La Marr Jurelle Bruce’s How to Go Mad without Losing Your Mind: Madness and Black Radical Creativity is a paradigm-shaping book for future scholarship around mental difference. Bruce’s American studies background and interdisciplinary approach provide a nimble, critical, and affirmative take on radical black art, music, and literature at the intersection of black, disability, gender, and mad studies. The last of these, mad studies, is a newly emerging field. Bruce’s book not only helps announce the emergence of this new field but significantly advances the analytic, cultural, historical, and theoretical sophistication of mad scholarship.

As a result, How to Go Mad is a must-read for those of us engaged in the intersectional politics and scholarship of difference. Mad studies moves us beyond the either/or binaries of anti-psychiatry versus pro-psychiatry to better engage with embodied, affective, material, social, political, and personal dimensions of sanist prejudice. Sanism works similarly to—and intersects—ableism, racism, sexism, heteronormativity, ageism, and other structures of prejudice to create thick lattices of exclusion, subordination, and domination (Russel, Ali, and Lewis forthcoming; Beresford and Russo 2021; Green and Ubozoh 2019).

Bruce engages this intersectional lattice of structural prejudice at the start of How to Go Mad with a powerful and imaginative linking of Hortense Spiller’s work on the slave ships of the Middle Passage and Michel Foucault’s work on early modernity’s ship of fools. Bruce brings these two ships together in our imagination to help us see the intersectional roots of sanism and racism as they converge in the discursive practices of early Euromodernity.

Although it is unlikely that a slave ship ever crossed a ship of fools in geographic space, these vessels converged in the discursive domains and cultural imagination of early Euromoderniy. According to the era’s emergent antiblack and antimad worldviews, both of these ships were floating graveyards of the socially dead. Both ships were imagined to haul inferior, unReasonable beings who were metaphysically adrift amid the rising tide of Reason. (4)

Bruce enters the fray of this fraught legacy, where social constructions of difference and their hierarchical relations comingle with real-life consequences, exclusions, treatments, and otherings. As Bruce puts it, “On the one hand, madness is a floating signifier and dynamic social construction that evades stable definition. On the other hand, or maybe in the same hand, madness is a lived reality that demands sustained attention” (6).

Bruce teases out four overlapping meanings of “madness” that commonly intersect and interact with each other whenever we try to think about mental difference: 1) the phenomenological, lived experiences of “unruly minds,” 2) the medicalized categories of “psychopathology” and “mental illness,” 3) the emotional states, also known as “rage,” and 4) the many deviations and resistances to psychosocial rules, norms, and expectations. These four dimensions of madness—experiential, medicalized, outraged, and psychosocially resistant—intermingle and comingle in our perception, making it hard to communicate and avoid talking at cross purposes.

Bruce creates an approach to mental difference in which the mad-positive work of madness does not reductively collapse into pathological and medicalized frames. But what, we might ask, is the work of madness? The artists Bruce studies give us an answer: it is to passionately engage, resist, reimagine, and move beyond entrenched and problematic norms and structural prejudices. It is to take seriously our dis-ease with problematic norms and our yearning for another world. Rather than silencing these feelings, it is to channel them into creative practice, spiritual seeking, political change, and sometimes wild howling at the moon. At the same time, Bruce does not romanticize madness; the hardships and potential tragedies of madness are still very much at play, and “madness is capacious enough to hold the sensation of blessing and curse at the same time” (237).

Bruce explores the literature of Amiri Baraka, Gayle Jones, and Ntozake Shange; the music of Buddy Bolden, Sun Ra, Charles Mingus, Nina Simone, Lauryn Hill, Kanye West, and Kendrick Lamar; and the comedy of Richard Prior and Dave Chapelle. In these studies, Bruce uses a “mad methodology” that embraces a fluid ensemble of “epistemological modes, political praxes, interpretive techniques, affective dispositions, existential orientations, and ways of life” (9). Mad methodology allows Bruce to engage the complexity and variability of mad movements while “letting go” of the “imperative to know” (11, italics in original). At the same time, mad methodology extends a “radical compassion” that cares for, learns from, and shares vulnerability with the many madpersons who precariously trespass in the world of “Reasonable modernity” (10, italics in original).

Bruce’s discussion of the R & B artist and songwriter Lauryn Hill offers a valuable window into his approach to black artistry through mad methodology. After the release of The Miseducation of Lauryn Hill (1998), Hill’s public status pivoted from international superstar to someone who was “deemed crazy by media pundits” (151). As Bruce explains, Hill stepped off the expected norms of her superstar position, walked away from massive earnings potential, and spoke out about the traumas of trying to live up to a corporatized image in the face of “market forces, public whims, creative frustrations, personal tragedy and mental distress” (170). As an example, in a 2001 MTV Unplugged performance, Hill mobilized a kind of madness, implying that she was hearing voices, calling herself “emotionally unstable,” taunting the audience to admit their own instability, and calling herself a “mad scientist” who, as Bruce puts it, “conducts dangerous experiments in obsessive pursuit of revelation and breakthrough” (148). All the while, Hill sang of deep heartbreak, profound disillusionment with fame, outrage at the incursions of capitalism, and the possibilities of creative and spiritual epiphanies. Indeed, far from a medicalized pathology, crazy for Hill was a mad-positive option, and embracing it was the best way to get beyond the crushing expectations with which she was living; “As far as I’m concerned I’m crazy and deranged.... I’m emotionally unstable.... That’s my story, I’m sticking to it” (149).

Some journalists rejected sanist reactions to Hill, considering her performance in the context of a group of gifted black women performers who died young: “The life [Hill] had constructed was not the one she wanted to live. It had become more weight than she could carry without becoming a madwoman or a sadwoman or just one more name on a list that includes Billie Holiday and Florence Ballard and Dorothy Dandridge and all the sisters whose vibrant artistry couldn’t save their lives” (170). Rather than join this legacy, Hill found another way, explaining in 2006 that in her mind “it’s really about the Black woman falling in love with her own image of beauty” (170, italics added). And falling in love with her own image was barred if she was to live up to the image of the industry.

For Bruce, therein lie the complications. Madness is multivalent. Hill’s is not a hallmark happy story; it is unfortunate in many ways. It is also a story of mad—creative, political, and spiritual—breakthrough. As Bruce puts it,

Ms. Lauryn Hill wields madness as a multivalent technology for insurgent performance and personhood. She ... brandishes craziness to fend off interlopers and pursue peace; she erupts into tears that erode and slosh away “forbiddingly perfect” facades; she raises her cracked voice in an effort to crack and shatter complacency; she overhauls hit records to disturb easy listening and demand critical listening instead; and she presents an Afro-alienated and Afro-alienating persona to challenge presumptions about how black womanhood can look, sound, and be in the world. (171)

The profound takeaway from this discussion is that medicalized categories should not dominate madness: they must be in conversation with deeply experiential insights, rage against the norm, and psychosocial subversion and resistance. We have to be able to see that “sometimes an assertion of freedom looks and sounds like an outburst of madness” (170), which sanist logics over-hastily pathologize.

For Journal of Medical Humanities readers, Bruce’s work is a clarion call for heightened attention to emerging work in intersectional mad studies. Mad studies help health humanities scholars understand the way that medicalized approaches to mental difference are incomplete and at times oppressive. Bruce’s work also provides inspiration and encouragement to do what we can to change hegemonic approaches. Health humanities, psychological humanities, and mad studies can do important work inside medical models and medical and psychiatric education, research, and practice to limit their reductionism. When future scholars like Bruce look at the mental health world, hopefully they will see something more complex than today’s pathologizing and medicalizing frames.