Schizophrenia: A MENTAL DISEASE

-  A humanitarian perspective

 

Probably the most common mental disease is schizofrenia. There are many theories and opionions on the origins of the disease. Some psychiatrists regard it as a probably inhereted illness, others (e.g. the Scottish psychiatrist Ronald D. Laing) explain it predominantly in terms of a phenomenology of experience. 
   Traditional psychiatry tends to focus on the traditional signals or symptoms of schizofrenia (withdrawal, paranoid delusions, "hearing voices", feeling petrified (like a stone), being a robot/"operated by remote control", talking unintelligibly etc.) and perhaps explain them by referring to  biochemical anomalies in the patient's brain. This calls for drug treatment or shock treatment (ECT, electro convulsive therapy). Something is wrong with the apparatus of the mind. It must be "fixed" by the medical scientist. To Laing, the "delusions" of a schizofrenic are often understandable within the context of the phenomenology of that person’s experiencing the world

 

Ronald D. Laing

Ronald David Laing studied medicine at Glasgow University. He went to Gartnavel Royal Mental Hospital, Glasgow, to complete his psychiatric training. Here he started the "Rumpus Room", a comfortable room where staff and patients wore normal clothes and the patients were supposed to take part in "normal" daily activities of cooking and leisure. Laing started training as a psychoanalyst in 1958 and began research on schizofrenics and the families of schizofrenics at the Tavistock Clinic. In 1965 he opened the Kingsley Hall project as a commune setting for treating schizofrenics with his collaborators Aaron Esterson and David Cooper. With the former he published the book "Sanity, Madness and the family", which was a detailed research into the communication patterns of schizofrenics and their families. And with Cooper he published "Reason and Violence". Laing also experimented with the use of drugs, particularly LSD, as a method of treatment. He met Timothy Leary in New York in 1964. The Kingsley Hall Project closed in 1970.

Psychiatry and antipsychiatry

Ronald D. Laing wanted to treat mental patients in a new way. It was called anti-psychiatry. Laing rejected the traditional psychiatric approach to schizophrenia. In this approach the illness is seen within a traditional model of cause and effect. Instead he wants to look at the disease and the schizofrenics in a humanistic way that is inspired by phenomenological and existentialist philosophy:

When a psychiatrist diagnoses schizofrenia, he means that the patient’s experience and behaviour are disturbed because there is something the matter with the patient that causes the disturbed behaviour he observes. He calls this something schizofrenia, and he then must ask what causes the schizofrenia.

We jumped off this line of reasoning at the beginning. In our view it is an assumption, a theory, a hypothesis, but not a fact, that anyone suffers from a condition called "schizofrenia". (Sanity, Madness, and the Family, Preface to 2nd edition)

When the patient is considered a case wearing the label "schizophrenia", it is difficult to meet that person as another human being, and this is exactly what this particular mental disease calls for. It calls for a humanitarian approach rather than the approach of the test tube positivistic scientist.

It is nor uncommon for depersonalized patients, whether or not they are called schizophrenics, to speak of having murdered their selves and also of having lost or been robbed of their selves.

Such statements are usually called delusions, but if they are delusions, they are delusions which contain existential truth. They are to be understood as statements that are literally true within the terms of reference of the individual who makes them.

The schizophrenic who says he has committed suicide, may be perfectly clear about the fact that he has not cut his throat open or thrown himself into a canal, and he may expect this to be equally clear to the person whom he is addressing, otherwise that person is regarded as a fool. In fact, he makes many statements of this order, which may be expressly intended as snares for those he regards as idiots and the whole herd of the uncomprehending. (The Divided Self, Pelican Books 1965, p. 149)

It is not that easy to make a "scientific" (i.e. based on the positivistic tradition of experimental and biochemical medicine) diagnosis, according to Laing. Schizophrenia is also a cultural and societal phenomenon. The term "schizophrenia" is sometimes used to denote deviant behaviour. What is deviant, and what is normal? It varies in different societies. Also the definition of schizofrenia differs in various societies, i.e. the proportion of schizofrenics out of the total number of mental illness cases varies - not only in different societies, but also from one mental institution to another: "Even two psychiatrists from the same medical school cannot agree on who is schizophrenic independently of each other more than eight out of ten times at best; agreement is less than that between different schools, and less again between different countries." (Sanity, Madness and the Family, 2nd edition p. 12).

Sanity, Madness and the family

A schizophrenic then is a complex human being who is in complex interaction with his or her surroundings, and who is often more vulnerable than the majority of other human beings. Whether this is associated with biochemical changes is hard to prove. Very often it may be attributed to a family nexus with "victimizing" communication patterns and conflicting expectations from parents. When families may have this effect on the individual it is due to the fact that the loyalty within the family is so strong. Laing demonstrates this with the quotation ("The Politics of Experience and the Bird of Paradise". R.D. Laing 1967):

We are all in the same boat in a stormy sea, and we owe each other a terrible loyalty (G.K. Chesterton)

The family is viewed in a kind of systemic approach, in which the interdependence between the parts is vital. Very few investigations of families of schizofrenics have been based on direct observation of the members of the family. What interested Laing and Esterson was to develop a method that enabled them to:
    at the same time to study:
(1) each person in the family;
(2) the relations between persons in the family;
(3) the family itself as a system.

A family is a multiplicity of persons drawn from the kinship group and others who come in the family as friends or in other ways are regarded as part of the family. It is the family nexus that is the focal point of the investigation, i.e. the close-knit ties within the family and with the kinship members of it.
   It is within the family nexus that the forms of communication take place which may have disturbing consequences. One of the mechanisms that may lead to disease is the so-called double bind hypothesis.

 

THE DOUBLE BIND HYPOTHESIS

A little boy runs out of school to meet his mother:

1. He runs up to his mother and gives her a big hug. She hugs him back and says, 'You love your mummy?', and he gives her another hug.

2. He runs out of school; his mummy opens her arms to hug him, but he stands a little away. She says, 'Don't you love your mummy?' He says, 'No.' She says, 'Well, all right, let's go home.'

3. He runs out of school; his mother opens her arms to hug him and he stands away. She says, 'Don't you love your mummy?' He says, 'No.' She gives him a smack and says, 'Don't be cheeky.'

4. He runs out of school; his mother opens her arms to hug him and he stands a little way off. She says, 'Don't you love your mummy?' He says, 'No.' She says, 'But mummy knows you do, darling,' and gives him a big hug. (Self and Others)

This is probably a well-known scene from childhood. The attributions and the communication affect the child and the child's development in different ways. In the first case there are no hidden ambiguities. There is mutual confirmation. In the second case much depends on the non-verbal communication, which may -  or may not - invalidate the child's feeling of self. In the third case the child is treated as a separate being. The communication is governed by rules that do not invalidate the child's feeling of self. He knows where he stands. In the fourth case the mother attributes feelings to the son that dominates his own experience.

Of course it is easy to put the blame on the mothers. Some of the criticism of Laing says exactly this. However, Laing does not consider it proven that schizofrenia is caused solely by deplorable communication patterns in childhood, victimization of vulnerable members of the family nexus, etc. He does not rule out the potentiality of it being caused  by hereditary genetical factors as well.

Mental illness is in this view not like a computer breakdown in which a microchip is deficient and must be replaced. According to Laing, in traditional psychiatry mental patients are seen too much as objects. A label is put on the patient, and he or she is being treated accordingly. It is an open question whether much of the so-called "treatment" is actually treatment that will cure the patient of the disease. A more appropriate term might be: Alleviation of symptoms for a period while the appropriate drugs are used against that type of label. Perhaps the root cause of the disease is malfunctioning of the patient in his or her social environment.

 

 

 

 

 

 



 

 

 

 LINKS:

Artikel om skizofreni på dansk
En skizofren fortæller (på dansk)

Schizophrenia portal

History of lobotomy

Electroshock and psychosurgery (CCHR.org)

Stories of schizophrenics

A good schizophrenic weblob

Films: Milos Forman: One Flew over the Cuckoo's Nest
 Ken Loach: Family Life

The Ronald D. Laing Society

Antipsychiatry Coalition

Story of Syd Barrett - Pink Floyd

Syd Barrett lyrics

The transorbital lobotomy

Howard Dully receiving his "ice pick" lobotomy Dec. 16, 1960 (photos)

Sk