Psychiatrist in dissent

Continuing with the theme introduced in Difference, deviation and dissent (18 Oct 2013) Sean O’Shea holds up a mirror to the world of mental health by discussing the work of psychiatry’s bête noire, the late Ronald David Laing (1927 – 1989).

Is love possible
Is freedom possible
Is the truth possible
Is it possible to be oneself as a human being
Is it possible to be a human being anymore
Is it possible to be a person
Do persons even exist anymore?

Game Theory and R.D. Laing’s Dream of Freedom

R. D. Laing was born on a cold wet October day in 1927 in Glasgow. He died sixty-one years later while playing tennis in the South of France. Not a bad innings one might say bearing in mind that men in Glasgow’s East End have a life expectancy of 54 – it is 71 in the better-off areas.

An unhappy childhood, his experience as a junior doctor and particularly his experience in psychiatric hospitals fuelled his sympathy with people who find themselves on the margins of society and are often defined as mentally ill. After completing his medical training he studied psychiatry and went on to qualify as a psychoanalyst, thus joining what Freud once referred to as the impossible profession.

He became a lead figure in the anti-psychiatry movement of the sixties, though this label was disavowed by him. He was also for a time a prominent figure in the counter-cultural movement which anticipated the demise of capitalism, and looked forward to the creation of a more egalitarian society in which human diversity would be celebrated and resources mobilised for the meeting of human needs rather than the pursuance of private gain.

Like many dissidents of this period he was influenced by Marxism, humanistic psychology, Eastern spiritual traditions, psychedelia and continental philosophy. Less recognised was the influence of the Scottish Christian tradition and the philosophy of personalism as exemplified in the work of John Macmurray, 1891-1976 (The Self as Agent and Persons in Relation).

The medical gaze

He was critical of what he called the medical gaze (a term coined by the French social theorist Michael Foucault, 1926-1984), which viewed people as physical systems which, for the purposes of treatment, were divided into their component parts. This attitude was demonstrated by the common practice amongst medical staff in hospitals of referring to “the liver” in bed eight, “the cancer” in bed eleven or “the bladder” in bed twelve. Laing maintained that regarding people in this way objectified and dehumanised them.

He was also critical of the strongly somaticist approach of post-war British psychiatry, which regarded mental health problems as neurological diseases. While he did not deny that there were some mental disorders which had identifiable organic causes such as dementia, many other imputed disorders were not, in his view, linkable to any identifiable brain pathology and as a consequence should not be regarded as illnesses.

He was dismayed by the standard treatment meted out to psychiatric patients at this time which included incarceration, electroconvulsive therapy (ECT), insulin coma therapy, lobotomies and latterly a strong reliance on powerful psychotropic drugs which, while having some beneficial effects had also severe side effects for many patients.

Laing’s particular area of interest was in researching and understanding the schizophrenic experience. He argued that the apparently irrational communication, disordered ideas, beliefs and experiences associated with schizophrenia were socially intelligible responses to intolerable psychological distress in interpersonal relations, and believed that such “mad” behaviour needed to be understood and worked through in a sympathetic social environment rather than treated as an illness.

The story goes that once faced with a naked woman diagnosed as schizophrenic rocking silently to and fro in a padded cell, Laing took off his own clothes and sat with her, rocking to the same rhythm until she spoke for the first time in many months.

Family life

For Laing interpersonal relationships were often characterised by people’s struggles to assert the openness and creativity of their own existence in the face of attempts by others, particularly those with power over them, to define, devalue or objectify them.

In his most famous books The Divided Self and Sanity, Madness and the Family Laing discussed the way distorted communications may entangle people in cycles of violence, fear and oppression.  He introduced the notion of “ontological insecurity,” which refers to how a person’s individual sense of identity can be undermined. Laing saw the process as associated with the absence of positive reciprocity between parent and child with failure to affirm the child’s separate existence, needs and feelings, insisting that the child meet the parent’s own demands and expectations. The child is forced to develop a front – a “false self.” The child may learn to comply with the parent’s image of them but inside they may feel unreal or phony. In such circumstances the child fails to develop a genuine sense of their own separate selfhood, and may experience relationships as precarious.

Laing also expanded on the notion of the “double bind” invented by the anthropologist and linguist Gregory Bateson (Towards a Theory of Schizophrenia, Behavioural Science, 1956). A double bind is an irresolvable situation in which a person receives contradictory messages. It leads to an emotionally distressing dilemma or state of perplexity as it requires a choice between equally unfavourable options, in other words a lose-lose situation. An example is when a parent tells their child that they love them while at the same time striking them or physically withdrawing from them. Or a child may be encouraged to speak freely, but be criticised or punished whenever they do so. Persistent exposure to contradictory messages of this nature may literally drive a person “mad” (The Divided Self: An Existential Study in Sanity and Madness).

For Laing, family and group life were theatres in which conflicting emotions of love and hate were enacted. The associated struggles and competing quests for identity and recognition left few participants entirely unscathed.

The notion of the family as a crucible of potentially contradictory emotions, a source of refuge and a war zone, was not original to Laing. It can be traced back to some of the earliest depictions in classical Greek mythology and the work of Freud. However, Laing’s strength lay in his ability to illustrate and describe family conflicts in accessible language through detailed case studies (Sanity, Madness and the Family, co-written with his colleague Aaron Esterson, 1923-1999).

Laing’s ideas were a key inspiration for David Mercer’s successful and controversial play In Two Minds (1967), which vividly and dramatically depicted the harrowing experience of a young girl labelled schizophrenic who was entrapped in a dysfunctional family. It illustrated how her apparently “mad” behaviour made sense as a strategy for surviving an untenable situation. This play was later made into a successful film called Family Life directed by Ken Loach which was widely used as a training resource in social studies courses.

Psychic emergency

As his thinking evolved Laing came to believe that some of the states commonly regarded as schizophrenic could also be regarded as stages in personality transformation or spiritual awakening. If correctly understood and supported, these psycho-spiritual crises or psychic emergencies could result in emotional healing and personal growth.

Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.

The Politics of Experience & the Bird of Paradise, R.D. Laing

The mystical literature of both East and West testifies to and valorizes such states, and “theia mania”, meaning divine madness, was referred to in the Platonic dialogue Phaedrus (370BC).  In this dialogue the philosopher Plato depicts Socrates as citing moments of inspiration and Dionysian frenzy – during which individuals were released from constraints of rationality – as instances of theia mania. States of enthusiasm (enthousiazon) and ecstasy (trance-like state in which a person transcends normal consciousness) were valued by the ancients as “gifts from the gods” and distinguished from diseased states of mental dysfunction.

Experiences of spiritual awakening, transformation of consciousness and ecstasy are not congruent with the mainstream, western materialistic world view, are commonly problematized or viewed as pathological by orthodox psychiatry and with scepticism by the established churches.

In contemporary society, people might seek support with undertaking potentially perilous spiritual journeys – whether entered upon involuntarily or deliberately – but who might guide them on their way?

Therapeutic communities

If mental disorder and schizophrenia in particular were related to distorted communication, then undistorted communication within a non-oppressive social milieu could have healing potential; hence Laing’s advocacy of the therapeutic community as an alternative way of supporting those with mental health problems.

The term therapeutic community was coined by the psychiatrist Thomas Main (1911-1990) in a paper entitled The hospital as a therapeutic institution. Such social therapy projects were initiated in some post-war psychiatric hospitals, and flourished for a while in the sixties and seventies, under both public and private auspices, in community as well as in hospital settings. These projects were often transitional in nature and each developed its own particular style and ethos.

The common philosophy was that people should be active participants in their own and each other’s mental health care, with open discussion of thoughts and feelings, suspension of hierarchies, flexibility of roles, sharing in the tasks of daily living and a concerted attempt to promote more genuine human relations. It was a democratic, participative approach that often included group psychotherapy, individual psychotherapy and the use of music and art as a means of healing and personal growth.

In 1965 Laing and others founded a charity, The Philadelphia Association, to promote and develop their work and offer training in alternative ways of understanding and supporting people with mental health problems.

Kingsley Hall in the East End of London was one of a number of therapeutic community households developed around this time. It was intended as a place where people could disentangle themselves and work through their “madness” in a sympathetic and supportive milieu without resort to drugs. Residents availed themselves of the permissive atmosphere to confront their demons and descend into their private infernos sometimes discretely, sometimes noisily.

Mary Barnes (1923-2001), one of the residents at Kingsley Hall, achieved notoriety when, during periods of regression, she created paintings using her own faeces.  She went on to become a successful artist and co-wrote an account of her journey through madness with her psychotherapist Dr Joseph Berke (Free Association Books in 1991).

The lease on Kingsley Hall expired in 1970 and the project closed, much to the relief of locals who were not pleased to have on their doorstep an apparently anarchic experiment in communal living populated by some very odd communards, and some even more odd doctors.

Experiments in alternative approaches to working with people with mental health problems were to decline in the 1980s and 1990s. This was partly due to financial stringency and pressure from NHS reforms, including the introduction of care in the community and the associated purchaser-provider split.

The advent of a new managerial culture within the health and social services brought preoccupation with inputs, outputs, measurable targets and cost effectiveness. These factors combined to produce a climate which was inhospitable to unconventional, collectivist innovations in health and social care.

In part two of Psychiatrist in Dissent I will discuss these changes in more detail, consider the politics of diagnosis and examine Laing’s legacy.

• Ken Loach’s film Family Life 1971 is available to watch free on You Tube. Just Google ‘Family Life 1971’  You Tube

SOS March 2014

 

 

 

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