Saturday, August 8, 2009

all the lonely people...where do they all come from?

This is an old post that I have transferred to this blog.

Several years ago I purchased a documentary entitled Asylum. I watched it again earlier this week and felt that I was watching it with a fresh pair of eyes.

In 2008 I was in my second year of graduate school and was interning at a psychiatric inpatient hospital. This documentary really spoke volumes to me. I was able to compare and contrast the methods of institutionalism today, the history of institutionalism and the methods that Dr. Laing used here. I think this is a very interesting documentary for mental health professionals.


In 1971, a group of filmmakers were granted the opportunity to film for several weeks at a unique home for "mentally troubled" individuals in London, UK. The Archway Community was based in large part on the theories of the late radical psychiatrist R.D. Laing, including his belief that the hierarchical structure of the usual doctor-patient relationship could be broken down by communal living - an effort to break the cycle of people being fruitlessly shuttled between mental hospitals and their often dysfunctional homes. The film participates in this ethos, simply observing the housemates as they interact with each other, often in fascinating digressions that illustrate Laing's thesis at the time that "madness", while painful, could sometimes have creative and socially positive outcomes. A tremendously humane and powerful document of community.

The film depicts 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.
They do yell, they do talk to themselves and respond to internal stiumuli. 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.

R.D. Laing (October 7, 1927 – August 23, 1989), was a British Psychoanalyst, Social Phenomenologist, Radical Psychiatrist, and Existential Philosopher. He is often associated with the anti-psychiatry movement although, like many of his contemporaries also critical of psychiatry, he himself rejected this label. He made a significant contribution to the ethics of psychology.

Although Laing's community lasted only five years (1965-70) his work (including books such as Divided Self ) but Laingsociety.org exists today where studies devoted to Laing's philosophy continue.

I have not formed a complete opinion of Laing and his work. I plan on reading and researching more. His belief that "madness" is often contibuted by the family and environment is backed up by research. He was often labelled as a anti-psychiatrist. 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 illness 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. 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 to themselves 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 definately challange our current mental health system.

...Psychiatry is unique in several respects. It is the only branch of medicine that treats people psysically 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 imprisions 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 undesireable to desireable. 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 practise psychiatry.

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

- R.D. Laing



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