Libertarian Psychiatry:
an introduction to
existential analysis
PETER FORD
s1
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.”
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.”
[1] 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.”
[2] 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 …’.”
[3] 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”
[4] (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.”
[5] 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”
[6] (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.[7] 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”.[8] 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.”
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
[9] 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.”[10] 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. …”[11] 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.”[12] 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”.”[13]
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.”
[14] 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. …”
[15] 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).
* 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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