The case for reopening the asylums
In February of 1951, a young Scottish psychiatrist called Ronald David Laing headed off to the small village called Killearn, just north of his native Glasgow. Killearn housed the West of Scotland Neurological Unit, and Laing would spend the nine months here under the tutelage of the neurosurgeon Joe Schorstein. Most of the unit’s work was on people who had suffered head injuries from car accidents, but there were also some cases of a more disturbing nature. It received psychiatric patients who were judged to be of a particularly disturbed or violent temperament. They would be subjected to lobotomies, the now discredited neuropsychiatric procedure where a patient’s skull was opened with an instrument resembling an ice-pick, after which a drill was inserted with the aim of causing extensive brain damage. The result was a pacified patient, but one with very limited capabilities.
Laing’s mentor Schorstein was opposed to the procedure and refused to perform it. Whilst some criticised the procedure for lacking medical evidence of its effectiveness, Schorstein saw it for what it was: a brutal assault on a human being, aimed at changing their behaviour by inflicting brain damage. Laing was more radical still. Seeing such a barbaric procedure pass itself off as medicine made him start to question the entire field of psychiatry. He reasoned that if a supposedly scientific field could justify the use of lobotomies, it could justify the use of anything. Whilst Schorstein did not draw these same conclusions, the fact that he reacted to the use of lobotomies with horror gave the 23-year-old Laing the confidence that he was onto something.
Shortly afterwards, Laing was drafted as a psychiatrist in the British Army. The young psychiatrist, who in his spare time would read works by the philosopher Jean-Paul Satre in the original French, found army life oppressive. At the British Army Psychiatry Unit of the Royal Victoria Hospital at Netley, however, he found more dubious procedures being carried out in the name of medicine. Hospital patients were subjected to another now-discredited practice called Insulin Shock Therapy. Insulin Shock Therapy involved injecting psychiatric patients with high doses of insulin, which would produce deep comas and seizures. These seizures would then be reversed by injecting the patients with glucose. These procedures would be carried out, day after day, in dark rooms over the course of weeks, until the patient had been said to have recovered.
Once again, the use of such procedures caused Laing to question the psychiatric profession itself. He asked himself why, if these procedures would never in a million years be used on “normal” patients, they were being used on people with psychiatric conditions. One night Laing decided to test his hypothesis. A patient Laing later referred to as “John” was having a serious episode. Typically, the psychiatrist would order that the patient be forcibly tranquilised with drugs. Instead of doing so, Laing ordered that the door to the padded cell be opened, and he sat down on the floor next to “John”. He stayed for half an hour or so and simply talked to the patient, who then calmed down.
This experience would push Laing to distrust psychiatry as medicine. He started to see links between the treatment of patients and the existential philosophy that he was reading in his spare time. This eventually resulted in the publication of his first book in 1960, The Divided Self, which would go on to become a classic in the field of psychotherapy.
Laing’s book was perfect to open the decade of the 1960s. Inspired by very real abuses in the psychiatric profession, the book seemed to point toward reform — counselling psychiatrists to stop acting so much like prison guards and instead actually talk to their patients. Yet, as with much in this tumultuous decade, initially positive calls for reform eventually led to an unstoppable destructive nihilism.
In 1964, Laing and his co-author Aaron Esterson published Sanity, Madness, and the Family. In the book Laing started to push his critique much further, far beyond the walls of the psychiatric hospital. Laing and Esterson claimed that the cause of serious psychiatric conditions such as schizophrenia was a toxic family life. “We do not accept ‘schizophrenia’ as being a biochemical, neurophysiological, psychological fact,” the authors write, “and we regard it as palpable error, in the present state of the evidence, to take it to be a fact.”
It goes on to study the families of ten patients suffering from schizophrenia. Laing and Esterson are careful not to claim that they have discovered evidence that schizophrenia is caused by poorly adjusted family dynamics. They hide behind the language of phenomenological epistemology to duck this question. The authors are merely providing a “descriptive account”, they tell us. Yet this account seems to strongly suggest that schizophrenia is the result of toxic interpersonal family dynamics. So do statements such as: “We have tried in each single instance to answer the question: to what extent is the experience and behaviour of that person, who has already begun a career as a diagnosed ‘schizophrenic’ patient, intelligible in the light of the praxis and process of his or her family?”
Those without conditions should try to replicate them through experimental drug use
A flood of so-called “anti-psychiatric” books and activism followed. A distinctly Marxist flavour could be detected throughout. The anti-psychiatrists believed that they had found a new type of oppression: the oppression of the supposedly “mad” by the self-proclaimed “sane”. Those diagnosed with psychiatric problems, on the Marxist reading, were revolutionaries who had rebelled against the stifling norms of bourgeois domesticity.
Far from the modest reformism of the 1950s, the 1960s anti-psychiatry movement became increasingly unhinged, eventually claiming that serious psychiatric conditions like schizophrenia were, in fact, a new type of revolutionary consciousness. Those without such conditions should try to replicate them in themselves through experimental drug use. Laing became a celebrity often referred to as “the Mick Jagger of psychiatry”. The Beatles, Jim Morrison of The Doors, poet couple Ted Hughes and Sylvia Plath were all admirers. The fact that many of Laing’s fans soon met unfortunate ends through drug overdoses or suicide seemed to bother the Scottish psychiatrist far less than the Insulin Shock Therapy he had denounced a decade before.
Laing’s alternative psychiatry became increasingly ridiculous. By the 1970s he developed a team that would offer people the experience of a “rebirthing workshop”. The person who signs up for the “treatment” is offered the experience of once again breaking out of the birth canal. They are surrounded by the other members of the team and must physically push against the group until they break through. Laing believed that this simulated the traumatic moment of birth and would thereby promote psychological healing.
Laing’s druggy celebrity exploits were pure showmanship in comparison to the plans of the hardcore, organised Marxists, however. Italian psychiatrist and neurologist Franco Basaglia — also a communist revolutionary — wanted to hijack state power and dismantle the psychiatric hospitals. Basaglia had been running an experimental psychiatric hospital in Gorizia, near the Yugoslav border. His liberal approach to psychiatry soon created problems. In September 1968, a patient called Giovanni Miklus was released for a day and took the opportunity to murder his wife with a hammer. Basaglia and one of his colleagues were charged with manslaughter, although both were eventually cleared. In 1977 a woman requested but was refused treatment at his hospital; she then drowned her four-year-old son in the bath.
Basaglia was not deterred by these setbacks. A common theme amongst the anti-psychiatrists is extreme sympathy for psychiatric patients when they are subjected to confinement, but little empathy for the victims of their experimental techniques. Despite the deaths surrounding Basaglia he pressed on, continuing his crusade to close the psychiatric hospitals. He eventually got his way. Law 180 or Basaglia’s Law was signed by the Italian Parliament in 1978. The Italian psychiatric hospitals were almost all closed and replaced by looser community-based services, which would only confine patients for short periods when they were experiencing acute psychiatric episodes. This new form of psychiatry became known as “care in the community”. In combination with the more widespread use of psychiatric drugs, it remains how psychiatry is practised to this day.
As with so much that happened in the 1960s, the forces of change were not the counterculture alone. Commercial and governmental interests inevitably played a role — in the case of the closure of the asylums, that role was large and probably determinate. In 1961, one year after R.D. Laing had published his first book attacking the medicalisation of the mentally ill, the Minister for Health Enoch Powell gave a speech that has since become known as the “Water Tower speech”. Powell was under the sway of statisticians at the Ministry who were studying the efficacy of new psychiatric drugs. He thought that because of these drugs, within 15 years many psychiatric beds would be decommissioned. “This is a colossal undertaking,” Powell said in his speech, “not so much in the new physical provision which it involves, but in the sheer inertia of mind and matter which is required to be overcome.” The 1960s were such a decade of promise and change that even archconservatives like Powell got caught up in it all — it speaks volumes that his rhetoric would not have looked out of place in a countercultural sit-in.
What followed was nothing short of a media campaign against the asylums and their related institutions. Crusading journalists focused on the dysfunction and neglect at many of these institutions. In the summer of 1967 News of the World published a series of stories on Ely Hospital, a large psychiatric hospital in Cardiff. The report made accusations of theft and the mistreatment of patients, which sparked an inquiry. There is little doubt that abuse existed at the institutions, but the trick with these “scandals” is always to be selective. Were there similar abuses going on at, say, public schools? Almost definitely, but they were not in the crosshairs of reformers and cost-cutting politicians. No institution is perfect — and those that are based on compulsion, like asylums, schools and prisons, are ripe for abuse. The asylums in those days were already earmarked for abolition, however, by politicians like Powell and the overeager psychopharmaceutical industry that backed him.
The latter should be highlighted. In 1961, when Powell made his speech, no one could have imagined the sheer size to which this industry would grow. As of today, the global antipsychotic drugs market — the drugs that are used to treat psychiatric patients both inside and outside of hospital — is worth $14.54bn. Whilst the drugs themselves are effective, the rate of growth of their prescription raises serious questions as to whether too many people are now taking them — especially as they tend to have very serious side effects. Unlike with the asylum system in the 1960s, no one is incentivised to look under the hood of the contemporary psychiatric drug industry. In fact, all the incentives militate against doing so, as the pharmaceutical companies constitute a major lobby group in many countries.
The end of the asylum system came under Thatcher in the early-1980s. By that time the flood of news stories, books, movies like the 1975 film One Flew Over the Cuckoo’s Nest, and white papers had sealed the fate of the asylum. The Thatcher government was perfectly placed to hammer the final nails into its coffin. Laser-focused on cost-cutting and buoyed with the rhetoric of “consumer choice” encouraged by the drug companies, the Thatcher government proved to be the asylum system’s undertaker. As with so many things in the postwar period, the 1960s radicals painted the target, and the 1980s neoliberals fired the killer shot.
Ineffectiveness was, as it so often is, accompanied by an excess of moral preening
The failures of the new care in the community system were obvious almost immediately. In 1988, the businessman Sir Roy Griffiths published a green paper entitled “Community Care: Agenda for Action”. The paper highlighted serious problems with the community care model. Sir Griffiths noted that after the closure of the asylums, there existed a “no-man’s land” for those who had been effectively ejected from the asylums. It was no longer clear who was supposed to care for them, and so they fell through the cracks. No one in the community cared enough to take responsibility, Griffiths said. He suggested reforms, but it was easier to destroy than to build. The reforms went nowhere. More green papers followed. Public health boffins bickered amongst themselves — but nothing changed. The problem festered, getting worse and worse every year. At least everyone could agree on the righteousness of the crusade to close the asylums, though. Ineffectiveness was, as it so often is, accompanied by an excess of moral preening.
“Ask any gathering of people who are not members of the psychiatric profession what they think of care in the community,” reads an editorial in The British Journal of Psychiatry from 2001, “and most, if not all of them, will reply that it has failed.” The editorial in question goes on to try to defend the model, but the facts seem to overwhelm the attempts. Most psychiatrists today regard care in the community as a dismal failure. Yet this fact is not discussed outside of psychiatric circles.
This is surprising because we see the effects all around us, most notably the enormous amount of homeless people in our cities. It is estimated that 53.7 per cent of the homeless in Britain have severe mental health issues. 62.5 per cent have substance abuse problems. The crude idea, which floats around especially in liberal-left circles, that homelessness is the result of lack of housing does not stand up to scrutiny. The studies on this matter are legion, and most homelessness charities readily concede that the largest drivers of homelessness are mental illness and substance abuse.
It is difficult to come by statistics on the homeless in Britain that go back to the time of the closure of the psychiatric hospitals. Data from other countries can help us in this regard, however. Consider the case of New York City, where we have good data going back to the early-1980s. First, some context to the changes brought about by care in the community: before it became the standard psychiatric approach, there were a lot of psychiatric beds in the United States. In 1955, at the peak of the asylum regime, there was one psychiatric hospital bed in the country for every 296 people. This level of coverage ensured that the mentally ill could be treated on a rotating basis. Fast forward to 2014, however, when the care in the community regime was fully in place. In that year there was one psychiatric hospital bed for every 3,319 people.
What happened to homelessness in the cities after this? It skyrocketed. In 1983 there were just over 4,000 adults sleeping each night in homeless shelters in New York City. In 2023 there were 25,261. It is clear to anyone who cares to look that care in the community has resulted in mentally ill people being thrown out of psychiatric hospitals where they were treated and onto the streets. The reality of so-called care in the community is that people do not care, and the homeless are left on the sidelines of the community. These reforms, pushed by the radical left in the 1960s and 1970s, have produced barbarous results. They have resulted in the proliferation of mentally ill people living — and dying — on our streets. It is something that we should feel eternally shameful for.
If we need more convincing of this obvious link, let us turn to Japan. Japan is one of the only developed countries that did not experiment with care in the community. Largely insulated from the mad schemes of the 1960s radical left, Japan has maintained its psychiatric beds. Let us compare Japan to Britain in this regard. In 2020, Britain had roughly 35 psychiatric beds for every 100,000 people. Japan, on the other hand, had around 260.
Now let’s see how Japan stacks up in terms of its homeless population. In 2022, Japan had a homeless population of 3,448 according to government statistics. Yes, 3,448 people are homeless in Japan. Compare that to Britain, which has around 271,000 homeless people. Also recall that Japan has a much larger population than Britain. Put another way, Japan has roughly 2.7 homeless people for every 100,000 residents. Britain, on the other hand, has 402.5.
What the Japanese numbers show us is that it does not have to be this way. We have subjected the mentally ill amongst us to a radical social experiment, and the results have been homelessness, drug addiction, exploitation and early death. We try to ignore it. We avert our eyes from the people who are rotting on our streets. We pretend that it can be solved by better shelters or whatever other crackpot scheme that has not worked for decades. At a certain point, this is no longer a social experiment gone wrong, but simple cruelty.
In the Spring of 2008, a decomposing corpse was found in a tent in a remote area of Formentera, an island off the coast of Ibiza. Next to the corpse were two empty bottles, one of vodka, one of wine. The homeless man in the tent had drunk himself to death. His name was Adam Laing, and he was the 41-year-old son of the radical psychiatrist R.D. Laing. When these reports surfaced, the media latched onto the irony. The son of the psychiatrist who blamed mental disorders on toxic family relationships had been found dead of alcohol poisoning whilst living homeless in a tent. Adrian Laing, another of Laing’s sons (he had ten children by multiple women), told the newspapers: “It was ironic that my father was a family psychiatrist when he had nothing to do with his own family.”
Certainly, Laing’s own failings are worth reflecting on, but perhaps those final weeks of Adam’s life are even more relevant. Adam was, by all accounts, a drifter. He never had permanent work, and he drank too much. Most people were surprised that he drank himself to death, however. Just before this happened, Adam’s long-term girlfriend had broken up with him. We can only assume that this precipitated an episode of mental illness that eventually resulted in his death. Adam died homeless in a tent. If he had been confined for a few weeks in an institution like the ones that his father hated, would he still be alive today? It seems perfectly possible — and how many other of the so-called homeless can this be said of? We continue to morally preen about the closure of the “backwards” Victorian institutions of the past, yet we neglect the most vulnerable amongst us, leaving them to fend for themselves and ultimately die in alleyways and beside drains. Maybe we should take a long, hard look in the mirror before congratulating ourselves on our “enlightened” opinions.
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