To the Madhouse

This month’s British Journal of Psychiatry reprints a poignant poem from the late English physician and poet Edward Lowbury:

To the Madhouse

What she has told us all a hundred times –
That old, unwanted women can again
Be hunted down, accused of pointless crimes
And burned in the public square; that it is vain
To plead ‚Äì or prove ‚Äì one’s innocence; that men
With solemn looks will come into the house,
And say, fearing a scene, `You’ll feel no pain;’
`It’s for your good;’ `We’re not ungenerous;’
What she foretold, when we dismissed her fear
Saying `You dreamed such things’ ‚Äì it now comes true:
The door is open, and the men are here.
Calmly they question her, and with a new
Smiling indifference drag her from the room
And through the streets to the expected doom.

The poem is apparently from one of his collections, entitled New Poems 1935–1989.

The image of the ‘mad woman’ is a recurrent theme in poetry and literature, particularly of times past, and was famously discussed in the 1979 book The Madwoman in the Attic.

One of the Wordworth’s most famous poems, The Mad Mother, is, perhaps, the best known example and recounts the words of a young lady who is experiencing what we would now call postpartum psychosis.

On the surface, it has a more cheerful outlook than Lowbury’s poem, although the content of the mother’s words belie the situation of the subject, rending the piece considerably more disturbing in many ways.

The picture on the right is by the 18th century French painter Th√©odore G√©ricault and is entitled Portrait of a Woman Suffering from Obsessive Envy and is from his series of ten ‘portraits of the insane’.

At the time it was believed that madness could be seen in the face, and Géricault wanted to capture how different forms of insanity expressed themselves Рa project that preceded later attempts to do the same with photography.

Sadly, only five of the portraits survive, but they remain some of the most important works in the history of portraiture.

Link to short BJP article on the poem.
Link to Wordworth’s poem The Mad Mother.
Link to piece on G√©ricault’s ‘portraits of the insane’.

Shadows of R.D. Laing

The Observer discusses the recent and somewhat lonely death of Adam Laing, the son of revolutionary psychiatrist R.D. Laing, in an article tinged with both sadness and irony.

Adam Laing was apparently found alone in a remotely pitched tent on the Spanish island of Formentera, surrounded by mostly emptied bottles of alcohol, having had a heart attack during a drinking binge.

R.D. Laing was famously troubled himself, suffering from both alcoholism and depression, and for a psychiatrist that specialised in the influence of the family on mental health, he was a notoriously absent father.

He is often, rather clumsily, associated with ‘anti-psychiatry’. Although he rejected the label himself and was certainly not against psychiatric treatment, he did propose some radical ideas that chimed with the counter-culture of the 1960s.

One of this most important contributions was suggesting that family dynamics had an influence on the development and expression of psychosis.

In many ways his ideas were the forerunner of subsequent work on psychosis and ‘expressed emotion’ – another clumsy term that is used to described the extent to which family members talk about another family member in a critical or hostile manner or in a way that indicates marked emotional over-involvement.

In a now widely replicated finding, the number of critical and undermining comments made in a family to a person with psychosis is known to predict the chance of relapse. This has led to the development of family therapy for psychosis which has been shown to reduce relapse rates.

Laing was more concerned with the development of psychosis and argued that the content of hallucinations and delusional beliefs often reflected thoughts that would otherwise be inexpressible in the fraught emotion of a dysfunctional family.

Perhaps Laing’s most naive, and ironically, most popular essays, The Politics of Experience and The Bird of Paradise suggested that madness was a quasi-mystical state in which the psychotic person had been thrown into a process of ‘ego transcendence’.

Psychosis was, therefore, a process of catharsis and the person should be guided on their journey, rather than treated to moderate their chaotic mental state.

For some people, this is almost certainly true, but these people are sadly in the minority. Most find psychosis a disturbing experience and we there is now accumulating evidence that outcome is far worse for people who have longer periods of untreated psychosis.

Laing was important in pointing out that the mental health system can often add to the disturbing experiences rather than temper them, but he often wandered off into vaguely focused anti-authoritarian diatribes in both his writing and talks which made him a darling of the underground but which obscured his more valuable insights.

The Observer article discusses the contrast between Laing’s work and his difficult personality and family life.

Like this one, it’s an article on the death of a man that largely talks about his long departed father.

It’s difficult to read without being struck by the irony that even in death, R.D. Laing’s work and personality have overshadowed his family life.

Link to Observer article on Laing (thanks Tom and Karel!).