Abstract
The role of the humanities in medicine, especially mental health, is now well established. The importance of the subjective experience of people in the clinical encounter; the values and meanings that influence and determine how healthcare decisions are made and responded to; and the degree to which language pervades, structures, limits or enriches communication within the clinical space, are now explicit. This edited book extends, deepening our appreciation and understanding, the ways in which context, history, and politics impact on conceptional notions of madness. Furthermore, it demonstrates the capacity of literary theory to not only reflect but also to refract the realities that underlie behaviours and experiences termed madness. Finally, as if to make the point clear that the role of literature is not merely theoretical, it ends with a section on the instrumental uses of literature in clinical practice.
One of the challenges of the postmodern world is the loss of the grand, monolithic narrative that disregards the emic, subsuming it within a supposed universalizing etic. Alan Weber’s chapter, “Layla and Majnun in Historical and Contemporary Conceptions of Madness in Islamic Psychology,” introduces the role of context, cultural as well as religious, in framing potential causes of inner turmoil, perhaps too, prescribing what emotions or beliefs arise in specific situations. Here then is a relativizing dialogue in which translations are inevitable with terms such as melancholia, delusionary disease, excessive love, and depression becoming the currencies that are exchanged to facilitate our cross-cultural understanding. Whether or not these terms cover the same semantic field in both Arabic and English is moot. Weber’s chapter makes it impossible to ignore the competing explanatory claims in mental health and, without saying so explicitly, centres psychiatry as a contested field. Sebastian Galbo’s chapter, “Apartheid’s Garden: Dismantling Madness in J.M. Coetzee’s Life & Times of Michael K,” develops this theme further by examining how politically oppressive systems such as apartheid South Africa can co-opt the power of diagnostic systems to disenfranchise political enemies by labelling them as mentally ill and thus fit for incarceration. In this reading, madness is not a medical condition, but a social construction perpetuated by racist and politically oppressive regimes.
I found Clare Allan’s chapter, “Sniffs and Dribblers: Poppy Shakespeare and the Identities of Madness,” particularly helpful, as it focuses on a subject that I have argued for—namely, that fiction allows the reader to inhabit a disturbed inner world and in doing so makes what is unfamiliar recognizable and comprehensible and helps to dismantle, in Allan’s words, “the artificial barrier between madness and sanity” (p. 75). She extends this proposition when she says: For writing (and reading) fiction is all about crossing identity borders: borders of gender, colour, class, profession, and nationality, to name but a few. The novelist is a sort of identity trafficker, their ultimate mission to smuggle the reader across the border of the individual self. (p. 88)
Once we are into the terrain of the function of fiction (if I can put it that way) we are not very far from language itself and the power of words, including the failure of words, especially in describing and denoting what can be both perplexing and uncanny. Mary Elene Wood in her chapter, “Spill the Words: Speechlessness and Creativity in the Writing of Janet Frame,” addresses the business of the unsayable, the enigma of meaning-making in psychotic speech, and the surprising uses of metaphor and imagery in conversation. It ought not be astonishing that it is difficult, if not impossible to find the right words for nebulous and inchoate feelings. So, it is not that some things are unsayable but that they are also unspeakable or sometimes incomprehensible, hence beyond words. The strain this has on our usual habits of listening is obvious, as are the refreshing aspects of discovering anew the immense resources of language and the materiality of words, something that is second nature to poets.
So far, I have remarked on the semantic aspects of language use in madness. Alice Hervé, in her chapter, “Pronominal Shifts and the Confusion of Self with Not-Self,” touches on the ways that syntax itself can signal problems within the nature of self, particularly in the awareness of the boundaries of the self and the distinction between self and other selves and indeed other objects. But, even more unusually, abnormalities in body awareness can exist and then it is not simply a problem in I–thou relations but in I–it relations where parts of the body are ascribed “it” identities or are nonexistent. Thus, relationships that are foundational to existence may be disrupted and then encoded in language use. Charley Baker, in her chapter, “Rethinking Clinical and Critical Perspectives on Psychosis in Kathy Acker’s Writing,” examines these issues showing how the body itself becomes a physical way of speaking, by being acted upon by way of self-harm, and emotional pain can be transformed into actual physical pain with bleeding standing in for emotional release. Baker faces squarely one of the challenges of madness for fiction—how to make coherent and comprehensible, experiences that, by definition, are chaotic and fragmented, without the loss of authenticity and honesty. She offers two possible solutions: the first is to be dismissive of the narrative as mad, the second is to make an ethical response that takes seriously the experience that is being described and to seek to find the thread that ties fragmented experiences into a comprehensible whole. It may, of course, be the case that these experiences are incomprehensible and should be accepted as such. Baker concludes, “Readings of Acker’s work therefore offer the possibility of finding coherence in incoherence, method and resistance in madness, calm in chaos” (p. 158).
There’s the recurring question of whether literature can actually help patients, either through reading or writing. This is not an anodyne question as it homes in on what literature is. Does literature have a function outside of itself, is it instrumental in nature or is it, like all art, an expression of something deeply human, that has intrinsic value without utility? Signe Uldbjerg addresses some of these questions in her chapter, “Writing Therapy, Writing Data: Therapeutic Writing as a Methodological and Ethical Approach in Researching Digital Sexual Assault.” Literary writing is conceived as providing precision and beauty to amorphous and difficult emotions. Reading is also not a single process but involves or includes expressive, autobiographical, or aesthetic approaches. Expressive reading, in this account, involves bodily engagement with the text. In autobiographical reading, the reader recognizes themselves in the text and in aesthetic reading, the reader focuses on the formal qualities of the text. Uldbjerg introduces an approach to using therapeutic writing, both as therapy as well as research.
Gammelgaard, in his introduction to this book, writes: The authors explore mental illness (as cultural, historical, phenomenological concept) through interpretation of salient literary examples. Hence, literature and psychopathology are put into dialogue by mounting research questions concerning representation of mental illness in literature. (p. 1)
What a wonderful goal, to put literature and psychopathology in dialogue, and I can testify as a psychopathologist, to the extraordinary and enriching achievement of that goal. I have prospered from my engagement with the many complex and enlightening ideas in this book. I cannot recommend this book enough.