – it’s just life experience, there’s no special theory to learn.
The kind of reality that someone is in when they’ve gone mad is very distant from that of normality but it is rational and what you have to do is try to understand that rationality in its own terms and try to build a bridge between it and your own. It’s important to raise that a mad person’s way of perceiving and describing the world is just as valid as your own, but the way they have used language to describe reality has become more and more complex and metaphorical as they have felt what they are saying is invalidated by others. It’s important not to invalidate their reality in any way – that is liable to make them feel worse because they feel they can’t communicate with others – but to restore communication by more or less agreeing with what they are saying.
However, the problem is not that their version of reality is different from yours, the problem is that they are afraid that they will be harmed or rejected as a result of their unusual perceptions and you have to reassure them that you accept them. You have to expand their reality and your own and explore what people mean by statements like “I am God” and how they came to that conclusion. I mean there’s no problem in someone being God if they’re happy with it and it doesn’t hurt anyone else – however, in fact it’s probably going to be expressive of a lot of unhappiness that they want to share with someone else. You have to go mad with them for a bit to help them make sense of their lives and come back down to earth. It will be a very different earth though for both of you.
If someone has been carted off to the mental hospital, the more people who go to visit them the better, especially because the authorities are much more prepared to let someone go if they know there are people who will take care of the person and who will cause them trouble I they don’t let them go. I know of a woman who was kidnapped (not against her will, against that of the authorities) by about 50 of her friends and who is now, 2 years later, completely OK – but obviously that needs good preparation. Don’t take any bullshit from psychiatrists or nurses although play them along if you think they might let the person go. Get the person to sign forms saying that they don’t want Electro Convulsive Therapy (ECT) and heavy tranquilisers, and make sure the psychiatrist gets copies and knows you will take them to court if they force them on your friend., let alone any other harm that might come to them.
If someone is on tranquilisers, try to persuade them to come off, because otherwise they’ll just be a vegetable for the rest of their life, but warn them that they will probably go mad again sooner or later because they haven’t sorted out the original problem. They’ll be very scared and disorientated for a few days when they’re coming off.
So that’s it. Madness is basically about terror, the terror of not being accepted or exposed to violence because your ideas are different and other people find them emotionally difficult. It is the terror of doing non-alienated ‘philosophy’, philosophy in direct relation to reality, instead of what passes as philosophy in our universities. What’s why to academic philosophers, with the exception of Foucault, madness is a taboo subject. The best therapy on this ‘North Face of the Truth’ is the love and care of one’s friends – though usually when people go mad it’s because people are being false to them in some way and are trying to deny it by calling them mentally ill. The best way to help someone who has gone mad is to face your own terror and be honest about your feelings.
Worth reading is ‘I didn’t need to go mad here’ by Joseph Berke (very practical), ‘The Four Gated City’ and ‘Briefing for a descent into Hell’, both by Doris Lessing (two novels on madness) and ‘The Politics of Experience’ by R.D. Laing).
It is very kind of Asylum to reprint this old article of mine. It was a distillation of various episodes in my life when I’ve interacted with people up against it in a lonely struggle for truth. It’s interesting to compare this with something which is big on the scene these days: Open Dialogue – which might sound like much the same thing. But I dislike very much the professionalisation involved with Open Dialogue: they are offering 3-year courses with certificates – aiming at professionalisation and costing a lot of money (it doesn’t say how much on their website). I have to say that having done this stuff for real – and screwed up and made mistakes, which is part of it – I am extremely sceptical about it. The thrust of my article is actually anti-professionalisation – that basically we were a bunch of squatters and mental health users without much of a clue. I’m sure some of what is taught on an Open Dialogue course is valuable, but I’m not sure that the people who devised it know any more about mental health than you or me – but actually the message is that anyone can do this stuff. I wonder how open to the politics of madness these professionals are.
Note: This article was first published anonymously in Asylum 2.3 (1987). It has been lightly edited and cut down to fit our current submission policy.
Donnard White 2019
See here for details of Helen Spandler’s rediscovery of this article.
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