Philosophers traditionally distinguish between excuses and exemptions. We can excuse someone and still see them as a participant in normal human relationships, but when we exempt someone, we see them as something to be managed and handled: we take an objective attitude to them. Madness is typically assumed to ground exemptions, not excuses. So far, the standard philosophical picture. Seeing other people as objects to be managed and handled rather than as persons with whom one can have relationships is, however, ethically problematic. If I am mad myself, consistently seeing myself this way becomes downright unsustainable. A better option, I will argue, is to fully appreciate my own difficulties and learn to show myself compassion and understanding. I, then, can excuse myself on those grounds. Furthermore, a compassionate self-excusing attitude leaves room for both nuance and improvement in a way that total exemption does not. Finally, I will argue that many mad actions ought to be considered justifiable and justified rather than in need of exemption or excuse.