What things do I point to in Laing and Szasz's thought?

More views of - or before - Cambridge Film Festival 2012
(Click here to go directly to the Festival web-site)

13 October

Following on from Ronnie, gae hame!, I have some thoughts to share about Drs Laing and Szasz and their place in the order of things...

1. Dignity and respect - talked about in recent days, as if just invented with applicability to being an in-patient, but the story tells us that Ronnie was alongside, literally, someone who, naked, just rocked and would not engage, so he did the same. But, for all these schemes such as Star Wards, because it's not in the culture of mental-health nursing, nothing much is different, not least at the level of patients feeling that they're in an underclass because of being 'ill': on a crude scale, a sort of pecking order, anything that the relatives have to say (and so they can support, and speak up for, the patient about troubling side-effects, because, unlike the patient him- / herself, those people count) carries far more weight, and the status of anything said by the patient is less important than the family pet's views of his or her care.

2. Coercion - if I compel you to do or suffer something, even for your own good, how is it likely that you will feel about the thing that you did (or suffered), about me for forcing you, and about myself for having been a person who is legally allowed to be treated in that way? Whatever a breakdown is, if it leads to an admission, being dehumanized by hospitalization and institutionalization makes for far more trauma for the in-patient (whereas his or her aberrant behaviour hacked off friends, neighbours, relatives and /or the police, and so, for their sake, he or she gets detained) than the breakdown itself. I think that Thomas questioned why, if someone has to be coerced, there can be therapy, rather than distrust, resentment, fear, pain, on the part of the patient towards the detaining authorities - my analogy, but a bit like trying to carry out dentistry on someone who is not willingly opening his or her mouth.

3. Compassion - much more than those basic things at 1, above, - partly involved in doing what Ronnie did in rocking with that patient, and which feeling for and honouring the respect and dignity of patients would not, in itself, lead to. Compassion wholeheartedly and without reservation puts your lot in with the other person's*, often thought of as unconditional love, and is almost at an opposite pole to psychiatric practice of Ronnie's time - you wouldn't have found many endorsing the rocking anecdote as concordant with their views of patients.

4. Criminality - if I lock you up, whether you're drunk and have smashed some things, or in psychosis and have done the same, and you don't appreciate the situation (in the latter case, thought of as lack of insight), you will nonetheless - at some level - know that you are being treated as if you have done something wrong. As I look at what Thomas might have meant at 2, above, and think of mental health in England and Wales, the police can (forcibly) take you to a place of safety, they may be involved in any sectioning process or in taking you to hospital (if you do get sectoned), and they are the people who take you back, if you escape (or try to). In our own system, then, the coercion and the criminal taint are linked, even though, under the Minstry of Justice's control, there is quite separate legal provisions for the foricble detention of people on remand for or convicted of criminal offences: the in-patient not only feels imprisoned, mistreated, misunderstood, misrepresented, but has a perception that some criminal wrong is the reason for all this punishment. And, amidst all this, he or she is supposed to recover, respond to treatment, and - which is itself ambiguous as to health and character - get better.


For what it is worth, those are my thoughts on what Thomas and Ronnie still have to say to us, decades on...


End-notes

* In Ronnie's case, I suggest that he probably took compassion too far, rather than the approach of being empathic, which, for anyone with mental-health issues, is a less costly and, literally, less soul-destroying way of relating to patients. Whatever happened to him in later life, with booze - but he was a Glaswegian - and the effect of efame or whatever, I guess that he may have given too much of himself, and in a way that Adrian, one of his sons, likes to report (he has written a biography) that Ronnie did not do at home, by usually describing home life as a crock of shit.


If you want to Tweet, Tweet away here