A good psychiatrist

I could imagine him falling asleep in front of a schizophrenic patient and I realized that he was probably the only psychiatrist in the world who would actually do such a thing. He would not be afraid of psychotics because their experience is not foreign to him. He has been to the farther reaches of the mind himself, has experienced their ecstasies as well as their terrors, and would be able to give an authentic response, based on his own experience, to virtually anything a patient could show him.*

Ronald Laing died 18 years ago today. He was a hero and a fuckup and many speak his name with reverence because not only did he get it, he insisted that getting it is no big deal, that all you have to do is try.

At face value Laing was a scholar educating other scholars about the experience of madness, but on a deeper, more altruistic level he was actually channeling psychosis, talking to and for the outcasts who experience it. That’s his legacy, which for some is more like a presence we turn to reflexively, not to flee but to ground the self in the unmistakable experience of Omygod-I’m-losing-the-plot, because terrifying as that is, reading Laing makes you less terrified, while maintaining awareness of what’s happening to your mind. And being “with yourself” in concern and compassion opens the door to doing the things that help to live through it. What a nightmare life would be without his books on the shelf.

…I think that it’s definitely true that some people, ah, you might say, blow it… they go over the hill, you know. Well, they go over the hill, they go into the wilderness, they lose their bearings, they lose their way, they become completely disorientated, they don’t know who they are or where…now. I’ve been in a certain amount of that territory myself, ah, without being labeled insane, and I can sometimes – sometimes – you know, when someone has gone over the hill and got lost, I can sometimes go out if I, if I want to take the trouble to do so, and go out and hunt for that person, and find them, where they’ve got to, and meet them there, and say, “… Do you want to come back?”

RDL, interview, Arts and Entertainment Network, May, 1987

So I’ve been surfing the web for a proper tribute by a representative of the so-called sane and am pleased to have found something both schooly and intimate, at a blog called Still Point. These off-the-cuff musings on The Divided Self are lovely and discursive and capture the main teachings of the one who did so much to articulate what had no words before him.

Excerpted from
Another Wounded Healer, RD Laing
Communicating with those diagnosed as Mad

In the course of his life, R.D. Laing moved from the forefront of humane, and humanist, psychiatry to a position of notoriety. Latterly, he was alcoholic, professionally unlicensed, and as disturbed, at times, as anyone he had ever treated. His work also descended into near-madness. Be that as it may, his work from his early and middle years is insightful and truly humanizing and ennobling of his severely ill patients. This last point alone is surely an important reason for never forgetting his contribution to healing the mentally ill. Thankfully, there is a Society for Laingian Studies with an official site at http://www.laingsociety.org/

Laing may be said to have contributed much to what today is called “critical psychiatry.” This latter movement challenges the medical tendency to overly or almost completely scientifically explain away and categorise supposed ‘mentally ill’ behaviour. However, unlike the “anti-psychiatric” movement, it demands recognition and understanding of those who are stigmatised by a psychiatric diagnosis because, for example, they hear voices, or engage in some other behaviour incomprehensible to medical specialists. In many ways, therefore, critical psychiatry continues the project to which Laing contributed so much.

… One term he favoured was “ontology” which in philosophical circles refers to the study of existence, and in the more esoteric realms of metaphysics would refer to the study of existence or being in itself apart from the nature of any existent object. Needless to say, this latter esoteric… study was not what Laing referred to.

Most of us, according to Laing, experience ourselves as “ontologically secure” and this is how he defines this term: Such a person “will encounter all the hazards of life, social, ethical, spiritual, biological, from a centrally firm sense of his own and other people’s reality and identity.” (ibid., p. 39). Hence, for Laing, the mentally ill experience themselves as “ontologically insecure”as there is no sense of their own or other people’s reality or identity.
Therefore, Laing talks about “the primary ontological security” of us so-called mentally healthy or sane individuals in contrast to the “primary ontological insecurity” of the mentally ill or insane. Laing was revolutionary in valuing the content of psychotic behavior and speech as a valid expression of distress… albeit wrapped in an enigmatic language of personal symbolism which is meaningful only from within their situation. According to Laing, if a therapist can better understand his or her patient, the therapist can begin to make sense of the symbolism of the patient’s madness, and therefore start addressing the concerns which are the root cause of the distress. Laing engaged, then, with the patient in their “primary ontological insecurity” insofar as this was humanly possible. The WIKI puts it thus: “For Laing, madness could be a trans-formative episode whereby the process of undergoing mental distress was compared to a shamanic journey. The traveler could return from the journey with important insights, and may even have become a wiser and more grounded person as a result.”

In his chapter on “ontological insecurity” Laing refers to literature and the experience of suffering – to Shakespeare, to Keats, to Kafka and to Beckett. While all four spoke about and undoubtedly experienced the evil of suffering in their lives, one can only agree with Laing that both Kafka and Beckett experienced it at a different, perhaps deeper, definitely more alienating a level than the first two. Why? Well for starters both Keats and Shakespeare evil along with a strong sense of personal identity whereas the latter two experienced it without such a sense of personal identity – in fact that sense of personal identity had been stripped away. Hence in these existential works there is despair, there is terror, and there is a gnawing experience of boredom – this last is called anhedonia in psychological circles. Laing even turns to the artistic oeuvre of the modern Irish artist Francis Bacon to depict a similar sense of meaningless to existence.

Laing argues, it would seem, that Shakespeare and Keats experienced some sense of “primary ontological security” whereas our latter two authors might have experienced some sense of “primary ontological insecurity” – namely that they too had some inkling of what it means to be mad or to go mad.

Here is what Laing says about the growing young person: “To anticipate we can say that the individual whose own being is secure in this primary experiential sense, relatedness with others is potentially gratifying; whereas the ontologically insecure person is preoccupied with preserving rather than gratifying himself: the ordinary circumstances of living threaten his low threshold of security.” (ibid., p. 42)

Laing goes on then to discuss three categories of anxiety encountered by the ontologically insecure person. These titles alone are enough to scare us indeed.

1) Engulfment: Laing quotes a patient from an analytic group in hospital: “At best you win an argument. At worst you lose an argument. I am arguing in order to preserve my existence.” The import of this statement cuts me to the quick to say the least, because, thankfully I have never been that low, or so low as to question or even to doubt my “ontological security.” Here the person … fears that they will lose any sense of self at all – every possible relationship threatens the individual with loss of identity. Reflecting on my own relationships or attempted relationships with the “ontologically insecure” I now know exactly what Laing is getting at and it helps me in retrospect to understand why these individuals withdrew into their own worlds. So engulfment is a high risk for these individuals – a risk in being understood, comprehended, grasped, loved even, because once such happens they are literally identity-less, lost, drowned, engulfed.

2) Implosion: This again is an extremely strong word and Laing acknowledges this. Here the person fears that his/her whole world is about to crash in on them or implode. It is an experience of terror. Laing goes on to point out that his word is again most suitable because the patient feels empty, quite like a vacuum. For the patient his experience is emptiness, is nothingness and the world of the other can and possibly will come crashing in.

3) Petrification and Depersonalization: the first of these words means literally being “turned to stone.” I have an experience of seeing someone thus. This, Laing, points out is the fear of being turned into an “it” rather than a subject or an “I.” I am reminded here of the famous Jewish philosopher Martin Buber who wrote a very interesting and beautiful book called “I-Thou” which I read years ago for philosophy and which I must re-read and review for these pages. Anyway, the truly human and mentally healthy person will have an I-Thou relationship with most significant others. An I-it relationship, needless to say, is a depersonalized relationship, to use Laing’s term. The patient as person feels that he or she will lose their autonomy and all inner life and is totally depersonalized.

One cannot help but notice that the Nazis were adept at making their captives and inmates in their hellish and murderous concentration camps “petrified” and “depersonalized” by the systematic stripping away of every vestige of personality and identity. No wonder, even the strongest physically, intellectually and even morally died. As Frankl so well pointed out only the spiritually or psychically strong survived, that is those who had the strength of spirit (not even character) to find some little (or is it even great?) meaning in sheer absurdity and in the most brutal of hells.

I am left again with the feeling after reading this deep if brutally honest and disturbing chapter that R.D. Laing is much to be thanked for his understanding of the suffering of others.

~~~
Very nice. All you have to do is try.

*Fritjof Capra in Uncommon Wisdom, p. 155