Sanity, Madness and the Family

R.D Laing, Aaron Esterson

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781315473871
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoanálisis

In the late 1950s the psychiatrist R.D.Laing and psychoanalyst Aaron Esterson spent five years interviewing eleven families of female patients diagnosed as 'schizophrenic'. Sanity, Madness and the Family is the result of their work. Eleven vivid case studies, often dramatic and disturbing, reveal patterns of affection and fear, manipulation and indifference within the family. But it was the conclusions they drew from their research that caused such controversy: they suggest that some forms of mental disorder are only comprehensible within their social and family contexts; their symptoms the manifestations of people struggling to live in untenable situations.

Sanity, Madness and the Family was met with widespread hostility by the psychiatric profession on its first publication, where the prevailing view was to treat psychosis as a medical problem to be solved. Yet it has done a great deal to draw attention to the complex and contested nature of psychosis. Above all, Laing and Esterson thought that if you understood the patient's world their apparent madness would become socially intelligible.

This Routledge Classics edition includes a new Foreword by Hilary Mantel.

Families

Family One
The Abbotts

Maya is a tall, dark, attractive woman of twenty-eight. She is an only child. Until she was eight she lived with her mother and father, the manager of a general store. From then until fourteen she was an evacuee with an elderly childless couple and from fourteen to eighteen when she was first admitted to hospital, she was once again with her parents.

She has spent nine of her last ten years in West Hospital.

Clinical Perspective

Maya’s ‘illness’ was diagnosed as paranoid schizophrenia. It appeared to come out of the blue. A report by a psychiatric social worker based on interviews with her mother and father described the onset in the following way:

Patient did not seem to be anything other than normal in her behaviour until about a month before her admission to hospital. She had of course been worrying about her school work, but the parents were used to this, and from past experience regarded her fears as quite groundless. One afternoon she came home from school and told her parents that the headmistress wished her to leave the school. Parents were immediately worried as they knew this was not right. Further, the patient reiterated this on other occasions. She then said that she could not sleep, and shortly afterwards became convinced that burglars were breaking into the house. A sedative was prescribed but the patient at first refused to take this. One night when she did so, she sat bolt upright in bed, and managed to stay awake in spite of the drug. She then decided her father was poisoning her, and one day ran out of the house and told a neighbour that her father was trying to poison her. Parents eventually found her and brought her home. She did not seem frightened of her father and discussed the matter quite calmly with him, but refused to be convinced that he was not trying to get rid of her. A doctor was called and advised that she have treatment immediately. Patient was more than willing to have treatment, and entered hospital as a voluntary patient.

Ten years later her parents gave us the same report.

In the past ten years her behaviour has given rise to clinical attributions that she had auditory hallucinations and was depersonalized; showed signs of catatonia; exhibited affective impoverishment and autistic withdrawal. Occasionally she was held to be ‘impulsive’.

Expressed more phenomenologically, she experienced herself as a machine, rather than as a person: she lacked a sense of her motives, agency and intentions belonging together: she was very confused about her autonomous identity. She felt it necessary to move and speak with studious and scrupulous correctness. She sometimes felt that her thoughts were controlled by others, and she said that not she but her ‘voices’ often did her thinking.

In our account, as we are not approaching our study from a clinical but from a social phenomenological perspective, we shall not be able to compartmentalize our inquiry in terms of clinical categories. Clinical signs and symptoms will become dissolved in the social intelligibility of the account that follows.

What we are setting out to do is to show that Maya’s experiences and actions, especially those deemed most schizophrenic, become intelligible as they are seen in the light of her family situation. This ‘situation’ is not only the family seen by us from without, but the ‘family’ as experienced by each of its members from inside.

Our fundamental question is: to what extent is Maya’s schizophrenic experience and behaviour intelligible in the light of the praxis and process of her family?

Structure of Investigation

Our picture of this family is based on the following interviews.

Interviews	Occasions
Mother	1
Father	1
Daughter	2
Daughter and mother	29
Daughter and father	2
Mother and father	2
Mother, father, and daughter	8
	__
	45

This represents fifty hours’ interviewing, of which forty were tape-recorded.

The Family Situation

Mr and Mrs Abbott appear quiet, ordinary people. When Maya was eighteen Mrs Abbott was described by a psychiatric social worker as ‘a most agreeable woman, who appeared to be friendly and easy to live with’. Mr Abbott had ‘a quiet manner but a kindly one’. He seemed ‘a very sensible man, but less practical than his wife’. There did not appear to be much that he would not do for his family. He had excellent health, and impressed the interviewer as ‘a very stable personality’.

Maya was born when her mother was twenty and her father thirty.

When his daughter was born, Mr Abbott had been reading of an excavation of a Mayan tomb. ‘Just the name for my little girl’, he thought.

Mother and father agreed that until sent away from home at eight Maya had been her daddy’s girl. She would wake him early in the morning and they would go swimming. She was always hand-in-hand with him. They sat close together at table, and he was the one to say prayers with her last thing at night. They frequently went for long walks together.

Apart from brief visits home, Maya lived away from her parents from eight until the age of fourteen. When she came home then to live permanently with them, they complained she was changed. She was no longer their little girl. She wanted to study. She did not want to go swimming, or to go for long walks with her father any more. She no longer wanted to pray with him. She wanted to read the Bible herself, by herself. She objected to her father expressing his affection for her by sitting close to her at meals. She wanted to sit further away from him. Nor did she want to go to the cinema with her mother. In the house, she wanted to handle things and to do things for herself, such as (mother’s example) washing a mirror without first telling her mother.

These changes in Maya, mentioned by her parents retrospectively as the first signs of illness, seem to us to be ordinary expressions of growing up. What is of interest is the discrepancy between her parents’ judgement of these developments and ours.

Maya conceived as her main difficulty, indeed her main task in life, the achievement of autonomy.

You should be able to think for yourself, work things out for yourself. I can’t. People can take things in but I can’t. I forget half the time. Even what I remember isn’t true memory. You should be able to work things out for yourself.

Her parents appear to have consistently regarded with alarm all expressions of developing autonomy on Maya’s part necessarily involving efforts to separate herself from them and to do things on her own initiative. Her parents’ alarm remains unabated in the present. For example, her mother objected to her ironing without supervision, although for the past year she had been working in a laundry without mishap. Mr and Mrs Abbott regarded their daughter’s use of her own ‘mind’ independently of them, as synonymous with ‘illness’, and as a rejection of them. Her mother said:

I think I’m so absolutely centred on the one thing – it’s well, to get her well – I mean as a child, and as a – teenager I could always sort out whatever was wrong or – do something about it, but it – but this illness has been so completely em – our relations have been different – you see Maya is er – instead of accepting everything – as if I said to her, er, ‘Black is black’, she would have probably believed it, but since she’s ill, she’s never accepted anything any more. She’s had to reason it out for herself, and if she couldn’t reason it out herself, then she didn’t seem to take my word for it – which of course is quite different to me.

‘Since her illness’, as they put it, she had become more ‘difficult’. She did not ‘fit in’ as she had done. The hospital had made her worse in this respect, although Maya felt that it had helped her to ‘use her own mind’ more than before. Using one’s own mind entails of course experiencing for oneself generally. What to Maya was ‘using my own mind’, and ‘wanting to do things for myself’, was to her parents ‘forwardness’ and ‘brightness’.

Until eighteen Maya studied hard, and passed all her exams. She took refuge, as she said, in her books, from what she called her parents’ intrusions. Her parents’ attitudes became highly equivocal, at one and the same time proud and patronizing, hurt in themselves and anxiously concerned for her. They said she was very clever, even ‘too clever perhaps’. They thought she worked too hard. She was getting no enjoyment reading all the time, so she had to be dragged away from her reading. Her mother said:

We used to go to the pictures in those days and I used to say eh – and sometimes she’d say, ‘I don’t think I should go to the pictures tonight, Mum, I think I should do some homework.’ And then I’d say to her, ‘Oh well, I’m disappointed,’ or that I’d made up my mind to go or something like that, or, ‘Well, I’ll go on my own,’ and then she’d say, ‘All right, I will come.’ She really had to be forced to go out, most of the time.

When Maya said that her parents put difficulties in the way of her reading, they amusedly denied this. She insisted that she had wanted to read the Bible; they both laughed at the idea that they made this difficult for her, and her father, still laughing, said, ‘What do you want to read the Bible for anyway? You can find that sort of information much better in other books.’

We shall now consider more closely certain recurring attributions made about Maya both by her parents and by psychiatrists.

For ten years she was described uniformly in psychiatric report after report as apathetic, withdrawn, lacking in affect, isolated, hostile, emotionally impoverished. Her parents also saw her in this way. She had been told by them so frequently since she was fourteen ...