Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  Sarah’s parents, the Danzigs, Orthodox Jews, listen in to their daughter’s phone calls, secretly investigate the boys she goes out with. Her reading the Bible at night is translated as laziness, whereas the very fact of her thinking seriously worries them: ‘Sitting up all night thinking and not telling anyone what she thought. Not that we particularly want to know what Sarah’s thinking or doing, although it’s only natural that a mother should be curious…She’s thinking and thinking…It’s enough to twist anybody’s mind.’ Sarah’s mind was duly twisted.

  Not so very much had changed in cultural attitudes towards women’s intellectual work, it seems, from 1887 to the 1950s. Then, Charlotte Perkins Gilman, the now famous author of that document of women’s madness, The Yellow Wallpaper, and suffering from a postnatal depression, was finally released from Weir Mitchell’s rest cure only to be instructed to ‘Live as domestic a life as possible…Have but two hours’ intellectual life a day. And never touch pen, brush or pencil as long as you live.’

  Claire’s mother insists that she knows her daughter’s feelings better than she does. She mystifies Claire by constantly shifting her position on things, negates and muddles her meanings in conversation, so that nothing can be criticized or attacked. Her own omissions and hypocrisies destroy Claire’s inner world and render her speechless.

  Ruby has bangings inside her head and voices outside calling her ‘slut’, ‘dirty’. One moment she says her mother loves her, the next that she is trying to poison her. People lie on top of her at night to have intercourse with her, and she has given birth to a rat. Her sense of reality is in shreds. It turns out that two months before admission she has had a miscarriage. The family lives a texture of lies, hiding the fact of Ruby’s own illegitimacy from her, though everyone else knows: in this extended family ménage her biological father (who doesn’t live with them) is known to Ruby as Uncle; her mother as Mummy, her aunt as Mother, her Uncle as Daddy, her cousin as Brother. The family unite in trying to make her feel both ‘mad and bad’ when she perceives what is going on beneath the chatter about this ‘lovely family’ who are ‘really good’ to her.

  Ruth, twenty-eight, who has been hospitalized six times, was, according to her parents the Golds’ account, a happy, considerate, respectful, normal child, who had never posed any problems until her sudden and unaccountable breakdown at the age of twenty. She then became inexplicably uncontrollable, abusive, resentful, dressed ‘strangely’ and tried to ‘ape’ her brother who was a writer. The sum of these descriptions makes up what her parents and the doctors name as Ruth’s ‘illness’. It emerges that Ruth’s mother has secretly, and without admitting it to herself, stepped in to cut off Ruth’s first love affair in parallel with what her own mother had done to her sister, also named Ruth, many years earlier. The act resulted in the sister’s suicide. After her mother’s breaking up of her relationship, Ruth attempts to live a less limited, ‘bohemian’ life, not unlike her brother’s, but these attempts are labelled ‘illness’ by her family. While her account is being written, Ruth has returned home to live with her parents. When the interviewer asks her if she feels she has to ‘agree with what most of the people round you believe’, she answers, ‘Well, if I don’t, I usually land up in hospital.’

  The hospital or asylum was where many young women ‘landed up’ in these difficult decades of the fifties and sixties when doctors read normality off a code book that had strict and repressive rules for women. Both Sylvia Plath and Anne Sexton, who like Plath had a trajectory of psychiatric ‘illness’ and suicide, expose the way in which the existing limits of sanity disavow their own experience as women. In several of her early novels, where she charts histories of breakdown, Doris Lessing evokes madness as an appropriate response to an impossible situation. Breakdown is an honest reaction when life as it is lived at every turn contradicts both what people say is the case and the accepted rules of behaviour.

  But what was it about Laing’s own trajectory that made him so astute and radical a listener to the voices of these women, even if he never understood their experience as being particularly tied in with their gender?

  R.D. Laing (1927–89)

  R.D. Laing, whose widely read books–in particular, The Divided Self (1960), The Politics of Experience and the Bird of Paradise (1967)–catapulted him into being a hero of the counterculture, was born into the rough Glasgow neighbourhood of the Gorbals to lower-middle-class Presbyterian parents who seemed so astonished at his conception that his mother hid her pregnancy until just before Ronald David was due and went into a decline after his birth. His father was an electrical engineer and the principal baritone of the Glasgow University Chapel Choir. Paternal beatings, a cruel maternal discipline, sexual repression, together with a fastidious Puritanism in relation to food, characterized a childhood so difficult that perhaps without the recourse to music, avid reading and the attention of good teachers, Laing would have suffered the ‘schizophrenia’ of his later patients. For many years he shared a room with his mother, who insisted that she could read her child’s mind to fathom any lies–a claim he tested by lying. The ‘fear and trembling’ of this experience, the punishments meted out, are key to the existential fragmentation Laing evokes in The Divided Self. Parental denial of the child’s reality, ‘knots’, double binds and a kind of doublethink which claimed love where there was hate–what he later called a deep-programming against living–were part of the coercive and unloving atmosphere his mother created.

  But an adolescent Laing shored up childhood vulnerability with the rigours of philosophy, literature and the classics. He found heroes in the Dictionary of National Biography. This wide reading is evident in all his later books. Arguably not unlike Freud, his considerable literary gifts as a writer of harrowing scenes from family life and the inner adventures of the modern soul are key to the contagious spread of his ideas in the late sixties.

  After studying medicine at Glasgow University, Laing in 1951 began National Service and served as a lieutenant at the British Army Psychiatric Unit at Netley until 1953. There was a particular horror to the neurosurgical ward there. Patients had been placed into deep insulin comas, which narrowly avoided the epileptic fit the treatment could so easily induce. Since ‘light is extremely epileptogenic under a lot of insulin’, the ward was entirely blacked out and the stomach tubes through which the waking glucose would be poured had to be administered with only a torch strapped to the head. With patients whose veins were completely collapsed, finding the right target was hardly easy. The roots of Laing’s anti-psychiatry were firmly laid down during these years: the patients he treated here, the padded cell in which he spent the night in trying to understand a patient, Peter, whom he took home with him, despite the diagnosis of schizophrenia, so as to save him from ECT, made their way into his first book.

  From 1953, Laing completed his psychiatric training in the women’s wards of the Gartnaval Royal Mental Hospital. Here he experimented with a special ‘Rumpus Room’–an early version of Kingsley Hall–in which refractory patients could both be quiet and receive more attention as well as participate in activities–knitting, drawing, music. Both his early postings underlined for Laing the radically dictatorial powers psychiatrists had over their patients’ lives as well as the paradox, from the patients’ side, of treatments that could be both feared and sought.

  In his final book Wisdom, Madness and Folly, part memoir, part reflection on psychiatry, Laing returned from his wilder views of madness as psychedelic prophecy to reflect on the problems of his profession. Psychiatry is unique, he noted, in that it treats people physically in the absence of any known physical pathology, often treats them against their will, and imprisons them if it judges necessary. Yet who is to fulfil a function that society wants fulfilled, if not the psychiatrist?

  It is not easy. What do we do when we don’t know what to do? I want that guy out of sight, out of sound, out of mind…The situation keeps cropping up in our society, when, no matter how liked, esteemed or l
oved, some people become insufferable to others. No one they know wants to live with them. They are not breaking the law, but they arouse in those around them such urgent feelings of pity, worry, fear, disgust, anger, exasperation, concern, that something has to be done. A social worker or psychiatrist is ‘brought in’.

  There is a ‘consumer demand’ for the service psychiatry provides, Laing notes in the language of the eighties. If psychiatrists don’t perform it, the police or some other body will. But if the psychiatrists take on the task of changing ‘undesirable states of mind and forms of conduct into less undesirable or even desirable ones’, the point has to be to do so humanely.

  Laing decided he would not do to patients what he wouldn’t want done to himself. The politics of humane relationship needed to enter the psychiatric hospital, where violence, in the name of cure, and an authoritarian medical structure inflicted the very condition it intended to treat. Diagnosis itself, as Laing describes so powerfully in his first book The Divided Self, prevented apt treatment: ‘in his eagerness to find signs and symptoms, the psychiatrist has not time to simply try and understand the patient’.

  For Laing, the schizophrenic patient is someone who has never been born into full existence: she is ‘ontologically insecure’, terrified that the world will implode or that she will turn to stone, and so hides her frightened, chaotic true self, instead offering to the world a compliant, ambassadorial, false self.

  The Divided Self ends with Laing leaving his post as Senior Registrar at the Southern General Hospital to take up a job at the Tavistock Clinic and to train at the Institute of Psychoanalysis. Here his analyst was Charles Rycroft, who later chortled that, for all Laing’s anti-psychiatry, he himself had resigned from the British Psychoanalytical Society long before his famous analysand. Laing’s training supervisors were Marion Milner and Donald Winnicott. The influence of Winnicott’s writings on Laing is everywhere evident in The Divided Self, which Laing sent to Winnicott before its eventual publication with a letter noting that in describing the transition from ‘a sane to a mad way of being in the world’ he had drawn his ‘inspiration largely from your writings’.

  Despite this and for all his evident brilliance, Laing was never wholly accepted by an increasingly conservative British Psychoanalytical Society: there was malaise over his more radical pronouncements, even though Laing’s initial anti-psychiatry was fed from within their own ranks. Indeed, the training committee itself was split over Laing’s qualification: for all his knowledge, they felt ‘Dr Laing is apparently a very disturbed and ill person and wondered what the effect of this obvious disturbance would be on patients he would have to interview’. Laing’s later experiments with the hallucinogenic LSD with patients, as well as his problems with drink in the last decade of his life, may well have fulfilled the worst fears of the conservatives on the committee. But during the sixties and early seventies, while the Vietnam War raged and the counterculture grew, the potency of Laing’s analysis made of madness a radical politics. The ‘psychedelic psychiatrist’ who thought of schizophrenia as a kind of epiphany, far superior to normal experience, became a prophet of that counterculture.

  In 1962, while on a research visit to the United States, Laing met the Cambridge anthropologist Gregory Bateson, whose ideas on the double bind fed directly into his thinking on the genesis of schizophrenia. Since 1956, Bateson had been publishing papers on a specific pattern of disturbed communication in which one member of the family is subjected to a pair of conflicting injunctions, or ‘binds’, in a situation from which there is no escape. For example, the mother persistently repeats that sweets are bad for the child, but offers them as rewards. The child loses out in both instances. Choices in double binds are always part of a lose–lose game. The child begins to avoid interaction and to lose confidence in the validity of her own perceptions. The groundwork for schizophrenia is laid down.

  On Laing’s return from America, an anti-psychiatry group coalesced. It included the South African psychiatrist David Cooper, with whom Laing was to write Reason and Violence, an introduction to Sartre’s philosophical thinking; the American, Joseph Berke, and Aaron Esterson, a fellow Glaswegian. All were hospital doctors who found work in the existing mental health system demoralizing. They formed themselves into the Philadelphia Association and established, in 1965, an alternative: an anti-psychiatry unit in Kingsley Hall in London’s East End. Here, instead of the shock and drug treatment the hospitals provided, patients could in theory travel back to childhood and reforge the early experience which had left them psychically maimed, in order to become creative adults.

  From a speech delivered at London’s Institute of Contemporary Arts in January 1964, it becomes clear that Laing’s thinking had evolved. The illness of the times was normality, not schizophrenia. He was now the guru of an age in which madness was the signal of a revolutionary strategy.

  From the moment of birth, when stone-age baby confronts the twentieth-century mother, the baby is subjected to forces of outrageous violence, called love, as its mother and father have been and their parents and their parents etc, mainly concerned with destroying most of its potentialities. This enterprise on the whole is successful. By the time the human being is 15 or so, we are left with a being like ourselves. A half-crazed creature, more or less adjusted to a mad world. This is the normality of our age.

  In this new understanding, schizophrenia was no longer a psychiatric condition, an illness produced by a disabling family life, but an indictment of the ‘one-dimensional’ imperialist world’s violence and limitations which repressed both sexuality and transcendence. Schizophrenia was a stage in a psychic healing process. It contained the hope of an entry into a mystical ‘hyper-sanity’.

  Kingsley Hall was the sympathetic space in which the cyclical voyage which led to an existential rebirth could take place. The Hall’s star patient, Mary Barnes, was a veteran of psychiatric hospitals, something of a career patient who had been subject to ECT and drug treatment time and again. She had applied for and been refused analysis with Anna Freud. Under Dr Joseph Berke she regressed to nappy-wearing infancy, created her famous ‘shit paintings’, smearing her faeces over the walls of the increasingly chaotic but internationally infamous Kingsley Hall, only to re-emerge from the ardour of the anti-psychiatry cocoon as the artist she had always wanted to be. The story of her case, written in two versions within one book by Berke and herself, is an instance of the new democracy of anti-psychiatry.

  Laing and his colleagues destigmatized madness for the sixties and gave it the cachet of a rite of passage for troubled souls. Schizophrenia became an intelligible response to harrowing existential conditions, nurtured in the family and in a troubled society. In two of Doris Lessing’s novels of the period, The Golden Notebook and The Four-Gated City, breakdown and madness function as radical stimulants to new insight. Madness provides an alternative way of seeing to be set against the cold, repressive world of Establishment normality. The doctors’ antipsychotics–aimed at inducing a zomboid, controllable normalcy–are to be rejected at all costs.

  But Laing’s therapeutic practice was more problematic than literary versions of journeys into madness could suggest. Kingsley Hall might be a site where the disturbed could ‘safely get in touch’ with their earliest selves and supposedly come out the other end, after a not illiberal quantity of hallucinogenics were imbibed by both doctor and patient. But the wild tripping was rarely as safe as all that. In fact, it was often downright dangerous. It could provoke ugly behaviour and encourage breakdown–as the original of Anna Wulf’s American lover in The Golden Notebook, Clancy Sigal, learned and later evoked in his satirical novel Zone of the Interior. Sigal had initially gone to Laing for a conventional analysis to overcome his writer’s block. He had followed Laing to Kingsley Hall and fled in the midst of a drug-exacerbated breakdown. Zone, deemed libellous by publishers, remained unpublished in Britain for years. Sigal’s Meditation Manor is an unruly and dangerous place: its charismatic head is a tr
ipping, irresponsible, egomaniacal Dr Willie Last. Its schizophrenic ‘existential guerrillas’ are fought over while doctors, oblivious to yet-to-be-invented sexual politics, vie for the most attractive patients, while Mary Barnes, the real-life schizophrenic star, lives in a corrugated tin tank in the cellar of Kingsley Hall where her nursing includes regular hosing down.

  Laing himself moved off the premises before the end of the Hall’s five-year lease, which was not renewed. The experiment was not one to be replicated. But the experience led to the creation of a series of halfway houses, alternatives to asylums, safe points on the way out of institutionalized life for schizophrenic patients still needing attention. Indeed, such halfway houses held out the promise of more humane treatment and a partial integration into society. Once the asylums began to shut down in the seventies, these halfway houses could have benefited from an expansion which sadly never took place, though Laing’s colleague Aaron Esterson created the model Arbours Association, which still runs three houses.

  The shutting down of asylums in Europe and in the USA had as much to do with government cutbacks and a general attack on outmoded institutions as with a specific anti-psychiatric impetus. Most important to their demise, however, was the contemporaneous rise of new drugs such as the antipsychotic chlorpromazine (Thorazine) and the mood stabilizer lithium used in manic depressive illness, or bipolar disorder. These could keep the most visible signs of madness–psychotic mania–under control. Treating madness through outpatient centres was now a real possibility.

  After an initial use by Henri Laborit at the Val de Grâce Military Hospital, the first to pioneer chlorpromazine was the Sainte-Anne in Paris, where Jacques Lacan and Clérambault had worked. Henry Ey, its head and founder in 1950 of the World Psychiatric Association, together with Jean Delay, inventor of the term ‘psychopharmacology’, and Pierre Deniker introduced it to patients here in 1952 and found that it calmed mania and returned reason. Testing its efficacy on nine patients, they discovered chlorpromazine to be far superior to ECT and insulin and less dangerous. By 1953, a psychiatric revolution was under way. In a moment as radical as the one in which Pinel had relieved patients of chains, the howls and the straitjackets of the mental ward became things of the past.