It is now ten years since the death of R.D. Laing, and time enough surely for the dust to have settled on his controversial career sufficiently for a revaluative look at his work. I have been re-reading some of Laing’s books, prompted partly by a new book about him [R.D. Laing: A Personal View by Bob Mullan] and partly by a number of persistent questions in my own mind about the labels ‘schizoid’ and ’schizophrenia’ which are used not only by psychiatrists but commonly enough also by psychotherapists.
This is the list of “symptoms for a diagnosis of schizophrenia, from the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual: delusions (false beliefs); hallucinations (false perceptions); disorganised language; disorganised or catatonic behaviour; and ‘negative symptoms’ or emotional flatness. A patient must have at least two of these in order to be diagnosed as schizophrenic.”  What I find particularly striking about this list of ’symptoms’ is how ordinary they are – lots of people I know and myself as well often show at least two of these ‘symptoms’! I must suppose that the psychiatric doctors who use the manual can read things into this list of ‘symptoms’ which I don’t see in it. And although he was a psychiatrist, Laing also found himself unsure of what this diagnostic activity was supposed to signify: ”I must confess here to a certain personal difficulty I have in being a psychiatrist, which lies behind a great deal of this book [The Divided Self 1960]. This is that, except in the case of chronic schizophrenia, I have difficulty in actually discovering the ‘signs and symptoms’ of psychosis in persons I am myself interviewing.” 
In reviewing some of the early literature about schizophrenia, Laing points out that the patient’s behaviour is far from incomprehensible if it is seen as a response to his current real situation – for instance, being examined by Dr Bleuler in front of students and talked through, over and about, but not to. Laing goes on: “Now it seems clear that this patient’s behaviour can be seen in at least two ways, analogous to the ways of seeing a vase or face [in the well-known image where the shapes can be interpreted as either a vase or two faces in outline]. One may see his behaviour as ‘signs’ of a ‘disease’; one may see his behaviour as expressive of his existence. The existential-phenomenological construction is an inference about the way the other is feeling and acting… To see ‘signs’ of a ‘disease’ is not to see neutrally.” [Ibid, pp30-l
] And in his book on Sanity, Madness and the Family , Laing goes so far as to state that “it is clear that ‘schizophrenia’ is a social event…” 
Laing’s journey to this point is usefully described by Bob Mullan in his new book. Mullan was apointed by Laing to write his biography, but after Laing’s death his family prevented Mullan from having access to papers and materials he would need to write the biography, and Laing’s son, Adrian, produced a biography of his father in 1994. Mullan’s dissappointment at being prevented from writing the book he had been preparing with Laing himself is not concealed in the book he has finally written. He carefully called it “A Personal VIew”, and to emphasise the point he has written a good deal of his own autobiography in it which does not relate directly to Laing’s life. He does, however, perform a very important task in bringing all of Laing’s writings to the readers attention, and in contrast with the filial biography, he views Laing as a serious and professional therapist, even to the extent of mythologising him a little – as in the following description of Laing’s first clear step along his path as a psychotherapist:
“A moment of epiphany arrived when, alter hearing the loud and incoherent rantings of a patient, Laing went to routinely administer tranquilising medication. Instead he decided to sit down with the patient inside the padded cell. The man calmed down sufficiently for the medication to be redundant. Lamg repeated his visits almost nightly and felt “strangely at home there’, lounging on the floor, feeling relaxed and comfortable. Against procedure, he would claim that what he was doing was research. After some time it became clear to Laing that not only did he feel at home, enjoying being with the patient more than he liked being with the staff, but that listening to the patients was therapy, as was treating them as individuals, human beings.” 
Plainly in ‘listening’, and in treating the patients as individual human beings rather than ‘cases’, Laing was deliberately giving up his role as the all-knowing doctor and cure-master. In The Divided Self, Laing defines psychotherapy in a way which is surely far closer to humanistic therapy than to psychiatry:
“Psychotherapy is an activity in which that aspect of the patient’s being, his relatedness to others, is used for therapeutic ends. The therapist acts on the principle that, since relatedness is potentially present in everyone, then he may not be wasting his time in sitting for hours with a silent catatonic who gives every evidence that he does not recognise his existence…”
and “…the task of Psychotherapy was to make an appeal to the freedom of the patient. A good deal of the skill in Psychotherapy lies in the ability to do this effectively. (5)
From 1956 Laing worked at the Tavistock Clinic in London, where John Bowlby was a director, and trained in psychoanalysis at the Institute of Psychoanalysis where W.R. Bion, D.W. Winnicott and Melanie Klein all taught at times, and it seems to me that although Laing fiercly resented and repudiated their ‘authoritarian’ ways, their work and ideas are clearly related to his own. His basic contention, that the social dimension of people’s ‘madness’ or schizophrenia is essential to understanding them, is not difficult to relate to the ideas of Object Relations psychology as expressed by these other writers, and it seems worthwhile to explore some similarities. Various aspects of the notion of Omnipotence, which are common to Klein and Winnicott, seem to me to be fundamental in Laing’s wor k as well. His comment quoted above about his difficulty in ‘diagnosing’ people when he is himself interviewing them, is significant; for it reflects his realisation that the therapist is as present in the process as the patient, and so it is not just madness but also therapy which is a ‘social event’. The psychiatrist’s objective detachment in order to make a diagnosis may seem, if we view it in this way, no t unlike the denial (of the other person’s existence) which is so salient a feature of the ‘schizophrenic’ patient’s behaviour.
The eleven case studies which comprise Laing’s book, Sanity, Madness and the Family, demonstrate not only that the ‘patient’s’ behaviour is quite understandable in the context of the family system, but also that the patient has frequently been reduced first to utter confusion and then to silence or compliance by the force of the family system bearing down on her:
“Interviewer: Do you feel you have to agree with what most of the people round you believe?
Ruth: Well, if I don’t I usually land up in hospital.” 
In The Divided Self, Laing notes what happens to the inner self when this compliance is exacted:
“The self, as long as it is ‘uncommitted to the objective element’ is free to dream and imagine anything. Without reference to the objective element it can be all things to itself – it has unconditioned freedom, power, creativity. But its freedom and its omnipotence are exercised in a vacuum and its creativity is only a capacity to create phantoms. The inner honesty, freedom, omnipotence and creativity which the ‘inner’ self cherishes as its ideals, are cancelled therefore by a coexisting tortured sense of self-duplicity, of the lack of any real freedom, of utter impotence and sterility.” 
Here Laing highlights the misery of maintaining a highly idealised and omnipotent ’inner self’ at the same time as living out the ‘false/compliant self’ which is acceptable socially and to the family. His description of it seems very comparable with Melanie Klein’s, though she uses very different language:
“The sense of omnipotence, in my opinion, is based on the mechanism of denial… (and is) an attempt to master in an omnipotent way the unbearable sufferings within.” 
Laing is sensitive to the sufferings and isolation of the patients and believes that their compliance must be due to fear, “for why else would anyone act, not according to his own intentions but according to another person’s?” But he believes in the existential loneliness of the other and maintains: “The kernel of the schizophrenic’s experience of himself must remain incomprehensible to us… We have to recognise all the time his distinctiveness and differentness, his separateness and loneliness and despair.” 
Klein, on the other hand’ develops the mechanism of ‘omnipotent denial’ in a way that e xplains the isolation and cut-off state of the ‘schizophrenic’, which Laing rather senses than explains :
“Omnipotent denial of the existence of the bad object and of the painful situation is, in the unconscious, equal to annihilation by the destructive impulse. It is, however, not only a situation and an object that are denied and annihilated – it is an object relation which suffers this fate; and therefore a part of the ego, from which the feelings towards the object emanate, is denied and annihilated as well.” 
Mary Barnes, one of Laing’s patients, has written a very full and explicit account of her own ‘journey through madness’ where she describes the terrifying sense she has of her own omnipotence, which makes her feel that any kind of adverse event must be a punishment to her:
“… Lying in bed, after the strain of the previous months, was a relief, but it was also a deepening of my misery as I went down into my despair. Lying, biting the bedclothes, groaning with IT, waiting for IT to pass. Was IT, my anger, resolving? At the time I didn’t know in words what was happening. The point was, it was beginning to happen, the resolution of my anger. Joe (therapist) was helping me to let it happen, to lie still, to let myself be, with IT.
Sometimes Joe would ask me, ‘Want a bath?’
‘I’ll go and get it ready.’ Back again. ‘Mary, you can’t have a bath, there’s no hot water.’
This was agony. Why? What had I done? Did Joe really mean the water was cold? Better not say anything, try to let it pass.
In time, ‘There’s no hot water’ came simply to mean the water was cold, not hot, t hat was all. Mary Barnes: water. Two separate things. I wanted a bath. I couldn’t have a bath but I was not being punished. Sad, but not dead with shame, or broken to bits with anger.” 
Later Mary Barnes realises, “Therapy treatment, then, was coming to know what I wanted… The ‘right’ thing had always been what someone else wanted of me.” It seems very clear from all this why Laing could not continue in practice as a medical and psychiatric doctor. The model of omnipotent denial is surely just as present in the doctor’s attitude to the ‘schizophrenic’ as in the ‘schizophrenic’s’ attitude towards other people.
My eye was caught by a brief article in The Observer a few weeks ago, illustrated by the picture showing two faces or a vase which Laing mentions in The Divided Self. The article was entitled “Doing Quizzes Can Beat Schizophrenia” and it describes some state-of-the-art research in which people diagnosed as ‘schizophrenic’ are shown to be ‘benefited’ by doing puzzles which, like the picture have two discrete ‘answers’. The researchers found that ‘schizophrenics’ find it hard to switch between two interpretations of the same glyph and that when they are encouraged to do this, it improves their general thinking. I was amazed that this was regarded as new work. As long ago as 1940, Melanie Klein wrote: “ Ambivalence… enables the small child to gain more trust and belief in real objects, and thus in its internalised ones – to love them more, and to carry out in an increasing degree its phantasies of restoration with loved objects.” . Laing’s work entirely supports this idea, and goes much further as well, since perhaps only he was able to see the duplicity of the system implied by the diagnosis of ’schizophrenia’. His special insight into these systems of double binds is brilliantly displayed in his poems, Knots: –
“How clever has one to be to be stupid? The others told her she was stupid. So she made herself stupid in order not to see how stupid they were to think she was stupid, because it was bad to think they were stupid. She preferred to be stupid and good, rather than being bad and clever.
It is bad to be stupid: she needs to be clever to be so good and stupid. It is bad to be clever, because this shows how stupid they were to tell her how stupid she was.”
1. My source for this information is The Independent on Sunday, 8th August 1999.
2. R.D. Laing, The Divided Self: An Existential Study in Sanity and Madness, 1960, pp 27-8.
3. R.D. Laing & A. Esterson, Sanity, Madness and the Family, 1964.
4. Bob Mullan, R.D. Laing: A Personal View, 1999, p 53.
5. Op.Cit. p 26, p 60.
6. Op.Cit. p 175.
7. Op.Cit. p89.
8. Melanie Klein, Psychogenesis of Manic Depressive States, 1935.
9. The Divided Self, p 38 …” What is required of us? Understand him? The kernel of the schizophrenic’s experience of himself must remain incomprehensible to us. As long as we are sane and he is insane, it will remain so. But comprehension as an effort to reach and grasp him, while remaining within our own world and judging him by our own categories whereby he inevitably falls short, is not what the schizophrenic either wants or requires. We have to recognise all the time his distinctiveness and differentness, his separateness and loneliness and despair.”
10. Melanie Klein, Notes on Some Schizoid Mechanisms, 1946.
11. Mary Barnes and Joseph Berke, Mary Barnes: Two Accounts of a Journey Through Madness, 1971, p 182.
12. Melanie Klein, Mourning and Manic Depressive States, 1940.
13. R.D. Laing. Knots, 1970.