The Divided Self (Pelican) - R.D. Laing

"Everyone in some measure wears a mask..."

... only for those with schizotypal personality disorder the mask ceases to be a defence, it corrodes the fragile self of the sufferer, turns against its wearer and can ultimately lead to full schizophrenic psychoses.

I get the impression on reading this book that RD Laing was responsible for injecting some much needed humanity into mental health treatment back in the sixties. As a support worker in mental health today I find much of Laing's emphasis on the subjective experience of the sufferer as relevant and important, yes, but at the same time quite obvious. Anyone reading Thomas Paine's Rights of Man will have much the same reaction, that after so long and so much change much of the book's radical feel has been lost. But skip back to four or five decades before the term person-centred-care was thought up, back to a time when anything ostensibly incoherent from a patient was written off as merely the `symptom of a disease', then we can begin to feel thankful that at least someone in fifties Glasgow was paying attention to what Heidegger and Sartre were up to.

The book is split into three parts. The first defines the idea of ontological insecurity (the dread of implosion, engulfment or petrifaction a person's identity) and ways of approaching the patient as a person and not as clinical material. The second explores Laing's version of the false-self system, a fatal defence mechanism whereby a person will remove themselves to the bell jar in order to protect but ultimately starve what they consider their inner `true' selves; we find here examples of people who, though clearly disturbed, have not as yet lost their capacity for coherent action in the world. The third part attempts to reveal what it means when that coherency does break down.

Laing's position, that objectivity in this field is not only pointless but impossible, and his insistence on a therapeutic engagement with distressed people on their own terms, allows him to provide a persuasive narrative for the descent into schizophrenia. He shows that people do not simply `go mad', but that each patient contains a history detailing their own slow and involuntary self-destruction. The book reads as a descent by-proxy from the relatively minor condition of a man who can only enjoy imagining having sex with his wife (just to be clear, yes, he is getting some), to the final condition of the `dilapidated hebephrenic', in her own words "born under a black sun", who must be found out between her other fragment selves after nine years of abandoned consignment to the agitation wards of a psychiatric hospital. Laing has written as much a tragedy here as a psychology book, as much worth reading for its emotional impact as for the clarity of his theory. Definitely recommend it.

Very compassionate, but seems not very therapeutic

Laing's compassion for those currently mentally ill (and others), as found in this book and others by him, is powerful. It's very fortunate that he raised his voice (and wrote so well) about the coldness and at time inhumanity that can be found within psychiatry.

Existentialism may, in some hands, support healthy therapy but it seems it may also serve, as it seems to in this book, as:

a) a largely empty explanatory system, i.e. a rich set of concepts that enable one to create a great story about what is going on with someone, but a story that leads nowhere outside of itself. Satre's "Saint Genet" seems such an application, an interesting framework perhaps for a "biography" but layered in fictitious play.

b) a false comfort system that might lead troubled people to see themselves as an important part of some global battle against alienation ... instead of facing real immediate needs.

Getting a job may be more important than ecstasy. Taking a pill may be wiser than considering one's "false self" or going further on some great voyage toward transcendence. True, Laing has acknowledged the value of pills and the possibility of genetic/biochemical causes, but, as seen in this book, that was a very tiny part of his concern. What he wanted, this overcoming of the false self, this ending of violence seemed to have turned out to be largely orthogonal to the needs of many of the psychotic, for many of whom the right medication and daily routine has enabled them to enter the mainstream of society productively. Whether existence precedes existence was of no consequence to these people in getting well; now that they are, they can decide to what extent existentialism and Laing's vision counts. My impression is that, except for the great contribution he has made in encouraging compassion to them, his analyses matter very little and rightly so. It seems unfortunate that his great compassion (and writings on) got mixed in with his attempts to apply his existentialist notions, which tend to be very complicated.

Kingsley Hall, as described by Laing himself in interviews, was a compassionate start at providing humane mental health treatment, but seems to have been therapeutically a mess. Sartre seems vastly less effective than some of the growing number of anti-psychotic medications and it seems a great disservice to the many of the mentally ill to suggest otherwise. Despite some disclaimers, Laing, as in "The Divided Self" and "The Politics of Experience", seems to have done just that. He witnessed some terrible medical practices and he recognized they were so and called attention to that, but then he opted for mind games like existentialism and knots instead of providing practical guidance. "The Divided Self" is great in some ways and, for a young man of 28, forgiveable.

Nonetheless, "The Divided Self" seems a bad book for most anyone who is mentally troubled and it seems a bad book for most anyone who will be dealing with anyone mentally troubled. Boring practical choices made day to day seem infinitely more useful than such existentialist analysis and fantasies of transcendence.

Compassionate and Insightful

I am not in the medical profession, however, do struggle with my own and other family members' mental health problems. Until now, I had never read a description or analysis of the process of schizophrenia which seemed to be true of what I have personally witnessed. Laing has utmost regard for patients and a real interest in trying to understand them. Unlike most of the psychiatric world which is now hung up on diagnosis and categorisations above all else and at the cost of the individual's needs. I feel better equipped and more able to understand what mental processes the concept of schizophrenia is founded upon, and as such, less resistant to psychiatry in general.

An existential approach to the conception of the self

In this valuable study, Dr Laing proposes to examine the way some individuals are very proficient in acquiring a false self in order to adapt to false realities and to give an account of specifically personal forms of depersonalisation and disintegration. It is no small task for the therapist to articulate what the patient's "world" is and his way of being in it in order to outline his psychopathology. The author states that if we look at his actions as signs of a disease, we impose categories of thoughts on the patient in our effort to try to explain his mental state and it isn't easy for the therapist to transpose himself into the patient's strange and alien view of world in order to understand his existential position.
Dr Laing states that many patients suffer from "ontological insecurity" because they feel insubstantial, the ordinary circumstances of life constituting a continual threat to their own existence. He mentions personalities like Franz Kafka, Samuel Beckett and Francis Bacon. Then Dr Laing proceeds by giving the account of three forms of anxiety encountered by the ontologically insecure subject: engulfment, implosion and petrification. To illustrate these three forms, the author describes the case of Mrs R. who suffered from agoraphobia and schizohphrenic withdrawal.
Interestingly enough, the schizoid individual constantly feels vulnerable as he is exposed by the look of another person and that is why he fears live dialectical relationships with live people and prefers to relate himself to depersonalised persons or to phantoms of his own fantasies, thus the distinction between the "embodied" and "unembodied" self. Such an individual is afraid of the world, frightened that any impingement will be total and engulfing. He is afraid of letting himself "go", of coming out of himself or of losing himself because he feels that he will be depleted, exhausted, emptied, robbed or sucked dry. So for the schizoid individual, direct participation in life is felt as being at a risk of being destroyed by life. One aspect of this individual's ontological insecurity is the precariousness of his subjective sense of his own aliveness and the sense that others threaten this tentative feeling. The schizoid individual strongly believes in his own destructiveness by others. This view is in accord to the existentialist's philosophy represented by Jean-Paul Sartre who stated in his famous theatre play "Huis Clos" that "L'enfer, c'est les autres."
Thus a false self can arise in the individual which is in compliance with the intentions and expectations of the other or with what are imagined to be the other's intentions or expectations. Indeed, the self-conscious person feels he is more the object of other people's interest than in fact he is. And so the schizoid individual carries out defences like being like everyone else, being someone other than oneself, playing a part, being nobody or being incognito and anonymous. So if the gaze of others is experienced as a threat, there is a constant dread and resentment at being turned into someone else's thing (what Sartre called "l'être-pour-autrui"), of being penetrated by him, and a sense of being in someone else's power and control. Freedom then consists in being inaccessible. Love too for schizoid individuals is viewed as disguised persecution since it aims to turn him into an object of the other.
This type of individual can be himself in safety only in isolation. With others he plays an elaborate game of pretence and his social life is felt to be false and futile. But the more he keeps his "true self" concealed and unseen, the more he presents to others a false front and the more compulsive this fake presentation of himself becomes. This can lead to a complete disintegration of the personality.

A brilliant attempt at explaining how psychoses develop

I write this review as a psychiatric social worker. I have been doing this job for about 5 or 6 years and have discovered that the psychiatric system in this country basically reacts to people with schizophrenia as if all their remarks - which certainly often sound pretty strange - are unintelligible and without significant meaning. The more weird stuff a patient comes out with the more important it is to give them medication to block out the thoughts they are having.

In the training I had Laing was briefly discussed but no real attempt was made to convey the sense of his teaching. He suggests, as other reviewers have explained, that mental illness is intelligible, even logical, and by implication at least to some extent treatable with a genuinely therapeutic approach.

By the late 1970s Laing's work was being confidently dismissed by the psychiatric establishment but recently a lot of work has been done picking up the themes expressed in Laing. People might want to look at the work of Mary Boyle, Lucy Johnstone, and Romme and Escher. However no-one explains the process of going mad more convincingly than Laing in my view and to read him now is amazing because it seems to me in the profession now so few people even think of actually trying to understand schizophrenia.

Some of Doris Lessing's novels are also very good on the nature of madness - try 'The Four-Gated City'.