‘knots, tangles, fankles’: Book Review

Jeremy Kearney reviews knots, tangles, fankles (V. Press, 2021) by Alex Reed.

In 1964 when R D Laing and Aaron Esterson published the findings of their research into families where young female members had been diagnosed by doctors as suffering from schizophrenia it was met with widespread hostility by the psychiatric profession. The book, Sanity, Madness and the Family, consisted of vivid case studies based on multiple interviews not just with the young women but also their families and analysed the interactional and communicational processes between family members.

The negative response was not surprising as the book challenged the existing medical view that psychosis was a medical problem to be treated, instead suggesting that symptomatic behaviour and communication could become comprehensible with an understanding of the social and family context. However, as the standard medical view was that the existence of schizophrenia was an established fact, this encouraged the more general idea that Laing and Esterson were arguing it was the family that caused schizophrenia.

In order to counter this claim, Laing and Esterson wrote a new preface for the second edition of the book in 1970 in which they said:

“We propose no model of it (schizophrenia). This is the position from which we start. Our question is: are the experience and behaviour that psychiatrists take as symptoms and signs of schizophrenia more socially intelligible than has come to be supposed?” (Laing and Esterson 1970: 12)

This question also provides the impetus for Alex Reed’s fascinating and subtle poetic exploration of the case studies in Sanity, Madness and the Family in his first full collection of poems knots, tangles, fankles. The title comes from another book by R D Laing, Knots (1972) in which he attempted to distil the paradoxes of family interactions he and Esterson had studied in the earlier book into pithy, epigrammatical texts.

Reed uses the research material in Sanity, Madness and the Family to re-imagine it through the story of one particular family, the Dixons, consisting of Hazel, a sixteen-year old, her mother and father and the psychiatric services they come in contact with.

Building on the model of research in the book where the interviewers interviewed different members of the family, both individually and in various combinations, Reed draws on his poetic imagination, and his experience as a family therapist, to give voice to all the members of the family and also the professionals who engage with them. Using the possibilities offered by the relationship between printed text and the page each person is given their own recognisable identity where different speakers have different fonts, cases, line structure and word position, as well as tone, word choice and accent. Mirroring the process of a live family interview, the approach also allows multiple voices to speak in the same poem simultaneously.

The initial poems examine how intimate human relationships can get tangled up in ambiguities, contradictions and binds of miscommunication as Hazel tries to explore her own individuality but is also restricted and controlled by her parents.

She confides in her diary and speaks in lower case, short sentences and simple statements dreaming of possible futures and becoming aware of her awakening sexuality. But quickly her mother’s voice intrudes:

                                     we saw a dress, just what i wanted

                                     mum wasn’t sure

                                     well, if you like it dear

                                     but I don’t think you do 

                                     we’ll find something better

                                     something more – you

                                                       (‘dear diary, tuesday 9th january 1962’)*

Her mother speaks in bold, long stanzas and gossipy language as if she was talking to a friend on the phone:

         Now, this is the latest stage. She says she wants to be

         independent. Can you believe it? On Saturday I told her I’d

         take her shopping. We’d stop for a treat at Lyons Tea Room…

         Do you know what she said to me? I can do what I want!

                                                                           (‘In a roundabout way’)

The language of the father is tentative and unfinished with pauses between phrases as he struggles to understand why his daughter is changing:

         dear little girl               my poor little girl         come

         will you come     sit here      on daddy’s knee  

         smile             won’t you smile               wear your smile

         for me             we’ll talk together

                                                                 (‘daddy’s knee’)

In this restrictive context Hazel retreats into herself seeing her world shrinking and her family as living in a doll’s house and herself as a doll that is used and misused and kept frozen in a box:

                            and when you take her out again…

                            and she will smile, the same

                            as the first time you ever saw her

                                                                 (‘tiny tears’)

As Hazel’s distress increases she tries to protect herself by disassociating from what is happening around her:

                   hold my breath

                   they won’t hear me                          Even now I hear her thinking

                    If only she’d listened when we told her. If she’d listened when we warned her

                   my eyes are misty

                   sinking deeply

                                                                 (‘voices from the landing’)

Although the parents have more power in the family system than their daughter Reed does not suggest that therefore they must be judged as causing Hazel’s symptoms and distress. By giving them their own voices we get to understand the difficulties, limitations and regrets that emerged from their own family contexts. The mother, Gloria, relates how she experienced a ‘sleeping sickness’ as a young newly married woman:

                   … As if a grey mist had settled around me (‘Mist)

Both mother and daughter use the image of ‘mist’ to describe their experience, perhaps a hint towards Laing’s concept of mystification which “…is to befuddle, cloud, obscure, mask whatever is going on…” (Laing, 1964).

The poems in the book’s second half deal with Hazel’s admission to a mental hospital and Reed shows great skill in handling the multiple voices that co-exist within the psychiatric system. Poems are presented as interviews, case notes, reports, minutes and lists and he is unflinching in his exploration of the depersonalising effects of the chemical and electrical forms of treatment used in psychiatry at the time. These poems are written in Hazel’s voice and the reader cannot but be moved by the suffering she experiences.

Both Esterson and Laing appear in the text and the imagining of the therapeutic encounters between Esterson and Hazel are some of the few moments of human relatedness within the hospital’s repressive system. These are written as gentle, three line stanzas of the internal thoughts of Esterson as he attempts to make sense of what Hazel is trying to communicate through her behaviour. Careful descriptions of Hazel’s behaviour and demeanour lead to the introduction of moments of difference and possibility:

                   she sways from the waist in her chair

                   sways to the side

                   then backward and forward…

                   then, for an instant, she lifts her eyes

                   as if stepping from her swaying body

                   to place a bright flare in the space between us

                                                                           (second meeting)

Later Hazel speaks about her meetings with Esterson, the space he gave her to speak and to disperse some of the ‘mist’:

         at first I wasn’t sure of you

                                couldn’t make you out at all..                           

                                it seemed i was talking to myself

         but for the first time

         i could hear my own voice…

         & when the hour came to an end

         you finally spoke

         in your tender way

                                    we needed this to clear the air

                                                                 (‘the space between words’)

There is a very engaging cameo appearance by Laing when first he gatecrashes an interview between Hazel and Esterson and then a re-construction of one of Laing’s (well-known) late night visits to Esterson’s house at a time when they were both under pressure from the psychiatric establishment:

         Laing stumbles in without invitation

         Glenfiddich stuffed in his overcoat pocket

         sorry pal, did a wake ye…

         he brings his nose close to mine

         to kiss or crash

         his forehead against my skull…

         you’re the only one I can talk to Aaron

         we must hold together as best we can


The collection is movingly completed by the final poem presented as a letter a much older Hazel writes to Dr. Esterson. It shows her as a mature woman who has not only escaped from the binds that held her but is also able to read her own story dispassionately while enjoying getting on with her own life.

         a few years back I read the book that you wrote

         with your strange friend dr laing

         sanity, madness and the family-

         eleven girls just like me…

         the mist finally cleared

                                and I made the most of every minute

         soon there will be a tap at the door

                                 my granddaughter bustling in, laughing

                                                                               (‘my dear dr esterson’)

knots, tangles, fankles is a highly ambitious and original collection where Reed takes the complex and detailed research of Sanity, Madness and the Family and transforms it into a multi-vocal poetic sequence which not only engages with its radical theoretical ideas but also speaks to the human distress and pain experienced by some individuals and their families.

* note – it is only possible to reflect some of the stylistic techniques employed in the poems in the quotes used.


Laing, R.D. 1964. Mystification, confusion and conflict. I. Borzormenyi-Nagy and J. Framo (eds), Intensive family therapy. New York: Harper and Row, Chapter 9.

Laing, R.D. and Esterson, Aaron. 1970. Sanity, Madness and the Family: Families of schizophrenics. Harmondsworth: Penguin Books.

Laing, R.D. 1972. Knots. Harmondsworth: Penguin Books.

Jeremy Kearney trained as a social worker and family therapist and worked for many years in a university context. He has written a number of books and articles addressing various aspects of theory and practice in the social sciences. He currently contributes to the Dublin Review of Books.

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