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Vincenzo Di Nicola
MPhil, MD, PhD, DLFAPA, FCPA, FCAHS
Conflicts of Interest
 The author has no financial conflicts of interest to
declare.
Educational Objectives
By attending this presentation, participants will have the
opportunity to improve competence or performance by learning
about …
 The philosophical grounding of Ronald David Laing’s work in
psychiatric phenomenology and the existentialism of Jean-
Paul Sartre.
 An introduction to J.-P. Sartre’s existential psychoanalysis
and how it differs from Freudian psychoanalysis.
 R. D. Laing’s legacy in the psychotherapeutic treatment of
schizophrenia.
Seminar Plan
 Is the psychotherapy of the mental suffering we call
schizophrenia possible?
 R. D. Laing is arguably the figure most associated with
opening this question, so how did he come to grapple
with this question?
 To answer this, we must open a series of questions –
from how to understand schizophrenia to the history of
its treatment in psychiatry and psychoanalysis.
Seminar Plan
 The philosophical grounding of Ronald David Laing’s
work in psychiatric phenomenology and the
existentialism of Jean-Paul Sartre.
 An introduction to Jean-Paul Sartre’s existential
psychoanalysis and how it differs from Freudian
psychoanalysis.
 R. D. Laing’s legacy in the psychotherapeutic treatment
of schizophrenia.
Schizophrenia
“The Sublime Object of Psychiatry”
Reference: Woods, A. (2011). The Sublime Object of Psychiatry: Schizophrenia
in Clinical and Cultural Theory.
Image of Madness
in the age of reason
Source: Étienne Esquirol (1838)
Patient in mechanical restraints
replacing chains at the Bicêtre
Esquirol – mental illness found in
the “passions of the soul” and
does not completely affect the
reason
The Bethlem Royal Hospital
London, England
The Bethlem Royal Hospital
 New Order of Our Lady of Bethlehem, London, England
 775 years old – founded 1247 AD
 On its fifth site – over the years Bethlehem was
contracted to Bethlem, corrupted in common parlance to
“Bedlam” (meaning madness or chaos)
 This lithograph is of the third site – now the Imperial War
Museum
 The joke is that it went from one form of madness to
another
The Weighing House (1763)
William Hogarth
Schizophrenia
 Eugen Bleuler – coined the term “schizophrenia” (1907-1911)
 Karl Jaspers – empathic chasm – “the worm in psychiatry’s
apple”
 Kurt Schneider – “pathognomonic symptoms”
 Gregory Bateson – “double-bind theory of schizophrenia”
(1956)
 Silvano Arieti – Interpretation of Schizophrenia (1955, 1974)
 R. D. Laing – “a perfectly rational adjustment to an insane
world”
 Mara Selvini Palazzoli – “families in schizophrenic transaction”
Social Science Contributions to the
Understanding and Treatment of Schizophrenia
 Norman Cameron – sociologist
 “The paranoid pseudo-community” (1943, 1959)
 Gregory Bateson – anthropologist
 “The double-bind theory of schizophrenia” (1956)
 “a metaphor that is meant”
 “Manzanita Wood” – Man’s an eater (if conditions were right,
he) would
 Erving Goffman – sociologist
 “The asylum as a total institution”
 Cf. Asylums (1961), “The Place of insanity” (1969)
 Michel Foucault – psychologist/philosopher/historian
 “Madness in the age of reason”
Social Science Contributions to the
Understanding and Treatment of Schizophrenia
 Angela Woods – historian, lecturer in Medical
Humanities at Durham University, UK
 The Sublime Object of Psychiatry: Schizophrenia in
Clinical and Cultural Theory (2011)
 A contested diagnosis in psychiatry and a metaphor
for cultural theorists
 Examines representations of schizophrenia across a
wide range of disciplines and discourses:
 biological and phenomenological psychiatry,
psychoanalysis,
 critical psychology, antipsychiatry, and
 postmodern philosophy
Psychoanalytic Contributions to the
Understanding and Treatment of Schizophrenia
 Early Theorists
 Eugen Bleuler – coined the term “schizophrenia” (1911)
 four A’s – affect, autism, ambivalence, associations
 positive and negative symptoms
 Viktor Tausk – “the influencing machine” (1919)
 Paul Federn – “psychoanalysis of the psychoses” (1952)
Psychoanalytic Contributions to the
Understanding and Treatment of Schizophrenia
 Elaborations
 Jacques Lacan – neuroses, perversion, psychoses
 “man is the subject captured and tortured by
language”
 psychosis is a special but emblematic case of
language entrapment
 Frieda Fromm-Reichmann – roots in early childhood
experiences
 John Rosen – “direct analysis”
Jacques Lacan
(1901-1981)
« L’inconscient est structuré comme un langage »
Psychoanalytic Contributions to the
Understanding and Treatment of Schizophrenia
 Major Theorists
 R. D. Laing – “the divided self”
 roots in the family which I call the “crucible of experience”
(Di Nicola, 1997)
 “a rational adjustment to an insane world”
 “mystification, invalidation, ontological insecurity”
 aliases of the divided self are the split self and the false self,
echoed in Sartre’s notion of authenticity vs. bad faith
Reference: Laing, R. D. (1960). The Divided Self: An Existential Study in
Sanity and Madness.
Di Nicola, V. (1997). A Stranger in the Family: Culture, Families, and
Therapy.
Psychoanalytic Contributions to the
Understanding and Treatment of Schizophrenia
 Major Theorists
 Silvano Arieti – “interpretation of schizophrenia”
 “meeting the schizophrenic in their own world”
 psychological aetiology, family disturbance
 psychotherapy aims to create a new, healthier, more
adaptive personality, the psychotherapist is a guide
Reference: Arieti, S. (1974). The Interpretation of Schizophrenia.
(Winner of the National Book Award)
Psychoanalytic Contributions to the
Understanding and Treatment of Schizophrenia
 The core construct of schizophrenia has undergone a
radical revision since its first “construction”
 The pioneering innovations of psychoanalysts like R.
D. Laing and Silvano Arieti – the latter being one of
the founders of this group (AAPDPP) – appear
increasingly prescient
 They are being vindicated for their insights, courage
and humanistic visions
Schizophrenia
 The stakes:
 Schizophrenia is understandable psychologically
 Arieti, Bateson, Laing – versus Freud’s claim
 We can empathize with schizophrenic experiences
 Arieti, Laing – versus Jaspers’ claim
 Schizophrenia is rational
 Laing’s claim – is it?
“Psychiatry Against Itself”
Reframing Anti-Psychiatry
Reference: Di Nicola, V. (2021). The end of psychiatry. In Psychiatry in
Crisis.
Four Psychiatrists
 Four notable 20th century Western psychiatrists who
criticized their field, contributing to a redefinition of
psychiatry:
 Ronald David Laing (1927-1989) – a psychiatric & social
radical
 Jacques Lacan (1901-1981) – a psychoanalytic rebel
 Franco Basaglia (1924-1980) – a psychiatric reformer
 Frantz Fanon (1925-1961) – a political revolutionary
Reference: Di Nicola, V. (2021b). The end of psychiatry.
Frantz Fanon
R. D. Laing
Jacques Lacan
Franco Basaglia
Ronald David
Laing
(1927–1989)
Ronald David Laing
 Scottish psychiatrist-psychoanalyst
Ronald David Laing is known for his
pioneering studies in the tradition of
psychodynamic psychiatry (Ellenberger,
1970) of the alien and alienating
experiences that are known under the
rubric of schizophrenia (Woods, 2011)
 References: Ellenberger, H.F. (1970). The Discovery of the
Unconscious: The History and Evolution of Dynamic
Psychiatry.
 Woods, A. (2011). The Sublime Object of Psychiatry:
Ronald David Laing
(1927-1989)
 R. D. Laing was a radical psychiatrist-psychoanalyst
who returned psychiatry to its clinical roots
 Incisive critiques of Ludwig Binswanger’s
Daseinanalyse, existential analysis, and psychiatric
practices in general
 Appealing to social phenomenology and negating
the mystification of mental illness
 Placing the suffering of the self in social, familial,
and political contexts
What Is Social Phenomenology?
 “… R. D. Laing’s contribution to the understanding of
the mind operates in a field that can be broadly
characterized as empirical interpersonal
phenomenology, which is a branch of social
phenomenology.”
 “The philosophical foundations of a ‘dialogal
knowledge’ have not so far been comprehensively
and systematically laid down … the very possibility of
persons is hardly conceivable other than as ghosts of
a category already dépassé.”
 “… the problems of method are as vexing as they are
unresolved.”
References: Laing, R.D. (1987a). Ronald David Laing. In: R.L. Gregory, ed.,
The Oxford Companion to the Mind.
Social Phenomenology
 “Nevertheless, Laing has studied various facets of
very disturbed and disturbing personal relations.”
 “The attribution of the absence in the other of the
capacity to form good enough personal relationships
is the basis for the diagnosis of schizophrenia. This
diagnosis is both an attribution (he is incapable of
forming a personal bond; he is cut off) and a causal
theory to account for this attribution (the reason he is
cut off is because he is suffering from a mental or
physical illness).”
Social Phenomenology
 “In The Divided Self Laing construed this attribution as a
function of an extremely disjunctive relationship between the
person who is in the role of a depersonalized – and
depersonalizing – diagnosing psychiatrist and the person who
has become a depersonalized, and sometimes
depersonalizing, diagnosed patient.”
 “This construction is a contribution towards a personal
understanding (Verstehen) of what is going on between
psychiatrist and patient, in contrast to a scientific explanation
of what is going on in the patient alone. In fact, [Laing] offered
a personal understanding of the psychiatrist’s scientific
explanation and construed it as, unwittingly, a way of cutting
off the cut-off person from the possibility of reunion and
renewal.”
Social Phenomenology
 “The psychiatric, diagnostic look is itself a
depersonalized and depersonalizing cut-off look.”
 “To understand what is going on in and between
people it is necessary to place the interpersonal
happenings within their social context.”
Social Phenomenology
 “When the psycho-social interior of the families of
schizophrenics was looked at from the twin
perspective of praxis and process [from Sartre’s
work], instead of looking at the schizophrenic alone,
it appeared that those experiences and actions
which are regarded as signs and symptoms of a
pathological process within one individual were
much more socially intelligible than they had been
taken to be by most psychiatrists.”
References: Laing, R. D. (1987a). Ronald David Laing. In: R. L.
Gregory, ed., The Oxford Companion to the Mind.
Laing in Action
 Do we have access to Laing’s actual methods?
 Yes, like Freud, Laing’s reputation is largely built on the
narrative force of his case reports
 “Julie”: “The ghost of the weed garden” in The Divided Self
 Suffering from schizophrenia, hearing voices, struck postures,
mainly mute since age 17
 1954: 180 sessions, 250 hours
 Laing struggled with whether psychosis was understandable
 Laing’s conceit: The patient as mentor to the psychiatrist
 Reference: Laing, R. D. (1960). The Divided Self: An Existential
Study in Sanity and Madness.
Laing in Action
 Do we have access to Laing’s actual methods?
 Laing elaborated his thoughts and working methods in other ways:
 critiques of other psychiatrists, including Karl Jaspers and
Ludwig Binswanger
 stories of his own training and practice
 his own family and autobiography
 Opening lines of the 1968 Massey Lectures:
“The first family to interest me was my own. I still know less
about it than many other families. This is typical.”
 Reference: Laing, R. D. (1969). The Politics of the Family. Massey
Lectures 1968
Schizophrenia
 The stakes:
 Schizophrenia is understandable psychologically
 Arieti, Bateson, Laing – versus Freud’s claim
 psychological
 We can empathize with schizophrenic experiences
 Arieti, Laing – versus Jaspers’ claim
 humanistic
 Schizophrenia is rational
 Laing’s claim – is it?
 political
Jean-Paul
Sartre
(1905-1980)
Jean-Paul Sartre
(1905-1980)
 As a writer, Sartre’s most famous phrase was,
“Hell is other people”
 No Exit (1944/1946)
 As a philosopher, Sartre’s most famous assertion was,
“Existence precedes essence”
 Existentialism Is a Humanism (1946/1948)
 Sartre limned a theory of the emotions and called for an
existential psychoanalysis, rejecting the Freudian
unconscious
 Sketch for a Theory of the Emotions (1939/2002)
 Being and Nothingness (1943/1956)
Jean-Paul Sartre
 Sartre called for an existential psychoanalysis, rejecting the
Freudian unconscious
 Being and Nothingness (1943/1956)
 Rejected the notion of the unconscious – why?
 Due to his radical belief that we are “condemned to
freedom”
 Reference to internal or external constraints was “bad faith”
 Yet, how can a psychoanalyst employ a model that denies
the unconscious? And did Laing confront this question
directly?
Jean-Paul Sartre
 Sartre’s (1943/1956) call for an existential
psychoanalysis “had not yet found its Freud”
 R. D. Laing is precisely that figure
 We could say that Laing externalized the
unconscious, understanding internal processes
through interpersonal relationships
 (Cf. “the relational turn” in PsyA, Stephen Mitchell,
Sabina Spielrein)
References: Sketch for a Theory of the Emotions (1939/2002)
 Being and Nothingness (1943/1956)
Laing’s Contributions to the
Understanding and Treatment of
Schizophrenia
 Laing was the psychiatrist who brought Sartre’s
vision to the clinic, as Sartre later acknowledged
(Sartre, 1964; cf. Cannon, 1991)
References: Sartre, J.-P. (1964). Foreword. In: Laing R. D., & D. G.
Cooper, Reason and Violence – A Decade of Sartre’s Philosophy, 1950-
1960.
Cannon, B. (1991). Sartre and Psychoanalysis: An Existentialist Challenge
to Clinical Metatheory.
I am convinced that your efforts will bring us closer to the
day when psychiatry will, at last, become a truly human
psychiatry.
– J.-P. Sartre (1964)
Source: Stohlman-Vanderveen & Di Nicola (2021)
Source: Stohlman-Vanderveen & Di Nicola (2021)
Laing’s Contributions to the
Understanding and Treatment of
Schizophrenia
 Influenced by Sartre, Laing has given us such terms
as:
 mystification (a direct invocation of the Marxian term),
 invalidation (a clinical translation of the core Marxian
trope, alienation), and
 ontological insecurity (from the phenomenological
tradition)
 Laing called his approach social phenomenology
(Laing, 1987b).
References: Laing, R. D. (1987a). Ronald David Laing. In: R.L.
Gregory, ed., The Oxford Companion to the Mind.
Laing, R.D. (1987b). The use of existential phenomenology in
Laing’s Contributions to the
Understanding and Treatment of
Schizophrenia
 Laing claims, in part, that schizophrenia is rational
 Yet, it’s neither rational nor reasonable
 Something doesn’t have to be rational, reasonable or
functional for us to understand it or even to
empathize with it (cf. Arieti, 1974)
 This is a version of the fact/value distinction –
is/ought – ought cannot be derived from is – David
Hume (1739)
 Slippery slope from observation to description to
explanation to justification
Conclusion:
Laing’s Legacy
 In his Very Short Introduction to Psychiatry, Tom Burns
referred to Laing’s social phenomenology with a
dismissive “Don’t ask.”
 Laing’s work on the families of schizophrenics triggered
research at the Institute of Psychiatry on expressed
emotion (EE) and related research (cf. Clare)
 Whether it was ultimately quixotic or romantic, Laing
asked critical questions about the validity of the concept
of schizophrenia (tension between a biological
intervention for a phenomenological observation) – what
he called a “false epistemology”
References: Laing, R. D. (1987a). Ronald David Laing. In: R.L. Gregory, ed., The
Oxford Companion to the Mind.
Laing, R. D. (1987b). The use of existential phenomenology in psychotherapy. In:
J.K. Zeig, ed., The Evolution of Psychotherapy.
Conclusion:
Laing’s Legacy
 He validated the phenomenological experience of
alien and alienating experiences and tried to make
sense of them with respect and dignity in the
interpersonal contexts of family and society
 Thus, opening the possibility of the psychotherapy of
psychosis/schizophrenia
 He anticipated today’s approach to peer helpers,
lived experience, and sufferers to be on ethical
boards and research teams in psychiatry
 He is part of the history of phenomenological
psychiatry, humanistic psychiatry, and family therapy
Conclusion:
Laing’s Legacy
 The neglected legacy of Laing’s thought
 His contribution to social theory and a social
understanding of such processes as paranoia (Scott &
Thorpe, 2006)
 He was squarely in the tradition of critical psychiatry,
critiquing it and calling for change without rejecting the
profession altogether, going so far as to insist that he was
an “orthodox psychiatrist” rather than an anti-psychiatrist
 Laing brought that critical tradition to the professions of
psychiatry and psychoanalysis as well as to a wider
public with greater reach than any psychoanalyst since
Freud himself (Friedenberg, 1973; Beveridge, 2011; Di
Nicola, 2021a, 2021b)
Conclusion:
Laing’s Legacy
 Did Laing achieve his goals? Let’s follow the titles of
his books …
 The Divided Self, Self and Others, Knots
 The Divided Self is brilliant while Self and Others
continues to explore how the self fragments and gets
caught in the “knots” of interpersonal relations –
similar territory to Melanie Klein’s splitting and
projective identification
 What this means is that you can put madness on the
couch – and understand it through a dialogue with an
individual suffering with it
Conclusion:
Laing’s Legacy
 What he doesn’t achieve is the third step –
integration, health, ‘sanity’ – self with others
 Laing reaches out to Sartre for a solution to this
problem, but Sartre doesn’t have an answer
 They share a blind spot: Laing’s formulations of the
“politics of the family” instilling a “divided self” are
echoed in Sartre’s pithy encapsulation of the human
predicament in his play, No Exit
 L’enfer, c’est les autres – “Hell is other people”
Multiple Choice Questions
1. R. D. Laing’s legacy includes his:
 (A) Contribution to social thought
 (B) Social understanding of psychotic experiences
 (C) Rejection of the unbridgeable chasm between
psychiatrist and psychotic patient
 (D) Existential phenomenology in psychotherapy
Multiple Choice Questions
1. R. D. Laing’s legacy includes his:
 (A) Contribution to social thought
 (B) Social understanding of psychotic experiences
 (C) Rejection of the unbridgeable chasm between
psychiatrist and psychotic patient
 (D) Existential phenomenology in psychotherapy
 Answer: A, B, C, D – all are correct.
Multiple Choice Questions
2. R. D. Laing is known for his:
 (A) Critique of Ludwig Binswanger’s Existential Analysis
 (B) Rejection of Karl Jaspers’ approach to the psychotic
patient
 (C) Studies of the ‘divided self’
 (D) Embrace of anti-psychiatry
Multiple Choice Questions
2. R. D. Laing is known for his:
 (A) Critique of Ludwig Binswanger’s Existential Analysis
 (B) Rejection of Karl Jaspers’ approach to the psychotic
patient
 (C) Studies of the ‘divided self’
 (D) Embrace of anti-psychiatry
 Answer: A, B, C are correct. D is not. Although he is
associated with the anti-psychiatry movement in
London, he rejected that term and called himself an
‘orthodox psychiatrist’.
References
 Bakewell, S. (2016). At the Existentialist Café: Freedom, Being, and Apricot
Cocktails. London, UK: Chatto & Windus.
 Beveridge, A. ( 2011). Portrait of the Psychiatrist as a Young Man: The
Early Writing and Work of R.D. Laing, 1927-1960. Oxford, UK: Oxford
University Press.
 Binswanger, L. (1958). The case of Ellen West: An anthropological-clinical
study (trans. Werner M. Mendel & Joseph Lyons). In: Existence: A New
Dimension in Psychiatry and Psychology (Rollo May, Ernest Angel & Henri
F. Ellenberger, eds.). New York: Basic Books, pp. 237-364.
 Cameron, N. (1943). The paranoid pseudo-community. American Journal
of Sociology, 49(1): 32-38. https://doi.org/10.1086/219306
 Cameron, N. (1959). The paranoid pseudo-community revisited. American
Journal of Sociology, 65(1): 52-58. https://doi.org/10.1086/222626
 Cannon, B. (1991). Sartre and Psychoanalysis: An Existentialist Challenge
to Clinical Metatheory. Lawrence, KS: University Press of Kansas.
References
 Di Nicola, V. (1997). A Stranger in the Family: Culture, Families, and Therapy.
Foreword by M. Andolfi, MD. 380 pp. New York, NY and London, UK: WW Norton &
Co.
 Di Nicola, V. (2011). The enigma of Ellen West (pp. 121-125). In: Letters to a Young
Therapist: Relational Practices for the Coming Community. New York & Dresden:
Atropos Press.
 Di Nicola, V. (2021a). The end of phenomenology (pp. 65-82). In: Di Nicola, V. &
Stoyanov, D., Psychiatry in Crisis: At the Crossroads of Social Science, The
Humanities, and Neuroscience. Foreword by K.W.M. (Bill) Fulford, MD, Afterword by
A. Frances, MD. Cham, Switzerland: Springer Nature.
 Di Nicola, V. (2021b). The end of psychiatry (pp. 83-121). In: Di Nicola, V. &
Stoyanov, D., Psychiatry in Crisis: At the Crossroads of Social Science, The
Humanities, and Neuroscience.
 Di Nicola, V. (2022). Foreword: Homo animal tam familial est quam politicum/Man is
an animal that is as familial as it is political, Daniel Tutt, Psychoanalysis and the
References
 Ellenberger, H.F. (1970). The Discovery of the Unconscious: The
History and Evolution of Dynamic Psychiatry. New York, NY: Basic
Books.
 Friedenberg, E.Z. (1973). Laing. Fontana Modern Masters, ed. F.
Kermode. London, UK: Fontana/Collins.
 Itten, T., & Young, C., eds. (2012). R.D. Laing: 50 Years Since The
Divided Self. Ross-on-Wye, UK: PCCS Books.
 Jaspers, K. (1912/1968). The phenomenological approach to
psychopathology. British Journal of Psychiatry, 114: 1313-1323.
(Original in German, 1912)
 Kernberg, O.F (1998). Love Relations: Normality and Pathology, rev.
ed. New Haven, CN: Yale University Press.
 Laing, R.D. (1960). The Divided Self: An Existential Study in Sanity
and Madness. London, UK: Tavistock Publications.
References
 Laing, R.D. (1961). The Self and Others. London, UK:
Tavistock Publications.
 Laing, R.D. (1964). Review of General Psychopathology by
Karl Jaspers (Manchester University Press, 1963).
International Journal of Psychoanalysis, 45: 590-593.
 Laing, R.D. (1969). The Politics of the Family. Massey
Lectures 1968, Eighth Series. Toronto, ON: CBC
Publications.
 Laing, R.D. (1982). The Voice of Experience: Experience,
Science and Psychiatry. New York: Penguin Books.
 Laing, R.D. (1987a). Ronald David Laing. In: R.L. Gregory,
ed., The Oxford Companion to the Mind. Oxford, UK: Oxford
University Press.
References
 Laing, R.D. (1987b). The use of existential phenomenology in psychotherapy.
In: J.K. Zeig, ed., The Evolution of Psychotherapy, pp. 203-210. New York:
Brunner/Mazel.
 Laing R.D., & D.G. Cooper (1964). Reason and Violence – A Decade of
Sartre’s Philosophy, 1950-1960. With a foreword by Jean-Paul Sartre. London,
UK: Tavistock Publications.
 Sartre, J.-P. (1939/2002). Sketch for a Theory of the Emotions, trans. by P.
Mairet, Foreword by M. Warnock. New York, NY: Routledge Classics. (Original
in French, Esquisse pour une théorie des émotions, Paris: Hermann & Cie,
Éditeurs, 1939)
 Sartre, J.-P. (1943/1956). Being and Nothingness: An Essay on
Phenomenological Ontology, trans. by H.E. Barnes. London, UK: Routledge.
(Original in French, L’être et le néant : Essai d’ontologie phénoménologique.
Paris: Librairie Gallimard, 1943)
 Sartre, J.-P. (1964). Foreword. In: Laing R.D., & D.G. Cooper, Reason and
Violence – A Decade of Sartre’s Philosophy, 1950-1960. With a foreword by
Jean-Paul Sartre. London, UK: Tavistock Publications.
References
 Scott, S. & Thorpe, C. (2006). The sociological imagination
of R. D. Laing. Sociological Theory, 24(4): 331-352.
 Stohlman-Vanderveen, M. (Interviewer), Di Nicola, V. “The
Crisis of Psychiatry Is a Crisis of Being: An Interview with
Vincenzo Di Nicola,” Recently Published Book Spotlight,
Blog of the American Philosophical Association, October 8,
2021.Available from:
https://blog.apaonline.org/2021/10/08/the-crisis-of-
psychiatry-is-a-crisis-of-being-an-interview-with-vincenzo-di-
nicola/. Last accessed on June 29, 2022.
 Woods, A. (2011). The Sublime Object of Psychiatry:
Schizophrenia in Clinical and Cultural Theory. Oxford, UK:
Oxford University Press.

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The Social Phenomenology of RD Laing: A Re-Appraisal of R.D. Laing, His Relationship to J.-P. Sartre, and the Psychotherapy of Schizophrenia

  • 1.
  • 2.
  • 3. Vincenzo Di Nicola MPhil, MD, PhD, DLFAPA, FCPA, FCAHS
  • 4. Conflicts of Interest  The author has no financial conflicts of interest to declare.
  • 5. Educational Objectives By attending this presentation, participants will have the opportunity to improve competence or performance by learning about …  The philosophical grounding of Ronald David Laing’s work in psychiatric phenomenology and the existentialism of Jean- Paul Sartre.  An introduction to J.-P. Sartre’s existential psychoanalysis and how it differs from Freudian psychoanalysis.  R. D. Laing’s legacy in the psychotherapeutic treatment of schizophrenia.
  • 6. Seminar Plan  Is the psychotherapy of the mental suffering we call schizophrenia possible?  R. D. Laing is arguably the figure most associated with opening this question, so how did he come to grapple with this question?  To answer this, we must open a series of questions – from how to understand schizophrenia to the history of its treatment in psychiatry and psychoanalysis.
  • 7. Seminar Plan  The philosophical grounding of Ronald David Laing’s work in psychiatric phenomenology and the existentialism of Jean-Paul Sartre.  An introduction to Jean-Paul Sartre’s existential psychoanalysis and how it differs from Freudian psychoanalysis.  R. D. Laing’s legacy in the psychotherapeutic treatment of schizophrenia.
  • 8. Schizophrenia “The Sublime Object of Psychiatry” Reference: Woods, A. (2011). The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory.
  • 9. Image of Madness in the age of reason Source: Étienne Esquirol (1838) Patient in mechanical restraints replacing chains at the Bicêtre Esquirol – mental illness found in the “passions of the soul” and does not completely affect the reason
  • 10. The Bethlem Royal Hospital London, England
  • 11. The Bethlem Royal Hospital  New Order of Our Lady of Bethlehem, London, England  775 years old – founded 1247 AD  On its fifth site – over the years Bethlehem was contracted to Bethlem, corrupted in common parlance to “Bedlam” (meaning madness or chaos)  This lithograph is of the third site – now the Imperial War Museum  The joke is that it went from one form of madness to another
  • 12. The Weighing House (1763) William Hogarth
  • 13. Schizophrenia  Eugen Bleuler – coined the term “schizophrenia” (1907-1911)  Karl Jaspers – empathic chasm – “the worm in psychiatry’s apple”  Kurt Schneider – “pathognomonic symptoms”  Gregory Bateson – “double-bind theory of schizophrenia” (1956)  Silvano Arieti – Interpretation of Schizophrenia (1955, 1974)  R. D. Laing – “a perfectly rational adjustment to an insane world”  Mara Selvini Palazzoli – “families in schizophrenic transaction”
  • 14. Social Science Contributions to the Understanding and Treatment of Schizophrenia  Norman Cameron – sociologist  “The paranoid pseudo-community” (1943, 1959)  Gregory Bateson – anthropologist  “The double-bind theory of schizophrenia” (1956)  “a metaphor that is meant”  “Manzanita Wood” – Man’s an eater (if conditions were right, he) would  Erving Goffman – sociologist  “The asylum as a total institution”  Cf. Asylums (1961), “The Place of insanity” (1969)  Michel Foucault – psychologist/philosopher/historian  “Madness in the age of reason”
  • 15. Social Science Contributions to the Understanding and Treatment of Schizophrenia  Angela Woods – historian, lecturer in Medical Humanities at Durham University, UK  The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory (2011)  A contested diagnosis in psychiatry and a metaphor for cultural theorists  Examines representations of schizophrenia across a wide range of disciplines and discourses:  biological and phenomenological psychiatry, psychoanalysis,  critical psychology, antipsychiatry, and  postmodern philosophy
  • 16. Psychoanalytic Contributions to the Understanding and Treatment of Schizophrenia  Early Theorists  Eugen Bleuler – coined the term “schizophrenia” (1911)  four A’s – affect, autism, ambivalence, associations  positive and negative symptoms  Viktor Tausk – “the influencing machine” (1919)  Paul Federn – “psychoanalysis of the psychoses” (1952)
  • 17. Psychoanalytic Contributions to the Understanding and Treatment of Schizophrenia  Elaborations  Jacques Lacan – neuroses, perversion, psychoses  “man is the subject captured and tortured by language”  psychosis is a special but emblematic case of language entrapment  Frieda Fromm-Reichmann – roots in early childhood experiences  John Rosen – “direct analysis”
  • 18. Jacques Lacan (1901-1981) « L’inconscient est structuré comme un langage »
  • 19. Psychoanalytic Contributions to the Understanding and Treatment of Schizophrenia  Major Theorists  R. D. Laing – “the divided self”  roots in the family which I call the “crucible of experience” (Di Nicola, 1997)  “a rational adjustment to an insane world”  “mystification, invalidation, ontological insecurity”  aliases of the divided self are the split self and the false self, echoed in Sartre’s notion of authenticity vs. bad faith Reference: Laing, R. D. (1960). The Divided Self: An Existential Study in Sanity and Madness. Di Nicola, V. (1997). A Stranger in the Family: Culture, Families, and Therapy.
  • 20. Psychoanalytic Contributions to the Understanding and Treatment of Schizophrenia  Major Theorists  Silvano Arieti – “interpretation of schizophrenia”  “meeting the schizophrenic in their own world”  psychological aetiology, family disturbance  psychotherapy aims to create a new, healthier, more adaptive personality, the psychotherapist is a guide Reference: Arieti, S. (1974). The Interpretation of Schizophrenia. (Winner of the National Book Award)
  • 21. Psychoanalytic Contributions to the Understanding and Treatment of Schizophrenia  The core construct of schizophrenia has undergone a radical revision since its first “construction”  The pioneering innovations of psychoanalysts like R. D. Laing and Silvano Arieti – the latter being one of the founders of this group (AAPDPP) – appear increasingly prescient  They are being vindicated for their insights, courage and humanistic visions
  • 22. Schizophrenia  The stakes:  Schizophrenia is understandable psychologically  Arieti, Bateson, Laing – versus Freud’s claim  We can empathize with schizophrenic experiences  Arieti, Laing – versus Jaspers’ claim  Schizophrenia is rational  Laing’s claim – is it?
  • 23. “Psychiatry Against Itself” Reframing Anti-Psychiatry Reference: Di Nicola, V. (2021). The end of psychiatry. In Psychiatry in Crisis.
  • 24. Four Psychiatrists  Four notable 20th century Western psychiatrists who criticized their field, contributing to a redefinition of psychiatry:  Ronald David Laing (1927-1989) – a psychiatric & social radical  Jacques Lacan (1901-1981) – a psychoanalytic rebel  Franco Basaglia (1924-1980) – a psychiatric reformer  Frantz Fanon (1925-1961) – a political revolutionary Reference: Di Nicola, V. (2021b). The end of psychiatry.
  • 25. Frantz Fanon R. D. Laing Jacques Lacan Franco Basaglia
  • 27. Ronald David Laing  Scottish psychiatrist-psychoanalyst Ronald David Laing is known for his pioneering studies in the tradition of psychodynamic psychiatry (Ellenberger, 1970) of the alien and alienating experiences that are known under the rubric of schizophrenia (Woods, 2011)  References: Ellenberger, H.F. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry.  Woods, A. (2011). The Sublime Object of Psychiatry:
  • 28. Ronald David Laing (1927-1989)  R. D. Laing was a radical psychiatrist-psychoanalyst who returned psychiatry to its clinical roots  Incisive critiques of Ludwig Binswanger’s Daseinanalyse, existential analysis, and psychiatric practices in general  Appealing to social phenomenology and negating the mystification of mental illness  Placing the suffering of the self in social, familial, and political contexts
  • 29. What Is Social Phenomenology?  “… R. D. Laing’s contribution to the understanding of the mind operates in a field that can be broadly characterized as empirical interpersonal phenomenology, which is a branch of social phenomenology.”  “The philosophical foundations of a ‘dialogal knowledge’ have not so far been comprehensively and systematically laid down … the very possibility of persons is hardly conceivable other than as ghosts of a category already dépassé.”  “… the problems of method are as vexing as they are unresolved.” References: Laing, R.D. (1987a). Ronald David Laing. In: R.L. Gregory, ed., The Oxford Companion to the Mind.
  • 30. Social Phenomenology  “Nevertheless, Laing has studied various facets of very disturbed and disturbing personal relations.”  “The attribution of the absence in the other of the capacity to form good enough personal relationships is the basis for the diagnosis of schizophrenia. This diagnosis is both an attribution (he is incapable of forming a personal bond; he is cut off) and a causal theory to account for this attribution (the reason he is cut off is because he is suffering from a mental or physical illness).”
  • 31. Social Phenomenology  “In The Divided Self Laing construed this attribution as a function of an extremely disjunctive relationship between the person who is in the role of a depersonalized – and depersonalizing – diagnosing psychiatrist and the person who has become a depersonalized, and sometimes depersonalizing, diagnosed patient.”  “This construction is a contribution towards a personal understanding (Verstehen) of what is going on between psychiatrist and patient, in contrast to a scientific explanation of what is going on in the patient alone. In fact, [Laing] offered a personal understanding of the psychiatrist’s scientific explanation and construed it as, unwittingly, a way of cutting off the cut-off person from the possibility of reunion and renewal.”
  • 32. Social Phenomenology  “The psychiatric, diagnostic look is itself a depersonalized and depersonalizing cut-off look.”  “To understand what is going on in and between people it is necessary to place the interpersonal happenings within their social context.”
  • 33. Social Phenomenology  “When the psycho-social interior of the families of schizophrenics was looked at from the twin perspective of praxis and process [from Sartre’s work], instead of looking at the schizophrenic alone, it appeared that those experiences and actions which are regarded as signs and symptoms of a pathological process within one individual were much more socially intelligible than they had been taken to be by most psychiatrists.” References: Laing, R. D. (1987a). Ronald David Laing. In: R. L. Gregory, ed., The Oxford Companion to the Mind.
  • 34. Laing in Action  Do we have access to Laing’s actual methods?  Yes, like Freud, Laing’s reputation is largely built on the narrative force of his case reports  “Julie”: “The ghost of the weed garden” in The Divided Self  Suffering from schizophrenia, hearing voices, struck postures, mainly mute since age 17  1954: 180 sessions, 250 hours  Laing struggled with whether psychosis was understandable  Laing’s conceit: The patient as mentor to the psychiatrist  Reference: Laing, R. D. (1960). The Divided Self: An Existential Study in Sanity and Madness.
  • 35. Laing in Action  Do we have access to Laing’s actual methods?  Laing elaborated his thoughts and working methods in other ways:  critiques of other psychiatrists, including Karl Jaspers and Ludwig Binswanger  stories of his own training and practice  his own family and autobiography  Opening lines of the 1968 Massey Lectures: “The first family to interest me was my own. I still know less about it than many other families. This is typical.”  Reference: Laing, R. D. (1969). The Politics of the Family. Massey Lectures 1968
  • 36.
  • 37. Schizophrenia  The stakes:  Schizophrenia is understandable psychologically  Arieti, Bateson, Laing – versus Freud’s claim  psychological  We can empathize with schizophrenic experiences  Arieti, Laing – versus Jaspers’ claim  humanistic  Schizophrenia is rational  Laing’s claim – is it?  political
  • 39. Jean-Paul Sartre (1905-1980)  As a writer, Sartre’s most famous phrase was, “Hell is other people”  No Exit (1944/1946)  As a philosopher, Sartre’s most famous assertion was, “Existence precedes essence”  Existentialism Is a Humanism (1946/1948)  Sartre limned a theory of the emotions and called for an existential psychoanalysis, rejecting the Freudian unconscious  Sketch for a Theory of the Emotions (1939/2002)  Being and Nothingness (1943/1956)
  • 40. Jean-Paul Sartre  Sartre called for an existential psychoanalysis, rejecting the Freudian unconscious  Being and Nothingness (1943/1956)  Rejected the notion of the unconscious – why?  Due to his radical belief that we are “condemned to freedom”  Reference to internal or external constraints was “bad faith”  Yet, how can a psychoanalyst employ a model that denies the unconscious? And did Laing confront this question directly?
  • 41. Jean-Paul Sartre  Sartre’s (1943/1956) call for an existential psychoanalysis “had not yet found its Freud”  R. D. Laing is precisely that figure  We could say that Laing externalized the unconscious, understanding internal processes through interpersonal relationships  (Cf. “the relational turn” in PsyA, Stephen Mitchell, Sabina Spielrein) References: Sketch for a Theory of the Emotions (1939/2002)  Being and Nothingness (1943/1956)
  • 42. Laing’s Contributions to the Understanding and Treatment of Schizophrenia  Laing was the psychiatrist who brought Sartre’s vision to the clinic, as Sartre later acknowledged (Sartre, 1964; cf. Cannon, 1991) References: Sartre, J.-P. (1964). Foreword. In: Laing R. D., & D. G. Cooper, Reason and Violence – A Decade of Sartre’s Philosophy, 1950- 1960. Cannon, B. (1991). Sartre and Psychoanalysis: An Existentialist Challenge to Clinical Metatheory.
  • 43. I am convinced that your efforts will bring us closer to the day when psychiatry will, at last, become a truly human psychiatry. – J.-P. Sartre (1964)
  • 44. Source: Stohlman-Vanderveen & Di Nicola (2021)
  • 45. Source: Stohlman-Vanderveen & Di Nicola (2021)
  • 46. Laing’s Contributions to the Understanding and Treatment of Schizophrenia  Influenced by Sartre, Laing has given us such terms as:  mystification (a direct invocation of the Marxian term),  invalidation (a clinical translation of the core Marxian trope, alienation), and  ontological insecurity (from the phenomenological tradition)  Laing called his approach social phenomenology (Laing, 1987b). References: Laing, R. D. (1987a). Ronald David Laing. In: R.L. Gregory, ed., The Oxford Companion to the Mind. Laing, R.D. (1987b). The use of existential phenomenology in
  • 47. Laing’s Contributions to the Understanding and Treatment of Schizophrenia  Laing claims, in part, that schizophrenia is rational  Yet, it’s neither rational nor reasonable  Something doesn’t have to be rational, reasonable or functional for us to understand it or even to empathize with it (cf. Arieti, 1974)  This is a version of the fact/value distinction – is/ought – ought cannot be derived from is – David Hume (1739)  Slippery slope from observation to description to explanation to justification
  • 48. Conclusion: Laing’s Legacy  In his Very Short Introduction to Psychiatry, Tom Burns referred to Laing’s social phenomenology with a dismissive “Don’t ask.”  Laing’s work on the families of schizophrenics triggered research at the Institute of Psychiatry on expressed emotion (EE) and related research (cf. Clare)  Whether it was ultimately quixotic or romantic, Laing asked critical questions about the validity of the concept of schizophrenia (tension between a biological intervention for a phenomenological observation) – what he called a “false epistemology” References: Laing, R. D. (1987a). Ronald David Laing. In: R.L. Gregory, ed., The Oxford Companion to the Mind. Laing, R. D. (1987b). The use of existential phenomenology in psychotherapy. In: J.K. Zeig, ed., The Evolution of Psychotherapy.
  • 49. Conclusion: Laing’s Legacy  He validated the phenomenological experience of alien and alienating experiences and tried to make sense of them with respect and dignity in the interpersonal contexts of family and society  Thus, opening the possibility of the psychotherapy of psychosis/schizophrenia  He anticipated today’s approach to peer helpers, lived experience, and sufferers to be on ethical boards and research teams in psychiatry  He is part of the history of phenomenological psychiatry, humanistic psychiatry, and family therapy
  • 50. Conclusion: Laing’s Legacy  The neglected legacy of Laing’s thought  His contribution to social theory and a social understanding of such processes as paranoia (Scott & Thorpe, 2006)  He was squarely in the tradition of critical psychiatry, critiquing it and calling for change without rejecting the profession altogether, going so far as to insist that he was an “orthodox psychiatrist” rather than an anti-psychiatrist  Laing brought that critical tradition to the professions of psychiatry and psychoanalysis as well as to a wider public with greater reach than any psychoanalyst since Freud himself (Friedenberg, 1973; Beveridge, 2011; Di Nicola, 2021a, 2021b)
  • 51. Conclusion: Laing’s Legacy  Did Laing achieve his goals? Let’s follow the titles of his books …  The Divided Self, Self and Others, Knots  The Divided Self is brilliant while Self and Others continues to explore how the self fragments and gets caught in the “knots” of interpersonal relations – similar territory to Melanie Klein’s splitting and projective identification  What this means is that you can put madness on the couch – and understand it through a dialogue with an individual suffering with it
  • 52. Conclusion: Laing’s Legacy  What he doesn’t achieve is the third step – integration, health, ‘sanity’ – self with others  Laing reaches out to Sartre for a solution to this problem, but Sartre doesn’t have an answer  They share a blind spot: Laing’s formulations of the “politics of the family” instilling a “divided self” are echoed in Sartre’s pithy encapsulation of the human predicament in his play, No Exit  L’enfer, c’est les autres – “Hell is other people”
  • 53. Multiple Choice Questions 1. R. D. Laing’s legacy includes his:  (A) Contribution to social thought  (B) Social understanding of psychotic experiences  (C) Rejection of the unbridgeable chasm between psychiatrist and psychotic patient  (D) Existential phenomenology in psychotherapy
  • 54. Multiple Choice Questions 1. R. D. Laing’s legacy includes his:  (A) Contribution to social thought  (B) Social understanding of psychotic experiences  (C) Rejection of the unbridgeable chasm between psychiatrist and psychotic patient  (D) Existential phenomenology in psychotherapy  Answer: A, B, C, D – all are correct.
  • 55. Multiple Choice Questions 2. R. D. Laing is known for his:  (A) Critique of Ludwig Binswanger’s Existential Analysis  (B) Rejection of Karl Jaspers’ approach to the psychotic patient  (C) Studies of the ‘divided self’  (D) Embrace of anti-psychiatry
  • 56. Multiple Choice Questions 2. R. D. Laing is known for his:  (A) Critique of Ludwig Binswanger’s Existential Analysis  (B) Rejection of Karl Jaspers’ approach to the psychotic patient  (C) Studies of the ‘divided self’  (D) Embrace of anti-psychiatry  Answer: A, B, C are correct. D is not. Although he is associated with the anti-psychiatry movement in London, he rejected that term and called himself an ‘orthodox psychiatrist’.
  • 57. References  Bakewell, S. (2016). At the Existentialist Café: Freedom, Being, and Apricot Cocktails. London, UK: Chatto & Windus.  Beveridge, A. ( 2011). Portrait of the Psychiatrist as a Young Man: The Early Writing and Work of R.D. Laing, 1927-1960. Oxford, UK: Oxford University Press.  Binswanger, L. (1958). The case of Ellen West: An anthropological-clinical study (trans. Werner M. Mendel & Joseph Lyons). In: Existence: A New Dimension in Psychiatry and Psychology (Rollo May, Ernest Angel & Henri F. Ellenberger, eds.). New York: Basic Books, pp. 237-364.  Cameron, N. (1943). The paranoid pseudo-community. American Journal of Sociology, 49(1): 32-38. https://doi.org/10.1086/219306  Cameron, N. (1959). The paranoid pseudo-community revisited. American Journal of Sociology, 65(1): 52-58. https://doi.org/10.1086/222626  Cannon, B. (1991). Sartre and Psychoanalysis: An Existentialist Challenge to Clinical Metatheory. Lawrence, KS: University Press of Kansas.
  • 58. References  Di Nicola, V. (1997). A Stranger in the Family: Culture, Families, and Therapy. Foreword by M. Andolfi, MD. 380 pp. New York, NY and London, UK: WW Norton & Co.  Di Nicola, V. (2011). The enigma of Ellen West (pp. 121-125). In: Letters to a Young Therapist: Relational Practices for the Coming Community. New York & Dresden: Atropos Press.  Di Nicola, V. (2021a). The end of phenomenology (pp. 65-82). In: Di Nicola, V. & Stoyanov, D., Psychiatry in Crisis: At the Crossroads of Social Science, The Humanities, and Neuroscience. Foreword by K.W.M. (Bill) Fulford, MD, Afterword by A. Frances, MD. Cham, Switzerland: Springer Nature.  Di Nicola, V. (2021b). The end of psychiatry (pp. 83-121). In: Di Nicola, V. & Stoyanov, D., Psychiatry in Crisis: At the Crossroads of Social Science, The Humanities, and Neuroscience.  Di Nicola, V. (2022). Foreword: Homo animal tam familial est quam politicum/Man is an animal that is as familial as it is political, Daniel Tutt, Psychoanalysis and the
  • 59. References  Ellenberger, H.F. (1970). The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York, NY: Basic Books.  Friedenberg, E.Z. (1973). Laing. Fontana Modern Masters, ed. F. Kermode. London, UK: Fontana/Collins.  Itten, T., & Young, C., eds. (2012). R.D. Laing: 50 Years Since The Divided Self. Ross-on-Wye, UK: PCCS Books.  Jaspers, K. (1912/1968). The phenomenological approach to psychopathology. British Journal of Psychiatry, 114: 1313-1323. (Original in German, 1912)  Kernberg, O.F (1998). Love Relations: Normality and Pathology, rev. ed. New Haven, CN: Yale University Press.  Laing, R.D. (1960). The Divided Self: An Existential Study in Sanity and Madness. London, UK: Tavistock Publications.
  • 60. References  Laing, R.D. (1961). The Self and Others. London, UK: Tavistock Publications.  Laing, R.D. (1964). Review of General Psychopathology by Karl Jaspers (Manchester University Press, 1963). International Journal of Psychoanalysis, 45: 590-593.  Laing, R.D. (1969). The Politics of the Family. Massey Lectures 1968, Eighth Series. Toronto, ON: CBC Publications.  Laing, R.D. (1982). The Voice of Experience: Experience, Science and Psychiatry. New York: Penguin Books.  Laing, R.D. (1987a). Ronald David Laing. In: R.L. Gregory, ed., The Oxford Companion to the Mind. Oxford, UK: Oxford University Press.
  • 61. References  Laing, R.D. (1987b). The use of existential phenomenology in psychotherapy. In: J.K. Zeig, ed., The Evolution of Psychotherapy, pp. 203-210. New York: Brunner/Mazel.  Laing R.D., & D.G. Cooper (1964). Reason and Violence – A Decade of Sartre’s Philosophy, 1950-1960. With a foreword by Jean-Paul Sartre. London, UK: Tavistock Publications.  Sartre, J.-P. (1939/2002). Sketch for a Theory of the Emotions, trans. by P. Mairet, Foreword by M. Warnock. New York, NY: Routledge Classics. (Original in French, Esquisse pour une théorie des émotions, Paris: Hermann & Cie, Éditeurs, 1939)  Sartre, J.-P. (1943/1956). Being and Nothingness: An Essay on Phenomenological Ontology, trans. by H.E. Barnes. London, UK: Routledge. (Original in French, L’être et le néant : Essai d’ontologie phénoménologique. Paris: Librairie Gallimard, 1943)  Sartre, J.-P. (1964). Foreword. In: Laing R.D., & D.G. Cooper, Reason and Violence – A Decade of Sartre’s Philosophy, 1950-1960. With a foreword by Jean-Paul Sartre. London, UK: Tavistock Publications.
  • 62. References  Scott, S. & Thorpe, C. (2006). The sociological imagination of R. D. Laing. Sociological Theory, 24(4): 331-352.  Stohlman-Vanderveen, M. (Interviewer), Di Nicola, V. “The Crisis of Psychiatry Is a Crisis of Being: An Interview with Vincenzo Di Nicola,” Recently Published Book Spotlight, Blog of the American Philosophical Association, October 8, 2021.Available from: https://blog.apaonline.org/2021/10/08/the-crisis-of- psychiatry-is-a-crisis-of-being-an-interview-with-vincenzo-di- nicola/. Last accessed on June 29, 2022.  Woods, A. (2011). The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory. Oxford, UK: Oxford University Press.