Difference between revisions of "Anarchy 70/Libertarian Psychiatry: an introduction to existential analysis"

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{{tab}}In 1965 there were 160,000 people in mental hos&shy;pitals in Britain and an estim&shy;ated 200,000 psy&shy;chotics in the com&shy;mun&shy;ity. Nearly half of all hos&shy;pital beds are oc&shy;cu&shy;pied my the men&shy;tally ill. In a tele&shy;vision pro&shy;gramme on mental health<ref>{{w|BBC}} {{qq|{{w|Panorama|Panorama_(TV_series)}}}} on {{qq|Mental Health}}, 6th June, 1966.</ref> the number of men&shy;tally ill in Britain was given as half a million. The tele&shy;vised psy&shy;chi&shy;atrist sug&shy;gested that there were four main cat&shy;egor&shy;ies of ill&shy;ness: people with mental de&shy;form&shy;ity, {{p|357}}old people with {{qq|mental equip&shy;ment in de&shy;cline}} (&hellip; per&shy;haps old people with no&shy;where else to go?{{ref|aster2|**}}), people with physiolo&shy;gic&shy;ally normal mental equip&shy;ment but with ac&shy;quired neur&shy;otic pat&shy;terns, and lastly, vic&shy;tims of {{qq|bio{{-}}chem&shy;ical ill&shy;ness}}{{dash}}in his words, {{qq|Struck down out of the blue}}. The fourth cat&shy;egory per&shy;haps re&shy;flects, more than any&shy;thing else, the cur&shy;rently fa&shy;voured styles of treat&shy;ment!
 
{{tab}}In 1965 there were 160,000 people in mental hos&shy;pitals in Britain and an estim&shy;ated 200,000 psy&shy;chotics in the com&shy;mun&shy;ity. Nearly half of all hos&shy;pital beds are oc&shy;cu&shy;pied my the men&shy;tally ill. In a tele&shy;vision pro&shy;gramme on mental health<ref>{{w|BBC}} {{qq|{{w|Panorama|Panorama_(TV_series)}}}} on {{qq|Mental Health}}, 6th June, 1966.</ref> the number of men&shy;tally ill in Britain was given as half a million. The tele&shy;vised psy&shy;chi&shy;atrist sug&shy;gested that there were four main cat&shy;egor&shy;ies of ill&shy;ness: people with mental de&shy;form&shy;ity, {{p|357}}old people with {{qq|mental equip&shy;ment in de&shy;cline}} (&hellip; per&shy;haps old people with no&shy;where else to go?{{ref|aster2|**}}), people with physiolo&shy;gic&shy;ally normal mental equip&shy;ment but with ac&shy;quired neur&shy;otic pat&shy;terns, and lastly, vic&shy;tims of {{qq|bio{{-}}chem&shy;ical ill&shy;ness}}{{dash}}in his words, {{qq|Struck down out of the blue}}. The fourth cat&shy;egory per&shy;haps re&shy;flects, more than any&shy;thing else, the cur&shy;rently fa&shy;voured styles of treat&shy;ment!
  
{{tab}}By far the largest group is the third{{dash}}the {{qq|neur&shy;otics and psychot&shy;ics}}. Among these {{qq|{{w|schizo&shy;phrenia|Schizophrenia}}}} is the most common dia&shy;gnosis. {{qq|In most European coun&shy;tries about one per cent of the popu&shy;la&shy;tion go to hos&shy;pital at least once in their life&shy;time with the dia&shy;gnosis schizo&shy;phrenia.}}<ref>{{w|David Cooper|David_Cooper_(psychiatrist)}}, {{qq|The Anti{{-}}Hos&shy;pital: An Ex&shy;peri&shy;ment in Psy&shy;chi&shy;atry}}, {{w|''New So&shy;ciety''|New_Society}}, 11th March, 1965.</ref> But what mean&shy;ing can be given to these stat&shy;istics and as&shy;sess&shy;ments without a stand&shy;ard of san&shy;ity or mad&shy;ness? {{qq|Defin&shy;i&shy;tions of mental health pro&shy;pounded by the ex&shy;perts usually re&shy;duce to the no&shy;tion of con&shy;form&shy;ism, to a set of more or less ar&shy;bit&shy;rar&shy;ily pos&shy;ited so&shy;cial norms. &hellip;}}<ref>{{w|David Cooper|David_Cooper_(psychiatrist)}}, {{qq|Viol&shy;ence in Psy&shy;chi&shy;atry}}, ''Views'', No. 8, Summer, 1965.</ref> The label&shy;ling of people as mad can have the so&shy;cial func&shy;tion of defin&shy;ing the area of {{qq|san&shy;ity}}{{dash}}per&shy;haps there is a par&shy;al&shy;lel with {{w|Durkheim|Émile_Durkheim}}{{s}} theory of crime and pun&shy;ish&shy;ment as {{qq|neces&shy;sary}} to re&shy;spect&shy;able so&shy;ciety to mark off the limits of per&shy;mis&shy;sible and toler&shy;ated beha&shy;viour. {{qq|So&shy;ciety needs lun&shy;at&shy;ics in order that it may regard itself as sane.}}<ref>ibid.</ref> It could also be argued that cer&shy;tain kinds of so&shy;ciety {{qq|need}} lun&shy;at&shy;ics as their man&shy;agers; a dis&shy;cus&shy;sion in {{w|''Peace News''|Peace_News}} re&shy;cently was con&shy;cerned with the un&shy;certi&shy;fi&shy;able mad&shy;ness of the {{w|Amer&shy;ican Presid&shy;ent|Lyndon_B._Johnson}} in rela&shy;tion to a {{qq|col&shy;lect&shy;ive norm of in&shy;san&shy;ity}}. A Cor&shy;re&shy;spond&shy;ent noted: {{qq|No sig&shy;ni&shy;fic&shy;ant mem&shy;ber of a power estab&shy;lish&shy;ment can ever be {{q|cert&shy;ifi&shy;ably in&shy;sane}} since it is this same estab&shy;lish&shy;ment which de&shy;ter&shy;mines the defin&shy;i&shy;tions of {{q|san&shy;ity}} and {{q|in&shy;san&shy;ity}} and which de&shy;cides{{dash|checked only by the oc&shy;ca&shy;sional con&shy;science of an oc&shy;ca&shy;sional pro&shy;fes&shy;sional medi&shy;cal man}}when {{qq|in&shy;san&shy;ity}} becomes {{qq|{{w|cert&shy;ifi&shy;able|Involuntary_commitment}}}}.}}<ref>Part of a letter by Pierre{{-}}Joseph Brie, {{qq|In&shy;san&shy;ity and the Egg}}, {{w|''Peace News''|Peace_News}}, 1st July, 1966.</ref>
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{{tab}}By far the largest group is the third{{dash}}the {{qq|neur&shy;otics and psychot&shy;ics}}. Among these {{qq|{{w|schizo&shy;phrenia|Schizophrenia}}}} is the most common dia&shy;gnosis. {{qq|In most European coun&shy;tries about one per cent of the popu&shy;la&shy;tion go to hos&shy;pital at least once in their life&shy;time with the dia&shy;gnosis schizo&shy;phrenia.}}<ref>{{w|David Cooper|David_Cooper_(psychiatrist)}}, {{qq|The Anti{{-}}Hos&shy;pital: An Ex&shy;peri&shy;ment in Psy&shy;chi&shy;atry}}, {{w|''New So&shy;ciety''|New_Society}}, 11th March, 1965.</ref> But what mean&shy;ing can be given to these stat&shy;istics and as&shy;sess&shy;ments without a stand&shy;ard of san&shy;ity or mad&shy;ness? {{qq|Defin&shy;i&shy;tions of mental health pro&shy;pounded by the ex&shy;perts usually re&shy;duce to the no&shy;tion of con&shy;form&shy;ism, to a set of more or less ar&shy;bit&shy;rar&shy;ily pos&shy;ited so&shy;cial norms. &hellip;}}<ref>{{w|David Cooper|David_Cooper_(psychiatrist)}}, {{qq|Viol&shy;ence in Psy&shy;chi&shy;atry}}, ''{{l|Views|https://lccn.loc.gov/sf83002178}}'', No. 8, Summer, 1965.</ref> The label&shy;ling of people as mad can have the so&shy;cial func&shy;tion of defin&shy;ing the area of {{qq|san&shy;ity}}{{dash}}per&shy;haps there is a par&shy;al&shy;lel with {{w|Durkheim|Émile_Durkheim}}{{s}} theory of crime and pun&shy;ish&shy;ment as {{qq|neces&shy;sary}} to re&shy;spect&shy;able so&shy;ciety to mark off the limits of per&shy;mis&shy;sible and toler&shy;ated beha&shy;viour. {{qq|So&shy;ciety needs lun&shy;at&shy;ics in order that it may regard itself as sane.}}<ref>ibid.</ref> It could also be argued that cer&shy;tain kinds of so&shy;ciety {{qq|need}} lun&shy;at&shy;ics as their man&shy;agers; a dis&shy;cus&shy;sion in {{w|''Peace News''|Peace_News}} re&shy;cently was con&shy;cerned with the un&shy;certi&shy;fi&shy;able mad&shy;ness of the {{w|Amer&shy;ican Presid&shy;ent|Lyndon_B._Johnson}} in rela&shy;tion to a {{qq|col&shy;lect&shy;ive norm of in&shy;san&shy;ity}}. A Cor&shy;re&shy;spond&shy;ent noted: {{qq|No sig&shy;ni&shy;fic&shy;ant mem&shy;ber of a power estab&shy;lish&shy;ment can ever be {{q|cert&shy;ifi&shy;ably in&shy;sane}} since it is this same estab&shy;lish&shy;ment which de&shy;ter&shy;mines the defin&shy;i&shy;tions of {{q|san&shy;ity}} and {{q|in&shy;san&shy;ity}} and which de&shy;cides{{dash|checked only by the oc&shy;ca&shy;sional con&shy;science of an oc&shy;ca&shy;sional pro&shy;fes&shy;sional medi&shy;cal man}}when {{qq|in&shy;san&shy;ity}} becomes {{qq|{{w|cert&shy;ifi&shy;able|Involuntary_commitment}}}}.}}<ref>Part of a letter by Pierre{{-}}Joseph Brie, {{qq|In&shy;san&shy;ity and the Egg}}, {{w|''Peace News''|Peace_News}}, 1st July, 1966.</ref>
  
{{tab}}In offi&shy;cial stat&shy;istics there must, in any case, be a murky over&shy;lap area between what comes out as {{qq|crime}} and what as {{qq|lunacy}}{{dash}}and a lot of luck in who ends up in which in&shy;stitu&shy;tion. Per&shy;haps it is the in&shy;stitu&shy;tional bureau&shy;cracy that has most need of the labels: {{qq|Ac&shy;cord&shy;ing to the common&shy;sense defin&shy;i&shy;tion,}} writes Dr. Theodore Szasz, {{qq|mental health is the abil&shy;ity to play what&shy;ever the game of so&shy;cial living might con&shy;sist of and to play it well. Con&shy;versely, to re&shy;fuse to play, or to play badly, means that the person is men&shy;tally ill. The ques&shy;tion may now be raised as to what are the dif&shy;fer&shy;ences, if any between so&shy;cial non&shy;con&shy;form&shy;ity (or devi&shy;a&shy;tion) and mental ill&shy;ness. Leaving tech&shy;nical psy&shy;chi&shy;atric con&shy;sider&shy;a&shy;tions aside for the moment, I shall argue that the dif&shy;fer&shy;ence between these two no&shy;tions{{dash|as ex&shy;pressed for ex&shy;ample by the state&shy;ments {{q|He is wrong}} and {{q|He is men&shy;tally ill}}}}does not lie in any ob&shy;serv&shy;able ''facts'' to which they may point, but may con&shy;sist only of a dif&shy;fer&shy;ence in our ''at&shy;ti&shy;tudes'' toward our sub&shy;ject.}}<ref>{{w|T. S. Szasz|Thomas_Szasz}}, {{qq|Polit&shy;ics and Mental Health}}, {{w|''Amer&shy;ican Journal of Psy&shy;chi&shy;atry''|American_Journal_of_Psychiatry}}, No. 115 (1958) (quoted by {{w|Erving Goffman|Erving_Goffman}} in {{w|''Asylums''|Asylums_(book)}}, p. 509).</ref> What sort of be&shy;ha&shy;viour is likely to lead those with the ap&shy;propri&shy;ate at&shy;ti&shy;tudes to see signs of mental ill&shy;ness and to set going the trans&shy;fer pro&shy;cess from {{p|358}}{{qq|person to pa&shy;tient}}? {{qq|Ordin&shy;arily the patho&shy;logy which first draws at&shy;ten&shy;tion to the pa&shy;tient{{s}} con&shy;di&shy;tion is con&shy;duct that is {{q|in&shy;ap&shy;propri&shy;ate in the situ&shy;a&shy;tion}}. &hellip; Further, since in&shy;ap&shy;propri&shy;ate beha&shy;viour is typic&shy;ally beha&shy;viour that some&shy;one does not like and finds ex&shy;tremely trouble&shy;some, deci&shy;sions con&shy;cern&shy;ing it tend to be polit&shy;ical, in the sense of ex&shy;pres&shy;sing the spe&shy;cial inter&shy;ests of some par&shy;tic&shy;u&shy;lar fac&shy;tion or person. &hellip;}}<ref>{{w|Erving Goffman|Erving_Goffman}}, ''{{w|Asylums{{dash}}Essays on the So&shy;cial Situ&shy;a&shy;tion of Mental Pa&shy;tients and Other In&shy;mates|Asylums_(book)}}'', New York, Anchor Books, 1961, pp. 363-4.</ref> As an ex&shy;ample of {{qq|in&shy;ap&shy;propri&shy;ate beha&shy;viour}}, con&shy;sider the case of {{qq|The Naked Prisoner}} ({{sc|{{w|freedom|Freedom_(newspaper)}}}}, 16.10.65). Mr. Paul Pawlowski was ar&shy;rested during a demon&shy;stra&shy;tion at the {{w|Spanish Embassy|Embassy_of_Spain,_London}} in {{w|London}}. Eventu&shy;ally reach&shy;ing {{w|Brixton Prison|HM_Prison_Brixton}}, he re&shy;fused to put on the stand&shy;ard pris&shy;on&shy;er{{s|r}} uni&shy;form and was con&shy;sequently locked up, naked, in his cell. Thus he re&shy;mained for ten days. On the tenth day he was inter&shy;viewed by a so&shy;cial worker: {{qq|&hellip; You know that two doctors have seen you while you have been in Brixton &hellip; they came to the con&shy;clu&shy;sion that what you need is a little stay in a mental hos&shy;pital.}} In fact he did not have the benefit of this con&shy;fine&shy;ment. The hos&shy;pital psy&shy;chi&shy;atrist de&shy;cided that Mr. Pawlowski{{s}} opin&shy;ions were not those of the ma&shy;jor&shy;ity but {{qq|people are not put into mental hos&shy;pitals for their opin&shy;ions. They do that sort of thing in {{w|Russia|Soviet_Union}}.}}{{ref|aster3|***}} Mr. Pawlowski was for&shy;tun&shy;ate in his psy&shy;chi&shy;atrist, but it is inter&shy;est&shy;ing to see how the pre{{-}}exist&shy;ing at&shy;ti&shy;tudes of offi&shy;cials brought him to the brink of ad&shy;mis&shy;sion. The overt polit&shy;ical im&shy;plica&shy;tions may make this ex&shy;ample ex&shy;cep&shy;tional{{dash|but it would not seem to be to the ad&shy;vant&shy;age of a person sus&shy;pected of mental ill&shy;ness to have been {{qq|mixed up in polit&shy;ics}} or {{qq|the dregs of so&shy;ciety in {{w|CND|Campaign_for_Nuclear_Disarmament}}}}}}which it seems, may well be taken as a con&shy;firm&shy;atory symp&shy;tom.{{ref|dagger|&dagger;}} The mental health service{{dash|like the edu&shy;ca&shy;tion {{qq|service}}}}is a func&shy;tional part of the present so&shy;cial system and, as such, acts to pre&shy;serve that system and its values. {{qq|The psy&shy;chi&shy;atric pro&shy;fes&shy;sion is a bureau&shy;cracy,}} writes James Green, a con&shy;trib&shy;utor to ''Views'', No. 8, {{qq|making an es&shy;sen&shy;tial con&shy;trib&shy;u&shy;tion to the run&shy;ning of gov&shy;ern&shy;ment and ad&shy;minis&shy;tra&shy;tion. &hellip; Most psy&shy;chi&shy;atrists would prob&shy;ably take for granted the struc&shy;ture and values of their own so&shy;ciety, in such a way that the thera&shy;peutic pro&shy;cess becomes a ques&shy;tion of re&shy;turn&shy;ing the sick person to his so&shy;cial con&shy;text or roles, e.g. his family, whether the con&shy;text and roles are them&shy;selves satis&shy;fact&shy;ory.}} Al&shy;though no doubt un&shy;repre&shy;sent&shy;at&shy;ive and redol&shy;ent of {{qq|what they do in Russia}} I can&shy;not resist quot&shy;ing the words of a psy&shy;chi&shy;atrist par&shy;ti&shy;cipant in a re&shy;cently tele&shy;vised dis&shy;cus&shy;sion: {{qq|Our func&shy;tion is to get people well enough to be in&shy;doc&shy;trin&shy;ated.}} It would be mis&shy;lead&shy;ing to sug&shy;gest that any&shy;thing but a tiny minor&shy;ity become in&shy;mates of asylums simply or only because they hold dis&shy;ap&shy;proved {{p|359}}opin&shy;ions, but pos&shy;sibly such cases may lead to a con&shy;sider&shy;a&shy;tion of the far more subtle {{qq|polit&shy;ical}} and so&shy;cial mean&shy;ing of the label&shy;ling and con&shy;fine&shy;ment of the un&shy;vocal ma&shy;jor&shy;ity.
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{{tab}}In offi&shy;cial stat&shy;istics there must, in any case, be a murky over&shy;lap area between what comes out as {{qq|crime}} and what as {{qq|lunacy}}{{dash}}and a lot of luck in who ends up in which in&shy;stitu&shy;tion. Per&shy;haps it is the in&shy;stitu&shy;tional bureau&shy;cracy that has most need of the labels: {{qq|Ac&shy;cord&shy;ing to the common&shy;sense defin&shy;i&shy;tion,}} writes Dr. Theodore Szasz, {{qq|mental health is the abil&shy;ity to play what&shy;ever the game of so&shy;cial living might con&shy;sist of and to play it well. Con&shy;versely, to re&shy;fuse to play, or to play badly, means that the person is men&shy;tally ill. The ques&shy;tion may now be raised as to what are the dif&shy;fer&shy;ences, if any between so&shy;cial non&shy;con&shy;form&shy;ity (or devi&shy;a&shy;tion) and mental ill&shy;ness. Leaving tech&shy;nical psy&shy;chi&shy;atric con&shy;sider&shy;a&shy;tions aside for the moment, I shall argue that the dif&shy;fer&shy;ence between these two no&shy;tions{{dash|as ex&shy;pressed for ex&shy;ample by the state&shy;ments {{q|He is wrong}} and {{q|He is men&shy;tally ill}}}}does not lie in any ob&shy;serv&shy;able ''facts'' to which they may point, but may con&shy;sist only of a dif&shy;fer&shy;ence in our ''at&shy;ti&shy;tudes'' toward our sub&shy;ject.}}<ref>{{w|T. S. Szasz|Thomas_Szasz}}, {{qq|Polit&shy;ics and Mental Health}}, {{w|''Amer&shy;ican Journal of Psy&shy;chi&shy;atry''|American_Journal_of_Psychiatry}}, No. 115 (1958) (quoted by {{w|Erving Goffman|Erving_Goffman}} in {{w|''Asylums''|Asylums_(book)}}, p. 509).</ref> What sort of be&shy;ha&shy;viour is likely to lead those with the ap&shy;propri&shy;ate at&shy;ti&shy;tudes to see signs of mental ill&shy;ness and to set going the trans&shy;fer pro&shy;cess from {{p|358}}{{qq|person to pa&shy;tient}}? {{qq|Ordin&shy;arily the patho&shy;logy which first draws at&shy;ten&shy;tion to the pa&shy;tient{{s}} con&shy;di&shy;tion is con&shy;duct that is {{q|in&shy;ap&shy;propri&shy;ate in the situ&shy;a&shy;tion}}. &hellip; Further, since in&shy;ap&shy;propri&shy;ate beha&shy;viour is typic&shy;ally beha&shy;viour that some&shy;one does not like and finds ex&shy;tremely trouble&shy;some, deci&shy;sions con&shy;cern&shy;ing it tend to be polit&shy;ical, in the sense of ex&shy;pres&shy;sing the spe&shy;cial inter&shy;ests of some par&shy;tic&shy;u&shy;lar fac&shy;tion or person. &hellip;}}<ref>{{w|Erving Goffman|Erving_Goffman}}, ''{{w|Asylums{{dash}}Essays on the So&shy;cial Situ&shy;a&shy;tion of Mental Pa&shy;tients and Other In&shy;mates|Asylums_(book)}}'', New York, Anchor Books, 1961, pp. 363-4.</ref> As an ex&shy;ample of {{qq|in&shy;ap&shy;propri&shy;ate beha&shy;viour}}, con&shy;sider the case of {{qq|The Naked Prisoner}} ({{sc|{{w|freedom|Freedom_(newspaper)}}}}, 16.10.65). Mr. Paul Pawlowski was ar&shy;rested during a demon&shy;stra&shy;tion at the {{w|Spanish Embassy|Embassy_of_Spain,_London}} in {{w|London}}. Eventu&shy;ally reach&shy;ing {{w|Brixton Prison|HM_Prison_Brixton}}, he re&shy;fused to put on the stand&shy;ard pris&shy;on&shy;er{{s|r}} uni&shy;form and was con&shy;sequently locked up, naked, in his cell. Thus he re&shy;mained for ten days. On the tenth day he was inter&shy;viewed by a so&shy;cial worker: {{qq|&hellip; You know that two doctors have seen you while you have been in Brixton &hellip; they came to the con&shy;clu&shy;sion that what you need is a little stay in a mental hos&shy;pital.}} In fact he did not have the benefit of this con&shy;fine&shy;ment. The hos&shy;pital psy&shy;chi&shy;atrist de&shy;cided that Mr. Pawlowski{{s}} opin&shy;ions were not those of the ma&shy;jor&shy;ity but {{qq|people are not put into mental hos&shy;pitals for their opin&shy;ions. They do that sort of thing in {{w|Russia|Soviet_Union}}.}}{{ref|aster3|***}} Mr. Pawlowski was for&shy;tun&shy;ate in his psy&shy;chi&shy;atrist, but it is inter&shy;est&shy;ing to see how the pre{{-}}exist&shy;ing at&shy;ti&shy;tudes of offi&shy;cials brought him to the brink of ad&shy;mis&shy;sion. The overt polit&shy;ical im&shy;plica&shy;tions may make this ex&shy;ample ex&shy;cep&shy;tional{{dash|but it would not seem to be to the ad&shy;vant&shy;age of a person sus&shy;pected of mental ill&shy;ness to have been {{qq|mixed up in polit&shy;ics}} or {{qq|the dregs of so&shy;ciety in {{w|CND|Campaign_for_Nuclear_Disarmament}}}}}}which it seems, may well be taken as a con&shy;firm&shy;atory symp&shy;tom.{{ref|dagger|&dagger;}} The mental health service{{dash|like the edu&shy;ca&shy;tion {{qq|service}}}}is a func&shy;tional part of the present so&shy;cial system and, as such, acts to pre&shy;serve that system and its values. {{qq|The psy&shy;chi&shy;atric pro&shy;fes&shy;sion is a bureau&shy;cracy,}} writes James Green, a con&shy;trib&shy;utor to ''{{l|Views|https://lccn.loc.gov/sf83002178}}'', No. 8, {{qq|making an es&shy;sen&shy;tial con&shy;trib&shy;u&shy;tion to the run&shy;ning of gov&shy;ern&shy;ment and ad&shy;minis&shy;tra&shy;tion. &hellip; Most psy&shy;chi&shy;atrists would prob&shy;ably take for granted the struc&shy;ture and values of their own so&shy;ciety, in such a way that the thera&shy;peutic pro&shy;cess becomes a ques&shy;tion of re&shy;turn&shy;ing the sick person to his so&shy;cial con&shy;text or roles, e.g. his family, whether the con&shy;text and roles are them&shy;selves satis&shy;fact&shy;ory.}} Al&shy;though no doubt un&shy;repre&shy;sent&shy;at&shy;ive and redol&shy;ent of {{qq|what they do in Russia}} I can&shy;not resist quot&shy;ing the words of a psy&shy;chi&shy;atrist par&shy;ti&shy;cipant in a re&shy;cently tele&shy;vised dis&shy;cus&shy;sion: {{qq|Our func&shy;tion is to get people well enough to be in&shy;doc&shy;trin&shy;ated.}} It would be mis&shy;lead&shy;ing to sug&shy;gest that any&shy;thing but a tiny minor&shy;ity become in&shy;mates of asylums simply or only because they hold dis&shy;ap&shy;proved {{p|359}}opin&shy;ions, but pos&shy;sibly such cases may lead to a con&shy;sider&shy;a&shy;tion of the far more subtle {{qq|polit&shy;ical}} and so&shy;cial mean&shy;ing of the label&shy;ling and con&shy;fine&shy;ment of the un&shy;vocal ma&shy;jor&shy;ity.
  
  
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{{r|Roger Moody: {{qq|Driving The Mad In&shy;sane}}, {{w|''Peace News''|Peace_News}} ({{popup|3.6.66|3 June 1966}}).}}
 
{{r|Roger Moody: {{qq|Driving The Mad In&shy;sane}}, {{w|''Peace News''|Peace_News}} ({{popup|3.6.66|3 June 1966}}).}}
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{{tab}}In his ac&shy;count of {{qq|[[Anarchy 4/Where the shoe pinches|de{{-}}in&shy;sti&shy;tu&shy;tion&shy;al&shy;isa&shy;tion]]}} ([[Anarchy 4|{{sc|anarchy}} 4]]) [[Author:Colin Ward|Colin Ward]] re&shy;ferred to the prison as {{qq|the most sin&shy;is&shy;ter of in&shy;sti&shy;tu&shy;tions}} and no doubt it is. But as anarch&shy;ists are aware, the state can make skil&shy;ful use of the {{qq|ap&shy;proved}} con&shy;cepts of crime and crim&shy;in&shy;ality to di&shy;vert at&shy;ten&shy;tion from its own more grandi&shy;ose but identical activ&shy;it&shy;ies: so we should be alert to the pos&shy;si&shy;bil&shy;ity that the in&shy;sti&shy;tu&shy;tions openly la&shy;belled as prisons are not the only ones serving that func&shy;tion. Sup&shy;pose, as Roger Moody says in his art&shy;icle that mental hos&shy;pital and prison are {{qq|dif&shy;fer&shy;ent terms for the same thing}}? If there is some truth in this there is con&shy;sequently an ad&shy;di&shy;tional danger in that any&shy;thing called a {{qq|hos&shy;pital}} has auto&shy;mat&shy;ic&shy;ally a pro&shy;tect&shy;ive cocoon around it as a result of its claim to pro&shy;vide ther&shy;apy. But surely the {{qq|volun&shy;tary}} presence of many of the pa&shy;tients in mental hos&shy;pitals en&shy;sures that they can&shy;not have a pun&shy;it&shy;ive char&shy;acter or ef&shy;fect? A dif&shy;fer&shy;ent ap&shy;proach is sug&shy;gested by the Amer&shy;ican so&shy;ci&shy;olo&shy;gist {{w|Erving Goffman|Erving_Goffman}}: {{qq|&hellip; We must see the mental hos&shy;pital, in the re&shy;cent histor&shy;ical con&shy;text in which it de&shy;veloped, as one among a net&shy;work of in&shy;sti&shy;tu&shy;tions de&shy;signed to pro&shy;vide a res&shy;id&shy;ence for vari&shy;ous cat&shy;egor&shy;ies of so&shy;cially trouble&shy;some people.}}<ref>ibid., p. 354.</ref>
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{{tab}}Goffman states that only a small number of pa&shy;tients enter mental hos&shy;pital will&shy;ingly, in the sense that they believe it will be good for them, having come to see them&shy;selves as {{qq|men&shy;tally un&shy;bal&shy;anced}}{{dash}}and as Laing and Cooper argue, even in these cases this self{{-}}per&shy;cep&shy;tion as being {{qq|ill}} or {{qq|mad}} can be in&shy;duced by the beha&shy;viour or strat&shy;egy of the person{{s}} im&shy;medi&shy;ate relat&shy;ives and con&shy;tacts. The sequence from {{qq|person to pa&shy;tient}} can follow a series of as&shy;so&shy;ci&shy;ated stages set in mo&shy;tion by a {{qq|com&shy;plain&shy;ant}} who sees an action on the part of the pre{{-}}pa&shy;tient as per&shy;haps a {{qq|last{{-}}straw}} and re&shy;fers him to a suc&shy;ces&shy;sion of {{qq|medi&shy;ators}}{{dash|prob&shy;ably drawn from among teach&shy;ers, so&shy;cial workers, clergy, psych&shy;iatrists, law&shy;yers, po&shy;lice}}one of whom, with co{{-}}opera&shy;tion from the {{qq|sick}} man{{s}} relat&shy;ives, will com&shy;mit the indi&shy;vidual to hos&shy;pital with legal sanc&shy;tion. {{qq|The so&shy;ciety{{s}} offi&shy;cial view,}} writes Goffman, {{qq|is that in&shy;mates are there because they are suf&shy;fer&shy;ing from mental ill&shy;ness. However, in the degree that the {{q|men&shy;tally ill}} out&shy;side hos&shy;pitals numer&shy;ically ap&shy;proach or sur&shy;pass those inside hos&shy;pitals, one could say that mental pa&shy;tients dis&shy;tinct&shy;ively suf&shy;fer not from mental ill&shy;ness, but from con&shy;tin&shy;gen&shy;cies.}}<ref>ibid., p. 135.</ref> In other words, good or bad luck{{dash}}de&shy;pend&shy;ing on your point of view. One might debate the degree to which this whole pro&shy;cess is {{qq|volun&shy;tary}}{{dash}}bear&shy;ing in mind that the indi&shy;vidual is un&shy;pre&shy;pared for the nature of his future life in the hos&shy;pital, is prob&shy;ably living {{p|360}}in so&shy;cially dis&shy;tres&shy;sing circum&shy;stances which would have the ef&shy;fect of making most al&shy;tern&shy;at&shy;ives seem favour&shy;able, and is sub&shy;ject to col&shy;lus&shy;ive pres&shy;sure from both relat&shy;ives and {{qq|medi&shy;ators}}.
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{{tab}}As {{w|Malatesta|Errico_Malatesta}} noted in his essay {{qq|{{l|Anarchy|http://theanarchistlibrary.org/library/errico-malatesta-anarchy}}}}, {{qq|Organs and func&shy;tions are in&shy;separ&shy;able terms. Take from an organ its func&shy;tion, and either the organ will die, or the func&shy;tion will re&shy;in&shy;state itself.}} The ex&shy;ist&shy;ence of the mental hos&shy;pital is just&shy;ified by its func&shy;tion of curing the men&shy;tally ill. {{qq|The pa&shy;tient{{s}} pres&shy;ence in the hos&shy;pital is taken as ''{{popup|prima facie|sufficient until proven otherwise}}'' evid&shy;ence that he is men&shy;tally ill, since the hos&shy;pital&shy;iza&shy;tion of these per&shy;sons is what the in&shy;sti&shy;tu&shy;tion is for.}} A very com&shy;mon answer to a pa&shy;tient who claims he is sane is the state&shy;ment: {{qq|If you aren{{t}} sick you wouldn{{t}} be in the hos&shy;pital.}}<ref>ibid., p. 380.</ref> One con&shy;sequence of this for the person ini&shy;tiated into a {{qq|career}} as a mental pa&shy;tient is that his past life will be re&shy;struc&shy;tured in terms of a {{qq|case history}}{{dash|and he may be denied rights of pri&shy;vacy over what he pre&shy;vi&shy;ously re&shy;garded as {{qq|his own busi&shy;ness}}}}any facet of which may now pro&shy;vide evid&shy;ence of {{qq|symp&shy;toms}}.<ref>For a re&shy;con&shy;struc&shy;tion of a psy&shy;chi&shy;atric inter&shy;roga&shy;tion see {{qq|The Case Con&shy;fer&shy;ence}}, ''{{l|Views|https://lccn.loc.gov/sf83002178}}'', No. 11, Summer, 1966. {{w|Elias Canetti<!-- 'Elia Canetti' in original -->|Elias_Canetti}} has written that {{qq|ques&shy;tion&shy;ing is a for&shy;cible in&shy;tru&shy;sion. When used as an in&shy;stru&shy;ment of power, it is like a knife cut&shy;ting into the flesh of the vic&shy;tim. &hellip; The most blat&shy;ant tyranny is the one that asks the most ques&shy;tions}} ({{w|''Crowds and Power''|Crowds_and_Power}}, Gollancz, 1962).</ref> Once inside, the pa&shy;tient may find the in&shy;ternal organ&shy;isa&shy;tion of they asylum domin&shy;ated by a {{qq|ward system}} separ&shy;at&shy;ing pa&shy;tients off into {{qq|dis&shy;ease}} cat&shy;egor&shy;ies, the vari&shy;ous levels pro&shy;vid&shy;ing dif&shy;fer&shy;ent stand&shy;ards of ac&shy;com&shy;mod&shy;a&shy;tion, food and grounds{{-}}and{{-}}town {{qq|priv&shy;ileges}}, among other factors of import&shy;ance in the life of the pa&shy;tient. The ma&shy;terial and so&shy;cial pro&shy;vi&shy;sions on each ward level are offi&shy;cially those that are most ap&shy;propri&shy;ate to the mental con&shy;di&shy;tion of the pa&shy;tient. But whilst the system may be just&shy;ified by its par&shy;tis&shy;ans on these grounds, it has an un&shy;ac&shy;know&shy;leged func&shy;tion as an inmate{{-}}con&shy;trol&shy;ling device. There is a direct par&shy;al&shy;lel here with the al&shy;leged pur&shy;pose of the {{w|stream&shy;ing|Tracking_(education)}} system in schools; in&shy;vari&shy;ably de&shy;fended on the basis of its edu&shy;ca&shy;tional value yet actu&shy;ally opera&shy;ting in schools as an im&shy;port&shy;ant com&shy;pon&shy;ent of the dis&shy;ciplin&shy;ary system. And in asylums, as in schools, these {{qq|divide and rule}} dis&shy;ciplin&shy;ary strat&shy;egies have de&shy;veloped as the best method of {{qq|man&shy;age&shy;ment by a small staff of a large number of in&shy;volun&shy;tary in&shy;mates}}.
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{{tab}}Because so&shy;ciety needs luna&shy;tics to pro&shy;vide it with re&shy;as&shy;sur&shy;ance of its own san&shy;ity, so it has need of in&shy;sti&shy;tu&shy;tions to con&shy;tain them. But as with prisons, the real enemy is not the ma&shy;terial struc&shy;ture{{dash|{{qq|It is our own anxi&shy;ety which forces us to lock people up}}<ref>A sen&shy;tence of Dr. Joshua Dierer{{s}}, speak&shy;ing at the {{w|World Federa&shy;tion of Mental Health|World_Federation_for_Mental_Health}}, 1960 (quoted by [[Author:Colin Ward|Colin Ward]] in {{qq|[[Anarchy 4/Where the shoe pinches|Where The Shoe Pinches]]}}, [[Anarchy 4|{{sc|anarchy}} 4]]).</ref>}}and it is through anxi&shy;ety about our own san&shy;ity that we build walls around the {{qq|men&shy;tally ill}}. {{qq|Mental hos&shy;pitals are not found in our so&shy;ciety because super&shy;visors, psych&shy;iatrists and at&shy;tend&shy;ants want jobs; mental hos&shy;pitals are found because there is a market for them. If all the mental hos&shy;pitals in a given region were emptied and closed down today, to&shy;morrow relat&shy;ives, po&shy;lice, and judges would raise a clamour for new ones; and these true clients of the mental hos&shy;pital would de&shy;mand an in&shy;sti&shy;tu&shy;tion to sat&shy;isfy their needs.}}<ref>Goffman, op. cit., p. 384.</ref>
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'''SCHIZOPHRENIA{{dash}}A PSEUDO{{-}}DISEASE?'''
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{{tab}}{{qq|In the popular mind the schizo&shy;phrenic is the proto{{-}}typical mad&shy;man{{dash}}author of the totally gra&shy;tu&shy;it&shy;ous crazy act that always has over&shy;tones of viol&shy;ence to others}}
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{{r|{{w|David Cooper|David_Cooper_(psychiatrist)}}: ''Viol&shy;ence in Psychiatry''.}}
  
  
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<font size="2">{{hang|{{note|aster|*}} See ''The Divided Self'', pp. 41-42. For an ac&shy;count of the con&shy;sequences of the ob&shy;struc&shy;tion of this oc&shy;cur&shy;rence: {{qq|an ex&shy;ist&shy;en&shy;tially dead child}} see p. 183. In ''Views'', No. 8, {{w|David Cooper|David_Cooper_(psychologist)}} writes: {{qq|&hellip; the begin&shy;ning of per&shy;sonal de&shy;velop&shy;ment is never pure passiv&shy;ity. &hellip; From the first moment of mother-<wbr>child inter&shy;action, where each is an&shy;other to the other, the child is in the posi&shy;tion of having to ini&shy;ti&shy;ate the pro&shy;ject to become who&shy;ever he is to be, and this is in prin&shy;ciple a free choice, his free crea&shy;tion of his essen&shy;tial nature.}}
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<font size="2">{{hang|{{note|aster|*}} See ''The Divided Self'', pp. 41-42. For an ac&shy;count of the con&shy;sequences of the ob&shy;struc&shy;tion of this oc&shy;cur&shy;rence: {{qq|an ex&shy;ist&shy;en&shy;tially dead child}} see p. 183. In ''{{l|Views|https://lccn.loc.gov/sf83002178}}'', No. 8, {{w|David Cooper|David_Cooper_(psychologist)}} writes: {{qq|&hellip; the begin&shy;ning of per&shy;sonal de&shy;velop&shy;ment is never pure passiv&shy;ity. &hellip; From the first moment of mother-<wbr>child inter&shy;action, where each is an&shy;other to the other, the child is in the posi&shy;tion of having to ini&shy;ti&shy;ate the pro&shy;ject to become who&shy;ever he is to be, and this is in prin&shy;ciple a free choice, his free crea&shy;tion of his essen&shy;tial nature.}}
  
 
{{note|aster2|**}}<!-- single asterisk in original --> An art&shy;icle in {{w|''The Observer''|The_Observer}} ({{popup|4.9.66|4 September 1966}}) an&shy;nounced the forma&shy;tion of {{qq|Pro&shy;ject 70}}{{dash}}{{qq|a plan to rescue men&shy;tally normal old people from the wards of mental hos&shy;pitals.}}
 
{{note|aster2|**}}<!-- single asterisk in original --> An art&shy;icle in {{w|''The Observer''|The_Observer}} ({{popup|4.9.66|4 September 1966}}) an&shy;nounced the forma&shy;tion of {{qq|Pro&shy;ject 70}}{{dash}}{{qq|a plan to rescue men&shy;tally normal old people from the wards of mental hos&shy;pitals.}}
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Revision as of 12:38, 1 August 2017


353
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 Sartreand 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.


s2
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”?


s3
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[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.


s4
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.”[16]

  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.”[17] 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.”[18] 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”.[19] Once inside, the pa­tient may find the in­ternal organ­isa­tion of they 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 un­ac­know­leged 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”[20]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.”[21]


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.



* 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


<references>

  1. Robert G. Olson, An Intro­duc­tion to Ex­ist­en­tial­ism, New York, Dover Publi­ca­tions, 1962, p. 52.
  2. ibid., p. 105 (a refer­ence to an epis­ode in Being and No­thing­ness, p. 495).
  3. J.-P. Sartre, Situations III, Paris, Gallimard, 1949 (quoted by Olson, p. 121).
  4. Olson, op. cit., p. 119.
  5. Sartre J.-P. Sartre, Being and No­thing­ness, London, Methuen, 1956, pp. 461-2.
  6. ibid., pp. 471-75 (quoted by Olson, p. 121).
  7. The first part of R. D. Laing’s The Self and Others is a lucid argu­ment against the basic con­cepts of tradi­tional psycho-ana­lysis.
  8. “Mas­sacre of the In­no­cents”, Peace News, 22nd January, 1965.
  9. BBCPanorama” on “Mental Health”, 6th June, 1966.
  10. David Cooper, “The Anti-​Hos­pital: An Ex­peri­ment in Psy­chi­atry”, New So­ciety, 11th March, 1965.
  11. David Cooper, “Viol­ence in Psy­chi­atry”, Views, No. 8, Summer, 1965.
  12. ibid.
  13. Part of a letter by Pierre-​Joseph Brie, “In­san­ity and the Egg”, Peace News, 1st July, 1966.
  14. T. S. Szasz, “Polit­ics and Mental Health”, Amer­ican Journal of Psy­chi­atry, No. 115 (1958) (quoted by Erving Goffman in Asylums, p. 509).
  15. Erving Goffman, <span data-html="true" class="plainlinks" title="Wikipedia: Asylums—Essays on the So­cial Situ­a­tion of Mental Pa­tients and Other In­mates">Asylums—Essays on the So­cial Situ­a­tion of Mental Pa­tients and Other In­mates, New York, Anchor Books, 1961, pp. 363-4.
  16. ibid., p. 354.
  17. ibid., p. 135.
  18. ibid., p. 380.
  19. For a re­con­struc­tion of a psy­chi­atric inter­roga­tion see “The Case Con­fer­ence”, Views, No. 11, Summer, 1966. Elias Canetti has written that “ques­tion­ing is a for­cible in­tru­sion. When used as an in­stru­ment of power, it is like a knife cut­ting into the flesh of the vic­tim. … The most blat­ant tyranny is the one that asks the most ques­tions” (Crowds and Power, Gollancz, 1962).
  20. A sen­tence of Dr. Joshua Dierer’s, speak­ing at the World Federa­tion of Mental Health, 1960 (quoted by Colin Ward in “Where The Shoe Pinches”, anarchy 4).
  21. Goffman, op. cit., p. 384.