British psychiatrist R D Laing (Photo by Stan Meagher/Express/Getty Images)

The decline of madness

The colourful history of the Tavistock Clinic

Artillery Row

The only public medical clinic in the UK authorised to prescribe puberty blockers to people under 18 was ordered to close this week, further cementing the UK’s reputation as a centre of “gender critical” convictions, or “TERF island”.

The soon-to-close Gender Identity Development Unit is run by the Tavistock and Portman NHS Foundation Trust. The Trust’s announcement has of course been met with wildly different reports. Mainstream outlets like the BBC and The Times seem clear enough that the problem was not merely spiralling demand and long waiting times. Rather, it is about the de-transitioned Kiera Bell’s High Court win against the clinic’s use of puberty blockers, and the damning findings of Dr Hilary Cass’s independent review that followed it. 

Nonetheless, Stonewall publicly celebrated the decision to close the clinic, claiming the move was a decision to “replace” the clinic to meet rising demand. Pink News even implied that Cass’s recommendation that more research into “life-saving” puberty blockers was critical, as a public validation of the controversial medication’s manifold benefits and healing potential.

Such conflicting reports add to the general sense of disorientation and confusion that attends society’s most entrenched and controversial battles. For both sides, the correct interpretation is merely a matter of common sense, but this state of affairs is inherently contradictory. What is being considered sensible is not held in common; this is the problem. 

Enter the Tavistock Clinic’s pre-gender woo-woo history

The NHS Trust responsible for the unit in question was originally called the “Tavistock Clinic”, or locally, as “the Tavi”. It has a long history on the forefront of approaches to mental health issues which were eventually to take issue with common sense itself. 

As Andrew Scull points out in his monumental cultural history of madness, Madness in Civilization, the word madness has, for hundreds of years, meant a “loss of reason, the sense of alienation from the common-sense world the rest of us imagine we inhabit”. He points out that common sense is defined by the Oxford English Dictionary as an “ordinary, normal or average understanding: the plain wisdom that is everyone’s inheritance”. 

Yet now, we cannot use the word madness as a valid category, for to do so would be cruel to those suffering psychopathologies — bespeaking “a callous disregard for the sufferings of those we have learned to call mentally ill”, says Scull. 

There are two key moments in the decline of the word madness in Scull’s analysis. The first was in the 19th century, when what was called the “moral treatment” of madness was gradually replaced by medical approaches. The former sought to inculcate virtues in those condemned to madhouses; the latter were the beginnings of what we today call psychiatry. “Madness” is a wide-ranging term, with ethical, social and cultural dimensions. “Mental illness”, by contrast, legitimised the new medical focus — illness was the preserve of doctors, not moralistic preachers or social commentators. 

After the second world war came the second, bigger change, when American, French and Italian legislatures all changed the words meaning “insane” or “aliens” to “mentally ill”, following English legislation from 1930 which changed “lunatic” to “a person of unsound mind”. 

There is of course much that is commendable in this. Words like mad, insane or lunatic place the sufferer into an entirely different category from the “sound-minded” or sane. At worst, calling someone “mad” can be more than callous disregard and threatens to make the mad person subhuman.

Enter the Tavistock Clinic’s pre-gender woo-woo history. It is situated in the incredibly wealthy and attractive North London suburb of Hampstead. It has a famous statue of Sigmund Freud outside, a stone’s throw from his London home, now the Freud museum. Until recently, there was a bookshop and coffee-shop round the corner, specialising in all manner of psychology, psycho-analysis and analytical psychology, named Karnac Books, after the ancient standing-stones of Brittany. 

Founded by Dr Hugh Crichton-Miller just after the First World War, the Tavi originally focused on treating shell-shock victims. Crichton-Miller’s philosophy aimed to forward the decline of calling people “mad” and others “sane”, the “them and us” mentality. He did away with beds, white coats and medical equipment. It developed into an early “therapeutic community”, with no hard and fast divisions between practitioner and sufferer, but everyone trying to get and stay well. Madness becomes something on a continuous spectrum with common sense; there is no binary, no break between the two. 

In 1935 it founded a clinical arm, later named The Portman Clinic. None other than Sigmund Freud, Carl Jung and H. G. Wells are numbered among its vice-presidents in its early years. Jung himself gave a week-long series of lectures at the Tavistock in 1935. In the 1930s and 40s it specialised in the new field of “mental health hygiene” or “preventative psychiatry”. This is now dominant in Western discourse — not seeking to treat outbreaks of mental illness, or what was earlier called “madness”, so much as promoting good mental health for all.

It went on to contribute to important developments in “attachment theory”, and pioneered “systemic family therapy”. Rather than isolate a young person displaying psychopathological traits as “mad”, this approach commendably studies the interrelationships among family members which invariably contribute to those traits, at least in a great number of cases. 

You can’t have crazies without having common sense

In the 1950s and 60s it continued to specialise in treating adolescents, and moved to its current premises in 1967. It was such an opulent location it was nicknamed “the Freud Hilton” by staff, which between 1956 and 1964 included R. D. Laing. 

Laing is perhaps the supreme exemplar of the direction in travel away from the “common sense vs madness” binary and toward the “spectrum of mental health”. His remarkable The Divided Self (1960) remains widely read outside the specialist field. It argues that even schizophrenic psychosis is on a perceptible continuum with more tangible, common sense forms of emotional estrangement. He is in many ways the ultimate boomer-shrink, a darling of the 1960s counter-culture for whom lavish servings of acid only served to bolster the view that what was once called madness in fact pervades culture and society. It was then only a short-step to arguing that there is no inherited wisdom” or common sense at all, just fluid social constructions and assumptions. 

It was only in 1996 that the Gender Development Unit was moved from another London Hospital to the Tavistock. Given the illustrious history that precedes it, it is a shame that the word “Tavistock” now means just this unit to the ears of most. 

Yet, there is continuity between the Tavistock of this week’s news and the decades that preceded it. Transgender ideology claims that everyone has some gender fluid traits, everyone has a “gender identity” which may or may not align to their biological sex (forgive me, “gender assigned at birth”). The intentions behind adopting considerate language, like speaking of people “of unsound mind” rather than “lunatics”, has been extended to the point of unconditionally and non-judgementally accepting a person’s lived experience, extending what Laing argued for, even to the degree of giving full-access to single-sex spaces and so on. 

There is also a marked discontinuity at play, however. The original Freudian and Jungian impetuses behind treatments of shell-shock, and utilising attachment theory, family therapy and much of Laing’s “anti-psychiatry”, involved a sensitivity to familial, social and cultural influences on the presentation of psychopathology. This would, until recently, come to be seen as just common sense in the population at large. 

Yet this is specifically where the latter-day Tavistock failed. The independent review highlighted the clinic’s refusal to undertake due diligence on the issue of why their young patients are increasingly female, and/or increasingly autistic. To engage with this question would mean engaging with social trends and the possibility of socially contagious psychological experiences. Ironically, this would once have been exactly what one would expect of the Tavistock tradition: looking to the network of relationships at play behind an instance of mental illness, not isolating it as something requiring a disconnected, pharmaceutical intervention. This is why previous mental illness crazes like 18th century “nostalgia”, or late 19th century “nervous disorders”, were once central to the development of mental health discourse. 

Maybe “crazes” are too close to “crazy” — and you can’t have crazies without having common sense. The broken binary between madness and common sense was shown this week to be stretched, but not to the point of snapping. 

Laing wrote that schizophrenia was an unusually intense expression of the endemic existential challenge we all face, of “being a whole person”, which occurs when that challenge breaks beyond “the common sense (i.e. community sense) way of experiencing oneself”. There is much wisdom in this, but things have been pushed too far. Now any “common sense” opinion that goes against the official line is assumed to be inherently problematic — leaving only an imposed way of experiencing oneself to become its wholesale replacement.

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