Asylum

Many years ago I purchased a documentary entitled Asylum. Well recently, I was interviewing a patient when he said to me that he did not feel that he was mentally ill. Unfortunately, many of patients I see have little insight into their illness.

This particular patient actually made mention of R.D. Laing, who was a psychiatrist who rebelled against the traditional prospective of mental illness.



Just recently I found a paper I had written in graduate school about R.D. Laing and his documentary Asylum and it provoked some thought.


R.D. Laing (October 7, 1927 – August 23, 1989)

First some history.

In 1971, a group of filmmakers were granted the opportunity to film for several weeks at a unique home for mentally ill individuals in London. The Archway Community was based in large part on the theories of the late radical psychiatrist R.D. Laing. Laing's belief was that that the hierarchical structure of the usual doctor-patient relationship could be broken down by communal living. Laing attempted to break the cycle of individuals being re-entering hospitals again and again.

The film observes the housemates as they interact with each other. The film allows us to witness a group of psychotic residents who cook, eat, and do chores together. They enjoy each other's company and at times quarrel. They struggle with themselves but are able to live together without playing the role of the "patient". They seek therapy when they need it and take medication. The psychiatrists stay with them engage with them.

The patients at times do yell, they do talk to themselves and respond to internal stimuli. They also laugh and support each other.

All of them had the strength to recognize that they were not content with their situations and wanted to challenge themselves to cope and heal.

So, who exactly was R. D. Laing? He was a British Psychoanalyst, Social Phenomenologist, Radical Psychiatrist, and Existential Philosopher. He is often associated with the anti-psychiatry movement.

Laing's community lasted five years (1965 to 1970) and he wrote such books as Divided Self.

Laingsociety.org exists today where studies devoted to Laing's philosophy continue.

Laing believed that "madness" is often contributed by the family and environment is backed up by research. I think that one's environment affects anyone whether they are psychotic or not.

I think his idea to form a communal living for those with illness was quite helpful for some, especially during the 1960s when conditions of state hospitals were quite horrible and inhumane.

The idea of mental hospitals were actually thought of by Quakers and social workers in the U.S. who thought that those with psychotic illnesses could benefit from productive programs and home like atmospheres.

Unfortunately, when psychiatrists and health insurance companies took over all that was over.

Patients of psych hospitals no longer stay for years and years and often do not receive enough assistance. It's all about discharge now. Patients are often brought to the psych ER by police and usually stay anywhere from 3 days to 2 weeks.

Once a patient is "stabilized" on medication they are referred to long term care such as a step down unit or a board and care (board and care facilities are usually very disheveled) facility.

Some are discharged to shelters or are "discharged to self" where they end up on the street again.

I've seen discharges that I have not been happy with and patients continue to come in to the hospital time and time again.

Laing's views definitely challenge today's mental health system.

Excerpt from R.D. Laing's Asylum

Laing in his own words...

...Psychiatry is unique in several respects. It is the only branch of medicine that treats people psychically in the absence of any known physical pathology...It is the only branch of medicine that treats people against their will, in any way it likes, if it deems necessary. It is the only branch of medicine that imprisons patients, if judged necessary.

...by and large psychiatry functions to exclude and repress those elements society wants excluded and repressed.

There are hundreds of thousands of people in every country in the civilized world who lapse into wretched and crippling states of mind. If they get to be too much for us we turn them over to a psychiatric service; they are not at liberty to refuse them. Their wretched minds and rejected conduct now fall within the observation and control of psychiatry, which is given a two fold mandate. First to keep such persons excluded from the ordinary outside world for as long as ordinary company out there cannot abide them. This can be, and is done. The second mandate is to stop, if possible, to change if possible, their conduct and states of mind from undesirable to desirable. These two duties are placed on psychiatry. It is ensured that psychiatrists carry out these tasks by giving them the power to do so, a power they cannot refuse if they want to practice psychiatry.

I was frightened by the power invested in me as a psychiatrist and by the way I was expected to use it.

Today in the mental health industry there is a model known as The Recovery Model. It is a model that steps away from the traditional medical model where medications are the primary form of treatment in inpatient psychiatric hospitals.

When I was in graduate school The Recovery Model was just being introduced and many had a difficult time accepting it as a model at all. I admit I had some difficulty with it as it seemed to push us professionals to the side.

The model focuses on self empowerment and autonomy within the client. Sounds good right? In some ways yes. The model is being implimented in various ways. Individuals are encouraged to take charge of their treatment through recovery focused group therapy rather than individual group therapy. Some individuals are running groups themselves without the use of a professional. While this certainly has value it has it's minuses as well.

Some individuals are not ready for group work and very much need the assistance of one on one treatment.

There is much to be said about this model and I could go on and on but the point is that The Recovery Model is effective in many ways.

One way in particular is that it promotes self-esteem. I can't tell you how much it irriates me when I hear someone refer to a mentally ill individual as "crazy." I reserve to word crazy when I am essentially stating that I find something to be ridiculous.

The individuals I work with are highly intelligent. Some speak several languages, others have master degrees, and some incredible street smarts. I witness wit and humor and kindness in the people I work with. And yes some have of history of violence or are registered sex offenders. Many hear voices (auditory hallucinations) or see things that are not there (visual hallucinations). Many have grandiose dellusions or have little insight into their illness.

They are my heroes and I feel so humbled by them. They teach me so much every day and I am in constant awe of their strength. I am quite fortunate to be able to work with such amazing human beings.

I find it unfortunate that so many of our treatment facilities for mentally ill patients are limited to psych hospitals. Few residential treatment facilities exist where patients can truly work on their issues.

The cycle of admittance and discharge from hospitals is on going as so many do not receive the help that they need.

The sad fact of the matter is that patients with physical ailments are given better care than those who have a mental illness. It's 2009 and yet this backward thinking is still accepted.