Tag Archives: Thomas Szasz

Madness and Meaning

By Dr David Laing Dawson

As a young physician entering the world of the asylum, the mental hospital, the world of insanity, like many others before and since, I was fascinated by the prospect of finding meaning within madness, understanding behaviours that appeared, at first blush, inexplicable, understanding the de-contextualized speech patterns of many patients, understanding their delusions and voices.

This was the era of Timothy Leary, of a wish on the part of some to find a chemical path to enlightenment, the era of R.D. Laing seeking parental and family causes of insanity, of Thomas Szasz telling us that mental illness is a myth, the time of Foucault telling us that our society causes madness, and Alan Watts telling us that, really, madness was just an alternate flight path.

And, I must admit, madness, delusions, hallucinations, voices, fractured speech patterns, catatonia, mania, and even stuporous depression, contain rich and fertile ground for an artistic and literary imagination, and always fodder for philosophical questions about reality, meaning, semiotics, the nature of a human being, the manner in which we define deviance.

In our therapeutic communities of the day we talked and talked, in small groups and large groups. We listened to delusional ranting, to the reporting of voices emanating from the back of the head or from the dead, from an alien spacecraft, from God, and from the devil. I have spoken with several Queens, a few Christs, a man who tried to kill a president, a man harbouring evil beings inside his body, a man with the gift of teleportation, with many who believed the radio and television and popular songs were sending them personal messages, to many who believed they were being controlled by radar, radio waves, microchips, to men who wanted to cut off their genitals, to others who wanted to gouge out their eyes, to a few who wanted to kill someone who was controlling them from afar.

Of course we can find meaning in all of this, in each and every delusion, in each and every ephemeral message. And the meanings can be deep, intellectual, fanciful, alluding to Greek Mythology, Shakespeare, intrusive government programs, Kafka. They can be Freudian, Jungian, Adlerian, Foucaultian. They can even be new age and theosophic.

Or the meaning can be found more simply in those basic parameters of our social world and our sense of self: power, control, influence, intimacy, sexuality, responsibility, worth, love, hate, guilt, fear.

But does this help?

If it helps us empathize, yes. If it helps us form a relationship, develop trust, rapport, acceptance, yes. If it helps us accept these sufferers as fellow human beings, yes.

But might it not be more important to treat that young man who wants to gouge out his eye, before he actually does it, rather than worry about Oedipus Rex?

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Shrinks – The Untold Story of Psychiatry – A Review

Marvin RossBy Marvin Ross

Last week my colleague, Dr David Laing Dawson, provided his own personal history of prescribing psychiatric medications since he became a physician in the late 1960s. David’s experiences fit in with the development of that profession as described by Dr Jeffrey Lieberman in his new book Shrinks, The Untold Story of Psychiatry. Lieberman is a psychiatrist himself, chair of the Department of Psychiatry at Columbia University and the past president of the American Psychiatric Association.

It is highly readable book and what I particularly enjoyed were his anecdotes based on his many connections within the profession. He points out that RD Laing, one of the father’s of the anti-psychiatry movement, had his “convictions ….. put to the test when his daughter developed schizophrenia. After that, he became disillusioned with his own ideas. People who knew Laing told me that he became a guy asking for money by giving lectures on ideas that he no longer believed in.”

Lieberman attributes this information to Dr. E Fuller Torrey. Lieberman also mentions that the other leader of anti-psychiatry, Thomas Szasz, made it clear that schizophrenia did qualify as a true brain disease but that he was never going to say that in public.

Of less intellectual interest is the origin of the term shrink. Headshrinker entered broad use after a 1950 Time Magazine article about Hopalong Cassidy saying that anyone who predicted that he would become a hero of kids would have been led off to a headshrinker – Hollywood jargon for a psychiatrist. Hopy was my hero and I still remember lining up for hours in Toronto wearing my Hopy chaps and vest waiting for a chance to shake his hand.

North American psychiatry was heavily influenced by the psychoanalysts who, Lieberman points out, followed a rigid set of theories that were not grounded in science or scientific proof. In fact, two psychoanalysts from different schools of thought would likely come up with different interpretations for the same patient. As a reaction to this lack of rigour, science and the criticism from anti-psychiatrist, some in the profession began to establish menus of symptoms for each disorder based on data from published research. This was an effort influenced by the Kraeplin approach of the previous century.

And while the psychoanalysts had always emphasized cause based on unconscious conflicts, the development of this new Diagnostic and Statistical Manual (DSM) was to be based on two key concepts. First was that the symptoms must be distressing to the individual or must impair his ability to function. Second was that these symptoms must be enduring. It is interesting that the development of the DSM partly arose from the criticisms of the lack of evidence by anti-psychiatrists. Today, the anti-psychiatrists argue that the DSM is pathologizing everyday life. Lieberman states that the DSM-5 has actually reduced the number of diagnoses to 265 from the 297 in the DSM-4.

In addition to his description of the serendipitous discoveries of effective anti-psychotics, lithium for mania and anti-depressants, Dr Lieberman’s comments about families will please all who have kids with schizophrenia. It is worth quoting in its entirety:

It was not enough that parents had to endure the tragedy of a child’s mental illness; after this onslaught of inane diagnostic formulations, they also had to suffer the indignity of being blamed for the illness because of their own misbehavior. Schizophrenia and bipolar disorder……were now believed to be curable through the right kind of talk therapy. Like a pet cat in a tree, a deranged individual merely had to be coaxed into climbing down to reality.

All in all, a very informative and entertaining read.

One Step Forward, Two Steps Back – Mental Illness Treatment Over the Past 150+ Years – Part II

David Laing DawsonBy Dr David Laing Dawson

In the spring of 1969 a new psychiatric facility was opened on the campus of the University of British Columbia, the first component of a full service teaching hospital. This clearly heralded the future of psychiatry and the treatment of the mentally ill, or so I thought: a large outpatient department, space for a day hospital, and small wards for inpatients, wards for only 20 patients each, wide corridors, accessible nursing station, private rooms for some, no more than two to a bedroom and bathroom, earth-coloured patterned carpeting, earth-toned walls, residential style beds, comfortable furniture, warm lighting, pleasant dining room, a sitting area with lounge chairs and fireplace, meeting rooms, no locks on the doors. Even sliding doors to small balconies for many rooms occupying the ground and second floor.

Perhaps there was not quite enough security to manage the most disturbed, potentially violent patients, but it is really a small percentage of the mentally ill who do not respond well to treatment offered in a non-threatening compassionate fashion within a very comfortable environment. The impulse to flee is actually reduced when the door is open. The impulse to say NO is reduced when the treatment is offered gently and patiently. The impulse to rant and break things is reduced when the lighting is soft, the chairs comfortable, the colours soothing, the sounds not echoing off concrete walls. The impulse to hit someone is greatly reduced when that someone is not threatening you.

We were experimenting with forms of something we then called “The Therapeutic Community”, which really meant open meetings of staff and patients sitting in a big circle each morning, discussing everything from housekeeping issues to medications to ward rules and protocols, to the question of whether or not one patient should go off his medications or take more, and if another is ready for a weekend pass. It wasn’t thought of as “the treatment” but rather as a humane and democratic context for treatment, and an environment that would bring out the best in people.

It is true we were reading Thomas Szasz, R. D. Laing, Jay Haley, Erving Goffman, Michel Foucault, Gregory Bateson and all the others postulating that the roots of madness could be found in distorted parenting or unbridled capitalism or imposed social conformity, but you really don’t have to spend much time with someone in a manic state, a stuporous depression or an active schizophrenic psychosis before you know, as a colleague once succinctly put it, “It’s a brain thing.”

My next stop was England, to see first hand a large mental hospital that had eliminated locked doors altogether. Serving Cambridge and the surrounding shire it sat brooding on the fens just as you and Thomas Hardy would imagine, a large winged Victorian mansion with a few marginally more contemporary buildings around it. It was, by North American standards, poorly resourced, under-heated, and I was quickly appointed physician to six wards of forty patients each. But the doors were all unlocked; each ward had its daily community meeting, its occupational therapy programs, good nursing and medical care, grounds to walk on, work to do, social and entertainment programs. It was an asylum, a humane asylum, and proof of a sort that decent psychiatric care did not require modern buildings with state of the art security.

Still, it can be assumed, (and my personal survey supports this) that everybody, every patient, would prefer to live and be cared for in his own home rather than in any kind of institution.

It was 1971. We now had effective treatment for most psychiatric illnesses (not all but most). It was time to build an array of outpatient, community, and home treatment services that might gradually reduce reliance on mental hospitals.