Hilary Mantel. Introductions to Inner Circle Seminars conducted by Anthony Stadlen on the families in Laing and Esterson’s Sanity, Madness and the Family


Introductions by
Hilary Mantel
to
Inner Circle Seminars
conducted by
Anthony Stadlen
on the families in



1. Maya Abbott
Inner Circle Seminar No. 205

How many books go by us, in the course of a life: and how many afternoons, a book in hand? Of the questions I am asked as a writer, the one I find most difficult is: what are your influences? What shaped you? It is often too casual a question, and that’s why I find it difficult: the answer should fit a line or two in a magazine interview. You should say, ‘This book, or that book, built my books.’ But I find it difficult to separate texts and life events: a book may mean nothing at one stage of your life, everything at another, and there is always a question of timing: what brought me to that book, or that book to me, at a moment when I was equipped to understand and change? I should like to take you to an afternoon in 1973, a place, a time, a book, a moment of inner decision, dawning knowledge. In a word, I will tell you how I came to read SMF, at a decisive time in my life: almost twenty-one, on the cusp of graduating from university, and beginning to speculate, with some apprehension, about my future. If I speak personally, you will forgive me, because I am here just as a person: I am not a professional in this sphere, and I represent no one but myself.
That spring of 1973, I was already a married woman. I had married a fellow undergraduate, the man to whom I am married now. Why the hurry? When families fall apart at one seam, there’s an instinct to stitch themselves together at another; and my partner’s father had died the previous year: not suddenly, like a death in the street from accident or heart attack, but suddenly in the sense that a man who was well in autumn was ravaged by an aggressive cancer, and dead in January. The dislocation and distress speeded up our decision to marry, as if we were trying to save something from the wreckage.
My husband’s father left a family business, into which my husband had been expected to step; but it had to be sold, and our expectations were derailed, and so my husband decided to train as a teacher. He went over to Alsager in Cheshire, to an interview at the training college there, and while he was being shown around, I went to the library, and browsed the shelves and, because I had already read The Divided Self[1], I picked up Laing and Esterson’s book[2] and for some three hours I sat transfixed.
The histories begin with Maya Abbott[3]. Maya had been a wartime evacuee, away from her family between the ages of eight and fourteen: surely an unusually long time, but then one knew of evacuees who had never returned to their family of origin at all. I thought, as I often had, how unexamined the phenomenon of the evacuees was; I had often wondered what sort of parents they made themselves, and whether the bomb damage still so evident in the streets of my childhood suggested inner explosions in the psyche of parents and children torn apart. So immediately I thought, this is not the whole story: but when do we ever get the whole story? When I read the case histories now, what leaps out at me is the question of whether one of the things these families are covering up is sexual abuse. New times, new questions. But I did understand that the researchers did not set out to give a comprehensive account, or to judge, or to impose interpretation. Yet interpretation came naturally, spontaneously, to those well-grounded in metaphor. Before Maya was born, Mr Abbott read about the excavations of Mayan tombs and thought, ‘Just the name for my little girl.’ I remember the chill those words struck into me. I thought, she is born with the dead.
Of course I do not know her real name. All the identities are disguised. I assume, though, that the researchers chose a name that reflected the real one.[4] When Maya rejoined her family, it seems that they related to her not as the fourteen year old who had returned, but as the eight year old who had gone away. In between, she had dropped into some tomb, dungeon, oubliette. Or she had been in some suspended state in their imagination; this kind of suspension occurs in fairy tales, and keeps a girl frozen, pre-pubertal. Maya’s own story about her time away was that she had been in hospital. This is how she explained it later. She thought there had been something wrong with her.
I knew that my immediate reaction might be leading me away from the facts before me, and leading me, perhaps, towards some other story, that was meaningful in the context of my own family; but my attention was prisoner to the resonances those early pages created. So I read the book in one sitting. That is my impression. I cannot have read it in any great detail but I ripped through it and then I got my own copy[5]. I still have it. It has travelled the world with me; there are few books I have not left behind, replaced, jettisoned, to travel light, but I have always taken this one with me. The immediate effect on me was profound. I had been fascinated by The Divided Self but that book brought me news; I found it difficult. This book inflicted the shock of recognition, and I found it easy, and easy in the best possible way: I found it clear, and I found it clarifying. I know this, I thought. I have always known it. Moreover, I have lived it, in a sense I have lived it. These family conversations, I have heard them. I could, I felt, have constructed another chapter and called it The Mantels.
This is not the place to unfold the intricacies of my own family, but I must put you briefly in the picture so that you will see how easily I related to the families in the book. I was born in 1952, and I come from a working class family of Irish origin, migrated (long before I was born) to a Derbyshire village. I didn’t have a rural childhood; it was a mill village. It was like living on a dying planet: resources depleted, air running out. The mills were closing throughout my childhood, and there was a feeling that the future was elsewhere. The same fatigue and general air of pointlessness would soon blight pit villages. You said, why are we here? How soon can we go somewhere else? I wanted to emigrate to Australia. When I was old enough to read the papers, I used to yearn over the adverts for the £10 emigration scheme. I hoped to get as far away as possible.
I was the eldest of three children. My father’s name was Henry. When I was six or seven, a man called Jack, my mother’s lover, came to live in our house. My father didn’t leave; he just moved rooms. There was no point in pretence and no effort at pretence. We were, naturally, stigmatised. For four years we provided the village with a daily feast of gossip. None of the three adults seemed to know how to get out of this situation. It was like locking yourself in the village stocks and throwing away the key.
Four years on, my mother and father Henry parted company. We went to live in another town eight miles away and we changed our name to Jack’s. My brothers were too young to remember their former life. They thought Jack was their father. Jack, I believe, thought the younger of the two boys was his, but time showed he was wrong. For my part I did not know which man had fathered the boys. My sense of chronology was shaky and so was my knowledge of human reproduction. My mother, possibly, did not know, but she had her preferences, and they counted far more than facts. The sins of my father, my mother told me, were unspeakable; yet for four years of my childhood, she had spoken to me of little else.
When we moved house, her monologue changed. Our former life was erased. My mother and Jack were not married, but pretended to be. I never saw Henry again: he was disappeared, like a victim of Stalin. Photographs of him were thrown away. My mother cancelled her first marriage and purported that I too was Jack’s child. We were in contact all the time with people who knew about our past, but it was supposed to be a secret, and it was a secret I was charged with keeping, and I was considered the one most likely to blow the family’s future to bits by revealing the truth; so, it seems to me, I was punished in advance, in anticipation of the damage I might do. The mystification process, which the recordings in the book catch as it is happening, was a basic mechanism in my family. We ran on lies as a cooker runs on gas. No one was to blame, perhaps: no one person. Mystification is a process that can survive even the death of the mystifiers. Some families never get their story straight, generation to generation. Some extended families try to repeat patterns through generations, even when those patterns create misery and damage: as if, because they are recognisable, they are safer than anything new. As a novelist I find this fascinating: as a daughter, as a sister, I find it chilling. When I look back at my teenage years it seems to me that I was not only unhappy but caught up in profound ambivalence, like Absalom hanging from the tree waiting to be slaughtered.
This is a cursory glance at a situation which had many facets, none of them pleasant. But you will be familiar with the dynamics of a family where a parent is profoundly narcissistic, where both parents have a self-reinforcing paranoid style; and in case you think I am handing out blame, I should say that in the light of wider family history, the styles of both my mother and my stepfather are understandable. For me the difficulty was that you cannot thrive in such a family, and you cannot thrive outside it. By the time I was nineteen I was sick. I mean to say, I was physically ill. I was alive to the fact of something wrong in me, physiologically; I was also alive to the fact that in the economy of my family, illness had a particular function. So I was self-doubting, while unable to ignore my symptoms. I was aware that I was caught up in a long game, and that I could not see the end of it; yet present reality required relief. I could not get a diagnosis, but worse – I could not even get tests, or a proper examination, or a proper hearing. I know that my symptoms were confusing, that they did not offer a clear picture, a pointer. I accept that my manner was apologetic. I asked for help but I did not insist. Self-doubting, I undermined my own credibility. Yet a sure, swift leap occurred, and I can’t quite excuse it; my illness was assumed to be some sort of fiction, unless I could prove otherwise. Because the doctors I saw couldn’t work out what was the matter with me, they made the extraordinary decision that it was not they who were ignorant, it was I who was mad.

I say extraordinary: it is, looked at objectively. But in those days, the early 1970s, it was happening all the time. The medicalisation of unhappiness had begun, tranquillisers were being handed out like sweets, and the word ‘psychosomatic’ was passing into common use: it was taken to mean, ‘imaginary’. I was one of thousands of young women labelled, diagnosed and drugged; the stupidity of the era did seem to impact most on women. What seemed like a medical judgement was often a value judgement, a fact to which Laing and Esterson would draw attention. The cure for my supposed illness was a range of drugs; my brain was working wrongly and needed to be helped to work right; the reason for the wrongness, the lurking first cause, was over-ambition. I really longed, a psychiatrist told me, to work in a dress shop. If I abandoned my false pride and admitted this, I would be on the way to a cure. Every time I opened my mouth to defend myself, I seemed to make matters worse, my verbal facility merely an aspect of my disease. The vicious circle, the double-bind: I knew these mechanisms, these traps. And I knew them, as traps, to be horribly successful.
There is, Laing and Esterson pointed out, a deep and pernicious fallacy at the heart of much of the treatment of mental distress. A disease process is assumed, and all the words and deeds are interpreted in the light of that assumption, which tends to validate itself. Once the diagnosis of a ‘mental illness’ has been made, there is no clean way to see the person to whom that diagnosis has been attached, try as you might; all subsequent events are interpreted to reinforce a decision which has already been made, one which is in accord with the prevailing scheme, the prevailing orthodoxy. We see it happen all the time now: if you are in the US health system, the question is, what is your DSM classification? You must be fitted into one, as otherwise for insurance purposes you cannot be a patient, you cannot be suffering. If there is no classification to suit you, then wait a minute; one will come along. Pressure from the pharmaceutical industry puts the cart before the horse. If there is a cure, a disease must be found to suit it. If a pill is profitable, some consumer must be defined as in want of it. This disaster, in the era of which we speak, was a cloud no bigger than a man’s hand; but in any era, once a person is viewed through the prism of a diagnosis, that person’s reality is lost. And the women Laing and Esterson saw were often lost too, into a back ward. Those were the days of the long-stay institution, and once the woman had shaped herself, as she would, in response to the requirements of her new community, the chances of successful, lasting return to the world outside lessened month by month.
Laing and Esterson asked us to interrupt the process and suspend judgement; instead of assuming that words or deeds of the patient were unintelligible, therefore mad, should we look at the context in which they occur, and see if they became intelligible? Could we, by close attention to how these families communicated, cast light on why one member was so unhappy, or bore so much blame? The eleven families studied were chosen from two hundred with whom the researchers worked. The assumptions on which they proceeded are clear from each case history; these patients have been diagnosed as schizophrenic, but this study will hold ‘in parenthesis’ the question of whether schizophrenia has any reality, or what that reality might be. They were aware that the study would be regarded as ‘anecdotal’ and therefore met with derision. In the preface to the second edition, attempting to meet some of the objection already raised, they restated their case: are the experience and behaviour of their patients intelligible, in their context? The context here is the family; all the patients are young women, more or less dependent, embedded in a family network. They were at pains to say that they were not contending that parents were responsible for producing schizophrenia in their children. They were rather questioning the existence of the disease entity. It is this question that the world found so difficult to hear.
The scope of the book is carefully and precisely defined. Laing and Esterson are clear on what it is and is not. To every reader, it became perhaps a little more than the authors meant it to be, and it may be that I am as guilty as anyone of embellishing what is on the page, perverting it to my own ends. But for me it acted as a key. The room it unlocked for me was a spacious room and I still live in it. It opened up the possibility of greater knowledge, or allowed me to formulate into knowledge what I dimly perceived. I no longer regarded my situation as unique. For the three years of my degree course (I studied law) I had taken in information, not knowledge. I was like every other person of that age; the conversion into knowledge comes later, it is a life’s work. But I needed, because my back was to the wall, a particular kind of assistance. The book made sense of my world. You do want to know how your particular experience attaches to the general experience, and at twenty-one you can’t know; you are happy if you are taught by a book.
The book enlightened me but it did not act like a book of magic spells. It made my own situation intelligible to me but it did not at once give me the power to change it. It is easy for me to say in retrospect how I should have lived my life, what I should have done: at eighteen, I should have left my family and not gone back. But I had two younger brothers and I felt that by staying around I could help them. That was the conscious part of it; I suspect, though, that I could not extricate myself, because families like mine are enmeshed, they are sustained by their own damaging strategies. What the book did for me, immediately, was to stop me feeling ignorant. I had been told I did not know how the world worked. But it seemed I had noticed a lot. I was qualified to comment on what I knew.
About a year later two things happened. The first is that I made a decision that come what may I would never again accept a referral to a psychiatrist nor knowingly take a psychotropic drug. The question of whether I was or was not physically ill was still open, but the question of whether I was mentally ill was closed. It was a non-question. It was not up for debate. This may sound arrogant. But I believe it was necessary for me to draw a big black line between my past and my future. I had to save my life, I felt. I did not have a solution to my problems, but the solutions offered by others had led me deeper into trouble. I had taken on other people’s view of me as not just a sufferer, but a patient. I had taken the drugs they handed to me and they had produced in me symptoms which looked and felt like madness. Once I had experienced akithesia, I knew what madness felt like. So it was not a question of minimising, disguising, covering up my distress; it was a question of redefining it.
At the same time I began to write. This was my way of redefining me. I felt the insights I had from the book in many ways empowered me to do so; I had more faith in my own judgment and powers of observation and indeed, you might say that for a while they were the only things I trusted. The book helped me to think about power relationships in the family and wider society. About duplicity. About corrupt communications. But I didn’t, and I don’t see writing as therapy. It was therapy, I suppose, in the way that a rope is therapy for a drowning man. But if you set out to become a communicator, not a scribbling solipsist, you must get your head up above your circumstances; and it is in that gesture, that strategy of turning outwards that, in my view, some of the healing power of art resides.
I didn’t, as you might expect, write autobiographically. The first book I wrote was not the first I published. My career had what looked at the time like a false start. After many years of work I met with rejection and had to step back and reconsider and begin again. When I wrote my first published book I chose an epigraph from Pascal:
‘Two errors: one, to take everything literally: two, to take everything spiritually.’
That could stand as an epigraph for everything I have written since, and it is a kind of watchword for me, a rule: when I ask myself, ‘what is this thing?’ I am guided, I am warned, that I must look beyond the substance of any phenomenon to its inner nature, but I must not be blind to surfaces, I must be attentive to presentation, I must look squarely at the thing I am shown. Then when I have worked out what it is, I must ask, ‘And what else is it?’
Now, I am a professional user of metaphor. No writer of fiction can breathe without it. Looking though a writer’s eyes at questions of sickness and health, it seems to me that a failure to understand metaphor lies at the heart of much shaky diagnosis, and of much human unhappiness. Unfortunately, a facility with metaphor is not something that is easy to teach. It’s like trying to teach someone to see in colour, when their eye is only equipped for black and white and shades of grey. A person’s ability to express themselves through metaphor seems to have little to do with education or cultural level or intelligence; neither is a person’s ability to perceive metaphor constrained in this way. If, as in the case of these families, the penalty for plain speaking is too great, the sufferer must seek some other way to utter. Sometimes, for a patient, only symbolic expression of distress is safe.
But what if it is not safe? What if meaning slides from under language and tips us into the mire? What if the will is taken for the deed? What if a woman says, ‘I could kill you’ and so her husband calls the police? If fear simply freezes speech, distress will break out in physical symptoms, in nightmares and daymares. Or when the sufferer tries to articulate distress or ask for help, images leap unbidden to her assistance, zealous servants, too zealous sometimes; before you know it, the metaphor is out of your mouth, and you are ripe for misconstruction: for diagnosis: for treatment. A doctor who is inept with metaphor will interpret as a delusion what is, for a patient, a forceful and vivid attempt to express her reality. Once, doctors did not know this, because it was axiomatic that one did not ‘talk to psychosis.’ Laing knew that if you can get past that prohibition, and listen, you will hear in the language of supposed madness an art as sophisticated as the poet’s art; and I say that not to valorise or glamorise the sick soul, but to express my wonder at the business of being human, at the many strategies the mind and body has available, to work for its own salvation. Doctors of all kinds, not just psychiatrists, demand that the patient communicates on one level, a level that is rational, logic-bound. For the patient this is sometimes impossible – because the communications that must be made, the news that must be told, come from a part of the self where different rules apply. When a patient is in pain then, past a point, he screams. We do not accuse him of madness because we cannot parse the scream. We acknowledge the honesty of the communication. We try to alleviate his pain. We do not try to cure him by gagging him, or by putting our fingers in our ears. But this has been, very often, the fate of those whose pain is not easily named. The miracle of this little book is that within it we heard voices: not just those of the named patient, but of the confused and conflicted people about them; with the dead hand of the diagnosis removed, they became eloquent.
When I speak of the body and its metaphors, its ways of articulating distress, it is no news to you; nor is it news to you that listening is in itself a healing art. To a great many people in our society, it is news. To many of the doctors Laing worked with, it was news of an unwelcome sort, the kind of news you could only contrive NOT to hear by an effort of will: but many doctors did manage to live in the equivalent of a clockwork universe, long after its day had passed. Innovation, to them, meant new drugs. Thinking was always within the box. What they defined as progress was in fact redefinition and reordering of familiar premises: an intellectual shuffling of the feet.
I do not want to stigmatise one profession; it’s common. Historians do it; they pass the ball of received opinion from one generation to the next. That is an intellectual vice, but it does not have immediate, personal consequences. Weak powers of analysis, closed minds: when exhibited by clinicians, these blight lives. Where stupidity is willed, it becomes not a misfortune but a vice. A failure to ask difficult questions, to challenge your own assumptions, can call in question your ethical status. Sometimes, when you look at what has been done in the name of health, you ask, are these interventions not profoundly diseased? Are these actions, undertaken to cure, the actions of decent men? We assume humane intentions. Perhaps we should not. We assume a certain ethical fastidiousness, and we know we should not. You may remember the passage[6] in Wisdom, Madness and Folly, where Laing relates an experience as a medical student. His group were shown films produced by prolonged X-rays of the human body, displaying joint movement and the process of digestion. These films had been made by Nazi experimenters, and the experimental subjects would all have died in great pain. When Laing realised what he was being shown, he says, he walked out, along with another student. The other two hundred remained, unperturbed. When he approached his teacher he was told that the material was unique, and this contribution to knowledge should be used; otherwise, the victims would have died in vain.
It is a viewpoint. There is something to be said for it. The thing that appalled Laing, and I am sure we have all met similar instances, is that his fellow students were oblivious to the difficulty. They did not see that there was an issue. He felt, he says, ‘terror.’ It is an awful warning; those bright enough to become doctors can be, in many ways, dull. We assume it is a prime desire in those who wish to study medicine, that they alleviate human misery; we assume they wish to be good people; we should not assume they know how to be good. There is no parity between doctor and patient. A patient can be stigmatised a neurotic or a fraud. But a patient never calls a doctor a fraud. They may call them unethical, uncaring, but they assume they are competent and intellectually equipped for their task. But it seems to me that much medicine is fraudulent, in that much accepted practice depends on assumptions, about individuals and society, that bear radical re-examination.
I was reminded of this when a few years ago I wrote about Laing in a column[7] in the Guardian, explaining how I thought he had influenced me as a writer. I concentrated chiefly on SMF, and readers wrote to me, to set me straight. Only one letter-writer, and that was Anthony Stadlen, appreciated what I was trying to say. The others made the familiar objections which, in later editions[8], Laing and Esterson themselves engage with. They were resigned correspondents, more in sorrow than in anger; I was a lay person, they felt, who had been misled. Did I not know that Laing was a covert Marxist? Did I not know that he was a drinker? They themselves, in their many years as mad-doctors, had known many young schizophrenics emerge from families whose saintly qualities shone out from their medical notes. The same mechanisms the book had identified, they argued, could be found in families where no one was schizophrenic. I feel I can endorse that last point. But it does not affect the book’s observations. I wrote back, and reiterated what I have said above: Laing and Esterson did not set out to show that family interactions cause schizophrenia. They questioned the existence of the condition, and observed that the behaviour described as psychotic became intelligible, seen in context; to understand the context, you had to listen when the families told you about themselves.
This long failure to engage seemed to me dishonest. My letter-writers set up a man of straw, in order to knock him down. In their case study[9] of the family they call the Danzigs, the researchers listened to the things the family said about the patient, Sarah, and remarked, ‘They seem to be talking about wickedness, not sickness.’ In the same way, my letter-writers were confusing Laing’s personal qualities, to which they objected, with his arguments, which they had not evaluated. My correspondents appealed to me to trust their lifetime of experience. But that was the very thing I distrusted. It is hard even to entertain the notion that you may have founded your professional life on a giant misperception, and it is easier to deal with what crosses your desk, day by day, in the way it was dealt with yesterday: it is easier to deal with a symptom than with a person, and easier to deal with a sick person than to confront cultural malaise. It took me some years to see my story in a cultural context, as well as an individual one. The sense of wrongness – not of doing wrong, but being wrong – afflicted a couple of generations of women, caught between old expectations and new demands. A working class girl with an education might not necessarily know what to do with it; that was part of my problem. No one knew how to be a young woman in those days. I’m not sure anyone knows now. When you applied for a job, they would say to you, ‘When are you going to start your family?’ as if you were going to work some trick on them, or had ill-disguised criminal intent. If you said you had no man or children in mind, they would say, ‘What? A lovely girl like you? You’ll soon change your mind! Or some man will change it for you!’
I wish, looking back, I’d carried a tape recorder with me for a decade. It is hard to get your head up above circumstances, and see the big picture. That is the value of this book, which has endured all these years. You can leave the big picture to form itself. Just read the simple words the people speak.



2. Lucie Blair
Inner Circle Seminar No. 213
[Hilary Mantel was not present]



3. Claire Church
Inner Circle Seminar No. 220
The purpose of my introduction is to say what I notice about the Church family, drawing on the case study – and to show how the mechanisms that Laing and Esterson note in the case studies in general operate in this particular family. The protocols of confidentiality, though necessary, seem to disadvantage us more than with most of the families, because the setup seems unusual, and you would like to know a little more, to help you get a fix.
Mother is described a businesswoman and the daughter of a businesswoman: at one point she is self-described as a dressmaker, though it’s not clear if that’s what she does now or what she did when she began her career: and for long periods, it seems, the family live in hotels. But we must manage as best we can: and I note also that there are only two voices here.
As in our earlier seminar, I am keen to hear the tapes, because I am very much aware of the limitations of a transcript, and I will explain why. I know that to introduce an element of personal anecdote is to put pressure on the material, and raises the danger of distorting it – but that said, I am here as a person, rather than a theoretician, so if you will permit me I will allow myself to digress into my own experience.
I grew up with a mother and a stepfather, both volatile and angry people. Rows were their hobby, rows almost daily. No weekend went by without violent explosions. When I was about 14, crouching in another room with my homework, hoping not to be noticed, I fell into the habit of writing down exactly what they said, as if I were taking dictation. I realised even at the time that it was a mechanism to control and subdue my own anxiety, but it’s probably constructive, for a future writer. My transcripts showed several things clearly: the lack of logic in the conversation: my mother’s willingness to pursue every point: my stepfather’s blanket contempt for women, shown in his mimicry of what he thought was a female voice. When you read the rows back, they were blackly funny. Funny, as long as you were at a safe distance. I wasn’t.
Nowadays, I see all the time the partial nature of transcripts. When I give interviews to journalists they are taped. I read my words in cold print, and mostly I can’t deny those are the words I spoke, but the intent and meaning, and above all the irony, seems to have fallen out of them. When I think back to my family rows – the speakers were devoid of irony, but what was missing from my paper record was the feeling-tone, and the effect of the dialogue on others: the intense fear and helplessness provoked in a witness who had no choice but to see and hear, short of leaving the house and leaving the family. I think tone matters almost as much as the exact words. In our earlier seminar we heard tapes, but because my hearing is poor I could make out very little. However, the speaker’s personality came over clearly – and Maya’s voice was a surprise and a joy. I realise my unexamined expectation was of a downbeat depressive tone – and what we heard was quite different – so it was a warning to me about making assumptions.

Assumptions – that’s an important word here. Why, we ask, has the message of this book and these writers gone unheard, or been misinterpreted? Partly it is because of the assumptions that language traps us inside. Once the label schizophrenic is affixed, it may be easy – or not – to challenge the validity of the diagnosis in any individual case, but it’s difficult to get back beyond the assumption that the condition exists. We keep getting trapped into using the term. One interesting question, I suppose, is how far Laing himself and his associates fell into the trap – conceptually, if not verbally – whether they were misinterpreted because they were ambiguous, and whether they were ambiguous because their position shifted. Certainly Laing had shifted his position from where he was when he wrote The Divided Self, which is still the most famous of his books: but one book doesn’t define us. The blame question seems central – it’s often stated that Laing and Esterson ‘blamed’ families for ‘causing’ schizophrenia. That, I think, is not what they did – what they did was to challenge the reality of the condition. There are several overlapping but distinct questions. Do the family mechanisms cause the patient’s suffering? Do Laing and his supporters imply they do? And a different question: are the families to blame? Do our researchers blame them?
It’s become hard to talk about mental suffering without equating it to mental illness. There is no doubt the women in the case histories are suffering. The question is how we can talk about that suffering without falsifying its nature. When I was studying criminal law I used to be in an aggrieved spin about how my fellow students talked about ‘the criminal,’ before the use of the term was warranted – before the person had been tried – even before he had been accused. They would talk about ‘the criminal,’ even before we had established that the act under discussion was criminal – before we had established whether the person could form criminal intent, or had done so. I understood that they were using shorthand but I wasn’t willing to give way to it. It seemed to me that we should not be using policeman’s language and jailers’ language before we needed to. Assumptions of guilt are dangerous because they bleed quickly into the facts around them. You can’t easily get your mind clear again, or back to first principles, unless you keep your language clear.

It seems to me we have a similar difficulty here. We reach for a label and assume it represents a reality – when it may be just jargon, and the reality beneath it assumed, rather than imagined. We use it because it’s jargon – it’s short, and it’s easy, and we all understand broadly – to take the case under review – what schizophrenia is supposed to involve – a pattern of thought disorder, a history of affective impairment. It’s easier to allow the term to slide by, than critique it on each occasion. It seems Laing and his associates were not always clear and consistent about their own use of the term. That may be because they did not want to admit, or did not clearly admit, that their thinking had evolved. At some stage, for them, the reality of ‘schizophrenia’ started to melt away, but it is easier to keep on using the old term than to put it in inverted commas each time. Also (and here I am employing imagination, because I do not know what these difficult conversations must have been like) it must have been gruelling to steer through encounters with families who would misunderstand if you hinted that the illness did not exist. There is so much potential for misunderstanding. A diagnosis is something to cling to. It can serve as an explanation, even if false, and it can serve as an excuse for behaviour no one wants to examine too closely. Also, diagnosis has practical results. It creates a place within a system – it leads to a hospital bed, a treatment protocol – it leads to some sort of action, to outsider involvement, the comforting arrival of experts. So for families of patients, a label may be welcomed even if it’s erroneous. In questioning the validity of the term ‘schizophrenia’, Laing did not deny his patients were suffering – they were suffering and also malfunctioning, in terms of the society around them. He did not repudiate the term ‘madness.’ Yet he has been commonly accused of that. When I read these histories, I feel as if the ground is hot. At every step, take care where you are placing your feet.

Still, I find reading the transcripts illuminating. They are starkly exposing. It seems I am hearing in operation many of the mechanisms with which my own amateur transcripts made me familiar. If I may speak about the case histories generally – there are secrets in these families. The consequences of telling the secret are seldom spelled out and are all the more frightening for that: it is hinted that they are catastrophic. A special duty of keeping the secret is placed on one person. If she were to tell it, it would be especially indecent. The fact of her knowing it is in itself indecent. The fact that she knows means that her innocence is sullied and that innocence – like a daughter’s honour, in some cultures – is something that the whole family own, and talk about long after it has vanished, as if it were still a fact. One wonders about the sexuality of these families – but there are other secrets too – surrounding, for example, neglect of religious observation, or dishonesty in business – and also the big secret of who’s who: I suppose everybody born before the 1960s knows of a family in which a so-called ‘big sister’ was actually a mother, or an aunt was a mother: whole family networks came together to hide what they thought of as disgrace, and the collusion was not a one-off – because these were lies that had to be sustained and elaborated and carried on for years. I would say the patient wants to tell the secret and also wants to hide it. These women are profoundly ambivalent about their families. They are dependent. And the families who have encouraged the dependence also blame the patient for it. Mixed messages abound. Indeed there is hardly any other kind. The circumlocutions around sex were also elaborately confusing – and I suggest this was the case in families where no one was ever accused of being ill, but where blame was thrown around freely. You will see how Mrs Church worries about a fantasy Claire, and how she discusses sex and pregnancy in loaded and mysterious phrases. These could, I think, be absorbed by a young child – not the actual words perhaps, which aren’t understood – but the tone – so that the consequences of committing some blunder seem calamitous – it would be very bad to do that thing – but you don’t know what that thing is. This produces a state of permanent dark tension within the individual: there are areas where questions are prohibited; even if you could ask them, it’s intimated that the person who answers would suffer terribly because of your careless demand. Some families seem wrapped in a fairy tale – if certain words are said, they will be frozen, or exiled, or …or what? The vaguer the consequences, the more threatening they are.

Claire is a career patient, 5 years already in hospital when the work begins. Her brother Michael had already had a breakdown of some sort when he was 16. I’m not sure if Anthony can tell us more about Michael. I notice that in some families, dissent from a son is often tolerated, but dissent from a daughter is pathologised. I would imagine that’s less the rule these days, but you may have a view. I’m sure the patriarchal impulse doesn’t go away. I don’t know how far modern conditions demand it be reined in. But in this case, 2 of the children are subject to a diagnosis of mental illness.
The parents describe the family as happy and Claire as compliant. Mrs Church says Claire is very like her, so she understands her. How threatening that can be, to be told you are understood – that an interpretation of your actions is ready-prepared: the explanation comes before the action occurs, and everything you do will be interpreted as ‘like me’ – therefore right – or ‘not like me’ – therefore anomalous, and wrong. The children in this family can choose – I quote – ‘whichever way they wanted to go, provided it was the right one.’
Claire has certain specific, familiar complaints about her mother – that she has not allowed her to emerge as her own person. In this family there seems to be a tussle about who loves, and who doesn’t love. It’s a fraught area in many families and relationships. Is the one who loves too much the weak one, or the strong one? How much is the right amount of love? Guilt is heaped on the person said to be unloving. But love can be coercive, because conditional. Some families use the word like a weapon, some like a blindfold: they say they can’t possibly harm each other, because they love each other. When I look at the case histories as a whole, I see two common attributions made about the patients. One is over-sensitivity. One is coldness of heart. Both are wounding. Both are difficult to disprove. As you try to mend one offence, you stumble into the other. It’s a bind, a trap. You’re always trying to please, and always failing: and I think this is Claire’s situation.
‘Fussing’ seems to be a code word in this family for the expression of an infant’s needs for care and closeness. Mrs Church seems unsure whether she is a good mother, but she knows she is a sacrificial mother. The family story that prevails says that Mrs Church has been made ill by working so hard for her family – so the children, by implication, are to blame. The researchers notice the contradictions in her position; she is also said to be too ill to work for long periods – it’s not clear if it’s two different eras we’re taking about, or two different interpretations. There was an infant death in this family when Claire was 3. The child lost was an infant of 7 months. Mrs Church usually blames air raids for Claire’s nervous illness, but on one occasion she refers it to the loss of this baby. Michael, Claire’s younger brother, has been asthmatic and chronically ill from babyhood. To help this condition, he was taken into bed by his mother and sister. There is a family pattern. Mrs Church also had a younger brother who required looking after. The researchers say Michael was born when Mrs Church was profoundly depressed. I’m not sure of the timings here: whether she was in fact mourning, whether Michael was born into a family that was mourning the 7 month old. I wonder what the researchers mean by depressed – whether they are echoing a medical opinion given at the time – whether they are medicalising the mourning process – but we don’t have enough facts, from the transcripts.
But on the topic of pathologising, Mrs Church’s relationship with her GP is interesting. Never has the expression ‘family doctor’ seemed more loaded. She says she has spoken to the doctor about the fact that Claire doesn’t express herself – one wonders how she managed to present this as an illness. She says that the doctor reassured her, but now she knows she should have pursued Claire to find out what was wrong. If as a result Claire became upset, ‘I should have had to put up with it. ’ So an expression of negative emotion on Claire’s part would be a trial, an imposition on Mrs Church. She also mentions to the doctor once or twice that Claire isn’t interested in fashion. Again he reassures her. But you wonder, what does she take a doctor’s role to be? It is as if the doctors were there to make minor adjustments and tailor life to Mrs Church’s satisfaction. You wouldn’t trust Mrs Church to know what an illness is. It seems as if she wants a confidante and a servant, a yes-man. If I may allude again to my own family: illness is very important there, in puzzling ways. It was never an objective fact, but a subjective reality, defined by my mother. I too had an asthmatic younger brother, too sick to go to school, but he wasn’t elected to his role till I myself, at the age of 11, was ejected from the role of sick child and told I was well. Then he too, at the age of 11, was evicted from the role, because my mother wished to begin a career. She has always said she doesn’t like babies; a chilling thing for a child to hear. I think it may have been true, and a source of guilt, and one way for a woman to demonstrate her maternal credentials beyond all doubt is to have a sick child. A sick child is also a good excuse, if you want to do things but don’t dare; if you are afraid of failing, and want an excuse not to go out into the world. I am not saying that in this case Michael was ‘not really ill.’ We don’t know enough to say that – and of course, even if his symptoms had no identifiable physical cause, they were still real, still distressing.
Such a situation entraps the parent as much as the child. They construct a reality they both accept, and it’s in constant negotiation. When you read the transcripts what you see at work is the strategy or mechanism the researchers call mystification,’ which they describe it as ‘a constant shifting of meaning and position.’ It’s the practice of systematic inconsistency. Of narrative disruption, and narrative corruption. It ensnares the person in contradictions and makes them doubt their own memory and their own power of observation. It acts to cut links between cause and effect. Attitudes which are well-worn can suddenly be abandoned, and new and startling positions announced. And queries are met with a torrent of self-justification.
If you belong to such a family you develop a way not so much of listening, but of ‘listening through,’ to work out what is happening. It’s not the words but the non-spoken communications that enlighten you and maybe arm you. Clearly the researchers would be aware of these communications among family members, but the problem is how to record them. In one of the other families, certain members have a way of exchanging glances – collusive glances – which the patient is not supposed to see, yet can’t help see. Once you have learned to read your family, you may know what’s really going on: but you still can’t use that knowledge. You’re not allowed to have it. You cannot speak of what you see, or know what you know. Because it will be denied. And confusion and self-doubt sets in, and maybe isolation within the family – and so one person is chosen as victim, as sin-eater.

At the time of Claire’s crisis she was 23; the family business was failing. Claire describes her mother and father as business partners, not as parents. She may have been making a shrewd observation there – but one that, coming from her, couldn’t be tolerated. She is understood literally – it’s taken to be a delusion. Claire is not allowed metaphors. She is allowed delusions, because she is a patient. She understands herself to be at risk from imminent and dreadful violence, which literally speaking is not true. But she makes a metaphor. She says she has the atomic bomb inside her, which means she can destroy other people and destroy herself. It is said among writers that ‘censorship is the mother of metaphor.’ For an artist constraint can be fertile – but he is licensed for metaphor. Imagery is dangerous for the women in these case histories. They would do well to state exactly what they mean, in bald terms, except that all their lives they’ve been primed not to do that. They are barely allowed the weapon of irony. Self-expression is allowed within narrow limits. It’s almost trite to say that sometimes parents have trouble seeing their children as fully human: they see them as a reflection or sub-self or Mini-Me, or as objects. Mrs Church makes a remark about the hospital doctors – how it’s their job to fix Claire – as if her daughter were a machine that had broken down. And this is how Claire sees herself – a manufactured thing, volatile, lethal to everyone around, including herself and those who made her. A bomb doesn’t talk, it just explodes. That’s what you must do, if your feelings are bottled. Alternatively, if you can’t speak, you will show, your body will show: you will develop physical symptoms. If you dare not even show, perhaps you will become catatonic. If nothing within you is acceptable, including your thoughts, you will empty yourself out in a torrent of images and suffer the consequences; if your real being is overlooked, if you cannot be seen, you will consider yourself wiped away.



4. Sarah Danzig
Inner Circle Seminar No. 222

My notes for our meeting fall into two parts: those I made over the last few days by the light of reason and by day, and those I made in the darkness early this morning, Valentine’s Day, guided by feeling and intuition. As an outsider from another discipline, I ask myself what I can bring to the table in these seminars, and today I can bring my dream.
I dreamed that we, as a shadowy collective of strangers and semi-strangers, visited the Danzig household to help the family clear it up. Confidentiality was preserved in the dream. It was too dim to see the faces of the family, or our own faces. We found them sitting in misery in dirty and disordered rooms. They were in mourning for the family dog, a large, brindled muscular boxer dog, a beast of unruly energy. (As soon as I woke, I made the association with what Esterson says in The Leaves of Spring: that the family has lost touch with their animal selves.) Without this boisterous animal, the family were husks, shells. The energy had drained from them.
What they did not know was that the animal was still present, as a ghost: as lively, uncontrollable as it had been in life. It had brought other animals to the house. Together they rampaged through the rooms, trashing them, shitting everywhere. The Danzigs were very dimly conscious of the presence and also the inevitability of the animals, and their necessity – aware they should do something to accommodate them, they tried to feed them by pouring on to the floor the contents of cans of dog food, brown slurry which added to the mess and the stench.
The animals had no awareness of. or relation to, the humans they shared the house with. They did not mean them either good or ill. They simply possessed the territory.
Our task, as bringers of order, looked more impossible by the minute. We were Hercules in the Augean stable. But less successful.
When I woke I wrote my dream down. In The Leaves of Spring Esterson describes the family in terms of an unregulated bowel, stressing the anal quality of their interrelated phastasies. In waking life, I had resisted this: I understood, but I felt it was an unhelpful retreat in a Freudian direction. The dreams showed me in the most graphic way that I should think again, and admit how powerful and authentic Esterson’s perception was.
When I fell asleep after making my notes, I had a second dream. I was on my way to the seminar. But I got off the bus early, in Chelsea. Chelsea, in Mr Danzig’s period construction of the world, is the site of his children’s feared sexual transgressions. It is where bohemians of loose morals and sinister intent threaten the peace of his family. In my early exit I was mimicking John’s ‘premature ejaculation’ – premature, in the sense of pre-marital.
So I begin feeling I have already done a day’s work, and amused by my own inner processing. In waking life I do not feel it is our business to clean up the case history. I feel it is a work of retrieval and for me, it feels like a work of mourning. In the culture in which I was brought up early in life (northern, working class, Irish origins) mourning is a strenuous business. If you visit a family that is bereaved or where there is sickness, it is your job to help clean and restore respectability, so nothing of the family’s private misfortune need show. You look after the practicalities, taking particular care to clean the doorstep, the threshold between private and public. It can be a noisy, insensitive business, done badly; done well, a great relief to the suffering people in the house, who have a burden lifted and are free to concentrate on being rather than doing.

This is a sad story. Anthony will be able to bring us much extra information about the Danzig family, and shed light on what eventually became of Sarah. I have been re-reading Esterson’s book, The Leaves of Spring, published 1970. It is a complex book but I will try to summarise and refresh our memories.. The Danzig case study forms the first chapter. The rest of the book extends it, and offers certain theoretical perspectives and speculations, and a critique of psychiatry as Esterson sees it practiced, but the Danzig family is at the heart of it: mother and father, the eldest child Sarah, her brother John. There is another daughter, Ruth, still a schoolgirl. She does not form part of the investigation. The only thing we learn about Ruth from The Leaves of Spring is that she gets up at 6:45 every morning, and so is a paragon of virtue. The Danzigs are one of those families in which early rising equals moral worth.
Esterson gives something of the social and historical context. The families of both Mr and Mrs Danzig had immigrated to Britain at the end of the nineteenth century from Eastern Europe. Both families left relatives behind, and both had relatives who died in the camps.
Mrs Danzig’s mother and father were both tailors. After a struggle, the father came to own his own business. Mr Danzig’s father was a businessman too, with a reputation for ‘learning, piety and holiness.’ Mr Danzig was one of four sons. He idealises his family, but further exploration reveals they were not as harmonious as they appeared. Both families were notionally orthodox. Mr Danzig’s parents were more strictly observant. Mrs Danzig’s father, she says, knew how to overlook breaches of ritual – if she went out on the Sabbath, he would wink at it. She herself observes the rules in part at least, just to please her husband, as her mother in her day tried to please her father. But she says that what happens in the family kitchen is her affair – which is a ferocious sideswipe at the patriarchy, as the dietary rules are very much the heart of the matter.
Mrs Danzig is an only child. The marriage was arranged between the two families. Mr Danzig’s father decided it was time for him to get married and introduced him to a suitable candidate. Mrs Danzig simply obeyed her family. At the time of the study they have been together for twenty-five disharmonious years. Mr Danzig says that his wife has sometimes threatened suicide. He is aware she is unhappy, and says he is not happy either, but it must not be discussed in front of the children. He wants them to present a front of solidarity, to the children and to the outside world, whatever their private differences. He senses a pathology within the family, wondering at one point if his wife has caused Sarah’s illness. The parents quarrel a good deal, but when Sarah remarks on this, they deny doing so. Mrs Danzig doesn’t want her husband to bully or impose on the children. She says to him, ‘They are a different generation.’ She tries to keep the peace and act as a referee between John and Mr Danzig. Mr Danzig’s fear is that the children will, ‘run riot, run wild’, but Mrs Danzig says, it’s not the Victorian era. Esterson sees a desire to control her husband and son – he may sense that, but much of what she says, in cold print, is reasonable by any standard. Esterson sees her as undermining her husband’s masculine authority – which of course she is – but I can’t help thinking he is putting her into a bind, like Sarah, where she can’t do right. Mrs Danzig is one of these people who makes you want to unpick the word ‘housewife.’ She does seem to be married to the house rather than to her husband. She idealises her own father, who she says was wise, pragmatic, tolerant and in love with her mother. Mr Danzig denies this. They are both clear that they were never in love with each other. Sarah asks, ‘Why don’t you divorce?’ It seems that her parents come from an older world where marriage is a social institution, and the happiness of individuals is incidental; but it’s doubtful Sarah understands this. All she sees is the day to day conflict, and the denial of that conflict. I am interested in the way some families locate themselves in history and some try to cut free, and some are experts in forgetting and others can’t forget – and I wonder what to be Jewish means in this family, and if the past would ever be spoken of, and how it has been internalised. Mrs Danzig is adamant that John mustn’t marry out. But she says oddly, ‘There’s no harm in going to the synagogue on Saturday, that’s all right.’ It’s not a ringing endorsement of community or tradition. It’s as if she feels that the main feature of the faith is a set of petty rules fathers impose to make life difficult. Mr Danzig feels she doesn’t respect him, that she undermines his authority, and as in all families there is a system of shifting alliances between parents and children – but finally, Sarah is the one who is isolated.
Mrs Danzig describes Sarah as having been a good baby and a compliant child. At the age of thirteen she becomes ‘lazy.’ At seventeen she begins to withdraw into herself, becomes a nocturnal creature and eventually drops out of her studies. The pattern is so familiar in adolescence – I am sure we have all seen it, or been part of it ourselves – the young person sleeping at different hours from the rest of the family and disrupting the routine. In some families, what begins as a hormonally-driven need for extra sleep hardens into a form of protest against intrusion. It then agitates parents – who foresee dire consequences in the outside world – they nag – the young person feels more and more impinged upon. In any family it arouses resentment, when one member seems to have latitude and to be allowed an easy life; in a family like the Danzigs, this behaviour is an evasion of control, deeply disturbing and ungrateful. The young person might have dreams, and dreams cannot be policed. Lying in bed also creates dirty linen. And as Sarah is socially inept, and often angry, the fear is she might wash the dirty linen in public. Invariably when the child goes on to have a career as a patient this phase is seen, in retrospect, as the beginning of the illness. So it is with Sarah. Mrs Danzig will blame herself for not seeing that Sarah’s laziness was, in fact, illness. She says she should have called a doctor sooner.
At 21 Sarah’s behaviour took a more florid turn. She felt persecuted, she expressed anger with her family. Finally a quarrel with her mother precipitated a crisis. She ran out of the house, was gone all night and when she returned said she had been to a hotel with a man. This led to her first admission to hospital. It seems to be John who first suggested she needed a doctor, and at this point mother agreed, but father didn’t.
Anthony can tell us more about John. In the transcripts he seems self-aware. He admits that there is a double standard in the family, and that he is on the whole freer than Sarah, though he quarrels with his father about religious observation. But he plays a part in the effort to control Sarah – there’s a tiny thing that blazed out at me – by his mother’s account, John will come home from his evening out, see Sarah’s light is on, and switch it off. I wondered why I was so outraged by this – but I myself am an older sister – if one of my younger brothers had done that to me, I wouldn’t need a light, I’d be incandescent. We are so sensitive to crossing the line, to any derogation of our place in a family – but Sarah sometimes seems less a person than a sort of service to the others – a magic mirror, as I’ll say later.
So, hospital: after two weeks she returned home, spiritless and withdrawn. She shut herself in her room and read the Bible. Later she would say that in hospital she had been raped. In the climate of the time this would be taken as a fabrication, or at best as a metaphor, but now we would be less sure.
Sarah had taken a secretarial course and spent some time at art school. Both her parents and her brother describe her as highly sensitive, and her brother also says she is highly intelligent. After her hospitalisation she went to work in her father’s office. You can understand the protective impulse that creates this set-up. But big problems begin here. The Danzigs as a family are very keen to appear respectable and above board in everything they do, and to stand well in the eyes of their community and the outside word. When Sarah goes to work in the business she notices irregularities in the accounts which she naively takes to be mistakes, and so draws attention to them. Clearly she is meant to collude in these mildly dubious practices. But no-one has explained this to her. Her position is difficult because the other staff know about her hospitalisation and she is aware they talk about it. She also has the usual problems the boss’s daughter would have – people are wary of her, and it appears that she is the target of a malicious trick. In time she refuses to go to work. You can see the tension that would be generated. Sarah knowing what she does – she could ruin the family’s reputation. Shame and fear of scandal are very potent in this family, and they are increasingly ashamed of Sarah.
We may ask, what does Sarah do that convinces her family that she is ill? She sleeps and wakes at odd hours, she refuses to go out, she believes her parents quarrel. She says her parents listen to her phone calls. She gets angry with her father when he enters her room without knocking. She smokes on the Sabbath: John says this makes her father ‘fume internally ‘ – wonderful choice of words – you wonder how often she is enacting for them the unruly behaviour they fantasise about. She is shy, and she refuses to be independent when her family tell her to be so. She stays awake thinking or reading. John says she is thinking about herself. Her mother says she is thinking, ‘rubbish – a lot of nonsense’. She reads the Bible a good deal, which Mrs Danzig doesn’t think is normal. She plays a trick on her father, putting lemonade in his tea – a trick that I am sure you will find thought-provoking. I’m not suggesting that Mr Danzig was sexually intruding on Sarah in a physical sense, only that she is aware of undercurrents of soured sexuality in the household. Sarah says that she is afraid of her father. They say she is not. She has no power to describe her own feelings. Nor is she sure if she has any right to privacy. Mr Danzig describes his intrusive behaviour as love. It’s fair to add that he also goes into John’s bedroom and goes though his things. He justifies this need to know about his children’s lives as a need to protect them. Sarah needs to be on guard against ‘men with glib tongues.’ John needs to be wary of ‘confidence tricksters.’ Like many of the families in the study, the Danzigs apprehend the outside world as a very dangerous place. Esterson says they are ‘divorced from the animal in them’ and alienated from their own instinctive life. It appears the parents’ own sex life has been unsatisfactory, and they are very fearful of the possible results of their children’s sexuality. They worry of course that Sarah will get pregnant. Mrs Danzig agrees that it is all right for John to have sex, but only with non-Jewish girls. They worry that John will make a woman pregnant, that he will catch an STD, or be blackmailed. Despite this, Sarah is encouraged to go out – but she has to give an account of herself. It is right to have boyfriends, but she must bring them home for approval. Sarah has never had much social confidence. She has asked her mother to advise her how to behave in social situations, but Mrs Danzig has grown exasperated about the amount of reassurance she needs. She tells her, ‘People don’t bother about you. They forget you the minute you go out of the room.’
This seems a technique calculated to deprive a shy person of any resources. When we say reassuringly, ‘Nobody is looking at you,’ the implication is that you are not worth looking at: indeed, you’re barely there. But the parents are very self-conscious and afraid of public opinion, as if they were constantly observed. Mr Danzig worries people will think less of him because of Sarah’s illness. He hasn’t shown leadership, hasn’t controlled his family.
Whilst objecting to the strange hours she keeps, the family in some respects organize themselves around her, her mother cooking meals for her whenever she appears. They say she is spoiled. They have got themselves into a bind: they indulge her and then blame her. Sarah is subject to mystification. They do open her letters and listen to her telephone calls, but of course they say that they don’t. She’s the member of the family expected to be compliant and respectful, not to call their bluff: and so she has to perform all sorts of metal contortions to reconcile what she witnesses with what she’s allowed to mention. The Danzigs both have stern views on the duty of children to pay back the investment, in time and resources, that parents have put into them. Mr Danzig talks in terms of assets: you invest in your children, and you get interest from them. Sarah is failing to pay him back. She has run out of control and become a sexual being, and now she’s gone mad. You can’t help think of The Merchant of Venice: ‘Oh my ducats! Oh my daughter!’ The Christian who reports Shylock’s cry is a hostile reporter, and he calls his pain confused, strange, outrageous, but there’s no mistaking his desolation: the sealed bag has gone, the jewels, you can’t distinguish between your own flesh and your money, you work hard for both – it’s not, if I may say, only a Jewish mistake.
Mrs Danzig equates Sarah’s state to a natural disaster. It is something that happens to the family, not in the family. It is a calamity, like being flooded out.
Esterson says this family have ‘no experience of inwardness and none of self-doubt’. They are alarmed by evidence that Sarah has an inner life they can’t know, a private place where they can’t follow her. They want her to take sleeping pills and tranquillisers – this would put paid to her habit of sitting up at night and thinking. The family also, Esterson says, lack any sense of paradox. They have no way of facing and containing their own contradictions. When inconsistencies in their thinking and behaviour are pointed out, the family think they are being criticised.
Most people do. I wonder if Esterson expects too much of them. There are inconsistencies in his own behaviour. Anthony has said he has found apparent contradictions in the Sarah Danzig tapes. When Esterson first records Sarah he remarks, after she has left his room, that she has a "schizophrenic illness". I learn from Anthony that in Oct 1963 on a home visit, Laing (meeting the Danzigs for the first time) says: "I hope you don't think we're saying there's nothing wrong with Sarah. Sarah's a schizophrenic." He adds a saving phrase, something like ‘in the medical understanding,’ to indicate his dissent. Esterson says shortly afterwards (or on another occasion: Anthony can verify)"It's not helpful to think of Sarah as having an illness." It’s quite understandable that their thinking evolves and their terminology shifts, but you can see it must have been confusing for the patients who were in the middle of that shift.

In talking to the Danzigs, it seems that Esterson interrogates them quite fiercely about their religious attitudes. He seems to want to convict them of hypocrisy, yet there is nothing odd or rare in their social strategies. The household calls themselves orthodox. Both parents relax the rules to different degrees. But outside the house they watch their step. Outside, they are witnesses to their faith. Their religion is something to be performed and demonstrated – the performance defines you, and it is important for social cohesion to carry it through convincingly. It is hard to understand why Sarah’s reading the Bible appears transgressive, but we become aware that she is seen as usurping her father’s function. There is no spirituality in the family, but Sarah seems to belong to an older world when study of the Law was the highest duty. In fact Sarah’s role is, as Esterson says, ‘keeper of the family conscience’. Her role is to, ‘see no evil, hear no evil, speak no evil, and feel no evil.’ It’s as if they need to witness themselves through her eyes – she has to be a mirror in which they can see an ideal shape of themselves, pure, free from transgression, free from contradiction. There’s a gap between that desire and the knotty, collusive reality – that’s the gap Sarah falls through.
Sarah was hospitalised for a second time after an outburst against her father. John says that in her anger she used ‘sexual words.’ Esterson points out that it was on the Day Of Atonement that they sent her back to hospital – an unaware, unspiritual family acting as if entranced by a tradition they don’t consciously think about. Sarah is the sacrificial animal who is ejected, sent out – except that she is a human sacrifice.
When she is in hospital her parents say that they have left her telephone messages daily. Esterson believes this is not true: it seems, though we can’t be sure, the family admitted it was not true. Sarah then believes the staff are maliciously withholding the messages. She cannot believe ill of her parents. She believes it is the doctors who wish to detain her. She refers any malfeasance to an outside agency, a higher power – the doctors, the telephone company. These attempts to make sense of her world are seen as delusions. Her compliance and passivity in hospital are seen by the family as a trick to persuade the doctors to let her out. If she talks about her disturbing ideas and feelings she is showing signs of illness, but if she doesn’t, she is still sick, just cleverly pretending to be well. At this point its difficult to see what she is to do or how she is to help herself.

When I first came across Sanity, Madness and the Family I felt that it was holding up a torch for me, but I didn’t see the full extent of what it illuminated. The case studies seemed to shine a light on the workings of families like mine. It is only a couple of years ago that I read The Leaves of Spring for the first time. I find the book illuminating, exasperating and profoundly moving. Illuminating in the obvious sense, that it extends the case study: also in the sense that I pick up from the longer transcripts a certain hostility and obtuseness in the writer, and I wonder how far this is perceived by the family. But of course, the tone is everything, and the non-verbal communications – and maybe I am worrying unduly here – I am only saying what I pick up from the cold print. And I say ‘exasperating,’ because once Esterson has decided that the family functions as a collective bowel which imagines it needs to be regulated, he labours the point. I don’t dispute the force of his description, in the context of the family’s dread of disorder, Mr Danzig’s accumulative and retentive character and fear of dirt and mess, Mrs Danzig’s zealous but failing attempts to keep order – Esterson says she is diligent but not competent, domestically – I’m entertained by his picture of her trying to serve tea, but I think a few of us might get in a muddle with the teaspoons and biscuits if we were going to talk to strangers about whether our child was mad or not. My concern was that Esterson was intent on fitting the family into a theoretical framework. Yet at the same time I have no doubt he intuits their state of being. If I did have doubts, my dream removed them.
And I find the book moving, if I may speak personally, because the later chapters seem to cast light on what I’ve lived and written over forty years. He explores the concept of revolution, in the personal and political sense, as a continuous remaking, a process: and he unfolds the concept of reversion. For me, this was a gift of a useful term for something I had written about, but had no single word for. ‘Regression,’ is his term for moving back in time, but within the individual’s life-history: in reversion, the ‘I’ is obliterated, and the experiencing individual falls outside time, and into the realm of the transpersonal. How that might feel, I have explored in my novel Beyond Black, which is about a professional psychic, and I find this part of Esterson’s book has helped me tie the topics together – revolution and reversion, charisma, cults, the collective mind. What I also find deeply moving is an image, one that I find most haunting of all those thrown by the case studies – and that is the picture Mrs Danzig evokes, of Sarah in her blue nightdress, alone, sitting in the family kitchen, indulging in the treacherous business of thinking in the watches of the night.



5. Ruby Eden
Inner Circle Seminar No. 226

I think in all these case histories there is no picture so harrowing as the picture of Ruby Eden held down by her female relatives while they try to abort her child, at the same time heaping abuse on her. I won’t be giving too much away if I tell you at the outset that the outcome for Ruby, after she leaves these pages, was better than one has reason to hope. I will leave Anthony to unfold that part of the story, while I concentrate on what the book tells us. I usually apologise at this stage for dragging my personal history with me. No one wants to think they have nothing to offer but autobiography. We would like to think we have some faculty of abstraction, to get us beyond our own lives to general principles. But these cases are accessible to anyone to think about, and if a reader brings nothing else, she can bring her own experience of being human, living in a family, trying to become a person in her own right. My reverence for the process of these seminars is driven by gratitude to these 11 women and the researchers who compiled this material, because it has helped me uncover certain mechanisms which operated within my own family, and make sense of my own past. Essentially, the histories confirm to me that I know what I know: I remember how it feels to have that security confiscated.

In the one way the material here is impoverished. The researchers mention their difficulty in getting key interviews. There is only about half as much material as in the Danzig case, and there is much paraphrasing, so we miss the peculiar eloquence of transcripts. But if it’s deficient in one way, it still exemplifies and condenses the core issues. We have a family suspicious of outsiders, easily shamed, afraid of scandal, living in a situation comprehensively and systematically falsified, where uncle is daddy and aunt is mother, where lies are transparent, but it’s necessary to act as if you don’t see through them.
The very beginning of the account directs one to look at language, as it gives us the official terms used about Ruby. When she is admitted she is in an ‘inaccessible catatonic stupor.’ She has stopped eating, stopped communicating, made herself like a corpse – as if the only good Ruby is a dead Ruby. The case history speaks of ‘clinical psychiatric terms,’ and so makes it clear that other terms are available. The assumption that governs the clinical description is that Ruby, and others suffering in a like manner, have passed beyond choice: they are victim of a disease that flies in, like an air-borne infection, and alights on them. Mrs Danzig in the previous case refers to her daughter’s supposed illness as something that ‘has happened’ – ‘ we thought these things only happened to other people’s children’ (116) she compares it to being flooded out – to a natural disaster, or what the insurance industry calls an act of God.
At this distance, we can see sense in what Ruby’s doing and saying – we see it might be a tactic for self-preservation. We don’t know from what’s on the page how Ruby came to be admitted, or what she was told about her condition. A suspect questioned by the police is often best advised to say nothing. Ruby’s situation is analogous to someone detained for an unnamed crime and for an unspecified length of time. A girl so mystified, a member of a family so confused and confusing, a girl encouraged to doubt her own sense of reality, a girl belied and stigmatised – perhaps her best tactic is to say nothing, do nothing, block out what she can as self-protection, move into a fortress of silence and inaction till she can in some way work out what are the rules here.
I’m not discounting how alarming it must be to see someone shut themselves down in this way. I imagine it would first present as a nursing problem, not a philosophical problem. But then, we are told, Ruby is ‘coaxed’ to eat. So her will is still alive. The carers know she can choose. In her inaccessible state, she still has agency. In psychiatry the diagnostic terms alienate – in a way they don’t, in a physical illness. You can say someone has typhoid fever without casting them outside the normal, but if you say they ‘have schizophrenia’ you exoticise them – a glance at the media any day shows you we are still governed by that thumping literalism that insists a broken leg and a broken mind are the same kind of thing.
Ruby is a paradise for a medic with a check list of symptoms. She has delusions of reference, hears voices that threaten and abuse her, has grandiose delusions with a religious and sexual content. She is deemed to have inappropriate feelings about her situation – she laughs, or seems indifferent. Her ‘sense of reality’ is in shreds, the writers say – putting the phrase in brackets. We are drawn to ask what exactly is reality in this case – exactly what is going on here – not in a psychological sense, not in a spiritual sense, but simply, what is happening in the daily lives of this family? Like other families in the studies, they have a capacity not only for reshaping their present but for rewriting the past, and punishing and invalidating a member who casts doubt on their veracity and accuracy. Ruby is keen to be ‘good’ by falling in with the family version. When she reports that she hears ‘voices’ denigrating and abusing her, it is literally true. In real life, the voices belong to her family and their neighbours. But her family deny they are hostile to her and deny that the neighbours gossip. These voices are therefore disembodied – no one will own them. It is not surprising that to Ruby the voices seem outside herself, as such critical commentary is the soundtrack to her life. When Ruby is supposedly ‘mad,’ she knows and states accurately what her family think of her. Her return to ‘sanity’ is marked by her acceptance of the family version – that her family are good, loving, and want what’s best for her. To be considered ‘sane’ and ‘well’ she has to deny what she truly knows.
Ruby lives with her real mother, and an aunt she calls mother. At one stage she calls her uncle daddy. When Ruby’s real mother was pregnant she was rejected by her own family, it seems, and so she moved in with Peggy and Jim – her sister and brother in law – and this is where she still lives. Ruby, the unwanted and inconvenient child, is the focus of the family’s anxious attention, and of intense ambivalence. She is asked to believe her family love her. If she doubts this, she’s in trouble. She is told the neighbours are not talking about her, when they are. The family express to the researchers their shame – describing Ruby as a slut and a prostitute. Her uncle accuses her, to the researchers, of making sexual overtures to him, and admits he has tried to throw her out of the house – though when Ruby mentions this has occurred he denies it. (135) Her perceptions are falsified – there is nothing she can rely on, not even where a matter of fact is at issue.
Ruby’s real father, who she calls uncle, has another family elsewhere. Ruby has not been officially told she is illegitimate, until she herself becomes pregnant. Her cousin believes she has known for a long time. This is one of the family mystifications. You know, but you don’t know: you’re not allowed to know. When she was a child, her uncle would say to her, ‘come and sit beside your dad,’ and she would go and sit on the other side of the bus; it occurs to me she was mutely stating the true state of affairs: that’s not my dad. (137) But – as when she is admitted to hospital – a mute statement is all she can manage. Her mother and aunt have different ideas of what Ruby should do, but she is the one who has the task of reconciling their different demands. It doesn’t occur to them that she could ignore them both, and obviously it doesn’t occur to Ruby either. To somehow please them both, to please everybody – that’s her burden and her task.
I ask myself, as I’m sure you do, what’s happening sexually among these people. Her uncle shows his workmates pictures of Ruby, (137) with the intention of showing her off as sexually attractive, and then constructs a picture in which Ruby visits injury on those who desire her, blinding them, like a creature from a myth. It is said that Ruby would stroke her father and slap him playfully: I find it difficult to imagine what he is wearing when she slaps his legs until they are red. The families in the book make us consider the shift in public attention that made sexual abuse of children visible – after generations when it appeared not to occur, because no one was looking. The unspeakable is constantly speaking in these histories – but it may be no one is listening. The patients in the case histories are trapped in a bind where their metaphors are taken as delusions, but their literal complaints – of actions, of deeds, of possibly criminal deeds – are taken as metaphorical. When Ruby says people are lying on top of her at night having sexual intercourse, this may be her way of expressing her fear of the people around her or her suspicion of their intentions, and/or it may be a protest – she may have consented to sex but still felt coerced and ‘in the dark’. Or it may simply be true. Such things happen within the family and within institutions, as we now acknowledge.
Ruby repeats the ‘stroking’ with her cousin Alistair, and I wonder what he means when he says it’s not entirely her fault. It sounds as if Ruby is trying to placate people. There is huge resentment between family members, who accuse each other of being ‘pampered’ and ‘spoiled.’ These words keep jumping out. They talk about play – ‘I’m not the playful type,’ uncle says – and whatever they mean by play, it’s something that might happen between adults – Ruby’s mother says the uncle will ‘play sometimes with me and Peggie.’ And sometimes the stroking of Alistair turns into a ‘game,’ between Ruby and himself.
It seems sinister, but we have no more facts to go on, not from the page alone. Ruby’s delusions seem like condensed, encoded, symbolic expressions of her situation. She has given birth to a rat, she says. We have been told how she’s been subjected to the abortion attempt: any woman violently handled in that way, if the child sticks, is bound to fear that the child will be damaged. You ask yourself what happened when Ruby’s own mother was pregnant. The family say history is repeating itself. You wonder if that includes an abortion attempt. She wasn’t, in any event, a wanted child, and it may be true that the only good Ruby is a dead Ruby.
This is not a family who have slid into misrepresentation – they have consciously made a lie that they can all get along with, and which they believe protects them from damage and disgrace. But given the nature of the community they live in, it’s a fair bet that their neighbours know who is who. It’s an open secret. It’s the open secret that interests me particularly in these case histories. I try not to stand in my own light, by over-identifying, but I too grew up in a family where there was a deliberate muddle over identity, and also with two people who pretended to be married to each other but weren’t – often a necessary pretence in those days, and something I am sure many others did. I knew who my father was, but he wasn’t the man I called father, for the world’s purposes; my real father had in fact been written out of the family drama. My younger brothers assumed the man they called their father was their father; I knew he possibly wasn’t; lies were not told directly about that issue, but they were told by implication. I never had more than half-knowledge, but I couldn’t improve on it, because questions were forbidden, so I had the burden of carrying a secret of unknown dimensions: I didn’t know where its boundaries were, I didn’t know when I was straying into the danger zone. I made the assumption that my brothers were my half-brothers, and it took a lot of time, and the emergence of family resemblances, for the facts to show themselves to me. The truth was like a photograph taken at the end of the 1950s, and slowly, slowly developing itself over decades. It seemed that if I wanted the truth, I just had to wait.
But when I was growing up I was perplexed about what I was allowed to know and what I wasn’t, and what other people knew about my family. I didn’t know how far the secrecy about our circumstances extended, so I was permanently wrong-footed. It seemed that any reference to the family at all, outside the four walls, might be wrong; so as with Ruby, even casual conversation could lead to accusations of giving too much away. There was a sense of impending catastrophe; it was like living in a factory that made high explosives.
And yet, everything was permeated by a sense of falsity and exaggeration. Suppose you grew up in a building where you were forbidden access to certain areas. And you were told ‘We make gelignite, that’s our family business.’ But you suspected that in the forbidden zone they really make jelly babies. You still have to pretend the danger is there. The whole place is plastered with KEEP OUT signs and hazard warnings. So you walk on tiptoe and speak in whispers. Yet your elders clump about in big boots and shout. You must ask then, are you the locus of danger: are you a walking peril?
In those circumstances, it’s easy to understand what process of making metaphors is at work if, for example, a person says, ‘I have a bomb inside me,’ or ‘I am poisonous’. When Ruby goes to the hairdresser and mentions she’s making a visit to a relative, it seems harmless, but it becomes a grievance, it’s treated as an indiscretion that is close to a betrayal. The neighbours know about her pregnancy, and that she has been hospitalised, and talk about it, but her family deny she is the focus of gossip.
In my family the complication was that many people did know about our circumstances. I too was keeping an open secret. I am interested in Ruby’s claim that she was the Virgin Mary and the wife of Cliff Richard. As to the first, I don’t know if Ruby had any particular religious background. But we all know that the Virgin Mary represents an impossibility – virgin AND mother – it’s a feat no other woman can hope to achieve. But Mary is not just a locus of anatomical impossibility. I remember how often I was told as a child, ‘The Virgin Mary sees everything you do,’ as if surveillance were her speciality – she was an extension of human mothers in that way, and she could read and judge your thoughts, and because you couldn’t actually be her, she was perpetually disappointed. She simply can’t be pleased.
And Cliff Richard: there’s a life with a fundamental misrepresentation in it, which you may be aware of: he was born in India and seems his family have some Indian blood, but at the time his career got underway, his management must have decided that it would harm him if this were known, so the story was created that he was thoroughly white English and his parents had been merely visiting India at the time of his birth. The whole family – he has sisters – assented to this deception, at one time admitting to a Spanish ancestor – and as far as I’m aware it’s never really been resolved, though the family have confessed to a grandfather who committed bigamy – he pretended to be dead, but he wasn’t dead, he was in Coventry. Or Birmingham, in some reports. He had gone to England and had a second family.
As for the Indian ancestry, you think – surely, nowadays, no one would stage that sort of charade? But it’s not so long ago that Michael Jackson was bleaching and remodelling himself in the glare of the world’s cameras, and denying that he was doing what we could all plainly see. I’m not suggesting that Ruby was aware of the duplicitous nature of her fantasy husband, but just pointing out that open secrets exist on a massive, public scale. The families in the case histories are hugely optimistic in expecting their lies to be believed, in or out of the family house, but they are not mad, or even that unusual. As you know, if you mention this book, if you mention Laing & Esterson, you will be told that their theories are discredited. If you ask, ‘What is the theory that is discredited?’ you will be told they ‘blamed the family’ for schizophrenia – when by the time they produced this book they deeply doubted the term ‘schizophrenia’ makes any sense or corresponds to any reality. It may be that sometimes they ‘blame’ the family in the loose popular sense of the term – that’s to say, they judge them adversely. It would be above the human standard to make no judgment at all, when you consider the vulnerability of some of the young patients. But they do not ‘blame the family’ in the sense of saying that the family cause schizophrenia – the introduction makes clear that they repudiate the term – or at least, they set it aside. And we have to keep reminding ourselves that they are not pathologising the family – that is not the shift they are making. These families, enmired in their own misrepresentations, are part of a wider culture and society that has trouble saying what it means and meaning what it says. I don’t know if there could be a society that has a cleaner relationship with the truth: but to ask that takes us into the deep waters of collective identity and the myths that hold tribes and nations together. When delusions are nurtured on such a massive scale, it seems harsh that people like Ruby are the ones described as mad.

An afterword: some information from Anthony’s researches.

Ruby was born in 1943 and is still alive. She has had a long, stable and happy marriage, and after her marriage, her cousin Alistair states, had no more need for contact with mental health services. (I don’t remember his exact term.)
The extracts from the interviews in this case were written down by Esterson (or possibly partly by Laing after a joint home visit to Ruby after her discharge). They are not transcriptions from tapes. However, Anthony stresses that L & E were accurate and skilled in capturing exact expressions.
There is an important figure missing from the tapes – Ruby’s maternal grandmother, with whom the whole network – Ruby and her mother, Peggy and Jim and Alistair – were housed at one time. Ruby on tape describes her grandmother as ‘Victorian.’ When Ruby’s mother was ‘in trouble’ her parents repudiated her, but wartime exigencies resulted in their living under the same roof. Ruby vividly remembers hurting her back when her grandmother dragged her along the ground by her long plaits. She was about 8.
The young Ruby (on tape) speaks warmly of her cousin Alistair as generous and like a brother. She describes a background of ‘nattering’ – constant criticism – from her mother and aunt. The older Ruby is still reluctant to criticise her female relatives. Peggy seems to have been dominant, though she is the younger sister. Young Ruby says on tape to Esterson that her uncle was ‘boss’ in the household – not just the titular head, but the real power. Alistair says that Ruby’s mother, though not retarded, was of limited ability and slow to assimilate information. ‘Old Ruby’ movingly describes her mother’s hard work in a factory, her hands always in water.
Ruby’s father, though a married man with another family, visited her regularly and took her and her mother on holiday. He broke off contact by letter just at the point when Ruby discovered her own pregnancy. Two reasons were given by Ruby’s mother; one was that he had to look after his sick wife, and the other was that he had discovered Ruby was a ‘slut’ and was disgusted by her. Both these things could be true. We don’t know whether the latter attribution was added on later by mother; or it may be that even before her pregnancy was announced, her father had become aware that Ruby was sexually active. Clearly he did not know about the pregnancy itself at the point when he wrote the letter, or he would have given that as his evidence of her bad character.
Ruby describes herself her young self as a ‘tomboy’ and ‘naughty.’ In her early teens there were two spells in St Ebba’s Hospital, Ewell – this hospital had an adolescent unit for patients 12-17, but Ruby also speaks of being with older women patients. She is not clear what led to her admissions. (Or maybe I’m missing it?)
During the hospitalisation described in the book, Ruby was seen by Esterson, who was in charge of admissions, and Anthony believes he began his interviews soon after. Ruby remained in the hospital after Esterson had left and was given drugs and ECT. She speaks of Esterson with great warmth, and it is easy to pick up from the tapes his careful, friendly, egalitarian manner in talking with patients. It is more like a conversation between friends than an interview.

The episode in which Ruby lost her illegitimate child remains murky. Alistair witnessed an abortion attempt, it seems. But young Ruby also says that she had drunk a great quantity of gin, a method of ‘shifting’ a child renowned in folklore, and that she fell downstairs; after this accident, in which she hurt her back, she saw the doctor, who advised rest if she was not to lose the child; her mother and aunt then told her to walk about, precisely so that she would lose it. The foetus was 3-4 months and ‘would have been a little girl,’ says Ruby. The chain of cause and effect is hard to work out and possibly it was easier at the time not to try to pinpoint exactly what led to the pregnancy’s ending.
Some listeners to tapes of the young Ruby were struck by what seemed to them a synthetic quality – she sounds perhaps older than she is, and is trying to do so – but all agree that she is cogent and articulate.



6. June Field
Inner Circle Seminar No. 230

I would like to begin with a general comment on the cases – less pertinent to June Field than the cases in general, but I want to share it while it’s in my mind. A couple of weeks ago I gave a lecture in the US, and I was asked to talk on ‘The Writing Life.’ I said that I think writers don’t have to be born, to some extent they can be made: but I also think that some people, long before they have formed any ambition to be a writer, form certain habits, a certain disposition, which prepares them for their life to come. The future writer is heading to a degree of isolation, to a room – a narrow room, but a well-populated one: the living and the dead crowding around as you work – the sense of stories unwritten, suppressed voices under the floorboards, fists banging in the wall.
I spoke of the writer and her family: ‘You begin by looking at your immediate surroundings, you house and your street, and you register anomalies. Your evolving consciousness is like an instrument that can be used to measure an earthquake and trace it – you pick up on disturbances that will occur, but also register the effect of those that have occurred, maybe 50 years before.’
At that point it struck me that I was talking not only about the embryonic writer, I was talking about the women in the case histories. They also notice the anomalies and the gap between what is said and what is done – they may not be able to interpret what they observe, but the very fact of pointing to it can be threatening to the family. The simplest example is in the Sarah Danzig case – she went to work for her father and found discrepancies in the accounts, which she mentioned innocently, trying to put things right – not realising that in a mild way her father was fiddling the books. Sometimes the discrepancy in a family’s account of itself stems from the fact that illegitimacy is being concealed: so, you have two fathers, or your supposed sister is your mother. Also, there are double standards, which the child must somehow not notice: ‘Do as I say, not as I do,’ should be the motto of many of these families, and they often show a fear of the outside world and unify themselves by a ‘them against us’ mentality, while concealing the divisions within – there’s a lot of papering over the cracks, and often it’s been going on for more than one generation.
I emphasise, as we always must, that when I speak of June’s family, I am looking to cast some light on how she sees the world. I am not looking for an explanation of why she is ill – the whole point is that Laing & Esterson do not necessarily take her behaviour to be illness. We have to keep restating this, because it is the most misunderstood, most misrepresented facet of these case histories. Yet the authors are quite clear: they suggest that what the women do is comprehensible, without the need of explanations that pathologise them, and in June’s case, the point comes over very clearly: as they say in Maya Abbott’s case, the clinical signs and symptoms become dissolved in social intelligibility. All these patients are walking into a giant preconception – which is that the concept of mental illness is valid and applies to them. This preconception is set in stone, in bricks and mortar in the shape of hospitals, and it is enshrined in medical training, in social assumptions, and in budgeting: the chronic complaint is that not enough resources are allocated to treat mental illness, and to question what is being treated is still dangerously radical. And of course you can see why the status quo obtains – it’s easier to stigmatise individuals, to privatise the problem, rather than challenge social institutions and entrenched pieties. I am not questioning the good will and compassion involved. How can doctors and nurses help, unless they can find an illness to treat? They are deeply invested in the diagnosis. To question the reality of it is to question their own existence. I need not continue on this line – you are all familiar with it. But I feel that it needs to be stated repeatedly, because people are so conditioned to acceptance of the present system and its intellectual underpinnings, and so earnest in their desire to help those who are ‘ill.’
The first thing about June: she is very young. 15. At 14 and a half her personality is said to have undergone a change. You might call it growing up, preparing to be a woman, becoming aware of sexuality. It is June’s mother who begins calling it illness. In the table laying out the case I notice the use of the word ‘anamnesis’ – I think I’m correct in saying it’s the only time they use it – as you know, in old-fashioned medical usage it means compiling a case history by question and answer. But then in platonic thinking, it means the recovery of the knowledge that is innate in our souls, which we mislay when we become incarnated; and in Christian theology it means a re-enactment that more than a commemoration, but is a living connection with what once took place – so the eucharist is not just a commemoration of Christ’s last supper, but a sacrament by which the believer abolishes time and space and gets a seat at the table. In June’s case, the circumstances of her early life were re-enacted, when for a week during her hospitalisation she was fed like a small child by her mother, thus restoring their early relationship. Only after this did June begin to feed herself, as if she were trying to start her life all over again.
When June was a small child she had a hip dislocation and was in plaster for a long time. At the age of 2 she was in hospital for 6 weeks. ‘I pushed June around for four years,’ her mother says. (In the metaphorical sense, she seems to have continued pushing her around.) June had to learn to walk in a leg-iron. She could not be put down on the ground, for fear she would damage the plaster, because she was a strong heavy child, and her mother describes how she would use a system of dog leads and tethers to fasten her on the bed but allow her some limited freedom of movement. The researchers remark on a certain blitheness with which Mrs Field talks about June’s early life – she thinks of June as a very happy little girl – indeed she may have been, as she would not remember any other kind of life, but it’s hard not to imagine her as tearful and frustrated at times – as one supposes Mrs Field herself must have been. Mrs Field reassures the listener, ‘I didn’t ever leave her.’ She was happy, June was happy, the family was happy – it’s happy all round – and Mrs Field doesn’t want this picture to change with the years.
June didn’t gain freedom from the surgical devices till she was ten. Then she’s standing on her own two feet. But it’s all pretty uneventful, as reported, till she is 14 and a half. The change noted by her mother takes place over a period of 6 months. June goes away to a church camp for a month. The researchers say her mother was the only one to go with her – I assume they mean she escorted June, then went home. During this time June split up with her best friend, and there were other developments in her life about which we have no specific details. After this separation, her mother says, ‘I did not know her.’
I was at Stratford a couple of days ago to see the new production of The Tempest. Ever since I first read the play I have thought that the storm that sinks the ship and wrecks a party of men on the island is somehow caused by Miranda, though she doesn’t know it. Prospero takes the blame or the credit, but I’ve always believed she is in unconscious collusion. Miranda is 15. It’s her suddenly emerging sexuality, her fertility, that disturbs the island. Caliban tries to rape her. Her father knows change is inevitable – he can’t now be the only man in her life. She needs men, so men are brought, but a ship must founder, the sky must spilt with lightening, and all the unseen spirit forces on the island are activated. A family can be like an island too, and sometimes it can’t contain the forces unleashed when one member tries to change places or change status.
It occurred to me also that in the days of the case histories the threshold of adult life was different, because 15 was the school-leaving age: we’re not told, I don’t think, whether June was leaving school: there was a strange period of in-between status, with the age of majority at 21. It’s interesting to cast forward to the Mary Irwin case and see the similarities. Mary was 20 when she was seen by the researchers, but she was about 15 when her troubles began. Like Mrs Field, Mary’s mother described her infant daughter as ‘happy – no trouble – just happy.’ The researchers comment on how she treats Mary as if she were a nurse and Mary the patient. Like June’s, her teenage transgressions are mild to the outside observer, but her mother sees them as evidence of illness: ‘I’ve got to think she’s ill,’ she says, ‘or I couldn’t put up with it.’ Like Mrs Irwin, Mrs Field seeks to be at one with her daughter, and this separation, when June goes to the camp, is the beginning of what she sees as a split between them, and a split between June and her old self. By her mother’s account, June has gained weight. She seeks solitude. She’s rude and truculent and contrary. She doesn’t believe in God anymore and we gather that God or at least religious conformity is a force in this family. At times, June’s mother says, she looks evil.
Only Mrs Field sees this – not her father, sister, headmistress nor two GPs. The examples of her oppositional behaviours are mild in themselves, but they are violation of this family’s code of conduct and of her place in the family. It seems she is trying to find a place in the adult world but she is tethered by her mother’s attributions. It wouldn’t be surprising if June were resentful of her continuing dependence, of the expectations placed on her. But we learn that she has hidden things from Mrs Field for some time. Since 13 she has been having boyfriends while pretending to be at a church club. It’s not clear in the text how sexual these relationships are. Are the boyfriends young people the family know, and it’s just that the relationships have become less childish than the adults imagine? Or are they young men they don’t know – in which case there’d be some point to the mother’s remark about how she can’t trust June with any Tom, Dick or Harry. Without more facts it’s hard to know how far her fears about June’s friends are reasonable or not, the kind of fears any parent would have, or whether she’s trying to micro-manage June’s outside contacts.
You would of course like to know more about Sylvia, June’s elder sister. Mrs Field seems more detached from her, but doesn’t lament that. The parents say that June used to be physically affectionate, but isn’t now. Sylvia was never affectionate – her chilliness or self-containment, or whatever it is, is described as more ‘refined’ – so in a way she is given approval for it. June’s neediness is both encouraged and derided, and as she recovers from her ‘illness’ her mother’s ridicule of her is pronounced. June’s father seems passive, but also a dramatiser – saying that June is ‘lost to him’ because she has taken a small sum of money. Her mother speaks of June as if her basic functions are infantine – she says June just falls asleep, without being able to control it – and she speaks as if these basic functions fall to be overseen by her elders: ‘I couldn’t have you going, falling asleep,’ she says.
There is some turning point we don’t know about. If I have one wish with these case histories, it’s to know what happens in the household, or to the patient, to precipitate their admission – I mean, the hours or the day before. Presumably before her admission June’s stroppiness rose to new heights. I’m not trivialising what may have happened. So much that goes on between parents and teenagers is banal, and foreseeable, but it’s not trivial. It seems to me that sometimes people at this age do need asylum, but there isn’t one, so they run away or break down. When family members are entangled, their feelings are sharp and sore, and everyone needs a bit of time out, physical distance, a breathing space. As a society we refuse to know this. It seems to me nothing we learn about the family stops us from idealising it. We do not know any perfect families, but we hope they exist somewhere. Sometimes the least healthy place for the child is the parental home – but that is the last thing parents can admit. These families in the case histories are the kind who huddle into themselves, and there never seems to be a saving outside influence – a mentor, or another relative – who can throw the young person a lifeline.
June’s struggle to grow up is not successful – not for the while, anyway, and by the time she comes to hospital, she is in crisis. She won’t eat, won’t speak, doesn’t want to move. She’s not reporting mental distress, she’s acting it out physically. June can’t win. The better she does at articulating her own position, the worse she does, in her mother’s eyes, and when she graphically shows the bind she’s in, by becoming still and mute, then other people agree she is ill. (As always, the diagnostic terms seem to couch the signs as an infliction from the outside, like the plague. This way of describing takes away the agency from the patient; the hospital considers the patient is not deciding against movement, speech, food – she is under a compulsion.) Yet it is not at all clear, in this case, whether June feels she cannot move, speak, eat, or whether she chooses not to do so. If you made a new protocol, whereby you simply observed a patient’s behaviour and said, ‘At the moment she is behaving in this way, doing x and not doing y,’ it might take some of the terror and strangeness out of her situation, but when a hospital describes it also makes a judgement – a diagnosis is a judgment.
In June’s case, it seems the words ‘schizophrenia’ was not used to the family; but whether the diagnosis was presumed, and by whom, is another story. You can tick June off on the check list. Flattening of affect, delusions – florid delusions about poison and the destruction of the world. As always you wonder glumly if, when the patient shows the textbook signs, whether the textbook isn’t playing a part – she fulfils the expectations of the hospital which is geared up to treating the patient – why would she be here, if she isn’t ill? The patient’s ‘break with reality’ is said to be diagnostic. But the boundaries of her reality are set and patrolled by others. Lack of insight is said to be diagnostic, but the people around may be far less searching in their demands on themselves, in their interrogation of the world, than the one designated a patient. That person’s efforts to rescue themselves are often muddled and make them seem even less competent than they are. For June, who won’t eat, it seems survival depends on regression. She must eat, her mother must feed her. Mother is as necessary as she was when June was an infant. So Mrs Field has the glory of being right. She has said that June is not capable of independence, and now it is demonstrated – here is something very simple that the whole world can witness.
When it comes to June’s recovery, the question is what her mother regards as ‘better’ – as opposed to what June and others think is better. It’s interesting, the language the case history uses here – ‘steps forward’ and ‘steps back.’ In hospital June regressed to the stage where there was no progress without her mother, and so afterwards her mother gets to define what progress is. She is anxious when June is seen with a young male patient, and she suggests to June that she forces her company on boys. You can imagine how any such hint sabotages a young girl’s confidence. You wonder about Mrs Field’s own growing-up, and if in some way she is trying to pre-empt humiliation for June. In any event, any boys whom June goes around with will have to be able to take ‘responsibility’ for her – as if Mrs Field will pass the burden to someone worthy, but there’ll be no interim period in which June manages herself.
Earlier I spoke of the likenesses between the writer and the patient. Of course there are crucial differences. Up to a point, writers live with imprecision, with formless, borderless concepts, but then they find the exact words to pin down their experience, and in my belief that habit of skewering starts early; you may be suffering, but like someone with a religious mindset, you start to look for the use of it, and without knowing it you start to take charge – you use language to boss your experience around. If their families are desperate and dysfunctional, writers have a habit of making that pay off, in later life. For writers, the worse things get, the better they get. Your failures, your sins, your embarrassments – they all find a use, disguised thickly or thinly. Not so in these lives. For these women the consequences of not fitting in, of knowing too much and saying the wrong thing, are severe and lasting. When we leave June she’s striving for recovery. What happened next, Anthony can tell us.

After the seminar:
Wisdom from Anthony and some afterthoughts.
It seems that Mrs Field was in fact a nurse. (This may be why she feels she has a special status when it comes to detecting ‘illness’ in her daughter; others can’t see it, but she is more expert.)
The family were Methodists.
At the time of her admission June was hallucinating soldiers in field-grey uniforms, sent by Hitler, outside the family house. We know this from a later publication by Esterson.
Her detention was compulsory. We notice that she was ’making sense’ within days, at her first interview with Esterson.
Relatives say June married happily at 31. She died of a pulmonary embolism aged 47, after she was injected with lithium. I am not clear whether this was a result of a medical accident relating to the injection itself, or whether it was an adverse reaction to what was injected. (Maybe the relatives don’t know?)
After her discharge June had some contact with psychiatric services – mostly as an outpatient? We assume she was diagnosed as bipolar or that she was in a hypomanic state at some point – hence the lithium. It seems she would sometimes ‘run away’ and turn up unexpectedly to friends – I thought ‘eccentric’ was a good word for her reported behaviour, but she doesn’t seem to have done anything in subsequent years to cause harm to herself or anyone else, or to show ‘illness’ in the way she did at fifteen.



6. Ruth Gold
Inner Circle Seminar No. 233

I’d like to start at the end, at the point where Ruth is at home, with her parents, and embracing their view of the world. She still has doubts over their attitudes and their construction of the recent past, but she can only express them tentatively; she is dubious, she says. The interviewer asks, ‘But do you feel you have to agree with what most of the people around you believe?’
She replies, ‘Well if I don’t I usually end up in hospital.’
Ruth shows herself clear-sighted, unillusioned, and seems to speak for many of the subjects of the book. Like a dissident in a totalitarian regime, she has no negotiating position; she bows to superior strength, and accepts the practicalities of survival. Her ambitions, her creativity, are put behind her.
Ruth is 28 at the time of the study. Her career as patient begins at aged 20, and she has been admitted 6 times, with a fluctuating diagnosis, hysteria or schizophrenia, but various institutions have settled on the latter. It strikes me that nowadays, well-read people are willing to consider hysteria as a complex social construct, and yet still talk about ‘schizophrenia’ as if the term denoted something as specific and clear as a broken leg. Hysteria has entered into literature and art, it’s been claimed for civilisation, if you like; disorders of mood have also become part of the cultural landscape, because celebrities claim to be bi-polar: whereas the popular picture of a person with schizophrenia, encouraged by the media, is of some shambling wreck sleeping on the streets, or worse, running through them brandishing an axe or a gun. This is why it matters so profoundly, to examine the concept in a radical way – because all these years on from the publication of the book, the basic concept of schizophrenia – whether it makes sense, whether it’s valid – is still passing without a challenge. I will speculate on what might have happened in this family, but I want to say I am wary; I try to put limits and safeguards on my imagination; the last thing I want to do is to embroider, and steal the case histories away and make them over into literature. There is so much reality behind them, so much life lived to which we have no acccess now.
It is far from clear, from the transcripts anyway, that Ruth has a disease, but it is easy to see how her life has lurched into crisis. She has trouble functioning in the role her family want her to play; there is a vacancy for a good daughter, but she doesn’t fit it, which is why the researchers evoke the image of the Procrustean bed – she is being squashed and stretched to fit. And the spontaneous growth of an adult woman – of creativity, of complexity – is a challenge this rigid family can’t accept. As the years pass, it seems the particular person that is Ruth is being lost – in the clinical process, as well as in other ways. She’s being subsumed into her diagnosis. The authors say that it is typical that medical reports of the patient become ‘more stereotyped and succinct’ as time goes on. I find those words some of the saddest words in all these histories. In these cases, the term ‘schizophrenia’ has worn a groove or furrow into reality, and each year the groove is worn deeper, and the patient has fallen into it and is becoming lost from view. So the staff, I suppose, are looking at their expectations of the patient, rather than the way the patient behaves; almost everything is cast as a symptom; the patient can be said to be better, or worse, but stands little chance of losing the attribution of illnesss entirely; she could even be declared cured, and discharged for ever, but she couldn’t get back to being simply a woman, without a diagnosis. At least not in the eyes of the hospital; we have met brave examples of patients who became un-patients, have walked back into their lives, but Ruth isn’t one of them: though she does say, quite baldly, ‘I don’t think I’m ill at all.’
This is a small family: older brother, long ago left home: mother, father – who won’t be interviewed without his wife, and so becomes an echo or mimic of her – or an ‘ape,’ to use the family’s own word. It seems as if the brother would be very important, but there is no transcription of an interview with him – perhaps we will learn later why that is. More and more, as our seminars go on, it’s the gaps I notice. Sometimes the extra information that Anthony has gathered is revelatory, but he doesn’t tell me in anything in advance; my job is to pay attention to the words on the page. But I never think of these young women as paper and ink. One of the things that moves me about the book is how much of them lingers; they entered an underworld when they became patients, and there are not many survivors now – in the physical sense. It would be inflationary to suggest we can go into the underworld and lead someone back: but what can do in these seminars, I think, is to put out a hand into the dark and see who grips it.
At the last seminar we speculated on what the families may have been told was happening to their hospitalised member. Antony said he doubted the term ‘schizophrenia’ would ever be used. Jenny suggested that they would be told, ‘nervous breakdown.’ I’ve long been fascinated by this term, and I remember once hearing someone ask, how do you go about having a breakdown? How do you make clear you are broken down? Do you lie on the floor? What exactly do you have to do to illustrate your inner desperation? The person who asked that question could see crisis looming, I suppose, or had been close to crisis, but still felt that there was an element of choice, and an action required – it wasn’t enough to say ‘I feel really bad and I need time out’ – you had to show, not tell – you had to do something graphic, before you could stop the world and get off. But I would guess that after a certain point, the action takes care of itself – the sadness and the anger and the fear burst the dam of self-control, in a way that looks irrational, and may be very alarming to an onlooker, and horrifying to the person who is undergoing it – but the underlying feelings may not be irrational at all – those feelings may be a perfectly logical and comprehensible response to confusion and suffering, to being misled, or discovering facts that cast doubt on the story that makes a life hang together. This may seem so obvious that it doesn’t need saying: but I think it does need saying and repeating, in the context of these cases. The behaviour of the subjects is not arbitrary. They are not throwing up inexplicable symptoms. Cause and effect have not parted company in their lives. But the attention of the families, and then of the medics, focuses on overt behaviour that is seen as out of character – noisy, disruptive, shows you up in front of the neighbours – and behaviour quickly transits into symptom – particularly in families who can’t tolerate dissent or even difference, who are already enclosing some form of shame within their structure, or holding a secret, and who are unwilling to characterise a daughter as bad – they would rather she be mad, and so all parties be absolved of responsibility. I always want to know what happens in the day, the hour, before the person for the first time enters into the condition of patient. You wouldn’t accuse Mr and Mrs Gold of having much imagination, but they give a vivid, desolating picture of a young woman hitting a life-crisis:
‘she came home that night – oh it was about ten o’clock at night, in a taxi, sobbing and crying, with her shoes – the heels of her shoes broken, and from then on we went from one psychiatrist to another.’
No screenwriter could do better. You could write a whole thesis, I suppose, on what happens when a high heel snaps – how suddenly helpless even a sober woman becomes, even in broad daylight: but how the associations take us far beyond footwear malfunction: it’s always night in our imagination, and the city, and streetlights shining through the rain, and drink is involved, and perhaps some sexual misadventure, and whenever her heel is broken, her coat is open and her hair is messed up and her mascara is running, and she’s probably got bruises – here’s an unravelling woman, an awful warning – and what then arises is pity, and a measure of contempt. And those are the reactions Ruth has seemed to elicit from her parents all along. As for her illness, about which they talk so much – it is remarkably elusive.
We have to go back. Ruth is a compliant child. She is everything her parents want. She is obedient, happy. There really isn’t much to say about her. There’s no cloud on the horizon until she is 18 or so, when she becomes depressed following the end of a love affair. But there is a shadow hanging over her, as the parents are well aware. Mrs Gold had a younger sister, who killed herself at 19 after a broken engagement. Ruth is named after her. Ruth is understandably pre-occupied with the dead woman, because it seems their lives are running in parallel. Ruth wants to know what happened and why, and whether the first Ruth was regarded as insane, and how their circumstances line up – perhaps I am reading something in to the words on the page, but it seems there is a kind of sinister complacency in the way her mother handles the topic – a dismissal of Ruth’s concerns – ‘she didn’t even know her’ – and at the same time – I cannot prove this, I am just intuiting it – it’s as if some form of malign teasing is going on. It is as if the disaster in the previous generation has been handed to Ruth, parcelled up – it remains sealed, hints are dropped about the contents, but all she can do is feel its shape. When Mrs Gold talks about her sister’s death she says she was young, she didn’t mean to do it, it was a manipulative gesture, she was only trying to frighten people: the power of her death is taken away, it’s made incidental and almost ridiculous, like Ruth’s efforts to be an artist.The question of ‘naming after’ is something I’ve tried to approach in my own fiction, but without coming to any conclusion as to what it meant in my own family. Freud said that he named his children for people he had been fond of, rather than naming them according to fashion, and then, he said, ‘Their names made the children into revenents.’ But if you open what Auden called ‘a lane to the land of the dead,’ you must know it is a two-way street. The dead come back for a second chance, but a meeting may be required, a cross-over point; it seems to me that the ‘naming after’ gave Ruth a great push in the direction of death, when she was scarcely born.
So we ask, how much life is permitted to Ruth? Her family are clearly narrow people – her mother is certainly articulate, but resents the burden of education – she regarded being taught music as an imposition: and father is self-righteous about being philistine. When people talk in these terms they pose as the undeceived, as if art were a trick they had seen through. Ruth’s older brother is an artist of some sort – a writer, one guesses. Ruth has timid aspirations of her own. Her family pour scorn on them. She is accused not of wanting to be a writer, but of ‘aping the writers’ – as if she were promoting a false image of herself, deliberately deceiving and pretending. She wanted to be a dress-designer, we are told, and began a training course, which is belittled by mother – she can’t remember the name of the school, it was a ‘little’ course, and a ‘short’ training – nothing serious, and Ruth didn’t stick to it; given her family’s denigration of her aspirations, you can see why. Her illness, we are told by her mother, hits her in the form of an ‘attack’ and the warning of it comes when she dresses in what the family think of as an artistic way. She wears coloured stockings. A difference of taste in this family equals dissent, a crack in the façade of wholesomeness and solidarity. The kind of people Ruth wants to mix with are a threat to respectability. Sometimes, occasionally, she has brought someone home to stay the night – not for sexual purposes, that’s not the problem, or at least not the expressed problem – the problem is the challenge these strangers pose to the family’s outlook. There is a dispute over the simple facts of Ruth’s day-to-day life. Her mother says she has little social life. Ruth says she does – it’s just that it’s not one her parents approve of. They don’t like the places she goes or the people she meets, and when she makes choices they don’t like, they say that’s not really Ruth – it’s her illness. She goes to a drinking club. She doesn’t ‘really’ drink, her parents say. And they’ve never seen her drunk, they admit. If anyone drinks, it’s the sick self; their good girl would never do that. Sick Ruth is abusive, they say; she blames her family for making her ill, she is resentful, and she can’t care for herself; her mother has to tend her as if she were an infant.
As for the events before the breakdown: ‘history is repeating itself,’ the interviewer says. Despite what the parents say about family harmony, it seems as if the two years before the first hospitalisation were choked with conflict. Ruth’s boyfriend, Richard, was a medical student. Her parents say he is selfish and spoiled. Richard’s parents don’t approve; they want him to study, not get enmeshed with a girl. Both sets of parents put pressure on Richard to break off the relationship. Eventually it is broken off. Ruth thinks it is her decision. Her mother even asks her to consider if it is the right decision, think about it very carefully – with no hint that she herself is playing a part in events. When Ruth sees Richard with another girl, she is deeply hurt. Her parents sympathise – as you would, if your teenage daughter was nursing a broken heart. They don’t admit to a piece of duplicity that many reasonable people would regard as unforgivable.
After the relationship ends, Ruth falls into depression. There is a sudden and strange weight gain, there are instances of erratic behaviour, and then the crisis. Then at some point, it seems Ruth realises she has been manipulated. But when she accuses her mother of interfering in her life, her mother says this belief is a symptom of her illness.
At the end of the story the hospital returns Ruth in a state of passivity that the family must find satisfactory, because it mimicks the compliance of her childhood. Her parents stress their focus on her, their self-sacrifice, and she agrees they know best. The alternative, as she says, is hospital. Besides the Procrustean bed, the other image that springs to mind is that of a doll – one of those 1950s/1960s dolls with staring glass eyes, very clear and seeing nothing; it’s as if the parents had made such a doll – and this doll can squeak, in imitation of human speech, but not convincingly, only in set phrases – it is idealised, it is adored, but you can haul its plastic flesh around in all directions, and its smile never falters, and no one could mistake it for being alive.
This is a case where it is difficult not to be angry with her parents, on Ruth’s behalf; but that is not the same as ‘blaming her family for her illness,’ which is the popular perception of what Laing and Esterson did: what they are questioning is whether ‘illness’ is the right term for what is happening. On a human level I always wish we knew more of the worldy context of the families – what they have to cope with, what formed them, what the childhoods of the parents were like – but I am also interested in their inner context, the myths that they seem to enact. Here, there is anxiety about what the world will think, because the parents consider themselves as the social norm – but there is also powerful threat directed inward – the mother must stave off a reckoning with herself. We can only imagine her ambivalence to the new-born child, when she named her daughter after her dead sister. She would surely say it was an act of commemoration, of reverence. You could see it benignly, as an attempt to give a child to the sister, to share her. But you can also see it as a prophecy, where Ruth sleepwalks to its fulfilment.
I don’t mean that her mother willed Ruth to collapse or suicide, but rather that she arranged for her to be dead-and-alive. Ruth is a re-run. I’m interested in the time-slip genre in women’s fiction – a woman from our time finds herself caught up in the life of a dead woman from long ago – her ancestress, in fact or by adoption. The slip doesn’t just happen, like putting your foot through a rotten floorboard – there is an intention to deal with the past, to return to it: the main character is pursuing research of some kind, or she is involved in solving a crime. First she develops a fascination with the past figure, then an obsession, and finally she is ensnared. And almost always, in the past, there is a fatal or near-fatal male figure; love compromises and damages the heroine, and the love is lost: but what the time-slip genre posits is a male figure whose power can outlast generations. The only creature who can do that is the image a woman carries inside. I am interested that Ruth felt she had lost somebody or something important, and that it was something that she couldn’t put a name to, till she realised it was her boyfriend: what has been taken away, by a trick, is her sustaining inner image, and what she has lost is control of her own story, and what is left is a void.

We are looking at the members of the family to see how the events might be socially intelligible, not to find causes for her illness, because we are not necessarily persuaded that she is suffering from an illness. Certainly she is suffering.



7. Jean Head
Inner Circle Seminar No. 236

The researchers say it is difficult to catch the flavour of this family in action – it doesn’t come across on the page, you need to hear and see them. They have 27 interviews, all but 3 on tape. That’s 35 hours, beginning soon after Jean’s admission, continuing through her crisis period of 3 weeks, then afterwards for 7 months. In varying combinations, we have Jean, her parents, her husband David, Jean’s brother, her foster-brother, even her employer. As usual, though, the case report leaves a lot of questions, and Anthony and the tapes may be able to answer some.

A DAUGHTER AND A WIFE
Most of the histories concern daughters still living with their families. Jean is both a daughter and a wife. She is able to get some distance from her parents only at the price of becoming dependent on her husband David. But he feels she has not sufficiently separated herself from them. He sees her as ‘a part of me, and not so much a part of them.’

The researchers say this is a key finding. I guess they mean that no one recognises Jean as a being in her own right. David interprets everything she says and does in the light in which he wishes to see it. If she is contrary, it’s because she’s ‘not herself’, or tired, or ill. If she’s not herself, who is she? This familiar expression becomes sinister when you live a life like Jean’s, where other people are the experts on your past and present life, and on what you feel – as if you exist by their grace.

FIRST BREAKDOWN
3 years before the hospitalisation described here, and before she was married, Jean had a breakdown in which she developed a certain delusion; she believed her parents and her fiancé were dead. She recovered in a few weeks in a general hospital. And to outward appearances, all was well with her, until 3 weeks before her admission, she developed creepy feelings about what was going on around her – that all was not what it seemed.

SECOND BREAKDOWN
She thought her colleagues at work were talking about her and plotting against her, planning to rob her. She was being followed by men who might be planning to attack her. Then, we are told, the feelings crystallised into delusion – which I take it means she hallucinated such persons. And at the same time there were feelings of heightened meaning that attached themselves to objects. She herself precipitated her admission by going to the police to ask for their help. What happens in this second episode is that Jean’s beliefs of three years back resurface. She says her husband is dead. So are her parents.

I am interested that the word used, in inverted commas, is that she ‘realised’ her husband was dead. So the suggestion is that she didn’t discover it, as something that had just happened: rather that she simply discerned the true state of affairs. Does this mean that in her mind she had been living with a dead man for some time? It’s as if the time closes up, between the two psychotic episodes, and in between them, in carrying on as if her husband was alive, she had been just complying, people-pleasing, pretending things were normal. I would really like to know what she said about these dead people. Did she think they were corpses who were simulating life, like zombies? Or did she think that living impersonators had replaced her dead husband and parents?

In any event, Jean has passed from abnormal, heightened sense perceptions into frank delusion, and a break with reality. We need not shrink from saying she’s mad. Contrary to what people sometimes think, this book is not denying that people may go mad. The question the authors ask is, is there method in her madness? Are these delusions just random, psychic junk? Is there a level at which they are intelligible, in the light of her past life and present situation? Jean’s manner, as she recovers, is child-like, but it is also a knowing, mocking imitation of childhood; she is sarcastic, we are told, and mimics her parents. There seems a lot of anger here, graphically but indirectly expressed, and a lot of frustration, and as you uncover her life history you see why.

THE SECT AND THEIR RULES
Jean and her husband and her parents belong to a fundamentalist Christian group. No pre-marital sex, no sexual fantasies within marriage, no make-up, no dancing, no theatre, no cinema, no TV, certain radio programmes permitted, though not on a Sunday: smoking frowned on, drinking I suppose prohibited. No anger, or at least no demonstration of it. No differences of opinion that could open the way to an argument. The researchers say, ‘There is probably no section of the community whose members expect more of themselves in certain respects than these people.’ As they point out, a person who tries to live by these rules is enmeshed in contradictions which create a permanent strain, as they try to reconcile the imperatives of the church and the outside world. You have to adapt to the world outwardly – but not inwardly. You are in the world, earning a living, but not of it: you are prohibited from most common pleasures, you are a full-time Christian, so your leisure time is absorbed by church activities, and probably – we don’t hear about this, but it seems likely – you are under observation by other members of your community. If Jean thinks people are watching her and talking about her she is probably right, just as Sarah Danzig was right, when in her workplace she tried to negotiate the difficult business of being the boss’s daughter.

HER PARENTS AND THE CHURCH: A CHILD MUST BE INDUCTED
Jean’s parents haven’t prospered materially. I suppose, too much charity. They actually practice their Christianity, so perhaps they tithe themselves or just give too much away – money or time or freedom. They want something a bit different for their children and put emphasis on security – perhaps, if we can conjecture, feeling times are changing, their group is not as tight as it was and that the church can’t act as a safety net: and also that the new generation wants and expects more by way of consumer power and material goods.

We don’t know for sure. We don’t find out much about how the family function socially. But these groups must cohere if they are to survive. The child is born not into a world where people muddle along, but one where they inherit the rules. The child has to be inducted. She must internalise the values that drive the rules. All the world’s pressures will push her the other way.

JEAN’S DOUBLE LIFE.

Like other parents in the study, Jean’s parents describe a compliant and contented child. What they don’t know is that Jean has a double life. At 9 she went to the cinema with a friend, and they didn’t find out. If God saw, he didn’t tell her parents. Through her teens she wore makeup, had boyfriends. It must have required great feats of organisation to keep her parents ignorant – if they really didn’t know. Jean had the help of her brother, who was slightly older. She managed to have a 4-year sexual affair, from 14-18. The boyfriend was presumably older and seemed to her cultured and had money and altogether moved in a different sphere, so when he wanted to marry her she could not think how she could do it without breaking away from her family. So she broke off with him. She became engaged to David, who was a member of her church. In the next 4 months she slept with several men. Then her first breakdown occurred.

Within a couple of months she was out of hospital, and married David, who knew nothing about her affairs. She was lying to everyone close to her, but she must be hostage to another set of people, off the page, outside the family, who know different facts about her. Once married, Jean is keen to suppress her own memory of the unruly phase in her life. She has to keep a lid on it, pressed down tight. It’s like being a spy, a double agent.

HOW THEY COMMUNICATE: AN EXAMPLE
In the transcripts, the family seem to wrong-foot each other all the time, using ordinary conversation as a sort of obstacle race that none of them can win. I find myself thinking that they are afraid of each other, because who is more likely than the people closest to you to notice a thought that’s going astray, to notice some undesirable tendency creeping in? Sometimes in these seminars I have talked about my own family, so you will think that we offer examples of every possible malfunction. But it’s the reason I have felt this book so important to me – it’s not just that when I came across it first, I saw patterns that were familiar, but that it continued to make sense: as the years passed and I confronted other circumstances, I saw how astute the researchers were.
One of my younger brothers became involved with a fundamentalist Christian group when he was in his late teens, and married within it when he was 19. I had a lot of time for this ‘fellowship’, as they called themselves, because I’d never before met religious people who followed the logic of their beliefs and tried to live as Christians. They were practical and generous and nurturing and they tried to care for each other. But at the same time, to talk with them could leave you wanting to scream with frustration. Reality had to be adjusted to be congruent with what they could bear. When the marriage broke down within a couple of years, the fellowship said that the young couple would certainly get together again, because there were no divorces in their church. And when there was no reconciliation, they reached for the language of pathology. Around the time of the marriage my brother had been in a bad road accident. He’d smashed up an arm and a leg and also hit his head. This, they said, had changed his personality. It wasn’t his fault. They didn’t judge him. They were praying for his recovery.
This was an outrage to the facts. The bump on the head was trivial compared to the rest. He had no impairment to cognition or change in personality. But all conversations were defensive, circular, drawn up like a waggon train, intent on keeping out all contradiction.

NOT ABOUT SICK FAMILIES.
So I feel the communication style of this family is familiar. And I feel the need to mention here another thing Laing and Esterson are accused of doing, that they don’t do. They are not pathologising the family as a unit. They are not shifting blame from patient to family. I used to be attracted to this idea of a sick family unit, and we come across individuals in these case histories, parents, who seem to behave in a monstrous way. Some people in these families have more power than others, and some misuse it, and sometimes you see how power gives individuals the capacity to cover up the bad things they do, whereas the young and powerless member is the one who is exposed to the world as bad or mad. But now I see that each family’s style is a logical outcome of their situation and their beliefs, and each individual is struggling within the confines of their own history. In this particular family, direct communication about an individual’s thoughts, wishes or intentions would totally destroy the fragile unity they are struggling to maintain in every interaction. Their strategies may seem an affront to logic, but they make sense if what matters most is self-preservation.

DAVID
David has huge expectations of Jean but denies having them; he says that the expectations are hers, she is a perfectionist. There are plenty examples of his conversational somersaults, around pages 170 – 171. The most contentious area of their marriage is whether they should have children, and when. David doesn’t want children. He doesn’t tell Jean that. He says they’re just postponing till they are more secure. He says they need more money and she believes him, so she holds down a full-time job, has taken in 2 lodgers, gets up at 6 and goes to bed at 10 pm except for the 3 nights weekly when she’s engaged in church work. No wonder she is always weary. David says that it’s when she’s tired or ill that differences of opinion arise between them, and she asks why she can’t have a baby now. When she’s fresh and rested and feeling well, she agrees with him – a family is better postponed. So Jean’s dissent is a sign of illness, her compliance a sign of health.

David is deceiving her and he knows he is. He seems to try to wrong-foot the researchers too, talking about giving the ‘kiddie a better start in life,’ (172) and insisting that he loves children (179) but saying on p 170, ‘I don’t want a family myself and would be quite happy never to have one.’ Jean’s employer remarks that the young couple are already well set-up in life, but Jean is trapped in unending efforts to create the conditions that David thinks are right – not knowing they will never be right. When she is recovering from her breakdown, her father insists Jean has the power to help herself, but it’s hard to see how she can if she walks back into the same contradictions.
I wonder, does the family have the power to change? To be free? To be honest? How might they go about it? It may not be right to regard them as a sick family, but they are certainly a family with a task before them.

JEAN VANISHES HER FAMILY AND THEY VANISH HER.
In the transcript on p 174, Jean sits with the family group and vanishes them by closing her eyes – as a small child does. And they discuss her as if she isn’t there: ‘She looks quite smart, David,’ mother says. Then they start up a sort of comedy routine, calling and whistling. I am dearly hoping we have this on tape because it’s hard to imagine how you can treat someone who is evidently awake, and listening, and sometimes speaking, as if she is comatose or anaesthetised and needs arousing. Jean makes the alarming statement that she does not know who her parents are, and her mother ignores this, only complaining that they have come a long way to see her and she should pass the conversational ball about a bit. What would you like me to ask you? Jean says. Whether you’re Faith…?
We don’t know if she means this abstractly. David is of a literal turn of mind. He says Faith is the name of somebody at work. Her father, confusingly, begins to talk about himself in the third person. Then the transcript becomes surreal. Mother says, I went to London – I didn’t meet you there: as presumably she had done on a previous occasion. Jean asks sarcastically, ‘Didn’t you?’ No, mother says – you’re here, aren’t you?

As Jean begins to recover, her parents and David are disappointed that she isn’t grateful to them – it’s not clear for what. As the weeks pass she becomes closer to what they think of as normal, but she’s still pushing and questioning, exposing the deceptions that underlie her life with David. The less she pushes, the more they define her as ‘better.’

THE COMPLIANT CHILD
The account offered of Jean’s childhood is the one we have become used to. It’s a picture of compliance. A battle over weaning, (183) but everything normal. She’s highly strung (188) but not jealous, not difficult. There is no requirement for control, because no dissent; Jean’s desires in life, as she grew up, were naturally attuned to those of her family.

Jean’s account is different. She was a fearful child and had nightmares and when she called out for help her father hit her. Her mother denies this. There were no nightmares. No irrational fears, and by their account, no punishments. No one in the family expresses anger, because they never really feel it. They are allowed righteous indignation, but not passion. It is a Christian duty to suppress any disharmony. Perhaps this family more than others insists on the correctness of what they are doing when they repress their children. It’s their policy, and the right one.

THE FOSTER CHILD
This brings us to the jaw-dropping story of the little boy the family adopted.
This poor child, Ian, was born with club feet and was further affected by polio, so he wore leg-irons. When they took in Ian he was a child of almost school age but had to be carried everywhere. He was more work than their own children. They were distressed by his need for attention and by his disobedience. Mother complains he used to drag and scrape his shoes – she seems convinced that he did this to spite them, and could move normally if he wanted to, though almost in the same breath she stresses that he could not. He was incontinent at night and was punished for that, and physically bound to prevent him biting his nails – which would also of course stop him touching himself to soothe himself in any way they disapproved of. They don’t believe he missed his mother, because he didn’t ask for her.

To us it’s quite chilling that Jean’s mother refers to disabled children or children separated from their parents as if they were a class apart: they’re adaptable, they don’t realise their own situation. It would be fair to say that some of this reflects the popular attitudes of the time. It isn’t only religious people who thought children were either apprentice devils or blank slates. In this family no particular weight is given to early childhood experience. They must have wondered why the researchers were asking them what games their baby played when she was in her pram. The game of throwing an object away and bringing it back is discussed in The Divided Self as the ‘weaning game.’ And I remember that there, a mother told Laing that she wouldn’t put up with this game – after going through it with her first child, she decided she’d had enough, so with her second baby, she threw the objects, and the baby crawled after them and brought them back, like a human retriever. I think this game is about learning that objects in general, not just the breast, still exist when you don’t see them: that things in the world go on without your having to know them or will them. And you still exist, even if no one can see you. It’s the last bit that seems to give trouble to some of the young women in the case histories. They are surrounded by false witnesses, who refuse to acknowledge their reality, and all the time insist they are someone other than the person they know themselves to be. Jean’s wild phase may as well never have occurred, if no one recognises that it did. She has to go to an extreme, to force a crisis in her world. She’s tried being bad and that didn’t free her. So she goes mad. I think she forfeits reality, recklessly throws it away, in order to shake and jolt her world and jolt some sense into it. She shouts in the faces of her family and still they don’t recognise what she is. Husband and mother and father may be living in the ordinary meaning of the word, but they are dead to sense, dead to information.

WHAT RELIGION MEANS TO THEM.
While in this family everything centres around their religion, we don’t hear anything that hints at spirituality. They don’t come upin Jean sitting up and reading the Bible, like Sarah and Maya. What religion means to them is a set of rules. Everything is focused on outward show. Father says that smoking or the cinema might not be bad in themselves, but he couldn’t engage in them because it might set a bad example to a young person.
I take it that this is an imperative of their creed: they must function as witnesses to God’s workings. In this theology, your only salvation comes through Christ’s sacrifice, and your faith. It’s not good deeds that save you – the good deeds act as advertisement that you are saved. It seems to me the researchers’ discussion of the religious milieu is eloquent and respectful, but I wish they had expanded a bit because I don’t entirely follow. They rightly say, speaking of the people who live by this creed, ‘They are unjustified by anything except faith. They are saved by nothing less than Divine Mercy and Grace.’ (p 167. ) If these are people who believe in pre-destination, as surely they are, then to a lay-person’s understanding their creed is a grim one, but I am not sure what the authors mean when they say on p 167 that such families, ‘expressly define their spiritual-carnal condition as a double-bind.’ I see how such beliefs can plunge you into despair, and I see how hard it is to observe all the strictures on thinking and feeling, but I don’t see how they are a double bind.
But I do see that for people of any kind of fundamentalist orientation there must be a difficulty in interpreting the world, a refusal of metaphor, a literalism, a tendency to make things black/white and either/or. If there’s one way – and that’s the divine way, as shown to the true believer – it doesn’t leave much room for subtle negotiations in human relationships. Your understanding is a box into which everything must be fitted, not a net that is held up to catch the nuance sof human interaction. There are only certain feelings and thoughts that can be named and recognised. The others must be nullified. If Jean doesn’t feel by the rules, she will be told how she feels. There’s no difference admitted between how she ought to feel and how she does feel. They close that gap. That kind of dissonance can’t be allowed.

STAUNCH AND ENDURING REBEL WITH THE VOICE OF A LITTLE GIRL
I am touched that Jean in hospital is described as speaking in the voice of a little girl, because as we know, a crisis comes for these young women when they try to claim adulthood and independence, and try to bear witness to what they know, what they have seen, what they really think. The writers say that Jean’s manner is that of ‘a puzzled child doing her best to meet the demands of adults’ – and that seems to describe so many of the patients – their common difficulty is that the demands of adults are not stable and often contradictory. I think what distinguishes Jean is the thorough nature of her rebellion, the duration of her pretence, the staunch refusal of her parents to admit the facts of her life.
They knew she had boyfriends, her parents say. Usually she brought them home to be inspected and usually they were of the right type. Some of them were worldly. They didn’t forbid these relationships but they prayed about them. They wanted her boyfriends to be Christian, by which of course they mean members of a group compatible with theirs. If they know about her double life there’s no hint of it. I think they must know, but they’d have to bury the knowledge. You wonder how deep the deception runs. It seems to be a labyrinth of denial.
Out of simple human curiosity, I look forward to anything in the tapes that will help understand how in practical terms she managed to split and double herself and how far the other Jean, the wild Jean, lived in the house like a spectre they’re all pretending not to see. However she did it, it must have taken some lying and bold contrivance – and, as I said earlier, giving herself as a hostage to other people. Somehow she has to manage to keep the two halves of her world distant, not knowing about each other, with no possibility of contact. What the history suggests is that, unable to move between two realities, Jean simply cancels her parents and her husband. She has these short times of escape, called breakdowns, where she says that they are dead. They are in fact dead to her reality, impervious, turned to stone, to gravestones, or entombed in their own rigid construction of the world. She can only express herself in mad-talk. Then she sits rigid in the hospital, and they have to attend on her.

In the description of her at the beginning, Jean in hospital appears like a puppet or doll. The researchers notice she still has something of this quality even when her family say she has gone back to normal. That says everything about how they see her – she is not fully human, not the agent of her own destiny.

DARKNESS
Jean’s family deny she was afraid of the dark as a child: well, perhaps a bit afraid, her mother says, (185) but only in the way she herself had been afraid when she was young, and anyway that fear normal for a girl. Jean had never been given a night-light, her mother says – so that proves it was not an issue.
       But of course this whole family is afraid of the dark within – they can’t look at any negative emotion or uncomfortable fact, or at their own shadow. But Jean is one who has confronted her own darkness. When she was 18 she worked at a large house in the woods. She imagined attackers were lurking in the trees and she would run all the way along the road. I am riveted by this image, straight from a fairytale. It seems to belong to a more primitive interior world, and I imagine Jean turning and walking deeper and deeper into the wood and being lost from view, as some of these patients were. But though I don’t know any details, I think that the story about her afterlife is more positive: over to Anthony.

Wisdom from Anthony:

Anthony spoke to Jean’s father c2005.

Jean had an older sister who died aged one hour. Her name actually was Jean.

No outside agencies were involved in the ‘adoption’ of the child Ian. It was a fostering arrangement was set up through personal contacts. Ian was the son of missionaries serving in India. Because of his disability they were not able to keep him with them.

Jean was a voluntary patient. During her marriage with David she had an affair, and they separated and later divorced. There were 2 children of this marriage. She married twice more, men she met at psychiatric outpatient clinics. She had no more children.

Jean died in 2011.



9. Mary Irwin
Inner Circle Seminar No. 239

The case history is an exploration of bewilderment. Mary is a young woman of 20 who has been educated in what illness looks like, but doesn’t know what health might look like. By the time the researchers see her she is an experienced patient. She has spent 22 months out of the last 24 in hospital: this is her third admission, her third institution.

The authors list the clinical terms that are used about her, which make Mary fit her diagnosis, and her diagnosis fit Mary. She has delusions of persecution: she says her mother is killing her mind. But she is not the disappointing type of schizophrenic who just sits in a heap; she puts on a show. That’s to say, she displays some of the more florid textbook symptoms: grimacing, catatonic immobility, catatonic excitement: and flexibilitas cerea, waxy flexibility – that is to say, she can be manipulated by another person into a position of their choice, and will stay in it till moved again. It strikes one that both doctor and patient are involved in a theatrical performance.

Mary’s symptom ‘speak to her condition.’ In fact, they bellow. But as usual, the metaphorical dimension seems to be lost on the people looking after her, who are ticking her off on a checklist. Among other symptoms are ‘vagueness, speculative woolly thinking about the meaning of life, inability to face life’s difficulties and aggressively overcome them.’ That describes the characteristics of the more thoughtful portion of humanity on a day to day basis, and almost the entire working life of a philosopher. But here is an ordinary young girl, not educated, not experienced: what business has she, asking what life is all about? As far as the hospital goes, she is the sum of her symptoms and her background is irrelevant. The researchers say, ‘No relationship was felt to exist between her various symptoms and her environment. ’

But the authors set out, as they do in each history, to challenge this. They ask, in the light of how Mary experiences the world, and in the light of her relations with other people, are her beliefs and strategies so unreasonable that they should be regarded as caused by an illness – which needs daily electric shocks to contain it, and powerful drugs to treat it? When Mary smashes things, which reportedly she does, she is behaving unbearably. But to behave unbearably is not necessarily to behave unreasonably. Mary is a good witness to herself – she may struggle to speak, but given a chance she does speak, and she is capable of making sense of her struggles in a way her doctors can’t.

Mary’s family consists of mother, father, sister Angela, two years older, and a 16-year-old brother, and they are interviewed in various combinations for 20 hours – if you look at the table at the back it says 2 hours were recorded in writing, the rest taped.

There is one unusual feature here: at some point before she became a patient in a psychiatric hospital Mary had suspected encephalitis, which can of course follow common childhood illnesses like measles. We don’t know whether she did have encephalitis – without brain scans it would have been harder to diagnose then – presumably you would do blood tests and a lumbar puncture, and with Mary the evidence of infection vanished over time. I wish the case history said more about this, because the disease in childhood has a long tail of unpredictable consequences in terms of damage to the developing brain, some of which don’t show up till later years – fatigue, difficulties with memory and concentration, mood swings, clumsiness, speech and language problems, general slowing-up of thought and reaction, changes in personality. However, it doesn’t seem to be something the psychiatric hospitals considered as an explanation or as a contributing factor in the way Mary presents herself. Her afflictions are regarded as a bolt from the blue.

According to her family Mary’s problems begin when she is 15. The picture they report is one of a young person uncertain of her direction in life, on the cusp of adulthood and therefore just beginning to challenge the powers that adults exercise over her. The first challenge her parents hear about is a challenge to the authority of her school. She asks a teacher if it is right to hit the pupils. It’s good to be reminded that that the power adults exercised over the young wasn’t simply moral and economic, it was physical too. When you think that Mary and her classmates are almost adults, it seems a preposterous way to go on, and it’s fair enough to question it, but Mary’s father, from whom this evidence comes, clearly thought it was impertinent.

But what the family think of as transgressions on Mary’s part are quite normal behavior. Her mother tells us they used to like the same clothes. Then the point comes where Mary wants to look like a young girl, and not a middle-aged woman. This is seen by her mother as disturbing and challenging. It stands in for a lot of things – sums up how she doesn’t understand Mary any more. She takes it for granted that she should. Mary should act as a mirror to her. But Mary has entered into a phase where she seems not to agree, automatically, with everything she is told. She is cheeky, stubborn, selfish: insubordinate. Her father complains she has annoying habits – sniffing, picking at her scalp, waggling her foot. These habits, the family feels, are not just Mary’s restlessness, but directed against them: her father says she would do ‘everything to try and annoy you.’ And she can’t hold down a job; she loses interest. After leaving school she held a job for two years, though it wasn’t a job she wanted in the first place. Then within a year or so she lost three jobs. The historical context here needs considering – this was a time when it was easy enough to find low-skilled jobs, and changing jobs often was normal in young people with no particular course of life in mind. But clearly it is worrying for her family, if the problem is, as it seems to be, that Mary gets sacked rather than leaving of her own free will.

Actual examples of objectionable behavior are hard to come by. As the researchers say, ‘the most that happened was that on one occasion Mary walked out after a row without saying where she was going and came back after a few hours.’ But her mother’s fears concentrate on what could happen, if Mary had the direction of her own life. Mary explains that from her point of view, her problems began when she was eleven, when her mother’s continuous pointless talking and complaining began to wear her out. Her mother was constantly impinging on her attention when they were in the house together. Mary seems like a person with a high requirement for peace and quiet, a sensitive girl who is treated with great insensitivity. Her talents and interests are belittled, and she is teased. Evidence of this comes not from Mary, but from her mother and father. Yes, they say, when she was at school she had some talent for music and painting. Mary was likable, and her teachers would get on her side, and over-value her work; she only did well where subjective judgment was involved. Mary is also the butt of family jokes, which she is expected to take in good part. She brings home a boyfriend, and mother and father ridicule him. Mary is deeply resentful – which her mother attributes to illness. One of the things she thinks the hospital will do for Mary, it seems, is to make her robust enough to stand up to her family’s sense of humour.

Mary feels that her mother puts her under ‘a debt of obligation’ for what she does for her, while her mother prides herself on her skill as a parent – the more so as she hated her own mother, was terrified of her, and had to battle to get away from home. When her children were younger, she says, her husband’s employer and ‘everybody I came into contact with,’ used to say she was a wonderful mother. Her expectations of the infant Mary were high. She talks about how she trained her to sleep through the night. She’d reason with her, and say that her elder sister had gone quietly to sleep, so she should, too. And this worked, she says. But she seems confused about the difference between a baby and a child who can speak and who could, notionally at least, be reasoned with. The researchers say that she speaks to Mary, in the present day, as if she were a 3 year old, and it’s possible that in her mother’s mind she has always been three, both before and after that age. She was ‘just the kind of baby everybody wants.’

Imagine having a child like that! It is a great distiction for a mother and would make her the object of envy. You will recognize a familiar figure in these case histories – the model child: little angel, little puppet. You may be reminded of June Field, whose mother treated her as a patient, acting toward her as a nurse. Like June, Mary was a happy child, never any trouble: golden curls, big blue eyes, clean, biddable, tractable. There is a blissful state of union between mother and daughter. In childhood these girls are not messy, recalcitrant, defiant – it’s when they’re mad that they babble, that they break things, that they run out into the street. In crisis, they start behaving like the child of their mother’s worst nightmares.

If you think what is it to be a compliant baby: a ‘good baby’ is one whose biological needs are already subjugated, timetabled to suit its family. The child is valued and praised for minimising the inconvenience of her existence – not for being a new person and an individual, not for adding to the family – but for not taking too much. One suspects a male child was expected to be more demanding, possibly punished but also admired. The female child must be self-denying. Without her family, the child can’t live: but within it, she can’t thrive.

Mary is distressed and exhausted by what she feels she has to do to become an adult – which is to keep her mother at bay, simply keep her mother quiet so she can think. What begins as an irritation – her mother talking on and on about the jobs she has to do – becomes experienced as a threat. In any family it can be difficult to find an acceptable way to grow up, with a mother who will not brook contradiction or stand for a rival. When you read these histories you get a senses of the raging, unused potential locked up inside the mothers. You may remember Julie in The Divided Self, the girl who called herself ‘the ghost of the weed garden.’ She said, ‘I’ve been frightened of my mother all my life and always will be.’ At the time we’re speaking of, with abortion forbidden, and contraception less reliable and less easily available than now, motherhood was not a state women could easily refuse, short of becoming celibate: nor could any ambivalence towards marriage and motherhood be admitted. If a woman didn’t go outside the home to work, then she had to make a conspicuous success of her only role. If she did work outside the house, she was guilt-ridden, and had to face a weight of social disapproval, and be blamed for social ills; and perhaps she would feel a need to demonstrate she was just as much a force in her children’s lives as if she had been minding them all the time. Either way, the mothers in this study bring a certain unsparing ferocity to the task, and tend to stress how much they have done for their families, how much they have sacrificed. Behind the claim lies an ambivalence and resentment they can’t admit to – not out loud. But it doesn’t take much for a child to conclude that she was not wanted, or is a burden. The smallest signal will do. The child’s fragile understanding amplifies everything: a casual word can be catastrophic to her sense of safety. She feels she has seen through to a truth that is painful and threatening: Julie said, speaking of herself in the third person, ‘everybody pretends to want her and doesn’t want her.’

The child who feels she is unwanted has a choice of tactics, but they’re all self-defeating. If she offers her love, is that an imposition? Might it make the mother go away? But if she doesn’t bother her mother with a demonstration of her love, the mother will then accuse her of being emotionally dead, ungrateful, not normal.

Mrs Irwin leaves no room for an emerging Mary. Regarding Mary’s supposed illness, she says, ‘I feel it’s me that’s done something wrong.’ When a parent makes that sort of statement, you know they expect it to be negated immediately. You feel Mrs Irwin has a set of witnesses hovering over the situation – all those people from her past who applauded her skills, now ready to reassure her, ‘It’s not your fault, it couldn’t be.’ But whether she’s a bad mother or a good mother, she puts herself at the centre of the drama. And Mary has a variety of strategies to try to push her away. She holds her breath. She employs a variety of distractions – the fidgeting her family complain of. She goes rigid inside, she says, to keep her mother out. And a point comes when she graphically demonstrates her strategy – she goes rigid outside too. At that point her behavior has passed over into being a symptom.

I said to you earlier that by the time the researchers saw Mary, she was an experienced patient. But before that there was a point where she, like the other women in the study, was an innocent sufferer. We’ve talked about how the diagnosis isn’t usually given to these patients or their families. The word ‘schizophrenia’ is rarely used – instead, we suppose, the hospital uses familiar terms like ‘nervous breakdown.’ As far as the patient herself is concerned, she is upset and frightened, and behaving in a way she can’t control, and having thoughts she doesn’t want to have. It’s a fair assumption that when you are distressed in this way, your distress is your own; that’s how you experience it, and it is reasonable to think that it is unique to you, a product of everything you are, everything you’ve lived through, your particular circumstances. But when our women come into treatment, they don’t know they are walking into a set of pre-made categories for distress.

The danger is that what doesn’t fit the categories is not observed and not recorded, and what is observed and recorded is noticed because it builds up the picture that the hospital is already looking for. It’s a system designed to falsify the meaning of experience. The nurses and doctors think they are describing, but they are also judging. The girl sits and doesn’t move; if you call her catatonic, you are giving an opinion as to the cause of her immobility, saying that it originates in pathology. A healthy person might be silent; a sick person is mute. When the descriptions become fixed and are repeated, it’s easy to forget that what is being described is not a clinical entity like a broken ankle. Once exoticising terms are employed, the patient will ever after suffer according to a formula. The clinical vocabulary makes that person alien, cuts them off from the general human experience. The simple route would be to ask the patient why she’s doing what she’s doing, but in the self-defeating practices of the trade at that time, that is the last thing you would do – because she is the last person who could know.

Mary gropes for words – but what she is trying to describe are feelings on the frontier of language. She has to keep her mother and everyone and everything else at a distance, so she can collect herself, feel out the contours of her own personality. But she knows that her strategy is not useful in the long term. Encased in her suit of armour, she misses so much, but if she relents, softens, if she tries to let good things in, bad things arrive too. It’s a fraught, confusing process, with the hospital a controlling environment that mirrors that of her home; when she says, ‘I seem to lose touch with reality,’ you wonder if that is an attribution made about her, something she has heard of as defining her illness. It is not something a person would naturally say about herself.

Does Mary think she is ill? After her first spell in hospital, she says, she came home in a great spirits. But her mother told her she was too full of herself. Her mother says she was over-confident and ‘jumped immediately into a job.’ Her attitude was selfish, and this showed she was ill – even though she felt she was well. When pushed for an example of Mary’s selfishness, or illness, mother says she can’t recall one. As Mary recovers from the third hospitalization, she says would like to leave home, perhaps: her mother agrees, and says they have urged her towards that course: but she immediately says, now is not the time, you need to wait till you are better. Mary implores her mother to tell her what health would look like, but can get no straight story. But unless her mother can tell her precisely what sort of thing she needs to be doing to show she is well, then, ‘If I get better again I won’t know if I’m right or wrong or when I’m going to crack up again.’ To be passive is to be ill: to be active in your own life is also to be ill.

And of course, from Mary’s experience, it is not she who will decide whether she is well or ill, it is other people, and in fact if you look at the murky episode of her sister’s wedding, the question is confusingly indeterminate and negotiable. Mary was expected to be a bridesmaid, and was asked by her mother, ‘Are you going to get better for the wedding?’

Her response to this was to take an overdose of aspirin. She was in hospital when this happened so you would suppose there must have been a proper record of events, but maybe not; certainly her mother is vague about how many pills Mary took, and says she wasn’t told about it for a long time. But when Mary woke up, she was fine. Not mad at all. She discharged her bridesmaid’s duties, went back to hospital and was mad again.

In Wisdom, Madness and Folly Laing talked about the Scottish psychiatric hospitals where he had worked:

…in the so-called back wards, I have seen catatonic patents who hardly make a move, or utter a word, or seem to notice or care about anyone or anything around them year in and year out, smile, laugh, shake hands, wish someone ‘a guid New Year’ and even dance…and then by the afternoon or evening or next morning revert to their listless apathy. If any drug had this effect, even for a few hours, even minutes, it would be world-famous….’

He attributed this miracle to the ‘spirit of fellowship ‘ – an alleviation of the intense loneliness of the men. It’s not clear whether it’s the idea of a new dress and a good time (or just a change) that lifts Mary’s spirits, or whether it was her family’s expectations that caused them to revise their view of her, just while it was convenient.

It’s hard to make any sense of this episode. If you look back at what Mary did when she was in hospital, her behaviour seems to encode what’s almost a satirical view of her life. Demonstrating ‘waxy flexibility’ is a neat comment from a girl whose family insists she is pliable, impressed by their needs and desires. She was said to display ‘automatic obedience’ – which I take it to mean that she acted like someone under the sway of a stage hypnotist, getting up and sitting down at the word of command – again, a reasonable demonstration of the way she has been expected to conform within her family. Even when Mary was at home, a sort of bitter comedy was performed: her sister describes an occasion when Mary took up one of her rigid positions, stuck in it, became normal when their landlady came in, and took up the position again when their father returned. There is no question in Angela’s mind – it was totally under Mary’s control. Like a play she was performing.

And this, I think, is what this beleaguered child resorted to: if you won’t let me speak of my inner state, if you keep interrupting me, talking over me, interpreting me instead of listening to me, knowing better than me, I will have to show you what I can’t tell you. What comes over is Mary’s sense of being locked in unceasing struggle. Her requirements are quite humble: to be allowed the space to work out her own needs and desires. ‘Is it right to think?’ she asks. ‘You should think, shouldn’t you?’

Sometimes the question has been raised in these seminars: why don’t the young women save themselves from their families. Why are they so enmeshed? Why don’t they walk away, at the point when they can?

But it is often the case that people cling to oppressive conditions even when it’s pointed out to them that their best interests lie elsewhere. Children cling to bad parents, because they’re the devil they know, and the wide world is full of devils you don’t know: and when children grow up, they deny that bad parents are bad, and they say, ‘they loved me really, in their way.’ People justify all sorts of monstrous abuse in their upbringing, and say it never did them any harm, and children try to love their parents even if to the outside observer it seems the parent should be in gaol: from the child’s point of view, it’s better to be oppressed than ignored, because that’s to fall into the void of nothingness – to have your existence denied, before you’ve been able to establish it for yourself. Better eat the bread of sorrow than be overlooked and get no bread at all.

In the case histories we are not dealing with the kind of abuse you go to gaol for – not that we know – but with more commonplace abuse of power and corrupt communications, which bewilder and tire and stress these young women to the point where you might say, they don’t know their own minds. You can say to these women, ‘There’s the door to freedom, go through it,’ and you have to try to understand why they hover on the threshold. Freedom is so hard, so testing, if when you sample it you are accused of ingratitude, over-confidence, and if you have been underminded as Mary has. In this set-up, being ‘better’ is defined as agreeing with people: whereas to the outside observer, health would begin at the point where the patient wished for health, wished for freedom, realized her freedom, and started to make use of it.

WISDOM FROM ANTHONY:
Mary was born in 1940 and was 50 at her death.
Her family is Scottish. She attended a secondary modern school, whereas her sister Angela attended a grammar school.
Angela has led a stable life: two marriages, children, modest career. After her marriage Angela was interviewed at home by Marion Bosanquet, a social worker. The younger brother seems to have cut himself off from the family early, joining the RAF and staying away thereafter.
Mary’s school reports don’t bear out her family’s poor opinion of her. She was able across a range of subjects, including maths (whereas the family view was that she only did well in subjects where personal factors influenced the marking.)
One teacher describes her as ‘a good notetaker and a good listener.’ Another remarks on her good manners.
Mary was serious about her painting and wanted to go to art school.
Esterson saw Mary 1961- 1962. After she was discharged she went home, but another incident with her family saw her back in hospital. She then became a career patient, outlasting the institution in which she was placed. After the closure of her long-stay hospital, she was transferred to some type of hostel or half-way house (we assume) and never left its care.
Anthony has given us a 1976 paper by Esterson called Families, Breakdown and Society, in which he includes an outline of Mary Irwin’s case and a longer transcription from a tape of Mary and her mother talking with him. This adds a good deal to the record in SMF. One gets a sense of Mrs Irwin’s dogged persistence in holding to her own version of events, though she can never supply any specifics; and also her latent anger with Mary, barely held in check even in the interview. Esterson concludes that Mary was never psychotic, but ‘was with complete justification in a state of existential despair and mystification…’ She did not need institutional psychiatry, he says, but rather a friend and confidante, and someone who could mediate with her parents on her behalf, and give her confidence in dealing with the world using her own resources.



10. Hazel King
Inner Circle Seminar No. 242

A few weeks back I was talking to a lady approaching her 90th birthday and she said, ‘Never sit down and take stock. You only end up crying.’
All the same, I think we’ve come to a point where we might take stock, if only because we’ve had a gap since we met: and just ask ourselves what we are doing. In part we are puzzling over the fate of a literary artefact. We know what is in this book, and we know what has happened to it subsequently: how it has been read and misread, and how people who think they have read it have actually failed to take its point. We ask ourselves why it didn’t change much in the real world; it didn’t make professionals think afresh, as it might have done, and it didn’t operate to change social policy or how we define and treat mental distress.
We can come up with various reasons – apart, I mean, from entrenched conservatism and limited intellects. One is that Laing’s flamboyant reputation stopped people taking his work seriously as the years passed, and that, unfortunately, Esterson’s contribution went down in the wreckage.
There is another and simple explanation for why present-day readers misunderstand the book. As an author I am drawn to this explanation, because I know that people can’t be relied on to read anything that comes before ‘Chapter One.’ They think, ‘ooh, stories!’ and they plunge in.
Because they don’t read the prefaces and the introduction, they conclude that the book simply portrays a set of nasty and sometimes grotesque families who victimise one member and make them ill. That would be an easy mistake to make. Readers also probably begin the book with pre-conceptions, thinking that the authors deny that anyone is mad, or that they claim families cause schizophrenia. Because of the case history form, the authors can’t hold an argument within each chapter. They can’t stop the story, to restate their position constantly, because they want to subjects to speak for themselves. Accordingly, the opening pages of this book really matter.
The first preface, from 1963, is a conventional list of acknowledgements and notes about the research. The second preface, from 1969, is very different. It grapples with the misunderstandings the book has caused to that date. As the authors say, most of the criticism is irrelevent, because the book has been taken to be what it is not. ‘There have been many studies of mental illness and the family,’ they say. ‘This book is not of them…’ Their purpose is to examine the term ‘schizophrenia’– it is not not to say such a condition exists – not to say it does not exist. What they do is to take 11 patients with the diagnosis, and ask, how far is what they say and what they do intelligible, if you look at it in the context of their lives and upbringing.
The introduction goes into their thinking in more detail and I imagine readers skip that too. Or they may as well, for all the change it makes in popular thinking. You will be aware that many people believe in schizophrenia as a fact, in the way they believe in a tree, or a white line in the road. They don’t grasp that there was a time before the term was invented, when the kind of behaviour the term describes would have needed another name. They think that you can say, ‘This patient has schizophrenia’ in the same way as you can say, ‘This patient has typhoid’ – as if you were saying, ‘we have run the lab tests, and this is the sad fact.’ Or as if you could take a scan, and see the disease working away within the skull. Medical practitioners know it’s not that type of diagnosis, but something much more problematical. Yet they act ‘as if,’ the authors say, it is a fact, and a chain of consequences follows the fact, all based upon an assumption that may not be valid. The authors want to put a delaying hand into the process. They want to say, let us peel away the assumptions we are making about these patients, and witness them – not seeing them through the prism of pathology, not checking off their words and deeds against a list that ‘proves’ them to be ill – but holding the question open.
And this is hard. The years have gone by and the intellectual effort of laying aside assumptions has been too much of a challenge for many professionals, and when a patient comes into hospital, in a distressed and maybe frenzied state, it must be consoling for nurses to think, this is what she has, this is what we do: and we are all aware of how much the world has changed since this book was written – the pressure under which decisions are taken, because the hospital places have gone and the need is for quick fixes. There are many reasons why patients and families themselves grasp at a diagnosis. The object of the book is not to hand out blame, to doctors or nurses or parents. Being human, of course, the writers have their views. Sometimes, even given the tight format to which it’s written, they can’t suppress their distaste for one family member or another, or their outrage at what is happening. And it sounds like blaming. But we must be clear. They are not blaming the family for illness. They are questioning the attribution of illness, and specifically the attribution of ‘schizophrenia.’
Today I am extra wary, because in announcement of the seminar, Anthony has said that his own research has shown that there is a serious inaccuracy in the original report. That is for later. My brief is to remind you of what’s on the page, accurate or not. It’s clear that the researchers themselves felt wrong-footed by this family, because they say that in the course of their 2 year investigation they were continually making new discoveries. They could only make sense of Hazel’s life by considering her extended family, and if you look at the table at the back, you can see how complex the interviews become; there’s only 3 hours of Hazel alone.
When Hazel comes to hospital she is 16. She is the eldest child, with two brothers of 13 and 11. She seems frightened, doesn’t speak, move or eat. She’s frozen. Then she begins to whisper. She says she fears her mother wants to poison her or get rid of her. And then, I quote, ‘She thought that the girls at school were saying she was silly and stupid, and that she wanted to murder her brothers.’
I don’t know what to make of that. Was Hazel saying that she wanted to murder her brothers, or is it what she thinks the girls at school are saying? Is she accusing herself, or is she being accused? In what world does a sister murder her brothers? In the world of myth, perhaps. This family seems to be acting out an archetypal drama – you think you have wandered into King Lear, or a Greek tragedy.
In the case history we are only considering Mrs King’s family. Mr King’s family are in Australia: which is a relief. We have to go back. There is a working-class great-grandfather who made a fortune. Like King Lear he has no sons and 3 daughters. The eldest daughter inherited his money. She never married – so what will become of the family fortune?
Now we come to the second eldest daughter. She has what the researchers call an ‘empire,’ even though her elder sister still has control of the money. Her subjects include her husband, who is a cipher, and her second daughter Sybil King, and also Sybil’s husband and family, which includes Hazel. Mrs King is herself a second daughter. Her mother the empress didn’t like her own elder sister, and doesn’t like her own eldest daughter, who is now Mrs Blake. But there is a superglue bond between Mrs King and her mother. Second daughter sticks to second daughter.
So where is the family money going to go? It boggles the mind, but this is what the researchers say: the money follows a male heir. So the race is on. Mrs King, not Mrs Blake, marries first. Second daughter beats eldest daughter. Mrs King, not Mrs Blake, is the first to become pregnant. Again, second daughter beats eldest daughter. But then Mrs King gives birth to Hazel, and subsequently, Mrs Blake has a son. Victory to Mrs Blake.
So you have to pinch yourself. This is the mid 20th century, not the mid 16th century. Hazel’s mother is locked into the pattern of rivalry between sisters that started in the previous generation – and when Hazel is born, she has lost.
The disaster – as it seems to Mrs King and her mother – is not just that Hazel is a girl – it’s that Mrs King was seen to try and fail to displace the elder branch of the family – and now she feels that both she and Hazel are disparaged and despised. There is an implication that Mrs King’s early marriage was in itself a tactic to steal a march on her elder sister. Mr King is a professional man, a scientist, and and the reseachers think he doesn’t realise he was just breeding stock. Maybe this part of the family story has not been revealed to him. It is impossible not to see the men of this family wearing fools’ caps and bells.
What does Mrs Blake think – the daughter who succeeded in having the boy? The reasearchers think she doesn’t really hold the feeelings of spite and anger that Mrs King and their mother attribute to her. They suggest the two of them project these feelings on to Mrs Blake in order to hate her all the better.
Mrs King has found it almost impossible to be apart from her mother. When she married, there was no honeymoon, and she stipulated a house directly opposite her mother. They see each other every day. She won’t go on holiday with Mr King and her children. He can either join her parents on holiday, as she and the children do, or go alone, or stay at home. And usually he stays at home. He feels he can’t disrupt the family system or his wife might break down. Hazel is part of a constellation of mother, grandmother and grandfather – but grandfather is under the control of the women. Hazel is not encouraged to be close to her father or her brothers. In fact Mr King is not allowed to take Hazel out. Hazel’s mother and grandmother says, ‘He cannot be trusted,’ and what they mean, we don’t find out. At one point Mr King left the family, but then he came back, feeling he might do something to protect the children, ‘save them as much as possible from the situation.’ But it isn’t clear that he manages to do anything helpful.
Hazel has never been out alone or brought friends home. She is allowed to go to school and Sunday school. Her grandfather generally escorts her there and back. Mr King feels her confinement to the family circle is not normal, but he doesn’t know what he can do. Mrs King casts Hazel as being devoted to her – as she is to her own mother. Such is this devotion that she doesn’t need and other friends or external contacts. This is not Hazel’s account of her own feelings, the researchers say, but in the account on the page, Hazel speaks only a few words: and they are broken utterances, not even full sentences, and objections rather than assertions. It is as if even here on the page she is engulfed by the larger family drama, barely present in her own story.
Both father and mother belittle Hazel to her face. ‘She’s not entirely without brains,’ her father says. They let her know that everything about her disappoints them. She may have some latent ability, her mother thinks, but it’s not come out, and it’s difficult to see how it can. Mrs King says that she is only reflecting the wider family’s disappointment in Hazel – it is hard not to take a negative view when everybody holds it. Hazel is given no encouragement to get on at school. She is told she doesn’t have to worry about exams, or sit the 11-plus. The family put this in a way that seems caring: they don’t want her to have the strain. But it must mean that Hazel never picks up any confidence, or gets any external validation, or any opinion that she could oppose to that of her family. She has no weapons and no armour.
Mrs King says Hazel is jealous of her younger brothers and inclined to sulk. She is spoiled in some way, it is alleged, and this is true, if being spoiled means being over-protected to the point of being stifled. Hazel is not seen, not heard: no wonder she comes to a place where there seems no point in doing or saying anything. Mrs King says she understands Hazel and knows what she wants, yet complains Hazel is closed against her efforts. Hazel brings no gratification. The Kings missed out on the money, if this account is true, because Hazel was not a boy – and she is not providing her mother with any other form of reward.
When Hazel is in hospital the ward staff seem puzzled by the family. They notice that they seem indifferent to Hazel’s distress. There’s a mention, which is not followed up, of Hazel not eating before she came into hospital, to the point where she is malnourished. We’d pay attention to that now, it raises a lot of questions – maybe that is what would attract attention to her as a girl in need of help. I’m not sure if Hazel has left school – because she could have left at 15 – and if there’s a gap where she’s entirely with her family. (ROSLA 1972) It sounds as if she is still at school, because the other pupils and what they are saying are on her mind when she comes into hospital, but then you think, didn’t anyone notice her losing weight?
And the puzzles deepen: Mr King says that his wife wanted another baby, and blames Hazel because that’s not happening – perhaps she means that because Hazel is such a burden, she can’t add to the family. So Hazel was not only to blame when she appeared in the world – for being a girl – she is also to blame for the non-appearance of another child, a wanted child. Mr King hints that Mrs King may have had an abortion. If so, she did this without telling him. In fact, he doesn’t know whether she was pregnant or not. He doesn’t expect to be told. You notice there are two generations of husbands who are sidelined: Mrs King’s father is regarded as totally under his wife’s control: Hazel’s father is distrusted and impotent, in the widest sense.
When the researchers describe Mrs King they present to us a woman who has never established a separate existence from her own mother. She hardly strays out without her family, is afraid of strange places and people, and prone to think others are talking about her; she has an excruciating self-consciousness that persuades her that people in the street are noticing her and ridiculing her.
So when Hazel says that girls at school are ridiculing her, two things occur to the reader: that it might be sober fact: but that even if it isn’t, that is the way Hazel has been taught to construe life: and she has very little guide to how the world works, she only knows how her family works. In that family, people behave the way they do because of events that occurred before Hazel was born, and in response to perceived malice and hostility in other family members, which may not even exist at all, which may be conjured up by their own feelings of guilt. They seem to be working out an archaic pattern that they can only see dimly, and Hazel has no chance of seeing it at all: she can’t distinguish the pattern from the background. So often with these families you see how salvation would lie in some outside perspective – if there were one person outside who the child could look to for a different description of the world: but here there’s only school, and I imagine Hazel as one of those children who is simply ignored if she causes no trouble. There’s Sunday school – and in some of these families’ lives, religion does play a big part, but we are not told what part it plays here.
We get a description of Mrs King from the researchers, for which I must quote their own words. ‘Mrs King is grossly hysterical, giggly, dissociated, frigid, subject to multiple anxieties…she does not know whether she has an orgasm or a climax, she is not sure whether or not her husband has ‘proper’ intercourse with her, she is not sure whether he uses a contraceptive or whether he ejaculates inside or outside her.’ (221)
She may be somewhat surprised to be asked. I’ve often felt that the families must be puzzled by the direction of the researchers’ enquiries, when they ask about the patients as babies. But now I think, how dare you? These questions must have seemed intrusive, bizarre, even mad. And I hate the language they use about Mrs King, and the judgements they make, not seeming to grasp that she must feel as if she’s undergoing an ordeal, and that questions like these are going to drive us further from the truth because they would cause anyone to shut down. I’d hate to think this went on in other cases.
The researchers talk about ‘our team’ and I would like to know who is involved. One of them succeeds by lucky chance in seeing Hazel’s grandfather, who they have not been able to interview, and who by this stage has been excluded from the tight group around Hazel.
Grandfather complains that Hazel has been turned against him, that Hazel blames him for keeping her a prisoner: which suggests that Hazel is fully aware of her situation, but not of who is responsible for it, that she doesn’t understand how power is distributed in her family. The interview with grandfather is snatched and furtive and it ends when Mrs King is seen coming home: it sounds as if she comes with giant footsteps, and the earth shakes. And I wonder about Mrs King. I have read you the contemptuous description of her. Her dependence on her mother suggests a weak person. And yet the family history, as written up here, bestows on her not only ambition, and an intense desire to beat down her elder sister, but the power to manipulate – maybe it was her mother who said, ‘we need to get the family money, we need you to have a son,’ but it must have been Mrs King herself who got the man and fixed the marriage, and then so handles him that he is utterly subservient and confused and null. So I can’t get a fix on this woman. Does she have real power in the family? If so, how does that show? If not, where does the power lie?
This snatched meeting with grandfather is described in a way that I can only see as highly-coloured and emotional, when we compare it to the way most of the data is written up: grandfather become upset and says that Hazel won’t be in the same room as him, and then, I quote, ‘He didn’t wipe away the tears that ran down the lines of his small round face – as though perhaps he was too used to having them there to notice. At one time he must have been a cheery, robin-like little man, with bright colouring and eyes…..’ (223)
Grandfather then goes into a soliloquy about Hazel that I just can’t credit. I am assuming the researcher didn’t switch on a tape recorder, and what grandfather is reported as saying seems unnatural to me, as if he were reading it from a card. I don’t doubt the content, but I feel that this is the edited verson, somewhat over-written when it’s written up later. I’m not blaming the team member for letting feelings show, but it seems incongruent with the usual style.
So I have worries about this case history. We are not told what happened to bring Hazel into hospital – a point on which I always fixate, as you know, because I want to know what occurs at the point where a drama becomes a crisis. We are told that she recovers over three months, has another less serious breakdown, and what is described as a partial recovery. When she came into hospital initially she felt unable to express herself except through silence, stillness, and then through figures of speech: she is deluded – in real life no one is trying to murder her – but her fears do approach the uncomfortable truth – maybe it is too late to get rid of her, but she is a girl who some of her family think should never have been born, and who is only allowed to exist on the most limited of terms.
I don’t feel optimistic about Hazel. I feel the forces constellated about her are too big for her to understand, and I feel that there’s a lot going on here that the reseachers didn’t get at: I think I would feel that even if Anthony hadn’t said that there was more to know. I said at the beginning that one of the things we are doing here is to puzzle over the impact and influence of this book, or lack of it. But we have another purpose: we are witnesses. We are removed now by many years from these case histories, but we think it important to listen to these voices afresh, and Anthony has let us do so – rescued the tapes, and undertaken taxing research into the afterlives of the subjects. I make no secret of how these stories affect me, of my own affinity with these souls: I feel as if they are drowned sisters, and I’m trying to get them back to the surface for a last look. Putting feeling aside, we are trying between us to get the story straight: even if it’s wrong by the way, we are trying to get it right in the end.

This seminar was unusual in that 3 members of the King family were present. They included an adopted daughter, much younger than Hazel, who was the fourth child Mrs King had wanted.
The family backed up Anthony, who had found pervasive inaccuracies – serious enough to upset the researchers’ melodramatic account of the family feud. In fact the feud seems not to have existed. Mrs King, not Mrs Blake, gave birth to the first child, and in fact there was no gender rivalry around the issue of who would get the family fortune. On the contrary, the unmarried woman who held the purse strings also held strong feminist views.
They confirmed that the family were over-protective, but because of distance from the events that led to Hazel’s hospitalisation they were not able to shed much light on the troubling issues the case history raises – for example, the status of the men in the family, or why Hazel’s father was thought untrustworthy, or whether this was actually true. They objected strongly to the portrayal of Mrs King in the report. She was not a woman they recognised. But a lot of time has passed and memories have blurred. When the voices of Mr and Mrs King were played on tape, their adopted daughter hardly recognised them, with their clipped old-fashioned diction.
Hazel, who is still alive in a care home, was given a lobotomy. This was privately performed, but we do not know who was the prime mover. (Hazel would still have been a minor, I think.) The family (very well-informed and intelligent people) do not distinguish the effects of Hazel’s ‘schizophrenia’ from her post-lobotomy deficits and difficulties. They see her personality as having a continuity – whereas it might be thought the operation on her brain severed the old Hazel from the new Hazel who was the creation of the procedure.
It seems likely the operation must have been presented to Mr and Mrs King as a possible cure, and now, to this day, it is seen by Hazel’s remaining family as a cure that largely failed. It leads one to reflect on the professionals’ habit of leaving patients and families mystified and cowed, and grateful when they should have been indignant. People were frightened of ‘mental illness’ and to some extent still are. This fear, and the idea that the whole field is of immense difficulty and delicacy, has kept families in the dark for decades. I was reminded of Sarah Danzig’s brother, also a well-informed man, who at the time Anthony recorded him still believed that the bowel problems which led ultimately to Sarah’s early death were somehow part of her ‘schizophrenia,’ rather than a side-effect of her medication.
Even with the help of the family it is difficult to form a picture of Hazel before her hospitalisation. Indeed, she is more of an absence than a presence in her own case history. Some participants felt that Laing & Esterson had failed to make their case here; they had not succeeded in convincing us that Hazel’s symptoms were socially intelligible. It should be said, however, that this does not leave us a residue of reported behaviour which can only be considered psychotic. It simply leaves us with inadequate knowledge of the case.
Regarding the home visit in which the encounter with Hazel’s grandfather took place: the peculiar tone was explained by one participant who is a former psychiatric social worker. He says that at the time PSWs were trained and encouraged to write in this highly-coloured way. I would like to know whether it was also a PSW, or the same one, who gave such a harsh account of Mrs King.
How did the researchers get it so wrong? Where did they get their original misinformation – which family member originated the bizarre story of the feud? A mystery remains.



11. Agnes Lawson
Inner Circle Seminar No. 247

Agnes Lawson, the plumber’s daughter: her very name is like a sigh, and I’ve always thought of her as if she were the heroine of a Victorian ballad. Of course I know now that her name can’t be Agnes, and her father has some other trade. I understand and appreciate how careful the authors were – or Esterson, at least— about confidentiality. There is every reason to substitute the personal details. But one name is not just the same as another, and social circumstances are never precisely equivalent.
This is the necessary weakness of the genre of the case history. We have learned through these seminars that some of the histories are fuller than others — we have learned from Anthony that some are inaccurate or incomplete. This is a singular chapter, because of the method of reporting. The researchers made recordings, but have chosen to paraphrase them, rather than provide transcripts. Anthony however has tapes, and we might be able to work out why they chose to work this way. The written interviewers which the team mention have not survived.
Agnes is the youngest of the family, with 2 other children, boy and girl, both married, both away from home. Her brother and his wife are interviewed, the sister is not, and her parents, we are told, would give interviews as a couple, but not alone. They would not allow the researchers in their home, so they could only be interviewed when visiting Agnes.

Her family background. The family history is one of poverty and ill-health, unemployment and over-crowded housing. One has the impression that of the families in the book they are the most materially deprived. Mrs Lawson had been in a TB hospital as a child. The Lawsons’ first two children had life-threatening misadventures. Mrs Lawson tried to breastfeed her first child, Shirley, because her doctor told her to, but the baby was malnourished and only picked up when at Mr Lawson’s insistence she was bottle-fed on baby formula. Jimmy was born lacking oxygen after a difficult birth. The midwife almost gave up on him; he pulled though, but his first 18 months were difficult.
So we have a family very stressed by circumstances. The history as we have it suggests Mrs Lawson is compliant to a damaging degree. She tells Agnes, ‘If you let people tell you what’s right, you’ll be all right.’ It seems that in the case of her first child, she trusted the doctor’s advice — which might have been handed out quite casually — more than she trusted the evidence of her eyes, when her baby was dwindling before them.
Agnes was an unwanted child. She was conceived just a few months after Jimmy’s birth and Mrs Lawson did not at once recognise that she was pregnant. It was a difficult pregnancy, she haemorrhaged after the birth, and for a year afterwards had no energy. But the Lawsons insist that as soon as Agnes was born they loved her, and that she was a spoiled child; and sometimes she agrees with this. But her father used to tell her that she was found on a doorstep, or in the street. This was his idea of a joke, and he carried on with it even though, by his own account, Agnes was a sensitive child.
Agnes’s medical history is complex, so I’ll summarise. She’s 27 when the researchers meet her. She was first hospitalised at 19, and given a diagnosis of paranoid schizophrenia. She was treated — I’ll come to that — and discharged after 6 months. She spends 2 years as an out-patient. Then there is a year in which she is not under supervision and when she holds down a job, sporadically: at some point she starts to train as a hairdresser, but it’s not clear at which point — her job history is erratic. After this period of a year she is referred to the hospital again, seen as an out-patient, and given drug treatment. After another year she is re-admitted. She is treated and after 4 months discharged.
She is now 24. She remains at home for a year, but a month after taking a job, she is re-admitted. She is given drug treatment, discharged after 6 months. After 2 years as an out-patient, she begins to relapse, and is admitted for the fourth time, aged 27. The diagnosis remains paranoid schizophrenia. 3 months after this fourth admission, Agnes is still somewhat deluded, from the hospital’s perspective, and lacking insight, but a plan is made for her to go to a College of Further Education to train as a shorthand typist. But where is she to live? She says her parents don’t want her. And clearly she is right — they stress how difficult it is to live with her. So Agnes is suspended uneasily between two careers – madness on the one hand, shorthand typing on the other – and at this point the researchers catch up with her and begin to piece together her story.

TREATMENT: By the time the researchers see her, Agnes has received drug treatment (which I imagine is Largactil, available in 1953?) and also a total of 100 insulin comas.

I’d like to read you what Laing says of his own experience of giving this treatment while he was an army psychiatrist. This is from Wisdom, Madness & Folly, his 1985 book. (p 90 in my 1986 Papermac edition: Chapter Four, The Army)
We don’t know what protocol was used when Agnes was treated – whether it was the violent procedure Laing describes in the army unit, or the more gentle method he saw in use in a unit in Dumfries. But we know Agnes had one set of treatment, 50 shocks, during her first admission. You ask yourself, since this didn’t produce long-term relief, even by the hospital’s own criteria, what the point was giving her fifty more at a later admission? But so it was. At the fourth admission her symptoms are described as auditory hallucinations and thought disorder.
She believes people are talking about her unkindly and can read her thoughts. She is woolly-minded, aggressive, impulsive, but also childish, afraid of people, and pre-occupied with religious ideas, presumably ones thought inappropriate for her to have. And she’s a defective economic being: she can’t hold down a job and support herself.
It’s a big charge-sheet against Agnes, much of it cast in the stereotyped terms we are used to ; so we have to ask, what is this thought disorder from which she suffers – is it possible that her view of the world has more basis in fact than the hospital recognises? And in the light of her circumstances, do her symptoms amount to madness, or are they comprehensible? Is there any evidence that Agnes has a progressive, treatable but incurable disease called schizophrenia, and is there any evidence this condition exists as an independent clinical entity? Does it exist, apart from in the minds of the people who are treating Agnes and other patients thought to be like her?

Before her 4th admission, Agnes complains of the hostility of her parents. She is, to quote the case history, ‘frightened and lonely, insecure and rejected.’ There was a point before her admission where she was not hearing voices, but she thought she might begin to: and then she does, she hears the voice of an electrician who has been working at the house, and who she thinks is interested in her and would like to take her out. Incidentally I puzzled about this electrician, and why Mr Lawson says he doesn’t know him, but I have realised that very likely they live in a house divided into flats, or in separate houses with one landlord, and it is probably the landlord who employed the electrician. (Anthony clarifies that the Lawsons lived in a council house at this date and that the electrician was sent by the local authority.)
It’s interesting how Agnes anticipates the arrival of the hallucinations — as if she is saying, ‘help me, because I am distressed, and getting more so.’ Given her cowed and compliant personality, it suggests that she knows what signs are said to distinguish her illness, and is ready to reproduce them; she knows what she’s supposed to be, and is being it as best she can. By this stage in her life, ‘patient’ is her strongest identity, together with ‘daughter’ – and for reasons not entirely clear, it seems that she is going to go on being a daughter and no more – her mother thinks she will not marry, and tells her she is unfit to look after a child, so she can’t hope for a rise in status. And if she wanted to marry, she is not sure how she would go about it.
Agnes doesn’t know if she is attractive to men: if she isn’t, would it be right to make herself more attractive? Or wouldn’t that be right? And what if they persist in finding her attractive, sexy, even if she does nothing to encourage that? Who would be to blame? It’s not clear if Agnes really has sexual experience with other people or whether she and her family are worrying about a state of affairs that might occur. She has masturbated since childhood and she feels very guilty about that. In bed at night she has sexual fantasies. They are not hallucinations, but she thinks they could lead to hallucinations. At times she has hallucinated lovers, like the electrician. They are real men, men she thinks might be interested in her. When they speak to her in her imagination, they are sometimes affectionate, sometimes dangerous.
Talking about sex is difficult. She tends to laugh and giggle when the topic is raised, which the hospital think is a sign of disorder. In several of these cases, the young woman at the centre is treated as if she were a sort of unexploded desire bomb: if she were to be ignited, it would be a disaster, and there’s no middle ground between virginity and the kind of promiscuity that has the whole neighbourhood talking. If Agnes is not to be a wife and mother, what are her sexual feelings for, but to get her into trouble of one kind or another? To Agnes, a sign of being grown-up would be to have a boyfriend. But she wonders, is that a form of selfishness? Would it mean she was pushing herself forward, wanting to be the centre of attention? She is unsure: is it healthy to want a sexual relationship, because it shows she is grown up – or is wanting it part of her illness, or likely to lead to illness?
Agnes thinks, and has been encouraged to think, that keeping her thoughts to herself is another sign of illness. Here are more contradictions. Her mother claim to be sensitive to atmosphere and able to understand other people’s thoughts easily : but when Agnes makes the same claim, then she is ‘imagining’ things. Imagination seems to be a danger area. I don’t know if Agnes is clear on the difference between imagining and hallucinating – or if she does know the difference, does she express it well enough to keep her safe from being thought madder than she is? Agnes agrees it would be wrong to keep secrets from her parents, who only want what is good for her. But in fact, she says, she can’t keep secrets – she is too talkative and open. Her parents take a dim view of openness of any sort. They say things like ‘they’re all rogues around here’ and ‘you want to watch yourself.’
What the family say about Agnes is confusing, repetitive, full of contradictions of the kind we have become familiar with, from the other case histories. They say she should go out more, but she is not one to go out: she does go out, but she goes to church, which is not good for her: and she should not go to hospital socials, she shouldn’t have ex-patients as boyfriends. The parents see the hospital environment as an unsafe place: the staff condone sexual relationships between patients or ex-patients. Yet the hospital is where she should be, because she is ill; the fact that she is in hospital proves it. They would not stop her having boyfriends, provided they were of a suitable type, but since they don’t meet them, , they don’t know what type they are. She should pull herself together and get a job, but then again she is not able to do a job, so she can’t be blamed.
Father’s objections seem mainly directed at her personality: she won’t be told, she is irritable, he doesn’t like the way she talks about Jesus. Though she irritates him and needles him, this is because she is ill: there was a golden age, before, when she was no trouble. Now her illness is all-pervasive. It accounts for anything her family find puzzling or challenging. Agnes has a tentative, wavering sense of self. Her opinions are usually those of the last speaker. She seems afraid of her father’s bad temper and her acts of resistance to him — her talking back — are called illness. The parents blame the hospital for any evidence of Agnes asserting herself. They say the hospital has not helped her — and father anyway is sharply conscious of the stigma of being a patient. But then to her face, they tell her to stay in hospital till she is better. When she tells them that other patients don’t like her, they treat this as a delusion, though the nurses say it is true. On the other hand, the hospital treats as a delusion her complaint that her workmates looked down on her; but her mother agrees that when she was training as a hairdresser, her fellow apprentices showed they despised her for living in a council house. And since she was sacked from one job for being slow, it is likely that her workmates do criticise her, just as she fears.
Agnes tends to parrot other people’s opinions of her. It seems she is not able to make a simple statement without taking it back in the second half of her sentence. Her supposed thought-disorder and her lack of insight might also be described as a lack of self-confidence in her own perceptions. She seems in doubt as to whether she is allowed an opinion.
Like many of the women in the study she is described as having been a good and compliant child. You feel she would try to be exactly what her parents wanted her to be, if she knew what that was. Her brother’s opinion is that Agnes is over-protected, and says he was the same, but when he left home and joined the army his independent life began. It strikes me that it might have been hard for the parents to ease up on their control as he grew up, because he had been such a frail child. But there is a mechanism for a boy to break away, as we have seen in other families. He is asserting his autonomy, where a girl is feared to be running out of control.
The modern reader of the case histories is sure to think at some point, ‘Why don’t these young women just leave home?’ I think we have to remember the historical context, in which wages were low for young women in unskilled work: no equal pay in those days. In some areas where women tended to be found, like retail or (as in Agnes’s case) hairdressing, there was little input from trade unions, and though it was easy to find work and change jobs, the opportunities open even to an educated young woman would shrink once she had a psychiatric record. So as a practical matter, it was difficult to break away and to become self-supporting. Socially speaking, it was isolating and anomalous; in working class households and many middle class household it was usual for a young woman, unless she was going away to study, to leave her parents’ house only for her marital home. Emotionally too, the effort would be enormous for these young women. It is possible to live in a state of covert war with one’s family, yet still find it difficult to turn away from them; you might say that the intensity of engagement in itself forms the bond, however unpleasant and destructive it is.
Very little is stable and graspable in Agnes’s world, and one of the most persistent attributions her parents make is that she has a poor memory. This allows them to deny anything she says about the past. There is no objective evidence that she has a poor memory, the study says, though Agnes admits she has difficulty in concentrating and finishing things; you think back to the drugs and treatments she’s had, and you wonder if they are implicated. One thing particular to Agnes seems to be that she has a different standard of housekeeping and hygiene from the rest of the family. There is no implication that she is obsessive. But she insists on a certain standard, or tries to. I imagine they take this very badly. They also accuse her of being the leaky member of the family — the one who tells their business to outsiders. You’ll remember from the other histories how often this comes up: the idea that the family is exposed, through the words and actions of the sick, unstable person. So if the young woman were to complain to an outsider, not only would the content of what she says be unreliable, but the very fact of her speaking out would be a symptom of illness.
The family really do have it all their own way: they claim that outsiders or casual visitors would never know anything was wrong with Agnes. She saves up her worst behaviour for the home; though they do not know what she is like in hospital. Mr Lawson is emphatic that she is not ‘normal. He seems to use this word a lot. He doesn’t think she will get better, but will go in and out for the rest of her life. He would shake her, if he thought that would do any good. But there is no route back to ‘normal.’ She will never get a job, coming from one of ‘those places.’
At a certain point in this account I start to hear voices myself. In particular I hear Mr Lawson, who seems to be a very angry man, telling the researchers that they can’t come to the family house and then, as indicated on the third page of the study, shouting that they can come if they like, they can come and talk to all the neighbours, he has nothing to hide. And there is a particular image that sticks in my mind, which Agnes herself presents to the researchers, and her brother and sister-in-law affirm: ‘Until she was fourteen she would sit on her father’s knee and comb his hair while he told her fairy stories.’ That image seems to me to come straight out of a fairy-tale itself, and a malign one. Agnes adds that she was attracted to hair, hence trying out her apprenticeship. Now little girls have garish plastic ponies with long manes and tails that they can groom. And I suppose little girls have always fixed each other’s hair. But Dad as My Little Pony — a fourteen year old on his lap — perhaps you will tell me what you think.
       Then there is Mrs Lawson’s best friend — conveniently, she has a best friend who talks about sex, as Mrs Lawson cannot. She has had 8 children, and talks in an uninhibited way, tells dirty jokes. She’s embarrassing, but also wonderful. She is quite unlike Mrs Lawson, who was completely ignorant of sex when she was married, and who says this ignorance did not do her any harm. I don’t seriously suggest Mrs Lawson’s friend is an imaginary friend, but I find her hovering in the vicinity of this family both odd and convenient: it’s as if they want to confess to their own unholy impulses, but can’t manage it, so they embody them in this unnamed woman.
Her father was very strict, Agnes says. He discouraged her from going out and then he changed his tune and told her she should enjoy herself. But she had passed beyond it. Her confidence had gone. She does mix with people – at church. She goes 3 times on Sundays, she reads the Bible, she prays. Jesus has become her friend. If Agnes’s faltering manner on the page is reflected in real life, it wouldn’t be surprised if people thought her odd. And her way of talking about religion, which her family object to as childish, may be faintly alarming, though Mrs Lawson was once a Sunday school teacher, and maybe it is she who first set the vocabulary and the tone. They say they have no objection to religion – though it’s not doing Agnes any good, and they find it hurtful that Jesus means more to her than they do.
Nothing in this account suggests that Agnes’s behaviour is damaging anyone else. That she is unhappy, uncomfortable in her skin, that she is inadequate in terms of the expectations of her world — one can’t easily doubt that. In conventional diagnostic terms, the clearest evidence of psychosis is her voice-hearing, which happens over a limited time and doesn’t seem to persist. Naturally, hallucinations are taken as a very serious symptom. But by their nature, they can only be reported by the person who suffers them — a person who is on every other count is liable to be disbelieved. Agnes seems to agree about her own unreliability. It may be that her memory really is bad, by her mid-twenties; it may be that her anxiety is so great that she can’t live outside an institution, and can’t easily live in it, either. It may be also that the case report fails to capture what she is like., or that the researchers never know the whole story. But in any event, by the time they catch up with Agnes, how much of her is left? What they see is the product of treatment, for better or worse.
I think we must always remember the fear these young women must have suffered: some of it caused by hallucinations and delusions that precede their hospitalisation, but some of it caused by the institution and its procedures. And we should remember that it is devastating, even when you are a young adult, to realise your family reject you and are ashamed of you, and that the people you trust and look up to are false. Agnes needs help to know where her boundaries are, and to work out who she can trust, other than Jesus: but she can’t get help within a system that has pegged her as insane. She’s invalidated at every turn and every time she goes for help, she’s damaged. He father is of course quite right in one way: her history is against her, and she’s accumulating more and more of it.
So we come back to the question the book directs us to ask: which is not, what’s wrong with Agnes, or what’s wrong with her family: but, since something in her words or actions has led to a diagnosis of schizophrenia, what can we take the term to mean? Does it mean you hear the voice of an electrician, when he’s not there? Does it mean you’re not very likeable, or articulate, or grown-up? Does it mean you want your own towel, or your own way? Because these are the traits, the requirements, that earn Agnes her diagnosis and her treatment. As the researchers say, she has lived for many years in a mystifying situation. The standard psychiatric interview is not set up to illuminate the context of her symptoms, so everyone supposes she is the victim of a meaningless pathological process, whereas really she is desperate and confused precisely because she is trying to search out meaning. I find myself thinking she must be have been a strong spirit to survive, however she flickers on and off the page.

Afterword: Anthony explained that his dealings with the Lawson family had not been easy and he had not been able to get family photographs or other material. He did however have Agnes’s death certificate, which described her as a ‘retired hairdresser’ and the group was happy to hear that she had been able to hold down a job in later life, and one that interested her.
The other pleasant surprise was to hear her voice – in later tapes, she sounded neither cowed nor compliant, and was able to stand up to Esterson when he failed to appreciate the way she dressed.
Not everyone agreed with me that Mr Lawson’s habit of sitting Agnes on his knee and and telling her fairy stories was sinister. There was a feeling that it might have been innocent. After we had listened to him on tape there was a consensus that he took a bullying tone with Agnes. Despite this he seemed to regard himself as her victim, as she upset his nerves, for which he had a tender regard.



12. Final Retrospective Seminar
Inner Circle Seminar No. 249

Recently I read a book of essays called The Legacy of RD Laing (ed. Guy M Thompson, Routledge, 2015). In the whole book there are four mentions of Sanity, Madness and the Family: two simply recording the book’s existence, and the other two each giving it one sentence. It obviously ranks low in the canon of Laing’s work. And yet for me, it is among the most important and enlightening books I’ve ever read. It has resonated through my life ever since I was the approximate age of the women in the case histories. In 1973 when I discovered it, I found it shocking, desolating, provoking: I still do: I never seem to exhaust it. In my introduction to the new edition I described it as ‘one of the most misunderstood and travestied work of the 20th century.’ I should have added, one of the most ignored.
The peculiar thing is, even those who have read it appear not to have read it. People will describe it to you as a study of eleven women with schizophrenia. It is really a study of eleven women with a diagnosis of schizophrenia, and there is all the difference in the world. I must quote the author’s preface to the second edition of 1969: ‘There have been many studies of mental illness and the family. This book is not of them…’
The authors go on to question the existence of schizophrenia, in a way that is precise and intellectual fastidious: ‘We do not accept schizophrenia as being a biochemical, neurophysiological, psychological fact… nor do we assume its existence…we propose no model of it.’ A paragraph or two earlier they emphasise: ‘We did not say, even, that we do not believe in schizophrenia.’
In the Introduction they say, ‘We recommend that this book be read with the very minimum of presuppositions.’
That has proved difficult for readers, whether they are general readers or professionals. For the general reader there may be some excuse. People love stories, and they see this is a book of stories, and they bypass the theory and plunge straight in. As a novelist I have learned not to put vital clues in a prologue, because you can’t rely on a reader to take in anything that happens before the heading that says ‘Chapter One.’ Academics and professionals should know it is important to read a foreword and an introduction. But they couldn’t see past their presuppositions. For them the reality of schizophrenia was built into the fabric of the world. So they read what they expected to read, not what the authors were at such pains to state.
Other readers interpreted the book, as it were, too liberally, mixing up its ideas with other current and fashionable ideas. Some people, while assuming the existence of schizophrenia, supposed the authors were seeking causes in the environment, in the family, in the culture: but that’s not primarily what they were doing. Some thought the message was that we should be nicer to mad people — and that wasn’t it either. The book wasn’t about relocating pathology in the family, or the wider culture. It wasn’t a message about tolerating our fellow humans in all their diversity, or about more humane and effective methods of treatment: it was an invitation to a radical rethink. What the authors say is plain enough, so I imagine that many people must have realised the implications and found they couldn’t face them; their minds simply ambled away to pastures where they were more comfortable. Because you could very well extend the question beyond schizophrenia and ask if the categories into which we were currently dividing madness meant anything: did they have any existence, except on paper, and outside the historical context in which they were invented? By our way of talking about ‘mental illness,’ were we not representing, without evidence, that the terms psychiatrists had coined corresponded to a biological reality? Were we proceeding by assuming that very thing which we needed to prove? Were we permitting the fate of thousands of distressed people to be decided on the basis of shoddy thinking? Were we being misled by terminology that sounded precise, but whose meaning melted away on inspection? Were we muddling up facts and opinions? Were we simply not listening to what patients said? Such simple questions — so simple they were devastating.
Elsewhere in his work, Laing seems to accept the reality of schizophrenia; he may not think as others do about it, but he thinks there is an ‘it’ to be discussed. In The Divided Self, first published 1960, he presents the case of Julie, who called herself ‘the ghost of the weed garden.’ Julie would fit right into this book: but he refers to her quite firmly as a schizophrenic throughout his account. Laing was young when he wrote his very influential book. He was entitled to change his mind, to advance his thinking. It’s unfortunate, though, that even the text of Sanity, Madness and the Family muddies the waters. Ideally — and in order to help those who haven’t taken notice of the Introduction — the word ‘schizophrenia’ should appear in inverted commas. It doesn’t always, and this makes it seem as if the authors have conceded. Of course it should be enough to make the point once: you shouldn’t have to conduct an argument through punctuation. And in fact, the book’s challenge is rephrased and recapitulated in each chapter. Yet the vital lines are somehow bypassed by readers, who then go on to argue with the authors for what they have not said.
At this distance one can see the book was too big a challenge to entrenched interests and ways of thinking. The more influence people gain in their profession, the less they are likely to welcome any thesis that suggests they shed their foundation myths. These authors demanded that you stand outside your discipline, to look at it and listen to it: and that is an effort too strenuous for many people, whatever the discipline is.
As for the lay person, despite all that is said about the destigmatisation of mental illness, there is still a great mist of fear and a smog of misinformation; it’s easier for people to avoid thinking about it by handing over to the professionals and assuming they know what they’re doing. If you have an individual in your immediate circle who is suffering mental distress, who is battered by grief and fear, who can’t cope with daily life and is spreading the distress to others, then naturally you grasp at the notion that the person is ill.
This is what we see again and again in the case histories: I have to believe she’s ill, the parents say, because for them the alternative is worse: the alternative, as they see it, is that the distressed person is behaving as she does by choice, and the structure of the family and the community creaks and protests at such behaviour. What is a family to do, when one member appears to break down? Perhaps it should consider its workings: outsiders are bound to ask some questions. Any process of enquiry might threaten unity, and expose the lines of power, overt and covert; it will require the family to speak about the very aspects of life it has tried to ignore. The prospect may be so uncomfortable that it may lead a family to conclude, half-consciously, that it is better to sacrifice one member than sacrifice the story they tell about themselves. At the worst, an individual runs out of control, and either you send for the doctor, or you send for the police. If there is illness, there is a lifting of responsibility all round: friends and relatives can pass on the decisions; there is a path towards alleviation — drugs, counselling, possibly hospitalisation. And for families under stress, any challenge to the accepted diagnostic certainties seems like a challenge to their veracity, or their ability to cope, or their ability to love each other; it arouses great antagonism; on a human level this is understandable.
It’s important to say that the authors do not disbelieve in the reality of madness. In their careers they have witnessed and described it. What they ask is whether, in the cases in the book, there is an intelligibility behind the words and actions of the women, that has been missed by those who have written them off as victims of a condition that doomed them — certainly in their time and place — to become career patients. On the face of it, a great deal has changed about the way the system runs, but there are still plenty of career patients — they’re just not in hospital. And the thinking that Laing and Esterson challenged still commands general assent. Even if professionals have refined their position, and are in debate about the reality and nature of mental illness, the media and the public still take schizophrenia to be a proven fact, a clinical entity of the same order as Huntingdon’s Disease or measles.
Then again — returning to the puzzle of the book’s reception — when you look at the body of Laing’s work, this book was eclipsed by the reputation and reach of The Divided Self. I think that book, for all its merits, unwittingly flattered its readers. It was dangerously interesting to a certain type of person. You will remember the figure of David, the philosophy student, with his theatrical cloak and cane. He wasn’t intended as a role model, but as I remember the era, a lot of young men of no particular talent thought they would be intensely fascinating if they defined themselves as schizoid individuals — they would be deliciously misunderstood. Sanity, Madness and the Family is a plainer book. It lacks the intellectual glitter — though not the intellectual depth, for those prepared to look into it. And no reader wished to be these women, or identified with them.
But I don’t want to be defeatist: the text remains and does its work. And these women, now mostly dead, are still alive in its pages, and alive in our discussions. We owe an enormous debt to Anthony’s tenacity and dedication and his tact, in uncovering so much material, bringing us family photographs, digging out the stories behind the stories. What he has discovered has greatly enhanced our understanding of the context in which these young women were invalided out of their routine lives and became patients. He has given us faces and he has given us voices. They were frozen on the page, but these seminars are a way of keeping faith with young women who never knew what a service they were performing.
Myself I found the faces unsurprising. You used to find albums of photographs in junk shops, and though you would know the people were strangers, if you kept on looking, a conviction might well grow that you did know them after all — the same flaws in the photography, all-purpose locations, locations, familiar clothes. And if you look at your own family photographs, you are not always sure who’s who, even if it should be well within your memory span; people seem to change so deceitfully from decade to decade, and fashions come around again, and a mother can be taken for a daughter, or vice versa.
I explained at an earlier seminar how I first came to this book, picking it up in a library which I was using as a sort of waiting room while my husband had a college interview. I had already read The Divided Self, but I didn’t know about this book, and when I did read it I experienced revelations, both about my past — my family life — and about my future. If I may digress, I should like to mention another reason why I care so much about how mental distress is viewed. In the late 1970s I was a teacher in a secondary school in Botswana, in a town called Lobatse, which was also home to the country’s only psychiatric hospital. Botswana is approximately the size of France, with population of, in those days, under a million, and — also in those days — a very scant infrastructure. The school where I taught was a boarding school. Many of its pupils were hundreds of miles from their homes, and the institution’s conditions were harsh; there was a culture of bullying and sexual exploitation. When I had been teaching there for a few weeks I realised that some of my teenage pupils were walking around under the influence of powerful psychotropic drugs, which they had been prescribed after out-patient visits to the psychiatric hospital. When they felt too miserable, or too persecuted, they referred themselves, and were given pills to cure, amongst other things, a culture-specific belief in witchcraft, which the European psychiatrist who was the hospital’s director clearly saw as a delusion. They were being treated as ‘schizophrenics,’ but what they were describing, I feel sure, were material conditions and everyday events, involving shaming facts which no one in authority had any interest in bringing to light; in addition, they were viewing their misfortunes through the prism of beliefs no more or less irrational than a western religious framework. This state of affairs alerted me, if I was not alert already, to the intellectual shoddiness of much orthodox thinking about ‘mental illness,’ and to its tendency to act as an agent of control, invalidating individuals whose behaviour or beliefs threaten the consensus. Botswana as that time was keen to be identified with western attitudes, including western medicine, and embraced theories about mental health as if they had the same status as facts about malaria. My pupils were casualties of this approach, but their suffering was trivial compared to that of the long-term inmates of the hospital. When the institution was wound down in the 1980s, after the arrival of a more enlightened director, many of the patients had no homes, families, no identity left.
But to return to our time and place and people, our book: let me introduce a startling new participant to the debate: St Ambrose, who was Bishop of Milan towards the end of the fourth century. This was his advice to young women: ‘If you conquer your family, you conquer the world.’ He was addressing himself to girls who wanted to leave their families and pursue a spiritual path, whereas their families wanted them to be wives and mothers — to do what their own mothers did. I find myself thinking that the lives of women like those in the study — often untrained and low-earning, less educated and free than their brothers, without reliable contraception, without easy access to abortion — were surprisingly, in view of the gap of time, like the lives of the women St Ambrose knew: they lacked economic status, their gender downgraded them, they didn’t have the bodily autonomy they might have hoped for, and they had to fight their families to have their aspirations recognised. Outwardly, the world has changed hugely since then, although the inner pressures on young women, the expectations heaped on them, seem no less tyrannical now. Mothers and daughters are central to the stories in the book: father is often a grey area, less easy to get a fix on. We have seen a pattern where a mother holds herself up to a daughter as if she is a mirror. The daughter is meant to look and see her mother’s features, looking back. If she sees something different, if she sees herself, then her perceptions are likely to be described as false or perverse. Every instance of difference is added up, and deprecated, till difference becomes a symptom.
We meet these families at a point where they look back on their own past and describe it in terms of Eden and the Fall. There was a time when their little girl was innocent. She was compliant and clean and obedient. Then comes adolescence; she starts to ask questions, she shows she has become a sexual being. She has private thoughts and wants to guard them. She no longer yields up an account of everything she experiences, or accounts for herself when she is out of the house. She wants to be with people the parents don’t know — but whom they judge unsuitable or dangerous.
Then the Fall comes: some kind of crisis. Because we live in modern times, a diagnosis is available. The family are able to think their child is sick, not evil. This is a relief. No one is to blame. The most that can be said is that they should have taken her to the doctor earlier. And there is no need to question the story about the child’s previous perfection. If they recall there were events in early life that didn’t fit the pattern, if there were small aberrations, then these are seen as the precursor to illness. Her whole life is read backwards from the moment of diagnosis, and it is read forward in terms the doctors set. From now on, all her behaviour is likely to be cast as a symptom of a pathological process.
As listeners we are human, and we bring our own stories to the eleven stories, and it has been fascinating to discover what we read and hear in common, and what we dispute, and where we differ: to me this process has been of great value, because my professional pre-occupation leads me always to ask what different readers take from a text. What is the possible range of interpretation? How do the words that are flat on the page come to life in our minds? Some of the families are hard to like. Some of them ramble, are inarticulate, plainly show us the contradictions and mystifications the patient had to live with. Almost all of them appear literal-minded and unaware of the undercurrents of what they say; we have to struggle not to put ourselves in a position of judges. I wonder if some of the stories would be told or heard differently nowadays, when we know more about the prevalence of sexual abuse in families. But it’s not necessary to know more than we do, in order to keep asking the question the book directs us to: when the young women are supposedly schizophrenic, is their behaviour intelligible, when placed in context? Can it be viewed as a valid response to an unnegotiable situation? Are their words and actions just the flailings of a disintegrating mind? Or is there, behind the disorder, an impulse towards a new order? A bid for self-possession?
Sometimes, Anthony Stadlen’s discoveries have helped us patch the holes in the narrative. For me, a lot of questions remain. I am pre-occupied with the crisis that delivers the young woman to the institution. That seems to me a defining moment, because after that everything she does is seen as possible pathology. She is no longer silent, she is mute: she is not simply still, but rigid, catatonic: she is a collection of symptoms, to be run up against the textbook criteria, and to fit them, or not; but mostly she will fit, because observers will see what they’re looking for. At this point she has left one family and joined a bigger family and will be seeking out its rules. It’s a looking glass world now: if she says she is well, it will prove she is ill. She will be, and I think this is very important, no longer just herself but herself plus psychotropic drugs, or the effects of ECT or insulin comas. In the attempt to find her, we are losing her.
No story can be kept clean. Here there is a tension between the demands of a true and full account, and the demands of confidentiality. To protect confidentiality the authors disguised names and occupations and tried to find equivalent circumstances. I understand that they did the best job they could. But we know that they could never make an exact fit. No two circumstances are ever complete equivalents and no name is quite like any other name. So to me, we began with eleven women, and now have twenty-two: the women on the page, whose traces we have pursued with magnifying glasses, and their shadow selves, who are still elusive.
But we have been able to hear them. I would like to pay tribute to Anthony’s painstaking dealings with the tapes; there is the intricate work of cutting out the names, to preserve confidentiality, and also the fact that they are so fragile and precious. For me the single most startling moment has been the first moment of hearing Maya Abbot’s voice: its clarity and strength and immediacy, bounding out into the room, defeating all my expectations.
We all have some problems with the tapes, but I don’t hear very well in any circumstances. This means I have to listen very carefully to things that are not words: to gaps, silences, hesitations, and above all to intonation. You may be amused at the unconscious bias I have found in myself. I have only recently seen the films Family Life and In Two Minds, because I wanted to find subtitled versions. I think they are both wonderful films, but In Two Minds has an actor playing a psychiatrist — or maybe he’s a real doctor, I don’t know — who is never on camera, he’s voice only. Now he is set up to ask all the sensitive and illuminating questions we would wish him to ask. But I realise that when I hear the calm establishment tones of a middle-aged doctor, talking to a young, distraught, less-advantaged woman, it makes me want to start the revolution immediately. This bypasses logic, and it’s unfair, but I realise I trust Aaron Esterson because I trust his accent. That, as well as his manner, seems to me to go some way to even up the power relationship, which is so much set against the patient.
So you can imagine I look forward to seeing him at work, and judging if I feel the same. For some of these patients Esterson opened the door, and though they were regarded as hopeless cases, they walked out of the institution, and out of the life prepared for those with a diagnosis of schizophrenia. So I ask myself, what was Esterson doing? He was listening. There is a special kind of listening that makes a speaker audible to herself. He was acting as a witness. It is as if he helps the women hold up a mirror to themselves. Maybe they could see themselves in his eyes, and in that way become witnesses to their own being, instead of looking at themselves through the eyes of their parents. It isn’t enough to explain a patient to herself; in order to loosen the grip of the past, it seems to me, the patient has to experience an opening sense of possibility. There must have been a moment for each of the women in the early case studies where her own story struck her: where she saw a pattern or meaning: a turning point where she began to think differently about her own capacities, and she decided, I won’t be a patient any more, I’ll be something else.
I have been dwelling with these women for around 45 years. I never knew the ends of any of the stories, till Anthony undertook to tell me, and till your attentive presences enhanced and illuminated the narratives. They will never be gone, as far as I am concerned, and I can only think my next step, if I could ever paint, is to paint them. I think of Ruth Gold in her coloured stockings: Ruby Eden’s female relatives pinning her down in the family living room: Jean Head running through the dark wood from her employer’s house: June Field dancing in the church hall: Sarah Danzig sitting in the family kitchen in the small hours, in her blue nightdress, with the lights blazing. What touches me is how far they are the children of light, for all the gloom that encircles them: how far they commit to the truth, to seeking it out, digging it out, even though they pay such a price for the search. 




Notes (by Anthony Stadlen)

[i] Laing, 1960 or 1965 [1960].
[ii] Probably Laing and Esterson, 1964 or 1970a [1964] (the hardback first or second edition). Hilary Mantel writes: ‘I can’t remember about the edition I read in the college library. I don’t think paperbacks were bought for libraries much in those days.’
[iii] Laing and Esterson, Chapter 1.
[iv] They did.
[v] Laing and Esterson, 1970b [1964]. Hilary Mantel writes: ‘My copy is the Pelican of 1969, the 3rd reprint: 1972.’ (The preface to the second edition is dated 1969, but the edition itself is dated 1970.)
[vi] Laing, 1985: 69-70.
[vii] Mantel, 2008.
[viii] Laing and Esterson, 1970a [1964]: vii-x; 1970b [1964]: 11-14. Preface to second edition.
[ix] Laing and Esterson, Chapter 4.

References

Laing, R. D. (1960). The Divided Self: An Existential Study in Sanity and Madness. London: Tavistock.
Laing, R. D. (1965 [1960]). The Divided Self: An Existential Study in Sanity and Madness. (Second edition.) Harmondsworth, Middlesex: Penguin.
Laing, R. D. (1985). Wisdom, Madness and Folly: The Making of a Psychiatrist, 19271957. London: Macmillan.
Laing, R. D. and Esterson, A. (1964). Sanity, Madness and the Family. Vol. 1. Families of Schizophrenics. London: Tavistock.
Laing, R. D. and Esterson, A. (1970a [1964]). Sanity, Madness and the Family: Families of Schizophrenics. (Second edition.) London: Tavistock.
Laing, R. D. and Esterson, A. (1970b [1964]). Sanity, Madness and the Family: Families of Schizophrenics. (Second edition – Pelican.) Harmondsworth, Middlesex: Penguin.

Mantel, H. (2008). Author, author: Every writer has a ‘How I became a writer’ story.

 http://www.theguardian.com/books/2008/sep/06/1.

Stadlen, A. (2017). ‘The simple words the people speak’: On Hilary Mantel’s introduction to a 2014 seminar on ‘Maya Abbott and the Abbotts’ in Laing and Esterson’s ‘Sanity, Madness and the Family’ (1964). Preceding this paper in this Journal.



Notes (by Anthony Stadlen)

[1] Laing, 1960 or 1965 [1960].
[2] Probably Laing and Esterson, 1964 or 1970a [1964] (the hardback first or second edition). Hilary Mantel writes: ‘I can’t remember about the edition I read in the college library. I don’t think paperbacks were bought for libraries much in those days.’
[3] Laing and Esterson, Chapter 1.
[4] They did.
[5] Laing and Esterson, 1970b [1964]. Hilary Mantel writes: ‘My copy is the Pelican of 1969, the 3rd reprint: 1972.’ (The preface to the second edition is dated 1969, but the edition itself is dated 1970.)
[6] Laing, 1985: 69-70.
[7] Mantel, 2008.
[8] Laing and Esterson, 1970a [1964]: vii-x; 1970b [1964]: 11-14. Preface to second edition.
[9] Laing and Esterson, Chapter 4.

References

Laing, R. D. (1960). The Divided Self: An Existential Study in Sanity and Madness. London: Tavistock.
Laing, R. D. (1965 [1960]). The Divided Self: An Existential Study in Sanity and Madness. (Second edition.) Harmondsworth, Middlesex: Penguin.
Laing, R. D. (1985). Wisdom, Madness and Folly: The Making of a Psychiatrist, 19271957. London: Macmillan.
Laing, R. D. and Esterson, A. (1964). Sanity, Madness and the Family. Vol. 1. Families of Schizophrenics. London: Tavistock.
Laing, R. D. and Esterson, A. (1970a [1964]). Sanity, Madness and the Family: Families of Schizophrenics. (Second edition.) London: Tavistock.
Laing, R. D. and Esterson, A. (1970b [1964]). Sanity, Madness and the Family: Families of Schizophrenics. (Second edition – Pelican.) Harmondsworth, Middlesex: Penguin.

Mantel, H. (2008). Author, author: Every writer has a ‘How I became a writer’ story.

 http://www.theguardian.com/books/2008/sep/06/1.

Stadlen, A. (2017). ‘The simple words the people speak’: On Hilary Mantel’s introduction to a 2014 seminar on ‘Maya Abbott and the Abbotts’ in Laing and Esterson’s ‘Sanity, Madness and the Family’ (1964). ‘The simple words the people speak’: An introduction to Hilary Mantel’s introduction to her and Anthony Stadlen’s (2014) 50th-anniversary Inner Circle Seminar on ‘Maya Abbott and the Abbotts’ in Laing and Esterson’s Sanity, Madness and the Family (1964) (January 2015)

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