R. D. Laing and Anti-Psychopathology: The Myth of Mental Illness Redux
The theme of this blog concerns R. D. Laing’s conception of psychopathology. This is not an easy topic to explore, in part because Laing was somewhat ambivalent about the concept and avoided even using this term. In The Politics of Experience (1967) Laing famously questioned whether schizophrenia, the form of psychopathology he is most identified with, even exists!
Yet, many of the people Laing saw in therapy suffered terribly and saw him in therapy in the hope that he could relieve their anguish. But what, precisely, was it that Laing was helping them be relieved of, if not a psychopathological condition?
The first psychotherapists were physicians and the term psychiatry, which was only coined in the nineteenth century, became the medical specialty of doctors whose mandate was to treat the psyche or the soul, or as we prefer today, the mind. Laing’s first book, The Divided Self, was his most concerted effort to show why psychiatrists, and for the most part psychoanalysts, have misunderstood the kind of suffering that people labeled schizophrenic, say, are experiencing, and why psychiatric nomenclature does little to help us understand the phenomena so labeled. If what psychiatrists believe they are treating is, as Laing suggested, not schizophrenia, or any form of psychopathology, then what is it they are treating? And why are we calling the activity we are engaged in treatment, or its derivative, therapy?
The diagnostic language Laing employed in his classic, The Divided Self (1960), is readily familiar to every psychiatrist and psychoanalyst who works with this population. Terms such as psychotic, schizoid, schizophrenic, paranoid—all standard nosological entities with which therapists the world over are familiar—proliferate throughout this book. He is speaking their language, so to speak, but the meaning he is assigning to these terms is anything but ordinary.
None of these terms is written in stone. In fact, they are constantly changing and undergo revision in every new edition of the DSM. Laing suggests that because there is no agreement in the psychiatric community as to how to recognize these symptoms and the mental illness they are purported to classify, it is impossible to take them seriously. What did Laing conclude from this disarray in categorization? That there is no such thing as mental illness, or psychopathology, so no wonder there is no agreement as to what “it” is.
When a doctor sets out to diagnose a typical medical illness, he customarily looks for physical symptoms in his patient. However, no one will ever locate any symptoms of psychopathology inside or on the surface of one’s body. Even an examination of the brain, which is now the darling of neuropsychiatrists and neuropsychoanalysts, will fail to locate the presence of any form of mental or emotional disturbance that we can label a mental illness.
Laing believed that we will never succeed in understanding such phenomena as long as we persist in looking at people from an alienating, and alienated, point of view. It is the way that we look at each other, the way that psychiatrists and psychoanalysts typically look at a patient, that Laing believed is the crux of the problem. The reason Laing calls The Divided Self an existential study instead of, say, a psychiatric, or psychoanalytic study is because the existential lens is a supremely personal way of looking at people—a person-to-person manner of regarding others and recognizing them, as Harry Stack Sullivan said, as more human than otherwise. This is another way of saying that the person, or patient, I am treating, is not a sick person, but a person like me. And it is the fact that he is just like me that makes it possible for me to understand and empathize with him in the first place.
Instead of trying to determine what makes “us”—the sane ones—so different from “them”—the ones that are crazy, Laing sought to explore what we share in common. Laing used the term schizoid—quite common in Britain but only marginally employed in the U. S.—to depict a state of affairs that lies at the heart of every person labeled schizophrenic, as well as many who are not so schizophrenic. The common thread is this: that the person so labeled, in his or her personal experience, suffers from a peculiar problem in his relationships with others: he cannot tolerate getting too intimate with other people, but at the same time cannot tolerate being alone.
This is a terrible dilemma to be faced with. Most of us, says Laing, either hate to be alone and throw ourselves into the social milieu with others—Jung would have called them extroverts—or we can’t bear social situations and opt instead to spend most of our time alone. These more introverted, private individuals may be gifted writers or scientists or deep-sea divers who are well suited to their relative isolation, whereas the extroverts among us make excellent politicians or actors or any number of other callings. In other words, we tend to incline in one direction or the other, and either may be a perfectly viable way of existing and living a happy life. The person who is schizoid, however, doesn’t excel at either. He cannot tolerate isolation, nor can he get genuinely close to others. He is caught in a vise, a kind of hell that is rife with unrelenting anxiety, what Laing calls ontological insecurity, because simply existing is a serious and unrelenting problem for him.
Laing’s agenda was far more radical than simply being nicer, or kinder to his patients. Instead, his concern was with being more real, or authentic, or honest. This, he believed, could only happen of we stop objectifying our patients into diagnostic categories that only serve to separate them from us. Perhaps the model that best exemplifies what Laing advocated is not a relationship between therapist and patient, or parent and child, but one between friends. After all, friends confide in each other, and confiding is an essential aspect of how Laing conceived therapy. Whether or not we think of ourselves as friends with our patients, Laing didn’t have a problem with calling the people who paid to see him his “patients” any more than he had problems with calling what they were doing “therapy,” both undeniably medical terms. But isn’t this inconsistent with what he has been saying about the myth of psychopathology?
Whatever problem Laing had with the institution of psychiatry, he never had a problem with being a doctor. He was proud of his medical training, and while such training is not essential to the practice of therapy, he thought it was as good a way as any to enter the field. Laing was fond of pointing out that the word therapy is etymologically cognate with the term attention or attendant. In ancient Egypt, a religious cult called the Therapeutae were literally attendants to the divine. So the term predates the subsequent medical appropriation of it by the Greeks. If we take the term literally, a therapist is simply a person who is attentive, or pays attention to, the matter that concerns him. Similarly, a patient is literally a person who patiently bears his suffering without complaint. The term doesn’t necessarily refer to someone in medical treatment because the kind of suffering is not specific. Laing concluded that if you put these two terms together you get one person, the therapist, who attends and is attentive to the other person’s, or patient’s, suffering. To what end? One hopes that such attention, with enough patience, good will, and most importantly, time will lead to something, to a point where the patient no longer requires such attention and can get on without it.
In fact, Laing never formulated an overarching theory of psychopathology to replace the edifice that psychiatry and psychoanalysis have built. For the most part, his focus was on schizoid phenomena and schizophrenia, not as specific diagnostic categories but, like Freud’s conception of neurosis, as a metaphor for varieties of mental anguish that compromise our ability to develop satisfying relationships with others. As the subtitle of The Divided Self suggests, Laing was more comfortable thinking in terms of sanity and madness than psychopathology. But what does it mean to be crazy? And what does it mean to be sane? That is another question. For the answer, stay tuned!
Laing, R. D. (1960) The divided self: An existential study in sanity and madness. New York: Pantheon.
Laing, R. D. (1967) The politics of experience. New York: Pantheon.
-- Michael Guy Thompson
Today’s guest contributor, Michael Guy Thompson, PhD, is a Personal and Supervising Analyst at the Psychoanalytic Institute of Northern California, author of more than 100 journal articles, book reviews, and books on psychoanalysis, phenomenology, and schizophrenia. He received his psychoanalytic training with R. D. Laing in London in the 1970s.
This blog is an excerpt of a paper to be presented at the “R. D. Laing in the 21st Century” symposium, in honor of the 25th anniversary of his death, at Wagner College, Staten Island, NY, October 26, 2013. For more information, please go to http://www.rdlaing2013symposium.com/.