|
 We
live in curious times. Before Sigmund Freud and
Carl Jung, no educated person would have regarded a
specialist in the mysteries of mental disorder as a
preceptor to humanity at large. As the 19th century
drew to a close, however, it slowly dawned on some
people that the malaise experienced by mad and
acutely neurotic individuals was different in
degree, rather than in kind, from the suffering of
relatively normal people struggling with the
constraints and injustices of civilized life.
Philosophy, art, literature, and drama all
contributed to this emergent cultural awareness.
Indeed, they created the climate of opinion that
enabled Freud and Jung to become cultural
icons.
Many
objected strenuously to this fashionable new trend.
Many still do. Some cling to an outdated
rationalism that attempts to expunge irrationality
in all its forms from our concept of the human.
Others insist that the boundaries between normals
and neurotics are not permeable, but distinct and
intelligible to any clear-headed individual,
although the authors of the DSM IV freely concede
that it is often difficult to impossible to
distinguish a disorder from a
"non-disorder."
In
any case, Freud and Jung heralded the emergence of
a new cultural form at the turn of the century; the
alienist or "head shrinker" as public intellectual.
Although Adler and Rank tried, no doubt, no one
else in the mental health professions achieved
comparable public stature until the cold war era,
when Bruno Bettelheim, Erik Erikson, Erich Fromm,
and R. D. Laing became the pre-eminent examples of
this new cultural trend. Indeed, by 1970, their
fame rivaled or exceeded that of Freud and Jung
because they spoke to issues, experiences, and
ideals with which young people could readily
identify in those turbulent times. Laing's place in
this group is quite distinctive, however.
Freud
said that neurosis and normality exist on a
continuum, and therefore, that normal people
succumb to acute neurotic conflict in certain
circumstances. This assertion strikes many of us as
self-evident, but was once considered a very
radical idea. But like his contemporaries, and most
of us, Freud thought of psychotics as having
a very different existence from normals and
neurotics . or "normal neurotics," as some prefer
to call them. Unlike their more adapted
contemporaries, said Freud, psychotics are not
amenable to psychoanalysis because they cannot form
a "transference," and by implication, a working
alliance, with the therapist. Freud was not alone
in this respect. Eugen Bleuler, who coined the term
"schizophrenia," once remarked that when all was
said and done, his patients were stranger to him
than the birds in his garden. And in a similar
vein, Karl Jaspers argued that an abyss of
understanding separates the schizophrenic from the
non-schizophrenic. Echoing Freud, Bleuler and
Jaspers, Carl Rogers said that schizophrenics are
utterly incapable of forming meaningful human
relationships, hinting that they were not merely
deficient in this respect, but that they actively
repudiate the bonds of human fellowship.
C.G.
Jung, a student of both Bleuler and Freud's,
disagreed. Indeed, his differences with Freud on
this point played a small but significant role in
the controversies that precipitated Jung's
resignation from the Presidency of the
International Psychoanalytic Association, and the
emergence in Zurich of Analytical Psychology
(Hogenson, 1984). Jung believed that psychotherapy
with psychotics is not always doomed to failure,
and that psychosis represents an existential
crisis, an attempt at a radical inner
transformation which he termed metanoia, a
term he borrowed from the New Testament, which is
usually translated as "repentance." Being Jewish,
and an atheist as well, Freud probably found this
usage a bit distasteful, but conceded that the
delusions and hallucinations of psychotics often
symbolize an abortive attempt at self-cure in
"Psychoanalytical Notes Upon An Autobiographical
Account of A Case of Paranoia" (1911). But he
remained thoroughly skeptical about the prospects
of analyzing psychotics successfully . in
principle, if not always in practice (Roazen,
2000).
Undeterred
by Freud's pessimism, in the 1920s several
psychiatrists began to explore the psychotherapy of
schizophrenia here in the United States. Adolph
Meyer, Richard Kempf, Harry Stack Sullivan, and
later, Marguerite Sechehaye, and Frieda-Fromm
Reichmann, were the most celebrated and successful.
Despite minor differences in theoretical
orientation, Sullivan and Fromm-Reichmann both
stressed that to do effective therapy with
psychotics, the therapist must be able to empathize
with their states of mind by drawing on their own
"psychotic potential." That means, in effect, that
they must be in touch with their own psychotic
core, while remaining firmly anchored in reality.
This is arduous work at the best of times, and well
beyond the capacity of the average psychiatrist or
psychoanalyst. Coping with anguish, confusion and
despair that intense, that annihilating, and doing
it routinely, is more than most people . and most
therapists, however dedicated and well-intentioned
. can bear.
Ronald
David Laing was cut from the same cloth as
Sullivan, Sechehaye and Fromm-Reichmann. Born in
1927, he was raised and educated in Glasgow, and
apprenticed in psychiatry in the British Army
during the Korean war. In 1951, while stationed at
the Royal Victoria Hospital at Netley, Laing read
Sullivan, Fromm-Reichmann and Sechehaye with keen
interest. There, and again at Catterick Military
Hospital (Yorkshire), where he was stationed from
1952 to 1953, Laing spent as much time as possible
in padded cells with the men placed in his custody.
This kind of intensive immersion in the
schizophrenic life-world was unheard of at the
time. He found that with enough patience and
persistence he could eventually get on their wave
length, and make sense of the peculiar speech and
gestures that his colleagues found completely
unintelligible (Laing, 1985).
When
Laing left the British Army in 1953, he conducted
similar experiments in civilian hospitals at
Gartnavel and Southern General Hospital in
Scotland, where his patients were generally women,
for almost three years. Then in 1956, he set out
for London, where he worked as a Registrar at the
Tavistock Clinic, and trained at The Institute for
Psycho-Analysis. Charles Rycroft was his training
analyst, while D.W. Winnicott and Marion Milner
were his clinical supervisors (Burston, 1996,
chapter 3). Significantly, however, Laing was
profoundly disenchanted with most analysts.
closed-minded and dogmatic world-views, and their
derogatory attitude toward psychotics (Burston,
1996, 2000). The Freudians and Kleinians in London,
for their part, did not trust Laing because he
committed the cardinal sin of taking Jung's notion
of metanoia seriously. This was not yet
evident in 1960, when he publishedThe Divided
Self. But it was vividly apparent in The
Politics of Experience, published in
1967.
According
to some critics, The Divided Self is Laing's
best book. It attempted to make the process of
going mad intelligible to ordinary people. Although
couched in the idioms of existential-phenomenology,
and quite critical of psychiatry and
psychoanalysis, The Divided Self was
relatively "low-key" in its criticism of mainstream
society and politics. By contrast, The Politics
of Experience, written in the midst of the
Vietnam War, bristled with angry denunciations of
psychiatry and psychoanalysis, of capitalism and
imperialism, of family piety, schools and
universities, and so on.
In
between The Divided Self and The Politics
of Experience, Laing published Sanity,
Madness and the Family with Aaron Esterson
(1964), Reason and Violence with David
Cooper (1964) and Interpersonal Perception ,
with Phillipson and Lee (1966). Along with
Esterson, Cooper and various friends and
co-workers, Laing founded the Philadelphia
Association, which he chaired from 1965 till 1982.
The Philadelphia Association is chiefly a
psychotherapy training organization now. But its
original mandate was primarily the creation of
therapeutic households or "safe houses" where
disturbed individuals could undergo a metanoic
journey free from the useless labels and coercive
practices of mainstream psychiatry (Burston, 1996,
chapter 4). Their most famous experiment, Kingsley
Hall, ran from 1964 till 1970.
Nestled
in the heart of London's east end, Kingsley Hall
was a meeting place whose function and leadership
were seldom clearly defined. It hosted training
seminars, fundraising events and informal meetings
with luminaries from the mental health field,
new-left activists, rock stars, artists, writers
and others. Some people reveled in the alternating
currents of carnival and of deep anger and
confusion that animated the place. Others were
shocked and dismayed. Other therapeutic households
that followed it were less chaotic, and less
accessible to the avid crowds of hippies, thrill
seekers and celebrities who thronged to Kingsley
Hall. As places of healing, they actually fared
better, as a rule (Burston, 2000, chapter
4).
In
any case, by 1969, Kingsley Hall and The
Politics of Experience had gleaned so much
media attention that they transformed Laing from a
medium-size British celebrity, and the darling of
the British left and artistic avant garde, into an
international celebrity on a par with Sartre or
Marshall McLuhan. It also conveyed the mistaken
impression that Laing was positioning himself to
assume some sort of leadership role in the
anti-Vietnam, pro-disarmament, and counter-cultural
movements, or indeed, had already done so.
This
was not the case, however. In 1968 Laing became
deeply disenchanted with leftist politics, and
began divesting himself of political commitments
and affiliations, turning inward, to Yoga and
meditation, and fostering the proliferating network
of therapeutic households the Philadelphia
Association had by now created. Nevertheless,
The Politics of Experience continued to
sell, conveying to the world an image of an angry,
politicized Laing that was already somewhat
discrepant with the mellower, more retiring and
essentially a-political person he was trying to
become.
Fed
up with the limelight, in 1970, Laing left for
India and Ceylon, where he studied Buddhist
mediation and Shiviite Yoga for 18 months. He
returned a changed man. Unlike his former, angrier,
radical self, the new R.D. Laing now enjoined a
kind of gentle, Buddhist austerity as the best path
to liberation, and expressed a great skepticism
about the left's agenda and methods (Burston, 1996,
chapter 5). Moreover, he no longer condemned the
nuclear family or the use of psychotropic
medication as a treatment of last resort, provided
these drugs were taken voluntarily, with the
patient's informed consent. He remained
categorically opposed to electroshock and
involuntary psychiatric treatment, and eager to
explore alternatives to psychiatry. But he now
rejected the "anti-psychiatry" label that others
had placed on him, and made several conciliatory
gestures toward his estranged psychiatric
colleagues.
But
Laing was not the only one who changed. In his
absence, the world had changed too. When Laing
returned from India, the Philadelphia Association
was in turmoil, and many former colleagues who left
the organization, like David Cooper, Aaron
Esterson, Morton Schatzman and Joseph Berke, had
published books and acquired followings of their
own. Moreover, many old allies on the left who were
wounded or puzzled by his retreat to Asian
mysticism now turned on him. In the mental health
field, for example, Peter Sedgwick, Joel Kovel,
Giles Deleuze and Felix Guattari vigorously
denounced him. And they were joined by a growing
chorus of ambivalent appraisals and abrupt
dismissals by prominent feminists like Juliett
Mitchell, Phyllis Chesler, Elaine Showalter, and
others.
Despite
the boos and brickbats of the early and
mid-seventies, Laing retained some of his old
cachet, and could still draw a crowd almost
anywhere he chose. But his creativity faltered, and
his main book in the seventies, The Facts of
Life, was a disappointing flop, commercially
speaking, that alienated even many loyal fans. By
the late seventies, the Left had truly and
completely taken its leave of him, and the
universities of the Anglo-American world were
inundated by the wave of new French theory embodied
in the works of Bachelard, Baudrillard, Deleuze and
Guattari, Derrida, Foucault, Jacques Lacan,
Lyotard, as well as feminist-Freudians (and
anti-Freudians) like Kristeva, Cixous and Irigeray,
and so on. They buried Laing -- in the
universities, at any rate. And curiously enough,
Laing played a significant role in facilitating
this new trend to the English-speaking
world.
In
1961, with the help of David Cooper, Laing edited
the first English translation of Foucault's
Madness and Civilization in a Tavistock
series entitled "Studies and Existentialism and
Phenomenology." Foucault had divorced himself from
phenomenology some five years earlier, but Laing
stubbornly insisted on regarding him as a
phenomenologist (e.g. Laing, 1985, 1987). Laing's
regard for Foucault never wavered (Laing, A.,
1994). Indeed, Laing wept openly at the news of his
death (see Hanja Kochansky, in Mullan,
1997).
Unfortunately,
Laing's esteem for Foucault was never quite
reciprocated. In 1975, when they finally met,
Foucault's courtesy toward Laing was strained and
ironic, and he seemed to regard Laing as an
irrelevant has-been. That is certainly how most of
his compatriots viewed him. Laing was no longer
fashionable, and he knew it. And in all likelihood,
though he seldom said so, he probably suffered from
nagging doubts about the viability of the
therapeutic communities he founded with the
Philadelphia Association. Some were a singular
success. But many floundered or folded, leaving a
legacy of bitterness and disillusionment behind
them.
In
any case, in the late seventies, Laing entered what
might be construed as a protracted mid-life crisis.
He second marriage had deteriorated, he suffered
from chronic writer's block, and almost abandoned
his once flourishing private practice in favor of
group marathons based on improbable ideas about
birth traumas and intrauterine experience.
Meanwhile, every rumor and breath of scandal that
emanated from his circle and his increasingly
turbulent life was circulating freely --
including the deathless rumor that he had finally
"flipped out." As it happens, he did not, though
his personal conduct and public appearances became
more volatile and erratic, and many people had more
trouble distinguishing between Laing the skeptic,
scholar and psychotherapist and Laing the cynic,
sybarite and publicity hound. His attempts at
re-packaging himself as a lay preacher, poet, and
producer of movies and musicals during the late
70's only deepened that confusion. Worse still, his
frequent lapses into silliness, sadism and
self-aggrandizement shortly before and after his
second divorce in 1984 were used to discredit the
ideas and causes he championed (Burston, 1996,
chapter 6).
In
the books and papers that appeared between 1976 and
his untimely death in 1989, one sometimes saw
flashes of the old brilliance. But by the time he
recovered his footing, more or less, his health was
failing fast. Shortly before Laing's death, Andrew
Feldmar and Kirk Tougas in Vancouver released a
video entitled "Did You Used to Be R. D. Laing?"
documenting a group co-run by Laing and Feldmar in
the spring of '87. The title of the video was
culled from a question addressed to Laing by
someone vaguely familiar with his work or
reputation who probably thought he was already
dead -- another widespread rumor at the
time.
Although
nonsensical on the face of it, the question "Did
you used to be R.D. Laing?" can be construed as a
covert statement. In effect, the questioner was
saying: "I suspect that you are someone who used to
be somebody." In other words: "Hey man,
you're history!" And indeed he was, in most
people's estimation. Mention Laing nowadays and
most people can dimly conjure up a flamboyant rebel
of the psychedelic era, a chum of Tim Leary, Ram
Dass, and Allen Ginsburg -- which he was, of
course, off and on. But press them to describe what
he stood for, what he actually thought or said, and
you'll only elicit a trickle of platitudinous sound
bites, proving that serious reflection on his work
has virtually halted. The lasting fame that Freud
and Jung achieved, and that some predicted for
Laing, eluded him, and the recent stream of books
about him, (my own included), have done nothing to
change that.
My
first book on Laing, The Wing of Madness,
appeared in 1996, and since then many people have
asked me why Laing's credibility declined so
dramatically over the years. By way of a reply I
generally rattle on about his internal
contradictions, his inability to follow through and
finish his various projects, his flamboyant and
provocative gestures, and so on. All true, up to a
point. Laing must shoulder some of the
responsibility for his current neglect --
something he was apparently unwilling or unable to
do. But on further reflection, the reasons for his
brief fame and rapid decline are much more complex,
and have less to do with his enigmatic personality
than with changing climates of opinion. Let me
explain.
The
Divided Self was published in 1960. At the
time, and for another decade afterwards, psychiatry
had little evidence to support -- much less
prove -- the view that schizophrenia is
basically a neurological disorder. Indeed, many
critics -- including many
psychiatrists -- freely concede that the
extant theories of schizophrenia (and evidence in
their support) were astonishingly flimsy at the
time. That being so, Laing's eloquent appeal to
treat the schizophrenic as an anguished, despairing
person, rather than a bundle of irksome
neuropathology, struck a deep and responsive chord
in and out of the mental health field, particularly
in view of the coercive atmosphere, and the
pervasive apathy, anonymity and indifference of
most mental hospitals, and the horrifying
side-effects of drugs, lobotomy and
electroshock.
Since
the mid-seventies, however, numerous breakthroughs
in the brain-imaging field demonstrate that there
are significant correlations between certain
varieties of brain disorders and certain
schizophrenic symptoms. A clear cut etiology for
any single form of schizophrenia is still quite
elusive, but the newer drugs and psychosurgical
techniques are more effective and less disabling or
disfiguring than their predecessors. So there is
progress of a sort going on here.
But
even now, despite manifold improvements, compliance
rates among diagnosed schizophrenics in the United
States are still quite low -- as low as 20%,
by some estimates. That means that about 80% of
mental patients do not take their medication as
prescribed; some take it episodically, and some not
at all. This says something about the culture of
psychiatry, and the pervasive mistrust that has
grown up among psychiatric patients (and
ex-patients). Beyond the self-serving rejoinder
that patients mistrust psychiatrists (and therefore
do not comply) because they are "ill" or
"incompetent," what else may account for this
striking climate of non-compliance, psychologically
speaking?
This
brings us to a very peculiar problem. For reasons
that are not yet clear, some people are actually
quite relieved when they are told that their
anguish, confusion and despair, their sense of
helplessness, futility and self-loathing, and so
on, are simply the by-products of neurological
dysfunction. This verdict gives them palpable hope
for improvement, and they are only too glad to
tinker with dosages and to try new medications till
the right one materializes, eventually. For these
people, the loss of dignity, of self-command and of
hope that they suffer while symptomatic are viewed
as temporary setbacks, to be conveniently erased
when their neurological integrity is restored, more
or less. Patients like this are a boon to
biological psychiatry -- their greatest, most
grateful and most loyal fans, who are not easily
disappointed or deterred by mishaps or mistreatment
of one sort or another.
Other
patients are averse to this whole approach. They
feel that this way of construing things trivializes
and demeans them, that it defines and deforms their
experience in ways that are at variance with their
deepest, though often groping and inarticulate
sense of who they really are. Whether they
know it or not, people like these are often looking
for something akin to a religious experience as a
solution to their difficulties -- an new
experience or a fresh perspective that will elicit
or confer deeper meaning on their suffering, giving
it some ennobling raison d'être,
assuring them it is actually in aid of
something. It doesn't take much insight to see why.
They feel that their lives have been hijacked or
derailed somehow. They don't just want their
suffering to stop, or to see some light at
the end of the tunnel. They desperately want that
tunnel to be a necessary rite of passage to a new
and better place than the one they left behind, one
which they are loathe to return to.
In
addition to patients (or prospective patients) like
these, there are people who shun conventional
psychiatric remedies because they feel shattered by
the blows of life, and look to the psychotherapist
to address their deep sense of victimization at the
hands of others, to enable them to clarify and cope
with it more satisfactorily than they can at
present. If the psychiatrist isn't listening, or
isn't helpful in this respect, they will not stay
the course.
Finally,
many candidates for a psychiatric diagnosis have
both of the aforementioned tendencies in
extremely pronounced form. Being told that what
they feel or experience is purely the result of a
disordered brain is quite distressing for them, and
prompts deeper self-doubt and/or distrust of
others. In Laing's terminology, they feel
"invalidated" by a summary appraisal like this, and
fear that their mental-health worker is colluding
with all the others who neglect or oppress them,
despite their overt or conscious intentions.
Rightly or wrongly, then, they are likely to
experience the standard treatment approach as
disrespectful and coercive, and they've had quite
enough of that already, thank you very much. As a
result, they are far more likely to go astray with
conventional psychiatric treatment. And their
numbers are legion.
Laing
drew attention to these and other features of
work-a-day psychiatry long ago, but many things
have changed since The Politics of
Experience created such a sensation. The
general public isn't as moved by the plight of
these people as they were in Laing's day. And
though Laing was far more effective with people
like these than the average clinician in a
one-on-one setting, he never developed a workable
alternative to the conventional mental hospital. In
the absence of such an alternative, people in
distress are inclined to rely on the devil they
know. Besides, really good psychotherapy is time
and labor intensive. It requires a substantial
emotional investment from the therapist as well as
the patient. It is not cheap and not fast, and in
the recent climate of fiscal restraint we want a
quick fix: something clean and cost-effective, not
messy and time consuming.
OK.
But let's not kid ourselves. These new drug
treatments do not work for everyone, not even those
who do comply with their physician's advice.
And while drug companies minimize their
side-effects -- they always do -- their
long term repercussions may come back to haunt
those whose treatment was "successful" in the first
instance.
Another
reason Laing is neglected now is that we are weary
of the culture of victimization. And rightly so .
We are all so frightfully fed up with people making
lurid careers of their victimization that we try to
ignore them, and in our state of numbed
inattention, we need to be reminded of how
nauseated we actually are by this cultural state of
affairs. Only a lucid appreciation of our
impatience and disgust enables us to distance
ourselves from these almost reflexive feelings
sufficiently so that we may remember that many
mental patients really are profoundly
victimized by those who claim to be their nearest
and dearest, and that they often have no form of
redress, and no way of explaining or calling
attention to themselves. Even when they do have the
means, they often lack the ability to make
themselves heard, because life has robbed them of
the confidence and clarity they need to address us
on our terms, and in a language we
readily understand. The most that many of them
can manage, finally, is to let their symptoms do
the talking, and hope vainly that someone,
somewhere will "hear" their strange, disembodied
voices.
This
is a hard nut to swallow. Most mental health
professionals are trained to believe that diagnosis
entails the accurate identification of a disease
entity or some discrete form of psychopathology
situated in the body, brain or unconscious of the
patient/client. The corollary assumption at work
here is that until the disorder in question is
correctly diagnosed, an appropriate treatment
cannot be prescribed. However, Laing argued that
labeling the individual often has little to do with
accurate assessment of the patient's real problems,
and that the remedial interventions mandated by a
specific diagnosis often serve complex social
functions by equilibrating extant
social-systems, i.e. maintaining the status quo. In
short, clinicians frequently locate the cause of
the disturbance in individuals to divert
attention from the processes that actually
engendered their disturbed behavior. If they did
not, they would often construe the "signs and
symptoms" of these diagnostic entities as
intelligible responses to what Laing termed
"unlivable situations" -- ones which the
patient can neither understand, nor tolerate, nor
change effectively.
Laing
often told a story about a weeping mother who came
to inquire about her teenage son, "Julian," who had
just been diagnosed schizophrenic. She would spare
no expense to avoid the standard psychiatric
zombification doled out to troubled teenagers like
him. When asked about the initial onset of Julian's
problems, she said that some months previously, he
started to insist that the man his mother married
was not his real father. That was only the
beginning, unfortunately. Soon other delusional
fantasies, charges of conspiracy and deception,
appeared. But this was the central or core
complaint, which he never relinquished, and which
was driving her and her husband to
distraction.
After
seeing the boy once, Laing informed the mother that
he might be able to help her son if she would level
with him. Was her husband truly the boy's
father? After beating around the bush, the mother
finally confessed that he wasn't. In fact, Julian
was conceived during a premarital fling she had
hidden from her husband all these years. Laing then
informed the mother that he could not help her or
her son unless she was honest with herself and her
husband about his real paternity. So long as she
and her husband construed his suspicions as
delusional, Laing noted, the psychiatrists she
engaged to treat Julian would act as unwitting but
thoroughly obliging accomplices to a sustained
family cover-up. At some cost to herself, no doubt,
the mother eventually leveled with her son and her
husband, and in a few months, the boy was back to
normal.
Cases
like these, which were not uncommon in Laing's
practice, suggest that there is often much literal
as well as symbolic truth in the (real or alleged)
delusions of schizophrenics, and that an honest
attempt to discern and to validate those truths may
be indispensable, therapeutically speaking. It also
indicates that people who are deeply disturbed and
disturbing to others need not be suffering from
brain damage or the ravages of repression,
regression and/or other specifically internal
disturbances. They may be reeling from the effects
of what Laing termed interpersonal defenses,
which are subtle, silent and usually unconscious
tactics designed to silence and/or discredit a
prospective patient who may very well recover his
or her sanity when these collective defenses are
exposed. Far from being an act or expression of
medical gnosis -- or of "knowledge,"
as the Greek roots suggest -- the act of
diagnosing may be the perfect cover for ignorance,
perhaps willful ignorance: a way of not
knowing the patient, as Laing would say.
In
such circumstances, the treatment patients receive,
however well intended, often compounds the damage
they've suffered, rather than reversing it. And
this is especially so when the diagnosis of
schizophrenia -- or some other grave mental
disorder -- is rendered in ignorance of the
deeper levels of the patient's experience and
social surround.
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