▸  The Psychoanalytic Experience

 ▸  My Way to Existential Psychoanalysis

 ▸  Working with Schizophrenia

 ▸  The Myth of Mental Illness

 ▸  Living at Portland Road

 

 

Living in One of R.D. Laing's Post-Kingsley Hall Households

By Michael Guy Thompson

 

Kingsley Hall was the first of Laing’s household communities that served as a place where you could live through your madness until you could get it together and live independently. It was conceived as an “asylum” from forms of treatment — psychiatric or otherwise — that many were convinced were not helpful, and even contributed to their difficulties. Laing and his colleagues, including David Cooper and Aaron Esterson, leased the building from a London charity and occupied it from 1965 to 1970. The house was of historic significance, having been the residence of Mahatma Gandhi when he was negotiating India’s independence from British rule. Muriel Lester, the principal trustee of Kingsley Hall, agreed that Laing’s vision for its use was faithful to its long-established humanitarian purpose. Kingsley Hall was leased to his organization — the Philadelphia Association — for the sum of one British Pound per annum.

In 1970 the lease expired and Laing moved his, by now famous, operations to a group of buildings that were acquired by various means. Esterson and Cooper departed and a new cadre of colleagues and students who shared Laing’s unorthodox views about the “non-treatment” of schizophrenia joined him. They included Leon Redler, an American, Hugh Crawford, a fellow Scotsman and psychoanalyst, John Heaton, a physician and phenomenologist, and Francis Huxley, the nephew of Aldous Huxley and an anthropologist. Numerous post-Kingsley Hall houses gradually emerged, each adhering to the basic “hands-off” philosophy that had been initiated at Kingsley Hall. Each place, however, was different, reflecting the personalities of the people who lived there as well as the therapist or therapists who were responsible for each house.

By the time I arrived in London in 1973 to study with Laing there were four or five such places, primarily under the stewardship of Leon Redler and Hugh Crawford. I opted to join Crawford’s house at Portland Road. Though it was essentially like the others, I was drawn to Crawford’s personality and the unusual degree of involvement he effected with the people living there. While some of the houses went to extraordinary lengths to adopt a hands-off approach to the members of their household, Crawford employed a more engaged, in-your-face intimacy that I found inviting and comforting. Most of the people living there were also in therapy with him, an arrangement that was unorthodox, though had its advantages. Getting in wasn’t easy. Since there was no one officially “in charge,” not even the therapist who visited regularly, there was no one from whom to seek admittance. No one was paid to work there, not even the therapist who was responsible, but not in charge. And because I didn’t happen to be psychotic, I lacked the most compelling rationale for wanting to join. Some of the students I had met told me how they had visited Portland Road and, while sipping tea, offered to “help out.” “What’s in it for you?,” they were asked. When they replied that, being students, they wanted to learn more about psychosis and what it meant to be mad, they were summarily rejected. Having failed the test, they were never invited to return.

It occurred to me it would take some time, as with any relationship, to gain sufficient trust to be welcome. I attended Crawford’s seminars on Heidegger and Merleau-Ponty, went to the occasional Open House that welcomed strangers, and slowly made my presence felt. Eventually I was invited to participate in a “vigil,” a group of around-the-clock, relay of two-person teams commissioned to accompany a person who had succumbed to a psychotic episode. These affairs usually lasted a couple of weeks, sometimes longer, before they abated.

In my first such experience, a man in his twenties was in the throes of a manic episode, in Laingian terms, a psychotic “voyage” of self-discovery. Having managed to stay cool and not panic in such situations, I suppose I proved I could be counted on and sensitive to the extreme vulnerability of the people living there. After six months or so, I was finally invited to live at Portland Road. Crazier people fared better. Like Laing, I had struggled with depression since childhood. My mother committed suicide when I was fourteen, and I was still struggling with the guilt I felt at not being able to prevent that. But depression was not usually a rationale for living at Portland Road. In Britain, just about everyone was depressed due to the weather, so that was hardly out of the ordinary. Typically, a person who was interested would call, say he or she was going through a crisis or had simply reached the end of their tether, and they would be invited to come around to visit. On arrival, everyone who lived there, a dozen people or so, would meet with the visitor. He, in turn, would have the evening to himself in order to make his case heard. What were people at Portland Road looking for? By the same token, what criteria do psychotherapists use in evaluating a prospective patient’s suitability for undergoing therapy? At Portland Road this was especially problematical because many of the applicants were not interested in therapy and, if they were, had a hard time finding a therapist who was willing to work with them off of medication. Still, there were similarities between the two frames of reference.

Freud, for example, had looked for patients who, irrespective of how neurotic they happened to be, were nevertheless prepared to be honest with him. The fundamental rule of analysis assumes a capacity for candor. Similarly, at Portland Road people were expected to be candid with the people to whom they offered their case, no matter how crazy they might be. The residents who conducted the interview were looking for a sincerity of purpose and a hint of good will beneath all the symptoms the interviewee was saddled with, seeking, no matter how crazed or crazy, to contact that part of their personality that was still sane.

To complicate matters further, every applicant had to be admitted unanimously. One negative vote and you were rejected. Yet, once in, the new member could count on the unadulterated support of everyone living there, because of the fact that everyone supported his moving in. The sense of community and fellow-feeling was extraordinary. So was the frankness with which everyone exercised their “candid” opinions about everyone else. The effect could be startling, as one was slowly stripped of the ego that was so carefully created for society’s approval. I soon realized why candor is something most of us prefer to avoid, however much we complain about its absence. Again, the similarity to the psychotherapy experience was unmistakable. But now, instead of having to contend with merely one therapist for one hour a day, at Portland Road you were confronted with an entire cadre of relationships, all of whom engendered transference reactions, all of which you had to manage and work through.

I would now like to introduce Jerome, a twenty year-old man who had been referred to Laing by a psychiatrist at a local mental hospital. Jerome was a rather slight, dark-haired and extremely shy person who, in a quiet and tentative manner, told us the following. Over the past two or three years Jerome had developed a history of withdrawing from his family — mother, father, and a younger sister — by retiring to his bedroom and locking himself in. His parents would try to cajole him to come out of his room, and when that didn’t work they became angry and threatened to punish him if he did not open his door. Jerome refused to budge. Eventually, his parents contacted the local mental hospital for help. Jerome was then forcibly taken from his room and removed to hospital via ambulance and restraints. Once there, he persisted in his behavior and refused to speak to anyone. All the while, he couldn’t say why he was behaving this way or what he hoped to gain by it. He simply believed that he must.

He was soon diagnosed as suffering from catatonic schizophrenia with depressive features. A series of electro-convulsive therapy sessions were administered and before long Jerome was returned to his ordinary, cooperative self. Six months or so later he repeated the same scenario: withdrawal, removal to hospital, ECT, recovery. Never any idea as to why Jerome persisted in this behavior was ever determined. But each time he repeated it, a lengthier course of treatment was required to bring him back “to his senses.” He and his family endured this routine on three different occasions over a period of two years.

The psychiatrist who contacted Laing confessed that his colleagues at the hospital had thrown in the towel with Jerome and vowed that if he were admitted to the hospital again he wouldn’t leave. This, now, was the fourth such episode. On this occasion, when his parents implored Jerome to come out of his room he replied that he would on one condition: that Laing would see him. Jerome had read The Divided Self and concluded that Laing was the only psychiatrist he could trust not to “treat” him for a mental illness.

When Jerome visited Portland Road, he recounted what he wanted. He wanted a room of his own, to stay until he was ready to come out. We were asked to honor his request and, with some trepidation, we agreed to his terms. I single Jerome out, of all the other people I came to know at Portland Road, because he presented us with the most serious challenge we had ever had to face. Due to the nature of his terms, Jerome effectively deprived Portland Road of its most effective source of healing: the communion shared by the people living there. Jerome’s plan undermined the philosophy that Laing and Hugh Crawford had formulated, a sense of fellow-feeling that honored a fidelity to interpersonal experience, no matter how crazy or alarming a person’s participation in that process was. We felt that Jerome was entitled to pursue the experience he felt called upon to give way to, even if the outward behavior his experience effected was problematic. Though a person’s experience is a private affair, the behavior with which one engages others is not. Because the two are invariably related, the philosophy at Portland Road was to tolerate unconventional behavior to an amazing degree in order to facilitate the underlying struggle that person was engaged in.

The conventional psychoanalytic setting, for example, places enormous constraints on a person’s behavior, including the use of a couch to facilitate candor. At Portland Road, you were obliged to live with the behavior that everyone else exhibited, so the course of a given person’s behavior was unpredictable, and sometimes violent. In other words, there was an element of risk at living in such conditions because no one knew what anyone else was capable of and what lengths some might go to in order to be “true” to what they were experiencing, authentically.

True to his word, Jerome took to his room and stayed there. He had his own room, which no one saw him come in or out of. Though it wasn’t uncommon to forgo the occasional meal, the way Jerome removed himself from the household was extreme. No one even saw him sneak downstairs for food in the middle of the night, or to use the bathroom. Our sense of worry soon turned into alarm. Jerome apparently wasn’t eating anything and it became increasingly clear that he was also incontinent. We tried talking to him. Out of frustration we said, “This wasn’t part of our agreement”, to turn us into a hospital where we would have to take care of him. “Oh yes it is!” Jerome insisted. Still, Jerome wasn’t in any ostensible pain. He didn’t seem especially depressed, or anxious, or catatonic. He was just being stubborn! He insisted on doing this his way, even if he could not or would not explain why.

We reminded Jerome that we had put ourselves out on a limb for him, keeping his parents in the dark while he was jeopardizing his health. Where was the gratitude, a gesture of good will, in return? Jerome refused to discuss his behavior or explore his underlying motives. Nor would he acknowledge his withdrawal as a symptom that was generating a crisis. He simply submitted to, and was inordinately protective of, his private experience, the details of which he refused to share. Jerome eventually agreed to eat some food in order to ward off starvation, as long as we brought it to him. The stench of his incontinence became onerous, though Jerome was apparently oblivious to it. Not surprisingly, he soon became the topic of conversation each evening around the dinner table.

“What are we going to do about him?,” we wondered. Ironically, he had transformed Portland Road into a mental hospital. We were constantly concerned about his physical health, his diet, and the increasing potential for bed sores, which he eventually developed. He continued to lose weight due to the meager amount of food he was eating. We could either tell him he had to leave or we had to capitulate to the extraordinary conditions he presented us with. As news of our dilemma leaked out, Laing became increasingly nervous. Once Jerome developed bed sores he was in danger of being taken to a hospital for medical treatment. Compounding everything else, Jerome couldn’t keep down the meager amounts of food he was eating and vomited it up frequently. Whether this was self-generated or involuntary we didn’t know.

None of us possessed the expertise or inclination to serve as a hospital staff. Who was going to clean him, bathe him, and all the other things that were essential to his survival? Some of us eventually consented to be his nursemaid in order keep his condition stable. At least he was alive and more or less coping. But how much longer would we have to wait before Jerome finally came out of it and abandon his isolation?

Four more months went by. By now Jerome’s family insisted they visit and threatened legal action if we wouldn’t permit them to. We weren’t, however, about to let that happen. Crawford implored us to remain patient and let things take their course. Laing, however, was especially worried, but given our determination to see this through, he agreed to support us and keep Jerome’s family, who had by now complained to him, at bay. Meanwhile, Jerome continued to lose weight and was becoming ill. Now, six months into this, we faced a real crisis. Jerome developed bed sores, but he continued to resist talking to us or to relent in his behavior. On the contrary, he bitterly protested our efforts to bathe him and even to prevent his starvation.

We finally decided that a change of some kind was essential if we hoped to see this through to a satisfactory conclusion. We decided that Jerome needed to be in closer proximity to the people he lived with, whether or not he wanted to. The threat to his physical health and the lack of contact, in the most basic human terms, was alarming. If he couldn’t, or would not, join us, perhaps we could join him. So we decided to move him into my bedroom to share. In deference to the sacrifice of my previously private room, others agreed to bathe Jerome and feed him on a regular schedule, change his bed sheets, spend time with him, and endeavor to talk to him, even if he refused to reciprocate. We gave him therapeutic massages to relieve the loss of muscle tone and for some physical contact. We resigned ourselves to the fact that we had, whether we liked it or not, become a “hospital,” however reluctant we were to. We felt confident, however, that his condition was bound to improve.

In fact, his condition stabilized, but that was about all. I got used to the stench, the silence, the close quarters. But it didn’t help my depression, sharing a room with a ghost who haunted the space but couldn’t occupy it. I needed something to relieve the deadness that now permeated our shared space, so I invited the most floridly “schizophrenic” person in Portland Road, another young man who believed he was Mick Jagger, to move into our room with us, making it three who were sharing the room. This new person, who I will call Mick, serenaded Jerome morning and night with his guitar – which he had no idea how to play! – and probably made Jerome feel even crazier than before. But hey, at least it was a livelier, if more insane, arrangement, and with all the commotion and Jerome’s complaining I soon recovered from my depression. Whether Jerome liked it or not, our “rock star” guest was here to stay, and I admit to the guilty pleasure I felt in the comfort that Jerome was not in complete control of our lives.

Before long a who year had transpired, but still no discernible change in Jerome. In the meantime, a number of crises had occurred between Jerome’s family and Laing, Laing’s growing impatience with us, our impatience with Jerome, and finally, between ourselves and Hugh Crawford for not supporting our numerous efforts to have Jerome removed from the house. We were ready, eager!, to admit defeat and resign ourselves to an unmitigated failure. Jerome’s condition was apparently interminable. His “asylum” with us had become for him simply a way of life. It seemed obvious to us now that this was all he had really wanted from us, to live in the squalor he had generated around himself.

The time, in the immortal words of Raymond Chandler, staggered by and the urgency of Jerome’s situation gradually became a commonplace, and somehow less urgent to resolve. Life continued at Portland Road independent of Jerome’s situation. Others had their problems too, which were addressed in the communal way that was our custom. Another month slipped by, and then another, until I finally lost track of the time and stopped counting. Jerome had long ceased to be the nightly topic of conversation and his presence had become a fixture, like the furniture in the house. Nobody even noticed when the year and a half anniversary arrived since Jerome had arrived at Portland Road. We had become so accustomed to his odd definition of cohabitation: the baths, the linen changes, the serenades, that we hardly noticed that evening by the fire when Jerome nonchalantly sauntered downstairs to use the bathroom. When he was finished he flushed the toilet, peeked his head into the den to say hello, and quietly returned upstairs. To put it mildly, we were in a state of shock, and pinching ourselves to make sure we weren’t dreaming.

An hour later, Jerome came back, summarily announced that he was famished, and effectively terminated the fast that had reduced him to 90 pounds of weight. This was a Jerome we had never even met: talkative, though shy, but suddenly social nonetheless. We couldn’t believe our eyes and ears. How long, we immediately worried, would this last, before he returned to our room and his isolation?

By the next day, Jerome had obviously taken a new turn. He was finally, if inexplicably, finished with whatever he had been doing, engaged in God-knows what manner of bizarre silent meditation. Naturally, we wanted to know. “What on earth were you up to, Jerome, all that time by yourself?” I asked him. “What was it you were getting out of your system?”

I don’t think any of us expected an answer. We didn’t think that Jerome had one, but it turned out that he did. He told us that the reason he had isolated himself all that time, for a year and a half, was because he had had to count to a million, and then back to zero, uninterrupted, in order to finally achieve his freedom. That was all he had ever wanted to do, over the past four years, since his first compulsion to withdraw into his bedroom at home. No one had ever let him do it.

But why, we asked, did it have to take so long? A year and a half! Did it have to take that much time? We had given him his way, hadn’t we? According to Jerome, yes and no. After all, we didn’t just let him be. We intruded and interfered, talked to him, played music, gave him massages and generally distracted him from the task at hand, his counting. He said that every time he got to a few thousand, even a few hundred thousand, someone broke his concentration with a song, a massage, or whatever, and he was obliged to start counting all over again, from the beginning. The worst, he said, was when we added the guitar player! “But why didn’t you just tell us,” we asked, “what you were doing?” “We would have eagerly obliged, if only we knew what you were doing.” “That wouldn’t have counted,” Jerome shot back. “It was essential that you let me have my way, but without having to explain why.”

Apparently, it was only when our collective anxiety over Jerome’s behavior subsided, after the anniversary when we finally gave up and backed off, that he was able to complete the task that he had set himself to accomplish. We had eventually, without entirely appreciating its significance, submitted to his conditions, permitting him to get on with, and submit to, his own self-imposed mission of whatever mad inspiration had compelled him to count to a million and back again, uninterrupted, without excuse or explanation.

The unorthodox nature of the “treatment” that Jerome received at Portland Road is impossible to compare with conventional treatment modalities. Nevertheless, the question is invariably asked: did it really “work?” And if so, how? Nearly forty years later, Jerome has never experienced another psychotic episode again. He soon left Portland Road, resumed his life, and proved to be an unremarkable person, really, ordinary in the extreme. Naturally, we wondered why Jerome had felt the need to withdraw in the first place. What were the dynamics, the unconscious motivation that prompted such a radical solution to his problems? These were questions that Jerome couldn’t answer. It is telling, and doubly ironic, that Jerome didn’t need those questions to be answered in order to repair what he, in his shattered condition, couldn’t himself comprehend.

This story won’t make much sense to anybody who attempts to glean from it an identifiable treatment philosophy, unless they take into account the central importance that Laing gave to the inherent problem of freedom in every therapy experience. This was a concern that had also preoccupied Freud in the development of his clinical technique, just as it did the existentialist philosophers, such as Kierkegaard, Nietzsche, Heidegger, Sartre, with whom Laing was principally identified. How does one “help” those who are in some measure of personal jeopardy without impinging on that person’s inherently private, though socially intelligible, right of freedom?

Freud’s solution to this problem was analytic neutrality, the cornerstone of his clinical technique. It followed the ancient dictum: “do no harm,” what Laing recognized was a form of benign neglect. In many ways, Jerome’s experience at Portland Road was a perfect example of benign neglect put into practice. The respect we tried to pay this young man was all that any of us felt qualified to offer. We didn’t understand what was the matter with him, nor did we pretend to. We weren’t sure what would help nor what might make matters worse, so we did as little as possible. Following the principle of neutrality, we employed benign neglect as as unobtrusively as we could. Neither Laing nor Crawford directed the treatment, because there was no “treatment” to direct.

The way that we struggled with and responded to Jerome’s impasse as if unfolded will no doubt be regarded as reckless, indulgent, dangerous, even bizarre by the psychiatric staff of virtually every mental hospital in the world. His behavior — intransigent, stubborn, resistant — would no doubt be met with an even greater force of will, determination, and power than his own. Who do you suppose, given the forces at play, would ultimately “win” such a contest? Naturally, the use of medicating drugs would be brought to bear, and electric shock, as well as whatever form of incarceration is deemed necessary.

Few, if any, psychoanalysts believe it is possible to treat such an impasse with analysis. Yet, our treatment of Jerome was arguably a form of analysis, stretched perhaps beyond its limit. Because Jerome refused to talk, we were obliged to let his behavior do the “talking.” D. W. Winnicott, Harry Stack Sullivan, Frieda Fromm-Reichmann, Clara Thompson, and Otto Allen Will, Jr., are only some of the prominent psychoanalysts who helped people in this kind of crisis. Some have recounted the many hours they spent with patients who were silent, letting time run its course until something broke through the impasse they were struggling with. Who would deny that Jerome resisted treatment? But what manner of treatment can a person wholeheartedly submit to when it coerces its way in, without invitation or compassion? And let’s be frank about this, without love. It seems to me, on reflection, that it was our love for Jerome that finally had its way when we backed off from all of our efforts to “help” him, when we were able to just let him be, as he had asked us to, and allow him to join our community, but on his terms, not ours.

Love is a hard thing to pin down, because there are many types of it, and not all of them are applicable to the therapeutic process. Jerome for searching for the truth, his truth, and was determined to find it, whatever the cost. In a manner of speaking, his journey was a search for authenticity, to be capable of being the person he was, however unpleasant or demanding that might appear to others. He had spent his life cowing ot others, and the time came when he had had enough. What he wanted from his family, and the psychiatrists who treated him, was the freedom to be real, or genuine, without airs or pretense. Jerome couldn’t spell this out; few of us are able to. But he knew, somewhere in his soul, what he had to do, and what the freedom to be himself would feel like. When you think about that, his journey was not just an act of desperation, it was an act of courage, where everything was on the line, come what may.

Laing saw his role as one of helping the people who came to see him “untie” the knots they had inadvertently tied themselves in. He believed this entailed extraordinary care to not repeat the same types of subterfuge and coercion that had got them into those knots in the first place. Jerome had tied himself in a knot, and had come up with his own solution as to what he needed to do in order to untie it, including his insistence on doing it silently. That we were able to get out of his way and facilitate his task was nothing short of a miracle.

This degree of non-intrusion in the context of psychotherapy is a rarity. Those therapists who believe it is incumbent on them to run a “tight ship,” who maintain their authority over their patients at all costs, and who reduce the therapy experience to a set of techniques that can be learned by rote aren’t likely to embrace a method of “treatment” that is as modest in its claims as it is cautious with its interventions. Jerome taught me that techniques are of no use when all a person is asking is to be accepted for who he is, unconditionally.