Madness and Literature 2: “A Hideous Torture on Himself”

When not working at the Archives and Museum, the part-time Friends Secretary is also researching the nineteenth century casebooks. She presented at the Madness and Literature conference, examining representations of self-mutilation (a term introduced and defined by psychiatrists, including Bethlem superintendents George Savage and Theo Hyslop, in the 1880s) in nineteenth century literature and psychiatry. The title bears reference to Nathaniel Hawthorne’s The Scarlet Letter, first published in 1850. Set in puritanical seventeenth-century Massachusetts, the novel tells the story of the punishment of Hester Prynne, forced to wear an embroidered “A” on her chest (the “scarlet letter” of the title) as punishment for having borne an illegitimate child. At the close of the novel, this “A” is exhibited burnt into the chest of the Reverend Arthur Dimmesdale, publicly revealing him to be the child’s father, made physically and mentally ill through the long-guarding of his guilty secret. In Hawthorne’s work, the origins of the wound are debated, although to late nineteenth and early twentieth century psychiatrists, as well as certain of the spectators described by Hawthorne, the only “rational” explanation was that Dimmesdale’s self-punishment had been “followed out by inflicting a hideous torture on himself.”

Although Hawthorne’s representation of Dimmesdale was certainly not intended as a medical case history, the case was referenced by medical writers who had no problems with what some later authors, including Henry James, saw as a crude use of symbolism in an otherwise psychologically interesting novel. Indeed, many nineteenth century medical writers on self-mutilation expected their patients’ acts to be similarly symbolic, analysing motives and “hidden meanings” in a manner often starkly at odds with that in which other problematic behaviours were portrayed (in the Bethlem casebooks, refusal of food or persistent removal of clothes, for example, is usually simply dismissed as troublesome).

We can find many examples in the Bethlem casebooks of these attempts – by patients and practitioners – to give meaning to self-damaging actions such as face-picking, hair-plucking and self-cutting. In 1889, James Hipwood’s attendant stated that the former had cut his face because “he liked to see the blood that followed.” To his mother, meanwhile, Hipwood said that he cut himself because “he wanted to see if he could feel anything.” Yet, in Bethlem, an alternative explanation was implied. Although the doctors found it hard to get anything out of their patient at all, he did tell them “that he does not want to live & hints at something dreadful that is going to happen & at great suffering which he will have to bear.” The medical officers suggested that “he is apparently trying to prepare himself [for this] by inflicting pain on himself now.”

Photograph of Mary Stoate, admitted to Bethlem in 1895

Bedlam at the Globe Theatre

The Archives & Museum was recently visited by the cast of the forthcoming production at Shakespeare’s Globe, Bedlam. Playwright, Nell Leyshon, covered her own visit in an article in The Evening Standard (read it here): interestingly her conclusions bore remarkable similarity to those of the Illustrated London News correspondent who visited Bethlem in 1860. Remarking on what he saw as evident progress in the Hospital since the eighteenth century, this could do little to fill “the vast abyss of human mental misery.”

We should remember that the progress remarked on in 1860 reflected much wider changes – in medical treatment (with the declining popularity of bleeding and purging as a standard response to both physical and mental disease), and the growth of the county asylum system, and an increasingly bureaucratic and professionalised mental health field. For some, however, seemingly outdated treatments continued popular: in 1860, one 38 year old housewife at Bethlem demanded to be cupped and bled “as the only means to relieve the distress of her head.” The medical officers did not comply with her requests.

Yet, it seems fitting that Leyshon’s play reflects the use of the word ‘Bedlam’ in the Globe’s heyday. In the 1600s, the term entered popular parlance as a general term for insanity, chaos or riotousness, as well as referring specifically to the Hospital and its former inmates. In Shakespeare’s King Lear, Edgar disguises himself as a “Tom o’ Bedlam,” a common term to refer to former inmates who might subsequently become wandering vagrants, while the Hospital itself appeared in the early Jacobean satire, Northward Ho, written by Thomas Dekker and John Webster. Such plays tend to provide romanticised or exaggerated views of asylums and the mad, for dramatic effect, humour, social commentary or political allegory. They provide better insights into the fears and obsessions at large in the world outside the hospital, than they do about conditions that actually obtained inside it.  Plus ça change, plus c’est la meme chose.

Bedlam, by Nell Leyshon, runs from 5 September to 1 October at Shakespeare’s Globe, complemented by an art exhibition previously on show at the Bethlem Gallery – Portraits: Patients and Psychiatrists.

Where in the World?

When you’re looking back over your holiday snaps at the end of the summer, spare a thought for the cataloguers at Bethlem Royal Hospital’s Archives & Museum. Every now and then they come across something completely inexplicable in the collection. Here’s one we found a little while ago. The Great Western Railway building to the left of picture (at the top of the harbour slipway) suggests that it is a West Country harbour town, pictured in the late nineteenth, or early twentieth, century. The church looks distinctive, but our knowledge of English ecclesiastical architecture is not encyclopaedic. We’d be glad of assistance with this one. Just add your comment. Once we know which town this is, we’ll start work finding out how a photograph of it came to be in our possession.

Phantasmagoria: New Exhibition Explores Hallucinations in Art

A new exhibition opens at the Bethlem Gallery next week, exploring hallucinations in Surrealist paintings and drawings from the collection of the Bethlem Archives and Museum. Artworks, by Basil Beaumont, Herbrand Williams, Julian Trevelyan and others, were created as part of series of experiments at the Maudsley Hospital into the hallucinogenic effects of the drug mescaline in the late 1930s.

In the late 1930s two of the Maudsley doctors, Dr Eric Guttman and Dr the Hon Walter Maclay started a series of unprecedented experiments. In previous studies both doctors had noted that many patients suffering from schizophrenia wanted to make art in an attempt to ‘explain themselves’. However, they also noted that only a minority of patients had the capacity to translate their hallucinations into pictorial form. These findings led the doctors to invite professional artists from the Surrealist movement, who they believed shared their interests in the unconscious and irrational, to take part in experiments involving the drug mescaline. The results of these Mescaline hallucinations or ‘experimental psychosis’ are a vivid and revealing insight into the psychology of those involved.

All are welcome at the Opening Event, which takes place on Wednesday 25 August, from 3 – 6pm.

Exhibition continues: 26th August – 10th September
Opening times: Wed, Thurs, Friday, 11am – 6pm
(including Saturday 4th September 11am – 6pm, when the Archives and Museum will also be open)
Address: The Bethlem Gallery, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX
Travel: Nearest British Rail: Eden Park (or a short bus ride from East Croydon on route 119 or 194)

Madness and Literature: Report from International Health Humanities Conference

Throughout history, numerous links have been made between literature and madness. Aristotle linked genius and melancholy, contending that many great men suffered from what later centuries would refer to as ‘morbid’ states of mind, linked to creativity in such works as Robert Burton’s Anatomy of Melancholy (1621). But in what ways should we connect madness and literature in the 21st century? Many and varied methods were suggested in a diversity of papers at the first International Health Humanities conference at the University of Nottingham last weekend.

Attended by a broad group, from clinicians to historians, literary critics to carers and service users, participants posited the general suggestion that engagement with literature can help us to understand and appreciate – and thus better treat – madness: a term chosen in preference to ‘mental illness’ in order to incorporate social and cultural, as well as biomedical, dimensions. While advances in biomedicine have aided treatment of a variety of mental health issues over the last few decades, many questions remain unaddressed. Mary Elene Wood, of the University of Oregon, indicated, in her review of patient narratives of illness in The Schizophrenia Bulletin, that the complaint of many service users is that the content of their delusions and hallucinations can be ignored by biomedical practitioners. Patients assert their need to make sense of these symptoms, incorporating them into their sense of ‘self.’ Indeed, approaches to the slippery concept of selfhood were those most often highlighted over the weekend. Dr Javier Saavedra, of the University of Seville, suggested that the assumption that the ‘self’ must be a single, stable and consistent entity might not always be beneficial, while keynote speaker Dr Kay Redfield Jamison, Professor of Psychiatry at the Johns Hopkins University School of Medicine, indicated the hugely variable ways in which others might respond to madness, and how attitudes might reinforce or problematise the individual’s sense of self.

Other speakers illustrated the ways in which literature can highlight the social construction of madness. Keynote speaker Professor Elaine Showalter, of Princeton University, detailed some interesting trends in the frequency of certain diagnoses, relating these to contemporary social fears and obsessions. For Showalter, Capgras Syndrome may be the disease of our time. Sufferers of Capgras Syndrome present the delusion that people, animals and objects around them have been stolen or abducted, only to be replaced by an identical imposter. Initially regarded as a form of hysteria, current explanations for Capgras Syndrome tend towards the neurological, focusing on damage to certain areas of the brain. According to Showalter, this approach cannot explain certain patterns in the way in which delusions present, suggesting that cultural influences – in an era of surveillance, global paranoia and conspiracy theories – may remain relevant.

In his closing remarks, co- organiser Professor Paul Crawford of the University of Nottingham spoke of the conference aims, and their hopes for a future in which biomedical, psychological and cultural approaches to mental illness can exist side by side, complementing each other. While scientific research undoubtedly has great worth, the challenges encountered in diagnosis, stigmatisation and areas of therapeutics indicate that no one form of understanding mental health should be privileged at the exclusion of all others.

The conference was organised by Charley Baker, Dr Brian Brown, Dr Maurice Lipsedge, Professor Ron Carter and Professor Paul Crawford. For more information on the Madness and Literature Network, and details of future events, visit: www.madnessandliterature.org