It is madness. And if you don't know who you are, or if your real self has drifted away from you with the undertow, madness at least gives you an identity. It's the same with self-loathing. You're probably just normal and normal-looking but that's not a real identity, not the way ugliness is. Normality, just accepting that you're probably normal-looking, lacks the force field of self-disgust. If you don't know who you are, madness gives you something to believe in.