Hamish Hamilton, £20, 368pp. £18 from the Independent Bookshop: 08430 600 030

What is Madness?, By Darian Leader

Emile Kraepelin was a German contemporary of Freud's and, along with Freud himself, set the agenda for modern psychology: for everything we still think about today when it comes to the mind and the brain. Unlike Freud, Kraepelin was uninterested in individual patients and in flimsy material like dreams, conversation and sexuality. He wanted to name mental illnesses, gathering symptoms together in categories which made sense for other doctors. Most significantly, he saw psychosis as an illness of the brain rather than a creative correction made by the mind.

Click here to get money off this book from at Independent's bookshop

There isn't a family in the world without its own mad person. However, when we think of madness, we think of psychosis, and we think of its most florid manifestations: voices, delusions, paranoia, irrationality, people who want to be Napoleon, others who don't know which gender they are and those who are being addressed by, and often pursued by, the CIA. The mad are both over-certain and indecisive: they can be Stalin or Hamlet.

Great literature is bursting with the mad; all important writers have wanted to engage with extreme states of mind, and not infrequently have inhabited them themselves. A list of mad writers would be the history of literature. Literature brings madness within the ambit of ordinary life, whereas medicine has too often been phobic about it, and has not only attempted to exclude and isolate it, but "cure" it at any cost.

It hasn't been a good hundred years for the mad. Writers may have a wide range words to describe strange states of mind; they have the ability to make difficult but necessary distinctions, like that between depression, mourning and melancholia, for instance, or sadness, unhappiness, despair and desolation. But doctors have the hospitals, and they have the power. Psychiatrists, those Dr Frankensteins of the medical world, have too often locked away the mad, experimented on them, put them in comas, cut off parts of their brains, forced electricity through them, and fed them with drugs which have made them iller. I say "them" because the mad – so close to us, and indeed within our psyches, and representing our own darkness – have been segregated and often confined; for fear, perhaps, that they will contaminate the rest of us.

But as Darian Leader brilliantly shows, things are never so simple. Deciding who the mad actually are, and how mad they have to be to be considered mad, is quite a job. After a hundred years no one has come up with a diagnosis which most psychiatrists can agree on; they haven't even agreed on the right label for the illness. The same patient could easily be called hysterical, depressed, psychotic or manic, depending on which symptom they declare to which doctor in which country.

The fact that madness may remain unidentified as a somatic condition has led psychiatrists to attempt to locate a part of the brain where the madness can be found. If this part can be known, then the pharmaceutical companies could come up with a drug which treated it. Not only would the companies become richer, and the mad not only cured, but we could tell far in advance which people would be mad and which wouldn't.

Psychiatrists and brain scientists have hunted about for decades but have come up with nothing substantial when it comes to the source of illnesses like the psychoses, schizophrenia and bi-polar illness. The only result, unfortunately, has been that the public now speaks of "brain chemistry" and "genes" as if they refer to something real.

Psychology's Plato, Sigmund Freud, was a revolutionary and remains so – a danger to us all - insofar as he actually attended to his patients as individuals and saw their desire and its vicissitudes as being at the centre of their lives. As Leader states, "madness and normal life are compatible rather than opposed". It was listening to the mad, as Freud did, rather than looking at them, which was the turning-point in both psychoanalysis and psychiatry.

Leader says that "What matters is to unearth the logic in what psychotic subjects say about their experience." Although the mad are different to one another, and we are all mad in our own ways, the mad, in many ways, are the most rational of all. It may be painstaking, time-consuming and expensive work attending to the voices, delusions and paranoid constructions of the mad, but it is not impossible to unpick the threads which bind these subjects within themselves. As GK Chesterton writes, "the madman has lost everything except his reason."

Just as a cursory glance at the 20th century would inform us that attempting to separate the "healthy" from the "unhealthy" is always disastrous; so it is dangeous to separate the person from their symptom. For Leader, the creation of symptoms such as delusions are forms of self-creation and protection: the useful texts of the insane.

Removing a patient's symptom with undue haste could result in the triggering of a psychosis. Leader cites a case of Freud's, where he cures a woman of a long agoraphobia, only for her to succumb to psychosis. She then had to be hypnotised by a colleague, who reinstated the shield of her symptom.

There are dozens of talking therapies and more and more patients. Do they work? They do, if we put notions of "cure" to one side, and if we remember that it is always possible for people to become interested in themselves in new ways.

Leader reminds us that adults have been vulnerable children for a long time and therefore are difficult to change. They love their symptoms, usually more than they love their lives. People also love to suffer and to make others suffer; they also love to be punished.

As any poet would tell you, being human is very difficult, and most likely maddening; and there's no cure for that. It is also perfectly possible to be mad and to live a productive and useful life.

Hanif Kureishi's 'Collected Essays' and 'Collected Stories' are published by Faber & Faber

Arts and Entertainment
Stewart Lee (Gavin Evans)


Arts and Entertainment
No half measures: ‘The Secret Life of the Pub’

Grace Dent on TV The Secret Life of the Pub is sexist, ageist and a breath of fresh air

Arts and Entertainment
Art on their sleeves: before downloads and streaming, enthusiasts used to flick through racks of albums in their local record shops
musicFor Lois Pryce, working in a record shop was a dream job - until the bean counters ruined it
Arts and Entertainment
Serial suspect: the property heir charged with first-degree murder, Robert Durst
TV review
Arts and Entertainment
Igarashi in her

Art Megumi Igarashi criticises Japan's 'backwards' attitude to women's sexual expression

Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

Arts and Entertainment
It's all in the genes: John Simm working in tandem with David Threlfall in 'Code of a Killer'

TV review
Arts and Entertainment
Far Right and Proud: Reggies Yates' Extreme Russia

TV review
Arts and Entertainment
Kanye West was mobbed in Armenia after jumping into a lake

Arts and Entertainment
The show suffers from its own appeal, being so good as to create an appetite in its viewers that is difficult to sate in a ten episode series

Game of Thrones reviewFirst look at season five contains some spoilers
Arts and Entertainment
Judi Dench and Kevin Spacey on the Red Carpet for 2015's Olivier Awards

Ray Davies' Sunny Afternoon scoops the most awards

Arts and Entertainment
Proving his metal: Ross Poldark (played by Aidan Turner in the BBC series) epitomises the risk-taking spirit of 18th-century mine owners

Poldark review
Arts and Entertainment
Eddie Redmayne is reportedly favourite to play Newt Scamander in Fantastic Beasts and Where to Find Them

Arts and Entertainment
Tom Hardy stars in dystopian action thriller Mad Max: Fury Road

Arts and Entertainment
Josh, 22, made his first million from the game MinoMonsters

Grace Dent

Channel 4 show proves there's no app for happiness
Disgraced Top Gear presenter Jeremy Clarkson
Arts and Entertainment
Game face: Zoë Kravitz, Bruce Greenwood and Ethan Hawke in ‘Good Kill’

film review

Arts and Entertainment
Living like there’s no tomorrow: Jon Hamm as Don Draper in the final season of ‘Mad Men’

TV review

Arts and Entertainment
Yaphett Kotto with Julius W Harris and Jane Seymour in 1973 Bond movie Live and Let Die

Arts and Entertainment

Arts and Entertainment

  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    NHS struggling to monitor the safety and efficacy of its services outsourced to private providers

    Who's monitoring the outsourced NHS services?

    A report finds that private firms are not being properly assessed for their quality of care
    Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

    Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

    The Tory MP said he did not want to stand again unless his party's manifesto ruled out a third runway. But he's doing so. Watch this space
    How do Greek voters feel about Syriza's backtracking on its anti-austerity pledge?

    How do Greeks feel about Syriza?

    Five voters from different backgrounds tell us what they expect from Syriza's charismatic leader Alexis Tsipras
    From Iraq to Libya and Syria: The wars that come back to haunt us

    The wars that come back to haunt us

    David Cameron should not escape blame for his role in conflicts that are still raging, argues Patrick Cockburn
    Sam Baker and Lauren Laverne: Too busy to surf? Head to The Pool

    Too busy to surf? Head to The Pool

    A new website is trying to declutter the internet to help busy women. Holly Williams meets the founders
    Heston Blumenthal to cook up a spice odyssey for British astronaut manning the International Space Station

    UK's Major Tum to blast off on a spice odyssey

    Nothing but the best for British astronaut as chef Heston Blumenthal cooks up his rations
    John Harrison's 'longitude' clock sets new record - 300 years on

    ‘Longitude’ clock sets new record - 300 years on

    Greenwich horologists celebrate as it keeps to within a second of real time over a 100-day test
    Fears in the US of being outgunned in the vital propaganda wars by Russia, China - and even Isis - have prompted a rethink on overseas broadcasters

    Let the propaganda wars begin - again

    'Accurate, objective, comprehensive': that was Voice of America's creed, but now its masters want it to promote US policy, reports Rupert Cornwell
    Why Japan's incredible long-distance runners will never win the London Marathon

    Japan's incredible long-distance runners

    Every year, Japanese long-distance runners post some of the world's fastest times – yet, come next weekend, not a single elite competitor from the country will be at the London Marathon
    Why does Tom Drury remain the greatest writer you've never heard of?

    Tom Drury: The quiet American

    His debut was considered one of the finest novels of the past 50 years, and he is every bit the equal of his contemporaries, Jonathan Franzen, Dave Eggers and David Foster Wallace
    You should judge a person by how they peel a potato

    You should judge a person by how they peel a potato

    Dave Hax's domestic tips are reminiscent of George Orwell's tea routine. The world might need revolution, but we like to sweat the small stuff, says DJ Taylor
    Beige is back: The drab car colours of the 1970s are proving popular again

    Beige to the future

    Flares and flounce are back on catwalks but a revival in ’70s car paintjobs was a stack-heeled step too far – until now
    Bill Granger recipes: Our chef's dishes highlight the delicate essence of fresh cheeses

    Bill Granger cooks with fresh cheeses

    More delicate on the palate, milder, fresh cheeses can also be kinder to the waistline
    Aston Villa vs Liverpool: 'This FA Cup run has been wonderful,' says veteran Shay Given

    Shay Given: 'This FA Cup run has been wonderful'

    The Villa keeper has been overlooked for a long time and has unhappy memories of the national stadium – but he is savouring his chance to play at Wembley
    Timeless drama of Championship race in league of its own - Michael Calvin

    Michael Calvin's Last Word

    Timeless drama of Championship race in league of its own