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The Meaning of Madness By Neel Burton. Acheron Press. 2008. £14.99 (pb). 202pp. ISBN: 9780956035301

Published online by Cambridge University Press:  02 January 2018

Adam Polnay*
Affiliation:
Child and Adolescent Mental Health Services, Pentlandview Lodge, Roslynlee Hospital, Roslin EH25 9QE, UK. Email: Adam.Polnay@nhslothian.scot.nhs.uk
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Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2009 

This book aims to explore what mental disorders can teach us ‘about human nature and the human condition’. This ambitious plan, coupled with the fact that the book was written ‘over two weeks’, means it certainly moves with pace.

Each chapter starts with a description of a mental disorder, which is then used as a way into different territory, often philosophy. Although the intended audience is not made explicit, Burton assumes little prior knowledge of mental disorder, and the text has the feel of a primer pitched at those interested in psychiatry, but not necessarily practising psychiatrists.

As Burton has not defined his audience, he seems to take on responsibility for the reader. For example, when he raises existential questions in a chapter on suicide, he feels the need to advise a potential reader who may be ‘struggling with mental disorder and contemplating suicide that… the bare experience of life is intrinsically valuable’.

A similar responsibility is implied when discussing how bipolar disorder is overrepresented in artists. Burton is careful not to romanticise mental illness and counteracts, almost as a disclaimer, ‘All mental disorders are drab and intensely painful, and most people who suffer from one would never wish it on anyone, least of all themself’.

This bleak statement perhaps overcompensates, and betrays the sensitive position that the author is in. This tension is fascinating, but on occasion the text swings between different levels of discussion, from educational, to philosophical argument, to didactic advice. I note that the author's previous publications were either ‘straight’ psychiatry textbooks or self-help books, and these very different registers are sometimes discernible in this book that aims between the two genres.

As a clinician, I found the chapter on depression particularly interesting. Burton points out that the cognitive distortions seen in people with depression are not far removed from the concept of ‘depressive realism’ – that people with depression see the world more accurately. These people may have ‘the healthy suspicion that life has no meaning.’ The author acknowledges that this line of argument might be anathema to psychiatrists dealing with the realities of managing depression. However, he eloquently floats the hypothesis that depression (at least in milder forms) can be adaptive, by signalling that ‘something is seriously wrong that needs working through’. Awareness of this meaninglessness could, he claims, help people to challenge their priorities.

The book does not provide easy solutions; the chapters usually finish with open ends and extended quotations. While this opens up the debate and implies that there are no concrete answers, this format may be the pragmatic result of a complex book written at speed. Its effect is often to give a fresh perspective on a familiar disorder.

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