Views & Reviews Medical Classics

All the Madmen

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3809 (Published 21 July 2010) Cite this as: BMJ 2010;341:c3809
  1. David Ingle, core trainee year 3 in psychiatry, South West Yorkshire NHS Foundation Trust
  1. davingle{at}doctors.org.uk

    “All the Madmen” was inspired by the mental health problems of David Bowie’s brother and was released 39 years ago (before Bowie achieved major fame), on the album The Man Who Sold the World. It recognises the separation from society of mentally ill people, who are sent to “mansions cold and grey.” In a lucid interval, spoken instead of sung, the national shame of mental illness and policies of alienation and institution are questioned with sadness: “Where can the horizon lie / When a nation hides / Its organic minds in a cellar.”

    Faced with the prospect of discharge, the patient protagonist recognises his comfort in Librium, considers his ability to cope outside, and pushes the risk buttons with, “I can fly, I will scream, I will break my arm / I will do me harm.” He adopts a catatonic posture, standing with a foot in his hand, talking to the wall. He is accepting of electric shock treatment. When he asks, “I’m not quite right at all . . . am I?” is this a cryptic taunt that he knows he is putting it on, pushing the psychiatrist to keep his place in the institution? Or, more worryingly, is he questioning his own sanity and certainty?

    The patient too separates the mad from the sane and prefers the company of the first, emphasised by the chorus: “I’d rather stay here / With all the madmen / Than perish with the sad men / Roaming free / And I’d rather play here / With all the madmen / For I’m quite content / They’re all as sane as me.” How apt this is too for today’s psychiatrists, blocked from interaction with patients by production line ward rounds, working time directives, ineffective audits, and management meetings, wondering if the organisation they work in is more psychotic than the patients they want to relate to.

    Unfortunately, thanks to psychiatric intervention (most likely a lobotomy), the patient is unable to maintain a happy status quo: “Day after day / They take some brain away.” Along with loss of brain is loss of libido. Now he is simply “not quite right at all,” there is no question of “Am I.” He still does not want to be set free, but now it is because he is helpless. He has lost control to the institution, which tells him what is real, and he does not object.

    The story ends with the narrator in a state of definite psychopathology, a bilingual clang association: “Zane, Zane, Zane ouvre le chien.” The listener can reflect on a reference to Huxley’s Doors of Perception or on our inmate screaming for the exit door after his treatment.

    As with much of Bowie’s most thought stimulating work, “All the Madmen” allows more than one interpretation and generates uncertainty—important themes in psychiatry. This patient centred song does modern psychiatry justice by reminding us of the stigma of mental illness and by personalising the patient as he makes his journey through the institution to institutionalisation. It raises the question of how far psychiatry has progressed since the distant time when Bowie had yet to dye his hair orange.

    Notes

    Cite this as: BMJ 2010;341:c3809

    Footnotes

    • All the Madmen

    • Song by David Bowie

    • Released 1971 (UK)

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