Abstract
When we come to understand that there are often complex reasons why people experience altered states, we can find ways to create safety and support.
Mad studies scholarship has recently developed to counter many conventional mental health understandings and practices. Consider it the knowledge creation arm of an inclusive movement that aims to de-pathologize, advocate for, and respect the lived experiences of people medicine and society deem mad. Historically and culturally, madness has been a moving target given how it has been defined and addressed. For Foucault (2013), madness exemplified how “dividing practices” come to be societally and institutionally used to separate normal from pathological ways of being human. Once divided, the normals often stigmatize, marginalize, and dehumanize how they relate to the abnormals. The civil rights and women’s movements have inspired other marginalized (i.e., abnormal) people to find their voices and contest how others understood and responded to them. Such contests require going beyond the dominant or accepted understandings of the day, and this has been especially the case for people who fit the capacious term “mad.” Mad pride activists re-appropriate the psychiatric language used to divide them from others, to instead educate others and invite them to join in celebrating their uniqueness. The Mad Studies Reader (Lewis et al., 2025) brings together diverse scholars, cultural critics, and activists determined to reframe how madness can be understood, and how those deemed mad might be related to differently.
The Mad Studies Reader is over 650 pages and 45 chapters in length. Edited by a psychiatrist (Lewis), psychologist (Ali), and advocate/educator with lived mental health experience (Russell), the book is organized in four sections entitled: Innovative artists, Critical scholars, Concerned clinicians, and Daring activists. The editors guide the Mad Studies Reader narrative by introducing each section as a diverse subculture within mad studies while also bringing their voices to introduce each chapter. Their editorial aims are heuristic, to draw readers into the tensions and complexity that arise in trying to understand and ethically respond to the madness’ multifaceted nature. The chapter contributions vary in length and quality but sample a wide spectrum of topics and authors – from mother blaming and brains, to relations between art and madness, to lived experiences from the Black Wisdom Collective, reflections from the UK Critical Psychiatry Network, and a long letter to a mother of a son institutionalized for schizophrenia. Subtitled Interdisciplinary Innovations in Mental Health, the Mad Studies Reader includes but goes well beyond anti-psychiatry critiques and what Nikolas Rose (1985) termed the “psy-complex.” Improved ways of relating between “mad” service users and professionals are explored, considerations of how artistic or spiritual temperaments and processes intersect with madness are covered, Sanism is problematized as a cultural discourse, and bipolar survivorship is discussed in a chapter on the Icarus project. Conventional understandings of madness and mental health are critiqued, embraced, and sometimes both critiqued and embraced—depending on each chapter’s authors. Madness in this sense always lies beyond comprehensive efforts to understand and respond to it.
The Mad Studies Reader’s first section examines relationships between madness and art, since “All art . . . works with the full range of human experience” (Lewis et al., 2025, p. 19). The arts are portrayed, hermeneutically, as ways of making and conveying the sense of experiences which defy rational thought and articulation. Mad-positive music, blurry lines between artistic and mad experiences, artists surviving insane asylums, the disenchanted lives of Betty and Veronica from the Archie comic book series, the notion that depression may be liminal and serve a dormancy or gestational purpose in some lives, or that delusions and hallucinations can make artistic sense – these are some topics explored in the Mad Studies Reader’s first section. The second section focuses on critical scholarship, and its contributors adapt decolonizing, feminist, anarchist, disability studies, science and technology studies, Fricker’s epistemic injustice, and Foucauldian ideas to critique contemporary mental health responses to madness. I learned about philanthro-capitalists’ roles in underwriting psychiatric care. Standout chapters explored the monopolistic role of commercialized mental health science (e.g., Big Pharma) in reducing the sense that madness should be understood biochemically, or conversely through structural determinants of health alone. One chapter explored de-pathologizing trauma through activist theatre, while another addressed the mad “child” metaphor as reflective of colonial intersections between white supremacy and colonialism, ablism, and sanism. For prospective readers questioning the conceptual anchors of contemporary mental health, this section is rewarding though selective. It did not draw on recent enactivist and or 5E ideas (e.g., De Haan, 2020; Rose, 2025) for critiquing dominant ideas about madness.
The third section concerns mental health practice and kicks off with a chapter from Szasz, late in his career, about mental illness still being a myth. Contesting Sanism (“a bedrock for understanding the kind of violence directed at the mad community and the always present threat to their realization of justice,” Leblanc-Olmstead & Poole, 2025, p. 362) is a central theme of this section. Therapists are reminded of their potential complicity in perpetuating unjust life circumstances by exclusively focusing on clients’ symptoms and inner worlds. Spiritual emergence and mystical experiences are shown to often catalyze a need for changed lives beyond restoring life to normalcy. Mad-positive models of mental health are presented as well as alternative community / relationally based responses to bio-psychiatry, like Open Dialogue. While explicit methods of therapy are not a focus here, a welcoming and inclusive relational response features throughout. I had hoped for a bit more on family-based treatment. The final section focuses on mad activism, extending to mad pride, in pushing for a less sanist society based on epistemic justice (Fricker, 2007) in accepting mental differences. This section may create discomfort for readers who have not questioned conventional mental health knowledge and practice. The authors are frequently ex-patients (survivors), some of whom went on to academic and professional helping careers. There is a human rights thrust to these chapters that describe communities and peer support networks which develop resistance knowledges to mental health interventions they were coerced to experience. Other authors advocate for neuro-diversity or mad acceptance, sometimes in ways that brought me close to ambivalence and queasiness, such as when reading about mad parents and their children.
The Mad Studies Reader is being published just as the politics and economics of health and mental health, not to mention societal inclusiveness, are increasingly being questioned. The editors are to be commended for the breadth and diversity of contributions made here. A polyphony and at times a cacophony of voices are on offer. Blending client, practitioner, and researcher voices across these chapters may yield selective rewards for some readers, though I welcomed the diversity of ideas and experiences covered here. This is far more than an anti-psychiatry book, a compendium of coerced psychiatry patient experiences, or a manual for democratizing understandings and decision making in mental health. It is a big read on a growing movement at a time when questions about mental differences and the quality of mental health care are becoming hard to ignore.
