Anarchy 70/Libertarian Psychiatry: an introduction to existential analysis

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Libertarian Psychiatry:
an introduction to
existential analysis

PETER FORD

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

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

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

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

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EXISTENTIAL FREEDOM

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

Sartre: Being and No­thing­ness

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

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

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

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

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

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THE INSANE IN A MAD WORLD

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

R. D. Laing: The Divided Self.

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

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

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

  In offi­cial stat­istics there must, in any case, be a murky over­lap area between what comes out as “crime” and what as “lunacy”—and a lot of luck in who ends up in which in­stitu­tion. Per­haps it is the in­stitu­tional bureau­cracy that has most need of the labels: “Ac­cord­ing to the common­sense defin­i­tion,” writes Dr. Theodore Szasz, “mental health is the abil­ity to play what­ever the game of so­cial living might con­sist of and to play it well. Con­versely, to re­fuse to play, or to play badly, means that the person is men­tally ill. The ques­tion may now be raised as to what are the dif­fer­ences, if any between so­cial non­con­form­ity (or devi­a­tion) and mental ill­ness. Leaving tech­nical psy­chi­atric con­sider­a­tions aside for the moment, I shall argue that the dif­fer­ence between these two no&sh­y;tions—as ex­pressed for ex­ample by the state­ments ‘He is wrong’ and ‘He is men­tally ill’—does not lie in any ob­serv­able facts to which they may point, but may con­sist only of a dif­fer­ence in our at­ti­tudes toward our sub­ject.” What sort of be­ha­viour is likely to lead those with the ap­propri­ate at­ti­tudes to see signs of mental ill­ness and to set going the trans­fer pro­cess from

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

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

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CURATIVE—OR PUNITIVE?

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

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

  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 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”—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.”

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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 “sub­con­scious” 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 a 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.”

s6

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{{dash|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: “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’ and ‘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, 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”

---

* 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).

†† 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.”

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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