Rhythm Method

Not long ago a friend of mine was walking back to her car after the cinema when, not unusually for the time and the place, a distraught man placed himself in her way. She was not frightened; he was easily identified as mad, not bad. A shuffling walk, a drooping, defeated posture which required a special effort to raise his head so he could address her, and eyes, when they lifted, which were more distressed than aggressive. He put out a hand, as if the fact of his body being in her path would not be enough to gain her attention. ‘Can I talk to you?’ he asked. My friend felt around in her handbag and came up with some money which she pressed into his hand. It was a normal inner city exchange. Except that the man shook his head, put the money back into my friend’s open bag, took some more from his own pocket and dropped that in too. ‘No, I’ve got money. It’s not money. I want to talk to you,’ he said, and launched into a rambling tale of woe about being evicted from his hostel and how it felt to have nowhere to go and no one to tell. He was not asking for anything except what is most difficult to give: time and attention.

At its simplest, at least in the early days, what the existential psychiatrists were advocating was careful listening. Their point, though, was never that simple: they were advocating listening for, not just listening to. Apart from the fact that psychotics, like everyone else, would benefit from being heard, there was the bold suggestion that they were actually saying something which their doctors needed to be told in order to do their job. The mad monologue contained real information, and psychiatrists would have to listen to their patients in the way medical doctors had to take into account what physically distressed patients said about the nature of the symptoms.

In the early Sixties, R.D. Laing and others began to define psychosis in terms of its relation to society, and psychotics as individuals who in their own way were making sense of their social circumstances. The mad might be alienated, but they were not aliens, and therefore their doctors must be, not alienists, but interpreters of the language of the alienated. If that seems obvious now, we have Laing and his fellow theorists to thank for it. At the time it came as something of a revelation, not least because there was an audience beyond the psychiatric community primed by the Zeitgeist of the late Fifties and early Sixties to fall on their ideas and make much – too much, perhaps – of them.

I was a member of that wider audience. When Volume One of Sanity, Madness and the Family by R.D. Laing and his colleague Aaron Esterson, was published in 1964, I was 17 and living in the house of a woman who had rescued me a couple of years before, both from my disordered family and from the psychiatric hospital I was stuck in. The book took the form of case-histories of diagnosed schizophrenics, but what made it different from the usual run of psychiatric textbooks was that the views and voices of the patients and their families were presented side by side.

It was the case of the ‘Abbotts’ that made an impact on me. ‘Maya Abbott’ believed that her parents were trying to influence her by telepathy and thought-control, and showed clinical signs of ‘catatonia ... affective impoverishment and autistic withdrawal’. Laing and Esterson discovered on speaking to the parents of the girl who now experienced herself as a machine, that for many years they had indeed been trying to influence her thoughts, believing her to be telepathic; that for some time before she became ‘ill’ they’d been experimenting with their daughter – sending each other signals which ‘Maya’ was not supposed to perceive – in order to test their hypothesis and alter her attitudes and behaviour.

For Laing and Esterson, the ‘Abbotts’ confirmed their thesis that madness could have a socially intelligible basis. For me, there was a starburst of recognition. At 13, I fled my emotionally erratic mother and went to stay with my father, with whom I’d had no contact for three years, and Pam, the woman he lived with. It wouldn’t be anyone’s idea of fun to have an angry adolescent arrive out of the blue, but the way Pam responded to me was, from the moment I arrived, mystifyingly aggressive. Nothing I did was right; everything was criticised or scorned. She ignored me when I tried to initiate or join in conversations, but called me idle and useless when she found me reading. She objected to me spending too much time in my room, but if I walked into the living room she’d go silent and turn her back on me. She complained that I didn’t help out with the chores, but when, after that, I made a cup of tea after a meal, she poured it away and made a new pot. I wasted money by taking too many and too deep baths, but I was also ‘dirty’. It seemed to me that she was viciously unkind even before I’d a proper chance to make a nuisance of myself. I withdrew into a sullen silence and relations became impossible. Gradually, I began to believe that Pam was trying to poison me.

My social worker was disbelieving, even though I left out my poisoning theory. Obviously I was having Oedipal (or Electral) difficulties and suffering delusions of persecution. In all honesty, it seemed a bit improbable even to me. But things were so bad in the house that the social worker got the council to send me away to boarding school. It was when the long summer holidays were imminent that I got a letter from Pam confessing that before I’d gone to live there, she had a secret meeting with my mother whom she’d never met before, and together they had made a plan. Since (not unreasonably) Pam didn’t fancy having a difficult adolescent around, and (very dubiously) my mother wanted me back, the pair of them decided that Pam was to treat me in such a way as to ensure I’d be miserable enough to want to return to my mother. Now that the plan had plainly failed, and alarmed, I suppose, at the prospect of six weeks’ togetherness, Pam wrote to me at school to explain and apologise, and suggested we make a fresh start.

Sanity, Madness and the Family showed me how fortunate I was to get that letter which made it clear that it wasn’t me who was behaving madly, and how fortunate, too, I had been to get away from them. What was extraordinary about the book to me then wasn’t just the news that my family might have driven me mad – I already had an inkling of that – but that my family was not a unique quirk in a universe of normality. To have been a party to a cosmic irregularity left the answer to the ‘Why me?’ question wide open – I might still, in some way I didn’t understand, have deserved it – but if normality itself was under suspicion there was something wider and less personally reprehensible to be investigated.

What I – and I think quite a lot of other people who fell on this material – failed to notice was the word ‘sanity’ in the title Sanity, Madness and the Family, and the fact that it was planned as the first of two projected volumes. The second book was to complement the first by studying the interaction of families in which no one had been diagnosed as schizophrenic, and was intended to investigate the theory that, while mad-making behaviour was always present in the families of schizophrenics, it was only sometimes present in families with no pathological members. Volume Two was never written, with the result that the key (and still unanswered) question which would explicitly have arisen as to why potentially mad-making behaviour only caused madness in some people was never addressed. The unwritten second volume on ‘normal’ families allowed both Laing and his admirers to skip the question and to suggest instead that there were no normal families, no normal society, and that the highest form of existential sanity was to be found in the individual who refused to conform to the madness of a demented civilisation. The autism of the mad became a heroic, hyper-sane response to an inauthentic world.

Well, it made sense to me, and I launched myself into the world of mental ill-health with all the fervour of a career move. I had a problem, though: I didn’t have the right symptoms, the sort which might allow me (and the radical shrinks) to think of myself as a channel for social prophecy and higher truth. I was only a dull, inoperative depressive of the kind Laing showed not the slightest interest in. So far from liberating myself from the shackles of society’s false diagnosis, I found, in my enthusiasm for existential psychiatry, a new logical framework in which to house and develop my free-floating guilt: if I wasn’t mad (properly mad, correctly mad, Laingian mad) then I was a miserable existential failure and as insubstantial as my depression insisted I must be. Laing, the clarifier of the concept of the double-bind, had invented a brand new version of his own. Exciting times? You bet.

Of course, I was young and flying without any background to keep me from floating away on the wings of misunderstanding, but judging by the practical results of Laing’s theory and his own life’s progress, my reasoning on the basis of what I read may not have been too far off the mark. It may even have been that Ronnie Laing, romancer of madness, suffered from the same problem as me. According to Charles Rycroft, who was his training analyst, he had ‘an extremely effective schizoid defence mechanism against exhibiting signs of depression’. Laing was a depressive who needed drugs and drink to achieve what came naturally to his patients. He was more than capable of behaving badly, but perhaps behaving madly was beyond him. A tragedy of a kind, but, in retrospect, a massive irresponsibility towards those who were his concern. Like many at the time, he chose to overlook what is clear to anyone who has spent time with the mentally ill – the extraordinary pain involved. To find authenticity in the signs of madness is like finding a desirable simplicity in poverty; only those not obliged to experience either can afford such intellectual slackness.

Considering their relationship, Adrian Laing’s account of his father’s life and work is an astonishingly disciplined effort, which only occasionally betrays his private feelings (‘Ronnie’s nauseating desire to rationalise external events began at a very early age’). If anything, the controlled attempt not to allow personal judgment to colour his narrative results in a book that often reads more like a curriculum vitae than a biography. But you can see why: Laing was the kind of father that would have given Papa Kronos indigestion. He made babies by the tribe (ten altogether) and deserted them in pursuit of his destiny with barely a glance back in their direction. He didn’t see the five children of his first family for two years, and by the time he made a visit Adrian had forgotten what he looked like. When his daughter, Susie, was terminally ill in her early twenties, he made a special and exceedingly rare trip to Scotland to tell her, against the wishes of the rest of the family, her doctor and her fiancé, that she would be dead in six months. Then he returned to London almost immediately, leaving others to cope with the emotional aftermath of his searing honesty. Subsequently, his oldest child, Fiona, had a breakdown, and Laing failed to provide support. ‘It would not be fair to say that Fiona was callously abandoned,’ says his son, but it sounds as if some wording very close to that would be fair.

Perhaps none of that is our business. There are no end of families badly treated by self-obsessed individuals who have made great and lasting contributions to the wider world. The personal failures ought not to detract from an assessment of the work. But there is a question to be asked of a purveyor of wisdom who displays none in his dealings with the individuals in his life.

There was wisdom, or at least great intelligence and originality, in the early days. The Divided Self still comes across as a serious new attempt to describe the dynamics of schizophrenia. It was written before the collaboration with Esterson, while Laing was still a working psychiatrist in Gartnavel Hospital. He has no difficulty in acknowledging the reality of ‘insanity’, and describes a plausible decline from ‘normal’ schizoid thinking to psychotic insanity. If it isn’t a final description of the aetiology of mental illness, at least it’s an interesting view of it. On the other hand, his unquestioning belief in the existence of an authentic, absolute self which is subverted by society looks carelessly romantic, and no thought is given to the possibility of a predisposing biochemical component in mental illness (or its symptoms).

Fame struck. Laing went to a lot of dinner parties. He began his training analysis with Rycroft, and in spite of grave doubts on the part of the Institute’s training committee (‘Dr Laing is apparently a very disturbed and ill person’), he qualified as a psychoanalyst. Things started going strange once Kingsley Hall was up and running. Laing had founded a group known as the Philadelphia Association along with Esterson, David Cooper, Clancy Sigal and Sid Briskin, and these men formed the core group of loving brothers. The idea had been to find a house in which people could live while in the throes of a psychotic episode, where the process of madness could run its course without intervention. Kingsley Hall in the East End had been formerly used as a settlement house. Gandhi had once lived there – and the brothers obtained it in 1965 for a peppercorn rent. It was a place to go crazy in and going crazy had already been defined as a counter-cultural necessity, so no one held back. ‘David Cooper was beginning to crack up ... There was concern that Clancy Sigal was cracking up. Aaron Esterson and many others thought Ronnie was cracking up. Ronnie thought Aaron’s problem was that he was unable to crack up.’ Adrian Laing doesn’t mention whether there were any patients waiting their turn, but psychiatric nurse Mary Barnes had already settled in for her lengthy non-symbolic regression and was demanding full-time nappy-changing and bottle-feeding: who would have taken care of the lay crazies?

It was also the case that Laing panicked when faced by intractable madness. He was not a good practitioner. When Clancy Sigal’s ‘true’ self failed to emerge despite LSD sessions and non-interventionist therapy, and he flipped out too alarmingly even for Laing’s taste, he was forcibly sedated and handed over to the regular mad-doctors for sectioning. Sigal never forgave Laing, and when he later wrote a scabrously funny novel on the whole existential psychiatry scene, Laing threatened to sue if it was published in Britain.

Adrian Laing suggests that it was his father’s excess of fame, too soon, and the slide into guru-in-chief of the counter-culture which was responsible for his decline. By 1967, in The Politics of Experience, he was writing, ‘We are all murderers and prostitutes,’ and later in the same book: ‘If I could turn you on, if I could drive you out of your wretched mind, if I could tell you I would let you know ... I am trying to fuck you, dear reader, I am trying to get through.’ Adrian Laing confirms that the new philosophy was an amalgam of ‘scotch whisky, Californian grass and Czechoslovakian acid’, with, doubtless, more than a soupçon of megalomania sloshed in for good measure. Later came Knots and Do You Love Me, with such gems as ‘Was that a kiss?/or a hiss/from the abyss?’, and in between Laing threw himself into the natural-birth movement, where he was not very much wanted by the likes of Leboyer and other obstetricians who were doing very nicely without him. By the late Seventies he changed tack and found an enthusiasm in re-birthing for adults rather than new birthing for foetuses, taking a troupe of re-birthers (including Adrian) around the country like itinerant soul-midwives. In the Eighties he could be found around Hampstead chanting Tibetan mantras and performing Native American warrior rituals for the greater good of suburban souls. As his life got smaller and his concerns narrower, he became a hopelessly alcoholic and unreliable shaman/showman who was liable to burst into tears in the middle of a lecture.

But was he one of his own existential heroes? Perhaps, by his own definition, he was. Very likely he would have said so. Possibly he would have settled for being an iconoclast, which lets him off the hook as a reformer. If causing a stir was all he wanted to do, then he succeeded. What you can’t help feeling was that there was a terrible waste of talent, though such a thought is nonsensical. He must be credited with provoking psychiatry into rethinking its automatic reliance on drugs, ECT, brain butchery, and what often amounted to the imprisonment of sick people. Though it’s tempting, it’s too harsh to blame Laing for the callous pragmatism of Thatcher’s version of care in the community. Yet as a reformer he never made it clear how, once the mad had been liberated from their chains, he was going to deal with their anguish. Indeed, he made that anguish seem exotic and desirable, which was, perhaps, his most damning fault. A doctor who does not take his patient’s pain into account is failing at a most basic level.

One special difficulty for psychiatrists trying to relate to the psychotic is what information theory defines as the signal-to-noise ratio. Mad monologues are filled with random noise; exceptional skill is needed to distinguish between valid signals and meaningless interference. It might make life easier for everyone if shrinks were seen as telephone engineers of the psyche. Ever since Freud, mind doctoring has been trying to present itself as a science, but the role confusion has always pulled patients in both directions. It’s never clear when we settle on the couch or across the desk whether we have put ourselves in the hands of experts or sages. It seems more than likely that doctors have the same problem defining themselves.

Laing was undoubtedly a divided man; a charismatic ill at ease with his own intellect. It often looks as if each part went its own separate way, and his own puzzlement, as well as that of his onlookers, is understandable. Adrian Laing tells the story of his father on a speaking tour of the States in the early Seventies, when doctors in Chicago asked him to examine a young woman who was diagnosed as schizophrenic. She was silent, naked and had done nothing for months but rock back and forth. Laing, the charismatic, stripped off all his clothes and sat with her, rocking in time to her rhythm. After twenty minutes she started talking to Laing and the doctors were stunned. ‘Did it never occur to you to do that?’ Laing asked afterwards. Even if it had occurred to the Chicago mind-doctors to get naked and rock the young woman back to health, they might have wondered where they were to find the time and resources to deal with all their other patients. We aren’t told what exactly the young woman said when she finally spoke. Maybe something like ‘Get your sodding clothes on. I’m the madwoman and you’re the doctor, Doctor.’ Laing continued on to San Diego after performing his Attenborough-among-the-wild-things number; he’d done his stuff. It was a personally creative moment, perhaps, but not a very serviceable one for the development of psychiatry.