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Monday, August 02, 2021






R.D. Laing’s Language of Experience

by Gavin Miller


abstract


The radical psychiatrist R.D. Laing (1927-1989) was an accomplished author with an extensive philosophical knowledge that informed his ideas on reading, writing, and interpretation. Laing argues that psychiatry should be modeled on skilful textual exegesis rather than scientific explanation. The exegesis of a psychotic’s words and actions is difficult, he infers, because the impoverishment of our experience cuts us off from the sense that lies within seeming madness. Like philosophers such as Edmund Husserl, Laing therefore criticizes the way in which the natural sciences have invalidated subjective experience. He consequently employs a rhetoric designed to disclose with renewed vigor its complexity, variety and reality. Laing fails, however, to find an alternative to scientific reason: "experience", in his weakest work, is an irrational realm of mystical and self-validating certainty that closely parallels Heidegger’s later accounts of "Being".


article


Despite a revival in psychiatric studies of his writings, the literary importance of the radical Scottish psychiatrist R.D. Laing has been underestimated in the years since his death in 1989. Yet Laing was immensely influential not only upon psychiatric practice, but also upon the arts. He influenced the novelists Doris Lessing and Alasdair Gray, the screenwriters David Mercer and Clancy Sigal, the playwrights David Edgar and Peter Shaffer, and poets such as Allen Ginsberg and Tom Leonard (for further details, see Showalter 220-47; Mullan Creative Destroyer 26-29, 89-91, 214-16, 304-6; Miller 53-85). Laing’s influence upon the creative professions is not accidental: in many ways, his psychiatric writings were consciously literary productions. Indeed, his earliest ambition was to be a writer. While a high school student in 1940s Scotland, he worked his way through the local public library: "I wanted to be a writer. [. . .] I gave myself the age of thirty as an absolute deadline for the publication of my first book" (Laing Wisdom, Madness, Folly 68-76). This literary aspiration does not mean, however, that Laing’s eventual psychiatric writings were merely works of fiction. Psychiatry, as Laing saw it, needed what writing could give it: a sensitivity to obscure and recondite meanings, a revalidation of immediate experience, and a renewed "disclosure" of the world. But to value writing in this way brings potential risks: Laing’s appreciation of the "world-disclosing" properties of poetic language becomes, in his worst work, an infatuation with a realm of mystical, self-validating certainties.

Previous discussion of Laing’s literary status has been marred by the mythology that surrounds the man. Even as perspicacious a critic as Elaine Showalter, who has praised Laing’s literary talents, makes some notable blunders. She claims that "Laing was born in 1927 in the Gorbals, the roughest, darkest, and most depressed district of Glasgow" (Showalter 224). The date is right, but the place is wrong: Laing was born in Govanhill, a middle-class district, and there he lived with his lower middle-class family (see Burston 9). The point of such mislocation is readily apparent: the imagery of roughness and darkness, of male brutality, assists Showalter in her claim that Laing’s psychiatry was masculinist—"a male adventure of exploration and conquest" that "drew upon his own heroic fantasies" (Showalter 236).

A parallel rhetoric is offered by Clancy Sigal’s Zone of the Interior (1976), a novel to which Showalter refers, and which seems to have informed her depiction of Laing as an intellectual pugilist. Sigal’s roman ŕ clef remained unpublished in the UK for almost thirty years because of fears of libel. It features Laing as "Willie Last", an LSD-guzzling psychiatric guru sitting at the center of a network of folly and messianic rhetoric. This caricature of Laing, though often entertaining, also positions him somewhere in sub-rational masculine darkness. Last’s dialogue is rendered in a pseudo-phonetic orthography and spattered with apostrophes, while the narration of the central character (a North American) is rendered in orthographically standard, and thus rational and properly human English: "He [Willie Last] came to the front door himself. All my previous shrinks had had snooty housekeepers. ‘Och Sidney Bell, is it? Come in, mon. It’s a pleasure tae meet ye. I’ve read yir work’" (Sigal 3); later, Sidney tells how, "Dr Last hastened to assure me I was mad ‘only in th’ eggistainshul sense’" (Sigal 21).

In a curious irony, the Scots poet Tom Leonard has remarked, although not with conscious reference to Sigal’s work, that in this traditional technique of narration, "the dialect speaker tends to appear in a narrative like Laing’s patient in a hospital: there is complicity between author and reader that the speaker is ‘other’, that the user of such language cannot be the person who has written or who is reading the work" (Mullan Creative Destroyer 59). Showalter and Sigal therefore both rhetorically position Laing as the "other". He slides from psychic conquistador to Caliban, a thing of darkness (and roughness, and depression) who struggles to imitate the speech of his masters. Naturally, it is hard to imagine an account of, say, Jacques Derrida that would carelessly and conveniently misrepresent his place of birth, or which would record his speech as if he were a comical Frenchman—a kind of Inspector Clouseau of the Sorbonne. As literary readers, we therefore have a duty to look beyond what Leonard calls the "smokescreen anecdotage about Laing" (Mullan Creative Destroyer 91); and this means turning to Laing’s texts, rather than to reports of his person. There is indeed some truth in the charge that Laing was at times a mere rhetorician who preferred striking assertion to careful argument. Yet there is a quite complex philosophical progression that explains Laing’s tendency to venerate "experience" as a privileged source of mystical, self-certifying insight.

Any study of Laing’s language must start with his contention that the psychiatrist is, or should be, a skilled reader. In his first book, The Divided Self, published in 1960, literary hermeneutics provides Laing’s model of the therapeutic encounter: "The personalities of doctor and psychotic, no less than the personalities of expositor and author, do not stand opposed to each other [. . .]. Like the expositor the therapist must have the plasticity to transpose himself into another strange and even alien view of the world. In this act, he draws on his own psychotic possibilities, without forgoing his sanity" (Laing Divided Self 34). The therapist is an exegete, making sense of a puzzling and baffling text by drawing upon the possibilities of being that he shares with the patient. Laing’s understanding of his psychotic patients therefore displays a keen literary sense. Metaphors for unusual experiences abound in his "readings" of psychotic speech: "Fire may be the uncertain flickering of the individual’s own inner aliveness [. . .] Some psychotics say in the acute phase that they are on fire" (Laing Divided Self 45). There are allusions and inter-textual relations: a patient who has no secure sense of her existence except in the presence of others is, to Laing, "like Tinker Bell. In order to exist she needs someone else to believe in her existence" (Laing Divided Self 56). Puns and multiple meanings also abound. Another patient claims she is a "tolled bell" (Laing Divided Self 187): a bell that is tolled because she feels passive, controlled from the outside, but also a beautiful and passive girl, a "belle" of the ball, who has become what she was told to be. Laing’s literary skills are needed to understand such patients because, as he puts it, they express "‘existential’ truth [. . .] with the same matter-of-factness that we employ about facts that can be consensually validated in a shared world" (Laing Divided Self 87).

Rather than trying to "explain" psychosis, Laing offers various genres and motifs which may help to bring sense from words and actions that seem incomprehensible. Even silence and immobility may be a communicative action, rather than mere "behavior". In his autobiography Wisdom, Madness and Folly, for instance, Laing confronts a hypothetical catatonic: "Is he a pillar of salt? Is he god incarnate [in] stone? Is he the still centre of the turning world?"; only when such possible understandings are exhausted, can one rightly ask the final question on the list, "Is there something the matter with his neurochemistry?" (Laing Wisdom, Madness, Folly 87). Throughout Laing’s work there is an insistence on charitable exegesis wherever possible, rather than upon impersonal, non-intentional explanatory forms. The terminology and conceptual scaffolding vary from work to work: from ontological insecurity, to the schizoid condition, to "double-binds", to "knots", to proscribed transcendental consciousness, and so on. But the ambition is the same throughout: to restore a fully interpersonal relationship with the other, rather than to have a relationship in which he or she is understood as possessed by some causal, or quasi-causal, mechanism.

Laing’s way of understanding is therefore very different from that employed in traditional psychoanalytic interpretation, particularly that directed at psychotic speech. Laing’s opposition to psychoanalytic interpretation is present throughout his career, but is most clearly expressed in The Voice of Experience (1982), where he argues that, like sophomorish literary analysis, it is an obstacle to confrontation with "otherness". Wilfred Bion’s psychoanalytic interpretations of a psychotic patient prove particularly provoking to Laing. In the case study that Laing cites, Bion’s patient complains about a lack of interesting food and new clothes, laments the condition of his socks, and says that picking a piece of skin from his face has made him "feel quite empty" (Laing Voice 50). Bion interprets this as the patient’s attempt to communicate to him a feeling that he (the patient) has eaten his (Bion’s) penis. Such constructions, says Laing, are "a grinding machine which reduces any sense to total nonsense", and forestall any genuinely revelatory interpersonal relationship: "It is difficult to imagine what the patient could say that could tell Bion anything he does not think he knows" (Laing Voice 52). Such reduction of the other to the same, to the already-known, merely extends the impersonal attitude: "A psychosis, like a dream, like a brain, is up for grabs, for rotation, reversal, reshuffling, slicing, apposing, juxtaposing and transposing" (Laing Voice 49)

Laing therefore tries to find what is intelligible in terms of the "here and now" of the other’s experience, rather than to pursue one-sided interpretations built around the "there and then" of repressed psychic materials. In The Divided Self, at any rate, this means that Laing’s exegeses are (consciously) in the spirit of Sartre’s discussion of subjective experiences such as nausea, shame, and vertigo. "Vertigo" for Sartre has nothing to do with inner-ears or repressed psychic trauma; it’s a subjective disclosure of freedom—the vertigo that I feel by a sheer drop is a consciousness of my freedom to throw myself into it, regardless of any psychic causality which might be supposed to impede me (see Sartre 30). Laing, in discussing experiences of being on fire, or being petrified, and so forth, is trying to do for psychotic psychology what Sartre does for more everyday experience.

Indeed, Laing’s affinity with the European phenomenological movement offers one of the surest routes to an understanding of his idea of language, and how it should be used. Laing draws the logical conclusion from what he sees as a mistaken assumption that the psychotic’s speech is unintelligible. We are, he believes, experientially impoverished—cut off from the many different modalities of experience that are phenomenologically apparent. This is why we cannot easily understand the psychotic, and it is also why we are unable to understand ourselves. We are, he claims in "The Politics of the Family", all victims of a modern "holocaust of [. . .] experience on the altar of conformity" (Laing "Politics of Family" 101). The implied chiasmus is of course obvious: from the holocaust of experience there arises the twentieth-century’s experience of holocaust. In his 1967 bestseller, The Politics of Experience, Laing declares: "Our behavior is a function of our experience"; "If our experience is destroyed, our behavior will be destructive" (Laing Politics 12).

The destruction of our experience, its reduction to ash or some other useless residue, was to Laing philosophically elucidated by phenomenology’s critique of the natural sciences. Husserl in The Crisis of the European Sciences (1936) pointed out the side-effects of a "scientific" or "causal" theory of perception. Such a theory treats experience of the world as primarily the effect of a cause, and so experience becomes nothing more than the effect produced by the mind as objects causally impinge upon it. What we see, feel, hear, smell, savor, and desire, may have no more resemblance to what "really" exists than the crash of a cymbal to the stick that hits it:

The phenomena are only in the subjects; they are there only as causal results of events taking place in true nature, which events exist only with mathematical properties. If the intuited world of our life is merely subjective, then all the truths of pre- and extrascientific life which have to do with its factual being are deprived of value. They have meaning only insofar as they, while themselves false, vaguely indicate an in-itself which lies behind this world of possible experience. (Husserl 54)

Or, as Laing puts it in a 1980 Lecture, "What is the Matter with Mind?", "Sight, sound, taste, touch and smell [. . .] all sensibility, all values, all quality, all feelings, all motives, all intentions, spirit, soul, consciousness, subjectivity: almost everything, in fact, which we ordinarily take to be real is de-realized, is stripped of its pretensions to reality" (Laing "Matter with Mind" 10-11). A similar expression of this idea is found by the English philosopher A.N. Whitehead (1861-1947), whose work Laing also knew (and cited in The Voice of Experience (see Laing Voice 15n)). The scientific view divides the world into an unknowable causal nature, and the apparent nature given in experience: "Causal nature is the influence on the mind which is the cause of the effluence of apparent nature from the mind" (Whitehead 31). Experience, in Whitehead’s words, is "effluence" not just as what "flows out" from the action of thing upon mind, but also as a flow that is waste, toxic, or contaminated, like the effluent from a factory or a sewage works.

Laing notes that scientists typically refuse to see what philosophers such as Husserl and Whitehead have understood: that even the basis of science, sensory experience, must be reduced by science itself to an "effluent". To borrow Laing’s words, "all experience, along with the most strangely modulated and transformed [. . .] is consigned by science to its slop bucket" (Laing Voice 69). Since all experience is merely an illusion mechanically produced by a realm of beings-in-themselves, then, as Laing puts it in an interview with Douglas Kirsner, the scientific view is essentially "that experience is a psychosis of matter" (Mullan Creative Destroyer 45): everything we experience should, in a consistent scientific worldview, really be as delusive and illusory as the experience of a madman.

Laing fights fire with fire. The scientific account of truth is based upon a nonsensical metaphor in which experience accurately represents something which can never be experienced—truth is the "relation between a picture and the undepictable reality the depiction in the picture alludes to" (Laing Voice 29). Against such incoherent metaphor, he musters his own rhetorical armory. In his Schumacher lecture, Laing ends with a list (which I shall not quote in full) of "[a] few of the other modes of existence outside the investigative competence of natural science": these include, "love and hate, joy and sorrow, misery and happiness, pleasure and pain, right and wrong"; "everything, in fact, that makes life worth living" (Laing "Matter with Mind" 18-19). Laing wants to open our eyes to the diversity and variety of experience, to everything beyond the "primary qualities" or "things-in-themselves" nonsensically preserved in the scientific worldview. To do this, he increasingly employs the neglected rhetorical device of enumeratio, the making of a list or catalogue. The variety and irreducible diversity implied by enumeratio is central to Laing’s depiction of experiences that may be otherwise rendered anodyne or trivial. In his autobiography, Wisdom, Madness, and Folly, World War Two is decomposed by Laing into the horrors of modern conflict (enabled, of course, by modern technological rationality): "When World War II started no one could imagine how it could possibly end without endless devastation, poison gas, germ warfare, torture, mutilation, rape, pillage, massacres, killing and killing and killing, shelling, bombing, sea warfare, food shortage, famine and pestilence" (Laing Wisdom, Madness, Folly 35). Enumeratio is also the scheme with which Laing depicts the things that genuinely make him feel alive: "My life-saving consolations were moonlight and gaslight, the angel on the dome of the library, music, the coal fire, fun, indeed all things—sky, sun, stars, clouds, rain, sleep, snow, flowers, trees, birds, flies, prayer, a few people, even asphalt, fog" (Laing Wisdom, Madness, Folly 52). The figure repeats throughout Wisdom, Madness and Folly, from the many ways of committing suicide with "razor blades, nuts and bolts, soap, broken glass, lavatory chains, buttons, knives, forks, spoons, hair, hammers, files, combs, broken saws, coins, lavatory paper, clothing" (Laing Wisdom, Madness, Folly 118) to the fascination of night-time experience—"solitude, silence, desolation, camaraderie, romance, meditation, prayer, vigil, carousing, music, the moon, the stars, the dawn" (Laing Wisdom, Madness, Folly 29).

There are various other techniques by which Laing forces his readers to confront the inauthenticity with which they might attempt to downgrade vast domains of their experience to some "psychosis" of their own neurological matter. He has a gift for novel metaphor—for the reworking of what George Lakoff would call an "Idealized Cognitive Model" of madness (see Lakoff 68-76). For example, when describing the refractory wards of Gartnavel mental hospital in Glasgow during the 1940s, Laing recalls an uncanny and oddly hopeful experience that draws upon an analogy with twentieth-century avant-garde composition. In his own words: "the ward sounded like an out-of-tune orchestra endlessly tuning up, each instrument unrelated and out of pitch", yet there is a kind of harmony, as "when the jumble of sound in a difficult piece of music all suddenly makes sense" (Laing Wisdom, Madness, Folly 123). The possibility of this hidden tunefulness inspires Laing in his early experiments with a therapeutic community based on minimal intervention. By offering his musical model, rather than a medical model, Laing hopes that the reader, seeing (or perhaps hearing) madness differently, will also perceive that drugs are not a cure for an illness, but a way of trying to "harmonize" the madman with his society: "There are drugs to calm agitation, to soften frantic feelings, to tone down awful moods, to modulate the tonal region of feelings, to regulate thoughts and the style and content of imagination and dreams" (Laing Wisdom, Madness, Folly 25).

There are undoubtedly many more rhetorical strategies in Laing’s discursive writings. Some are listed, for instance, by Martin Howarth-Williams (see Howarth-Williams 64-68), including the use of archetypal imagery, syntactic parallelisms, and abrupt juxtapositions between different discourses (such as mystics and politics, or religion and science). To fully consider all Laing’s prose devices is beyond the scope of this article. To analyze fully the rhetoric of his more identifiably literary or poetic writing—that of his Sonnets (1977), the spiraling logic of Knots (1970), the mini-dramas of Do You Love Me? (1977), or the dialogues of Conversations with Children (1978)—would also require lengthy consideration.

But one strategy in particular stands out as a clue to Laing’s philosophical legitimation of his rhetoric. If there is indeed a modern "holocaust of experience", then it may be that the traces of an earlier meaning can gesture towards what has been repressed, sidelined, or simply exterminated in our lived reality. In his second book, Self and Others, published in 1961, Laing close reads Jean Genet’s play The Balcony by drawing attention to the etymology of the word prostitute: "Most of the play takes place in a brothel. The girls in the brothel are shown to be, in a literal sense, pro-stitutes. They stand for (pro-stare) whatever the client requires them to be, so that he can become for a while that figure which he wishes to be" (Laing Self and Others 103). The existential meaning in prostitution is its furnishing of a "collusive identity" (Laing Self and Others 104). To collude is to play together at self-deception: "The term collusion has the same root as de-lusion, il-lusion, and e-lusion. The root ‘lusion’ ultimately comes from the past participle of the Latin verb, ludere. [. . .] It can mean to play, to play at, or to make a sport of, to mock, to deceive" (Laing Self and Others 98). Such rediscovery of language is a frequent trope within Laing’s work. Elsewhere, he draws attention to the etymology of words such as companion (literally, a bread-sharer), orientation (to find the East), diagnosis (to see through), and the obvious (that which stands in one’s way, and so both evident, and an obstacle). As Martin Howarth-Williams rightly concludes, "This technique involves looking afresh at a common word [. . .] to discover new, or often, very old, meanings, which are literal, thereby sweeping away, or at least, relativizing, the conventional meaning" (Howarth-Williams 65).

This concern with uncovering an older, forgotten meaning, came to Laing from Heidegger. Glasgow in the 1950s, as well as apparently being (according to Showalter) a dark and depressed domain, was also an important centre for the translation of German-language philosophy into English. As well as Ronald Gregor Smith’s translations of Martin Buber, Glasgow also produced what was for many years the only English translation of Heidegger’s Sein und Zeit, the version produced by John Macquarrie and Edward Robinson (see Heidegger Being and Time). Laing, indeed, was known to both Macquarrie and Robinson: "John Macquarrie was working on the translation [of Sein und Zeit] which I thought was a total disaster and at times I tried to persuade him that the whole point of Heidegger was totally lost by translating sein, which is the German infinitive of the verb to be, sein, by ‘being’" (Mullan Mad to Be Normal 367). The influence of Heidegger is quite apparent throughout Laing’s work. In his second book, Self and Others, for example, Laing meditates on the English idioms that revolve around how "a person ‘puts himself into’ his acts", how he "may seem to be ‘full of himself’ or ‘beside himself’, or ‘to have come to himself’ again after ‘not being himself’" (Laing Self and Others 117). This everyday existential vocabulary directs us, he says, to a different notion of truth, one different from the representational account presupposed in causal theories of perception (see above). Citing Heidegger, Laing contends that "in natural science truth consists in a correspondence, an adaequatio, between what goes on in intellectu and what goes on in re" (Laing Self and Others 120). Yet, "there is another concept of truth which is to be found in the Greek word αληπεια. In this concept, truth is literally that which is without secrecy, what discloses itself without being veiled" (Laing Self and Others 120). The concept of truth as aletheia, or disclosure, is central to the literariness of Laing’s writing. This conceptual refocusing of truth brings together Laing’s existential exegesis of schizophrenic speech, his opposition to reductive psychoanalytic interpretation, his revalidation of "anomalous" experience, and his poetic reworking of psychiatry’s rhetoric. Laing claims in The Politics of Experience that "[w]ords in a poem, sounds in movement, rhythm in space, attempt to recapture personal meaning in personal time and space from out of the sights and sounds of a depersonalized, dehumanized world. They are bridgeheads into alien territory [. . .] Their source is from the Silence at the center of each of us" (Laing Politics 24).

Laing argues for the function of language as a poetic disclosure of so-called "inner" being, our "personal idiom of experiencing our bodies, other people, the animate and inanimate world" (Laing Politics 6). This claim that poetic art discloses being (or Being) is much the same as that made by Heidegger in his later work, where he asserts that "language alone brings beings as beings into the open for the first time", and concludes that "All art, as the letting happen of the advent of the truth of beings, is as such, in essence, poetry" (Heidegger "Work of Art" 197). This indebtedness to Heidegger helps to explain what many have seen as the failings of Laing’s later work—an unwillingness to argue, an indifference to evidence, and a tendency to mystical assertions. Although there is a temptation to attribute these failings to the merely psychological causes at work upon Laing (e.g. drug and alcohol abuse), there is also undoubtedly a logically intelligible path to such a mode of discourse. Habermas has argued that Heidegger’s project, by insisting upon disclosure as the primary meaning of "truth", eventually produces a series of incommensurable "truths" that are "in each case provincial and yet total; they are more like the commanding expressions of some sacral force fitted out with the aura of truth" (Habermas 154). Thus, as Laing starts to echo Heidegger more faithfully (The Politics of Experience is particularly filled with such repetitions, e.g. the paraphrasing of Heidegger’s "What is Metaphysics?" (Laing Politics 22-23)), he begins to follow the same path. Reason quickly becomes downgraded to a mere instrumental mastery over the world as Laing echoes, for example, Heidegger on the technological disclosure of nature as a "standing-reserve" (Heidegger "Technology" 322)—to describe a goose as "raw-material-for-pâté", says Laing, is "a brutalization of, a debasement of, a desecration of [. . .] the true nature of human beings and of animals" (Laing Politics 38). What Laing correspondingly elevates is not rational discourse, but a supposed realm of self-validating certainties. In The Voice of Experience, for instance, Laing voices his fascination with re-incarnation: "Belief in a cycle of reincarnation is worldwide. Whole civilizations have been dominated by it"; such experience "is in no way accounted for by being dismissed as the delusions and hallucinations of the mind unable to reach to the haven of scientific disenchantment" (Laing Voice 99). Similarly, in The Politics of Experience, religious faith is also above rational critique: "Faith was never a matter of believing He existed, but of trusting in the presence that was experienced and known to exist as a self-validating datum" (Laing Politics 100).

What therefore marks, and mars, Laing’s later work is something like the same mystical certainty that Habermas notes in Heidegger:The event of Being can only be meditatively experienced and presented narratively, but not argumentatively retrieved and explained [. . .] Dasein ["being-there", i.e. human being—GM] is no longer considered the author of world-projects in light of which entities are at once manifested and withdrawn; instead, the productivity of the creation of meaning that is disclosive of the world passes over to Being itself. Dasein bows to the authority of an unmanipulable meaning of Being and rids itself of any will to self-affirmation (Habermas 152-53).



No doubt this sounds very abstract. Consider then an illustration from Laing’s writings: he claims that "[f]ew are made to believe their experience. Paul of Tarsus was picked up by the scruff of the neck, thrown to the ground and blinded for three days. This direct experience was self-validating" (Laing Politics 100-01). By imbibing Heidegger with his LSD, Laing came to the position outlined in The Politics of Experience: "True sanity entails in one way or another the dissolution of the normal ego [. . .] and the eventual re-establishment of a new kind of ego-functioning, the ego now being the servant of the divine" (Laing Voice 101). The schizophrenic journey is therefore something more than the masculine voyage of exploration described by Showalter; it is equally a Heideggerian transition in which "[t]he being of phenomena shifts and the phenomenon of being may no longer present itself to us as before" (Laing Politics 92).

Laing never fully retreated from this position (which is frequently glossed as the "romanticization of schizophrenia"—an accurate, yet partial understanding of his thesis, which is as much philosophical as psychiatric). It haunts his work, particularly in his repeated hints at the reality of re-incarnation—as in Conversation with Children, for instance, when his young son insists that he was a soldier who killed a lot of people, "last time I was alive" (Laing Conversations 1). Sigal’s mockery of this thread in Laing’s thought is thus scarcely an exaggeration: "When a patient is so sure she came fr’ another planet", announces Willie Last, "th’ integrity of her statement slices my rationality off at th’ knees" (Sigal 206). Yet the movement of Laing’s philosophy of language is far from eccentric: the progress from hermeneutics, existentialism, and phenomenology, to something approaching a deconstructive free-for-all (in which aliens and re-incarnation are all equal "truths") could be seen as a compressed history of an important strand in literary and critical theory. Laing’s vices were, and are, shared by the intellectuals of his generation: like many, he followed the critique of "instrumental reason", but could find no alternative model of rationality. His language of experience directs us toward what is "heterogeneous" to the scientific destruction of phenomenal reality, and it does so with the skill of an accomplished novelist, playwright, or poet. But, without some alternative rational criterion with which to separate wisdom from madness and folly, Laing’s language becomes at times a "mere" rhetoric which promotes a mystical submission to the anonymous power of "experience".

Works Cited

Burston, Daniel. The Wing of Madness: The Life and Work of R.D. Laing. Cambridge, Mass. and London: Harvard University Press, 1996.

Habermas, Jürgen. Philosophical Discourse of Modernity: Twelve Lectures. Trans. Frederick Lawrence. Cambridge and Oxford: Polity and Blackwell, 1987.

Heidegger, Martin. Being and Time. Trans. John Macquarrie and Edward Robinson. Oxford: Blackwell, 1962.

---. "The Origin of the Work of Art." Martin Heidegger: Basic Writings. London: Routledge, 1993. 139-212.

---. "The Question Concerning Technology." Basic Writings: Martin Heidegger. Ed. David Farrell Krell. London: Routledge, 1993. 308-41.

Howarth-Williams, Martin. R.D. Laing: His Work and Its Relevance for Sociology. London: Routledge & Kegan Paul, 1977.

Husserl, Edmund. The Crisis of European Sciences and Transcendental Phenomenology: An Introduction to Phenomenological Philosophy. Evanston: Northwestern University Press, 1970.

Laing, R.D. Conversations with Children. London: Allen Lane, 1978.

---. The Divided Self: An Existential Study in Sanity and Madness. Harmondsworth, Middlesex: Pelican, 1965.

---. The Politics of Experience. New York: Pantheon, 1967.

---. "The Politics of the Family." The Politics of the Family and Other Essays. London: Tavistock, 1971. 65-124.

---. The Self and Others: Further Studies in Sanity and Madness. London: Tavistock, 1961.

---. The Voice of Experience. New York: Pantheon, 1982.

---. "What Is the Matter with Mind?" The Schumacher Lectures. Ed. Satish Kumar. London: Blond & Briggs, 1980. 1-27.

---. Wisdom, Madness, and Folly: The Making of a Psychiatrist 1927-57. Canongate Classics 89. Edinburgh: Canongate, 1998.

Lakoff, George. Women, Fire and Dangerous Things: What Categories Reveal About the Mind. Chicago: University of Chicago Press, 1987.

Miller, Gavin. Alasdair Gray: The Fiction of Communion. Amsterdam: Rodopi, 2005.

Mullan, Bob. Mad to Be Normal: Conversations with R.D. Laing. London: Free Association, 1995.

---, ed. R.D. Laing: Creative Destroyer. London: Cassell, 1997.

Sartre, Jean-Paul. Being and Nothingness: An Essay on Phenomenological Ontology. Trans. Hazel E. Barnes. London: Routledge, 1969.

Showalter, Elaine. The Female Malady: Women, Madness and English Culture, 1830-1980. London: Virago, 1987.

Sigal, Clancy. Zone of the Interior. Hebden Bridge, Yorkshire: Pomona, 2005.

Whitehead, A.N. The Concept of Nature. Cambridge: Cambridge University Press, 1920.

To cite this article, use this bibliographical entry: Gavin Miller "R.D. Laing’s Language of Experience". PSYART: A Hyperlink Journal for the Psychological Study of the Arts. Available http://www.psyartjournal.com/article/show/miller-rd_laings_language_of_experience. July 8, 2021 [or whatever date you accessed the article].

Received: October 15, 2006, Published: December 3, 2006. Copyright © 2006 Gavin Miller

Friday, December 24, 2021

Study: Psychiatric Diagnoses Are ‘Scientifically Meaningless’ In Treating Mental Health

by John Anderer

LIVERPOOL, England — No two people are exactly alike. Therefore, attempting to classify each unique individual’s mental health issues into neat categories just doesn’t work. That’s the claim coming out of the United Kingdom that is sure to ruffle some psychologists’ feathers.

More people are being diagnosed with mental illnesses than ever before. Multiple factors can be attributed to this rise; many people blame the popularity of social media and increased screen time, but it is also worth considering that in today’s day and age more people may be willing to admit they are having mental health issues in the first place. Whatever the reason, it is generally believed that a psychiatric diagnosis is the first step to recovery.

That’s why a new study conducted at the University of Liverpool has raised eyebrows by concluding that psychiatric diagnoses are “scientifically meaningless,” and worthless as tools to accurately identify and address mental distress at an individual level.

Researchers performed a detailed analysis on five of the most important chapters in the Diagnostic and Statistical Manual of Mental Heath Disorders (DSM). The DSM is considered the definitive guide for mental health professionals, and provides descriptions for all mental health problems and their symptoms. The five chapters analyzed were: bipolar disorder, schizophrenia, depressive disorders, anxiety disorders, and trauma-related disorders.

Researchers came to a number of troubling conclusions. First, the study’s authors assert that there is a significant amount of overlap in symptoms between disorder diagnoses, despite the fact that each diagnosis utilizes different decision rules. Additionally, these diagnoses completely ignore the role of trauma or other unique adverse events a person may encounter in their life.

Perhaps most concerning of all, researchers say that these diagnoses tell us little to nothing about the individual patient and what type of treatments they will need. The authors ultimately conclude that this diagnostic labeling approach is “a disingenuous categorical system.”

“Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.” Lead researcher Dr. Kate Allsopp explains in a release.

According to the study’s authors, the traditional diagnostic system being used today wrongly assumes that any and all mental distress is caused by a disorder, and relies far too heavily on subjective ideas about what is considered “normal.”

“Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.” Professor John Read comments.

The study is published in the scientific journal Psychiatry Research.

laing enterprises - The official website for R.D. Laing

https://www.rdlaingofficial.com

R.D. Laing was a controversial figure to the Establishment and a hero to the counter-culture movement of the 1960s which viewed R. D. Laing as a pioneering humanitarian whose works


  • scihi.org/laing-anti-psychiatry-movement

    2016-08-23 · Ronald David Laing was born in the Govanhill district of Glasgow, Scotland, on 7 October 1927, the only child of civil engineer David Park MacNair Laing and Amelia Glen Laing (née Kirkwood). He studied medicine at Glasgow University from 1945 to 1951. There he developed a special interest in psychotic patients.

    • Estimated Reading Time: 8 mins




    • Monday, August 02, 2021

      R D LAING 

      By Richard Sennett
      Oct. 3, 1971

      Credit...The New York Times Archives
      See the article in its original context from
      October 3, 1971, Section BR, Page 2

      About the Archive
      This is a digitized version of an article from The Times’s print archive, before the start of online publication in 1996. To preserve these articles as they originally appeared, The Times does not alter, edit or update them.
      Occasionally the digitization process introduces transcription errors or other problems; we are continuing to work to improve these archived versions.


      In a moment of anger in his new book, R. D. Laing writes, “Our own cities are our own animal factories; families, schools, churches, are the slaughterhouses of our children; colleges and other places are the kitchens. As adults in marriages and business we eat the product” These charges may all be true, but they are tiresome, written in such a way that the reader turns them off. The strongest impression I have after reading “The Politics of the Family and Other Essays” is that Laing has substituted an easy rhetoric of accusation and condemnation for the struggle to understand people's feelings that dignified his earlier work.


      In the dullness of his attacks on an inhumane society, Laing is, of course, not alone. Many of those who took fire during the recent years of turbulence are now passing through a moment when a great number of painfully acquired ideas threaten to enter the comfortable landscape of cliche. I don't mean that radical rhetoric is out of date, because the fissures in society stimulating it are still there; I mean rather that something is going wrong with the way we perceive injustice, something is atrophying in the words and ideas to express anger, so that the rhetoric remains true but no longer truly angers. Why this should be so, Laing's new book, in its very weariness, helps clear.

      Lassitude follows periods of upheaval with almost monotonous insistence in history, but an exhaustion of sensitivity usually comes upon a people after they have endured a revolution or great change in their lives. The extravagants of Paris who emerged after the death of Robespierre gloried in precious clothing and precious sentiments, all the while mouthing the old revolutionary slogans; the “empty men” of the Weimar Republic, as Brecht called them, also bore the marks of exhaustion left by a domestic war. But the present loss of sensitivity is different, and puzzling, for when we turn away from the enthusiasm for apocalypse that sets the tone of newspapers and television, we face a society whose wars, poverty, racism and all the rest, are changing slowly if at all. Can it be only that we are tired response to the world—argued with stale anger from listening to so much talk about the need for change?

      The writings of R. D. Laing have moved from early books which put forth a complex, painful vision of the human oppression involved in the phenomenon society labels “insanity” to books which replay all the early themes in such a fashion that the reader feels he is in a closed and stuffy room. Laing's thought has disintegrated dramatically in the last four years, but it is unworthy of him simply to itemize that decline. For what has happened to ?? shows why it is not just a matter of words that makes contemporary words of anger stale.

      “The Divided Self,” his first book, appeared in England in 1960, when Laing was 28. The book's power lay in Laing's ability to catch the rationality behind seemingly irrational behavior, a logic he revealed by making the reader see through the eyes of someone labeled schizophrenic. Laing did not “explain” schizophrenia as a disease; he showed how schizophrenia was a perfectly logical way of coping with impossible, longstanding situations in a person's family or immediate society. Much of this ground was prepared for Laing by the American anthropologist Gregory Bateson—probably one of the greatest and most neglected writers on human behavior in this country.

      A few years earlier (1956) Bateson had arrived at a theory of “double binds” to explain the contradictory language people called schizophrenics speak. A double bind is a situation in which a person is issued two contradictory negative commands he or she must follow in order to gain love. A mother tells her daughter to do dishes before math homework if she wants love from Mammy; the father tells the girl she must do math first if she wants his love.

      When contradictions like this persist, what is the child to do? She wants and needs the love of both parents. It becomes logical for her to obey both parents at once: she may make dishwashing motions while reading her math, or call the dishes she handles plus and minus signs. In this way she comes to appear disconnected and deranged to her teachers or to a social worker, when in fact it is a situation she had no hand in creating that is deranged.

      Bateson was concerned with the logic of “illogical” language. What Laing seized on in “The Divided Self” and in books that followed in rapid succession—”Self and Others” (1961), and “Sanity, Madness and the Family” (with A. Esterson in 1964)—was to ask why these contradictory and painfully disorienting situations should come into being.

      In the course of these books Laing came to think that parents are no more to blame for posing the child insane demands than is the child for responding insanely. Forces out of their personal control make them hurt the child; few of the people in families of schizophrenics, Laing remarked, ever want to create sickness; they have to, they are driven souls. Who then is responsible?.

      Laing came to believe that everyone and no one is. Society makes insanity, he argued; sanity is a condition in which people are willing to obey social rules, even if the commands are inhumane and irrational. The rebels are labeled insane. That little girl is a rebel in her acts because she didn't try to paper over a contradiction; she tried to respond as honestly as she could to the demands made on her, and her show of honesty prompted others to think she was sick.

      Here, too, Laing was not alone. Michel Foucault's brilliant first book, “Madness and Civilization” (1961), argued that a long history stands behind the practice of treating the deviant as insane, so that, in his “illness,” he doesn't have to be taken seriously. The incarceration of Soviet dissidents in mental hospitals is an overt example today, but Foucault and, later, Laing argued that all of “civilized” society, practices this behavior, unaware of its own repression.

      By the time Laing wrote “The Politics of Experience” (1967), it seemed logical that he would become a social analyst, a man whose experience as a psychiatrist would give him, and his readers, new insights into how society organized repression. But these insights were not forthcoming. Rather than follow the logic of his own anger and become a social critic, he chose to make his patients, whom he had formerly seen as dignified in their suffering, into heroes. He dealt with society only by clinging to those people who were its victims and whose actions, if not intentions, showed they were fighting back.

      This tendency to cling to the victim as hero took hold of Laing in two ways. Everything he saw in his consulting room, all his intellectual associations and allies, made him think that traditional psychiatric logic, pos iting “rational” standards of behavior, was a sham, was really a tool for keeping dissidence down. If Laing were to become a social critic, if he began to ask why society brought into being these human traumas, wouldn't he run the risk of becoming one of “them,” wouldn't his gifts of sensitivity and originality fall prey to the deadness of that sane world? There is a failure of nerve here, a fear of putting himself in enemy territory, but it is complex and humane because it is a fear of losing his own humanity.

      Of course the victims of brute power arouse sympathy, and any victims who show signs of resistance command respect. But the spectator of their plight, free to leave them and go home, engaged in their woes by empathy rather than necessity, always runs the risk of feeling that the victims have something he doesn't, that in their suffering they have transcended the vicious world that the empathetic observer gets along in. He is led by the force of his own sympathy to admire them, to want to be like these rebels, at least to champion them. As a a result, society seems ever less real apart from its effect on the lives of its victims, and the sympathizer's own life seems less real too; he orients his own reactions to society by those who are suffering so much more than he is. As their follower, their champion, he feels he too is

      Blacks in the South and the urban ghettoes who were treated this way during the 1960's told their white friends to go home; the blacks felt used. Laing's sympathy for his mentally ill patients is enmeshed in the same contradictions that led to a crisis between black and white civilrights workers, but he has gone a step further. Laing has come to see madness not just as an act of rebellion, but as an act of “liberation,” of “waking up,” of a “freeing” of the individual from society's constraints. Rebellion and liberation are separated by a simple matter of fact: a liberation ends the causes of the distress that makes people want to rebel. Laing, however, has turned this around, and looks at madness as a liberation in which the individual reorganizes the world on his or her own terms, so that society can be shut out. But why then are mentally ill people usually in great and un

      We do not know much of how Laing's patients feel about their doctor's sympathy. Kingsley Hall, the therapeutic community Laing organized in London, has had some dramatic successes and failures. But I suspect that the patients' relief at finding a professional who does not treat them with condescension must be balanced by the burden Laing places on them as his proxies. Further, we must ask what does the conversion of a victim into an existential hero do to the sympathizer, to the man losing himself in the struggles of others? This tendency is not Laing's alone, it is characteristic of many of his readers, who have learned during the last decade to feel angry by identifying with the victims of our society; the results of this identification are what Laing's latest boox has to show.

      “The Politics of the Family and Other Essays” has as it; main section a rewrite of five radio talks given In 1968 over the Canadian Broadcasting Corporation as the eighth series of Massey Lectures; the three other essays in the book come from a talk given to English social workers during the same year and two pieces previously published in specialized medical books in England. All the essays are ostensibly concerned with the role of the therapist intervening in family crises.

      I should say at once that the reader who was moved by “The Divided Self” will find in these essays of a decade later a few pages with the old force. For example, Laing gives a brilliant analysis of how the famed 19thcentury French psychiatrist B. A. Morel drove a patient mad: failing to explore the reality before him seriously, that a young boy hated his father, Morel assumed instead that there was some hidden physical disease to explain this unnatural and impolite feeling; the boy was institutionalized and eventually became no more than a vegetable because the doctor refused to accept the “mad” idea of father‐hatred as equal in lucidity to the presumptions of natural filial affection ruling the doctor's own

      Sadly, the few passages with the old fire are sandwiched between dead prose like the following: “As Sartre would say, the family is united by the reciprocal internalization by each (whose token of membership is precisely this interiorized family) of each other's internalization.” Much of the book reads at this level or worse; Laing can no longer write clearly unless he is showing someone being hurt.

      Laing cannot talk about the theories and intellectual constructs surrounding mental illness with the same imagination and originality with which he talks about the mentally ill patient because he won't permit himself to. All of Laing's own powers of originality are concentrated on speaking for the patient; but the patient, as Laing elsewhere argues so strongly, is not the maker of his own illness. What can Laing use to confront the tormentors? Examples of their practices gone wrong. But there is no way of explaining what has gone wrong other than by using their terms. He sounds like Doctor Laing, pompous and boring, because it is he who made the split between doctor and human being, for fear he would not have the strength to confront the doctors without his patients to hold on to.

      Making the victim a proxy for his own anger forces Laing's thoughts about victimization itself into a pedestrian mold. In “The Politics of the Family” he argues that there is a triangle composed of blind authority, the invasion of intimate feelings, and “waking up” through mental illness. From the moment of their birth men are contaminated by others, ultimately by society. Laing draws a “map” of this invasion, but the countryside and the routes of invasion have all been laid out before by Freud, David Rappoport and Alfred Adler—none of whom gets much credit. Laing argues that nuclear war and genocide are connected to schizophrenic feelings without drawing the connections at all. How can this psychiatrist help us if outside the consulting room his great gifts of intelligence go dead, and he mechanically and woodenly repeats the ideas of others? This failure of intellect is especially disturbing since the behavior Laing perceived in his consulting room could not be adequately explained by the older

      This invasion from the outer world, Laing says, is blind, unintentional: each person or social group wounds others only hoping to protect itself. I believe this, but I don”t understand why. Laing believes it, and doesn't think it matters why, because “why” gets us too far away from the “reality that is the patient.”

      So when Laing talks of waking up, of liberation, he ends at an impasse. If this is a vicious and insane world what are men to do? How are they to wake up? The analysis of schizophrenia on which Laing's work rests is that people are forced into what society calls insane behavior when they try to take the world seriously; it is the essence of his argument that you do not become insane by some willful act or failure of your own. If you did, we would be back in the world of Morel where patients needed to learn to control themselves better. If I, a sane man, want to wake up, and I can't will myself into mental illness, what

      Here is the closest Laing comes to an answer “I consider many adults (including myself) are or have been, more or less, in a hypnotic trance. ... Attempts to wake before our time are often punished, especially by those who love us most. Because they, bless them, are asleep. They think anyone who wakes up ... is going crazy. Anyone in this transitional state is likely to be confused. To indicate this confusion is a sign of illness, is a quick way to create psychosis.”

      It is an obsessive litany: You will be punished for being mentally ill when you wake up. But how do I get there? There is no therapy in this therapist's writings.

      The conversion of his patients into “models” of behavior inhibits Laing from talking about three issues. The first is himself: “When I was thirteen, I had a very embarrassing experience??f shall not embarrass you by recounting it.... The first family to interest me was my own. I still Imow less about it than I know about many other families. This is typical.” A humanistic psychiatry does not have to bear the burden of autobiography or ‐confession, yet Laing cannot talk about himself openly in the detail he feels entitled to talk about his patients. When he uses “I” in this book, it usually is in terms of putting himself in the place of a suffering patient

      Laing thinks of himself as an existentialist—indeed, one of his best books is a commentary with David Cooper on Sartre called “Reason and Violence” (1964), which has just been published for the first time in this country by Pantheon and Vintage Books. But as a writer he has become the worst of existentialists, one of the “spectators” Sartre so detests. How can a writer be an existentialist when he discounts himself?

      Secondly, Laing talks about how emotions get twisted, but seldom talks about what emotions there are in the heart to twist. A reader who wants to find out about the range of feeling involved in human trust, in friendship, in sensuous pleasure, will not find it in Laing. “The Divided Self” described an idea of “ontological security” in which men felt able to take a wide variety of risks; the books since “The Politics of Experience” show a writer who can imagine only one.

      This is to say, finally, that Laing has lost that capacity to dream which is necessary in any enduring radical vision. Critics like Marx and Freud did not content themselves with saying justice would reign when the old abuses disappeared.. Each of them tried to create a scenario for a just life that was greater than a mirror image of the old. For Marx, socialism ended the abuses of capitalism, but Communism instituted human relationships of a wholly new order. The acts of intelligence Freud called ego strengths were not compromises between the warring factions of instinct and external circumstance; they were creative powers to make new meanings, new satisfactions. Because Laing now has lost the power to dream and make his readers dream and desire, his catalogue of abuses is losing its power to anger.

      What has gone sour in Laing is not unique to him, but is representative of the deadening of sentiment in the last few years that has seized us, his contemporaries. His refusal to think about the enemy mirrors our own: white racism, genocide, monopoly capitalism these are the villains and what more do we need to know about them but that they must be destroyed?

      In truth, the resistance each man can mount to repression has to be renewed in his life, not by repeated declarations of will, but by continual doubts about what and why he is fighting. “A revolutionary is motivated by great feelings of love,” said Che, but he is also moved by curiosity; I think a man is liberated not by becoming completely absorbed in the fact that he is oppressed, but in exercising his power to understand with a certain grim disinterest the forces impinging on him. Political sensitivity thrives on uncertainty because the possiibility to be moved, to revolt, and be moved again, comes only from a deep distrust that at last one has settled what is

      Intellect keeps uncertainty alive, and the failure to use it closes one up in the room where Laing is imprisoned. White, middle‐class persons who have come to sense what blackness means to an American black, or warfare to a Vietnamese, now speak of “identifying” with these struggles. Few of us in Laing's generation speak of identifying with the middle class, because we don't like it, and we think we can make change only by orienting our sensibilities around persons or conditions ineradicably different from ourselves. When Laing crossed that barrier and began to live through others, he went dead inside, could not speak of himself as probingly as he could speak for his patients, lost the power to create anger at the world which held them both so harshly in its grip. I wish I knew where it would lead to think out the realities of our lives as persons who are not dramatically suffering, but I do know that until we stop this' presumptuous sentimentality, until uncertainty and curiosity about who we are ourselves return, we will become increasingly bored with our own “causes” and tolerant of the society that brings them into being.■



      Wednesday, May 10, 2006

      Mirror Mirror On The Wall


      They looked in the mirror and found themselves wanting. Senate committee pushes for new mental health commission

      And how will they pay for this?
      Committee: Drinkers should fund mental health program Since we all know that drink is the rue of the working class and work is the rue of the drinking class.

      And since this is Liberal Senators who are pushing this maybe they got nostalgic for a little bit of Trudeaumania.

      Margaret Trudeau's 'dark place' of despair

      Margaret Trudeau shares struggle with depression

      We were all depressed during the Trudeau era.

      Since madness and mental illness are social constructs it is no wonder that Margaret internalized the darkness and lonliness of living with Canada's Philosopher King. It was a dark time, even though it was the seventies, as much as it was a time of self indulgence.

      Mental Health is a serious matter, of course, but it is a 'medical' specialization that arose from alienation. It is an attempt by the medical establishment to grapple with the conditions of impersonal subjectivity created by capitalism. For which they are agents of social conditioning, to make us believe we are not subjects alienated by capitalism but are merely subjects of our own making.

      Which is why I reccomend reading R.D. Laing and David Cooper along with Wilhelm Reich, and Michael Foucault.

      IN his highly influential book, Madness and Civilization, Michel Foucault indicted the modern West for its treatment of the "insane." According to Foucault, Western societies, bowing before the Enlightenment idol of Reason, built a theoretical and institutional quarantine against madness. The Cartesian rational mind must not suffer from exposure to irrationality; the madman must not roam freely through town and country as he did during the Middle Ages, a mocking reminder of human mortality and God's infinite wisdom. Instead, Foucault claimed, the insane were thrown into cells with other dissidents from the rising bourgeois moral order--the poor, the criminal, and the licentious. The supposed liberation of the mad during the late eighteenth and early nineteenth century by "alienists" Phillippe Pinel in France and William Tuke in England, he argued, only furthered their exclusion. These reformers herded the mad into asylums, where an arid "science" of psychiatry silenced their Dionysian voices. Enlightenment, Foucault held, was bought at the cost of excluding the mad: Such was the heavy price of Reason's "progress." Public Interest: Madness and Enlightenment. - Review - book reviews


      I was fortunate to hear Dr. Laing speak in Calgary before the very Mental Health community that he was opposed to. His speach was quite challenging to their conceptions of dealing with conditions of schizophrenia. In that he opined that the best method is the therapist working directly with the patient by entering their madness and walking them out, ala the shaman or the LSD tripper. Failing that he defended Bedlam, the imprisonment of those who could phsically harm themselves, with the attendants being the threapists who are trainined in martial arts to struggle physically with the patient and subdue them, since this was the physical reality they needed to come back in to. Further he shocked members of the audience by insisting on allowing glass in the patients cell/room for them to be able to cut themselves to physically return to their bodies from their out of body states. Laing thesis is that madness is a reality that must be breached by the therapist, not a condition that must be controled by drugs.
      Is the pharmaceutical industry distorting psychiatry practice


      R. D. Laing and The Politics of Diagnosis


      The Politics of Experience RD Laing (1967)

      Introduction to 1967 Dialectics of Liberation conference

      Psychiatry Anti-Psychiatry Re-Visited

      Anti-psychiatry - Wikipedia, the free encyclopedia

      Madness and Colonization: Psychiatry in the British and French empires, 1800-1962

      Power and discipline in psychiatry's knowledge base

      The Genealogy Of Power: On Michel Foucault


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      Tuesday, July 25, 2023

      Treatment of psychiatric patients in the community requires long-term political and financial support, study shows

      R.D.LAING SAID THIS YEARS AGO




      UNIVERSITY OF EXETER




      Major changes aimed at treating psychiatric patients in the community instead of hospital requires clear and strong leadership, as well as and long-term political and financial commitment, analysis shows.

       

      The study has found the transition is usually prolonged and requires adequate planning, sustained support and careful coordination.

       

      The successful implementation of these changes relies in careful financing and coordination, as well as the use of available research and evidence, strong and sustained advocacy, comprehensive community services, and a well-trained workforce engaged in the process.

       

      The transition requires long-term political and financial support, and understanding local needs and forces is crucial to its success.

       

      The paper, authored by Cristian Montenegro and Felicity Thomas from the University of Exeter,Matías Irarrazaval and Jorge Urrutia-Ortiz from the Universidad de Chile and Josefa González-Moller from the Pontificia Universidad Católica de Chile, has been published in the journal Global Mental Health. It reports the result of a scoping review that includes 52 studies on the process of de-institutionalisation.

       

      Psychiatric deinstitutionalisation involves the closure or reduction of psychiatric hospitals, reallocation of beds, and the establishment of comprehensive community-based services for individuals with severe and persistent mental health difficulties. The study identifies barriers to success, such as inadequate planning, funding, leadership, limited knowledge, competing interests, insufficient community-based alternatives, and resistance from the workforce, community, and family/caregivers.

       

      Countries undergoing the transition and those initiating the process need a detailed understanding of their specific needs and contextual features at the legal, institutional, and political levels.

       

      Dr Montenegro said: “Our analysis shows that before hospitals are closed there should be an assessment of the institutionalised population. This assessment should shape existing and new community-based services on their needs and preferences. A thorough analysis of how to overcome institutional inertia is crucial.

       

      “Comprehensive and sustainable investment is necessary, and the different aspects of the transition should be adequately costed, including new facilities, support of independent living, training, new professional roles, and the reinforcement of primary health care. 

       

      “Training, incentives and guarantees of job stability are required. Curricular changes in psychiatric training, with an increased emphasis on community-based care and recovery-oriented practices, are necessary.”

       

      The analysis shows how misconceptions can hinder efforts. One such misconception is the belief that closing psychiatric beds leads to an increase on homelessness or imprisonment among people with mental health problems. However, analysis of existing research shows that homelessness and imprisonment have occurred only sporadically. Most studies reported positive changes in social functioning, stability, improvements in psychiatric symptoms and enhanced quality of life and participant attitudes towards their environment. Instances of deterioration following deinstitutionalisation was rare. This suggests that even long-stay patients, who commonly experience functional impairment due to schizophrenia, can achieve better functioning through deinstitutionalisation.

       

      Failure at the process level, including planning and implementation, can result in negative and even fatal outcomes for patients. In South Africa, between October 2015 and June 2016, a poorly executed attempt to relocate 1,711 highly dependent patients led to 144 deaths and 44 missing individuals. This tragedy stemmed from ethical, political, legal, administrative, and clinical errors.

       

      Jorge Jorge Urrutia-Ortiz said: “Our work provides a framework for assessing the presence of barriers and facilitators in deinstitutionalization processes. This framework can assist stakeholders and other relevant parties in developing a comprehensive understanding of their unique context.”

       

      Wednesday, May 04, 2022

      Mental illness plays havoc with the mind as well as the heart

      Peer-Reviewed Publication

      UNIVERSITY OF SOUTH AUSTRALIA


      University of South Australia scientists have uncovered another reason why society should be paying more attention to mental health: it is closely aligned to blood pressure and heart rate variations.

      A new study published in BioMedical Engineering draws a link between mental illness and widely fluctuating blood pressure, which can lead to cardiovascular disease and organ damage.

      UniSA researcher Dr Renly Lim and colleagues from Malaysian universities say there is clear evidence that mental illness interferes with the body’s autonomic functions, including blood pressure, heart rate, temperature and breathing.

      “We reviewed 12 studies on people with anxiety, depression and panic disorders and found that, regardless of age, mental illness is significantly associated with greater blood pressure variations during the day,” Dr Lim says.

      “We also found that for people who are mentally ill, their heart rate does not adapt to external stressors as it should.

      “Contrary to what many people think, a healthy heart is not one that beats like a metronome. Instead, it should adjust to withstand environmental and psychological challenges. A constantly changing heart rate is actually a sign of good health.”

      Reduced heart rate variation (HRV) is common in people with mental illness and indicates that the body’s stress response is poor, exacerbating the negative effects of chronic stress.

      Unlike a person’s heart rate – how many times a heart beats in a minute – which is usually consistent, HRV is more complex and is the time between two heartbeats, which should change according to external stressors.

      “What we aim for is not a constantly changing heart rate but a high heart rate variation. This is achieved through a healthy diet, exercise, low stress and good mental health.”

      Low HRV occurs when a person’s body is in fight-or-flight mode, easily stressed and common in people with chronic diseases, including cardiovascular and mental health problems.

      While large blood pressure variations (BPV) during the day are not ideal, at night the systolic pressure should dip by between 10-20 per cent to allow the heart to rest. The researchers found that in people with mental health issues, their blood pressure does not drop sufficiently at night.

      The reduced dipping – under 10 per cent – can be caused by many factors, including autonomic dysfunction, poor quality of sleep and disrupted circadian rhythms that regulate the sleep-wake cycle.

      “The takeout from this study is that we need to pay more attention to the physical impacts of mental illness,” Dr Lim says.

      “It is a major global burden, affecting between 11-18 per cent (one billion) of people worldwide. Since mental illness can contribute to the deterioration of heart and blood pressure regulation, early therapeutic intervention is essential.”

       

      Notes for editors

      Association between mental illness and blood pressure variability: a systematic review” is published in BioMedical Engineering. For a copy of the paper, email candy.gibson@unisa.edu.au

      The research was undertaken at the University of Malaya, University of South Australia, Universiti Kebangsaan Malaysia, and Universiti Tunku Abdul Rahman.