Diagram of the House at Charenton

Below is a plan of Charenton, the setting of Peter Weiss’s Marat/Sade, as it was in 1836. Since the site was apparently redesigned in 1845, it seems likely that this plan represents the hospital as it was known to the historical de Sade and Coulmier.

I have also translated the key to the diagram, to make it clearer (and show how many ‘bathhouses’ there were). My French isn’t fantastic, so I’m sure some of this is inaccurate, and the major problem is the attempt to render Nineteenth century French terms for madness into idiomatic English for the Twenty-first. I’ve tried to get some sense of what these terms imply, but have provided the original in square brackets afterwards, so that people better at French than I am can come to their own conclusions, and tell me in the comments.

Many thanks to @miss_sobriety on twitter for bouncing ideas around about possible translations.

Plan of the house at Charenton [Charenton Hospital]

1. Main Gate

2. Porter’s lodge

3, 3, 3. Front courtyard.

3’. Passage from front courtyard to courtyard 10.

4’. Parlour above store rooms.

4. Four story building. On the ground floor, store rooms: on the first, a large hall, occupied by placid madwomen [aliénées tranquilles]: on the second, the director’s rooms, and a lounge for convalescents of both sexes: on the third, the bursar’s offices and some employees’ lodgings: the top floor is taken up with the big clock.

5. Four story building. On the ground floor, store rooms: on the first, the kitchens: on the second, the offices of the director, and those of the treasurer, and a room for the head doctor: on the third, the bursar’s lodgings (with a view of the gardens): on the fourth floor, lodgings for the employees.

6. Gallery which runs under the eaves of the third floor, connecting the director’s apartment to the dining room.

7. Stairs to the chapel.

8. Enclosed courtyard for the women, leading to garden 18.

9. Stairs by which one descends to courtyard 10.

10. Courtyard for madwomen who are scabrous, with a tendency to clamour [ordinairement agitées et galeuses].

11. Four story building. On the ground floor, a gallery which runs the whole length of the building, and onto which open the rooms occupied by agitated women: on the first floor, a corridor with rooms for women who are far out of their reason, yet calm [très déraisonnables, mais tranquilles].

12. On the first floor, a warm-room for agitated women: on the first floor, a warm-room which also serves as a work-room.

13. Courtyard for very disturbed women

13’. Courtyard related to the baths.

14. Isolation building for very disturbed women [très agitées].

15. Six dressing rooms [loges] and a gallery: above, a sick bay for suicidal patients [or attempted suicides – les suicides].

16. Bathhouse.

17. Dressing rooms [loges] for disturbed [agitées] women and a gallery overlooking the courtyard.

17’’. Warm-room.

18. Garden for placid madwomen [aliénées tranquilles].

19. Four story building. On the ground floor, a large hall for lunatics [les aliénées]: on the first and second floors, lodgings for the medical inspector, the chaplain, the warder, and some residents: on the third, a sick bay which, due to the uneven ground, is no more than one floor above the terrace: on the fourth floor, under the roof, is the women’s laundry.

20. The director’s personal garden.

21. Greenhouse.

22. Courtyard of the new building for placid madwomen [aliénées tranquilles].

23. Gallery.

24. Three story building. On the ground floor, a dining room, a meeting and work room, a dormitory: on the first floor, dormitories and bedrooms: on the second, two large dormitories.

25. Three stories, the ground floor with a gallery, divided into bedrooms: the same on the two higher floors.

26. Bathhouse, with a semi-circular dormitory above.

28. Terraces and gardens.

29. Courtyard used to store wood.

30. Four story building. On the ground floor, offices: on the first, the chapel: on the second, the dining room: on the third, a sick bay for placid madmen [aliénés tranquilles]: on the fourth, a dormitory.

31. Kitchen courtyard, separated from the garden by a terraced wall.

32. Bridge leading from the third floor of building 5 into the garden.

32. Billiards room at the height of the small bridge 32.

33. Bath courtyard.

[3]4. Four story building. On the ground floor, store rooms; on the first floor you find, at the same level as courtyard 33, a sick bay for lunatics, both those who are disturbed and those who are catatonic [les aliénés paralytiques et agitées]: on the second, a sick bay for those who are placid or only slightly disturbed [tranquilles ou peu agités]: on the third, rooms with one or two beds.

35 & 38. Buildings connected at right angles, with four stories. Along the middle of each floor, a corridor, on each side of which open rooms of one and two beds: heated meeting rooms.

36. Bathhouse.

37. Courtyard for maniacs/those in a frenzy [furieux].

39. Courtyard for those who are disturbed and incurable [agités et incurables].

40. Dovecote.

41. Building containing the pump which provides water for the whole house.

42, 42, 42, 42. Courtyard and promenade.

43. One story building: On the ground floor, dressing rooms and a gallery: on the floor above, corridor and bedrooms.

44. Heater for the first floor.

45. Heater for the ground floor.

47. One story building. On the ground floor, the bakery: on the first floor, which is at the same level as the courtyard no. 42, three dressing rooms for the most disturbed lunatics [les aliénés les plus agités].

48. Hayloft.

49. One story building. On the ground floor, the cowshed: on the first floor, a large sick bay.

50. One story building. On the ground floor, the pharmacy, and a room for four sick paupers who are not insane: on the first floor, the lodgings of the medical assistant, and the laundry.

51. Stairs connecting the medical assistant to the large sick bay [49].

52. Store rooms and workshops.

53. Farmyard.

54. Autopsy room.

55. Gardener’s lodge.

56. Sloping path leading from the front courtyard, under building no. 49, to garden 57.

57. Garden.

58. Lodgings for several employees.

59. A small pond.

P. Bridge crossing a branch of the Marne, leading to an island owned by the institution.

E. General sewer.

I. Island.

M. Isolated house belonging to the institution.

Figure 2 – New female quarters.

1. Gallery open to the country air.

2. Meeting room.

3. Two dormitories, each with a single row of beds.

4. Galleries.

5. Servery.

6. Room, furnace and apparatus for the baths.

7. Round pathway.

8. Corridor, onto which open the bedroom doors.

9. Bedrooms.

10. Lounge and dining-room.

11. Dormitory.

12. Lodgings for nurses, and passages.

In the middle of the courtyard, a fountain and a lamppost.

Source: Esquirol, Etienne. 1836. Des Maladies Mentales Considérées Sous Les Rapports Médical, Hygiénique Et Médico-légal, Volume 2, pp. 702-6.
Available here.

1793 Account of Private Asylums

Just a quick update today:

While I was working in the National Theatre archive, I discovered this gem of an extract that director Jeremy Sams had the cast of his 1997 production of Marat/Sade read as background to the production. It’s taken from the January 1793 issue of Gentleman’s Magazine:

When a person is forcibly taken or artfully decoyed into a private madhouse he is, without any authority or any fuller charge than that of an impatient heir, a mercenary relation, or a pretended friend, instantly seized upon by a set of inhuman ruffians trained up to this barbarous profession, stripped naked and conveyed to a dark room. If the patient complains, the attendant brutishly orders him not to rave, calls for assistance, and ties him down to a bed, from which he is not released until he submits to their pleasure. Next morning a doctor is gravely introduced who, taking the report of the keeper, pronounces the unfortunate person a lunatic, and declares that he must be reduced by physic. If the revolted victim offers to argue against it by alleging any proofs of sanity, a motion is made by the waiver fro the doctor to withdraw, and if the patient, or rather the prisoner, persists in vindicating his reason, or refuses to take the dose, he is then deemed raving mad. The banditti of the whole house are called in, the forcing instruments brought, upon which the sensible patient must submit to take whatever is administered.

I don’t have much comment to offer on this, except that it demonstrates the fact that even the ‘private asylums’ which preceded the more ‘open’ institutions of the 1800s suffered from the supposition that inmates were not necessarily ‘insane’, and that social contexts were as likely a reason for incarceration as psychosis.

The Representational Politics of the “Lone Psycho”

It’s not a groundbreaking position to argue against the dominant media narrative of the ‘lone psycho’. Simon Baron-Cohen opposed this approach to Anders Brevik in the Guardian during the aftermath to that story last year. However, I’m often shocked by just how much resistance I come up against when I suggest that, maybe, throwing around medically loaded terms like ‘psychopath’, in the context of events like this week’s massacre of 16 Afghan civilians by a US soldier, might have consequences.

Surely, I was told, it’s clear that whoever did this was a psychopath, demonstrating no remorse or feeling for his fellow man. You don’t need to be a psychiatric professional to see the difference, and it’s actually offensive and elitist to suggest that shrinks have more knowledge than the man on the street. The US staff sergeant who allegedly carried out the Afghan attacks, along with Anders Brevik, Raoul Moat, and every other mass-murderer you care to mention, was obviously a ‘lone psycho’, just some kind of psychological anomaly who must face the full force of the law.

But what if such a simplistic reading was not just a common-sense, obvious conclusion to draw from events? It is, of course, far scarier to believe that people can commit horrific acts without falling into any category of psychic distress, or that there can be broader social and institutional issues feeding into these acts, than to insist that terrible acts are committed ahistorically and aculturally, as a result of mental illness – scientifically definable, and nothing that needs any deeper investigation. If terrible acts such as these are merely anomalous, then strong psychotropic drugs, a padded cell, or the needle are all that is needed to bring society back into order again. Until the next time.

The political utility of the ‘lone psycho’ is clear. In the case of Brevik it masks the spectre of increased far-right militancy. In the case of the latest massacre in Afghanistan, it allows Obama to condemn the actions, and other members of military staff to express surprise and disbelief. Include suggestions of ‘a breakdown’ or ‘traumatic brain injury’, and rather than raising any questions about military training, or the attitudes of NATO troops towards Afghan civilians, this is suddenly a one-off: “This kind of rogue event is almost unknown in Afghanistan”.

However, while the attribution of mental illness to those who commit terrible acts of violence and murder is useful tool to depoliticise potentially embarrassing events, masking any possible cultural, social or historical factors which may have made such actions more likely, they also serve to cement an impression of mental illness within the minds of those who watch the news.

As the regular attribution of ‘psychopathy’ to the US soldier on twitter demonstrates, many people have very fixed ideas about what this particular condition, and its neighbour ‘Anti-Social Personality Disorder’ entail. Evoking shades of the media scare stories about ‘schizophrenics’ in the wake of Thatcher’s ‘Care in the Community’ policy, the reality of mental illness is coloured by media presentation. Peggy Phelan, in her book Unmarked, describes the relationship between representation and reality in the formulation ‘the real is read through representation, and representation is read through the real’. In other words, a discussion about media influence in discourse has to take into account the fact that people also prejudge media images, and are not merely conditioned by them.

This raises a problem when discussing the image of the ‘lone psycho’. The tendency of sensationalist news reports to attribute mental illness to violent criminals means that many people will not have ‘real’ experience with which to qualify mediated ‘representations’, due to discrimination against and assumptions about the behaviour of mentally ill people. At the same time, it means that the apparent ‘reality’ of violence among mentally ill people will lead the the assumption that anyone who has committed violent acts with no apparent motive must be mentally ill. We are caught within circular reasoning which dehumanises all sufferers of mental illness (even conditions such as depression and anxiety when they are at their most severe), while also depoliticizing actions which are no doubt shaped by more complex factors than merely experience of mental illness.

As a result of this problem, I’d appeal to everyone who reads this to try to avoid attributing mental illness to individuals who have committed violent crimes (or who cut you up dangerously on the motorway, for that matter). The US soldier who massacred 16 Afghan civilians may have suffered a breakdown, or had a traumatic brain injury, but he was also doing a job which entailed killing Afghans as a basic condition of work. Brevik may suffer from paranoid schizophrenia, but he also had a minutely worked out political programme, and his actions fitted within that. On the other hand, as far as I know, none of my schizophrenic friends have killed anyone, while ever increasing numbers of political commentators (and social media friendly charities) are agitating for wars in many, many different countries, and funding armies with the profits.

Biopower and Mad Prejudice

While writing a comparison of Peter Brook’s 1964 Marat/Sade with Anthony Neilson’s recent revival (see previous post), I noticed that both a Financial Times Review and the RSC programme refer to Herbert Marcuse’s idea of ‘repressive tolerance,’ set out in a 1964 article. Marcuse argues that ‘what is proclaimed and practiced as tolerance today, is in many of its most effective manifestations serving the cause of oppression.’ He cites foreign military intervention, built-in obsolescence in products, a limited school curriculum and other elements of twentieth century society as examples of conduct which is tolerated in order to maintain an oppressive consensus. This ‘tolerance’ becomes passive, so that merely remaining silent about these practices signals a widespread vote in favour of continuing them. Conversely, attempts to alter these practices are tolerated only ‘provided they did not make the transition from word to deed, from speech to action.’

Where this becomes relevant to Marat/Sade, and to social attitudes towards Madness in general, is in the limitation that classical Liberalism places on tolerance. Marcuse cites JS Mill’s statement that liberty (hence tolerance) was ‘to apply only to human beings in the maturity of their faculties’. Children, as well as ‘any state of things anterior to the time when mankind have become capable of being improved by free and equal discussion’ can legitimately be controlled by despotic rulers, whether governments, or petits Napoleons like Weiss’s portrayal of asylum director Coulmier. When combined with Mill’s later discussion of ‘the distinctive endowments of a human being’, said to be ‘perception, judgment, discriminative feeling, mental activity, and […] moral preference,’ it seems likely that those labelled as ‘Mad’ would also be excluded by Mill, since general impressions of mental illness were, and often continue to be, based on some disturbance in these ‘distinctive endowments’.

This conception of personhood is, in many ways, one of the foundational concepts justifying the extent to which the poor conditions and overt (legal and inter-personal) coercion still experienced by mentally ill people (as shown in a recent Guardian article). Building on Marcuse’s arguments, and to an extent demonstrating how this ‘repressive tolerance’ is maintained, Michel Foucault describes a system of ‘biopower’, which, in brief, involves the constant self-reenforcing of assumptions about normality, so that those who do not fit with scientific understandings of normality are, subconsciously, seen as inferior, while each individual within a given society strives to perform his or her own normality in order to avoid appearing abnormal.

Is it possible to circumvent this problem? Or are we stuck with a situation in which ‘scientific’ observation and the values of tolerance established and limited in classical Liberalism, combine to ensure that mentally ill people are tolerated only insofar as they conform to social determined and reenforced norms?

A pure Marxist appeal to social structures and social oppression will not serve as a satisfactory solution, as to argue, as a recent New Left Review piece does that human unhappiness manifested as depression ‘is an absence of democracy, and consequently a basis for resistance and critique’ is as reductive as it is important. It is true that, to a certain extent, psychic distress is exacerbated and can even be caused by the demands and pressures of late capitalism, with their emphasis on consumption rather than interpersonal relationships, but to reduce the experience of mental illness merely to an accident of economic policy is to lose sight of the individual and seek to normalise experience back within a different but equally coercive manifestation of biopower.

Instead, I found a potential solution in a reading based on the ideas of Emmanuel Levinas. In Totality and Infinity, Levinas discusses the power of the human face as the ultimate ethical demand made by the Other. For Levinas, the Otherness of the face is not a relative concept but a pure alterity – ‘infinitely transcendent, infinitely foreign’. This alterity is at once ‘holy’, being the totality of the desire for knowledge, and provokes a desire to kill, as ‘murder exrcises a power over what escapes power’ – the only way to fully gain power over, and hence fully understand, the Other.

In this moment, at which we desire both knowledge and power with almost equal force, we experience the full ethical demand of the face:

There is here a relation not with a very great resistance, but with something absolutely other: the resistance of what has no resistance – the ethical resistance. The epiphany of the face brings forth the possibility of gauging the infinity of the temptation to murder, not only as a temptation to total destruction, but also as the purely ethical impossibility of this temptation and attempt.

In other words, in feeling the potentiality of conflict, the threat of murder, we glimpse the infinite reality of the exhortation not to kill, not within any specific religious system of morals, but as a demand visible in our recognition of the fundamental unknowability of the Other, hence any other, and hence ourselves. It is not that the face contains truth, for Levinas, but that it ‘does not leave any logical place for its contradictory’ – understanding the simultaneous part-similarity and transcendent difference between self and Other provides an ethical experience which ‘convinces even “the people who do not with to listen”‘.

This ethical demand, this recognisable inability to recognise has a special function in the understanding of psychic distress. Rather than representing a deviation from a scientifically determined norm, a deviation which limits the possibility of tolerance, the distressed individual is unknowable the the same extent as any other Other, the difference here being not one of degree or kind, since such terms make no sense when discussing infinite unknowability.

Although, as was pointed out by @artsyhonker during a twitter discussion, Levinas’s use of the face suggests an exclusion of non-sighted indivuduals (he opens his discussion ‘inasmuch as the access to beings concerns vision’), his idea of the face as an object ‘present in its refusal to be contained’ could equally be replaced by the voice, or the tactile sensation of the touch of the other – the experience of present-ness, such as forms the heart of the dramatic experience. In this way, the presence of the face, the experience of the Other’s irreducible ethical demand, which is unique to the theatrical and the performed, offers a potential way to reveal and challenge the structures of biopower which currently justify the intolerance of society at large to psychic distress.

RSC Marat/Sade – Review

So far, this production has received extremely mixed reviews. From the Guardian‘s Michael Billington, who condemns the ‘overheated’ ‘shock effects’ in a production he otherwise enjoyed, to the Daily Mail‘s Quentin Letts, who uses his review to attack every element of the performance, as well as every other subsidised theatre in the country, critics have united in their condemnation of the direction and their unfavourable comparisons to Peter Brook’s 1964 production (also for the RSC).

I have to admit that, when the inmates of the Charenton asylum came onstage, twitching and making pre-linguistic noises, I was beginning to regret trekking out to Stratford, and paying for extra train tickets having forgotten my rail card. This, surely, was the worst kind of fringe-theatre representation of madness, not the fruit of a collaboration between the RSC and Anthony Neilson.

However, as the play progressed, I was won over. The fact that Marat’s execution was only a play within a play was emphasised not only through the framing devices and interruptions scripted by Weiss, but also by the reactions of the ‘inmates’ playing roles in this play. Far from being gratuitous use of bad language, the repeated ‘fuck’s sake’ and other expletives were some of the most naturalistic moments of the performance, expressing the legitimate frustrations of individuals obliged to take part in what amounts to a publicity exercise for Charenton masquerading as ‘therapy’. This frustration and lack of patience with proceedings is emphasised so often (the derisive look given by ‘Marat’ to de Sade while reading the text of his first contribution to their debate from cue cards, the mocking emphasis given to the line ‘what was the point of this charade?’ by the Herald in the final scene) that it is surprising that so many professional reviewers have condemned the acting as wooden and the bad language as unnecessary. If, for example, Arsher Ali plays Marat with a lack of interest it is not because he is disinterested in his own part, but the character he is playing (a paranoiac in an asylum playing Marat) doesn’t really care about the part Sade has written for him.

The performance of the song ‘Fifteen Glorious Years’ following Marat’s death exemplified the aesthetic: I made a note describing it as ‘the most half-arsed chorus-line ever’, and this remains an accurate description, as the cast shuffles its way through uninspired choreography and tuneless singing, accompanied by a 50s Americana-inspired synth reminiscent of the intermission music from Monty Python’s Holy Grail. It may just be my current research interests, but from the sometimes-forced contemporary references to this scene, the production managed to be extremely entertaining, while also capturing the soul-destroying embarrassment inspired by some of the worst examples of ‘service-user theatre’.

Of course, there is more to this production that its representation of madness (and I’ve not yet had enough time to formulate all my thoughts on this issue). I was struck by the number of pointless allusions to earlier plays, from the image of Charlotte Corday’s head poking from the centre of the stage during her nightmare about the guillotine, evoking both Samuel Beckett and Sarah Kane, to the much-discussed anal rape scene, alluding to the many examples of anal rape in the short-lived ‘in-yer-face’ movement of which Neilson was a prominent part. Although effective techniques in themselves, the sheer force with which these references are made actually distract from the moment, a distraction which, in combination with the use of internet pornography viewed on smart phones to replace the scene of ‘general copulation’ called for by de Sade, provides a scathing critique of the vacuous heart of postmodernism through its own postmodern excess.

It doesn’t all work. Even within the frame of the play within a play, the use of niqabs to disguise the figures in Marat’s nightmare seemed somewhat forced, and I’m still baffled as to why Corday eventually kills Marat with a pistol rather than the knife she has been carrying around for the rest of the play (and, indeed, where the pistol came from). However, these are minor niggles in a play which even redeems its own caricature of service-users as unable to speak, as the ‘prelinguistic sounds’ with which one of the characters opens the play (and which continue to punctuate the action throughout) are resolved at the end into the word ‘open’ in de Sade’s closing comment ‘I’m left with a question that is always open’.

The RSC took a risk in reviving this show – opponents of subsidised theatre were always going to use it as a way to attack subsidy and its ‘misuse’ promoting ‘filth’. Many who would usually defend similar shows had their loyalties spit by the feeling that reviving a play so well produced by Peter Brook may be sacrilege. But, with Neilson and his well-known passion for crowd-pleasing spectacle at the helm, the company has produced a show which I believe history will judge more kindly than critics with axes to grind. Both before the show and at the interval I could hear people discussing where the play featured in lists including such peers as Brenton’s The Romans in Britain, and there can’t have been many walk-outs. And, as Mr Letts will no-doubt be shocked to hear, the septuagenarian on the front row who had a dildo waved in his face not only returned for the second half, but applauded more heartily than most at the curtain.

What’s in a name?

Terminology and Ideology in Mental Health Research

In a fairly random sample of articles discussing issues surrounding mental health and engagement, a dizzying number of different and conflicting terms draw attention to the deeply politicised nature of the area. Are we dealing with ‘service users’, as found in articles such as Liz Sayce’s ‘Stigma, discrimination and social exclusion’ (Sayce 1998)? ‘Clients’, as often found in official reports such as found in an analysis of submissions to a Scottish Executive suicide prevention framework (Ridley 2004)? Patients? Mentally ill people? Mad people? Indeed, many articles use some of this terminology interchangeably (and often critically), further highlighting the fact that the conceptual position of individuals within the mental health system is far from stable. In this post, I’m going to (briefly) examine the history and implications of each term.

Patient

This term was found to be the one most preferred by both mental health workers and individuals within the system in a 2000 survey in the US (Sharma, Whitney, and Kazarian 2000). One of the reasons for this is that, in its staunch medical association it legitimises the experience of the individual. In addition, it suggests an end-point to treatment, rather than an on-going and possibly interminable process.

However, there are problems with the term. Most objections focus on the implications of passivity and invalidity, and the wholesale embrace of the medical model bound up with the term. This is especially problematic for groups such as ‘Mad Pride’, as, with Thomas Szasz, many members of these groups believe that the medical paradigm is used to justify the coercive repression of deviance.

The term ‘mentally ill person’ shares many of the positive and negative features of ‘patient’.

Service User

The term ‘service user’ suggests an active involvement in the mental health system. Rather than being a ‘recipient of care’, the implication is that the individual is making an active choice to take advantage of available services. In this way, it is seen to be an improvement on ‘patient’, as it is linguistically empowering, and has paved the way for ‘user involvement’ initiatives, in which user representatives have been involved in discussions about changes in care and support structures, as well as the legal framework of mental health.

The idea of the service user can be criticised, however, on the basis that the sense of ‘empowerment’ provided by the term is often illusory. Not all individuals will be able to sit on official committees, and even those who do may face the dismissiveness afforded those considered to be representatives of ‘unreason’ (in Foucault’s terms). Many of those without the ability to represent themselves will remain legally compelled to remain in hospital or comply with regimes of medication – ‘service users’ only as a result of coercion. In addition, although a result of campaigning by groups of individuals both within and outside the mental health system, ‘service user’ contains the germ of marketisation, the idea that the only way to win rights within a system is by converting the system into a competitive commercial system in which ‘the customer is always right’.

More recent criticisms of the term, in the UK at least, have focussed on the impact of welfare and health budget cuts on the level of service provision available, arguing that it is offensive to define individuals by services which they may no longer be able to access as a result of central government cutbacks.

Client/Consumer

Both these terms represent a further evolution of the ‘consumer rights’ framework of mental health campaigning, already implied by ‘service user,’ and as such are subject to the same advantages and disadvantages. ‘Client’ offers a slightly more positive image of the relationship between individual and service, suggesting an active and collaborative process, but still one conceptualised primarily through contractual obligations rather than care and support.

Survivor/Mad person

These terms are generally employed by those people whose experience of the mental health system has been anything but positive. Rather than attempting to reframe the relationship between the system and the individual in terms which seem to offer a greater sense of collaboration, these terms engage critically and dialectally with the narrative of mental health services as part of the caring profession. This tactic aims to draw attention to perceived injustices and coercive structures within the system, as well as questioning the extent to which medical techniques are actually beneficial to those within the system.

These terms can be criticised, especially by those within the medical professions, as anti-evidence and anti-scientific. They have also been attacked by other individuals within the system who see their experiences as nothing to be proud of or celebrate. However, they, and direct action movements such as Mad Pride/Reclaim Bedlam, offer a totally different voice within the debate, and as such are worth of inclusion.

Conclusion

I am still unsure as to the terminology that I will use in my project, since there is no absolute ‘best term’. However, I do feel it important to note that the survivor/mad pride movement is the only voice which offers an internal (patient/user/survivor) perspective on the increasing medicalisation and commercialization of the field (evident in parallel between the increase in Pharmaceutical lobbying of governments and the growth of ‘client’-type terminology). Such perspectives are essential in any examination of public representations and performances of ‘mental illness’. Thomas Szasz offers another critical voice, but he would be more likely to support the terminology of the ‘client’, since he argues that only a contractual agreement between ‘practitioner’ and ‘client’ can prevent the coercive excesses of the ‘therapeutic machine’.

 

Ridley, Julie. 2004. National Framework for the Prevention of Suicide and Deliberate Self-harm in Scotland: Analysis of Written Submissions to Consultation (Central Research Unit Papers). Scottish Executive, October 4.

Sayce, L. 1998. “Stigma, discrimination and social exclusion: Whatʼs in a word?.” Journal of Mental Health 7 (4): 331–343.

Sharma, V, D Whitney, and SS Kazarian. 2000. “Preferred terms for users of mental health services among service providers and recipients.” … Services.

Bethlem Hospital Archives

I’ve recently discovered this excellent resource for the history of madness, or just for general interest – the online archive for the Bethlem Royal Hospital, otherwise known as Bedlam.

I came across it while attempting to verify the existence of a document called a ‘Petition of the Poor Distracted Folk of Bedlam’, supposedly composed by patients and submitted to the House of Lords. Although widely reported (including a reference in the book Personal Development and Clinical Psychology), the document does not appear in Bethlem’s archives, and as far as the archivist, Colin Gale, knows, it is a ‘phantom reference’.

However, even if the first genuine patient perspective of Bedlam dates from as late as 1818, as Gale suggests, the other materials in the Bethlem archives include case notes from the early twentieth century, and a list of admissions from the late 1600s, as well as other materials, many of which have been scanned with the support of the Wellcome Trust and are free to view online.

 

Why We Need An Alternative to ‘Stigma’

I have a guest blogpost this week at for NAMI Massachusetts, which suggests that the concept of ‘stigma’ is not the most useful way to address the inequalities surrounding mental illness.

The post can be found here:

http://www.namimass.org/why-we-need-an-alternative-to-%E2%80%98stigma%E2%80%99

Why Medical Language Can’t Defeat Stigma

At PsychCentral, Joe Kraynak argues that using the terms ‘brain disorders’ or ‘brain dysfunctions’ can avoid the problem of people questioning whether conditions such as depression and bipolar disorder are really illnesses. His argument (following R. E. Kendell) runs that, since the mind/body dichotomy is false, terms such as ‘mental illness’ suggest that these conditions are ‘all in the mind’ in a way that, say, epilepsy is not. The implication of this argument is that we could reduce the stigma associated with ‘mental health’ by emphasizing the fact that the conditions referred to under this umbrella are medical conditions with a physical cause like any other.

Notwithstanding the fact that the causes of psychic distress remain uncertain, and that the physical basis of these conditions are largely working hypotheses, the argument that stigma can be reduced through a more thoroughgoing connection between ‘traditional medicine’ and psychiatry is far from compelling. A. K. Thatchuk addresses the assumptions in this argument in a 2011 article for the International Journal of Feminist Approaches to Bioethics:

Likening mental illnesses to physical illnesses (1) reinforces notions that persons with mental illnesses are of a fundamentally “different kind,” (2) entrenches misperceptions that they are inherently more violent, and (3) promotes overreliance on diagnostic labeling and pharmaceutical treatments. I conclude that too much has been invested in the claim that the body is somehow morally neutral, and that advocates of this approach oversimplify, misrepresent, and underestimate the personal and social costs of physical illness (Thatchuk 2011).

Her argument is that focusing on the biochemical differences between people with ‘brain disorders’ and people without actually increases the extent to which they are stigmatized in the sense of being ‘marked as different’. An approach which draws attention to problems with an organ system actually emphasizes the ‘mark of difference’ that defines stigma, and implies that this difference is biological and genetically grounded – and hence an inherent flaw. The body/mind distinction Kraynak identifies as problematic is, although flawed, far too deeply rooted to be defused by a simple substitution of ‘mental’ with ‘brain’ – stigma and discrimination towards the conditions he cites as having accepted physical causes are arguably more severe, if also more overt, than towards sufferers of bipolar disorder and major depression.

Physical illness in general exists within a morally grey area, and, as the Coalition government’s attitude towards disability benefits shows, there always exists the suspicion that any given individual is malingering – especially in the face of stories of ‘heroic cripples’ and ‘stoic invalids’ which pervade discourse about disability and sickness. As Petra Kuppers argues, the ‘difference’ constituted by disability and sickness can be related to that constituted by race or gender:

Disability as a social category is not the same as race or gender, but it shares important aspects with these ways of knowing difference. All three terms relate to differences that are constructed as binaries and as biological, and that come with heavy weights of excess meaning: like race and gender, disability structures people into separate categories (2003: 5).

Although it is true to argue that there is little evidence supporting an absolute distinction between body and mind, it is also clear that aligning mental and physical illnesses more closely will not serve to eliminate stigma or convince skeptics of the reality of depression, bipolar disorder or other similar conditions. Instead, campaigners should focus their attention on the stigma and discrimination experienced by people suffering from any sickness or disability, placed within a framework which emphasizes human rights and human dignity without trying to diminish the real challenges experienced both as a result of specific impairments and of the social structures which perpetuate negative attitudes towards them.

When looking at ‘mental illness’ specifically, it is especially important that the social and interpersonal issues associated with different conditions is taken into account, rather than merely a diagnosis-centered focus on the physical, biochemical basis of mental distress. Failing to do so can lead to an exacerbation of conditions due to a refusal on the part of physicians to accept that certain responses may be legitimate in certain situations. Both good treatment of psychic distress and the challenging of stigma and discrimination require a wide-ranging approach which does not attempt to reduce causes and experiences to a simple result of biochemical changes.

Madness and Theatre: Does Anyone Care?

Why, you ask, would anyone want to spend 3 years of their life researching how mental distress is represented in contemporary British drama? Surely there are more important issues, and, anyway, theatre has lost its position as lead source of entertainment, now only serving a minority of the middle-classes.

All of this may be true – there are certainly more important issues in the area of mental health research, and theatre audiences have indeed been dwindling. However, since theatre from Edward Bond to Sarah Daniels, Caryl Churchill to Mark Ravenhill has possessed (at least self-styled) ‘radical’ aesthetics, it is interesting to see how these authors treat the issues surrounding madness.

For Churchill and Daniels, madness is repeatedly invoked as a trope for the effect of patriarchy on women – marginalized and denied a voice, the characters in, for example, Daniels’ The Madness of Esme and Shaz manifest their oppression through madness, a trope drawn partly from half of the dichotomy presented by Gilbert and Guber in The Madwoman in the Attic. Bond and Ravenhill tie an interest in psychic distress with politico-economic themes in, for example, Lear and Shopping and Fucking respectively.

In fact, madness became more central to theatre in the so-called ‘In-Yer-Face’ movement of the 1990s, not least with the plays of Sarah Kane. When something which affects a large number of people for at least part of their lives is also being treated extensively on the stage, it is important to examine the reasons for this. As yet, very few reviewers or academics have treated these instances as actually having an impact on how people view ‘real’ mental-health service-users, preferring to see madness as it has always been – a literary trope with little connection to real-life experience.

This is clearly a problem. Feminist literary theorists have demonstrated how language shapes the way we conceive of sectors of society, and the representation of women as ‘types’ has been rightly identified as a symptom of the oppressive social discourse operating around them.  The same analysis must be applied to the representation of mad/mentally-ill people, especially when these representations occur in plays with an otherwise radical and inclusive agenda.

When plays focused on exclusion and discrimination use madness as only a trope, or a way to add dimensions to a character, or as a symptom of wider social disquiet, they diminish the impact of madness on the individual, as well as reenforcing the stereotypes which contribute to discrimination against mental health service users. On the other hand, representations which complicate or challenge these stereotypical views can contribute towards a more nuanced view of mad/mentally ill people, thereby combating the discrimination which causes social ostracism and exacerbates distress.