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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)

 

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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

 

The Reading Room: Seamus O’Mahony on Richard Asher

10 Jun, 15 | by cquigley

 

Brimful of Asher

Seamus O’Mahony, Consultant Physician, Cork University Hospital

 

Richard Asher: Talking Sense. London: Pitman Medical, 1972.

A Sense of Asher. London: British Medical Association, 1984.

The Royal Society of Medicine recently (3 November 2014 – 24 January 2015) held an exhibition called “Richard Asher (1912-1969): A Celebration”. Asher, an English physician and writer, is mainly unknown to those under fifty. He was appointed as physician to the Central Middlesex Hospital in 1943, and worked there until his resignation in 1964. He was a general physician, with interests in haematology, endocrinology, hypnosis, and the physical basis of mental illness. He argued passionately in favour of generalism, and warned against what he saw as increasing over-specialisation. Asher had a unique, aphoristic, literary style: he wrote articles which were easy to read, witty, and which often challenged received opinion. He had a passion for clear, elegant English, but admitted that his prose style did not come easily. His essays ranged from the purely clinical to the speculative and philosophical; he wrote not only for the medical journals, but also the popular press. He was an inspirational clinical teacher, and an accomplished and much sought-after lecturer. He is probably best known for coining the term “Munchausen’s Syndrome”.

One of Asher’s clinical commitments was as consultant in charge of the mental observation unit at the Central Middlesex, where he saw an average of 700 patients a year. This experience provided him with the clinical material for such articles as “Myxoedematous Madness” (1949), “The Physical Basis of Mental Illness” (1954), and, of course, “Munchhausen’s Syndrome” (1951). In 1964, the hospital authorities decided to appoint a psychiatrist to take charge of this unit. Asher was deeply offended, and resigned his consultant post. His remaining years were plagued by ill-health and melancholy; he took his own life at the age of fifty-seven.

Asher described himself as “a physician more at home at the bedside than in the laboratory”, and wrote many articles on what he regarded as the heart and soul of clinical medicine: the history and physical examination. He advised his students and readers to ignore the textbooks and to think for themselves. Most of his essays were inspired by simple clinical observations, prompting the thought: “Nobody seems to have commented on the fact that …” He argued for the supremacy of experience and noticing. He inspired such famous protégés as Jonathan Miller and Oliver Sacks.

If Asher had a passion for detail in the history and physical examination, he had an even greater passion for clarity of expression, and the correct use of words. He was modest about his abilities as a writer, claiming that “the standard of medical writing is so low that a doctor literate enough to put on paper something that can be read and understood without much suffering is soon looked on as a literary giant of cultured scholarship.” He often pointed out that “style” in prose was the result of painstaking hard work and much re-writing. He was, observed the medical journalist Ruth Holland, proof of the truth of C.E. Montague’s maxim: Easy reading, hard writing.

Asher abhorred obscurity, slip-shod thinking, jargon and inelegant prose. Indeed, he listed obscurity as one of “The Seven Sins of Medicine” (1949), the other six being Cruelty, Bad Manners, Over-Specialization, Love of the Rare (Spanophilia), Common Stupidity, and Sloth. He noted how obscurity advanced academic careers: “Remember that the harder anything is to understand, the more readily will committees allocate money to it. Much sensible medicine is obvious, but the obvious does not impress.” He could have been accused of biting the hand that fed him when he wrote a piece for the BMJ called “Why are medical journals so dull?” (1958). He wrote that journal authors “clog their meaning with muddy words and pompous prolixity …”

He valued clarity in thought as much as plainness of expression and elegance of style. He was a student of formal logic, taking inspiration from such works as Rupert Crawshay-Williams The Comforts of Unreason (1947), Robert H. Thouless’s Straight and Crooked Thinking (1930), and Lewis Carroll’s Symbolic Logic (1896). He was aware of the discomfort caused by cognitive dissonance: “Some beliefs are cherished a long time before some pundit kills them for us, and the extraction of a firm rooted belief is as unpleasant as the removal of an impacted wisdom tooth.” He derived his own word – “apriority” – to describe a kind of lazy thinking, particularly the notion of treatments that had a theoretical reason for why they might work, but for which there was no evidence that they did work. He was pessimistic about changing doctors’ thinking: “It has been held by some teachers that rational thinking in medicine would be improved if doctors were taught logic. I rather doubt this. Most of our ideas are accepted because they are convenient or likely, and not because of logical reasoning.” Asher was friendly with Richard Doll and Archie Cochrane, and was a champion of the concept of Evidence-Based Medicine, decades before the phrase was coined.

Asher had an uncomfortable relationship with psychiatry, culminating in the disastrous termination of his duties as physician in charge of the mental observation unit at the Central Middlesex. He wrote that psychiatry is “regarded by other doctors with a mixture of suspicion, reverence, and ridicule”. He particularly disliked such phrases as “Psycho-dynamic” and “psycho-biological” relationships: “The use of those key words lends an impressive but nebulous air of humane profundity to your utterances and conveys that ordinary doctors are unsympathetic and remote beings with no interest in their patients’ feelings.”

He agreed, however, with the psychoanalyst Michael Balint that the most important therapy at the doctor’s disposal was the doctor himself. He doubted, however, that “communication skills” could be taught:

It can be learnt by experience and to some extent by watching great doctors handling their patients, but it cannot be taught like pharmacology. All the power of tongue and pen, and all the wisdom of textbook and lecture can never teach a doctor the knowledge of when to probe and when to leave alone, when to chide and when to reassure, when to speak and when to keep silent. They are private mysteries with a different solution for every one of the million permutations of personality involved between a doctor and his patient. (“Talk, Tact and Treatment” [1955]).

This passage encapsulates Asher’s enduring appeal. His assertion is clearly and elegantly expressed, it questions received opinion, and is based on decades of clinical experience.

Asher believed that medicine’s dominion was limited. He argued against screening, “fussing” over health, “vain strivings after longevity”, and aggressive interventions in patients with incurable cancer. He knew that medicine had little to offer for many patients, and admitted ruefully that “it is better to believe in therapeutic nonsense than openly to admit therapeutic bankruptcy.”

Two collections of his essays and articles (Talking Sense [1972], A Sense of Asher [1984]), are both long out of print. Asher’s students are either of advanced age or dead. Decades on, however, his prose still sparkles. He mocked what he saw as pompous, illogical and just plain wrong. His article on “The Dangers of Going to Bed” (1947) was hugely influential in ending the routine practice of prolonged bed-rest, with all the dangers listed listed by Asher. He had a sharp instinct for humbug. What windmills would he tilt at in 2015? He would have been pleased by the triumph of Evidence-Based Medicine, but would have rebelled against the tyranny of protocols and guidelines, and Evidence-Enforced Medicine. He would have been horrified by the growth of the pharmaceutical industry, and by how easily it has suborned academic medicine and the journals. He would be dismayed by the slow death of medicine as a profession, and its imperceptible transformation into a service industry. He would have witnessed how the sins which he enumerated culminated in the catastrophe at Stafford. He would have been gratified that the Royal College of Physicians has belatedly come around to his view that physicians should be generalists first.

Asher did not feel appreciated within his profession, perhaps because his wit was confused with frivolity, and his clarity of expression mistaken for a lack of depth. Sydney Smith responded to a similar accusation: “You must not think me necessarily foolish because I am facetious, nor will I consider you necessarily wise because you are grave.” Come on, BMJ publications: why not re-issue the books?

The Reading Room: A review of ‘Pain and Emotion in Modern History’

2 Jun, 15 | by cquigley

 

Pain and Emotion in Modern History. Boddice R (ed). Basingstoke: Palgrave Macmillan, 2014

 

Reviewed by Dr Deborah Padfield

Visual Artist and Research Associate, UCL CHIRP Interdisciplinary Research Fellow, Slade School of Fine Art

9781137372420

Pain and Emotion in Modern History claims to be ‘a rich exploration of the affective expression of pain, the emotional experience of pain (with or without lesion) and the experience of others’ pain as pain (sympathy, compassion, pity, tenderness ‘ (p.1). Referencing and building on the work of others, for example Scarry, Moscoso, Bourke, Cohen and Hodgkiss, this book more than justifies that claim. It is a fascinating collection of essays from a variety of disciplines and practices, which, woven together, produce a profound discussion of pain and emotion.

Boddice starts from the premise that not only is pain difficult to communicate, but also to define, describing it as ‘at best a confusing label; at worst … hopelessly inadequate’ (p.1). What is refreshing is that the book attempts to unpack its complexities through a conviction that pain’s ‘polyvalence’ is expressed not only linguistically but ‘bodily, orally’ and ‘emotionally’ (p.1). The understanding and experience of pain is framed as socially, culturally and historically constructed. Boddice asserts that it is through the drive to communicate pain, to translate it into words, grimaces, images – the search for metaphors with which to capture it – we literally ‘figure out’ what it is. What I also find appealing about this work is its emphasis on the person witnessing as much as on the sufferer, thus acknowledging witnessing and suffering as inexorably interlinked.

The book draws on the expertise of a wide range of historians, literary and philosophical scholars, a practicing artist and those in the medical humanities from a variety of countries, to unpick and reveal intersects between pain and emotion. The result is a patchwork of perspectives building on and cross-referencing each other so that the sum is more than the parts.

Javiers Moscoso’s graphic descriptions of treatment for cancer pain in early Modern Europe highlight the tensions between local and official medical knowledge, and the desperation of those willing to undergo any treatment in the search for a cure, ranging from eating the ‘raw and palpitating flesh of local green lizards’ (p.20) to doses of between one and six spoons of arsenic, thus leaving themselves open to fraud and quackery (not irrelevant today). The fact that sufferers recovered from some of these terrifying practices highlights the power of hope, exercised within what Moscoso describes as a framework of emotion and fear. He does not get drawn into a detailed discussion of the ‘placebo effect’ but asserts the value of historians for illuminating interpretation of sources. He also alludes to the interplay between objective evaluation and subjective accounts provided by patients, paving the way for discussion of patient narratives, which is taken up in subsequent chapters. Already rich in detail and analysis, Moscoso argues convincingly that a greater historical analysis is needed of the ways in which fear and pain have been counterbalanced by promises and expectations, in what he terms an ‘economy of hope’ (p.31).

Continuing to place the understanding of pain within historical and cultural frameworks, Paulo Santangelo takes us to Late Imperial China, where he analyses the main terms used for representing physical suffering, revealing pain as located within the collective imagination and a ‘whole body-mind-heart’ system (p.36). Exploring this interaction of emotion and sensation, Santangelo builds on the work of Moscoso, Bourke and others, evidencing ways in which the perception and experience of pain is influenced by its cultural context. He reveals a semantic ambiguity within the Chinese figures for pain, which collapses physical, emotional and moral conceptions of pain expressing injury, wound, damage, and harm with distress, including sad-grief-distress, worried-grief distress and being broken hearted. Citing a range of Chinese medical treatises, Santangelo shows how many early texts express the belief that states of mind were able to influence physical pain. He concludes that the interconnection between body and heart-mind in early Chinese medical texts is ‘more strongly emphasized than in modern Western cultures perhaps because of the lack of a Platonic imprint of soul-body dichotomy‘ (p.47).

The current IASP definition for pain is up for scrutiny in the following chapter by David Biro, who asks whether affective states –‘construed as injuries to the mind – can trigger the same kind of pain as injuries to the body’ (p.53) Biro argues for a re-definition of pain broadened to accommodate psychological and emotional as well as physical injury to reflect feelings of injury to the person rather than to the body. Biro approaches the subject from a uniquely privileged position as physician, patient and literary scholar, making him particularly sensitive to the importance and difficulties of expressing, conceptualizing and defining pain and the critical relationship between language and experience. Using examples largely taken from literature as well as the paintings of artist Frida Kahlo, Biro illustrates how people suffering from psychological pain also use metaphors related to physical injury, and argues that there are neural correlates for both physical and psychological pain. He concludes ‘Pain is the aversive feeling of injury to one’s person and the threat of further, potentially more serious injury. It can only be described metaphorically’ (p.61).

The relationship between physical and psychological pain and the challenge of invisible pain are taken up by Joanna Bourke in the context of phantom suffering. She uses the case of Lieutenant Francis Hopkinson, a first world war amputee, to explore two debates within medical practice, that of the relationship between lesion and suffering, and theories of the emotional basis for suffering, which, she argues, prompted the current psycho-social model of pain.

Bourke charts how medical attention initially focused on Hopkinson’s physiological phantom limb pain and not on his psychological pain. Hopkinson, like many others, found it increasingly difficult to persuade his doctors that his suffering was ‘real’, which reflects the double layer of suffering for those with chronic pain; not only do they live with pain itself, but as Scarry highlighted (1985), the doubt of others serves to increase pain. Bourke relates how medical reports increasingly reported Hopkinson as of a ‘marked neurasthenic type … highly introspective type and very resentful’ (p.72). The problem, as Bourke clearly shows us, is that Hopkinson came up against the privileging of physiological injury over emotional injury and the clinical beliefs of the time that stump and phantom limb pain were essentially ‘neurotic’ in nature. What is more shocking is the conclusion of R.D. Langadale Kelham, who in the 1950s carried out a four year study of 200 men with phantom limb pain, and concluded that the person affected was ‘more often than not a person with an unsatisfactory personality. … who, becoming obsessed by his symptoms, and brooding upon them and his disability, tends to dramatise their degree, using undoubted exaggerations in his description of his sufferings’ (cited p.73). Bourke’s fascinating journey through the life of Hopkinson ends with the conclusion that even though one might have expected him as a white male from a privileged class who had served as an officer to have elicited sympathy, the tragic reality was that ‘the invisibility of his wound – his stump seemed to be ‘normal’ and the limb that burned like fire did not exist – trumped all scientific theorizing. Theories about physiological pain pathways, psychiatric pathologies. psychosomatic symptoms … failed to ease suffering that was anything but ‘phantom’’ (p.84).

The book moves from the intensity of the microscopic narrative to Wilfred Witte’s macroscopic review of the treatment of phantom limb pain from the beginnings of the nineteenth century to the present day, where the bio-psychosocial model and multi-disciplinary treatment have become the norm. Some of the now shockingly negative attitudes Bourke described are echoed here with Witte reporting amputees with phantom limb or stump pain being described by physicians as ‘abnormal’ or ‘deficient’. The chapter ends on a hopeful note with the Sub–Committee for Stump Nerve Pain of Amputees (1968 – 1970) and the Federal Ministry of Labour advocating that the condition not be judged by a single specialist based on symptoms, but by physicians from various disciplines and patients whose voices now had to be heard, ‘so that the categorization of abnormal and deficient had to be dropped’ (p.101). Witte highlights the achievements of American anaesthetist John Bonica, whose work marked a turn in chronic pain therapy, publishing The Management of Pain in 1953 and, in 1961, realizing his concept of a pain clinic with a multidisciplinary structure at the University of Washington in Seattle. Witte asks whether changes in pain therapy corresponded not only to advancements in anaesthetics but also to linguistic changes where the narratives of patients gained significance, and language shifted towards theories of cognition and aims of ‘managing’ rather than ‘curing ‘chronic pain.

Noemi Tousignant tackles the institutionalization of pain diagnosis and measurement in the USA, which she claims has tied pain to ‘more-than-sensory’ experience, ‘to selves and thus to emotional experience’ (p.112). The chapter traces the ‘quest for reliable pain-measuring technologies since the turn of the century’ (p.111) and is a fascinating exposé of attempts to quantify subjective experience, charting early attempts to exclude emotion in the search for objectivity to Beecher’s work in the 40s and 50s, which argued that pain sensation was indivisible from the reaction to it. Tousignant argues convincingly that Beecher’s work was ‘an important episode in the historical process of authorizing emotion as a component of anything worth calling ‘pain’’ (p.124).

Sheena Culley’s chapter moves us from the history of pain measurements and the analgesic clinical trial to analgesia itself – here the history of aspirin. Drawing on ways in which aspirin was marketed historically for anything from a sedative to a stimulant for physical and/or emotional pain, and on the writings of key figures such as Jan McTavish, David Morris, and Michel Foucault, Culley explores how aspirin and its successors have shaped cultures of pain and how the social construction of the feminine that they presented influenced a gendered understanding of pain. Culley concludes that, with the introduction of depression as a recognized medical term and the surge of antidepressant drugs from the 1960s onwards, aspirin and other over the counter medicines stopped being marketed as cures for emotional pain, and thus the image of the neurotic or hysterical woman disappeared. However, she hypothesises that the image of the hysterical female has not disappeared entirely from our understanding of pain ‘whether she resides in the discourse of chronic fatigue syndrome or of anorexia, or in a particular framing of female depression’ (p.145), arguing that ‘it remains for scholars in the medical humanities to continue to analyse the contemporary entanglement of biological and cultural aspects of pain and disease’ (p.145).

Liz Gray explores the suffering of animals, asking how, in the context of pain being an emotion as well as a sensation, can we truly understand the experience of another, particularly when that other is an animal? Here we have no shared language and no shared language of facial expression. Viewing the publication of Darwin’s ‘The Expression of the Emotions in Man and Animals’ of 1872 as a watershed in the research of expression of emotion, and drawing on the work of the Scottish naturalist physician William Lauder Lindsay and his contribution to comparative psychology, Gray outlines how animals’ capacity to experience emotional pain was accepted in part because of an acknowledgement that they suffered physical pain. She claims (slightly alarmingly) that Lindsay’s interest in the animal mind stemmed from his experience as a physician at the James Murray Royal Lunatic Asylum. Physical restraint of the ‘insane’ had been shown to be damaging to emotional and mental health. Similarly, Lindsay concluded that the causing of physical pain to animals was (unsurprisingly) linked to the development of mental health problems. Gray concludes with Lindsay’s belief that ‘The asylum, as a house for the mentally damaged of society, ought to have been a site for compassion and humanitarian care, as with every laboratory and even every home’ (p.161).

Danny Rees focuses on the expression of pain in humans, taking his title down in the mouth from Gillray’s depiction of a patient being bled by his doctor, Breathing a Vein, (1804). The image captures the essence of this book as it reflects the facial expressions of witnesses as well as those of sufferers. Rees makes a distinction between the visual expression of pain and the language used to describe it, feeding into a larger discussion on the inexpressibility of subjective experience. However, his focus remains on the history of representations of facial expressions for pain, which he regards as visual dimensions of emotions and valid ‘representations of internal states‘ (p.165). Rees traces ways in which early anatomical and scientific experiments defined the face of pain, contributing to the concept of ‘universality’ (p.166), asking why the face has been the locus of ‘repeated, probing attention’ (p.166). Referencing Amanda Williams, Rees begins by articulating the functionalist position that expressing pain in a way others can read aids survival ‘the function of pain is to demand attention and prioritize escape, recovery and healing‘ (p.166). He gives an informed and detailed account of the historical inconsistencies of approaches to expression from the Ancient Greek Sculpture Laocoon, through Charles Le Brun, Charles Bell, and Charles Darwin to Dr Guillaume Benjamin Amand Duchenne (who experimented with trying to separate the movement of facial muscles expressing emotion from the experience of feeling emotion) to Italian physiologist Angelo Mosso. After a fascinating historical journey through sculpture, etchings and photography, Rees concludes that ‘a range of historical meanings can be derived from a common (set of) expression(s)’ (p.185).

Whitney Wood takes a detailed look at the relationship between fear and pain in childbirth narratives of Late Victorian Canada. She begins with the words of Lucy Ronalds Harris in the late 1860s whose memories of fear and anxiety from the birth of her first child marred subsequent experiences of pregnancy. Other examples, such as Lucy Maud Montgomery (author of Anne of Green Gables) who wrote of her ‘martyrdom of misery, partly physical, partly anxious’ (p.191), are woven into an overview of the changing medical and cultural perceptions of the female body during the nineteenth and early twentieth centuries, as well as a wider discourse on the collapse of divisions between emotional and physical pain. Wood draws on leading figures such as Bourke, Bending, Scarry and Morris to expose the power relations within the rhetoric surrounding emotion and pain to refute the idea that ‘pain can be logically divided into two separate types, physical, and emotional or mental’ (p.192). Wood argues that the dismantling of female networks, caused in part by increasing migration in the second half of the nineteenth century, contributed to a greater willingness among middle class women to accept physician-assisted and hospital-based births, feeding into a growing pathologisation of pregnancy and childbirth. She ends by concluding that women not only conformed and contributed to existing medical discourses but ‘were active participants in the process of medicalising childbirth’ (p.198).

Scarry runs like a seminal vein through this book, her claim that pain achieves its unshareability in part as a result of its resistance to language provoking attempts to prove its shareability. Daniel Grey’s chapter The Agony of Despair: Pain and the Cultural Script of Infanticides in England and Wales, 1860-1960 begins by arguing just that, that pain is not only ‘shareable’ but shareable via visual, textual and oral means, and ‘that it is assigned historically and culturally specific meanings by those who witness and experience it’ (p.204). He picks up the relationship between pain and fear, exploring how and why the closely ‘entwined experiences of pain, shame and fear, became – and remained – key elements of the construction of infanticide in England and Wales for at least a century‘ (p.205). Grey observes how both the Infanticide Act of 1922 and its amendment in 1938 allowed women who killed their babies to be convicted of manslaughter instead of murder if they were deemed to be suffering from a ‘mental disturbance’. Grey reveals that both lay and professional opinion of the time stressed that it ‘was the combination of physical pain and mental anguish that was primarily to blame for the crime’ (p.205). He examines the narratives of pain through his examination of infanticide cases, demonstrating that both lay and medical opinion expected to interpret ‘potential signs of physical pain and emotional distress on the part of the defendant when giving evidence’ (p.205). Grey argues that descriptions of both physical and emotional pain were central to attempts at understanding infanticide in the nineteenth and early twentieth centuries. He concludes with the acknowledgement of a potential risk in examining accounts of physical and emotional pain of eliding specificities while ignoring the broader shifts in culture and society in terms of gender relations, observing how these scripts of women’s bodily and emotional pain do not fit with the equally contested discourse surrounding ‘the killing of infants by their fathers’ (p.215).

Continuing with the theme of understanding another’s pain, Linda Raphael turns to fiction. Chiming with Moscoso’s assertion that we are as likely to sympathise with pain through a fictional representation as any real-life experience, Raphael argues that when we read fiction ‘we have access to characters’ inner lives in a way that gives form to feeling’ (p.220), something David Biro might also agree with. She hypothesises that fictional representations ‘involve us cognitively and emotively in human experience’ (p.220) picking two stories involving a parent and child to explore ways in which language and face to face encounters sometimes facilitate and sometimes hinder understanding another’s pain. Drawing on a range of philosophers, Raphael asks what happens ‘to the self in this focus on sympathizing with the other’ (p.222). It is a particularly apposite question in a book that places so much emphasis on witnessing pain and the encounter with the sufferer. She concludes that to regard pain as ‘a stimulus to heterogeneous emotional responses is one way to avoid misunderstanding the other, despite the considerable limits on our ability to fully imagine the emotional experience of another’ (p.239).

James Burnham Sedgwick continues the focus on the person witnessing pain, here considering those who have the unenviable task of observing, investigating, recording or judging the atrocities examined at the International Military Tribunals (IMTs) in Nuremberg and Tokyo, following World War II. Sedgwick’s research highlights ‘the powerful and unexpected ways in which pain (direct physical, indirect psychological or other forms) can manifest itself in personal and historical change’ (p.243), arguing that the process of observing pain can transform into pain itself. He asks ‘Is all pain equal? Can it be shared?’, which could be viewed as a preoccupation of this book. Once again drawing on Scarry (1985), who argued that ‘what is “remembered” in the body is well remembered’, Sedgwick suggests that fixing pain and its legacies in the body neglects the scars of the mind. He adds the unsettling insight that even when shared at a distance, ‘the trauma and pain of others can cause psychosomatic changes in the self’ (p.244). It is a beautifully written, reflective and scholarly contribution, pulling together many of the themes from earlier chapters while examining the authenticity of suffering. He observes that the drive to overcome traumatic memory through ‘speaking out’, through art and through writing, can provide cathartic release for sufferers, acknowledging that there is a consensus around ‘bearing witness’, which for him makes intuitive sense. However he warns that ‘simply by investigating and hearing the cathartic release of survivors, participants in court and related institutions become vulnerable to a new set of disruptive collateral emotions’ (p.245). His words echo those of David Biro when he advocates a more inclusive definition of pain and trauma, ‘pain felt in observing and confronting humanitarian crises engenders emotional, spiritual, moral, professional and even physical alternations that include but are by no means limited to psychological change. All of this counts – or should count – as pain, even trauma, in the right conditions’ (p.249).

Witnessing and documenting pain is further examined by the artist Johanna Willenfelt in the final chapter. Willenfelt explores the representability of physical pain in what she terms ‘inter-bodied relationships and encounters’ (p.260), asking ‘how the emotive transient and transformative space of contemporary art might contribute to new understandings of the notional experience of sharing pain.’ This chapter serves as a fitting finale to a fascinating book as it presents its own distinctive take on the enigma of sharing pain while resonating with many of the themes outlined in earlier chapters. Focusing on her project Documenting Bodies (2010), Willenfelt states that she will be primarily ‘thinking through and with’ her own artistic practice and the ‘interplay between the medical sphere and the artist’s studio’ (p.260). However, I would have preferred more focus on her practice and less dependence on theoretical discourse, although this may have been the context in which she found herself or the perceived expectations of her readers. A fascinating point she brings to the discussion is the notion that ‘sharing pain’ must be understood equally ‘as the relationship one maintains with oneself as well as the one we enter into with objects and things in the outside world’ (p.272). This has echoes of Irigaray’s argument that it is respect for the self as much as for the other that allows speakers to enter the communication process successfully (Irigaray 2008). There is a charged moment in the text where Willenfelt discovers narrations by patients, doctors, surgeons and post-mortem examiners in the medical and surgical archives of the General and Sahlgrenska Hospital in Gothenburg – ‘the imprints of other people’s hurting bodies’ (p.263). These resonate with her own experience of suffering from chronic pain, activated by and intersecting with these alien pain narratives. From the archive entries she selects twenty or so to interweave and print on material, which then appear to be draped over hospital beds. The work recontextualises the narratives, weaving them in and out, not only with each other but also with those of the viewer. Willenfelt concludes by accepting that while observing someone in pain can never equate with directly experiencing that pain oneself, to have one’s suffering acknowledged by any living creature as witness is nonetheless liberating.

Many might take issue with the book’s central thesis that pain is an emotion, but few, having read it, could argue with its premise that emotion and pain are intrinsically linked. I would recommend anyone interested in the intersect between pain and emotion to go out and buy, beg or borrow a copy. Pain and Emotion in Modern History is an impressively researched must-read, presenting pain as a multifaceted, evolving, social, historical, physiological and psychological event to which we do not have, and may never have the answer.

 

References

Irigaray, L. (2008) Sharing the World. London: Continuum

Leriche, R. (1939) The Surgery of Pain (trans Young A.) London: Balliere, Tindall and Cox, p.202

Scarry, E. (1985) The body in pain: The Making and Unmaking of the World. Oxford: Oxford University Press

Williams A. C. de C. Williams (2002) ‘Facial Expression of Pain: An Evolutionary Account’, Behavioral and Brain Sciences, 25: 439

 

 

The Reading Room: The 2015 Hippocrates Poetry and Medicine Prize

28 May, 15 | by cquigley

 

The Hippocrates Prize for Poetry and Medicine is an annual international prize for an unpublished poem on a medical subject. It was launched in 2009 and consists of awards in three categories:

  • An Open Category
  • An NHS Category
  • A Category for Young Poets (14-18 years).

The 2015 judges were poets Rebecca Goss and Simon Rae, author and poet Theodore Dalrymple, and psychiatrist Femi Oyebode. The awards were announced at the 6th International Symposium on Poetry and Medicine on May 22.

First Prize in the Open Category was awarded to teacher and writer Maya Catherine Popa from New York City for her poem A Technique for Operating on the Past, which was inspired by her neuroscientist great grandfather.

The NHS first prize went to former counsellor Kate Compston from Cornwall for a poem about revealing the diagnosis of dementia, Lovely Young Consultant Charms My Husband.

Parisa Thepmankorn from New Jersey received the 2015 Hippocrates Young Poet Prize for Intraocular Pressure.

Links to YouTube readings of these poems and all winners in each category can found here
http://donaldsinger.blogspot.co.uk/2015/05/2015-hippocrates-prize-awarded-to-new.html

 

Khalid Ali: Fil Review ‘Mediterranea’

26 May, 15 | by Ayesha Ahmad

 

Lambert Wilson, actor and musician, Master of Ceremonies of Cannes Film Festival 2014, said “The world is written in an incomprehensible language, but cinema translates it for us universally. Without its guiding light, each person would remain in isolated darkness”. Exactly a year later in May 2015, an Italian film “Mediterranea” directed by Jonas Carpignano, sheds a light into the trials and tribulations of illegal African immigrants in Europe.

more…

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