- Wisdom, Madness and Folly: The Making of a Psychiatrist by R.D. Laing
Macmillan, 147 pp, £9.95, February 1985, ISBN 0 333 37075 9
Schizophrenia is now held to be one of the major illnesses of mankind, but its recognition as a clinical syndrome is of relatively recent origin. There is something very odd about the sudden arrival of the chronic schizophrenic on the stage of history at the end of the 19th century. One hypothesis which has been canvassed recently is that schizophrenia was a novel condition, unknown before the end of the 18th century, which spread as a slow, possibly viral epidemic across Europe and the United States in the 19th century, contributing in large measure to the vast increase in the population of asylums, and culminating in its recognition, under the name dementia praecox, as a definite syndrome by Emil Kraepelin in 1899. But a more historically-minded reading delivers a rather different interpretation of the coincidence between the identification of the chronic schizophrenic as a progressively deteriorating type and the transformation of the asylum into a custodial institution for the socially unproductive. On this view, the formulation of schizophrenia as a chronic condition was deeply implicated in a field of social forces in which people who suffered from mental tribulation came to be represented as lacking any semblance of social value.
To argue in this way is to espouse the kind of dynamic nominalism which Ian Hacking proposes as a way of understanding the dilemmas of the human sciences. ‘Categories of people,’ Hacking suggests, ‘come into existence at the same time as kinds of people come into being to fit those categories, and there is a two-way interaction between these processes.’ So, for example, the writings of Michel Foucault are to be understood as ‘in part stories about the connection between certain kinds of description coming into being or going out of existence, and certain kinds of people coming into being or going out of existence’. On this reading, the category of schizophrenia, and the authoritative description of the schizophrenic, came into being at a time when different kinds of people became available for diagnosis as chronic types and scientific operators stood prepared to identify them as such. What was offered was not an innocent reporting: under the institutionalised conditions of observation afforded by the asylum the chronic schizophrenic came more closely to resemble what others in any case already took him to be.
Recent studies of schizophrenic lives across the years of this century have lent a good deal of plausibility to arguments of this kind and demonstrated, among other things, the crucial role played by the individual’s sense of his own value – his assessment of his relation to moral community – in the outcome of schizophrenic illness. The lives of schizophrenics are certainly not devoid of causal properties, but the extraction of these from their historical context is a hazardous affair, and over the past century our understanding of schizophrenic predicaments has been greatly impeded by intellectual frameworks which have sought to disclaim the historical constitution both of schizophrenic lives and of the categories in which we attempt to describe schizophrenics.
Within this difficult, and often bewildering, territory the voice of Dr R.D. Laing has been heard – and in equal measure celebrated and scorned – for more than a quarter of a century. The historical sensibility of Western psychiatry, particularly in its British manifestation, has been very limited and that Laing’s writings received such startling acclaim – well beyond any reasoned evaluation of their contribution to our understanding of schizophrenia – is in no small part a tribute to the intellectual ineptitude of a good number of his colleagues and to the widespread suspicion that the proclamations of psychiatry have failed to measure up to the important issues. What has motivated Laing all along has been the belief that psychiatry has tended to put schizophrenic patients beyond the human bond and to denude them of any form of value, and his aim has in part been to devise accounts which restore a sense of dignity and human connection to schizophrenic lives. ‘Some enhanced understanding of what is going on between psychiatrist and patient,’ he says in the present volume, ‘does not preclude a scientific explanation of what is going on in the patient alone, and such a scientific explanation does not need to be a way to cut off a cut-off person from the possibility of human reunion, communion and renewal.’ However, there are different strands in Laing’s writing which compete and conflict with one another and it must be admitted that the present work displays relatively few of the strengths of his earliest and all of the weaknesses of his later writings.
Wisdom, Madness and Folly is an account of Laing’s personal, intellectual and professional development over the first thirty years of his life – the period that culminated in the writing of The Divided Self, his first and best book – together with a lengthy diatribe on what he takes to be contemporary psychiatry. One cannot but be appalled and angered by much of what is said here. ‘No facts,’ Laing tells us in the introduction, ‘are in dispute’: rather his endeavour is to describe these ‘facts’ from a different point of view. Yet in numerous instances he reveals a stunning disregard both for the detail of what others have said and for what can demonstrably be seen to be happening to psychiatric patients. He asserts that ‘according to orthodox psychiatry’ (‘orthodox’ and ‘mainstream’ are favoured words in Laing’s vocabulary, used to distance himself from almost everybody), ‘over one in ten of us is a schizophrenic.’ No one to my knowledge has ventured such a claim: in this country, for example, the lifetime incidence rate for schizophrenia is between 0.8 and 0.9 per cent, or about one in every 125 of the population. Similarly, in the chapter entitled ‘Psychiatry Today’, there is nothing about such ‘facts’ of our contemporary existence as the run-down and closure of mental hospitals (a movement in which one might have expected Laing to take an interest), or about the vicissitudes of ex-mental patients in the community. Instead we are told that the preliminary psychiatric examination of a person ‘may, and often does, inaugurate a period of weeks, months or years during which that person is kept imprisoned – that is, in involuntary custody, and there drugged, regimented, reconditioned, brain given electric lavages, bits possibly taken out by knife or laser, and anything else the psychiatrist decides to try out’.
The account of his childhood (the trials of ‘wee Ronnie’ in negotiating, and attempting to make sense of, his family situation), and of his early professional development, has its moments, but, in the main, two things come through: a laziness in the writing, an unwillingness to follow a line of argument to its completion, a constant shifting from one anecdote to another; and a sharp contrast, as displayed in the writing itself, between the Laing of today and the intense self-discipline of Laing in his twenties, a discipline that is most evident in the text of The Divided Self. Those parts of the present volume which work best are the ones where Laing permits himself to re-engage with the institutional contexts of his youth, the Army psychiatric unit at Netley, the Gartnavel Royal Mental Hospital in Glasgow, and the Department of Psychological Medicine at Glasgow University. Concerned to mitigate the worst excesses of institutional environments and to engender more hopeful possibilities in his relations with his patients, Laing emerges as a dedicated and perceptive practitioner, for whom the institutional framework provides at one and the same time the limitations against which he struggles and the condition of a notable empirical rigour.
The strength of The Divided Self was that it enabled us to expand our sense of human community to include the realities of schizophrenic predicaments. If it was not possible to identify the schizophrenic as a social agent, he was nonetheless a social agent whose life had run into serious trouble. There was nothing to suggest that (to quote from the present book) he was one of a ‘motley crew of geniuses, psychotics and sages’ who have awakened from the socially ‘induced fiction in which we are all enmeshed’. If we ask the question ‘what is the schizophrenic doing?’ then, contrary to the traditional view of him as ‘talking nonsense’ or ‘displaying his symptoms’, it may be helpful to propose the answer: ‘he is trying to sort out his relation within community or within the story of which he is part.’ Such a frame can help suggest the forms of vocabulary that are appropriate to coping with schizophrenic people as fellow citizens (if that is what we are minded to do) rather than exclusively as objects of clinical investigation. But it cannot give us an exclusive purchase on what schizophrenics are doing, neither can it disclose anything ‘deep’ about the world-views of schizophrenics. If in one important aspect Laing’s aim has been to show that, contrary to what others have said about them, schizophrenics, for all their peculiarities and confusions, are viable human beings, the besetting weakness in his writings has been the tendency to develop extravagant claims around his observations: most notoriously, the claim that the utterances and performances of schizophrenics can be rendered ‘socially intelligible’ when viewed in the light of their family circumstances. If late 19th-century psychiatrists, and some of their 20th-century counterparts, proclaimed a privileged view of the schizophrenic as a form of degenerate, then Laing has proclaimed an equally privileged insight into the lives and circumstances of schizophrenics. It is indeed an index of Laing’s sense of his own privilege that he can so easily abjure the writings of others in this field, notably the work of Manfred Bleuler from the Burghölzli Hospital in Zurich, whose study The Schizophrenic Disorders is not only the most thoroughgoing account of the life-histories of schizophrenics available, but also the most perceptive discussion of the dilemmas of the social scientist in the study of schizophrenia.
To confront Laing’s later writings with the criterion of scholarly rectitude is perhaps the wrong way to read him. We might do better to see him, not as an investigator of empirical histories, but as a sectarian preacher inveighing against a generalised failing of modern life. What we are given is an insistent highlighting of the worst case as a means to sustain the general vision.
The key word, which serves to identify this failing, and to specify the longing for a pre-modern condition of community, is ‘camaraderie’. Psychiatry ‘was, and is’, he tells us, ‘one interface in the socio-economic-political structure of our community where camaraderie, solidarity, companionship, communion is almost impossible, or completely impossible’. The absence of camaraderie between doctor and patient was borne upon him when he was ‘in the British Army, a psychiatrist sitting in padded cells in my own ward with completely psychotic patients, doomed to deep insulin and electric shocks in the middle of the night. For the first time it dawned upon me that it was almost impossible for a patient to be a pal or for a patient to have a snowball’s chance in hell of finding a comrade in me.’
The restrictions on community in contemporary society are certainly an impediment to the well-being of schizophrenics, but those who are attempting to take current policies of community care seriously, and to treat them with less cynicism than the present government, will want something more than lamentations of this kind. At his best Laing serves to remind us (as did the Quakers in previous centuries) of a capability – a form of response and relation – which has to a considerable extent disappeared from our dealings with the mentally ill. The rationalisations of the last century helped to mitigate the more brutal features of the 18th-century’s treatment of the insane, but what they also brought about was a vast increase in the population of the insane and the reduction of large numbers of people to a condition of chronic demoralisation. The degree of self-understanding displayed by psychiatry in this affair has not always been encouraging, but if we are to attempt to negotiate new understandings of (and new prospects for) schizophrenic lives then we shall need something a good deal humbler than what Laing has to offer. The present volume of reminiscences ends in 1957. We must hope that we will be spared further volumes covering the subsequent decades.