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ROBERT BOYERS
punished for what they said [Berke never tells us about this punish–
ment] , but the staff was under no pressure to do so. Power remained in
the hands of the administration, although everyone would be told that
the group was free and open." Just so, "everyone talking freely of what's
on his or her mind clashed with the fact that the door to the ward was
not even open." To dwell on such matters is to obscure the nature of the
disturbance afflicting so many inmates of mental institutions, and since
Berke understands so well what is wrong, we are surprised to see him so
insistent here. Many of the patients have been brought to their confusion
precisely by the failure of parents and others to set limits and make clear
distinctions. What have the Laingians been telling us, after all, if not that
mental illness is a strategy by which one opts out of intolerable situa–
tions many of which are experienced as too confusing to sort out. The
function of the analyst is, at least in part, to indicate the nature of the
decision
involved in breakdown, and to demonstrate a resolve not
actively to play roles in which he has been cast by patients.
In
this way,
limits are maintained, conventions like the therapeutic relation acknowl–
edged as conventions even as they are participated in. The capacity to
admit and to manipulate conventions is a strength that must be achieved
if the patient is to be restored to any sort of confidence. To suggest to
patients in hospitals that they are as free to go as to come, to be leaders
as to be victims, after they have cast themselves as wards of an institu–
tion, is to confuse matters further than necessary.
The Berke-Barnes book is, though, a moving and in some ways an
instructive document. While it can in no way be taken as a model of the
therapeutic relation -- Berke is an extraordinarily compassionate and
gifted man of a kind we may not hope to find in any profession - - it
does provide an accurate account of the extent to which therapy with
severely disturbed individuals has lately been developed, and of what
results may be anticipated. More, the book has a good deal to tell us
about the therapeutic acceptance of anger and of submission, potential
elements of experience many of us have denied ourselves. Had Berke
focused on these matters, and dwelled less insistently upon the fashion–
able issues, he'd have told us as much about the disabilities of "normal"
experiences as about breakdown and renewal.
