The Church's Surrender to Psychiatry (InterVarsity Press,Chicago, 1999)
From Chapter One:
My Training as a Psychologist and Retraining as a Family Therapist
When I was twenty-four, I decided to become a psychologist, and I entered graduate school a year later, in 1976. Despite the fact that I had read and been influenced by Szasz and Laing, as I progressed through graduate school I became more and more influenced by the psychoanalytic (Freudian) way of looking at the world. Secretly, I thought of myself as an initiate into the great Freudian tradition; my readings and studies had given me insight into the complexities of the human psyche, and I possessed the esoteric knowledge that would enable me to heal my patients and to guide them through the spiritual labyrinth of the world. I had succumbed to the intellectual glamour of the Freudian worldview. The influence of Laing and Szasz had waned, although there was at least a residuum of my former heresy: unlike most psychoanalysts, I believed that "schizophrenia" was a curable, rather than an incurable, emotional disorder--and I found "schizophrenics" to be fascinating people.
Fortunately, after graduate school I gradually became disenchanted with Freudianism (psychoanalysis). I attribute this disenchantment initially to my study of family therapy, which convinced me once again that there was no such entity as "mental illness" and that the person deemed mentally ill by mental health authorities was being scapegoated for problems whose locus was not within the individual but between individuals, usually within the family.
In other words, the model of family therapy that I studied maintained that the cause of the present distress of the "identified patient" was not so much traumatic events in the past but dysfunctional relationships in the present. The solution therefore was not, as Freudianism insisted, to relive the past and attempt to achieve insight into the origins of one’s problems but to modify the dynamics of interpersonal relationships involving the "patient" in the present.
In 1985 I studied with psychiatrist Salvador Minuchin, one of the original founders of the family therapy movement, author of numerous books and an international authority on family therapy. The following year I studied with Jay Haley, another family therapy luminary who had previously worked with Minuchin at the Philadelphia Child Guidance Center. Both Haley and Minuchin became renowned for the extraordinary effectiveness of their family therapy interventions on the lives of individuals regarded by psychoanalysts as "severely mentally ill." (In the 1950s when Haley and Minuchin were first establishing themselves as professionals, psychoanalysis was the dominant form of treatment in the mental health field, and they encountered considerable opposition in their efforts to promote family therapy as a more effective alternative.)
Haley explicitly rejected the idea that "schizophrenia" was a disease, and he described his successful treatment of "disturbed young people" in his book Leaving Home, which was published in 1980. Haley's theory was that the young person who was deemed "schizophrenic" was unconsciously trying to save the faltering marriage of his or her parents. By becoming crazy the young person distracted the parents from their own conflicts and stimulated them to come together in an effort to rescue their son or daughter.
I think Haley overgeneralizes: not all cases fit this pattern. However, on one point I find him particularly persuasive: many psychiatrically labeled persons I have met were reacting in a socially troubling way to unacknowledged conflicts of other family members. The tragedy of traditional therapy, Haley argues, is that by confirming the young person as mentally sick, he or she becomes the scapegoat for other family members--who are thus defined as having no serious problems--and is trapped into a lifetime career as a professional mental patient.
Unfortunately, neither the work of Laing or Szasz nor that of Minuchin or Haley had much effect on the mental health system as a whole. Laing’s work with schizophrenics, based on the idea that schizophrenia was in essence a spiritual crisis rather than a disease, spawned a few therapeutic asylums for "schizophrenics," such as the highly successful Soteria House (designed by psychiatrists Loren Mosher and Alma Menn). But these had disappeared by the mid-1970s after the countercultural ferment of the 1960s had dissipated.
Szasz's writings also motivated a number of vigorous civil rights-minded lawyers to establish legal precedents in the 1960s that restricted the power of psychiatrists to impose unwanted "treatments" on the "mentally ill." In a variety of ways psychiatrists proved successful in circumventing these legal restrictions in the 1970s, 1980s and 1990s.
As family therapists became integrated into the psychiatric-industrial complex that was receiving a massive infusion of funds from the pharmaceutical companies, they abandoned the idea that "crazy" behavior was a response to interpersonal conflicts in the family and redefined the meaning of "family therapy" as practiced with "schizophrenics." For most therapists family therapy no longer means, as it does for Haley and Minuchin, exploring and modifying interpersonal dynamics that cause one or more family members to become "psychotic." It is now understood as merely seeing the family as a whole in the treatment setting.
Most family therapists have now adopted the process that Haley had critiqued (see above) and no longer attempt to prevent "the identified patient" from being labeled and confirmed as mentally ill. As "family therapists" they now work as junior allies of the psychiatric establishment, helping to convince the "healthy" family members to accept and cope with the ostensibly tragic and inexorable fact that one of their members is chronically mentally ill and needs to be on powerful psychotropic drugs for the rest of his or her life.
The specter of the widespread development of nonmedical alternatives to the treatments for the problems of life that appeared in the 1960s had been exorcised by 1990, and the dominance of psychiatry within the mental health system was securely established once again.
The Woodstock of Psychotherapy
Yet in 1985 there were still pockets of therapists dispersed throughout the country who believed that the therapy profession was on the eve of a revolution, a transition to a more humanistic, less traditional, less pharmaceutically oriented model. Approximately seven thousand of these therapists (including me) converged on Phoenix, Arizona, in 1985 for a conference sponsored by the Milton H. Erickson Foundation. Virtually all of the major innovators in the profession were gathered there--mostly but not exclusively those who had rejected the idea of mental illness and who advocated for reforms in the mental health system--including R. D. Laing, Thomas Szasz, Salvador Minuchin and Jay Haley. The conference attendees, who were mostly under forty years old, were told on a number of occasions by the speakers that the future of therapy lay in their hands.
R.D. Laing was in good form. It had been arranged for Laing to interview a bona fide "paranoid schizophrenic"--whom he had never met before--in a private room, while an audience of several thousand therapists watched on a video screen in a conference hall downstairs. (Needless to say the young woman was informed in advance of the arrangement.) Despite the fact that the woman, Christy, knew she was being watched, she readily opened up to Laing and shared with him the unusual ideas (e.g., there was a conspiracy out to "get her") that evidently had earned her the label of chronic psychotic. Laing did not attempt to talk her out of this idea (although he disagreed with her on occasion)--in fact, he agreed. He stated, "I mean this whole setup is an enormous conspiracy, and you're right in the middle of the conspiracy just now." "So," he added with a chuckle, "if you came here to get away from the conspiracy; you haven't done very well." When she asked him what kind of conspiracy he was talking about, he said he thought it was a benign conspiracy, a sign that the universal mind (the term she had used earlier in the conversation) was "waking up." The conversation concluded with a lively discussion of the Bible.
After her twenty-two minute talk with Dr. Laing, she asked if she could accompany him downstairs to watch while he answered questions from the other therapists, a request that seemed to surprise even Laing himself. During the question period Laing responded caustically to one of the questioners who stated that nothing of value had occurred in Laing's interaction with Christy:
This young woman sitting beside me is supposed to be an absolute paranoid schizophrenic on medication. [She had been withdrawn from medication at Laing's request a day or two before their dialogue.] She’s sitting here just now perfectly compos mentus, perfectly clear, facing this most intimidating situation from the stage, not exhibiting any symptoms of schizophrenic disorder. If you knew of any medication that could do that in twenty minutes, from there to here, would you say you wouldn't give that to a patient? You would have to spend the rest of your life being a biochemist to understand what the chemical effect of that sort of thing is supposed to be in the central nervous system. So you don't know anything about this sort of process. Have the humility to admit that, and keep your place!
After a number of questions, some curious, some appreciative, some critical, the young woman asked to make a few remarks in conclusion. "I don’t go around like a paranoid schizophrenic all the time. I know how to keep my cool, and I think this guy [Laing] would be a great psychotherapist, because he does that... because he knows how to tap into other people’s minds... not by just asking questions and trying to figure things out like some doctors."
At this point Salvador Minuchin emerged from the audience to express his own appreciation of Laing and Christy's interaction and to reprimand the audience for what he took to be their failure to grasp the implications of what had occurred.
I think you should learn something from Ronald. Because I don't think you did. You see, what we have experienced here is a communion of love. What I was observing, and I felt entranced, I felt in love with this young person, and she was able to elicit from Ronald, and so did he from her--that kind of experience. It was experience not at the level of words, but there was an element of joining, that was expressed in their hands, in their legs, they were moving exactly in the same place, and I loved it. And I think it's important that you should know that. I am talking to the physician that talks about drugs. Because the drug that existed there is very, very powerful.
Minuchin was underscoring the point that what had occurred between Laing and Christy challenged one of the primary dogmas we had all been taught to believe in graduate school: that "schizophrenics" are not capable of forming relationships, that they are not amenable to therapy and that the most therapists can do is to help them to function on a very low level by maintaining them on "medication." Yet Laing had managed to win Christy's trust in a very short period of time, and his acceptance of her enabled her to manifest her own intelligence and charm. Although Laing and Minuchin had different theoretical orientations, both of them were iconoclasts who were critical of the ways in which the dogmas of the mental health profession limited the individual's capacity to grow and to change. Both were critical of the profession's reliance upon psychiatric drugs.
Laing's dialogue with Christy was in stark contrast to a dialogue he reproduced in his book written in 1982, The Voice of Experience, between one of the most highly regarded psychoanalysts in the century; Wilfred Bion, and his schizophrenic patient. Bion advocated that interpretations should be "simple," "exact" and "mature." What follows is an excerpt from Bion’s session with his patient:
PATIENT: I picked a tiny piece of my skin from my face and feel quite empty.
ANALYST: The tiny piece of skin is your penis, which you have torn out, and all your insides have come with it.
PATIENT: I do not understand... penis... only syllables and now it has no meaning.
ANALYST: You have split my word "penis" into syllables and now it has no meaning.
In the next session the exchange went as follows:
PATIENT: I cannot find any interesting food. I do not feel able to buy any new clothes and my socks are a mass of holes.
ANALYST: By picking out the tiny piece of skin yesterday you injured yourself so badly you can not even buy clothes; you're empty and have nothing to buy them with.
PATIENT: Although they are full of holes, they constrict my foot.
ANALYST: Not only did you tear out your own penis, but also mine. So today there is no interesting food--only a hole, a sock. But even the sock is made of a mass of holes, all of which you made and which have joined together to constrict, or swallow and injure, your foot.
Evidently this and subsequent sessions proved to Bion that the patient was so delusional that he believed he had literally eaten Bion's penis, leaving a persecuting hole the patient felt a need to fill up. Ten days later Bion reported, "A tear came from his [the patient's] eye and he said with a mixture of despair and reproach, 'Tears come from my ears now.'"
Laing remarks wryly that it is no wonder tears were coming from his ears after having to listen to Bion's absurd interpretations day after day, week after week, month after month, year after year. (This psychoanalysis went on for years, we are told, which is not unusual.) While Bion's statements are entirely fantastic, the patient’s statements seem to convey simply and exactly (albeit metaphorically) that what Bion is saying makes abso1ute1y no sense to the patient. Laing remarks that "it is difficult to fathom the difference between Bion's psychoanalytic fantasies and what is usually called a psychotic delusional system." It is in fact the analyst here, the "expert," who seems more "out of contact" with reality than the patient.
Although Laing says that the two individuals are "equally crazy" he goes on to make the point that the patient is in fact making a profound communication when he states that tears were coming from his ears. If Laing were seeing such a patient, he says he can imagine a sigh. "I might be caught by his talent to say so much in so little... I could not help but feel that the tears in his ears might betoken a sense on his part, which I can not help but share, of something sad, maybe even pathetic, about our relationship. There is truly an abyss between these two men."
If Laing had conversed with Bion's patient, one imagines that the patient would have felt understood, as Christy did. But Bion as a psychoanalyst was more interested in fitting the patient into the procrustean bed of his own theories than in communicating with him as a fellow human being. It is no wonder that psychoanalysts reach the conclusion that schizophrenics are unable to form relationships with therapists....