Wednesday, October 29, 2008

Review: The Crucible of Experience

[Daniel Burston. The Crucible of Experience: R.D. Laing and the Crisis of Psychotherapy. Cambridge, Mass.: Harvard University Press, 2000.]

This is a book about the ideas of famous Scottish radical therapist R.D. Laing -- once a countercultural icon and inspiration for many anti-psychiatry activists even though he himself rejected the term "anti-psychiatry." The book is written by a U.S. American academic who teaches psychology at Duquesne University who has also written a biography of Laing and a book on Erich Fromm.

Laing was born into a messed up middle-class family in Glasgow, Scotland. He studied medicine at university (though also read heavily in philosophy), became a psychiatrist, practiced in the British Army, and later trained as a psychotherapist. Beginning in 1960 he published a series of books that became part of the counter-canon for those critical of orthodox psychiatry and that made him a celebrity for rebellious youth in the '60s and '70s. Until about 1968 he was explicitly sympathetic with and somewhat involved in the Left, but after that point he rejected political involvement and was highly skeptical of political movements. His fame had ebbed significantly by the late '70s. He continued to write, but his later work did not generate the same excitement as what he had written earlier in his life. He died in 1989. Despite being the subject of a number of recent books, his important intellectual contributions to understanding how people work are largely assumed by professionals to have been superseded by more recent research in biological psychiatry without taking the time to engage with his work in the ways that would illustrate that this is not actually the case.

The focus of this book is Laing's ideas rather than his life, but it begins with a brief biographical sketch. It then goes on to describe the philosophical antecedents of Laing's work, mainly people who can be identified as being or were influences on existential phenomenologists. His work traces back to people like Nietzsche, Sartre, Heidegger, Kierkegaard, Martin Buber, Emmanuel Levinas, Wilhelm Dilthey, Karl Jaspers, and Edmund Husserl.

Some brief definitions:

Existentialism is an approach to philosophy that stresses that despite disparate social and historical situations, differences in age, gender, ability, and so on, all people, by virtue of their mortality, partake of the same basic structure of existence -- of throwness, contingency, and the need to infuse or confer value and to impart meaning to life through action and decision, and thus to take responsibility for their personal destiny. (pp. 15-16)

...

Phenomenology is an approach to philosophy that emphasizes that there is a world of immediate or 'lived' experience preceding the objectified and abstract world of natural-scientific inquiry. Therefore, fidelity to the texture of human experience, through patient and painstaking description, should precede any effort at explaining the phenomenon in abstract or quantitative terms. (p. 16)


This is not an area where I have a lot of background, which limited my ability to easily integrate into my existing understanding all of the interesting ideas that Burston rapidly ploughed through in this chapter. However, it was interesting and actually not a bad introduction to some of this stuff despite its rapid pace, and I'm glad I had the chance to read it. The grounding of phenomenology in respectful attention to experience struck a chord for me, and it is something that I would like to learn more about at some point. That said, the choice made to build the book starting with this chapter is pretty indicative of the author's project, which is more about exploring Laing's ideas on their own terms than about critically relating his ideas and the various ways in which they have been taken up to a larger framework grounded in struggles for social change. Which is useful in its own right, but which clearly indicates what the book is not going to talk about.

The remaining four chapters of the book look at Laing's ideas in a thematic way. There is a chapter on his relationship to the process of therapy, one on his ideas about the family and schizophrenia, one on his evolving ideas about "normality," and one on his evolving ideas about "mental health."

Constructing clearly defined periods in history or in an individual's work always puts you at risk of oversimplifying but it can be useful. Burston identifies three major periods in Laing's work. The first precedes 1964, the second stretches from 1964 to roughly 1969, and the final period includes all of his later work.

In the first phase, Laing understood mental health as being largely determined by whether or not a person experienced "primary ontological security."

According to Laing, ontologically secure people have a firm and stable sense of identity, a secure feeling of personal autonomy, and a capacity for genuine self-disclosure. They are not terrified of intimacy or beset by nagging anxiety and doubt as to who (or what) they are. In addition, they are able to sustain good-enough interpersonal relationships and can seek pleasure and gratification within the farmework of these relationships.

...

By contrast, ontologically insecure of 'schizoid' people have a shaky sense of identity. They fear intimacy and self-disclosure, lest they be engulfed, petrified, or otherwise impinged upon by others and their precarious sense of autonomy irrevocably shattered. Accordingly, they route more and more of their emotional and intellectual commerce with others through their false selves, using a semblance of sociability as a camouflage whose purpose is to ensure the 'real' self's survival. (p. 134)


He saw early experiences in one's family of origin as playing an important role in shaping a person's sense of ontological security. Particularly problematic, in his view, were situations in which children constantly had their realities denied and observations of the world deceptively contradicted by the people around them.

The second phase of his work focused more exclusively on people overtly suffering in serious ways, especially people given the label "schizophrenic" by psychiatric authorities. He maintained an emphasis on social and familial origins for mental distress. In its most extreme form in this period, he took the position that being fully functional and "normal" in a world as insane as this one is actually a sign of significant disconnection from reality. He saw psychosis, and especially breakdown in the course of psychosis, as a path towards a more smoothly integrated and functional self. In this period he definitely had have successes in working with people that conventional psychiatry would have drugged into insensibility and given up on.

People like these experienced the symptoms of their disorder as the outward stigmata of a radical inner transformation, a tortured epiphany whose symbolic and existential significance registered only after their crisis began to abate. It had to be lived before it could be understood. Following Jung, Laing called this process "metanoia" -- the ancient Greek word for "repentance." (pp. 70-71)


The final phase of his work focused on ideas of the formation of self in the months before birth, and was often connected with ideas of rebirth in some sense as part of therapy.

Burston's analysis is that the final phase offers little of lasting interest, but that there are definitely ideas and approaches in the first two phases that deserve much greater attention from contemporary theorists than they receive. It was the ideas of the second phase that were taken up so enthusiastically by rebellious youth in the '60s and '70s, often, it seems, in ways that Laing did not agree with, despite his desire for the fame that their attention brought him. Certainly the idea of "mental illness" as a response, at least in some cases and to a certain degree, to a sick and oppressive society is something that I think is a very useful one, but I think I agree that it lead to excesses both in Laing's practice and in the rhetoric of some of those who took up his ideas. The centrepiece of Laing's work in this period was Kingsley Hall, which was intended as a safe space for people to make their journey to metanoia. While there were people who found both the approach and the space to be helpful in ways that nothing else had been, others experienced a kind of abandonment to structurelessness that was itself a torment. Rife sexism in how Kingsley Hall was experienced is one key feminist criticism of Laing's legacy, though it is not examined in this volume. And certainly though Laing himself was much less given to glorifying and romanticizing the extremely painful process of breakdown than his detractors have claimed, certainly many people who took up his ideas did exactly that.

These issues notwithstanding, my inexpert opinion tends to be somewhat in line with Burston's much more authoritative analysis in seeing value in the ideas of primary ontological insecurity, social contributions to much "mental illness," the content of so-called "madness" as often substantially communicative, and the value of 'coming out the other side' for some people. Certainly Burston's description of Laing's actual therapeutic method, which bore a lot of similarities across these periods, resonated with me. He scorned the idea of "technique" in therapy and believed that "the art of psychotherapy consists in being fully present to the other person without being judgmental, intrusive, or dishonest" (p. 36). Of course there was much more to it than that, but the centring of genuine human connection in supporting people who need support instinctively feels to me like the way to go.

A tension that the book noted but did not explore in ways that I would've liked was between this radical commitment to connecting with people in the course of therapy, which was very much a part of his practice and not just his rhetoric, even with people exhibiting behaviours that would conventionally be understood as very severe symptoms, with Laing's ongoing attachment to conventional diagnostic categories and conventions, not so much in his writings but in some aspects of his actual practice. It seems to me that this speaks to a deeper tension between completely resisting any impulse to objectify other people and irresistable pressures towards some sort of (transient?) objectification -- in this case, objectification organized around figuring out how people work, but I think it is a tension that is inherent to many aspects of human relationships. It is also related to my sense of the tensions between radical therapists and ex-inmate-driven anti-psychiatry spaces. I'm not sure what I think about it, or how I would resolve my own never-realized desire to engage in practices that are radically and completely not objectifying in every sphere of life with the fact that trying to understand a friend or loved one's behaviour inherently contains some element of (hopefully sympathetic) objectification.

In any case, this was an interesting book that I am glad that I read. However, it largely does not deal with Laing's work with explicit attention to how it might relate not just to the ideas of other putatively Great Thinkers and to therapeutic practice with individuals and families, but to questions of oppression, resistance, and radical social change.

[For a list of all book reviews on this site, click here.]

2 comments:

Rhondda said...

Since I have been coming to your site and reading your book reviews, I thought I should comment and tell you how much I have enjoyed them. This book in particular, is one that I would like to read.
Thanks for your thoughtful and discerning reviews.
Rhondda

Scott said...

Thanks Rhondda!