Wednesday, August 22, 2007

Personality 6

R.D. Laing – Another Wounded Healer

Communicating with those diagnosed as Mad 2

Before I continue my thoughts on what sanity and insanity are I should like to say a few words about Dr. Ronald Laing. Suffice it to say that he was a brilliant, if almost totally unorthodox, Scottish psychiatrist. Also he was a conflicted man in himself, hence my reference to his being a wounded healer. But this fact does not lessen him in my estimation – in fact, in a way, it rounds him out as a very real human being who suffered, but also it gave him a great understanding of the patients whom it was his privilege to treat. He was a great and weak human being like many of us. I think, often times, we like to sanitize the lives of our heroes. Which of us can boast a perfect life? We are all really so frail.

Anyway, Ronald Laing was born into a lower middle class family in the Govanhill district of Glascow in 1927, studied medicine at the University of Edinburgh and qualified as a psychiatrist. He wrote extensively on mental illness and particularly on the experience of psychosis or madness which I defined in the last post here on these pages. He is famous for his ideas, influenced primarily by existential philosophy, on the causes and treatment of mental illness, which went against the psychiatric orthodoxy of the time by taking the expressions or communications of the individual patient or client as representing valid descriptions of lived experience or reality rather than as symptoms of some separate or underlying disorder. The WIKI informs us that “he is often associated with the anti-psychiatry movement although, like many of his contemporaries also critical of psychiatry, he himself rejected this label. He made a significant contribution to the ethics of psychology.” (See article on Laing on the WIKI site)

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 SLS

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.

Personally I have known three people who are afflicted with schizophrenia and have tried with varying degrees of success and failure to communicate with them. I attempted to do so and have never nor will I ever regret these efforts. This is a contributing factor to my wishing to study psychotherapy and psychoanalysis when I retire from my teaching career. Anyway, back to my re-reading R.D. Laing’s first book, The Divided Self (Penguin, 1960).

I loved Laing’s simple aim and indeed motivation in this book “to make madness and the process of going mad, comprehensible…to give in plain English an account, in existential terms, of some forms of madness” (op.cit., p. 9) Not alone that Laing took his so called “mad” patients seriously as individuals, worthy of respect and sought to listen to their stories – that is, how life and the experience of life was for them and in them, that is, his emphasis on the word existential, which he italicized in the above quotation. He did not seek to categorize them in any narrow sense which would have been anathema to R. D. L. He also stressed the important role both society and the family had in the process of the patient’s going mad. He has often been criticized for his attribution of a certain amount of causality for madness to the family because of the further guilt-tripping of the family that’s involved here. However, Laing pointed out that the family can in no way be held responsible for this because quite simply they were mostly if not totally unaware of what they were doing to each other. (A contemporary holistic approach to mental health and mental ill-health will incorporate both the findings of standard psychiatry based on psychopharmacology and modern approaches to psychotherapy. I have already alluded to the fact that it is not an either/or scenario but rather a both/and one with respect to the debate (or war in some circles) between the biological approach and the therapeutic one to mental ill-health).

As a good existentialist R.D. Laing was influenced by reading Heidegger, Hesse, Sartre, Merleau-Ponty, Minkowski, Tillich and Bultmann as well as the standard Psychoanalysts. From them he borrowed much of his terminology. 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 (my description of metaphysics with apologies to those who know more than I on the subject) 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, (unlike the great existentialist psychiatrist and philosopher Karl Jaspers who dismissed the patient’s experiences as “un-understandable” and worthy of little consideration), 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 them 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 actually such an “ontological insecurity” that he or she 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. Indeed, with other great human beings whom I have discussed in these pages, I would truly have loved to have met him.

To be continued.

Tuesday, August 21, 2007

Personality 5

Squaring the Circle?

Communicating with those diagnosed as Mad 1

What follows here makes absolutely no presumptions of any type of authority and is merely my personal opinion. Indeed, I suppose I just want to get my mind around what exactly the terms “sanity” and “insanity” mean. Like all divisions which we humans make for differentiating between opposites often it would seem that the dividing lines are not that crystal clear, yet we know there is a division more or less somewhere between them. Perhaps an analogy from topography or cartography like the borders between different countries is a useful comparison because they are very far from being straight lines on a map and they also traverse heights and depths as well as breadth – I refer to hills and mountains, lakes and seas here in this latter part of this sentence. Hence, no accurate demarcation lines can be drawn between sanity and insanity, though the psychiatric community does make an effort to draw these somewhat less than accurate lines.

I have met many people who have suffered from various psychiatric illnesses, having “lived” in a psychiatric hospital for seven weeks in late 1998. As I was getting better towards the end of my sojourn among the mentally wounded I began to notice all the different character types and all the different diagnoses that were made of the various other patients I encountered: Reactive Depression, Endogenous (or Uni-polar) Depression, Manic (or Bi-polar) Depression, patients who suffered from Panic Attacks, those who were afflicted with Schizophrenia in all its manifestations from Disorganized to Paranoid. Then there were the various addicts from Alcoholics to Drug Addicts. There were others still who suffered from various other nervous disorders like Anxiety and various other Phobias, the most common being Agoraphobia. This last phobia is the only specific phobia treated separately, owing to its frequency in clinical practice and its often debilitating character. All the hundreds of other phobias are classified under two headings: (1) Simple Phobias and (2) Social Phobias. My diagnosis for clarity here was and still is Endogenous Depression for which I continue to take medication. Thankfully I have been well, very well indeed for the past 7 years.

Anyway, paragraph two here is the source of my interest in this subject. It is also one of my reasons for being interested in psychotherapy and for my intention to pursue this field when I leave teaching in the near future. This specific blog entry is encouraged also by my re-reading R.D. Laing’s pioneering attempt to understand schizophrenia called The Divided Self (Penguin, 1960). While Laing occasionally refers to such persons as being insane, the experts point out that this latter term has been so brutalised and so abused that it is no longer used in mainline psychiatric medicine. It is used only in forensic psychiatry and in legal circles as in what’s called the “insanity defense” in murder cases. However, for clarity, I wish here to distinguish between a psychosis (psychotic disorder) and neurosis (neurotic disorder). The defining characteristic of the former is “gross impairment in reality testing” (The Penguin Dictionary of Psychology, 1985, p. 598). In other words the person finds it hard to distinguish between what is the real and what is the unreal in his/her day-to-day living. Classic symptoms here include delusions and hallucinations. Standard literature lists the following as psychoses: Manic-Depression, Paranoia, Schizophrenia and some others. Neuroses, on the other hand are not as crippling of the individual, though they are experienced as painful. Here the boundaries between real and unreal are largely left intact – by and large the patient can get by socially, though with some problems. (Obsessive Compulsive Disorder is a neurosis)

The subjects of Laing’s work were mainly the Schizophrenic. In other words they were psychotic not neurotic. I state this for my own clarity of thought in these few paragraphs which are essentially my struggling to define what I outlined in my first paragraph. The book I’ve quoted, The Divided Self was written by a very young psychiatrist. Here are Laing’s words in the preface to the pelican edition in 1968: “I wrote this book when I was twenty-eight. I wanted to convey above all that it was far more possible than is generally supposed to understand people diagnosed as psychotic.” (op. cit., p. 11) As early as 1968 Laing began to question who was really sane – the people who sat in their tin boxes on their way to work (or those who make war in Iraq or in Israel, or We who poison the atmosphere, etc?) vis a vis the patients whom he interviewed with such empathy. Here’s what he goes on to say in this preface: “In the context of our present pervasive madness that we call normality, sanity, freedom, all our frames of references are ambiguous and equivocal.” (ibid., p., 11)

P.S. Laing, of course, gives typical sixties examples of contemporary ‘sanity’ like “better dead than Red” or “All men are machines” (what some scientists were and are still saying) while examples of the then current “madness” were persons who say “I have lost my soul” or “I am a Machine.” Laing was courageous to ask the question "Who is mad?" Where do we draw the lines between sanity and madness? Or again who is drawing the lines?

(To be continued)

Above I have pasted a picture I took of a sculpture the victims of the Irish Famine in Boston in March 2002. I think the pain represented in their features is similar to that of those mentally ill.

Monday, August 20, 2007

An Educational Interlude

Picking A Physicist’s Brains

I read, as I have always read, as the mood takes me and generally have about six books on the go at any one time – most likely a novel, a biography or autobiography, a psychology or psychiatry book, a collection of letters, a book on general science (very general) and a book in either Irish or Italian. I’ve been reading Richard P. Feynman’s book of collected letters called rather appropriately Don’t You Have Time To Think? on and off for the past few months. I have always been lucky to receive books as presents as well as buying them. This book was bought for me by a friend, Jackie Wogan, who is an SNA in our primary school. I am always particularly thrilled when I am the recipient of a rather well-chosen and particularly brilliant book. If you love letters or have even the slightest interest in physics you should buy this book.

What struck me about this book and I have previously quoted at length from it as regards its humanity, is its sheer integrity and honesty, especially as regards R.P.F. ’s commitment and devotion to his first wife whom he helped nurse as she died young from TB. Then the wit and humour and sheer humility of this man is breath-taking to say the least. With these letters one can cry and laugh out loud by turns.

However, here I wish to pick R. P. F.’ s mind as regards education which is my own field. I suppose that’s one of the few things I have in common with my subject – that we share an interest in the communication of ideas and in the formation of young and indeed old minds. Hence what follows represents some of the results of my random pickings!

(i) Everywhere in these letters one is confronted with Richard Feynman’s enthusiasm for his subject. This, to my mind, is one of the most important qualities any teacher at any level in our education system should have. I remember reading in Russell’s famous History of Western Philosophy a definition of enthusiasm as being “drunk with the very presence of God within oneself.” (This is a metaphor obviously, but is literally what en-thus-iasm means, i.e., en-god-ed as it were)

(ii) Follow Your Heart: This has long been one of my own pieces of advice to youngsters at school. Follow what you are interested in. It has always both amazed and alarmed me how some parents wish to live out their unfulfilled dreams in their offspring without a thought as to what their children wish to do in life. Here’s what R. P. F. says about the academic future of a friend’s 15 year old son: “He must have freedom to pursue his delight.” And to another young person he gave this advice: “Work hard to find something that fascinates you.” (Op.cit., p. x )

(iii) Think for Yourself. It took me a long time myself to learn this lesson. Way back in 1985 while I was working on a Master’s thesis my director said to me: “I don’t want to know what Dr. X or Y or Z thinks - I want to know what Tim Quinlan thinks. Brian MacNamara SJ was the proud possessor of many qualifications, and it was he who taught me to think for myself. As Timothy Ferris says in the wonderful introduction to Feynman’s book, R. P. F. had no time for the “sage on the stage” and often advised his students to follow their own thought processes and good clear logic not the statements of authorities no matter who they were. I loved this answer to a physics student which shows both R. P. F. ’s commitment to good logical thinking, his questioning of authority (even himself) and his sheer humility: “You should in science, believe logic and arguments, carefully drawn, and not authorities. You also read the book (The Feynman Lectures on Physics, Vol 2, Ch 5) correctly and understood it. I made a mistake, so the book is wrong… I goofed. And you goofed too for believing me.” (Op.cit., p. 290)

(iv) A Socratic Approach. Those of us who have even a little education in the rudiments of Philosophy and Logic will be acquainted with the Socratic approach to both argumentation and knowledge. It’s all about argument and counter-argument to find basic contradictions in any thesis proposed. (It’s rather like a form of cross examination of a witness in a court case).

(v) Socrates was a great needler or, as he called it, a gadfly. It did not win him any friends among the needled and in the end it backfired on him, as wisdom so often does on the wise when they come into contact with the foolish. And so he ended up with the cup of hemlock in his hand - proof that the mindless hath its reasons the mind knows not of but had better learn about if it wants to go on living. The greatest knowledge we can possess, Socrates maintained, the only knowledge that matters a damn, is the awareness of our boundless, fathomless ignorance, something his greatest disciple and diligent biographer Plato could never quite grasp, for all his obvious, peacock-like spectacle of brilliance. R. P. F. liked rejecting the easy answers similar to our friend Socrates. He was able to tolerate ambiguity and accept his own ignorance. “I can live with doubt and uncertainty,” he said on many occasions during his life and in many places in these letters. “I think it’s much more interesting to live not knowing than to have answers which might be wrong.” (op. cit., p. xi.) In 1963 he told a Senate audience that he felt a responsibility as a scientist to know “the great value of a satisfactory philosophy of ignorance." (op. cit., p. xi)

(vi) The importance of good intentions or motives. I have found that great scholars are mostly humble individuals, following naturally from the foregoing two points. Feynman was similarly a man of great humility and authenticity. He was well aware of his own shortcomings and often throughout these letters refers to the fact that he was not that good at languages and literature, but that he excelled in Math and Science. Typically he took the trouble to reply to amateur scientists, high school students and even “cranks” as long as their enquiries struck him as arising from honest intentions.

(vii) R. P. F believed in what we may term the Uncertainty Principle. The truth is neither simple nor clear. Sometimes I feel we should use the plural of this word, as the singular tends to mislead us into thinking that there is an abstract body of truth somewhere out there. Anyway, here is a nice quote from R. P. F. on truth in both the Sciences and in the Humanities: “truth in physics is rarely perfectly clear, and that is certainly universally the case in human affairs. Hence, what is not surrounded by uncertainty cannot be the truth.” (op. cit., p. 301 – in a letter defending the appointment of Dr La Belle as Caltech’s first tenured female professor (Professor of English).

(viii) Let education be a lifetime adventure. R. P. F. had interesting hobbies like safe cracking and playing the bongo drums. He also learnt to draw in his forties. All you adults out there take notice. You’re never too late to learn something new.

(ix) By playing games you learn. Michelle, his daughter, and editor of these lovely letters says this: “The household I grew up in was similarly unusual. We played many games. On camping trips, we would go to great lengths to put ourselves in the middle of nowhere…On Sunday mornings my father would often forego reading the newspaper in favour of a wild hour of loud, often discordant music, drumming, and storytelling with my brother and me.” (op. cit., p. xvii.)

(x) Have a laugh and plenty of fun while you work. Here’s Michelle again: “He showed us all how to look at the world. He showed me how to laugh. For that and for so much more, I thank him.” (op. cit., p. xxi)

(xi) A university like Princeton should be “an idea factory” (op. cit. p. 84). All universities should be this!

(xii) A positive pedagogy:People love to learn something; they are “entertained” enormously by being allowed to understand a little bit of something they never understood before. One must have faith in the subject and in people’s interest in it.” (op. cit., p 98, letter from 1955). There is much solid advice there for all teachers, whether they be young or old!

(xiii) On how to select people for jobs, academics even for lecturing posts or students for courses: “There is today, in my opinion, no science capable of adequately selecting or judging people. So I doubt that any intelligent method is known… a student who has been at the very top of his class for all his previous schooling, finding himself below average at Cal Tech may have a 2:1 chance to get discourages and drop out, for psychological reasons. No matter how we select them, half the students are below average when they get here.” (op. cit., p. 135.)

(xiv) Everybody’s good at something. In a letter to a friend about his son only getting a C in Physics R. P. F. wrote: “Do not be too mad at Mike for his C in physics. I got a C in English Literature. Maybe I never would have received a prize (Nobel) in physics if I had been better in English.” (op. cit., p 185).

(xv) Give as many subjects a say as possible, but don’t teach too much: “Science should not overwhelm the other subjects. Too much of a good thing will give everyone indigestion. Also, are we already in danger of a general crisis from teacher overload?” (op. cit., p. 216)

(xvi) Books are not Teachers: “I believe that a book should be only an assistance to a good teacher… Stay human, and on your pupil’s side.” (op. cit., p. 218)

(xvii) There is so much more than could be garnered from this wonderful book of letters, but I’ll finish here with his advice to a young prospective physicist: “The man happy in his work is not the narrow specialist, nor the well-rounded man, but the man who is doing what he loves to do. You must fall in love with some activity.” (op. cit., p. 229).