In which we set the scene.

There were two kinds of patients in British mental hospitals of the late fifties and early sixties: those who had admitted themselves, and those who had been 'sectioned' - that is, involuntarily confined with the signature of two doctors and the responsible next of kin. Once inside, there was little or no difference in treatment, but the voluntarily admitted could, were they aware of their rights, discharge themselves.

Treatment in the fities and sixties was of three kinds. The sedative drugs such as Largactil and the barbiturates (for sleep) were coming into use. There were physical treatments - electric shock, lobotomies. Insulin and other shock treatments had generally vanished from use. And there were various forms of 'talking cure'.

Patients generally slept in dormitories. There would be one or two common rooms. There was some segregation according to severity of symptom. There would be closed wards, and in a town of any size there might be two institutions, one taking more extreme cases than the other. These had a fearsome reputation in the community. You could hear in the voices of ordinary people, when they assumed you had no association with psychiatry, how they spoke of a relative or acquaintance being in Garlands in the Northwest or, in Oxford, in the Littlemore, or still worse, in London in the Maudsley. What you heard was dread.

Whatever the therapeutic theory, in practice the hospitals were run by the orderlies. They were working people for whom the job was an alternative on the same level as being a fireman, policeman, prison warder, care home worker. The New York municipal civil service offered good jobs to the white working class families who lived in Brooklyn. In the same way, the state in the UK was a good employer for similar people, and the mental hospitals were one avenue.

We need to remember that the UK, or at least England, had a tradition of housing people in institutions. The workhouses of the 19th century continued well into the 20th, and often metamorphosed into care homes. They were abolished as workhouses in 1948, but some were still in use as homes in the seventies. The traditions of administration were national and spread across institutions. The Great and the Good were on the Boards of Directors. The management roles were filled by degreed place holders. Those who dealt with the residents were the orderlies. The same principles governed the administration of mental hospitals. The model of governance at arms length by the Great and the Good still applied. The communal living model of the workhouse still applied. Mental hospitals were a sort of hybrid of the old workhouses and the new prisons, with, naturally, a therapeutic justification and purpose.

Should you have found yourself in a mental hospital in about 1960-65, and still have your wits about you enough to observe and reason, a number of things would rapidly have become clear to you. First, nothing remotely therapeutic was going to happen to you, other than the passage of time. Second, what drugs you were given and whether you were at risk of one of the physical treatments was solely at the discretion of the orderlies. Third, you would see your doctor at most once a week, and he was powerless to affect the conditions of your daily life. Fourth, there was going to be absolutely nothing to do to pass the time.

The treatments given were neither safe nor efficacious. The sedative anti-psychotics such as Largactil did calm, but produced permanently the characteristic slurred speech, puffy skin, rigid expression and involuntary facial movements which became dreadfully familiar to anyone who worked in this area. ECT was generally regarded by both patients and orderlies as a punishment for bad behaviour, and greatly feared. It seems likely that it would have been equally effective applied to the soles of the feet rather than the parietal lobes. It was administered in those days at intensities which permanently destroyed memories. It was effective, as any form of torture will occasionally be, because it mobilized all the life force of the individual in the direction of survival. It clarified the mind most fiercely.

Lobotomies, whose incidence varied, being most common at the Maudsley in London, greatly worsened the condition of almost all patients subjected to them. It was not very common, though in all 17,000 people were treated like this in the UK[1], which makes the UK, on a population basis, one of the most enthusiastic practitioners of this form of institutional abuse. But the threat of it hung in the air everywhere and acted as a deterrent. Harold Pinter makes a graphical reference to it in 'The Caretaker'. There is a scene in which the horror of what was common knowledge is most skillfully drawn on. The characters talk around the issue. gradually moving towards it, but it is clear to the audience, long before the denouement, exactly where they must be headed. Anyone who recalls seeing the play or later the film must realize, looking back, that this is one of those moments in which a work of art depends for its power on, and illuminates, the darkest areas of the cultural practices of a society.

This left the 'talking cures', of which the best that could be said was that they were harmless. The traditional diagnosis was to separate patients into the psychotic and the neurotic, and to separate the psychotic into the manic-depressive and the schizoid. The neurotic would receive the talking cure, others one of the more aggressive treatments. Electric shock was a standard treatment for what was diagnosed as manic-depression, but not the schizoid conditions. Later it became apparent that the classification and diagnosis of these ailments was little better than random, but we did not know that then. We really believed that there were distinct clinical conditions with their own aetiology and prognosis.[3]

There were none of the light tranquilisers which have since so changed both social life and the field of mental health. You could prescribe tranquilisers or sleeping pills, but you did so knowing that this was heavy medicine, and it was done rarely and with caution. With the arrival of the SSRIs it became socially possible to have a substantial minority of the population on them, while still driving, operating machinery, doing accounts, making investment decisions, and they are now handed out like aspirin on request. It is only a slight exaggeration to say that then, you were either sedated or you coped, and mostly, you had to cope. Laing therefore would have been exposed to many more people who had adopted various forms of more or less bizarre coping strategies than any practitioner today will ever see. Eccentricity has been a casualty of the SSRI revolution.[2]

The advice one gave in those days to any distressed friends or acquaintances who were at risk of admission to mental hospitals was: this is a life threatening situation you are in. Its time to treat it as such. On the admission interview, explain that you have never been able to resolve your feelings about your father or mother. Never admit to hallucinations, feelings of persecution or conspiracy. It is permissible to be mildly, but only mildly, troubled by obsessive thoughts and trains of ideas or phobias whose origin you don't understand. You do have difficulties with the opposite sex, and fitting into social groups, and this deeply troubles and depresses you. You strongest need is to have someone to talk to about all this.

Your life depends on being able to carry this off.

The talking cures were available mainly to the middle classes, and were divided into the Freudians, the Jungians, and the Kleinians. We had not yet discovered transactional analysis, or getting in touch with our true feelings. When Churchill died, there was no outpouring of national grief at his funeral, but there was an enormous silence.

The past is a different country, and England was different then. In most of the country, crime was low, muggings almost unknown. You can see how much lower by looking at the statistics on crimes known to the police. The curve is astounding. You could not get a drink in a bar after 10.30 at night. Whisky was a luxury, wine expensive because imported, and we were always in the middle of a Sterling crisis of some sort. Beer was the common drink, and it was weak by today's standards - 5% would have been strong bottled beer, and the draught bitter in the pubs was under 4%. Public drunkeness was rare and unthreatening. Today the centres of larger towns are no-go areas on weekend evenings, violence and vomiting are universal, bands of drunken young people of both sexes mingle with a massive police presence and ambulances on standby. Then, the worst you would find was cheerful noise at 11pm, occasional fights, and deserted streets at midnight.

Cars then were expensive, mobility was limited, there were no dual highways. People travelled by train in either first or third class coaches (second class coaches had been abolished) or locally in buses, or cycled. On most country roads you could walk with pleasure and cycle in safety, meeting a few cars an hour. There were no supermarkets. The town centers were filled with small shops. A typical town of a few thousand people would have a couple of butchers, a greengrocer or two, a couple of ordinary grocers selling cheese, bacon, jam, butter. There'd be a baker, an ironmonger (or hardware store). Probably a couple of 'outfitters' selling menswear, and several shoe shops. Two newsagents, also selling books and stationary. Two electricians, selling appliances and radios. A public library, well stocked with books. And a Cooperative branch grocery and white goods store, used by the working classes. In the big industrial cities there were factories whose workforce streamed in and out in crowds at shift breaks. At seaside resorts landladies rented shabby rooms with bed and breakfast, and exiled their guests during the day, rain or shine.

It was a class-ridden country, almost all white, but operating a system in which everyone had invisible caste marks on their foreheads to show their place in the hierarchy, and in which any sort of 'luxury' was only affordable by the rich. The expression 'a traitor to his class' meant something. In Public Schools, dormitory windows were open year round, to teach the endurance of hardship so necessary for future colonial administrators. Cold baths were taken in summer. Beatings were routine; the administrators would have to endure, and administer, pain.

In the public education sector, the entire country took an examination at 11 which was a sort of IQ test. Those who passed it started an academic education; the rest went to a sort of trade school. There were further examinations at 16 and at 18. The tiny minority of the clever, or the hardworking, having jumped these hurdles, would get a state financed university education. Universities too were sharply stratified into three classes. There was Oxford and Cambridge, closely followed by the London universities. After that came the newer, or Red Brick, universities. With a university degree you could enter the administrative grades of the civil service, or a management training scheme with one of the larger blue chip companies. To leave a 'grammar' school at 16 or 18 meant a routine clerical job.

The contraceptive pill had not appeared, the bidet had never taken root, showers were rare, bathing less than scrupulous, deodorants were rarely used, male homosexuality was illegal, and legal abortions were very hard to come by. Sexual experiences outside the richer classes accordingly tended to the ignorantly Hogarthian and could disgust the fastidious, as much as they offered excitements foreign in today's hygienic world to those of differently sensitive dispositions. It was illegal to publish Lady Chatterley's Lover. The Lord Chamberlain examined London plays for indecency, and compelled changes where they offended him. Men and women were, if not from Mars and Venus, at least from different planets. For a girl, getting pregnant while unmarried was something of a scandal and a disaster. People lived in communities, public opinion counted for something. Churchgoing was common. It was a country in which, if you were in a responsible position, you could feel an obligation to attend, to 'set an example', or 'because it was expected'.

It was a culture of everyday life founded on emotional repression, concealment, copings of various sorts, denials, pretences. The stiff upper lip. It has left its traces, particularly in matters of class, in England today. No-one now would ever ask someone they had met, as people did occaionally, pointedly, then, 'if you come from the North, why do you not have a Northern accent?'. The answer, which could not be given, was 'because I am passing - in the American sense'. But, they are still passing. Few in England speak with the accent they were born with, or retain the tastes they grew up with. Now, everyone in England is to some extent passing for something they are not authentically. The difference is that then, we occasionally called each other on it in matters of class. Now it is so common as to be invisible.

This past which formed Laing is not a country we should regret, any more than we should regret the Old South, with which it had much in common, though that was based on race, not class. We should simply register how different it was from any modern English experience, and how much it formed Laing's experience. It was in this environment that Laing looked at his patients in hospital, listened to what they said, talked to their families, and concluded that not everything was exactly as it was generally accepted to be. Laing had antennae, he was exquisitely sensitive to what he saw as inauthenticity, he had read and digested Sartre, he had breathed in Bloomsbury through the pores of his skin, and he knew, or thought he knew, the true nature of what he could see around him, and he knew that however it looked, whatever it was sold as, it was totally different under the surface.

One way to imagine this is to read Forster. The people in Room with A View, and the other early novels, have a vivid and immediate sense of what is real, what is right, and what is fake. They have a sense of the authentic, applied to personal relations, and authenticity in personal relations is seen, in the tradition of Moore and Bloomsbury, as the cornerstone of morality.

Laing had that sense too, though he applied it to areas Forster had never imagined, and perhaps was convinced by this English tradition of the rightness of Good Feeling, that his insight was well founded. Its a minority stream in English culture, but it is real and substantial, and pervasive enough that like Laing, you can swim in it, while feeling outside the mainstream, but deriving support from it. You don't even realize you are in a tradition. You may well feel your insights are personal, but they are not, they are in the tradition and conditioned by it.

From this perspective, Laing concluded that the reality of the diagnosis and treatment of mental illness was as inauthentic, and different from the way the conventional wisdom represented it, as everything else in the life of personal relations in England.

But how was it really, under the surface, according to Laing? And was he right?

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Notes

[1] "In absolute terms, psychosurgery was most prevalent in the United States, with approximately 40,000 persons lobotomized, followed by Great Britain with approximately 17,000 and the three Scandinavian countries with a combined figure of approximately 9,300(Pressman, 1986; Tooth and Newton, 1961; Tranøy, 1992; Valenstein, 1986)."

Lobotomy in Norwegian psychiatry, JOAR TRANØY & WENCHE BLOMBERG

History of Psychiatry, 16(1)

[2] Alan Turing was 'treated' for homosexuality, believed to be clearly a mental abnormality as well as a crime, probably due to an abnormal relationship with the mother, by estrogen injections in 1952-3. In some ways the definition of mental illness was wider then then now, in other ways much narrower. The stigma of mental disturbance has diminished as less draconian treatments have become available. At the same time, there has been an increased readiness to treat all inability to achieve general happiness and particularly sexual fulfilment as treatable pyschiatric conditions. The boundary between treatment and punishment was hard to determine in those days. It is a question, as you can see in the Turing example, whether British society really understood that there might be a distinction.

[3] Years later an article appeared in the Scientific American summarizing some research. A professor had persuaded his students, who were perhaps braver than they realized, to present themselves at various mental hospitals, and on interview, they recited a standard script and then behaved normally thereafter. Their diagnosis varied randomly. No more proof was really necessary that the language we had learned to describe the people we were dealing with was, in the verificationist sense, meaningless. Two professionals, looking at the same facts, with equivalent training, agreed only at a chance level on what they were observing. What then was the meaning of "schizophrenic"? It was clearly not the rule for placing individuals into or out of the set of schizophrenics, because there was no such rule. The shock of this realization is conveyed dramatically in The Crucible, when one of the characters finally says 'There are no witches.' Were there really, then, no schizophrenics? What had we done? This was Laing's question.


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