MSc Thesis: Mental Health in Scottish Theatre

Below is the abstract of my Edinburgh MSc thesis, and a link to a pdf of the full text.

I hope that this might be useful to people looking at Scottish Mental Health policy, as well as students studying Neilson’s plays, or just people interested in the range of activities that comprise ‘mental health in theatre’.

I’ll probably make some attempt to get some of this published, so any feedback is very, very welcome.

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How Theatre NEMO and Anthony Neilson use drama to challenge perceptions of mental ill health in Scotland 2003-2010.

Abstract
Despite a continued interest in the study of power-relations and discourse following Michel Foucault’s work on psychiatric power in society, there has been little attempt to examine the representation of mental illness in literature and culture as anything other than an artistic trope. This thesis examines the specific ways that performances have engaged with mental health discourses in Scotland since the passing of the Mental Health (Care and Treatment) (Scotland) Act 2003. By reading Anthony Neilson’s The Wonderful World of Dissocia and Theatre NEMO’s Does Anyone Know in the light of Scottish policy discourse, the thesis draws attention to the potentials and limitations of performance as a medium for engaging with the issues facing mental health service-users. This includes the impact of physical presence in performance and the risks of falling into conventional, stereotyped views of madness. By doing this, the thesis exposes the extent to which the power-relations within the mental health system are related to mental distress, as well as the ways that transformational strategies in performance can have a positive impact in revealing and challenging these power-structures.

Full text [pdf] available here

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Art Therapy at Charenton

 

It is true that plays like the one imagined in Marat/Sade took place in Charenton, but, if we are to believe Coulmier’s successor, Esquirol, they were not a particularly effective mode of treatment:

The means of diverting the mind are […] after labor, the most efficacious agents in the cure of the insane, but we cannot rely upon the success of those which exalt the imagination and passions.

The lypemaniac, always suspicious, appropriates to himself whatever strikes his senses, and makes it serve as aliment to his delirium. The maniac becomes still more excited by the representation of the passions, by the vivacity of the dialogue, and the playing of the actors, if he is present at a theatrical representation. Our opinion regarding amusements of this kind is supported by the example of the Egyptians and Greeks. But with them these exhibitions partook of a religious character, adapted to calm the passions, and to impose upon the imagination, at the same time that the mind was diverted by the pomp of the ceremonies. A mind at all accustomed to reflection, is astonished that theatrical representations should formerly have been permitted at Charenton; and a German author regards the multiplication of theatres as one of the causes of the great number of insane people in Germany. The maniacs could never be present at the theatrical representations of Charenton, the monomaniacs rarely, – and the imbeciles could not be benefited by them. Those to whom the spectacle could be useful, were already cured, and it would have been more profitable to restore them to liberty than to shut them up for three hours in a place, confined, heated, and noisy, where every thing tended to produce cephalalgia. Thus there were few representations that were not signalized by some violent explosion of delirium, or by some relapse. This mode of amusement, by which the public were imposed upon by being informed that the insane themselves played comedies, never obtained the approbation of the Physician in chief of the Establishment. Royer-Collard exerted himself vigorously against it, and was ultimately successful in bringing it to an end. I once accompanied a young convalescent to a Comic Opera. He every where saw his wife conversing with men. Another, after the space of a quarter of an hour, felt the heat in his head increasing – and says, let us go out, or I shall relapse. A young lady, being at the Opera, and seeing the actors armed with sabres, believed that they were going to assail her. All this happened, notwithstanding I had selected both the individuals I was to accompany, and the pieces that were to be acted. A theatrical spectacle can never be suited to the condition of the insane, and I much fear, not even to that of convalescents.

Weiss, David, and Marat/Sade

Just a titbit today.

Jeremy Sams’s 1997 National Theatre production uses Jacques-Louis David’s painting ‘The Death of Marat’ as a strong visual reference for Corin Redgrave’s Marat, even going so far as to visually quote it in tableau at the moment of Marat’s assassination.

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Looking at the image, I noticed that the letter of introduction from Corday which he holds in his hand is quoted by Weiss in Marat/Sade. Corday implores Simone (in Geoffry Skelton’s translation) ‘I am unhappy/And therefore have a right to his aid’, while David’s fictionalised letter reads ‘il suffit que je suis bien malhereuse pour avoir Droit a votre bien veillance’.

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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.

The hospital at Charenton

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.