Jeremy Spandler reviews A Philosophy of Madness: The Experience of Psychotic Thinking (The MIT Press, 2020) by Wouter Kusters (translated by Nancy Forest-Flier).
This is Part One of a Book Forum on A Philosophy of Madness. The Forum consists of four reviews and a reflection from the author.
For Part Two by Emma McCabe, click here.
For Part Three by Becki Smith, click here.
For Part Four by Mohammed Abouelleil Rashed, click here.
For Part Five by Wouter Kusters, click here.
This fascinating, rich, well-written and, by implication, well-translated book was first published in Dutch in 2014 and received the Dutch Socrates Award in 2015 for the best philosophy book published in that language. Kusters is a philosopher and linguist. He also had two psychotic episodes in 1987 and 2007. The book is informed by these experiences (and couldn’t have been written without them), but it is not, primarily, a first-person account of psychosis. It is a philosophical examination of the experience of being psychotic, but it also explains how philosophy tends to stray so far from the everyday world that madness results.
Who will find this book valuable? In the preface to the English edition, Kusters explains that he has received responses from mainly three types of reader. Firstly, mental health professionals asked him to give presentations on what the experience of psychosis is like. Secondly, people who have been labelled with a psychiatric diagnosis who expressed how the book allowed them to explore their own ‘mad journey’. Thirdly, readers interested in the book’s perspective on philosophy. I contend that this book would be of great interest to these three types of reader.
Kusters argues that philosophy and madness have everything to do with each other. However, this association has been lost because madness has been turned into a medical or neurobiological problem. He points out how the claim that psychosis is, for example, a dopamine-level disruption says nothing about how the mad world is actually experienced. Even if a connection were found between madness and the brain, we would not know what madness actually is. Kusters concludes that most modern psychiatric literature is irrelevant to understanding madness.
Psychopathology assumes that madness strikes ‘locally’ – affecting either the emotions, mood, cognition or perception – and the effects proliferate from there. A key thesis of the book is that madness isn’t something local in this sense, but instead overturns the domain in which all these localities are grounded. In other words, it affects the whole person all at once. This means that psychopathological distinctions – between schizophrenia and mania for example – become less relevant and we can legitimately talk in more general terms about madness and psychosis.
The book focuses on the first-person experience of madness and is driven by a phenomenological approach, but seeks to take traditional phenomenological psychiatry beyond the safe shores of impassive observation. It also uses psychoanalytical approaches and what Kusters calls ‘spiritual psychiatry’ (e.g. Edward Podvoll). However, he claims that all these approaches are reluctant to move beyond speaking about madness from a position of safe banalities. He claims that plunging into the ocean of madness requires a language and a way of thinking that is not just about madness, but also flows into madness: philosophy.
Philosophy is used in the book to explain madness, but madness is also used to get to the bottom of philosophy. He goes as far as to say that, “the philosopher’s theoretical reflections have their counterpart in the practical breakdown of the madman [sic]: madness is philosophy lived out in practice” [page 15]. Kusters uses the ideas of philosophers like Husserl, Plotinus and Taylor to analyse madness, but he uses the same philosophers to provide examples of mad thought. The book is very far from dry analytical philosophy.
The book is divided into four parts. Part I provides a phenomenological analysis of madness and discusses a range of mad experiences, including Kusters’ own. He reflects on four themes: collapse of reality, shifting of boundaries between the inner and outer worlds, altered perception of time, and the transformation of space.
Part II seeks to transport the reader down what Kusters calls a ‘stream’ of madness with the guidance of philosophical mystics and mystic philosophers in order to explain psychotic detachments from everyday life. He seeks to imitate or relive mad processes, rather than provide an overview or analysis – let alone a diagnosis.
Part III ventures further into the interface between mysticism and madness: the madperson is transformed into a philosopher and the philosopher into a madperson. Kusters says that, “here I will try to describe the goal of the mystical path: the ecstasy, along with the heights and depths of madness” [page 280].
The first three parts are used in part IV to re-interpret classical cases of paranoia, megalomania and delusions of reference. He seeks to demonstrate that they are manifestations of the human condition rather than examples of individual failure, illness or disorder. “Those who escape from the everyday world (part I) and then ascend into the Wahnstimmung of mysticism and enlightenment (parts II and III) will eventually crash in one of the many forms of fragmentation …” [page 463]. Kusters explains that these forms include philosophical perplexity, solipsism, chronic psychosis, religious mania and paranoia.
As a person who has experienced psychosis on a number of occasions, I agree with Kusters’ premise that psychosis is best understood philosophically. As Kusters emphasises, madness is part of the human condition, not an aberration. I will explain further below.
As I have outlined, Kusters explores the interface between mysticism and madness and employs insights derived from philosophical mystics and mystic philosophers. He finds particular value in the ancient Christian mystical tradition. What has this to say to someone like myself who is an atheist and a philosophical materialist? This depends on whether mysticism is compatible with these positions. For example, Kusters refers to mystical ecstasy. As far as this is simply a type of experience, then there is nothing incompatible between such an experience and atheism and philosophical materialism. I have had what I consider to be ecstatic experiences, both when I was psychotic and when I was not. Were they what Kusters would consider to be mystical experiences? He states: “Not that we know exactly what mysticism or mystical experiences are …” [page 163]. So I don’t know; they were what they were.
A philosophical materialist, like me, believes that mind and consciousness are results of material processes, without which they cannot exist. Therefore a religious, mystical or spiritual realm – if such a realm implies the existence something beyond the material – cannot exist. This is the reason why I’m an atheist; the existence of god or a divine being implies, as far as I understand these concepts, the existence of something that is outside the material world. A non-reductive philosophical materialist, also like me, rejects the belief that philosophical materialism implies that mind and consciousness can be understood in purely material terms. A psychiatrist who claims that psychosis being caused by a neurobiological imbalance in the brain is all you need to know in order to understand psychosis is demonstrating that they are a reductive philosophical materialist. This applies whether or not psychosis is actually caused by a neurobiological imbalance in the brain. This corresponds to Kusters’ central and vital point that even if a connection were found between madness and the brain, we would not know what madness actually is. I conclude, as Kusters does, that madness cannot be successfully turned into a medical or neurobiological problem.
So what type of philosophy do we need to understand madness? I think we need an existential philosophy of a non-religious kind. On the existential view, it not sufficient to know all the truths that the natural sciences could possibly tell us in order to understand the human condition. Human beings cannot be understood as beings with fixed properties – in Sartre’s classic formulation, ‘existence proceeds essence’. An existentialist believes that human beings by necessity wrestle with issues regarding living an authentic life and are (condemned to be) free to make decisions when there is often no rational reason to choose one option over another. Rationality, at least on the neo-Humean view I accept, is very little help in making decisions because it cannot tell us what is a valuable life for us (not what we do value, or why we value it, or whether we should value it). When we struggle with what existentialists like Kierkegaard, Camus and Sartre considered to be the absurdity of human life, this can send us mad. If this is partly or wholly what Kusters means by saying that madness can help us understand philosophy, then I concur. Madness is both a part of the human condition and can help us understand the human condition – and therefore philosophy. Just as existentialism believes that philosophy cannot be practiced in the disinterested manner of an objective science, an existential approach believes that madness cannot be comprehended in such a way. This approach does not require the belief in a mystical or spiritual realm and therefore the rejection of (non-reductive) philosophical materialism.
As I have stated above, Kusters believes that traditional phenomenological psychiatry needs to move beyond the safe shores of impassive observation and the approach I am recommending can do this. We need to understand the mad person’s world from their own perspective – Laing calls this an intersubjective approach (Laing 1969) – not from that of an external observer. As an example of this approach, Laing and Esterson provide eleven case studies which convincingly show that young women who have been diagnosed with schizophrenia have been put in impossible positions and driven mad by family dynamics and social praxis (Laing and Esterson 1964).
It might be thought that rejecting all forms of mysticism and spirituality which are incompatible with (non-reductive) philosophical materialism fatally damages what Kusters attempts to achieve in this book, but this is not necessarily so. Firstly, he deliberately does not define mysticism or spirituality, so I don’t know whether his understanding of mysticism and spirituality is incompatible or not. Secondly, if they are incompatible, I believe that most of the claims that make up his project can be translated into existential terms, although it is beyond the scope of this review to do so. I do not believe that anything essential would be lost, but is not up to me to determine what is essential to Kusters’ project.
Note: A different version of this review appeared in Asylum: The radical mental health magazine. Vol 28 No 1 (Spring 2021). https://asylummagazine.org/
Laing, R.D. and Aaron Esterson. 1964. Sanity, Madness and the Family. Routledge.
Laing, R.D. 1969. Self and Others (2nd Edition). Routledge.
Jeremy Spandler has a Ph.D. from the University of Bristol. He has had a number of psychotic episodes and has (a) been diagnosed with the mental illness of bipolar disorder/manic-depression and (b) finds it valuable to interpret himself as a manic-depressive. See his article in Asylum Vol 17 No 4 for an explanation of the difference between (a) and (b).