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R. D. Laing: Sanity, Madness and the Problem of Knowledge

Trevor Pateman

Abstract: A reading of one case study in R D Laing and A Esterson, Sanity Madness and the Family, trying to highlight the cognitive (epistemological) aspects of the schizophrenic predicament.

In 1970, Penguin Books re-published in paperback R.D. Laing and A. Esterson's Sanity, Madness and the Family , which caused me to buy the book and read it again. Despite myself, I re-read the book as a philosopher, but in the event this proved to be fruitful. It is a philosopher's reading of the book's first case study, the study of the Abbott family, that I present in this essay.

A glance at the Appendix to the chapter on the Abbotts, transcribing their conversations, will show that many if not most of the statements made by the parents about the 'schizophrenic' daughter, Maya, and by Maya about herself are factual statements. For example, Maya says that she worried over her examinations. The parents contradict this: she did not worry. In general, both parties make claims to knowledge - the daughter about herself and the parents about their daughter - but their claims contradict each other.

Most of the family argument which Laing and Esterson reproduce in the chapter on the Abbotts is also about matters of fact. The dominant feature of these arguments is, in my reading, conflict over what is or was the fact of the matter. In this conflict what I wish to single out is Maya's inability either to state or, more radically, to know what is true and what is false in a given situation. I shall suggest as a possible explanation that this could be because she has not learnt to tell true from false. Despite the strange protestations of Laing and Esterson in the Preface to this second edition of their book, there is good evidence in the text for inferring that this failure to learn must be explained in a way which involves reference to the behaviour of the parents and not simply by invoking some (undiscovered) organic deficiency in the patient, Maya. In short, Maya does not learn because she is unable to, and she is unable to partly because of the way her parents behave.

Consider the following passage from Laing and Esterson's commentary on this case:

"An idea of reference that she [the daughter] had was that something she could not fathom was going on between her parents, seemingly about her.
Indeed there was. When they were all interviewed together, her mother and father kept exchanging with each other a constant series of nods, winks, gestures, knowing smiles, so obvious to the observer that he commented on them after twenty minutes of the first such interview. They continued, however, unabated and denied.
The consequences, so it seems to us, of this failure by her parents to acknowledge the validity of similar comments by Maya, was that Maya could not know [my italics TP] when she was perceiving or when she was imagining things to be going on between her parents. These open yet unavowed nonverbal exchanges between father and mother were in fact quite public and perfectly obvious. Much of what could be taken to be paranoid about Maya arose because she mistrusted her own mistrust. She could not really believe that what she thought she saw going on was going on." (p.90)

My reading of this runs as follows. We learn to 'tell right from wrong' mainly from our parents. They are our chief moral authorities, from whom we learn not simply a list of particular rights and wrongs, but general rules of right and wrong (ethical principles) and, importantly, criteria for telling right from wrong where no general rule obviously applies or where it is a case of making an exception to a general rule. Of course, all of this, no doubt, goes on unconsciously.

Though there is no common phrase like 'learning to tell right from wrong' to express it, I suggest that we also learn, mainly from our parents, how to tell true from false - veridical from delusive perceptions, correct from incorrect statements. Here again we learn not just lists; we also assimilate criteria. We acquire an unconscious mastery of the criteria and the ways of applying them which indicate to us when, for example, we can legitimately say 'I know . . .' and when we can only legitimately say 'I believe . . We learn when we have a right to be sure, when not, and so on. In other words, parents are our epistemological authorities - that is, authorities on questions like: What can we know? How can we know? How can we know that we know? When can we claim to know? and so on.

Maya, like most children, regarded her parents as epistemological ( 'cognitive' would be a possible alternative) authorities. In her case, as in all of the cases studied by Laing and Esterson, the degree of reliance she had to place on her parents was increased by the closed nature of the Abbott family. In addition, these families were often very Christian and this could add another reinforcement to the reliance on parents. For rejection of the parents as epistemological authorities could be construed as a breach of the rule: Honour thy Father and thy Mother.

Maya's parents consistently deny the truth of her statements and thereby undermine any developing mastery of epistemological criteria and / or her perceptions themselves. She is thus disabled from achieving a cognitive mastery of the world. The growth of cognitive autonomy is inhibited or destroyed, depending upon when and for how long these interactions continue. In the case of Maya the analysis is complicated by the fact that she was away from home from the age of 8 to the age of 14. In the absence of a clear knowledge of what happened in that period, my formulations of necessity vacillate a little. She remains epistemologically dependent on her parents, just as a child whose parents treated all cases of morality / immorality as unique and therefore failed to transmit any means of discriminating morally would render their children morally dependent. When Laing and Esterson say that she 'could not know' in the passage quoted above this 'could not' is a logical could not. It is not that the girl failed to exercise her cognitive skills; she simply had no sure cognitive skills to exercise. As the authors put it,

"Her difficulty was that she could not know when to trust or mistrust her own perceptions and memory or her mother and father". (p.43)

One could say that with Maya the educational process has broken down. If education is about leading out a child into autonomous existence, then epistemological education is about making the child cognitively autonomous. In transferring their cognitive skills to their children, parents dissolve the position of 'natural' (perhaps 'contingent' is a better word) authority which initially they have. It is precisely this and other dissolutions or abolitions of authority which Maya's parents will not tolerate. They cannot let their daughter grow up. Here is Maya's mother speaking, the first and last sentences being those of Laing and Esterson:

"She recalled a 'home truth' a friend had given her recently about her relation to Maya.
'She said to me, you know, "Well, you can't live anyone's life for them - you could even be punished for doing it" And I remember thinking "What a dreadful thing to think", but afterwards I thought she might be right. It struck me very forcibly. She said to me, "You get your life to live, and that's your life - you can't and you mustn't live anybody's life for them". And I thought at the time, "Well, what a dreadful thing to think." And then afterwards I thought, "Well, it's probably quite right".
This insight, however, was fleeting." (p.47)

The study of the Abbotts shows how parents can maintain their children in dependence not merely by material means, but also by cognitive means. These means include, in particular, the failure to transmit epistemological criteria, the Knowledge of Knowledge. The parents keep these criteria to themselves, and in the conversations reproduced in Sanity, Madness and the Family one can see them using these criteria as instruments of control and coercion.1

This is plain from the dialogues which daughter and mother have about the daughter's memory. Memory is a source of knowledge, but can be invoked in justification for knowledge claims only to the degree that it is reliable. Our individual assessment of the reliability of our own memory is made not just on the basis of our awareness of how often and in what sorts of cases we can't remember something which we think we could or should be able to remember. It also depends on the frequency and so on with which other people in a better position to know (epistemological authorities) validate our memory claims, Maya's mother uses her position as an epistemological authority2 with respect to her daughter's memory as a means of controlling and, hence, denying autonomy to her child. Thus, according to Laing and Esterson:

"Mrs Abbott persistently reiterated how much she hoped and prayed that Maya would remember anything if it would help the doctor to get to the bottom of her illness. But she felt that she had to tell Maya repeatedly that she (Maya) could not 'really' remember anything, because (as she explained to us) Maya was always ready to pretend that she was not really ill.
She frequently questioned Maya about her memory in general, in order (from her point of view) to help her realize that she was ill, by showing her at different times either that she was amnesic, or that she had got her facts wrong, or that she only imagined she remembered what she thought she remembered because she had heard it from her mother at a later date". (p.46)

Here I am reminded of George Orwell's 1984, where control over the records against which one could check the veracity of one's memory eliminates this as a possibility and throws people back entirely on their own resources. But without any intersubjectively accessible sources, or intersubjective confirmation of memories, each individual's memory capacity is itself weakened. The first act of defiance which Orwell's hero, Winston Smith, commits is to keep a Diary - an objectified record against which he can check his own memory and which is, in principle, publicly accessible. In philosophical terms, Orwell is working with a non-Cartesian conception of the thinking self: the thinking self for Orwell does not exist, essentially, in isolation from other thinking selves; its existence is interdependent with their existence. It seems to me that Laing and Esterson's work gives some sort of empirical support to this non-Cartesian position which one can find, for instance, in both Hegel and Wittgenstein - and these are authors whom Laing has read. In Hegel's Phenomenology of Spirit, in the section on the dialectic of Master and Slave, the non-Cartesianism is perfectly clear:

"Self-consciousness exists in itself and for itself, in that, and by the fact that it exists for another self-consciousness; that is to say, it is only by being acknowledged or 'recognised' ". 3

But Maya does not appear to have adopted Winston Smith's strategy. There is no reference to her keeping a Diary. More to the point, she has not left home. Her way out has been to withdraw into her own world, though (significantly) 'feeling at the same time most painfully that she was not an autonomous person' (p.43). I say 'significantly' for her way out is doomed to failure. It is only in the intersubjective world that criteria for knowledge can be found, and hence only in this world that the distinction between real and imaginary, and the stability of perceptions and conceptions, can be maintained. Maya's withdrawal is an impossible project. It cannot (logically cannot) lead to autonomy. For autonomy is tied to knowledge and the knowledge of knowledge. Here again we have some sort of empirical illustration of the philosopher's thesis about the connection between knowledge and freedom.

Without levity, one can suggest after this reading that if Maya needs anyone it is an epistemologist, not a psychiatrist. Unless, of course, some psychiatrists are really epistemologists.4


1. It is usual to add at this sort of point a phrase, "no doubt unconsciously". But in these families there is room for some doubt.

2. 'Arbiter' is the word Laing and Esterton use (p.43).

3. G W F Hegel Phenomenology of Mind, trans. J. B. Baillie. Allen & Unwin, 2nd edn, revised, 1949, p.229.

4. It would be better if some psychiatrists were really child snatchers. For Maya and those like her are not in a position to take the obvious way out and leave home; they can perhaps only be taken away and certainly they need help in establishing their own independence. It would be even better to abolish the form of family which Laing and Esterton study; but I am trying to interpret the situation of its victims not simply from the point of view of proving the necessity of this abolition but also to discover what can be done in the situation with which we still have to live. It will be clear from these remarks that I do not accept what Laing and Esterson have to say in the Preface to the second edition of the Sanity, Madness and the Family. The disclaimers they make there are so obviously contradicted by their own text as to appear simply bizarre. They have explicitly produced a theory of social causation in schizophrenia, though one which, admittedly, does not preclude the possibility of an organo-genetic component. But whatever the constitution of Maya's brain cells, there is no good reason for accepting the behaviour of her parents.

First published in Issue Number 1 of the journal Radical Philosophy, 1972. Minor corrections and revisions incorporated into this 2005 website version. A French translation appeared in Esprit (Paris), juillet-aout 1972, pp 180-84, and may re-appear on this website if we can manage the accents.