Becki Smith 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 Three of a Book Forum on A Philosophy of Madness. The Forum consists of four reviews and a reflection from the author.
For Part One by Jeremy Spandler, click here.
For Part Two by Emma McCabe, click here.
For Part Four by Mohammed Abouelleil Rashed, click here.
For Part Five by Wouter Kusters, click here.
Madness, Neurodiversity, and “Normal”
“Madness is kept out of bounds as a nadir of meaninglessness, a breeding ground for unreal apparitions, chimeras, and sham. It is usually ascribed to the mentally defective, to the neurologically impaired, and to those believed to be suffering from a brain disease. In this state, on the other side of an abstract barrier – which sometimes turns into a very concrete barrier – between the normal and the deviant, the healthy and the ill, madness is neutralized, anesthetised, and ultimately “fragmented” or “annihilated”. That is exactly what this book is about: the loss of the richness of the world of madness.” (Kusters, p.2)
There’s no doubt that A Philosophy of Madness is a groundbreaking, elucidatory work. Wouter Kusters explains that which is usually dismissed as inexplicable: what it is like to go mad. Psychotic thinking, schizophrenia and related “personality disorders” have long been misunderstood in popular culture; the words themselves are used as ableist insults to describe individuals whose behaviour is disruptive, unpredictable or antisocial. From the start of his book, Kusters makes it clear that he prefers to discuss “madness”, rather than subscribe to the more clinical terminology used by psychiatrists:
“My reason for using the terms ‘madness’ and ‘psychosis’ is precisely to circumvent medical-psychiatric classifications and, in doing so, to clear the way for the admission of madness to a domain of philosophy, culture, and spirituality” (p.4).
To illuminate the experience of madness, Kusters draws parallels between madness, mysticism and philosophy. This fascinating exploration gives the reader multiple entry points into the world of mystical/mad experience: those who have experienced direct religious encounters, studied philosophy, or experimented with psychedelic drugs will recognise familiar elements which will draw them into Kusters’ descriptions. While this philosophical exploration of the experience of being psychotic is a fascinating journey in and of itself, this reviewer was struck by the similarities between Kusters’ descriptions and those of another demographic which may recognise themselves in Kusters’ work: individuals who are neurodivergent. Indeed, some even argue that psychosis and schizophrenia are part of a spectrum which includes autism and ADHD.
The concept of neurodiversity, introduced in 1998 by sociologist Judy Singer, describes variations in human brain structure in a non-pathological way thereby challenging the current status quo which classifies conditions such as autism, ADHD, dyspraxia, dyslexia, psychosis and so on as “disorders” in the DSM-5. However, many neurodivergent individuals are rejecting the idea that the differences in their brain structure compared to one that is neurotypical constitute a deficit. Demedicalising these conditions allows people to take ownership of their own neurology; many describe discovering the neurodivergence community as a great relief, as they realised for the first time that their brains are not broken or dangerous, merely structurally different. As Kusters explains in his introduction, “Even if a connection were found between madness and the brain, we still would not understand what madness actually is … we are living at a time when everything dear to us – mind, experience, and culture – is being reduced to distantial data – that is, matter, behaviour, and biology – as if we have become alienated from our selves” (p.6).
Anti-psychiatrist thinkers in the 1960s highlighted that when behaviour is designated as disease or disorder, individuals’ rights and liberties can be overridden in the name of acting in their own interests. The fact that this can be presented as an objective, scientific endeavour means it is easily open to abuse, and powerful groups can define any socially repudiated behaviour as ‘mental illness’ in order to eradicate or control it. Generally agreed examples of this include the designation of male homosexuality as a mental disorder up until the 1970s, and the application of a ‘diagnosis’ of drapetomania to enslaved Africans in the Americas intent on escaping their enslavement. Today, critical psychiatrists continue this tradition of holding psychiatry to account by exploring the impact of white supremacy, neo-colonialism and patriarchy on patterns of diagnosis, treatment and incarceration.
This, then, is the clinical context in which neurodivergent people are operating. Today, some parents send their autistic children to intensive behavioural training programs (Applied Behavioural Analysis) in an attempt to make them act more “normal”. Autistic adults who have been subjected to this training describe it as abusive, ineffective, and akin to gay conversion therapy. We can assume that Kusters’ opinion of the psychiatric institution is similar: throughout the book he describes being locked up (“this is the last location, endless solitary confinement” p.32); compares clinical staff to Nazis (in the Overturen, written while Kusters was in a state of psychosis, he says, “so they’ve delivered me to the fascists…I have to become a German and order them to turn this man into the Jew” pp.30-31); and explores how those who are deemed to have “recovered” from their psychosis are pressured to disavow any identification with the extraordinary experiences they underwent.
Individuals depend on online neurodivergent communities for peer support, coping strategies both humorous (for example, the “Neurotypicality Research Inc.”) and serious, understanding and solidarity. Changing the narrative to discuss these conditions based on how they’re experienced from the inside, as opposed to descriptions of observed external behaviours, shifts the conversation from the clinical to the everyday. This has fostered fascinating discussions on sites like Twitter, between individuals comparing their lived experiences of neurodiversity.
What is interesting, having spent time in these online communities, is the similarities between Kusters’ description of madness and reported neurodivergent experiences of daily life. For example, time plays a key role in madness: “Another indicator of a psychosis…is disorientation in time…What kind of world is it in which someone doesn’t understand time?” (p.87). This is presumably intended as a rhetorical device to illustrate the perceived absurdity of the mad experience; however, time agnosia, also (problematically) known as time blindness – detachment from human time, in Kusters’ terminology – is a key trait of ADHD.
Both madpersons and neurodivergents, to different extents, experience time as subjective, changeable and relative. Interestingly, Kusters says of normal functioning within human time: “we trust in a knowledge that is half-conscious and half-automatic, and as a result we can manage quite well in life” (p.95). There are many neurodivergent people who seem to function without some or all of this automatic knowledge. Kusters uses the metaphor of “the four types of ‘oars’ we use to row through our daily life (reality, the inner/outer world, time, and space)” and what happens to them when we “enter the ocean of madness” (p.35). Perhaps neurodivergent people are rowing with faulty oars, or spending their daily lives in deeper and more turbulent water than a “normal” person.
Kusters also describes how the experience of space changes under conditions of madness – and again, there are parallels between the mad experience and the daily existence of neurodivergent individuals. For example, dyspraxic people have trouble with proprioception – the ability to locate objects and one’s own body in physical space, which leads to frequent accidents and injuries. And the question of how that impairment functions can potentially be understood, at least on a philosophical level, by Kusters’ explanations:
“Besides being understood as features of the objective world, the three dimensions can also be regarded as constructions imposed by the subject. In that case, they seem more like the instrument or theory by which space, which in and of itself is without dimensions, can be organized and described. In the subjective view, dimensions are not things that are measured; rather, they are the yardstick that does the measuring” (p.124).
The separation between external and internal is another boundary that blurs in madness:
“In no other illness is the outer environment, the situation (that is, from the lighting and furnishing of the room to the gestures, the voices, the behaviour and the words of the people) of such decisive significance as that of the psychotic. Anyone who is mentally healthy is incomparably more robust and less sensitive to the effects of his [sic] surroundings than the psychiatric patient” (Conrad, 1958, 82ff; Kusters p.129).
Again, while the experience of a period of psychosis is presumably more intense and overwhelming, many neurodivergent people with sensory sensitivities, visual and auditory processing issues and so on will recognise that their experiences deviate from the “norm” in similar ways to those of the psychotic, particularly in cases where neurodivergent people experience sensory meltdowns (a fight, flight or freeze response in reaction to sensory overload, which may take the form of crying, screaming, physically lashing out, or shutting down and refusing to speak or move).
These shared experiences of abnormalities in perception of time, space, and sensory input are a core component of the online neurodivergent movement. Anecdotally, a rise has been noted in people self-diagnosing or suspecting ADHD, autism and OCD during the past year of lockdowns. This can be partially attributed to routines and coping mechanisms breaking down and people learning, sometimes for the first time, how they function without structure. But there is also a strong element of democratising access to the understanding of these conditions, taking the authority back from the institution of psychiatry. Indeed, focusing on the experience of neurodivergence or madness, and coming to an internal understanding of one’s own psyche, may well be more constructive than seeking a professional diagnosis based on outward symptoms during a period of crisis.
Neurodivergent people generally experience most of their symptoms/traits all the time, whereas Kusters describes his periods of madness as discrete experiences bookended by some form of “normal” life. It is hard to know, however, where the boundaries should fall between neurodivergence and madness, just as Kusters struggles to draw a clear distinction between madness and mysticism: “Because both domains are so unknown and indefinable, I am not going to start out by formulating hard and fast hypotheses with regard to their similarities, differences, or causal connections … I will extend the parallel between mysticism and madness as far as it will go, hoping such an effort will cast a new light on madness, mysticism, and philosophy in general”(p.163).
Mental illnesses or disorders are prime sites for structural racism, ableism, misogyny and fatphobia to manifest. The privilege displayed in Kusters’ ability to go mad, “come back again”, and then secure a publishing deal for this work speaks volumes. A vast majority of the sources quoted and discussed in A Philosophy of Madness are privileged white men; the rare quotes from female sources tend to be collected in a published work by some male psychiatrist or other; and it was not clear whether any non-white accounts of psychosis were considered at all. For all the explorations of psychedelic drug use and accounts of religious experiences, Kusters doesn’t once mention the postpartum psychosis, which affects around 1 in every 500 new mothers.
Similarly, there are racial disparities in autism research and a significant gender imbalance in early diagnosis and treatment. The neurodiversity movement is doing crucial work in expanding recognised symptoms and presentations of neurodivergence; especially highlighting the reasons for systemic underdiagnosis of autism and ADHD in girls. Black advocates particularly address how manifestations of these conditions are shaped by cultural background, and how children of colour are more likely to be labelled as disruptive or badly-behaved when exhibiting traits of neurodivergence. It is important for anyone working and thinking in these fields to maintain awareness of how structural inequalities affect our understanding of who is impaired, and what support they deserve.
That said, the work that is currently being undertaken in many quarters to shed light on these long-vilified conditions, including A Philosophy of Madness, is already having a huge impact. Although we may be a long way from understanding how the physical structure of the brain creates or enables madness and neurodiversity, by approaching these experiences from a position of compassionate humanity we have the chance to build solidarity and create better communities for atypical people. With the right accommodations and free from the discrimination and fear of others, neurodivergent people and those considered mad can live fulfilling, creative and promising lives.
“So the mad world is not so much a world full of binding meaning as it is one full of playful possibility” (p.75).
Becki Smith is a writer, communications consultant and artist from Cardiff. She has a degree in philosophy and politics, and is active in online communities relating to neurodiversity, disability and human rights. You can see more from Becki via Twitter or Instagram.