‘Reading Bodies, Writing Minds: Mental Health in the Medical Humanities’ conference

Reflections by Jan Parker, University of Cambridge

Sincere thanks are due to the Organisers from the University of Nottingham, Michele McIntosh and Martin Brooks

And to the AHRC Midlands3Cities Doctoral Training Partnership & University of Nottingham’s School of English for their support

Reading : Writing Minds : Bodies: Medicine: Humanities Research : Practice

This conference delighted in crossing boundaries and braiding disciplinary traditional practices to ask and answer multifaceted questions. Exemplary: so important in cross domain (domains with different epistemological practices as well as methodological traditions, as, here, Medicine and Humanities) collaborations.

The result is to challenge categories as well as frames of understanding so often shown in a conference full of perceptive readings of all kinds of texts (with all kinds of audience, purpose, structure and authority, questioning each in turn).

Throughout, papers questioned the very dichotomies of the title – Reading : Writing/ Minds : Bodies / Medicine: Humanities…… and, importantly, I would add: Research : Practice.

What was everywhere evident and truly inspiring was the reflective attitude to the participants’ ‘home’ discipline when used on an interdisciplinary problem. Bringing together complementary discrete Humanities research traditions and [medical, historical] practice-based inquiry serves so vitally and importantly to question the purposes as well as research approach of those disciplines.

For ‘Medieval narratives offer alternative perspectives for hearing and mental health which can generate rich and fruitful dialogues with modern accounts’ concluded Bonnie Millar (University of Nottingham) in ‘Dissolving Boundaries: Medieval and Modern Perspectives on Hearing’.

This fascinating study added considerably to the awareness-generating and boundary-questioning, patient experiences collective www.hearing-voices.org. (Their ‘mission statement’ declares: ‘Our reputation is growing as the limitations of a solely medical approach to voices become better known. Psychiatry traditionally refers to hearing voices as ‘auditory hallucinations’ but research shows that there are many explanations for hearing voices…’;their ‘position paper’ opposes the all defining American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM V , saying ‘Rather than seeing voices, visions and extreme states as symptoms of an underlying illness, we believe it is helpful to view them as meaningful experiences.’)

Dr Millar argued that ‘In both medieval self-narratives and fictional stories hearing and authority can be intrinsically linked. The sensory components of these women’s visions have spawned a number of alternative retrospective modern medical diagnoses ranging from migraine attacks, neurosis, and bipolar disorder to temporal lobe epilepsy and Tourette’s syndrome. However, this paper will examine how through auditory metamorphosis Teresa de Cartagena, a fifteenth-century nun … depicts her acquired profound deafness as a virtue… Nonnormative hearing patterns and auditory transformations are indicative of virtue, communication with the divine or female authority. Medieval narratives offer alternative perspectives for hearing and mental health which can generate rich and fruitful dialogues with modern accounts.’

Indeed, in signalling its intention to question all the boundaries, the conference started with considering the abject those ‘freaks’ of nature that challenge the boundaries between life and death; flesh and spirit, self and other – conjoined twins (Joseph Holloway, University of Exeter: ‘Death Infecting Life: Conjoined Twins, Personal Identity & the Abject’).

Inter-disciplinary Epistemology and Meaning making

The immediate problem is to gather ‘evidence’ about mental states which modern medicine categorise differently; states whose causes, definitions and implications are described and ascribed very differently at different periods. The result is not just to document changing attitudes to & treatments of, eg, ‘lunacy’ (As, importantly, ‘Robert Goemans and Rebecca Goddard, University of Lincoln, on ‘Madness, Gender, and Class: The Construction of Identity and Experiences in the Lincoln Lunatic Asylum 1820-1840’: they showed how their research data allows an analysis of how restraint was applied differently to different groups, so indicating how late Georgian society constructed gender, class, and madness.)

But, more, by reflecting on the context to question the very process of cultural definition and framings of the category – are those with ‘melancholy’ ‘mad, bad or sad’?

This question demanded intercultural reading and brought surprising sympathies: Natalie Calder, Queen’s University Belfast, in ‘“all swetnes & deuocion is taken from me’: Remedying Spiritual Despair in Late Medieval England’ juxtaposed two texts written at either end of the ‘long’ fifteenth century in an examination of the ways in which such spiritual guides addressed despair and extreme mental distress in their audiences. And which ‘provide a sophisticated and sensitive means of addressing issues of mental illness among their audiences that is recognised almost as an expected state of being amongst those readers who sought to obtain a deeper, cognitive connection with God.’ The paper outlined the (perhaps surprisingly) sympathetic approaches each writer has towards his reader who is struggling to reconcile their extreme doubts and self-criticism with their faith. Linking the mental afflictions of unstable belief with other, more traditional examples of emotional and physical ailment, the texts seek to remedy what could be described (committing the cardinal sin of anachronism!) as depression within their audiences.

‘the cardinal sin of anachronism’

In fact, each and every speaker was exemplary in their understanding of the constructedness of the terms they were using. And this was not the least of the important implications of the conference: that ‘melancholy’, for instance, and indeed mental illness, is identified and evaluated multifacetedly across time and across cultures.

Starting with the keynote, Chantelle Saville, University of Auckland, ‘Picturing Pigritia in Late Medieval Moral Psychology’, each speaker was clear they were dealing with the representation as well as the embedding of terms ‘reading and writing’ ‘minds and bodies’.

From the problematics of ‘attempting to access the genuine mood, emotions and priorities’ from Medieval Last Wills and Testaments’ (Esther Lewis, University of Nottingham) to adumbrating and distinguishing contemporary definitions – Jonathan Coope, University of Nottingham, ‘On Eco-psychiatry and Historiography: Exploring Transcultural Mental Health Narratives through the Lens of Nature-connectedness “Theory” the importance and problematics of using kaleidoscopic and multidimensional as well as multidisciplinary lenses were demonstrated.

Addressing Melancholy

The delight, challenge and sometimes despair of real interdisciplinary work is when a term like ‘melancholy’ ‘depression’ ‘trauma and PTSD’ is simultaneously illuminated & contested. This is a vital challenge to the [continuously varied] baseline understandings of the now 5 editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

So I particularly valued the conference’s central concern with the portrayal (sic) of ‘melancholy’ – the medieval, Elizabethan and indeed Greco-Roman humoral disturbance.

Kevin Binfield and Kaley Owens, Murray State University discussed Mary Rawes’ ‘Address to Melancholy’, which ‘became a fixture in the portrayal of melancholy’. During her first confinement in 1808 in The Retreat at York, labouring under ‘a considerable degree of active mania’, she immediately wrote twelve quatrains. They argued that as an expression, the ‘Address’ provides a naked glance into Rawes’ psychological condition, diagnosed with ‘melancholia and hysterical mania’; that as a poem, it draws upon and varies conventions of literary form and the lexicon of melancholy. They concluded, significantly for the whole debate, that ‘the tensions between raw self-account and literary conventions as well as the question of authenticity that must arise in reading an account of depression written in a manic phase.’

This raises the continuously central issue of the question of identity: self and other representations of mental [in]stability. In ‘Margaret Cavendish and the Problem of Melancholy’, Molly Bridges (University of Birmingham) discussed Margaret Cavendish’s ‘eccentricity’, ‘madness’, diagnosis of melancholy. As her condition was corporeal, the question is raised then as now of the ‘psycho-somatic’; also the ‘parallel tradition that endowed the genial melancholic with a special capacity for creative brilliance’.

Similarly, Tim Craven (University of Edinburgh) in ‘The Metaphorical Representation of the Mind and Emotional Dysfunction in the Poetry of Anne Sexton’(1950s) examined how Sexton constructs and utilises metaphor to evoke the mind in extremis. Using close readings of individual examples, applying the analytical framework of cognitive poetics, and exploring the socio-medical context reflected in their creation he provided a model of literary-socio-medical analysis.

Representing/Writing mental illness

The analytical methodology of narratology deployed in ‘writing mental illness’ was both illuminatingly explored and critiqued by Ralph Höger (Universität Heidelberg): ‘Writing the psychiatric patient. A narratological approach to historical patient records’. He argued that as narratological analyses of this complex source material are still rare, the patient in doctors’ notes appears as a heavily fictionalised character; a literary unit first dissected by the implicit organisational laws of the asylum and then rearranged in the records according to cultural, scientific, and clinical criteria.

All these fascinating accounts raise the central question of Representation. Eg, Fiona Johnstone (Birkbeck, University of London): ‘Curating Mental Illness: Mr. A Moves in Mysterious Ways’ asked ‘Can exhibitions actively inform or improve experiences of mental health, rather than merely historicizing or critiquing them?’

And Kevin Harvey, Gavin Brookes and Dr Neil Chadborn (all University of Nottingham) raised the central contemporary question of multimodal discourse representation: ‘“Our Biggest Killer”[?]: Multimodal Discourse Representations of Dementia in the British Media’.

Civil war poetry & prose structuring (? expressing? revealing?) ‘PTSD’

Another ‘anachronistic’ term was fascinatingly explored by Erin Peters (University of Gloucestershire): ‘“Suddaine cures are commonly unsound”: Seventeenth-century Narrative Therapies’. In examining the public narration of psychological disability brought on by the lingering effects of combat trauma and memories of fear among soldiers and civilians during and after the English Civil Wars, she argued that ‘alongside the official and authorised interpretation of disability as a physical impairment, a popular understanding of the disabling and disfiguring nature of psychological damage developed. While conventional histories of psychiatry depict the medieval and early modern periods as dominated by demonological ideas about mental illness [mad as devilishly bad] and treatment of the afflicted as cruel and inhumane, the construction and dissemination, in popular print, of psychological disability theories and narratives before, during, and after the wars reveal that this period saw a growth of interest in the conceptualisation of psychological damage that was removed from ideas of ‘good’ and ‘evil’.

I was particularly interested in what seemed to be historical cases of ‘narrative therapy’ – of using the structuring activity of poetry to give shape to and control over a condition that is today diagnosed but not fully understood – PTSD. Demonstrating ‘the curative methods by which people attempted to treat invisible wounds and arguing that contemporary responses to the disabling nature of psychological trauma demonstrate a cognizance of the therapeutic value of attempting to construct publically available trauma narratives’.

Therapy – as restorying the self

This chimed with a concern in several of the presentations with arts therapies: eg Dramatherapy which ‘provides an unspoken voice for the client’s feelings to be expressed in a manner that is personally revealing, socially acceptable, culturally accessible and therapeutically constructive. Clients can represent mental health issues, reconstruct and link together past and present experiences to build an emotional life narrative, and construct a new way forward for the future. Through dramatherapy the problems that the children face can be located back within the story of their parent, rather than cast within the children themselves. Dramatherapy becomes a way to “re-story” themselves in the way they need, be it to re-cast themselves as the heroes of their own story or to lament the complicated loss of a parent’s presence.

Reflective inter-disciplinary and inter-domain hermeneutic strategies

Throughout, the richness of the material discussed and the confident deployment of hermeneutic strategies was itself exemplary and inspiring, as was the tact (difficult and important) in which terms like ‘melancholy’ were deployed.

For the impossible to draw Venn diagram of mental illness covers:

a) ‘diagnosis’- biomedical model;

b) ‘mad, bad, sad’ – the cultural construction and definition of the cause of ‘abnormal’ mental states and

c) ‘memetic’- the popular adoption and influential circulation of representations of models of, eg, the ‘hysteric’ or ‘melancholic’.

One paper was exemplary – sic – in managing to analyse a problem through these tripartite lenses.I quote:

Moira Hansen (University of Glasgow): ‘“O wad some pow’r the gift tae gie us”: Redefining the Melancholy of Robert Burns’.

‘Robert Burns, celebrated at home and abroad as the ‘heav’n-taught ploughman’ who gave a voice to the ordinary man, is probably as well-known for his tempestuous personal history as he is for his poetry and songs. In the 220 years since the poet’s premature death at the age of 37, his flaws and failings have been notoriously exaggerated and misrepresented as artefacts of excessive alcohol consumption or his temperamental poetic genius. Burns, however, has his own insights to offer; his personal correspondence includes regular references to episodes of melancholy, at times rendering the poet bed-ridden and unable to work, let alone capable of any creative output. Derived from on-going research exploring Burns’s mental health, a much-neglected aspect of the poet’s biography, this paper will draw on the poet’s letters and commonplace books to explore his understanding of and relationship with his melancholy. It will go on to illustrate how literary analysis of Burns’s writings within the context of a modern psychiatric framework is clarifying the nature of that melancholy, indicating it is not the consequence of an alcohol addiction or the artificial construction of a poetic persona, but evidence of an identifiable mood disorder as defined by clinical diagnostic criteria, representing a significant development of our understanding of the influences affecting the personal and creative life of Scotland’s national Bard’.

And, I would add a significant development of our understanding of the influences affecting the personal and creative self, the identification of the self with prevailing constructions and evaluation of mental states, of the boundaries and interconnections of mind, self and body, of the varying norms drawn by society beating the bounds of the acceptable and the moral and not least, questioning the ‘identification of mood disorder’ and the ‘definition by [culturally and historically various] clinical diagnostic criteria’.

The medical and psychiatric profession needs the challenge of the multifaceted, inter-domain as well as interdisciplinary Humanities research so evident throughout this conference, in order to challenge the ‘algorithmic’ approach to diagnosis, differentiation and discrimination of mental distress and illness.

The organisers wanted to thank the AHRC, Midlands 3 Cities, and the University of Nottingham’s School of English for their support.