Why Psychosis Is Not So Crazy: A Conversation with Stijn Vanheule

Mad in America: Rethinking Mental Health

Mad in America

Mental Health, Medicine, Health & Fitness

4.7 • 212 Ratings

🗓️ 25 June 2025

⏱️ 45 minutes

🔗️ Recording | iTunes | RSS

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Summary

Stijn Vanheule is a clinical psychologist, psychoanalyst, and professor of psychology at Ghent University. Trained in the Lacanian tradition, he has written widely on the structure of psychosis, the limits of psychiatric diagnosis, and the importance of attending to the subjective logic of mental distress.

His books include The Subject of Psychosis: A Lacanian Perspective, Diagnosis and the DSM: A Critical Review, and most recently, Why Psychosis is Not So Crazy, which offers a reorientation of how clinicians, families, and broader society might understand and engage with psychotic experience.

Drawing on psychoanalytic theory, case studies, and contemporary cultural examples, Vanheule treats hallucinations and delusions not as meaningless symptoms but as creative responses to existential disruptions. He emphasizes the importance of listening—clinically and socially—not for coherence imposed from the outside, but for the structure and logic within a person's seemingly incoherent world. His approach challenges dominant psychiatric models that prioritize symptom suppression, calling instead for a therapeutic attitude grounded in humility and collaboration.

In this interview, Vanheule discusses the role of hallucinations in restoring a shattered sense of meaning, the necessity of admitting one's limitations as a clinician, and the importance of everyday practices—gardening, conversation, shared meals—in building connections that can anchor recovery. Using a depathologizing lens, he discusses that to overwhelming existential challenges that make us all vulnerable, psychosis might not be a crazy reaction after all.

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Find a full transcript of the interview here: https://www.madinamerica.com/2025/06/why-psychosis-is-not-so-crazy-a-conversation-with-stijn-vanheule/

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Transcript

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0:00.0	Welcome to the Madden America podcast, your source for science, psychiatry, and social justice.
0:14.1	Hello, everyone, and welcome to Madden America. Our guest today is clinical psychologist, Steyn Van Hula.
0:21.0	Dr. Van Hula is a professor at Ghent University, Belgium, and a psychoanalyst in private practice.
0:26.8	He's the author of Diagnosis in the DSM, a critical review.
0:30.7	But actually, today we will talk about his newer book, which is called Why Psychosis is Not
0:35.9	not so crazy.
0:36.9	This book takes a really refreshing look at what psychotic experience is, its purpose, its meaning,
0:43.3	and how we can connect with those who at least appear to have lost connection with the world around them.
0:49.5	Dr. Van Hulay, welcome to Mad in America.
0:51.8	Thank you.
0:52.6	According to your experience of both working with patients and Lacanian theory, could you
0:57.1	briefly tell us what you think psychosis is?
1:00.3	And then later we can get into, you know, why you also say it's not so crazy.
1:05.1	Understanding basically of what is psychosis.
1:07.7	First of all, I would then say that I don't think of psychosis in terms of a disease.
1:13.5	But for me, it's a kind of a human experience.
1:16.6	And the idea here is that there is no standard way of experiencing the world and of
1:22.3	experiencing ourselves.
1:24.9	And that if we people are confronted with difficult challenges in our lives, in our
1:31.2	contexts, in our families, in our job, that we tend to respond in a certain way. And some of
1:38.1	these responses are more like standard responses, more attuned to what the collective way of reacting to events is,
1:47.2	but all of us have reactions that are a bit of standard.
	...

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