Anarchy 70/Libertarian Psychiatry: an introduction to existential analysis

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Libertarian Psychiatry:
an introduction to
existential analysis

PETER FORD

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This art­icle aims to draw at­ten­tion to the work of a group of British psy­chi­atrists of whom the best known are R. D. Laing and David Cooper. They have achieved some no­tori­ety in this country because of the ex­tent of their di­ver­gence, both in theory and prac­tice, from cur­rent psy­chi­atric ortho­doxy—and par­tic­u­larly as a con­sequence of their refer­ences to the pre­val­ent “treat­ment” of the men­tally ill as “viol­ence”. As a teacher, I am not qual­ified to at­tempt more than an out­line of their ideas as under­stood by me, after read­ing their books and art­icles and some related studies. But the im­plica­tions of the work of the British ex­ist­en­tial­ist group ex­tend beyond the limits of psy­chi­atry—and the very gener­ality of their as­ser­tions in­vites a re­sponse from the layman. Writing of the pro­cess which in their view results in the ul­ti­mate in­val­id­a­tion of persons through the label­ling of them as “mad”, Laing asks: “… what func­tion does this pro­ced­ure serve for the civic order? These ques­tions are only begin­ning to be asked, much less answered. … So­cially, this work must now move to further under­stand­ing … of the mean­ing of all this within the larger con­text of the civic order of so­ciety—that is, of the polit­ical order, of the ways persons exer­cise control and power over one an­other.” (New Left Review, No. 28.) Anarch­ism is about just this, and any theory, from what­ever dis­cipline, which leads to a ques­tion­ing of the polit­ical order of so­ciety should have rel­ev­ance for us—and we should know some­thing about it.

  Dr. Laing has written that his main intel­lec­tual in­debt­ed­ness is to “the ex­ist­en­tial tradi­tion”—Kierke­gaard, Jaspers, Heideg­ger, Bins­wanger, Tillich and Sartre—and of these there is no doubt that Sartre’s in­flu­ence has been the great­est. The British ana­lysts have clearly worked out their own the­or­et­ical basis and in many in­stan­ces have de­veloped Sartre’s ideas rather than merely adopted them as they stand. I am not cer­tain, for ex­ample how com­pletely Laing and Cooper share Sartre’s total re­jec­tion of the con­cept of “the un­con­scious”. However, their book Reason and Viol­ence: A Decade of Sartre’s Philo­sophy 1950-1960 (Tavistock, 1964) opens with a com­pli­ment­ary pre­fat­ory note from the French philo­sopher—I believe this is an un­usual honour for a book about his ideas—and this im­prim­atur sug­gests that what­ever their diver­gen­cies, they can­not be basic.

  In anarchy 44 J.-P. Sartre is re­ferred to as “one of the fore­most anarch­ist moral­ists” (Ian Vine: “The Moral­ity of Anarch­ism”). This de­scrip­tion com­pares in­triguingly with an­other, made by the so­cial­ist Alasdair MacIntyre, re­view­ing Sartre’s book The Prob­lem of Method in Peace News. He re­fers to Sartre as a newly found “spokes­man of genius” for “ersatz bolshev­iks” and “im­it­a­tion anarch­ists”. Not know­ing MacIntyre’s idea of the genu­ine art­icle, this does not ex­actly rule the French­man out and I believe his work may well just­ify a place on an anarch­ist’s book list. Writing with par­tic­u­lar refer­ence to Sartre’s recent work, MacIntyre notes that Sartre can offer no bonds, other than re­cip­roc­ally threat­ened viol­ence and terror, of suf­fi­cient strength to main­tain the co­he­sion of human groups in a world of “im­pos­sibly indi­vidual­ist indi­viduals”. Per­haps a spokes­man for Stirner­ites? Never­the­less, the poten­ti­alit­ies of Sartre’s philo­sophy as a basis for anarch­ism are in­cid­ental to my pur­pose here.

  The first of four epis­odes of this essay are in­tended to create a set­ting against which ex­ist­en­tial ana­lysis may be viewed.

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EXISTENTIAL FREEDOM

  “Man can­not be some­times slave and some­times free; he is wholly and forever free, or he is not free at all.”

Sartre: Being and No­thing­ness

  The con­cept of free­dom at the core of ex­ist­en­tial­ism is very dif­fer­ent from what I take to be the com­mon under­stand­ing of the term. In gen­eral usage, a man is free in as much as he can achieve his chosen ends with a min­imum of effort. Simil­arly, a man’s free­dom is re­duced as the ob­stacles between his de­sires and chosen ends are in­creased. Free­dom is re­garded as a measur­able quant­ity; one may have a lot or a little of it, and it can be taken away—or even “given”. The anarch­ist’s hypo­thet­ical destin­a­tion, the “free” so­ciety, may often be thought of in the sense of an har­mo­ni­ous envir­on­ment in which all re­mov­able ob­stacles between man’s de­sires and their ful­fil­ment have been elim­in­ated. But for Sartre, man is totally free by reason of his very being as man, and ob­stacles between de­sires and chosen ends are of no rel­ev­ance. To use a favoured ex­ist­en­tial­ist phrase, man is free by onto­lo­gical neces­sity. But his free­dom rests, within this con­cept, in his total re­spons­ibil­ity in the face of un­deter­mined choice and in his recog­ni­tion of the in­escap­able ob­lig­a­tion to choose. An intuit­ive aware­ness of this re­spons­ib­il­ity—per­haps pro­voked by some sort of “ex­treme situ­a­tion”—gives rise to what Sartre calls “the anguish of free­dom”. It is our fate to be free. “… One must always de­cide for one­self and efforts to shift the burden of re­spons­ib­il­ity upon others are neces­sar­ily self-de­feat­ing. Not to choose is also to choose, for even if we de­liver our power of de­ci­sion to others, we are still re­spons­ible for having done so. It is always the indi­vidual who de­cides that others will choose for him.” In so far as we are free in our choices, we “create” the ob­stacles that lie between our pro­ject and its ful­fil­ment: “an in­sig­ni­fic­ant public of­fi­cial in Mont-de-Marsan without means may not have the op­por­tun­ity to go to New York if that be his ambi­tion. But the ob­stacles which stand in his way would not exist as ob­stacles were it not for his free choice and values: in this case, his desire to go

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to New York.” Even though human free­dom, in his view, is total, Sartre ad­mits of a sense in which it may be spoken of in terms of degree. A man may be said to become “more free” as his con­scious­ness of total free­dom and re­spons­ib­il­ity in­creases; and cer­tain situ­a­tions in life can crystal­lize this aware­ness. In an ap­par­ently cryptic para­graph in Being and No­thing­ness Sartre de­scribes the German Oc­cupa­tion of France during the last war as such a situ­a­tion. “… the choice that each of us made of his life and his being was an au­then­tic choice because it was made face to face with death, because it could always have been ex­pressed in these terms: ‘Rather death than …’.” But the issue is not just one of an in­creased sense of re­spons­ib­il­ity for our day-to-day options—for in­stance in de­cid­ing upon a change in oc­cu­pa­tion, or merely which book to read next; most sig­ni­fic­antly we choose our­selves, and our day-to-day de­ci­sions neces­sarily re­flect this primary choice we have made. We are what we have chosen to be. All our sub­sequent modes of action are re­lated to this original “project-of-being”, “Freely chosen at the moment one wrenches one­self away from the in-itself to create one’s own world” (the in-itself: the world of things). This event I take to be com­par­able with what R. D. Laing calls “ex­ist­en­tial birth” which, he sug­gests, is as essen­tial for a fully human ex­ist­ence as the bio­lo­gical birth which it nor­mally follows.^* It is only in rela­tion to this funda­mental choice, the indi­vidual’s original “pro­ject-of-being” that his later beha­viour can be fully under­stood. The plaus­ibil­ity of this basic idea is not in­creased by Sartre’s denial of the divi­sion of the self into con­scious and un­con­scious modes; the idea of a tooth­less infant con­sciously de­termin­ing its future life­style and pur­pose is at first thought ab­surd. But whilst ex­pli­citly deny­ing valid­ity to the “un­con­scious” Sartre does separ­ate con­scious­ness into “re­flect­ive” and “non-re­flect­ive” levels, and it is at the non-re­flect­ive level that this funda­mental choice is made. He stresses that this original choice is in no way de­liber­ate: “This is not because it would be less con­scious or less ex­plicit than a de­liber­a­tion but, on the con­trary, because it is the found­a­tion of all de­liber­a­tion and because … a de­liber­a­tion re­quires an inter­pret­a­tion in terms of an original choice.” The con­cepts of “au­then­ti­city” and its ap­proxim­ate op­po­site “bad-faith” are in a sense under­stand­able as judge­ments (al­though Sartre claims only to use these terms de­script­ively) upon the degree of con­cord­ance between the choices of our re­flect­ive con­scious­ness and our original pro­ject-of-being. In a pas­sage which bears di­rectly upon ex­ist­en­tial ana­lysis he writes that a man “can make vol­un­tary de­ci­sions which are op­posed to the funda­mental ends which he has chosen. These de­ci­sions can be only vol­un­tary—that is, re­flect­ive. … Thus, for ex­ample, I can de­cide to cure myself of stutter­ing. I can even

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suc­ceed in it. … In fact I can ob­tain a result by using merely tech­nical methods. … But these re­sults will only dis­place the in­firm­ity from which I suf­fer; an­other will arise in its place and will in its own way ex­press the total end which I pur­sue. … It is the same with these cures as it is with the cure of hys­teria by elec­tric shock treat­ment. We know that this ther­apy can effect the dis­ap­pear­ance of an hys­terical con­trac­tion of the leg, but as one will see some time later the con­trac­tion will ap­pear in the arm. This is because the hys­teria can be cured only as a total­ity, for it is a total pro­ject of the for-itself” (the for-itself: the world of con­scious­ness and in­ten­tion).

  Sartre argues against the Freud­ian three-way split of the per­sonal­ity into id, ego and super-ego and the Psycho-ana­lytic dictum of con­scious beha­viour as de­term­ined by drives, in­stincts and de­sires al­legedly eman­at­ing from the id. As Sartre’s argu­ments hinge upon his stated belief in man’s on­to­lo­gical free­dom, Freud’s pro­ject of “de­term­ina­tion by the un­con­scious” is met with similar ob­jec­tions to those made against other de­term­in­ist theories and I need not at­tempt to sum­mar­ise them here. The only valid form of ther­apy is one aimed at dis­cover­ing an indi­vidual’s funda­mental pro­ject-of-being—and this is the pur­pose of ex­ist­en­tial ana­lysis (or psycho-ana­lysis; the pre­fix seems to be op­tional). “The prin­ciple of this psycho-ana­lysis is that man is a total­ity and not a col­lec­tion; he there­fore ex­presses him­self in his total­ity in the most in­sig­ni­fic­ant and the most super­fi­cial as­pects of his con­duct” (Being and No­thing­ness). Through the use of a tech­nique or method based on such as­sump­tions the ini­tially “crazy” actions of the in­sane may be made com­pre­hens­ible—and may even ap­pear “reason­able” if a picture of the world in which the pa­tient lives can be as­sembled.

  R. D. Laing has written that “only by the most out­rage­ous viol­a­tion of our­selves have we achieved our cap­ac­ity to live in relat­ive ad­just­ment to a civil­isa­tion ap­par­ently driven to its own de­struc­tion” and has de­scribed the “normal” person in the present age as “a half-crazed creature, more or less ad­justed to a mad world”. What is the norm that gives the gen­erally ac­cepted mean­ing to such relat­ive de­scrip­tions as “mad”, “insane”, “mal­ad­justed”? And what is the sig­ni­fic­ance of what is done to the people that are dis­qual­i­fied when meas­ured against this cri­terion; the people that the mad offi­cials label as “offi­cially mad”?

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THE INSANE IN A MAD WORLD

  “In the con­text of our present mad­ness that we call normal­ity, san­ity, free­dom, all our frames of refer­ence are am­bigu­ous and equi­vocal.”

R. D. Laing: The Divided Self.

  In 1965 there were 160,000 people in mental hos­pitals in Britain and an estim­ated 200,000 psy­chotics in the com­mun­ity. Nearly half of all hos­pital beds are oc­cu­pied my the men­tally ill. In a tele­vision pro­gramme on mental health the number of men­tally ill in Britain was given as half a million. The tele­vised psy­chi­atrist sug­gested that there were four main cat­egor­ies of ill­ness: people with mental de­form­ity,

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old people with “mental equip­ment in de­cline” (… per­haps old people with no­where else to go?^**), people with physiolo­gic­ally normal mental equip­ment but with ac­quired neur­otic pat­terns, and lastly, vic­tims of “bio-​chem­ical ill­ness”—in his words, “Struck down out of the blue”. The fourth cat­egory per­haps re­flects, more than any­thing else, the cur­rently fa­voured styles of treat­ment!

  By far the largest group is the third—the “neur­otics and psychot­ics”. Among these “schizo­phrenia” is the most common dia­gnosis. “In most European coun­tries about one per cent of the popu­la­tion go to hos­pital at least once in their life­time with the dia­gnosis schizo­phrenia.” But what mean­ing can be given to these stat­istics and as­sess­ments without a stand­ard of san­ity or mad­ness? “Defin­i­tions of mental health pro­pounded by the ex­perts usually re­duce to the no­tion of con­form­ism, to a set of more or less ar­bit­rar­ily pos­ited so­cial norms. …” The label­ling of people as mad can have the so­cial func­tion of defin­ing the area of “san­ity”—per­haps there is a par­al­lel with Durkheim’s theory of crime and pun­ish­ment as “neces­sary” to re­spect­able so­ciety to mark off the limits of per­mis­sible and toler­ated beha­viour. “So­ciety needs lun­at­ics in order that it may regard itself as sane.” It could also be argued that cer­tain kinds of so­ciety “need” lun­at­ics as their man­agers; a dis­cus­sion in Peace News re­cently was con­cerned with the un­certi­fi­able mad­ness of the Amer­ican Presid­ent in rela­tion to a “col­lect­ive norm of in­san­ity”. A Cor­re­spond­ent noted: “No sig­ni­fic­ant mem­ber of a power estab­lish­ment can ever be ‘cert­ifi­ably in­sane’ since it is this same estab­lish­ment which de­ter­mines the defin­i­tions of ‘san­ity’ and ‘in­san­ity’ and which de­cides—checked only by the oc­ca­sional con­science of an oc­ca­sional pro­fes­sional medi­cal man—when “in­san­ity” becomes “cert­ifi­able”.”

  In offi­cial stat­istics there must, in any case, be a murky over­lap area between what comes out as “crime” and what as “lunacy”—and a lot of luck in who ends up in which in­stitu­tion. Per­haps it is the in­stitu­tional bureau­cracy that has most need of the labels: “Ac­cord­ing to the common­sense defin­i­tion,” writes Dr. Theodore Szasz, “mental health is the abil­ity to play what­ever the game of so­cial living might con­sist of and to play it well. Con­versely, to re­fuse to play, or to play badly, means that the person is men­tally ill. The ques­tion may now be raised as to what are the dif­fer­ences, if any between so­cial non­con­form­ity (or devi­a­tion) and mental ill­ness. Leaving tech­nical psy­chi­atric con­sider­a­tions aside for the moment, I shall argue that the dif­fer­ence between these two no­tions—as ex­pressed for ex­ample by the state­ments ‘He is wrong’ and ‘He is men­tally ill’—does not lie in any ob­serv­able facts to which they may point, but may con­sist only of a dif­fer­ence in our at­ti­tudes toward our sub­ject.” What sort of be­ha­viour is likely to lead those with the ap­propri­ate at­ti­tudes to see signs of mental ill­ness and to set going the trans­fer pro­cess from

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“person to pa­tient”? “Ordin­arily the patho­logy which first draws at­ten­tion to the pa­tient’s con­di­tion is con­duct that is ‘in­ap­propri­ate in the situ­a­tion’. … Further, since in­ap­propri­ate beha­viour is typic­ally beha­viour that some­one does not like and finds ex­tremely trouble­some, deci­sions con­cern­ing it tend to be polit­ical, in the sense of ex­pres­sing the spe­cial inter­ests of some par­tic­u­lar fac­tion or person. …” As an ex­ample of “in­ap­propri­ate beha­viour”, con­sider the case of “The Naked Prisoner” (freedom, 16.10.65). Mr. Paul Pawlowski was ar­rested during a demon­stra­tion at the Spanish Embassy in London. Eventu­ally reach­ing Brixton Prison, he re­fused to put on the stand­ard pris­on­ers’ uni­form and was con­sequently locked up, naked, in his cell. Thus he re­mained for ten days. On the tenth day he was inter­viewed by a so­cial worker: “… You know that two doctors have seen you while you have been in Brixton … they came to the con­clu­sion that what you need is a little stay in a mental hos­pital.” In fact he did not have the benefit of this con­fine­ment. The hos­pital psy­chi­atrist de­cided that Mr. Pawlowski’s opin­ions were not those of the ma­jor­ity but “people are not put into mental hos­pitals for their opin­ions. They do that sort of thing in Russia.”^*** Mr. Pawlowski was for­tun­ate in his psy­chi­atrist, but it is inter­est­ing to see how the pre-​exist­ing at­ti­tudes of offi­cials brought him to the brink of ad­mis­sion. The overt polit­ical im­plica­tions may make this ex­ample ex­cep­tional—but it would not seem to be to the ad­vant­age of a person sus­pected of mental ill­ness to have been “mixed up in polit­ics” or “the dregs of so­ciety in CND”—which it seems, may well be taken as a con­firm­atory symp­tom.^† The mental health service—like the edu­ca­tion “service”—is a func­tional part of the present so­cial system and, as such, acts to pre­serve that system and its values. “The psy­chi­atric pro­fes­sion is a bureau­cracy,” writes James Green, a con­trib­utor to Views, No. 8, “making an es­sen­tial con­trib­u­tion to the run­ning of gov­ern­ment and ad­minis­tra­tion. … Most psy­chi­atrists would prob­ably take for granted the struc­ture and values of their own so­ciety, in such a way that the thera­peutic pro­cess becomes a ques­tion of re­turn­ing the sick person to his so­cial con­text or roles, e.g. his family, whether the con­text and roles are them­selves satis­fact­ory.” Al­though no doubt un­repre­sent­at­ive and redol­ent of “what they do in Russia” I can­not resist quot­ing the words of a psy­chi­atrist par­ti­cipant in a re­cently tele­vised dis­cus­sion: “Our func­tion is to get people well enough to be in­doc­trin­ated.” It would be mis­lead­ing to sug­gest that any­thing but a tiny minor­ity become in­mates of asylums simply or only because they hold dis­ap­proved

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opin­ions, but pos­sibly such cases may lead to a con­sider­a­tion of the far more subtle “polit­ical” and so­cial mean­ing of the label­ling and con­fine­ment of the un­vocal ma­jor­ity.

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CURATIVE—OR PUNITIVE?

  “Many of us, for quite some time have con­sidered that prob­lems of pun­ish­ment and re­pres­sion are most acute in the con­text of im­prison­ment. But this is not so; the really in­tract­able prob­lem in this sphere is that of the mental hos­pital.”

Roger Moody: “Driving The Mad In­sane”, Peace News (3.6.66).

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* See The Divided Self, pp. 41-42. For an ac­count of the con­sequences of the ob­struc­tion of this oc­cur­rence: “an ex­ist­en­tially dead child” see p. 183. In Views, No. 8, David Cooper writes: “… the begin­ning of per­sonal de­velop­ment is never pure passiv­ity. … From the first moment of mother-child inter­action, where each is an­other to the other, the child is in the posi­tion of having to ini­ti­ate the pro­ject to become who­ever he is to be, and this is in prin­ciple a free choice, his free crea­tion of his essen­tial nature.”

** An art­icle in The Observer (4.9.66) an­nounced the forma­tion of “Pro­ject 70”—“a plan to rescue men­tally normal old people from the wards of mental hos­pitals.”

*** This may be an al­lu­sion to a case which was re­ceiv­ing some pub­li­city at that time. Zenya Belov, a student, was con­fined in a Russian mental in­sti­tu­tion around Septem­ber, 1965—and he is pre­sum­ably still there. It was al­leged that he had shown “schizo­phrenic symp­toms” (“drawing dia­grams, trying to re­organ­ise the world graph­ic­ally”) but the only “symp­toms” evid­ent to the British students who were with him shortly before the onset of “ill­ness” were his “un­ortho­dox and re­form­ist polit­ical views”.

† Refer­ences to a letter from Brenda Jordan in Peace News (17.6.66).

Relev­ant Books and Art­icles not men­tioned in Refer­ences:

R. D. Laing, “Series and Nexus in the Family”, New Left Review, No. 15.

David Cooper, “Sartre on Genet”, New Left Review, No. 25.

R. D. Laing, The Polit­ics of Ex­peri­ence and the Bird of Para­dise, Penguin Books, Autumn, 1966.

R. D. Laing, H. Phillip­son, A. R. Lee, Inter­per­sonal Per­cep­tion: A Theory and a Method, London, Tavistock, 1966.

T. S. Szasz, The Myth of Mental Ill­ness, London, Seeker and Warburg, 1962.

Carl R. Rogers, On Becoming a Person, London, Constable & Co., 1961.

NOTES

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