by Aaron Ross
Instructor: Tim O'Donnell
R. D. Laing's and Aaron Esterson's controversial book, Sanity, Madness and the Family, is an examination of the families of eleven mental patients diagnosed as being schizophrenic. The authors propose to enlighten the psychiatric community by rendering the symptoms of schizophrenic individuals socially intelligible. This, of course, is done by studying the relationships among the family members, and supposedly demonstrating that schizophrenics are not "talking a lot of nonsense."(1)
In so doing, the authors challenge not only the contemporary theory of schizophrenia, but the entire clinical viewpoint of modern psychiatry. They claim that the "shift of view that these descriptions embody has a historical significance no less radical than the shift from a demonological to a clinical viewpoint three hundred years ago."(2) (Italics theirs.) A bold statement, to be sure, but what justifies it?
In my opinion, Laing and Esterson have no basis on which to lay claim to such an achievement. In fact, they have not even really rejected the clinical method, but merely cloaked it. They have, in large measure, dispensed with clinical jargon in their book. However, this hardly constitutes a radical paradigm shift.
For example, the authors repeatedly state that they assume no pathology, organic, psychological, or social, to be in evidence. Yet they speak constantly of psychotic symptoms, and not only when presenting the "clinical attributions" of the patient's psychiatric record. They recount delusional thinking, ideas of influence, unconscious denial, et cetera, often placing these terms in quotation marks, as if that grammatical device could possibly disguise the clinical judgments being made.
How can such experiences as hallucinations and delusions not be pathological? Surely, the content of such experiences may be meaningful, but when there is an obvious and demonstrable discrepancy between reality and perception, there must be a disfunction in the physical and/or psychic apparatus which produces the distortion. Just because it makes sense does not mean that it is "normal," that nothing has gone wrong.
By rejecting the pathological model of mental illness, the authors undermine their own procedures and methods. In fact, the repudiation of the clinical viewpoint brings the entire study into question. If these people are not "ill," what is the need for therapy? Why interview them and write a book at all? If nothing is out of place, why interfere with the family nexus?
The stated intent of the study is to make schizophrenia "intelligible." This must mean the creation of a new theory of schizophrenia, an explanation of the process, especially in regard to the family. Yet in responding to criticism that their work is unscientific, Laing and Esterson deny that they seek to explain the phenomenon at all:
Such criticism would be justified if we had set out to test the hypothesis that the family is a pathogenic variable in the genesis of schizophrenia. But we did not set out to do so, and we have not claimed to have done so. We set out to illustrate by eleven examples that if we look at some experience and behaviour without reference to family interactions, they may appear comparatively socially senseless, but that if we look at the same experience and behaviour in their original family context they are liable to make more sense.(3)
This statement is an evasion. To avoid the charges of negligent scientific methods, the authors resort to diversionary tactics. Obviously, anything taken out of context is likely to have its meaning distorted. Placed in context, it will have a more coherent, intelligible meaning. What has been proved? Nothing.
In my opinion, the aim of this book is a reactionary one. Its intent is to disprove the traditional model of schizophrenia as a mental disease of genetic or organic origin. It fails to do so.
The flaws in the study are numerous, but the most glaring can be found in the selection criteria applied to prospective subjects. First, the study is restricted to women, with no explanation as to why. Second, the age limits are set between 15 and 40 -- childbearing age -- again, with no justification. Most important, the authors disqualify any individual "subject to any organic condition (e.g. brain injury, epilepsy)."(4) If the true intent of the study is to discredit the physiological theory of schizophrenia, then it can have no hope of doing so. By definition, all subjects are free from organic brain disorders. Therefore, they are free from organic brain disorders. This tautological argument is of course valid, but, again, it proves absolutely nothing.
The book and the "phenomenological viewpoint" it espouses are logically meaningless. Despite the internal consistency of the arguments concerning the undermining of perception by the psychotic individual's parents and the patient's subsequent inability to form a unified self, the book only shows that these particular people are not schizophrenic in the accepted sense. The extrapolation that this argument holds in every case is totally unjustified.
The entire structure of the is based on a false assumption: that "No generally agreed objective clinical criteria for the diagnosis of 'schizophrenia' have been discovered" -- or will be. The authors have provided us with a clear case of "garbage in, garbage out." They claim that "There are no organic structural changes noted in the course of the illness," and that "There is no general acceptance that any form of treatment is of proven value...."(5) In the 26 years since the publication of Sanity, Madness and the Family, these have been proven unequivocably false. How ironic that the authors ask that the book be read with a minimum of presuppositions, when they themselves bring so many false assumptions to bear.
(1) Laing, R. D., and Esterson, Aaron, Sanity, Madness and the Family. Penguin Books, London, 1987, p. 14.
(2) Ibid., p.27.
(3) Ibid., p.12.
(4) Ibid., p.15.
(5) Ibid., p.17.