First Person Narratives 1

Our Archivist and Education & Outreach Officer contributed a paper to a recent conference held to ‘evaluate the clinical encounter, the relationship between doctor and patient, and the language of illness and pain’. While their paper explored the visual ‘language’ of recovery ‘spoken’ by ‘before’ and ‘after’ photographs of English psychiatric patients in the late nineteenth and early twentieth centuries, the conference theme was interpreted in a diversity of ways by various speakers.

First-person written testimony always brings fresh perspective to discussions such as these – we recently drew blog readers’ attention to a case in point – and there is no narrative more engaging than that of Mabel Z. Cunningham, whose memoir, published posthumously as Jeremiah’s Sister, is so scarce that it appears to remain available only in online excerpts, nowhere in hardcopy. (If anyone can locate a library copy, no doubt Ellen Dwyer of Indiana University-Bloomington, the academic who brought this narrative to the attention of conference-goers, would be delighted to hear of it.)

We have just had our attention drawn to an article in the British Medical Journal which we wish we had known about in time for the conference. In Through the Wasteland, Jackie Hopson and Jeremy Holmes reflect on their respective experiences of a shared clinical encounter. Here a journey from a family home described as ‘a dangerous place to be’ through county asylum admission (‘places of fear, punishment and long incarceration’ but also ‘the only refuges available to many’) and referral to Bethlem Hospital’s Charles Hood Unit (‘an excellent therapeutic community’) to an adulthood of light and shade is carefully and honestly recounted. So is a movement away from therapy that actually serves to reinforce self-hatred and the ‘division of suffering’ between doctor and patient towards a long-term relationship of support in which acknowledgement of vulnerability can become a two-way street. Jackie has kindly written a more detailed account of her stay in the Charles Hood Unit, which will be posted later this month.

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.

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

Welcome to the Bethlem Royal Hospital Archives and Museum Blog

This blog has been set up by the Bethlem Royal Hospital Archives and Museum and will provide regular updates on the Museum Relocation Project and other activities of the Archives and Museum, written by the small staff team, as well as interesting historical notes from the archives – 450 years of mental health history, including personal accounts of mental illness before 1900 – written by staff and researchers.