Talk Therapy

Barbara Taylor’s new book highlights a very personal inner journey.

The Last Asylum: A Memoir of Madness in Our Times is a story of salvation. After moving from Canada to do postgraduate studies at the London School of Economics, Taylor struggles to complete her doctoral thesis and has her first breakdown. There are multiple problems over the next two decades including depression, suicidality and substance misuse.

“I was literally my own worst enemy,” she writes, “simultaneously victim and victimizer, brutalized and brutalizer.”

Things improve thanks to psychoanalytic therapy, treatment by a psychiatrist and two admissions to a psychiatric hospital. But of these, it is psychoanalysis that Taylor flags as pivotal. “Psychoanalysis works, when it works,” she tells us, “by transferring the patient’s ‘illness’ on to the analytic relationship so that its mechanics—the unconscious fantasies and fears that drive the illness—can be exposed and, over time, dismantled.”

In her case, this means ending a litany of failed heterosexual relationships and resuming an academic career that had gone off the rails soon after her breakdown. Today she lives with her same-sex civil partner and children in the United Kingdom and is a distinguished academic historian and award-winning feminist author. If you are concerned that I should have given you a spoiler alert, do not worry. The book is not about this narrative. It actually ignores the brilliance of Taylor’s career, her academic awards, her full professorship at the University of London and what happened after her triumph over mental illness. Very Canadian? Perhaps.

The Last Asylum is a must-read for people interested in the field of psychoanalysis. If you are searching for a full account of Taylor’s life, however, you will come away wanting more. Similarly you might wish she had elaborated on the careers of her astonishing Welsh communist father, who took part in the Spanish Civil War, and her mother, who had a lasting impact on human rights in the Prairies.

You may also feel you want to learn more of Taylor’s view of the United Kingdom as it went through significant social changes. She was in Britain during the race riots of the late 1970s and ’80s, through the relationship of Charles and Diana, the dismantling of the unions and the miners’ strikes, the fall of Thatcher, the rise of the European Union, the birth of Cool Britannia and Tony Blair, Britain going to war in Africa and the Middle East for oil, the rewriting of the civil contract and a wholesale transformation from a post-war collectivist mentality to an increasingly individualistic society. And you might want to hear Taylor’s views on all this especially because she was a Canadian outsider, a feminist and historian with a trenchant way of commenting on contemporary mores.

But all these things are either absent or heavily downplayed. Instead, The Last Asylum focuses on the problematic aspects of Taylor’s childhood, as well as her relatively brief stints in a psychiatric hospital. As she delves into this past, the memories are often raw with passion and anger. Only gradually does she come to understand and acknowledge the demons that make her life a misery. Classically Oedipal, she tells us she loved her father, despite the fact that he was “a domestic tyrant of the old school,” and despised her mother. She and her mother were “locked together in a death grip.” As Taylor reached adolescence, the relationship gradually became a “war over Daddy” and “a nightmare of envy and hate.”

All of this is related by Taylor with eloquent honesty, but I cannot help but wonder what would have happened if her considerable writerly powers had been streamed differently. Could her thoughts have been less focused inward and more focused outward? Would The Last Asylum have then been a seminal autobiographical account of her compelling journey as well as that of an outsider making sense of tumultuous social change? Perhaps that is a book she may still want to write.

But we need to look at the book that she has actually written, and since the culminating purpose of The Last Asylum seems to be its defence of psychoanalysis, the reader must pay close attention to the strategies she uses in attempting this—for The Last Asylum is not just a personal narrative. At times Taylor steps back to summarize the recent history of psychiatric trends in the United Kingdom, a summary that she employs not just to give her own story wider resonance, but also so that she can pass judgement on what she sees as the contemporary betrayal of the mentally ill by the medical establishment through its emphasis on community care.

The two elements of her tale—the personal and impersonal—do not sit easily together, not least because Taylor expends little energy connecting the two. Most significantly, she presumes that her readers will be aware of the nuances of psychiatric methods and their evolution, when in fact it is likely that many will not.

Let’s provide what is hopefully some useful context. Most laypeople know psychoanalysis is a system of therapy that aims to treat mental health problems by investigating the interaction between unconscious and conscious parts of the mind. It sees mental health problems as conflicts between basic drives that are mainly unconscious and our ideals, morals and values that are mainly conscious.

What is less widely familiar is that there are more than 20 different schools of psychoanalysis. In broad strokes, each one of these schools presumes that personality is part inherited and partly due to what happens to you in childhood, although the relative emphasis differs depending on the school. Childhood is considered important because how we lead our life is partly governed by irrational drives that we develop during this time. In adult life, conflicts between our irrational drives and our morals or ideals lead to psychological problems. If the drives are deep-seated, then trying to resolve them may be difficult. Through psychoanalysis, a skilled therapist can help us bring our inner conflicts from our unconscious to our conscious, thereby permitting some sort of psychological resolution.

Several of the dominant forms of psychotherapy are based on Freud’s ideas. He developed a number of theories that included the Oedipus complex as a central tenet and the idea of libido as the source of hate, aggression, guilt, neuroticism, a death drive and eroticism. Some observers have argued that Freud saw the whole world through sex-tinted glasses. That was probably completely in line with his patients who were trying to release themselves from the straitjacket of their 19th-century upper class Austrian lives. And it resonated further, given the extent to which Freud’s theories have become fundamental to western culture’s understanding of the individual.

That means many of us take Freud for granted, although if you spend any time working or living outside the West you soon come to realize that Freud has little traction there. This is partly because the focus on sex and libido is considered distasteful in many non-western contexts. In particular, the idea of even figuratively wanting a sexual relationship with your parents is considered anathema. But there are other potential reasons for this lack of influence as well. In cultures fashioned on the ideal of service to the community, theories that make people think about themselves rather than others are not welcome.

There are psychoanalytical traditions more in harmony with these principles. I will focus on an important alternative tradition here, although there are others. One of Freud’s students, Alfred Adler, split from Freud and developed a theory of individual psychology that can only be described as a value-based model of personality development and philosophy of living. Adler’s psychology aims to encourage the development of healthy, cooperative individuals, families and couples in order to help society develop equality and democratic living.

In essence Adler’s psychotherapy is outward focused: it is about the person in their context and includes an understanding that service for others and compromise is a way to build your sense of community and make your life complete. In Adler’s theories there is more to life than sex and more to the world than you. His work is more about making yourself happy by making the world a better place, rather than making yourself happy by understanding where your drives come from and accepting those drives.

I do not question that getting in touch with your childhood misunderstandings of life actually treats mental illness. As Taylor and many others have argued, it is useful and for some vital. The issue for me is whether there is a richness that is lost by looking inward in this way. Does the type of increased narcissism that much of psychoanalysis promotes really help us move forward as a society?

In addition, at several times she refers to the expense of her own psychoanalytic journey and the fact that the sort of intensive treatment she received was not even remotely accessible to the vast bulk of Britain’s population. She also goes out of her way to stress what she sees as the social inequities lurking within contemporary psychiatric thinking. But this scattered treatment hardly adds up to a nuanced critique of the social aspects of psychoanalysis in societies such as ours, especially from the pen of a seasoned cultural historian.

The fact that Taylor is alive, well and writing great books is a gift to society. It is a testament to her hard work and that of psychiatrists, psychologists, psychotherapists, psychiatric nurses, social workers, and her friends and fellow patients in the United Kingdom’s National Health Service.

Still, as I finished The Last Asylum I also could not help but wonder what sort of book it might have been if Taylor had had psychoanalysis that focused her energies outward into society rather than inward toward her drives and childhood. After all, the true triumph of humanity is not what can be offered to the select few in defeating their internal demons in ways that may merely extend their narcissistic urges. Instead it is what a civilized society can equitably offer to the many. It is about us putting our energy into thinking about we rather than me.