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Madness is an integral part of the human condition. We are only just beginning, with the help of modern science and post-psychoanalytic thought to unravel the mysteries of the human mind and its effect on our psychological and physiological well-being. Before psychoanalysis and neuroscience, with all the medical advances now available, madness was the subject of myth, legend and literature, and was feared and reviled as well as romanticized. The stories of so many great artists and writers whose genius has bordered on madness reminds us of the fine line we tread as humans between a managed and fruitful life and one that spins out of control into the darker areas of the mind. Is madness relative? What some people perceive as madness is perceived by others as mystical or creative. Certain rituals and ways of behaving are considered normal in one culture and mad in another. The problem is, who decides?
As therapists we hope to be referred the ‘healthy’ neurotic patients with strong enough ego strength and intellect to benefit from psychodynamic treatment, and who will not invade and disturb our own areas of personal madness. However, this does not always work so neatly, and we need the tools at least to begin to understand, and to be able to flag up those whose symptoms may not benefit from our kind of therapy. Not all psychoanalytic therapists have done a psychiatric placement, and even then the knowledge