Peter Sedgwick

Dangerous Half-Truth in Attack on the NHS

Who’s Mad – You or the System?

(5 February 1972)

From Socialist Worker, 5 February 1972. (review)
Transcribed by Ted Crawford.
Marked up by Einde O’Callaghan for the Marxists’ Internet Archive.

Peter Sedgwick reviews the new David Mercer film Family Life and discusses current left-wing attitudes to the treatment of mental illness

Few readers will need to be told of the great frequency and seriousness of mental and emotional disturbances which afflict large masses of the working population, including not only those who receive psychiatric treatment but also the members of the families living in the same household.

Active militants in the trade union and socialist movements often have to contend, not only with the pressing demands of the struggle and the attacks of the capitalist class and its agents, but also (what is perhaps hardest of all to bear) with psychological collapses, varying in their severity and character, but uniformly stressful in that they have to be faced in the isolated surroundings of the family home.

The stress or collapse may affect the child, the spouse, or the parent of the political activist, or indeed the activist himself (or herself).

In fact, if it affects any of his close relatives, he is hardly likely to remain unscarred by the immense strain which such problems bring. To take these problems outside the confidential circle of the family, into the doctor’s surgery or even to the sympathetic ears of close friends, is usually a step taken with great reluctance and often with a delay amounting to years, while the crisis in the household steadily accumulates.


For a long time, indeed, this psychological hell may not be regarded as arising primarily from an ‘illness’ at all or it may be seen as caused by some kind of physical illness, ranging from anaemia to ‘nerves’; The stigma of ‘mental illness’, along with fears of an hereditary taint and guilt feelings about moral responsibility for what has happened still operates very powerfully, even in these allegedly enlightened days.

The presence of physical illness at home can usually be discussed, at least in vague terms, among workmates and friends and accepted as the basis for sympathy or as an excuse for withdrawal from some organisational commitments. To admit to ‘mental illness’, however, whether affecting a relative or the militant himself, is still a much more shameful matter.

Mental stress and breakdown, whether psychiatrically treated or not, is thus one of the most grievous hidden costs of life in this type of society. There is no way of gauging how many thousands of individuals have the lives poisoned or wrecked in the secrecy of their own dwelling, while maintaining an apparently cheerful public ‘front’ outside the home.

Some limited scope, however, for the discussion of personal psychological problems under capitalism has been provided in recent years by the body of work which has been presented in more-or-less popular form by a Scottish psychiatrist R.D. Laing, and his colleagues.

Laing has concentrated on one important group of the ‘mental illnesses’ that; are diagnosed by doctors, namely the distinct order which is termed schizophrenia. This is among the most serious maladies recognised by modem psychiatric medicine: it is very hard to define in a few words since it includes a number of rather different ways of withdrawing from reality.


But anybody who is diagnosed as ‘schizophrenic’ by a psychiatrist is usually incapable of holding down a regular job, at any rate without episodes of breakdown that may last weeks or months, and is nearly always in serious trouble in his personal relationships

R.D. Laing has offered a number of theories about the nature of ‘schizophrenia’, and the methods used by doctors to treat patients diagnosed with this condition. His books on the subject are readily available (some of them of them are best-sellers in cheap paper back) and readers who want to discovered more about his ideas can easily do so.

Roughly, he says firstly that ‘schizophrenia’ is not a mental illness at all but a disapproving label which is fixed on people by their relatives acting in collusion with psychiatrists to condemn these victims to a long career inside a mental institution. And, secondly, that since our kind of society is clearly mad anyway, the people who are called madmen by public opinion may (at least in some cases) be the sanest of us all

What doctors and relatives call hallucinations’, ‘delusions’ or other ‘symptoms’ of insanity may really be important experiences for the person undergoing them, something like a mystical meditation or a really good trip on LSD. Laing condemns all the methods of psychiatric treatment that are commonly used to treat schizophrenic patients in the Health Service, and has tried, along with his followers, to set up a number of small-scale units in which so-called schizophrenics helped by close personal support and encouragement with little or no medication way of drugs.

There is no evidence that these units have been any more successful than good NHS hospitals. Laing’s ideas have had some success in the medical profession, if only because mental patients like what he has to say, are sometimes able to influence their psychiatrists by argument.

He has enjoyed a tremendous vogue among young people and older middle-class trendies, most of whom know nothing about the subject apart from what they have read in Laing. At the moment this school of thought is in some disarray, for Laing (after flirting with Marxist language on and off during the last few years) has pulled out permanently from all his patients and sympathisers and gone off to monastery in Ceylon where he has been spending about 17 hours a day meditating on Buddhism.

Since a fierce civil war has been going on in Ceylon between the government there (which is a stooge of foreign capitalism) and a revolutionary movement of youth, trade unionists and peasantry, Laing’s departure for that country at this particular time has somewhat spoiled his progressive reputation, particularly since the Buddhist establishment in Ceylon supports the state’s bloodthirsty repression of the left.

Laing’s theories are enjoying a boost from an extremely powerful film made by a writing and production team of convinced Socialists. This is Family Life scripted by David Mercer, produced by Tony Garnett and directed by Ken Loach, now at the Academy Cinema in London It has had rave reviews from virtually all the critics especially liberal or left-wing ones.

The basic story is one that is found repeatedly in all Laing’s accounts of what the dreadful psychiatrists do: a naive young girl (appealingly played by Sandy Ratcliff) is driven slowly into a condition of frightened inert withdrawal by her two horrible parents, who goad her, nag her and generally mess her up with their repressive, authoritarian, dishonest, brutal (or sometimes saccharine sweet) chatter.

At first the poor girl gets some sympathetic psychiatric help in a ward run by a Laingian doctor, who is called Mike by his subordinates and conducts therapy-sessions through earnest discussion about relationships. This nice doctor is however witch-hunted from the hospital by a snooty, Tory-minded administration, and when Sandy goes in again for treatment it is at the hands of a cold, tight-lipped doctor (who seems to live only for the purpose of giving electro-shock treatment to his victims) and a complacent, uncomprehending and bureaucratic nursing staff.

Sandy escapes from the horrors of the National Health Service on the back of her boyfriend’s Vespa, but is mercilessly hunted down by yet another repressive, authoritarian, bureaucratic doctor who comes with the uniformed fuzz to drag her back to the ward. As a result of these exertions, she is finally reduced to a pitiable state of vegetable lunacy, and placed on display before a classroom of toffee-nosed medical students as a typical case of the disease ‘schizophrenia’. End of film.

We are given to understand that, beneath her outward weird behaviour, Sandy is groping towards a true revolutionary analysis of modern capitalism. ‘A machine in the centre of the world is controlling us all!’ she obligingly yells to the ward nurses, who obviously think the poor woman is crazy and quell her revolutionary speech with an injection of potent tranquilliser.

The message of Family Life is basically that since life in our society is repressive and exploiting, mental illness is one more form of protest which deserves our sympathy and solidarity. And the psychiatric treatment of mental illness (except in a form which is virtually unavailable to the working masses, i.e. through intensive therapy of the Laingian type) is seen as a part, perhaps an essential part, of the brainwashing, head-fixing, mind-dulling apparatus of modern capitalism.

This message is in many respects true. But it is a half-truth at best. And the half of the message that is false is dangerous – all the more dangerous because it is likely, through this skilful, well-intentioned film, to reach and impress a wide audience.

For if there is no such thing as mental illness, we can have no use for the idea of mental health. We can therefore make no demands on the system to provide better facilities, material and personal, for the treatment of the mentally ill. There can be no question of drawing up a programme for a greatly improved psychiatric service within the NHS.

We cannot demand the expenditure of millions of pounds on more and better mental hospitals, more and better doctors and nurses – at the expense of armaments and the profits of the rich – for Mercer has told us that all that these hospitals, doctors and nurses do is to brainwash potentially revolutionary people through the use of drugs and electro-shock.

Unwittingly, the authors of this film have created a climate of opinion in which their audiences will no longer be so keen to resist the present massive Tory attack on the psychiatric facilities of the Health Service. For the Tories also want to close down the mental hospitals, to cut central expenditure on the aftercare of the mentally ill and throw them on the mercy of the local authorities who will find it easy to reduce expenditure for this powerless and unpopular section of the community.


In that case, the burden of mental illness will be thrown back on to the working class, to be dealt with in the isolated, walled-off home-situation of the agonised common man and woman. It is a burden which is already intolerable: it must be a central demand for the working class and socialist movement that, on the contrary, the state must accept responsibility for the care of the mentally afflicted – not on the cheap, by impersonal mass-produced treatment in overcrowded hospitals, but as expensively and expertly as we would wish to be treated ourselves.

More generally, Family Life panders to the common prejudices which create the stigma of mental illness. It tries to persuade us that there really is something horrific and shameful about seeking medical help during a time of emotional distress; that to submit to a controlled state of unconsciousness which may afford temporary (but essential) relief from a personal nightmare – which is what electroshock therapy does when properly administered – is some kind of surrender to the ruling class; that to take a tranquillising; pill or injection – again perhaps for relief rather than any profound cure – is to accept conformity with the goals of our hateful social system.

It cannot possibly encourage any person with serious mental trouble to seek voluntary treatment from any existing NHS facilities – it can only discourage and frighten them. And it cruelly mocks (through its caricature of the family situation of a schizophrenic patient) the awful dilemmas which confront thousands of actual families in which all, perhaps, are ‘ill’ but one particular person is actually crazy.

The majority of diagnosed schizophrenics who enter treatment are not bullied youngsters but older people aged 30 and over and it is a consistent finding of medical sociology that schizophrenia strikes the lowest social classes with the greatest frequency in proportion to numbers. The Laingian schizophrenic, living full-time in a sympathetic commune with his psycho-analyst, savouring the ups and downs of his romantically mystical ‘trip’, is a delightful spectacle for the intelligentsia who come to watch him; he is not a practical possibility for the average working man or woman undergoing mental torment in the midst of family responsibilities.

There are many aspects of Mercer’s (and Laing’s) case which deserve support. It is probable that the actual diagnosis-label ‘schizophrenia’ is too confused to be of much further use in psychiatry. (Psychiatrists in this country, incidentally, tend to avoid using it in comparison with their American colleagues; a diagnosis of ‘depression’ is made nine times more frequently over here than in the USA, and in one study when a film of a disturbed patient was shown to a sample of 32 British psychiatrists, none of them called him ‘schizophrenic’ while a third of the sample of 40 American psychiatrists used this label.)


We know, but still need to be told, that many mental hospitals are bad, that many psychiatrists are incompetent and reactionary. The same of course applies to hospitals, doctors and nurses dealing with physical medicine, only nobody thinks of using this to attack the very existence of public amenities for treating physical illnesses.

Politics and psychology both demand serious and disciplined theory and practice; in both we should avoid being captivated by fashionable trends. Lenin’s advice to a sick comrade was at all costs to stay away from marxist medicos and go to bourgeois specialists instead: ‘Really in 99 cases out of 100, doctor-comrades are asses ... To try on yourself the discoveries of a Bolshevik – that’s really terrifying.’

Dr R.D. Laing is not even a Bolshevik, It is to be hoped that those who thought that he was a ‘doctor comrade’ will have some serious second thoughts.


Last updated on 5.12.2004