Anarchy 70/Libertarian Psychiatry: an introduction to existential analysis

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Libertarian Psychiatry:
an introduction to
existential analysis

PETER FORD

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

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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.

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 of 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”?

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 by the men­tally ill. In a tele­vision pro­gramme on mental health the number of the 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”. This 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 or not this is good for him, and without ques­tion­ing 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.

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).

  In his ac­count of “de-​in­sti­tu­tion­al­isa­tion” (anarchy 4) Colin Ward re­ferred to the prison as “the most sin­is­ter of in­sti­tu­tions” and no doubt it is. But as anarch­ists are aware, the state can make skil­ful use of the “ap­proved” con­cepts of crime and crim­in­ality to di­vert at­ten­tion from its own more grandi­ose but identical activ­it­ies: so we should be alert to the pos­si­bil­ity that the in­sti­tu­tions openly la­belled as prisons are not the only ones serving that func­tion. Sup­pose, as Roger Moody says in his art­icle that mental hos­pital and prison are “dif­fer­ent terms for the same thing”? If there is some truth in this there is con­sequently an ad­di­tional danger in that any­thing called a “hos­pital” has auto­mat­ic­ally a pro­tect­ive cocoon around it as a result of its claim to pro­vide ther­apy. But surely the “volun­tary” presence of many of the pa­tients in mental hos­pitals en­sures that they can­not have a pun­it­ive char­acter or ef­fect? A dif­fer­ent ap­proach is sug­gested by the Amer­ican so­ci­olo­gist Erving Goffman: “. . . We must see the mental hos­pital, in the re­cent histor­ical con­text in which it de­veloped, as one among a net­work of in­sti­tu­tions de­signed to pro­vide a res­id­ence for vari­ous cat­egor­ies of so­cially trouble­some people.”

  Goffman states that only a small number of pa­tients enter mental hos­pital will­ingly, in the sense that they believe it will be good for them, having come to see them­selves as “men­tally un­bal­anced”—and as Laing and Cooper argue, even in these cases this self-​per­cep­tion as being “ill” or “mad” can be in­duced by the beha­viour or strat­egy of the person’s im­medi­ate relat­ives and con­tacts. The sequence from “person to pa­tient” can follow a series of as­so­ci­ated stages set in mo­tion by a “com­plain­ant” who sees an action on the part of the pre-​pa­tient as per­haps a “last-​straw” and re­fers him to a suc­ces­sion of “medi­ators”—prob­ably drawn from among teach­ers, so­cial workers, clergy, psych­iatrists, law­yers, po­lice—one of whom, with co-​opera­tion from the “sick” man’s relat­ives, will com­mit the indi­vidual to hos­pital with legal sanc­tion. “The so­ciety’s offi­cial view,” writes Goffman, “is that in­mates are there because they are suf­fer­ing from mental ill­ness. However, in the degree that the ‘men­tally ill’ out­side hos­pitals numer­ically ap­proach or sur­pass those inside hos­pitals, one could say that mental pa­tients dis­tinct­ively suf­fer not from mental ill­ness, but from con­tin­gen­cies.” In other words, good or bad luck—de­pend­ing on your point of view. One might debate the degree to which this whole pro­cess is “volun­tary”—bear­ing in mind that the indi­vidual is un­pre­pared for the nature of his future life in the hos­pital, is prob­ably living

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in so­cially dis­tres­sing circum­stances which would have the ef­fect of making most al­tern­at­ives seem favour­able, and is sub­ject to col­lus­ive pres­sure from both relat­ives and “medi­ators”.

  As Malatesta noted in his essay “Anarchy”, “Organs and func­tions are in­separ­able terms. Take from an organ its func­tion, and either the organ will die, or the func­tion will re­in­state itself.” The ex­ist­ence of the mental hos­pital is just­ified by its func­tion of curing the men­tally ill. “The pa­tient’s pres­ence in the hos­pital is taken as prima facie evid­ence that he is men­tally ill, since the hos­pital­iza­tion of these per­sons is what the in­sti­tu­tion is for.” A very com­mon answer to a pa­tient who claims he is sane is the state­ment: “If you aren’t sick you wouldn’t be in the hos­pital.” One con­sequence of this for the person ini­tiated into a “career” as a mental pa­tient is that his past life will be re­struc­tured in terms of a “case history”—and he may be denied rights of pri­vacy over what he pre­vi­ously re­garded as “his own busi­ness”—any facet of which may now pro­vide evid­ence of “symp­toms”. Once inside, the pa­tient may find the in­ternal organ­isa­tion of the asylum domin­ated by a “ward system” separ­at­ing pa­tients off into “dis­ease” cat­egor­ies, the vari­ous levels pro­vid­ing dif­fer­ent stand­ards of ac­com­mod­a­tion, food and grounds-​and-​town “priv­ileges”, among other factors of import­ance in the life of the pa­tient. The ma­terial and so­cial pro­vi­sions on each ward level are offi­cially those that are most ap­propri­ate to the mental con­di­tion of the pa­tient. But whilst the system may be just­ified by its par­tis­ans on these grounds, it has an un­ac­know­ledged func­tion as an inmate-​con­trol­ling device. There is a direct par­al­lel here with the al­leged pur­pose of the stream­ing system in schools; in­vari­ably de­fended on the basis of its edu­ca­tional value yet actu­ally opera­ting in schools as an im­port­ant com­pon­ent of the dis­ciplin­ary system. And in asylums, as in schools, these “divide and rule” dis­ciplin­ary strat­egies have de­veloped as the best method of “man­age­ment by a small staff of a large number of in­volun­tary in­mates”.

  Because so­ciety needs luna­tics to pro­vide it with re­as­sur­ance of its own san­ity, so it has need of in­sti­tu­tions to con­tain them. But as with prisons, the real enemy is not the ma­terial struc­ture—“It is our own anxi­ety which forces us to lock people up”—and it is through anxi­ety about our own san­ity that we build walls around the “men­tally ill”. “Mental hos­pitals are not found in our so­ciety because super­visors, psych­iatrists and at­tend­ants want jobs; mental hos­pitals are found because there is a market for them. If all the mental hos­pitals in a given region were emptied and closed down today, to­morrow relat­ives, po­lice, and judges would raise a clamour for new ones; and these true clients of the mental hos­pital would de­­mand an in­sti­tu­tion to sat­isfy their needs.”

SCHIZOPHRENIA—A PSEUDO-​DISEASE?

  “In the popular mind the schizo­phrenic is the proto-​typical mad­man—author of the totally gra­tu­it­ous crazy act that always has over­tones of viol­ence to others.”

David Cooper: Viol­ence in Psychiatry.

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  The vari­ous titles given to mental dis­eases, says Goffman, serve to meet the needs of hos­pital census regu­la­tions. “When pressed . . . staff will allow that these syn­drome titles are vague and doubt­ful.” A lot of people at the present time, ap­pear to have schizo­phrenia—this dia­gnosis is ap­plied to two out of three pa­tients in British mental hos­pitals and it has been estim­ated that for every “schizo­phrenic” re­ceiv­ing some form of treat­ment there are ten “un­detec­ted” in the com­mun­ity.

  One psycho-​ana­lytic view is that schizo­phrenia is the out­come of a split between a person’s “con­scious” and “un­con­scious” forces which in the normal state are believed to work sim­ul­tan­eously. An­other idea—in schizo­phrenia “there is a subtle change in brain chem­istry which inter­feres in some way with nerve im­pulses.” The pop­ular­ity of this view and others sim­ilar to it has led to an em­phasis on sur­gical or phys­ical treat­ment such as electro-​con­vuls­ive ther­apy (a low voltage shock passed between the temples) and, in some cases, opera­tions on the brain (leu­co­tomy and lo­botomy). In at least one London hos­pital schizo­phrenics have been placed in deep freeze. Drugs are much used. And it seems that what are taken to be the symp­toms of the dis­ease can be elim­in­ated by the use of such means at least for a time. As Sartre ob­served, one “can ob­tain a result by using merely tech­nical methods.” But, as the writer of a sur­vey in The Ob­server (5.6.66) com­mented: “No one knows, ex­cept in the fuzzi­est out­line, what the treat­ments do. And none of them is a cure.” John Linsie in his article in anarchy 24 pointed out that the ef­fect­ive­ness of drugs and E.C.T. in tem­por­arily re­moving “symp­toms” has per­haps pre­vented more wide­spread re­search into the basic aeti­ology of the “dis­ease”. Schizo­phrenia often oc­curs within the same family and some re­search­ers believe that it is trans­mitted ge­net­ic­ally. John Linsie quoted Mayer-​Gross: “It may now be re­garded as estab­lished that hered­it­ary factors play a pre­domin­ant role in the causa­tion of schizo­phrenic psy­cho­sis”—and then trumped this with the opinion of an­other expert, Roth: “No simple ge­netic hypo­thesis ac­cords with all the facts.”

  This I hope is enough to pro­vide some basis for R. D. Laing’s and A. Esterson’s state­ment in the intro­duc­tion to San­ity, Mad­ness and the Family that there is no more dis­puted condi­tion in the whole field of medi­cine. “The one thing cer­tain about schizo­phrenia is that it is a dia­gnosis, that is a clin­ical label, ap­plied by some people to others.” The es­sen­tially so­cial pro­cess which results ul­tim­ately in the fixing of this label to one person is the under­lying theme of three books and a good many articles by Dr. Laing and his col­leagues. I shall try to out­line their ac­count of this pro­cess sub­sequently, but an idea of their truly rad­ical con­clu­sions can be given here:

  “We do not use the term ‘schizo­phrenia’ to de­note any iden­ti­fi­able condi­tion which we believe exists ‘in’ one person.”

  “I do not myself believe that there is any such ‘condi­tion’ as schizo­phrenia. . . .”

  “Schizo­phrenia is not a dis­ease in one person but rather a crazy

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way in which whole famil­ies func­tion. . . .”

  “Schizo­phrenia, if it means any­thing, is a more or less char­ac­ter­istic mode of dis­turbed group beha­viour. There are no schizo­phrenics.”

THE FAMILY—“FROM GOOD TO BAD TO MAD”

  “Over the last two dec­ades there has been a grow­ing dis­satis­fac­tion with any theory or study of the indi­vidual which ar­ti­fi­cially isol­ates him from the con­text of his life, inter­per­sonal and so­cial.”

R. D. Laing: The Self and Others.

  Sartre holds that all groups are struc­tured against an aware­ness of a “spec­tator”. This “spec­tator” may be an indi­vidual—as in the case of chil­dren seeing them­selves as “pupils” in rela­tion to a teacher—or an­other group, as in the case of workers con­sti­tu­ting them­selves against man­agers. This spac­tator he calls the “Third” for whom the group ex­ists as an object. Laing and Cooper seem to have de­veloped their views on groups—and in par­tic­u­lar, the family system of the future “schizo­phrenic”—from Sartre’s inter­preta­tion of group struc­ture and cohe­sion. In elab­or­at­ing their theories the British ex­isten­tial ana­lysts have made use of a number of terms, some of their own crea­tion, whilst others are also used by Sartre. This rather tech­nical and eso­teric lan­guage creates a dens­ity in some of their writing which ob­scures the im­port­ance of what is being said; in my view, the value of Laing and Cooper’s book Reason and Viol­ence is much re­duced by their over-​reli­ance on such terms and it is a pity that what one senses to be im­port­ant ideas are couched in lan­guage which re­quires a good deal of de­cipher­ing before it becomes in­tel­ligible. If this par­tic­u­lar book had been in ex­ist­ence at the time Orwell was pre­paring his essay “Polit­ics and the English Lan­guage” it would have pro­vided him with some re­mark­able cau­tion­ary ex­tracts.

  The British ex­ist­en­tial­ists make use of two words, series and nexus, in dif­fer­en­ti­ating between kinds of group—and two words, praxis and pro­cess, which de­scribe group dy­nam­ics or the rela­tion­ships between group mem­bers. A series is typic­ally, a human as­so­ci­a­tion on negat­ive grounds—for ex­ample a bus queue in which the sole link between per­sons is a com­mon desire to travel on the bus; each person in the queue being “one too many” for the others. Also re­garded as series are per­sons united solely on the basis of op­posi­tion to some shared con­cept: anti-​semites sharing only their hatred of Jews, or one could per­haps say anarch­ists, united by shared op­posi­tion to the state (the only belief com­mon to all anarch­ist views). A series may move towards being a group through “an act of group-​syn­thesis” (Laing’s term). “If I think of cer­tain others as together with me, and cer­tain others as not together with me, I have already under­taken two acts of syn­thesis, re­sult­ing in we and them. However, in order that we have a group iden­tity, it is not enough that I re­gard, let us say, you and him as con­sti­tu­ting a we with myself. You and he have to per­form sim­ilar acts of syn­thesis, each on his own behalf. In this we (me, and you, and him), each of us recog­nises not only our own private syn­theses, but also the syn­theses that each of the others makes.”

  The dis­tinct­ive qual­ities of the nexus are that each person ac­know­

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ledges: the need of each for the others; the ex­ist­ence of strong bonds between mem­bers (not main­tained prin­cip­ally by in­sti­tu­tional or organ­isa­tion struc­tures, or a shared ex­ternal “com­mon ob­ject”). “The rela­tion­ships of per­sons in a nexus are char­ac­ter­ised by en­dur­ing and in­tens­ive face-​to-​face recip­rocal in­flu­ence on each other’s ex­peri­ence and beha­viour.” The family, or at least the family as we are ac­cus­tomed to think of it, is repre­sent­at­ive of a nexus.

  Praxis and pro­cess are both terms used by Sartre. Basic­ally, praxis is what is done by some­one: “deeds done by doers”, “the acts of an indi­vidual or group”; whilst pro­cess re­fers to “what just hap­pens”, activ­ity not in­tended by any­one and of which no one person in a group may be aware.

  The posi­tion of the person within the group will af­fect his idea of him­self—of who he is. In the same way his view of others in the group af­fects their defin­i­tions of them­selves. And again, his beha­viour will be af­fected by his idea of what other people make of him. As a person moves during even one day, from group to group, from one mode of as­so­ci­a­tion to an­other, he must adapt him­self to each con­text: “Each group re­quires more or less rad­ical in­ternal trans­forma­tion of the per­sons who com­prise it. Con­sider the meta­morph­oses that the one man may go through in one day . . . family man, speck of crowd dust, func­tion­ary in the organ­isa­tion, friend. These are not simply dif­fer­ent roles: each is a whole past and present and future, of­fer­ing dif­fer­ing op­tions and con­straints, dif­fer­ent degrees of change or iner­tia, dif­fer­ent kinds of close­ness and dis­tance, dif­fer­ent sets of rights and ob­liga­tions, dif­fer­ent pledges and pro­mises.”

  Dr. Laing’s second book The Self and Others deals with the way in which a person is af­fected by his situ­ation in a “nexus” of others, in par­tic­u­lar within the family. “The others either can con­trib­ute to the per­son’s self-​ful­fil­ment, or they can be a potent factor in his losing him­self (ali­en­a­tion) even to the point of mad­ness.” He as­serts his belief that “fantasy is a mode of ex­peri­ence” and that rela­tion­ships on a fantasy level are “as basic to all human rela­ted­ness as the inter­ac­tions that most people most of the time are more aware of.”

  What hap­pens in the fam­il­ies of “schizo­phrenics”? It is im­port­ant to em­phas­ise that it is not the thesis of these workers that the family rather than the indi­vidual is “ill”. A group is not an organ­ism—even though it may ap­pear to be one to its mem­bers or to ob­servers out­side it. A human group of what­ever size, does not pos­sess either a body or a mind that can be either well or ill. In the family, a per­son’s self can be either con­firmed or dis­con­firmed by the actions and in­flu­ence—in­clud­ing in­flu­ence in “fantasy”—of others in the family nexus. Mysti­fi­ca­tion of a person can be car­ried so far that all genu­ine ex­pres­sions of in­depend­ent de­velop­ment are denied valid­ity. “In the fam­il­ies of schizo­phrenic pa­tients in­ten­tions, which link up with the ‘psy­chotic acts’ of the pa­tient are denied, or even, their anti­thesis as­serted so that the pa­tient’s actions have the ap­pear­ance of pure pro­cess un­related to praxis and may even be ex­peri­enced by him as such.” In the moving final sec­tion of The Divided Self (called “The Ghost of the Weed

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Garden”) R. D. Laing de­scribes the clin­ical bio­graphy of a schizo­phrenic. This was based on a series of inter­views with the pa­tient, mem­bers of the pa­tient’s family, both indi­vidu­ally and jointly with other mem­bers. These inter­views were de­signed to secure the in­forma­tion neces­sary for an ex­ist­en­tial ana­lysis and were not a form of group psy­cho­ther­apy. It is here that Laing first out­lines the se­quence which would ap­pear to be typical of this kind of family inter­ac­tion: whilst each family mem­ber had his or her own view of the pa­tient-​to-​be’s life, they all agreed on three basic phases:

1. “The pa­tient was a good, normal, healthy child; until she gradu­ally began
2. “to be bad, to do or say things that caused great dis­tress, and which were on the whole ‘put down’ to naughti­ness or bad­ness, until
3. “this went beyond all toler­able limits so that she could only be re­garded as com­pletely mad.”

What was seen by the mother as her daugh­ter’s “good” period, in infancy and early child­hood, she de­scribed with such re­marks as “she gave no trouble”, “she always did what she was told”. Laing com­ments that what to the mother were signs of good­ness, were signs that the child had never been per­mit­ted to become “ex­ist­en­tially alive”—in fact “being ex­ist­en­tially dead re­ceives the high­est com­menda­tion”. The “bad” period was the time of ad­oles­cence, during which the pa­tient made her great­est strug­gle towards a real­isa­tion of her own self through auto­nom­ous action but found that her ef­forts were con­tinu­ally de­feated by “the com­plete ab­sence of any­one in her world who could or would see some sense in her point of view”. The trans­fer from “bad” to “mad” came as some­thing of a relief to the rest of the family, who “blamed them­selves for not real­ising sooner”. As the mother said: “I knew she really could not have meant the awful things she said to me. In a way, I blame myself but, in a way, I’m glad that it was an ill­ness after all, but if only I had not waited so long before I took her to a doctor.”

  In San­ity, Mad­ness and the Family (the first volume of an un­com­pleted study) Drs. Laing and Esterson present ex­tracts from inter­views with mem­bers of 11 fam­il­ies, all of which con­tained daugh­ters dia­gnosed as “schizo­phrenic”. In the Intro­duc­tion to this book the authors write: “. . . we believe that we show that the ex­peri­ence and beha­viour of schizo­phrenics is much more so­cially intel­li­gible than has come to be sup­posed by most psy­chi­atrists . . . we believe that the shift of point of view that these de­scrip­tions both em­body and de­mand has an histor­ical sig­ni­fic­ance no less rad­ical than the shift from a demon­o­log­ical to a clin­ical view­point 300 years ago.” Beha­viour which is eventu­ally inter­preted by the family as a sign of mad­ness is, they argue, the out­ward ex­pres­sion of a desper­ate at­tempt on the part of the “mad one” to “make sense of a sense­less situ­ation”—to pre­serve some au­then­tic ele­ments of per­son­ality—a strug­gle for auto­nomy, spon­tan­eity, re­spons­ibil­ity and “free­dom”. Here is an ex­cerpt from Laing and Esterson’s tran­script of Mr. and Mrs. Gold’s ac­count of their daughter:

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“When she is her ‘real’ self, that is, when she is ‘well’, she is not to be seri­ously inter­ested in writers or art, not to wear col­oured stock­ings, not to listen to jazz in a jazz club, not to bring friends home, not to stay out late. It is only from time to time that Ruth tries to as­sert her­self over against this par­ental eternal es­sence, and when she does she wears clothes to her liking, and in­sists vehem­ently on going where and with whom she wishes. Then her mother ‘knows’ an ‘at­tack’ is coming on. She is told she is being dif­fi­cult, in­con­sider­ate, dis­re­spect­ful, thought­less, because she is causing her parents such anxi­ety—but they do not blame or hold her re­spons­ible for all this, because they know she is odd and ill. Thus mys­ti­fied and put in an in­toler­able posi­tion she becomes ex­cited and desper­ate, makes ‘wild’ ac­cus­a­tions that her parents do not want her to live, and runs out of the house. . . .”

  These writers claim, and I think demon­strate, that armed with a know­ledge of the pa­tient’s ex­ist­en­tial situ­ation, it is pos­sible to make sense of what “psy­chi­atrists still by and large re­gard as non­sense”. For example, Julie, the pa­tient in “The Ghost of the Weed Garden”, re­ferred to her­self whilst in her “psy­chotic” state as “Mrs. Taylor” and as a “tolled bell”. Dr. Laing inter­prets her chosen title “Mrs. Taylor” as ex­pres­sing the feel­ings: “I’m tailor made; I’m a tailored maid; I was made, fed, clothed and tailored” and a “tolled bell” is also “the told belle” “the girl who always did what she was told”. The schizo­phrenic’s “delu­sions” of per­secu­tion are real ex­pres­sions of re­ac­tion in re­sponse to real per­secu­tion and are ex­ist­en­tially true; that is to say they are “liter­ally true state­ments within the terms of refer­ence of the indi­vidual who makes them”.^††

  The person is now launched on a “career” as a mental pa­tient. He is con­firmed in this role by so­ciety’s agents the psy­chi­atrists, in col­lu­sion with the pa­tient’s family, and by pro­cess of be­trayal and de­grada­tion becomes an in­mate of a mental hos­pital, which in­sti­tu­tion em­bodies “a so­cial struc­ture which in many re­spects re­du­plic­ates the mad­den­ing pecu­li­ar­ities of the pa­tient’s family . . . he finds psy­chi­atrists, ad­min­is­trat­ors, nurses who are his verit­able par­ents, broth­ers and sisters, who play an inter­per­sonal game which only too often re­sembles in the in­tric­a­cies of its rules the game he failed in at home.”

  The ex­ist­en­tial ana­lysts have as­serted that a great deal of what passes for treat­ment in mental in­sti­tu­tions is viol­ence. Per­haps we can now begin to see what is meant by this. David Cooper in his art­icle in Views, No. 8 quotes Sartre’s defin­i­tion of viol­ence: “The cor­ros­ive

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action of the free­dom of a person on the free­dom of an­other.” And he ex­plains this: “The action of a person . . . can de­stroy the free­dom of an­other or at least para­lyse it by mys­ti­fica­tion.” In an art­icle printed in Peace News (22.1.65) called “Mas­sacre of the In­no­cents” R. D. Laing makes his under­stand­ing of the word clear: “Love and viol­ence, pro­perly speak­ing, are polar op­pos­ites. Love lets the other be, but with af­fec­tion and con­cern. Viol­ence at­tempts to con­strain the other’s free­dom, to force him to act in the way we desire, but with ultim­ate lack of con­cern, with in­dif­fer­ence to the other’s own ex­ist­ence or des­tiny.” The basic theme of his art­icle is that a most brutal and de­struct­ive form of viol­ence is “viol­ence mas­quer­ad­ing as love”. In rela­tion to the family and its “schizo­phrenic” mem­ber, action to secure care and at­ten­tion in hos­pital for some­one who is “ill” could well be inter­preted as an ex­pres­sion of con­cern and love. Whether or not one believes that this pro­cess and the pa­tient’s sub­sequent treat­ment is a form of viol­ence will de­pend in part, on whether one believes that there is any ill­ness “in” the person to be “cured”. It is not viol­ence to am­pu­tate a gan­gren­ous leg. We would all agree that it would be a viol­ent pro­ject to per­suade a person that his leg was dis­eased (“because you do not keep in step with us . . .”), to find a sur­geon who believes that there is a so­cial need for one-​legged people—and for him to cut off the leg. In the actual case of the hos­pital­ised schizo­phrenic each person in the chain sees himself as acting in the best inter­ests of the others . . . “but we have also to re­mem­ber that good in­ten­tions and all the wrap­pings of re­spect­abil­ity very often cover a truly cruel human real­ity.”

THEORIES IN PRACTICE: “THE ANTI-HOSPITAL”

  In his pamph­let Youth for Freedom (1951) Tony Gibson wrote to the ef­fect that the chief value of Summer­hill to the com­mun­ity lay in its having taken the gen­eral con­cept of what a school should be and turned it on its head. Dr. David Cooper’s unit in a large mental hos­pital “just north-​west of London” has done very much the same thing to the gen­eral con­cept of the asylum. To main­tain the edu­ca­tional par­al­lel, Dr. Cooper’s ex­peri­ment (judging from his ac­count of it in New So­ciety) also has great rel­ev­ance for those who would wish to at­tack the viol­ence im­plicit in the cus­tom­ary methods of so­cial organ­isa­tion in schools.

  The theor­et­ical basis of the ex­peri­ment rested on the find­ings of Laing and Esterson, pub­lished in San­ity, Mad­ness and the Family. I hope already to have given some idea of what these find­ings were: the family pre­serves its in­au­thentic system by using one of its mem­bers as a kind of “scape­goat”, ending by at­trib­ut­ing mad­ness to him. In gen­eral, so­ciety con­firms the at­trib­u­tions made by the “sane” relat­ives and in­valid­ates the pa­tient’s ver­sion of events by trans­lat­ing them into “symp­toms of a dis­ease”. The bear­ing of this theory on the psy­chi­atric ward, writes Dr. Cooper, is that “staff must begin to refuse to enter into the tradi­tional covert col­lu­sion with the pa­tient’s family. In the past this col­lu­sion has often meant that staff become im­plic­ated in a pro­gres­sive viol­ence that is per­petu­ated, in the name of treat­ment,

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against the la­belled pa­tient.” The workers on the “anti-​hos­pital” pro­ject main­tained one central con­vic­tion: that it was neces­sary to under­stand, in some meas­ure, the pro­cesses going on in them­selves before they could hope to have real in­sight into the “inner” world of their pa­tients.

  The unit—one ward in a hos­pital of some 2,300 pa­tients—opened in January, 1962, with 19 young male pa­tients, two-​thirds of whom had been dia­gnosed as “having” schizo­phrenia. They had all been previ­ously in the insulin-​coma ward. In the second year, the number of pa­tients was in­creased to 30.

  The pro­gramme during the first year was highly struc­tured, with daily meet­ings of the whole staff-​pa­tient group, separ­ate and regular staff meet­ings, oc­cu­pa­tional ther­apy and organ­ised re­cre­ational activ­ity. No “phys­ical” treat­ments were used except for the occa­sional dose of mild tran­quil­liser, and there was no indi­vidual psycho-​ther­apy; there were however regu­lar “inter­views” between ther­ap­ist and pa­tient and ther­ap­ist and pa­tient with vari­ous mem­bers of his family. After about a year, the staff became dis­satis­fied with the rigid­ities of the system and changes in the direc­tion of greater flu­id­ity were felt to be ap­pro­priate.

  Dr. Cooper writes of two areas in which the con­sequent “de­struc­tur­ing” had re­mark­able ef­fects—the tradi­tional busi­ness of get­ting pa­tients out of bed in the morn­ing and the at­ti­tude to the pro­vi­sion of work and activ­ities. “One of the com­mon­est staff fan­tasies in mental hos­pitals is that if pa­tients are not co­erced verbally or phys­ic­ally into get­ting out of bed at a cer­tain hour in the morn­ing they will stay in bed until they rot away.” This fantasy, like all anxi­ety over punc­tu­ality, is a form of pro­jec­tion. For the staff, the pa­tient re­pre­sents “that fright­en­ing as­pect of them­selves that some­times does not want to get out of bed in the morn­ing and come to work.” After con­sider­able dis­cus­sion and the trial of vari­ous ap­proaches by dif­fer­ent staff groups it was found that if the usual “rous­ing pro­ced­ures” were aban­doned the pa­tient did get up him­self—even if he “re­belled” to the ex­tent of re­main­ing in bed most of the day for a week or more. “No one rotted away after all and the gain in per­sonal auto­nomy seemed worth while.” Dr. Cooper re­lates one epi­sode when “all the oc­cu­pants of a six-​bed dorm­it­ory re­belled against the com­mun­ity meet­ing by stay­ing in bed until after 11 o’clock. One of the charge nurses went up­stairs to see what was going on. One of the pa­tients left to go to the toilet and the nurse seized the oppor­tun­ity to take off his white coat (worn not as uni­form but as pro­tect­ive clothing for cer­tain messy jobs like washing up) and climb into the vacant bed. The pa­tient, on his return, ap­pre­ci­at­ing the irony of the situ­ation, had little option but to take the va­cated ‘staff role’, put on the white coat and get the others out of bed.”

  The motiv­at­ing fantasy or belief behind the pro­vi­sion of work and “oc­cu­pa­tional ther­apy” activ­ities is fre­quently that this in some way pro­tects the pa­tients from the erod­ing ef­fects of in­sti­tu­tion­al­isa­tion. But Dr. Cooper ob­serves: “The bitter truth is that if they sub­mis­sively

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carry out all these re­quired tasks they become what is im­plied by these labels anyhow.” If one wishes to en­counter the ul­ti­mate in with­drawn chronic in­sti­tu­tion­al­isa­tion one has only to visit one of the more “active” and pro­duct­ive “factor­ies in a hos­pital” or “indus­trial oc­cu­pa­tional ther­apy de­part­ments”. In the unit, dis­cus­sion centred on this theme; the pa­tients were in any case show­ing re­sist­ance to con­ven­tional pro­jects. Jobs of a vigor­ous, de­struct­ive kind (“knock­ing down an air-​raid shelter”) which within a cer­tain mytho­logy, would have been sup­posed to pro­vide a proper out­let for ag­gres­sion, were not tackled with en­thu­si­asm. “People had real reasons to be angry with real other people at home and in hos­pital.” Ham­mer­ing away at brick walls was of no rel­ev­ance. Partly as a result of fail­ure to hold the pa­tient’s inter­est in tasks such as these—des­pite an at­tempt to in­flu­ence them by reduc­tion of their money al­low­ance—a situ­ation was reached in which “no organ­ised work pro­ject was pre­sented to the com­mun­ity”. The oc­cu­pa­tional ther­ap­ist de­cided that she would be better em­ployed in the unit as an assist­ant nurse. It was at this stage of de­velop­ments that the staff became con­scious of the break­down of role bound­ar­ies: “There was a pro­gres­sive blur­ring of role between nurses, doctor, oc­cu­pa­tional ther­ap­ist and pa­tients which brought into focus a number of dis­turb­ing and ap­par­ently para­dox­ical ques­tions: for ex­ample, can pa­tients ‘treat’ other pa­tients and can they even treat staff? Can staff real­ise quite frankly and ac­know­ledge in the com­mun­ity their own areas of in­ca­pa­city and ‘ill­ness’ and their need for ‘treat­ment’? If they did what would happen next and who would con­trol it?   “It was at this point that the most rad­ical de­par­ture from con­ven­tional psy­chi­atric work was ini­ti­ated. If the staff re­jected pre­scribed ideas about their func­tion and if they did not quite know what to do next, why do any­thing? Why not with­draw from the whole field of hos­pital staff and pa­tient ex­pect­ation in terms of organ­ising pa­tients into activ­ity, super­vis­ing the ward do­mestic work and gen­erally ‘treat­ing pa­tients’.” After this, the staff re­tained con­trol of the issu­ing of drugs and con­tinued their ad­min­is­trat­ive work. Other sec­tions of the hos­pital were made aware of the policy change in the unit and the de­tails of the new ap­proach were clari­fied at the com­mun­ity meet­ings. The im­me­di­ate ef­fect of the change was re­flected in piles of washing-​up left un­done and a marked in­crease in dirt. The normal level of staff anxi­ety in­creased as the pa­tients gave no sign of organ­ising among them­selves. The pa­tients were di­vided between those who wanted a re­turn to the pre­vi­ous system and others who “ap­pre­ci­ated the more au­thentic ele­ments in the policy change”. The crisis point came during Dr. Cooper’s ab­sence on holi­day. Up to that time, many of the staff had found as­sur­ance in the belief that the evid­ent dis­order was a con­sequence of en­act­ing the Doctor’s “ultra-​per­mis­sive” policy—they had done his bid­ding and what hap­pened was ul­ti­mately his re­spons­ib­il­ity. But during the period of his ab­sence, they acted together to put a limit to their in­tense anxi­ety and re­intro­duced some con­trols within the ward. This, Dr. Cooper sug­gests, was an ad­vance on their part in that they achieved a joint deci­sion and all mem­bers of the unit began to

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ex­peri­ence the real de­mands made by the “group real­ity”. Dr. Cooper’s ob­serva­tions at this point are inter­est­ing and re­call the dis­tinc­tions made by other writers between forms of au­thor­ity—“func­tional or ar­bit­rary” (Martin Buber) “overt or an­onym­ous” (Erich Fromm). Dr. Cooper writes: “This leads us on to the central prob­lem of the psy­chi­atric hos­pital of dis­tin­guish­ing between au­thentic and in­au­thentic au­thor­ity. . . . The au­thor­ity of the au­thor­ity person is granted him by ar­bit­rary so­cial defin­ition rather than on the basis of any real ex­pert­ise he may pos­sess. If staff have the cour­age to shift them­selves from this false posi­tion they may dis­cover real sources of au­thor­ity in them­selves. They may also dis­cover such sources of au­thor­ity in ‘the others’ who are de­fined as their pa­tients. . . . Per­haps the most central char­ac­ter­istic of au­thentic leader­ship is the re­lin­quish­ing of the im­pulse to domin­ate others. Domin­ation here means con­trol­ling the beha­viour of others where their beha­viour repre­sents for the leader pro­jected as­pects of his own ex­peri­ence. By domin­ation of the other the leader pro­duces for him­self the illu­sion that his own in­ternal organ­isa­tion is more and more per­fectly ordered. The Nazi ex­term­in­ation camps were one pro­duct of this Dream of Per­fec­tion. The mental hos­pital, along with other in­sti­tu­tions in our so­ciety, is an­other.” Sub­sti­tute “school” for “psy­chi­atric hos­pital” and “pupil” for “pa­tient” and one sees the wider rel­ev­ance of this pas­sage.

  The work­ers in the unit were faced with con­flict­ing pres­sures—pres­sures to con­form with the cus­tom­ary ap­proaches facing them in so­cial systems and rela­tion­ships out­side the unit (pro­fes­sional ad­vance­ment and will­ing­ness to con­form to some ex­tent going together)—and con­trary pres­sure from within the unit itself. This again re­sulted in ten­sion which obliged them to face the need for “com­mit­ment one way or the other”.

  The posi­tion of the ex­peri­mental ward in­side the frame­work of the large hos­pital prompted the growth of fan­tastic and dis­torted at­ti­tudes towards the unit in the minds of senior staff mem­bers work­ing out­side it; this in­dic­ated the deep chal­lenge which the new ap­proach made to their more tradi­tional con­cepts. For ex­ample an in­cid­ent one night, in which an hyster­ical girl pa­tient was helped back to her ward by a male friend was “pro­cessed” by the com­mun­ica­tions system until in its final form, it had become a case of at­tempted sexual as­sault.

  An as­sess­ment of the suc­cess of the “anti-​hos­pital” in terms of “results” (usu­ally meas­ured in such cases by the in­cid­ence of re-​ad­mis­sion) would not be any more mean­ing­ful than a judge­ment on Summer­hill based simply on the pupil’s suc­cess rate in public exam­ina­tions. The cri­terion of re-​ad­mis­sion rates is also in­ad­equate in that staff en­cour­aged pa­tients to return after dis­charge if they felt that a return to the unit would be of value to them. Never­the­less, even by this stand­ard the “anti-​hos­pital” re­sults com­pare fa­vour­ably with those achieved by more widely ac­cepted methods—17 per cent of pa­tients being re-​ad­mitted during a one-​year period fol­low­ing dis­charge. In the issue of the British Med­ical Journal which in­cluded these re­sults Dr. Cooper stated his belief that the ex­peri­ment has estab­lished “at least

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a prima facie case for rad­ical re­vision of the thera­peutic strat­egy em­ployed in most units for schizo­phrenia”.

  As a post­script to the fore­go­ing, I can deal only sketch­ily with an in­triguing aspect of the work of the British ex­ist­en­tial­ists—their ideas on the nature of “madness” itself. A re­cur­rent theme in R. D. Laing’s writ­ing is his em­phasis on the dis­astrously narrow field of ex­peri­ence which is cred­ited in con­tempor­ary life, as “real­ity”. “We are far more out of touch with even the near­est ap­proaches of the in­fin­ite reaches of inner space, than we now are with the reaches of outer space. . . . We are so out of touch with this realm that many people can now argue seri­ously that it does not exist.” It is no sur­prise that Dr. Laing has spoken on the power of the drug LSD to ex­tend the bound­aries of real­ity for those who make use of it re­spons­ibly. In The Divided Self he cites the value of the Proph­etic Books of William Blake and (in The Self and Others) re­lates Blake to his pre­vi­ous de­scrip­tion of a “psy­chotic”: “Blake’s posi­tion seems to me to have been this. Single ‘vision’ (one mod­al­ity of ex­peri­ence) is death. This is what most people regard as san­ity.” He also charts in this book and in other art­icles, the dual­ism im­plicit in the idea of fantasy to be found in most psycho-​ana­lytic works and in the minds of a good many psy­chi­atrists: “A very con­fused dual­istic philo­sophy of psy­chical and phys­ical, inner and outer, mental and phys­ical.” It is the opin­ion of Laing and Cooper that what is clin­ic­ally de­scribed as “a schizo­phrenic break­down” may be the onset in the indi­vidual of a voyage into the world of inner space and time. The word “inner” is mis­lead­ing, sug­gest­ing a place loc­ated “inside” the person; as they use the word it refers to “our own per­sonal idiom of ex­peri­encing our bodies, other people, the anim­ate and in­anim­ate world: imagin­ation, dreams, fantasy . . .”. And far from being a “dis­ease” this pro­cess, or “voyage”, may well be the path to greater aware­ness, the crisis of the indi­vidual’s strug­gle to real­ise him­self as a person, even—the onset of san­ity! (Dr. Cooper has sug­gested that it may be “when people start to become sane that they enter the mental hos­pital”). A person under­go­ing this ex­peri­ence may well be “dif­fi­cult for others” and is in need of special care—but not “treat­ment” in “the quite bizar­rely in­con­gru­ous con­text of the mental hos­pital”. Those who care for him should as­sume the role of guides—and people cap­able of pro­vid­ing this help will very prob­ably be those who have them­selves been through similar ex­peri­ences: “We need a place where people who have trav­elled further and, con­sequently, may be more lost than psy­chi­atrists and other sane people, can find their way further into inner space and time, and back again . . . the person will be guided with full so­cial en­cour­age­ment and sanc­tion into inner space and time, by people who have been there and back again. Psy­chi­atric­ally, this would appear as ex-​pa­tients help­ing future pa­tients go mad.”

  No fully auto­nomous unit in which this pro­cess can take place exists at the present moment,^††† but we can de­duce from the “anti-​

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hos­pital” ex­peri­ment, a good deal about what is re­quired for its suc­cess­ful real­isa­tion.

CRITICISM AND CONCLUSIONS

  The only ex­tended criti­cism known to me of the work and ideas of these British psy­chi­atrists is an article by B. A. Farrell called “The Logic of Ex­ist­en­tial Ana­lysis” which ap­peared in New Society (1.10.65). This writer argues that the ex­ist­en­tial­ists have dis­missed ortho­dox views on the causes and treat­ment of schizo­phrenia on in­ad­equate grounds and also make logic­ally un­warrant­able de­duc­tions from their re­search into the fam­il­ies of schizo­phrenics. Re­fer­ring to the claim of Laing and Esterson that they have made the “symp­toms” of schizo­phrenia in­tel­li­gible, he makes the point that even if they are suc­cess­ful in doing this, making the symp­toms in­tel­li­gible is not the same thing as estab­lish­ing truth for their hypo­thesis. Farrell com­ments that “this would be a trivial point to make” if we had other grounds for believ­ing that the nar­rat­ives were true. In rela­tion to their sug­ges­tions for treat­ment he asks for evid­ence that units of the “anti-​hos­pital” type pro­duce results “as good as, or better than, the tradi­tional methods”. In con­clu­sion he ad­vises them that some of the op­posi­tion to their work might not have been so vehe­ment had they avoided “abus­ive” and “in­tem­per­ate” lan­guage in their refer­ences to the Estab­lish­ment; and also that “they would help them­selves if they could avoid giving the im­pres­sion that they had fallen in love with their schizo­phrenic pa­tients.  . . .”

  Cor­re­spond­ents in sub­sequent issues sug­gested some answers to these criti­cisms. Com­ment­ing on Mr. Farrell’s re­mark on the lack of sup­port­ive evid­ence, Dr. John Bowlby wrote: “Although Dr. Laing’s is the only psy­chi­atric group in this country pub­lish­ing ma­terial of its sort, in the United States there are several. The two best known are the group at the Na­tional In­sti­tute of Mental Health . . . and the one at Palo Alto. . . . Each of these re­search groups has used methods and re­ported find­ings es­sen­tially similar to those of Dr. Laing. Some of their most re­cent re­ports . . . are of pro­jects that at cri­tical points in the pro­ced­ure are ‘blind’ in just the way that Mr. Farrell rightly re­quests. In addi­tion a number of find­ings de­rived from quite other methods are sup­port­ive. . . . There is thus sub­stan­tial evid­ence de­rived from more than one method in sup­port of the Laing type of hypo­thesis. . . . When com­pared with evid­ence ad­vanced to sup­port other types of hypo­thesis, it is not un­im­pres­sive. On the one hand it is far more sub­stan­tial than any yet of­fered in sup­port of psycho-​ana­lytic theor­ies, whether tradi­tional or Kleinian, and, on the other, more con­sist­ent than that sup­port­ing a genetic-​bio­chem­ical type of theory” (my italics).

  I have already made some re­fer­ence to the “re­sults”, in terms of re-​ad­mis­sions, of the “anti-​hos­pital” which were pub­lished in the

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BMA Journal and re­printed in New So­ciety three months after the ap­pear­ance of Mr. Farrell’s art­icle. They are indeed as good as, or better than, re­sults achieved by tradi­tional methods.

  Mr. Farrell’s final charge is valu­able in that it draws at­ten­tion to the basis of the method of ex­ist­en­tial ana­lysis as de­scribed and prac­tised by Dr. Laing and his col­leagues. I do not think that Dr. Laing would wish to deny that “love” is in­volved in his at­ti­tude towards his pa­tients and their pre­dica­ment. In The Divided Self he writes of the act of em­pathy—this is not a strong enough word—that is re­quired if the ther­ap­ist is to under­stand the pa­tient’s ex­ist­en­tial posi­tion. “I think it is clear that by ‘under­stand­ing’ I do not mean a purely intel­lec­tual pro­cess. For under­stand­ing one might say love.” In making this at­tempt the ther­ap­ist “draws on his own psy­chotic pos­sib­il­it­ies”. Al­though not a di­rect par­al­lel, one is re­minded of Homer Lane’s at­ti­tude towards emo­tion­ally dis­turbed “de­lin­quent” ad­oles­cents and his dictum of “being on their side” even when their ac­tions were most anti-​so­cial. A con­cept that re­curs in a similar way in Dr. Laing’s writ­ing is to “let the other be”: “The main agent in unit­ing the pa­tient, in al­low­ing the pieces to come together and co­here is the phy­si­cian’s love, a love that recog­nises the pa­tient’s total being, and ac­cepts it, with no strings at­tached.”

  As I hope I have suc­ceeded in in­dic­ating in this art­icle, the work of Drs. Laing, Cooper and Esterson con­sti­tutes far more than just an­other theory of what causes “schizo­phrenia”; a cor­re­spond­ent in New So­ciety char­ac­ter­ised it as “an ex­plor­a­tion of the neces­sary condi­tions for a fully human rela­tion­ship”.

  Dr. Laing has sug­gested that the reason why ex­plor­ation of the “inner” world of the self is in­valid­ated by so­ciety as “mad­ness” is that such ex­peri­ence is sub­vers­ive. “And it is sub­vers­ive because it is real.” Dei­fied de­struct­ive illu­sions—“the health of ster­ling”, “the Red menace”, “the inter­ests of the State”—are the stage-​props of normal so­cial life and these phantoms are con­firmed as “real­ity” by all the re­sources avail­able. Because the vast ma­jor­ity of people act in terms of these nega­tions “we find our­selves threat­ened by ex­term­in­a­tion that will be re­cip­rocal, that no one wishes, that every­one fears, that may just hap­pen to us ‘because’ no one knows how to stop it. . . . Every­one will by carry­ing out orders. Where do they come from? Always from else­where. . . .” Dr. Cooper has also de­scribed this tragic condi­tion: “The myth of Thanatos is a self-​actu­al­izing phant­asy. The bomb really did drop on Hiroshima. . . . The basic para­dox that we live is that man­kind needs illu­sions but the illu­sions it needs de­stroy it. Even through rela­tively in­noc­u­ous or ‘good’ illu­sions we im­prison our­selves meta­phys­ically and then find we have built real prison walls (per­haps around some­one else).”

  I hope that, as Dr. Laing has hinted, their future work will in­volve and imply further cri­ti­cism in depth, of our so­ciety; if this is the case it will have di­rect rel­ev­ance for con­tem­por­ary anarch­ism (not­with­stand­ing the as­so­ci­a­tion of these writers with a form of Marx­ism). In con­clu­sion, I would risk the state­ment that the body of work they have

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so far pro­duced—de­rived as it is from so­cial psy­cho­logy and ob­serva­tional re­search in the best Alex Comfort manner—al­ready “up­holds” a form of anarch­ism—a form which could be typ­i­fied by a phrase of Dr. Cooper’s: “The way of auto­nomy”.

---

* 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 have been 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).

†† See also Laing’s inter­preta­tion of the state­ments of a schizo­phrenic from the ori­ginal ac­count in Kraepelin’s Lec­tures on Clin­ical Psy­chi­atry, 1905 (pp. 29-31 The Divided Self). Laing writes: “What does this pa­tient seem to be doing? Surely he is carry­ing on a dia­logue between his own par­od­ied ver­sion of Kraepelin, and his own defi­ant rebel­ling self. ‘You want to know that too? I tell you who is being meas­ured and is meas­ured and shall be meas­ured. I know all that, and I could tell you, but I do not want to’.” Laing com­ments: “This seems to be plain enough talk.”

††† Since this was written an art­icle has ap­peared. “Schizo­phrenia as a way of life”, by Ruth Abel (Guardian, 4.10.66), de­scrib­ing a “fully auto­nomous unit” for “schizo­phrenics” estab­lished by Drs. Laing, Esterson and Cooper at Kingsley Hall in London. This pro­ject is fin­anced by The Phila­delphia As­so­ci­a­tion and it seems that two new centres have been opened during the last few months in North London, and it is hoped that these are only the first of “a chain of com­mun­ities”.

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