Audio Colloquies An Interview With R.D. Laing

recorded 1987 (?) Harper & Row [*Notes]

Part II

RDL: [...cont'd.] We're also considering different states of perplexity and confusion and misery and bewilderment and mental suffering. And I'm not sure, I'm not entirely happy that this should be pre-empted or it is appropriate to pre-empt this by an exclusively medical perspective. Medicine in a way is having a bit of an adventure in certain aspects of psychiatry. Looking at age-old forms of human distress which have only recently been regarded as appropriate to the domain of medicine and so at any rate there's something very problematic in that. And the other thing is the simple, straightforward within-medicine argument that we know in the history of medicine, a great deal of the history of medicine has been either discarding diagnoses that have been discovered to have never have existed or to have covered such a wide range of disparate phenomenon that they become useless. Such as, what was it, cholemia, which used to cover all sorts of forms of debility and "looking greenish", etc., etc., it's now specifically associated with leukemia some forms of leukemia, but that was much more common in the 19th century as any run-down, thin, neurasthenic, hysterical, or as we would say it now, young woman might be regarded as suffering from that. Or in the way epilepsy was thought of until we've narrowed it down and made it much more precise with EEG findings, we can now distinguish behaviour which is the outcome of actual recognizable EEG patterns in the brain we might even define epilepsy in terms of the EEG rather than in terms of twitches and whatnot, etc. And also a great deal of the treatment that has been related to these past diagnoses in medicine has been discarded. So, I'm remaining obstinately skeptic that some of the solutions that we presently have and that diagnostic categorisation in psychiatry are really here to stay and I'm saying that I'm not comfortable with them in the way I am with a great deal of the rest of medical diagnosis.

DK: Dr. Laing what is the value of hospitalising severely disturbed people? Is it corrective, punitive, or merely the removal of that person from society?

RDL: I think the main value is to provide asylum to someone who's terribly frightened, who's scared stiff, catatonic in other words, frozen stiff. This is someone who can't talk, can't move, they're struck dumb, and they're scared stiff in what we call medically a catatonic state. Well if I was in a state like that and people are at a loss to know what to do with me I would like to be taken somewhere, where I'd be taken care of and offered sanctuary where environmentally the circumstances would be as minimally threatening, dangerous, persecutory as we could make them. It's one of my regrets, not all but so many mental hospitals are so far away from being places of hospitality you might say, for someone who's very frightened. And of course, and I really do say of course, we have to protect society from dangerous, irresponsible people who are recalcitrant to reason, can't do anything about, and so forth. The "corrective" function of the mental hospital is a slightly too Chinese for me, I don't like the idea of it being compulsory, correction centres, I'd rather that be straightforward crime and punishment and prison than correction administered under the name of therapy. So sanctuary for the person and protection for society with an overlap between prisons, there can be crazy prisoners as there can be crazy patients.

DK: Was this what led you to set up Kingsley Hall and later to develop the Philadelphia Association? How did Kingsley Hall start?

RDL: Several of us thought the same way, one was actually one of the charge nurses in Dr. Seargent's unit at St. Thomas's who became very disillusioned with the efficacy of so much electric shocks with young and old and new and chronic and three other psychiatrists and a social worker and a writer. We thought we would put our resources together to see if we could get a place which would let it happen. This was based upon my clinical experience in mental hospitals where I'd become very doubtful whether by and large, over the long run, psychiatric methods of treatment broke more than even. Except for perhaps preventing someone from literally physically running themselves into death with exhaustion. I remember one woman who actually did die with persistent manic... we poured everything into her that we had, there was just no way of stopping her, she went on and on and on, no way we could get her to sleep, no way we could get her to stop anything and she died. Well short of the exceptional, within the limits of life itself not being endangered it seemed to me to be worth it medically, scientifically, to be able to have a door open to see now that so much early electric shocks and tranquilization was coming in that there was hardly any mental patient in a hospital for more than maybe two or three months at the very most, where the natural course of whatever it was disease, process, or whatnot they were going through was therapeutically affected, interfered with by chemicalisation or electricity, so that we were now going to be, I felt, in a position where no one was going to know what we in effect were doing because very few people had ever looked into what happened before someone got into this position and now we were not going to have any special unit, even one in Europe or one in America where a clinician could see what went on if we didn't bring these measures into play. And I still think it is very important to keep that door open.

DK: Did the Kingsley Hall experiment lead to the development of the Philadelphia Association?

RDL: The Philadelphia Association was actually in existence to start the Kingsley Hall thing, but it has led to the further development of that work that happened there. We had Kingsley Hall leased to us for five years, from '65 to '70, the work that began there has now spread out to eight houses in London, about 50 people staying in them.

DK: And what are the major findings from this work?

RDL: The findings have got to be presented very tentatively at this stage, there have been about 400 people, over these ten years, who have stayed in these places and something like 75 to 85 percent of these people would be diagnosable to fall into some psychiatric category, a lot of them would be diagnosed as psychotic. In the places there has been no use of any drugs at all, but there have been sometimes people around who are more together than others, but some times hardly anyone around who was someone we would regard as in an ordinary state of togetherness and going concern and so forth. I think what we found to a greater extent than has come to be supposed, people who are often very confused and miserable and disorganized can if they want to, and many of them do want to, keep themselves going, and it seems to be such simple things such as going to sleep when one wants, there's a day/night reversal, people can sleep during the day and be up all night. Now if that's stopped, as happens necessarily practically always within the hospital regime, it usually takes drugs to stop it. However if you let someone go into you might say, free-fall of biorhythm, and spin around reversed, they practically always do that for a bit and then come back into a usual pattern again. Issues of let's say eating, and cooking meals for oneself and making food for oneself that the people don't have to have food cooked for them, don't have to have it presented at the same time, whole issues don't have to be there, well this seems to suit some people, it doesn't seem to suit everyone, some people need and want a structure imposed. I think people who need an imposed structure to contain their incoherence, these are the people who maybe are best in mental hospitals. On the other hand, since mental hospital's practically the only option, there do seem to be people who find this other option where what they're after is in fact, to go into.... I think the monks in Mt. Athos in their monastic regime talk about autorhythmia, they have an understanding that they all live together but they can find their own place and their own time and don't have to eat together don't have to sleep together, they can find their own idiosyncratic rhythm and thereby find their balance. Well that seems to work for some people. It seems to keep also open a place where someone that I would from clinical psychiatric point of view say has gone into a schizophreniform episode, let's say without quarrelling about these matters they're not the sort of person who in fact would be taken to be a long-term chronic constitutional process schizophrenic sort of person that if you don't do anything we expect will further deteriorate and become more dilapidated. There do seem to be some people whose mental functions disintegrate under the impact of perhaps, as they feel, mind-boggling paradoxes and contradictions and confusion within their communicational web. So it all sort of falls apart - and then grows in again - quite quickly, and if one doesn't interfere with that process there seems to be a process of disintegration and reintegration. And in fact quite a few people have gone through that sort of thing, in other words they maintain a momentum of energy through their confusion and bewilderment and transformations of time and space, and go through it and come out of it, but some people of course get stuck. Well, four hundred people over ten years I haven't been able to see them all, but out of that maybe a couple of dozen people who have clearly come in, in great states of scatter and disarray, or have come there keeping themselves together and then the cookies crumbled you might say and become quite disorganized and unable to maintain themselves and then spontaneously seem to begin to pick themselves up, get themselves together and stay for a while and leave. Well what I'd very much like to do is I'd like very much to be able to say in advance which are the ones who are going to do this and which are going to do that. And still very much working on that.

DK: From the viewpoint of a social scientist Dr. Laing, how would you label yourself and your philosophy?

RDL: I would call myself a psychiatrist, I would like very much to disclaim the label of being an 'anti-psychiatrist', I don't regard myself as an anti-psychiatrist any more than Pasteur might have been called an anti-physician because he might have opposed some of the medical practices of his time, or Amroth Wright because he said "feed fevers" when people were starving fevers, in other words within the medical framework there's open, I hope, to disagree with perhaps more than the majority of one's contemporary physicians would disagree about in terms of the prevailing practice. I've got certainly criticisms about a lot of the prevailing practices of psychiatry both in the theoretical and the practical aspects. But that doesn't make me an anti-psychiatrist, it's on behalf of psychiatry that I'm making these criticisms of psychiatrists, some psychiatrists, who I feel are on an anti-psychiatric position. I regard myself as a psychiatrist in the tradition of western medicine. And the philosophical background I have is basically within the tradition of western medicine, western philosophy, western thinking. I feel closest to the humanists and the skeptics, the skeptic school of philosophy that is picked up in the contemporary phenomenological school of philosophy I find very congenial, training oneself to see things as much as one can bring oneself to as they are, with the actual suspension of judgement for the time being. I don't mean skepticism in the sense that it is sometimes being used as falling into a nihilistic attitude or a cynical attitude, the practice of suspension of judgement; in that sense I would be honoured to regard myself as a skeptic, in the tradition, say, of David Hume.

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