You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

Sarah West: Film Review “The Maggie” (1954) directed by Alexander Mackendrick

29 Aug, 15 | by Ayesha Ahmad

 

As part of the British Film Institute- BFI’s Britain on Film Project (www.bfi.org.uk/britain-on-film), the Maggie, (1954), one of the most endearing comedies made by Ealing Studios, has been digitized and re-released online and on DVD.

more…

Difficult Histories by Niamh NicGabhann

28 Aug, 15 | by BMJ

image

I was recently involved in a project which explored the histories and memories of St. Davnet’s Hospital, Monaghan. St. Davnet’s was founded as the Cavan and Monaghan District Lunatic Asylum in 1869, and its name changed to ‘Monaghan Mental Hospital’ in the late 1920s, and later to ‘St. Davnet’s Hospital’ in the 1950s. I was involved in this project through my engagement with Stair: an Irish Public History Company Ltd. This was a company which I co-founded with colleagues from the UCD School of History and Archives, with the support of Nova UCD. We saw the project advertised on etenders.gov.ie and put a bid together. The final project involved a number of strands, including an archives scoping exercise, the production of a book on the history of the site based on the archives, an oral history project, a community engagement project and primary schools programme, and the development of an exhibition on the history of the site at Monaghan County Museum. We were extremely lucky to have Monaghan County Museum as partners on this project, as they shared essential expertise, as well as part of their collection for the exhibition. Preparing an exhibition on the subject of mental health and mental illness, and on the history of one particular institution within the local town was not without challenges and difficulties. I wanted to write about the decisions that we made in selecting objects and stories for the exhibition, and in how we structured the overall narrative of the exhibition. Some further information on the project can be found here, in a site created by project manager and oral history lead researcher Fiona Byrne.

image

Nuts and bolts: We had a modest budget for the exhibition, which largely went towards the printing and production of panels for the exhibition, the creation of replica outfits and uniforms, and design and print of the catalogue, and other display-related costs (such as the glass heads for displaying nursing caps, above). We were lucky to be able to use the display cases, space and lighting at the museum, which cut down costs considerably. Some of these costs were also shared with the museum, which will be hosting the exhibition for a year. Installation and conservation of some objects brought from the hospital campus were taken care of by museum staff. As objects in the exhibition came from the hospital campus, from the museum collection and from private family donations, we needed to carefully document the provenance to avoid confusion at the end of the process.

image

Putting the collection together: As with many exhibitions, the final selection of objects reflect a series of compromises between what we wanted to include, what we had access to, what we felt was appropriate to include, and what we could physically deal with in the exhibition space. Interestingly, our own process of creating the exhibition reflects that described by several of the contributors to the volume of essays Exhibiting Madness in the Museum: Remembering Psychiatry, edited by Catharine Colebourne and Dolly McKinnon. As in many of the cases outlined by Colebourne and McKinnon, we found that the history project commissioned by the HSE was precipitated by institutional change, with the hospital closing for admissions in 2012. The large site is now mostly used for administrative and community care purposes, with some long-stay patients still living in one ward. The ‘collection’ of the hospital was largely put together and defined in the process of creating the exhibition – again reflecting several of the examples mentioned by Colebourne and McKinnon. Throughout the process of talking with former and current members of staff, certain objects and spaces were marked as significant and important carriers of memory, and were included in the site. These included, for example, the Monaghan Mental Hospital fire helmet, the brown straitjacket and the large wooden table in the laundry building. Other objects were selected as part of our own investigation into the site, for example, drama trophies that had been presented to the St. Davnet’s Players and the Belfast sinks from the laundry. Some objects, such as the staff ration box from the early twentieth century, or nursing certificates and medals, were donated by former staff members living locally, who were extremely interested in the history of the site and who were very involved in the exhibition. Several items in the exhibition had already been collected by the museum – these included the chalice and paten from the asylum, an early wooden ECT machine, examples of modified knives and forks for patient safety, and a staff white coat from the 1960s.

image

The archiving process in place at the hospital also created something of its own collection – while this largely involves highly confidential hospital records, which will be archived, stored and managed by the National Archives, it also included architectural maps, plans and drawings, and a collection of personal effects, such as hair pins, pocket watches, rings, glasses and religious medals. These objects were removed from patients on entering the asylum or hospital – in many cases, they were returned, or returned to family members following the death of a patient. The personal effects that remain, therefore, are likely to have belonged to people who had been patients in the asylum or hospital, and who died there without relatives to claim their possessions. These items provide a very personal connection to the lives of those who experienced life within the walls of St. Davnet’s. The idea of personal effects has also been explored by artist Alan Counihan in his exhibition at the Grangegorman campus, another of Ireland’s large-scale Victorian asylum buildings. The use of personal items representing the transition between everyday life and the life of the asylum or hospital can also be seen in the exhibition ‘The lives they left behind: suitcases from a state hospital attic’, based on the suitcases of personal effects found at the former Willard Psychiatric Centre in New York State. Important items within the archive at St. Davnet’s also include the first admissions register and the first minute books of the asylum – the admissions register was included in the exhibition, but it was closed and locked to protect the privacy of those named.

image

The ‘World Within Walls’ project involved communication with members of the local community, former staff members, and former and current service users – reflected in the oral histories which were available via listening posts throughout the exhibition. An important part of the collection came from the items which had been kept by the families of former staff as important mementos of their time there. These will return to the owners at the end of the exhibition, but form an essential part of the overall collection represented in the museum. These items included very personal items, such a teapot given by a patient to a member of staff by patients and staff at the hospital on the occasion of her marriage, and a lace collar which had been given to the mother of the same staff member, made by a patient. Other items included official items, such as a key book which would have been held by the gatekeeper, recording each key being checked in and out, nursing exam slips, prizegiving booklets, photographs of sports teams and drama groups, nursing pins and certificates in both English and Irish. This brief description gives some sense of the variety of objects which were included in the exhibition collection, and the different processes by which they were collected.

image

Creating a narrative: One of the challenges in putting an exhibition like this together was to find a way to create a narrative which was both historically informed, and which presented information in a clear and valid way to visitors, without avoiding or over-emphasizing judgements on past practices in mental health care in Ireland. It is very clear that, from our contemporary position, many of the practices in mental health care were unacceptable, and many of those who were committed to institutional care could and should have been cared for at home. Indeed, many of those committed should never have been committed in the first place, while it is clear that others did need institutional care. The history of asylums and mental hospitals are inextricably linked to broader social histories of families, of sexuality and ideas of sexual morality in the country, and ideas about mental health and illness. We needed to find a way of presenting histories within their historical context, providing as much information as possible about the broad social context and contemporary ideas about mental health care in order to allow visitors to make up their own minds. This was absolutely essential as visitors to the exhibition, located in a local authority museum, would almost certainly include former staff members, former service users, current service users, and family members of both groups. Ideas of appropriate mental health care have changed radically, and we wanted to present information as accurately, sensitively and appropriately as possible. While certain groups – particularly former staff members – often had very positive memories of working on the site, where they formed strong friendships and often met their life partners, this had to be balanced with the (harder to source) memories of patients and service users, which were often more mixed, and could be negative. In presenting these differing views on such a recent, and profoundly local history, we wanted to make sure that each view was adequately represented equally, allowing people to explore them and to make up their own minds about the histories and memories being presented.

image

We were also mindful of the advice given by curator Nurin Veis in Colebourne and McKinnon’s book, mentioned above. According to Veis, ‘in presenting narratives of psychiatric history a curator must examine and determine whether one particular story is being emphasized at the expense of another. There is sometimes a tendency in museum displays to perpetuate the concept of past gruesome medical horrors in order to venerate the successes of modern psychiatric medicine’. We absolutely did not want to fall into the trap of emphasising the most negative aspects of the history of the site. It was overwhelming clear to us throughout the research process that a lot of genuine care existed within what could be a very harsh system. We found that there was sometimes an expectation that the very worst would be emphasised – that the history of this institution would be similar to the absolutely horrific institutional histories being uncovered with regard to the Mother and Baby Homes and the Magdalene Laundries, for example. While there were, undoubtedly, many examples of unjust and sometimes horrific treatment within institutions of mental care, these must be balanced with a representation of daily reality. At the end of the process, it felt to me that the greatest injustice was the boredom, monotony and loss of liberty and self-determination suffered by many patients, particularly up to the 1960s. We wanted to present this history fairly and honestly. In trying to understand these systems, it can be difficult for people to accept that there was no one driving force, no one figure or institution that can be vilified and perhaps punished, but rather a whole range of social forces that contributed to the situation. At some of the public events where we presented our ideas for the exhibition, we sometimes felt under pressure to fit this history into a larger story of institutional abuse in Ireland – whereas there are some points of connection, it is a very different history, and must be engaged with on its own terms. The local context for the exhibition was also in our minds in creating these narratives – together with the advice given by Veis, we were loath to perpetuate stereotypes about what happened ‘inside’, risking reinforcing stigma around mental illness and mental health care. The balance between providing accurate and accessible information about life within the asylum and the hospital without falling into potentially damaging stereotypes was certainly a challenge for the exhibition team (myself, Fiona and Liam Bradley, curator at Monaghan County Museum, supported by the staff there and the steering committee of overall project led by the HSE).

image

In the end, we decided to focus on the shared life experiences ‘within the wall’s of St. Davnet’s through a number of key themes, rather than trying to deal with patient and staff life separately. This emphasis on the lives and experiences of those who spent so much of their lives within the walls of the hospital was signalled by the first object encountered by visitors – a replica of a female patient uniform (made by a local dressmaker using early 20th century photographs as a guide, as no originals remain). This decision reflects the fact that patients, on first entering the asylum or hospital, would have had their clothing and personal belongings removed, been given a hot bath, and the serviceable but anonymous uniform of the hospital. The themes chosen were ‘Building St. Davnet’s (maps and plans, an overview of the site, a timeline with major events within the hospital, put in context by major national or world historical events, a video walk-through of the site which provided an overview of the buildings and campus as it exists, an interactive map which people could use to orient themselves around the campus, and an 18th century book of maps which showed the site in relation to Monaghan town before the asylum was constructed). If you are interested in this aspect of the history, you can read my essay from the book on the asylum and hospital architecture here. The next section focused on the World of Work, and explored the kinds of work carried out by both patients and staff on the hospital grounds. The objects chosen for this part of the exhibition included sinks, a large wooden table and a fabric brand used in the hospital laundry, a place where many female patients would have spent long hours working, a fire helmet from the hospital fire brigade, a whistle used in reporting escaped patients, as well as images of staff in uniform, reflecting changes throughout the years. Information from the archives on staff and patient work (including when patients started to get paid for their work) was on the panels – we did not include any photographs of identifiable patients or service users in order to protect anonymity, but aimed to represent their experiences as fully as possible from the archives. The oral histories were an important part of this section, reflecting memories of work on site in the farms and on the wards. We also included a section on the well-known ‘Soviet’ or strike at St. Davnet’s in 1919, led by Peadar O’Donnell, and a section on nursing, including information on training, exams and everyday patterns of life as a nurse on the wards.

image

The next section was based on ideas of illness and recovery, and included a bed from the hospital, an early ECT machine and handbook on nursing and mental illness, as well as key information on reasons for committal, types of treatments used (including highly controversial treatments such as insulin comas), and experiences of illness that crossed the boundary between staff and patient, such as the Spanish Flu and the TB epidemic in Ireland, when part of the new buildings were used as a TB hospital for a period of time. We used doors from the hospital as dividers between the exhibition sections – many of the visitors to the site itself during a Heritage Week tour in August 2014 remarked on the sense of repetition and monotony produced by the endless wards and doors throughout the vast complex of buildings – while we could not replicate this within the temporary exhibition space at the museum, we tried to give a sense of the internal environment by using these doors, and also through the video walk-through, the use of hospital screens from the campus, a commissioned soundscape which gave an idea of the aural environments on site, and a video of a sports day on campus from the 1930s (which doesn’t show any patient faces clearly), displayed at the back of the exhibition).

image

The final section was based on the idea of everyday life within the asylum and hospital.  This, in some ways, was one of the most poignant aspects of the exhibition, reflecting the lives spent, often isolated and removed from the wider world, within the walls of the hospital. Oral histories which told of patients missing the moon landing on television as their routine meant that they had to go to bed – this is a microcosm of the world of routine and structure experienced by many, where they lacked self-determination and autonomy. A section on the development of mental health care policies included at the end of the exhibition, and prepared by the HSE, gave an overview of how new policies from the 1970s aim to change this, with a more patient-centred approach. Some of the objects from this section of the exhibition are listed above, but also included the removable taps from the baths (for patient safety), the keys allowing access to either the male or female wards, but not both (patients were segregated by gender to the latter years of the 20th century), the modified knives and forks used by patients, and also the chalice and paten from the asylum, marked as such, reflecting the role that religion played for patients – there is a Catholic and a Church of Ireland chapel on campus, as well as a graveyard, where some patients who died in the asylum or hospital were buried.

image

Finally, the last section of the exhibition included a panel on mental health and language, explaining the different terms used throughout the exhibition (including some terms that would be offensive today such as ‘lunatic’ and ‘imbecile’), and a panel on current mental health care directions provided by the HSE. The desk of the Resident Medical Superintendent was included here, and visitors could sit down, and write their own thoughts and reflections on the exhibition, to be hung on a clothes line with wooden pegs behind the desk. Further reading material on the history of the site was provided here, as well as information on mental health care services in the area, and contact numbers for people to use if they were impacted by any of the issues raised by the exhibition. We thought long and hard about including trigger warnings, but in the end, felt that the initial exhibition materials outside the room provided adequate information about its content, without sensationalising the subject matter. A final note – the exhibition was produced in association with the HSE, and therefore does reflect their views on current mental health care policies. We retained as much curatorial and scholarly freedom as possible throughout the presentation of historical material, and based this on best practice developed by curators and scholars on the subject internationally. There is a lot more that I could write about this subject, but I wanted to quickly put together a blog post before I forgot some of the discussions and debates that we had in putting it together. We would have been happier to have the strait jacket at the back of the space, rather than having it front and centre, but this was the only place that this exhibition cabinet could be placed due to the need to use the space for education workshops throughout the run of the exhibition, so some compromises had to be made. The exhibition will run until Feb 2016, and will then be available to tour to other venues.

For more information on the history of mental health in Ireland – Centre for the History of Medicine in Ireland (CHOMI) at UCD, as well as the publication of several recent books and collections of essays on the subject of psychiatric history by scholars such as Catherine Cox, Lindsay Earner-Byrne, Brendan Kelly and Pauline Prior, adding to the work carried out by those such as Mark Finnane on mental illness in Ireland after the Famine, and Joseph Reynolds on Grangegorman asylum.

Correspondence:

Dr. Niamh NicGhabhann,University of Limerick
niamh.nicghabhann@ul.ie

image

The Reading Room: Call for Reviewer

20 Aug, 15 | by cquigley

 

Julie Laplante’s Healing Roots: Anthropology in Life and Medicine is available for review.

Umhlonyane, also known as Artemisia afra, is one of the oldest and best-documented indigenous medicines in South Africa. This bush, which grows wild throughout the sub-Saharan region, smells and tastes like “medicine,” thus easily making its way into people’s lives and becoming the choice of everyday healing for Xhosa healer-diviners and Rastafarian herbalists. This “natural” remedy has recently sparked curiosity as scientists search for new molecules against a tuberculosis pandemic while hoping to recognize indigenous medicine. Laplante follows umhlonyane on its trails and trials of becoming a biopharmaceutical — from the “open air” to controlled environments — learning from the plant and from the people who use it with hopes in healing.” http://www.berghahnbooks.com/title.php?rowtag=LaplanteHealing

Those with interest and expertise in this area and who would like to contribute a review on the title to The Reading Room are invited to contact the editor [columba.quigley@btinternet.com] for further details.

The Reading Room: ePatients Conference, Queen’s University Belfast

12 Aug, 15 | by cquigley

 

ePatients

The Medical, Ethical and Legal Repercussions of Blogging and

Micro-Blogging Experiences of Illness and Disease

 

Institute for Collaborative Research in the Humanities

Queen’s University Belfast, 11-12 September 2015

The provisional programme for this conference is now available:

Friday 11th September

11.00 – 11.30         Registration

11.30 – 11.45          Welcome

11.45 – 12.45          Keynote 1:

                                      Anne-Marie Cunningham (Cardiff University)

                                    Learning with and from epatients

1.45 – 3.45               Panel 1:

                                      Chair: Nathan Emmerich (QUB)

Amy Brown (SUNY Upstate Medical University, Syracuse, New York): Grounding the Relationship Between Families and Physicians in a Digital Community: A Case Study

Columba Quigley (Reading Room Editor, Medical Humanities): The ePatient and Stories of Illness

Kristen Larson (Duke University): Autopathography and Online Community: Applying Biovalue to Understand the Lisa Adams Controversy

Yewande Okuleye (University of Leicester): You call it Marijuana and I call it Medical Cannabis: Online Identity Construction and Illness Narratives from the epatient/activist Perspective.

4.00 – 5.40              Panel 2:

                                       Chair: Pascal McKeown (QUB)

Maggie Bennett and Deborah Coleman (QUB): Cultivating Compassion through Analysis of Online Patient Narratives

Sylvia Hübel (Interfaculty Centre for Biomedical Ethics and Law, University of Leuven, Belgium): IVF Blogs and Online Forums as Sites of Patient Empowerment and Moral Agency

Angela Kennedy (independent researcher): Power and Conflict between Doctors and Patients: the Case of the ME Community

5.45                            Drinks Reception, The Naughton Gallery

7.00                           Conference Dinner, Deanes at Queen’s

Saturday 12th September

 10.15 – 11.45          Panel 3:

                                      Chair: Paul Murphy (QUB)

Rebecca J. Hogue (University of Ottawa, Canada): Cancer Blogging – A Survivor’s Story

Marie Ennis-O’Connor (Digital Media Strategist and Health Blogger): Connecting and Protecting: The Benefits and Pitfalls of Online Disclosure

Anne Lawlor (22q11 Ireland Support Group): Social Media as a Virtual Lifeline: A Support-Group Perspective of the Issues

12.00 – 1.00             Keynote 2:

                                     Julia Kennedy (Falmouth University)

                                     In Our Blood: Mapping Multiple Narrative Accounts of Leukaemia Online

 1.45 – 3.15               Panel 4:

Victoria Betton (University of Leeds and mHealthHabitat programme director (NHS)): Mental Health Discourses in Social Networking Sites

Ida Milne (QUB): A Rash of Reaction: the e-parent and the 2015 Measles Epidemics

Sally Burch (Patient Blogger at “Just ME”): The Use of Patient Blogs as a Care Resource

 

The deadline for registration is August 14, 2015.

Further information can be found here: https://epatientsconference.wordpress.com/2015/06/24/programme-and-registration/

The Reading Room: ‘Patients as People’

30 Jul, 15 | by cquigley

 

Emma Barnard MA (RCA)

___________________________________________________________________

 

PATIENTS AS PEOPLE – an Exhibition by Emma Barnard in collaboration with consultant surgeons and patients within the ENT department, Whipps Cross University Hospital, Barts Health NHS.

As a fine artist working predominantly within the field of photography, video and sound, I have for the past few years been resident at Whipps Cross University Hospital, Barts Health Trust, collaborating with ENT and more recently Dermatology consultant surgeons investigating what it means to be a patient within the NHS. My focus is on the human condition rather than diagnosis, and on how one might feel as a patient in a clinical, alien environment.

Four years ago, I found myself surrounded and engulfed by the pastel walls and polished floors of the hostile, medical space, as I was guided by the yellow line that led me to my appointment with an ENT consultant. Back then I was just another terrified patient sitting in a visually depleted waiting room, anxiety heightened by the wait itself. Two hours later, I was seen by the consultant when, hanging on to his every word, my auditory senses were heightened over visual ones – thinking just tell me it’s nothing serious…please! He did, I relaxed, and then without too much thought proceeded to blurt out ‘Has an artist ever done any work on patient experience?’ I subsequently wondered why I had voluntarily offered to spend time in a place that most people avoided at all costs.

The process that followed was not easy. In particular, convincing the relevant people at the hospital who believed that having an artist on site involved setting up an easel in a packed to the gills clinic, brandishing a palette and being creative with a paintbrush, took a lot of persuading.

‘Without your medical file you don’t exist within this environment’. First spoken to me by the ENT Head and Neck surgeon Michael Papesch FRACS, these powerful and thoughtful words triggered the name for the project, Patient As Paper. It was not long before the French philosopher Michel Foucault and his book The Birth of The Clinic came into view.

‘When medicine becomes the only social language, the distinction between the doctor and the patient gets more explicit. Their perception of each other becomes hierarchical. In this relationship, the physician is the healthy, wise and authoritative one; whereas, the patient is perceived by the doctor as sick and powerless, even though the doctor may also get sick sometimes. This is what Foucault calls the “medical gaze”.’

Hsuan and Lincoln 2007: 23

Foucault says: ‘Facilitated by the medical technologies that frame and focus the physicians’ optical grasp of the patient, the medical gaze abstracts the suffering person from her sociological context and reframes her as a “case” or a “condition.’

Hsuan and Lincoln 2007: 23

Image1

Patient As Paper – CType digital print 2013

 

As Nancy-Scheper Hughes exemplifies in her article ‘The Mindful Body’, ‘the doctor searches for the “real” cause of the headache, ignoring the social and personal implications of the illnesses with which the patient deals. Thus, through the discourse of medicalization, the sickness emerges as “a form of communication – the language of the organs – through which nature, society and culture speak simultaneously.

Scheper-Hughes and Lock 1987: 3

Patients are seen as the voiceless, lost in a system that reduces them to their diagnoses. Having previously been an advocate for various other groups, such as hard to reach NEETS (youth who are not in employment, education or training), Patient As Paper presented an incredible opportunity for me as an artist to once again make the unseen visible through art, by giving patients a voice. I am interested in using art to explore the patient’s perspective on being in hospital, and their emotional response to becoming a product of investigations and treatments. Patients may feel overwhelmed and disorientated by the hospital environment, and may experience loss of control. I am also interested in what doctors experience when looking after patients, particularly when this is emotionally challenging.

After a trail of recommendations, we were fortunate to meet Chris Mc Manus, Professor of Psychology and Medical Education at UCL, who wrote the following:

‘“Patient as Paper” explores photographically the meanings of silent biomedical artifacts such as notes, scans, micrographs and surgeons’ theatre drawings (be they on paper or skin). By inverting a patient and their notes, using superimposition and image-processing, photography forces a critical reflection on being a patient in the foreignness of hospitals, and on the complementarity of patients’ and surgeons’ visions of each other, as objects and people.’

Discussion dictated my next step. Following observation of the patient and surgeon consultation, I presented patients with an opportunity to express their reality, thoughts and feelings through art. In an ENT department, the face, the most potent visual correlate of the person, and personal identity are especially pertinent. The photographic portrait, taken after some discussion with the patient, is printed out and the person is encouraged to note what has impacted them the most about being a ‘patient’. Is there a defining thought, word or image? Proving that human beings can never just be a number, each individual is unique, and no two individuals have ever written or drawn the same content.

Image2

Emma Barnard working with patient Lee Anderson 2015

‘As a doctor I wanted to look at patient experience and different ways of understanding what the patients are going through mentally and emotionally and not just physically. Working with Emma allowed us to investigate this through the medium of fine art photography as a radically different way (from a medical perspective) of assessing patient experience. We as doctors are often subject to focusing on the science of medicine, despite our best intentions of treating patients as people. The core of this project is about the need for establishing this human connection as well as understanding what it means to be a patient.

To reflect upon these images invites the doctor and other healthcare professionals to consider what the patient is expressing about their care. Some images are very literal, others less so.  It is not so important that the viewer understands exactly what the patient themselves is thinking. The challenge for us as health care providers is to allow ourselves the opportunity to reflect on these images and thereby consider, in a novel, visual and artistic way, how the patient experience can affect us all.’

Mr Michael Papesch FRACS ENT Head and Neck Consultant Surgeon

‘Working alongside Emma has certainly changed my view of the patient consultation for the better. Many of the actions, words and phrases that are commonplace to me seem unusual or even shocking to a non-medically trained professional such as Emma. Emma articulates these thoughts and I gain greater insight into how the patients’ must be feeling. The images created by the patients never fail to amaze me. We all need to look at how we interact with patients during difficult and sometimes upsetting consultations. This kind of work reminds us that we are dealing with real people with real thoughts, fears and emotions and as such it has great value’.

Mr Paul Stimpson FRCS (ORL-HNS) ENT Head and Neck Consultant Surgeon

Now that I had secured this invaluable patient-centred work, it was important to give these people a voice in a more public way. Thus, the Patients As People exhibition was realized. Displaying artwork in a hospital setting comes with incredibly complex rules and regulations. Individual framed portraits on walls can be tricky, something that years of working with galleries and various venues had taught me. I sought inspiration from my biomedical environment and the many tests some of the patients had to endure in their pursuit of ‘getting better’. The idea was a play on the word and function of the X-Ray, a vision of one’s internal world. The exhibition itself could similarly be seen as a reflection of what was taking place within patients’ minds. A free-standing display was designed, containing several pockets where patient portraits could be contained.

Image3

Patients As People exhibition – George V Wing, St Barts, NHS Barts Health

Two and a half years ago, the launch at Whipps Cross University Hospital took place. Today, the exhibition is currently installed at its tenth venue, St Peters Hospital, Surrey, having toured the country to include the Department of Health London, Lancaster University and the NHS Leadership Academy in Leeds. One of the hosts Justine Thompson, Patient and Public Participation Lead, Strategic Clinical Network and Senate (East of England) Cambridge comments:

‘From the woman who is ‘boiling over’, to the young man who has totally obliterated his own face, every photograph in this powerful exhibition stops us in our tracks with its raw communication of human emotion.

Some of the pictures show outward serenity – but the self-authored graffiti often tells another story. These photographs are a graphic reminder that every person’s health story is as unique and individual as they are and that every encounter with a health care professional is likely to be an unwelcome voyage into the unknown. This is essential viewing to reconnect us all to the core of our own humanity.’

After a successful launch at St Peters Hospital the exhibition will remain there until the move to Ashford Hospital in September, launch date 23rd September. If you would like to attend the launch, please contact: Giselle Rothwell on giselle.rothwell@asph.nhs.uk

Heather Caudle, Chief Nurse who commissioned the exhibition to be installed at Ashford and St Peters writes ‘Seeing the person before the patient’: http://www.ashfordstpeters.nhs.uk/about-us/message/1269-seeing-the-person-before-the-patient

 

Future bookings are now being taken, if interested please contact Emma through one of the following:

Web – www.emmabarnard.com

Twitter – @PatientAsPaper

FB – Emma Barnard Artist

The Patient As Paper project is currently seeking funding/sponsorship. If you would like to contribute to this exciting initiative please contact Emma.

Other artwork, which explores medicine and religion from the Patient As Paper project, is being shown in the following touring exhibition:

‘If Yesterday Were Today’

Tuscany – 11th – 18th July

Berlin – September 12th – 20th

London – 3rd – 6th December 2015

 

References

Hsuan L. Hsu and Martha Lincoln, Winter 2007, Biopower, Bodies . . . the Exhibition, and the Spectacle of Public Health’, Discourse, Volume 29, Number 1

Nancy Scheper-Hughes and Margereth M Lock, 1987, The Mindful Body: A Prolegomenon to Future World in Medical Anthropology, Medical Anthropology Quarterly 1 (1)

 

___________________________________________________________________________

 

 

Vivek Santayana: Film Review – “Inside Out”

24 Jul, 15 | by Ayesha Ahmad

This year’s summer release by Pixar Animation Studios, Inside Out, follows the inner workings of the mind of Riley, an 11-year-old girl from Minnesota, as her life is suddenly turned upside down when her family moves to San Francisco. This film has already received great acclaim at Cannes Film Festival 2015 for its heartfelt relatable story, imaginative storytelling, beautiful animation and a delightful musical score. However the film’s complex subtexts are really what makes it remarkable, as they are richly informed by a wealth of psychological theories. 

more…

The Reading Room: A review of ‘The Cambridge Companion to The Body in Literature’

15 Jul, 15 | by cquigley

 

The Cambridge Companion to The Body in Literature

Edited by David Hillman and Ulrika Maude

CUP 2015

 

Reviewed by Alan Radley

Emeritus Professor of Social Psychology, Loughborough University, UK

a.r.radley@lboro.ac.uk

 

It was in the course of having a routine eye examination that I talked to the ophthalmologist about reviewing the present book, an addition to the Cambridge Companion series. Half-blinded by the light penetrating my eye, (“Look to the left; up; now at my left ear”) he asked if the book was organised by organs of the body. Under the circumstances this seemed an altogether sensible question. I explained that this was not so, though I doubt that either of us would have thought of the organ that Ulrika Maude – one of the book’s editors – chooses in order to illustrate how literature borrowed from the neurological pathologies revealed by medical science.

She uses a passage from George Eliot’s Middlemarch to show how the body performs non-intentional acts, which are conscious but not thought-conscious:

‘Her lips trembled, and so did his. It was never known which lips were the first to move towards the other lips; but they kissed tremblingly and then they moved apart.’ Maude compares this to the ‘Sirens’ episode of Joyce’s Ulysses, in which, ‘In the second carriage, miss Douce’s wet lips said, laughing in the sun’. (205) Maude points out that these lips are no longer merely trembling or kissing or even laughing in the sun but reveal an organ that, in producing language ‘in a deviant manner’, reveals ‘a physiological organ running away with itself’ rather than expressing the thoughts of the speaker. This difference is a result, Maude argues, of the emergence of body intentionality in relation to language that followed research into aphasia and other developments in neurology in the late nineteenth century.

While Maude’s chapter is the only one in the book that comes near to being organ specific, (thinking of the nerves as an organ), two other chapters show the direct influence of technological innovation on the way that the body is re-written in literature. One, by Steven Connor, reviews the way that the senses were first ordered and re-ordered through technological developments. Through that re-ordering the body takes into itself powers that enable changes in correspondences with the world. Quoting from Virginia Woolf’s To the Lighthouse, he points out that:

‘Perception reverses the entropy of the world. Better yet, it improves the world. To see the world enchants me, but in so doing, I enchant it too. I participate in the soul of the world.’ (192)

This enchanting of the world is one of the powers of literature, not as Connor says, ‘because everything passes through it, but because, as technographic apparatus, it is becoming part of everything.’ (193).

Paul Sheehan also picks up this transformational potential in his chapter on ‘Posthuman Bodies’, discussing the creation of mythic and monstrous bodies to explore modern concerns about cloning and androids.

The idea that literature reflects and yet transforms the body in its worldly operations is consistent with the aims of this volume as set out by the editors in their introduction. Hillman and Maude point out that ‘there are no bodies in literature.’ (3) This is because the concrete materiality of the body cannot be fully present in words. And yet the fact that the body is everywhere represented through language allows for a re-imagining (‘unbinding’) of forms of fixity to which the body is subject. Chapters on Ageing, Maternal Bodies, Dead bodies, Sexualities and Racialized Bodies serve to illustrate this point in detail and variety.

One chapter that addresses the book’s themes most successfully is Maud Ellman’s discussion of Eating, Obesity and Literature. This is because Ellman serves up a diet of rich metaphor (!) to show that ‘Readers of these novels learn to love fat in both corporeal and literary form.’ (64) Falstaff, Sancho Panza (whose surname means ‘belly’) and Molly Bloom are re-visited as characters who challenge the modernist obsession with thinness. I enjoyed Ellman’s chapter not only for its message but its presentational form, moving between ideas in literature, social norms and historical trends. To give an example, speaking of Ezra Pound’s argument that it is better to present one striking image in a lifetime that to produce a volume of writing she says:

His own minimalist poem, ‘In a Station of the Metro’ (1913), resulted from a kind of liposuction that reduced some thirty lines to two. In the same period, a crash diet is imposed on popular fiction to counter the flabby bourgeois epics of the past.’ (65)

The contributions in this book work best when they do this kind of metaphorical work to show transformational possibilities in the way that authors write about the body. I found the book less engaging in chapters that took ideas about literature together with philosophic concepts and discussed these twin aspects as entities. While there is a place for concept clarification (and I am sure many students find this useful), the book’s special offering is the tracing out of ideas using sources so that a transparency of thinking is made evident. For example, in his chapter on Pain and Violence, Peter Fifield gives an extended analysis of a section of Lawrence’s Sons and Lovers, in which Walter Morel falls ill and Mrs Morel ‘had him to nurse’. Fifield uses this analysis in the context of Elaine Scarry’s argument that pain deprives us of language and hence of nuanced feeling. By the revelation that “Mrs Morel was more tolerant of him..’ but that ‘Neither knew she was more tolerant of him because she loved him less’ (122), Fifield argues that ‘Walter’s illness is not the cause of the coolness, rather the occasion for deceptiveness and scepticism..’ (123). This insight is useful, though it was one occasion among many when I felt the lack of ideas that have been developed by social scientists working in the field of health and illness. On the topic of women’s bodies Mildred Blaxter wrote:

‘People have to inhabit their bodies, and their physical identity is part of themselves. Particularly as they grow older, they have a need to account for this identity, to draw together what they have experienced. This body is their inheritance, it is the result of the events in their life, and it is their constraint.’ (1983)

The nature of this accounting, its context and actors, is of course part of what Lawrence is doing with the Morels, as noted by Fifield. However, the developed writing about illness relationships and caring that medical sociologists have offered is precisely what could have opened out an analysis of this kind.

Indeed, at several points in the book (usually citing Virginia Woolf’s essay on illness) I wondered why there was no special chapter on this topic. If anything this seemed to me an odd omission, given that modern ideas about health and fitness, cosmetic surgery, in vitro fertilization and images of cancer and AIDS patients have occupied pages of novels and mass media. I looked for Susan Sontag’s name in the index but did not find it.

But how does language work in the expression of bodily powers and feelings? This is a big question, addressed by Andrew Bennett in a chapter focusing upon Romanticism. Bennett uses Wordsworth’s poem ‘Tintern Abbey’ to argue that it realises matters of presence and absence (of the speaker’s body) through an allusion to the senses. He says, ‘For the Romantics, in Nancy’s formulation, body and thought ‘are only their touching each other’. (79) It is the idea of presence that extends beyond the body in spatial terms to the apprehension of feelings (our ‘diviner nature’) that remain only as traces, like wrinkles in the sand made by the waves of the sea. According to Walter Benjamin our thoughts and feelings are out there, not in our heads. Regarding our beloved, he says, ‘feelings escape into the shaded wrinkles, the awkward movements and inconspicuous blemishes of the body we love, where they can lie low in safety.’ (1986:68) Bennett’s chapter is one that draws together many of the questions raised in other topic based contributions.

It also raised for me another question, which the book as a whole addressed only tangentially. What of the body of the reader? How is the reader taken up by reading novels, plays and poems that engage the senses, re-positioning them in respect of moments both historical and social? It seems to me this issue of presence – of re-presenting and of making present – is key to the ways in which the senses and affects are mobilised, diverted, muted so that the reader is brought before, or back or beyond. Jean-Michel Rabate concludes his chapter on Literature and Affect with a quote from Kafka:

‘[We] need books that affect us like a disaster, that grieve us deeply, like the death of someone we loved more than ourselves, like being banished into forests far from everyone, like a suicide. A book must be the axe for the frozen sea inside us’. (243)

Yes.

 

References

Benjamin, W. (1986) ‘One -way street’. In P. Demetz (ed.) Reflections: essays, aphorisms and biographical writings. New York: Schocken Books. pp 61-94.

Blaxter, M. The causes of disease: women talking. Social Science and Medicine, 17, 59-69.

Science Fiction & Medical Humanities: Special Issue CfP

4 Jul, 15 | by Deborah Bowman

Call for Papers for Medical Humanities

Science Fiction and the Medical Humanities

We are delighted to announce that Medical Humanities will be publishing a special issue: ‘Science Fiction and the Medical Humanities’. This edition of the journal will be guest edited by Dr Gavin Miller.

Themes

We invite papers of broad interest to an international readership of medical humanities scholars and practising clinicians on the topic ‘Science Fiction and the Medical Humanities’.

Science fiction is a fertile ground for the imagining of biomedical advances. Technologies such as cloning, prosthetics, and rejuvenation are frequently encountered in science-fiction stories. Science fiction also offers alternative ideals of health and wellbeing, and imagines new forms of disease and suffering. The special issue seeks papers that explore issues of health, illness, and medicine in science-fiction narratives within a variety of media (written word, graphic novel, theatre, dance, film and television, etc.).

We are also particularly interested in articles that explore the biomedical ‘technoscientific imaginary’: the culturally-embedded imagining of futures enabled by technoscientific innovation. We especially welcome papers that explore science-fiction tropes, motifs, and narratives within medical and health-related discourses, practices, and institutions. The question – how does the biomedical technoscientific imaginary permeate the everyday and expert worlds of modern medicine and healthcare? – may be a useful prompt for potential authors.

Subject areas might include but are not limited to:

• clinicians as science-fiction writers
• representations of medicine, health, disability, and illness in science-fiction literature, cinema, and other media
• the use and misuse of science fiction in public engagement with biomedical science and technology
• utopian narratives of miraculous biomedical progress (and their counter-narratives)
• socio-political critique in medical science fiction (via cognitive estrangement, critical utopias, etc.)
• science fiction as stimulus to biomedical research and technology (e.g. science-fiction prototyping)
• science-fiction tropes, motifs and narratives in medical publicity, research announcements, promotional material, etc.
• the visual and material aesthetic of science fiction in medicine and healthcare settings

Publication

Up to 10 articles will be published in Medical Humanities in 2016.

All articles will be blind peer-reviewed according to the journal’s editorial policies. Final publication decisions will rest with the Editor-in-Chief, Professor Deborah Bowman.

Important Dates

Please submit your article no later than 1 March 2016

Submission Instructions

Articles for Medical Humanities should be a maximum of 5,000 words, and submitted via the journal’s website. Please choose the special issue ‘Science Fiction and the Medical Humanities’ during the submission process.

If you would like to discuss any aspect of your submission, including possible topics, or the possibility of presenting your work under the auspices of the Wellcome Trust funded project ‘Science Fiction and the Medical Humanities’, please contact the Guest Editor in the first instance:  Dr Gavin Miller (gavin.miller@glasgow.ac.uk)

The Reading Room: A review of Oliver Sacks’ ‘On the Move: A Life’

24 Jun, 15 | by cquigley

 

On the Move: A Life by Oliver Sacks. London: Picador, 2015

Reviewed by Paul Gordon, Psychotherapist

 

Earlier this year, not long before this book was published, neurologist Oliver Sacks, author of hugely popular works such as Awakenings, Hallucinations and The Man Who Mistake His Wife for a Hat, announced that he had been diagnosed with terminal cancer. Nine years ago, he had survived a rare tumour of the eye, an ocular melanoma, the removal of which had left him with unilateral blindness. It has now metastasised to his liver.

This memoir, engaging and compelling as it is, takes on an added poignancy in this light.

Sacks was born into a medical family. His father was a respected and highly regarded GP in north west London, still doing home visits – the ‘heart’ of medical practice he believed – in his 90s. (He would book a cab for a day to take him round.) His mother was one of the first female surgeons in the UK and specialised in gynaecology. She was also, as Sacks discovered, a secret supporter of young women who wanted to become doctors, even helping to pay their fees.

Early in his life, Sacks escaped death on a few occasions. Twice he had to be rescued from drowning. He was also addicted to amphetamines as a young man, which could have proven fatal had he not sought help. The epiphany happened when he found himself on one occasion having an animated conversation with two imagined friends for whom he was also cooking breakfast. He rescued himself by finding a therapist, Dr Shengold, who he continues to see twice-weekly to this day.

Sacks was also born into a motorbiking family. In his previous memoir, Uncle Tungsten, he recalled his father going off on his high-pitched Squirrel at the weekend to clear his mind. This exposure infected the young Sacks, who got into bikes at an early age. Sacks, the writer, regales his readers with the story of riding in Regent’s Park on a BSA Bantam when he realised that not only had the throttle seized, but the brakes were not powerful enough to stop the bike. He proceeded to ride around the park until he ean out of petrol. Lovers of bikes, such as myself, will be enthralled by his accounts of riding in the US, where he moved to in his 20s, and the beautiful BMW R60, which features on the book’s cover. The memoir’s title comes from a poem by his friend and fellow exile, Thom Gunn, also a biker.

In many ways, this memoir is an act of gratitude to the many people who have loved Sacks, who ‘got’ him, and who have consistently supported and encouraged him. There is the friend from childhood, polymath and doctor Jonathan Miller; Colin Haycraft, the publisher at Duckworth, who at one point lets Sacks live on the premises so that he can finish his work; the aforementioned poet Thom Gunn; and Carol Burnett, the medic whom he met at Mount Zion when they were both starting out. It is Burnett who Sacks calls when, one day at a lunch counter, he sees his coffee as green and a fellow customer as having the head of an elephant seal. Burnett sits with him through four days of delirium DTs, ‘the only stable point in a chaotic and shattered world’. There is also his remarkable Aunt Lennie, his mother’s sister, Helena Penina Landau, who set up the ‘Jewish Fresh Air School for Delicate Children’ in Delamere Forest in Cheshire, an endless encourager in her letters and cards, and a gentle critic until her death.

There is the inspirational teacher in neurology too, Michael Kremer, whom Sacks met at the Middlesex Hospital in 1959, shortly after qualifying. Kremer seemed, Sacks reflects, to be able to read people’s minds, to see things at a glance, and encouraged his students to use all their senses and intuition to get to know their patients, rather than merely resorting to standard questions.

But Sacks also shares stories of some of the appalling behaviour he experienced from colleagues. He was clearly delighted in 1966 to get a job seeing ‘real patients’ at a headache clinic in the Bronx area of New York. He quickly realised that the migraine patients presented with a whole range of problems, not just headaches. Sacks’ boss at the time viewed the junior doctor’s medical assessment as a threat to his own medical knowledge and standing, and proceeded to ban Sacks from access to his research data. Undeterred, Sacks made friends with a janitor and went in at night to copy all the notes he had himself taken during the day. Sacks shares a further dispiriting anecdote: while working at the Beth Abram hospital, he was informed by the director that he had to give up the flat he had been living in as the director needed it for his mother. Sacks refused and was promptly dismissed, ‘in a stroke, deprived of job, of income, of my patients, and of a place to live’.

There are also the disappointments. Faber, who had published his first book Migraine in 1971, turned down Awakenings; he lost two manuscripts; a suitcase full of precious notes and photos never reached his new home; he had to watch in horror as nine months of research notes were destroyed by traffic on the South Bronx expressway because of his failure to secure his bag properly to his bike. There was the long struggle, eight years, to write A Leg to Stand On, Sacks’ account of breaking his leg in Norway while escaping from a bull, and his subsequent experience of perceiving the injured limb as an alien object. A review of the book, by the British poet James Fenton, Sacks recalls, ‘upset me deeply and brought me to a depressive halt for three months’. However, he is later uplifted by a more positive review in the New York Review of Books by the eminent psychologist Jerome Bruner. This affirmation energised Sacks and led to an explosion of writing that included the completion of The Man Who Mistook His Wife for a Hat.

In all of these works, Sacks created a new form of writing, although he himself would be the first to acknowledge a debt to the works of his intellectual mentor, the Russian neuropsychologist Alexander Luria. When he read Luria’s The Mind of a Mnemonist in 1968, Sacks believed that he was reading a novel. (Sacks discusses Luria here https://www.youtube.com/watch?v=eGqLfP-LtgE)

When Sacks’ first book Migraine appeared, it was favourably reviewed in The Times – ‘balanced, authoritative, brilliant’ – but Sacks, who had returned home for the event, recalls his father coming into his bedroom ‘pale and shaking’, believing that his son had committed a grave impropriety and that the medical authorities might misconstrue the article as advertising.

Sacks admits to what he calls a ‘too-muchness’, an inability to let things go when he is writing. Mary-Kay Wilmers, the editor of The Listener, a magazine then published by the BBC, asked him in 1972 to do a piece – his first ever commission – which he completed in one sitting. However, over the course of the following week, he sent Wilmers not just one, but eight alternative versions. When he cannot choose, Wilmers does, selecting ‘the seventh (or was it the sixth?) version’. Similarly, the footnotes to Awakenings came to three times the length of the book, threatening to sink the text, as his publisher Colin Haycraft states. Haycraft encouraged him to settle for a total of twelve footnotes.

Throughout the book, there is the shadow of Sacks’ younger brother Michael, ‘odd’ from an early age, who later became psychotic. He seemed to respond well to the early generation of anti-psychotic drugs, but soon demonstrated all the negative reactions – ‘grossly parkinsonian’ – so common in such cases. Michael spent his life in and out of mental institutions, ending his days in a care home on the same road where he had lived with his parents until their deaths.

I have never really understood objections to Sacks’ writing. Far from portraying people as strange specimens to be looked at, it seems to me that he has always reminded us that the realms of being human are wider than we might feel comfortable with, and that we have to find a place for those whose behavior may well be different or even bizarre. At one point, Sacks mentions being in love with his patients, ‘the sort of love or sympathy that makes one clear-eyed’. He reminds us that our ways of responding to illness are not the only ones. In 1987, he visited the La Crete Mennonite community in Alberta, which had a very high concentration of people with Tourette’s syndrome. The experience showed him how something like Tourette’s syndrome, neurological in origin, could be modified by context and culture, in this case, ‘a deeply supportive religious community in which Tourette’s was accepted as God’s will’.

Sacks is not offering any great insights or profound thoughts on life here, but perhaps something more important, the example of a life lived fully, recounted with candour and generosity, and without a hint of self-pity. He even succeeds in being open hearted towards his mother, who, he reveals, told him ‘You are an abomination. I wish you had never been born’ on learning that her son was sexually attracted to men. She was, Sacks comments, ‘haunted by the terrible verses in Leviticus’.

It seems fitting to end with Sacks’ own words. In the article announcing his diagnosis of metastatic cancer, he reflects: ‘I cannot pretend I am without fear. But my predominant feeling is one of gratitude. I have loved and been loved; I have been given much and I have given something in return; I have read and traveled and thought and written. I have had an intercourse with the world, the special intercourse of writers and readers.’ (New York Times, 19 February 2015).

 

 

 

 

 

 

The Reading Room: A review of ‘The Good Story: Exchanges on Truth, Fiction and Psychotherapy’

17 Jun, 15 | by cquigley

 

The Good Story: Exchanges on Truth, Fiction and Psychotherapy by Arabella Kurtz and J.M. Coetzee

London: Harvill and Secker, 2015.

Reviewed by Vivek Santayana, The University of Edinburgh

 

Abstract: Arabella Kurtz and J.M. Coetzee’s The Good Story is a dialogue between a consulting clinical psychologist with an interest in literary studies and a novelist with an abiding concern with psychoanalysis and moral psychology. Through their exchanges, Coetzee and Kurtz explore the ways in which fiction and psychotherapy overlap, such as in their mutual concern with how history, memory and the self are mediated through language. They also enact conceptual disagreements between psychotherapy and fiction, particularly with their commitment towards the existence of an external truth. These exchanges suggest that while literary practice and psychotherapy can benefit each other tremendously, significant challenges remain in bridging the conceptual gulf between them.

The Good Story is a series of exchanges between Arabella Kurtz and J.M. Coetzee that explore the possibility of dialogue between psychoanalytic psychotherapy and literary fiction. Both Kurtz and Coetzee, in the course of their correspondence, represent their trade: Kurtz is a consultant clinical psychologist completing training in psychoanalytic psychotherapy while Coetzee is a novelist and critic with an expansive career to date in fiction and non-fiction. Both Kurtz and Coetzee are deeply interested in what they might potentially gain from each other, as Coetzee has an abiding concern with moral psychology and psychoanalysis, and Kurtz is interested in what psychotherapists can learn from interpreting narratives through literary techniques. Their exchanges, often circuitous and digressive, examine the ways in which psychotherapy and literary fiction overlap, points at which they differ and, subsequently, the respective roles of the writer and therapist in listening to and finding truth in these narratives.

Coetzee and Kurtz’s exchanges are ambitious in the range of topics they address, such as the nature of truth in fiction and psychoanalysis, the method and role of psychotherapy, the authenticity of narratives, the construction of the self, the psychology of groups and the broader political and historical critique for which psychoanalysis can be used. To begin with, Kurtz identifies several ways in which literary fiction and psychotherapy overlap. The therapeutic encounter, for Kurtz, is a creative process, and the psychotherapist must be sensitive to the internal coherences and frustrations of patients’ narratives and the ways in which they manifest themselves within the formal characteristics of the narratives. Moreover, knowledge of the past, whether it is through memory-traces or historiography, is constructed and mediated through narratives. Both psychoanalysis and fiction are interested in how the self creates a narrative to give the past coherence and structure in order to construct its own identity. Coetzee and Kurtz are divided on the truth of these kinds of narratives, and they further disagree on the nature of truth itself (an external, ontological truth versus an intersubjective, aesthetic one). Nevertheless, it is clear from their exchanges that both literary practice and psychotherapy have a mutual concern with interpreting narratives and serving a specific therapeutic function, and hence mutually inform each other. This idea chimes particularly with Rita Charon’s work in the field of narrative medicine.

In some of the middle exchanges, these themes are drawn into a pointed postcolonial question about descendants of settler communities in South Africa, the United States and Australia – nations with which Coetzee has some degree of affiliation – and how these societies deal with a history fraught with genocide. These troubled histories recur in the present and haunt these societies. Coetzee and Kurtz examine, through the lens of defence mechanisms such as splitting and repression, the rhetorical strategies societies use to integrate self-affirming narratives of their present with an ethical disavowal of the atrocities committed by their forebears. One of the debates concerns the nature of regression within group psychology, and whether nationalism is a force that is inherently regressive or whether there is a possibility of positive identity. These discussions are grounded in an awareness of contemporary political problems, such as Australia’s oppressive immigration policies towards asylum seekers. Coetzee argues that all forms of nationalism and group-thinking are inherently regressive (as in the case of armies or gangs of children in schools), whereas Kurtz maintains that there is a positive, non-regressive possibility of group thinking (drawing from institutions like the NHS or the analysis of Oedipal relationships). But there is nevertheless a methodological problem underlying both positions, which both Coetzee and Kurtz discuss in due course, and that is the possibility of generalising from the analysis of an individual psyche or the dynamics of specific institutions to the much broader group psychology of a nation or society.

The exchanges between Kurtz and Coetzee are also eclectic in their breadth of references and interests. They draw from numerous literary examples, including Cervantes, Dostoyevsky, D.H. Lawrence, Hawthorne and Sebald, a number of compelling case histories as well as a body of psychoanalytic theory such as Sigmund Freud, Melanie Klein, Wilfred Bion, Isabel Menzies Lyth and Paula Heimann. There are clear philosophical themes, drawing from Plato, Kant and Levinas, which inform Kurtz and Coetzee views on truth and intersubjectivity, even though they are for the most part not explicitly stated. One of the most interesting discussion centres on Coetzee’s reading of Thomas Nagel’s paper What is it like to be a bat?, through which the author questions the limit of human empathy and projection in knowing ‘the Other’, thereby questioning the extent to which a psychotherapist can truly know what it is like to be the patient. Coetzee frequently challenges Kurtz on the idea of truth, and insists that rather than claiming to know the self and how it relates to others, psychotherapy should concede the fictitiousness of the narratives with which it engages.

The disputes between Kurtz and Coetzee are particularly instructive as they reveal how literary fiction and psychotherapy can diverge (at least in the way Coetzee and Kurtz characterise them). They disagree on the matter of truth, for example, as Coetzee is nostalgic for an external truth (either an event itself or some philosophical truth) that is inaccessible to narrative fictions like memory or psychotherapy. Kurtz on the other hand is agnostic of any such external truth and is instead concerned with a dynamic, inter-subjective notion of truth that represents the meaning-making process of the subject. The grounds of their disagreement seem subtle yet significant. Kurtz and Coetzee have difficulty finding common ground on the issue as well as a common terminology with which to address these questions. Their disagreements seem to suggest that a dialogue between psychoanalysis and fiction needs much more than a mere overlap between the methodological concerns with narrative and the self, but necessitates a reconciliation of distinct philosophical premises. The exchanges between Kurtz and Coetzee resemble a Socratic dialogue that foregrounds the challenges faced by psychotherapy and literature in bridging the conceptual rifts between them, while also exploring the tremendous benefit potentially achieved for both disciplines by conversing with each other.

However, one aspect of this dialogue between Coetzee and Kurtz that is particularly vexing is the apparent self-consciousness of its own structure. This is true of most of Coetzee’s novels, which employ metafictional devices to question their own ontological status as texts. It is particularly intriguing to apply what Coetzee and Kurtz say (about fiction, memory and constructing the self, for example) to the exchanges themselves (such as Coetzee’s recollection of his childhood or his account of his relationship with South Africa). Coetzee’s accounts of his life or opinions in these exchanges beg the question of whether or not these accounts are themselves fictions. This is complicated further by the fact that Coetzee seems to be channelling his own fictional narrator, Elizabeth Costello in The Lives of Animals, in his discussion of Thomas Nagel. All of this begs the question of how much Coetzee’s position should be taken at face value. Moreover, there are aspects where his argument seems to invite resistance and scepticism. For example, in light of postmodern rejections of an external, objective truth (something that Coetzee seems to have foregrounded in his previous novels), it is tempting to push against Coetzee’s nostalgia for truth. The most remarkable thing about The Good Story is that it not so much the decisive arguments that Coetzee and Kurtz make, but the revealing contradictions and ambiguities behind what they say.

 

The Good Story: Exchanges on Truth, Fiction and Psychotherapy by Arabella Kurtz and J.M. Coetzee

London: Harvill and Secker, 2015.

pp.198

£16.99

 

Medical humanities blog homepage

Medical Humanities

An international peer review journal for health professionals and researchers in medical humanities. Visit site



Creative Comms logo

Latest from Medical Humanities

Latest from Medical Humanities