Thursday, October 05, 2023

The catastrophe of so-called anti-psychiatry

I’ve mentioned Aaron Esterson before (see previous post). As I said in that post, Esterson co-authored Sanity, madness and the family with R.D. Laing (see extract from my book chapter). It was
the result of five years of study of the families of schizophrenics. The aim was to establish the social intelligibility of the events in the family that prompted the diagnosis of schizophrenia in one of its members. … Esterson is an underrated figure in the history of anti-psychiatry, a term that he thought devalued the work he was doing. The research he was involved with could be said to have succeeded in making the apparently absurd symptoms of schizophrenia intelligible. Esterson was the lead author of a study that showed that the results of family orientated therapy with people diagnosed as schizophrenic compared favourably with those reported for other methods of treatment (Esterson et al, 1965). Esterson (1976) made clear in a letter in The New Review about anti-psychiatry that, as far as he was concerned, Sanity, madness and the family was not an anti-psychiatric text. In fact, he saw anti-psychiatry, by which he meant the writings of Cooper and also of Laing, to the extent that he went along with Cooper, as a movement that had done enormous damage to the struggle against coercive, traditional psychiatry.

Anthony Stadlen wrote an obituary of Esterson in Existential Analysis. To slightly paraphrase Esterson’s views about schizophrenia from Anthony's obituary, Esterson wrote:-

Some labelled schizophrenics are mad by any criterion. Yet, some are not, but have been mystified into believing they are. And some have been driven frantic as if they were mad. And even the mad ones are not necessarily mad in the way they are said to be by those who label them.

As Anthony says, Esterson failed his psychiatric examinations the first time, as he tried to write truthful answers. It was a mistake he did not repeat when he resat them. Esterson conducted all the interviews himself for Sanity, madness and the family and Laing sat in on one interview with each family. As Anthony says, Esterson came to regard both Laing and David Cooper as frivolous and destructive: exemplars of the romantic, 'charismatic', leadership he would criticise in Leaves of Spring, which was a subsequent book enriching the details of one of the families from Sanity, madness and the family.

Anthony recently conducted Inner Circle Seminar No. 286 (see info) on Aaron Esterson as the third in his series on existential therapists born in the 1920s. Anthony has also posted a posthumously published article from Esterson from Existential Analysis. 

In the article, Esterson contrasts the practice of psychiatry with what he calls existential phenomenological analysis. He notes how psychiatry can negate experience, which he defines as the indivisible unity of a person intentionally acting. Persons experience and, so, behaviour is a function of experience. Existential phenomenology, therefore, studies the experience of persons in respect of their way of being in the world with others and with nature, and social phenomenological analysis studies relationships directly.  It has to suspend judgement on the rationality or otherwise of even bizarre-seeming behaviour and experience, so that even the most mad-seeming actions and experience may be found to be an intelligible and even a reasonable response to an unreasonable social situation. Personally I think a strength of Esterson's work is that he allows the clinical material to stand for itself with little elaboration of theory.

By contrast, Esterson goes on, general psychiatry is primarily concerned with people’s conduct that deviates from the social norm, without being illegal, and with so-called aberrant experience. It therefore diagnoses madness without viewing the other in relevant interpersonal context. Furthermore, the presumed irrationality is regarded as indicating a disease of the mind, analogous to a disease of the body. The person's experience and actions are thereby invalidated, whereas social phenomenology can provide intelligibility. The commonsense view that people can be driven crazy by the actions of others needs to be accepted. Once a person has been diagnosed as mentally ill, the stigma means that ordinary human quirks can come to be seen as signs of a malignant internal process which confirms the prior diagnosis. Esterson highlights the power imbalance between the person diagnosed and the person doing the diagnosis in that the person diagnosed is not allowed to question the diagnoser. The person is, as it were, presumed guilty until proven innocent. 

Esterson's method involved observing the relationships of the members of the family in all their permutations. To emphasise, Esterson was not saying there is no such thing as madness. But there is no brain dysfunction. It is essentially a delusion for psychiatry to believe so.

The Simon Silverman Phenomenology Center of Duquesne University, Pittsburgh, Pennsylvania,  unfortunately did not benefit from this rich analysis at its symposium on Psychiatry and Phenomenology, on 6–7 March 1986. This was because Esterson withdrew the paper because he received a letter from the Director of the Center saying "I daresay your talk will be well received, having read it". As Anthony Stadlen says, he telephoned the Chair of the Phenomenology Center in 2000, who remembered well that Esterson had withdrawn the paper. The Center had apparently concluded Esterson was mad. Anthony also telephoned the director at the time that Esterson withdrew, who said he was mystified by Esterson's withdrawal. Anthony thinks Esterson had partially misunderstood the reply of the original director, who was a superb translator of Heidegger and would have been an" ideal reader of his paper", although there was clearly feeling against Esterson's paper from within the Center. Anthony calls this a "mis-meeting between two of the world’s finest phenomenologists". In 2013, when Anthony phoned that original director again, he still rated Esterson's paper as "Quintessential phenomenology".

The triumvirate of David Cooper (see egs. extract from my book chapter and previous post), R.D. Laing and Aaron Esterson were the core of what came to be called Laingian anti-psychiatry (see eg. previous post), although, as I said above, Esterson did not see himself as an anti-psychiatrist, as neither did Laing. Anthony Stadlen tells me that Esterson said the triumvirate failed, which Esterson called a castrophe. Esterson left Kingsley Hall (see previous post) and the Philadelphia Association (see egs. my book chapter extract, book review and previous post), of which he was a founding member, in the spring of 1967. Certainly Esterson failed to get his important message across. I'm hoping Anthony Stadlen and others might be able to help resurrect it.

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