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As long as the institutional power base of psychiatry remains untouched, post modern psychiatry it seems, offers no fruitful way forward - but what of the emerging branches of critical psychology? Here a discourse has arisen which has challenged the traditional modus operandi of doing psychology. Seen by some as feminist and qualitative in its outlook, it has appealed to many who are unhappy with the prevailing positivist status quo, in which the study of meaning has been relegated to a sideshow. A notable footnote in the history of the discipline, Kelly's (1955) personal construct theory argued for a root and branch take over of psychology, using both quantitative and qualitative methods, in order to redefine it as the study of persons. Kelly, like Laing, sought to establish a science of persons, but, as Laing abandoned this quest, so too, Kelly's ship eventually ran aground, as construct theory, increasingly sidelined from mainstream psychology, fell pray to recruits from psychiatry and business, who, no doubt seeking spiritual solace from the raison d'etre of their usual occupations - renowned for their respective contributions to human misery - moved in for a feeding frenzy on the decaying corpus of radical psychology.
So in turning our attention to critical psychology, perhaps a key question is whether the goal of a radical science or a radical psychology of the person is now possible. In essence, such a discipline might pose two distinct but related challenges. One poses the question as to how we can live well. The other concerns the type of knowledge that we can construct to enable us to negotiate this task, and understand what it is we are doing. In short the practice and theory of living. Both of these are bound by the circumstances in which we find ourselves, whether these be described as late or post modernity.
It can't have failed to reach the attention of generations of psychology students, that while the above are questions which have attracted them to the discipline, and about which the discipline itself raises tantalising hopes of deliverance - nothing is ever forthcoming. At issue is whether anything ever can be if things continue on their present course. Questions have been raised (e.g Kvale, 1992) about the ability of psychology to adopt a critical post modern stance - critical that is toward the ruling ideology of consumerism. One reason for this, is that psychology itself as a discipline may well constitute one of the technologies of control, which encourage people to continue consuming and leave unquestioned the current visual, symbolic and material landscape. How to live well in the consumerist self-congratulatory professional psychology of the 21st century? Simple - remodel oneself - discursively of course - in the genetic, evolutionary, neurobiological and social constructionist fetishes of self knowledge. This amounts to work, consume, and individuate with identity. An ideology of resignation (Madsen, 1992). In short business as usual. Knowledge as a kind of action without action. And they say (Anderson, 1990) reality isn't what it used to be!
Critical psychology in its rejection of quantitative methodology, has applied social constructionist perspectives to refute the possibilities of objectivity in psychological and social measurement (Berger and Luckman, 1966). Despite the merits of calling our attention to the distorting influences of powerful interest groups in the production and legitimation of knowledge, and how such influence shapes our notions of truth (e.g. universality, freedom from moral values, emotional neutrality; see Roberts, 2001), some have made the grave error of wishing to reject from scientific enquiry, from the domain of the real, the very categories they invoke (e.g. class and gender) to describe the agencies responsible for such distortion. It is difficult to see how something like social class for example can be entirely socially constructed, when dominance hierarchies of various kinds abound in the animal kingdom (de Waal, 2001), and social class gradients in mortality are found for the overwhelming majority of the principal causes of death, in all human populations in which they have been studied (see Marmot and Wilkinson 1999). Here it is not people's construction of the meaning of social class which is shaping the social world - but the fact of social dominance and hierarchy which has real material effects. And yet we find instances where the material and biological reality underlying the system of social stratification is denied. Sherrard (1998) for example - and she is not alone - argues that what is of interest with regard to social class is "solely the subjective judgements of what constitutes class" (p.486). It would be intriguing to ascertain Sherrard's own subjective judgements of the relationship existing between the distribution of wealth and the distribution of health in human societies - in her eyes both entirely socially constructed presumably. Fascinating as it would no doubt be - it would tell us nothing about preventing premature death and ill-health in millions of people worldwide. This type of intellectually bankrupt (Cartwright, 2000) critical psychology with its emphasis on the plurality of perspectives, sits comfortably with the denial of reality, obscuring the plurality of power and its concentration in the hands of the few. In so doing, it rehearses the inability of most psychologists, whether they follow the methods of the natural or the social sciences, to properly study humans in their biological, cultural and social context. That the cultural context is being invoked to justify what is held to be a new critical stance is nothing short of mystification. At least Freud, who was preoccupied with internal reality, had the decency to recognise that what was internalised, began its life in the world outside the psyche. In conversation with Bob Mullan (Mullan, 1995), Laing made it clear that despite the strengths of constructivist arguments, for him, belief in truth and in the world as existent and coherent outside of the immediate human context was essential.
In a volume of collected essays from another critical voice, Dwight Fee (Fee, 1999) we find some of the contributors saddled down with the same rhetoric expressed by postpsychiatrists Bracken and Thomas. An expressed wish to, on the one hand, challenge the positivist-scientific paradigm enshrined in orthodox psychiatry, and on the other, confusion about whether existing clinical viewpoints in psychology and psychiatry can coexist with post modern critiques. As such, critical psychology seems unsure whether the future lies in seeking a place at the table, drinking with the devil, or to call for the rites of exorcism. Any dialogue it seeks to re-open between notions of trauma and mental illness, which does not call for the abolition of the concept of illness in the psychological domain, is one all psychiatrists will be happy to live with. With an ambiguous stance on these fundamental issues, the critical psychology of late has yet to pose a serious challenge to the focus group wielding, drug dispensing, corporate powers of business, government and medicine - with a nod to Illich (1976), what we might call the medical industrial complex.
The elaboration of minority identities and voices, at the cost of a deeper analysis of the role of political power in shaping psychological reality, mirrors the errors of the counterculture movement of the 1960's. Then, the realisation that 'the personal is political' led to self-absorption in personal therapy, the runaway growth of therapy culture, and neglect of effective political action against the common social structures, institutions and processes that generate much psychological damage in the first place (Curtis, 2002). Hearing minority voices of course can be a necessary step towards empowerment - but unless liberation from socially produced oppression is the goal, members of oppressed groups; women, disabled people, ethnic minorities and psychiatric service users - those whose narratives now fight for a place at the psychologists' table (and note the exclusion of social class from this narrative agenda) - all run the risk of finding that emancipation has been replaced by participation. Their allotted role in the countless new studies exploring their socially created selves, is to provide another landmark in the course of mapping out career trajectories for those psychologists who find, in the new exploration of meaning, the most effective route to career nirvana - enhancement of job status. A thoroughly post modern position that gives credence to Lyotard's view that the name of the game is the pursuit, not of truth, but power (Kvale, 1992). Post modern approaches presuppose the vacuity of meta narratives, but devoid of a meta narrative of justice or liberation from oppression, or of a real self which suffers, what other ends are being served by this obsession with local narrative? And what use is local narrative anyway, if what is represented in its name does not resemble what is locally true? Little wonder that many who wrap themselves in the flag of social constructionism have been accused of adopting a stance which is anti-humanistic (Gergen, 1995).
To date, users of the mental health system have largely escaped the attentions of the new breed of critical psychologists. Parker et al.'s (1995) deconstruction of psychopathology and its surrounding professional entourage is a notable exception, cautioning us that a distinction between lay and professional knowledge is currently untenable. This is because lay knowledge is constructed in the midst of mass socialisation into the biomedical 'reality' of psychiatric illness whilst psychiatric language itself is "thoroughly embedded in cultural practices of one kind or another "(p.57). These ideas find empirical support from Agnew and Bannister (1973) who have empirically demonstrated the overlap between lay language and the pseudo scientific linguistic constructions of diagnoses. Using personal construct theory, their results indicated psychiatrists demonstrated no greater reliability or stability in using diagnostic terms, than they achieved with everyday language. In Michele Crossley's (2000) version of critical health psychology however, the failure of the public to wholeheartedly endorse anti-psychiatric and social constructionist accounts of mental heath and illness, is interpreted with considerable largesse in favour of the status quo;
"..is it not somewhat hypocritical and naive to simply conclude as Parker et al. attempt to do, that critical ..psychology's viewpoint constitutes a better understanding than the views of the users themselves. (or indeed, of psychiatry, clinical psychology?) (p.127)
Given the level of lifetime exposure to the propaganda products of the biomedical industry, it would be remarkable indeed, if at this moment in history, many mental health services users, past and present, had not already swallowed the biomedical party line of brain chemistry gone awry. Most have heard this mantra chanted regularly by their general practitioners and psychiatrists. It is disappointing, to say the least, that concepts of stigma, labelling or internalised oppression which might go some way toward explaining users' adherence to the traditional model, have not occurred to someone who situates their work within a critical psychological framework. Does Crossley believe then, that critics of the pornography industry for example, are incorrect when they assert that the women working within it are being exploited, simply because there are women who earn their living from it who deny this? It goes without question, that people on the receiving end of oppressive practices have much that is of value to teach us. However 'the inside view' may also at times be clouded by the detrimental effects of life at the sharp end, and the view from outside offer greater clarity. It must be a matter of judgement in each concrete situation where the greater wisdom lies, and not something to be decided solely on the basis of who is saying it.
It is of particular interest then, and perhaps an indication of something more hopeful, that other commentators (Crossley, 1998), see in the psychiatric users movement, the most enduring legacy of Laing's work. Laing it is contended, was instrumental in bringing the user movement into being, by providing a platform for, and by giving a voice to, a group which until then had been effectively silenced by both theory and practice. In effect he helped create the conditions for a radical sea change in the nature of discourse on mental health and illness. This may yet come to be seen as a turning point in the history of ideas, setting in motion an inexorable decline in the medicalised view of madness. At present the areas of immediate concern within the psychiatric users movement are pragmatic; to get their voices heard on how users experience the mental health system and the 'treatments' it offers, to offer perspectives on the causes of distress and to ask what it is that people seeking help, want from mental health services (Read and Reynolds, 1996). Read (1996) has already called for greater information, choice and accessibility of services, advocacy, equal opportunities, income and employment, self help and self organisation.
The longer term challenge for the user movement lies in deciding between the strategic path of improving mental health services within the constraints imposed by current definitions of mental health, and of aiming to transform the meaning of mental health and with it, the place of psychologically disturbed individuals in society (Campbell, 1996). Whether critical psychology will contribute anything effective to this or any other political struggle is far from clear (Raskin, 2002). In order to assist in any practical project, a coherent underlying philosophy is essential, and while critical psychological approaches have proliferated, they have yet to produce a dominant coherent epistemology. Radical constructivism, epistemological constructivism, hermeneutic constructivism, anti-realism, limited realism, critical realism - take your pick. In contrast, the roots of Laing's work, in phenomenological, existential and Marxist perspectives, provide a firm epistemological footing for radical social change, although it is often forgotten that the theoretical framework which he bequeathed to the user's movement is grounded in a powerful methodology.
Laing's legacy may yet extend beyond the confines of the user movement. The method of social phenomenology he pioneered with Esterson (Laing and Esterson, 1964) to examine the patterns of communication between family members, spanning both current and previous generations, revealed the social intelligibility of what from the outside, had been taken to be pathologically disturbed behaviour and experience. The basic method had as its aim to study each person in the family, the relations between persons in the family and the family itself as a system. This involved many hours of direct observation and tape recording of what people said when alone, and when interacting with each other, and in keeping with the phenomenological approach involved a minimum of interpretation. It has been strangely underused. Recent texts on qualitative methods (Hayes, 1997, Symon and Cassell, 1998), for example, include discussion on life histories, story telling, interviews, conversation analysis, soft systems analysis, template analysis, thematic analysis, grounded theory, discourse analysis and critical incident technique to name but a few. The phenomenological approach is even considered. But social phenomenology - certainly not. Most of the applications in fact, involve analysis of an individual's responses independent of the social context in which the data was gathered - which must surely be considered contrary in an approach which attacks positivist science on the grounds of its poor ecological validity. Laing himself remarked some five years after the publication of the first edition of 'Sanity, Madness and the Family', that no comparable studies had been published since. Sadly, this remains the case today, 40 years later. Given the re-emergence of hermeneutical and qualitative approaches in the social sciences however, one must wonder whether Laing's exclusion from the fold can continue indefinitely. We can see some of the strengths of the method in the following account of 'Paul' taken from The Politics of the Family (Laing, 1971, p.48).
"He experiences himself as follows:
Right side: masculine
Left side: feminine
Left side younger than right side.
The two sides do not meet.
Both sides are rotten, and he is rotting away with them to an early death.
From psychoanalysis and other information:
His mother and father separated when he was five.
His mother told him he 'took after' his father.
His father told him he 'took after' his mother.
His mother said his father was not a real man.
His father said his mother was not a real woman.
To Paul, they were both right.
Consequently, on the one hand (or, as he would say, on his right side), he was a female male homosexual, and on the other hand (his left side), he was a male lesbian.
His mother's father (MF) died shortly after Paul was born. Paul's mother said he took after her father.
But the issue of real or not real has been reverberating in the family for several generations.
His mother's mother (MM) did not regard her husband (MF) as a real man.
Nor did his mother's father (MF) regard his wife (MM) as a real woman".
The explanatory power of such an analysis is evident. Again, Laing is arguing that the myriad network of actions, attributions and operations within the family can be reconstructed - not just to deconstruct the apparent 'madness' of one family member, but to determine what is actually going on. His project is thus profoundly modernist in character - seeking to the unravel the truth of how members of a family are relating to one another. In other words, the intention behind the social phenomenological method, is to reveal something about how human actors engage with each other in reality. This has clear practical advantages, in that a person, whose predicament in a given situation involves conflicting attributions and injunctions by various people concerning what is or is not going on and why, or for that matter someone from outside the family seeking to intervene in such a situation, needs a firm ontological anchor for understanding and creating the possibility of resolving the situation - for reaching a conclusion in reality, and not just in analysis. Envisaging the world as completely discursive, provides no foundations for unravelling reality from imagination, for discerning what exactly has gone wrong. Though such an analysis may lead to the replacement of one set of discursive practices with another, there can be no criteria for deciding which is best, as this would imply a modernist progressive outlook.
A completely relativist framework can do no more than place the constructions of all the agents in relation to each other. Lacking a meta narrative capable of overseeing these, no unambiguous direction for effective action can be signalled. Such a narrative rooted in a discredited biological reductionism and instrumental rationality is of course available. One product of this - labelling, may no doubt provide a spurious comfort to some, for the denial of any responsibility for one's plight (whatever role one occupies in it.) or how to escape from it is always seductive, but the end result would be further mystification, not clarification. In Habermas's terms, replacing a biomedical meta narrative with one grounded in social phenomenology would represent a transition from an instrumental rationality to a value oriented one (Jones, 2003). That is, the aims and goals, and the means to achieve these, exceed mere technical striving and by virtue of the role of the investigator-participant, change the situation at the human level.
Laing, as is well documented, moved away from the overtly political arena and the early experiments with therapeutic communities were either abandoned or left to continue without him (Burston, 1996). This is not the place to examine the motives behind these moves or to evaluate the successes or failures of those, and other therapeutic alternatives which he helped provide the impetus for. What is important here, is to remember that Laing provided us with a method of investigation that contained within it, the possibility of a science of the person, a science that sought to unite the alienated and inauthentic with the possibility of our (true) selves. Unlike Freud's, this was not an instrument of defence, and the rationale behind it can be rediscovered and re-employed.
"If one could go deep into the depth of the dark earth one would discover 'the bright gold', or if one could get fathoms down one would discover 'the pearl at the bottom of the sea'."(Laing, 1960, p.205)
Conclusion
Laing's views on sanity and madness, the paths between them and the means for investigating them are modernist in character, in contrast to most contemporary critical approaches which are relativist and post modern in nature. Attempts by psychiatry to don a critical mantel, scarcely mask a crude attempt to maintain psychiatric hegemony. Outside the psychiatric domain, critical approaches in common with Laing are distinctly hermeneutic in their approach and question the terms in which the language and practice of biomedical psychiatry deals with its human subjects. In addition they also recognise the failure of psychiatry to acknowledge and represent mental health system users in a democratic discourse. However fundamental philosophical differences remain which lead to differences in the implications which can be drawn from their respective positions.
To Laing, the self is an active agent in the world, embodied with the possibility of authentic living. Suitably estranged and subject to the invalidating injunctions, operations and mystifications of others, madness as an existential reality as well as a political one may ensue. Thus it is always more than a mere label. In contrast, the post modernists, from Foucault onwards (Rabinow, 1984) discern no human nature and no real self. Consequently, sanity and madness exist only as linguistic conventions, which express particular relations of power, in a society which requires the social regulation of people who are deemed troublesome by virtue of their conduct or experience. Trapped in a network of vying claims and counter claims from different protagonists, devoid of meta narratives; of context, justice, liberation, suffering, recovery, authenticity etc, critical relativists and postmodernists are unable to demystify the apparent irrationality on show - as the notion of mystification itself belongs in the modernist context in which it was born. It is thus argued that Laing's work still provides the more secure foundation for a sustained critique of biological psychiatry, and the necessary pre-requisite for a transformation of practice for those in psychological distress.
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