A Word For The Social Model of Madness: Psychiatry and The Family
When Shakespeare writes about how family and friends drive us mad, and treat us badly, it is great art – when a psychologist suggests it, then it is an outrage; this is a contradiction we find in our culture. The implications of openly accepting that close and dear ones as a source of malevolence and psychological trauma are extensive. It is the love that we dare not speak its name…?
Introduction
So when can love, affection or friendship become a hazard to your mental health ? How do we measure and deal with sociopathic behaviours in our social circles ? When do we allow ourselves to speak out against roles which people hold which are deemed so sacred that we would rather put up with psychological abuse ?
Famously R. D. Laing took on this fight, and in many eyes became a lunatic himself. He was one of many people who had come to expose the idea of the biological models of mental and emotional stress to much needed scepticism.
He and others questioned the idea of schizophrenia as a clinical entity and attempted to use interpersonal communication as a tool to get at the realities that each person was having to deal with from their existential point of view.
He and his colleagues suggested that the way some families worked could generate psychotic behaviour in one of the members of the family. This person could suffer from being – consciously or unconsciously – the scapegoat in the family group, bearing the elective burden of the family dysfunction. These ideas were inflammatory, and for many people and families, the idea that they might be instrumental in the mental and emotional dysfunction of the diagnosed individual was terrific.
This was a cultural taboo which Laing and others pressed at the boundaries of. Overprotective, domineering mothers; cold, insensitive fathers; self centred, malicious sisters; brutal, imposing brothers; cruel, calculating husbands; sly, manipulative wives; these ideas all declared a web of societal deceit that is ugly against the notion of the ideal family which is publically desired. The taboo to accuse the notionally primary source of support, care and empathy (i.e. the family) of being a potential cause of the destruction of an individual is deeply disturbing to our idealised senses of our selves.
An Idea Too Far: Putting The Map Down To Look At The Territory
This type of idea is so threatening to the symbolic economy of our human society that they have at points drawn out the urge to censor. An example is of the Victorian temperamental reaction to the ancient Greek play of Medea. A theme contained in the play is infanticide committed by Medea as revenge on her ex-partner.
In Euripides’ play Jason leaves Medea for Glauce who is the daughter of the king of Corinth. Medea sets out to avenging her husband’s betrayal by killing the children she had with him, Tisander and Alcimenes. Shanyn Fiske makes reference to this in her book ‘Heretical Hellenism: Women Writers, Ancient Greece and the Victorian Popular Imagination’:
“In such an atmosphere of moral and religious censorship, Medea in particular lost ground…Edith Hall has thoroughly discussed the continuity between midcentury debates about divorce legislation and the appearance of the first two nineteenth century Medea adaptations…..These two burlesques, argues Hall, helped to familiarize a lay audience with Greek tragedy and the Medea figure while simultaneously acting out problems introduced by the proposed legalization of divorce, such as the plight of women abandoned by their ex-husbands with no means of providing for themselves or their children. Silenced because of her nonconformity to dominant nineteenth century ideologies, Medea arose in the British popular imagination as a figure intimately associated with controversies surrounding women’s shifting social status.
Besides the divorce debates, Medea’s appearance in nineteenth century popular culture was also entangled with heightened concerns about and legislation regarding infanticide….in both Planche’s and Wooler’s works the murders are completely written out of the script….The shift in the portrayal of Medea’s infanticide marks an important transitional moment not only in Victorian assumptions about women’s “motherly instincts” but also in attitudes toward aberrant women who demonstrated an “unnatural” lack of maternal impulses. Mary Poovey has pointed out that these instincts were ‘considered woman’s definitive characteristic;…
This instinct, theoretically accounted for the remarkable fact that women were not self interested and aggressive like men, but self-sacrificing and tender”. Poovey argues that while such characteristics as passivity and compassion were attributed to natural differences between men and women, they were in fact cultural constructs that justified women’s separation from a competitive and often immoral social and political reality” [Page 38, by Shanyn Fiske, Heretical Hellenism: Women Writers, Ancient Greece, and the Victorian Popular Imagination, ISBN-10: 0821418173]
We are aware, are we not, of the allegorical nature of art, drama and myth – that these mediums provide us with ways of exploring and understanding complex realities and meanings that hold prominent place in our human world. We are aware also of, say, situations of acrimonious divorces which take place and situations that give rise to children being used as weapons to hurt the other parent. Is it not rational to accept that some people could potentially see their partners presence in a child and punish that child psychologically for the effect they have of raising ill feelings of lost ideals ? Is this not, to a varying extent, what was written of by Euripides ? Do we not have a duty to accept that there is a valid social model of mental illness that needs to be investigated in terms of families, friends, lovers, and society ?
A key book which examines some of the potential dynamics which feed into the mental un-wellbeing of an individual is that of ‘Sanity, Madness and the Family’ by R D Laing and Aaron Esterson. The book examines a series of case studies in which ‘schizophrenia’ is interrogated from the social perspective and attempts are made to get at understandings of the family dynamics that underpin this illness.
A series of families of diagnosed individuals were interviewed so to reveal the contextual meaning in the apparently meaningless behaviours and delusions they suffer from. It was this contextualising process which provided the framework for the psychological study and it made possible to see how alliances and fences within family groups are created and built upon at the expense of certain individuals. This can sometimes happen over generations and involve gender prejudices.
The study revealed the discrepancies which exist between verbal statements made by members of the family and the actualised non-verbal communication which goes on interpersonally between the family and the diagnosed individual. These dynamics create a situation which is hard to change because of the complexities and the unwillingness to confront noxious issues.
Another interesting book by R D Laing is ‘The Politics Of The Family‘ where he examines the capacity – and argues a tendency – to invalidate the subjective and experiential accounts of of psycho-social circumstance in favour of the idealised societal view of what should be happening within that space. In it he offers observations on how families unknowingly affect the lives of children from their birth and impose stresses and strains on the individual which are not commonly held in the societal account of the family.
“We speak of families as though we all knew what families are. We identify, as families, networks of people who live together over periods of time, who have ties of marriage and kinship to one another. The more one studies family dynamics, the more unclear one becomes as to the ways family dynamics compare and contrast with the dynamics of other groups not called families, let along the ways families themselves differ. As with dynamics, so with structure (patterns, more stable and enduring than others): again, comparisons and generalizations must be very tentative….
….The family may be imagined as a web, a flower, a tomb, a prison, a castle. Self may be more aware of an image of the family than of the family itself, and map the images onto the family. ‘Family’ space and time is akin to mythic space and time, in that it tends to be ordered round a centre and runs on repeating cycles. Who, what, where is the centre of the family ? According to one description: ‘My family is like a flower. Mother was the centre and we were the petals. When I broke away, mother felt that she had lost an arm. They (sibs) still meet round her like that. Father never really comes into the family in that sense’. [From Chapter One, The Politics Of The Family, R. D. Laing, ISBN: 0887845460]
So whilst our perceptions can focus on the map rather than the territory, the menu rather than the meal, or the image of the family rather than the actuality of the behaviour between the members of the family, we must actively acknowledge that – just as depicted in drama, art and myth – malevolence, sociopathy, and alienating behaviours arising within families can be the causes of mental illnesses.
This idea is disturbing; It disturbs and disconcerts, but maybe this is a good and important thing to happen in the contexts of a society which is increasingly drugging people for emotional and psychological disturbances without investigating the deeper causes. This notion of examining the members of a family, the family as a unit as the source of psychological un-wellbeing is very inconvenient for medical practitioners – and inconvenient for psychiatric medication sales people.
Personality Disorder and The Double Bind of The Medic
Putting the doctor in the position of acknowledging a psychologically manipulative spouse, an unkind parent, a selfish child, or an empathically aberrant social circle raises intricacies for the medic which are problematic. Just as informing the person that they are best not to be in poverty as it is likely to create depression in them, telling them that they are best to leave their husband or wife because their relationship is not a good one creates various conundrums for the medical practictioner. This is an unenvious position, and simply administering intoxicating medicines (which by definition psychiatric medicines are), can be seen as a strategy of avoidance as much as an attempted solution.
However, there are deep ethical issues at stake here, and people who are paid to help people achieve health – and as a part of health, happiness – are morally and ethically obliged to attempt to get at the root causes rather than dealing with symptoms as they arise. Equally, there is a societal imperative to protect and respect the medical and welfare practitioners who are attempting to help people – to the best of their knowledge – from being expected to make people happy all of the time for matters and situations which are often results of the persons choices/actions. The solution is to be found in the enquiry of open dialogue and support to act on choices.
The explanations of what the drivers are for people’s behaviour and feelings must attempt to examine all the factors. Without this stance, the whole process is lost at sea as a central posit of scientific method is to analyse all the factors which can have a bearing on the observed phenomena; equally, the phenomena must be observable, discrete and definable. The methods of the social sciences attempt to develop tools to build understandings which deal with the human psyche.
Psycho-analysis and psychology are two such fields which sometimes contrast with medical models that reduce behaviours simply to a neurochemical imbalance – often without being able to demonstrate the hard facts they imply behind the statements of medical authority. Equally, there are clear examples of where a measurable neurochemical imbalance affects the way we behave and feel such as disturbances of thyroid function, heavy metal poisoning with mercury, and Huntington’s Chorea.
In trying to get at an understanding of truth(s) in psychology/psychiatry, the danger is that a binary view is created in approaching understandings of behaviour where one is adopted at the expense of the other. Both nature and nurture contribute critical factors that help shape our feelings and behaviour. Unfortunately, the nurture aspects are under-represented in the age of pharmacy and dwindling social care budgets.
How our families treat us massively determines how healthy, happy and balanced we become as individuals. As a social mammal, the human being has a core requirement for company and affection. Detrimental psychological conditions need not necessarily be situations where overt negative actions are asserted upon another person, but could simply be the absence of some important social factor:
“Mrs R.’s presenting difficulty was a dread of being in the street (agoraphobia). On closer inspection, it became clear that her anxiety arose when she began to feel on her own in the street or elsewhere. She could be on her own, as long as she did not feel that she was really alone. Briefly, her story was as follows: she was an only and a lonely child. There was no open neglect or hostility in her family. She felt, however, that her parents were always too engrossed in each other for either of them ever to take notice of her. She grew up wanting to fill this hole in her life but never succeeded in becoming self-sufficient, or absorbed in her own world. Her longing was always to be important and significant to someone else. There always had to be someone else. Preferably she wanted to be loved and admired, but, if not, then to be hated was much to be preferred to being unnoticed. She wanted to be significant to someone else in whatever capacity, in contrast to her abiding memory of herself as a child that she did not really matter to her parents, that they neither loved nor hated, admired nor were ashamed of her very much”. [Page 54, The Divided Self]
The things which matter might be expressed in something as simple as a hug which does not show up on blood pressure monitors or paper notes in the natural sciences. This is why, for example, the Existential Phenomenology approach in psychology was developed as a way of humanizing the the medical practice to balance the effects of the natural sciences perspectives and attribute value to first hand accounts as a source of insight.
Normalising the Absurd
People can get used to most nearly anything under certain circumstances. It is a strange truth that many people choose to stay in abusive relationships despite knowledge that they will suffer further. Albert Camus writes about this normalising process in his book ‘The Stranger’:
“Still, that phase lasted a few months only. Afterward, I had prisoner’s thoughts. I waited for the daily walk in the courtyard or a visit from my lawyer. As for the rest of the time, I managed quite well, really. I’ve often thought that had I been compelled to live in the trunk of a dead tree, with nothing to do but gaze up at the patch of sky just overhead, I’d have got used to it by degrees. I’d have learned to watch for the passing of birds or drifting clouds, as I had come to watch for my lawyer’s odd neckties, or, in another world, to wait patiently till Sunday for a spell of love-making with Marie. Well, here, anyhow, I wasn’t penned in a hollow tree trunk. There were others in the world worse off than I. I remembered it had been one of Mother’s pet ideas—she was always voicing it—that in the long run one gets used to anything” [Page 48, The Stranger, Albert Camus, ISBN: 1517406927]
In the story, the protagonist Meursault is arrested and sent to jail after attending his mother’s funeral when he disinterestedly killed a man who he recognised from a previous fight. His lawyer is disgusted at his lack of remorse, and, in particular, at his lack of grief at his mother’s funeral. Later, the examining magistrate demands that Meursault put his faith in God. He refuses, insisting that he does not believe in God. The magistrate cannot accept Meursault’s lack of belief, and brands him “Monsieur Antichrist.”
In 1955 Camus wrote: “I summarized The Stranger a long time ago, with a remark I admit was highly paradoxical: ‘In our society any man who does not weep at his mother’s funeral runs the risk of being sentenced to death.’ I only meant that the hero of my book is condemned because he does not play the game”…
Can we talk of a fear of not playing the game ? Has the peer pressure of societal ideals got such gravity that we would be endangered in our personal lives to abandon notions of family to the public world ? Are there prejudices which are linked with being divorced ? Does it raise such social discomfort when we express a disconnect with siblings that it is better not said out loud lest we alienate ourselves socially ? Are there social and familial double binds which we find ourselves in and accept for the sake of the quietest life possible ? Does the person who challenges the normalization of the absurd find themselves perceived as mad ?….
The Road To Hell Is Paved With Good Intentions
The problem with parent-child relationships – and any situation where there is a power differential – is that should the parent not actively listen or have the tools to empathise, learn from or coordinate with the child (or other person) as a human being of equal value, then there are the dangers of imposition and tyranny.
Many tyrants believe that they are acting in the best interests of everyone concerned. The old adage ‘power corrupts…’ applies in the smallest of places, and in the place of the family and familial a silence needs to be occasionally broken. One of the most interesting places to observe in a mental hospital is the waiting area where people get checked in. There are a few reasons why this is a unique place in the hospital, one of them being that, as an undeclared observer, you can sit in a public place and watch the changes in behaviours as different actors enter the setting.
I once spent some time watching in such an admissions space, where one could sit and others would assume that you had been attended to. It is rather like standing at a bus stop; people assume that you are meant to be there, as that is where people wait for the buses. If you stood all day at the bus stop to observe people who got on and off buses, then you would apparently blend into the setting. It is the same for an admissions area of a hospital as there is no audit process for who you are.
I was particularly taken when I saw people being frogmarched in by partners, or parents, sternly and vocally lambasting the individual who was about to receive the full attentions of the Royal Edinburgh psychiatric hospital. The instances which stood out in my mind were those where the people who were being committed were almost entirely passive, absorbing what aggression was being put their way. There was usually a tone of irritation riding high…
What was intriguing was the change in character and tone which took place in the people who were committing the person – not in the person who was receiving the psychiatric attentions, who usually remained consistently behaved . Suddenly it seemed, sometimes, that these irate characters would come over all p’s and q’s, sweetness and light, laying out the manners when the medical staff came in with their white linens. Then the expressions of concern and worry would be paraded under the banner that they only want the very best for the person they were committing…
These are merely my untrained anecdotal observations, and my interest had been garnered when, of a certain age, I had noticed that people were starting to be committed – teenagers. I can think of one case where a teenage boy was committed to a psychiatric facility for getting drunk on Jack Daniels and calling his father obscenities; his father was a prison warden and had him interred. He spent several medicated months in the hospital where observation periods expanded and expanded, and where his parents were the ones who were the litmus on the facts of the situation.
Another person – teenage boy – was referred to a psychiatric facility because he was confrontational with school staff. He wound up being medicated to high heaven, becoming rather uncommunicative, and passing away at a certain point via an overdose. The details of these people I will keep discrete, however, these are two in a constellation of examples of my generation who have been taken through the psychiatric process. I was to become intrigued with how the system worked and wanted to understand the facts about how my peer group were being categorized.
To finish this article off, I leave you with an excerpt from Ken Robinson’s book ‘The Element’ which looks at how the parents of Paulo Coelho imposed their care on him through adopting the power and authority of psychiatry:
“This is what happened to Paulo Coelho. Mind you, his parents went further than most to put him off. They had him committed repeatedly to a psychiatric institution and subjected to electroshock therapy because they loved him. The next time you feel guilty about scolding your children, you can probably take some comfort in not resorting to the Coelho parenting system. The reason Coelho’s parents institutionalized him was that he had a passionate interest as a teenager in becoming a writer.
Pedro and Lygia Coelho believed this was a waste of a life. They suggested he could do a bit of writing in his spare time if he felt the need to dabble in such a thing, but his real future lay in becoming a lawyer. When Paulo continued to pursue the arts, his parents felt they had no choice but to commit him to a mental institution to drive these destructive notions from his head.
‘They wanted to help me,’ Coelho has said. ‘They had their dreams. I wanted to do this and that but my parents had different plans for my life. So there was a moment when they could not control me anymore and they were desperate.’ Coelho’s parents put Paolo in an asylum three times…. Coelho’s novel The Alchemist was a major international best seller, selling more than forty million copies around the world.”
[Page 223 The Element by Sir Ken Robinson, ISBN: 0141045256]