This chapter focuses on actual and potential relationships between madness, Mad Studies and the politics and ideology that we are subject to and which are the context of our lives. The two political ideologies that came to dominate the first half of the twentieth century bear early and sharp witness to this: Soviet Communism and German Nazism. The true focus of Mad Studies should be one beyond the psych system and psychiatrization of everything. It will also benefit by learning from the linking of material struggles in the global south to challenge the maddening nature of our world and our often irrational political and economic structures and assumptions more generally. The broader connections between ‘mental health problems’ and political systems have now been well rehearsed by social epidemiologists. The dominant global politics in the twenty-first century has been neoliberal; that is to say based on globalized free market-driven economics with reduced expenditure on supportive welfare services.