Defeating Mia in the attic on Madhouse difficulty is an extreme and challenging task, as she is incredibly vicious and aggressive and almost constantly in a berserk state. Moreover, in this high difficulty, you have significantly less ammo to fight with. However I found that if you aim at her as she is approaching, she will start charging towards you, giving you the chance to block her attack and kick her back, thus being able to shoot her freely, then run away to keep a distance. Doing this on repeat guarantees that Ethan won't get a single scratch from her chainsaw. As you see in the video, even though I missed a couple of shots, my bullets were more than enough to beat her.

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