The Divided Self
This book has a positive historical role in repositioning the patient’s lived experience right back at the heart of discussions about what it is to have schizophrenia.
Laing, R. D. The Divided Self: An Existential Study in Sanity and Madness. New York: Penguin Books, 1990.
R. D. Laing writes in the preface of this book that his is “a study of schizoid and schizophrenic persons” with the basic goal of making “madness, and the process of going mad, comprehensible” (p. 9). At the outset, Laing uses diagnostic language that is familiar to every psychiatrist and psychoanalyst. Terms such as psychotic, schizoid, schizophrenic, and paranoid proliferate this book. Yet this is not a psychiatry text. Laing argues that psychosis is not a medical condition, but an outcome of a “divided self,” or the tension between the two personas within us: one our private, authentic, real identity and the other the false self that we present to the world. Talking in the language of existential philosophy and phenomenology (which makes this a bit of a difficult read), Laing focuses on what psychosis is like for the patient. He seeks meaning in psychotic experiences and attempts to understand them from the point of view of the patient.
Laing sets of his theory of schizophrenia with the overall aim of explaining that psychosis is a reaction to an intolerable external world. He develops the concept of “ontological insecurity.” He describes this as an indefinable feeling of something lacking for an individual and a primary disturbance of the self. According to Laing, this ontological insecurity is at the root of schizophrenia. At the inner core of a person is their self. The self is in the world and relates to the world by means of its body. Most people, most of the time, feel safe in their world. Laing refers to this as “primary ontological security.” However, for some individuals, this security becomes an ontological insecurity in that they feel persecuted by reality itself. An individual becomes concerned with preserving themselves. Their fear of their own dissolution into non-being and non-existence becomes so great that the self becomes dissociated from both its own body and from the whole external world of people and events. It is therefore unable to have a direct relationship with others and it instead relates to objects of its imagination and memory. Its own bodily experiences and actions become foreign, part of a false self system. The false self arises in compliance with the intentions or expectations of the other, or with what are imagined to be the other’s intentions and expectations” (p. 98).
[The false self] consists in acting according to other people’s definitions of what one is, in lieu of translating into action one’s own definition of whom or what one wishes to be. It consists in becoming what the other person wants or expects one to become while only being one’s “self” in imagination or in games in front of a mirror. In conformity, therefore, with what one perceives or fancies to be the thing one is in the other person’s eyes, the false self becomes that thing (pp. 98-99).
Laing argues that individuals who have their real self undermined during childhood will go on to develop a false self to interact with the world. These individuals are then at risk of developing psychosis when, under pressure, the real self dies and the false self becomes overwhelmed and is no longer able to cope. The outsider, estranged from herself and society, cannot experience herself or others as real. Therefore she invents a false self and with it she confronts both the outside world and her own despair. The disintegration of her real self keeps pace with the growing unreality of her false self until, in the extremes of a schizophrenic breakdown, the whole personality disintegrates.
Laing backs up his theory with clinical vignettes and patient histories of schizophrenic individuals. The existential lens through which he views patients is a supremely personal way of looking at people. It is like saying of the schizophrenic one is examining: “this person is not a sick person, this person is like me.” And it is this “like me” factor that makes it possible to understand and empathize with the schizophrenic. Instead of looking at clusters of symptoms, Laing seeks instead to actually talk to patients and to listen to what they have to say. These patients tell stories of their lives, their experiences, and the things that cause them anxiety in everyday life. Laing does not focus on what makes “us” (sane) different from “them” (insane), but instead focuses on what we share in common with each other. I think that is what makes this text so powerful.
For Laing, the profession of psychiatry and psychoanalysis have proven to be a barrier to truly understanding the lives of the mad. Through the use of scientific nomenclature used to classify symptoms, the professionals have alienated us by depersonalizing the odd aspects of people’s behavior. Instead of seeing these people as objects or an illness, we should view them as human beings who live inside their own worlds. What Laing is advocating is for developing a kinder and more humane way of relating to patients. As a result, even though Laing is a psychiatrist, he is highly critical of the discipline of psychiatry in treating schizophrenia and of the standard doctor/patient relationship. It has not always been the case that medical doctors have had reign over the mentally ill. According to Michel Foucault in Madness and Civilization: A History of Insanity in the Age of Reason, it is purely by accident that medical doctors became responsible for treating madness in the first place and it is only recent history that the mad were deemed mentally ill. Historically, people who acted psychotic were thought to be possessed by evil spirits. It was in the seventeenth century in Europe that people began to grow concerned for their safety as crazy people wandered the streets. As a result, they were confined as a means of protection. This lead to the creation of the lunatic asylum. It was Philippe Pinel who argued that the mentally ill should be attended to as sick people in order to humanize their treatment and it was the Madhouses Act of 1774 which saw physicians as the sole arbitrators that determined who was diagnosed as insane.
Laing’s theory of schizophrenia raises some questions. First, Laing suggests that the speech of a schizophrenic patient is intelligible. Laing interprets much of what his patients said as the consequence of disturbed family relationships or as a concealed attempt to retain some of their identity, but it remains unclear whether schizophrenic speech disorders can be explained this way. Second, the few case histories Laing provides hardly qualify as adequate scientific evidence for a theory of schizophrenia. As of today, we still not know what causes schizophrenia or indeed whether what we call schizophrenia is a single disease entity. Since Laing wrote his book we have evidence of genetic factors, structural brain damage, and intellectual dysfunction in schizophrenia, which any adequate theory about the cause and effect of schizophrenia would have to explain. This does not, of course, exclude the possibility that social factors, including the influence of the family, could play a part in such an explanation. But it seems highly unlikely that this is the sole explanation.
Lastly, psychiatrists are privy to aspects of experience which normal life is designed to hide or avoid and it seems worth paying attention to their accounts in our quest for a greater understanding of human nature. Psychiatry attracts dilettantes who read in order to find a solution to their own problems. There is even a term, the “neuronovel” to describe a genre of burgeoning literature narratives that feature protagonists with psychiatric disorders. While the author who coined this term believes that the genre is too pathological for the literary world, I think we ought to embrace it for the insights gleaned from the phenomenological accounts of those who suffer from severe mental illness. If we want our literature and science to inhabit the full measure of the human condition, it must stretch to accommodate new ways of knowing the world.