I was intrigued by positive reviews for a book which would seem to do itself no favours with its title question. 300 pages may be a long definition by dictionary standards, but explaining madness, like explaining consciousness or the size of the universe, in just one book seems like an impossible task.
Darian Leader guides his readers through his theories, the practice of which has clearly helped a number of his clients. The central theory posited - that psychosis is a combination of nature and nurture and can lay dormant for years or for a lifetime - sounds reasonable and is illustrated by several compelling examples. Leader's treatment of his clients relies on using their own attempts to find meaning, whether by a sustained delusion, use of language etc. which over time allows them to adjust and cope with their lives. His professional and human interest in those he helps is obvious, and he insists that treatment should not simply be aimed at stopping behaviour which might, rather than a symptom, be an attempt to relieve suffering.
He explains some of Freud's work in terms simple enough for the lay reader to grasp, but this lay reader, at least, remained slightly sceptical that Freud or even Lacan's size really does fit all. While the chapters on causes of psychosis and triggers of psychotic episodes seem thorough, I was left feeling that any number of not-unusual situations would produce madness, both the state of being and of going mad, in many children. This is not to say that I agree with the reviewer who felt that problems would be solved by better housing, more love etc. Psychosis is clearly quite distinct from melancholia or paranoia, or even neurosis. Leader's point is that psychotics don't have the basic elements, or building blocks, in place to deal with life situations because of a halt in development. He also admits that the constructs that help the psychotic are perhaps just more outlandish versions of the fantasies that help us all to cope with reality.
The absence of a fifth star is for two reasons: one is my lacking the knowledge to place this within the framework of current theories of mental health, and the other is that even if you advocate psychoanalysis for people with psychoses, the length of time needed in therapy would make it unlikely that most people could find either a therapist or the funds.