Engaging “Madness”: A Guide for Significant Others and Families


About six years ago, I discovered the Mad in America website. That was eight years into the journey my wife and I have undertaken together to heal the effects of her childhood abuse. (She has given permission for me to tell our story.) We’d already been together for 20 years when her trauma burst into our marriage and family in the form of dissociation and extreme states. Though the extreme states were scary at first, and created chaos in our relationship, I never considered her “mad,” “crazy,” or any of the other pejorative terms that our culture uses for people who are experiencing mental distress.

Instead, from the start, my wife was my teacher on how best to walk with her on this healing journey. She asked me not to read any of the popular information available about extreme dissociation because I’d already begun a process of fully engaging with her and she didn’t want me to stop doing so because some book or expert said otherwise. I honored that request for a couple of years until we had firmly established a methodology that felt comfortable and in which we saw a lot of healing take place.

Then, I began to read some expert literature online, and realized we had naturally inclined toward implementing the principles psychoanalyst John Bowlby had delineated decades earlier: safe haven, proximity maintenance, affect regulation, and others. Without our having formal knowledge of them, they had already helped us. So I studied them more thoroughly so that I could better integrate them into my interactions with my wife, performing the role of her primary attachment figure. We both benefitted from that adjustment, and today we purposefully embrace attachment principles with each other and even with our adult son.

We didn’t do it all by ourselves. During the first five years of our journey, my wife saw an alternative counselor (completely outside the system) who, happily, had prior experience with trauma and dissociation. Her help gave me the time to deal with my own issues, ranging from anger to disillusionment over our relationship, and to develop a working philosophy and methodology that would both hold our relationship together and enable my wife and me to heal as individuals. The counselor also gave me time to learn how best to be a companion for my wife. By the time the two of them amicably parted ways years later, I was already bearing the bulk of this responsibility. I’d learned to become comfortable in that role as we walked together and as I became more in tune with her needs and my own.

Things were going relatively well for us during years six and seven of our journey. We had learned to tear down the dissociative walls separating various parts of my wife’s greater self. The extreme states were beginning to fade into the rear-view mirror, and our relationship was becoming healthier than either of us had experienced in 25 years together. I thought that we would soon move into a new phase of satisfaction and enjoyment in our marriage…until an unexpected fork in the road sent us down a difficult path we are still navigating today.

And yet, the healing continues, just at a much slower pace. My wife is connecting and “syncing” with all of the dissociated parts of herself that were once lost in her traumatic childhood, and I continue to fulfill my role as her primary attachment figure. This part of the journey has required a lot of sacrifices from both of us. But now we know what we must do to see healing and reconnection with this latest part of her greater self, even though this stage has taken longer to complete than all the previous stages combined.

Sharing a Road Map

Through discovering Mad in America,  I realized that compared with so many of our fellow sojourners, our healing journey through extreme states has been truly different. Yes, it’s been incredibly difficult, but thankfully my wife didn’t suffer the loss of agency and social status, forced drugging, or any of the other indignities psychiatry and our culture at large have foisted on those experiencing mental distress, treating the crisis as a problem rather than an opportunity to showcase the best of our humanity.  To make it this far, we’ve had to learn to attach strongly to each other. That bond has held us together through the pain and sacrifices we’ve each had to make, creating something positive rather than adding trauma on top of trauma.

So, in an attempt to bridge the gulf between our collective experiences and traditional mental health system approaches, last year I wrote a booklet titled Before You Call for Help, which covered some of the foundational lessons I learned on our 14-year healing journey. Mad in America graciously agreed to put the booklet in their Family Resources section, here. But when I began to attend one of MIA’s online support groups a few months ago, I realized this booklet was just too cerebral and didn’t paint a clear enough picture of what an alternative healing journey outside the biomedical paradigm can look like.

And so I recently wrote another booklet, Engaging “Madness.” In it, I attempt to paint a clearer picture of our experience by using lots of personal stories from our healing journey. I still outline some basic presuppositions that allowed us to take this different pathway, but this time I make my personal experiences as her healing companion the foundation of the booklet.

There are five short sections comprising 42 pages. Toward a Working Philosophy talks about some of the important life experiences that prepared me to take this healing journey with my wife and how they formed the way I walk with her.

Engaging “Psychosis” discusses how I learned to see her experiences from her perspective, and thus why don’t view them as “psychotic.” The Rip Van Winkle effect, as I call it, helps explain so many of our loved one’s experiences, which our culture dismissively labels as psychosis.

Engaging “Delusions” (and “Paranoia”) discusses my failed attempts to argue my wife out of her delusions. Once I learned to engage her perceptions on their own merits, then healing was possible.

In the Engaging Voices section, I briefly relay my experiences connecting with three of the eight voices my wife heard on this journey. When my wife first began to hear voices, she wanted me to engage them. And so we proceeded with a trial-and-error approach of learning to listen to rather than shun the voices. I recall how my wife’s angry voice and I slowly moved from an adversarial relationship to one of mutual assistance to one of loving friendship and more. I also recount engaging two “mute” voices, the last of which couldn’t remember our interactions from day to day because she seemed able to access only short-term memories.

In the last section, Engaging Extreme States, I share how the attachment principles of safe haven, proximity maintenance, and affect regulation gave me the tools to not only walk through those extreme states with my wife but also help her find real healing so that it has been years since she has suffered from them.

As I say, I learned to help my wife heal by becoming that stable presence in the midst of her flashbacks, panic attacks, and more. We also found our way through eating “disorder” issues and body “dysmorphia” as we untangled the dissociation and reconnected her to parts of herself that were able to counteract these tendencies. As well, we went through years of comatose episodes and discovered how to easily navigate them until we were able to effect a complete cessation by changing her “internal working model” as described by Bowlby.

A Call to Action

There are many promising, alternative efforts out there including Soteria House, peer respite, and Open Dialogue. But in the end, we—the family, the spouses, the significant others—are the ones who must stand in the gap for our loved ones when they fall into extreme distress. It’s never convenient. It doesn’t just happen at the therapist’s office or when they are staying at a specialized sanctuary or incarcerated during a forced hospitalization. They need our love and healing support 24/7, whenever the extreme states and more overtake them. But I believe that if we are empowered to understand the basic principles John Bowlby laid out, we will have many of the tools we need to walk through our loved ones’ mental hurricanes and turn them from fear-inducing events for everyone involved to healing and bonding events for both sufferer and companion.

So I encourage you to read my booklet. And I’d also like to hear from people interested in creating a network of family, spouses, significant others, and anyone else interested in supporting each other as we walk with our loved ones on a mutual healing journey. It’s not easy. It’s the most difficult thing I’ve ever done, but I love my wife and she is worth it, and I believe there are others reading this who would agree their loved one is worth it, too.

Booklet →






Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. The “Mad” designation is a victory for the family. As usually too is suicide.

    So it is important to never be in a situation where one will passively accept such a label, and to never give up in the struggle for justice by harming oneself.


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    • Hi Joshua,
      though it doesn’t really come out in this little introduction explicitly, in the booklet I make it clear that I don’t accept the terms ‘mad’, ‘psychosis’, ‘delusional’ or ‘paranoia’ when talking about my wife’s experiences or my attitude toward them and that is why they all appear in quotation marks…unlike voices and extreme states which do not appear in quotation marks in the booklet and yet I still take issue with how our culture views them.

      My wife is just my wife, and when I engaged her in all her experiences, things made sense from her perspective and so we found a way thru them TOGETHER.

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  2. Hello again Sam,
    It cannot be an accident that just a few moments ago I sent a comment on your last piece (under the “Why Do We Lock People Up?” essay) asking if you had ever considered your wife’s experiences to be “spiritual emergence”? I see you’ve given us a lot more information here and it will be enlightening to read your booklet when time permits. So, thanks again!

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  3. Sam Ruck reports that he has commented here for about 6 years. Over 600 comments. I’ve read MOST of them. I am deeply, deeply impressed, to read about the love & dedication that Sam has given his wife. Sam has, over these 6 years, written almost a text-book on how to FOLLOW, and WALK WITH, and TRULY HELP an abused loved one. His wife is very lucky to have Sam, and I’m sure Sam feels very lucky to have her. Had she been in the traditional “mental health system”, she would NEVER have received the level of caring & love that Sam gave her. Nor the help & healing. Sam’s case is unique, and as an “anecdotal report”, psychiatry will give it little notice or credibility. But we here at MiA recognize the GREAT LOVE which Sam’s story of life with his wife represents. DEEP RESPECT to you two, Sam Ruck!…. May God’s blessings shower upon you….KEEP UP the GOOD WORK!….

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    • Hi Bradford,
      thank you for the generous comment. I wish you weren’t correct…that our case is just seen as anecdotal, sigh. Even here in the Mad in America, counter cultural movement, I have struggled to find a place to really change the conversation how family can be available 24/7, 365 days a year for their loved ones and so we MUST be the ones taught and empowered to walk with them while respecting their total agency.
      But it’s more than that; my wife and I embraced her extreme states, her extreme dissociation and everything else…and we found a way thru them. I’ve tried to shout ‘eureka’ for 15 years, but I just can’t find anyone with a big enough platform to help me spread the word. I so appreciate MiA giving me this chance to do so, but I was heartbroken by the lack of response and even ‘hits’ to this blog and even the free downloadable booklet.

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