Anarchy 70/Libertarian Psychiatry: an introduction to existential analysis
an introduction to
This article aims to draw attention to the work of a group of British psychiatrists of whom the best known are and . 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.” ( , 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 “theIn tradition”— , , , , and —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 (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. anarchy 44 J.-P. Sartre is referred to as “one of the foremost
The first of four episodes of this essay are intended to create a setting against which existential analysis may be viewed.
“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.” 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 without means may not have the opportunity to go to if that be his ambition. But the obstacles which stand in his way would not exist as obstacles were it not for his free choice of values: in this case, his desire to go
Sartre argues against the  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.three-way split of the personality into and the 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.
R. D. Laing has written that “only by the most outrageous violation of ourselves have we achieved our capacity to live in relative adjustment to a civilisation apparently driven to its own destruction” and has described the “normal” person in the present age as “a half-crazed creature, more or less adjusted to a mad world”. What is the norm that gives the generally accepted meaning to such relative descriptions as “mad”, “insane”, “maladjusted”? And what is the significance of what is done to the people that are disqualified when measured against this criterion; the people that the mad officials label as “officially mad”?
THE INSANE IN A MAD WORLD
“In the context of our present madness that we call normality, sanity, freedom, all our frames of reference are ambiguous and equivocal.”
In 1965 there were 160,000 people in mental hospitals in Britain and an estimated 200,000 psychotics in the community. Nearly half of all hospital beds are occupied by the mentally ill. In a television programme on mental health the number of the mentally ill in Britain was given as half a million. The televised psychiatrist suggested that there were four main categories of illness: people with mental deformity,
By far the largest group is the third—the “neurotics and psychotics”. Among these “ 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 ’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 recently was concerned with the uncertifiable madness of the 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 ‘ ’.”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.” ” 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.” 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
“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.”
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
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 : “. . . 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.”
As  One consequence of this for the person initiated into a “career” as a mental patient is that his past life will be restructured in terms of a “case history”—and he may be denied rights of privacy over what he previously regarded as “his own business”—any facet of which may now provide evidence of “symptoms”. Once inside, the patient may find the internal organisation of the asylum dominated by a “ward system” separating patients off into “disease” categories, the various levels providing different standards of accommodation, food and grounds-and-town “privileges”, among other factors of importance in the life of the patient. The material and social provisions on each ward level are officially those that are most appropriate to the mental condition of the patient. But whilst the system may be justified by its partisans on these grounds, it has an unacknowledged function as an inmate-controlling device. There is a direct parallel here with the alleged purpose of the 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”.noted in his essay “ ”, “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 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.”
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.”
“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.”
One psycho-analytic view is that schizophrenia is the outcome of a split between a person’s “conscious” and “unconscious” forces which in the normal state are believed to work simultaneously. Another idea—in schizophrenia “there is a subtle change in brain chemistry which interferes in some way with nerve impulses.” The popularity of this view and others similar to it has led to an emphasis on surgical or physical treatment such as electro-convulsive therapy (a low voltage shock passed between the temples) and, in some cases, operations on the brain ( and ). In at least one London hospital schizophrenics have been placed in deep freeze. Drugs are much used. And it seems that what are taken to be the symptoms of the disease can be eliminated by the use of such means at least for a time. As Sartre observed, one “can obtain a result by using merely technical methods.” But, as the writer of a survey in The Observer ( ) 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 : “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, : “No simple genetic hypothesis accords with all the facts.”
This I hope is enough to provide some basis for R. D. Laing’s and  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:’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.”
“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
“Schizophrenia, if it means anything, is a more or less characteristic mode of disturbed group behaviour. There are no schizophrenics.”
THE FAMILY—“FROM GOOD TO BAD TO MAD”
“Over the last two decades there has been a growing dissatisfaction with any theory or study of the individual which artificially isolates him from the context of his life, interpersonal and social.”
Sartre holds that all groups are structured against an awareness of a “spectator”. This “spectator” may be an individual—as in the case of children seeing themselves as “pupils” in relation to a teacher—or another group, as in the case of workers constituting themselves against managers. This spactator he calls the “Third” for whom the group exists as an object. Laing and Cooper seem to have developed their views on groups—and in particular, the family system of the future “schizophrenic”—from Sartre’s interpretation of group structure and cohesion. In elaborating their theories the British existential analysts have made use of a number of terms, some of their own creation, whilst others are also used by Sartre. This rather technical and esoteric language creates a density in some of their writing which obscures the importance of what is being said; in my view, the value of Laing and Cooper’s book Reason and Violence is much reduced by their over-reliance on such terms and it is a pity that what one senses to be important ideas are couched in language which requires a good deal of deciphering before it becomes intelligible. If this particular book had been in existence at the time 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
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 bookWhat 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.” 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.”  In the moving final section of The Divided Self (called “The Ghost of the Weed
- “The patient was a good, normal, healthy child; until she gradually began
- “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
- “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:
These writers claim, and I think demonstrate, that armed with a knowledge of the patient’s existential situation, it is possible to make sense of what “psychiatrists still by and large regard as nonsense”. For example, Julie, the patient in “The Ghost of the Weed Garden”, referred to herself whilst in her “psychotic” state as “Mrs. Taylor” and as a “tolled bell”. Dr. Laing interprets her chosen title “Mrs. Taylor” as expressing the feelings: “I’m tailor made; I’m a tailored maid; I was made, fed, clothed and tailored” and a “tolled bell” is also “the told belle” “the girl who always did what she was told”. The schizophrenic’s “delusions” of persecution are real expressions of reaction in response to real persecution and are existentially true; that is to say they are “literally true statements within the terms of reference of the individual who makes them”.††
The person is now launched on a “career” as a mental patient. He is confirmed in this role by society’s agents the psychiatrists, in collusion with the patient’s family, and by process of betrayal and degradation becomes an inmate of a mental hospital, which institution embodies “a social structure which in many respects reduplicates the maddening peculiarities of the patient’s family . . . he finds psychiatrists, administrators, nurses who are his veritable parents, brothers and sisters, who play an interpersonal game which only too often resembles in the intricacies of its rules the game he failed in at home.”The existential analysts have asserted that a great deal of what passes for treatment in mental institutions is violence. Perhaps we can now begin to see what is meant by this. David Cooper in his article in Views, No. 8 quotes Sartre’s definition of violence: “The corrosive
THEORIES IN PRACTICE: “THE ANTI-HOSPITAL”
The theoretical basis of the experiment rested on the findings of Laing and Esterson, published in Sanity, Madness and the Family. I hope already to have given some idea of what these findings were: the family preserves its inauthentic system by using one of its members as a kind of “scapegoat”, ending by attributing madness to him. In general, society confirms the attributions made by the “sane” relatives and invalidates the patient’s version of events by translating them into “symptoms of a disease”. The bearing of this theory on the psychiatric ward, writes Dr. Cooper, is that “staff must begin to refuse to enter into the traditional covert collusion with the patient’s family. In the past this collusion has often meant that staff become implicated in a progressive violence that is perpetuated, in the name of treatment,
In his pamphlet Youth for Freedom (1951) Tony Gibson wrote to the effect that the chief value of to the community lay in its having taken the general concept of what a school should be and turned it on its head. Dr. David Cooper’s in “just ” has done very much the same thing to the general concept of the asylum. To maintain the educational parallel, Dr. Cooper’s experiment (judging from his account of it in ) also has great relevance for those who would wish to attack the violence implicit in the customary methods of social organisation in schools.
The unit—one ward in a hospital of some 2,300 patients—opened in January, 1962, with 19 young male patients, two-thirds of whom had been diagnosed as “having” schizophrenia. They had all been previously in the insulin-coma ward. In the second year, the number of patients was increased to 30.
The programme during the first year was highly structured, with daily meetings of the whole staff-patient group, separate and regular staff meetings,and organised recreational activity. No “physical” treatments were used except for the occasional dose of mild , and there was no individual ; there were however regular “interviews” between therapist and patient and therapist and patient with various members of his family. After about a year, the staff became dissatisfied with the rigidities of the system and changes in the direction of greater fluidity were felt to be appropriate.
Dr. Cooper writes of two areas in which the consequent “destructuring” had remarkable effects—the traditional business of getting patients out of bed in the morning and the attitude to the provision of work and activities. “One of the commonest staff fantasies in mental hospitals is that if patients are not coerced verbally or physically into getting out of bed at a certain hour in the morning they will stay in bed until they rot away.” This fantasy, like all anxiety over punctuality, is a form of projection. For the staff, the patient represents “that frightening aspect of themselves that sometimes does not want to get out of bed in the morning and come to work.” After considerable discussion and the trial of various approaches by different staff groups it was found that if the usual “rousing procedures” were abandoned the patient did get up himself—even if he “rebelled” to the extent of remaining in bed most of the day for a week or more. “No one rotted away after all and the gain in personal autonomy seemed worth while.” Dr. Cooper relates one episode when “all the occupants of a six-bed dormitory rebelled against the community meeting by staying in bed until after 11 o’clock. One of the charge nurses went upstairs to see what was going on. One of the patients left to go to the toilet and the nurse seized the opportunity to take off his white coat (worn not as uniform but as protective clothing for certain messy jobs like washing up) and climb into the vacant bed. The patient, on his return, appreciating the irony of the situation, had little option but to take the vacated ‘staff role’, put on the white coat and get the others out of bed.”The motivating fantasy or belief behind the provision of work and “occupational therapy” activities is frequently that this in some way protects the patients from the eroding effects of institutionalisation. But Dr. Cooper observes: “The bitter truth is that if they submissively
The workers in the unit were faced with conflicting pressures—pressures to conform with the customary approaches facing them in social systems and relationships outside the unit (professional advancement and willingness to conform to some extent going together)—and contrary pressure from within the unit itself. This again resulted in tension which obliged them to face the need for “commitment one way or the other”.
The position of the experimental ward inside the framework of the large hospital prompted the growth of fantastic and distorted attitudes towards the unit in the minds of senior staff members working outside it; this indicated the deep challenge which the new approach made to their more traditional concepts. For example an incident one night, in which an hysterical girl patient was helped back to her ward by a male friend was “processed” by the communications system until in its final form, it had become a case of attempted sexual assault.An assessment of the success of the “anti-hospital” in terms of “results” (usually measured in such cases by the incidence of re-admission) would not be any more meaningful than a judgement on Summerhill based simply on the pupil’s success rate in public examinations. The criterion of re-admission rates is also inadequate in that staff encouraged patients to return after discharge if they felt that a return to the unit would be of value to them. Nevertheless, even by this standard the “anti-hospital” results compare favourably with those achieved by more widely accepted methods—17 per cent of patients being re-admitted during a one-year period following discharge. In the issue of the which included these results Dr. Cooper stated his belief that the experiment has established “at least
As a postscript to the foregoing, I can deal only sketchily with an intriguing aspect of the work of the British existentialists—their ideas on the nature of “madness” itself. A recurrent theme in R. D. Laing’s writing is his emphasis on the disastrously narrow field of experience which is credited in contemporary life, as “reality”. “We are far more out of touch with even the nearest approaches of the infinite reaches of inner space, than we now are with the reaches of outer space. . . . We are so out of touch with this realm that many people can now argue seriously that it does not exist.” It is no surprise that Dr. Laing has spoken on the power of the drug to extend the boundaries of reality for those who make use of it responsibly. In The Divided Self he cites the value of the of and (in The Self and Others) relates Blake to his previous description of a “psychotic”: “Blake’s position seems to me to have been this. Single ‘vision’ (one modality of experience) is death. This is what most people regard as sanity.” He also charts in this book and in other articles, the dualism implicit in the idea of fantasy to be found in most psycho-analytic works and in the minds of a good many psychiatrists: “A very confused dualistic philosophy of psychical and physical, inner and outer, mental and physical.” It is the opinion of Laing and Cooper that what is clinically described as “a schizophrenic breakdown” may be the onset in the individual of a voyage into the world of inner space and time. The word “inner” is misleading, suggesting a place located “inside” the person; as they use the word it refers to “our own personal idiom of experiencing our bodies, other people, the animate and inanimate world: imagination, dreams, fantasy . . .”. And far from being a “disease” this process, or “voyage”, may well be the path to greater awareness, the crisis of the individual’s struggle to realise himself as a person, even—the onset of sanity! (Dr. Cooper has suggested that it may be “when people start to become sane that they enter the mental hospital”). A person undergoing this experience may well be “difficult for others” and is in need of special care—but not “treatment” in “the quite bizarrely incongruous context of the mental hospital”. Those who care for him should assume the role of guides—and people capable of providing this help will very probably be those who have themselves been through similar experiences: “We need a place where people who have travelled further and, consequently, may be more lost than psychiatrists and other sane people, can find their way further into inner space and time, and back again . . . the person will be guided with full social encouragement and sanction into inner space and time, by people who have been there and back again. Psychiatrically, this would appear as ex-patients helping future patients go mad.”No fully autonomous unit in which this process can take place exists at the present moment,††† but we can deduce from the “anti-
CRITICISM AND CONCLUSIONS
The only extended criticism known to me of the work and ideas of these British psychiatrists is an article by B. A. Farrell called “The Logic of Existential Analysis” which appeared in New Society ( ). This writer argues that the existentialists have dismissed orthodox views on the causes and treatment of schizophrenia on inadequate grounds and also make logically unwarrantable deductions from their research into the families of schizophrenics. Referring to the claim of Laing and Esterson that they have made the “symptoms” of schizophrenia intelligible, he makes the point that even if they are successful in doing this, making the symptoms intelligible is not the same thing as establishing truth for their hypothesis. Farrell comments that “this would be a trivial point to make” if we had other grounds for believing that the narratives were true. In relation to their suggestions for treatment he asks for evidence that units of the “anti-hospital” type produce results “as good as, or better than, the traditional methods”. In conclusion he advises them that some of the opposition to their work might not have been so vehement had they avoided “abusive” and “intemperate” language in their references to the Establishment; and also that “they would help themselves if they could avoid giving the impression that they had fallen in love with their schizophrenic patients. . . .”
Correspondents in subsequent issues suggested some answers to these criticisms. Commenting on Mr. Farrell’s remark on the lack of supportive evidence, Dr. John Bowlby wrote: “Although Dr. Laing’s is the only psychiatric group in this country publishing material of its sort, in the I have already made some reference to the “results”, in terms of re-admissions, of the “anti-hospital” which were published in the there are several. The two best known are the group at the . . . and the one at . . . . Each of these research groups has used methods and reported findings essentially similar to those of Dr. Laing. Some of their most recent reports . . . are of projects that at critical points in the procedure are ‘blind’ in just the way that Mr. Farrell rightly requests. In addition a number of findings derived from quite other methods are supportive. . . . There is thus substantial evidence derived from more than one method in support of the Laing type of hypothesis. . . . When compared with evidence advanced to support other types of hypothesis, it is not unimpressive. On the one hand it is far more substantial than any yet offered in support of psycho-analytic theories, whether traditional or , and, on the other, more consistent than that supporting a genetic-biochemical type of theory” (my italics).
Mr. Farrell’s final charge is valuable in that it draws attention to the basis of the method of existential analysis as described and practised by Dr. Laing and his colleagues. I do not think that Dr. Laing would wish to deny that “love” is involved in his attitude towards his patients and their predicament. In The Divided Self he writes of the act of empathy—this is not a strong enough word—that is required if the therapist is to understand the patient’s existential position. “I think it is clear that by ‘understanding’ I do not mean a purely intellectual process. For understanding one might say love.” In making this attempt the therapist “draws on his own psychotic possibilities”. Although not a direct parallel, one is reminded of ’s attitude towards emotionally disturbed “delinquent” adolescents and his dictum of “being on their side” even when their actions were most anti-social. A concept that recurs in a similar way in Dr. Laing’s writing is to “let the other be”: “The main agent in uniting the patient, in allowing the pieces to come together and cohere is the physician’s love, a love that recognises the patient’s total being, and accepts it, with no strings attached.”
As I hope I have succeeded in indicating in this article, the work of Drs. Laing, Cooper and Esterson constitutes far more than just another theory of what causes “schizophrenia”; a correspondent in New Society characterised it as “an exploration of the necessary conditions for a fully human relationship”.
Dr. Laing has suggested that the reason why exploration of the “inner” world of the self is invalidated by society as “madness” is that such experience is subversive. “And it is subversive because it is real.” Deified destructive illusions—“the health of ”, “the ”, “the interests of the State”—are the stage-props of normal social life and these phantoms are confirmed as “reality” by all the resources available. Because the vast majority of people act in terms of these negations “we find ourselves threatened by extermination that will be reciprocal, that no one wishes, that everyone fears, that may just happen to us ‘because’ no one knows how to stop it. . . . Everyone will by carrying out orders. Where do they come from? Always from elsewhere. . . .” Dr. Cooper has also described this tragic condition: “The myth of is a self-actualizing phantasy. The really did drop on . . . . The basic paradox that we live is that mankind needs illusions but the illusions it needs destroy it. Even through relatively innocuous or ‘good’ illusions we imprison ourselves metaphysically and then find we have built real prison walls (perhaps around someone else).”I hope that, as Dr. Laing has hinted, their future work will involve and imply further criticism in depth, of our society; if this is the case it will have direct relevance for contemporary anarchism (notwithstanding the association of these writers with a form of ). In conclusion, I would risk the statement that the body of work they have
** An article in ( ) announced the formation of “Project 70”—“a plan to rescue mentally normal old people from the wards of mental hospitals.”
*** This may have been an allusion to a case which was receiving some publicity at that time. Zenya Belov, a student, was confined in a Russian mental institution around September, 1965—and he is presumably still there. It was alleged that he had shown “schizophrenic symptoms” (“drawing diagrams, trying to reorganise the world graphically”) but the only “symptoms” evident to the British students who were with him shortly before the onset of “illness” were his “unorthodox and reformist political views”.
† References to a letter from Brenda Jordan in (17.6.66).
†† See also Laing’s interpretation of the statements of a schizophrenic from the original account in ’s , 1905 (pp. 29-31 The Divided Self). Laing writes: “What does this patient seem to be doing? Surely he is carrying on a dialogue between his own parodied version of Kraepelin, and his own defiant rebelling self. ‘You want to know that too? I tell you who is being measured and is measured and shall be measured. I know all that, and I could tell you, but I do not want to’.” Laing comments: “This seems to be plain enough talk.”
††† Since this was written an article has appeared. “Schizophrenia as a way of life”, by Ruth Abel ( , ), describing a “fully autonomous unit” for “schizophrenics” established by Drs. Laing, Esterson and Cooper at in London. This project is financed by and it seems that two new centres have been opened during the last few months in , and it is hoped that these are only the first of “a chain of communities”.
, “Sartre on Genet”, , No. 25.
, The Politics of Experience and the Bird of Paradise, Penguin Books, Autumn, 1966.
, , , Interpersonal Perception: A Theory and a Method, London, Tavistock, 1966.
, The Myth of Mental Illness, London, Seeker and Warburg, 1962.
, On Becoming a Person, London, Constable & Co., 1961.
- Robert G. Olson, An Introduction to Existentialism, New York, Dover Publications, 1962, p. 52.
- ibid., p. 105 (a reference to an episode in Being and Nothingness, p. 495).
- , Situations III, Paris, Gallimard, 1949 (quoted by , p. 121).
- , , p. 119.
- , , London, Methuen, 1956, pp. 461-2.
- ibid., pp. 471-75 (quoted by , p. 121).
- The first part of ’s The Self and Others is a lucid argument against the basic concepts of traditional psycho-analysis.
- “Massacre of the Innocents”, , 22nd January, 1965.
- “ ” on “Mental Health”, 6th June, 1966.
- , “The Anti-Hospital: An Experiment in Psychiatry”, , 11th March, 1965.
- , “Violence in Psychiatry”, , No. 8, Summer, 1965.
- Part of a letter by Pierre-Joseph Brie, “Insanity and the Egg”, , 1st July, 1966.
- , “Politics and Mental Health”, , No. 115 (1958) (quoted by in , p. 509).
- , , New York, Anchor Books, 1961, pp. 363-4.
- ibid., p. 354.
- ibid., p. 135.
- ibid., p. 380.
- For a reconstruction of a psychiatric interrogation see “The Case Conference”, , No. 11, Summer, 1966. 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” ( , Gollancz, 1962).
- A sentence of Dr. Joshua Dierer’s, speaking at the Colin Ward in “Where The Shoe Pinches”, anarchy 4). , 1960 (quoted by
- Goffman, op. cit., p. 384.
- An estimate made by the Swiss psychiatrist , quoted by in “The Anti-Hospital”.
- John Linsie in “Schizophrenia: A Social Disease”, anarchy 24). , “Healing Process in Schizophrenia”, , 1948 (quoted by
- , “What is Schizophrenia?”, , No. 28.
- and , Sanity, Madness and the Family, London, Tavistock, 1964.
- , “What is Schizophrenia?”,
- , “The Anti-Hospital”,
- , Violence in Psychiatry, , No. 8.
- , “Us and Them”, , No. 11.
- and ,
- , “Us and Them”,
- , “Two Types of Rationality”, , No. 29.
- , p. 155.
- 374asylum, and “degradation ceremonial” for the psychiatric examination preceding the patient’s admission. in makes use of the term “career” to denote “the social strand” of a person’s life inaugurated at the moment of his definition as a mental patient; “betrayal funnel” to describe the circuit of figures (relatives, psychiatrists, etc.) whose interactions end with the patient’s confinement in the
- , “Violence in Psychiatry”,
- , 11th March, 1965.
- , No. 5476, p. 1462.
- , “What is Schizophrenia?”,
- Extract from letter in , 4th November, 1965.
- , The Divided Self—An Existential Study in Sanity and Madness, London, Tavistock, 1960 (Pelican Books, 1965).
- ibid., p. 165.
- A phrase from a letter by J. D. Ingleby ( , ), , 28th October, 1965.
- “A Ten Day Voyage”, , No. 8.
- “Us and Them”,
- “Freud Revisited”—a review of ’s , , No. 20.