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 Three
men dominate the history of 20th century
psychiatry: Freud, Jung and Ronnie (R.D.) Laing.
All were visionaries, who attracted loyal
followings. Sadly, history also reveals how each
had feet of clay. Although much has often been made
of the moral frailties of each man, this should not
detract from a careful appraisal of the value of
their work. We were reminded of this last fact when
we listened again to Anthony Clare’s interview
with Laing in his radio series, In the
Psychiatrist’s Chair. Laing talked
candidly about his isolate childhood, the
development of his introspective nature, and the
mother who unwittingly nurtured the most
controversial psychiatric voice of the past fifty
years. Who would have forecast that a solitary
child, from a middle class Scots home, would have
so rocked the foundations of 20th
century psychiatry? The very mention of his name,
more than a decade after his death, is sufficient
to trigger vituperative debate. This may, of
itself, be sufficient evidence for the endurance of
his influence.
Whether
Ronnie Laing’s mother was mad, or just another
example of the cold and distant creatures not
uncommon in Presbyterian Scotland, was a question
left unanswered in that interview. However the
experience of loveless, childhood isolation clearly
sensitised the young Ronnie to others who appeared
similarly cut off from the world and ultimately
themselves. Although he eventually fell victim to
the carefully blended misery of alcohol abuse and
melancholy, his key interest was in people in
psychosis. What might be the meaning of their
exaggerated experiences and extreme behaviour and
how did they come by them? Perhaps these alienated
souls reminded him of his own alienation –
providing a mirror for his own soul, which appeared
tortured in a quite different way. In the Clare
interview Laing challenged the common view that he
had romanticised madness, especially in its
‘schizophrenic’ form. Such disordered
mental states made Laing feel acutely
uncomfortable. He saw such people as at risk of
drowning in their own distress, and he never had
any desire to get in the water, and risk drowning
with them. There was more than touch of irony in
that comment, since the details of the Dionysian
downfall of the most famous psychiatrist of the
love generation are well known. At 61 he died of a
heart attack playing tennis - too competitively as
was his wont – in the South of France. In the
interview, recorded five years earlier, Laing
laughed nervously as he recalled how his mother had
told his daughter how she had once fashioned a
voodoo doll, intent on creating a heart attack in
her only son. His weary, but still good-humoured
voice, suggested that Laing was all too aware of
Death closing in on him. Perhaps also he was aware
that his mother would have the last laugh.
In
this reprise of the original recording, Anthony
Clare noted that every living psychiatrist owed
something to Laing, although the details of his
debt were never explored. Instead Clare tried to
establish himself as a heavyweight Laingian critic,
rather than as celebrity shrink. It seems
self-evident to us that the legacy of R. D. Laing
cannot – indeed should not – be
restricted to the institution of psychiatric
medicine, not least because it did so much to damn
what it saw as the heresy inherent in Laing’s
recorded thought. Indeed, the General Medical
Council revoked Laing’s right to practice, on
apparently petty grounds, offering further evidence
of medicine’s desire to rid itself of its most
famous ‘turbulent priest’.
Laing’s
influence extended far beyond psychiatry,
psychotherapy and medicine. However, the practical
application of Laing’s thought – by the
man himself and some of his most famous allies and
former pupils – was largely non-medical.
Indeed, we might interpret the application of his
philosophy – especially through his frequently
revised views on psychotherapy – as a nursing
approach, focused on nurturing the
conditions – social and interpersonal –
under which people might finally seize their own
power and use this, constructively, to define
themselves, rather then be subjugated, if not
actually driven to madness, by others.
Given
Laing’s focus on the experience of madness,
the radio interview reminds us of the inherent
value in hearing him talk in the rough Glaswegian
brogue, which can be refreshing to the ear. At
times he articulates certain words carefully –
as when he talks of the denigration
of the experience of madness – giving
emphasis to the word’s root in denial.
Ironically this careful attention to language
eludes Professor Clare who, throughout refers to
his subject as ‘Laang’
despite both Laing and his son, Adrian – who
offers a concluding commentary – calling
themselves Layng. It might be stretching
Clare’s lapses too far to suggest that they
betray a failure to listen – or even a refusal
to hear what is being said. However, it seemed like
a significant lapse. Such failings - or resistances
- are common among psychiatric professionals, not
just psychiatrists. In the view of many who have
been patients, such carelessness often signals the
professional’s capacity for rapport, and its
progeny, empathy. Perhaps one of the obvious
differences between Laing and his critic and
inquisitor, Clare, is that whereas the latter
became famous for chatting, in an intimate yet cosy
fashion, to celebrities who were, by and large,
comfortable in themselves and their identities,
Laing made his name as a counter-culture figure,
largely by dint of his close, but risky, contact
with people who were as dispossessed as they were
mad.
Indeed,
in the eyes of many Laing let himself get too close
– empathically speaking – to his
patients, and risked burning himself in the
process.
It
is worth noting that, despite an unspoken
acknowledgement of his failing powers, Laing
resisted either apology to his many critics, or any
formal acknowledgement of his huge, and many might
say, enduring influence. Perhaps he was aware that
his status as the only psychiatrist to have been
interviewed in this radio series was, in itself,
sufficient evidence of his cultural
significance.
Regrettably,
the great fuss over his many alcohol-fuelled
appearances on television, and his willingness to
let his views be politicised recklessly in the late
60s, has obscured the Laingian legacy – much
of it not part of his original ambition. Very early
in his career, in Glasgow in the 1950s, he created
a ‘rumpus room’ for disturbed patients.
This was to become a model of the ‘safe
space’ that acutely disturbed people needed,
and where they might give free rein to their
disturbed and disturbing emotions. The very name
suggests the presence of the maternal in Laing.
Without patronising the people who were nominally
in his care, he recognised that – like
children – mentally distressed people needed a
space within their temporary home (hospital) where
they might be in their madness. A couple of
years later he wallpapered and furnished another of
the bleak rooms at Gartnavel Hospital to create a
real ‘living-room’ for four
‘back-ward’ women patients, who
eventually were discharged, much to everyone’s
surprise. That the women eventually found their way
back into institutional care merely attested to the
lack of support for them in the so-called
‘natural community’. The ultimate failure
of this project may well have turned Laing’s
vision from attempting to re-model hospital care,
in favour of the establishment of more genuine
community based alternatives – through the
Philadelphia Association.
These
early projects did, however, signal the
possibilities of ‘nurturing’ people into
recovery. Later, his experimental community at
Kingsley Hall inspired many of his followers and
former students, to develop the potential of
therapeutic households. Arguably the most famous of
these – Loren Mosher – developed the
Soteria House project in the USA, which
demonstrated over many years the possibility of
nurturing recovery in people with schizophrenia,
within an ordinary living environment, largely
without any overt medical treatment (Mosher).
Another North American disciple, Edward Podvoll,
developed Laing’s emphasis on the importance
of being fully present, carefully blending
Buddhist concepts of the mind, with Laing’s
more traditional Western phenomenological approach.
From Podvoll’s original work has emerged the
important Windhorse project, within which people
are helped to emerge from severe psychotic states,
through intensive support provided within
‘therapeutic households’.
These
experimental projects, which emphasised the value
of nurturing emergence from psychosis, through
often extraordinarily ‘ordinary’ forms of
human support, represent the nursing legacy of
Laing’s original work in the 50s and 60s.
Indeed, Podvoll – a psychiatist - described
people in psychosis as needing a ‘genuine
nursing of the mind’. It is perhaps ironic
that male psychiatrists should have discovered the
human virtue - and therapeutic value - of
organising a sustainable and sustaining caring
environment. These, often quite extraordinary
projects are, however, arguably only the tip of the
iceberg of Laingian influence. The contemporary
concepts of ‘safe houses’, supported
accommodation, therapeutic households and,
especially, the virtue of validating the distress
of acutely mad people, owe much to his
often-eccentric example. Little wonder that he
became an icon for the emerging survivor groups
like Survivors Speak Out, and indirectly inspired
developments like the Hearing Voices Network, which
discovered almost thirty years later that
experiences dismissed as meaningless symptoms of a
hypothetical brain dysfunction, could be understood
and, often, represented a coded form of the
distress the person had experienced earlier in
life.
Talking
of his own chronic melancholy, Laing suggested to
Clare that, were he to descend deeply into the
slough of despond, to the extent that he could no
longer function, he would hope that a psychiatrist
would offer him some medication that might relieve
his distress. Perhaps significantly, he added that
he would like to be removed to a nursing home
where he might be suitably cared for. This is
hardly surprising, since it reflects little more
than what he had long believed was appropriate for
the people in his own care. Whilst he knew the
value of medication, he knew its limits. As
researchers like Alanen and his colleagues in
Finland have shown, it is possible for as many as
40% of people with a diagnosis of schizophrenia to
recover without any psychotropic medication. Others
may, in Alanen’s view, only need small doses
of medication to help put them in the right state
to benefit from the kind of nursing and
psychotherapeutic care that Laing had espoused a
generation earlier.
Clare
appeared distinctly uncomfortable with Laing’s
sensitivity, suggesting that he might have been
‘too sensitive to be a doctor’. As we
have noted, much of Laing’s work can be read
more as a ‘nursing of the mind’ than
medical practice. Listening to Clare’s
espousal of the need for medical distance, one
appreciates why Laing’s huge compassion
disturbed so many psychiatrists, especially those
who had presided for so long over often abusive and
dehumanising conditions of treatment.
Ultimately,
however, Laing could not sustain the wild
trajectory of his own personal growth. The caring
emphasis of his work – often focused on
severely disturbed women – suggests that he
had spent his professional life trying to
rehabilitate, metaphorically, the mother who had
treated him with such callous, if not pathological,
disregard. Finally the pins that his mother
inserted in that voodoo doll found their spot and
the light went out on young Ronald. Fortunately,
his ideas have inspired a succession of voices,
eager to develop his alternative vision of
humanitarian psychiatry. The Laingian legacy
remains in light.
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