Was R D Laing a Postmodern Psychiatrist?
Recent years have witnessed the emergence of the concepts of ‘postmodern psychiatry’ or ‘post psychiatry’ as reflected in a number of publications. Such writings share a critical stance toward the prevailing values underpinning psychiatry which are considered inadequate on several counts. In this paper it is argued that postmodern psychiatry is better understood in the context of postmodern theory and that the analysis presented in postmodern psychiatry, rather than representing an entirely new stance, is more accurately understood as the latest expression of a long running intellectual heritage which has existed on the margins of mainstream psychiatry for decades. It is shown that there is a strong continuity between key themes in postmodern psychiatry and in the writing of RD Laing.
Psychiatry’s origins lie within the conceptual framework of modernity which can be traced to the European enlightenment. The founding fathers of the enlightenment or ‘Age of reason’, philosophers such as Hume, Descartes and Bacon set out to decipher the laws of the universe through reason or rational enquiry, their exclusive faith in reason representing a reaction against ‘pre-modern’ modes of thinking considered to be rife with superstition and myth. Modernist values were to dominate during subsequent centuries and were very much the bedrock on which scientific and technological progress occurred. But such values are increasingly called into question with modernism being deemed ‘flawed’, anti humanistic and ultimately an inadequate paradigm for psychiatry. The concept of Postmodern Psychiatry or Post psychiatry has emerged, attracting considerable interest as reflected in a cluster of publications (Bracken and Thomas 2001, Laugharne 2004, Lewis 2000) in which Psychiatry stands accused of excessive technicism, insensitivity to personal, spiritual and psychosocial values, reification and neglect of contextual factors etc.
Is Postmodern Psychiatry new?
Postmodern psychiatry can be regarded as a recent expression of a long running theoretical heritage, existing in psychiatry and psychology for numerous decades united by a somewhat skeptical attitude towards the prevailing positivist paradigm. Traces of the ideas which agglomerate around the notion of postmodern psychiatry are seen in continental Existential and Phenomenological philosophy and in the derivative schools of Existential psychotherapy and Humanistic psychotherapy. These ideas also find expression in the work of R D Laing in whom there seems to have recently been renewed interest, reflected for example in a series of conferences organized under the joint auspices of the Royal College Of Psychiatrists and the Philadelphia Association (most recently March 2005). Against this background, parallels between Laing’s thought and Postmodern Psychiatry are highlighted.
Perspectives On Postmodernism
Postmodern Psychiatry is understood in the context of the notion of Postmodern Theory which although encompassing a broad corpus of work spanning a number of different decades and disciplines is nonetheless bound together by unifying themes based around a repudiation of modernist values. Major proponents (many of whom were direct influences on Laing ) include Heidegger, Lyotard, Foucault, Kristeva, Sartre, Wittgenstein, etc., (see Appignanesi & Garratt 1995 and Butler 2002) and whilst all are united in their critical stance to towards modernity and share the sense of its imminent demise there are inevitable shades of difference in emphasis. Lyotard (1979) and Heidegger (see Steiner, 1978) were among the critics of the dominant view of man as a ‘machine’ or as a ‘resource’ subject to exploitation by industrial society. postmodern thinkers reject the authority of meta narratives or to single dominant explanatory models. This view is elaborated in the writing of Lyotard (1979) and expressed in his celebrated postmodern rallying cry "Let us wage a war on totality". Science is seen as the dominant meta narrative and it’s privileged position in this regard is challenged in the postmodern analysis which also shatters Modernity’s claims to absolute, final knowledge often leaving uncomfortable feelings of uncertainty. Language became an increasingly dominant concern for late twentieth century philosophers with the emerging French Poststructuralist thought of such figures as Derrida and Foucault considered being a key strand within postmodern thought. Marcuse (1964) emphasized the tendency in modern society towards conformity with compromise of values such as individuality and self determination. As Kellner states "Marcuse used the adjective ‘one dimensional man’ to describe practices that conform to pre existing structures, norms and behaviour in contrast to multidimensional discourse" .
Normality And Pathology
Laing repudiated the notion of a single ‘standard of normality’ in society. In concert with the sentiments of contemporaries such as Fromm (1956) and Huxley (1958) Laing was critical of society’s pronouncements in regards to either the morality or madness of others. Laing’s objection was with the deeply ingrained tendency in modern society to conceptualize madness and sanity as lying on opposite sides of a fundamental divide. Foucault, whom Laing greatly admired had undertaken a penetrating socio-historical analysis to reveal the manner in which madness had come to be objectified and brought under the gaze of post enlightenment European society in the ‘age of reason’ increasingly defining itself through its distance from all forms of ‘irrationality’. (Foucault 1961) The conceptualization of a sane norm to whom the majority belong and which stands in absolute contradistinction from the experience of the psychotic individual is not only flawed for Laing and others but leads to an exaggerated perception of ‘not measuring up’ compounding a psychotic individual’s sense of estrangement. Cognizant of the representation of this estrangement through language, Laing rebuked what he called ‘psychiatric jargon’. Terms such as ‘failiure of adjustment’ or ‘mal adaptation’ which implied a single standard of being human in respect to which the ‘psychotic cannot measure up’ (D S p.27). In Wisdom, Madness and Folly (1985) Laing refers to terms such as primitive, irrational, alogia etc arguing that they are not so much words of description as they are ‘the rhetoric of abuse’ and the ‘vocabulary of Denigration’. This insight is further illuminated by considering the observations made by Anthropologist George Devereux. Writing in 1956 and using language which is somewhat anachronistic to contemporary sensibilities, Devereux noted that whilst psychosis did indeed exist in primitive society, the structure of society was such that it did not result in the psychotic either ‘losing status’ or being ‘wrenched away’ from the setting of his regular life" (see Littlewood and Dein 2000 ch.13). This perception in modern society of a fundamental ‘alienness’ of psychotic experience extended to the widespread belief, held until recently almost as an article of faith by psychiatrists in the fundamental non-understandability of psychosis. This view was supported by Jaspers who held that ‘an abyss of understanding separates the schizophrenic from the normal person.’ (Burston 2000 p.66). This position was clearly one from which Laing departed. Indeed Laing professed his aim ‘to make madness and the process of going mad comprehensible’ in the preface to The Divided Self. Laing’s criticism of the prevailing conceptualizations of Normal and Pathological went further. The standard of normality, deviation from which engenders a sense of estrangement is itself a false standard for Laing, a sort of anti standard in fact and one to which Laing does not accord the commonly held value. Laing transposes the direction of the implicit value relationship between the Normal and the Pathological to the extent that he arrives at a somewhat inverted conceptualization. Burston refers to this as ‘Laing’s antinomian view of adaptation’ (Burston 2000 p.59). For Laing, normalization in society and congruence with its values entailed an orientation which distanced the individual from his authentic self. Inhabiting this ‘false self’ mutes his likelihood of accessing certain ‘inner modes’ of experience and it was with this estrangement from the unique inner self, the ‘existential estrangement’ that Laing (in the company of such thinkers as Heidegger, Sartre etc) was most concerned.
Laing affirmed his awareness of the changing social and cultural milieu. In The Politics Of Experience (1967) writing "We are living in an age in which the ground is shifting and the foundations are shaking", "we have all reason to be insecure".
Laing’s repudiation of the privileged status of ‘objective’ over ‘subjective’ knowledge including his challenge of the claims of ‘neutrality’ of science particularly by bringing to attention the role played by the observer’s presence or intention and his emphasis on intersubjectivity form the theoretical backbone of The Divided Self. Such ideas can themselves be seen firstly as paralleling theoretical developments in a diverse range of disciplines and secondly as prototypical of ideas increasingly reproduced in postmodern psychiatry. Following Dilthey and others (Raschid, 2005), Laing addressed the distinction between Explanation and Understanding. Explanation, which is predicated on an ‘ontological separation’ of Object and Subject, whilst relevant to the study of machines or ‘It Process’, is deemed to be inadequate for the ‘study of persons’ of whom it delivers depersonalized and reified accounts. "Although conducted in the name of science, such reifications lead to false knowledge" (DS p.24). For Laing, in order to approach an understanding of the patient it is necessary to relinquish the objective stance in favour of an alternative ‘frame of reference’ or what Laing calls ‘intentional gestalt’. Postmodernism embraces multiple or pluralistic perspectives. Borrowing Kristeva‘s phrase, (quoted in Kleinman 1988) ‘alternative significations’ of experience may either supplant or coexist with strictly illness models. Such alternative significations, in permitting the invocation of say spiritual/theological interpretation or by emphasizing creative potential or by emphasizing the unique significance of a ‘breakdown’ in the context of an individual’s life journey serve to counter the existential injury of an otherwise sterile ‘illness interpretation’. The postmodern landscape of meaning then would be somewhat richer than the modern one through re instating and in a sense re legitimizing what Bracken and Thomas (2001) describe as "spiritual, moral, political and folk understandings of madness" that had once flourished before they were replaced by the enlightenment driven "framework of psychopathology and neuroscience". Laing’s embrace of such ideas constitute an important cornerstone of his thought and are captured most lucidly in arguably his most frequently quoted (as well as misquoted and misinterpreted ) words: "madness need not be all breakdown. It may also be breakthrough. It may be liberation and renewal  as well as enslavement and existential death" (Politics Of Experience, 1967). Out of such concerns over its potential to restrict access to vistas of meaning otherwise possible that Laing repeatedly decries the term schizophrenia, on one occasion referring to it as ‘a straitjacket that restricts psychiatrists and patients’ (The Politics of the family, 1969).
Language And Context
The Enlightenment assumption that language can accurately and/or objectively represent reality  is challenged. Yet Language influences the particular way in which the world is viewed, it perpetuates certain modes of thought and inevitably language as a universal and languages as specific cultural ‘mirrors’ embody commitments to certain values and so are far from ‘value free’. The terms psychotherapy and psychiatry as examples, arguably express a commitment to Cartesian ‘dualistic’ values. Quoting Wittgenstein "The thought is the language", Laing referred to the ‘technical vocabulary’ in use which serves to engender a view of man as an ‘isolated entity’ split into ‘falsely substantiated entities’ such as ‘mind, body, psyche, etc.’ (D S p.19). This insight is shared by Watts who states "Language represents the world as if it were an assemblage of distinct bits and particles. The defect of such grids is that they screen or ignore interrelations" (Watts 1963). This theme is raised more recently in Kendell’s assertion that the distinction between ‘Mental’ and ‘Physical’ disorder is predicated on a commitment to a false Cartesian dichotomy and in Lewis’ indictment of enlightenment driven "either-or" logic (Lewis 2000). The postmodern attitude to language perhaps best described as ‘tentative’ is suggested by various enjoinders to apply the prefix ‘so-called’ as indeed Kendell (2001) does in the case of ‘physical illness’ and ‘mental illness’ and Laing does with ‘schizophrenia’ (P. O. E. p.107). However, Language although imperfect is at the same time, indispensable and necessary and this twin property is one to which the postmodern is sensitized and is captured by Derrida’s notion of ‘under erasure’ in which the word is written alongside another version of the same word only with a line drawn through it, (Derrida 1967). The postmodern attitude moves beyond a cartesian conceptualization of mind, body, family, society as mutually distinct categories. Some researchers view traditional notions of Mind and Body as anachronisms arguing for their abandonment in favour of terms such as Bodymind or Mindbody (see Pert 1997 with reference to Connelly). Other writers including Lasch and Bordo offer novel reconceptualizations of ‘mental illness’ in social and historical contexts (see Bordo 1993) Laing was interested in the family as well as wider societal contexts acknowledging the arbitariness of the dividing line between ‘family‘ and ‘society’ (Mullan 1995 p.274). Laing’s later writings reveal a growing interest in the complexities of interpersonal processes in various contexts expressed in concepts such as ‘social nexus’ .
Key themes in Laing’s thought bear an affinity with the tenets of postmodern psychiatry. Postmodernism rejects the modern will to consensus and coherence and Postmodernism writers, comfortable with a notion of the world as a composite of mutually disparate entities (see Isaiah Berlin’s writings on ‘pluralism’  attempt to characterize the world’s constitutive elements and organizing (or disorganizing) principles around terms such as ‘pastiche’, ’irony’, ‘kaleidoscope’ etc. (Berger 2003). Burston suggests that the "fact that Laing never presented a single, integrated model of insanity or the therapeutic process is not necessarily grounds for reproach" and goes onto suggest that Laing be read "more in the spirit of Kierkegaard and Nietzsche than of Kraepelin or Freud" (Burston 2000 p.146 ). Laing stood in opposition to what he perceived as psychiatry’s ills, it’s ubiquitous leanings towards reductionism, crude scientism and neglect of the subjective elements of individual experience. Laing refrained from co modifying his ideas into a standardized ‘laingian therapy’ to be packaged, marketed, etc. "They got Laing". Laing replied when asked what people got when they saw him in therapy "…not existential therapy, not post-modern Freudianism…" (Mullan 1999 p.121). Laing had his own intellectual forbears and the thread linking him to them in turn weaves its way into ‘postmodern psychiatry’. But for the occasional exception (eg Beveridge 2002 , Shulman 2003) Laing’s anticipation of contemporary trends in Psychiatry tends not to be widely acknowledged. Nor is there usually anything but a passing reference to the synchronicity of Laing’s writings with the unfolding canon of postmodern thought.
 The concept of metanoia refers to a radical change in consciousness usually in the spiritual
Sense and was used by Laing in his conceptualization of psychosis emphasizing its
potential in an individual’s ‘existential journey’ to effect a transformative shift in
consciousness. Kingsley Hall In East London under the Philadelphia Association sought to
apply such principles in a ‘non drug . Non restraint setting’. The ‘experiment’ began in 1965
But Kingsley Hall was in a state of dereliction by 1970. For a well known candid account from a
Resident see Two accounts of a journey through Madness . Barnes and Berke (1971)
 within the same ‘community’ of language users, similar words maybe used to signify
different meanings and conversely, alternative words used to signify similar meanings. For a
discussion of the resulting conceptual confusion in one area of psychopathology;
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 Isaiah Berlin proposed that the ability to accommodate contradictory elements
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Declaration of interest
Tony B. Benning
Specialist Registrar in Adult Psychiatry
Michael Carlisle Centre