Legacies of ‘Anti-Psychiatry’ and R.D. Laing
Benjamin Noys explores the legacies of 'anti-psychiatry' through the early work of R.D. Laing as part of a series for World Mental Health Day 2015.
It’s surprising, but it doesn’t appear that the Italian radical psychiatrist Franco Basaglia, ‘the man who closed the asylums’, actually met the Scottish psychiatrist and radical R. D. ‘Ronnie’ Laing. They certainly shared much in common. Both had an interest in philosophy, particularly phenomenology, and wanted to bracket the diagnosis of mental illness, the better to explore the experience of these states. They both conducted radical institutional experiments, Laing at Gartnavel Royal Hospital and then at the private community Kingsley Hall, Basaglia at the state asylum in Gorizia and later in Trieste. Their texts appeared together, they became celebrities of ‘anti-psychiatry’ and, in the long and continuing years of reaction we are living, have been treated as figures that went too far: symbols of the political and cultural ‘excesses’ of the ‘60s’. The new sobriety of the 1980s, a sobriety giddy with the enraptured embrace of ‘wealth generation’, had little time for those who had dared to claim the ‘mad’ might be victims of a ‘sane’ society.
After all, in 1978, Italy had passed the ‘Basaglia law’, the 180 law, closing the large asylums, while Britain would engage in a longer process of so-called ‘care in the community’, which often involved little care amidst the destruction of communities. The radicals appeared to have been recuperated. Basaglia and Laing, in one of those painful ironies of history, would then be blamed for the right-wing assault on the welfare state, while their intentions and histories were much more complicated. In 1978 Franco Basaglia warned, shortly before his death, that the closure of the asylums was only the start of a struggle to democratise society and re-define the ways in which we care for those who suffer. That warning would go unheeded.
Here I want to return to the legacy of ‘anti-psychiatry’ by returning to the early work of R. D. Laing, especially his books The Divided Self (1960) and Sanity, Madness and the Family (1964), the latter co-written with Aaron Esterson. These books offer something more complex than the clichés that surround Laing: prophet, mystic, madman.
In Lang's view, we treat people who experience themselves as robots, machinery, or animals as crazy, but we don’t find anything crazy in theories that treat people as robots or animals. Our theories of madness may be madder than the language spoken by those who are ‘mad’. The ‘word-salad’ of the schizophrenic may contain more insight into the inner world than the psychiatric, medical, or psychoanalytic language we translate it into. This is the basis of all Laing’s thinking – our theories freeze and reify experience, and we need to be freed to listen. They stop us from actually listening to the ‘mad’, safely putting us on the side of the sane. In this way, however, we repeat the same fragmented, robotic, split, and depersonalised speech that we hear from the schizophrenic.
Of course, the idea that we might listen to the mad has itself gone out of favour once more. We diagnose, we medicate, and, if forced to, we send the mad to a therapist. Once, the asylum silenced madness; now that silencing is, appropriately, privatised. So, Laing’s fundamental gesture – to listen to madness, to consider it might make sense – is still radically foreign to us. While we still preserve the cultural place for the figure of the madman or madwoman who tells the truth, listening to the actually ‘mad’, hearing or speaking with them, hardly occurs.
To hear the mad, Laing begins by suspending questions of the origin or cause of schizophrenia, and even of its existence. Laing presumes that schizophrenia makes sense, even if that sense is not something we can grasp. This act of suspension has a philosophical origin. It lies in the gesture of the phenomenological epoché. The ‘epoché’ is a bracketing – eliminating all forms of secondary knowledge to return to how we experience things in our consciousness. In the famous words of the inventor of phenomenology, Edmund Husserl, this is to return ‘back to the things themselves’. Laing transfers this analysis to the schizophrenic, first listening to what they have to say.
In listening to the ‘word-salad’ of schizophrenics, what Laing detects is a pattern of disturbed communication. For Laing, "schizophrenic" behaviour is 'a special strategy that a person invents in order to live in an unliveable situation.’ In response to the demands of society – demands which are contradictory and maddening, ‘an infernal dance of false dualities’ – the schizophrenic is fragmented, split, depersonalised, and reified (treated as a thing). For psychiatrists, then as now, schizophrenia is a biological disorder, resulting from genetic factors interacting with environmental triggers. Laing suspends this ‘knowledge’, which is actually based on little evidence, to trace patterns of communication that might open up the frozen and ‘mad’ forms of social life that structure our experience.
Laing also draws on dissident strands of psychoanalysis, particularly the work of Donald Winnicot. Winnicott controversially focused on the early relationship between the child and mother. We will return to mothers. But Winnicott also influenced Laing with his idea of the ‘false self’: the risk to mental health caused by conformity to the world. Working with evacuees during the Second World War, Winnicott noted that those who sat well-behaved in their new environment were in fact traumatised, while those who lashed out showed some faith in their ability to test this new reality. Laing, however, would also remember Winnicott repeatedly struggling to pronounce the word 'phenomenology'…
In The Divided Self, Laing developed the concept of the ‘false-self’ to account for the experience of the ‘schizoid’ patient, who lies on the verge of psychotic breakdown. For Laing, what he calls the ‘false-self system’ in the schizoid is a result of a fundamental ‘ontological insecurity’ – a lack of a sense of having a place in the world or being wanted. As Peter, one of the case studies in The Divided Self, puts it, he felt he entered life ‘as a thief and criminal.’ This original lack is ‘repaired’ by the construction of a compliant self, but, as Laing writes, ‘what was designed in the first instance as a guard or barrier to prevent disruptive impingement on the self, can become the walls of a prison from which the self cannot escape.’
In the experience of psychosis even this prison starts to collapse. Separated from reality by our false self we come to feel dead inside and the outer world becomes threatening and dangerous. The result is that we come to live what Laing called ‘a death-in-life existence in a state approaching chaotic nonentity’. As such, for Laing the issue is our being-in-the-world, rather than sexuality, as for Freud. The failure of primary care leaves us unable to ‘be’, to find our own existence, and the result is that we can never have an authentic experience. The schizophrenic breaks down as their own place in the world is destroyed. Their hope lies in finding a way back to an authentic self.
In many ways, Laing turned psychoanalysis against itself, challenging us: ‘We must see if we now can survive without using a theory that is in some measure an instrument of defence.’ The theory that was supposed to deliver insight actually operated as a protection against the experience of madness, and one that reified madness into an inert state rather than a living process. If the ‘schizoid’ suffered from an experience of deadly lifelessness, was living a kind of death in life, then often the psychiatrist also could only respond with dead concepts. In place of the ‘infernal dualities’ of everyday life, which include this deadly exchange of confirmed messages, Laing tried to substitute a more authentic process of communication that did not assume a static and stable position of power and knowledge.
‘The ghost of the weed garden’
One of the central experiences of reading Laing is amazement at his case studies, in which the supposedly ‘mad’ offer more insight and understanding than those diagnosing them. Without wanting to diminish the experience of these people, reading these case studies is close to the ‘kitchen sink realism’ of 1950s writing – acute stories of domestic entrapment and persecution. The final case study of The Divided Self concerns Julie, a chronic schizophrenic, who was admitted to hospital at seventeen and met by Laing nine years later. Julie dramatizes the experience of death and destruction that lies at the heart of the experience of madness. Her basic psychotic statement was that ‘a child had been murdered’. In Julie’s account this refers to an actual child, who was wearing her clothes when it was killed. But it also could have been herself. She had either been murdered by herself or by her mother, she was not sure which. In Laing’s reconstruction it is obvious that the child that has been murdered is Julie and, it seems, prime responsibility lies with her mother. Julie had always been a good child, but her compliance indicates, as we have seen, a false-self system. In Julie’s disorder she is a ‘tolled bell’, which Laing’s translates as a ‘told belle’ – ordered to be good. We could add, of course, that a bell is tolled by another, made to ring by an action from the outside.
Julie has gone from being good to being bad to being mad, as she tries to break out of the false-self system and fails. She calls herself Mrs Taylor, as ‘I’m tailor-made’, to which Laing adds: ‘I’m a tailored maid; I was made, fed, clothed, and tailored.’ Again, Julie knows what is going on; her communications are, in one sense, accurate. Of course, we seem to have returned to the theory of the ‘schizophregenic mother’, a theory which is often the cause for the dismissal of Laing. In fact, Laing objects himself, noting in his later work that it is mothers ‘who are always the first to get the blame for everything’. He suggests, instead, that we expand out our notion of these maddening communications to society as a whole.
What the case studies reveal is the profound pathology of the family. This is especially true for daughters, who are the victims of maddening communications that force them into the contradictory position of being the ‘good girl’. Laing and Esterson note, at one point, ‘We have clinical terms for disturbed, but not for disturbing persons.’ These disturbing families drive their children into madness, or have their children contain and reflect the madness of the family.
While these families form ‘relatively closed systems’, what’s also striking is Laing’s attention to class. The patient Peter, from The Divided Self, is trapped in a familial false self, but this false self is also one being forced into a transition from a working-class background into the middle class. His madness is about trying to conform to this new role. Many of the case studies indicate how paranoia and anxiety emerge out of the gossip that sustains ‘close-knit’ working-class communities, which falls most on female behaviour. ‘Claire Church’, a case study of a woman from a middle-class background, indicates another kind of pathology of class.
Claire said of her mother and father that they were not her real parents, that they were not a husband and wife, or a mother and father, but simply a pair of business partners. This was taken to be a delusion.
Between the middle-class obsession with success and achievement and working-class anxieties of aspiration and ‘getting above one’s station’, Laing’s work with his patients provides a map of class pathology.
There is an undeniable literary power to Laing’s case studies. Julie invokes in her speech the ‘black sun’, echoing the delirium of the French nineteenth-century poet Gérard de Nerval, who descended into madness and committed suicide in 1855. This could be thought to be poetic license by Laing, but such an assumption would be patronising. The fact that his often working-class schizophrenics demonstrate philosophical and poetic insight, that they know as well, or better, than their psychiatrist, is, I think, a point almost lost today. We are too happy to accept the mad artist, and to repeat the usual litany of Nietzsche, Van Gogh, and Artaud. Such instances are dramatic, romantic, and creative. We are much less happy to believe those who are diagnosed with schizophrenia might have something to say, and much less happy to engage with the lived experience of suffering and ‘madness’ as it confronts us.
In The Politics of Experience Laing offers a metaphor of planes flying in formation to explain his attitude to schizophrenia. The schizophrenic is flying ‘out of formation’, but not ‘off course’, as the whole formation may be ‘off course’. Laing suggests that we should neither idealise those ‘out of formation’, nor simply force them back ‘into formation’. Rather, Laing argues that we should treat schizophrenia as a journey, as an experience, and should create a place and guidance for those undertaking such a journey. He wryly notes that ‘Psychiatrically, this would appear as ex-patients helping future patients go mad.’ In another formulation, he states: ‘Madness need not be all breakdown. It may also be break-through. It is potentially liberation and renewal as well as enslavement and existential death.’
The flippant or quick reading, which Laing himself can proffer, suggests a simple alternative: liberation or enslavement. Liberation is a result of the mad aiding themselves, while enslavement is the fault of ‘society’. In fact, we could argue that Laing’s sympathy to the position of the schizophrenic, who inhabits a kind of absolute alienation from society, is replicated in his own analysis. The result is a tendency to reproduce a sharp distinction of the individual and their possible authenticity from the automatically alienating effects of ‘society’, and this threatens to block real consideration of how mental ‘illness’ is socially embedded and how it might function as a point of critique to alter social relations. Franco Basaglia was critical of Laing’s belief that he could work outside the system, when the struggle was within and against the system. Laing fell into an ironic error, as he had used Hegel’s point about fear of action and fear of entering into social relations to characterise the pathological dimensions of the schizoid state. Laing himself could not integrate his analysis of ‘existential death’ with the historical forms and patterns of domination in such a way as to alter them. It may be Laing’s own later prophetic and mystical mode came out of a deepening of this detachment from society, as the shift from concrete analysis led to the abstract alternative: inside and oppressed, or outside and liberated.
Despite, or because of, these tensions, which speak to all such experiments, Laing’s work still offers lessons to our unpropitious times. In particular, this lies in Laing’s recognition of class and gender pathologies, which mean that ‘mental illness’ is not exterior to society, but a symptom and sign of these social pathologies. Laing’s own identification with the absolute alienation of the schizophrenic, his own exclusions and failures, threaten to leave these insights detached and isolated. This is, of course, reinforced by over thirty years of defeat for radical experiments. Yet, if we return to Laing, we might see that the ‘voyage’ to liberation can be helped and aided, but that there is no guarantee of break-through. It is the very possibility of such a journey that we have, however, learned to deny.
Benjamin Noys is Professor of Critical Theory at the University of Chichester. His more recent work is Malign Velocities: Accelerationism & Capitalism (Zero, 2014).