Philosophy & Madness: A Discussion with Wouter Kusters

Wouter Kusters

Wouter Kusters is a Dutch philosopher and linguist from the Netherlands. He is best known for his books, ‘Pure Madness, A Quest for the Psychotic Experience’ and ‘A Philosophy of Madness: The Experience of Psychotic Thinking.’ The latter was translated into English in 2020 and published by MIT press and forms the basis of this interview. Wouter underwent two experiences of what is commonly called ‘psychosis’, which he explores and explains through the lenses of philosophy, spirituality and mysticism. It is a long and sometimes challenging read, and more detailed than the usual MIA content. However, we wanted to give readers a flavour of this important book, which shows how both philosophy and madness can be understood as different ways of searching for the answers to, in Wouter Kusters’ words, “the most fundamental questions of existence.” 

— Interviewed by James Barnes.

JB: Hi Wouter. Thanks so much for agreeing to this discussion. The first thing to say is that I thought your book was deeply fascinating, and I think very important. The book, as I understand it, is the culmination of a very personal journey into the belly of ‘madness,’ in which you grapple with the most basic questions of existence, and also in some sense a description of that very journey. I wonder if you could begin by saying something about the journey that you went on and how it relates to the book? 

WK: Firstly, to be clear, my journey into and through the surreal landscapes of madness was not planned, it has never been part of a research project or a guided expedition, and I did not undertake it in the clothes and mindset of an observing psychologist or analysing psychiatrist. In fact, I never really wanted to go there, and did not know of the place beforehand. However, after having been there twice, it has continued to provide spiritual, intellectual and practical fascination.

When I was a student, I had other plans. After high school, I studied linguistics and hoped to explore and engage with the world and find satisfaction and meaning in it, by just, you know, the usual practices, pleasures and fantasies of a young student. Then, this path was suddenly interrupted by an acute psychotic episode, for which I ended up in the isolation cell and endured a two-month period of obligatory confinement in a psychiatric hospital. Of course, the why-question of this psychosis was asked then, and a mix of factors — like a troubling love relationship and too much experimenting with the strong (LSD) and light (THC) psychedelics available at that time — gave provisional answers that felt sufficient for that moment. Moreover, the tentacles of the medical mental health system in the Netherlands were not at that time so all pervasive as they are today, so that I could just pick up my study again, and apart from the weekly talking sessions with a psychotherapist, I was not haunted or bothered by the prognostic spells and risk calculations of a psychiatric regime that rules by DSM discourse and psychoactive drugs.  

After the publication of this book, I took part in numerous workshops, meetings and conferences around mental health and psychiatry in the Netherlands, and the question of “what is psychosis” kept my attention. So, I decided to shift my career, stopping my academic research in linguistics, and putting all my intellectual cards down on the study of philosophy, starting from scratch, studying all the classics and modern philosophy, always with this special focus in the back of my mind: ‘What does the view of this or that philosopher on reality, on the mind, on the world imply for psychotic reality, the psychotic mind and the psychotic world?’ I was a quite fanatic student of all kinds of literature encircling such issues, but then, unexpectedly, in the hot summer of 2007, just after having submitted my bachelor thesis, ‘The experience of time during psychosis’, I became psychotic again, again ending up in the isolation cell, with two months of subsequent confinement on the psychiatric ward.  

It was as if all my knowledge about, and philosophical encircling around, the heart of madness suddenly broke a limit, gravitated to a central core, and then exploded into freeing fragments radiating outwards towards an infinity of madness, which was both abysmal as well as ecstatic at the same time. One of the odd things that happened that summer of 2007 was that the nurses and the psychiatrist already knew me from my books. I was a so-called ‘expert-by-experience,’ living it out once again. One of the psychiatrists had even written a review of Pure Madness around that time, and some of the nurses brought copies for me to sign. For me, that was beyond strange. I knew exactly what psychosis was — I was right in the middle of it — and yet I couldn’t pull myself out. The psychosis presented itself to me as an inescapable truth and reality.   

Before the reader stops here assuming that I am going to ‘romanticise’ the madness of this period, I will say that apart from all intellectual learnings, spiritual insights, and philosophical reveries of that time, I was also deeply desperate and in the grip of a horror and nothingness that could not be filled with anything real and substantial — if there was anything. In the aftermath, I suffered a so-called ‘post-psychotic depression’ that I would not recommend anyone. Nevertheless, I value and appreciate what I saw, where I was, and ‘when’ I was very much, but I would not recommend anyone who is consciously or unconsciously preparing to go on that trip, to do so in anything but a ‘viable, controlled’ manner (by, for example, reading my book or taking classes in philosophy or theology).   

After that second psychotic period, I felt all the more strengthened to continue my exploration into madness, more and more in the form of writing, first on the occasion of my academic study into philosophy and then after that four years working on Filosofie van de waanzin (A Philosophy of Madness) which was published in the Netherlands in 2014.  

JB: On the one hand you are a ‘philosopher of madness,’ on the other, you bring philosophy itself into the realm of madness. You enter into conversation with the western philosophical and psychiatric traditions, but you come from the position of someone who is within the lived reality of psychotic experience — from the inside-out, so to speak. You do the same with the ‘mystical tradition,’ which we might describe as the direct, experiential approach to the truths of existence. I wonder if you could say something about the multiple perspectives you take up in the book?

WK: Before, during and after writing, I had numerous discussions and conversations with friends, acquaintances and all kinds of experts, by study or by experience, in the fields of both madness and philosophy. To be sure, a considerable part of these ‘conversations’ were internal dialogues between me and various writers and thinkers from today and the past. These were the influences on me that I eventually embodied in the text as various voices or positions.   

The first general position I take in the text is that of a philosopher, one who examines the data of first-person accounts of psychosis, including my own memories of madness in the ‘data set.’ I describe concepts and experiences of reality, perception, thinking, space and time in ‘normal’ experience, and the differences with psychotic experience. This covers the first part of my book. In this first section of this, I argue that philosophy provides a better approach than many mainstream psychological and psychiatric accounts, and with fewer prejudices towards psychosis. I write this part in the context of the modest but important tradition in psychopathology called the ‘phenomenological approach’ — best exemplified by early German and French psychiatrists like Eugene Minkowski and Wolfgang Blankenburg, and revived in last couple of decades by the work of Louis Sass. Here the philosopher is attentive to what exactly is going on, what is being said, what shows itself, and tries to track this with an open mind, so to say, to find common patterns in the experience of psychosis and the world of madness.  

But then, after such a phenomenological analysis of psychosis, the analyst — whether it be the author or the reader, the psychiatrist or the philosopher — remains standing at the proverbial safe shore of normal, trustworthy language, discourse and thought about the psychotic other, while this other, the analysand, is the one diving, swimming and drowning in psychosis. How to induce the reader into that seemingly bizarre mad perspective, mad mind and mad world? There remains something elusive in all the detached explanations and representations of analytic, sober discourse of what it is like to be psychotic. The experience itself is so difficult to phrase and explain without losing some of its mysterious, uncanny quality. Psychosis is more than a kind of summation of delusions and hallucinations — as it is often depicted in psychiatric theory, even in its phenomenological strand.  

In the second and third part of my book I focus more on all kinds of feelings and thoughts of unity, infinity, revelation, and the deep reality shifts in the psychotic world. Therefore, in addition to a kind of philosophical argumentation, I use a lot of ‘data’, which is to say, stories and theories from mysticism and religious studies in those parts of the book. In fact, I take a position there between the mystic and the madman, and try to compare and contrast language, thought and imagination in madness and in mystic and spiritual spheres. My position as the author then slowly shifts from a neutral philosophical outsider to a mystic mad ‘insider’, that tries to explain madness by way of mysticism. In these parts the position of the all-knowing philosopher is slowly being undermined, and the position of the philosophical voice becomes infected with the virus, the fire and the enigma of madness, especially in its messianic form.   

In these latter parts of the book, another thesis comes to the foreground. After part two, I not only philosophise about madness, but show and argue that philosophy itself may lead towards a conceptual and real-life domain that we might call mad. The thesis here is that consequent philosophising may well lead to madness, and that the deep existential or spiritual crisis that the term madness covers, is, in turn, a source of a kind of proto-philosophy. For me, this entanglement of philosophy and madness is the most important thread in my book. Philosophy is not only an excellent means to study madness, but it is also in a sense a dangerous activity, which may itself lead to madness. This madness is the core concept and experience that philosophy is both attracted to and repulsed from. Plain examples of this are found both in the famous and the less well-known philosophers that had, on one or more occasions, periods in which they thought and experienced in ways that we today would call ‘mad’. To name just a few: Plotinus, Thomas Aquinas, David Hume, Samuel Kripke, Friedrich Nietzsche, Georg Cantor, Michel Foucault. For artists and poets, we already know of this connection, of course, which has been affirmed quantitatively in larger research. To make this connection, I often use the famous words of Nietzsche, ‘And when you stare for a long time into an abyss, the abyss stares back at you.’ 

JB: So, just to paraphrase for our readers, you start by analysing your/others’ experiences of madness from a sort of disengaged, conceptual standpoint, assessing them in light of phenomenological theory. You then open this up to the realm of ‘mystical thought,’ which is to say, experiences and ideas that go beyond conventional thinking and into spiritual and religious realms. The abstract conversation then begins to lose its importance, and you move into more direct expressions of the experiences involved, enticing the reader ‘share in’ as opposed to ‘think about’ them.  

WK: Yes. And as I was also saying, philosophising may well itself lead to madness, in its highbrow intellectual academic form, as well as in all other forms that are expressed in socially less acceptable and clumsy ways. I argue for this thesis, but I also show it in the text and try to provoke it in the reader. Thus, I have woven a kind of paradox into my book: philosophising about madness slowly converges towards madness, then falls itself into madness, which is again the content for the study of the philosopher. So, there is an ouroboros (the snake that eats its own tail, or perhaps vomits out its own tail?) motif in my book, which is akin to the motif of the Mobius ring. This motif runs through my whole book: if you carefully follow my text, step by step, there comes a moment when you may suddenly realise that you are no longer on the ‘outside’, on the side of common sense, shared conventions and meanings, but on the ‘inside’, on the side of the words that when taken by themselves, out of context, could be called mad.  

To sum up, these two positions — of a philosopher and of a madman — are the two main positions in the book. I use many quotes and ideas from a wide range of thinkers, but the two main perspectives are those. There is also, of course, an overarching position: the position of myself with respect to those seemingly separate positions. And let me say why I wrote this book, and for whom. The main reason was to tell the truth, in a broad sense of the word — and to be sure, ‘the Nietzschean abyss’ is also the place where any truth evaporates — so that was a hell of a job, and took nearly 800 pages. But I think there is so much bad information, plain ignorance and theoretical hollowness about what it is like to be psychotic, that I really needed all these words. With respect to the ‘for whom’ question, I had in mind a reader like myself, but many years younger. During all my writing I had my son and anyone else in mind who had not yet been there, but who was in whatever way whatsoever a potential voyager there, by way of so-called madness, or by way of philosophy. I wanted to show the next generations what the pleasure, problems and pitfalls of philosophy are: its truths, its paradoxes, and the possibility of its concomitant real-life psychotic experiences — metaphorical high mountains and deep abysses. 

JB: This term ‘the abyss’ is central to what you are saying, thinking, experiencing. Could you elaborate?  

Yes. This term/metaphor is a useful vehicle for exploring the cross-over terrain of madness and philosophy. The staring into the abyss is not just done by those who carry the title of philosopher; it is also done by many ‘psychotics’ (or ‘madmen’ as it has been translated in my book). From this abyss — which we could also call a rupture, or perhaps more generally, a crisis — all kinds of entities, ecstasies, anxieties and horrors arise, triggering all kinds of reactions. In the individualising cognitive sciences, there is an attempt to identify what arises from the abyss, and to what reactions these (identified, measurable) stimuli lead. And then, when knowledge about conjectured causality and correlation is supposedly gained, they pretend to develop interfering techniques to protect individual minds from the abyss in order that they/we can live on ‘firm ground,’ so to speak. Well, we all know what the practical strengths and limitations of such approaches are, but I am more interested in the abyss than in the construction labour of impenetrable fences — or, call them ‘anti-psychotics’ — that protect our visions from the void. The abyss is not a sphere from which we receive messages that can be defined, categorised, and processed, but a realm that asks us questions, that brings us out of order, that shocks our foundations — a domain against which we both fight and which constitutes our most inner self. The questions we receive from there are the focus of any philosopher who is, in earnest, a thinker. The philosopher searches these questions, and deals with them in numerous ways: by contemplating, thinking, reading, fantasising, etc., and, in practice, by immersion into any kind of ‘learning centre’, which of course does not have to bear the name of a philosophy department 

Now, an important difference for many ‘madmen’ is that they just find themselves in these abysses, without preparation, with no language or tools to navigate there, with no others, and without any sense of freedom within the fall. The seduction to reduce it to a psychological crisis, or even a neurobiological crisis is then overwhelming — and from a practical point of view it is quite prudent to do so. Nevertheless, many of the questions and problems that continue to haunt those deemed mad or psychotic have nothing to do with a personal or neurological problem, but all with the greater questions. Being in a condition of madness means you are trying to resolve the most fundamental questions of existence, but in an uncontrolled, wildly associative way. You want to know what it’s all about, what good and evil are, what is at the very heart of existence: you want to know the meaning of life and the cosmos.   

To be sure, I know, a criticism from mainstream psychiatry would run like: ‘Well, you as a philosopher perhaps experienced some philosophical themes in your privileged psychosis, but other psychotic persons are simply deeply psychologically and neurologically damaged, and we take care of the poor and the sick. While you are simply marketing your false idols of the tongue, we are focused on the place where everything happens: the reality of the brain.’ And in a way, they are not absolutely wrong, at the end of the day — the end of the day when we gather together around the fire, and the biological goods of warmth, food and company are distributed. But that issue then would turn into a political issue, which we won’t discuss here.  

Nevertheless, as one defence for my view, at the University of Ghent, Belgium we recently completed an empirical research study of persons with lived experience of psychosis, in which their wishes about receiving care were gathered by qualitative interview. We found, and I quote, “..our findings also highlighted the more existential value delusions contain for some individuals. The acquired detachment and distance from everyday experience were not always experienced as a deficit or affliction, but sometimes also as a transformative experience through which everyday conventions and concerns appear in a different, and often less “natural” or compelling light. In this sense, delusional experience opens towards more philosophical and existential quandaries that inquire into the status and justification of our everyday certainties and habitual forms of life. What seems to be required here are approaches that are able to acknowledge and discuss in an open and non-normative way the uncertainty and contingency that permeate our everyday practices which delusional experience most incisively brings to the fore.” And, I know, I quote from my own research, but there is plenty of research into that that also takes the political questions and implications into account, on the occasion of which, I just want to refer to the utmost important work of Nev Jones in this.  

JB: So, to paraphrase again, the ‘mad person’ is grappling with the very same profound questions as the philosopher, but is doing so in more chaotic, ‘uncontained’ and perhaps, as a result, confusing way. The content — i.e., preoccupations with philosophical, spiritual, religious matters common in those so diagnosed — is not a ‘symptom’ of a disease process but indicative of a radical immersion in these immense conundrums of existence. I also take you to be saying that the mad person may have gone a little too far into this and has entered a sort of philosophical freefall. The key difference between the mad person and the philosopher, then, is not one of biology or pathology, but of the context and container in which this exploration is taking place. Is that right? 

WK: Yes, that is absolutely right. But with this caveat: it could also be argued that both philosophy and madness are themselves symptoms of a disease process, the logical outcome of our endowment, since prehistory, with a consciousness that can reflect on its own emptiness. But the key difference between the mad person and philosopher still lies where you place it, yes.  

JB: Conventionally, psychiatry views madness as essentially involving some sort of erroneous or distorted perception/comprehension of ‘the objective world.’ You take the basic stance in your book that this view is deeply flawed, which is a view that I very much share. We are so accustomed to thinking about reality in terms of an objective, causally ordered world existing in an objective space and time (which we could call scientific realism/materialism) that questioning this often seems heretical. The fact of the matter is, though, that this basic model of reality is simply an idea, an idea which is quite convincingly challenged within philosophy, not to mention within physics. However, it is the model largely presumed by psychiatry and the cognitive sciences, from which it follows that if one has a very different experience of space, time and causality, as you find in psychotic experience, then there must be an error, distortion, misapprehension etc. (for which an ‘external’ cause must then be found). Drawing on figures such as Hume, Wittgenstein and Heidegger, you illustrate how our experience of the world — even on the basic level of space, time and causality — depends on, and in some sense is created by, implicit social rules and framings. From that standpoint, ‘common sense reality’ is effectively an intersubjective construction, more akin to a shared narrative than to something ‘out there.’ This becomes explicit, glaring even, in psychosis, which for you describes a ‘falling out’ of this intersubjective space, and in doing so, encountering a radically different configuration of space and time. There is, as you put it, an ‘ontological shift.’ Have I got this right?

WK: Yes, that is also absolutely right. And let me add this: both psychiatry and the cognitive sciences have as their focus point individual so-called delusions and hallucinations, which strips the individual from their embeddedness in social, cultural, spiritual and cosmic circles. What I propose instead is to take these contexts into account. In doing so, we can argue that psychosis is a breach of common sense, a detachment from silent conventions and hidden rules of practise, a shuffling and distortion of shared narratives. If we study psychosis, then, we should know about how common sense, conventions and narratives ordinarily operate, and only then can we get a sense of what it means to live in a place ‘outside humanity.’ However, the strategic problem, as we so often have to deal with the mainstream psychiatry view, is that we tend to battle it on their grounds. So, we also are inclined to take the brain/mind as a starting-point, but if we do, the burden of proof is then on us to add these contexts again that we should not have separated in the first place. That is an effect of the dominance of psychiatric discourse. Me, myself, I also took that route in my book. I started with perception, cognition, and only by working through this stuff did I reach the conclusion where I have this draw with, let’s say, all kinds of archetypes — like ‘the mystic’, ‘the rebel’, ‘the poet’, ‘the lost soul’, ‘the hero’, etc. — that I show are relevant for our thinking about psychosis. 

A funny effect of this is that my book has proven to be an eye-opener for many psychiatrists, with regards to the relation between spirituality and madness, for example. To them, I open up a wide view on the realms that madness belongs to, which often comes as a surprise, having been indoctrinated during their education by all these stories about the meaningless victims of brain disorders. But, then, those with a bit less ‘scientific training’, like many of these psychiatric nurses, and of course many patients and their relatives themselves, knew it all along! Of course, Jesus would be put in a mental hospital today; of course, madmen are engaged in real questions of life and death; of course, madness is an enigma that is used and elaborated in all kinds of movies and literature. Of course, there is more to madness than neurobiological disorders.   

But, let’s be careful, let’s not assume that there is some kind of folk-psychology that knows better and let’s also not make a stereotype of the psychiatrists, nor of their level of engagement into my or other alternative or critical theories. I know that the influence of my book has been strong, particularly on psychiatrists in the Netherlands and Belgium, and they all have intentions to improve and work in a world of care of and well-being for their patients. The problem is not the absence or presence of the good will of individual psychiatrists, but that there is a kind of official story — a legitimising narrative, a psychiatric discourse — that is embedded in the common perspective — the so-called modern, objective attitude — that plays a dominant, but certainly not unchallenged role. The broader historical forces and patterns in which this situation is embedded have to do with larger aspects of modern society. It has to do with modernisation, secularisation and disenchantment. These are all aspects everyone in our society has to deal with, and it is certainly not the case that we can reject these, or simply ‘abolish’ these. Let me just give one quote that I also discuss in my book by Charles Taylor (the renowned Canadian critical and catholic social philosopher) which throws quite another light on the usual narrative, according to which the early 19th century psychiatrist ‘liberated’ the madmen from their shackles, supposedly bringing them into the light of rational science. Taylor says:  

Casting off religion was meant to free us, give us the full dignity of agents; throwing off the tutelage of religion, hence of the church, hence of the clergy. But now we are forced to go to new experts, therapists, doctors, who exercise a kind of control that is appropriate over blind compulsive mechanisms; who may even be administering drugs to us. Out sick selves are even more being talked down to, just treated as things, than were the faithful of yore in churches.”  

JB: Yes, I very much take your point. It can be easy to locate all the blame in psychiatry or the mental health system at large, but the fact remains that the dominant models involved are embodiments of a worldview, which is itself doing a lot of the driving. But I think it would also be fair to say that these models do play a decisive role in the worldview’s incarnation, specifically in how we come to understand or construct ourselves as minded beings and what it means to deviate from such things. They are on the front line, so to speak.  
Moving on, you have defined madness as ‘the moment in a conversation that one of the interlocutors decides to halt the interaction, legitimizing this by adducing that communication would no longer be possible and motivating this by calling the other “psychotic,”’ which I thought was brilliantly astute. In light of the above, does it also make sense to think of such diagnostic interactions as rooted in a sort of ‘confusion of tongues’ between residents of different worlds? 

WK: I like your ‘confusion of tongues’ phrasing. Doctor language, with all its surrounding habits of the consulting room, the expert knowledge, the diagnosis, etc., defines the situation. The patient is brought before the doctor and forced into the patient role: show symptoms, or talk about symptoms, and search together for an underlying medical problem or disorder. Talking about “green ideas that sleep furiously”; switching to unknown languages; creating words to give meta-commentary on situations; or talking about the absurd, ecstatic or horrific features of the cosmos and beyond; all are waived away as inappropriate to the context, a context defined by the doctor’s consulting room.  

In addition, there is an extra-peculiar feature of the tongues of the madman. Just suppose that you have been in a psychotic war, a war that nobody knows about. You fought your battles, were wounded, partly healed, partly dragging your wound inside your inner scars — as we all do — and the war comes back again, forcing you to speak, think and experience as a warrior. And, just to open our associative memory, suppose that your enemy has something to do with that abyss we discussed before. Well, suppose then that of all your experiences in this war, only 1% can be captured in words, out of which only 1% you dare phrase in the interaction with the psychiatrist in the office. Well, what can we do? Inside wars, outside wars? Do we need the other 99% to fill the gap, to write on the walls? In reality what we need is peace and rest, not diagnoses nor being incentivised back into ‘normality.’ And what roles do languages play in such situations? Where does language end, and when does something speak for itself? What I have tried to do in my book is to capture in words what is beyond words, to catch reality, so to speak. But we should never forget that words and language are also there to flee reality. We are stuck in there, and we never get in there at the same time. We are not real, but only have the hope of momentary, passing glimpses of reality.  

JB: That’s really interesting, thank you. Another thing that I found very important — and which resonates with my own preoccupations — is the central role of paradox and the ‘in-between’ in how I understand you speaking of madness, and, indeed, the world. To take one particularly relevant example that you talk about: the reality status of psychotic experiences (e.g., ‘hallucinations’ and ‘delusions’). The characteristic either/or thinking inherent in the psychiatric model (born of its realist assumptions) means that when someone reports that they ‘see’ or ‘hear’ something, that thing must either be objectively there for everyone to witness, or it is pure subjectivity, a fantasy etc. If it is the latter, and the person insists on it being ‘real,’ then, following this model, there must be some sort of disorder (i.e., biological, psychological). If we drop the realist philosophical assumptions, however, I think it is readily apparent that everything we experience is both subjective and objective, both created by the ‘outside world’ and the ‘outside world’ created by us. Psychotic experiences in this context are perhaps describing particularly ‘blended’ or ‘non-dual’ standpoints on experiences, with regards to which the categories of objective/subjective, external/internal are simply inappropriate. I wonder if you could say something about this theme?  

WK: Yes, I agree with you. Perhaps the paradox is the deepest theme in my book, which is the word for the image of the Mobius ring that I mentioned earlier. Indeed, a paradox underlies the entanglement of the inside and the outside, of what is in our mind and what is in our world. Paradox also indirectly underlies the difficulties of describing what a delusion or a hallucination is. But again, thinking about paradoxes of hallucinations in the context of a critique of psychiatric methodology or ideology is not so productive, I think. And after all, all those psychiatrists with their psychiatric practices have no time and no interest for the paradoxes of madness. They just want to improve the lives of their patients, and many of them have a quite pragmatic stance — give them a technique or a tool, and they are happy. Several times I have spoken in mental health meetings and said that their patients want to talk about ‘non-duality’ and paradoxes, about life and death and God, and they have simply said, “That’s fine they do, but not with me, send them to the pastoral counsellor.” In other words, paradoxes have something (quite much in fact) to do with madness, but mostly by way of philosophy, and hardly by way of psychiatric practice.   

When examining how paradoxes function, we can say that madness is less about living in another private bizarre reality and more about living in our ordinary reality but then stumbling on problems that are hidden in (or ‘under’ the pavement of) ‘realism,’ and being haunted by them, which grow the more attention you pay to them. In a way, as I already said, being psychotic and in the grip of paradoxes has more to do with too much consciousness and too much authenticity than with an incapacity to properly think or reason. And the trap of both philosophy and madness may well be that once the cracks in realism have opened, you cannot mend the breaks anymore. The scars of the battles with those breaks remain, or better said: now you recognize that so-called normal life is full of scars. And by trying to untie the knot, the knot only becomes tighter. A remarkable quote from Wittgenstein, one not that popular among the Wittgensteinians, but nevertheless relevant here: “The real discovery is the one which enables me to stop doing philosophy when I want to—the one that gives philosophy peace, so that it is no longer tormented by questions which bring itself into question.” This is also why my book has become 800 pages.   

Therefore, one more remark on this. It is certainly not the case that I am a propagandist of philosophy in my book. Yes, there are various spots in my book where I suggest that a psychotic journey could be endured in a better way if those involved could somehow engage with it in a more philosophical way. However, especially in the later chapters of my book, there also hangs a dark cloud around all philosophising. Philosophy never promised you a rose garden, neither do I. Furthermore, it could well be argued that there is some kind of anti-human tendency in extreme philosophical and psychotic thought. Both philosophy and madness may have intense ‘superhuman’ or ‘a-human’ powers that burn anything substantial, anything meaningful, away into a hole of nothingness. But, well, the interests of life are not necessarily those of philosophy. Philosophy is not a technique to reach happiness; it does not aim to solve life’s problems, and it is not per se directed at improving human value.  

Let me use that war metaphor again, which may clarify this here for the case of madness. Assume, again, that for some mad people they have been in an inexpressible war that nobody knows about. They fought with the questions of the abyss, of the negative. They fell, they got wounded, and some of them came back in seemingly normal form. But what if after their war, after their journey, they are not the same anymore — no longer on the side of our sense of community or humanity? What if they have just deserted humanity and are seduced to take part in the other side? What if the anti-human, the post-human, or the pre-human forces are in some way more attractive than going back to all those restricted senses of being human, of being yourself? And then I think: what if through the voices of madness so many other voices also speak — the voices of the shaman, the possessed, the alien, the werewolf, the cyborg, the super-brain, but also the unborns and the dead, the animals, the birds, the insects, and the life-to-come. We are legion, in a way, and that is what is feared. That is what they usually call the unpredictability of madness. And it is one of the functions of individualising, reductionist psychiatry that focuses on disorders to reduce the fears for humanity of this non-humanity that lives within humanity. I know, this metaphor is not clear-cut, but when we take it seriously, at least we can acknowledge that the ‘psychotics’ or the ‘schizophrenics’ just by their plain being are somehow a mirror — a threat to our own safe, communal senses of humanity. The paradox cannot be mastered, not by any psychiatrist, neither by any madman.  

JB:  Brilliant, yes. You describe what is for me a key issue here. If one talks of ‘the abyss’ or ‘paradox,’ ‘transpersonal,’ or really anything that doesn’t fit with some version of realism, then one is doing ‘metaphysics’, or worse ‘mysticism’, both understood in the modern day west in a pejorative, condescending way. What is forgotten is that realism/scientific materialism is itself metaphysics — and not very convincing metaphysics at that — tacitly, unthinkingly assumed be true. The result is that scientists and physicians assume that they are getting on with the business of reality, when in fact they are enacting the philosophy of the zeitgeist without realising it, which might be a good definition of being in the grips of a ‘paradigm.’ As such, anything that contradicts or deviates from this is deemed suitable only for the armchair or the arts at best, and at worst, for ‘the primitive’ ‘the confused’ ‘the mad.’ With that set-up, and by means of that set-up, disagreements about the nature of reality become foregone conclusions which, as you say, has a lot more than our collective philosophical leanings invested in it. It seems particularly relevant in this regard that metaphysics (and indeed ‘mysticism’) suffered a very similar fate to madness and on a similar historical time scale. Metaphysics was effectively declared nonsense at roughly the same time as medical psychiatry was born. This doesn’t seem to me to be so much about ‘philosophy,’ as about the kinds of experience that are permitted in a given zeitgeist. Any thoughts on this?  

WK: I also argue this for mysticism in my book. With regards to the fate of metaphysics things are complicated, but let me elaborate just a little on the history of metaphysics and philosophy as far as this is relevant for your questions here concerning madness and psychiatry. I think that, just as Foucault argues, we can indeed see a kind of shift in the sciences that deal with the human around the beginning of the 19th century. I would describe this shift — after Immanuel Kant, and in the wake of the emerging sciences — as moving from a focus on being and reality, to a focus on knowledge and the knowing subject. At the beginning of the 20th century, another shift took place often called the ‘linguistic turn,’ after which philosophy became quite critical and self-reflexive with regards to the functioning of language. This broad new focus on the subject’s knowledge and language came about in interaction with the developing sciences — both the natural sciences and the human and the social sciences — and also, in the end, the theory and practice of psychiatry.   

I think this shift clarifies the background of why psychiatrists, even from the more attentive and empathic school of phenomenology, are so over-focussed on psychiatric patients behaving according to the model of the sciences that presume this backdrop. In how patients are talked to, and especially in the academic literature about ‘mental states’, ‘beliefs’ and ‘delusions’, patients are scrutinised in terms of quasi-scientific preoccupations: do what patients think concur with ‘reality’? Do they ‘jump to conclusions’? Do they have empirical evidence for what they say and fantasize? This narrow focus on what mad-language — and language in general — is about corresponds to the narrow focus of how our dominantly science driven, capitalist societies conceptualise what life and language is about. As if we all walk around with private ‘beliefs, opinions, meanings, and world views’ in our heads, and as if we should negotiate these on a market of propositions and truth! How far away can all those researchers with their participating observations and objective scientific questionnaires be from ‘what the mad people think’!   

We could also phrase this as metaphysics being replaced by scientific materialism as the measure for the scientist and as a model for the madman. Now, I think that the solution, or way to work around this, is not in rejecting or de-bunking this positivist view, but just to go your own way, go outside, or, as Gilles Deleuze and Felix Guattari said in ‘Anti-Oedipus,’ “A schizophrenic out for a walk is a better model than a neurotic lying in the analyst couch. A breath of fresh air, a relationship with the outside world.” And I would add, let the internal and external dialogues in mental health and madness be enriched by all these other ways language and experience intertwine. So much of the ‘psychotic word salad’ is never meant for communicating opinions or ‘psychological problems’ at all. Why not join madness and build new cosmologies, touch heaven and hell in words, and comment on a hyper-abstract, hyper-ironic, often absurdist level on so-called reality?  

Just build other networks. When we feel too much pressure from the standard psychiatric and psychological views, there are many places to flee to and get inspiration from. It could be from modern strands of metaphysics, psychoanalytic thought or Deleuzian views, or their esoteric refinements in fringe philosophies like those of ‘speculative realism.’ But it could also be from all kinds of critical psychiatry, especially those that have been transformed and received extra impetus in the last decades, driven as they are by the facts and praxis of on the one hand the ecological crisis, and on the other the post-colonialist and anti-racist movements.  

JB: My final question: I wanted to ask you about what you think mental health services should look like. For me, your book was remarkably measured and sober in its reflections on psychiatric attitudes towards madness. I took from it that you are sympathetic to the old ‘anti-psychiatry’ positions and disagree that at least psychosis should be framed as an illness, but that you also see a role for some biomedical approaches and the ‘medical gaze.’ I wonder if you might expand on this?  

Well, I am sober indeed, because of what I said at the beginning. I am in this whole field not because I have particular models about what best practices should look like in dealing with ‘mental health.’ The whole endeavour I’ve embarked on concerns thinking and speaking about how to live and how to die, how to be present, and how to be absent — in the mind and in the world — and how experiences that are often called ‘mad’ or ‘psychotic’ are interwoven with these. In the period in which I worked on my book, thinking about psychosis as well as being psychotic, I was travelling through many kinds of philosophy and quasi-religious and mystical thoughts and connected these to what is called psychotic thought. How, in the end, this or that society or community should practically deal with what is called ‘mental health,’ is in fact quite far away from my considerations.   

However, let me say a few things here in general. There is indeed a kind of medical gaze that looks at madmen as if they are just ordinary persons, but attacked by a neurobiological illness or disease that could only be helped by medication. This attitude is not only found among psychiatrists but stands for a powerful image, or a way of looking and acting, with respect to mad people in mass media and society as a whole. And of course, when this gaze is dominant, and oppresses other ways of looking at psychotics, it should be criticised, which I have done in the past, and which I occasionally also do in my book.  

But criticising the medical gaze does not imply that other kinds of gazes would be better. The alternatives to the medical gaze are often jumping out of the frying pan into the fire. Take, for instance, the destigmatisation campaigns, at least the ones we see in the Netherlands. They go at pains to state that it is not the case that you are psychotic, or schizophrenic, but that you have psychosis. They say: “patients are so much more than their ‘mental disorder’!” And, “take a look at the whole person and see her illness as separate from her inner self!” Of course, this is well-meant advice, and in many contexts also good practical advice, but at the end of the day they only replicate the one-sided discourse and ideology they pretend to criticize. The same applies to today’s popular so-called ‘dimensional’ approaches. By dissecting and analysing psychotic experiences — which are utterly other and belong to the negative — into their supposed constituent, continual dimensions the suggestion is that they are on one line with normalcy. “Everybody is sometimes a little mad, you have just gone too far!” And although this dimensional approach also has an emancipatory drive at its core, it turns out that for this approach, psychosis can only be seen as a deviation from the mean, not as having an essence in itself. I think that many strands of what goes under the banner of modern cognitive science is basically so far wrong that it leads nowhere other than to tiny, minor, managerial corrections to the modern person in relation to the ever more refined demands of what modern, capitalist society demands of its members.  

In other words, when criticising neuro-bio-psychiatry, I would not bet on some hidden kind of ‘good’ mental or spiritual nature, hidden in everyone’s soul. Instead, I would take advice from the thinkers that somehow acknowledge the other side of the coin — not life and analyses of ‘positive data’, but death and abiding in nothingness: “waiting for Godot”, so to speak. And, at the end of the day, I would prefer to be gazed at as a biological creature with biological needs and desires much more than as a sick mind locked up in a body, though on the condition that the spiritual, the mystical and the meaningful are also parts of our bios — our biographies, our autobiographies, our writings on the wall.  

But to come back to your question, I have given advice on numerous occasions in the Netherlands, since I am considered to be an ‘expert of psychotic experience.’ What I then give is just basic advice, like, forget all your theory about what psychosis is, forget about your theories about minds, bodies, psychology, etc. Just make contact without hidden agendas, therapeutic purposes or conversation goals. That they asked for my autograph in the clinic — yes, that was absurd, but I liked it! When I think back to what kinds of contact were most inspiring at those times, there are various things. I remember that in the first two weeks of my hospitalisation I always woke up early, at which time the cleaning team did its round on the ward. I always had these nice little conversations with one of them, when we smoked together in some kind of stolen time in the ‘smoking corner.’ And that was not about supposed psychic problems, but about life and death in plain language, about how best to clean the floor, how to “analyse the ground,” with all kinds of absurd humour and word plays thrown in. That was also possible with some of the nurses, when not in their mood of ‘doing therapy.’ One last political comment here: why not pay the cleaning team or the nurses the psychiatrist’s salary?  What I also enjoyed very much was the contact with my peers, imaginary or real, speaking and acting from a similar position as ‘prisoners’ in existence who are somehow not accepted by society — conversations and interactions with them were the best. Let’s therefore end with an enigmatic quote from Peter Kingsley, scholar of Greek philosophy and one of the modern mystics: 

First, madness has to be experienced; then controlled. And to do this is to discover all kinds of sanities, of ways for operating skilfully in the world. … To be controlled by insanity is to be feeble. To be controlled by sanity is to be even feebler. But when you have become so mad you are prepared to leave the purity of your madness behind, then the memory of it, preserved in every cell of your body, will stop you ever becoming contaminated by sanity. This is what it means to live in two worlds and not be limited by either.”  

JB: Wouter, it has been an absolute pleasure. Thank you for such an illuminating and thought-provoking discussion. Until next time! 

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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