Book Review: R.D. Laing and the Paths of Anti-Psychiatry

Do we need another book on R.D.Laing? Perhaps not, if such a book focuses once more - as at least three books have done recently - on the life story of this gifted and troubled man. What we do need is a thorough examination of the philosophical background of Laing's theory of psychotherapy which was hovering so uneasily - some may say, fruitfully - between psychoanalysis and existential phenomenology.

Zbigniew Kotowicz has not written such a book. He has, however, tried to put Laing's thinking and working into the context of similar attempts to break the stranglehold of mechanistic and medical approaches to mental disturbances in the US, Italy and Germany. Whether 'anti-psychiatric' is necessarily the best term for these protests remains questionable - though psychiatric organisations were the public battleground, the protest was directed, on the whole, against psychoanalysis as much as against psychiatry. The term 'anti-psychiatry' was used in this country by David Cooper, Laing himself rejected it. But whatever the name, here was a new way of looking at what was called 'mental illness'.

Whether there was an actual connection between the British, German and Italian anti-psychiatric protests does not emerge from Kotowicz's book. I am inclined to think that these reactions against an ossified and lifeless categorization of phenomena and experiences arose spontaneously - and, as often happens, simultaneously - in different minds and at different places and developed then in very different ways. In spite of differences, there were common aims: '... they all belonged to a shared platform of a fight against the institution, against the psychiatric diagnosis and for the restoration of legal, moral and human rights to those who were invalidated by the psychiatric machinery.' (p. 79)

This description of the anti-psychiatric attitude certainly characterizes the writings of the American psychiatrist and psychoanalyst Thomas Szasz. His book The Myth of Mental Illness was the most pointed and most widely known critique of psychiatric practice and institution. Szasz dissociated himself most decisively from the group around Laing and Cooper, and in Kotowicz's exposition the reasons seem to have been mainly political: Szasz attacked their left-wing leanings. But a more important difference seems to be that Szasz did not share the existential-phenomenological outlook of this group and remained firmly rooted in a Cartesian realm of dualism.

Both in Germany and Italy political elements dominated events. The rebellion - and it was no less - at Heidelberg University was inspired by a charismatic leader, Wolfgang Huber, who represented the interests of the patients against those of the staff. It soon turned into a naked power struggle between patients and authorities which was ruthlessly crushed. Huber as well as some of the patients had to serve prison sentences. The events are vividly described by Kotowicz, and though fairly unusual in the history of psychiatry, they are a striking example of the destructive effect a crude politicization can have on crucial human concerns.

The experiments of the psychiatrist Franco Basaglia in Italy took a very different course. With a group of other psychiatrists he first transformed a provincial hospital into an open institution, and was later asked to reorganize the local mental health services in Trieste. After seven years the central psychiatric hospital had been replaced by a network of mental health centres, and the gulf between population and patients had been bridged. This happened in a count where mental health laws had not been changed since the beginning of the century, and led to the introduction of new legislation which established full rights for patients and pronounced the need to dismantle psychiatric hospitals. This new law was called 'Basaglia's Law', and though its implementation was not as successful as had been hoped, Basaglia's ideas (which like Laing's were based on existential and phenomenological texts) found a realization which was perhaps unique. According to Kotowicz, Basaglia's main interest was 'society' response to madness' rather than the nature of madness itself. His aim was to play 'a part in liberating the patients from the oppression of the psychiatric institutions' (p.85).

Kotowicz concludes that the Heidelberg rebellion, Basaglia's reforms, and Kingsley Hall, Laing's short-lived experiment in community therapy, 'all belong in the universe of anti-psychiatry. They reflect different aspects of the movement.' He goes on to say that 'the outcome of these experiments also follows a course which in hindsight seems almost inevitable. In Germany it was violent confrontation; in Italy, due to the strength of the Communist party, there were far-reaching changes; in England the therapeutic community projects suffered the marginalization that charitable bodies invariably do' (p.86)

This judgement makes me feel uneasy. It is my impression that the way people look at psychological disturbance has subtly changed over the years, and that the ideas of Laing and his followers play a greater part in this change than can be easily shown. But this is another book on R.D.Laing which has not yet been written.

It is also necessary to see that none of these anti-psychiatric experiments are grounded in a consistent existential-phenomenological view of life. Kotowicz's narrative makes it very clear that Laing's commitment to such a view was at best erratic and never properly thought through. I sometimes wonder whether an existential phenomenology can ever arise from a stream of thinking which, from its Platonic beginnings on, put reality outside the realm of direct experience.

Hans W. Cohn