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 The psychiatrist R.D. Laing was born in Glasgow, on 7 October 1927. He died, aged 61, on 23 August 1989, while playing tennis in St Tropez. Memorial services were held in London, New York, and other cities across the world. In the course of his troubled life, Ronald Laing moved from the forefront of humanist psychiatry to a position of notoriety. Latterly, he was alcoholic, professionally unlicensed, and as disturbed, at times, as anyone he had ever treated. His work also descended into near-madness - he declared, for example, that his problems could be traced to the hostility of his mother's uterus, eight days after he was conceived. It is hard to forget such a figure; but it is easy to overlook the enormous influence upon psychiatry of his early work and ideas.
Much
attention has been paid to the psycho-biographical
aspects of Laing's life. There can be little
doubt that an upbringing such as Laing's would
create either an outright madman, or an excellent
psychotherapist. He seems to have been raised in
the kind of family he would later come to analyse
as amongst the causes of schizophrenia. He was an
unwanted child whose mother concealed her own
pregnancy, cut him off from friends and family, and
required that her obvious dislike for the fact of
her son's existence be regarded as maternal
solicitude. But if this upbringing gave Laing a
motive and material for his theories, it did not
give him the intellectual skills to analyse his own
experience.
To
find the ideas which helped to create The
Divided Self we must look beyond the personal
context of Laing's life, and investigate
instead the fertile intellectual milieu which
fostered his talent. Much has been made of
Laing's induction into the group associated
with the neurosurgeon Joe Schorstein and the
psychotherapist Karl Abenheimer. There can be
little doubt of the consequent influence of
European existential thought upon Laing: indeed,
were it not for his national service, Laing would
himself have moved to the continent to study under
a colleague of the existential psychotherapist,
Karl Jaspers. The existential school of psychiatry
undoubtedly contributes to the ideas behind
Laing's most important work, The Divided
Self (1959). Laing himself insists that
'this book attempts an
existential-phenomenological account of some
schizoid and schizophrenic persons.' His basic
argument is that psychiatry tends to see the
patient 'as a complex physical-chemical
system, perhaps with its own idiosyncrasies but
chemical none the less for that; seen in this way,
you are no longer a person but an organism.'
It takes 'the language of existential
phenomenology' says Laing, to appreciate that
a person may be seen 'as a person or
[...] as an organism' accordingly as
he or she is 'the object of different
intentional acts.' When a man is treated as an
organism, 'there is no place for his desires,
fears, hope or despair as such. The ultimates of
our explanations are not his intentions to his
world but quanta of energy in an energy
system.'
Oddly,
though, Laing's most explicit acknowledgement
with regard to this distinction is not to an
existential psychoanalyst, but to the Scottish
philosopher, John Macmurray. As Laing puts it,
Macmurray's philosophy attempts 'to
think of the individual man as well as to
experience him neither as a thing nor as an
organism but as a person.' In works such as
The Self as Agent and Persons in
Relation, Macmurray sets out to explain
philosophically why human life cannot be thought of
under objective categories, and why, indeed, the
world of things is derivative of a world that is
primarily active and interpersonal. Laing differs
from Macmurray, though, in one significant area. In
Persons in Relation, Macmurray argues that a
psychiatrist must approach his patient with an
objective attitude:
The behaviour of the neurotic is compulsive [...] The motives of his behaviour are no longer under intentional control, and function as 'causes' which determine his activity by themselves. This, at least, is the assumption underlying the change of attitude [by the therapist], the assumption that human behaviour is abnormal or irrational when it can only be understood as the effect of a cause, and not by reference to the intention of an agent.
Laing,
however, would see this a failure on
Macmurray's part to consider the possibility
that seemingly insane behaviour may, in fact, be
intelligible, intentional agency.
Laing's
psychiatry is unified by the idea that
psychiatrists habitually preclude an understanding
of their clients as intentional beings. Indeed, so
ingrained is objectification in the name of
'objectivity' that our automatic
temptation is to say that 'psychiatry'
cannot understand its 'patients'. In
fact, there is no psychiatry beyond the
intentionality of practising psychiatrists; and
'patients' are not in fact patients, they
are agents. In so far as psychiatrists do
not see themselves as engaged in what Laing calls a
'study of human beings that begins from a
relationship with the other as person,' then,
a priori, they turn troubled persons in
malfunctioning things. The behaviour of the client
is now a matter of structural or chemical causes in
the brain. The possibility that the client may be
engaging in some kind of comprehensible intentional
behaviour is automatically excluded.
Laing
therefore argues that many of the seemingly
incomprehensible utterances of the mad can be
understood by a sufficiently sympathetic
listener:
It
is not uncommon for depersonalized patients
[...] to speak of having murdered their
selves and also of having lost or been robbed of
their selves.
Such statements are usually called delusions,
but if they are delusions, they are delusions
which contain existential truth.
For
Laing, these declarations express the despair of an
individual who has never been able to realise her
own spontaneous and autonomous life in relation to
others. As a consequence, she has withdrawn from
social being; her 'true' self is an
inner, mental existence, concealed (for a while)
behind a 'false' exterior self of
compliant, embodied life. What seem to be bizarre
utterances which could only be 'caused'
not 'meant,' are attempts to express the
loss of a vital relation to the social
world.
Laing's argument may be generalised to more familiar examples of mental illness. Consider for example the distinction made between reactive and endogenous depression. The former is regarded as having some kind of external 'cause' - the death of a loved one, say - while the latter, in the absence of such an event, is regarded as due to some internal pathology. This distinction is, of course, facile. The difference is really between misery for which the doctor can find an intelligible reason, and that for which he cannot. The latter kind is regarded as 'malignant,' as 'pathological,' as if these were inherent qualities, rather than an admission of a failure of comprehension. There is indeed depressed behaviour which is wholly without reason - but this danger is in complacency over this distinction. Not so long ago, a woman who was miserable because she was a housewife with two children to look after might have been regarded as pathologically depressed - particularly if she was unable to explain why she should be so unhappy in her role. Who knows what other seemingly secure attributions of endogenous mental disorder may rest upon a similar insensitivity?
To
Laing, the uncritically objective attitude to the
madman is really a very ancient form of social
exclusion. He discusses in his autobiography,
Wisdom, Madness and Folly (1985), an
incident in which the psychiatric staff with whom
he works are offered by buns baked by patients. The
majority refuse. Laing remarks:
'Excommunication runs deep. A companion means,
literally, one with whom one shares bread.
Companionship between staff and patients had broken
down.' There is no rational ground for the
refusal to eat the buns; merely an irrational
revulsion at the social meaning of this everyday
ritual of communion. To eat the buns would be to
break bread with the mad: but the mad, to the
staff, are not kin with the sane; by virtue of
their supposed neurological malfunctions, they are
not acknowledged as fully human, intentional
agents. This archaic social distinction is one
familiar from a tradition of Scottish thought which
predates Laing. In his Lectures on the Religion
of the Semites (1894), the Victorian social
anthropologist, William Robertson Smith, discusses
the rituals which establish group life. Pre-eminent
amongst these is the communion meal:
Among
the Arabs every stranger whom one meets in the
desert is a natural enemy, and has no protection
against violence except his own strong hand or
the fear that his tribe will avenge him if his
blood be spilt. But if I have eaten the smallest
morsel of food with a man, I have nothing
further to fear from him; 'there is salt
between us,' and he is bound not only to do
me no harm, but to help and defend me as if I
were his brother.
Those
who are outside of such communion are aliens:
they are subhuman; they are animals who resemble
people. The psychiatric distinction between the
sane and the mad, in its unthinking exclusion of
intentionality from the disturbed, is a modern
echo of an archaic distinction.
This
a priori exclusion of the mad from
recognition as intentional agents is central to
most mainstream psychiatry. Every week offers some
new discovery of the causes of mental illness.
Scientists, the papers tell us, are confident of a
certain genetic cause, or of the imbalance of
certain chemicals in the brain. And yet, the
fundamental objection remains: any human trait, or
behaviour, can be given a strictly biological
description. Schizophrenics may indeed, as studies
have suggested, be born with an especially small
amygdala-hippocampal complex. Yet that such a
structure should be viewed as abnormal is entirely
derivative of the abnormality encountered in
contact with a schizophrenic. Without this primary
experience of incomprehensibility, the correlative
structure of the brain is merely an entirely
neutral fact that is not, in itself, a disorder.
If, however, a schizophrenic's behaviour is
comprehensible then the search for a physical
causality would, in all senses of the word, be
impertinent.
The
primary objectification of the mentally ill, which
lies behind all natural-scientific investigation of
madness, is the main object of attack for those who
have followed (however unconsciously) in
Laing's footsteps. For example, until 1973,
the 'bible' of American psychiatry, the
Diagnostic and Statistical Manual of Mental
Disorders, classified homosexuality as a mental
illness. This classification was discontinued due
to social and political pressures from outside
psychiatry. No scientist suddenly stumbled upon the
unreality of this particular
'psychopathology.' Rather, as a result of
political activism, a group whose behaviour had
lead them to be excluded from society were now let
back in. Their homosexual intentions were
recognised, and no longer reduced to defective
genetics, hormonal malfunctions, or wrongly
conditioned reflexes. Now, even if today's
genetics and neuroscience should discover a
cast-iron distinction between homosexuals and
heterosexuals, we should merely have an irrelevant
fact. Similar political movements are now afoot to
demand recognition of those who are excluded by a
psychiatric diagnosis because, for example, they
hear voices, or engage in some other behaviour
incomprehensible to North American physicians. One
can only hope that a new category of mental illness
is not created in order to account for such defiant
opposition to mainstream psychiatry.
This
year sees the 75th anniversary of Laing's
birth. It is a peculiar fact that, had Laing been a
more successful human being, he would probably now
be a more neglected figure. Students of Scottish
culture tend to neglect the achievements of quietly
respectable thinkers. Laing's later life of
notoriety, though, cannot be smothered by the usual
cultural amnesia. Those who care to look into
Laing's work will find insight and candour;
and beyond that, an unfamiliar context of
psychiatric and philosophical ideas developed by Dr
Jekylls who had no Mr Hydes to ensure their lasting
memory.
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