33Chapter 28. Conclusion: Who Is Actually Insane?

This book didn’t begin with an idea. It began with a needle. Baku. Psychiatric Hospital Number Two. The year 2000. I stood in the ward as a young resident doctor, watching as they prepared an injection of sulfosin. A patient with chronic schizophrenia. A method rejected by the global scientific community decades earlier. Decades had passed. The world had said “no”—but here, they still said “yes.” A man who posed no real threat to anyone but himself. And there he lay before me. The needle flashed. The pain that was about to begin. The senselessness that was about to unfold. Remember this ward. Because everything you’ll read next grows out of it.

I asked myself: Who here was truly in a state of madness?

Now, having written this book, I want to return to that question. And answer it. Or, more accurately, to acknowledge that this question has no single answer, and in that impossibility lies the central lesson.

Who was in a state of madness?

He wasn’t here by choice. Invisible vices gripped his body. The vices of illness. The same schizophrenia that had severed his ties to reality. What was happening behind his fevered gaze? Voices? Visions? The doctors knew the answer. He did not. His brain was lying to him. His fear was a chemical storm in his synapses. His delusions were not metaphors. They were broken neural circuits. Madness? No. This wasn’t a tale of possession. It wasn’t a choice born of despair. This was a diagnosis. Clinical. Precise. Ruthless. It happens. Brains fail. Like lungs with pneumonia. Like the pancreas with diabetes. Like blood vessels with a stroke. Only here, the target was reality itself. And the boundary between “I” and the world slowly dissolved. Eaten away by the acid of illness.

Not the doctors standing beside me. They were specialists, like me. They had diplomas. They had been trained. They believed in what they were doing. They weren’t in a state of clinical madness—no psychiatrist would ever diagnose any of them with psychosis.

Yet they were doing something structurally close to madness—systematically applying a method with no scientific basis, utterly convinced of its usefulness. They saw no contradiction between what they’d been taught in universities and what they practiced. They considered normal what the global scientific community deemed an anomaly.

This wasn’t the madness of an individual brain. This was the madness of a system. A collective error, perpetuated for years, resistant to self-correction, protected by corporate solidarity and institutional inertia.

Not me, the young resident by the window. I was inexperienced, young, powerless to stop what was happening. I watched and stayed silent. My silence was an act of survival in a system where I was the youngest and the weakest.

But my silence was part of that same systemic disease. Every young doctor, every resident, every junior staff member who stays quiet when standards of care are violated contributes to a collective illness. My silence back then was forgivable, because I didn’t know what to do. My silence today, when I do know, would be unforgivable. That is why I am writing this book.

Madness in Our Time

That scene took place twenty-five years ago. Much has changed since then.

Some of what changed is good: sulfazine has become a thing of the past in most post-Soviet clinics. International standards of psychiatric care are gradually being adopted in our region. Young doctors have broader access to the world literature. Patients increasingly know their rights. Ethical codes, the Madrid Declaration, the WPA Code of 2020 — all of it is available to anyone who wants it. The pharmacotherapy of schizophrenia has improved: second- and third-generation antipsychotics have arrived, with fewer side effects.

Some of what changed is bad: the old systemic madness — the madness of Soviet psychiatry — has been replaced by a new one. A madness external to medicine, but aimed at the same patients. Constellation practitioners, theta healers, regression therapists, “authors of unique methods,” “hereditary healers,” “ancestral memory specialists,” “coaches” promising instant happiness. Millions of social media followers. Billions of rubles a year. Hundreds of thousands of patients receiving, instead of treatment, an imitation of treatment that makes their real condition worse.

The pandemic of madness has changed its form but has not shrunk. It has spread wider. It has reached deeper. It has grown more flexible. It has grown more deceptive.

Three Questions for the Reader

Now — three questions I want you to answer for yourself as you close this book.

Who is in greater danger: the person who hears voices in a locked ward, receives antipsychotics, and within a few weeks returns to reality — or the person who daily announces to an audience of a hundred thousand that he “reads the field of your lineage,” and whose condition will never go into remission, because it is never diagnosed, looks like success, and is reinforced by every new client?

Who is more dangerous to society: a depressed patient spending forty-five minutes a week sorting through his feelings with a professional — or a person vested with power who broadcasts to millions that “official medicine is a conspiracy” and passes laws that affect those millions?

Who is more dangerous to those close to them: a person with schizophrenia who takes medication and sees a doctor — often a wonderful spouse, parent, worker — or a “normal” parent who, on advice from a social media feed, doesn’t take a child experiencing a first psychotic episode to a psychiatrist but drives him to a regression therapist instead?

In all three pairs, the answer is the same. And in all three, it is the opposite of what a thousand-year habit of fearing the wrong people suggests to society.

The definition of madness that I propose

I gave this definition in the intermezzo of Part One — before all the diplomas, awards, and price lists. I’ll repeat it here now, when an entire book stands behind it.

Madness — in the clinical sense — is a disorder that disrupts a person’s connection with reality and their ability to function adequately.

Madness — in the broader sense I use in this book’s title — is the systemic, persistent, self-uncorrectable denial of reality that harms both the bearer and those around them.

By the second — expanded — definition, anyone is mad who: — systematically sells services that are physically impossible to deliver; — systematically denies scientific facts in favor of their own beliefs regardless of evidence; — harms others with their practices but justifies it with “their mission,” a “gift,” or “calling”; — creates a circle of followers who shield them from criticism; — is incapable of considering the possibility of their own error.

By this definition — some psychiatric patients are not mad. They are ill, but they know they are ill. They accept treatment. They adjust their reality. They learn.

And some people outside psychiatric wards, living free, successful, famous, wealthy — are utterly mad in every sense of the word. They are not ill by medical standards. But they are abnormal by the standards of rational engagement with reality. And — unlike clinic patients — they actively infect others with their condition.

My own position

I am a psychiatrist. I treat illnesses. I am not a politician. I am not a messiah. I don’t have answers to every question.

I know only one thing. Every day, the same tragedy unfolds before me. People who have lost everything except their last shred of hope sit across from me. Their lives lie in ruins — not from illness, but from lies. Fakery. Deception. Ten years. Fifteen. Twenty. Two decades they walked in circles, blind, knocking on the wrong doors. Invisible clocks counted seconds, minutes, years. Hundreds of thousands. Millions of rubles — money earned in sweat and blood — wasted into nothing. Paid for services that don’t work. No force on earth will give those years back. Never. And beside them — their children. Children whose fates are twisted like paper crumpled in a fist. Poisoned by esoteric practices their parents, unwittingly, used to toxify their families. Lost years. Gone forever. They can’t be reclaimed.

And behind each of these people stand hundreds of thousands of followers of the same influencers who “treated” them. And thousands more influencers just like them, gaining new followers every day.

This is an epidemic. Not metaphorical. Real, with real casualties and real economic losses. With a real — though as yet untaken — chance to stop it.

My request to the reader

You’re holding this page before your eyes. You’ve read to the end. Why? This book didn’t let you go. That means something struck a chord. Deep. Under your skin. Perhaps you’ve walked through this darkness yourself. Felt the searing burn of what’s described here. Maybe someone close to you spiraled into this abyss—and you stared into their dilated pupils, searching for recognition there. Or maybe you’re a colleague. A mental health professional. One who locks the doors behind them every day. Or you’re a teenager just starting your path, already sensing the chill of encroaching fog. You’re a parent, fists clenched painfully behind your back, worrying about your child. You’re a journalist, politician, teacher. Someone shaping the world they must live in.

From any of these positions, you can do something. The simplest—tell one person about this book: someone who could save years of their life and avoid profound disappointments. Harder—speak publicly: if you have an audience, however small, share a scientific perspective. Harder still—act within your profession: doctors—treat better, educators—teach more precisely, journalists—verify more thoroughly, lawyers and politicians—change the rules.

And the hardest—don’t retreat when you meet resistance. And you will meet it. The pandemic insanity industry is vast and lucrative. Its defenders are vocal and aggressive. They’ll accuse you of intolerance, offending sensibilities, totalitarianism, pseudoscience (ironically, exactly that), and ignorance. They’ll deploy every rhetorical weapon at their disposal. Because their economic model depends on silence.

Don’t back down. Just—keep speaking.

The Last Word Goes to the Patients

And last but not least.

If you’re the person I’ve written about in this book: a patient with anxiety, depression, OCD, psychosis, family struggles, or trauma. A patient now thinking: “I’m suffering. I don’t know where to turn. I read this book, and psychiatrist Kenan Ragimov says I need real specialists. But how do I know who’s real?”

Let me answer briefly—the full response is in the appendix. There you’ll find “How to Spot a Real Specialist” checklist and red flags. It’s designed to be photographed, shared, pinned on walls.

Here’s the core: A real specialist promises no miracles and doesn’t rush you. Their diploma checks out in state registries; their methods belong to science, not personal ideology; their office has no place for ancestral programs, energies, or past lives. They candidly discuss side effects, don’t keep you fearful, and see you as a partner—not a soul awaiting revelation.

If you’ve found such a person, consider yourself lucky. Work with them. If you didn’t find them right away, keep looking—it’s perfectly normal to try a second or third time.

But don’t go to a family constellation therapist. Don’t go to a regression therapist. Don’t go to a theta healer. Don’t go to a “specialist in ancestral memory.” Don’t go to the showman from The Battle of Psychics.

Your life is not their business model.

The Last Scene

I’m returning to Baku’s Hospital No. 2. To the year 2000. To the scene where this book began.

The patient has been given an injection. He’s lying on his stomach, eyes tightly shut—he knows what’s coming next; he’s been here for years. In a few hours, the fever will start. Then, four points of pain that won’t subside for three days. The ward smells of camphor and bleach. Outside is an ordinary Baku day, and in the hospital courtyard, someone is hanging laundry.

By the window stands a young doctor. He’s twenty-four. He understands—already understands—that what’s about to happen isn’t medicine. He has the words to say it. He doesn’t say a single one.

Twenty-six years. Twenty-six years I’ve been watching him—and for twenty-six years I haven’t been able to approach him. To ask: Why are you silent? I know the answer. I’ve always known. The answer is me. He’s silent because he’s the junior. Because that’s how it’s always been done. Because in this system, a question is audacity. And audacity is punishable. Period. That’s the formula of madness. Remember it, because it doesn’t just rely on those who commit it—it relies on those who stand by. Those who watch. And those who stay silent. Silence is its oxygen.

That ward no longer exists—not in the form I once knew it. Sulfazin has disappeared from our departments—not everywhere, not immediately, but it’s gone. The patient is likely long dead. I don’t know his name. I’ve dedicated this book to him—it’s all I can do for him, and it’s shamefully little, but it’s more than anyone else in that ward did for him.

Recently, in my own clinic, during a case review, a young resident raised her hand and asked me—calmly, without defiance, in front of everyone: “On what basis did you add the second medication? What data supports the combination over monotherapy in this case?”

A profound silence has settled in the chamber of my memory.

For a split second, I felt a reflex from that old system rise within me: How dare she? And then, overwhelming it, came what I’ve worked twenty-six years for: She dares. She must dare. A junior’s question to a senior isn’t audacity. It’s medicine’s immune system. It’s the only thing that separates a clinic from a cult, a department from a parish, a method from a formula.

I went over the data with her. On one point, she was right, and we adjusted the treatment plan. The patient will never know—they’ll just feel better a little sooner.

This is my answer to the year 2000. Not this book—the book is just an explanation. The answer is that question, asked out loud. The young doctor by the window has finally spoken. It took twenty-six years, and he’s not speaking in my voice—and that’s even better.

Thirty centuries. For thirty centuries, humanity drilled holes into skulls — to release from the sufferer’s head what wasn’t there to begin with. Trepan. Crucifixion. Scalpel. Insulin. Ice pick. Sulfur. Figurines. Ether. Eight tools. One result. The hole was always drilled in the wrong place. Every single time — the wrong place. Because it wasn’t what resided in the patient’s head that needed releasing. It was what resided in the healer’s head. Certainty. Without verification.

At last, a way out has been found. It doesn’t require trepanation. It requires a question, asked aloud, and an honest answer to it.

Ask. Demand evidence. Don’t stay silent by the window.

And then, the holes in the skull — all of them, in every form — will finally no longer be necessary.

Kenan Ragimov, psychiatrist, psychotherapist, Baku, 2026