Book Review: ‘Mad World: The Politics of Mental Health’ by Micha Frazer-Carroll

As a student on the MSc Mad Studies programme at Queen Margaret University in Edinburgh, I’ve read my fair share of academic articles and books on the subject of madness. The course is only a few years old – the first of its kind in the world – and not well known, nor easily explained. A common talking point among students is ‘so what do you say to other people when they ask what it is?’ We’ve all been met with surprise, confusion and even alarm when we mention the course subject to acquaintances, partly because it is a relatively new and unfamiliar area but mostly because it challenges the status quo.

The field of Mad Studies offers a critique of the mainstream mental health model and provides a very flexible space in which to consider a variety of arguments about psychiatry, pharmaceuticals and contemporary mental health practice. Yet what we sorely need is to bring the arguments of Mad Studies out of the academic arena and into mainstream conversation. The mad movement is slowly gaining traction, and Micha Frazer-Carroll’s accessible and compelling Mad World makes a vibrant and insightful addition to the discourse.

Foundational to her thesis is an anti-capitalist stance. She writes, “This book mobilises anti-capitalist, ‘mad’, disability justice and anti-racist thinking in particular to carve out a radical political approach to mental health. It names the capitalist economic system, specifically, as a significant producer of suffering in contemporary life.” Each chapter investigates a different aspect of mental health and how it relates to our capitalist society, with a view to questioning our assumptions and framing alternatives.

The book covers a range of topics – from the history of asylums to the ways that work exacerbates mental distress, from the culture of disorder diagnosis to the ways that different art forms create spaces for dissent and inquiry. The chapter on ‘knowing’ mental health provides a particularly subtle and astute examination of mad knowledge and how we make sense of mad experience. Likewise, a chapter on disavowal offers a penetrating study of the relationships among activist groups and the ways that we betray our potential allies by creating boundaries around identity. The subtitle of Mad World is ‘The Politics of Mental Health’ and these chapters deliver a well-thought-out contextualisation of the contemporary political landscape.

In particular, the chapter entitled ‘Law and disorder’ offers a damning expose of the relationship between the police and the mental health system in the UK. As has been observed in the Mad Studies classroom, the psychiatric system exists in tandem with the state apparatus, in order to contain and suppress disorder and dissent. Frazer-Carroll pulls no punches in her own assessment:

“As the institution deployed to manage populations that are disruptive to capital accumulation and societal ‘order’, it should be no surprise that police play a key role in mental health crisis response. The punishment, incarceration and violence enacted on Mad/Mentally Ill people by police is therefore not a side-effect of policing, but the intended outcome.”

While offering a critique of the dominant mental health system, Mad World also takes the trouble to outline some hopeful alternatives in its penultimate chapter. For example, the Trieste model in Italy offers “a ‘no locked doors’ policy – all engagement with services is voluntary, and doesn’t entail people being cut off from their communities.” Here in the UK, the Joshi Project (based in Glasgow) is campaigning to bring the Trieste model to this country. Other UK-based projects explored in this chapter include the Mad Pride event (incidentally returning to London on 15 July 2023) and the Hearing Voices Network, which runs peer support groups for those who hear voices and see visions. “The Hearing Voices approach is transformative because it rejects the idea of any singular ‘objective reality’, acknowledges that we all experience things differently, and what feels real varies from person to person.”

The strongest aspect of Mad World and what I enjoyed most in this book was the author’s incredible sensitivity to and acknowledgment of the complexity and downright messiness of mental experience. She writes that “our minds are complication, conflicting and ever-changing, and so our responses to mental health and Madness will need to be just as complex, multifaceted and dynamic too.” For Frazer-Carroll, the mad movement itself must reflect this messiness:

Uncomfortable as it may be, there will never be ‘an answer’. We must be agile, open to failure and criticism, able to scrap failed attempts and collect the fragments that worked, to respond to emotions as they change, and to the world as it changes too. This involves an embrace of not knowing, of making space and humility to be wrong.

This book is an incredibly well-written and clear-thinking introduction to the issues at stake in the mad movement. It offers a contemporary and forward-thinking analysis of how mental well-being is both damaged and politicised in capitalist society. Most significantly, it brings Mad Studies out of the classroom and into the hands of ordinary readers. When people ask me what Mad Studies is about, I will gladly refer them to Mad World

Mad World: The Politics of Mental Health can be pre-ordered here (£12.99 paperback/£7.99 ebook).

Julia Macintosh is a writer, coach, facilitator and mad scholar based in Edinburgh. She co-edits Unpsychology Magazine and writes at Madreality on Substack. She also co-hosts Mad Studies groups through the Meetup platform. Her lived experience includes two episodes of psychosis and subsequent hospitalisations, and a diagnosis of bipolar disorder. She can be found online at: