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 At
the outset, I think it is important to state that
we need to maintain humility in the face of
"schizophrenia." That is because it always manages
to elude us. I recognise that many of my
psychiatric colleagues were engaged, as I was, in
scientific research on mental illness. Ever since
the discovery of Dementia Paralytica, we
have been searching similar explanations for
schizophrenia (Dementia Praecox), in fact
for its organic cause. However, it is frustrating
to report that, after nearly a century of research,
we have found no strong correlations that "pin
down" such mental illnesses within a
neurophysiological framework. Insanity, just like
the mental patient, is elusive to our
understanding. Within this context, I want to talk
about the work of a colleague and friend, Ronald
Laing, who abandoned quantitative research into
mental illnesses in favour of qualitative research.
He attempted a kind of phenomenology of madness in
an effort to express what it's like to have a
mental illness. His aim was to recognise within the
"patient" the problems of living in the light of
the existential paradoxes that are common to
humanity.
I
want to talk about what Ronald Laing has left to us
and I would like to avoid some of the biographical
scandal that surrounded him during his life. Laing
was the guru of the abandoned, rejected, depressed
and lonely. He seemed deliberately to court high
publicity and, as a shamanic leader of the sixties,
could indulge in some of the most outrageous
antics, usually involving sex and drugs. The period
in which he wrote may be encapsulated in the
popular slogan: "Don't change your mind, there's a
fault in reality." That disturbed the classical
psychiatrist who couldn't understand it. Surely
reality is reality? Reality for Laing, though,
referred to human despair, loneliness, insecurity
and fear of the other. However, I wish to avoid the
glare of scandal, even though it may be attractive,
and dwell a little on the philosophical basis of
Laing's thought in order to outline the major
achievements and limitations of his own
Weltanschauung. I also wish to explain the
impact he had on my life.
My
first introduction to the work of R. D. Laing was,
typically enough, through some of my patients. It
was typical in that I have learnt most of what I
value in my working life through those people who
were called my patients. They came to me with a
book called The Divided Self. They
encouraged me to read it. They told me that if I
wanted to understand them, then here was a writer
who had an inkling of what it was like to be mad. I
must explain that at this time I was a profoundly
scientific psychiatrist, engaged on highly
respected research on the production of hormones in
manic depressives and other patients who had a
regular cycle of psychoses. But, at the same time,
I was scientific enough to be open-minded and was
willing to read anything that might help me
understand my patients and enable me to engage with
them. This always seems to be the greatest
difficulty for psychiatrists' engaging with people
who are so highly defended that little seems to
touch them.
I
must be honest and say that reading The Divided
Self was not an experience comparable to
walking on the road to Damascus. But I can point to
it and say that it was one of the influences that
gradually changed my position, from being a
physical scientist to a humanist thinker, when
considering the problems of psychiatry. This was an
influence that continued in my few meetings with
Ronald Laing and further reading of his works. I
was flattered that he said I was the only
neuropsychiatrist with whom he could
discuss.
But
my first reaction to reading The Divided
Self was, I think I have to confess, to find it
a curious work. For it began with a completely new
perspective for the psychiatrist. Our perspective,
at the sharper end of psychiatric illness, usually
dealing with psychosis was not to expect to
understand the psychiatric patient. Indeed from
Jaspers onward one of the characterising
definitions of psychosis was that it was impossible
to understand what the patient was saying. Thus
every psychiatrist in the Western World would be
bemused by the philosophical curiosities that could
be found in their patients' discourse, but would
not even try to attempt to understand them. They
would try to treat them, with concern and
understanding and would try to end the disruptions
and broken relationships that the "illness" seemed
to cause. But understanding a patient was like
throwing away the book of signs and symptoms. It
seemed unthinkable. After all, psychiatrists need
their own defences and barriers.
But
here at the beginning of The Divided Self,
Laing analyses the words of one of Kraepelin's
patients and begins to make sense of his
utterances. It is not possible, says Laing, to see
a patient as a bundle of symptoms or as an organism
and to understand his existential position.
The human being is a relating being made of I and
thou (thus acknowledging his debt to Buber) and if
he is treated as a separate mental apparatus he can
then only be treated as the object or the it
of the psychiatrist's medical concerns. If we try
to understand the existential phenomenology of the
person termed schizophrenic, it is no help to
relate to the barriers he has put up to the world
or within himself, with further barriers. Thus if
someone describes himself as dead, he may be
describing the truth of his existence as he
experiences it. But this will not be acceptable to
most psychiatrists. It is difficult, says Laing, to
recognize the schizophrenic's "despairing aloneness
and isolation" (Laing, 1965: 17).
Here
Laing makes reference to the existential
philosopher Kierkegaard and I think it is worth
pausing for a moment to consider the contribution
of Kierkegaard to Laing's philosophy. Indeed, it is
important to recognise that Laing's ideas did not
form as the result of some intellectual immaculate
conception, they come from a long tradition and
culture of existential thought and European
humanist philosophy. In Kierkegaard's work we see
that the "self" is seen as a relationship: the
relationship of a person to him or herself. Thus
our despair, which according to Kierkegaard most of
us spend much of our time avoiding, is not being
able to accept ourselves, wishing to get rid of
ourselves. This despair is like a living
death:
Despair
is the sickness unto death, this tormenting
contradiction, this sickness in the self;
eternally to die, to die and yet not to die, to
die death itself. For to die means that it is
all over, while to die death itself means to
live to experience dying ... despair is exactly
a consumption of the self, but an
impotent self-consumption not capable of doing
what it wants. But what it wants is to consume
itself, which it cannot do, and this impotence
is a new form of self-consumption, but in which
despair is once again incapable of doing what it
wants, to consume itself. This is a heightening
of despair, or the law for the heightening of
despair. This is the hot incitement or the cold
fire in despair, this incessantly inward
gnawing, deeper and deeper in impotent
self-consumption. Far from its being any comfort
to the despairer that the despair doesn't
consume him, on the contrary this comfort is
just what torments him; this is the very thing
that keeps the sore alive and life in the sore.
For what he -not despaired but- despairs over is
precisely this; that he cannot consume himself,
cannot be rid of himself, cannot become nothing.
(48-9)
Laing
describes this sense of internal division in terms
of ontological insecurity, which is a sensation of
easily being able to lose oneself, of not
experiencing continuity of self as a single and
separate being. This seems to show itself in two
opposite ways either through isolation as though
others are either going to engulf or literally
petrify one, or to clamp on to somebody else,
limpet-like and to let the other person define one.
s personality. This can work well for a time but,
normally a breach in this defence shows itself
through separation and the original anxiety
returns. As Laing sets out his explanation of
ontological insecurity he sweepingly denies that
any concept of the unconscious is going to help us.
In this he keeps company with Sartre. There seem to
be no sexual desires compelling the anxiety (as in
Freudian theories). The greatest desire (and fear)
which these patients demonstrate is their desire to
be, or to cover up their lack-of-being with someone
else's personality. This desire is hardly
unconscious.
But
what, we may ask, is the cause of this insecurity
of existence? At this point in time, Laing gives us
many clues but no answers. One patient who
complained of a "vague but intense fear" attached
this feeling to the fear of her parents. Nothing
she could do was right for them. "If she did one
thing and was told it as wrong, she would do
another thing and would find that they still said
that that was wrong. She was unable to discover, as
she put it - what they wanted me to be" (1964:
56). However, Laing still sees this information as
the phantasies of his patient's parents.
Another
patient did not complain of her parents' cruel
treatment of her, but felt rather that her parents
did not notice her. She spent the rest of her life
trying to be significant to someone, which she
could never be because she wasn't anyone to begin
with. For this woman, as Laing puts it (following
Berkeley), esse was percipi; (to be
was to be observed), she had to be seen in order to
feel she existed. If she looked in the mirror she
was frightened that there was no-one there. Here we
may see the importance for the child of being
noticed, of being seen. We may also note the
crucial effects of indifference on a child's
development.
But
how does a child survive in such a difficult
situation? Here we come to one of Laing's key (but,
as I will explain, flawed) theories, heavily
influenced by the existential theory of the true
and false self. Laing believed that any child
growing up in difficult circumstances will
construct a false self system as he is too
frightened to reveal his true self to his parents.
In such circumstances the child will seem
extraordinarily well behaved or "as good as gold."
Underneath this mask there may be the
protoorganisation of the "real" self but this is
something that the person will not test out with
his parents because he is afraid of his parents'
reaction. Thus the child hides his true self in
order to protect it.
Now,
of course this notion of true and false self owes
much to Sartre's ideas on bad faith in Being and
Nothingness (Sartre, and, perhaps, even more to
Heidegger's ideas of "authenticity" in the face of
the knowledge of our death in Being and
Time). But it does seem to be an extremely
difficult and unwieldy concept. Nowadays we would
find it more than difficult to discover what a
"true" self is as we all have to live through
negotiating compromises with others.
I
would suggest that a more happy formulation would
be a dichotomy between the "compliant" self and the
"complicit" self. The compliant self only complies
with his surroundings; he does not negotiate with
them. Underneath this compliance of course may be a
very rebellious self that brooks no contradictions.
Unhappily, this total rebellion usually reveals
itself as madness. But the complicit self works in
a completely different way. The complicit self will
work within the rules of an organisation in order
to get the best out of it (even a Marxist like
Lenin saw the pragmatic virtues of having to fit
in) and does not necessarily feel that he is losing
himself if he does have to compromise.
Unfortunately, as Binswanger noted, the compliant
self seems to recognise only "either/or" in the
situation- either victory or defeat. However, the
complicit self will play the rules of the game and
will to some extent compromise on objectives in
order to achieve the maximum success possible
within any human situation.
Laing's
analyst, D. W. Winnicott, also developed a theory
of a "true self/false self" organisation within the
personality. I don't wish to give precedence to any
of these ideas, I am simply trying to explain the
Zeitgeist from which Laing's ideas
developed. If we understand the tradition from
which Laing emerged, we can understand him as part
of a developing movement within psychoanalysis and
not as the lonely genius/iconoclast as he was
portrayed, particularly by his enemies. Winnicott's
formulation of the true/false dichotomy, owing just
as much, I believe, to Heidegger's ideas of
authenticity, were in some sense more dialectical
and less romantic, in that he recognised that we
all have to develop a persona in order to negotiate
with others through the difficulties of
life.1
Indeed, by persuading a child to say "Thank you"
before he is ready to feel gratitude, we make young
hypocrites of the new generation.
There
is one case in Laing's work, The Divided
Self, which I found particularly expressive. It
concerns a patient who Laing names - Peter-
who suffered from the delusion that he stank, that
his body gave off a noisome and noxious smell to
himself and to others. Once again, as a child,
Peter did not suffer from overtly cruel treatment.
But his mother did not seem to see him. His only
acknowledgment from his father was being called "a
big lump of dough" which seems to be a euphemism
for being called a "big lump of dung." As he grew
up, this patient felt guilty for existing and tried
to maintain a high-wire act of not existing and yet
of "going through the motions" with other people.
He came to understand his "smell" as an expression
of having died and rotted within. We must recognise
these life and death issues in psychiatry.
Having
read The Divided Self I wanted to make
contact with Ronnie Laing, because I suppose I was
suffering from my own divisions. I was a reasonably
successful research psychiatrist, profoundly
chemical in my research outlook but at the same
time I enjoyed existential philosophy. Thus I was
bemused to find a psychiatrist who could employ
existential philosophy to explain otherwise
inexplicable symptoms. There then followed a
friendship and an interchange of views that I think
I can claim was mutually useful. At this time Laing
had been shunned by the mainstream of psychiatry
and, however rebellious he was, I think he enjoyed
being able to discuss and argue and test out his
views with a colleague from a very different
persuasion. In fact, he never, in our arguments
dismissed the scientific researches that I and many
of my colleagues were engaged in. He only asked
that our ideas be treated as scientific hypotheses
yet to be proven, which of course, they have not
yet been. I also found Ronald Laing to be quite
helpful and critical when discussing our
relationships with patients. As I described to him
the way in which I tried to be friendly, kind and
considerate to my patients he warned me to remember
the superiority of my position as Professor. He
said I was like an Admiral with all the ribbons and
badges of office who tells an ordinary sailor in
bell-bottoms to have a cigarette and talk "man to
man." It was a useful warning and helped me in my
attempts to be less patronising to my
patients.
Thereafter
Laing worked a lot with Bateson, the famous
anthropologist and psychologist who coined the
"Double Bind" theory, and the therapists and
psychologists working with Bateson and family
therapy, including Haley and Searles. Thus more and
more, Laing worked upon a theory of schizophrenia
as a rational expression of the way that so-called
schizophrenics were treated by their group. He
noticed that in certain ways they seemed to be
driven mad or that the patient's madness seemed to
be a particularly heightened expression of the
dysfunction of the families they were in. For this
insanity of communication Laing, with his colleague
Esterson, used terms such as "untenable situations"
for those moments where an adolescent was expected
to be independent but in an environment that was
highly controlled by one or more members of the
family. Although Laing was criticized for "blaming
the parents" he was trying to show that madness did
not only arise within the individual, but arose as
part of a social mechanism. But this is a part of
his work that I believe is under elaborated.
And
here, it is important to recognise the limitations
of Laing's work and ideas which I think can be best
exemplified by his establishing of a community for
schizophrenics and those suffering psychotic
breakdowns in a place called "Kingsley Hall." In
many ways it was a brave and exciting adventure. It
was true to the experiment of "anti-psychiatry," a
term which Laing rejected, but which refers to the
belief that psychiatry did more harm than good and
that simply to remove the medical hierarchy and
conditions would, at least, do less harm to the
patients, than sending them to a psychiatric
clinic. Kingsley Hall, for a few years, became a
kind of centre for the alternative culture
where theatre groups, writers, musicians, and
artists could visit. But, like many other communal
projects of this era, the energy dissipated after a
few years and Laing's interests moved elsewhere.
And this is where, in particular, I want to draw
attention to Laing's less impressive achievements.
For Laing, unlike Basaglia of Italy, did not have a
social context within which to understand the
difficulties of the mad and therefore, working
co-operatives, involving people in practical
projects, did not become part of his vision.
Unfortunately, we have come to know that Laing
blocked the translation of Basaglia's work into
English and this rejection also represents a great
lacuna in Laing's theories.
While
Basaglia pursued a social and political strategy
with the aim of returning the problems of society
back to the society which engendered them
(Basaglia, 1985: 51), Laing, for the most part,
ignored social policy and thus could not bridge the
gap between individual and universal. In fact, his
understanding of the schizophrenic always veered
between the personal and the mystical and there was
little room for a practical social policy of
involving mental patients in our society. Although
Kingsley Hall had some spectacular "cures" for its
inmates (notably Mary Barnes with Joseph Berke) we
have to admit that even for Laing, "cures" of
schizophrenics were few and far between, and he,
like the rest of us, achieved limited practical
success in helping people live with their problems.
In fact, Laing, in a later work, poses our problem
very clearly:
If
a violinist in an orchestra is out of tune and
does not hear it, and does not believe it, and
will not retire and insists on taking his seat
and playing at all rehearsals and concerts and
ruining the music, what can be done? If all
persuasion fails, is there anything else to do
than to have him or her removed, by physical
force, against his or her will. . . ? (Laing,
1986: 3)
For
this is the difficulty of our situation. If
I am honest, which perhaps I can afford to be now I
am retired, I have cured very few people of
schizophrenia and those people who got well under
my care and seemed to improve their own lives (or
as we say "get better") recovered often almost
spontaneously or as a result of life events.
Certainly, I could not pin down any improvement to
something I had done. In the same way, apart from
the notorious stories, Ronald Laing effected very
few cures. But perhaps the very word "cure" coming
from our medical model leads us back into the old
traps. I think we have to recognise and respect the
mental patient's difference and distinctness and
respect his need to maintain his separateness. Then
all we can do is "invite him to the table" and ask
him to communicate with us. Even if to admit this
is to confess to our own impotence, we must
recognise that an individual's willingness to
engage with us and with our society must remain his
own responsibility and choice.
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