Reviewing Schizophrenia 3: The Divided Self: Laing

Reviewing Schizophrenia 3: The Divided Self: R.D. Laing

How far does our family of origin shape our personality, mental state and behaviour?  How far do our genetics form those same realities?  It is that age-old, often-repeated question about the nature-versus-nurture debate.  A balanced approach answers that they both do.  Before I discuss R.D. Laing’s contribution to psychiatry and psychotherapy, let me begin with an exceptionally cynical poem by Philip Larkin (1922 – 1985), which presents the misanthropic and fatalistic view that parents ruin their children, passing on misery that deepens "like a coastal shelf," advising that one should avoid having children to stop the cycle of abuse.  I think it provides a fitting epigraph for the life and times as well as the thoughts and teachings of the exceptional and eccentric psychiatrist, Ronald Laing:

This Be The Verse (1971)

They fuck you up, your mum and dad.  

    They may not mean to, but they do.  

They fill you with the faults they had

    And add some extra, just for you.

 

But they were fucked up in their turn

    By fools in old-style hats and coats,  

Who half the time were soppy-stern

    And half at one another’s throats.

 

Man hands on misery to man.

    It deepens like a coastal shelf.

Get out as early as you can,

    And don’t have any kids yourself.

 

A man called Adam Laing, 41 years of age, was found dead on the Spanish island of Formentera, the smallest of Spain’s Balearic Islands, in late May 2008.  Adam’s decomposed body was discovered in a tent pitched on private land, the floor scattered with the detritus of a drunken night.  Who was this man who suffered such a lonely and tragic death far away from his native England?  He was none other than Dr R. D. Laing's oldest son from his second marriage.  Dr Laing was at the forefront of the humanist and existential thrust in psychiatry that fed into what was then called the Anti-Psychiatry Movement.  It had been widely reported that Adam had suffered greatly from the breakup of his parents’ marriage when he was a teenager and that he had never really recovered from the trauma.  There was surely a horrible irony here insofar as one of Ronald David Laing's lasting contributions to psychiatry in the 1960s and 70s was linking mental distress to a dysfunctional family upbringing. In my last post, I underscored the fact that while Professor Browne’s agreement with Laing that the central problem for schizophrenics is the failure to separate (properly) from the family, he faulted his old friend for demonising parents and making something quasi-sacred of the psychotic person.  Furthermore, Laing himself was troubled by his own personal problems, suffering from both episodic alcoholism and clinical depression, according to his self-diagnosis in a BBC Radio interview with Professor Anthony Clare in 1983.  That interview can be listened to in full here: Laing and Clare

As a psychiatrist, brilliant, wild and unconventional, R. D. Laing pioneered the humane treatment of the mentally ill. However, as a father, clinically depressed, alcoholic and often absent, he bequeathed his 10 children a traumatic childhood and his two wives an equally stressful legacy. For all his professional benevolence and well-known care for patients, Laing was a flawed parent.  Indeed, he never even managed to rise to the level of his colleague at the Tavistock Clinic, London, Donald Winnicott’s concept of “a good enough parent.”  Adrian Laing’s biography of his father and his interview with two journalists, Elizabeth Day and Graham Keeley, leave us in no doubt at all on that matter: “But how on earth could R.D. Laing, the celebrated psychiatrist whose entire reputation rested on his theories espousing the compassionate treatment of the mentally ill, reconcile his professional position with his personal behaviour?” Guardian

The book I want to review here is Dr Laing’s The Divided Self (Penguin Books, 1990). I first read this humanist classic in the late 1970s, having been introduced to it by a fellow student.  With a keen interest always in existential and psychological issues, I soon acquired it.  However, many of his theories, especially his contention that the harrowing disorder of schizophrenia did not exist at all, have long since been dismissed as unscientific; nevertheless, as an existential, humane and psychotherapeutic approach, his writings remain a rich resource for anyone with an interest in mental health issues.  When Laing died in 1989, Dr Anthony Clare, writing in the Guardian, said of him: “His major achievement was that he dragged the isolated and neglected inner world of the severely psychotic individual out of the back ward of the large gloomy mental hospital and onto the front pages of influential newspapers, journals and literary magazines… Everyone in contemporary psychiatry owes something to R.D. Laing.”  It is, of course, disappointing but not disillusioning, that one’s heroes have feet of clay.  It is not disillusioning because Laing was such a humane man who was a gifted and extraordinarily close listener to a section of suffering humanity, namely the psychotic and schizophrenic, when the psychiatric establishment by and large saw them merely as mad or insane, biochemically or neurotically disturbed patients, whose only hope lay in pharmacological intervention or in psychosurgery, that is, either in lobotomy or leucotomy.  Furthermore, Laing had a good grasp of philosophy, especially of the classic texts of existentialism, and the deep alienation and anxiety of the members of modern society described therein. That he neglected his family is perhaps unforgivable, but I will leave that judgment to his family to decide.

Laing subtitled this book An Existential Study in Sanity and Madness.  That summarises his intention and goal in writing.  He wanted to make madness and the process of going mad comprehensible to the multitudes.  Also, he pointed out that his “main indebtedness” intellectually was to the existential tradition.  In his preface to the Pelican Edition in 1964, he lamented the fact that moderns could only see one dimension to man, a reference to the philosopher Herbert Marcuse. He proceeds immediately to turn the modern view of reality upside down by declaring “normality, sanity and freedom” to be “our present pervasive madness” (p. 12) and by declaring that the psychotic may be saner than we think.  We live in a world that has “an inveterate tendency to depersonalise or reify persons.” (p. 23).  Laing’s goal, and indeed practice, was to personalise his patients, treat them as real human beings with fears, hopes and longings. Indeed, his foundational existential philosophy is that the patient brings “his whole being-in-the-world” (p. 25) into the psychotherapeutic encounter and that his ‘relatedness to’ and ‘separateness from’ others are both foundational to his ‘being’ and indeed to the enterprise of psychotherapy. (p. 26)

 He makes gripping points regarding subjectivity and objectivity early on:

In contrast to the reputable ‘objective’ or ‘scientific’, we have the disreputable ‘subjective,’ ‘intuitive,’ or worst of all, ‘mystical.’  It is interesting, for example, that one frequently encounters ‘merely’ before subjective, whereas it is almost inconceivable to speak of anyone being ‘merely objective’ (p. 25).

Laing has left philosophical psychology/psychiatry with two important existential terms, which he describes comprehensively, terms which attempt to describe a person’s subjectivity, i.e., “ontological security” and “ontological insecurity.”  You and I are ontologically secure when we have a sense of our presence in the world and we feel “alive, whole and, in a temporal sense, a continuous person.”  We have a “centrally firm sense” of who we are (p.39).  However, psychotic or schizophrenic persons lack such a firm sense of who they are and have no secure sense of their presence in the world; they are stripped of all sense of self.  Laing points out that similarly, characters in the works of modern authors like Kafka and Beckett are devoid of a sense of self, whereas Shakespeare’s characters and Keats’s poetry are suffused with a strong sense of identity.  Those of us who love modern literature will readily agree with this observation. 

Laing continues that so-called schizophrenic patients fear three subjective experiences, all of which threaten their identity: (i) Engulfment: the fear that their being will be taken over, compromised, invaded or even snuffed out, (ii) Implosion: the fear that the whole world will crash in upon them, a severe form of Donald Winnicott’s concept of “impingement of reality.” (iii) Petrification and Depersonalization, terms which need no explanation as such as they express exactly how the person feels (p. 43 – 48).  The patient’s dread of any or all of these three occurring “is one motive for schizophrenic withdrawal” (p. 59)

Laing goes on to describe in detail how the self becomes divided between an authentic "real self" and a socially constructed "false self".  The “real self” is the authentic, private, and spontaneous identity which we all have deep inside us, while the “false self” is a compliant "sane" façade which we construct to interact with the world and protect our inner self from perceived threats and from being hurt.  With these two aspects of self firmly in mind, Laing theorises that psychosis results from a radical and fierce disconnection between the real and false self that occurs for such unfortunate individuals. He theorises that psychotic individuals develop schizophrenia due to extreme childhood experiences of not being seen for their true selves.  In an effort to preserve their identity, ontologically insecure people tend to split their personality.  Some people may show a precarious separation from their bodies that further separates them from the world.  Eventually, a divided identity crosses the line of (in)sanity and becomes schizophrenic.  They are consequently filled with fears of engulfment, implosion, or petrification when the false self is rejected.  Insanity, then, can be understood as a radical reaction to the divided or split self.  Again, the implication of this is obvious: the medical disease as an endogenous or neurobiological reality is ruled out of court and its genesis attributed to the split in personality formed in the family and local community.  Another way of stating this is to say that mental illness is a sane response to an insane world and that a psychiatrist has a duty to communicate empathetically with patients.  One can easily understand that there was an enormous backlash after his book was published from families who thought he was blaming them for their children's mental illness.  From the early 1960s to the late 70s and early 80s, Laing captured the countercultural zeitgeist of the times.  As I said above, he managed to stand reality on its head: he believed that social 'sanity' was fabricated by mutual consent and that the mentally ill were as fully human as the medics who were classifying them.

In short, this book still remains a classic for its controversial and countercultural take on the role of psychiatry, now long since dismissed as unscientific.  However, it remains essential reading for its humane, humanistic and profoundly empathetic understanding of those who suffer from psychotic disorders and offers good insight into their lives and lived experiences.  Altogether, a good read that offers us a rich existential analysis of personal alienation.