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The International R.D. Laing Institute

Colloquia Topics Index [link]Politics of Diagnosis

Audietur et altera pars1


It is no coincidence that Plato, who often made use of the medical metaphor in his dialogues, described Socrates as the "doctor of souls." Like the gadfly of Athens, the abiding concern is with the neglect of the spirit in contemporary psychiatric practice, but practitioners must try to avoid his fate.

I do not know how to convey to readers the experience of mental suffering. Perhaps no one can really do so. I believe that it was Freud in one of his great essays who distinguished between mere "mourning" and "melancholia" by suggesting that "with melancholia, the shadow of the object of loss falls accross the ego." Loss is certainly a word that comes to mind when I recall my own bout with mental illness. Despair, hopelessness, exquisite agony, paralyzing suffering are all words that come to mind too. In my case the experience resulted in the loss of my profession and social standing, in the loss of many friendships, and of lots of money too as well as of a life that I had struggled to build over decades. I am now left to cope with the stereotypes and stigma and incomprehension of people. Yet I think of myself as a fortunate survivor, for I know that I came close to ending my life and that many others in similar circumstances have actually done so. Paradoxically, the greatest obstacle to my recovery was posed by the so-called mental health professionals whose job it was to help me. Moreover, this obstacle largely consisted in a set of assumptions about my suffering as an "illness," something external to me, and myself as "sick" and therefore to be cured "externally" also -- whether through medication or other "treatment" provided from above, as it were, by an "expert."

But the feeling of a patient in extremis under such treatment is of being reduced to the condition of a frog in a laboratory that is about to be dissected by people in white coats, who seemingly haven't got a clue about what is wrong, but are going to find out "for my own good." This is a phrase one hears a lot from mental health "experts": "This is for your own good." Often this judgment is arrived at without consulting the "patient." "The patient" (one no longer has a name) is objectified, reduced to a set of categories and labels to be found in textbooks, described and referred to in a hideous jargon, often while one is in the room, turned into a topic for conversation and what Foucault might have called, "normalization." One is ignored as the experts consult among themselves. One's opinion does not matter. One doesn't know because one is not wearing a white coat.

All of this is terribly wrong. In my slow return to what passes for sanity and normal life, in my gradual so-called recovery, I began to improve only when I ignored the advice of experts. I returned to my own sources of strength in the books of the thinkers I most respected: Schopenhauer and Nietzsche, Freud and Jung, Tolstoy and Mann, Kafka and Proust and Shakespeare, Sartre and Laing. Most especially, R.D. Laing -- whose genius was a source of boundless solace and comfort. There is simply no other writer who has so perfectly understood the experience of madness, of acute mental suffering, of the all-pervading sense of "ontological insecurity" in the midst of a schizophrenic break.

In The Divided Self Laing states:

The words of the current technical vocabulary either refer to man in isolation from the other and the world, that is, an entity not essentially in relation to the other and in a world, or they refer to falsely substantialized aspects of this isolated entity. Such words are: mind and body, psyche and soma, psychological and physical, personality, the self, the organism. All these terms are abstracta. Instead of the original bond of I and You, we take a single man in isolation and conceptualize his various aspects into the "ego," the "superego," and the "id." The other becomes either an internal or external object or fusion of both. How can we speak in any way adequately of the relationship between me and you in terms of the interaction of one mental apparatus with another? How, even, can one say what it means to hide something from oneself or to deceive oneself in terms of barriers between one part of a mental apparatus and another? This difficulty faces not only Freudian metapsychology but equally any theory that begins with man or a part of man abstracted from his relation with the other in this world.1

What Laing understood better than anyone is the degree to which such pathologies are, if not produced by societies and social settings today, at least encouraged and reinforced and worsened by them, that the conditions of contemporary life are themselves quite mad in many ways -- in terms of how they warp and deform the spiritual aspects of persons. Better than anyone, he knew that madness is the product of adjustment to insane circumstances. Commenting on Laing's later work, Professor Daniel Burston in The Crucible of Experience notes that:

For Laing, the "normal" person in contemporary society enjoys a state of "pseudo-sanity" that forsters the atrophy of critical thinking, precludes the possibility of genuine transcendence, and promotes violence through the demonization of those who do not belong to one's own reference group. Accordingly, he now said that true sanity is not predicated on the ability to shed one's false self intermittently, as circumstances allow, but radically and completely, until the false self or ego "dies" or is transcended in a spiritual katabasis that takes one "inward" and "downward," rather than "up" and "outward." ... One can pursue this goal deliberately, through spiritual disciplines, or be thrust involuntarily on this descent into an "inner space" in a process that, if properly facilitated, results in a rebirth and reintegration of the personality.2

The very worst thing that any therapist can do is to interrupt or distort or obstruct the completion of this journey on the part of one who has it thrust upon him; and yet, this is exactly what most contemporary therapists try to do with medication and other interventions, often out of sheer ignorance. I was astounded to discover that psychiatrists entrusted with the care of others had never heard of such major thinkers as Kierkegaard and often knew writers such as Laing or Adler or Jung less well than I did. No therapist I ever spoke to knew my first language or the history and culture of the land of my birth or bothered to learn these things nor, for that matter, much about me; rather, the goal was to find a way to label me and dispose of me. This is not an unusual experience for "patients." If Wordsworth is right that "the child is father to the man," then children who experience and are scarred by wars and revolutions, by hunger and poverty, by forced emigration, by paternal deprivation, may well find themselves in the midst of an existential crisis in their late thirties from which a forced interruption can be disastrous.

My plea to therapists everywhere is for greater humanity and not just technical competence, for understanding in the hermeneutic sense, rather than an attempt at knowledge in the scientific sense of all symptoms and causes and treatments of mental illness. The afflicted hope for a Buberian "I and Thou" sort of therapeutic encounter with a person who is a physician/therapist, rather than a prescription and a bored request from an expert for a "phone call in the morning." The suffering human being wants that humanity to be uppermost in the therapist's mind, he or she wishes to retain some dignity and to be an equal participant in discussions about his or her plight, one whose contributions are valued. Laing's sadly neglected work rightly counsels therapists to avoid an excessive focus on "correcting" or "curing" behavior and to recognize the equal (or greater) importance of understanding experience, especially the experience of the schizophrenic break, and of allowing themselves to feel compassion and empathy.

In a time of war and displaced persons, of confusion and suffering, Laing understood that, to some degree, we are all displaced persons and we are all confused and suffering -- only some of us more so than others.


1Laing, R.D. The Divided Self. Tavistock, 1960, p.19

2Burston, D. The Crucible of Experience: R.D. Laing and the Crisis of Psychoptherapy Harvard University Press: 2000, p. 135

© 2003 Juan Galis-Menendez

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