Where madness begins

Source: Wo beginnt der Wahnsinn? | 42 - Die Antwort auf fast alles | ARTE, ARTEde, 28:21, uploaded 2025-05-23, playlist index 246.

The ARTE programme begins with a familiar insult. Calling someone “crazy” often means that the person seems completely different, unpredictable and hard to understand. The word places the person outside a shared order, which makes the order feel safer. The programme asks who sets that order and where a difference in thought or perception becomes a psychiatric condition.

The word “crazy” and the psychiatric question

The opening narration treats normality as a human invention. People need shared ideas about what counts as ordinary so that they can act together, yet no natural line marks the normal person from everyone else. The narration turns the question back on the viewer: if normality is a social construction, does anyone count as crazy, or does everyone carry some small departure from the norm?

Philipp Sterzer, a psychiatrist at the University Psychiatric Clinics Basel, gives the clinical question a firmer shape. He prefers to leave the everyday word “crazy” undefined because it carries negative associations and can gather several different disorders under one label. Psychosis comes closer to the phenomenon people usually mean. In psychosis, the person’s contact with what other people call reality can break down in thought and perception.

Sterzer describes five red cars passing one after another at a traffic light. Most people treat the sequence as an unlikely coincidence. A person prone to psychosis may read it as a sign aimed at them, perhaps evidence that someone knows something about them or that a conspiracy is sending a message. The perception of the cars remains intact. The change lies in the meaning attached to the coincidence, which now appears to contain an agent or a higher power.

He then stages a more intimate example. Someone becomes unsure of the boundary between the self and the room. A sound, a sheet of paper pointed towards the speaker and a cameraman’s hand in his pocket begin to feel connected. The person concludes that the interviewer has arranged everything and instructed the cameraman. That conclusion supplies an explanation for an alarming state of uncertainty. Sterzer calls the first feeling a threatening mood of expectation. The belief that the interviewer caused it brings relief because it gives the fear a shape.

This creates a problem for the ordinary idea that a delusion should be removed because it is false. A belief can feel coherent and useful while it is forming. A guest who has experienced psychosis describes an episode in which the AfD had just won many votes in her constituency. She developed an extreme fear of Nazis and links the episode to her heightened sensitivity to the political situation. The programme asks whether such states are simply detached from ordinary thought or exaggerated versions of patterns that healthy people share.

Perception, prediction and the missing hard boundary

The programme’s psychiatric account rests on a model of perception. The brain receives sensory signals and interprets them through an inner model built from what it has learned. It does not receive the world in a finished form. The Hollow Face Illusion makes this visible. When a hollow mask turns towards the viewer, most people see a face bulging outwards because their expectations about faces override the shape that reaches the eyes. Someone in psychosis may have greater difficulty using the inner model to organise new impressions and may therefore recognise the hollow face as hollow.

The example shifts the moral weight of the word “crazy”. A psychotic person may perceive an aspect of the scene that other people miss. Sterzer still gives a practical criterion for delusion: a conviction appears false from the standpoint of other people and remains unchanged when facts and data challenge it. He adds that the same description can fit beliefs held by ordinary people, including beliefs that evidence does not alter. The programme therefore leaves the boundary open. It gives no hard point at which delusion begins and normality ends.

The history of rulers shows why diagnosis needs care. The programme mentions Ludwig II, who commissioned castle after castle, Nero, who supposedly burned Rome, Stalin, who may have suffered persecution delusions, and Hitler, whose grandiosity included the wish to conquer the world. Manfred Lütz, a psychiatrist and author, rejects posthumous diagnoses. Calling Hitler schizophrenic or crazy can soften the moral description of his crimes and attach the crimes to mental illness. The American Psychiatric Association’s rule against diagnosing people one has never examined supports his refusal. Historical figures remain a problem for historical explanation rather than a licence for remote clinical labels.

Suffering as a practical boundary

The programme moves from reality-testing to the question of harm. Mania changes a person’s mood and thought and can produce the inflated confidence associated with grandiosity. During a manic phase, a person may feel better than ever. Lütz imagines someone taking a taxi from his home to Hamburg for breakfast, spending several hundred euros, and declaring that next week he will become a millionaire. The person feels no suffering at that moment. After the phase, the taxi trips may have ruined his finances, his family and his friendships. Public humiliation and reckless sexual behaviour can add to the damage.

The distinction matters to Lütz’s view of diagnosis. The episode can feel pleasurable whilst its consequences cause severe suffering. Diagnosis should therefore ask whether a person suffers and whether their life has become impaired. The label “crazy” contributes little to that decision.

The programme cites studies which, according to its description, find psychotic symptoms in roughly six to eight percent of the healthy population, with some people experiencing them repeatedly or for long periods without receiving a diagnosis. The film uses the figure to place psychotic experiences on a continuum. It presents the statistic as a reported research finding and gives a systematic review in the description, though the programme itself does not explain the study’s sample, definitions or limits.

Lütz tells a story from early in his psychiatric work. He cared for a woman who heard the voice of a deceased teacher every afternoon. Seeing that her medication was low, he increased it so that the voice would disappear. When he returned three weeks later, the woman was furious. She had liked the voice and regarded its disappearance as an unwanted intervention. Lütz reduced the medication, the voice returned, and the relationship recovered. He draws a direct rule from the encounter: the patient sets the goal of therapy, not the doctor.

The story gives the programme a useful qualification. An unusual perception becomes a clinical problem through the person’s experience of it and the effects it has on their life. Treatment can itself create suffering when it removes something the patient values. The film keeps that principle alongside the earlier examples of mania and psychosis, where a person may need help before they can recognise the cost of a state that feels good or meaningful.

Norms, chairs and neurodiversity

The programme returns to the social meaning of normality through a chair. Most people picture a chair with four legs and a conventional backrest. A small backrest, armrests or three legs alter the object without making it cease to be a chair. The category has a centre and a wide range of variations around it. That centre helps people organise daily life, while the real objects remain more varied than the stereotype.

The concept of neurodiversity extends this point to human minds. It treats some neurological differences as part of natural human variation and questions the use of illness language for every departure from an imagined standard. The programme separates a mental illness, which can arise through life events and can often be treated, from a neurodevelopmental condition, which a person has from birth and continues to live with. The distinction is presented as a general orientation rather than a complete account of every diagnosis.

The film uses autism as its main example. Until the 1970s, psychiatry often failed to distinguish autism from schizophrenia, which helped place autistic people under the label of madness. The programme describes autistic perception as a different way of processing sensory input. An autistic person may focus intensely on a particular interest and may find social interaction difficult. A guest compares the experience to a string of lights in which every bulb appears equally present, so attention cannot settle on a first priority. Rotating the string creates a path from one bulb to the next. The image explains why orientation and structured guidance can reduce fear.

The neurodiversity movement emerged from people with these experiences in the mid-1990s. It challenged discrimination, sought better access to work and helped many people form a more positive view of themselves. The programme also keeps a tension inside the movement’s argument. If every condition is described only as a difference and no condition counts as illness, people with severe impairments and their families can lose a claim to concrete support. Acceptance and treatment remain compatible when the person receiving help decides what kind of help they want.

Stigma and the uses of difference

The history of psychiatry carries the cost of these categories. The film recalls people being handed to the Inquisition, imprisoned or displayed at fairs before psychiatry became a modern medical discipline in the nineteenth century. Under National Socialism, several hundred thousand people who had experienced psychiatric conditions were sterilised or murdered. Lütz connects the later social residue to the earlier belief that mental illness was hereditary, catastrophic and a burden on society. He also points out that doctors had promoted this stigma during the 1920s, before the Nazis turned it into state policy.

Modern discrimination takes quieter forms. People can lose access to jobs because of a condition they experienced years earlier. The programme’s speaker argues for a more open account of human difference, including forms of life that need a different place in society. Some cultures give people who perceive or associate things differently a role as shamans or seers. Their unusual perceptions can acquire social value within that culture. The point is about the social setting around a perception, not a claim that every unusual perception carries special knowledge.

A guest describes her own manic state as a period of rapid speech, intense intuition and exaggerated enthusiasm. She wrote large amounts of poetry in couplets at a speed she could not reach in her usual state and decided that she should become a writer. Psychiatry described the ambition as grandiosity. She asks who gets to make that judgement, since a dream of writing a book can also precede a real work. The question stays open. An experience can feel fertile and utopian to the person living through it while still changing their ability to function.

The film names Charles “Buddy” Bolden, Vincent van Gogh and Syd Barrett as artists whose psychiatric histories have fed the old association between genius and madness. Sterzer offers a narrower reading of the research. Large genetic studies, he says, associate a higher polygenic risk score for schizophrenia with a greater likelihood of working in a creative profession among healthy people. He calls this an indirect clue. An acute psychosis usually makes sustained work harder, which leaves a small space between a trait that may support unusual associations and a condition that overwhelms a person’s ability to act.

The same caution applies to the programme’s discussion of giftedness and ADHD. It says that some specialists estimate that twenty-five to fifty percent of gifted people have been wrongly diagnosed with ADHD. The source gives no named specialist or study for that figure. Its larger point is that the same behaviour can look like a limitation or a capacity depending on the diagnostic frame and the state of scientific knowledge. Psychiatric categories also change as people change. A doctor recalls reading old medical reports and wondering why diagnoses kept changing, then realising that a person’s condition can change over time as well. Categories help choose treatment. A permanent psychiatric identity can still misdescribe the person.

Accepting the part that does not fit

The closing argument asks people to accept some degree of mental difference. Resistance can strengthen a problem, the programme says, while acceptance creates room to respond to what is happening. Trauma and other difficult experiences can push a person towards a psychiatric crisis. The film treats that possibility as part of human life and says that anyone could experience such a state under the right conditions.

That claim does not erase the need for care. It asks society to examine its fear of people who seem difficult to explain. Their behaviour can act as a mirror in which other people see weaknesses they would rather leave unexamined. The programme’s final recommendation follows from that discomfort: accept the personal variations that make a person distinct, while using norms as tools for orientation rather than as final measures of human worth. A little departure from the standard can make a new idea possible.

Limits and further reading

The programme is a 28-minute science documentary built from interviews, narration and illustrative examples. Its central distinctions come from the speakers’ clinical and personal accounts. It does not supply a full diagnostic framework, and it gives limited detail about the studies behind its numerical claims. The six-to-eight-percent figure, the association between schizophrenia risk and creative work, and the twenty-five-to-fifty-percent ADHD estimate should therefore remain attached to the programme’s reporting. The historical examples and the links between particular artists and psychiatric states also receive no full source discussion in the film.

ARTE’s description lists the following sources and further links:

• Systematic review of the psychosis continuum, which the description gives alongside the six-to-eight-percent claim.
• Nature study on schizophrenia risk and creative occupations, linked by the description in a PDF URL with an access token.
• Giftedness and ADHD: Identification, Misdiagnosis and Dual Diagnosis.
• Lea De Gregorio, Unter Verrückten sagt man du.
• Philipp Sterzer, Die Illusion der Vernunft.
• Manfred Lütz, selected publications.
• Béatrice Millêtre, books and publications.