What Is Madness?

Leader works through psychosis by way of Lacanian clinical structure, treating madness less as a catalogue of symptoms than as a particular way of holding oneself together, or failing to. He distinguishes triggered breakdown from the forms of madness that persist quietly for years, stabilised around work, a relationship, or a fixed idea, and never announcing themselves as illness.

Drawing on cases including Aimee, the Wolf Man, and Harold Shipman, he argues that psychotic structure can be present without florid crisis, and that what looks like recovery is often the patient's own labour of construction. He sets this reading against symptom checklists and the drift toward ever shorter diagnostic categories.

For clinicians, the value lies in how he reframes what stabilisation asks of the analyst: not the removal of a delusion but support for the structure a patient has already built. First published in 2011 by Hamish Hamilton, it draws on Freud, Lacan, and the author's own consulting-room practice.