Rethinking Madness

Rethinking Madness: Towards a Paradigm Shift In Our Understanding and Treatment of Psychosis (Sky's Edge Publishing, 2012) is a book by the psychologist Paris Williams which explores creative ways of dealing with madness (psychosis). Williams says that psychotic experiences, which cause significant distress, typically occur deep within the mind. Given suitable conditions, this process can often result in a positive outcome, but Williams avoids the romantic notion that psychosis is always beneficial. Much of what Williams says is in close accord with a recovery approach.

Williams says that the term "psychosis" has many meanings, and the definitions that have been put forward are controversial. Even the DSM-IV-TR, says that "the term psychosis has historically received a number of definitions, none of which has achieved universal acceptance".

Williams says that the diagnosis of schizophrenia is also the subject of much debate: Despite over a century of intensive research, no biological markers or physiological tests that can be used to diagnose schizophrenia have been found, its etiology continues to be uncertain, and we don’t even have clear evidence that the concept of schizophrenia is a valid construct. However, diagnosis and treatment based upon the diagnosis continues unhindered by these serious problems.

William's definition does not match the dominant psychiatric viewpoint on psychosis, which characterizes it as primarily resulting from brain pathology. Neuroscience research has found that dopamine, serotonin, glutamate, and GABA all tend to functionally abnormally in those with schizophrenia. A 2020 survey of clinical psychologists in the United Kingdom found that some practitioners have found success incorporating the idea of transformative psychosis into care. The paper concluded that the care models used by clinicians represented an extension of practices recommended by professional organizations such as the American Psychiatric Association and not a qualitatively distinct approach.