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H IS TO RY O F P SY CH IA TR Y

R. D . Laing revisitedA llan BeveridgeIn Scotland's National Portrait Gallery, therehangs the only portrait of a 20th century Scottishpsychiatrist to have been com missioned by thispantheon to the country's great and good. Thesubject of the painting is, of course. R. D . Laing,who was not only Scotland's most famouspsychiatrist, but, for a brief period in the 1960sand early 1970s, the m ost fam ous psychiatrist inthe world. He was the world's first mediapsychiatrist, and his books sold in m illions andw ere translated into m ore than 20 languages.As we approach Laing in the 1990s, there arestill deeply divided opinions as to his w orth. O neview, mainly held by psychiatrists, is that heenjoyed a fashionable notoriety in the 1960sw hen peddling anti-establishm ent opinions, butthat his view s on schizophrenia w ere dangerousnonsense, which encouraged patients to stoptheir m edication, and w hich created the im pression that the fam ily was somehow to blame fort he cond it ion .The recent triumphal march of biologicalpsychiatry, with its emphasis on genetics andphysical treatment, is seen as rendering hisw riting largely irrelevant. In tandem , the spectacular alcohol and drug-fuelled decline of hislater years is taken as confirm ation that his w ork

w as the product of an unstable charlatan.The alternative view, mainly held by non-psychiatrists, is that Laing championed thecause of the mentally ill. In opposition to theim personal em pire of orthodox psychiatry, w ithits d ru gs an d ele ctroc on vu lsive th erap y, its larg eand forbidding mental hospitals, and its beliefthat the 'mad' were incomprehensible and inaccessible, Laing brought humanity to thesubject. He demonstrated that the mad werepeople too, and that their utterances could beunderstood. His subsequent demonisation bytraditional psychiatry is taken, according to thisv iew, a s e vid en ce th at p sy ch ia try is irre de em ab lyw edded to a biological m odel of m ental illness.W hat sense can we make of these conflictingview s? S hould w e, as psychiatrists, even botherto make sense of them . There are two reasons, Ithink, why we should reconsider R . D. Laing.First, there has recently been a resurgence of'Based on a paper delivered to the Royal College ofPsychiatrists. Scottish D ivision. W inter M eeting.E dinburgh. 5 D ecem ber 1997.

interest in him . In the past three years there havebeen no less than six books about him. Theseinclude: three biographies (Laing, 1994, Bur-ston, 1996, C lay, 1996); a critique of his theories(Kotowicz, 1996): a compilation of personalrem iniscences by his many acquaintances andcolleagues (M ullan, 1997): and the transcripts ofa series of w ide-ranging interview s he gave in hisfin al y ears (M ullan , 1 99 5).Second, since he died, one of his mosttrenchant critics, Anthony Clare (1980), w hodebunked many of Laing's theories in hisPsychiatry in Dissent, has, in a number ofarticles, adopted a m ore sym pathetic line. W hilereco gnisin g L ain g's failin gs, b oth as a p erso n an das a thinker, C lare (1997) w rites:"Y et the fact rem ains that this com plicated, contradictory, agonised and spiritually tortured m an exacted a formidable effect on British and on worldp sy ch iatry. H e dra gge d p sy ch iatric illn ess an d th osewho suffered from it right on to the front cover ofnewspapers and magazines where they have remained ever since and he gave the most powerfuland eloquent voice to those w ho until then had beenmut e in t he ir i so la tio n."I w ould like to reconsider the life and work ofR . D . Laing. Before doing so. it is worth

identifying the key ideas associated with hisnam e. T hese are:(a) The experience of psychosis is understa nd ab le . E xis te ntia l p hilo so ph y e na ble sus to enter the world of the sufferer,(L aing , 1 96 0: T he D iv id ed S elf].(b) Psychosis makes sense if one considers itin the context of disturbed fam ily communication (Laing & Esterson, 1964:S oniiy, M adness and the Fam ily).(c) Insanity is a legitimate response to so-called 'sane' society. In effect, society is

sick (Laing, 1967: The Politics of Experience and the Bird of Paradise).(d) M adness is a journey of self discovery,w hich can bring spiritual enlightenm ent(Laing, 1967: The Politics of Experiencea nd th e B ird o f P arad ise).

BiographyRonald David Laing was born on the 7 October1927, at 21 A rdbeg Street in G lasgow . H e w as an45 2 Psych ia tr ic Bu ll et in (1998) , 22 . 452-456

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H IS TO RY O F P SY CH IA TR Yonly child, born som e 10 years after his parentsmarried, and. so they very curiously claimed,long after they had stopped having sexual intercourse. H is m other. Amelia, m anaged to concealher pregnancy until the very day of delivery,suggesting prudery, sham e or a perverse need tokeep others in the dark (B urston, 1996).Ronald had a troubled relationship w ith hismother, who seems to have lacked affection forhim . She made up stories to provoke discord inthe fam ily, and w as prone to extravagant suspicions and bouts of jealousy. W hen Ronald wasfiv e, he b ecam e v ery fo nd o f a little w oo den h orse.His mother had the toy burned, saying the boyw as getting too attached to it.Years later, Laing recalled, his mother wasscandalised by seeing the word 'fuck' in one ofhis books and started the practice of stickingpins into an effigy of her son, called a "Ronalddoll", with the express aim of inducing a heartattack (Burston. 1996). W as Laing's mother'mad'? The answer would seem to be yes. Twoof Laing's m edical friends told the biographerDaniel Burston that they considered that sheh ad a p sych otic illn ess.Laing's relationship w ith his father w as m orepositive. D avid L aing w as an electrical engineerwith G lasgow Corporation, and he and Ronaldshared a passion for m usic. W hen Laing enteredm edical school, his father suffered a depressivebreakdown, brought on by religious doubts.Laing provided psychological support to hisfather during this time, and he was later tocomment that his father w as his first patient. Inold age, David Laing developed a dementingillness and spent the last years of his life inLeve rndal e Hospi ta l.Laing was a clever child, and his parents w ereambitious that he do well. He was enrolled atHutcheson's Boys Grammar school, where heexcelled in the humanities, and where he was am odel pupil. A precocious youth, he extended hisknowledge by voraciously reading his waythrough the collection of the local Govanhillpublic library. By the age of 15, he had readVoltaire, M arx, N ietzsche, Kierkegaard andFreud. It was not all intellectual enquiry, however. The psychoanalyst, D r Jam es Tem pleton,w ho w as at school w ith L aing recalls:"A t an early age we both became involved in theScripture Union . . . W hen we were about 15 andbeginning to have our doubts about all this evangelic al stu ff, w e rec eiv ed a circ ula r fro m th e S crip tureUnion which pointed out that during the past yearthere had been something like 345 indecent portra yals o f w om en in the c in em a. R on nie a nd I d ecid edthat we were missing out on the really importantthings in life and we resigned from the ScriptureU nio n (Q uo te d in B urston . 1 99 6)" .Laing left Hutcheson's in 1945 to study

medicine at Glasgow University. During this

period he had a wide circle of friends and,alongside his m edical studies, he continued hisex plo ratio n o f ph iloso ph y, literatu re an d m usic,as well as drinking and meeting women. Lainghow ever failed all his final exam inations, w hichhe later attributed to upsetting the medicalesta blishmen t. A s he w rote:"I've often w ondered w hether m y failure m ight havehad something to do with our Final Year Dinner,when, sitting with the professors at the top of thetable, as an after dinner speaker, I drank too muchwhiskey, claret and port, and expressed far toocandidly w hat I felt about a few things in m edicine"(Laing , 1985 ).However, the reason for his failure seems tohave been more prosaic. As a result of all hisextra-curricular activities, he simply did notdevote enough tim e to his studies.Laing graduated six months later in 1951 atthe age of 24. He began work at the Glasgow andW est of Scotland neurosurgical unit at K illearn,near L och L om ond, w here he m et Joe Schorstein,a leading neurosurgeon, w hom L aing (1985) w aslater to describe as 'm y spiritual father'. Schor

stein, the son of a V iennese rabbi, w as im mersedin European philosophy and helped to furtherLaing's knowledge of continental thinkers.Schorstein and Laing w ere part of a philosophical discussion group which met regularly inGlasgow.In fact Laing's time in G lasgow was crucial tohis later intellectual developm ent, but this hasusually been ignored by commentators, whohave been surprised that the early Laing was sow ell versed in C on tin en tal ph iloso ph y, comin g ash e d id from th at p ro vin cia l o utp os t o f c iv ilisa tio n,the W est of Scotland. In their book. T he E clipse ofScottish Culture, Beveridge & Turnbull (1989)have pointed out that, during this period, therew as, in fact, a thriving philosophical tradition atG lasgow , to w hich L aing had been exposed.T his tradition concerned itself w ith E uropeanexistentialist thought, and with the relatedScottish school know n as the 'personalists'. Infact L aing's (1960) first book. The D ivided Self,makes specific mention of one of the leadingScottish personalist philosophers, John M ac-Murray, who argued that the techniques ofnatural science w ere inappropriate to the studyo f peop le .L aing next planned to study w ith K arl Jaspers,the author of the monumental G eneral Psycho-pathology, and w ith w hom he had corresponded,but army service was then compulsory. Theauthorities decreed that he should work in aB ritish A rm y psychiatric unit in E ngland, w hichis where he served until 1953. He recalls thatstaff w ere under strict instructions not to talk topsycho ti c pa ti en ts :

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H IS TO RY O F P SY CH IA TR Y"You must not let a schizophrenic talk to you. Ita gg ra va te s t he p sy ch ot ic p ro ce ss . I t i s l ik e p romo tin ga h aemo rrha ge in a h aem op hiliac o r g ivin g a la xativ eto som eone w ith diarrhoea. It inflam es the brain andfan s th e p sy ch osis" (L ain g, 1 985 ).Indeed, British psychiatry at this time wascharacterised by a strongly som aticist approachto mental illness, and there was widespread useof insulin com a therapy, electroconvulsive therapy and lobotomies. Laing's first civilian posting

was at Gartnavel Royal Hospital, whose superintendent was the humane if eccentric AngusMacNiven. MacNiven took a sceptical view of thenew ly-em erging physical treatm ents, and staffaiGartnavel during this period were open toalternative social m odels of therapy.It was here that Laing, along with his colleagues, McGhie and Cameron, conducted whathas come to be known as the Rumpus Roomexperiment (Cameron et al, 1955). The backwards of Gartnavel were overcrowded and understaffed, and Laing and his colleagues wonderedto what extent the behaviour of the patients,most of whom suffered from schizophrenia, wasthe product of their environm ent.Laing and his colleagues persuaded Dr MacNiven to let them have a large comfortably-furnished room , and to allow 12 of the mostintractable patients to stay there for an extendedperiod. The nurse-to-patient ratio w as increased,and the atmosphere was generally more relaxed.After 18 months in this new environment, all 12patients were so improved that they weredischarged.One year later, however, they were all back.Some of Laing's colleagues argued that thisdemonstrated that schizophrenia was a lifelongcondition, only partially am eliorated by environmental manipulation. Laing, in contrast, maintained that there was something wrong with thesocial environm ent outside the hospital.Laing's clinical experiences at Gartnavelformed the basis of his first book. The DividedSelf, which he was writing while still a registrar.Laing's avowed aim was "to make madness, andthe process of going mad comprehensible". Thishe attempted to do by drawing on the work ofexistentialist philosophers, such as K ierkegaard,Sartre and Buber, and writers, such as FranzKafka and W illiam Blake. Laing maintained thatthe medical model, with its notion that thepatient was a faulty biological mechanism ,served to dehum anise the patient.A key passage from the book highlights Laing'sapproach. He quotes an extract from Kraepelin,in which the German professor describes presenting a patient, suffering from schizophrenia,to a medical class. Kraepelin gives a detailedaccount of the patient's speech and behaviour,and concludes that the patient's interactions are

incomprehensible. In other words, he demonstrates the signs and sym ptom s of schizophrenia.In contrast, Laing sought to make sense of thepatient's presentation. He suggests that thepatient was objecting to being exhibited in alecture hall by Kraepelin, and that his responsescould be understood if this was taken intoaccount. A s L aing (1960) w rites:"N ow it seem s clear that this patient's behaviour canbe seen in at least two ways . . . One may see hisbehaviour as 'signs' of a 'disease'; one m ay see hisb eh av io ur a s e xp re ss iv e o f h is e xi ste nc e" .The Divided Self appeared in 1960 after Lainghad moved to London to take up analytic trainingat the Tavistock Clinic. It remains his mostpopular book and ushered in his media career,which soared in the 1960s. During this period hewas at his most prolific. In 1961, Self and Others(Laing, 1961) appeared, which exam ined theinterpersonal aspects of m adness.His 1964 book, Sanity. Madness and theFamily (Laing & Esterson, 1964) sought tounderstand the speech and behaviour of patientssuffering from schizophrenia in the context ofdisturbed fam ily communications. Although helater denied that he had ever said that the fam ilycaused schizophrenia, this book and his subsequent pronouncements, created a climate, thatstill lingers on today, in which relatives were seenas responsible for the patient's breakdown. In

addition the book was viewed poorly by academicpsychiatrists, who complained that there was nocontrol group, and that the author and hiscolleague had relied on their subjective impressions of the families they interviewed, ratherthan using standardised rating procedures.Laing's estrangement from mainstream psychiatry was completed in 1967 with the publication of the apocalyptic The Politics of E xperienceand The Bird of Paradise (Laing, 1967). In astirring and grandiloquent polem ic, Laing wrote:"From the m om ent of birth, w hen the stone-age babyconfronts the tw entieth-century m other, the baby iss ub je ct ed to t he se f or ce s o f v io le nc e, c all ed l ov e, a s i tsm other and father have been, and their parents andtheir parents before them . These forces are m ainlyc on ce rn ed w ith d es tr oy in g mos t o f it s p ot en ti al iti es .T he e nte rp rise is on th e w ho le su cc ess fu l. B y t he tim ethe new hum an being is fifteen or so. w e are left w itha b ei ng l ik e o ur se lv es . A h alf -c ra ze d c re atu re , mor e o rless adjusted to a m ad w orld. T his is norm ality in ourp re se nt wor ld " ( La in g. 1 96 7) .It was clear that, by this stage, Laing wasplaying to the counter-culture gallery of the1960s. He was, by now, on what Peter Sedgwick(1982) has dubbed "the Radical Trip". Laing's

views struck a chord with the post-war studentgeneration, especially in America, where thebook was a campus bestseller. Laing himselfw as an enorm ous draw at lectures and conferences

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H IS TO RY O F P SY CH IA TR Ythroughout the latter half of the 1960s. In histalks, he grouped the psychotic patient w ith thecrim in al and th e po litical dissid ent in a c oalitio nof oppressed bearers of an authentic statem entabout the hum an condition (C lare, 1990).In The Politics of Experience and the Bird ofParadise, Laing also portrayed madness as avoyage of self-discovery, that could lead tospiritual enlightenm ent for the traveller. Thischim ed w ith the ethos of the counter-culture,and had literary antecedents in the R om antics.However it did not play w ell with mainstreampsychiatry, w ho saw it as dangerously glam ourising m ental disorder. A lthough The Politics ofExperience and The Bird of Paradise enjoyed agreat vogue at the time, it ultimately served togreatly w eaken Laing's reputation as a seriouscomm en tato r o n m ental illn ess.D uring this period, Laing also set up K ingsleyHall, in London, as a refuge for the mentallydistressed w ho d id n ot w ish dru gs or h osp italisation. It w as underpinned by the philosophy thatm adness w as a potentially self-healing voyage,and that if sufferers were provided with asupportive enough environm ent, free from coercion or m edical intervention, they w ould em ergerecovered.C lancy Sigal (1976), an A merican w riter, w hospent tim e at K ingsley hall, w rote a fictitious andhumorous account of his experience there in an ov el e ntitle d. Z on e o f th e In te rio r. L ain g a pp ea rsas Dr W illie Last, a pun on whether Laing'sre pu ta tio n wo uld su rv iv e. A lth ou gh e xa gg era te d,this extract captures something of the waymental illness was idealised at Kingsley H all,w hich Sigal renam ed 'the M anor':"O riginally, L ast had taught m e that m adness w as ac omp re he ns ib le , b ut d efi nit ely p sy ch oti c r es po ns e t oinvalidation. B y subtler stages it had becom e som ethin g else , a k in d o f s up ers an ity im plicitly s up erio r tothe alie natio n th at n orm als ca lled n orm ality . In dee d,a ny on e at the M an or w ho w asn 't to tally o ff h is ch um pwas treated as a second class citizen. So thecom petition was to go as crazy as possible the waysom e kids w ill try to appear brighter than others for ateacher who gives gold stars for the right kind ofansw ers. L ast not only encouraged this w orshipfulattitude to insanity but also personified it ...Ins isting o n the ora cu lar p ow ers o f sc hizo ph ren ics,who were 'foreign correspondents back fr' utherw urlds w i' battlefield reports w e haven't th' w it taeunscramble', he said that the only way to decodesuch reports w as to clim b into the schizophrenic'ssoulbe one" (S iga l, 1976 ) .During the 1960s, Kingsley Hall attractedvisitors from all around the world, as well ascelebrities, poets, rock stars, m isfits and form erpsychiatric patients. It disintegrated into chaosby the end of the decade, and even Laingadmitted that it had not been a great success.For many, its failure illustrated the lim its of a

non-interventionist approach to m ental illness.In its defen ce, it d id in spire su bseq uen t attem ptsto treat the m entally ill outside the institution,culm inating in the community psychiatry projects o f to day .The end of the 1960s saw Laing retreating toCeylon (since 1972, Sri Lanka) to spend timew ith the country's holy m en, before returning toB ritain tw o years later. From then until his deathin 1989, there is a sad picture of decline anddissipation. H is writing dried up, and his fewbooks during this period w ere, for the m ost part,slight and insubstantial, containing eccentricmusings about the psychological trauma of thefoetus, and short poems about the deviousnature of human communication. His publicappearances w ere increasingly the occasion fordrunken and outrageous behaviour, while hisprivate life becam e ever m ore chaotic. Laing notonly had problems when fame was thrust uponhim in the 1960s, he had even greater problemswhen it w as taken away.In 1985, Laing was interviewed by AnthonyClare (1992) for the programme in the Psychiatrist's C hair. Typically he arrived at the studiodrunk, but, as he sobered up, he spoke m ovinglyabout his childhood, and his fears that he wassuffering from mid-life melancholia, like hisfather and his father before him . or in his w ords"the typical S cottish C alvinist involutional m ela nc ho lic ty pe o f re lig io us n ih ilis tic rumin atio ns "(C la re , 1 992) .The same year also saw the publication of oneof Laing's (1985) best books, his account of hisearly yea rs, en titled W isd om , M ad ness an d F olly ,a book which has been described as mandatoryreading for anyone who is or intends to be ad oc to r (C la re , 1 99 0).In it Laing also back-tracked on some of hisearlier, radical pronouncements. W ith Laingthere was the curious m ixture of the rebel,delighting in paterle bourgeois, and the conform ist, w ho craved respectability and recognition from the establishment. In his last years hem ade negotiations to be appointed to the C hair ofPsychiatry at Glasgow and was disappointedw hen he w as unsuccessful (M ullan, 1995).R . D. Laing died in 1989. Somewhat againstexpections, he dropped dead while playingtennis, rather than as the result of alcoholicm isadventure. H e had in fact stopped drinking inth e last y ear o f h is life. C haracteristically, h is lastwords were that he did not want a doctor to becalled.

ConclusionThe legacy of R. D. Laing is a m ixed bequest. Hiswork on schizophrenia has not held up, and heR . D . La in g revisited 45 5

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H IST OR Y O F P SYC HIA TR Yw as at least indirectly responsible for the trend toscapegoat the patient's relatives. H ow ever, D aniel Burston, whose biography of Laing is thebest currently available, has contended thatL aing's often disgraceful and inebriated behaviour in later years, and his polem ical excesses atthe height of his guru-hood in the 1960s, haveserved to detract from what he sees as hisimpor ta nt in te ll ec tu al c on tri bu ti on t o p sy ch ia tr y.Anthony Clare (1990) has stated that Laing'sm ajo r co ntrib utio n w as to id en tify th e d eh um anising consequences of treating people as malfunctioning mechanisms, and he argues thatL aing's m essage has im portant im plications notju st fo r p sy ch iatry , b ut fo r th e w ho le o f m e dicine.In the 1990s there is a growing disquiet inm edicin e g en erally th at th e focu s o n b io tec hn ology has led to a state where doctors areincreasingly poor at relating to their patients. Inan influential leader in The British MedicalJo urn al, P ro fesso r W ea th era ll (1 99 4) h as asked ,"Are doctors inhumane?", and has examinedw ith dism ay the m ounting evidence of doctors'u nfe elin g tre atm en t o f th eir p atie nts .In a new book, entitled T he L ost A rt of H ealing,the A merican cardiologist and N obel prize w inner, Dr Bernard Lown (1997), has claimed thatthe overemphasis on medical science and technology has created a clim ate in w hich doctors nolonger have the time or the ability to listen totheir patients, and have thereby lost the art ofhealing. The social historian, Professor RoyP orter (1 99 5) h as recen tly o bserv ed:"T he rise of diagnostic technology, the religion ofs ta tis ti cs , n umbe rs a nd o bje ct iv ity , t he in cre as in glysc ie ntific se lf-im age o f th e m ed ica l pro fes sio n, an d apow erful com mitm ent to drug therapies . . . have allm idw ived the 'm edical m odel', and its subsequentex ten sio n fro m g ene ral m edicin e to ps yc hia try . . . th epatient as a person has been tending to 'disappear' ".I think that, for all his many failings andpolem ical excesses, the best of Laing's work

addresses these concerns, and has helped, in

the words of one of his colleagues, "to put theperson back in the patient" (M ullan, 1997).ReferencesBEVERIDGE.C . & TURNBULL .R . ( 19 89 ) T he E clip se o f S co ttis hC ul tu re . E din bu rg h: P oly go n.BURSTON,D. (1996) The W ing of M adness. The Ufe andWork o fR . D . L ain g. C am br id ge, M A: H arv ard U niver sityPress.CAMERON ,. L ., L AING ,R . D . & McGHiE , A . (1 95 5) E ff ec ts o fenvironmental changes in the care of chronics ch iz op hr en ic s. L an ce t, i i. 1 38 4- 13 86 .C LA RE ,A . (1980) Psychia try in D issent (2nd edn). Lond on:Tavlstock. ( 19 90 ) R on ald D av id L ain g 1 92 7-1 98 9: a n a pp re cia tio n.P sy ch ia tr ic B ul le tin . 1 4. 8 7-8 8. ( 19 92 ) I n th e P sy ch ia trist's C ha ir. L on do n: H ein em an n. ( 19 97 ) A nth on y C la re . In R . D . L ain g. C re ativ e D estr oy er(ed. B . M ullan), pp. 1-3. L ondon: C assell.C LAY.J . (1 99 6) R . D . L ain g. A D iv id ed S elf . L on do n: H od de rand S to ught on .KOTOWICZ,Z. (1996) R. D. Laing and the Paths oj Anti-

P sy ch ia tr y. L on do n: Rout le dg e.LA IN G.A. (1994) R D. Laing. A Biography. London: PeterOwen.LAING .R . D . ( 19 60 ) T he D iv id ed S el f. L on do n: T av is to ck . (1 96 1) S elf a nd O th ers . L on do n: T av isto ck . ( 1 96 7) T he P oli ti cs o f E x pe ri en ce a nd t he B ir d o f P a ra dis e.H armo nd sw or th : P en gu in . ( 19 85 ) W isd om . M ad ne ss a nd F olly . L on do n: M acmilla n. & ESTER SO N(1964) Sanity. M adness and the Fam ily.London : Tav is tock.LOW N. B . (1997) The Lost Art of Healing. Boston, M A:H ou gh to n M if lli n.M ULLAN .B. (1995) M ad to be N orm al. Conversations w ithR . D . Laing. London. F ree A ssociation B ooks. (ed.) (1997) R. D. Laing: Creative Destroyer. London:Cassell.PORTER.R . ( 19 95 ) P ar kin so n's D is ea se ( Pa ra ly sis A gita ns) .In A H istory of C linical Psychiatry (eds G. B errios & R .P or te r) , p p. 1 13 -1 22 . L on do n: A th lo ne .SEDGWICK,P . (1 98 2) P sy ch o P olitic s. L on do n: P lu to P re ss.

SIG AL, C . (1976) Zone of the Interior. N ew York: Thom asCrowell.WEATHERALL.D. J. (1994) The Inhumanity of medicine.B ritish M ed ic alJ ou ma l. 3 09 . 1 67 1-1 67 2.A llan B ev erid ge, C on sultan t P sy ch iatrist, Q ueenMarg aret H osp ita l, D unferm lin e, F ife K YI 2 O SU

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