Aren't We All? Rethinking the Line Between Madness and Meaning

Someone describes an experience that does not fit neatly into a chart. A vision. A voice. A week of sleepless, electric certainty that the world is alive and speaking directly to them. And then the question arrives, gently, almost as a confession: was that a symptom, or was that something else?

CRAZY is a Soul Syndicate series of long, unhurried conversations about that line. It does not pretend the line is fake. Serious mental illness is real, it causes real suffering, and people in crisis deserve real care. But it keeps pressing on an uncomfortable observation: the framework we use to read these states is not fixed. It was built in a particular place, at a particular time, by particular people. And across history and cultures, the very same experience has been read as a curse, a calling, a crime, a disease, and a doorway.

How the West has handled minds it could not explain

Start with the burning times, told accurately. Between roughly 1450 and 1750, most historians estimate that somewhere in the range of 40,000 to 60,000 people, the large majority of them women, were executed for witchcraft across Europe. The historian Brian Levack, whose The Witch-Hunt in Early Modern Europe is the standard reference, arrives at a careful figure of around 45,000. The popular claim of nine million victims is a myth with no basis in the record; it traces to an unsupported nineteenth-century estimate that took on a life of its own. The real number is smaller and more than terrible enough.

The machinery had a manual. Around 1486 to 1487, a Dominican inquisitor named Heinrich Kramer published the Malleus Maleficarum, the “Hammer of Witches,” in Speyer, long credited jointly to Jakob Sprenger though Kramer is now regarded as its principal author. It became a working guide for identifying and prosecuting witches. Read with a clinical eye, much of what it describes as demonic, the trances, the voices, the strange convictions, is the same human material a hospital would later relabel.

The instinct to treat the troubled mind by acting on the body is even older. Trepanation, drilling or scraping a hole in the skull, is among the oldest surgical procedures we have evidence for, dating back to roughly 6000 BC. Some of those skulls show healed bone; the patient survived. Whatever the practitioners thought they were releasing, the impulse is recognizable: open the head, let the affliction out.

And the impulse did not stay in prehistory. In 1949 the Portuguese neurologist Egas Moniz shared the Nobel Prize in Physiology or Medicine for the lobotomy. In the United States, Walter Freeman turned it into an assembly line with his transorbital, ice-pick technique. His last lobotomy, performed on a patient named Helen Mortensen in February 1967, ended in a fatal brain hemorrhage, and he was barred from operating afterward. A Nobel Prize and a kitchen ice pick, separated by a couple of decades. The point is not that medicine is malicious, but that confident frameworks for “fixing” the mind have been wrong before, catastrophically, and were applied with the full authority of their era.

What a healer sees where we see a patient

Malidoma Patrice Somé (1956 to 2021) was a teacher and writer from the Dagara people of Dano, in Burkina Faso. His memoir Of Water and the Spirit (Penguin, 1994), followed by The Healing Wisdom of Africa (1998), described a worldview in which some of the states the West reads as psychosis are read instead as the difficult, dangerous birth of a healer: a person unusually open to another order of reality, who needs guidance to carry it rather than medication to silence it.

A word of caution. There is a widely shared piece online titled “What a Shaman Sees in a Mental Hospital,” usually attributed directly to Somé. It is not an essay he wrote. It is adapted from Stephanie Marohn's book The Natural Medicine Guide to Schizophrenia (2003), which presents and quotes his perspective. The view is genuinely his; the prose is hers. This series tries to get that right, because the easiest way to discredit a real idea is to attach it to a fake citation.

His books

Of Water and the Spirit1994 · Amazon →

The Healing Wisdom of Africa1998 · Amazon →

Ritual: Power, Healing and Community1993 · Amazon →

You do not have to adopt the Dagara cosmology to take the structural point. Somé's framework treats the sensitive, overwhelmed person as someone with a role to grow into, embedded in a community that knows what to do. Ours often treats them as a malfunction to be isolated and corrected. Two maps of the same territory. Neither is the territory. But the map changes what you do when you arrive.

Where the idea meets evidence, and where it doesn't

Here it would be easy to overreach. The strongest evidence is not that madness is awakening, but that the meaning a person assigns to an unusual state, and the meaning their culture assigns to it, varies enormously, and that variation seems to shape the experience itself.

The Stanford anthropologist Tanya Luhrmann led a study, published in the British Journal of Psychiatry in 2015, comparing how people who hear voices experience them in the United States, India, and Ghana. Americans more often described their voices as violent, intrusive, and a sign of a broken mind, and reached more quickly for diagnostic labels. Many participants in India and Ghana described richer, more relational, sometimes benign voices, including voices they understood as kin or as God. The samples were small, around twenty people per site, and the work is exploratory rather than definitive. But the pattern is hard to ignore: culture appears to get inside the symptom.

The journalist Ethan Watters argued in Crazy Like Us (2010) that as the United States exports its diagnostic categories, it may also be homogenizing how the world expresses distress, overwriting local idioms with its own. Inside Western psychiatry, Stanislav and Christina Grof coined the term “spiritual emergency” and edited a 1989 collection by that name, arguing that some crises that look like breakdown can, with support, become breakthrough. That thinking left an institutional mark: in 1994 the DSM-IV added the category “Religious or Spiritual Problem” (code V62.89). The official manual now concedes that a spiritual crisis can be clinically significant without being a disease.

Where this thinking took root

Esalen InstituteBig Sur, California · esalen.org →

None of this proves any given person's psychosis is secretly enlightenment. It establishes something more modest and durable: the boundary between illness and experience is drawn partly by culture, the official map has already been redrawn once to admit it, and the humane response is to ask which side of the line a person is on rather than to assume.

Why the edges of the mind matter to everyone else

The phrase “crazy wisdom” is not just a figure of speech. It renders the Tibetan term yeshe chölwa, roughly “wisdom gone wild,” popularized in the West by Chögyam Trungpa. The tradition it names takes seriously the possibility that genuine insight sometimes arrives looking unhinged, and that a culture with no place for the unhinged may also have no place for the insight.

There is careful work in this neighborhood too. The psychologist Kay Redfield Jamison, who has written openly about living with bipolar disorder, documented in Touched with Fire (1993) a recurring association between mood disorders and artistic creativity. An association, not a cause, and not an argument for leaving anyone untreated. But it is a data point in a larger pattern: many of the people who have moved the species forward, the founders, the artists, the reformers, would not have fit comfortably inside a normal distribution.

That is the quiet civic argument underneath the whole conversation. Innovation, almost by definition, comes from minds that process the world differently. A society that flattens every deviation into pathology, and medicates it toward the mean, may be sanding off the very edges it depends on for renewal. The case for treating difference with curiosity rather than alarm is not only moral. It is practical.

From suppressing the experience to relating to it

If the line is real but the framework is negotiable, the practical question becomes: what does it look like to support a mind in crisis without either abandoning it or simply silencing it? A handful of approaches have tried, with an honest record of promise and limits worth stating plainly.

The Hearing Voices Movement, founded in the Netherlands by the psychiatrist Marius Romme with the researcher Sandra Escher, grew directly out of a challenge from a voice-hearer named Patsy Hage. Its premise is that the goal is not always to eliminate a voice but to understand and relate to it. The Soteria houses, started by the psychiatrist Loren Mosher in California around 1971, offered a home-like residential setting for people in acute psychosis, with sparing use of medication and a great deal of human presence; its early results were encouraging and the funding later ran out. Open Dialogue, developed in Western Lapland, Finland and associated with the psychologist Jaakko Seikkula, brings the family and social network into treatment from the first day and uses medication cautiously.

Here is the part it would be dishonest to skip. The strikingly good long-term outcomes reported for Open Dialogue come from small, uncontrolled studies in a single region, and a large randomized trial in the United Kingdom has not confirmed a clear advantage over standard care. These approaches are humane and genuinely promising. They are not yet established by high-quality controlled evidence. Saying so is not a knock on them; it is the difference between selling hope and telling the truth.

What these models share with contemplative practice is a stance, not a doctrine: meet the experience with attention instead of panic. Mindfulness, stripped of its marketing, is training in exactly that. Learning to observe a thought or feeling, even a frightening one, without being swept under is the practiced version of what Campbell called swimming instead of drowning. It is not a cure for serious illness, and anyone who sells it as one should be ignored. It is a way of being with one's own mind that makes the difference between the two outcomes a little less a matter of luck.

Both things are true at once

The scale of the need is not in question. The World Health Organization estimates that hundreds of millions of people live with depression or anxiety, and that more than a billion live with a mental health condition of some kind. In the United States, roughly one person dies by suicide every eleven minutes, according to the CDC. During the COVID-19 pandemic, the WHO estimated a roughly 25 percent increase in anxiety and depression worldwide in its first year. Whatever else is true, the suffering is real and enormous, and dismissing treatment would be its own kind of cruelty.

So CRAZY is not arguing that nobody is ill, or that medicine is the enemy, or that a crisis is just a misunderstood gift. It is arguing for holding two true things at once: mental illness causes real harm and deserves real care, and the framework we use to sort experience into “sick” and “well” was made by humans, has been wrong before, and is narrower than the full range of what minds actually do.

The Potawatomi botanist Robin Wall Kimmerer writes, in Braiding Sweetgrass, that “all flourishing is mutual.” The person in crisis and the society around them are not separate problems. How we treat the minds at the edges is, in the long run, how we decide what kind of whole we are willing to be. Aren't we all, in the end, somewhere on that water, hoping someone taught us to swim.