The silence of Laing and its echo in Szasz’s essay on antipsychiatry

Background: The new review debate (TNR)

During the 1970s, at a time when the role of psychiatric institutions was being questioned, one of the foremost critics, Thomas S. Szasz (1920–2012), wrote a series of articles in The New Review (TNR) dissociating himself from another of the leading critics, R. D. Laing (1927–1989), with whom his name had hitherto frequently been associated under the phrase ‘antipsychiatry’. The first of these was entitled ‘Antipsychiatry: The paradigm of the plundered mind’ (Szasz, 1976a). Despite the personal nature of the articles, Laing declined to respond in print, and instead Leon Redler, a colleague of Laing’s in the experimental community known as the Philadelphia Association (PA), supplied a point by point riposte.

There is little in the literature to indicate the reaction of Szasz to Laing’s decision not to take part in TNR exchanges, or of the consequences Laing’s silence had on Szasz. Possibly, and this comes within the field of speculation, this silence was not well-received by Szasz. I tend to think that he had perhaps hoped that Laing would reply to his criticisms, and he would thus engage with an opponent of equal intellectual status. I can guess that having to adapt to a rival like Redler, and not Laing as he had hoped for, was humiliating and frustrating for Szasz. As I will show later, and as Theodor Itten also expresses (T. Itten, personal communication, April 18, 2021), Szasz (2009) aimed to devalue Laing and other practitioners in the PA in his book on antipsychiatry. ¹ As Szasz (2009, p. 41) would remark many years later, disdainful of critics, Laing did not answer my criticisms directly. Instead, he deputized Leon Redler (born 1936), one of his lieutenants, to do so. In a 2,000-word letter to TNR, Redler denied everything.

What is the exact content of that ‘everything’ to which Szasz makes reference? Redler first set the record straight with respect to Szasz’s affirmation that Laing had created the so-called antipsychiatry movement alongside David Cooper. As Kotowicz (1997) observes, Szasz conflated Cooper’s and Laing’s views, leading him to accuse the latter of romanticizing madness, to the point of encouraging people to have psychotic experiences. Laing did not hold these views. He only said that some people get through a psychotic breakdown without psychiatric intervention and that in some psychotic breakdowns, there may be a sign of a mystical experience. This view falls far short of suggesting that mysticism might be a route to social liberation. The term antipsychiatry actually originated not with Cooper, but with Dr. B. Beyer in 1912, in reference to a growing opposition to perceived abuses of the profession in the ambit of civil commitment and the insanity defense (Lothane, 1992), but was re-fashioned by Cooper as a label encompassing all those eschewing current institutional practices (Burston, 2020, p. 159). For his part, Laing had said repeatedly that he was not an ‘antipsychiatrist’ but a physician and psychiatrist, though not practicing conventional psychiatry. What he denounced was not psychiatry itself, but conventional psychiatry as an institution, and especially involuntary psychiatry, which he regarded as a coercive medical practice. Redler (1976) attributed this error in ideological identification to Szasz’s reliance on Cooper’s writings. In similar vein, Laing’s collaborators in the PA, chiefly the afore-mentioned Redler, published a series of rebuttals (many in TNR), clarifying what they saw as misconceptions and misrepresentations of their work. The exchanges continued sporadically through the 70s and 80s in book reviews, interviews, and conferences (Balbuena, 2021); neither party was ever reconciled, and even 20 years after Laing’s death, Szasz (2009) published a highly personal repudiation of Laing. Why did Laing decline to take part in TNR debate? It was never clear what motivated Laing’s reticence. As Laing’s biographer, Burston (1996, p. 171) points out, though he did not reply to Szasz directly, Laing was distressed by the virulence of the attack, and often wondered why Szasz didn’t challenge him in person before resorting to such harsh polemics in print. In an attempt to find an answer to this crucial question, I wrote to Burston, and to his defender, Redler. Burston, was unable to provide a reason for Laing’s lack of response, nor indeed for the delegation of this task to Redler:

. . . for some obscure reason, Laing preferred not to defend himself. (Laing declined to respond to many of his critics in print, so this may not be that unusual.) . . .. He [Szasz] never conceded an inch, only redoubled his attacks. Laing was a very flawed human being, but he deserved better.

(D. Burston, personal communication, December 23, 2020).

For his part, Redler’s memories of events at some 45 years remove are a little tentative, recalling that Laing asked him to respond, but that he didn’t (so far as memory served) show it to others in the PA, apart from Laing, before sending it as his personal response. However, Redler is very sure of the tenor of the exchanges:

Particularly on Szasz’s part, it seemed more like an ill-informed and ill-tempered polemic, with personal bitterness and aggression on Szasz’s part that I don’t recall in Laing’s feelings toward or response to Szasz.

(L. Redler, personal communication, December 30, 2020).

These accounts left me feeling dissatisfied, and, wishing to know more, I wrote to Theodor Itten, who was an apprentice of Laing’s at the time and not in the ‘inner circle’, but was nevertheless able to provide an eye-witness account of events. In his view, Szasz had the opportunity to visit Laing in London to discuss their differences face to face before going public, but lacked the courtesy to do so. This, he felt, was the primary cause of Laing’s disinclination to become involved, but also notes that ‘ideological issues often, so Laing, were also concerned with the issue of “the father”!’ (T. Itten, personal communication, December 25, 2020).

Itten’s account is consistent with an interview with Laing by Robert Mullan (1995, pp. 221–224) on antipsychiatry, in which Laing affirmed that he ‘wasn’t going to give Szasz the credit of replying to it [Szasz’s TNR article]’. Laing did, however, go on to express the view that Szasz had a ‘fixed idea’ about him. And although he did not respond directly to Szasz’s attacks, he did, some time later, write a critical review of Szasz’s works Schizophrenia (Szasz, 1976b), The Theology of Medicine (Szasz, 1977), and Myth of Psychotherapy (Szasz, 1979), in Round the bend (Laing, 1979), in which he tackles Szasz’s original (and continued) accusations. On the issue of idealizing persons with schizophrenia, Laing notes that this misunderstanding was compounded by Szasz’s attribution to him of the ‘vulgar error’ of ‘considering insanity as supersanity, and mythologizing the madman as a person of superior artistic, moral or psychological gifts, virtues, or powers’ (Laing, 1979, p. 69). Redler (1976) rebutted these assertions, saying that there was no ‘idealization of insanity’ in Laing’s writings, lectures, practice, or that of the PA. Rather, he affirmed that those working daily alongside Laing in the PA knew only too well the suffering of people experiencing mental health challenges to merely intellectualize about it.

Ideological differences in terms of psychiatric practice

Szasz never attempted to present his views in a systematic way. However, as Vice (1992, p. 18) rightly points out, every position to be attributed to him is either found explicitly stated in his writings or can be legitimately inferred from such statements. Further, Szasz (1961, 1970a, 1987) rejects the explanations of mental illness offered by psychiatry on the grounds that it presupposes views of human nature which ignore or violate moral autonomy, the basis of his own theory of community. Hence, in order to reincorporate the patient into the moral community, one must offer a moral critique of the evasion of responsibility encouraged and sustained by such categories as ‘mental illness’. The institutional psychiatrist, as well, must be indicted for his or her coercive care (Vice, 1992, p. 41). Paradoxically, in happening so, psychiatrist and patient are brought back into the moral community as mutually guilty members. Accordingly, whereas Szasz (1970b, 1977) insisted that the entire structure of psychiatry, including its psychological derivative, psychotherapy, should be abolished, Laing (1967) believed that however flawed psychiatry is, we still need it, or something like it, to help those people who need someone to relieve them of their unremitting emotional and mental distress (Thompson, 2015). Thus, even though Laing and Szasz shared an interest in changing conventional psychiatry practice and the mode of understanding and treating psychic suffering, each side maintained different conceptions about psychiatry, psychopathology, and mental illness. This latter would explain why Szasz’s attitude toward persons experiencing mental illness, and especially to persons diagnosed with schizophrenia, was very different from Laing’s (Szasz, 1976b; Vice, 1992). In similar fashion, whereas Laing appears to have endorsed a soft, permissive, and often passive attitude toward those with mental health challenges, Szasz’s approach was uncompromising, harsh, and often punitive (Clare, 1976). In parallel, Szasz used these differences to discredit Laing. In this respect, he attributed Laing’s antipsychiatric position – one Laing (1985, p. 11) himself did not recognize – to the idea that Laing’s philosophy rested on the collectivist creed of Marxist anti-capitalism (Balbuena, 2021). The truth is that Laing’s political thought changed over time. As a result, those who knew him at different times describe him variously as a Left-Leaning Scottish nationalist (in the 1960s) or a Romantic Liberal (in the 1970s; Burston, 2020), while Szasz (1976a), by his own admission, was a right-wing radical. With respect to Laing’s political affiliations, Redler is puzzled by the communist/socialist attributions, and actually recalls feeling disappointed when Laing seemingly abandoned the left-wing sympathies he appeared to hold at the time of the Dialectics Congress in 1967 (L. Redler, personal communication, December 30, 2020). Szasz, on the other hand, was in his own words ‘as far right as you can go’, and was associated with groups like the John Birch Society and the Church of Scientology. From this perspective, Redler is unsurprised that members of the PA might have seemed like communists or socialists, though, he wryly suggests, anarchists might have been more accurate. In his view, no one political philosophy predominated, but rather ‘[t]here was a desire to meet the challenge of finding our way. . .. for many, a personal and urgent necessity, while others focused on an effective and ethical way to respond to the suffering in others while seeking the roots of suffering in self and others’. For Redler, it was this desire to alleviate suffering in others, rather than any political affiliations, which unified the PA, something he doubted was of concern to Szasz (L. Redler, personal communication, December 30, 2020).

Existential analysis

Before entering into Szasz’s ideas about antipsychiatry, it will be useful first to consider Existential Analysis, the house organ of the Society for Existential Analysis (SEA), and locus of Szasz’s renewed attacks on Laing. Szasz had been invited to address a seminar at the SEA as early as 1989, and in 1994, some 5 years after Laing’s death, he joined the Editorial Board. Szasz’s (1976a) rancour toward his British colleague had not abated in the years since his first diatribe against Laing, as witnessed by the counterblasts he launched against Burston’s (1995, 1998, 2004, 2009) intermittent articles on Laing published in EA in the 90s and noughties. For anyone who believed that the personal dispute against Laing which Szasz had initiated in the latter half of the 70s had run its course with Redler’s response on Laing’s behalf, the articles Szasz published in EA clearly demonstrated the contrary. Indeed, he did not refrain even when Burston himself joined the editorial board in 1997 (a position still held at the time of writing), or when other practitioners sympathetic to Laing, namely John M. Heaton (1925–2017) and M. G. Thompson (1947–), were appointed. Heaton acted as co-editor (alongside Simon de Plock), from July 2000 to January 2007, and as board member the remaining 10 years until his death. Thompson joined the editorial board in 2005, where he remains today. Both had worked alongside Laing in the Philadelphia Association [PA] in the mid-1970s. Heaton had founded the PA Training Program in Phenomenology and Psychoanalysis in 1971, whilst Thompson had received his psychoanalytic training from Laing and Hugh Crawford at the PA, and served as the organization’s administrator from 1973 to 1980.

The strong animadversion noted above of Szasz toward Laing saddens me, when both shared a philosophical interest in existentialism, as was well-reflected in Burston’s (2004, 2009) papers on Szasz and Laing and antipsychiatry published in EA. Szasz’s reply is directed at Laing, and appeared in the journal. Existential Analysis was also of importance in the repercussions of Szasz’s book on antipsychiatry, and of Laing’s influence on the development of existential therapy in the UK.

The journal was founded in 1990, 2 years after of the creation of the SEA. The Society was created as a platform for existential therapists, who sought to increase the visibility, scope, and aims of their clinical work through the creation of a professional journal, Existential Analysis. According to van Deurzen (2010, p. 225), one of the founders of the SEA in 1988, the society and its corresponding journal represented an overarching organization for the approach, and provided existential practitioners with a home and a forum for exchanging views.

Van Deurzen notes that it was Laing who encouraged her in setting up the society, and had promised to give a talk on his method of doing therapy, although he died in 1989 before he was able to do so. Van Deurzen (2010) was the founding chair and many others contributed much to the success of the society, including the subsequent chairs, Ernesto Spinelli, Mike Harding, Paul Smith-Pickard, and Paul McGinley. Today, van Deurzen practices as an existential psychotherapist, counseling psychologist, and philosopher. Chapter 27 (pp. 218–224, subtitled ‘Antipsychiatry’) of her work, Everyday Mysteries. A Handbook of Existential Therapy (2nd ed., 2010), is dedicated to Laing. It focuses on the tremendous impact within mainstream psychiatry and beyond of the publication of Laing’s The Divided Self (1960). The following chapter, 28 (pp. 225–228), examines the contribution of the British School of Existential Analysis and Psychotherapy, and in particular the philosophical based approaches such as that represented by Steven Gans and Leon Redler (2001) among others.

Returning now to Szasz’s ideas about antipsychiatry, Anthony Stadlen, an existential-phenomenological psychotherapist who contributed various papers to Existential Analysis, provided the following information on the topic of his long correspondence with Szasz and his opinion on Laing and Szasz regarding antipsychiatry. Stadlen spent many years exchanging views with Thomas Szasz, drawing his to the way that Laing practiced both psychiatric coercion (Clancy Sigal) and the insanity defense (Stonehouse and Mina Semyon), while also defending Laing against the allegation of van Deurzen and Kenward that he was ‘deterministic’. Stadlen also acted as an advocate of Laing’s and Esterson’s in his Inner Circle Seminars. Szasz regarded this work as important and thought that Stadlen’s research on the families in Sanity, Madness, and the Family was important (A. Stadlen, personal communication, January 2, 2021).

From a slightly different angle, Burston’s papers on Laing and Szasz published in Existential Analysis shed light on his thoughts and feelings about Szasz, Laing and anti-psychiatry, and by extension Szasz’s criticisms of his observations about Laing and his associates. An attentive reader, aware of the intellectual stature of Laing as a thinker and therapist of distinction, would first note how Burston (2009) never uses Laing’s creativity to minimize or excuse his many sins. In Burston’s (2004) view, the publications of Szasz and Laing reveal far more points of convergence and intellectual kinship than Szasz was willing or able to admit. In saying this, Burston was roundly criticized by Szasz, even though he never excused or ignored Laing’s many faults and failings. In this respect, it is interesting how Burston’s own left-liberal political leanings were considered by Szasz as a sign of his uncritical admiration of Laing in detriment to Szasz. Burston gives a more balanced image of how this was perceived within the journal Existential Analysis. Burston (2009, p. 7) laments the degree of politicization and personal attacks within the journal. Whilst he acknowledges Szasz’s no small part in the situation, he defends Szasz’s libertarianism, which he brands ‘an updated version of 19th century liberalism, a la John Stuart Mill’, and applauds his commitment to the premise that ‘freedom and personal responsibility are always inextricably intertwined’. He nevertheless felt that Szasz’s criticisms of Laing were repetitive, and that ‘having already responded to him three times in the pages of Existential Analysis, I was tired of reading the same complaints and arguments from him’ (D. Burston, personal communication, December 23, 2020). In fairness to Burston, he only intended to evaluate the Laing’s stance in comparison with Szasz’s regarding psychotherapy and antipsychiatry. In this respect, he also reflected on Laing’s debt as clinician to existential-phenomenology, and the influence this exerted on the Laingian clinical approach (Burston, 1995). Nevertheless, it is also important to say that, though Laing’s work was rooted in existentialism, he was quite clear from the outset that his work was not a consistent application of any one thinker’s perspective (Burston, 1998). Burston has always been regarded as a serious and honest researcher (and not an uncritical admirer of Laing) with a very broad intellectual curiosity, as his long research trajectory and many published works testify. This gives him the advantage of being independent and not under the sway of any labeling or school of thought. Despite the affirmations of others, Burston never regarded himself as a ‘Laingian’, in the same way that, having written books about several important figures such as Erich Fromm, Erik Erikson, and more recently, Karl Stern, he does not identify as a Frommian, Eriksonian, or Sternian either. He is simply a biographer and historian of the mental health disciplines – psychiatry, psychoanalysis, psychology – who choses subjects whose contributions to the field were extremely important, but who have been unfairly maligned, misunderstood, or simply forgotten. John Heaton was in a somewhat similar position. He was sometimes described as a Laingian, but never embraced the label. Granted, he played a very important role in the PA, but had already acquired a sound knowledge of phenomenology before he joined forces with Laing there. He was a (sometime) friend and collaborator of Laing’s, not a Laingian per se. (D. Burston, personal communication, December 29, 2020).

After these reflections on the relationship of Laing with philosophy (through papers published by Burston on the topic) and Szasz’s attacks on Laing via Burston, which have served as waystations on the path to Szasz’s book on antipsychiatry, the next section discusses the book itself.

Szasz’s criticisms of Laing in his antipsychiatry essay

Before embarking on Szasz’s monumental 2009 work, it is worth noting that among the background sources Szasz cites for his book was an essay co-authored by R. Roberts and T. Itten, published 3 year earlier, entitled Laing and Szasz: Antipsychiatry, Capitalism, and Therapy (2006). Six year after its first publication, the paper was incorporated as chapter 24 of Itten and Young’s study, R. D. Laing, 50 years since The Divided Self (2012), albeit with slight modifications, and under the new title of Laing and Szasz revisited.

The essay makes the point that, though Szasz’s and Laing’s views coincide in attacking the medicalization of human distress and the coercive nature of the psychiatric system, Szasz had frequently expressed considerable antipathy toward Laing. The main reason for this hostility, the authors’ claim, derived from Laing’s critique of institutional psychiatry from within a Marxist framework, a position he took despite his own discord with leftist critics of his work and his rejection of the crude historicism which philosophers such as Karl Popper (1960) had discredited. Broadly speaking, Laing remained sympathetic to the Marxist analysis of historic change and the Marxist tradition of conducting precise analyses of prevailing conditions at any given time. In contrast, Szasz strongly refused to countenance any connection between his critique of the socio-economic forces hidden in the relentless rise of institutional psychiatry and Marxist criticism of the dominant social order (Roberts & Itten, 2006). Nevertheless, Laing and Szasz theorized from different ideological positions how to eradicate the institutional and organized oppression. Roberts and Itten (2006) speculate that the ideological differences between Laing and Szasz could have been avoided had they engaged in dialogue on how each conceived the Marxist matrix. According to Roberts and Itten (2006, p.788, 789) perhaps if Szasz had clarified his understanding of Marxist theory, distinct from the Soviet versions of Marxist-Leninism, Stalinist totalitarianism, and state capitalism, a more rational and useful debate might have been possible. In its place Szasz berated the antipsychiatrists in general, and Laing in particular, for not clearly stating whether they objected to psychiatric incarceration.

Further, Laing’s position is not aided by the infamous incident at Kingsley Hall involving Clancy Sigal (1926–2017), an American writer, his one-time friend, colleague, and patient, who was forcibly administered medication against his will (Szasz, 2009). As suggested above, Szasz is correct in his charge that Laing (and his colleagues) did not take psychiatric coercion seriously enough (it should be noted here that for Szasz psychiatric relationships are consensual-contractual or coercive-carceral). In addition, paraphrasing Roberts and Itten (2012, p. 270), Szasz foresaw the encroachment of psychiatry into everyday life, a danger Laing never envisaged, though his anxieties on the applications of scientific methods to the human person are much in evidence. In this respect, Laing judged that it was not necessary for psychiatric interventions to be relabeled, but that they should be changed in their fundamental character. For his part, Szasz’s remedy of abandoning the traditional medical model for a contractual psychiatry immune from state interference did not resolve any problems either. As Roberts and Itten (2006, p. 792) observe, if such a contractual psychiatry were to be of any use, then presumably its recipients would benefit from it. Such contractual arrangements would necessarily be available only to those who could afford them, thus excluding the poor in society. Consequently, Szasz’s solution serves only exacerbate the unequal distribution of well-being in society. Roberts and Itten (2006, p. 792) go on to imagine a dystopia of new ‘entrepreneurial psychiatrists’ composed of the psychologically privileged rich and the psychologically disadvantaged poor.

In his preface to Antipsychiatry. Quackery squared (Szasz, 2009), Szasz begins by saying that the term antipsychiatry is a dramatic misnomer, the blame for which he squarely lays at the door of Laing and Cooper. He accuses them of attracting attention to themselves while deflecting attention from what they really did – in his view, psychiatric practice based on coercion and pretexts, and sustained by psychiatric power and authority. Although a psychiatrist himself, Szasz firmly denied that his writings pertained to either psychiatry or antipsychiatry, affirming instead that his works were the product of conceptual analysis, social-political criticism, and common sense. In short, he rejected psychiatry and antipsychiatry with equal vigor. Like the prisoners in Plato’s allegory of the cave, illumination could only be achieved outside their confines (or in Szasz’s case the field of psychiatry). Even so, it is difficult to explain how, with the mentality of an expert trained in psychiatry, and an audience composed chiefly of psychiatrists, Szasz claimed that his writing belonged to a different intellectual domain to that of psychiatry. Itten expresses a similar line of reasoning when he wonders why, if for Szasz mental illness did not exist except as fiction, he never resigned from his professorship of psychiatry. Itten goes on to point out that Szasz never offered psychotherapy as the Philadelphia Association had done, although he did lend himself to Scientology, which could only damage his reputation. (T. Itten, personal communication, January 18, 2021). In my opinion, this last question can only be answered with a round no. Szasz did not repudiate psychiatry, only traditional, coercive psychiatry, thus becoming an antiestablishment psychiatrist. He eschewed being labeled an ordinary psychiatrist, as he saw himself as a crusader and informed agitator permanently criticizing and questioning conventional psychiatric practices. In doing so, he wanted to be a part of psychiatry, while also seeking to oppose it, which perhaps explains why he never resigned from his professorship of psychiatry. At the same time, Szasz accused Laing of what he claimed for himself, namely, wanting to be part of both psychiatry and antipsychiatry. Szasz attacked the professional trajectory and personality of Laing, focusing particularly on his character flaws, his association with David Cooper (whom Szasz painted in his darkest moments, raddled with drugs and alcohol) and his aggressive behavior toward Esterson. It was as if the harsh theoretical criticisms were insufficient, and Szasz (2009) also needed to denigrate him, his reputation, and his closest associates. Nor does Szasz, a self-declared conservative-libertarian, allow theoretical-practical challenges to psychiatry from a left wing perspective such as Laing’s. In my view, the latter half of 20th century history demonstrated that neither left- nor right-wing regimes can claim political superiority. It depends on how progress and social wellbeing have been put into practice. Their difference in approach to the mentally ill is well explained by Szasz (2009, pp. 26, 27), who trained and worked in the tradition of the private practice of medicine and psychoanalysis, shunned psychiatric institutions, limited his work to consensual relations with persons who supported themselves and paid for his services, and regarded the boundaries – ‘contract’ – between the obligations and duties of expert and client as being of paramount importance. In contrast, Laing trained and worked in psychiatric institutions, created a new one of his own, and pretended to erase the economic, existential, and professional boundaries between himself and his clients. Bearing this in mind, one might well imagine that despite certain minor disagreements, both were basically on the same side, interested in reversing the way mental patients were treated and were not listened to. Such a notion is clearly false, since Szasz continued and deepened his diatribe, claiming that Laing’s psychiatric practice, as well as his personal life, was permeated by the use of psychoactive drugs. Undoubtedly, Laing was not a saint, but nor was he unrepentant villain either (D. Burston, personal communication, December 29, 2020). However, Szasz makes the most of Laing’s human debilities for a merciless attack on him. Szasz should have stuck to psychiatric grounds, and avoided ad hominem attacks aimed at humiliating and discrediting him. Szasz (2009) proudly declares that there are no skeletons similar to Laing’s in his cupboard; had there been, he argues (pp. 82, 83), they would have long since been brought to light by his critics. He goes on to argue that Laing’s very public scandals, involving his drinking and the treatment of his family, constituted ‘public information about a public person’ and were hence open to public censure. Needless to say, Szasz’s judgment is damning. Mullan (1995) wonders how it was possible that, as someone who only met Laing on three occasions during his life, Szasz spoke of Laing in such defamatory terms. As noted above, Laing was not a saint, especially in his bouts of depression and heavy drinking, when he exhibited cruelty to others. Although deplorable, it is no justification for Szasz to hurl offence at him without being able to evaluate his personal life separately from his career. In my view, Szasz is frequently unable to extend a little professional benevolence toward Laing, characterizing his work through his life, and vice versa. In an example of this, Szasz affirms that Laing was a violent individual whose belligerence and combativeness were illustrated in Clancy Sigal’s comic novel, Zone of the Interior (Sigal, 1976). As Szasz (2009; pp. 59, 60) observes, the work is an important document as the events it recounts were subsequently confirmed by Joseph Berke, one of those who had been there. Szasz regarded this incident as irrefutable evidence that Laing was not opposed to psychiatric coercion. He labels Laing’s affirmation that ‘breakdown . . . can be a breakthrough’ an ‘apocalyptic-utopian’ slogan, fueling a craving for fame. This latter idea led me to wonder whether it wasn’t Szasz who was foremost in terms of controversy and attention-getting, not only for his spoken pronouncements and many books published, but also for his harsh, adversarial attacks on a potential competitor. As for Sigal, the 3 December 2005 edition of The Guardian (Sigal, 2005) printed his reminiscences of his experiences with Laing, whom he alternately describes as his therapist, mentor, friend, and occasional sparring partner. Sigal recounts his sense of betrayal at how was treated on suffering a ‘schizophrenic breakdown’. Contrary to the cornerstone of Kingsley Hall philosophy that psychosis was not an illness but a trance-like state to be valued as a healing agent, Sigal was physically overpowered and drugged with the powerful sedative Largactil. In doing so, Laing had not only broken a code, but had also committed a prima facie medical offence, as Sigal’s consent was not sought. Paraphrasing Szasz (2009, p. 67), the Largactil assault on Sigal incriminates Laing as the psychiatrist equivocator, for treating Sigal not as a person, but as an object without a will of his own. In this case, the ‘boundary violation’ of the doctor-patient relationship was broken as Laing and his colleagues feared that Sigal had become suicidal. His condition could not be known for certain (Thompson, 2007), but certainly Sigal himself believed he was not. From a bioethical perspective, the dilemma lay in choosing whether life was no longer in danger or obtaining the informed consent of the patient. In my view, in putting the preservation of life over the risk of death, Laing was forced to apply psychiatric coercion to Sigal (albeit thus violating the first Hippocratic principle of doing no harm). Whether there were more patients toward whom Laing acted in a similar way is unknown to me, this being the only apparent exception that aroused Szasz’s derision of Laing’s malpractice. In sum, in Szasz’s eyes, Laing did not practice the nonviolence he preached. Indeed, Szasz believed that the real reasons underlying Laing’s actions were loud and clear. In this regard, Szasz’s conjecture was that it would have looked very bad indeed for the psychiatrists at Kingsley Hall if the press reported that one of its founders [Clancy Sigal] went home and killed himself. If Laing and his colleagues had been truly concerned for Sigal’s life and believed that nothing short of psychiatric incarceration could ‘save his life’, they would have had to call the police and had him sectioned/committed. Thus it is plausible that had Sigal’s book been published in Britain in 1976, Laing would have been exposed and perhaps punished as a criminal, Kingsley Hall would have been shut down, and the legend of the ‘savior of the schizophrenic’ would have been cut short (Szasz, 2009, pp. 71, 72). All in all, in 2005, 16 years after Laing’s death and 29 years after the publication of Zone of the Interior (Sigal, 1976) in the Unites States, Szasz (2009) affirmed that interest in antipsychiatry had all but disappeared, and the term – more popular than ever – had become a grab-bag category for any person or group that was in any way critical of psychiatry’s disease or drug du jour. Perhaps Szasz was right in his view of antipsychiatry as antiquated and ill-suited to the needs of modern people in mass society. However, in my modest opinion, the spirit of antipsychiatry still remains alive in all those professionals (working under umbrella of ‘alternative psychiatry’ or ‘critical psychiatry’) who criticize psychiatric labeling and its connection to pathogenic economic-social systems. This mind-set is still more necessary if mainstream psychiatry today is that represented by somaticists, who attribute mental diseases to pathogenic microorganisms, or to chemical or genetic abnormalities.

In 2012, 3 years after of the publication of Antipsychiatry: Quackery squared (2009), Szasz died. His life as a high-minded psychiatrist devoted to denouncing the abuses of conventional psychiatry, and his considerable contribution to a better understanding of human nature, were paid homage in two commemorative studies (Haldipur et al., 2019; Schaler et al., 2017). For his part, Laing was paid tribute in the form of the multi-author volume edited by Thompson (2015).

Concluding remarks

In this paper and elsewhere (Balbuena, 2021), I have refrained from taking sides in the disciplinary, but also personal, battle between Laing and Szasz. In this respect, Redler made me wonder, after reflecting profoundly on this issue, whether there really was a debate between the two (L. Redler, personal communication, December, 30, 2020). Bearing this in mind, in my view, such a debate did take place, at least as far as Szasz was concerned, as he explicitly says at the end of his introduction to Antipsychiatry. Quackery squared (Szasz, 2009, p. 7). Szasz had eagerly hoped to deal directly with Laing and not have others like Redler or Berke ² respond. Formally speaking, all debate is a dialectic struggle in which debaters show ability in arguing and thinking in order to persuade. In essence, Szasz and those in contest with him, did this impeccably. In retrospect, as I have evaluated here, Laing’s silence had consequences. The first of these was the acrimonious debate between Szasz and Laingians (or at least, those who questioned everything which Szasz claimed about Laing). Coincidental to this issue, the position from which Szasz viewed Laing was overtly political, showing more rather ferocious and crude arguments than a considered critique (Kotowicz, 1997). The second involves Existential Analysis, on the editorial board of which sat Szasz, as well as Burston, an important biographer of Laing, and others like Thompson or Heaton, friends of Laing. From among these, I have picked out here Burston’s papers on the existential Laingian approach and the influence on this of others such as Martin Heidegger, as well as Szasz’s attacks on Laing via Burston’s papers published in this journal. As mentioned above, Szasz became a member of the editorial board of Existential Analysis in 1994, 5 years after Laing’s death, many works on Laing having been published in the journal since its inception. The 1991 edition of Existential Analysis was issued as a memorial issue to Laing, who had died in 1989. Among the many contributors, in alphabetical order, were names like Aaron Esterson, Alfons Grieder, John M. Heaton, Adrian Laing, Douglas Nicholson, Andrea Sabbadini, Ernesto Spinelli, and Emmy van Deurzen. Since then, it is difficult not to find any work published in relation to Laing or Szasz. If I mention this it is because maybe EA became a journal in which, with the exception of Szasz’s attacks on Burston’s papers defending Laing, it was possible that both influential psychiatrists had a quiet space in which their ideas were brought to the fore and discussed. In a very different line of thought, as I have shown here, is the debate on antipsychiatry, in which Szasz mercilessly attacked Laing. In any case, Szasz’s argument that he is inconsistent is totally wrong and ill-informed. Laing never denied the existence of mental distress, mental misery, confusion, suffering, and so on. As Laing himself affirmed (Mullan, 1995, p. 222), he only tried to show that this notion was more socially intelligible than most people supposed. However, Szasz looks out of place with these Laingian assertions, something more noticeable still after an attentive reading of his detailed book on antipsychiatry, to which I have dedicated a long section of this paper, including my own ideas and speculations. Many mental health professionals today would concur with Szasz’s views on mental illness, but also with Laing’s praxis on how to treat the mentally ill and reconnect them with society.