Sanity, Madness and the Family: Families of Schizophrenics

by R.D. Laing, Aaron Esterson

In 1958, while working at the Tavistock, John Bowlby introduced Laing to Gregory Bateson's double bind theory of schizophrenia. Intrigued, Laing engaged another Glaswegian, Dr. Aaron Esterson, in an intensive phenomenological study of more than 100 families of diagnosed schizophrenics in the London area. In 1962, Laing travelled to meet Bateson and his co-workers in Palo Alto (and elsewhere across the U.S.A.) In 1964, Laing and Esterson published the results of their study in a brilliant and deeply disturbing book, Sanity, Madness & The Family, which John Bowlby described as the most important book about families in the 20th century.

Genres: Psychology, Nonfiction, Philosophy, Psychoanalysis, Psychiatry, Mental Health, Science

288 pages, Paperback

First published January 1, 1964

About the author

Ronald David Laing was a Scottish psychiatrist who wrote extensively on mental illness – in particular, the subjective experience of psychosis. Laing's views on the causes and treatment of serious mental dysfunction, greatly influenced by existential philosophy, ran counter to the psychiatric orthodoxy of the day by taking the expressed feelings of the individual patient or client as valid descriptions of lived experience rather than simply as symptoms of some separate or underlying disorder.

Laing was associated with the anti-psychiatry movement although he rejected the label.

Reviews

[Fergus, Weaver of Autistic Webs · Rating 4 out of 5]

I’m a Bipolar Soul whose Magic can forever Fester in my Heart, unless I sober up! For a sober mind dispels the magical mists and leaves simplicity in its wake.

Modern Madness arises by refusing to let emotional life Flow ordinarily - and in consequence, not being able to win for losing - and by continuing to search for meaning beyond the basic, and tried and true values our brain had been given at childhood.

That's impossible. For it is an impassable Double Bind. It is to construct a bronze idol of oneself, with clay feet as in Nebuchadnezzar's dream. And Nebuchadnezzar fell into madness.

Modern Madness begins when we reject all of society's ethical answers, as Nietzsche did to his certain doom. For only society gives our brains functionality.

And that functionality is embedded in our original upbringing, and our education.

Reject that, or what it has now become, and you reject yourself.

That's what I did in 1970. Never having been told the truth about the past, I lashed out at my enemies blindly, using invalid reasons.

The tangled wires of my brain short-circuited, and with medical inducement it shut down.

That's the personal madness of modernity.

My meds gave me peace - because madness is a Double Bind which in its pure futility must be stopped and transmuted into tranquility.

***

Where does that leave us patients?

In Limbo. Limbo is the traditional final home of the lost, unshriven ones among us - if our souls remain in continual unrest in this life. Souls in Limbo, Dante says, are the Proximate Damned.

My own trauma in the face of modernity twisted the world right outta shape... Now it had become downright bizarre:

Peace packed up and left.

Unrest was all that remained.

And it will stay, unless we have certain faith that we can positively mitigate this modern madness.

Faith puts bronze in our clay feet. We are no longer confused about the big picture. Our venial peccadilles we can leave alone, as vital components of our essential humanity. Don't sweat the small stuff.

***

You see, modern psychiatric veterans cannot always pretend to be fully functional, because they have rejected our society's functionality.

They fondly think life is deeper than all that. But it is no deeper than its foundation.

Our books and friends with their pat answers only take us back to Limbo. Even the neurotypicals are now confused. Unless daybreak floods through their hearts.

Because we veterans of a simpler world have jettisoned our functionality by searching through mere doublethink for answers. Hence our current intolerant politics.

Rapid fluctuating change always upsets our common meaning anew. Without holistic emotional functionality, deep shared common meaning cannot exist. Our totems, Freud said, have been abandoned because they are now mocked.

To be honest, we Have to be thankful we still have the seed of meaning in our lives, having been reduced to a hopelessly inchoate machine language.

That very same original machine language must be allowed to run emotionally unhindered - yet, paradoxically morally curbed - again.

Only when it runs will we be happy, and we can mitigate this modern disaster.

To do that, we must keep our brains active - either in physical activity - or in the contentious inspiration of our reading.

We must let our program run again in the free flow of unprejudiced love.

With faith.
***

Only by acceptance and not by rejection of the world are we saved.

This threatening new kinda personal unbalance is the bequest of a woke, unbalanced world. Thus it threatens to become universal.

Where once it was the domain of only the mentally unbalanced, it is now our worldwide lingua franca.

For by denying the positive functionality of this modern society it sends us off anew in a futile search -

Cruising for yet another bruising -

In our classically Double-Bind Bruised Minds.

For it is only through an emotionally positive and loving acceptance of this world, our inheritance, that we are healed.

[Rachel · Rating 4 out of 5]

I read this because I am obsessed with the idea that pathological conditions cannot be located within an individual. This book, though not without its problems, did not disappoint. Highly recommended to those interested in the history of madness.

[Erik Graff · Rating 5 out of 5]

After reading them in paperback, I purchased Laing's The Divided Self, Self and Others, and Sanity, Madness and the Family in hardcover. The investment seemed worth it because at the time the third book had had a great influence on my thinking.

Sanity, Madness and the Family addresses schizophrenia from the perspective of social conditioning, supposedly finding from an extensive empirical survey that a study of the families of schizophrenics will reveal causes for the psychosis sufficient to discount hypothetical physical aetiologies. The study, viewed in light of Laing's philosophical stance, is of dubious objectivity, but it still has value in nature/nurture disputes in that it makes the nurture side of the argument plausible.

[Andrew Barnett · Rating 5 out of 5]

This book blew my world open. Yes, people become schizophrenic due to their environment. Yes, people can be driven to madness by their families, when they are told their pain is their fault, or not real, and they are isolated, and are forced to accept a reality that is not true to their experience. It is clear in each of these families how the individuals went crazy, and in their own way, are the sanest people in their families, and have moments of connected clarity about their family life and dynamics that the rest of the family is denying the reality of. This is an important book, that when taken seriously, is perhaps the truest and most accurate account of how a person becomes 'crazy'. Please read it.

[Rebecca DeLucia · Rating 3 out of 5]

i think what laing and esterson lack here is the empathy of their contemporary winnicott with regard to really hearing the corresponding socioeconomic anxieties of parenting; SM&F leans severely to the side of overskepticism towards and indictments of the familial non-patient interviewees as they hunt down the double bind or a home situation in which a person’s psychosis is influenced mainly by contradictory messages or double-speak—like it all has to do w an atmosphere of glib hypocrisy in western post-war modernity. it’s apparent throughout that in the early 60s it was radical to make sense of women deemed senseless, to map their problems from within the family context, to suss out the effects of misogyny in the nuclear unit and in the culture as a whole. it tends to oversimplify by saying what’s abnormal is actually quite normal, and lack of freedom seems to be the axis each of these cases has in common. still, as a document of their pioneering method and also for the 60s british middle class colloquialisms its a worthwhile read.

[Cliff M · Rating 5 out of 5]

Really shocking to see (in these case studies) how the behaviour of parents can engender behaviour in children that can be interpreted as pathological. And yet these are (by and large) ‘normal’ and ‘good’ families. Criteria for selection were not based on family background but on symptoms of the patient, and yet it is the behaviour of the families not the patients that is most disturbed and disturbing.

An important book but also a rather sad book. These young women could have been so much happier if raised in different environments. Hopefully we have learned some lessons from this study...

[Eita Kaleb · Rating 4 out of 5]

A pesar de que las técnicas psiquiátricas han progresado y se han actualizado, éste libro es un vestigio importante (no del todo incorrecto) acerca del estudio de la esquizofrenia.
La modificación que viene del mismo es que no se centra en un estudio esquemático de los psiquiatras aplicados en las pacientes, sino en estudiar directamente a la familia de las pacientes, lo cual sorprende en cada entrevista realizada a cada una de las once familias de esquizofrénicas.
Una frase que me gustó de uno de los psiquiatras fue :
"Tenemos términos clínicos para los perturbados, pero no para los perturbadores."
La cual llamó poderosamente mi atención al descubrir a través de las páginas que además de los agentes externos, la familia te puede volver loco.
Cosa curiosa es que en la época en la que se lleva a cabo el estudio (década de los 60) la contradicción a la familia podía desencadenar que a uno le encerraran en un loquero o que la misma familia fabricara toda una situación grave para un paciente que debido a su edad manifestaba rebeldía. Y es todavía más curioso que las once pacientes entrevistadas no parezcan auténticas esquizoides cuando se les entrevista; mientras que las familias de la mayoría se portan totalmente obstinadas, controladoras y manipuladoras. De ahí destaco una opinión por separado entre una madre (figura muy determinante en cada situación, que incluso pareciera provocar a propósito la locura de su hija) y su hija:
"Opinión de la madre:
Nos llevábamos todos perfectamente bien.

Opinión de la hija:
Yo sólo te daba gusto."

En cuanto a su estructura, siendo el primer libro que leo de este género, debo decir que la traducción hace un buen trabajo al ir explicando los comportamientos y padecimientos que tienen las pacientes. Sin embargo, algunas palabras como "Siempre" o "Bueno,..." se repiten constantemente y hace que pareciera que el argumento no avanza, lo cual puede hacer cansada la lectura en algunos fragmentos.
Me llevo del libro una buena experiencia, a la vez aterradora y doliente por llevarme a la pregunta sobre ¿Cuántas personas han sido encerradas en manicomios sólo por rebelarse contra su familia?

[Yusuf · Rating 4 out of 5]

R.D. Laing and Aaron Esterson set out to answer a simple, although apparently controversial, question: To what extent are the experiences and behaviours (i.e. symptoms) of these schizophrenic patients intelligible in terms of the process and praxis of the family nexus? In other words, are they random pathological manifestations of an illness, or do they make sense in the context of each patient's family?

They do that by conducting fairly well-recorded and structured interviews with 25 families of patients diagnosed with schizophrenia (deliberately all females for some reason), the first 11 of which are reported in this book. The authors' method was to study each patient, her relationships with each family member, and the family as a system. They attempted to present their raw observations and findings untreated by any interpretations, which I appreciated.

There seemed to be many constant insightful themes across these families. What stood out to me, as well as broke my heart, was how the patients' families constantly treated them and spoke to them in contradictory and mystifying ways, sometimes subtly, but other times it was maddeningly blatant. It also struck me as frightening what the families perceived their child's illness consisted of; they tended to see struggles to mature into an independent adult, as well as mere disagreements in preferences, as central symptoms in their child's 'illness'.

I think the authors have demonstrated their modest claim in these 11 patients. "Surely, if we are wrong, it would be easy to show it by studying a few families and revealing that schizophrenics really are talking a lot of nonsense after all." I wonder if anyone has attempted to show that since the publication of this book.

[Kari · Rating 4 out of 5]

Despite being written in the 1960s, the message that Laing puts across through these case studies is still as relevant today as it was at the time of writing. Mental health cannot be assessed out of context. Every action and trigger has a root in the environment of the patient and to separate them or neglect them completely is to me totally illogical. Humans do not live in isolation but have daily interactions and experiences that shape their lives and thoughts. To take mental health symptoms as purely organic is to ignore what is staring us in the face - we are (whether we like it or not) a product of our environment. The nature of our illnesses are constantly being shaped by the interpretations and determinations of others. As Laing shows, if this diagnosis is taken based on the families sole decree of what is wrong then it will naturally be skewed and even purposely false. I hope that Laing and his colleagues managed to affect some change in the lives of the girls discussed in this book. Unfortunately the books only sets out the case studies and does not follow up with the result of their findings. A fascinating read that will leave a lasting impression.

[Enrique Valdivia · Rating 5 out of 5]

I read this in college for a course in feminist philosophy taught by Maria Lugones, who now teaches at SUNY-Binghamton. She was the teacher who most influenced my politics and critical thinking. An amazing person. Reading this book enabled me to look at my family in a new way. I hesitate to call what I found "truth". It was more like the beginning of a journey out of the my family's consensus about what was true. Laing's ideas are out of favor these days. But this is still an important book. As Lugones put it in class the day we discussed it, what we call insanity can sometimes be understood as "a rational response to an irrational situation."

[Bigmakmotorbreath · Rating 5 out of 5]

every body can relate to these studies by dr. Laing.It's all about the narcissism of parents destroying lives. Alice Miller wrote a bit about that- really affirming stuff

[Philip · Rating 5 out of 5]

Nine different women clinically diagnosed as schizophrenic are interviewed multiple times and in multiple combinations with their family of origin and sometimes extended family members.

What emerges from these interviews is that the standard psychiatric interview is not sufficient to get a clear picture of who a person is ,the cause(s) of their troubles and how to proceed as regards treatment. It's interesting that 60% of psychiatric drug prescriptions in the United States are not even given by psychiatrists but by general practitioners who spend no more than 15 minutes with a patient. However, these interviews demonstrate clearly that even the 45 minutes or 50 minutes a psychiatrist will privilege a patient with is not nearly sufficient.Perhaps the most fascinating part of this book for me was how many subtle and seemingly subtle ways in which parents can create serious mental problems in their child generally unbeknownst to the parents through their behavior. Sometimes, the parents are simply repeating what they themselves got from their parents.Education and status doesn't necessarily confer less problems which points to the real problems of hyper specialization that exists in our world despite it's obvious advantages.

We live in an age run by pharmaceutical companies. They are, by the way, the largest lobbying group in the US. There can be no more unscientific and damaging branch of medicine than psychiatry. Their products are tested for no more than 12 weeks maximum and long-term studies are virtually nonexistent. When this book was written, in 1964, there was a common belief amongst people, including clinicians, that mental issues like schizophrenia are brain disorders or brain illnesses. Almost 65 years later, we have no more proof of that than we did then. But such faulty reasoning persists. Humans need to believe in something. In the past, they had God and religion. Now, we have big medicine(along with so-called scientific thinking generally)and ,in a market economy like ours, GDP is our other God.

[Stephanie Christodoulou · Rating 3 out of 5]

Interesting just very dated in its approach about schizophrenia

[Claire · Rating 3 out of 5]

Once again, this text shows just how convincing Laing's works truly are, despite me not actually being convinced by his theories. This work definitely shows the connections between the patients' schizophrenia and how their families construct or lead to that diagnosis and in that sense it was quite interesting. I also appreciated how much respect the authors had for the patients' words. This work was incredibly repetitive, but I suppose that's in the nature of having a collection of case studies all set on proving the same thing. It is also interesting how much of it read like a play or short story, which goes back to Freud's lament that his case studies should read like fiction. An interesting text.

[Katja · Rating 4 out of 5]

This is a scary book. It contains eleven stories, all real, of eleven young schizophrenic women and their families. The point made in every story is basically the same: the bizarre beliefs and strange behavior become intelligible if one considers every woman in the context of her family. And those are all crazy families. For example, the Edens are the father, mother, aunt, uncle and cousin. So far so good. But the (later schizophrenic) daughter grew up knowing them as (in the same order) uncle, mummy, mother, daddy/uncle and brother. "Happy families are all alike; every unhappy family is unhappy in its own way" is very true when it comes to the families from this book.

[Jonathan · Rating 4 out of 5]

Quite shocking how well the family context of these diagnosed schizophrenic patients fits their pathology. They are made for measure but that still doesn’t answer how proportional the genetic and environmental factors of influence are. What is a schizophrenic? Laing describes cases he doesn’t answer but these apparently very typical families are all very neurotic and you can only wonder why the siblings aren’t also schizophrenic! It seems a schizophrenic is someone who has lost the ability to glue together various fantasies as is necessary when constructing a meaningful subjective reality. As long as you can hold on to your own denial sanity is possible!

[Audrey · Rating 4 out of 5]

This book turns fifty this year. The authors' thesis is that schizophrenia is a confabulated diagnosis and that when patients are seen in the context of their families, symptoms are better understood as attempts to cope with dysfunctional or unbearable family dynamics. I did not come away at all convinced of this thesis in terms of what is today called schizophrenia, but I still loved the book. I think it showed powerfully that the 'diseased' person may be the one that is unable to cope within a closed and toxic family system. I loved the transcription of the 1960s dialogue.

[Elizaveta · Rating 5 out of 5]

A terrifying, intense and relatable book.

[Malcolm Gorman · Rating 5 out of 5]

An eye-opener.

[David · Rating 5 out of 5]

Just from this first study, which was a difficult enough read in itself, it was clear to me that there is a point in R.D. Laing's implication of family life in the development of these types of illnesses.

In my situation, at least in part, there was a certain (although obviously lesser) amount of undiagnosed mental health problems in my family that they did not want to understand themselves or have to deal with, and never got treatment for. There was also my family's attitude towards mental health which was quite backward, even for the time.

Therefore when I was growing up, the interplay between them and their attitudes towards mental health, and their own mental health, and my mental health - that synergy - there was a certain amount of 'pinning all the problems on me' over a number of years as I developed and learned as a child, and it did negatively influence my mental health.

Certainly my own succeptability to this illness was already there, and probably was genetic, but I do think that it added to it, and helped it develop.

So yes I think there is something there, and I think this area should be studied more in psychology, personally, without blame and without judgement.

[Aya · Rating 5 out of 5]

This is such a great read! It's very easy to read because the chapters arent connected; they each separately go over the family history and clinical interviews of young schizophrenic women and their family members. You get an analyst's view into the intimate family drama for 11 chapters, any one of which would make a successful soap opera.

The authors set out to present clinical cases of schizophrenia and to show how the familial context and upbringing of each case are very heavily tied to the symptoms of the 'disease', to the point of questioning the usefulness of a diagnosis and treatment that reduce the problem to the individual, and that often exacerbate the collusion and 'condition'. This book very convincingly achieves the authors' objectives of highlighting some reductive limits of the medical conceptualization of schizophrenia at the time (which largely extends to this day unfortunately).

[Ashleigh Hoare · Rating 4 out of 5]

This was recommended to me by my Masters supervisor as it uses the case studies to gather data (which is also my methodology).

This was a study done in the 1960s over a five year period. Eleven women diagnosed and hospitalized with Schizophrenia were interviewed along with their families - at the time, the family context and the patients experience in that context was not taken into account when making a diagnosis.

Researchers found a lot of illness was diagnosed because behaviour and attitudes deviated from familial expectations. A very progressive approach for it's time, and a reminder that social and cultural attitudes influence what we consider to be deviance and illness.

[Dimfy · Rating 4 out of 5]

Ik vond het indrukwekkend om te lezen wat voor een vergaande gevolgen bepaalde (disfunctionele) familiedynamieken kunnen hebben op de ontwikkeling van iemands ervaring van zichzelf, anderen en de wereld om hen heen (eigenlijk: op wat voor manieren mensen elkaar 'gek' kunnen maken). Het wekt in mij een enorm ontzag (en misschien ook een klein beetje vrees?) op voor de manier waarop we enorm afhankelijk lijken van elkaar voor ons realiteitsbegrip. Dit onderzoek laat zien op wat voor manieren deze afhankelijkheid kan leiden tot een verstoord begrip van het zelf, van anderen en van de buitenwereld.

[Pdx · Rating 4 out of 5]

Highly intriguing stories of interpersonal and intrapersonal conflict between families and the supposed ' psychiatrically ill' patient. Recommend if one is interested in Object Relations theory.


'As her mother said "if you let people tell u whats right, youll be all right"' as quoted from the last story of the Lawsons helps describe the scenario .
No man's an island .
Again, would be open to integrative complexity from schools of feminism, evo bio, neuroscience and Jungianism; particularly interested in biases based on gender and it's critiques as many stories describe the congergence of women's freedom and the role of historically calling such a patient 'ill in the head'.

[Jan · Rating 4 out of 5]

An interesting look at how families can effect the mental state of their members, and how subtle control mechanisms can lead to reactive psychotic behaviours in vulnerable individuals. Quite dated now, as society has become more tolerant and better aware of the issues described in the book. Having said that, it is still worth a read if you are interested in the social-psychological dynamics of families.

[Laura · Rating 4 out of 5]

Review to come!

[Aatqa Arham · Rating 4 out of 5]

Intriguing. Some interviews were held striking similarities to Pinter’s ‘The Birthday Party’.

[Berry Bertschinger · Rating 5 out of 5]

Very Sad, but revealing.

[Reader · Rating 4 out of 5]

Fajnie się czytało polecam

[Pippa · Rating 4 out of 5]

Very interesting, not least because parents in many of these case studies, to the modern sensibility, appear to have Aspergers Syndrome. I realise that there is a huge debate about how much parents/carers are to 'blame' for the development of mental illness, but these case studies tied in very precisely with a situation I have personal knowledge of, and it does seem sensible to me to look at potential triggers for 'mental illness'. Certain factors reappear consistently in the studies - talking over children; denial that they are separate, with different likes and needs, and lack of concern when they are almost comatose (probably inspired by a belief that they must be just acting.) There are obviously only a limited number of studies but the pattern that emerges is disturbing. I also like the way he points out that we have a word for one who is 'disturbed' but not for one who is 'disturbing'.