We like to draw a firm line between the people we casually call ‘mad’ and the rest of us. The mad ones make no sense; they have gone into another world; they are – in a way that almost comforts us – no longer quite human.
Yet what the last hundred years of psychotherapy have taught us is that the so-called mad are in fact much closer to the apparently balanced majority than is typically countenanced – and that if we look with sufficient rigour at the unusual and counter-productive behaviour the mentally unwell exhibit, we almost always find a logic within it that can be decoded, listened to and in many cases dealt with. We might say: mad behaviour contains a complex, frightening and baroque flight from an unmanageable.
Let’s look at some typical presenting problems of people diagnosed with mental illness:
1. Someone who says that they control the entire world and that they are at all times secretly influencing everything that happens in major events in public life.
One way to understand this kind of grandiosity is to see it as what is called ‘a manic defence’ – that is, a defence against its very opposite. Someone who has been made to feel utterly invisible, who has been controlled from a young age and stripped of a sense of agency and dignity, may in time flip psychotically into an opposite conviction – as a way to avoid a reckoning with a suffering that cannot be assimilated. This is a common feature of many mental illnesses: they stem from a failure to mourn something overwhelming, as here the idea that one has apparently never mattered to a soul.
2. Someone develops a refusal to go outside because they think that at any moment, a stranger in a park or in a shop might turn around and try to kill them.
Like many varieties of unwellness, this one reverses and then generalises its underlying truth. We start to think that ‘everyone’ is trying to kill us when, in fact, there may be one person we are boundlessly angry with, but can’t bear to acknowledge our rage against – perhaps because they are our own mother or father and maybe because they did something no parent is ever meant to do to a defenceless child. Unconscionable events are to be found behind almost every case of so-called ‘madness’.
3. Someone who develops a phobia against all sharp objects and spends hours removing from their house anything that might pierce through skin: knives, but also forks, spatulas, tweezers and so on.
A talented mental health professional will here immediately wonder: Who is this person furious with and why? They will try to move them from trying to prevent a murder to wondering who they might be very angry with. The more we can bear to think, the less we will need to colour the world with the legacies of our unconscious losses.
4. Someone who shows up in hospital in an excited state with a 300,000 word book spelling out in enormous detail how everyone on earth is actually an alien sent by a foreign power inhabiting a gigantic spaceship making its way around another galaxy.
Sometimes ‘madness’, behind the outward drama and mystification, really contains a basic metaphor that speaks of a simple, poignant truth. Perhaps, in this case, everyone feels horrifically ‘like an alien’ – and it might be far easier to think that that this is what they actually are, with their brains connected up to an invisible foreign satellite, than to absorb a more awful humdrum reality: that other people are quite human but that they have nevertheless, tragically, ignored our own humanity for as long as we’ve been on the earth.
5. A conviction that we might have touched a child sexually – and a horror of ever seeing a small child in case we suddenly do something untoward with them. An accompanying fear that the police is likely to knock at the door at any moment and accuse us of a crime.
Once again, this phobia contains an inversion of the likely truth. The sufferer takes on board extreme degrees of guilt and responsibility because – though it isn’t easy to make a detour around every park or playground and to panic at the sound of every police siren – it is still easier to do this than to square up to the horror that may have befallen us at a helpless age: we prefer to inhabit the role of the perpetrator than to face up to a catastrophic instance of our violation.
As for the thoughts of the police, these constitute a paranoid defence against something yet worse: being totally alone. After all, the upside of the police is that they are always thinking about us; they are about to show up to see us at any moment, even in the middle of the night, when it’s otherwise deadly quiet and eerie. Someone is thinking about who we are and the details of what we have done at 3am. Terror can be the closest thing we know to a feeling of being held in mind.
6. A constant need to clean ourselves of the germs and pollutants that lie all around. We’re in the bath at least five times a day. We disinfect anything we touch.
Once more, we’re dealing with a pain that has jumped from reality to metaphor. Someone somewhere along the way has made us feel unclean and ‘bad’ and we are manically trying to rid ourselves of a sense of unwantedness that we are unable to master in any more cognitive way. We’re craving acceptance – but have the strength to think only of ever more harmful and devastating germs that might be pursuing us.
Almost every incident of ‘madness’ involves truths that the sufferer doesn’t have the resources to handle, normally because they were never shown a bare minimum of patience and concern in their early days – and now can’t reflect steadily on their pains and losses. Almost every case of madness contains within it instances of cruelty that could not be borne in ordinary, everyday ways, that could not be thought about and shared (because no one was around, because the adults were out of control) and that a sufferer therefore had to erect a superstructure of folly in order to cope with. There have had to be aliens and satellites and prescribed rituals and obsessions because one can’t find any other way to come to terms with the simpler but more devastating underlying truths: ‘no one loved me’, ‘someone who should have cared didn’t’ or ‘I could die and no one would notice.’
We start to take on board a lacerating but in the end almost hopeful idea: that it is nothing more nor less than a lack of love that – ultimately – drives us mad. And its opposite could save us.
