In these first pages of the book Laing sets out why he is an antipsychiatrist in collaboration with Esterson

1. Preface and Introduction to Sanity, Madness and the Family
Laing and Aaron Esterson state their point of view quite clearly:
‘In our view it is an assumption, a theory, an hypothesis, but not a
fact, that anyone suffers from a condition called ‘schizophrenia.’
They add to this: ‘We did not say, even, that we do not believe in
schizophrenia.’ (p 11).
Others whom Laing has met in the course of his research include
John Bowlby and Irving Goffman (in the US).
The Preface to the Second Edition also states that a psychiatrist
may observe that something is the matter with a patient, which
s/he calls schizophrenia, and the authors then go on that it is
therefore incumbent to identify the causes of schizophrenia.
Hence the authors’ rejection of the diagnosis of schizophrenia,
because of what that method of working also entails.
Laing and Esterson then quote Bannister, D (1968) who opts that
schizophrenia is such a diverse, diffuse and confused a concept
that it is scientifically unusable, and this means that research
into schizophrenia is unusable.
There are no reliable quantifiable criteria to settle
disagreements on whether to give a diagnosis of schizophrenia.
This would be useful, for the authors state that probably only 8
of 10 psychiatrists would agree on the application of a diagnosis
to any individual patients.
The authors propose no model of schizophrenia for they
completely disagree that there is a fact of schizophrenia. Their
question is: can social factors be applied where schizophrenia is
diagnosed? By involving family, this will not explain schizophrenia
(for the authors are not seeking to do so) but it may help to make
sense of an individual. Methodology: are Laing and Esterson going
about answering this question in a valid way? - social influences? A
reaction has been to ignore the authors’ question, and then to
demand and assume that other questions be answered. The eleven

2. cases used to illustrate the authors’ stance are elsewhere in this
book, a chapter each. Criticism is that looking at these cases
proves nothing, for there are no controls (no randomised
controls), no guides on sampling the data, no reliable rating scales
(probably not referred to very much in 21st
century data analysis.)
If the authors’ criteria had included the family as a variable in
individuals’ pathology and the development of schizophrenia, then
considerations as above would be valid objections. As with their
denial of the fact of schizophrenia and that which entails from
that, the authors seek to give sense to experience and behaviour
by reference to the family, where there would be less sense and
explanation without reference to the family, more socially
senseless.
The upshot is that in their researches the authors have
identified some themes every time they have looked at the eleven
and more cases, every time they have chosen that lens.
For psychiatrists who do not go beyond the boundaries of their
wards and clinics, they cannot get a full picture including the
common themes logged by the authors. Sociologists who number
crunch from medical records are similarly not looking at what
counts. There is futility in such approaches to social processes
and to clinical case histories. (This would have been a ground
breaking attitude at the time and can be seen in the context of
ethnography and qualitative methodology of later years.) (Perhaps
this is chiming in with Goffman’s ethnographic work of that era -
maybe they were beyond doubt cutting edge.)
The preface ends with the rhetorical question that no similar
studies have taken place before or after this one. If therefore
schizophrenia and families can be drilled into and answers to any
question obtained, why has it not been established by others that
schizophrenics are indeed just talking unintelligible rubbish?
*****

3. Introduction
The subjects of the study were all female with at least a small
family and who had been in hospital for at least a year. Three
cases were taken from ‘East Hospital.’ For ‘West Hospital’ the
same criteria were applied, with every third patient admitted
after the study started, included in the work. There were also
other criteria. All families agreed to cooperate.
Laing and his co-author restate their scepticism of the definition
of schizophrenia deriving from Bleuler’s work, and also detail
current research into families and sufferers which seeks to
describe the impact of schizophrenia on the family, and the
influence of the family on the course of schizophrenia.
‘Schizophrenics’ here is defined as those who have experiences
and behaviours that are not only human but also have the
pathology. There is no clear aetiology to distinguish
schizophrenia.
To distinguish schizophrenia, it is not a fact, it may be a
legitimate hypothesis, schizophrenia is neither an assumption or a
judgement. The treatment by a psychiatrist where schizophrenia
is taken as a (diagnosed) fact, takes away all human agency. The
term schizophrenia, for Laing et al, is attributed by certain
persons to others as schizophrenic, and this is the context in the
book for the use of the term, that of some to others, and Laing
et al withhold a judgement on the validity or implications of such
an attribution. Likewise parenthesis applies to terms of pathology
in the family. This is not a context employed by Laing at al, but it
is acknowledged to be the context of others.
On the family and individuals, Laing et al state that individuals are
objects in the world of others and also live in an area of time and
space where they have experience which gives them perspective
on situations they share with others. In families, members have
different perspectives according to different relations to

4. different relatives. It is possible to see what kind of a world a
family has constructed for itself. The authors refer to Jean-Paul
Satre. The notion of family pathology is a confused one.
The methodology of the authors is threefold: the person in the
family; intra-family relationships; and the family as a system.
When the purpose of Laing and Esterson’s research was
explained, all families approached agreed to participate as they
wished for the outcome of helping the individuals. The
researchers aspire to an eventual complete audio-visual record of
the interviews which are the substance of the research.
There is a remark about psychoanalysis which has the purpose of
linking the subconscious to behaviour. This Laing et al will not do
and the amount of attributions as adjunct to the interviews is
minimal.
There is mention of a phenomenological approach.
There is aspiration that what the authors are doing will be a
bridge from old methods of research into a new way of
understanding madness.
Their question is: how is a schizophrenic’s experience intelligible
in the light of the family nexus?