"Do you feel you have to agree with what most of the people round you believe?" "Well, if I don't I usually land up in hospital." It is London in the late 1950s. A woman, Ruth, sits opposite a Scottish doctor in his consulting room. On his desk a tape recorder reels away softly. She speaks with an air of quiet defeat, having already had the bad news, the diagnosis. It's been the same for a long time: schizophrenia. Hospital for her means a regimen of neuroleptic ("brain-seizing") drugs, tranquilisers, perhaps even being plunged repeatedly into an insulin-induced coma.
The doctor, while sympathetic, offers no cure. He is merely conducting research. Although he is a psychiatrist, he has become disillusioned with the medical model of mental illness: he understands that schizophrenia is not like diabetes or cancer. It was called into existence only relatively recently; it is not unusual for psychiatrists to disagree on which of their patients might be schizophrenic; there is no laboratory test that can determine whether someone has the disease or not. Most doctors regard it as a malfunctioning of the personality, without rhyme or reason.
This one, RD Laing, thinks he can understand even the most baroque madnesses, that they are legible. His view is that a diagnosis of schizophrenia is better seen as a social, rather than medical, phenomenon. Sanity, Madness and the Family, a record of interviews with 11 schizophrenics and their relatives, is an attempt by him and his colleague, Aaron Esterson, to put this beyond doubt.
Much of the institutional apparatus Laing and Esterson were rebelling against was intact when my parents trained as psychiatrists a decade later. It lasted until the 80s, when my dad used to take me to the Victorian asylum where he worked to sit in his office and be fussed over by the nurses. From the window I could see the chapel in the grounds – used for funerals, never baptisms or weddings. For many, the circle of life had closed here.
But by that time, the long-stay hospitals were being shut down, frightened patients wondering how on earth they would live outside the suffocating embrace they had been held in for 20, 30, sometimes 40 years. Psychologists had entered the scene, empowering nurses to question the previously unassailable consultants.
Oblivious to these changes, I simply wanted to know why people went mad. Seeing things, hearing things, thinking you were God. There was an air of the supernatural about it; as though the patients I caught glimpses of in the common room, staring into space as the tea trolley rattled past, were possessed, or even ghosts themselves.
No one could give me a satisfactory answer. So when I picked up Laing's The Divided Self, not from my parents' bookshelves but from those of my first landlady in London, I found I couldn't put it down. Here was someone explaining madness, showing how the fragmentation of the person was an intelligible response to an intolerable pressure, often the pressure of the infamous double-bind.
The mechanics of the double-bind are best conveyed by examples from the real world, of which Sanity, Madness and the Family is a compendium. It takes The Divided Self's philosophising and makes it concrete. Over many months, Laing and Esterson interviewed each of the 11 patients, their parents and siblings, individually, in pairs, and as groups. Their aim was to get a clear picture of the workings of the family, and to discover if the subject's madness made sense in context.
For me, reading the transcripts was like being granted access to case notes locked away in the hospital files. It was voyeurism, but desperately sad. There was Maya, whose parents interpreted any expression of autonomy as her "not being herself" and therefore part of her illness. Independent thought or action was labelled "being difficult". During the course of the interviews, it is revealed that Maya's parents believe she has a sixth sense and can read their thoughts. They furtively try to test this theory out, exchanging winks and knowing smiles. When confronted by Maya, they deny having made the gestures. This is "mystification": she is told that things she has perceived have not in fact occurred. She is trained to "mistrust her own mistrust" – an invitation to paranoia if ever there was one.
"We were not able to find one area of Maya's personality that was not subject to negation of different kinds," say the authors. The pattern, of mystification, invalidation and the double bind is repeated with Lucie, Claire, Sarah, Ruth and all the others – each one pinned so that nothing they can say or do is right.
Laing has become notorious as the man who blamed schizophrenia on families. But those who dismiss him on that basis have to ask if any attempt to understand a person's mental state can be made without reference to their closest relationships. More recent work on the neurological correlates of schizophrenia does not undermine Laing's argument that this still unreliable diagnosis can be better understood if the social context is taken into account. Neither do his ideas rule out the possibility of an in-born predisposition to psychosis.
Like many thinkers whose work is regarded sniffily today, aspects of his approach have, in fact, been absorbed into the mainstream. Psychiatry is practised more humanely now than 30 or 40 years ago. The medical model, though bolstered by for-profit healthcare which incentivises clear-cut diagnoses and drug treatment, is no longer the last word.
And I have learned that, desperate as they might have been, there was nothing spooky about the patients at my my dad's hospital. The weren't cursed, or possessed, as my child's imagination had it, and as society had it for hundreds of years. Laing's work on madness in context can be viewed as the final nail in the coffin for this view of mental illness. It should serve as a continuing warning for those tempted by the equally naive idea that madness is nothing more than a kink in the double helix.
Twitter: @D_Shariatmadari
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