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Guest Essay: “A mind diseased”: Examining the evolution of madness using Shakespeare’s Macbeth by Sarah Ahmed

31 Aug, 14 | by BMJ

 

INTRODUCTION

Over the years, our understanding of what it means to be mad has evolved. Ancient civilisations held the belief that madness was as a result of spiritual possession; the Enlightenment’s concept of rationality remade madness into an external manifestation of internal grief; in the last century we have started to develop biological theories of mental health as we begin to understand more about how the brain works on a synaptic level.[1] It has even been suggested by prolific writers such as Szasz and Foucault that madness is not a disease at all but rather “a cultural construct, sustained by a grid of administrative and medico-psychiatric practices”.[1 (p.3)] It follows that as our understanding of madness has developed, so too have our readings and interpretations of madness in literature as we apply new theories of illness to fictional characters (perhaps in an attempt to empathise more strongly). Bossler said that “Shakespeare’s characters have always been a fertile field for the application of psychological principles”[2 (p.436)] and Shakespeare’s graphic descriptors of a “mind diseased”[3 (5.3.41)] have leant Macbeth to continuous reinterpretation.

In many readings of Macbeth the play has been approached using a particular literary theory or frame of reference. For example, Freud and his followers have analysed the play using the lens of psychoanalysm,[4] prion-based theories of madness have been applied to the text[5] and some have suggested that Macbeth’s madness is a result of battle fatigue.[2] Alternatively the play has been analysed using an approach more in line with New Historic theories of interpretation by considering the historical and social context of the time: the humoral theory of health[6, 7] has been applied to the play and the characters’ dramatic evolutions have been examined from a religious[8] or gendered perspective.[6] Each interpretation presents a new way of understanding old characters and each will be explored below as we examine how our understanding of madness has evolved and argue that if a frame of reference is important to our understanding of Macbeth, a deeper appreciation might be achieved by considering the notion of madness from the perspective of the Elizabethans.

 

FRAMES OF REFERENCE

By simply using a literary approach it is clear both Macbeth and Lady Macbeth undergo dramatic evolutions over the course of the play, be this into madness or something else. Macbeth, who is initially seen to cower beneath his wife’s ambition, “grows ever more frightening…as he becomes the nothing he projects”; conversely, Lady Macbeth implodes and withdraws from society.[9 (p522)]

Macbeth’s decline begins almost immediately following the couple’s decision to take the crown – the great warrior Macbeth is seen to be anxious about the proposed murder, saying “If it were done when ‘tis done, then ‘twere well/It were done quickly”.[3 (1.7.1-2)] Even before the murder his worries manifest themselves as hallucinations when he sees the now famous “dagger of the mind”,[3 (2.1.38)] which first appears clean before being doused with “gouts of blood”.[3 (2.1.46)] His deterioration progresses when he returns to the stage after murdering the King and claims auditory hallucinations, hearing “a voice cry, ‘Sleep no more:/Macbeth does murder sleep”’.[3 (2.2.38-39)] In saying this Macbeth becomes almost premonitory (like the Weird Sisters) as he does indeed suffer sleep disturbances later on, a “symptom” which is often quoted in discussions of his madness.

Lady Macbeth’s fall is more measured and gradual – whilst Macbeth is hearing noises she admonishes him as she would “shame/ To wear a heart so white”.[3 (2.2.67-68)] Here the colour white has connotations not only of innocence and purity but of cowardice; it evokes the white feathers of World War One which were given to the men refusing to enlist. Most of Lady Macbeth’s dramatic evolution occurs off-stage as is typified by the change in her mode of speech. In the banquet scene of Act3 Scene 4 Lady Macbeth’s gravitas and assurance is obvious in how she address the nobles in verse:

Think of this, good peers,

But as a thing of custom. ‘Tis no other,

Only it spoils the pleasure of the time.[3 (3.4.96-98)]

She is the very embodiment of regality. This is contrasted against Act 5 where she speaks only in prose. In Shakespeare’s plays prose was often reserved for the lower classes, or for conversations between characters who are knew each other well, such as Rosalind and Celia in As You Like It.[10] It was also used in the speech of characters who were mad or feigning insanity, as verse was apparently “too regular and orderly for expressing madness”.[10] As such Hamlet, Ophelia and King Lear all speak in prose at some point in their respective plays.

 

The (d)evolutions of Macbeth and his wife have also been subject to particular frames of reference. A psychoanalytic reading would suggest that Macbeth’s madness is due to a “psychic catastrophe”,[4 (p. 1483)] which is a direct result of his murder of the King. In this reading the King acted not only as Macbeth’s Superego, but that of the whole country, representing “the unifying power which bound the warrior’s destructiveness and directed it towards external enemies in order to preserve stability in the kingdom”.[4 (p.1488)] This goes some way to explaining why Macbeth is so affected by this particular killing as the King was not only his head of state but the means through which “Belladonna’s bridegroom”[3 (1.2.54)] could funnel his inner destructive nature. Conversely, the witches represent a “malignant regression to primitive states of mind”[4 (p.1484] and the other extreme of Macbeth’s psychic spectrum. In taking heed of their premonitions Macbeth turns towards his Id; in returning to them for help and validation Macbeth gives in to his base nature.

A Freudian reading doesn’t label Macbeth’s behaviour with a diagnosis but instead strives to understand why the Thane behaves the way he does. A Freudian would believe that Shakespeare merely described behaviour which he had observed in mankind but never had a frame of reference to explain what he saw; Freud’s theory provides this context.[4] The ease with which some of Shakespeare’s plays lend themselves to a Freudian interpretation has been used as evidence for this view with the most famous example being Hamlet and its connection to the Oedipus story. This idea that Shakespeare described human nature accurately but was missing the terminology to explain what he saw has been used repeatedly in various literary theories and evokes Lawrence Olivier’s famous proclamation that Shakespeare was, or is, “the nearest thing in incarnation to the eye of God.”

 

More recent theories of madness, which have originated as our understanding of both biology and psychology has developed, have also been applied to Macbeth. One such theory is that Macbeth suffered from Creutzfeldt-Jakob disease (CJD), or another similar prion disease.[5] The paper which proposed this theory was published in the Clinical Infectious Diseases Journal, highlighting how a person’s background can be used to form the frames of reference they use in their interpretation not only of the scientific world but of literature. It is important to note that the authors of the paper admit that Shakespeare may not have intended Macbeth’s dramatic evolution to mirror the natural history of a prion disease; similar to advocates of psychoanalysm they believe the playwright showed “an uncannily prescient understanding of prion disease transmission via exposure to neural tissues”[5 (p.299)]but lacked the context to explain it. The variety of human and animal offal present in the witches’ brew is considered the possible source of transmission.[5]

In creating their theory that Macbeth may have suffered from CJD the authors look beyond the usual symptoms of traditional madness – sleep disturbances and hallucinations – and find quotative evidence for more specific indicators of prion disease such as “neurological and cognitive deterioration”[5 (p299)] as well as “myoclonus and involuntary movements”.[5 (p.301)] However in most of the examples found it is possible to take what Shakespeare wrote and interpret it as a metaphor. For example, evidence for myoclonus is found in the following quote:

Take any shape but that, and my firm nerves

Shall never tremble. Or be alive again,

And dare me to the desert with thy sword;

If trembling I inhabit then, protest me

The baby of a girl.[3 (3.4.102-103)]

It may be that Shakespeare intended the reader to take the above literally and imagine Macbeth trembling; conversely it is just as likely that he meant it as a metaphor and Macbeth trembles in fear of the Ghost – even today we use similar expressions. After all, Shakespeare was foremost a poet. The following quote has also been attributed to myoclonus: “Then comes my fit again. I had else been perfect”.[3 (3.4.20)] It is similarly ambiguous as there is nothing in the script to suggest that Macbeth has an actual fit; it is more likely to metaphorically psychological in nature.

 

In a similar fashion, Macbeth’s dramatic evolution has been attributed to a diagnosis of battle fatigue.[2] Similar to explaining Macbeth’s madness as CJD, or even in examining it through the lens of psychoanalysm, the theory’s creator admits that although Shakespeare may not have set out to describe a case of battle fatigue, “the only thing new about [attributing a diagnosis of battle fatigue] is its name. Human nature remains the same”.[2 (p436)] Again it is interesting to note that the author of this paper is a military veteran.

The symptoms of battle fatigue are similar to those of traditional madness and CJD – “obsession of anxiety, jumpiness and inability to sleep”;[2 (p.437) however Macbeth has also been exposed to all the causes of battle fatigue.[2] The ceaseless toil of first the war and then the murder, combined with Macbeth’s powerful imagination, tips the balance of sanity towards dominant thoughts of blood and war.[2]Macbeth’s subsequent murders are explained as him returning to the place where he has known most success – the battlefield – in an attempt to cure himself of his malady; he tries to find peace by doing what he does best, except now he “enjoyed killing others too much to kill himself”.[2 (p437)]

 

IS IT ENOUGH?

In each of the above theories Macbeth is interpreted using a particular frame of thought; as was particularly prominent with the CJD and battle fatigue examples the frames of reference were drawn from the author’s life experiences. It is interesting to note that in each of the above readings it was claimed that Shakespeare merely described human nature (admittedly with some finesse and precision); what each new theory brings is context based on new interpretations of madness. Applying contemporary theories of (psychological) illness to diagnose literary characters is a phenomenon which is not just limited to Macbeth, or even to Shakespeare’s work: Winnie the Pooh’s Pooh and Piglet have been diagnosed with ADHD and General Anxiety Disorder respectively;[11] it has been suggested that Darcy may place on the Autistic Spectrum.[12] It is possible that our current biological theories will one day be disproved and appear outdated to future generations, and highly probable that as we develop new theories of madness these too will be applied to fictional characters, and we will have new ways of interpreting the actions of the Thane and his Lady.

However it is also probable that Shakespeare intentionally modelled his characters around Elizabethan notions of madness; unfortunately we can never know what Shakespeare meant when he described “a mind diseased”.[3 (5.3.41)] However by accepting that Shakespeare was an accurate portrayer of human nature we can begin to understand what Elizabethans thought about madness by examining the play in its historical and social context. Braunmuller agreed by saying that critical “claims are often false to the play’s complex relation with the social and political circumstances in which it was first written and first performed”.[3 (p.1)]Knowing more about these circumstances could be hugely useful, not only in giving readers a deeper understanding of the play but in showing us how mental illness was viewed in the 1500s/1600s. It is in this vein which we will continue.

 

HISTORICAL AND SOCIAL CONTEXT

Medicine, health and the medical professions feature heavily in Shakespeare’s plays and those of his contemporaries,[13] and “it has long been recognized that England in the period from 1580 to 1640 was fascinated with madness”.[6 (p.316)] However it has been suggested that Shakespeare’s knowledge is greater than that of a regular Elizabethan.[14] The reasons for this stretch beyond the scope of this essay but it can be assumed that Shakespeare knew about current theories of health and illness. It was during the Elizabethan era that madness started to become medicalised and was seen as humoral in nature; it was also associated with gender and religion. Each of these viewpoints have been used to interpret Shakespeare’s work.

 

Humoral theory stated that melancholy, now known as depression, was caused by an excess of black bile, the humor associated with winter and dryness. This resulted in a combination of “passivity, unsociability, fury, stupidity, paranoia, lust, anger, mania, but especially sorrow and fear”.[6 (p.319)] Most of these, in varying combinations, are seen in Macbeth and Lady Macbeth after they decide to kill the King. The use of humoral metaphors has been explored extensively in Shakespeare; in Macbeth it is especially with relation to Lady Macbeth and her ambitious nature.[7]

 

Despite more “scientific” theories it was also around this time that madness began to become gendered – although the frame of reference may have shifted from religion to reason, women were still seen as weak, second class citizens.[6] Melancholy in its purest form was associated with “the upper class, the literate, the masculine”.[6 (p. 319)] Conversely women were thought to suffer from melancholy’s sister, hysteria.[6] This idiosyncrasy can be clearly seen in Shakespeare’s Hamlet where Hamlet’s (possibly feigned) madness is always seen to be quite noble in nature – he is never anything less than the distressed Prince of Denmark – whereas Ophelia’s is seen almost to be “beautiful, sweet, lovable, pathetic”.[6 (p. 322)]

This gendered madness can also be seen in Lady Macbeth’s descent, which holds many similarities with Ophelia’s madness. Like Ophelia, Lady Macbeth speaks in riddles and without apprehension of her surroundings; both repeat key phrases in their deliriums with Lady Macbeth meditating on all the blood her and her husband have spilt; both return to the stage in their mad stage in the second half of the play after a prolonged absence; both their lives end in apparent suicides. The women of the play become “cultural scapegoats”[6 (p. 328)] as Lady Macbeth’s sex automatically acquaints her with the “so withered and so wild”[3 (1.3.38)] Weird Sisters. Conversely we sympathise with Macbeth, seeing him “not as the victim of a revengeful God, but as a victim of Macbeth himself”.[8 (p. xxii)] This is because Macbeth’s madness and feverish passion is seen as manly – at the start of the play even the strong Lady Macbeth expresses a desire to be “unsex[ed]”,[3 (1.5.39)] to possess the cruelty associated with ambition which her husband seemingly possesses.

 

The role of religion also plays an important part in the play. Although the theories of Enlightenment had started to permeate into society, religion and God still strongly influenced the way in which people interpreted their world. With this in mind it is possible to see the dramatic evolutions of Macbeth and his wife as religious punishments given due to breaches in their God-given consciences. It has been suggested that “the external phenomena associated with conscience manifest themselves more clearly in Macbeth and his wife than in any other of Shakespeare’s dramatic personages”.[8 (p. ix)] Madness aside, there are many Christian references throughout Macbeth. Lady Macbeth advises her husband to “look like th’innocent flower,/But be a serpent under’t”[3 (1.5.63-64)] in a reference to the story of Adam and Eve in the Garden of Eden. By counselling her husband to be a serpent she equates murder with its patron, the Devil. In preparation for the murder Macbeth reassures himself that Duncan’s ‘virtues/Will plead like angels”.[3 (1.7.18-19)] Lennox wishes that “a swift blessing/May soon return to this our suffering country”,[3 (4.1.48-49)] suggesting that holy salvation is needed to save Scotland from Macbeth’s unholy crimes. The fact that the Doctor advises Lady Macbeth “more needs…the divine than the physician”[3 (5.1.64)] has been used as evidence to suggest that “Shakespeare wanted us to view her condition as the result of remorse, as the outcome of her guilty conscience”.[8 (p. 15)] However this statement can be viewed in one of two ways – either the Doctor is aware that Lady Macbeth has committed unholy crimes and so needs spiritual retribution more than a medical solution; it could also suggest that the Doctor believes all cases of somnambulism to be spiritual in nature and so recommends a divine solution.

Perhaps this conflict between religion and science is indicative of Shakespeare’s own, confused beliefs. It is not impossible that he realised that “by constructing a language through which madness can be represented, the popular theatre facilitated the circulation of the discourse; by italicizing the language of madness, it encouraged its interrogation and transformation”.[6 (p. 338)] Especially true in the Elizabethan age this is particularly poignant today; theatre provides us with a way of interpreting health and disease – it allows us to be privy to people’s perceptions of illness and influences how the public view a certain disease.

 

THE EVOLUTION OF MADNESS: A CONCLUSION

As we develop new ways of understanding health and disease we have returned to old texts to apply our knowledge. This is especially true with regards to psychological illness, and Shakespeare’s work is often subjected to these new readings. You can chart the evolution of madness through critical interpretations of Macbeth; the same applies for readings of depression in Hamlet or dementia in King Lear. On one hand it is interesting to consider why we do this – scientifically speaking quotes from Shakespeare do not count very highly on the ladder of evidence based medicine. I like to think it’s a question of human nature and empathy. We can be so affected by the actions of a fictional character that we are moved to tears or laughter; characters become real to us and we want to know why they behave the way they do, both to satisfy our human curiosity and to perhaps explain why we are so emotionally affected by fiction.

It is also interesting that many of the theories we have explored use the same quotes as evidence; one line can be interpreted in many different ways. Most of the authors considered have admitted this – human nature remains constant and we simply assign different labels to it. Perhaps madness has not evolved at all, but rather as a society we have outgrown one way of thinking and are eager to make our mark on the world by creating another; where better to find reassurance that what we believe is correct but in the great fictional works that define our society?

And what did Shakespeare mean when he described “a mind diseased”? Whilst every new reading brings something profound to a seminal work perhaps it is only by considering the historical and social context that we can fully appreciate what it was that the Bard was trying to convey. As much as we – as readers, critics, health care professionals – would like to diagnose his characters we should always remember that perhaps Shakespeare was simply being a writer and creating characters who would give good performances, characters which would appeal to the public’s expectations. Madness, like beauty is in the eye of the beholder: “in the drama, as in the culture outside it, madness is diagnosed by those who observe it”.[6 (p. 321)] Ultimately, readings and contexts aside, how we view a work of art is an inherently personal experience, influenced as much by our own lives as by society; perhaps it is enough that we feel something, rather than feel nothing at all.

 

References

  1. Porter R. Madness: A Brief History. Oxford: Oxford University Press; 2002
  2. Bossler R. Was Macbeth a Victim of Battle Fatigue? College English 1947; 8 (8): 436-438
  3. Shakespeare W. Braunmuller AR, editor. Macbeth. Cambridge: Cambridge University Press; 2008
  4. Tarantelli CB. “Till destruction sicken”: The catastrophe of mind in Macbeth. Int J Psychoanal 2010; 91: 1483-1501
  5. Norton SA, Paris RM, Wonderlich KJ. “Strange things I have in head”: Evidence of Prion Disease in Shakespeare’s Macbeth. Clin Infect Dis 2006; 42: 299-302
  6. Neely CT. “Documents in Madness”: Reading Madness and Gender in Shakespeare’s Tragedies and Early Modern Culture. Shakespeare Quarterly 1991; 42 (3): 315-338
  7. Fahey CJ [Internet]. Altogether governed by humours: The four ancient temperaments in Shakespeare. Graduate Theses and Dissertations 2008. URL: http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=1229&context=etd [Accessed July 2014]
  8. Toppen WH. Conscience in Shakespeare’s Macbeth. Groningen: JB Wolters; 1962
  9. Bloom H. Shakespeare: The Invention of the Human. London: Fourth Estate; 1998
  10. Schwartz DB [Internet]. Shakespearean Verse and Prose. Last Edited 2005. URL: http://cla.calpoly.edu/~dschwart/engl339/verseprose.html [Accessed 4th June 2013]
  11. Shea SE, Gordon K, Hawkins A, Kawchuk J, Smith D. Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A.Milne. CMAJ 2000; 163 (12): 1557-1559
  12. Bottomer PF. So Odd a Mixture: Along the Autistic Spectrum in ‘Pride and Prejudice’. London: Jessica Kingsley Publishers; 2007
  13. Spurgeon C. Shakespeare’s Imagery and what it tell us. Cambridge: Cambridge University Press; 2005
  14. Davis FM. Shakespeare’s Medical Knowledge: How Did He Acquire It? The Oxfordian 2000; 3: 45-58

 

Other sources:

Barroll JL. Artificial Persons: The Formation of Character in the Tragedies of Shakespeare. South Carolina: University of South Carolina Press; 1974

Bradley AC. Shakespearean Tragedy: Lectures on Hamlet, Othello, King Lear, Macbeth. 3rd Edition. London: Macmillan Press; 1992

 

Sarah Ahmed is a final year medical student at the University of Birmingham, UK

A version of this article will be presented at the 7th Global Conference – Madness: Probing the Boundaries at Mansfield College, Oxford ( 5th-9th September 2014).

Correspondence to: 09saraha@gmail.com

 

Ayesha Ahmad: Book Review ‘Final Chapters: Writings about the end of life’

7 Aug, 14 | by Ayesha Ahmad

‘Final Chapters’ is the product of a creative writing competition organised through the Dying Matters Coalition, which was established in 2009 by the National Council for Palliative Care. The book invites 30 contributors to describe their reflections on dying.

more…

Medicine Unboxed: Students – Call for Participation

29 Jul, 14 | by Deborah Bowman

Medicine Unboxed aims to examine medicine from the perspective of the arts and humanities, and arises from the view that good medicine demands more than scientific and technical expertise, also requiring ethical judgment, empathy, and an understanding of human experience. Last year saw the first Medicine Unboxed: Students meeting at which students of the arts, health and medicine came together to share, explore and discuss drawing on the unique perspective and experience of being a student or in the early stages of a profession.

Medicine Unboxed: Students 2014 is curated by Prof. Deborah Bowman and Dr. Lucy McEllan and takes place at the Parabola Arts Centre, Cheltenham on the afternoon of Friday 21st November from 2-5 p.m. The theme for both Medicine Unboxed andMedicine Unboxed: Students is ‘Frontiers’.

We are seeking proposals for participation. Medicine Unboxed thrives on diversity and inclusivity. We are particularly keen to welcome students (undergraduate or postgraduate) from all backgrounds, including (but not limited to) art, drama, music, medicine, literary studies, philosophy and allied health subjects. You can submit a proposal, interpreting the theme ‘Frontiers’, in one of four broad categories:

1. Provocations and Debates – proposals are likely to focus on a contested aspect of health, illness and its treatment and/or to explicitly engage with multiple points of view;

2. Exhibitions and Performance – submissions in this category are likely to be creative e.g. poetry readings, monologues, excerpts from plays, creative writing, musical performances, stand-up comedy, art exhibits, short films etc.

3. Workshops and Interaction – proposals may include experiential activities such as drawing, creative writing, singing and voice activities, improvisation etc or an interactive approach to a question or concept.

4. Conversations – submissions in this category are likely to take the form of short papers or prompt material presented to, and discussed with, the audience.

Proposals may be from individuals or groups. They should be no longer than 500 words and include the i) title, ii) format, iii) names and affiliations of the people involved and iv) a summary of the contribution proposed. You should also indicate in which category you would like your proposal to be considered. Please email your proposal by 1 September 2014 to Prof. Deborah Bowman (dbowman@sgul.ac.k). All proposals will be reviewed by the advisory group for Medicine Unboxed: Students and decisions will be communicated by 15th September 2014.

If you would like to attend Medicine Unboxed: Students but prefer not to submit a proposal for participation, you will be most welcome to join us as an audience member. Tickets for Medicine Unboxed: Students cost £5 and you can register your interest by emailing Dr. Lucy McEllan (lucymclellan@nhs.net).

Follow: @medicineunboxed and @MUstudents

Explore: http://mustudents.wordpress.com/

Join: https://www.facebook.com/groups/175072369272118/?fref=ts

 

The Artist in Theatre: On the Primacy of the Subjective Narrative by Jac Saorsa

8 Jul, 14 | by BMJ

Drawing Women’s Cancer explores the lived experience of gynaecological illness through a unique interrelation between art and medical science. Based in Cardiff and supported by Cardiff University and Cardiff and Vale University Health Board, the project began in 2012 as a collaboration between myself and Amanda Tristram, gynaecological surgeon. Since then it has produced two major exhibitions and several presentations both national and international.

Drawing Women’s Cancer project builds on the premise that philosophy, medical science and visual art all involve an inclusive, and often passionate form of ‘seeing’, and that they are brought into mutual relation through the equally inclusive concept of language. The concept of inclusivity here emphasises the idea that although language is the root and branch of dialogue, and indeed of narrative, neither of these phenomena are necessarily bound to the word.

As an artist and a writer, my concept of language constitutes far more than simply words, and as such it is the language of practice – and its corollary, process – that most concerns me. Consequently I understand both dialogue and narrative as practices and processes in their own right, both ‘creative’ and both profoundly and intimately immersed in experience, wherein language is evident and influential in all its forms. The Drawing Women’s Cancer project, which constitutes an in-depth exploration of experience, is therefore fundamentally and methodologically driven by a hermeneutic approach that embraces a multidisciplinary concept of language in order to delve deeply into areas of subjectivity that can often be felt impossible to express in verbal form.

Narrative language is a vital part of Drawing Women’s Cancer wherein personal narratives as related to me and transcribed either verbatim or in note form provide the foundation for the research as a whole. These are the bedrock of the experimental approach and, together with written narratives that reflect my own feelings about my encounters with women patients, and my experiences in theatre, they underpin the combination, the conceptual superimposition of word and image, verbal and visual, that is engendered through the creative process – itself unashamedly steeped in subjective experience. The creative process thus reflects and perpetuates the dialogical process that characterises my conversations with patients in a continuing dialogue between myself and drawings as I work on them. At the same time the process also responds to a further dialogue, one that speaks to my experience of the ‘Others’ experience of illness. Narrative here shakes off the strait jacket of monologue. It refuses to be confined to any prescribed spatial and temporal dimension. Narrative here becomes polyvocal and takes primacy as the vehicle by which the project as a whole continues and extends.

When a drawing is complete the story is far from over, indeed it has only just begun, and a drawing’s inherent communicative force lies in its capacity as an autonomous art object to maintain a dialogical character even beyond the relationship with its creator. As a work of art a drawing can simultaneously express and provoke emotional significance in an inter-subjective relation with the viewer, who in turn can creates his or her own narrative on ‘seeing’ in it the voices of those suffering the impact of illness, and this leads, ultimately, to the instantiation of what I want to call the meta-language, a form of communication beyond dialogue, beyond narrative and even beyond itself in terms of the expression of subjectivity. It is on the basis of narrative then, and its dialogical implications, that creative representations of the lived experience of gynaecological cancer can open up a ‘discursive space’ wherein a deeper understanding of the relation between a disease diagnosis and the overall existential impact of illness can potentially stimulate further conversations between patient and physician, between patients and their carers, and within the public arena in terms of awareness and acceptability.

So, in the true spirit of interdisciplinary practice in the Medical Humanities the Drawing Women’s Cancer project offers a direct challenge to the rationale of an uncompromising ‘art-science’ dichotomy by demonstrating that, in practice, neither can be disassociated from our understanding of humanity and the manner in which, as human beings, we engage or disengage with the society in which we are a ‘person’. Art, medical science and philosophy are all inescapably entangled here in a web of our own being and are constituent parts of the same overall human project, but visual art perhaps has the more obvious capacity to ‘bear witness’ to the trials that are often borne in the pursuance of being…in our physical enactment and psychological representation of life. Drawing Women’s Cancer is not only about disease, or medical intervention, or suffering, or the impact of illness; it is about all of these things. It is about, as Radley notes, what it feels like when ‘all sense of normality, and all the expectations of a future that accompany good health, suddenly become less real’. It is about the experience of illness, where that experience overrides all others. It is about creating a language that has the power to speak, not necessarily for the women whose personal stories are taken as the point of departure, but rather because of them, so that they may return.

For the rest of this post I would like to offer one of my own written narratives, an account of a recent opportunity to witness a gynae-oncological operation. I have attended various operations during the course of the project and all of the women who have allowed me to witness this part of their experience do so with the conviction that it will help me understand more profoundly what they are going through. Having, to borrow a term from legal channels, an ‘appropriate adult’ seems also to help sometimes as they try to deal with the natural anxieties that such an experience brings on.

Body in Flux

The image accompanying this post is a painting rather than a drawing. It is an ‘autoethnographic’ image that represents a similar operation to the one that the narrative below refers to. It serves, I hope, to demonstrate how visual language, even where there is no attempt to necessarily create an objective representation of the scene, can nevertheless communicate autonomous and coherent expressions of profound experience.

The painting is called Body in Flux. The narrative is called, simply, The Op.

Twenty minutes ago I was talking with her while she waited to be called down to theatre. She had smiled at me but it was a weak, anxious smile and there was fear in her eyes. We had a brief conversation – she seemed to appreciate the company. Hers is a difficult history, when she began to notice something was wrong she had tried to ignore the symptoms, ‘for the children’. She convinced herself it was just something minor, no need for a doctor, but she got tired of pretending she was OK and in the end she did go for help. As she lives in West Wales, she went to the local hospital and to her relief they told her there that it was nothing serious after all – ‘just abnormal cells’, nothing too much to worry about. They did however organise an appointment for here at the clinic here in Cardiff, for a biopsy. This was unusual, and even though they said not to worry, she did anyway. She worried about being in the city, she worried about her two small children at home, she worried she might die.

It is cervical cancer, quite advanced. She is to undergo a radical hysterectomy. The whole of her uterus and the surrounding tissue, the cervix and the upper part of her vagina are to be removed. The ovaries too, probably.

Reality hit hard a few weeks after the biopsy. It came suddenly, in a phone call. It was the shock! The word ‘cancer’ still makes her cry. She has no partner. She said she wasn’t ‘active in that way’ – not for ages – so she hadn’t been for Pap test for years. She had thought there was no need. She said she felt ‘stupid’ now. She is a primary school teacher; they had called her on her mobile as she was walking the kids to the classroom. They had the results of the biopsy. They told her that she had a tumour, that she had cancer. Now, here, waiting to go down to theatre, her eyes well up as she whispers the word. ‘It was the shock’, she says.

She is asleep now under the lights in the theatre. The lights are not harsh, just very strong. The huge circular structures from which they descend are acutely and disturbingly present, not just here in the room, but even more powerfully in my memory. The monstrous size of them and the pitiless, piercing illumination they provide still haunts me, despite my efforts to exorcise the horror of my own experience in the weeks that followed in paint on canvas.

I am anxious then, for her, for me, for us both. This operation is one that remains very close to the surface of my own consciousness and my presence here has psychological connotations that I cannot ignore or supplant with more rational thought, so deeply are they rooted. This is a test then to the personal limit of my focus on subjective experience. Amanda, the surgeon, knows this. She asked me when we arranged this visit, “Are you going to be OK with this one?” I felt the same way I did when she asked the very first question, the one that kick-started the whole Drawing Women’s Cancer project; she had said “Can you draw what it feels like to have gynaecological cancer rather than just what it looks like?” I knew then that I wanted to try.

Jonathon, the surgeon working with Amanda, reaches up to angle the bulbs. They are covered in their own protective ‘gloves’ so that he doesn’t burn his hands. His hands are so very important. I stand behind Amanda who is pushing paper wadding into the vagina – ‘packing’ it so that it doesn’t ‘move’ during the operation. There is so much paper left over on the floor between her feet. It is to ‘protect the excess’. The pushing, packing, continues and she says, “I pushed too hard once. I was in training and I was so scared of the consultant… we noticed that there was a lot of blood just dripping out onto the floor!”

Amanda goes to a side room to attend to the paperwork and Jonathon is left to make the first cut. Firm and certain. Vertical, from the navel to the pubic bone. He draws the diatherm slowly, painfully, through the skin of the belly and it trembles around the small part of it that is taut and stretched between his fingers. “A cut needs tension”. I am surprised that he uses a diatherm for this initial cut, deep and long as it had to be, so I ask. “Yes”, he replies, “it’s the way we do it now, but some surgeons do still use a scalpel.”

The edges of the cut sizzle and blacken. Smoke and the acrid smell of burnt flesh arise from the wound that becomes bigger, deeper as he works. He cuts down, confidently and deftly through layers of fat. My artist’s eye focuses on how the colours that move through the wound, from the skin, through the fat, to the fleshy muscle, are aesthetically beautiful in harmonious juxtaposition. First the hues of red: crimson, napthol, and the brightest perylene mingle with tiny glimpses of green and blue, the colours of shadows on the flesh, and then on through the spectrum of yellow, from the deepest cadmium to the palest, ‘prettiest’ lemon, the colours of the daffodils that are blooming outside and carry so much significance here in Wales. Cenhinen (kenHINen) means leek in Welsh, while cenhinen pedr means daffodil, or St Peter’s leek. Over the years the two became confused until the daffodil was finally adopted as a second national emblem of Wales. The cenhinen pedr then are blooming today, even as the wound is opened and the fat gives way and melts under the surgeon’s hand.

I think of Chroma, in which Derek Jarman, painter and filmmaker, extends Melville’s view that we ‘learn’ colour whilst not necessarily understanding it. It is understanding that I am seeking here, in subjective form, and in the wound as I watch it open, the red of the initial cut becomes Jarman’s ‘moment in time…quickly spent. An explosion of intensity.’ Further on, as the diatherm moves down through the soft tissuethe red ‘burns itself. Disappears like fiery sparks into the gathering shadow’. Jarman imagined four stages distinguishable in alchemy: the blackening of MELANOSIS, the whitening of LEUCOSIS, the yellowing of XANTHOSIS and the reddening of IOSIS. For me they appear here, but in a different order as I watch the diatherm cut beyond borders, deeper into the body, opening up and invading its private, once autonomous spaces. I feel the sting, but as Jarman says, Painters use red like spice’.

Amanda is back. She brings more even wadding to ‘mop up the excess’. The excess: ‘an amount of something that is more than necessary, than is permitted, or is desirable’. Excess here then, even beyond the metastasising cancer that in itself is excess to the normal cell structure.

I stand on a stool, watching as Jonathon cuts deeper into the muscle. The rectus abdominis yields to the unrelenting diatherm and allows him access to the peritoneum and the abdominal cavity. There it is, the uterus, itself now become ‘excess’. Amanda holds it in her hand. “Look” she says as she gently lifts it towards me, “and here are the ovaries”.

Fat, organs, tissue, all spill over the edges of the now gaping wound. Colours mingle at all levels of the ‘warm’ scale. I am shocked – no, not shocked – more bemused to witness what appears as a mess, a fluid ‘jumble’ of organs that belies the naïve impression that I now realize I have always held that inside we are very orderly and self-contained. Art takes precedence over science here as the boundary between order and disorder becomes confused. Either way the relationship between the two is here emphatically demonstrated through the idea of structure, the structure of the body in this case, which becomes simultaneous with function through the overall concept of process.

Jonathon and Amanda push the organs around with their hands, bullying them into compliance as they try to force them into the chest and pelvic cavities in order to isolate the uterus. But the organs keep spilling back out as if defending, even nurturing the one that is the object of attention. Yet more wadding is pushed in to hold back the tide, up into to the chest and down into the pelvis. Finally, with his arm up to the elbow inside the passive form Jonathon, like Canute, pushes and shoves with a physical force that promises a painful recovery. I am stunned by the seeming violence of it all, the brutality, the deeply and bloodily visceral reality of scene. The edges of the wound are pulled wider open with clamps that grasp the bloodied flesh and become bloodied in their turn. Now, the diatherm, held lightly first in Jonathon’s hand, then in Amanda’s probes and cuts on respective sides of the pelvic cavity, now an empty space devoid of organs and ‘excess’, save the hapless uterus, the one, which is soon to become the other. It sits isolated, bounded by smooth, ‘slippery’ walls that shine and appear translucent and yet opaque at the same time. It looks so small, so vulnerable under the threat of the diatherm, and the ovaries, white and tiny, are hiding, sheltering, in the darkness of the void.

The violence of the procedure is salutary in terms of my understanding. The pushing, the shoving, the manipulation of the bodily structures and organs, bloodied tools that are first discarded, then retrieved, then put into service to cut, to staple, to open and to close, all this is played out in front of me in sanguine ritual. The same blood pools in the crevices on the body and on the floor at Amanda’s feet, small bits of the flesh that it once made red are thrown up onto the green sheet, or down onto the floor. This is not clean, not clinical; this is raw, visceral, almost primeval. It feels… it feels. This is the unadulterated, non-sugar-coated authenticity of surgery; the cutting, the slicing, the pushing and the pulling, the packing, the mopping up… and it is all the raw bloodiness of real flesh, real wounds; nature rent and protesting. The body, once a closed space of quietude and privacy, now wide open, stretched, clamped and ‘mined’ for the tumours that threaten its very existence as they create of the acting Self (that part of being human which here, in this theatre, is absent) Sontag’s ‘non-self’.

I draw nearer to see as best I can while careful to avoid any contact with the green sheet that protects the human being who has become subject to – or is it object to –this therapeutic violation. Standing beside Amanda, I have a clear view of how she works, now with force, now with gentleness, but always with dominance. The body submits. Once the surface and the underlying defences have been breached there is little to resist the relentless subjugation of its autonomy. The chest is rising and falling gently however, normality and regularity at least in this respect confirmed by the anesthetist who watches the fluctuations of his parallel and multi-coloured digital lines.

Carefully now, the surgeons begin to work more slowly and delicately. Brutality is replaced – in the details – by the sensitivity that must dictate the smallest and most intimate of incisions. They need to explore, to single out the pelvic lymph nodes, the arteries the nerves. They are suspicious. The cancer may not have settled only in the cervix, there may be subsidiaries, so, like Selzer’s ‘predators’ on the prowl they move quietly, deliberately, stalking the prey, the obscure ‘lumps’ of flesh that have become firm to the touch and thus differentiated from the soft masses within which they hide.

And so they delve with life-preserving precision into the depths of the body, first one side then the other, moving slowly, constantly aware of how far they can to go before breaching a physical boundary impossible to cross with any hope of returning. The main tumour will be taken coldly and cleanly with the uterus, an eradication of the very taproot of the cancer’s existence, but its morbid potentiality may lie in the lymph nodes. Carefully then they search, steadily and without pity, isolating, feeling, cutting, debating, and moving on. They take various samples, all of which ‘feel’ benign, and then, there it is. A tiny lump of bloody flesh is dropped into a plastic vial and a phone call is made. This sample they are not so sure of, they need to do a ‘frozen section’. The operation has to be delayed while they await the result of the analysis because, they tell me, if it is positive there’s no point in going on. I feel suddenly cold although it is very warm in the theatre. They switch off the lights.

She is under anaesthetic for eight hours. I have to leave, and Amanda does another operation, the next lady on the list, while her first lies covered with the wound open but packed with the endless wadding paper while the sample is sent to the lab. I receive a text later in the evening. The sample was negative and they completed the hysterectomy. They left one ovary.

 

Jac Saorsa

July 2014

Dr Ahmed Rashid: “Diseases of the heart: Where theology meets cardiology”

6 Jul, 14 | by Ayesha Ahmad

Associations between religion and health have been debated for many years. This interest has been paralleled in the medical literature and has led to the inclusion of religious, cultural and sociological topics into medical school curricula, encouraging future clinicians to adopt a more holistic approach to understanding patients and their behaviours.

Much of the research focus has been into church-going populations in North America although the cosmopolitan nature of the modern world means that most clinicians are likely to encounter patients from any world religion. Islam is the second largest religion in the world after Christianity, but consideration about the potential impact it may have on health behaviours has rarely been considered.

He [will prosper] who brings to God a heart protected and pure.” (Quran, 26:89)

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Deborah Bowman in conversation with Leslie Jamison, author of ‘The Empathy Exams’

22 Jun, 14 | by Deborah Bowman

 

 

Join the Editor of Medical Humanities, Deborah Bowman, in conversation with Leslie Jamison as they discuss her acclaimed essay collection ‘The Empathy Exams’ and more. Leslie’s work questions how we understand each other and the concept of empathy, drawing on her time as an actor working with medical students and her own experiences of illness and vulnerability. It promises to be a fascinating evening and a rare opportunity to meet an author described by the New York Times as ‘extraordinary’.

This is a free public event, open to all and part of the St George’s, University of London series The Art of Medicine.

Details:

Date: Monday 7th July at 5.30 p.m.

Venue: Boardroom H2.5 Hunter Wing
St George’s, University of London Cranmer Terrace,
London SW17 0RE

Register via e-mail: events@sgul.ac.uk

Hope to see you there.

 

5th International Symposium on Poetry and Medicine at the Royal Society of Medicine, Wimpole Street, London on Saturday 10 May 2014

17 May, 14 | by BMJ

Reflections from the 5th International Symposium on Poetry and Medicine by Clare Best

 

This year’s Symposium invited us to focus on how we might begin to define the term ‘medical poetry’ and asked if that is even a useful aim. Michael Hulse started the day with a thought-provoking talk proposing that the Romantic ego has evolved and survived in the area of medical poetry whereas it is now rare in other contemporary poetry. He argued that the natural successors of the Romantic poets, those foregrounding the self in extremis, are concerned with what he terms ‘primary medical poetry’ –  in which a person writes about his/her own experience of illness or treatment from the point of view of an existential self. ‘Secondary medical poetry’ is the term Michael used to describe poetry written about medical experiences happening to a close other. He saw ‘tertiary medical poetry’ as including poetry that stands at another remove from the medical experience, being more engaged with scientific, historical, ethical and other aspects of medicine.

 

Michael’s talk was a helpful starting point, and throughout the day speakers came back and back to the different kinds of medical poetry he had suggested. After years of hearing nothing but the term ‘confessional poetry’ used in reference to poetry of extremis written in the first person, I liked Michael’s idea of affirming ‘a central literary site’ for the Romantic ego.

 

A particular highlight of the Symposium, for me, was Sandy Goldbeck-Wood’s beautifully fluent and convincing presentation of her work on how biography drives biology. I have always been interested in how the body expresses adverse experiences as symptoms, and I found myself nodding as Sandy spoke about how ‘both poetry and psychosomatic illness might be seen to be forms of embodied feeling or knowledge, both resisting “purely conscious” forms of communication’. Yes!

 

There were many, many other highlights, including Alan Beattie’s warm and generous account of Norman Nicholson’s life and poetry, Ahmed Hankir’s powerfully dramatic rendition of his ideas around the wounded healer, and Jens Lohfert Jorgensen’s brilliantly engaging presentation of the Danish poet Morten Sondergaard’s Wordpharmacy (do have a look at http://www.wordpharmacy.com) – I’ll be ordering my copy immediately.

 

Then there was poetry itself of course: poems of medicine and surgery, remedy and reverie, diagnosis and prognosis, all kinds of poems to make you laugh and cry. I was honoured to present some of mine from Self-portrait without Breasts alongside Rebecca Goss reading vivid and beautiful poems from Her Birth and Lesley Saunders reading from her stunning collection Cloud Camera.

 

Philip Gross gave gorgeous readings from Deep Field and Later, leading us on into the final part of the day which celebrated the winning and commended poets in the three categories (Young Poet, NHS and Open Awards) of the 2014 Hippocrates Prize for Poetry and Medicine. Conor McKee won the Young Poet section with ‘I Will Not Cut for Stone’, Ellen Storm won the NHS section with ‘Out of Hospital Arrest’ and Jane Draycott won the Open section with ‘The Return’. Many congratulations to all the winning and commended poets.

 

I came away from the Symposium once again inspired and uplifted by the truth and power of poetry that addresses medical subjects. I came away knowing that in the face of extreme and threatening medical events, in situations where our identities are challenged and even deconstructed or changed forever, poetry can excite us into new appreciations of life and of who we are and can be. As I see it, the more science probes and uncovers the physical and medical experiences of our lives, the more we need poetry to interpret and express these experiences. Poetry and medicine are perfect companions.

 

Thank you Donald Singer, Michael Hulse, Nicola Williams and all the others including the judges Sarah Crown, Robert Francis QC, Philip Gross and Kit Wright, who made Saturday happen. It was a wonderfully rich day. I’m already looking forward to next year’s Symposium.

 

Find out more about the Hippocrates Initiative for Poetry and Medicine at: www.hippocrates-poetry.org

 

Clare Best

www.clarebest.co.uk

http://selfportraitwithoutbreasts.wordpress.com

 

 

Dr Nikesh Parekh: Film Review The Lunchbox- ‘Letters, chillies, and memories’

4 May, 14 | by Ayesha Ahmad

Set between an apartment block in suburban Mumbai and a modest office floor, The Lunchbox is a film of understated elegance exploring human emotions and connections. Ila (played by Nimrat Kaur) is a young, middle-class Indian woman who is desperately trying to rekindle a waning marriage by preparing her husband delicious lunches that are delivered by the ‘Dabbawala’ system that is widely acclaimed for its efficiency; Dabbawala is an Indian word for men who deliver vast numbers of lunchboxes hanging off the sides of their bicycle in Mumbai and some other cities in India.

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Beautiful Science at the British Library: A Review by Isobel Elstob

3 May, 14 | by Deborah Bowman

 

We are delighted to publish this guest review by Isobel Elstob who visited the Beautiful Science Exhibition at the British Library for Medical Humanities. The exhibition is showing until 26 May 2014.

 

Review of Beautiful Science: Picturing Data, Inspiring Insight

Folio Society Gallery, British Library

20th February – 26th May, 2014

 

Isobel Elstob

Correspondence to: izzyelstob@hotmail.com

 

 

How do we represent the material – and immaterial – world visually? This is the question that underpins the Folio Society’s exhibition Beautiful Science at the British Library. The Folio Society Gallery, in which the exhibition is displayed, is a small and awkward space that functions vertically and can be entered from two sides. This is important because such a space has very little to offer the curators in terms of dictating a visitor’s viewing route. The result of this is a non-linear viewing experience that the curators have counteracted through a thematic, rather than chronological, display of objects.

 

The themes that the curators have selected for representation are ‘Weather and Climate’, ‘Public Health’ and ‘The Tree of Life’. Within each of these sections, too, there is less a sense of chronology than the ambition to compare like-with-like pan-historically; in fact, the desire to demonstrate either the accuracy or the usefulness of past methods of visualising phenomena by displaying them beside recent, most often computerised, models. A particularly attractive example of this approach is the inclusion of HMS Rochester Ship’s Journal from the early eighteenth century (1709-12) displayed dialogically beside the UK Met Office’s computerised and interactive two-dimensional globe on which bright pink and blue lines shift and shimmer. These lines represent weather data collected along the spice trade routes between the continents, such as that laboriously recorded by the Captain of the Rochester. This relationship between two examples of data collation and representation demonstrates the intelligent contemporary exploitation of the documentation of information historically. But it reveals something more problematic, too, for an exhibition that seeks to contrast the sophistication of our technology with the originality of our predecessors: the finely-rendered tabulated descriptions found in the Rochester‘s captain’s journal are more beautiful – to use the exhibition’s own choice of word – than the impressive computerised globe etched with brightly-coloured streaks. Beauty is not simply in the eye of the beholder. Beauty is inherently a natural phenomenon, and, therefore, one that exists – and that we will find – in our own, human, creations. The page of the Rochester‘s journal that has been selected for display demonstrates this – beautifully. Perched amongst the looping, precise handwriting of the ship’s captain, that describes ‘Moderate gales of Wind and fair Weather’, sits an ink drawing of a small, speckled bird. The captain, we are told, frequently interspersed his tables of data and description with similar sketches of ships, wildlife and places that he observed throughout his voyages. In such pages, then, are represented two aspects of this man’s – and all men’s – approach to the world: the objective and the subjective. The interaction and relationship between these two ideals permeates this exhibition. Before the mid-nineteenth century the concept of objectivity, as we understand its meaning today, did not exist. Rather than science requiring the removal of human agency in the representation of natural phenomena, it was experience, not self-effacement that had counted previously. We can see this in the words of Edmond Halley, whose 1686 map, An Account of the Trade Winds and Monsoons, is exhibited. Halley writes: ‘It is not the work of one, nor a few, but a multitude of Observers, to bring together their experience requisite to compose a perfect and complete History of these winds.’ The change in attitudes might be traced in Luke Howard’s 1847 Barometrographia, which we are told is amongst the earliest consistent scientific observations recorded, and, more than that, is, in part, mechanically drawn by a self-recording barograph over which Howard subsequently plotted the phases of the Moon. Mechanical objectivity in its genesis is thus displayed.

 

Objectivity today relies on the satellites and the supercomputers that are now at the disposal of scientists. But the representations that such methods produce may well still be beautiful, such as the NASA map depicting the ocean surface currents between 2005 and 2007 that is shown at one of the exhibition’s entrances. One wonders, however, if it is not the subject – our blue and swirling oceans as seen from space – rather than the method of representation, that makes such computerised renderings so appealing. A direct comparison can be drawn between paper and screen within the ‘Public Health’ section, which includes Florence Nightingale’s ‘Rose Diagrams’ depicting the causes of mortality in the ‘Army of the East’. Professor David Spiegelhalter of Cambridge University has taken Nightingale’s engraving and made it interactive to help the viewer better understand its purpose. Such an appropriation is a productive method, too, for highlighting the ‘Lady with the Lamp’s’ work as a statistician in her own right, rather than merely an attendant of wounds. Furthermore, whether it be the Rochester voyaging in gales along the spice routes, or Nightingale sourcing her data from the military field hospital through which she paced, many of the historical documents in Beautiful Science invoke a far wider cultural context than the particular information that they describe. John Graunt’s Natural and Political Observations upon the Bills of Mortality (1662), for example, is a collation of sixty years of London parish records on causes of death. Within the table we find that the number of people in the capital who died due to being ‘Burnt or Scalded’ was three in the year of 1647, and rose to eleven in the year of 1651. Medical conditions such as French Pox, Rickets and Worms are listed alongside causes of death such as ‘Hanged and made with themselves’ and even ‘Frighted’ (of which nine people are recorded to have died in 1660).

 

But it is Beautiful Science‘s exploration of the motif of ‘The Tree of Life’ that is the most poignant section of the exhibition (this is also borne out, perhaps, by the fact that this area appears to attract a far greater concentration of viewers). Interactive technology here, in the form of the One Zoom Tree, allows the viewer to discover the evolutionary links between thousands of species of mammals, birds, reptiles and amphibians. Interestingly, these, very modern, representations of our own – and many other creatures’ – location within the animal kingdom is depicted as a sprawling tree, with branches emerging intermittently from a central trunk. Life on earth has been represented in the form of a tree across the ages and across multiple civilizations. From Mayan to Nordic culture, to the tree from which Eve plucked the apple, this organic life form has functioned pan-historically and pan-culturally as the most apt metaphor for visualising the force and centrality of Life on our planet. Beautiful Science reveals this tendency through some remarkable inclusions. Ernst Haeckel’s The Pedigree of Man (1879) is displayed beside Charles Darwin’s On the Origin of Species by Means of Natural Selection (1859), which is open at the only page within the publication that contains an illustration: a lithograph by William West that depicts the relationships between various species and their descent from common ancestors in what has become known as ‘The Tree of Life’ diagram. At once more problematic and more affecting, cultural attempts to depict the very nature of life will always be more personal to us than representing ocean current patterns or even epidemics of disease. For what is being represented in such imagery is our selves. Beside the historical publications of Haeckel, Darwin and Jean-Baptiste Lamarck is displayed a pair of back-lit black panels that contain a series of brightly-coloured circular diagrams – each one shining with a luminosity that is indeed beautiful to behold. These Circos Visualisations of Genomic Data compare the human genome with those of the chimpanzee, the dog, the opossum, the platypus and the chicken. Within each circular frame these comparative diagrams rise and descend and swirl and ebb like a collection of precise but abstract paintings. Perhaps technological representation is most striking when it represents the essence of us and how it is that we slot into nature’s own material manifestations. In contrast to the evolutionary implications of Haeckel’s and Darwin’s diagrammatic representations of life stemming from a unifying central source, the curators also show us an example of the way in which the relations between creatures had been visualised in Western culture prior to evolutionary theory’s successful claim of the mantle for understanding the natural world. Robert Fludd’s 1617 The Great Chain of Being depicts an hierarchical pyramid encircled by the cosmos, with Sophia the Goddess of Wisdom represented in human form standing for the pinnacle of natural perfection: us. A human-centric model such as this has Aristotelian roots, and monopolised cultural interpretations of the natural realm right up until the nineteenth century. It is not only possible but probable, therefore, that the ‘Tree of Life’ itself will be replaced with what will be considered to be a more suitable model at some point in the unforeseeable future.

 

The question that Beautiful Science most explicitly asks is how have we represented the world around us. But perhaps a more intriguing thesis might be why do we possess the compulsion to represent it at all? It is clear from this exhibition that the motivations behind visualising data and information have been as numerous as the methods invented to do so. The ways in which such visualisations have been accomplished suggests that science is not yet (and may never be) entirely objective. Indeed, Beautiful Science demonstrates, rather, that the human, subjective desire for beauty is as strong as the human, objective desire to possess information, and that our thirst for images is as compulsive, perhaps, as our thirst for knowledge. But let us hope that the technological age in which we live does not alienate us from nature to such a degree that we consider ourselves once more to be Gods of Wisdom, superior and dissimilar to all that surrounds us.

Review: “Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals.”

28 Apr, 14 | by gbelam

We have another great review today, of Lori A Brown’s book “Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals.” It’s by Sophie Jones of Birkbeck College, University of London, and considers aspects of architecture, landscape & design, and wider ideas about feminism and attitudes to women’s health in the USA.  Looks like a fascinating area for discussion. 

- Georgia Belam

 

Review: “Contested Spaces: abortion clinics, women’s shelters and hospitals.” by Lori A Brown

By Sophie Jones

 

‘Is it possible to build non-sexist neighborhoods and design non-sexist cities? What would they be like?’[1] Posing these questions in 1980, Dolores Hayden vocalized the utopian impulse of feminist architecture. A generation of women architects were convinced that Hayden’s question had an affirmative answer. Their plans for housing complexes with integrated childcare centres and cooperatively-run kitchens were not merely isolated amendments to the world as they knew it, but blueprints for a materialist feminist revolution. In Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals, Lori A. Brown brings this heritage of feminist architecture to bear on contemporary approaches to these charged sites. Brown asserts, ‘Space matters. Space is at stake. Control over geography is being legislated by those who want to eliminate a woman’s right for reproductive choice.’[2] Her proposals, which include bullet-resistant windows and abortion clinics in shopping malls, bespeak a different political climate: these are constrained negotiations, not revolutionary demands.

 

Brown’s research into the spatial politics of abortion clinics—and, to a lesser extent, women’s shelters and hospitals—is primarily focused on the United States, with some comparative analysis of Canada and Mexico. The author, an architect based at Syracuse School of Architecture, announces her project as a dual intervention, correcting her discipline’s lack of social engagement while drawing public attention to the feminist politics of the built environment. Debates about abortion often prioritise the subject of time, dwelling on the abstract question of when the foetus acquires a right to life. Contested Spaces marks a welcome turn to the spatial, as growing numbers of women across North America face harassment outside clinic doors, if and when they manage the long, expensive journey to their nearest abortion provider. Brown has transformed these hostile landscapes into diagrams punctuated by sobering statistics. On one map, a stark black line represents a 404 mile journey across South Dakota to the only clinic in Sioux Falls—a route served by no public transportation.

 

The book, which Brown positions ‘somewhere between theory and practice’, is concerned not only with the siting, accessibility and security of buildings, but also with the way architecture manifests social antagonisms.[3] This approach makes sense, but the abrupt shifts between registers are telling. A section about Dr. George Tiller, the Kansas abortion provider shot to death by a terrorist in 2009, segues awkwardly into a recommendation that clinics install meditation rooms for quiet reflection. The story of Paulina del Carmen Ramírez Jacinto, who was refused an abortion at the age of 13 after being raped during a break-in at her family home in Baja California, is followed by a consideration of the importance of lighting and paint choices in reproductive healthcare facilities. Noting the disjunction here is not a matter of policing the boundary between the serious and the trivial. Rather, it is to pay attention to the conditions that interrupt feminist blueprints for the future before they become reality.

 

Women, as Contested Spaces demonstrates, have historically found ways to repurpose structures designed to enclose them. In the 1960s and early 1970s, California’s Army of Three and Chicago’s Jane Collective helped women to access ‘menstrual extraction’ procedures, often in domestic spaces. Brown notes that, for these underground collectives, ‘Domestic space became the space of choice, liberation, security and safety from the law.’[4] Meanwhile, the Netherlands-based initiative Women on Waves dodges national abortion laws by providing terminations at sea. As Brown astutely observes: ‘Connected with neoliberal policies, this project exploits the idea of free trade zones and International waters and exists because it plays against hegemony’s own system through legal loopholes of globalization.’[5] A similar intervention occurred recently in South Dakota when, faced with a prospective ban on almost all abortions, Cecilia Fire Thunder proposed opening a clinic on her reservation, which was beyond federal jurisdiction. In mapping the coordinates of a world without punitive borders, these projects testify to the potential scope of feminist spatial theory.

 

Yet the visions for feminist space projected by past generations of abortion rights activists seem woefully truncated by contemporary compromises. Among these are the ‘bubble laws’ adopted in some US states, which institute ‘zones of protection’ around clinics and the patients entering them. For Brown, the difficulty of enforcing these laws lends their name an ironic resonance: the translucency and fragility of bubbles mirrors the precarious status of abortion access. Her interviews with private clinics in the most restrictive US states—which include Mississippi, South Dakota, and Utah—uncover inventive tactics for grappling with government pressure and anti-abortion hostility. Clinics have developed an impressive repertoire of strategies for combating the harassment of their patients: installing sprinkler systems outside clinics, scheduling landscaping work to spray demonstrators with grass, and setting up speakers to drown out protest noise with music.

 

With the battle lines drawn, the project of drawing up blueprints for revolutionary feminist health spaces appears simultaneously urgent and remote. Few clinics have the freedom to choose their location because many landlords refuse to let space to abortion providers. Meanwhile, renovation proposals attract excessive levels of scrutiny from public officials beholden to the anti-choice movement. Is it better to be a free-standing clinic, with the autonomy to install tight security at entrances and exits, or to be absorbed into a multi-unit complex, where patients and workers have more anonymity? When making design decisions such as these, providers feel trapped between a rock and a hard place.

 

Brown writes, ‘Reproductive healthcare facilities have become twenty-first century equivalents to medieval cities where walls and moats were once used for security from intruders.’[6] There is, perhaps, an alternative to this state of enclosure. One of the clinic directors told Brown that abortion needs to become part of a larger movement for social justice, linked to campaigns for childcare, education, and health. This is the insight of the reproductive justice movement, instigated by women of colour in the US who have drawn attention to the problems of isolating abortion as a single issue.[7]

 

Contested Spaces opens with a synoptic journey through feminist geography and architectural theory, taking in Nancy Fraser on subaltern counterpublics, Iris Marion Young on pregnant embodiment, Homi Bhabha’s notion of a third space, and Elizabeth Grosz on the mutual constitution of bodies and cities. In her conclusion, however, Brown risks collapsing this nuanced discussion of space into a question of location. She writes:

 

I advocate for clinics to become more centrally located in our daily spatial lives. They need to be front and center in our society, not hidden away and difficult to access. Locate them in shopping malls where protests cannot happen due to malls not being public space.[8]

 

Brown goes on to argue that terminations should be provided not only in mainstream hospitals but in shopping malls, military bases, jails, prisons, high schools and churches. Grouping these institutions together as elements of our ‘daily spatial lives’ evades the important distinctions between their modes of funding and management. It is odd that Brown does not consider the stake shopping mall abortion clinics might have in a privatised healthcare system, given the centrality of abortion to debates over the Obama administration’s Affordable Care Act. Meanwhile, the nuances of reproductive healthcare in prison are ill-served by the proposal for jail-based abortion clinics, particularly in the wake of revelations that California prisons subjected female inmates to forced sterilisation as recently as 2010. A tension between pragmatism and utopianism animates Contested Cities, and its conclusion appears to decide in favour of the former. Meanwhile, Hayden’s challenge – ‘What would a non-sexist city look like?’ – reverberates, as a reminder of way the architecture of reproductive justice can be integrated into a broader vision for social change.

 

 

[1] Dolores Hayden, ‘What Would a Non-Sexist City Be Like? Speculations on Housing, Urban Design, and Human Work’, Signs, Vol. 5, No. 3, S170-S187.

[2] Lori A. Brown, Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals (Farnham: Ashgate, 2013), p. 101.

[3] Contested Spaces, p. 37.

[4] Contested Spaces, p. 78.

[5] Contested Spaces, p. 82.

[6] Contested Spaces, p. 185.

[7] See http://www.sistersong.net/index.php?option=com_content&view=article&id=141&Itemid=81

[8] Contested Spaces, p.

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