Critical Psychiatry outlines the history of a group of thinkers that has come to be known as the anti-psychiatry movement. Though it has been called a movement, the individual thinkers’ and authors’ ideas were often in conflict but what they share is a critical perspective on psychiatry as a discipline and institutionalised modes of care.
The current crisis in mental health services means that it is time to examine once again the key themes of critical psychiatry. The excesses of the 1960s radicalism have meant that these themes - with an emphasis on the individual dignity of all those involved in mental health services - have been lost. These need to be rediscovered as part of a solution to current difficulties but also as the starting point for a new model of service provision.
Critical Psychiatry is a history of ideas. It provides a critical evaluation of key thinkers and the application of their work to contemporary mental health service settings.
|Sold by:||Barnes & Noble|
|File size:||552 KB|
About the Author
Ian Cummins is senior lecturer in social work at the University of Salford. His main research revolves around the experiences of people with mental health problems in the Criminal Justice system with a focus on policing and mental illness. This is linked to an exploration of the development of the penal state and its interaction with community based mental health services. He is interested in the ways the CJS has become, in many incidences, the default provider of mental health care
Read an Excerpt
R D Laing: the psychiatrist of the counterculture
Psychotic behaviour has an internal meaning for individuals
The family has to be analysed to get to the root of mental distress
Psychosis can be a positive and potentially enlightening experience
Ronald David Laing was born in Glasgow on 7 October 1927. He described a very fraught emotional family upbringing. His mother appears to have had undiagnosed mental health problems. In a famous radio interview on In the Psychiatrist's Chair with Anthony Clare, Laing recounted an incident from his childhood in which his mother burnt a toy horse that was a favourite of his. She did this to stop him becoming too attached to it. His father suffered mental health problems, experiencing bouts of depression. Laing once called him his 'first patient'. As outlined below, Laing famously saw the family and upbringing as the root of adult mental health problems. It becomes very tempting to see his own childhood as a major factor in the development of this analysis. Laing studied medicine at the University of Glasgow. He failed his final exams at the first attempt – something he later attributed to his challenge to the medical establishment but was probably the result of a failure to commit himself to his studies. Laing then completed his National Service, including a period working with traumatised soldiers. On leaving the army, he returned to Glasgow before working and studying at the Tavistock Institute.
In the 1960s, Laing's books such as The Divided Self and Sanity,Madness and the Family sold in huge quantities and became key texts of the emerging counterculture. Laing himself became a very well-known figure – giving sold-out lectures and frequently appearing on TV. He began to experiment with drugs, struggled with alcohol and had problems in his personal life. As his star waned, these became more problematic. In 1989, Laing died of a heart attack suffered while playing tennis in Spain – he was 62.
Among the critics of psychiatry who are discussed in this volume, Laing has the most radical view of mental illness – particularly schizophrenia. At times, he compares the experience of psychosis to a mystical journey – on a par with that of the shaman. In that sense, he is the only writer who sees mental illness as a potentially positive or enlightening experience. To understand how he reached this point, we need to begin with the influence of his initial education in psychiatry at Glasgow. During this period, Laing came under the influence of Professor David Henderson. Henderson wrote A Textbook of Psychiatry for Students and Practitioners with Robert Gillespie (first edition 1927), which was influential in the development of modern psychiatry. Henderson himself was strongly influenced by Meyer and his emphasis on the importance of social as well as biological factors in the development, diagnosis and treatment of mental illness. Meyer argued that a holistic approach was required that would include occupational therapy and community-based facilities alongside formal psychiatric treatment and assessment.
Laing was the author of several major works that set out his philosophical position. He is possibly as far removed from the Kraepelin school of psychiatry as it is possible to be. His work is much more concerned with ontological questions that have traditionally been the realm of major philosophers. He uses mental illness and responses to it as a means of examining the human condition. In his radio interview with Anthony Clare, Laing described his fear that he would be overtaken by middle life melancholia in the same way as both his father and grandfather had been. His father became convinced that a work colleague who was due to retire planned to murder him so that he would not be promoted. Laing sees this propensity for melancholia as the product of deeply rooted Calvinist pessimism. His description of family life in the interview is not of a house that was full of gales of laughter.
In the preface to The Divided Self, Laing calls it '... a study of schizoid and schizophrenic persons; its basic purpose is to make madness, and the process of going mad, comprehensible'. This sets out the scope of his ambition – it should be noted that he wrote this very influential work at the age of 28. It also demonstrates that Laing did not deny the existence of mental illness. He never accepted the term anti-psychiatry; he was more anti-psychiatrist than anti-psychiatry.
Laing wrote Sanity, Madness and the Family, which was published in 1964, with fellow Glaswegian psychiatrist Aaron Esterson. Esterson shared with Laing an interest in existentialist philosophy. At the time, they were based at the Tavistock Institute which was then headed by John Bowlby. The book presents 11 family case studies based on hundreds of hours of interviews. This book can be viewed, in retrospect, as the beginning of Laing's rupture with mainstream psychiatry. It was poorly received by the wider profession, which viewed it as an act against the families of those suffering from schizophrenia. This was despite the fact that Bowlby himself saw it as one of the most important works in psychiatry of the twentieth century. Laing stated that the book asked a very fundamental question that traditional diagnosis never approaches or considers: Can we reach some understanding of the experiences and behaviours that psychiatrists classify as symptoms of schizophrenia? The usual reading of this work suggests that Laing saw these behaviours as a rational response to the irrationality of the world in which they were situated. However, it can be argued that Laing and Esterton did not regard delusions as rational – rather that they saw them as having meaning. This meaning could be established by placing the delusions in the family and social context of the lives and relationships of the sufferers. The traditional medical model and approach does not allow psychiatrists the time to do this or the scope to look for the potential meanings in bizarre behaviours, actions or patterns of speech.
The Politics of Experience and The Bird of Paradise was published in 1967. This marked not only a complete break with mainstream psychiatry but also the height of Laing's fame and influence. The book was a phenomenal success, selling millions of copies worldwide. Sedgwick (1982) called it the 'Radical Trip'. In this collection of essays, Laing presents his sixties radicalism to the world. His previous works had not been anywhere near as overtly political as this one. Laing sees the world around him as "mad"; and given the political upheavals of the mid-1960s, one can understand this perspective. He goes one stage further to suggest that those experiencing psychotic experience have reached a higher stage of consciousness. Even allowing for the excesses of the period in which it was written, this is the area of Laing's work that has been the most heavily criticised.
THE RUMPUS ROOM AND THE ESTABLISHMENT OF KINGSLEY HALL
Laing's first job as a civilian psychiatrist was at Gartnavel Royal Hospital in Glasgow. It is important here to note that at that time in the late 1950s the old asylums were in very poor condition. These services and their patients had been neglected for some time. The result was overcrowded wards with few staff. The conditions on the wards were poor, often insanitary. There was little, if any, constructive activity. The range of treatments available or used by psychiatrists was also very limited. This is the almost nightmarish vision of the mental health ward that, as we shall see later, is presented in the novels of Janet Frame, Ken Kesey and Sylvia Plath. Laing's army experiences had seem him recognise the importance of establishing some form of human contact with his traumatised patients. At first glance, this might appear odd and a statement of the obvious. However, in the context that Laing was working, it was a very radical stance.
When Laing arrived at Gartnavel, the back wards of the hospital were understaffed and overcrowded. The female patients had generally been resident in the hospital for years, if not most of their adult lives. In the Laing archive, there is a paper where he outlines his first encounters with this group of patients on the ward (Burston, 1996). Several fought to give him a hug or sat on his lap – clearly this is something that would breach virtually every current mental health professional code of ethics. Laing goes on to describe his patients as being so cut off from their surrounding and normal human contact that they were experiencing a living death. This description seems a world away from the position that psychotic experiences are a mystical journey. However, Laing here is highlighting, in his rather florid prose style, the impact of institutionalisation and neglect. To his immense credit – remember he was a young registrar when he went to the hosptial – he decided to do something about it. There were 65 patients on the ward with four or sometimes only two staff. The patients were often violent or aggressive and would shout obscenities or attack staff.
Laing arranged for a room opposite the ward to be painted, comfortably furnished and a range of craft materials to be provided. A group of patients who had been in hospital for at least four years, and were seen as the most socially isolated, were selected to spend time in the so-called rumpus room between 9am– 12noon and 2pm– 5pm. The experiment had little impact initially but as it developed the patients became less and less socially isolated. They became more involved – cooking meals, helping staff to maintain the unit and so on. After 12 months Laing, when he wrote up this work, described the group as less socially isolated, their behaviour as less distressing to themselves and others, and there seemed to be a greater sense of community. Staff–patient relationships had improved. Patients' personal care had improved significantly. In his description of this work, Laing does not make any comment on the impact or otherwise that this experiment had on symptoms such as delusions or hallucinations that the patients may have been experiencing. In the context of the wider 1950s pessimism about the prospects for the treatment of 'long-stay patients' – a marvellously Orwellian phrase – the rumpus room has to be viewed as a radical experiment.
Twelve patients were selected to be part of this new approach. Laing claimed that after 18 months they had all been discharged but within a year they had been readmitted. These results were interpreted in two polar opposite ways. For those who were critical of Laing, it was evidence of the folly of his view that schizophrenia was not a disease but the result of societal and family factors. For Laing, it demonstrated quite clearly that the women had returned to toxic family environments. These were the cause of the subsequent relapses. Abrahamson (2007) in examining the work of the rumpus room has looked at the patient records for the period. He can find no evidence that any patients were actually discharged. The misleading claims that they were casts doubt on the whole nature of the experiment. It does seriously undermine the basis for the much broader claims that Laing subsequently made on the basis of this work. However, the impact of the rumpus room does not only have to be measured in terms of whether patients were discharged. Given the nature of their previous experiences in hospital and the regime to which they were subjected, it would be rather astonishing if all the patients had been seen as in a position to be discharged after 12 months. What Laing did here was to reaffirm the human and emotional potential of the patients. He also showed that it was possible to change approaches and staff attitudes. At its core, this work is based on compassion and a recognition of the fundamental human dignity of the patients – a message that will never lose its resonance. Despite these achievements, in his work we hear little if anything from the women themselves. They remain shadowy figures – an off-stage chorus to the work of Laing. This work formed the basis for the arguments he put forwarded in The Divided Self.
Laing moved to the Tavistock Institute in 1956 and remained there until 1964. In 1965, alongside others including David Cooper, the man credited with coining the term anti-psychiatry, he established the Philadelphia Association to campaign for improved mental health services. In the same year, he set up a therapeutic community at Kingsley Hall. At this time, Laing was at the height of his cultural fame and status. Kingsley Hall had taken on an almost mythic status. Therapists and patients lived together in an experiment in community living. The accounts of Kingsley Hall tend to focus on this and other very unconventional approaches to issues such as the use of LSD. It also became something of a destination for rock stars and film icons such as Sean Connery on their way to enlightenment. A resident Mary Barnes and a psychiatrist Joseph Berke wrote a memoir of Kingsley Hall – Two Accounts of a Journey Through Madness. This became the basis for a David Edgar play – Mary Barnes – that was staged at the Royal Court in 1979. Mary Barnes was an artist, poet and writer who struggled with mental illness throughout her life. At Kingsley Hall she underwent regression therapy. During this time, she began to paint – initially using her own excrement and then oils. Her work was exhibited in 1969 and she then worked on the book with Berke. Kingsley Hall collapsed in chaos in 1970. Its excesses cast a shadow over the work of Laing from that point onwards.
LAING, THE FAMILY AND MADNESS
One of the general criticisms aimed at critical perspectives on psychiatry is that it seeks to "blame" families for the mental distress that their loved ones are experiencing. This is seen as compounding the distress of families. Looking to family dynamics as the root cause of mental illness is not solely associated with anti-psychiatry. One could argue that Freudian approaches and attachment theory are other examples of this dynamic. However, they appear to be somewhat less overtly critical of the family. Laing was at the forefront of these ideas. He argues that mental distress is the result of the scapegoating that these individuals have experienced. In the arguments about the rumpus room patients, he suggested that their readmissions showed that the family environments that they had returned to were toxic and induced a relapse.
The starting point for this view of the family is Bateson et al's (1956) notion of the double bind. They argued that those individuals who are labelled as suffering from schizophrenia are responding to the dynamics of their parental environment. The symptoms of schizophrenia should be understood as a response to the distress that this environment caused. They are, therefore, cathartic. A double bind arises in an intense personal relationship where one party – the subject (in this case the child) – is presented with logically conflicting demands that are impossible to meet – eg 'if you do A you will be punished, if you fail to do A you will be punished'. In the double bind theory of schizophrenia, the punishments are the removal of parental love and affection. Bateson goes on to argue that the subject is receiving two orders of message at the same time – one of which is being denied but the subject knows is being sent. These messages create confusion and inevitably place the subject in positions where their actions appear contradictory.
Laing's work chimed with sociological and feminist analyses of the structure of the family in late modern capitalism. The second wave of feminism saw the family as the key institution in the reproduction and maintenance of patriarchal structures. I think that it is difficult to regard Laing as a feminist but his work provided further support to arguments that the family was a problematic institution. He argued that it was the cause of much psychological distress and damage. Mental illness is thus situational and in some senses a logical response. Psychosis could be understood as the attempt to demonstrate ontological concerns. Laing's views are summarised here:
From the moment of birth, when the stone-age baby confronts the twentieth-century mother, the baby is subjected to these forces of violence, called love, as its mother and father have been, and their parents and their parents before them. These forces are mainly concerned with destroying most of its potentialities. The enterprise is on the whole successful. By the time the new human being is fifteen or so, we are left with a being like ourselves. A half-crazed creature, more or less adjusted to a mad world. This is normality in our present world.
(Laing, 1967 p 58)(Continues…)
Excerpted from "Critical Psychiatry"
Copyright © 2017 Ian Cummins.
Excerpted by permission of Critical Publishing Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
R.D. Laing: the psychiatrist of the counterculture
Michel Foucault: the man in the high castle
Erving Goffman: madness, and the asylum as a total institution
Frantz Fanon: Black Minds Matter - race, psychiatry and revolutionary politics
Thomas Szasz: a libertarian challenge to the 'therapeutic state'
Franco Basaglia: psychiatry as radical politics
David Rosenhan: an experiment revisited
Plath, Frame and Casey: psychiatry and the literary imagination