The Abyss of Madness

by George E. Atwood

Despite the many ways in which the so-called psychoses can become manifest, they are ultimately human events arising out of human contexts. As such, they can be understood in an intersubjective manner, removing the stigmatizing boundary between madness and sanity. Utilizing the post-Cartesian psychoanalytic approach of phenomenological contextualism, as well as almost 50 years of clinical experience, George Atwood presents detailed case studies depicting individuals in crisis and the successes and failures that occurred in their treatment. Topics range from depression to schizophrenia, bipolar disorder to dreams, dissociative states to suicidality. Throughout is an emphasis on the underlying essence of humanity demonstrated in even the most extreme cases of psychological and emotional disturbance, and both the surprising highs and tragic lows of the search for the inner truth of a life – that of the analyst as well as the patient.

Genres: Psychology, Psychoanalysis, Psychiatry

240 pages, Hardcover

First published September 7, 2011

Reviews

[Steven-John Harris · Rating 5 out of 5]

An outstanding book about the work with the depths of human suffering. I wrote more previously, but I want to remark about the last three chapters. The chapter on depression is challenging and thoroughly engrossing and a rich guide to exploring meanings of depression as a human condition to be understood instead of medicated away into numbness (perhaps another level of depressing the personality?). The next chapter on ghosts, an idea he entertains as shadows of our existence in the form of different selves, unfulfilled, lives not lived out and other such ideas. This is an important idea for dream work. Finally, I was surprised to find the last chapter so fascinating. A brilliant discussion of how modern philosophers (Kierkegaard, Nietzsche, Wittgenstein, etc.) appeared to write their philosophies from some outsider looking in but as an expression of not only the human condition, but their human condition, including some very important painful splits they appear to have been trying to heal! This kept me up, unlike many books can at my age! Six stars (if it were possible)!

[Hana Qorbanzadeh · Rating 5 out of 5]

یه کتاب خیلی جمع و جور و خوب. درباره اینه که جطور بیماری هایی در طیف جنون رو با شناسایی تروما و یاداوری خاطرات گذشته درمان می‌کنن و بهش میپردازن.
این بین روایت هایی که داره درباره هر اختلال خیلی مفید و کمک کننده از یک مثال بارزه

[Amirreza Mahmoudzadeh-Sagheb · Rating 4 out of 5]

"The Abyss of Madness" by George E. Atwood

Atwood's tries to give interpretations about delusions are impressive. Also, he sometimes tries to paraphrase the meaning of patient's delusions instead of just accepting or rejecting them which can be detrimental by either reinforcing the delusions or making the patient guarded and uncooperative in front of the professional.
Atwood doesn't see the delusions and hallucinations merely as symptoms and signs of a brain pathology, but he sees them as some kind of manifestations of an injured mind which wants to protect itself by such extreme defensive mechanisms.
However, Atwood's anti-psychiatry and anti-psychopharmacology opinions aren't favorable to me. Firstly, he doesn't consider that we don't have enough psychotherapists to work with psychotic patients for such a long time (several decades, as he claims himself). Secondly, when patients are in an emergent situation, we don't have enough time to wait for them to get better by the gradual system of psychotherapy. Thirdly, most of the side effects of psychopharmacology comes from the point that some physicians prescribe drugs so badly; for example some of them don't pay attention to the side effects profiles of drugs they prescribe. However, Atwood doesn't consider that psychotherapy can be detrimental for psychotic patients in some situations as well.
Anyway, I appreciate Atwood's idea about the metaphorical meaning of delusions and hallucinations. If we try to understand them, we'll be able to help the patient better and understand him. Then, patients wouldn't be categorized into DSM-V diagnoses for us.

Another point to mention is that Atwood criticizes psychopharmacology and says that it doesn't have enough evidences, while he advocate his own psychotherapy system which has much less supporting evidences. And when it comes to this point, he justifies it by saying that psychotherapy cannot be standardized into a simple unified shape to be trialed in RCTs.

Anyway, I used to have some overvalued ideas that didn't progress to delusions maybe only because I didn't have enough genetic predisposition for developing them. I became able to understand the roots of those ideas later when my situation was stabilized. However, Atwood even opposes using antidepressants as mental painkillers. He thinks painkillers block the path of thinking about the root of pain. His opinion is like asking a patient with bone fractures to learn from his mistakes without giving him any morphine to calm him down. He doesn't consider the emergent features of such situations.

I believe that psychopharmacology shouldn't be used as a magic treatment or the only way to treat the psychic pathology; but it should be used in conjunction with psychotherapy in order to help the patient to think more vividly about the roots of the pathology and help him to solve them gradually. They shouldn't be used as a way to temporarily extinguish the fire and forget it until the fire burns the forest once again.

Sometimes, some of Atwood's ideas (like those one in the "ghosts" chapter) seem to be like fantasizing. I believe that in psychotherapy we should abstain from surreal theories and try to establish logical theories.

I also liked Atwood's opinion that sometimes a psychic pathology isn't merely rooted in the patient, but it roots in the awful situation of the society, as well. And the society calls the person "patient", while their own corruption is the real sickness.

I didn't like Atwood's trying to justify some philosophers' lives merely based on some simple facts about their childhood. Well, childhood is important and impactful, but it's not the only determining factor in our lives.

Generally, this book gave me valuable insights to be able to look at psychosis from another side. Psychosis and neurosis aren't only some categories. Every patient who struggles with them, has his own story behind them which is peculiar to him. Psychosis and neurosis don't happen randomly and only based on chance. There are some kind of logics behind them.

"For all the remarkable, kind people whose voices
were silenced too soon by mental illness — and for those who suffer in silence."
- JL. Bullock

[Fateme · Rating 4 out of 5]

لذتی که ازش بردم لایق پنج ستاره بود ولی خب به عنوان یه کتاب علمی با تعداد انگشت شماری از ایده هاش مخالف بودم با این حال ارزش چندبار خوندن رو داره

[St Fu · Rating 4 out of 5]

It didn't really take me three and a half months to read this book. I read most of it straight through but then reached the chapter about the philosophers and it was: different. So I stopped for a while and only came back to it yesterday.

What I liked most about this book is the clinical parts. Dr. Atwood sees what our culture prefers to think of as mental illness from the standpoint of the person experiencing it. So-called symptoms aren't malfunctions of the mind (or the brain, if you insist on being a materialist) but make sense from the standpoint of the patient and should be approached accordingly. This means, for example, that if someone is depressed, it's not a chemical imbalance or a cognitive error but an understandable response to that person's experienced life. So-called treatment, then, consists of empathically helping that person work their way through those "depressing" events which they could not face alone.

The philosophy chapter, which it turns out was co-authored with Atwood's colleagues, extends this idea by treating philosophy as expressions of the philosopher's life, or a Nietzsche put it, "a confession on the part of its author and a kind of involuntary and unconscious memoir". This is interesting to read but lacks the immediacy of the clinical moments of the previous chapters. Perhaps in saying so I am involuntarily revealing how my life has been organized around a lack of that immediacy in my formative years.

[Parham · Rating 5 out of 5]

چقدر بینش امیدوارکننده و روشنی داشت به آینده برای من... چقدر خوندن‌ش برای خود فرد می‌تونه کمک‌کننده باشه!

[Bill Fawcett · Rating 5 out of 5]

deep