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Review

Book Review: Deleuze and Baudrillard: From Cyberpunk to Biopunk

25 Apr, 17 | by amcfarlane

Deleuze and Baudrillard: From Cyberpunk to Biopunk by Sean McQueen, Edinburgh: Edinburgh University Press, 2016, 288 pages, £70.

Reviewed by Dr Anna McFarlane (University of Glasgow)

Sean McQueen’s first monograph ambitiously aims to create “a cognitive mapping of the transition from late capitalism to biocapitalism” (1) and to do this through tracing trends in science fiction from the cyberpunk movement of the 1980s and early 90s through to a subgenre only recently designated as ‘biopunk’. Following Fredric Jameson, a scholar known for his analysis of postmodernism and Marxism in late capitalism, McQueen argues that cyberpunk is the quintessential literature of late capitalism and therefore a fitting place to begin his analysis of this recent cultural movement from late capitalism to biocapitalism which, McQueen argues, “is the frontline of capitalism today, promising to enrich and prolong our lives, whilst threatening to extend capitalism’s capacity to command our hearts and minds” (1-2).  In McQueen’s schema this is a transition from the ‘control’ of late capitalism to the ‘contagion’ of a biocapitalism that he argues is an increasing threat to individuality and the autonomy of the body.

The book’s title belies its contents to some extent, given that the first half of the book does not focus on texts from cyberpunk’s ‘canon’, such as it is, but focuses on the ‘cyber-‘ aspect of cyberpunk to investigate texts that engage with the concept of control. Anthony Burgess’s A Clockwork Orange (1962) is not generally considered cyberpunk-proper in reviews of the genre, but its themes of control, and of the renegade individual fighting subjection by the state, certainly resonate with the work of figures in the cyberpunk canon such as William Gibson and Pat Cadigan. Another of McQueen’s chosen texts, JG Ballard’s novel Crash (1973), has been subject to debate about the extent to which it can be considered science fiction, let alone cyberpunk. Such deviations from the ostensible theme may be traces of the monograph’s origins as McQueen’s PhD thesis, but their reworking in this monograph is satisfying for those coming to the book for considerations of Deleuzian and Baudrillardian thought, who might consider the texts to which their philosophies are applied a secondary consideration. McQueen successfully cuts through the archaeology of decades of readings and misreadings of these two thinkers, often with a sharp word for scholars who come to the original philosophy with their own preconceptions, and hence leave it repeating unjustified or inconsistent critiques of these two thinkers. His own readings come across as fresh and new, perhaps because he works against a backdrop of scholars who have become too accustomed to invoking the names of Deleuze and Baudrillard without putting in the time to tackle their complex bodies of work first-hand.

The primary interest in the book for scholars of the medical humanities comes in the latter half, where McQueen turns to biopunk. This is a relatively new term in science fiction scholarship (following in the -punk traditions of cyberpunk, steampunk, and dieselpunk, to name but a few), but McQueen finds the term’s origins in classic science fiction, such as Mary Shelley’s Frankenstein (1818, commonly considered science fiction’s foundational text) and HG Wells’s The Island of Dr Moreau (1896). The first example of contemporary biopunk McQueen draws upon is Vincenzo Natali’s 2009 film Splice, in which a couple who work for a pharmaceutical company use DNA to create a hybrid creature.

The film draws on the tradition of Frankenstein to express fears of uncontrollable technological change, while also specifically critiquing a biocapitalism guided primarily by profit margins, rather than by philosophical or ethical considerations about the effects of its research.

McQueen’s readings of Deleuze and Baudrillard focus on some of these thinkers’ key concepts, how these have been relevant to cyberpunk and its investigation of ‘control’, and how they might function in contemporary debates about the ‘contagion’ that McQueen finds characteristic of biopunk. He contrasts Deleuze’s concept of the ‘body without organs’ with Slavoj Žižek’s ‘organs without a body’, both of which attempt to offer a representation of desire without the restrictions of hierarchy (to draw on only one valency discussed in the book). Žižek provides something of a bridge between Deleuze and Baudrillard here, as his Lacanian impulses are echoed in Baudrillard’s attempts to consider psychoanalysis, and how it might function in a society defined by the imaginary realm of consumption and consumer fetishism. Under biocapitalism, the consumption impulse could quickly move towards the point where the market’s freedom to use cells and discarded bodily tissue for profit is in tension with the long-held belief that it is immoral to profit from the cells of organs – as argued by Marlon Rachquel Moore in a recent article for BMJ Medical Humanities, “Opposed to the being of Henrietta: bioslavery, pop culture and the third life of HeLa cells”, which teases out the historical racial injustice that is now being relived, without hope of reparations, by the family of Henrietta Lacks whose ‘immortal’ cells continue to be the basis for untold profit in the biotechnology industry. The move from co-opting the labour of classes of the population under slavery, and later forms of capitalism, to co-opting the use-value of the body itself is the journey with which McQueen engages here as he moves from readings of Karl Čapek’s R.U.R. (Rossum’s Universal Robots) (1921), the science fiction play that brought the word ‘robot’ into English usage, and Eric Garcia’s The Repossession Mambo (2009, filmed in 2010 as Repo Men) which sees a biounderclass fitted out with artificial organs and forced to pay crippling interest rates or face having their organs repossessed – and dying in the process.

The electronic copy of this book, from which I reviewed, leaves something to be desired. Like many academic books, it uses endnotes which cannot be easily referenced as one reads in the electronic form, and the book’s use of abbreviations for the major works of Deleuze and Baudrillard exacerbate this problem as the reference list at the beginning of the book cannot be easily consulted. This makes for particular difficulties when quotes from the major texts are picked out as introductory to chapters and their sections, leaving the reader occasionally unsure as to which of the theorists is being quoted. However, the content of the book ultimately extends the case for considering biopunk as a unique and important subgenre of science fiction that, in turn, deals with the unique and important development of biocapitalism. McQueen’s readings of Baudrillard and Deleuze manage to scrape away some of the sedimented assumptions and misreadings of the past and offer exciting new ways to consider their work. His reference to both major and minor texts from both thinkers will introduce readers to insights they had not previously considered – again, especially relevant to students of the medical humanities might be Baudrillard’s comparison between cancer and capitalism in The Transparency of Evil (1990), the biopolitics of organ transplantation in Kazuo Ishiguro’s Never Let Me Go (2005), or Thierry Bardini’s account of subjectivity after bioengineering, Junkware, which McQueen turns to in his final chapter reading of Brandon Cronenberg’s Antiviral (2012).

As I pointed out above, McQueen’s book does not always stick to the limits laid out in his title, (for example when he reads texts that are not considered archetypically ‘cyberpunk’ under that rubric, or in the latter half of the monograph where Foucault’s thought is just as crucial to his argument as that of either Deleuze or Baudrillard), and his book should come with a warning for those who have never tackled Deleuze or Baudrillard before, given the slew of concepts that are not fully unpacked here for beginners. However, the book that emerges is cohesive and amounts to an often passionate argument for considering class consciousness in the era of bioengineering, biohacking, and biopolitics.

Book review: Is Literature Healthy?

22 Nov, 16 | by cquigley

9780198724698

 

 

Is Literature Healthy?

by Josie Billington. Published by Oxford University Press, 2016.

 

Reviewed by Dr Neil Vickers

 

Many years ago, I blagged a ticket to an invitation-only symposium on the subject of medicine and narrative, held under the auspices of what was then the Arts and Humanities Research Board. The premise of the meeting was that humanities academics were sitting on a goldmine – something called narrative – but were too high-minded or obtuse to rate it at its true worth. There were a few big names in attendance but the star turn was a researcher from the hospital soap, Holby City. Here was someone who knew how to link medicine and narrative in a way millions approved of, on an almost weekly basis. We were also invited to read Jed Mercurio’s novel, Bodies, which was being adapted for television but hadn’t yet been broadcast. The organisers hoped that by studying ‘hard-hitting’ narratives of healthcare from a variety of disciplinary perspectives, we might stumble upon facts concerning medicine, or healthcare, that had eluded observation by other means. It was never explained why narrative would be better at picking these things up than other kinds of investigation. It was assumed that narrative was a good in its own right and that we would all find ways of making common cause through it. Needless to say, we didn’t. It was clear that narrative was as vexed a term as ‘literature’ and even though we were focusing on fictional texts some of those present – including your reviewer – felt that what would be found would depend on the quality of the sources. Rubbish in, rubbish out. The idea that narrative, merely by being narrative, would yield up untold secrets was a piece of magical thinking.

Josie Billington’s Is Literature Healthy, is, among other things, a compendium of everything I wish I’d said that day. Billington is a literary scholar who works at Liverpool University’s Centre for Research into Reading, Literature and Society (CRILS). Her book is a plea for literary reading but she starts from a premise that is seldom aired at meetings of literary scholars or medical humanists: that our culture has lost its literary edge. We no longer have an adequate metric for valuing literature because we have forgotten what makes literary experience distinctive. We think it has to do with narrative. For Billington, the problem isn’t that literature is missing from medical syllabuses or even university literature departments (though even there, it is missing). It is missing from life.

Chapter 1, ‘Healthy and Unhealthy Thoughts’, introduces the reader to the ideas of the British psychoanalyst Wilfred Ruprecht Bion (1897-1979), as set out in four fiendishly difficult works published between 1962 and 1970. Bion believed we have an inherited propensity to distance ourselves from meaning because it disturbs our mental balance. To become attuned to meaning we have to be willing to acknowledge the extent of what we do not know. We have to acknowledge our dependence on others. We also have to submit to experiences whose outcomes may be very threatening. Bion traces the development of our capacity to bear meaning to early infancy. If our anxieties have been ‘contained’ by a mother, say, we can set aside some of their physical impact and face them as mental entities. In this form they are not necessarily rational. They may appear as shards of thought disconnected from the rest of what goes on in our mind or as dream images; or they may exist as unconscious phantasies. Bion gives the name ‘alpha function’ to the process by which the psychobiological sources of anxiety are converted into forms of mental life of this way. He thought it was a lifelong process. Now most humanists, like most scientists, treat this zone of our lives with polite disdain. But Billington argues—very persuasively, in my view—that literary reading is profoundly enmeshed with alpha function. When a piece of literature moves us deeply, it is because it resonates with something in our history that carried a great weight of anxiety when we experienced it the first time around. The work of reading allows us to continue the processes by which we came to terms with it or failed to do so. If we feel more alive, it is because the most primitive stakes in our existence have been thrown into relief. An analogy from biology suggests itself. It used to be thought that DNA that didn’t code for a protein – i.e., at least 95 per cent of human DNA – was ‘junk’. We now know that so-called junk DNA provides the instruction manual for turning genes on and off.

It requires something like Bion’s alpha function to follow a character like Dorothea Brooke or Anna Karenina through their confusion. We must attune ourselves to their mental states, make these our own, before we can do anything with them. Literary reading begins when we strive to catch the primitive edge of experience which is a literary text’s true growing point. In Billington’s words, ‘the experience must not be used—only let be, in its words… a book can have thoughts that humans cannot have’ (44). In a reading designed to be provocative to medical humanists of Tolstoy’s The Death of Ivan Ilyich, Billington praises not the butler’s assistant Gerassim’s empathic witnessing of his master’s sufferings (the standard Med Hums reading), but Tolstoy’s depiction of what it is like to live completely beyond the reach of human care. I loved it.

The second chapter, ‘Telling a New Story’, does three things. It offers a broadly-brushed but incisive critique of narrative medicine. It explains why literature is not coterminous with narrative. And finally, with an eye to Billington’s own practice at CRILS, it explains why healthcare interventions that seek to use literature must go beyond narrative. Billington is fully alive to the humanistic aspirations underpinning narrative-based medicine. In particular she recognizes and approves of its concern to treat ‘the whole person’ and to vouchsafe patients a voice in any therapeutic process. But in cases of depression, for example, she thinks the whole person is absent to himself or herself. To be depressed often means not to have a story. The hero of this chapter is another psychoanalyst, Michael Balint (1896-1970), Sándor Ferenczi’s great pupil and literary executor. Balint is remembered in this country as the founder of ‘Balint groups’ which were designed to help GPs listen psychoanalytically to their patients’ complaints. Billington appears to think that the best kind of general practice will do just this. A good doctor, like a good literary reader, will know how to bear with his patient’s confusion and not substitute his own understanding for it prematurely. The limits of narrative-based medicine stem from its obsession with immediately-measurable variables and its conviction that story per se is empowering. It will often be easy for a clinician to give a narrative shape to their own or other people’s lives. It will not always go very deep. At this point, Billington appeals to what was once a commonplace of literary criticism. At the heart of poetic experience is something that lies beyond words. By virtue of its preoccupation with the ineffable parts of human experience, the parts whose importance we barely know how to articulate, the zone of Bion’s alpha function, the nineteenth-century realist novel is in fact a mode of poetry. It is only superficially a narrative form. Its power to move us is patterned after our experiences of poetry and the chapter concludes with a description of participants in reading groups run by Billington finding their own deepest selves mirrored in verse by, among others, Ben Jonson and Elizabeth Barrett Browning.

The third chapter, ‘Reading in Practice’ describes Billington’s work with her colleagues at CRILS and The Reader using reading aloud as a therapeutic intervention with patients with depression and chronic pain. The meetings were video-recorded and individual reactions noted. Billington is at pains to say that this intervention has nothing to do with bibliotherapy, where readings are often matched to conditions. The assumption is that the sufferer will be ‘found’ by the text ‘in a deep sense and at a deep level’ (105). It is his or her ‘inner life’ that she and her colleagues wish to engage. They believe it has a therapeutic effect arising from the ‘something deeper’ that literary reading provides. I think the time has come to test this claim experimentally. The final chapter puts forward an exemplary reading of John Berger’s masterpiece, A Fortunate Man, though, pace Billington, I think that book owes more to Marx than to Balint.

Underpinning this entire book is a compelling theory of literary reading which could be made more explicit. If I had to summarise it, it would go something like this. The reader of a great literary work such as Middlemarch gets to experience the process of containing the vicissitudes of Dorothea’s fate by rehearsing George Eliot’s words as if they were his or her own, allowing them ‘to be’, without attempting to put a construction on them, and simultaneously of being contained by the total process of getting through the book. It is this doubleness at the heart of literary experience that makes perseverance so rewarding. It is only superficially the same as telling a story or piecing one together. It is being acted upon by means of a story. A Kleinian, such as Bion once was, might see it as a benign species of projective identification. But all sorts of lexicons can capture it.

The medical humanities have become more complex and more theoretically savvy over the years. But we desperately need more books like Billington’s that address us quietly and clearly, about something very basic. Literature and the literary have lost their cachet in our field. If you want to know why it should be restored, read this book. The case could not be better made.

Book Review: This Mortal Coil

18 Oct, 16 | by cquigley

 

9780199599035

Fay Bound Alberti, This Mortal Coil: the human body in history and culture, (Oxford: Oxford University Press, 2016)

 

Reviewed by Hazel Croft

 

We all have stories to tell about our bodies. They are, as Fay Bound Alberti writes, ‘the inescapable material reality we live with and in.’ In today’s scientific and medical world, however, our bodies are often viewed as a series of parts to be examined rather than an interconnected whole. In This Mortal Coil, Alberti explores the history of how and why we came to see our bodies as an assemblage of parts to be scrutinised, assessed and treated. Reading this book, I was reminded of my own story of how I came to be diagnosed with a large, benign tumour on my pituitary gland. I spent over two years seeking treatment from my GP and optician for what seemed to me to be a variety of unconnected symptoms. Finally, during an emergency visit to hospital when my eyesight failed, one doctor asked me to describe everything I could remember about changes in my life and body in recent years. It was only when I recounted my seemingly disparate symptoms of gaining weight, frequent headaches, feeling anxious, irregular periods and failing eyesight as one narrative story that the doctors were able to make a diagnosis. Such a holistic approach is all too rare in the context of today’s highly specialised, and often under-resourced, medical services, however. As Alberti highlights, ‘Today’s government funding, research, building, and personnel resources form separate systems to deal with mental health (psychiatry and psychology), the heart (cardiology), the brain (neuroscience), the skin (dermatology), the gut (gastroenterology), and so on.’

In This Mortal Coil, Alberti features a series of historical case studies to examine how we came to view the body, and its ailments and injuries, in this compartmentalised way. She starts with the moving story of her teenage daughter Millie’s diagnosis with scoliosis, a severe curvature of the spine, which has caused her great discomfort and pain. Millie has had to endure endless surgery to try to straighten her spine, including the insertion of metal rods into her back, causing Alberti to ask, ‘At what point do the rods and screws become part of her “real” body?’ Millie’s spine was treated as a discrete object to be assessed and treated, disconnected from her emotions about her spine and her anxieties about her body image. Millie’s story foregrounds some of the major themes of the book – the separation between the body and the mind, and the ruptures between our sense of self and our bodily organs. As Alberti writes, ‘In modern health care our ability to treat the spine as a part we can repair, like the heart, like a limb, necessarily displaces our “self” from the body part in question.’

In the ensuing chapters, Alberti takes us on a fascinating voyage through the body and its parts examining the history of the skeleton, heart, brain and stomach, and the less charted territory of the breasts and genitals, the skin and the tongue. In each case, Alberti shows how changes in medical knowledge, and in the language and metaphors we use to explain and describe our bodies, have transformed the way we have experienced, lived within and felt about our bodies. This journey takes us through political, medical and philosophical developments that transformed our understanding of the body as being controlled by the balance of the four humours, to the brain-centred understanding we have of the body today. Moreover, these changes in the conceptualisation of the body and its organs have always been inflected with historically-specific gendered and racialized assumptions about human behaviour and emotions. Taking an explicitly feminist perspective throughout, Alberti explores how differences between the sexes were naturalised and encoded in scientific and medical texts. She looks, for example, at how the bones the bones were gendered by the scientific classifications of the structure and shape of the male and female skeleton. The assumption that women will have smaller skeletons, developed in the 18th and 19th centuries, has meant that even today physically large women, or conversely physically small men, have not been recognised in archaeological surveys of human remains.

Such gendered explanations come to the fore in the chapters where Alberti focuses on the history of female bodies, and how scientific and medical ideas about female and male bodies have naturalised inequality between men and women. I found the chapters on the history of the breast and female sexual organs to be some of the most compelling and original in the book. In her chapter on female genitalia, for example, Alberti traces the often overlooked history of the vagina, the vulva, the hymen and the clitoris. She shows how the vagina has often been viewed and represented, in both medical and cultural texts, by the absence of a penis, a ‘no thing’, as it is described in the slang Shakespeare deploys in Hamlet. Even today, Alberti argues, dictionary definitions seldom describe the vagina as a sexual organ in and of itself, but rather as a canal or a passage, leading to elsewhere – its purpose presumably to gratify the male penetrator. Female sexual organs have historically been very sketchily represented in medical textbooks. This is particularly the case with the clitoris, the one human organ designed solely to provide pleasure, which remains the most under-researched and under-represented organ of the female body. As Alberti writes, the clitoris ‘symbolises historically persistent fears about female sexuality: disorderly, uncontrollable, and independent, a force for agency above and beyond its medico-scientific and social framework’. In contrast, the far less biologically complex flap of skin in the vagina, the hymen, has been invested with undue medical and cultural significance, repeatedly referred to as literal and figurative ‘evidence’ of a woman’s virginity and purity.

Alberti also traces how absence of body hair has come to be seen as an ideal of feminine beauty in Westernised societies. How did we get to a place, Alberti asks, ‘where the almost complete removal of public hair, a process that is painful, inconvenient, expensive, and repetitive, is not only fashionable but also the idealised “norm”, female body hair being seen, at least in most of Europe and the United States as unattractive, unfeminine, and even dirty?’ Here she pinpoints how excessive body hair on women became pathologized in the 19th century, particularly with the development of evolutionary theory whereby excessive body hair became associated with being animal-like and primitive. In the case of Julia Patrana, a black woman with excessive body hair who was exhibited across Europe in a touring ‘human zoo’ in the 1850s and 1860s, we see how gendered and racialized prejudices intersected in medical and popular representations about the black, female body.

Alberti even devotes a chapter to the gendered history of the tongue, exploring how the tongue has been a powerful metaphor confirming women as lesser beings than men. If I had previously considered the tongue as a biological entity, it had been as a rather innocuous organ that enabled us to speak and communicate. Although technically the tongue is sexless and without individual agency, Alberti argues that its history is ‘rife with social, sexual, psychological, linguistic, and physiological significance.’ The tongue, like all organs of the body, cannot be separated by the gendered linguistic metaphors that have been used to describe it. Female tongues have historically been seen as untrustworthy and as a threat to social order. In early modern Britain, the 17th and 18th centuries, for example, women were frequently characterised as having ‘vexatious’, ‘sharp’ or ‘scolding’ tongues – as illustrated by the character of Katherine, the ‘nag’ in Shakespeare’s Taming of the Shrew. By the 18th century, women’s tongues were said to drive men to violence, and an ‘evil tongue’ was enough to exonerate a man from beating, and even murdering, his wife. Cruel punishments were devised to keep women’s tongues under control – including the ‘scold’s bridle’, a metal contraption that was strapped to the woman’s head to prevent her from speaking.

Although Alberti analyses the organs of the body in separate chapters, she skilfully subverts the view of the body as an assemblage of disparate parts. By taking the body apart, she writes, we might even be able to reconstruct it anew. She concludes the book with a call for a holistic approach to the body and its ailments, one that views the body as more than the sum of its parts. My fear is that this holistic approach is out of sync with the current direction of medical thought and practice in a neoliberal capitalist economy, where medical research and treatment is dominated by competing specialisms and by giant pharmaceutical companies, which seem to be ever more voraciously targeting their wares on specific bodily organs and diseases in the race to maximise profits. As Alberti remarks in her conclusion, although the body represents the limits of our sense of self, the skin marking the boundary between ourselves and the world, we are not self-contained beings, separate from the social and political environments we inhabit. Rather, writes Alberti, we are ‘social beings that communicate with others – not only through tongues as symbols and organs, but through social practices, behaviours and our very materiality.’  It would be interesting to explore further the ways in which social structures and practices, such as the dominance of work in our daily lives and constraints on time and leisure, have altered our bodies and the way we think, feel and talk about them.

In This Mortal Coil, Alberti has provided a compelling history, which explores the relationship between the biological body, with its bones, skin, guts and genitals, and the language and metaphors we use to describe it, without reducing one to the other. Written accessibly, and in beautiful prose, this book will appeal to historians, social scientists, medical professionals and the general reader alike. Highly recommended.

 

Hazel Croft is an associate research fellow at Birkbeck College, University of London

Exhibition Review: Rest & Its Discontents

6 Oct, 16 | by cquigley

leaflet-lowres_page_1

 

Rest & Its Discontents Exhibition

Curated by Robert Devcic, founder of GV Art London

Mile End Art Pavilion, 30 September until 30 October 2016

 

Reviewed by Natasha Feiner

 

Modern life is busy, exhausting, and stressful. Yet, rest remains as important as ever. But what does it mean to rest in the modern world? Does rest, or its absence, impact on individual health and wellbeing?

 

London, UK. 4th March, 2016. Campaigners from the Mental Health Resistance Network and DPAC block traffic on the busy Old St round in portest against the use of Maximus job coaches in GP surgeries to "create jobs by prescription." They say disabled people will be bullied into unsuitable work and lose benefits through sanctions. Peter Marshall/Alamy Live News

Mental Health Resistance Network, Reclaiming our lives and work struggles past, present and future

Rest & Its Discontents, a major new exhibition exploring the dynamics of rest, seeks to answer these questions. It draws on the research of Hubbub, an international collective of social scientists, artists, humanities researchers, scientists, broadcasters, public engagement professionals and mental health experts. Over the past two years the team, based at the Wellcome Collection in London, has explored the dynamics of rest, exhaustion, noise, tumult, and work, as they operate in mental health, neuroscience, the arts and the everyday. This exhibition is their final major event.

Rest & Its Discontents features the work of over twenty-five Hubbub contributors. Work from a number of different academic disciplines is presented in a multitude of formats including audio recordings, film, and interactive installations. A number of topics are explored in the exhibition, including therapeutic relaxation, breath and musical ‘rest’, and sleep studies.

antonia-barnett-mcintosh-breath-still-from-film-2015-image-courtesy-of-ed-prosser-2

Antonia Barnett-McIntosh, Breath, still from film, 2015. Image courtesy of Ed Prosser

nina-garthwaite-default-mode-radio-network-image-courtesy-ed-prosser

Nina Garthwaite, Default Mode Radio Network. Image courtesy Ed Prosser

Highlights include ‘The Cubiculum’, which invites visitors to explore the history of mind-wandering through sound and spoken word, and ‘Cartographies of Rest’, a multi-screen installation that visualises interactions between noise and mood.

The exhibition is accompanied by an event series, including workshops, poetry performances, and panel discussions with psychologists and journalists. I have booked tickets for ‘The Meditative Response’ workshop, which will bring together historian Ayesha Nathoo and composer Eugene Skeef. The workshop promises to ‘create a collective experience akin to the relaxation response’. Other events this month will centre on anti-work politics, self-tracking, and mental health.

A BBC Radio 4 series, The Anatomy of Rest, also accompanies the exhibition. First broadcast in September, the three-part series it is now available in full on BBC iPlayer. Presented by Claudia Hammond, the series asks what rest means to historians, poets, and neuroscientists. The final episode announces the results of the ‘Rest Test’, which asked 18,000 people from 193 countries why and how they rest. The data from the test has been visualised as a fabric pattern covering a series of benches in the Mile End exhibition space.

claudia-hammond-the-rest-test-rest-zone-2016-digitial-print-image-courtesy-of-lustlab

Claudia Hammond, The Rest Test & Rest Zone, 2016, digitial print. Image courtesy of LUSTlab

An open access publication, The Restless Compendium, explores many of the exhibition’s themes further. Comprising twenty-two essays on rest and its opposites, it extends and develops many of the exhibition’s major themes. The Restless Compendium is available here as a free download: http://hubbubresearch.org/restlesscompendium/

Rest & Its Discontents is wide-ranging in its exploration of rest and its opposites. It is, like the Hubbub project more broadly, truly interdisciplinary. As a result it offers novel and interesting perspectives that, while at times abstract, will no doubt interest humanities scholars, scientists, and medical practitioners. The exhibition is best enjoyed alongside its accompanying event series, radio show, and publication. These are all speak to each other and add new layers of depth and meaning to the installations and displays at the Mile End site.

sj-fowler-maja-jantar-soundings-iii-2016-image-courtesy-of-ed-prosser1

SJ Fowler & Maja Jantar, Soundings III, 2016. Image courtesy of Ed Prosser

 

For more information, and to book events, visit: http://hubbubresearch.org/

 

The Mile End Art Pavilion, Clinton Road, London E3 4QY.

Opening hours 12:00-18:00, Tuesday-Sunday. Closed on Monday.

Late opening Thursday 6 October, until 21:00.

Admission is free.

 

Natasha Feiner is a PhD student at the University of Exeter. Twitter @natashafeiner.

Book Review: The Slumbering Masses

3 Oct, 16 | by cquigley

UMN06 Wolf-Meyer Selected.indd

 

Matthew J. Wolf-Meyer, The Slumbering Masses: Sleep, Medicine, and Modern American Life (Minneapolis & London: University of Minnesota Press, 2012)

Reviewed by Steffan Blayney

 

Need a quick recharge? Power up with a power nap. Geniuses like Dali and Einstein loved sneaking in some extra ZZZs.

Opening up my Mozilla Firefox web browser, a cartoon Albert Einstein greets me with this friendly message. Albert’s suggestion – one of a rotation of quirky, entertaining factoids on the Firefox homepage – is indicative of a particularly modern attitude towards sleep. The examples of Dali and Einstein, it implies, show that sleep is not just a period of repose, but something that can – and should – be organised in constructive ways. More than simply providing a break from work or play, sleep can be used to ‘power up’ the sleeper, so that they might make the best and most productive use of their waking hours.

In The Slumbering Masses, anthropologist Matthew J. Wolf-Meyer traces the origins and implications of this and other of our contemporary notions of sleep, charting in particular the rise of sleep medicine in the twentieth century. The book is resolutely interdisciplinary, combining archival research with ethnographic fieldwork in sleep clinics and support groups, as well as numerous interviews with doctors, patients, and their family members. While Wolf-Meyer’s focus is limited to the United States, much of his argument can be applied across the Western industrialised world. The way we sleep, he argues – and the way we think about sleep, both medically and culturally – is the product of a particular combination of historical and social forces, largely coming into play from the late nineteenth century.

While we tend to think of sleep as a natural fact – a human constant across cultures and time periods – recent scholarship has uncovered a rich, and often surprising, history and sociology of sleep. In his 2001 article ‘Sleep We Have Lost’ – expanded in his 2005 book At Day’s Close – historian A. Roger Ekirch revealed that, before the advent of industrialisation, most people in Europe did not sleep in one consolidated period overnight, but more usually in a segmented or ‘biphasic’ pattern of ‘first’ and ‘second’ sleeps, interrupted by a period of wakefulness.

Our conceptions of ‘normal’ sleep provide Wolf-Meyer’s starting point for The Slumbering Masses. How, he asks, have we come to view eight hours of sleep – consolidated, motionless, solitary or with an intimate partner, in a room set aside for the purpose – as, if not an inviolable norm, at the very least the standard to which we must all aspire? Like Ekirch, Wolf-Meyer apportions a large degree of responsibility to industrialisation, and – more broadly – to a particular set of discourses associated with the rise of capitalism. With a nod to Max Weber, Wolf-Meyer devotes a chapter to ‘The Protestant Origins of American Sleep’. Early protestants’ commitment to worldly industriousness, the argument goes, generated a view of sleep as the enemy of productivity. A whistle-stop tour through more than three centuries of American protestant thought uncovers repeated characterisations of sleep as temptation, distraction, or waste of time. In 1690, the Massachusetts preacher Cotton Mather warns his readers that the devil lays ‘his most fatal snares … on the bed, where it is lawful for us to sleep’ (54). A century later, Benjamin Franklin admonishes his elite Parisian friends for their irregular hours, advising a strict routine of four-in-the-morning starts.

The advent of industrialisation and the factory system, with the concomitant requirement to regulate and coordinate large numbers of bodies, saw the question of sleep become a biopolitical problem. It was not the ‘lone sleeper’ but the ‘slumbering masses’ that became the subject of concern and regulation. In the nineteenth and twentieth centuries, Wolf-Meyer argues, ‘normal’ sleep became defined in relation to the spatial and temporal rhythms of industrial capitalism, centred on the working day and the working week. It was increasingly assumed that workers would build up fatigue during the day or over the week, enabling them to sleep for a solid period each night before returning to the factory ready for work. Against this background, alternative forms of sleep became pathologised as ‘sleep disorders’. In this context, the rise of sleep medicine in the twentieth century can be seen as a form of discipline, directed at aligning our bodies with the spatiotemporal demands of industrial society.

The four central sleep disorders discussed in The Slumbering Masses are sleep apnea, insomnia, parasomnias (such as somnambulism, night-terrors, sleep sex, and sleep eating), and narcolepsy. Each of these, Wolf-Meyer argues, is, in their own way, a disorder of time and of space, and a disorder of social life. The body does not sleep when and where it should. Sleep medicine attempts to realign individual’s bodies with the spatiotemporal rhythms of society through therapeutic interventions: behavioural, prosthetic, or pharmaceutical. Its model of treatment is not curative, but regulative, requiring the patient to submit to a regular and ongoing regime of closely monitored, chemically-controlled, or prosthetically-enhanced sleep and wakefulness.

‘An overlooked aspect of biopower’, Wolf-Meyer writes, ‘is the construction of the inevitable over and above its usual insistence on the production of the normal’ (155). The production of knowledge about bodies is concerned not only with what the body should do, but with what the body, by definition, must do: the limits and flexibilities of its behaviours, rhythms and potentials. Disordered sleepers, Wolf-Meyer argues, threaten our expectations about the body’s inevitabilities. Their stubborn refusal to align their bodies with the social demands placed upon them, disturb the very spatiotemporal order of capitalist modernity.

While some cultural critics (prominently Jonathan Crary in his 2013 book 24/7: Late Capitalism and the Ends of Sleep) have argued that the constant demands of technology and the market are destroying our sleep, Wolf-Meyer makes the more subtle argument that capitalism functions to make us sleep more efficiently. Rather than demanding the ‘end of sleep’, the social relations of capitalism require that we sleep in certain ways, and at specified times, so as to make us the most productive subjects in our waking hours. The model of the late capitalist subject, Wolf-Myer argues, is not the insomniac – ‘constantly awake, alert, and productive’ – but the narcoleptic, medicated ‘both to remain alert throughout the day and to sleep soundly at night’ (17).

If Wolf-Meyer’s nuance provides a useful corrective to polemics such as Crary’s, however, he does at times run the risk of ignoring important recent transformations in the structuring of time and space under neoliberal capitalism. In an economic environment no longer governed by the regularities of the factory, the traditional boundaries between work and leisure, production and consumption, day and night, are increasingly flexible. While Wolf-Meyer is critical of theorists who have predicted the ‘end of sleep’, he is perhaps premature in dismissing the ‘twenty-four hour society’ as a failed project. For example, while emphasising a reversal in the late-twentieth century drive towards open-all-hours businesses in the United States, Wolf-Meyer neglects the impact of the internet and mobile technology in ensuring that we are able to remain consumers even when the shops are closed. In the UK, to provide just one example, a recent Guardian article reported a rise of 30% in online shopping between the hours of midnight and 6am.[1]  Moreover, as one of the most interesting passages in The Slumbering Masses explores, one effect of globalisation has been to align the hours of workers in developing countries with the socioeconomic rhythms of Western capitalism, requiring, for example, operatives in Indian call centres to work according to American or European time zones, office hours, and holidays. The implication of this form of ‘spatiotemporal imperialism’ (188) is that our regular eight hours in the West may come at the expense of the disrupted sleep of millions of others around the world.

The Slumbering Masses is wide-ranging in its explorations of sleep and sleep disorders past and present. Interspersed with chapters on the history of sleep medicine and the pharmaceutical industry are often fascinating digressions on, amongst other things, sleep in children’s literature, the career of the ‘sleepwalking defence’ in American criminal law, and the manipulation (or minimisation) of sleep in extreme sports and the military. The downside of this impressive scope, however, is that the book can often feel unfocused. While numerous lines of argument are introduced, not all are followed through, while their relationship to an overall master-thesis is sometimes unclear. Wolf-Meyer’s prose is often dense, and at times frustratingly imprecise. Items of theoretical jargon are introduced with little explanation, only to be jettisoned a few pages later, often with the effect of obscuring, rather than clarifying, his arguments.

Wolf-Meyer’s strengths lie in his ability to combine patient historical research with a concern for the contemporary, and in his anthropologist’s attentiveness to the structures of everyday life. Perhaps due to his extensive fieldwork on the both sides of the doctor-patient divide, he is able to provide an account of sleep medicine that, while critically-informed, is at the same time refreshingly sympathetic, far-removed both from a top-down approach to the history of medicine that disregards the experiences of patients, and from the often caricaturish approach of much medical history, which presents practitioners as no more than the stooges of a nefarious ‘medical imperialism’. Having discussed the numerous past and present forms of sleep that humans have indulged in, The Slumbering Masses ends with a call for a new bioethical stance based towards variation and difference. ‘Multibiologism’, as Wolf-Meyer terms his (perhaps utopian) proposal, would entail ‘a cultural and medical acceptance of nonpathological variation within species, which recognises both society and biology as mutable limits’ (244). With a medical model less tied to an opposition between the normal and the pathological, he suggests, variations across bodies and behaviours might provide the basis for an expanded conception of human potential, and for a multiplication of new possibilities for life and society.

 

Steffan Blayney is a PhD student at Birkbeck, University of London. Twitter @SteffanBlayney.

[1] https://www.theguardian.com/money/2014/oct/10/internet-online-shopping-30-per-cent-rise-midnight-6am-john-lewis

Film review: The Carer

3 Aug, 16 | by cquigley

 

‘To age or not to age- that is the question’- review of The Carer – 5*

UK, Hungary, 2016, directed by János Edelényi

Starring: Brian Cox, Coco Konig, Emilia Fox, and Roger Moore

In general release in the UK cinemas from 5th August 2016

https://www.regentstreetcinema.com/programme/the-carer/

 

Reviewed by Dr Khalid Ali, Screening Room Editor

 

Watching The Carer at its European premier in Edinburgh International Film Festival in June 2016, I was strongly reminded of the ‘mirror neuron’ theory which postulates the ‘firing of a neuron in an observer that is exactly firing in the brain of another person performing a particular action- (https://en.wikipedia.org/wiki/Mirror_neuron). The eminent Italian neuroscientist Vittorio Gallese argues that ‘mirror neurons’ explain the underlying ‘emotions of empathy with film characters’ that viewers experience when watching a film. In ‘Neurocinematic science’, film audience engages fully and connects with ‘life unfolding on the silver screen’ in an ‘Embodied simulation’ (http://www.huffingtonpost.com/entry/mirror-neurons-and-why-we_b_3239534).

I had a strong sense of understanding and relating to the trials and tribulations of Sir Michael Gifford (Brian Cox) a veteran Shakespearean theatre actor who is suffering from the unkind advance of old age. Recurrent falls due to early Parkinson’s disease is one of many daily humiliations; bowel and bladder accidents, forgetfulness, bad temper and isolation in his country mansion are few others. His daughter, Sophia (Emilia Fox) recognizes the urgent need for a 24 hour ‘carer’ to help with his daily activities. Dorottya (Coco Konig), a young Hungarian refugee, a carer in a nearby nursing home, is offered the job of caring for him after a grilling interview by Sophia. Unbeknown to everyone, Dorottya is a young amateur actress aspiring to join the prestigious London Academy of Music and Dramatic Arts.  Living with Sir Gifford is not ‘a walk in the park’; she has to survive the daily challenges; language barriers are insignificant compared to his snobbery, arrogance, and cantankerous behavior.

Slowly the two find a common ground in Shakespearean plays; one of the most moving scenes is when Dorottya helps Sir Michael after an embarrassing bowel accident by quoting Shakespeare while cleaning him up. Outings to the local pub and an impromptu visit to the nursing home where Dorottya used to work, and performing scenes from ‘King Lear’ to the residents strengthen the bond between them. Their burgeoning fondness for each other is met with suspicion from his daughter, and old time friend and manager Milly (Anna Chancellor). The inevitable confrontation between Sir Gifford, Dorottya and his family happens when he insists on accepting a lifetime achievement award which will be broadcast live on national TV. His family and private physician, Dr Satterthwaite (Andrew Havill) are seriously worried that he will subject himself to national mockery if he falls over or forgets his lines in the live awards ceremony. Collectively they dismiss his capacity to make decisions and hold him hostage in his mansion. What follows is a delightful and powerful testament to the resilience of old age fuelled by creativity and a touch of recklessness.

Never before have the four Giants of Geriatric Medicine, a term coined by Bernard Isaacs (1924-1995) (http://www.bgs.org.uk/index.php/geriatricmedicinearchive/203-biographies/2220-a-giant-of-geriatric-medicine-professor-bernard-isaacs-1924-1995) , been so poignantly portrayed in film; falls, immobility, incontinence and confusion are so masterfully played by Brian Cox, CBE, in a tour-de-force performance.

In today’s world where ageing is viewed negatively as a ‘demographic time bomb, and a financial burden’ it is refreshing to find a film where ageing is not a ‘curse’. Intergenerational dependency is sensitively handled; Dorottya teaching Sir Gifford how to use a mobile phone while he teaches her how to hone her acting skills is a master-stroke. Nurturing creativity and embracing new technology can contribute to the well-being of both the older person as well as their carers.

In addition to its genuine exploration of ‘physical and psychological health in old age’, the film also manages to handle other serious issues such as ‘Capacity in senior citizens’; where time and time again families and doctors neglect the wishes of an older person claiming they are ‘acting in their best interests’ as an excuse for not seeking their opinion.

In a film exploring the world of a retired Shakespearean actor, a plethora of ‘quotable one liners’ is to be expected. However the final speech has to be repeatedly viewed to appreciate its nuance, wisdom and playfulness. Another fact the film masterfully puts forward is the notion that ‘old people are neither angels nor demons’ they are not aliens, they are similar to younger generations as fellow human beings struggling with everyday life, trying to make the best of difficult times and circumstances.

The frustration of the motor and non-motor symptoms of Parkinson’s disease is keenly observed; an eye-opener for doctors and other professionals caring for people with Parkinson’s disease.

The film is a ‘labour of love’- from its writers Tom Kinninmont, the late Gilbert Adair, and director János Edelényi. Targeting primarily an ‘older audience’, The Carer might well be 2016 sleeper hit that attracts a wider audience from all age groups; The Best Exotic Marigold Hotel meets Quartet meets Youth. Watching The Carer, I was convinced that ‘mirror neurons’ exist and explain the strong emotions of empathy I experienced with the characters on the silver screen. I was reminded once more that films have the power to ‘teach doctors how to communicate with and care for patients, their families and carers’.

To see a trailer of the film: http://www.imdb.com/video/wab/vi3754669081/

Podcast of interview with writer Tom Kinninmont:

 

Address for correspondence: Dr Khalid Ali, Khalid.ali@bsuh.nhs.uk

Film Review: The Fugitive Doctor in ‘River’

30 Jun, 16 | by cquigley

 

‘River’, Canada, Laos, 2015, directed by Jamie M. Dagg

Screen_Shot_2016-04-27_at_18.26.59

Released on DVD and digital download on 18th July 2016

Reviewed by Dr Khalid Ali

Doctors and crimes of professional misconduct have been the focus of films such as ‘Coma, USA, 1978’, and ‘Shutter Island, USA, 2010’, while  doctors volunteering in NGOs in troubled zones were the subject of films such as ‘Sleeping sickness Germany, 2011’ and more recently ‘The last face, USA 2016’.

‘River’, a new Canadian film, combines the two themes in its storyline; John Lake ‘Rossif Sutherland’ is an American volunteer doctor in Laos who accidentally kills an Australian citizen in a drunken rage. In his attempt to flee the crime scene, John goes through a harrowing journey across the Mekong River. He tries to get the support of his fellow doctors in the NGO; one of them, Dr Stephanie (Sara Botsford) faces the moral dilemma of whether she should be a whistle-blower and report him to the authorities or should help him escape, while another doctor Douangmany (Douangmany Soliphanh) takes advantage of John’s desperation and uses him as a drug-mule. The loopholes in the legal system between Thailand and Laos give John an opportunity to escape prison. Struggling with his professional role as a doctor who should be saving lives, but an infallible human being at the same time, John approaches the American Embassy in Vientiane for help.

Public interest in doctors’ criminal offences fuelled the media exposure of extreme cases such as the notorious Harold Shipman, and the recent news of Dr Pramela Ganji who was convicted by New Orleans jury in a 34.4 million fraud scheme (1).

The film raises serious questions about the ability of the legal system to exercise ‘equity and fairness’ when operating in a foreign environment such as Laos that is not accountable to regulations set by Western professional bodies. The requirements set by the General Medical Council (GMC) and the British Medical Association (BMA) in England are clear in mandating a ‘code of conduct and practice’ that a doctor should declare a criminal conviction (2, 3).

In addition to its exploration of accountability and violations in healthcare professionals, the film works extremely well as a gripping action thriller winning the best film award at the Academy of Canadian Cinema and Television. Rossif reprises the role of a doctor in turmoil following in his father Donald Sutherland’s footsteps who played a doctor in the cult comedy MASH (USA, 1970).

‘Whistleblowing’ is another thought-provoking theme the film raises; Rodulson argues that reading and appreciating Homer’s the Iliad can support medical students’ understanding of ethical dilemmas (4). ‘River’ achieves a similar feat by portraying a challenging ethical and moral situation where a doctor is ‘trying to do the right thing’.

References

  1. https://www.justice.gov/opa/pr/new-orleans-jury-convicts-company-owner-and-doctor-roles-34-million-fraud-scheme, accessed Wednesday 29th June 2016.
  2. http://www.gmc-uk.org/guidance/ethical_guidance/21184.asp, accessed Wednesday 29th June 2016.
  3. https://www.bma.org.uk/advice/employment/contracts/criminal-record-checks-and-declarations/criminal-convictions-declaration, accessed Wednesday 29th June 2016.
  4. Rodulson V, Marshall R, Bleakley A. Whistleblowing in medicine and in Homer’s Iliad. Med Humanities 2015; 41: 95- 101.

 

Dr Khalid Ali, Screening room editor

Address for correspondence: Khalid.ali@bush.nhs.uk

Wellcome Book Prize Winner 2016 – ‘It’s All In Your Head’ reviewed

23 Jun, 16 | by cquigley

It's All in Your Head

 

Suzanne O’Sullivan, It’s All In Your Head: True Stories of Imaginary Illness. London: Vintage, 2016; first publ in hardback 2015 by Chatto & Windus

Reviewed by Professor Edward Shorter

The very subtitle of the book makes one nervous: “stories of imaginary illness.” If there is one phrase that psychosomatic patients – who have symptoms without lesions ­– do not want to hear it is that their problems are “all in their heads.” Even though O’Sullivan may use the phrase ironically, it does take us back to the days when discovering organic causation was the Mecca of medical practice and psychiatry was left to “the shrinks.” Of course things are more complicated, and O’Sullivan, a neurology consultant at the National Hospital for Neurology and Neurosurgery knows this well. The book does make some finer distinctions so that “all in your head” doesn’t come out and hit us in the face. But still, O’Sullivan says that “psychosomatic refers to physical symptoms that occur for psychological reasons . . . How many are aware of the frequency with which our emotions can produce serious disability where no physical disease of any sort exists to explain it?” So in other words the origin of such symptoms is clearly psychological. These patients amount, she says, to fully a third of the cases seen in general practice and in neurology.

The book is a kind of odyssey of patients O’Sullivan has seen whose problems seem to have been caused by mental distress – a tour interleaved with explanations of historical figures such as the Parisian neurologist Jean-Martin Charcot, who once peopled this scene.

O’Sullivan has gone to such lengths to obscure the patients’ actual identities that one is never entirely sure whether the “Paulines” and “Matthews” that parade through these pages are more fictional than real – though their complaints are real. And O’Sullivan, it must be said, writes beautifully, a low-key golden flow of prose that makes the book simply a good read. There are no references. No authorities are invoked. This is the author, a veteran neurologist, speaking to us from the heart.

But is what the heart says true? How reliable is her analysis that psychosomatic symptoms are “physical symptoms that mask emotional distress”?

Right off the bat, there are problems with this stress-causes-functional-illness model. There are several major causes of psychosomatic symptoms, some of which get short shrift.

One, O’Sullivan tells us about classical psychosomatic symptoms that are caused by “stress” or by the emotional overlay of underlying organic disease. Her patients’ emotional woes are apparent to her in the course of many clinical interviews, and she ends up referring many of them to a “psychiatrist.” This is the most useless referral imaginable, as psychiatrists shun and fear psychosomatic patients and can usually do little for them because the patients themselves reject the whole notion of “psychogenesis”; patients usually accept such referrals only with the greatest reservation, convinced – not entirely incorrectly – that they are being turfed.

Two, O’Sullivan is silent about a huge source of psychosomatic illness, namely the phenomenon of suggestion. Patients who can be suggested into illness require no deep psychological problems, no intractable “stress,” to become symptomatic. They simply are suggestible.

A perfect illustration of suggestibility is epidemic hysteria: Sally begins vomiting and suddenly all the ten-year-olds in the schoolyard start vomiting as well. The public health authorities rush in. There is alarm in the press. An organic cause is never found but everybody is better the next day. It is an epidemic of suggestion that has invested the schoolyard.

The culture can be a source of suggestion as well, a subject on which O’Sullivan is silent. The culture can tell us that “fatigue” or “pain” are acceptable models of presenting illness, and these patients turn up in physicians’ surgeries with “myalgic encephalomyelitis” (ME), known as “chronic fatigue syndrome” (CFS) on the other side of the Pond. They do not in fact have an occult organic illness called “ME” but have suggested themselves into their chronic pain, fatigue and dizziness because the culture says those are appropriate symptoms. (And the culture has largely ceased to sanction “paralysis” as a convincing symptom – too easy to disprove with a negative Babinski.)

Three, frank psychiatric illnesses may spin off somatic symptoms. Patients with melancholic depression will light up the medical charts like a Christmas tree. Their aches and pains are legion, and disappear once the melancholia – one of the most treatment-responsive illnesses in psychiatry – is successfully treated. Catatonia shoots off somatic symptomatology, the stupors, tics and stereotypies often misdiagnosed as organic disease and the catatonia not recognized. Why does this matter?Catatonia is another highly treatment-responsive disorder, but there’s nothing “psychosomatic” about it. In medicine, therefore, the concept of psychosomatic can get one into rough psychiatric water.

It is striking that O’Sullivan sees deep sadness as a source of psychosomaticity rather than as a symptom of glaring psychiatric psychopathology. “I have met many people whose sadness is so overwhelming that they cannot bear to feel it,” she writes. Yoo hoo!  Such melancholic patients are indeed candidates for psychiatric treatment, not for repeated neurological assessments.

There is, finally, a fourth variety of apparent “psychosomatic” illness. But it is quite foreign to the other three and is usually not included in reviews of the topic. It is malingering. One rather has the feeling that some of O’Sullivan’s patients –  their gaze strictly averted from hers, their long silences – were malingerers. (She presents one.) You can’t prove that someone is not fatigued, or not in pain. But you can prove that they don’t have multiple sclerosis or another upper motor neuron lesion. So malingerers choose symptoms that can’t be disproven. And many physicians who work, for example, in insurance medicine, cast a cynical eye upon many of the complaints that O’Sullivan takes for true-bill.

How best to treat these patients? O’Sullivan has good words for a procedure that has largely passed from medicine, namely the amobarbital (amytal) interview. But it is increasingly seen as outmoded and dangerous (the barbiturates have undeservedly acquired a bad reputation, and most physicians are simply not in the habit of prescribing them).

O’Sullivan believes in letting the patients have it full blast: Your “disability has a psychological cause.” Sorry. The patients are left open-mouthed, since virtually every psychosomatic patient in the history of the world has had a profound belief in the organicity of his or her woes. And even though we have exalted “never lying to patients” to a beacon of medical ethics, in fact there are moments when a bit of evasion may prove therapeutic.

“Shahina” comes in with a contracture of the fingers of one hand. Another consultant recommends a botulinum injection. Bingo! The contracture releases instantly. Shahina is cured! Now, usually you take your therapeutic victories where you can get them. But O’Sullivan presses on. She tells Shahina that normally the botulinum works only after a day or two. “The speed at which your hand responded to the toxin makes me wonder if there is a chance that the spasm in your hand might have had a psychological rather than a physical cause.”

Shahina responds, “You think I’m mad?” No, of course not but…

This is actually a model of what not to do: throw patients into confusion with the relentless urge to enlighten them about their supposed psychological problems.

For other patients, as I have argued above, the psychiatrist is held out as the solution of choice. This is a problematic idea, and it is dismaying to see it propagated so vehemently in these pages. Psychiatrists tend to be baffled by such referrals. “This is a patient whose chief complaint is chest pain? C’mon!”

The general internist, the rheumatologist, or another neurologist should be the physicians of reference, because only they are able to build the necessary therapeutic alliance, to keep the myth of organicity semi-intact. It is this myth that patients require to retain their self-respect, while the real therapy takes places in the context of the doctor-patient relationship. What actually works is spending a lot of time with these patients and letting them tell and, if necessary, retell their stories. This is cathartic. But it is advice that is most unwelcome to many clinicians because it takes so much time.

It is not really fair for me to second-guess Dr O’Sullivan from the comfort of my armchair thousands of miles away. Physicians on the front line of medicine, at Queen’s Square and elsewhere, have to cope as best they can – and with relatives that make Himmler seem like Santa Claus. (O’Sullivan’s patience in dealing with these furies is remarkable.) The take-home message is that the book is a great immersion in psychosomatic problems. One may quibble about some of the author’s therapeutic choices but this is for the Thursday afternoon seminar room. If you want to get a head-on feeling for the clinical experience of psychosomatic patients, read this book.

 

Edward Shorter is Jason A Hannah Professor of the History of Medicine in the Faculty of Medicine of the University of Toronto, where he also has the academic rank of Professor of Psychiatry. Among his books is From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York: Basic Books, 1992)

 

 

THIS IS A VOICE at Wellcome Collection reviewed

16 Jun, 16 | by cquigley

L0081645 'His Masters Voice'. Painting by Franci

‘His Masters Voice’. Painting by Francis Barraud, 1919. Credit:Courtesy of the EMI Group Archive Trust

 

THIS IS A VOICE

Wellcome Collection, 14 April – 31 July 2016

Reviewed by Steven Kenny

 

Approaching the exhibition entrance of THIS IS A VOICE at the Wellcome Collection, it is easy to think the voice is treated as criminal, being contained, controlled and its behaviour segregated from the world outside. Initial thoughts would suggest that it is being acoustically surveyed; with the steady opening and closing of the exhibition door, sound rushes to the exit. Yet its attempts are ultimately futile, the room has been sound proofed, noise restricted from accessing the outside world. On entering the space, grey triangular padded shapes line the walls, detail reminiscent of a kitsch science fiction film from the 1980s. The exposed patterned structures, evocative of the décor of Ridley Scott’s periled spaceship in Alien, enclose you in a warm, familiar hug of nostalgia. Sensing that this space is one visually tread before, it is easy to forget the prestigious institutional context of the exhibition. THIS IS A VOICE, a show investigating the potential of the voice in all its forms, techniques, objects and cultural baggage, is particularly engaging for it knowingly understands such a topic cannot be wholly represented (due to various cultural and language complexities). Yet it does a heartfelt job in attempting to at least understand how the voice as a product, both commercially and non-commercially viable, can be exhibited. Curatorial flourishes can be found everywhere, from the nooks and crannies of seated listening stations to the maze-like paths that allow a gentle flow of avid listeners from one space to the next. From attending numerous shows at the Wellcome Collection I must comment that THIS IS A VOICE is one of the most stimulating and generally refreshing exhibitions to be held in its space.

It would seem that an inner versus outer exploration of the body and the voice is focused on throughout. One telling example of this is immediately apparent in the work Circular Song, 1974 by Joan La Barbara. A half dome like structure hangs from the ceiling, the speaker’s hollow interior pervading the space below with sound. The experience of entering this wall of sound is generally unnerving, a constant and increasingly uncomfortable echo of inhaling and exhaling performed by the artist, breathes all over you. It is nightmarish, a deathly noise that would seem totally apt in the exhaling howls of a victim being chased by a stalker in a nerve inducing slasher film. Sound in this manner is represented as an abject substance, an uncanny emotional pulling of the visitors’ own sentiments to the body and the amplified vocalisation of a body process that now seems one of disgust. Yet this is in direct contrast to Marcus Coates multi-screen film installation Dawn Chorus, 2007, which is silly, funny and surprisingly touching. This room is filled with the fluttering sounds of birdsong, a number of monitors positioned at varying heights depicting subjects in everyday locations comically singing along to each sound created. Experiencing this work initially seemed deceptive­­–I could not understand how both image and sound aligned so perfectly, as though the birdsong was actually being produced by a human lip whistle. Subjects pursed their lips and jotted their heads up and down in perfect alignment. The façade is lifted on reading the work’s description: ‘After recording the dawn chorus with multiple microphones, the individual birdsongs were slowed down to last approximately 16 times as long, which enabled the participants to imitate them, while being filmed’. Yet not knowing these details did not matter as my imagination roamed freely around the space. I observed each subject as one would watch a bird in the wild, mesmerised by its harmonic whistle and merry bouncing of its head.

Words

THIS IS A VOICE at Wellcome Collection, 2016. Credit:Photography by Michael Bowles

Dotted around the exhibition are various textual works, the written word laid bare. Erik Bunger’s wall text I Hearby Command You to Give Voice to These Letters Silently or Out Loud, 2011 was surprising in that it forced an involuntary restriction of my own voice from permeating the gallery. I so badly wanted to shout out loud the words I was reading yet thought better than to add to the already noisy space. Yet on second thoughts maybe that would have made for some interesting spectator reactions. Bunger’s playful register, was paralleled by Mikhail Karikis’s digital prints (photographs by Thierry Bal) Sculpting Voice, 2010, where the artist was photographically recorded pulling various facial gestures. Three prints line the wall in sequence, each exhibiting Karikis’s comically retuned face, made even more comical by the muting of what would probably have been quite a painful or otherwise loud projection of sound.

L0081817 THIS IS A VOICE at Wellcome Collection, p

THIS IS A VOICE at Wellcome Collection. Credit:Photography by Michael Bowles

 

The exhibition saved its loudest and most intriguing work for last. Entering the final room of the show, you would think that you might have woken in a Lynchian nightmare. Best described as an interactive, participatory constructed, sound installation, a lone and somewhat foredooming sound booth, tempts the spectator.

L0081800 Matthew Herbert, Chorus, 2016

Matthew Herbert, Chorus, 2016. Credit:Photography by Michael Bowles

The aptly titled Chorus, 2016 is by the British electronic musician Matthew Herbert, whose work ‘asks visitors to sing a single note within a professional recording booth following a set of instructions. The visitor’s voices are then automatically added to a chorus of voices, including performers and staff from the Royal Opera House, forming an ever-expanding sound installation that plays in the exhibition space and at the Royal Opera House’s Stage Door in Covent Garden’. I entered the space to sing the requested solitary note. Escaping my throat, my voice joined the squeaks, squeals, and sometimes correctly pitched notes above. Noise reverberated violently throughout the room, puncturing the space like a diminished fifth encroaching a melodic passage. The voice in this exhibition is presented as an ever-changing entity, one that is able to attack, calm and arrest.

 

Articles from Medical Humanities on the human voice:

Kelly BD. Searching for the patient’s voice in the Irish asylums. Med Humanit 2016;42:87-91.

Demjén Z and Semino E. Henry’s voices: the representation of auditory verbal hallucinations in an autobiographical narrative. Med Humanities 2015;41:1 5762.

Puustinen R. Voices to be heard—the many positions of a physician in Anton Chekhov’s short story, A Case History. Med Humanities 2000;26:1 3742.

 

Art, Life and Illness

16 May, 16 | by cquigley

 

David Marron: Encounters

 

Columba Quigley

GV Art London, David Marron, Geras 3, 2013, charcoal and acrylic on board, 60 x 42cm

David Marron, Geras 3, 2013. Image courtesy of the artist and GV Art, London

I was fortunate to catch this exhibition, held over the May Bank Holiday weekend at Lumen Studios, The Crypt, St John on Bethnal Green.

David Marron is both an artist and a paramedic.

The exhibition consisted of 12 pieces, charcoal, acrylic and collage on paper, standing on and supported by crutches.

These are multi-layered and complex works. As you stand before each, more unfolds with every moment of prolonged gaze.

Marron’s probing work is steeped in the essence of humanness, in the complexity, vulnerability and fragility of life itself and of those who inhabit it.

The artist’s experience as a paramedic affords him a unique viewpoint – that liminal space that he witnesses between wellness and illness, between living and dying, where life is suspended and where outcome is often unknown.

Following the exhibition, I had the opportunity to chat to Marron about his work. Initially trained in fine art, his working life brought him to the world of hospitals and the unwell. This witnessing, of the transformations and experiences of illness, changed the nature of Marron’s art. Previously, he reflects, his work had been more self-obsessed. Becoming part of the world of illness transported him away from a more personal interior world and towards a consideration of that of others.

In his work as a paramedic, Marron might only spend very short periods of time with patients on their journey to hospital. The encounters that moved him emotionally resulted in a transmutation of the feelings such interactions generated into the drawings on display. Yet each piece does not represent a single encounter or a specific individual, but is rather a conflation of a number of similar emotional experiences.

The piece Run Away Robin, for example, is not a direct portrait but was informed by a number of encounters with patients suffering from dementia. The piece represents a piecing together of the emotional fragments that Marron took away from such interactions: the nobility and stoicism that accompany the manner in which the elderly deal with memory loss; the masks they create, often using obstinacy and non compliance to hide their fears; and the fragmentation of self that accompanies the condition, here seen by the snippets of repeated words that hold meaning to the utterer even if uninterpretable by us.

 

GV Art London, David Marron, Run away Robin, 2015, charcoal and acrylic on paper, 84 x 59cm

David Marron, Run away Robin, 2015. Image courtesy of the artist and GV Art, London

A Tooth for a Tooth reminded me of Munch’s The Scream – that primordial sense of pain and anguish, seemingly uncommunicable in its silence. Any yet not, as we confront the distress so vividly here on canvas. The violence of this lived experience is hard to bear witness to, and yet there is so much tenderness in the lines that Marron draws to communicate this emotion that we rest our gaze and stay with the sufferer.

GV Art London, David Marron, A Tooth for a Tooth, 2014-15, Charcoal, acrylic and collage on paper, 84 x 59cm

David Marron, A Tooth for a Tooth, 2014-15. Image courtesy of the artist and GV Art, London

Marron is unafraid to share the challenges and pathos of the lived experience, witnessing it acutely as a paramedic. Yet his work also celebrates life throughout, most notably in Fentanyl Dreams, which vividly communicates the force of the newly born.

GV Art London, David Marron, Fentanyl Dreams, 2012-14, Charcoal, acrylic and collage on paper, 84 x 59cm

David Marron, Fentanyl Dreams, 2012-14. Image courtesy of the artist and GV Art, London

Marron is also a sculptor. However, for the works and themes presented in Encounters, drawing for the artist facilitated a unique truth and directness. He works quickly. Once inspired, the initial charcoal drawing is ready within 3-4 hours. Structures are built around this draft, followed by revisions. The sense of speed involved in their creation imbues the pieces with much energy and a less calculated finished product.

The exhibition also includes a video, En Route, which takes you on a journey through London, a horizontal view from within an ambulance. Buildings and sky whizz by, the world outside continuing and ignorant of what is happening inside the vehicle and within the world of the ill. The poem Ambulances by Philip Larkin came to mind:

‘Closed like confessionals, they thread

Loud noons of cities, giving back

None of the glances they absorb.

Light glossy grey, arms on a plaque,

They come to rest at any kerb:

All streets in time are visited.’

 

The poem ends:

‘Unreachable inside a room

The traffic parts to let go by

Brings closer what is left to come,

And dulls to distance all we are.’

from Ambulances, by Philip Larkin.

 

Our fragility, vulnerability, finiteness – further exemplified by the works being mounted on crutches – are clearly evidenced in Marron’s work, and are so beautifully communicated with much tenderness and compassion.

 

http://www.davidmarron.com

GV Art London, curators, producers & artist agent, represents David Marron amongst others.

 

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